[Federal Register: August 1, 2001 (Volume 66, Number 148)] [Rules and Regulations] [Page 40077-40102] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr01au01-23] [[pp. 40077-40102]] Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Rates and Costs of Graduate Medical Education: Fiscal Year 2002 Rates; Provisions of the Balanced Budget Refinement Act of 1999; and Provisions of the Medicare, Medicaid, and SC[[Page 40074]] [[Continued from page 40076]] [[Page 40074]] 365..................................... 1737 7.2239 1 3 5 9 16 366..................................... 4468 6.7258 1 3 5 8 14 367..................................... 584 3.1284 1 1 2 4 6 368..................................... 3136 6.4716 2 3 5 8 12 369..................................... 3180 3.2500 1 1 2 4 7 370..................................... 1151 5.9079 3 3 4 5 10 371..................................... 1368 3.6447 2 3 3 4 5 372..................................... 964 3.2811 1 2 2 3 5 373..................................... 3920 2.2487 1 2 2 3 3 374..................................... 130 3.0846 1 2 2 3 4 375..................................... 11 2.2727 1 2 2 2 4 376..................................... 249 3.0843 1 2 2 4 6 377..................................... 51 5.0392 1 1 4 6 12 378..................................... 158 2.4177 1 1 2 3 4 379..................................... 344 3.4506 1 1 2 4 6 380..................................... 60 2.0833 1 1 1 2 5 381..................................... 154 2.5065 1 1 1 3 5 382..................................... 45 1.2889 1 1 1 1 2 383..................................... 1746 3.6174 1 1 2 4 8 384..................................... 121 2.1488 1 1 1 2 4 385..................................... 1 1.0000 1 1 1 1 1 389..................................... 16 13.5000 1 3 6 11 24 390..................................... 14 4.0000 1 2 3 6 7 391..................................... 1 4.0000 4 4 4 4 4 392..................................... 2349 9.6841 3 4 7 12 20 394..................................... 1891 7.1364 1 2 4 8 16 395..................................... 87679 4.4004 1 2 3 6 9 396..................................... 15 4.6667 1 2 4 6 7 397..................................... 17705 5.1893 1 2 4 7 10 398..................................... 17713 5.9510 2 3 5 7 11 399..................................... 1727 3.5634 1 2 3 5 7 400..................................... 6492 9.1288 1 3 6 12 20 401..................................... 5625 11.2775 2 5 9 15 23 402..................................... 1500 4.0933 1 1 3 6 9 403..................................... 32010 8.0846 2 3 6 10 17 404..................................... 4672 4.2609 1 2 3 6 9 406..................................... 2526 9.9224 3 4 7 12 21 407..................................... 722 4.4252 1 2 4 5 8 408..................................... 2193 8.0228 1 2 5 10 18 409..................................... 2831 5.9325 2 3 4 6 12 410..................................... 33654 3.9062 1 2 4 5 6 411..................................... 13 2.3077 1 1 2 2 5 412..................................... 30 2.4000 1 1 2 3 4 413..................................... 6478 7.0869 2 3 5 9 14 414..................................... 780 4.2885 1 2 3 5 9 415..................................... 39078 14.3458 4 6 11 18 28 416..................................... 184735 7.3935 2 4 6 9 14 417..................................... 18 5.0000 1 2 4 7 9 418..................................... 23028 6.1229 2 3 5 7 12 419..................................... 15460 4.7254 2 2 4 6 9 420..................................... 3116 3.4881 1 2 3 4 6 421..................................... 11535 3.7877 1 2 3 5 7 422..................................... 83 3.0482 1 2 3 4 6 423..................................... 7539 8.1108 2 3 6 10 16 424..................................... 1308 13.6338 2 5 9 16 26 425..................................... 15852 3.9953 1 2 3 5 8 426..................................... 4552 4.4512 1 2 3 5 9 427..................................... 1669 4.6207 1 2 3 6 9 428..................................... 854 6.9859 1 2 4 8 14 429..................................... 26786 6.3438 2 3 5 7 12 430..................................... 59892 8.0207 2 3 6 10 16 431..................................... 319 6.4326 1 3 5 7 12 432..................................... 475 4.7684 1 2 3 5 9 433..................................... 5522 3.0996 1 1 2 4 6 434..................................... 23062 5.0233 1 2 4 6 9 435..................................... 15012 4.1096 1 2 3 5 7 436..................................... 3158 12.8322 4 7 11 18 27 437..................................... 8588 8.6778 3 5 8 11 15 439..................................... 1356 8.3857 1 3 5 10 18 440..................................... 5191 9.0326 2 3 6 11 20 [[Page 40075]] 441..................................... 604 3.2235 1 1 2 4 7 442..................................... 15588 8.4766 1 3 6 10 18 443..................................... 3738 3.4315 1 1 3 4 7 444..................................... 5303 4.1495 1 2 3 5 8 445..................................... 2450 2.8857 1 1 2 4 5 447..................................... 5497 2.4708 1 1 2 3 5 449..................................... 28365 3.7491 1 1 3 5 8 450..................................... 6935 1.9981 1 1 1 2 4 451..................................... 3 1.3333 1 1 1 2 2 452..................................... 22930 4.8560 1 2 3 6 10 453..................................... 5095 2.7978 1 1 2 3 5 454..................................... 4001 4.5431 1 2 3 5 9 455..................................... 939 2.5751 1 1 2 3 5 461..................................... 3677 4.3723 1 1 2 5 11 462..................................... 13083 11.2728 4 6 10 14 21 463..................................... 22068 4.1282 1 2 3 5 8 464..................................... 6542 3.0011 1 1 2 4 6 465..................................... 248 3.0202 1 1 2 4 6 466..................................... 1741 3.7030 1 1 2 4 8 467..................................... 1137 3.0633 1 1 2 3 6 468..................................... 59766 12.9438 3 6 10 17 26 471..................................... 11720 5.5506 3 4 4 6 9 473..................................... 7663 12.5910 1 3 7 18 32 475..................................... 107894 11.2229 2 5 9 15 22 476..................................... 4142 10.8841 2 5 9 14 21 477..................................... 25336 8.1162 1 3 6 11 17 478..................................... 108852 7.3022 1 3 5 9 15 479..................................... 24100 3.4573 1 1 3 4 7 480..................................... 562 20.9609 7 9 14 25 44 481..................................... 383 24.1253 10 18 22 27 39 482..................................... 5733 12.9843 4 7 10 15 25 483..................................... 42784 39.4479 14 22 33 49 71 484..................................... 331 13.0091 2 6 10 17 26 485..................................... 2959 9.7080 4 5 7 11 18 486..................................... 2017 12.4408 1 5 10 16 25 487..................................... 3506 7.3945 1 3 6 10 15 488..................................... 784 16.9031 3 7 12 22 36 489..................................... 14140 8.4372 2 3 6 10 17 490..................................... 5449 5.3577 1 2 4 6 11 491..................................... 12291 3.4475 2 2 3 4 6 492..................................... 2698 15.6675 3 5 8 25 34 493..................................... 55279 5.7576 1 3 5 7 11 494..................................... 30109 2.4447 1 1 2 3 5 495..................................... 159 15.0503 7 9 12 17 26 496..................................... 1475 9.7349 4 5 7 12 19 497..................................... 22725 6.1720 2 3 5 7 12 498..................................... 21513 3.3043 1 2 3 4 6 499..................................... 31077 4.7330 1 2 3 6 9 500..................................... 44660 2.6198 1 1 2 3 5 501..................................... 2200 10.9600 4 6 8 13 21 502..................................... 585 6.5692 3 4 5 8 11 503..................................... 5631 4.0012 1 2 3 5 7 504..................................... 118 30.5169 9 15 24 41 55 505..................................... 145 3.3517 1 1 1 3 7 506..................................... 931 17.4071 4 8 14 22 36 507..................................... 293 8.3379 2 4 7 11 18 508..................................... 671 7.4918 2 3 5 9 15 509..................................... 177 4.5367 1 2 4 6 9 510..................................... 1650 7.2358 2 3 5 9 15 511..................................... 608 4.8158 1 2 3 6 11 ---------------- 11079177 -------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 40076]] Table 7B.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay [FY2000 MEDPAR update 03/01 Grouper V19.0] -------------------------------------------------------------------------------------------------------------------------------------------------------- Number Arithmetic 10th 25th 50th 75th 90th DRG discharges mean LOS percentile percentile percentile percentile percentile -------------------------------------------------------------------------------------------------------------------------------------------------------- 1....................................... 34040 9.0038 2 3 6 12 19 2....................................... 6862 9.9787 3 5 8 12 20 3....................................... 2 43.5000 35 35 52 52 52 4....................................... 6120 7.1526 1 2 5 9 15 5....................................... 93853 3.1665 1 1 2 3 7 6....................................... 365 2.9671 1 1 2 4 6 7....................................... 13283 9.8362 2 4 7 12 20 8....................................... 3821 2.9089 1 1 2 4 7 9....................................... 1631 6.3194 1 3 5 8 13 10...................................... 17754 6.5545 2 3 5 8 13 11...................................... 3157 4.0744 1 2 3 5 8 12...................................... 47063 5.9088 2 3 4 7 11 13...................................... 6504 5.1948 2 3 4 6 9 14...................................... 321622 5.8761 2 3 5 7 11 15...................................... 146291 3.5528 1 2 3 4 7 16...................................... 11235 6.0446 2 3 5 7 12 17...................................... 3532 3.3061 1 2 3 4 6 18...................................... 26608 5.4190 2 3 4 7 10 19...................................... 8346 3.6416 1 2 3 5 7 20...................................... 5680 10.1768 3 5 8 13 20 21...................................... 1324 6.5249 2 3 5 8 13 22...................................... 2560 4.8176 1 2 4 6 9 23...................................... 9553 4.1807 1 2 3 5 8 24...................................... 53313 4.9825 1 2 4 6 10 25...................................... 25528 3.2186 1 2 3 4 6 26...................................... 33 2.9091 1 1 2 4 6 27...................................... 3519 5.0673 1 1 3 6 11 28...................................... 11477 6.2222 1 3 5 8 13 29...................................... 4545 3.5982 1 2 3 5 7 30...................................... 1 1.0000 1 1 1 1 1 31...................................... 3576 4.4855 1 2 3 5 8 32...................................... 1770 2.5644 1 1 2 3 5 33...................................... 1 1.0000 1 1 1 1 1 34...................................... 20751 5.0759 1 2 4 6 10 35...................................... 5893 3.3743 1 2 3 4 6 36...................................... 3217 1.4719 1 1 1 1 2 37...................................... 1465 4.0348 1 1 2 5 9 38...................................... 102 2.6569 1 1 2 3 5 39...................................... 918 1.9379 1 1 1 2 4 40...................................... 1561 3.4209 1 1 2 4 7 42...................................... 2235 2.2859 1 1 1 3 5 43...................................... 85 3.1882 1 2 3 4 6 44...................................... 1244 4.9518 2 3 4 6 9 45...................................... 2464 3.1717 1 2 3 4 6 46...................................... 3102 4.6518 1 2 4 6 9 47...................................... 1284 3.2749 1 1 3 4 6 49...................................... 2266 4.8010 1 2 3 6 9 50...................................... 2507 1.9418 1 1 1 2 3 51...................................... 205 2.6927 1 1 1 2 6 52...................................... 224 1.9196 1 1 1 2 3 53...................................... 2512 3.5760 1 1 2 4 8 54...................................... 2 1.5000 1 1 2 2 2 55...................................... 1521 2.7331 1 1 1 3 6 56...................................... 517 2.7389 1 1 2 3 5 57...................................... 712 4.0478 1 1 2 5 9 59...................................... 107 2.7850 1 1 2 3 5 60...................................... 2 3.5000 2 2 5 5 5 61...................................... 234 5.1624 1 1 2 6 13 62...................................... 3 1.3333 1 1 1 2 2 63...................................... 3039 4.4399 1 2 3 5 9 64...................................... 3070 6.1642 1 2 4 8 13 65...................................... 34702 2.8444 1 1 2 4 5 66...................................... 7035 3.1599 1 1 2 4 6 67...................................... 501 3.5768 1 2 3 4 7 68...................................... 16804 4.1202 1 2 3 5 7 69...................................... 5465 3.2767 1 2 3 4 6 70...................................... 24 2.9167 1 2 2 4 5 71...................................... 82 3.8049 1 2 3 4 7 72...................................... 893 3.5566 1 2 3 4 6 73...................................... 6690 4.3988 1 2 3 6 9 [[Page 40077]] 75...................................... 39476 9.9112 3 5 7 12 19 76...................................... 40377 11.4074 3 5 9 14 22 77...................................... 2406 5.0000 1 2 4 7 10 78...................................... 32319 6.7837 3 4 6 8 11 79...................................... 170615 8.4963 3 4 7 11 16 80...................................... 8981 5.6562 2 3 5 7 10 81...................................... 4 18.2500 3 3 4 8 58 82...................................... 62447 6.9403 2 3 5 9 14 83...................................... 6598 5.5518 2 3 4 7 10 84...................................... 1539 3.3197 1 2 3 4 6 85...................................... 20738 6.3135 2 3 5 8 12 86...................................... 2115 3.6648 1 2 3 5 7 87...................................... 60486 6.2986 1 3 5 8 12 88...................................... 395676 5.1294 2 3 4 6 9 89...................................... 529122 5.9478 2 3 5 7 11 90...................................... 53985 4.1475 2 3 4 5 7 91...................................... 57 4.4561 2 2 3 5 9 92...................................... 13873 6.3521 2 3 5 8 12 93...................................... 1692 4.0969 1 2 3 5 7 94...................................... 12158 6.3088 2 3 5 8 12 95...................................... 1621 3.7224 1 2 3 5 7 96...................................... 62414 4.6281 2 3 4 6 8 97...................................... 31618 3.6509 1 2 3 5 7 98...................................... 17 4.3529 1 2 3 4 6 99...................................... 19205 3.2061 1 1 2 4 6 100..................................... 7656 2.1813 1 1 2 3 4 101..................................... 20236 4.3987 1 2 3 5 9 102..................................... 5196 2.6522 1 1 2 3 5 103..................................... 494 47.2510 9 13 25 61 102 104..................................... 19992 14.2362 6 8 12 17 25 105..................................... 26203 9.7712 4 6 8 11 17 106..................................... 3425 11.4923 5 7 10 14 20 107..................................... 88610 10.3724 5 7 9 12 17 108..................................... 6099 10.2140 3 5 8 13 19 109..................................... 60766 7.6912 4 5 6 9 12 110..................................... 53054 9.2130 2 5 7 11 18 111..................................... 8563 4.7507 1 2 5 6 8 113..................................... 42570 12.2362 3 6 9 15 24 114..................................... 8788 8.4208 2 4 7 11 16 115..................................... 14447 8.1481 1 4 7 11 16 116..................................... 101326 4.5123 1 2 3 6 9 117..................................... 3750 4.1997 1 1 2 5 9 118..................................... 7731 2.6831 1 1 1 3 6 119..................................... 1315 4.8783 1 1 3 6 12 120..................................... 37900 8.5509 1 2 6 11 19 121..................................... 163108 6.3828 2 3 5 8 12 122..................................... 79700 3.6981 1 2 3 5 7 123..................................... 40952 4.5870 1 1 3 6 11 124..................................... 133892 4.3434 1 2 3 5 8 125..................................... 80872 2.7656 1 1 2 4 5 126..................................... 5210 11.7196 3 6 9 15 22 127..................................... 683001 5.2764 2 3 4 7 10 128..................................... 9485 5.6128 2 4 5 7 9 129..................................... 4174 2.7513 1 1 1 3 6 130..................................... 87705 5.6725 2 3 5 7 10 131..................................... 27378 4.2134 1 2 4 6 7 132..................................... 148681 3.0010 1 1 2 4 6 133..................................... 8355 2.3246 1 1 2 3 4 134..................................... 36411 3.2406 1 2 3 4 6 135..................................... 7338 4.5492 1 2 3 6 9 136..................................... 1233 2.7178 1 1 2 3 5 138..................................... 195523 3.9935 1 2 3 5 8 139..................................... 82943 2.5030 1 1 2 3 5 140..................................... 70338 2.6538 1 1 2 3 5 141..................................... 91110 3.6692 1 2 3 5 7 142..................................... 45981 2.6476 1 1 2 3 5 143..................................... 205686 2.1259 1 1 2 3 4 144..................................... 82529 5.3248 1 2 4 7 11 145..................................... 7242 2.7331 1 1 2 3 5 146..................................... 10755 10.3134 5 7 9 12 17 [[Page 40078]] 147..................................... 2637 6.4137 3 5 6 8 9 148..................................... 130066 12.2031 5 7 10 15 22 149..................................... 18560 6.5100 4 5 6 8 9 150..................................... 19923 11.2795 4 7 10 14 20 151..................................... 4860 5.8123 2 3 5 8 10 152..................................... 4399 8.1444 3 5 7 9 14 153..................................... 2100 5.3838 3 4 5 7 8 154..................................... 28872 13.1709 4 7 10 16 25 155..................................... 6655 4.2026 1 2 3 6 8 156..................................... 4 7.5000 1 1 5 6 18 157..................................... 7963 5.3929 1 2 4 7 11 158..................................... 4671 2.5359 1 1 2 3 5 159..................................... 16456 4.9981 1 2 4 6 10 160..................................... 11727 2.6592 1 1 2 3 5 161..................................... 11208 4.2057 1 1 3 5 9 162..................................... 7217 1.9216 1 1 1 2 4 163..................................... 7 3.5714 1 1 2 3 4 164..................................... 4857 8.4293 4 5 7 10 15 165..................................... 2086 4.7895 2 3 5 6 8 166..................................... 3559 5.0441 2 2 4 6 10 167..................................... 3316 2.6001 1 2 2 3 5 168..................................... 1361 4.7649 1 2 3 6 10 169..................................... 843 2.3238 1 1 2 3 5 170..................................... 12291 10.9867 2 4 8 14 22 171..................................... 1408 4.5014 1 2 4 6 9 172..................................... 30682 6.9445 2 3 5 9 14 173..................................... 2707 3.6679 1 1 3 5 7 174..................................... 242053 4.7969 2 3 4 6 9 175..................................... 32431 2.9309 1 2 3 4 5 176..................................... 15194 5.2285 2 3 4 6 10 177..................................... 9272 4.5310 2 2 4 6 8 178..................................... 3619 3.0683 1 2 3 4 6 179..................................... 12384 5.9738 2 3 5 7 11 180..................................... 86181 5.3581 2 3 4 7 10 181..................................... 26423 3.4153 1 2 3 4 6 182..................................... 245515 4.3381 1 2 3 5 8 183..................................... 84480 2.9129 1 1 2 4 5 184..................................... 80 2.9500 1 2 2 4 6 185..................................... 4826 4.5089 1 2 3 6 9 186..................................... 3 9.3333 1 1 9 18 18 187..................................... 683 3.9253 1 1 3 5 8 188..................................... 76140 5.5645 1 2 4 7 11 189..................................... 12060 3.1404 1 1 2 4 6 190..................................... 51 6.9608 2 3 4 5 8 191..................................... 8941 13.8186 4 6 10 17 27 192..................................... 1122 6.5294 2 4 6 8 11 193..................................... 5303 12.5218 5 7 10 16 22 194..................................... 721 6.7906 2 4 6 8 12 195..................................... 4350 10.1616 4 6 9 12 17 196..................................... 1166 5.7196 2 4 5 7 10 197..................................... 18895 8.9383 3 5 7 11 16 198..................................... 5786 4.5380 2 3 4 6 8 199..................................... 1725 9.6614 2 4 7 13 21 200..................................... 1081 10.3478 1 3 7 13 23 201..................................... 1431 13.7393 3 6 11 17 27 202..................................... 26168 6.4060 2 3 5 8 13 203..................................... 29251 6.6384 2 3 5 9 13 204..................................... 57757 5.7995 2 3 4 7 11 205..................................... 23128 6.1790 2 3 5 8 12 206..................................... 1970 3.8959 1 2 3 5 7 207..................................... 31072 5.0836 1 2 4 6 10 208..................................... 10149 2.8924 1 1 2 4 6 209..................................... 345519 5.0794 3 3 4 6 8 210..................................... 121933 6.8207 3 4 6 8 11 211..................................... 31780 4.9358 3 4 4 6 7 212..................................... 8 10.5000 1 1 4 9 29 213..................................... 9241 9.0019 2 4 7 11 18 216..................................... 6008 9.6949 2 4 8 12 20 217..................................... 16558 13.2636 3 5 9 16 28 218..................................... 21621 5.4328 2 3 4 7 10 [[Page 40079]] 219..................................... 19714 3.2188 1 2 3 4 6 220..................................... 6 4.0000 1 1 3 7 7 223..................................... 13397 2.8551 1 1 2 3 6 224..................................... 11274 1.9346 1 1 2 2 3 225..................................... 5805 4.8558 1 2 3 6 11 226..................................... 5230 6.5887 1 2 4 8 14 227..................................... 4702 2.7052 1 1 2 3 5 228..................................... 2373 3.7981 1 1 2 5 8 229..................................... 1118 2.4785 1 1 2 3 5 230..................................... 2395 5.2551 1 2 3 6 11 231..................................... 11467 4.9383 1 2 3 6 11 232..................................... 811 2.8792 1 1 1 3 7 233..................................... 5159 7.5251 1 3 6 10 15 234..................................... 3186 3.4203 1 1 3 4 7 235..................................... 5095 5.1460 1 2 4 6 9 236..................................... 38644 4.8192 1 3 4 6 9 237..................................... 1698 3.4953 1 2 3 4 6 238..................................... 8028 8.5896 3 4 6 10 16 239..................................... 49410 6.2190 2 3 5 8 12 240..................................... 11462 6.6902 2 3 5 8 13 241..................................... 3138 3.8368 1 2 3 5 7 242..................................... 2455 6.6550 2 3 5 8 13 243..................................... 88325 4.6695 1 2 4 6 9 244..................................... 12281 4.8027 1 2 4 6 9 245..................................... 5158 3.4420 1 2 3 4 6 246..................................... 1402 3.8759 1 2 3 5 7 247..................................... 16979 3.4022 1 1 3 4 7 248..................................... 10612 4.8149 1 2 4 6 9 249..................................... 11431 3.6726 1 1 2 4 8 250..................................... 3495 4.1021 1 2 3 5 7 251..................................... 2432 2.8647 1 1 2 4 5 253..................................... 19997 4.7768 1 3 4 6 9 254..................................... 10514 3.1844 1 2 3 4 6 255..................................... 1 3.0000 3 3 3 3 3 256..................................... 6097 5.0576 1 2 4 6 10 257..................................... 16468 2.7380 1 1 2 3 5 258..................................... 16096 1.9335 1 1 2 2 3 259..................................... 3805 2.6915 1 1 1 2 6 260..................................... 4920 1.4191 1 1 1 2 2 261..................................... 1875 2.2704 1 1 1 3 5 262..................................... 622 3.9807 1 1 3 5 8 263..................................... 23616 11.6630 3 5 8 14 23 264..................................... 4081 7.0034 2 3 5 8 14 265..................................... 3785 6.7974 1 2 4 8 14 266..................................... 2669 3.2345 1 1 2 4 7 267..................................... 233 4.2060 1 1 3 6 9 268..................................... 910 3.5824 1 1 2 4 7 269..................................... 8868 8.2049 2 3 6 10 17 270..................................... 2662 3.4530 1 1 2 4 7 271..................................... 20588 7.1370 2 4 6 9 13 272..................................... 5506 6.1593 2 3 5 8 12 273..................................... 1290 4.0233 1 2 3 5 8 274..................................... 2357 6.5965 1 3 5 8 13 275..................................... 249 4.3373 1 1 3 5 9 276..................................... 1189 4.7258 1 2 4 6 8 277..................................... 88891 5.7267 2 3 5 7 10 278..................................... 30673 4.3084 2 3 4 5 8 279..................................... 3 2.3333 1 1 2 4 4 280..................................... 15826 4.1974 1 2 3 5 8 281..................................... 7203 3.0314 1 1 3 4 6 282..................................... 3 1.6667 1 1 2 2 2 283..................................... 5701 4.5869 1 2 4 6 9 284..................................... 1863 3.0934 1 1 2 4 6 285..................................... 6259 10.2903 3 5 8 13 20 286..................................... 2081 6.4248 2 3 5 7 13 287..................................... 5745 10.5220 3 5 7 12 21 288..................................... 2705 5.7360 2 3 4 6 9 289..................................... 4801 3.0165 1 1 2 3 7 290..................................... 8818 2.3115 1 1 2 2 4 291..................................... 66 1.8333 1 1 1 2 3 [[Page 40080]] 292..................................... 4994 10.2367 2 4 8 13 20 293..................................... 385 5.3714 1 2 4 7 11 294..................................... 88615 4.6095 1 2 4 6 9 295..................................... 3318 3.7372 1 2 3 5 7 296..................................... 240050 5.1602 2 2 4 6 10 297..................................... 44040 3.4064 1 2 3 4 6 298..................................... 95 2.9158 1 1 2 4 5 299..................................... 1192 5.3079 1 2 4 7 11 300..................................... 16118 6.1471 2 3 5 8 12 301..................................... 3221 3.6107 1 2 3 4 7 302..................................... 7924 8.8892 4 5 7 10 15 303..................................... 19568 8.4192 4 5 7 10 15 304..................................... 11900 8.7432 2 4 6 11 18 305..................................... 3011 3.6430 1 2 3 5 7 306..................................... 7368 5.6221 1 2 3 8 13 307..................................... 2096 2.2457 1 1 2 3 4 308..................................... 7520 6.2090 1 2 4 8 14 309..................................... 4120 2.2998 1 1 2 3 4 310..................................... 24033 4.4040 1 1 3 6 10 311..................................... 8027 1.8343 1 1 1 2 3 312..................................... 1499 4.4957 1 1 3 6 10 313..................................... 594 2.3300 1 1 1 3 5 314..................................... 1 3.0000 3 3 3 3 3 315..................................... 30492 7.1080 1 1 4 9 16 316..................................... 105482 6.6227 2 3 5 8 13 317..................................... 1536 2.8561 1 1 2 3 6 318..................................... 5627 6.0105 1 3 5 8 12 319..................................... 428 2.7477 1 1 2 3 6 320..................................... 188146 5.3180 2 3 4 6 10 321..................................... 30418 3.7849 1 2 3 5 7 322..................................... 61 4.1475 2 2 3 5 8 323..................................... 17410 3.2221 1 1 2 4 7 324..................................... 7562 1.8803 1 1 1 2 3 325..................................... 8239 3.8229 1 2 3 5 7 326..................................... 2705 2.6699 1 1 2 3 5 327..................................... 11 3.0909 1 1 3 4 5 328..................................... 668 3.6722 1 1 3 5 8 329..................................... 76 2.0000 1 1 1 2 4 331..................................... 46575 5.5475 1 3 4 7 11 332..................................... 4939 3.2909 1 1 2 4 7 333..................................... 290 4.9828 1 2 3 6 10 334..................................... 10491 4.8593 2 3 4 6 8 335..................................... 11916 3.3087 2 2 3 4 5 336..................................... 37713 3.4950 1 2 2 4 7 337..................................... 30390 2.1186 1 1 2 3 3 338..................................... 1232 5.1080 1 2 3 7 11 339..................................... 1628 4.6161 1 1 3 6 11 340..................................... 1 1.0000 1 1 1 1 1 341..................................... 3766 3.0316 1 1 2 3 6 342..................................... 675 3.2207 1 2 2 4 6 344..................................... 3519 2.3743 1 1 1 2 5 345..................................... 1280 3.7914 1 1 2 4 8 346..................................... 4489 5.9082 1 3 4 7 12 347..................................... 366 2.9372 1 1 2 4 6 348..................................... 3077 4.1677 1 2 3 5 8 349..................................... 626 2.5335 1 1 2 3 5 350..................................... 6325 4.4024 1 2 4 5 8 352..................................... 766 3.9621 1 2 3 5 8 353..................................... 2557 6.4490 2 3 5 7 12 354..................................... 7609 5.8406 3 3 4 7 11 355..................................... 5530 3.2790 2 3 3 4 5 356..................................... 25303 2.2920 1 1 2 3 4 357..................................... 5580 8.4925 3 4 7 10 16 358..................................... 20492 4.3132 2 3 3 5 7 359..................................... 30149 2.7284 2 2 3 3 4 360..................................... 16035 2.8549 1 2 2 3 5 361..................................... 386 2.9948 1 1 2 3 5 363..................................... 2875 3.4650 1 2 2 3 7 364..................................... 1666 3.8427 1 1 3 5 8 365..................................... 1737 7.2239 1 3 5 9 16 [[Page 40081]] 366..................................... 4468 6.7258 1 3 5 8 14 367..................................... 584 3.1284 1 1 2 4 6 368..................................... 3136 6.4716 2 3 5 8 12 369..................................... 3178 3.2498 1 1 2 4 7 370..................................... 1151 5.9079 3 3 4 5 10 371..................................... 1368 3.6447 2 3 3 4 5 372..................................... 964 3.2811 1 2 2 3 5 373..................................... 3920 2.2487 1 2 2 3 3 374..................................... 130 3.0846 1 2 2 3 4 375..................................... 11 2.2727 1 2 2 2 4 376..................................... 249 3.0843 1 2 2 4 6 377..................................... 51 5.0392 1 1 4 6 12 378..................................... 158 2.4177 1 1 2 3 4 379..................................... 344 3.4506 1 1 2 4 6 380..................................... 60 2.0833 1 1 1 2 5 381..................................... 154 2.5065 1 1 1 3 5 382..................................... 45 1.2889 1 1 1 1 2 383..................................... 1746 3.6174 1 1 2 4 8 384..................................... 121 2.1488 1 1 1 2 4 385..................................... 1 1.0000 1 1 1 1 1 389..................................... 16 13.5000 1 3 6 11 24 390..................................... 14 4.0000 1 2 3 6 7 391..................................... 1 4.0000 4 4 4 4 4 392..................................... 2349 9.6841 3 4 7 12 20 394..................................... 1891 7.1364 1 2 4 8 16 395..................................... 87678 4.4004 1 2 3 6 9 396..................................... 15 4.6667 1 2 4 6 7 397..................................... 17705 5.1893 1 2 4 7 10 398..................................... 17713 5.9510 2 3 5 7 11 399..................................... 1727 3.5634 1 2 3 5 7 400..................................... 6490 9.1307 1 3 6 12 20 401..................................... 5622 11.2782 2 5 9 15 23 402..................................... 1500 4.0933 1 1 3 6 9 403..................................... 31997 8.0849 2 3 6 10 17 404..................................... 4670 4.2621 1 2 3 6 9 406..................................... 2527 9.9201 3 4 7 12 21 407..................................... 723 4.4219 1 2 4 5 8 408..................................... 2196 8.0255 1 2 5 10 18 409..................................... 2831 5.9325 2 3 4 6 12 410..................................... 33654 3.9062 1 2 4 5 6 411..................................... 13 2.3077 1 1 2 2 5 412..................................... 30 2.4000 1 1 2 3 4 413..................................... 6491 7.0875 2 3 5 9 14 414..................................... 782 4.2813 1 2 3 5 9 415..................................... 39080 14.3464 4 6 11 18 28 416..................................... 184735 7.3935 2 4 6 9 14 417..................................... 18 5.0000 1 2 4 7 9 418..................................... 23026 6.1212 2 3 5 7 11 419..................................... 15460 4.7254 2 2 4 6 9 420..................................... 3116 3.4881 1 2 3 4 6 421..................................... 11535 3.7877 1 2 3 5 7 422..................................... 83 3.0482 1 2 3 4 6 423..................................... 7539 8.1108 2 3 6 10 16 424..................................... 1308 13.6338 2 5 9 16 26 425..................................... 15852 3.9953 1 2 3 5 8 426..................................... 4552 4.4512 1 2 3 5 9 427..................................... 1669 4.6207 1 2 3 6 9 428..................................... 854 6.9859 1 2 4 8 14 429..................................... 26786 6.3438 2 3 5 7 12 430..................................... 59892 8.0207 2 3 6 10 16 431..................................... 319 6.4326 1 3 5 7 12 432..................................... 475 4.7684 1 2 3 5 9 433..................................... 5522 3.0996 1 1 2 4 6 439..................................... 1356 8.3857 1 3 5 10 18 440..................................... 5191 9.0326 2 3 6 11 20 441..................................... 604 3.2235 1 1 2 4 7 442..................................... 15588 8.4766 1 3 6 10 18 443..................................... 3743 3.4320 1 1 3 4 7 444..................................... 5303 4.1495 1 2 3 5 8 445..................................... 2450 2.8857 1 1 2 4 5 [[Page 40082]] 447..................................... 5497 2.4708 1 1 2 3 5 449..................................... 28365 3.7491 1 1 3 5 8 450..................................... 6934 1.9980 1 1 1 2 4 451..................................... 3 1.3333 1 1 1 2 2 452..................................... 22930 4.8560 1 2 3 6 10 453..................................... 5091 2.7969 1 1 2 3 5 454..................................... 4001 4.5431 1 2 3 5 9 455..................................... 939 2.5751 1 1 2 3 5 461..................................... 3676 4.3708 1 1 2 5 11 462..................................... 13083 11.2728 4 6 10 14 21 463..................................... 22068 4.1282 1 2 3 5 8 464..................................... 6542 3.0011 1 1 2 4 6 465..................................... 248 3.0202 1 1 2 4 6 466..................................... 1741 3.7030 1 1 2 4 8 467..................................... 1137 3.0633 1 1 2 3 6 468..................................... 55027 12.8995 3 6 10 16 26 471..................................... 11720 5.5506 3 4 4 6 9 473..................................... 7663 12.5910 1 3 7 18 32 475..................................... 107894 11.2229 2 5 9 15 22 476..................................... 4151 10.8829 2 5 9 14 21 477..................................... 25363 8.1252 1 3 6 11 17 478..................................... 108182 7.2900 1 3 5 9 15 479..................................... 24051 3.4569 1 1 3 4 7 480..................................... 562 20.9609 7 9 14 25 44 481..................................... 383 24.1253 10 18 22 27 39 482..................................... 5737 12.9796 4 7 10 15 25 483..................................... 42789 39.4482 14 22 33 49 71 484..................................... 331 13.0091 2 6 10 17 26 485..................................... 2959 9.7080 4 5 7 11 18 486..................................... 2017 12.4408 1 5 10 16 25 487..................................... 3506 7.3945 1 3 6 10 15 488..................................... 784 16.9031 3 7 12 22 36 489..................................... 14140 8.4372 2 3 6 10 17 490..................................... 5454 5.3577 1 2 4 6 11 491..................................... 12291 3.4475 2 2 3 4 6 492..................................... 2698 15.6675 3 5 8 25 34 493..................................... 55279 5.7576 1 3 5 7 11 494..................................... 30109 2.4447 1 1 2 3 5 495..................................... 159 15.0503 7 9 12 17 26 496..................................... 1504 9.7088 4 5 7 12 19 497..................................... 17585 6.5739 3 4 5 7 11 498..................................... 12931 4.1718 2 3 4 5 6 499..................................... 30519 4.7011 1 2 3 6 9 500..................................... 44330 2.6104 1 1 2 3 5 501..................................... 2200 10.9600 4 6 8 13 21 502..................................... 585 6.5692 3 4 5 8 11 503..................................... 5630 4.0014 1 2 3 5 7 504..................................... 118 30.5169 9 15 24 41 55 505..................................... 145 3.3517 1 1 1 3 7 506..................................... 931 17.4071 4 8 14 22 36 507..................................... 293 8.3379 2 4 7 11 18 508..................................... 671 7.4918 2 3 5 9 15 509..................................... 177 4.5367 1 2 4 6 9 510..................................... 1650 7.2358 2 3 5 9 15 511..................................... 608 4.8158 1 2 3 6 11 512..................................... 340 13.8971 7 8 11 16 25 513..................................... 115 10.6000 6 7 8 11 19 514..................................... 17025 7.8702 2 3 6 10 16 515..................................... 3788 5.9060 1 1 4 8 13 516..................................... 68886 4.7702 2 3 4 6 9 517..................................... 171423 2.6737 1 1 2 3 6 518..................................... 48733 3.5023 1 1 2 4 8 519..................................... 6359 5.1030 1 2 3 6 12 520..................................... 9489 2.1653 1 1 2 3 4 521..................................... 28014 5.9437 2 3 4 7 12 522..................................... 6852 9.4658 3 5 8 12 20 523..................................... 14954 4.0942 1 2 3 5 7 ---------------- 11094323 -------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 40083]] Table 8A.--Statewide Average Operating Cost-to-Charge Ratios for Urban and Rural Hospitals (Case Weighted) July 2001 ------------------------------------------------------------------------ State Urban Rural ------------------------------------------------------------------------ ALABAMA............................................... 0.343 0.410 ALASKA................................................ 0.417 0.697 ARIZONA............................................... 0.355 0.493 ARKANSAS.............................................. 0.466 0.445 CALIFORNIA............................................ 0.339 0.432 COLORADO.............................................. 0.422 0.577 CONNECTICUT........................................... 0.497 0.506 DELAWARE.............................................. 0.511 0.450 DISTRICT OF COLUMBIA.................................. 0.421 ....... FLORIDA............................................... 0.351 0.370 GEORGIA............................................... 0.461 0.469 HAWAII................................................ 0.412 0.549 IDAHO................................................. 0.541 0.561 ILLINOIS.............................................. 0.404 0.501 INDIANA............................................... 0.524 0.533 IOWA.................................................. 0.486 0.613 KANSAS................................................ 0.415 0.637 KENTUCKY.............................................. 0.479 0.492 LOUISIANA............................................. 0.401 0.491 MAINE................................................. 0.614 0.540 MARYLAND.............................................. 0.759 0.819 MASSACHUSETTS......................................... 0.511 0.571 MICHIGAN.............................................. 0.459 0.563 MINNESOTA............................................. 0.493 0.592 MISSISSIPPI........................................... 0.452 0.446 MISSOURI.............................................. 0.404 0.475 MONTANA............................................... 0.537 0.588 NEBRASKA.............................................. 0.448 0.610 NEVADA................................................ 0.306 0.503 NEW HAMPSHIRE......................................... 0.549 0.585 NEW JERSEY............................................ 0.394 ....... NEW MEXICO............................................ 0.466 0.491 NEW YORK.............................................. 0.524 0.607 NORTH CAROLINA........................................ 0.517 0.463 NORTH DAKOTA.......................................... 0.620 0.655 OHIO.................................................. 0.500 0.568 OKLAHOMA.............................................. 