[Federal Register: June 30, 1999 (Volume 64, Number 125)] [Proposed Rules] [Page 35257-35306] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr30jn99-49] [[Page 35257]] _______________________________________________________________________ Part II Department of Health and Human Services _______________________________________________________________________ Health Care Financing Administration _______________________________________________________________________ Office of Inspector General _______________________________________________________________________ 42 CFR Part 409 et al. Medicare Program; Prospective Payment System for Hospital Outpatient Services; Correction; Proposed Rule [[Page 35258]] DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration Office of Inspector General 42 CFR Parts 409, 410, 411, 412, 413, 419, 489, 498, and 1003 [HCFA-1005-CN] RIN 0938-A156 Medicare Program; Prospective Payment System for Hospital Outpatient Services; Correction AGENCY: Health Care Financing Administration (HCFA), HHS. ACTION: Correction of proposed rule. ----------------------------------------------------------------------- SUMMARY: This document corrects technical and typographic errors that appeared in the proposed rule published in the Federal Register on September 8, 1998 entitled "Medicare Program; Prospective Payment System for Hospital Outpatient Services. FOR FURTHER INFORMATION CONTACT: Janet Wellham, (410) 786-4510 (for general information). Kitty Ahern, (410) 786-4515 (for information related to the classification of services into ambulatory payment classification (APC) groups). Suzanne Letsch (410) 786-4558 (for information related to volume control measures and updates). Janet Samen (410) 789-9161 (for information on the application of APCs to community health centers). SUPPLEMENTARY INFORMATION: Background In FR Doc. 98-23383 of September 8, 1998 (63 FR 47551), we published a proposed rule that reflected a number of technical errors, resulting in inconsistencies between the proposed policies and the associated numerical values. Specifically, the numerical values in the proposed rule reflected incorrect data and data programming. This document sets forth corrected numerical values. The problems in the data and data programming are a direct result of the frequent modifications to our databases during the initial development of the model prospective payment system and the changes we made during the development of the proposed rule to reflect the final legislative provision enacted on August 5, 1997 in the Balanced Budget Act of 1997 (BBA 1997), Public Law 105-33. We have corrected our databases and our data programming, and this document corrects the numerical values published in the September 8, 1998 proposed rule. Correcting the data errors does not mean that the proposed policies themselves need to be revised. Correcting the data changes the impacts of the proposed policies to a very limited extent, but this document does not revise any of the policies reflected in the September 8, 1998 proposed rule. Accordingly, we have recalculated the current payment, total services (total units) and corrected relative weights, proposed payment rates, national unadjusted coinsurance, minimum unadjusted coinsurance, and service-mix index that were published on September 8, 1998. The service-mix indices previously published in the proposed rule are significantly different from the service-mix index published in this correction notice (in Addendum I) because the ambulatory payment classification (APC) relative weights used to calculate the service mix published in the proposed rule were scaled using a factor "for a high- level clinic visit for cardiovascular services (that is, APC 91356) rather than a mid-level clinic visit for cardiovascular services, identified as APC 91336." In addition, the service-mix index published in this correction notice incorporates the discount policy applied to multiple surgeries. However, the relative differences among hospitals did not change substantially between the proposed and corrected service-mix indices. These data corrections required that we also correct our simulations of current payment, costs, and total units, leading to slight differences from the September 8, 1998 published version. Fully modeling proposed payment after accounting for data corrections, we calculated a new calendar year (CY) 1996 conversion factor of $46.87, which is slightly higher than the published CY 1996 conversion factor of $46.32. In addition to the data corrections mentioned above, we also made a correction in the computation of the conversion factor to appropriately account for wage index adjustments in proposed payments. The adjusted CY 1999 conversion factor is $51.42. Corrected simulations of costs and total units impacted the results of the regression analyses that we use in conjunction with payment simulations to determine whether the payment system should include adjustments for specific classes of hospitals. However, the results do not change our conclusion hat no adjustments be proposed at this time. These corrections require revisions to the impact tables and they also affect entries contained in Addendum A, Addendum B, Addendum C, Addendum D, and Addendum G. Addendum J, Addendum K, and Addendum L are revised to reflect the correct version of the wage index. Because of the many corrections to these "materials, we are reprinting portions of the impact analysis and the entire impact tables and agenda, below, in this notice. The September 8, 1998 proposed rule also contained other technical and typographic errors. Errors related to the incorrect assignment of status indicators to certain CPT codes listed in Addendum B are corrected and reflected in the revised Addendum B printed in full below. [CONTINUED] The remainder of this document is contained in a (300KB) zip file which you can Download Here.
