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Cms-1290-P] Rin 0938-An43 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 412 [CMS-1290-P] RIN 0938-AN43 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities for Federal fiscal year 2006 as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before August 1 before each fiscal year, the classification and weighting factors for the inpatient rehabilitation facilities case- mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. In addition, we are proposing new policies and are proposing to change existing policies regarding the prospective payment system within the authority granted under section 1886(j) of the Act. 2 DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on July 18, 2005. ADDRESSES: In commenting, please refer to file code CMS-1290-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of three ways (no duplicates, please): 1. Electronically. You may submit electronic comments on specific issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. By mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1290-P, P.O. Box 8010, Baltimore, MD 21244-8010. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By hand or courier. If you prefer, you may deliver 3 (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850. (Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. For information on viewing public comments, see the beginning of the "SUPPLEMENTARY INFORMATION" section. FOR FURTHER INFORMATION CONTACT: 4 Pete Diaz, (410) 786-1235. Susanne Seagrave, (410) 786-0044. Mollie Knight, (410) 786-7984 for information regarding the market basket and labor-related share. August Nemec, (410) 786-0612 for information regarding the tier comorbidities. Zinnia Ng, (410) 786-4587 for information regarding the wage index and Core-Based Statistical Areas (CBSAs). SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS-1290-P and the specific "issue identifier" that precedes the section on which you choose to comment. Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all electronic comments received before the close of the comment period on its public Web site as soon as possible after they have been received. Hard copy comments received timely will be available for public inspection as they are received, 5 generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951. Table of Contents I. Background A. General Overview of the Current Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) B. Requirements for Updating the Prospective Payment Rates for IRFs C. Operational Overview of the Current IRF PPS D. Quality of Care in IRFs E. Research to Support Refinements of the Current IRF PPS F. Proposed Refinements to the IRF PPS for Fiscal Year 2006 II. Proposed Refinements to the Patient Classification System A. Proposed Changes to the IRF Classification System 1. Development of the IRF Classification System 6 2. Description and Methodology Used to Develop the IRF Classification System in the August 7, 2001 Final Rule a. Rehabilitation Impairment Categories b. Functional Status Measures and Age c. Comorbidities d. Development of CMG Relative Weights e. Overview of Development of the CMG Relative Weights B. Proposed Changes to the Existing List of Tier Comorbidities 1. Proposed Changes to Remove Codes That Are Not Positively Related to Treatment Costs 2. Proposed Changes to Move Dialysis to Tier One 3. Proposed Changes to Move Comorbidity Codes Based on Their Marginal Cost C. Proposed Changes to the CMGs 1. Proposed Changes for Updating the CMGs 2. Proposed Use of a Weighted Motor Score Index and Correction to the Treatment of Unobserved Transfer to Toilet Values 3. Proposed Changes for Updating the Relative Weights III. Proposed FY 2006 Federal Prospective Payment Rates 7 A. Proposed Reduction of the Standard Payment Amount to Account for Coding Changes B. Proposed Adjustments to Determine the Proposed FY 2006 Standard Payment Conversion Factor 1. Proposed Market Basket Used for IRF Market Basket Index a. Overview of the Proposed RPL Market Basket b. Proposed Methodology for Operating Portion of the Proposed RPL Market Basket c. Proposed Methodology for Capital Proportion of the RPL Market Basket d. Labor-Related Share 2. Proposed Area Wage Adjustment a. Proposed Revisions of the IRF PPS Geographic Classification b. Current IRF PPS Labor Market Areas Based on MSAs c. Core-Based Statistical Areas (CBSAs) d. Proposed Revisions of the IRF PPS Labor Market Areas i. New England MSAs ii. Metropolitan Divisions iii. Micropolitan Areas e. Implementation of the Proposed Changes to Revise the Labor Market Areas 8 f. Wage Index Data 3. Proposed Teaching Status Adjustment 4. Proposed Adjustment for Rural Location 5. Proposed Adjustment for Disproportionate Share of Low-Income Patients 6. Proposed Update to the Outlier Threshold Amount 7. Proposed Budget Neutrality Factor Methodology for Fiscal Year 2006 8. Description of the Methodology Used to Implement the Proposed Changes in a Budget Neutral Manner 9. Description of the Proposed IRF Standard Payment Conversion Factor for Fiscal Year 2006 10. Example of the Proposed Methodology for Adjusting the Federal Prospective Payment Rates IV. Provisions of the Proposed Regulations V. Collection of Information Requirements VI. Response to Comments VII. Regulatory Impact Analysis Acronyms Because of the many terms to which we refer by acronym in this propose rule, we are listing the acronyms used and their corresponding terms in alphabetical order below. ADC Average Daily Census AHA American Hospital Association 9 AMI Acute Myocardial Infarction BBA Balanced Budget Act of 1997 (BBA), Pub. L. 105-33 BBRA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L. 106-113 BIPA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program] Benefits Improvement and Protection Act of 2000, Pub. L. 106-554 BLS Bureau of Labor Statistics CART Classification and Regression Trees CBSA Core-Based Statistical Areas CCR Cost-to-charge ratio CMGs Case-Mix Groups CMI Case Mix Index CMSA Consolidated Metropolitan Statistical Area CPI Consumer Price Index DSH Disproportionate Share Hospital ECI Employment Cost Index FI Fiscal Intermediary FIM Functional Independence Measure FIM-FRGs Functional Independence Measures-Function Related Groups FRG Function Related Group FTE Full-time equivalent FY Federal Fiscal Year 10 GME Graduate Medical Education HCRIS Healthcare Cost Report Information System HIPAA Health Insurance Portability and Accountability Act HHA Home Health Agency IME Indirect Medical Education IFMC Iowa Foundation for Medical Care IPF Inpatient Psychiatric Facility IPPS Inpatient Prospective Payment System IRF Inpatient Rehabilitation Facility IRF-PAI Inpatient Rehabilitation Facility-Patient Assessment Instrument IRF-PPS Inpatient Rehabilitation Facility-Prospective Payment System IRVEN Inpatient Rehabilitation Validation and Entry LIP Low-income percentage MEDPAR Medicare Provider Analysis and Review MSA Metropolitan Statistical Area NECMA New England County Metropolitan Area NOS Not Otherwise Specified NTIS National
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