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Friday, August 1, 2003 Part III Department of Health and Human Services Centers of Medicare & Medicaid Services 42 CFR Parts 412 and 413 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2004 Rates; Final Rule VerDate jul<14>2003 17:06 Jul 31, 2003 Jkt 200001 PO 00000 Frm 00001 Fmt 4717 Sfmt 4717 E:\FR\FM\01AUR2.SGM 01AUR2 45346 Federal Register / Vol. 68, No. 148 / Friday, August 1, 2003 / Rules and Regulations DEPARTMENT OF HEALTH AND Stephen Phillips, (410) 786–4548, CC Complication or comorbidity HUMAN SERVICES Operating Prospective Payment, CMS Centers for Medicare & Medicaid Diagnosis-Related Groups (DRGs), Services Centers for Medicare & Medicaid Wage Index, New Medical Services CMSA Consolidated Metropolitan Services and Technology, Patient Transfers, Statistical Areas Counting Beds and Patient Days, and COBRA Consolidated Omnibus 42 CFR Parts 412 and 413 Hospital Geographic Reclassifications Reconciliation Act of 1985, Pub. L. [CMS–1470–F] Issues. 99–272 Tzvi Hefter, (410) 786–4487, Capital CPI Consumer Price Index RIN 0938–AL89 Prospective Payment, Excluded CRNA Certified registered nurse Hospitals, Nursing and Allied Health anesthetist Medicare Program; Changes to the Education, Graduate Medical DRG Diagnosis-related group Hospital Inpatient Prospective Education, and Critical Access DSH Disproportionate share hospital Payment Systems and Fiscal Year 2004 Hospital Issues, and Long-Term Care FDA Food and Drug Administration Rates (LTC)–DRGs. FQHC Federally qualified health AGENCY: Centers for Medicare and Sandra Hetrick, (410) 786–4542, RCE center Medicaid Services (CMS), HHS. Limits. FTE Full-time equivalent FY Federal fiscal year ACTION: Final rule. SUPPLEMENTARY INFORMATION: GME Graduate medical education SUMMARY: We are revising the Medicare Availability of Copies and Electronic HIPC Health Information Policy hospital inpatient prospective payment Access Council systems (IPPS) for operating and capital HIPAA Health Insurance Portability Copies: To order copies of the Federal and Accountability Act, Pub. L. 104– costs to implement changes arising from Register containing this document, send our continuing experience with these 191 your request to: New Orders, HHA Home health agency systems. In addition, in the Addendum Superintendent of Documents, PO Box to this final rule, we are describing ICD–9–CM International Classification 371954, Pittsburgh, PA 15250–7954. of Diseases, Ninth Revision, and changes to the amounts and factors used Specify the date of the issue requested to determine the rates for Medicare Clinical Modification and enclose a check or money order ICD–10–PCS International hospital inpatient services for operating payable to the Superintendent of costs and capital-related costs. These Classification of Diseases Tenth Documents, or enclose your Visa or Edition, and Procedure Coding changes are applicable to discharges Master Card number and expiration occurring on or after October 1, 2003. System date. Credit card orders can also be IME Indirect medical education We also are setting forth rate-of-increase placed by calling the order desk at (202) limits as well as policy changes for IPPS Acute care hospital inpatient 512–1800 or by faxing to (202) 512– prospective payment system hospitals and hospital units excluded 2250. The cost for each copy is $10.00. from the IPPS that are paid on a cost IRF Inpatient Rehabilitation Facility As an alternative, you can view and LDP Labor, delivery, and postpartum basis subject to these limits. photocopy the Federal Register Among other changes that we are LTC–DRG Long-term care diagnosis- document at most libraries designated related group making are: changes to the classification as Federal Depository Libraries and at of cases to the diagnosis-related groups LTCH Long-term care hospital many other public and academic MCE Medicare Code Editor (DRGS); changes to the long-term care libraries throughout the country that (LTC)–DRGs and relative weights; the MDC Major diagnostic category receive the Federal Register. MDH Medicare-dependent small rural introduction of updated wage data used This Federal Register document is to compute the wage index; the hospital also available from the Federal Register MedPAC Medicare Payment Advisory approval of new technologies for add-on online database through GPO Access, a payments; changes to the policies Commission service of the U.S. Government Printing MedPAR Medicare Provider Analysis governing postacute care transfers; Office. Free public access is available on and Review File payments to hospitals for the direct and a Wide Area Information Server (WAIS) MEI Medicare Economic Index indirect costs of graduate medical through the Internet and via MGCRB Medicare Geographic education; pass-through payments for asynchronous dial-in. Internet users can Classification Review Board nursing and allied health education access the database by using the World MPFS Medicare Physician Fee programs; determination of hospital Wide Web; the Superintendent of Schedule beds and patient days for