Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2005 Rates; Correction

AGENCY:

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

ACTION:

Correction of proposed rule.

SUMMARY:

This document corrects technical errors that occurred in the proposed rule entitled “Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2005 Rates,” including technical errors in four of the tables containing the proposed wage index values for FY 2005 (69 FR 28196, May 18, 2004).

FOR FURTHER INFORMATION CONTACT:

James Hart, (410) 786-9520.

SUPPLEMENTARY INFORMATION:

I. Background

FR Doc. 04-10932 contains our proposed rule to update the Medicare hospital inpatient prospective payment system for fiscal year (FY) 2005 and to implement a number of changes made by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173 (69 FR 28196, May 18, 2004). We have identified a number of technical errors and are correcting them in sections II. and III. of this preamble. These errors include:

• On page 28223, third column, lines 57 through 60, in our discussion of drug-eluting stents under section “b. Coronary Stent Procedures” under item “16. Other DRG Issues,” we cited incorrect numbers of cases involving drug-eluting stents in DRGs 526 and 527 from the FY 2003 MedPAR file.
• On page 28224, second column, under section “d. Implantable Cardiac Defibrillators” under item “16. Other DRG Issues,” we discussed a request for a national coverage determination (NCD) we had received on potential payment mechanisms to encourage the use of simple, single-lead implantable defibrillators when medically indicated, rather than expensive, technologically complex devices. The proposed rule stated that “The requestor further added that CMS could restrict use of complex defibrillators to patients for whom they are medically necessary, that is, in the population at low-moderate risk for sudden cardiac death.” We incorrectly associated this suggestion with the requestor, a manufacturer of defibrillators. CMS staff actually made this suggestion as part of the NCD on implantable defibrillators that is currently being reviewed. We regret any incorrect impression that may have been conveyed to the public regarding the manufacturer.
• In the Addendum of the proposed rule, errors in four of the tables containing wage index values resulted from the inadvertent omission of one of the geographic statistical areas that caused a misalignment of the stated wage index values in the tables for a number of areas.

1. On pages 28525 through 28535, in Table 3A—FY 2005 and 3-Year Average Hourly Wage for Urban Areas, the average hourly wages entries in columns 2 and 3 for 42 geographic areas (the entries for Erie, PA through Greensboro-High Point, NC, the entries for Newark-Union, NJ-PA through New York-Wayne-White Plains, NY-NJ, and the entries for Portland-South Portland-Biddeford, ME through Port St. Lucie-Fort Pierce, FL) are misaligned and, therefore, incorrectly stated. We are publishing the corrected Table 3A in its entirety under section III. of this notice.

2. On page 28539 through 28579, in Table 4A—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas, we inadvertently omitted four geographic areas. The geographic areas that were inadvertently omitted are as follows:

CBSA 21420, Enid, OK

CBSA 27460, Jamestown, NY

CBSA 29940, Lawrence, KS

CBSA 41140, St. Joseph, MO-KS

In CBSAs 21420 and 27460, all hospitals in these areas maintain their assignment to the geographic areas where they are currently located for the 3-year period, FY 2005, FY 2006, and FY 2007.

In CBSA 29940 and 41140, all hospitals geographically located in these areas are classified as rural under section 401 of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Balanced Budget Refinement Act of 1999, Public Law 106-554. The areas are assigned the statewide rural-wide wage index values.

We are publishing the corrected Table 4A in its entirety under section III. of this notice.

3. On page 28586, in Table 4C—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals that are Reclassified, we incorrectly included two entries for Wilmington, NC. The first of these two entries should have been for Wilmington, DE.

4. On pages 28589 through 28628, in Table 4G—Pre-Reclassified Wage Index for Urban Areas, due to a misalignment of the CBSA code and urban area with the wage index value, we inadvertently published incorrect wage index values for 195 areas between CBSA 21420 and CBSA 41100. We are publishing the corrected Table 4G in its entirety under section III. of this notice.

We note that as soon as we discovered the errors in these four wage index tables after publication of the May 18, 2004 proposed rule, we posted the corrected tables on the CMS Web site: www.cms.hhs.gov. We also notified providers, fiscal intermediaries, and health organizations through the Internet.

