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

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AGENCY:

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

ACTION:

Final rule; correcting amendment.

SUMMARY:

In the October 7, 2004 Federal Register (69 FR 60242), we published a correction to the final rule that appeared in the August 11, 2004 Federal Register entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2005 Rates.” This amendment corrects errors in that final rule and the correction of the final rule.

EFFECTIVE DATE:

January 1, 2005.

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Marc Hartstein, (410) 786-4548.

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

I. Background and Summary of Errors

In FR Doc. 04-17943 (69 FR 48916, August 11, 2004) the final rule entitled “Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2005 Rates” (hereinafter referred to as the FY 2005 final rule) there were a number of errors. Some of these errors were identified and corrected in the correction of the final rule that was published in the October 7, 2004 Federal Register.

We note that sections II.A., II.B., II.C. items 1 through 11 and 13, and II.D. of this correcting amendment apply to IPPS payments effective October 1, 2004, as if they had been included correctly in the FY 2005 final rule. Items 12 and 14 through 29 of section II.C. apply to discharges occurring on or after January 1, 2005.

A. Summary of Preamble Errors

In the FY 2005 final rule, we identified codes for spinal fusion procedures that were to be used in various combinations to identify cases that are eligible to receive new technology add-on payments for bone morphogenetic proteins (BMPs) for spinal fusion (69 FR 49009). We made an error in listing the spinal fusion codes for the Stryker Biotech OP-1 Putty product. FDA approved the use of OP-1 Putty for refusion of the spine with a posterior approach (codes 81.35 and 81.38) but not for initial spinal fusions (codes 81.05 and 81.08). It is our policy to restrict the payment of new technology add-on payments only to cases in which FDA-approved indications are present. Therefore, we should not have included codes 81.05 and 81.08 in the final rule as procedure codes that could be used with OP-1 Putty in order to receive new technology add-on payments. As a result, the correct codes for receiving the OP-1 Putty BMP new technology payments are 84.52 (for the BMP) and either 81.35 or 81.38 (for the refusion of the spine with a posterior approach) and without code 84.51 for the LT Cage.

This correction, which removes codes 81.05 and 81.08 from the new technology logic for Stryker Biotech OP-1 Putty, reflects our policy of not making new technology add-on payments for off-label uses. Currently there is no plan to release a January Pricer update; therefore, the next the update of the Pricer would probably be effective April 1, 2005. However, we do not believe that payment will be made for many cases as a result of this error. The FDA approved OP-1 Putty under a humanitarian device exemption (HDE). As a result, the FDA has imposed a strict limitation on the number of cases in which the product can be used. In addition, an independent review board reviews each case in which OP-1 Putty will be used to ensure that the use of the product is in the best interest of the patient. Therefore, we expect off-label use of the product will be minimal and we will not try to recover monies paid on claims reporting codes 81.05 and 81.08 in conjunction with the code for OP-1 Putty (84.52) that receive add-on payments during the 6-month period from October 1, 2004 through March 31, 2005.

Finally, we are not modifying the new technology payments for the InFUSE TM product because the code logic adopted in the FY 2005 final rule reflects FDA-approval criteria. However, we are making some revisions to our discussion of the code logic for InFUSE TM in order to clarify our policy of making add-on payments only for FDA-approved uses of this technology. (See II.A. of this correcting amendment for these revisions.)

B. Summary of Regulations Text Errors

In the FY 2005 final rule, we made an error in adding new § 412.230(d). Subparagraph (C) was inadvertently added to a nonexistent paragraph (d)(3)(iii) instead of (d)(1)(iii) (69 FR 49249). In the October 7, 2004 correction of the final rule, we also erred by adding a new subparagraph (B) to § 412.230(d)(3)(ii). In section II of this correcting amendment, we are amending § 412.230(d)(1)(iii) to add the subparagraph (C) that was inadvertently placed in paragraph (d)(3)(iii); revising paragraph (d)(1)(iii)(B) to reflect the language that was inadvertently placed in (d)(3)(ii)(B); making editorial changes to paragraphs (d)(3)(i) and (ii); and revising paragraph (d)(3) to reflect the correct text. (See section II.B. item 1 of this correcting amendment.)

The FY 2005 final rule (69 FR 49251) included § 412.534 regarding special payment provisions for long-term care hospitals-within-hospitals (HwHs) and satellites of long-term care hospitals (LTCHs). The LTCH prospective payment system (PPS) is a per discharge system and therefore the specific payment adjustment implemented in this regulation will be made for each Medicare patient who is discharged from the LTCH HwH or satellite of a LTCH during a cost reporting period if that patient was admitted to the LTCH or satellite of a LTCH from the host hospital and if the number of such patients exceeds specific thresholds (detailed in other sections of the regulation). We believe that adding the term “discharged” before the phrase “Medicare inpatient population” and changing the term “referred” to “admitted” (with regard to the source of patients) in the following subsections of the regulatory text will increase the clarity of our policy at § 412.534(c)(1), (c)(2), (d)(1), and (e)(1). Our policy goal in establishing § 412.534 is to distinguish between those LTCH HwHs and satellites that are functioning as totally separate providers from their host hospital and those that are behaving as units of the host, a configuration that is statutorily precluded and to provide a payment adjustment under the LTCH PPS when the LTCH HwH or satellite behaves like a unit. We have determined that this distinction can best be reflected by focusing on the percentage of total discharges from a LTCH HwH or satellite for a particular cost reporting period that were admitted from the host. (This policy rationale was first articulated in the September 1, 1994 IPPS final rule (59 FR 45389)). This policy is articulated on numerous pages in the preamble of the IPPS final rule (69 FR 48916, 49196, 49198, 49201, 49206, and 49213). The use of the term “referred” is imprecise with regards to this policy and we are correcting the Start Printed Page 78527regulation text to more precisely mirror the final policy as established in the preamble (see 69 FR 49196). Further clarifying the same policy, we are revising the phrase “threshold for discharges of patients from the co-located hospital” in § 412.534(c)(2), (d)(1), and (e)(1), respectively, to conform the regulation text to the preamble language on pages 49196, 49198, 49201, 49206, and 49213 where we state that we examine the percentage of a LTCH's or satellite's discharges that were admitted from the host. The present regulation text omits the phrase “who have been admitted;” and therefore, does not make as clear as it could that we examine the percentage of LTCH's or satellite's discharges from its host.

The revised regulation text will refer to the “threshold for discharges of patients who have been admitted from the co-located hospital.” The policy, as articulated above, is focused on identifying the percentage of patients discharged from the HwH or satellite that were admitted from the host hospital in order to apply a payment adjustment when specific thresholds (detailed elsewhere in the regulation text) are exceeded.

In the preamble to the FY 2005 final rule on pages 49196, 49206, and 49213, we established an adjustment for discharges from LTCHs or satellites if the LTCH or satellite is located in a rural area and is co-located with a host hospital or if it is co-located with the only urban hospital in the MSA or a MSA-dominant host hospital. On page 49206 of the preamble, we state that these particular adjustments are in effect “* * * following the phase-in period * * *” However, we inadvertently excluded this statement from the regulation text at § 412.534(d) and (e) which detail this adjustment. In the regulation text that specifies the phase-in period at § 412.534(f)(4), we establish a threshold of “* * * 25 percent or the applicable percentage determined under paragraph (d) or (e) of this section” which clearly indicates that we intended that the particular payment adjustments for rural, single urban, or MSA dominant hosts would go into effect only after the transition period set forth in paragraph (f). We are concerned that the regulation text in § 412.534(d) and (e) does not state this policy clearly and unambiguously. Therefore, we are adding the phrase “[S]ubject to paragraph (f) of this section” in both § 412.534(d)(1) and in (e)(1) to clarify that the specific payment adjustment established in § 412.534(d) for rural hospitals and in § 412.534(e) for single urban or MSA dominant hospitals begins after the phase-in described in § 412.534(f). Similarly, we are adding the phrase, “[E]xcept as provided in paragraph (f) of this section” at the beginning of § 412.534(c)(1), which indicates that the 25 percent threshold for the payment adjustment specified in the following paragraphs begins only after the transition set forth in paragraph (f). In the preamble to the FY 2005 final rule on pages 49196 and 49213, we established a “hold harmless” for cost reporting periods beginning on or after October 1, 2004 and before October 1, 2005 for “grandfathered” LTCHs HwHs and satellites. We stated that “* * * even for grandfathered facilities, in the first cost reporting period, the percentage of discharges admitted from the host hospital may not exceed the percentage of discharges admitted form the host hospital in its FY 2004 cost reporting period.” However, referring to HwHs and satellites that are governed by this policy (“grandfathered”), we state at § 412.534(f)(1) that “For each discharge during the first cost reporting period beginning on or after October 1, 2004 and before October 1, 2005 the amount paid is the amount payable under this subpart with no adjustment under this § 412.534.” We inadvertently omitted from this regulation text that these facilities are required to not exceed the percentage of discharges admitted from the host hospital in its FY 2004 cost reporting period as was indicated in the preamble of the FY 2005 final rule on pages 49213 and 49196. We are revising the wording in paragraph (f)(1) to include this requirement and thus precisely reflect the policy stated in the preamble by adding “but the hospital may not exceed the percentage of patients admitted from the host during its FY 2004 cost reporting period” to the end of that paragraph.

In the regulation text at § 412.534(f)(2), we specify that cost reporting periods beginning on or after October 1, 2005 and before October 1, 2006, the percentage of patients discharged from the HwH or satellite that may be admitted from the host hospital with no payment adjustment may not exceed the lesser of the “percentage of patients admitted from the host during fiscal year 2004 or 75 percent” and at paragraph (f)(3), we specify that cost reporting periods beginning on or after October 1, 2006 and before October 1, 2007, the percentage of patients discharged from the HwH or satellite that may be admitted from the host hospital with no payment adjustment may not exceed the lesser of the “percentage of patients admitted from the host during fiscal year 2004 or 50 percent.” The policy to which we are referring is on pages 49196 and 49213 of the preamble, but in the preamble we use the much clearer phrase “* * * FY 2004 cost reporting period.” in describing the specific period used for the comparison, rather than the “fiscal year 2004” in paragraphs (f)(2) and (f)(3). We are revising the regulation text in paragraphs (f)(2) and (3) replacing “fiscal year 2004” with “its FY 2004 cost reporting period” to conform to the above cited preamble pages.

Accordingly, we have revised § 412.534 to incorporate these corrections. (See section II.B. item 2 of this correcting amendment.)

In the October 7, 2004 correction of the final rule, we corrected § 413.79(a)(10) (69 FR 60252). In this correction, we inadvertently omitted the term “portions” from the beginning of the sentence. Therefore, we are correcting this error in section II.B., item 3 of this correcting amendment.

The October 7, 2004 correction of the final rule also included a correction to § 485.610 (69 FR 60252). This correction stated that paragraph (b)(3) is deleted. Since there were two paragraphs (b)(3) in the FY 2005 final rule, we want to clarify that only the first of these paragraphs was deleted. In section II.B. item 4 of this correcting amendment, we have republished § 485.610(b)(3) to clarify this correction.

C. Summary of Addendum Errors

In the October 7, 2004 correction of the final rule (69 FR 60242), we noted the correction of errors in the tables and addendum language of the FY 2005 final rule related to the wage indexes, geographic reclassifications, and IPPS payments rates. In addition, we posted corrected wage tables and geographic reclassification tables on the CMS Website at: http://www.cms.hhs.gov/​providers/​hipps/​ippswage.asp. We also noted that we would publish the corrected tables in a subsequent Federal Register document.

In section II.C. items 1 through 8 and 10 of this correcting amendment, we are publishing revised operating standardized amounts and capital Federal payment rates, including Tables 1A, 1B, 1C, and 1D as posted on the CMS Website as of September 29, 2004. Thus, these corrections simply make the standardized amounts and rates consistent with the hospitals' actual payment designations, which have been in effect since October 1, 2004. Items 9, 11, and 13 merely correct typographical errors in and the placement of the headings of the wage index tables. Start Printed Page 78528Accordingly, we believe it is appropriate to make the corrections in items 1 through 11 and 13 of section II.C. of this correcting amendment applicable October 1, 2004.

The FY 2005 final rule and the correction to the final rule were effective October 1, 2004. Since that date, we have identified additional errors in the wage index, geographic reclassification, and out-migration adjustment tables that were posted on the CMS Website. As discussed in this section, we are correcting the errors in the wage index, out-migration adjustment, and geographic reclassification tables in items 12 and 14 through 29 of section II.C. of this correcting amendment.

We granted several hospitals' wage data revision requests, but inadvertently failed to include the revised data in the wage index tables in the FY 2005 final rule. These errors affected the wage index value for several CBSAs. We are correcting these errors in the revised wage index tables in this correcting amendment.

In addition, we also have received information that several hospitals were assigned to incorrect labor market areas. We discovered that our data files incorrectly listed these hospitals in counties other than the counties in which these hospitals are actually located. These incorrect geographic designations affected the wage index computations for labor market areas in several States. We have revised the wage index computations for hospitals in the affected labor market areas to reflect the correct geographic designations of these hospitals.

Additionally, we discovered that we had incomplete and outdated information regarding hospitals located in urban areas that have been reclassified as rural under § 412.103 of the regulations. Accordingly, we have updated and corrected this information and revised the wage index computations for hospitals in the affected labor market areas. We also discovered, subsequent to the publication of the FY 2005 final rule, that we had inadvertently neglected to provide the hold-harmless wage index for providers in several counties that were previously designated as urban. In the final rule, we had provided that hospitals in areas that are classified as rural under the new MSA definitions, but had been designated as urban under the MSA definitions in effect through FY 2004, could retain their assignment to the wage index of the area in which they had previously been located. Accordingly, we have revised the wage index assignments for these hospitals.

Moreover, changes to county-level wage data due to the revisions described above, have also resulted in changes to the list of counties eligible for the out-migration wage index adjustment under section 505 of Pub. L. 108-173. In some cases, the wage data revisions have also resulted in changes to the amount of the adjustment. We have revised and corrected the list of eligible counties and the computation of the adjustment amounts. Thus, we are publishing revised versions of the tables displaying average hourly wages, wage index values, and capital geographic adjustment factors, specifically Tables 2, 3A1, 3A2, 3B1, 3B2, 4A1, 4A2, 4B1, 4B2, 4C1, 4C2, 4G, and 4H. We are also publishing a revised version of Table 4J, which displays the list of counties qualifying for the out-migration adjustment and adjustment amounts. In addition, we note that in Tables 4A2 and 4G of the FY 2005 final rule, we inadvertently included 2 rural geographic areas in our list of urban areas. The two rural geographic areas were Enid, OK and Jamestown, NY. In accordance with the 3-year hold-harmless provision, all hospitals in these areas will maintain their current geographic area assignment for the 3-year period beginning FY 2005 and ending in FY 2007. Accordingly, we have removed these two geographic areas from Tables 4A2 and 4G.

There were errors in several of the entries in Tables 9A1 and 9A2 of the FY 2005 final rule. Therefore, we are correcting these errors by republishing these tables in their entirety. These errors were brought to our attention after the publication of the FY 2005 final rule.

Lastly when identifying and correcting errors to the wage index, we believe it is appropriate to apply the changes to the wage index prospectively. As we stated in the January 3, 1984 final rule (49 FR 258), “Application of a retroactive adjustment to the rates [for corrections in the wage index] would erode the basis of the prospective payment system that payment will be made at a predetermined, specified rate.” Therefore, we will apply the corrections to the wage index, geographic reclassification, and out-migration adjustment tables to discharges occurring on or after January 1, 2005.

D. Summary of Appendix A (Regulatory Impact Analysis) Errors

Section IV of the correction of the final rule that appeared in the October 7, 2004 Federal Register stated that we would include a revised impact analysis in a forthcoming correction notice. Accordingly, we have included corrections to the regulatory impact analysis (Appendix A) based on the corrections summarized in section I.C. of this correcting amendment. In addition, we also note that we are deleting duplicative impact analysis language. (See section II.D. of this correcting amendment.)

II. Correction of Errors

Given the errors summarized in section I of this correcting amendment, we are making the following corrections to FR Doc. 04-17943 (69 FR 48916) and FR Doc. 04-22389 (69 FR 60242):

A. Correction of Preamble Errors

1. On page 49009, lines 9 through 51, the paragraph that begins with the phrase “Cases using InFUSE(TM) should be” and ending with the phrase “$1,995 for FY 2005” is corrected to read as follows:

“FDA has not approved coverage for InFUSE(TM) when it is applied through a posterior approach. It is our policy to restrict the payment of new technology add-on payments only to cases in which FDA approved indications are present. Therefore, we are excluding add-on payments for those cases that contain procedure codes that indicate off-label uses of InFUSE(tm).

The posterior approach is captured through one of the following codes:

  • 81.05 Dorsal and dorsolumbar fusion, posterior technique.
  • 81.08 Lumbar and lumbosacral fusion, posterior technique.
  • 81.35 Refusion of dorsal and dorsolumbar fusion, posterior technique.
  • 81.38 Refusion of lumbar and lumbosacral fusion, posterior technique.

Cases using InFUSETM should be identified by the combination of procedure codes 84.51 and 84.52, as described above and as required in the previous year of new technology add-on payments for this technology. Therefore, we are adopting the following code logic for new technology add-on payments for this product: cases in DRGs 497 and 498 with codes 84.52 and 84.51, but without any of the following codes: 81.05, 81.08, 81.35, or 81.38.

“For cases using the OP-1 Putty, the procedure code 84.52 (Insertion of recombinant bone morphogenetic protein) must be coded in combination with procedure codes identifying posterolateral spinal fusions, as is consistent with the FDA approval of this device. However, unlike InFUSETM, the OP-1 Putty is not used with a LT Cage (code 84.51). Therefore, we will provide new technology add-on payments for the OP-1 Putty through the following Start Printed Page 78529payment logic: Cases in DRGs 497 and 498 with code 84.52 and one of the following codes: 81.35 or 81.38 and without code 84.51.

“Both of these devices have FDA approval that is consistent with cases that would be assigned to DRGs 497 to 498. Because Stryker Biotech did not submit an application for new technology add-on payments, we were unable to do a complete analysis of the cost of the device. However, we have been able to determine that the costs associated with the OP-1 Putty are similar to those associated with InFUSE(TM). Therefore, we believe that the same payment amount for new technology add-on payments is appropriate for both devices. Accordingly, cases containing one of the above combinations of procedure codes and that fall into DRGs 497 or 498 will be eligible to receive the add-on payment, with a maximum of $1,955 for FY 2005.”

B. Correction of Regulation Text Errors

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Given the errors summarized in section I.B. of this correcting amendment, we are making the following correcting amendments to

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PART 412—[CORRECTED]

[Corrected]
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1. Section 412.230 is amended by—

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A. Revising paragraphs (d)(1)(iii)(A) and (B).

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B. Adding a new paragraph (d)(1)(iii)(C).

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C. Revising paragraph (d)(3).

End Amendment Part

The revisions and additions read as follows:

Criteria for an individual hospital seeking redesignation to another rural area or an urban area.
* * * * *

(d) Use of urban or other rural area's wage index.

(1) * * *

(iii) * * *

(A) With respect to redesignations for Federal fiscal years 1994 through 2001, the hospital's average hourly wage is at least 108 percent of the average hourly wage of hospitals in the area in which the hospital is located;

(B) With respect to redesignations for Federal fiscal years 2002 through 2005, the hospital's average hourly wage is, in the case of a hospital located in a rural area, at least 106 percent and in the case of a hospital located in an urban area, at least 108 percent of the average hourly wage of hospitals in the area in which the hospital is located; or

(C) With respect to redesignations for Federal fiscal year 2006 and subsequent years, the hospital's average hourly wage is, in the case of a hospital located in a rural area, at least 106 percent and in the case of a hospital located in an urban area, at least 108 percent of the average hourly wage of all other hospitals in the area in which the hospital is located;

* * * * *

(3) Rural referral center exceptions.

(i) If a hospital was ever a rural referral center, it does not have to demonstrate that it meets the average hourly wage criterion set forth in paragraph (d)(1)(iii) of this section.

(ii) If a hospital was ever a rural referral center, it is required to meet only the criterion that applies to rural hospitals under paragraph (d)(1)(iv) of this section, regardless of its actual location in an urban or rural area.

* * * * *
[Corrected]
Start Amendment Part

2. Section 412.534 is amended by—

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A. Republishing the introductory text of paragraph (c).

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B. Revising paragraph (c)(1).

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C. Revising the first sentence and republishing the last sentence of paragraph (c)(2).

End Amendment Part Start Amendment Part

D. Republishing the introductory text of paragraph (d).

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E. Revising the first sentence and republishing the last sentence of paragraph (d)(1).

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F. Republish the introductory text of paragraph (e).

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G. Revising the first sentence and republishing the second sentence of paragraph (e)(1).

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H. Republish the introductory text of paragraph (f).

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I. Revising paragraphs (f)(1), (f)(2), and (f)(3).

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Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals.

(c) Patients admitted from the hospital located in the same building or on the same campus as the long-term care hospital or satellite facility. Payments to the long-term care hospital for patients admitted to it or to its satellite facility from the co-located hospital will be made under either paragraph (c)(1) or paragraph (c)(2) of this section.

(1) Except as provided in paragraph (f) of this section, for any cost reporting period beginning on or after October 1, 2004 in which the long-term care hospital or its satellite facility has a discharged Medicare inpatient population of whom no more than 25 percent were admitted to the hospital or its satellite facility from the co-located hospital, payments are made under the rules at § 412.500 through § 412.541 in this subpart with no adjustment under this section.

(2) Except as provided in paragraph (d), (e), or (f) of this section, for any cost reporting period beginning on or after October 1, 2004 in which the long-term care hospital or satellite facility has a discharged Medicare inpatient population of whom more than 25 percent were admitted to the hospital or satellite facility from the co-located hospital, payments for the patients who are admitted from the co-located hospital and who cause the long-term care hospital or satellite facility to exceed the 25 percent threshold for discharged patients who have been admitted from the co-located hospital are the lesser of the amount otherwise payable under this subpart or the amount payable under this subpart that is equivalent to the amount that would be determined under the rules at Subpart A, § 412.1(a). Payments for the remainder of the long-term care hospital's or satellite facility's patients are made under the rules in this subpart at § 412.500 through § 412.541 with no adjustment under this section.

* * * * *

(d) Special treatment of rural hospitals. (1) Subject to paragraph (f) of this section, in the case of a long-term care hospital or satellite facility that is located in a rural area as defined in § 412.62(f) and is co-located with another hospital for any cost reporting period beginning on or after October 1, 2004 in which the long-term care hospital or satellite facility has a discharged Medicare inpatient population of whom more than 50 percent were admitted to the long-term care hospital or satellite facility from the co-located hospital, payments for the patients who are admitted from the co-located hospital and who cause the long-term care hospital or satellite facility to exceed the 50 percent threshold for discharged patients who have been admitted from the co-located hospital are the lesser of the amount otherwise payable under this subpart or the amount payable under this subpart that is equivalent to the amount that would be otherwise payable under Subpart A, § 412.1(a). Payments for the remainder of the long-term care hospital's or satellite facility's patients are made under the rules in this subpart at § 412.500 through § 412.541 with no adjustment under this section.

* * * * *

(e) Special treatment of urban single or MSA dominant hospitals. (1) Subject to paragraph (f) of this section, In the case of a long-term care hospital or Start Printed Page 78530satellite facility that is co-located with the only other hospital in the MSA or with a MSA dominant hospital as defined in paragraph (e)(4) of this section, for any cost reporting period beginning on or after October 1, 2004 in which the long-term care hospital or satellite facility has a discharged Medicare inpatient population of whom more than the percentage calculated under paragraph (e)(2) of this section were admitted to the hospital from the co-located hospital, payments for the patients who are admitted from the co-located hospital and who cause the long-term care hospital to exceed the applicable threshold for discharged patients who have been admitted from the co-located hospital are the lesser of the amount otherwise payable under this subpart or the amount under this subpart that is equivalent to the amount that otherwise would be determined under Subpart A, § 412.1(a). Payments for the remainder of the long-term care hospital's or satellite facility's patients are made under the rules in this subpart with no adjustment under this section.

* * * * *

(f) Transition period for long-term care hospitals and satellite facilities paid under this subpart. In the case of a long-term care hospital or a satellite facility that is paid under the provisions of this Subpart O of Part 412 on October 1, 2004 or of a hospital that is paid under the provisions of this Subpart O on October 1, 2005 and whose qualifying period under § 412.23(e) began on or before October 1, 2004, the amount paid is calculated as specified below:

(1) For each discharge during the first cost reporting period beginning on or after October 1, 2004, and before October 1, 2005, the amount paid is the amount payable under this subpart with no adjustment under this section but the hospital may not exceed the percentage of patients admitted from the host during its FY 2004 cost reporting period.

(2) For each discharge during the cost reporting period beginning on or after October 1, 2005, and before October 1, 2006, the percentage that may be admitted from the host with no payment adjustment may not exceed the lesser of the percentage of patients admitted from the host during its FY 2004 cost reporting period or 75 percent.

(3) For each discharge during the cost reporting period beginning on or after October 1, 2006, and before October 1, 2007, the percentage that may be admitted from the host with no payment adjustment may not exceed the lesser of the percentage of patients admitted from the host during its FY 2004 cost reporting period or 50 percent.

* * * * *
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PART 413—[CORRECTED]

[Corrected]
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3. Section 413.79 is amended by revising paragraph (a)(10) to read as follows:

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Direct GME payments: Determination of the weighted number of FTE residents.
* * * * *

(a) * * *

(10) Effective for portions of cost reporting periods beginning on or after October 1, 2004, if a hospital can document that a resident simultaneously matched for 1 year of training in a particular specialty program, and for a subsequent year(s) of training in a different specialty program, the resident's initial residency period will be determined based on the period on board eligibility associated with the program for which the resident matched for the subsequent year(s) of training.

* * * * *
Start Part

PART 485—[CORRECTED]

[Corrected]
End Part Start Amendment Part

4. Section 485.610(b)(3) is republished to read as follows:

End Amendment Part
Condition of participation: Status and location.
* * * * *

(b) * * *

(3) Effective only for October 1, 2004 through September 30, 2006, the CAH does not meet the location requirements in either paragraph (b)(1) or (b)(2) of this section and is located in a county that in FY 2004, was not part of a Metropolitan Statistical Area as defined by the Office of Management and Budget, but as of FY 2005 was included as part of such an MSA as a result of the most recent census data and implementation of the new MSA definitions announced by OMB on June 6, 2003.

* * * * *

C. Correction of Errors in the Addendum

1. On page 49275, third column, line 15, the figure “0.993833” is corrected to read “0.993659”.

2. On page 49278, top half of the page, the table is corrected to read as follows:

Operating standardized amountsCapital federal rate
National0.9489780.950591
Puerto Rico0.9731830.973749

3. On page 49280, top of the page, the table entitled Comparison of FY 2004 Standardized Amounts to FY 2005 Single Standardized Amount with Full Update and Reduced Update is corrected by changing the figures in second and third columns for the listed entries to read as follows:

Full update (3.3 percent)Reduced update (2.9 percent)
FY 2005 Reclassification Budget Neutrality Factor0.9936590.993659
Adjusted for Blend of FY 2004 DRG Recalibration and Wage Index Budget Neutrality Factors*Labor: $3,418.96Labor: $3,405.72
Nonlabor: $1,389.70Nonlabor: $1,384.32
FY 2005 Outlier Factor0.9489780.948978
Rate for FY 2005 (after multiplying FY 2004 base rate by above factors) where the wage index is less than or equal to 1.0000Labor: $2,823.64Labor: $2,812.70
Nonlabor: $1,730.62Nonlabor: $1,723.91
Rate for FY 2005 (after multiplying FY 2004 base rate by above factors) where the wage index is greater than 1.0000Labor: $3,238.07Labor: $3,225.53
Start Printed Page 78531
Nonlabor: $1,316.18Nonlabor: $1,311.08

4. On page 49283,

a. Second column, line 63, the figure “$416.63” is corrected to read “$416.53”; and

b. Third column, line 1, the figure “0.68” is corrected to read “0.65”.

5. On page 49286, third column,

a. Line 31, the figure “0.9997” is corrected to read “0.9995”; and

b. Line 35, the figure “0.9905” is corrected to read “0.9903”.

6. On page 49287, the table Budget Neutrality Adjustment for DRG Reclassifications and Recalibration and the Geographic Adjustment Factors” the following entries are corrected to read as follows:

Fiscal yearNational Incremental AdjustmentPuerto Rico Incremental Adjustment
Geographic Adjustment FactorDRG Reclassifications and RecalibrationCombinedCumulativeGeographic Adjustment FactorDRG Reclassifications and RecalibrationCombinedCumulative
2005010.99946 111.000941.00140 110.9913170.99115 111.000940.99208 110.98946

7. On page 49288,

a. First column,

(1) Line 48, the figure “1.0006” is corrected to read “1.0004”;

(2) Line 61, the figure “1.0006” is corrected to read “1.0004”;

(3) Line 64, the figure “0.9914” is corrected to read “0.9912”; and

(4) Line 67, the phrase “FY 002” is corrected to read “FY 2002”.

b. Second column,

(1) Line 3, the figure “1.0006” is corrected to read “1.0004”; and

(2) Line 4, the figure “0.9914” is corrected to read “0.9912”.

8. On page 49289,

a. Top of the page,

(1) Second column,

(a) Line 9, the figure “$416.63” is corrected to read “$416.53”; and

(b) Line 18, the figure “1.0006” is corrected to read “1.0004”.

(2) Third column

(a) Line 16, the figure “0.06” is corrected to read “0.04”

(b) Line 28, the figure “0.68” is corrected to read “0.65”

b. Middle of the page, the table entitled, Comparison of Factors and Adjustments: FY 2004 Capital Federal Rate 1 and FY 2005 Capital Federal Rate two entries and a footnote are corrected to read as follows:

FY 2004 1FY 2005ChangePercent change
GAF/DRG Adjustment factor 21.00251.00041.0040.04
Capital federal rate$413.83$416.531.00650.65
2 The update factor and the GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2004 to FY 2005 resulting from the application of the 1.0004 GAF/DRG budget neutrality factor for FY 2005 is 1.004.

c. Lower third of the page, the table, Comparison of Factors and Adjustments: FY 2005 Proposed Capital Federal Rate 1 and FY 2005 Final Capital Federal Rate, two entries are corrected to read as follows:

Proposed FY 2005Final FY 2005ChangePercent change
GAF/DRG adjustment factor 21.00151.00040.9989-0.11
Capital federal rate$416.59$416.530.9999-0.01

9. On page 49292, second column, seventh paragraph, the paragraph “Table 2—Hospital Case-Mix Indexes For Discharges Occurring in Federal Fiscal Year 2003; Hospital Average Hourly Wage For Federal Fiscal Years 2003 (1999 Wage Data), 2004 (2000 Wage Data), and 2005 (2001 Wage Data) Wage Indexes and 3-YEAR Average of Hospital Average Hourly Wages” is corrected to read “Table 2.—Hospital Case-Mix Indexes For Discharges Occurring in Federal Fiscal Year 2003; Hospital Wage Indexes For Federal Fiscal Year 2005; Hospital Average Hourly Wages For Federal Fiscal Years 2003 (1999 Wage Data), 2004 (2000 Wage Data), and 2005 (2001 Wage Data); and 3-Year Average of Hospital Average Hourly Wages”.

10. On page 49294,

a. Table 1A.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor is corrected to read as follows: Start Printed Page 78532

Table 1A.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor

[71.1 Percent Labor Share/28.9 Percent Nonlabor Share If Wage Index Greater Than 1]

Full update (3.3 Percent)Reduced update (2.9 Percent)
Labor-relatedNonlabor-relatedLabor-relatedNonlabor-related
$3,238.07$1,316.18$3,225.53$1,311.08

b. Table 1B.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor 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)Reduced update (2.9 Percent)
Labor-relatedNonlabor-relatedLabor-relatedNonlabor-related
$2,823.64$1,730.62$2,812.70$1,723.91

c. Table 1C.—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor is corrected to read as follows:

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

Rates if Wage Index Greater Than 1Rates if Wage Index Less Than or Equal to 1
LaborNonlaborLaborNonlabor
National$3,238.07$1,316.18$2,823.64$1,730.62
Puerto Rico1,554.79625.841,351.99828.64

d. Table 1D.—Capital Standard Federal Payment Rate is corrected to read as follows:

Table 1D.—Capital Standard Federal Payment Rate

Rate
National$416.53
Puerto Rico199.01

11. On page 49295, at the top of the page, the heading “TABLE 2.—HOSPITAL CASE MIX INDEXES FOR DISCHARGES OCCURING IN FEDERAL FISCAL YEAR 2003; HOSPITAL FISCAL YEAR 2005 WAGE INDEX; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2003 (1999 WAGE DATA), 2004 (2000 WAGE DATA), AND 2005 (2001 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES” is corrected to read “TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2003; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2005; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2003 (1999 WAGE DATA), 2004 (2000 WAGE DATA), AND 2005 (2001 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES”.

12. On pages 49295 through 49424, in Table 2—Hospital Case Mix Indexes for Discharges Occurring in Federal Fiscal Year 2003; Hospital Fiscal Year 2005 Wage Index; Hospital Average Hourly Wage for Federal Fiscal Years 2003 (1999 Wage Data), 2004 (2000 Wage Data), and 2005 (2001 Wage Data) Wage Indexes and 3-Year Average of Hospital Average Hourly Wages, the table is corrected to read as follows:

Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2003; Hospital Wage Indexes for Federal Fiscal Year 2005; Hospital Average Hourly Wages for Federal Fiscal Years 2003 (1999 Wage Data), 2004 (2000 Wage Data), and 2005 (2001 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages

Provider No.Case mix indexFY 2005 wage indexAverage hourly wage FY 2003Average hourly wage FY 2004Average hourly wage FY 2005Average hourly wage** (3 yrs)
0100011.46280.765117.984119.406120.656319.3592
010004****20.161322.267422.758521.6609
0100051.16700.917819.973319.606320.493720.0290
0100061.39450.790618.393119.097621.024119.4984
0100071.11150.765116.078117.546216.881116.8364
0100081.00170.831119.018219.657323.833320.8947
0100091.02500.889319.727320.430921.642220.5897
010010 h1.02030.909717.734819.264422.302119.7359
Start Printed Page 78533
0100111.62320.917824.892225.823124.816625.1564
0100121.22090.785620.337520.089621.762220.7424
0100150.94820.765119.820518.889020.473219.7680
0100161.29260.917820.317521.791823.041421.7886
0100181.30800.917819.551919.207120.588819.7714
0100191.22060.790617.641418.917720.133618.8827
010021 h1.18340.765125.333517.759620.710820.6787
0100220.92840.890922.125022.226725.879723.4461
0100231.74450.831118.456720.490123.779120.7075
0100241.63950.831117.374618.594220.006718.6270
0100251.21240.765117.470219.364919.856118.8705
0100270.76570.765116.515714.097514.958515.1595
0100291.53380.835719.339320.986821.672420.7210
010031****19.261221.017620.946320.4044
0100320.87180.765116.396816.471318.507317.1611
0100332.07230.917821.982824.508825.516523.9915
0100340.98570.831114.937914.933317.162515.6290
0100351.19930.917820.780821.618223.131921.8768
0100361.09020.765118.715719.250120.512519.4735
0100381.17140.801119.688718.657820.393519.6125
0100391.64040.883821.355023.033923.415122.6371
0100401.48710.807720.448620.777921.670820.9799
0100430.96150.917817.356719.901219.542218.9651
0100441.02380.765123.457625.856023.022024.0513
0100451.10160.839018.756922.771320.565820.5841
0100461.61840.807718.874119.675420.893519.9036
0100470.91170.780613.413016.169519.593716.1765
0100491.11410.765116.334916.297317.780116.8074
0100501.04860.917820.302820.739821.562520.8933
0100510.88030.833912.328014.300614.705313.7722
0100520.88960.765119.828911.901921.367316.4899
0100531.07290.765115.415617.323817.416016.7020
0100541.04910.889320.965620.638223.189421.5890
0100551.49180.765119.566718.966419.184719.2296
0100561.47170.917820.564521.110422.718321.5191
0100580.88230.915716.126517.780020.318217.9980
0100591.05480.889319.127020.553423.696321.1230
0100611.01680.815718.532017.044720.568318.6485
0100621.08830.765116.972117.178618.132317.4330
0100641.71610.917820.565022.228025.434522.4456
0100651.38460.807017.055717.269820.010818.1438
0100660.81120.765114.890414.869617.093515.6113
0100681.21490.917823.432218.330817.569020.1824
0100691.03780.765115.449717.095719.631717.4477
0100721.10300.794916.565218.880721.541918.9501
0100730.91930.765113.559414.982616.404314.9376
0100781.23590.801118.512720.144721.063319.8889
0100791.15430.883817.161220.740120.425419.3330
010083 h1.21270.811818.428219.852420.216619.4500
0100841.54360.917819.877321.652222.521921.4099
0100851.25550.889321.586022.528223.700722.6206
0100861.03520.765116.888618.012219.433218.0635
0100871.81810.799718.791519.762021.622620.0048
0100891.20940.915719.524119.578322.250820.4322
0100901.68040.799719.563520.028721.432220.3544
0100910.97010.765117.177517.467219.422218.0426
0100921.44020.839018.547819.935122.070920.1834
0100950.83960.833912.306412.524313.442612.7704
0100970.76910.831114.267515.159317.173515.4853
0100980.97760.765115.576315.162919.671716.5274
0100991.06630.765115.923216.330718.184916.8379
010100 h1.52560.811818.375519.814620.002719.4279
0101011.12130.794918.952519.071821.008519.6864
0101020.92560.765115.777816.463719.919617.3540
0101031.79930.917822.080222.570924.220122.9368
0101041.67440.917821.945720.939124.192922.2745
0101081.10650.831119.159620.778723.780321.1826
Start Printed Page 78534
0101090.98160.765115.962718.223521.712818.5994
0101100.74680.765115.581716.001519.270617.3294
0101120.96090.765115.604117.924317.296316.8980
0101131.65690.799718.277419.410620.418119.3908
0101141.34680.917819.377220.176321.531920.3330
0101150.84520.774415.351015.787217.598516.2135
0101181.25750.831117.462119.530218.856018.5514
010119****19.516320.524521.821520.6281
0101200.99500.799718.997519.436820.585519.6680
010121****15.234517.164017.032916.5712
0101251.03740.765116.511716.862216.841916.7415
0101261.08820.831119.593319.964723.185620.9538
0101280.85240.765116.689814.764617.935416.3915
010129 h1.06100.811816.760916.490518.782117.4262
0101300.97610.917817.461418.719018.494418.2496
0101311.29150.883819.049222.996924.219722.1728
0101340.8697*18.517817.7717*18.1134
0101371.24450.917821.357328.940229.766526.1994
0101380.75790.765114.136814.202513.508213.9815
0101391.50440.917820.570822.839024.941022.7783
0101431.19360.917818.908420.563922.131220.5538
0101441.53830.799718.827219.149720.642519.5545
0101451.24200.839020.815722.139423.197622.0834
0101461.06890.801118.366621.308319.994419.8782
0101480.87090.765118.459017.682918.530918.2453
0101491.29440.831119.019921.008623.159320.9862
0101501.06390.835719.481921.236020.673820.4784
0101521.31460.799719.899021.603822.162621.2042
010155****13.6137**13.6137
0101571.13660.790617.737319.697721.357419.5828
0101581.09150.889318.605218.546422.444019.7809
010159****19.3950**19.3950
010161******27.511927.5119
0200011.70711.216428.653030.145231.609130.2393
020002****28.2758**28.2758
0200041.20471.173329.235127.351629.992628.8392
0200050.8979*35.086032.7936*33.9497
0200061.16741.216433.084331.267333.421032.5617
020007****27.7271**27.7271
0200081.25341.311931.887733.454334.585633.3645
020009****18.5594**18.5594
0200100.9035*23.727620.7929*22.1109
020011****27.5062**27.5062
0200121.35221.173326.758627.995529.341928.1074
0200130.9687*29.564730.6423*30.1127
0200141.11941.173327.787029.680532.123329.9193
0200171.87701.216428.875330.301732.928130.7977
0200241.07821.173325.593328.093027.979927.2883
020025****29.4374**29.4374
0300011.21340.998522.899625.751327.757225.2939
0300021.99530.998523.145025.603827.962825.6016
030003****23.985022.1436*23.0546
0300041.0093*13.8452**13.8452
0300061.66350.912520.501923.288124.016922.4651
0300071.39471.056422.247326.155126.944225.2403
0300091.11420.912519.125819.913121.406520.1252
0300101.38780.912519.849620.720422.864721.1646
0300111.47580.912519.814121.002822.842221.2114
0300121.27900.998521.109924.236625.520523.8026
0300131.35070.912519.951721.976623.522921.8802
0300141.46270.998520.301723.366325.118922.9571
0300161.30520.998522.252624.338027.158324.6799
0300171.69800.998523.170221.879224.405523.1546
0300181.19980.998521.806724.921624.430823.7395
0300191.18870.998522.034123.297328.491724.3829
0300221.67360.998522.335124.994125.146124.2980
0300231.61291.077725.462628.662728.411227.6224
Start Printed Page 78535
0300242.11410.998523.766326.764128.347026.1920
030025****20.2690**20.2690
0300270.97660.912518.550019.458321.052719.7088
0300301.58040.998523.128025.242524.600524.2281
0300331.26431.056420.303426.381426.600924.3844
030034****19.5578**19.5578
030035****20.5339**20.5339
0300361.20000.998522.269024.943226.570824.6324
0300372.13630.998523.732523.054230.390725.3379
0300381.60050.998523.447725.263226.517825.1009
0300400.87100.912519.370721.271722.513021.0352
030041****18.4749**18.4749
0300431.27910.912520.565323.517226.082523.4414
0300440.95570.912518.678121.950319.571419.9272
030047****22.7385**22.7385
030049****19.7315**19.7315
030054****15.7974**15.7974
030055 h1.30971.134520.837322.861223.183722.3625
030059****27.3929*24.767626.9545
0300601.18630.912519.502121.768522.355121.2224
0300611.61780.998521.101322.970623.472222.5411
0300621.19970.912519.267021.163921.984920.8320
0300641.88610.912521.643522.800924.673223.0238
0300651.60090.998522.284624.606425.673824.2585
0300670.96650.912517.641418.400319.133218.3489
0300681.08540.912518.971819.709719.703019.4968
030069 h1.35341.134523.490324.543225.624324.5990
0300801.43350.912521.229922.895324.357322.8911
0300831.31180.998523.504924.327324.926924.2989
0300851.55870.912521.654221.819623.207022.2934
0300871.58890.998523.133925.635126.387825.1083
0300881.38640.998521.449123.576123.247822.8032
0300891.52080.998522.085024.505526.216624.3651
0300921.42030.998519.662524.051525.412723.2498
0300931.26580.998521.719523.248523.562322.9162
0300941.31930.998521.804924.599226.998524.3985
030095****20.5222**20.5222
0300990.90460.912519.809220.331026.799622.1687
0301001.95610.912523.586827.6299*25.8489
030101 h1.34191.134521.102923.766125.007723.1660
0301022.48910.998521.540527.9419*24.8036
0301031.63290.998528.930829.110528.283228.7420
030104****32.866934.6028*33.8315
0301052.61540.9985**27.690027.6900
0301062.37130.9985**30.479130.4791
0400011.09950.867016.388218.714123.147519.5432
0400021.17060.758116.135318.077619.342917.8255
0400031.08660.758115.518616.391818.500016.7495
0400041.59120.867019.010521.233523.350421.3232
040005****16.5465**16.5465
0400071.57950.884022.531923.399223.456523.1106
040008****20.2122**20.2122
0400101.41700.867019.825120.711422.098420.8951
0400110.97330.758117.133718.834619.031918.5339
0400141.29520.884019.399622.497024.084621.9495
0400150.98500.758117.960118.851318.079318.2951
0400161.69600.884019.808721.219822.721921.2351
0400171.11210.826716.564817.754519.436517.8909
0400181.06680.831018.820322.040823.851521.6003
0400191.14590.888721.046521.171121.531621.2611
0400201.52070.888717.605618.641920.913619.0968
0400211.16470.884021.332123.562024.777123.3281
0400221.57520.867019.239321.419423.746221.2573
0400241.04070.758117.150717.575020.110118.3059
040025****14.8070**14.8070
0400261.59910.926821.014322.769924.305322.7334
0400271.38540.826717.716119.338819.934818.9814
Start Printed Page 78536
040028****15.2850**15.2850
0400291.50390.884022.509422.188222.877022.5261
040030****16.5488**16.5488
0400320.9642*13.801316.278118.517116.1503
0400350.89220.758111.061111.823713.426512.0575
0400361.50230.884021.106621.674224.285122.3500
040037****15.4985**15.4985
0400391.27250.758115.281115.967317.797616.3796
040040****19.6705**19.6705
0400411.17070.884017.778320.464622.018820.0911
0400421.31020.923116.687516.228518.955017.2476
040044****17.1869**17.1869
0400450.96250.758116.664819.557218.795218.2593
0400471.05480.802618.629521.632321.533420.6477
0400501.10940.758114.208715.142815.478214.9341
0400511.02720.758118.215217.696418.894318.2885
0400530.99720.758114.150819.258620.815317.5782
0400541.04240.758116.521716.557316.737016.6038
0400551.47870.831017.423619.733622.223719.7620
040058****19.3124**19.3124
040060****15.4220**15.4220
0400621.55840.831019.425521.933621.640320.9790
040064****13.3479**13.3479
0400661.04310.884019.561921.776623.461621.6179
0400671.05380.758115.008116.051615.144115.3964
0400691.11160.888718.975420.596821.760720.4611
0400701.0039*18.6066**18.6066
0400711.53330.872618.495619.432422.935020.2395
0400721.08080.884021.332019.307920.826920.4867
0400741.13350.884020.846522.080022.614721.8283
0400750.98440.867014.668115.787516.258315.5643
0400761.01260.865621.801023.594721.044222.0817
0400770.98780.758114.723016.783218.326116.5572
0400781.52930.926819.636321.485424.458921.9124
0400800.99100.822922.815418.447021.348320.6735
0400810.83280.758112.479713.279713.714813.1618
040082****16.4840**16.4840
0400841.11790.884018.341020.116322.644120.4399
0400850.99850.758114.178215.581118.075615.8198
0400881.34990.895518.315920.003221.297419.8367
040090****16.6619**16.6619
0400911.28140.844020.290420.668823.025221.3255
040093****14.7132**14.7132
0401001.34230.774017.027117.888919.356018.1847
0401051.03200.758114.893615.469715.817115.4079
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