[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]]

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Part II

Department of Health and Human Services

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Health Care Financing Administration

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Office of Inspector General

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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.

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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.
   
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