• On pages 28663 through 28667, in Table 6A—New Diagnosis Codes, in the row entry for codes 521.06, through 528.79, in the “MDC” column, the MDC designations specifying “PRE” and “3” should have appeared on separate lines. For the convenience of the reader, we are publishing a corrected Table 6A in its entirety under section III. of this notice.
• On pages 28671 through 28674, in Table 6B—New Procedure Codes, we inadvertently omitted some of the MDC and DRG assignments entries in columns 4 and 5 for codes 84.59 through 84.69. For the convenience of the reader, we are publishing the corrected Table 6B in its entirety in section III. of this notice.
• On pages 28768 through 28770, in Table 9B—Hospital Reclassifications and Redesignations by Individual Hospital under Section 508 of Public Law 108-173—FY 2004, we incorrectly stated the “Wage index CBSA 508 Reclassification” entries in column 5 and the “Nearest County” designations identified in column 6 for several areas. The errors resulted from a programming error that occurred during the development of the data file. In section III. of this notice, we are publishing a corrected Table 9B in its entirety to reflect the corrected new (section 508) wage index MSA reclassifications and the identification of the nearest county.
• We are also correcting typographical, formatting, or other errors that appeared on various other pages of the FR document, as cited in sections II. and III. of this notice.

The comment period for the proposed rule ends on July 12, 2004 (69 FR 28196). Accordingly, we are correcting these technical errors in the preamble language and tables to assist interested parties in their review of the proposed rule. These corrections do not alter the substance of any of the proposals that were contained in the proposed rule.

II. Corrections to Errors in Preamble

In FR Doc. 04-10932 (69 FR 28196, May 18, 2004), make the following corrections:

1. On page 28205, third column, line 17, the figure “522” is corrected to read “518”.

2. On page 28212, second column, lines 12 and 13, the phrase “principal diagnosis of extensive third degree burns” is corrected to read “principal or secondary diagnosis of extensive third degree burns”.

3. On page 28223, third column, lines 57 through 60, the sentence “There have been a total of 42,356 cases in DRG 526, and 33,179 cases in DRG 527, with adjustments made for transfers to other facilities.” is corrected to read “There have been a total of approximately 11,084 cases in DRG 526 and 48,097 cases in DRG 527, with adjustments made for transfers to other facilities.”

4. On page 28224, second column, lines 13 through 21, the two sentences “The requestor indicated that, as part of CMS' coverage decisions, CMS could expand the population eligible for implantable defibrillators. The requestor further added that CMS could restrict use of complex defibrillators to patients for whom they are medically necessary, that is in the population at low-moderate risk for sudden cardiac death.” are deleted, and the sentence “As part of CMS' coverage decision, we are considering whether to restrict the use of complex defibrillators to patients for whom they are medically necessary; that is, the population at low-moderate risk for sudden cardiac death.” is added in their place.

5. On page 28269, second column, line 30, the term “FY 2004” is corrected to read “FY 2005”.

6. On page 28272, first column, line 62, the word “leans” is corrected to read “learns.”

7. On page 28273, first column, lines 12 and 24, the term “tracheostomy” is corrected to read “tracheostomy”.

8. On page 28273, first column, lines 59 and 60, the phrase “FY 2003 GROUPER Version 22.0” is corrected to read “FY 2005 GROUPER Version 22.0.”

9. On page 28317, second column, line 40, the date “2003” is corrected to read “2002”.

10. On page 28333, first column, line 59, the term “reviewer” is corrected to read “institution”.

11. On page 28353, second column, line 56, the phrase “rural area, or from a rural area to” is corrected to read “rural area, or from an urban area to”.

12. On page 28353, second column, line 66, the phrase “rural area to another urban area for the” is corrected to read “urban area to another urban area for the”.

13. On page 28369, third column, line 41, the term “reviewer” is corrected to read “institution”.

III. Corrections to Tables in the Addendum

In FR Doc. 04-10932 (69 FR 28196, May 18, 2004), make the following corrections to the specified tables in the Addendum:

1. On pages 28525 through 28535, Table 3A—FY 2005 and 3-Year Average Hourly Wage for Urban Areas is corrected to read as follows:

2. On pages 28536 through 28538, the title and subtitle of Table 3B are corrected to read as follows:

“Table 3B.—FY 2005 and 3-Year* Average Hourly Wage for Rural Areas

[*Based on the sum of the salaries and hours computed for Federal Fiscal Years 2003, 2004, and 2005.]”

In addition, the column heading for the second column is corrected to read “FY 2005 Average Hourly Wage”.

3. On pages 28539 through 28579, Table 4A—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas, is corrected to read as follows: