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Proposed Rule

Medicare Program; Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008; Correction

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Information about this document as published in the Federal Register.

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AGENCY:

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

ACTION:

Proposed rule; correction notice.

SUMMARY:

This document corrects technical errors that appeared in the proposed rule published in the Federal Register on May 4, 2007, entitled “Medicare Program; Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008” (72 FR 25356).

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FOR FURTHER INFORMATION CONTACT:

Randy Throndset, (410) 786-0131.

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SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 07-2167 of May 4, 2007 (72 FR 25356), there were a number of technical errors that we identified and corrected in the Correction of Errors section below.

II. Summary of Errors

In the May 4, 2007 published proposed rule, on page 25388, we Start Printed Page 33426provided a Table 4 “Regression Coefficients for Calculating Case-Mix Relative Weights” that illustrated payment regression coefficients, which represent the average addition to resource cost due to each severity level. We inadvertently miscalculated the payment for the case-mix groups in the second column of Table 4 and have corrected these errors.

We are republishing Table 4 in its entirety with the corrected information. The text on page 25388 describing Table 4 has also been changed to reflect the corrected data in the table as well as a typographical error. We are also correcting the language on page 25388 which describes how coefficients are scaled. A phrase was inadvertently omitted which notes that the calculation also adjusts for budget neutrality in the weights.

We are correcting text on page 25389, which incorrectly stated that we are proposing to adjust for nominal change in case-mix through a reduction in the weights. The adjustment for nominal change in case-mix is made through a rate reduction in the national standardized 60-day episode payment. We are also correcting some typographic errors. On pages 25389-25392, Table 5 “Case-Mix Groups, Average Cost, and Case-Mix Weight” includes the predicted average resource cost for the 153 case-mix groups of the proposed model. We inadvertently miscalculated the “Average Cost” in the fourth column. We are republishing Table 5 in its entirety with the corrected information.

On pages 25430-25431, Table 12a “NRS Case-Mix Adjustment Variables and Scores” sets forth the NRS scores for the five-group model. We inadvertently included incorrect scores in the third column and have corrected these errors. The table also corrects how the scoring is broken out for Outcome and Assessment Information Set (OASIS) item M0450, giving separate scores for stage 3 and stage 4 pressure ulcers, separating 1 pressure ulcer and 2 pressure ulcers within both stages 3 and 4, changing 3 pressure ulcers for stage 3 or 4 to 3+ pressure ulcers for stage 3, changing the 4+ pressure ulcers for stage 3 and 4 to 3+ pressure ulcers for stage 4, and deleting the score for 5 or more pressure ulcers. We are republishing Table 12a in its entirety with the corrected information.

We are also correcting text on page 25444 describing the calculation of the case-mix and wage-adjusted national standardized 60-day episode payment rate including non-routine supplies to correct an error in the order of the calculation. We are correcting typographical errors in the LUPA calculation example on page 25447.

Finally, we are correcting typographical errors in Addendum A on page 25459, in the rural Massachusetts and New Jersey wage indices. The text of the first footnote to Addendum A also incorrectly states that all counties within the State are classified as rural. The first footnote has been corrected.

III. Correction of Errors

In FR Doc. 07-2167 of May 4, 2007 (72 FR 25356), make the following corrections:

1. On page 25388, in the first column, the first full paragraph,

a. In line 1, the word “PSS” is corrected to read “PPS”.

b. In lines 5 through 10, the sentence “(To show the coefficients in actual, as opposed to resource cost, dollars, the coefficients were scaled by a multiplier representing the ratio of the HH PPS average payment level to the Abt Associates average resource cost level)” is corrected to read as follows: “(To show the coefficients in actual, as opposed to resource cost, dollars, the coefficients were scaled by a multiplier representing the ratio of the HH PPS average payment level to the Abt Associates average resource cost level after adjusting for budget neutrality in the weights (see section II.A.2.c. for an explanation of budget neutrality adjustment to the weights.))”.

c. In line 17, the figure “$861.74” is corrected to read “$869.55”.

d. In line 18, the figure “$219.44” is corrected to read “$221.43”.

2. On page 25388, in the first column, second full paragraph, line 4, the figure “$1,265.18” is corrected to read “$1,276.66”.

3. On page 25388, in the second column, first partial paragraph,

a. In line 5, the figure “$1,265.18” is corrected to read “$1,276.66”.

b. In line 6, the figure “$139.26” is corrected to read “$140.52”.

c. In line 7, the figure “$645.90” is corrected to read “$651.76”.

d. In line 9, the figure “$210.94” is corrected to read “$212.85”.

e. In line 15, the figure “$2,261.28” is corrected to read “$2,281.79”.