payment Documents Home page address is http:/ MSA Metropolitan Statistical Area adjustment purposes; and payments to /www.access.gpo.gov/naraldocs/, by NECMA New England County critical access hospitals (CAHs). using local WAIS client software, or by Metropolitan Areas EFFECTIVE DATES: The provisions of this telnet to swais.access.gpo.gov, then NCHS National Center for Health final rule, except the provisions of login as guest (no password required). Statistics § 412.230(e)(2)(ii)(A) (because it grants Dial-in users should use NCVHS National Committee on Vital an exemption) and § 412.278(f)(2)(i), are communications software and modem and Health Statistics effective on October 1, 2003. The to call (202) 512–1661; type swais, then O.R. Operating room provisions of § 412.230(e)(2)(ii)(A) and login as guest (no password required). PPS Prospective payment system § 412.278(f)(2)(i) are effective on August PRA Per resident amount 1, 2003. This rule is a major rule as Acronyms ProPAC Prospective Payment defined in 5 U.S.C. 804(2). Pursuant to AHIMA American Health Information Assessment Commission 5 U.S.C. 801(a)(1)(A), we are submitting Management Association PRRB Provider Reimbursement a report to Congress on this rule on AHA American Hospital Association Review Board August 1, 2003. CAH Critical access hospital RCE Reasonable compensation FOR FURTHER INFORMATION CONTACT: CBSAs Core Based Statistical Areas equivalent VerDate jul<14>2003 17:06 Jul 31, 2003 Jkt 200001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\01AUR2.SGM 01AUR2 Federal Register / Vol. 68, No. 148 / Friday, August 1, 2003 / Rules and Regulations 45347 RHC Rural health center D. LTC–DRG Reclassifications and Relative E. Costs of Approved Nursing and Allied RRC Rural referral center Weights for LTCHs for FY 2004 Health Education Activities SCH Sole community hospital 1. Background 1. Background SNF Skilled nursing facility 2. Changes in the LTC–DRG Classifications 2. Continuing Education Issue for Nursing TEFRA Tax Equity and Fiscal a. Background and Allied Health Education Activities b. Patient Classifications into DRGs Responsibility Act of 1982, Pub. L. 3. Programs Operated by Wholly Owned 3. Development of the Final FY 2004 LTC– Subsidiary Educational Institutions of 97–248 DRG Relative Weights Hospitals UHDDS Uniform Hospital Discharge a. General Overview of Development of the F. Payment for Direct Costs of Graduate Data Set LTC–DRG Relative Weights Medical Education b. Data Table of Contents 1. Background c. Hospital-Specific Relative Value 2. Prohibition Against Counting Residents I. Background Methodology Where Other Entities First Incur the A. Summary d. Low Volume LTC–DRGs Training Costs B. Summary of the Provisions of the May 4. Steps for Determining the Final FY 2004 3. Rural Track FTE Limitation for Purposes 19, 2003 Proposed Rule LTC–DRG Relative Weights of Direct GME and IME for Urban C. Public Comments Received to the May E. Add-On Payments for New Services and Hospitals that Establish Separately 19, 2003 IPPS Proposed Rule Technologies Accredited Approved Medical Programs II. Changes to DRG Classifications and 1. Background in a Rural Area Relative Weights 2. FY 2004 Status of Technology Approved a. Change in the Amount of Rural Training A. Background for FY 2003 Add-On Payments: Time Required for an Urban Hospital to B. DRG Reclassification Qualify for an Increase in the Rural 1. General Drotrecogin Alfa (Activated)—Xigris Track FTE Limitation 2. Review of DRGs for Complications or 3. FY 2004 Applicants for New Technology b. Inclusion of Rural Track FTE Residents Comorbidity (CC) Split Add-On Payments in the Rolling Average Calculation 3. MDC 1 (Diseases and Disorders of the a. Bone Morphogenetic Proteins (BMPs) for 4. Technical Changes Related to Affiliated Nervous System) Spinal Fusions Groups and Affiliated Agreements a. Revisions of DRGs 1 and 2 b. GLIADEL Wafer G. Notification of Updates to the b. DRG 23 (Nontraumatic Stupor and 4. Review of the High-Cost Threshold Reasonable Compensation Equivalent Coma) 5. Technical Changes (RCE) Limits 4. MDC 5 (Diseases and Disorders of the III. Changes to the Hospital Wage Index Circulatory System) A. Background 1. Background a. DRG 478 (Other Vascular Procedures B. FY 2004 Wage Index Update 2. Publication of the Updated RCE Limits With CC) and DRG 479 (Other Vascular C. FY 2004 Wage Index Changes 3. Application of RCE Limits Procedures Without CC) 1. Elimination of Wage Costs Associated 4. Exceptions to RCE Limits b. DRGs 514 (Cardiac Defibrillator Implant with Rural Health Clinics and Federally 5. Geographic Area Classifications for RCE With Cardiac Catheterization) and 515 Qualified Health Centers Limits (Cardiac Defibrillator Implant Without 2. Paid Hours V. PPS for Capital-Related Costs Cardiac Catheterization) D. Verification of Wage Data from the VI. Changes for Hospitals and Hospital Units 5. MDC 8 (Diseases and Disorders of the Medicare Cost Reports Excluded from the IPPS Musculoskeletal System and Connective E. Computation of the FY 2004 Wage Index A. Payments to Excluded Hospitals and Tissue) F.