0.409 0.492 OREGON................................................ 0.614 0.598 PENNSYLVANIA.......................................... 0.398 0.526 PUERTO RICO........................................... 0.486 0.584 RHODE ISLAND.......................................... 0.510 ....... SOUTH CAROLINA........................................ 0.440 0.463 SOUTH DAKOTA.......................................... 0.529 0.640 TENNESSEE............................................. 0.438 0.453 TEXAS................................................. 0.401 0.493 UTAH.................................................. 0.497 0.582 VERMONT............................................... 0.572 0.599 VIRGINIA.............................................. 0.459 0.496 WASHINGTON............................................ 0.582 0.639 WEST VIRGINIA......................................... 0.568 0.527 WISCONSIN............................................. 0.524 0.613 WYOMING............................................... 0.523 0.717 ------------------------------------------------------------------------ Table 8B.--Statewide Average Capital Cost-to-Charge Ratios (Case Weighted) July 2001 ------------------------------------------------------------------------ State Ratio ------------------------------------------------------------------------ ALABAMA........................................................ 0.044 ALASKA......................................................... 0.058 ARIZONA........................................................ 0.038 ARKANSAS....................................................... 0.049 CALIFORNIA..................................................... 0.034 COLORADO....................................................... 0.045 CONNECTICUT.................................................... 0.036 DELAWARE....................................................... 0.051 DISTRICT OF COLUMBIA........................................... 0.035 FLORIDA........................................................ 0.043 GEORGIA........................................................ 0.051 HAWAII......................................................... 0.038 IDAHO.......................................................... 0.046 ILLINOIS....................................................... 0.040 INDIANA........................................................ 0.056 IOWA........................................................... 0.049 KANSAS......................................................... 0.050 KENTUCKY....................................................... 0.046 LOUISIANA...................................................... 0.047 MAINE.......................................................... 0.040 MARYLAND....................................................... 0.013 MASSACHUSETTS.................................................. 0.053 MICHIGAN....................................................... 0.044 MINNESOTA...................................................... 0.047 MISSISSIPPI.................................................... 0.044 MISSOURI....................................................... 0.044 MONTANA........................................................ 0.053 NEBRASKA....................................................... 0.054 NEVADA......................................................... 0.030 NEW HAMPSHIRE.................................................. 0.061 NEW JERSEY..................................................... 0.036 NEW MEXICO..................................................... 0.045 NEW YORK....................................................... 0.051 NORTH CAROLINA................................................. 0.046 NORTH DAKOTA................................................... 0.074 OHIO........................................................... 0.047 OKLAHOMA....................................................... 0.046 OREGON......................................................... 0.046 PENNSYLVANIA................................................... 0.039 PUERTO RICO.................................................... 0.045 RHODE ISLAND................................................... 0.029 SOUTH CAROLINA................................................. 0.046 SOUTH DAKOTA................................................... 0.059 TENNESSEE...................................................... 0.048 TEXAS.......................................................... 0.046 UTAH........................................................... 0.047 VERMONT........................................................ 0.052 VIRGINIA....................................................... 0.055 WASHINGTON..................................................... 0.063 WEST VIRGINIA.................................................. 0.045 WISCONSIN...................................................... 0.051 WYOMING........................................................ 0.065 ------------------------------------------------------------------------ Appendix A--Regulatory Impact Analysis I. Introduction We generally prepare a regulatory flexibility analysis that is consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 through 612), unless we certify that a final rule would not have a significant economic impact on a substantial number of small entities. For purposes of the RFA, we consider all hospitals to be small entities. We estimate the total impact of these changes for FY 2002 payments compared to FY 2001 payments to be approximately a $1.9 billion increase. As such, this final rule is a major rule as defined in 5 U.S.C. 804(2). Therefore, we have prepared an impact analysis for this final rule. Also, section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any final rule that may have a significant impact on the operations of a substantial number of small rural hospitals. Such an analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). Section 601(g) of the Social Security Amendments of 1983 (Public Law 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the hospital inpatient prospective payment systems, we classify these hospitals as urban hospitals. It is clear that the changes being made in this document would affect both a substantial number of small rural hospitals as well as other classes of hospitals, and the effects on some may be significant. Therefore, the discussion below, in combination with the rest of this final rule, constitutes a combined regulatory impact analysis and regulatory flexibility analysis. We have reviewed this final rule under the threshold criteria of Executive Order 13132, Federalism, and have determined that the final rule will not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments. Section 202 of the Unfunded Mandate Reform Act of 1995 (Public Law 104-4) also requires that agencies assess anticipated costs and benefits before issuing any final rule that has been preceded by a final rule that may result in an expenditure in any one year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This final rule would not mandate any requirements for State, local, or tribal governments. In accordance with the provisions of Executive Order 12866, this final rule was reviewed by the Office of Management and Budget. II. Changes in the Final Rule Since we published the proposed rule, the market basket estimates for hospitals subject to the inpatient prospective payment system and hospitals and units excluded from the system have both risen by 0.2 percentage points. As a result, the updates are 0.2 percentage points higher than the updates reflected in the impact analysis for the proposed rule. With the exception of these changes, we are generally implementing the policy and [[Page 40084]] statutory provisions discussed in the proposed rule. III. Impact Analysis for CMS-1131-F and CMS-1178-F As noted previously, this final rule contains provisions implemented in two interim final rules with comment periods. The first, published August 1, 2000 (65 FR 47026), implemented, or conformed the regulations to, certain statutory provisions relating to Medicare payments to hospitals for inpatient services that were contained in Public Law 106-113. The second, published June 13, 2001 (66 FR 32172), implemented, or conformed the regulations to, certain statutory provisions relating to Medicare payments to hospitals for inpatient services that were contained in Public Law 106-554. As described in the preamble to this final rule, with the exception of minor changes to the process for receiving, reviewing, and approving new Medicare-dependent small rural hospitals (MDHs), we are not changing the policies described in those interim final rules with comment period. Therefore, the reader should refer to the impact analyses contained in those interim final rules for a discussion of the impacts of these changes. For the impact analysis in the August 1, 2000 interim final rule, the reader should refer to page 47043. For the impact analysis in the June 13, 2001 interim final rule, the reader should refer to page 32184. IV. Limitations of Our Analysis As has been the case in our previously published regulatory impact analyses, the following quantitative analysis presents the projected effects of our proposed policy changes, including statutory changes effective for FY 2002, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per case while holding all other payment policies constant. We use the best data available, but we do not attempt to predict behavioral responses to our policy changes, and we do not make adjustments for future changes in such variables as admissions, lengths of stay, or case-mix. We received two comments on the impact analysis for our May 4, 2001 proposed rule. Comment: One commenter, who was unable to reconcile the standardized amounts for FY 2002 proposed in the May 4, 2001 Federal Register with the standardized amounts published for FY 2001 (65 FR 47126 and 66 FR 32176), expressed concern with the level of detail provided by the impact analysis and requested a breakdown of the changes reflected in Column 8 of Table 1. The commenter also requested that we release the complete data so that hospitals could evaluate all the proposed FY 2002 policy changes on their own. Response: As we stated in the proposed rule, column 8 compares our estimate of payments per case, incorporating all changes reflected in this final rule for FY 2002 (including statutory changes), to our estimate of payments per case in FY 2001. It includes the effects of the 2.75 percent update to the standardized amounts and the hospital- specific rates for MDHs and SCHs. It also reflects the 1.1 percentage point difference between the projected percentage of outlier payments in FY 2001 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2001 (6.2 percent), as described in the introduction to this Appendix and the Addendum to this final rule. Additionally, there are differences resulting from the increased number of hospitals receiving DSH payments under Section 211 of Public Law 106-554 and from the increase in SCH rebasing to a 1996 blended rate. There are also interactive effects among the various factors comprising the payment system that we are not able to isolate. For these reasons, the values in column 7 may not equal the sum of the changes in columns 5 and 6, plus the other impacts that we are able to identify. Since we explain the update for FY 2002 in section II. of the Addendum of this final rule, and since the impact of those changes are the same for all types of hospitals, we do not believe it is necessary to isolate that change in a separate impact column. Also, we would like to note that all of the data used by us in the impact analysis are available to the public. Our impact file is posted on our website following the publication of each proposed and final rule. For information on obtaining the MedPAR file, the Provider-Specific File, and the cost report files on which all of our analysis is based, we refer the reader to section VIII. of this final rule. Comment: One commenter noted that, in the proposed rule, the budget neutrality factor in footnote 6 of Table 1 was printed as 0.992394 while the same factor was printed as 0.992493 on page 22872 and asked which factor was correct. Response: Footnote 6 to Table 1 in the proposed rule contained a typographical error. The budget neutrality factor used in the proposed rule was 0.992493 and was printed correctly on page 22872 of the proposed rule. V. Hospitals Included in and Excluded From the Prospective Payment System The prospective payment systems for hospital inpatient operating and capital-related costs encompass nearly all general, short-term, acute care hospitals that participate in the Medicare program. There were 48 Indian Health Service hospitals in our database, which we excluded from the analysis due to the special characteristics of the prospective payment method for these hospitals. We also exclude critical access hospitals (CAHs) from our analysis, due to the special characteristics of these hospitals. Among other short-term, acute care hospitals, only the 68 such hospitals in Maryland remain excluded from the prospective payment system under the waiver at section 1814(b)(3) of the Act. Thus, as of July 2001, we have included 4,795 hospitals in our analysis. This represents about 80 percent of all Medicare- participating hospitals. The majority of this impact analysis focuses on this set of hospitals. The remaining 20 percent are specialty hospitals that are excluded from the prospective payment system and continue to be paid on the basis of their reasonable costs (subject to a rate-of-increase ceiling on their inpatient operating costs per discharge). These hospitals include psychiatric, rehabilitation, long-term care, children's, and cancer hospitals. The impacts of our final policy changes on these hospitals are discussed below. VI. Impact on Excluded Hospitals and Units As of July 2001, there were 1,064 specialty hospitals excluded from the prospective payment system and instead paid on a reasonable cost basis subject to the rate-of-increase ceiling under Sec. 413.40. Broken down by specialty, there were 507 psychiatric, 210 rehabilitation, 260 long-term care, 77 children's, and 10 cancer hospitals. In addition, there were 1,446 psychiatric units and 926 rehabilitation units in hospitals otherwise subject to the prospective payment system. These excluded units are also paid in accordance with Sec. 413.40. Under Sec. 413.40(a)(2)(i)(A), the rate-of-increase ceiling is not applicable to the 68 specialty hospitals and units in Maryland that are paid in accordance with the waiver at section 1814(b)(3) of the Act. As required by section 1886(b)(3)(B) of the Act, the update factor applicable to the rate-of-increase limit for excluded [[Page 40085]] hospitals and units for FY 2002 would be between 0.8 and 3.3 percent, or 0 percent, depending on the hospital's or unit's costs in relation to its limit for the most recent cost reporting period for which information is available. The impact on excluded hospitals and units of the update in the rate-of-increase limit depends on the cumulative cost increases experienced by each excluded hospital or unit since its applicable base period. For excluded hospitals and units that have maintained their cost increases at a level below the percentage increases in the rate- of-increase limits since their base period, the major effect will be on the level of incentive payments these hospitals and units receive. Conversely, for excluded hospitals and units with per-case cost increases above the cumulative update in their rate-of-increase limits, the major effect will be the amount of excess costs that would not be reimbursed. We note that, under Sec. 413.40(d)(3), an excluded hospital or unit whose costs exceed 110 percent of its rate-of-increase limit receives its rate-of-increase limit plus 50 percent of the difference between its reasonable costs and 110 percent of the limit, not to exceed 110 percent of its limit. In addition, under the various provisions set forth in Sec. 413.40, certain excluded hospitals and units can obtain payment adjustments for justifiable increases in operating costs that exceed the limit. At the same time, however, by generally limiting payment increases, we continue to provide an incentive for excluded hospitals and units to restrain the growth in their spending for patient services. VII. Graduate Medical Education Impact A. National Average Per Resident Amount (PRA) As discussed in detail in section IV.H.2. of this proposed rule, we proposed to implement section 511 of Public Law 106-554, which increased the floor of the locality-adjusted national average (PRA for the purposes of computing direct GME payments for cost reporting periods beginning during FY 2002. The national average PRA payment methodology, as provided in section 311 of Public Law 106-113, establishes a ``floor'' and ``ceiling'' based on a locality-adjusted, updated national average PRA for cost reporting periods beginning on or after October 1, 2000 and before October 1, 2005. Section 511 of Public Law 106-554 increased the floor from 70 percent to equal 85 percent of a locality-adjusted national