4. On page 25388, in Table 4: Regression Coefficients for Calculating Case-Mix Relative Weights, the table is corrected as follows:

Table 4.—Regression Coefficients for Calculating Case-Mix Relative Weights

Intercept (constant for all case mix groups)$1,276.66
1st and 2nd Episodes, 0 to 13 Therapy Visits
C2384.11
C3869.55
F2221.43
F3382.50
S2 (6 therapy visits)504.49
S3 (7-9 therapy visits)943.50
S4 (10 therapy visits)1,387.86
S5 (11-13 therapy visits)1,771.84
1st and 2nd Episodes, 14 to 19 Therapy Visits
Constant2,191.26
C2539.55
C31,257.78
F2270.79
F3429.54
S2 (16-17 therapy visits)429.35
S3 (18-19 therapy visits)705.26
3rd+ Episodes, 0 to 13 Therapy Visits
Constant212.85
C2140.52
C3619.33
F2418.51
F3825.67
S2 (6 therapy visits)651.76
S3 (7-9 therapy visits)1,093.13
S4 (10 therapy visits)1,521.27
S5 (11-13 therapy visits)1,907.93
3rd+ Episodes, 14 to 19 Therapy Visits
Constant2,198.69
C2678.75
C31,405.22
F2394.26
F3693.30
S2 (16-17 therapy visits)294.71
S3 (18-19 therapy visits)719.09
All Episodes, 20+ Therapy Visits
Constant4,033.07
C2583.74
C31,396.22
F2490.14
F31,052.59

5. On page 25389, in the first column,

a. In line 3, the word “two” is deleted.

b. In line 3, the word “adjustments” is corrected to read “adjustment”.

6. On page 25389, in the second column,

a. In line 1, the words “and the” is deleted.

b. In line 2, the phrase “adjustment for nominal changes in case-” is deleted.

7. On page 25389, in the third column,

a. In line 1, the words “mix coding” is deleted.

b. In line 1, the word “are” is corrected to read “is”.

8. On pages 25389-25392, in Table 5: Case Mix Groups, Average Cost, and Start Printed Page 33427Case Mix Weight, the table is corrected to read as follows:

Table 5.—Case-Mix Groups, Average Cost, and Case-Mix Weight

Severity level for each dimension
ClinicalFunctionalServices utilizationAverage costCase-mix weight
1st and 2nd Episodes, 0 to 13 Therapy Visits+C47
C1F1S1$1,276.660.5549
C1F1S21,781.150.7742
C1F1S32,220.160.9650
C1F1S42,664.521.1582
C1F1S53,048.511.3251
C1F2S11,498.090.6512
C1F2S22,002.590.8705
C1F2S32,441.601.0613
C1F2S42,885.951.2544
C1F2S53,269.941.4213
C1F3S11,659.160.7212
C1F3S22,163.650.9405
C1F3S32,602.661.1313
C1F3S43,047.021.3244
C1F3S53,431.001.4914
C2F1S11,660.770.7219
C2F1S22,165.260.9412
C2F1S32,604.271.1320
C2F1S43,048.631.3251
C2F1S53,432.611.4921
C2F2S11,882.200.8181
C2F2S22,386.691.0374
C2F2S32,825.701.2282
C2F2S43,270.061.4214
C2F2S53,654.041.5883
C2F3S12,043.270.8881
C2F3S22,547.761.1074
C2F3S32,986.771.2983
C2F3S43,431.121.4914
C2F3S53,815.111.6583
C3F1S12,146.210.9329
C3F1S22,650.711.1522
C3F1S33,089.721.3430
C3F1S43,534.071.5362
C3F1S53,918.061.7031
C3F2S12,367.651.0291
C3F2S22,872.141.2484
C3F2S33,311.151.4393
C3F2S43,755.501.6324
C3F2S54,139.491.7993
C3F3S12,528.711.0992
C3F3S23,033.211.3184
C3F3S33,472.221.5093
C3F3S43,916.571.7024
C3F3S54,300.561.8693
1st and 2nd Episodes, 14 to 19 Therapy Visits
C1F1S13,467.921.5074
C1F1S23,897.271.6940
C1F1S34,173.181.8140
C1F2S13,738.711.6251
C1F2S24,168.061.8117
C1F2S34,443.971.9317
C1F3S13,897.461.6941
C1F3S24,326.811.8807
C1F3S34,602.722.0007
C2F1S14,007.461.7419
C2F1S24,436.821.9285
C2F1S34,712.732.0485
C2F2S14,278.261.8596
C2F2S24,707.612.0463
C2F2S34,983.522.1662
C2F3S14,437.001.9286
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C2F3S24,866.362.1153
C2F3S35,142.262.2352
C3F1S14,725.692.0541
C3F1S25,155.052.2407
C3F1S35,430.952.3607
C3F2S14,996.482.1718
C3F2S25,425.842.3584
C3F2S35,701.752.4784
C3F3S15,155.232.2408
C3F3S25,584.592.4274
C3F3S35,860.492.5474
3rd+ Episodes, 0 to 13 Therapy Visits
C1F1S11,489.510.6474
C1F1S22,141.270.9307
C1F1S32,582.641.1226
C1F1S43,010.781.3087
C1F1S53,397.441.4768
C1F2S11,908.020.8294
C1F2S22,559.781.1127
C1F2S33,001.151.3045
C1F2S43,429.291.4906
C1F2S53,815.951.6587
C1F3S12,315.181.0063
C1F3S22,966.941.2896
C1F3S33,408.311.4815
C1F3S43,836.461.6676
C1F3S54,223.121.8357
C2F1S11,630.030.7085
C2F1S22,281.790.9918
C2F1S32,723.161.1837
C2F1S43,151.311.3698
C2F1S53,537.971.5378
C2F2S12,048.540.8904
C2F2S22,700.301.1737
C2F2S33,141.671.3656
C2F2S43,569.811.5517
C2F2S53,956.471.7198
C2F3S12,455.711.0674
C2F3S23,107.471.3507
C2F3S33,548.841.5426
C2F3S43,976.981.7287
C2F3S54,363.641.8967
C3F1S12,108.840.9166
C3F1S22,760.601.1999
C3F1S33,201.971.3918
C3F1S43,630.111.5779
C3F1S54,016.771.7460
C3F2S12,527.341.0986
C3F2S23,179.101.3819
C3F2S33,620.471.5737
C3F2S44,048.621.7598
C3F2S54,435.281.9279
C3F3S12,934.511.2755
C3F3S23,586.271.5588
C3F3S34,027.641.7507
C3F3S44,455.781.9368
C3F3S54,842.442.1049
3rd+ Episodes, 14 to 19 Therapy Visits
C1F1S13,475.351.5106
C1F1S23,770.071.6387
C1F1S34,194.441.8232
C1F2S13,869.611.6820
C1F2S24,164.331.8101
C1F2S34,588.701.9946
C1F3S14,168.651.8120
C1F3S24,463.371.9401
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C1F3S34,887.742.1246
C2F1S14,154.101.8057
C2F1S24,448.821.9338
C2F1S34,873.192.1182
C2F2S14,548.371.9770
C2F2S24,843.082.1051
C2F2S35,267.452.2896
C2F3S14,847.402.1070
C2F3S25,142.122.2351
C2F3S35,566.492.4196
C3F1S14,880.572.1214
C3F1S25,175.292.2495
C3F1S35,599.662.4340
C3F2S15,274.842.2928
C3F2S25,569.552.4209
C3F2S35,993.922.6054
C3F3S15,573.872.4228
C3F3S25,868.592.5509
C3F3S36,292.962.7354
All Episodes, 20+ Therapy Visits
C1F1S15,309.732.3080
C1F1S15,799.872.5210
C1F1S16,362.322.7655
C2F2S15,893.472.5617
C2F2S16,383.612.7748
C2F2S16,946.063.0192
C3F3S16,705.952.9149
C3F3S17,196.093.1279
C3F3S17,758.553.3724

9. On pages 25430-25431, in Table 12a: NRS Case-Mix Adjustment Variables and Scores, the table is corrected to read as follows:

Table 12a.—NRS Case-Mix Adjustment Variables and Scores

DescriptionScore
Selected Skin Conditions:
1Primary diagnosis = Anal fissure, fistula and abscess19
2Primary diagnosis = Cellulitis and abscess13
3Primary diagnosis = Gangrene10
4Primary diagnosis = Malignant neoplasms of skin16
5Primary diagnosis = Non-pressure and non-stasis ulcers10
6Primary diagnosis = Other infections of skin and subcutaneous tissue19
7Primary diagnosis = Post-operative Complications 132
8Primary diagnosis = Post-operative Complications 223
9Primary diagnosis = Traumatic Wounds and Burns16
10Other diagnosis = Anal fissure, fistula and abscess8
11Other diagnosis = Cellulitis and abscess6
12Other diagnosis = Gangrene11
13Other diagnosis = Non-pressure and non-stasis ulcers8
14Other diagnosis = Other infections of skin and subcutaneous tissue7
15Other diagnosis = Post-operative Complications 115
16Other diagnosis = Post-operative Complications 215
17Other diagnosis = Traumatic Wounds and Burns7
18M0450 = 1 pressure ulcer, stage 1 or 212
19M0450 = 2 or 3 pressure ulcers, stage 1 or 220
20M0450 = 4+ pressure ulcers, stage 1 or 230
21M0450 = 1 pressure ulcer, stage 331
22M0450 = 2 pressure ulcers, stage 341
23M0450 = 3+ pressure ulcers, stage 357
24M0450 = 1 pressure ulcer, stage 452
25M0450 = 2 pressure ulcers, stage 480
26M0450 = 3+ pressure ulcers, stage 4104
27M0450e = 1(unobserved pressure ulcer(s))16
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28M0476 = 2 (status of most problematic stasis ulcer: early/partial granulation)18
29M0476 = 3 (status of most problematic stasis ulcer: not healing)28
30M0488 = 3 (status of most problematic surgical wound: not healing)18
31M0488 = 2 (status of most problematic surgical wound: early/partial granulation)5
Other Clinical Factors:
32M0550 = 1 (ostomy not related to inpt stay/no regimen change)21
33M0550 = 2 (ostomy related to inpt stay/regimen change)35
34Any “Selected Skin Conditions” AND M0550 = 1 (ostomy not related to inpt stay/no regimen change)22
35Any “Selected Skin Conditions” AND M0550 = 2 (ostomy related to inpt stay/regimen change)7
36M0250 (Therapy at home) = 1 (IV/Infusion)11
37M0470 = 2 or 3 (2 or 3 stasis ulcers)17
38M0470 = 4 (4 stasis ulcers)34
39M0520 = 2 (patient requires urinary catheter)17

10. On page 25444, after Table 23b entitled “Proposed National 60-Day Episode Amounts Updated by the Estimated Home Health Market Basket Update for CY 2008, Before Case-Mix Adjustment, Wage Index Adjustment Based on the Site of Service for the Beneficiary or Applicable Payment Adjustment for Episodes Beginning and Ending in CY 2008,” in the first column, in the first full paragraph, in lines 14 through 43, the sentence “Therefore, to calculate an episode's prospective payment amount * * *” and ending with the sentence “The resulting amount is the national case-mix and wage adjusted national standardized 60-day episode payment rate for that particular episode” is corrected to read as follows: “To calculate an episode's prospective payment amount, take the non-adjusted national standardized 60-day episode payment rate and multiply it by the appropriate case-mix weight from Table 5 of this rule. Next, multiply the case-mix adjusted national standardized 60-day episode payment by the labor portion (77.082 percent); multiply this result by the appropriate wage index factor listed in Addendum A or B to wage-adjust the 60-day episode payment. Next multiply the case-mix adjusted national standardized 60-day episode payment by 22.918 percent to compute the non-labor portion. Add this result to the wage-adjusted labor portion to get the case-mix and wage adjusted national 60-day episode payment without NRS. Calculate the NRS amount by multiplying the episode's NRS weight (taken from Table 11 of this proposed rule) by the NRS conversion factor. This adjusted NRS payment is added to the case-mix and wage-adjusted national standardized 60-day episode payment. The resulting amount is the case-mix and wage-adjusted national standardized 60-day episode payment rate including NRS for that particular episode.”

11. On page 25447, in the 12th line, the figure “0.22198” is corrected to read “0.22918”.

12. On page 25459, in Addendum A,

a. In the first column, in line 29, the Wage Index for “Massachusetts” the figure “1.0661” is corrected to read “1.1662”.

b. In the second column, in line 15, the superscript “1” which appears after “New Jersey” is deleted.

c. In the third column, in lines 17 through 22, the footnote “1” at the end of Addendum A, the sentence “All counties within the State are classified as rural. No short-term acute care hospitals are located in the area(s)” is corrected to read as follows: “There are no short-term, acute care hospitals located in rural area(s) in Massachusetts from which to calculate a wage index for CY 2008.”

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)

Start Signature

Dated: June 12, 2007.

Ann C. Agnew,

Executive Secretary to the Department.

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[FR Doc. 07-2987 Filed 6-13-07; 11:55 am]

BILLING CODE 4120-01-P