average PRA for FY 2002. For this final rule, we have calculated an estimated impact of this policy on teaching hospitals' PRAs for FY 2002, making assumptions about update factors and geographic adjustment factors (GAF) for each hospital. Generally, using FY 1997 data, we calculated a floor based on 70 percent of the national average PRA and a floor based on 85 percent of the national average PRA. We then determined the amount of direct GME payments that would have been paid had the floor remained at 70 percent of the national average PRA. Next, we determined the amount of direct GME payments that would be paid with the floor increased to equal 85 percent of the national average PRA. We subtracted the difference between the two and inflated the difference to FY 2002 to determine the impact of this provision. The figures we used in this impact, except for the FY 1997 weighted PRA of $68,464, are estimations and are for demonstrative purposes only. Hospitals must use the methodology stated in section IV.H. of this final rule to revise (if appropriate) their individual PRAs. In calculating this impact, we used Medicare cost report data for all cost reports ending in FY 1997. We excluded hospitals that file manual cost reports because we did not have access to their Medicare utilization data. We also excluded all teaching hospitals in Maryland, because these hospitals are paid on a Medicare waiver outside of the prospective payment system, and those hospitals' PRAs do not determine their level of direct GME payments. For hospitals that had two cost reporting periods ending in FY 1997, we used the later of the two periods. A total of 1,231 teaching hospitals were included in the analysis. Using the FY 1997 weighted average PRA of $68,464, we determined an 85 percent floor of $58,194 for FY 1997. We then determined that, for cost reporting periods ending in FY 1997, approximately 562 hospitals had PRAs that were below $58,194 (336 hospitals of these hospitals had PRAs that were below the 70-percent floor, and 226 hospitals had PRAs that were above the 70-percent floor but below the 85-percent floor). The estimated total cost to the Medicare program in FY 2002 of replacing the PRAs of the 562 hospitals with the 85-percent floor is $105.3 million. B. Closed Training Programs or Hospitals That Close Their Training Programs As discussed in IV.H.5, of the preamble of this final rule, we are allowing a hospital to receive a temporary adjustment to its FTE cap to reflect residents added because of the closure of another hospital's GME program if the hospital that closed its program agrees to temporarily reduce its FTE cap. We have calculated an estimated impact on the Medicare program for FY 2002 as a result of this policy. We used the best available cost report data from the FY 1997 HCRIS in our analysis. We estimate that approximately 5 to 10 programs, each with an average of 25 residents, close each year without advance warning, displacing the residents before they complete their training. Therefore, the number of residents displaced each year could be between 125 and 250. We estimated the impact of this change based on direct GME and IME payment amounts in FY 1997 to determine a total GME amount and updated the total with the CPI-U for FY 2002. At most, the estimated impact for this provision for FY 2002 is moving payments of between $10 and $20 million among different hospitals. This would result from redirecting these payments from the hospital that closed its program to the hospital(s) that takes on the residents. VIII. Quantitative Impact Analysis of the Final Policy Changes Under the Prospective Payment System for Operating Costs A. Basis and Methodology of Estimates In this final rule, we are announcing policy changes and payment rate updates for the prospective payment systems for operating and capital-related costs. We have prepared separate impact analyses of the final changes to each system. This section deals with changes to the operating prospective payment system. The data used in developing the quantitative analyses presented below are taken from the March 2001 update of the FY 2000 MedPAR file and the most current Provider Specific File that is used for payment purposes. Although the analyses of the changes to the operating prospective payment system do not incorporate cost data, the most recently available hospital cost report data were used to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to these final policy changes. Second, due to the [[Page 40086]] interdependent nature of the prospective payment system, it is very difficult to precisely quantify the impact associated with each final change. Third, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases, particularly the number of beds, there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available sources overall. For individual hospitals, however, some miscategorizations are possible. Using cases from the March, 2001 update of the FY 2000 MedPAR file, we simulated payments under the operating prospective payment system given various combinations of payment parameters. Any short-term, acute care hospitals not paid under the general prospective payment systems (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations. Payments under the capital prospective payment system, or payments for costs other than inpatient operating costs, are not analyzed here. Estimated payment impacts of FY 2002 policy changes to the capital prospective payment system are discussed in section IX. of this Appendix. The changes discussed separately below are the following: The effects of the annual reclassification of diagnoses and procedures and the recalibration of the diagnosis-related group (DRG) relative weights required by section 1886(d)(4)(C) of the Act. The effects of changes in hospitals' wage index values reflecting wage data from hospitals' cost reporting periods beginning during FY 1998, compared to the FY 1997 wage data. The effects of our final policy to increase the accuracy of the wage index calculation by changing the overhead allocation method used so that the salaries and hours of lower-wage, overhead employees and the overhead wage-related costs associated with the excluded areas of the hospital are more accurately removed when calculating the overhead costs attributable to wages. The effects of our final policy to include the contract labor costs of laboratories and pharmacies from Worksheet S-3 Part II Lines 9.01 and 9.02 in the wage index calculation. The combined effects of our changes to the wage index data and calculations and the changes in the DRG recalibration. The effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) that will be effective in FY 2002. The effects of our new policy to hold-harmless other hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic area as well as the area to which they are reclassified. The total change in payments based on FY 2002 policies relative to payments based on FY 2001 policies. To illustrate the impacts of the FY 2002 final changes, our analysis begins with a FY 2002 baseline simulation model using: the FY 2001 DRG GROUPER (version 18.0); the FY 2001 wage index; and no MGCRB reclassifications. Outlier payments are set at 5.1 percent of total DRG plus outlier payments. Each final and statutory policy change is then added incrementally to this baseline model, finally arriving at an FY 2002 model incorporating all of the changes. This allows us to isolate the effects of each change. Our final comparison illustrates the percent change in payments per case from FY 2001 to FY 2002. Five factors have significant impacts here. The first is the update to the standardized amounts. In accordance with section 1886(d)(3)(A)(iv) of the Act, as amended by section 301 of Public Law 106-554, we updated the large urban and the other areas average standardized amounts for FY 2002 using the most recently forecasted hospital market basket increase for FY 2002 of 3.3 percent minus 0.55 percentage points (for an update of 2.75 percent). Under section 1886(b)(3) of the Act, the updates to the hospital- specific amounts for sole community hospitals (SCHs) and for MDHs are equal to the market basket increase of 3.3 percent minus 0.55 percentage points (for an update of 2.75 percent). A second significant factor that impacts changes in hospitals' payments per case from FY 2001 to FY 2002 is the change in MGCRB status from one year to the next. That is, hospitals reclassified in FY 2001 that are no longer reclassified in FY 2002 may have a negative payment impact going from FY 2001 to FY 2002; conversely, hospitals not reclas
