Medicare: Correction,
[Federal Register: October 5, 1998 (Volume 63, Number 192)]
[Rules and Regulations]
[Page 53301-53308]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05oc98-13]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 409, 410, 411, 413, 424, 483 and 489
[HCFA-1913-CN]
RIN 0938-AI47
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correction of interim final rule with comment period.
SUMMARY: This document corrects technical errors that appeared in the interim final rule with comment period published in the Federal Register on May 12, 1998 entitled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities.''
EFFECTIVE DATE: These corrections are effective July 1, 1998.
FOR FURTHER INFORMATION CONTACT: Bill Ullman, (410) 786-5667.
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 98-12208 of May 12, 1998 (63 FR 26252), there were a number of technical errors. In the preamble, the errors relate to incorrect listings in two tables, technical errors in the discussion of one issue, a typographical error in a table, and an incorrect paragraph designation. In the regulations text, the errors relate to two incorrect paragraph designations, a misspelled word in the heading to a section, and a grammatical correction. In addition, we inadvertently erased a change made by the regulation titled ``Medicare Program; Scope of Medicare Benefits and Application of the Outpatient Mental Health Treatment Limitation to Clinical Psychologist and Clinical Social Worker Services (HCFA-3706-F)'' published in the Federal Register April 23, 1998 at 63 FR 20110. That regulation's revision to 42 CFR 424.32(a)(2) (see 63 FR 20130), regarding basic requirements for claims, was inadvertently erased by the interim final rule, which this notice corrects, titled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities'' published May 12, 1998 when it subsequently revised the same section (see 63 FR 26311). This correction notice incorporates the revisions made by both rules. Finally, we are correcting Sec. 483.20 (Resident assessment) because we erroneously used a superseded version of regulations text when revising that section. The corrections appear in this document under the heading ``Correction of Errors.''
Correction of Errors
In FR Doc. 98-12208 of May 12, 1998 (63 FR 26252), we are making the following corrections:
Corrections To Preamble
Page 26262, Table 2.C
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The dot lead-in between the ``Category'' column and the ``ADL index'' column and between the ``End splits'' column and the ``MDS RUG- III codes'' column is removed.
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First column titled ``Category''
Under the heading ``IMPAIRED COGNITION,'' the first line is corrected to read as follows: ``Score on MDS2.0 Cognitive Performance Scale ›=3.'' The second and third lines under the heading are retained but are blank.
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Second column titled ``ADL index''
After existing line 29, line 30 is added to read ``4-5.''
Existing line 34 is removed.
Existing line 37 is removed.
After existing line 38, line 39 is added to read ``11-15.''
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Third column titled ``End splits''
Line 28 is corrected to read ``Nursing rehabilitation.''
Line 29 is corrected to read ``Not receiving nursing rehabilitation.''
Line 30 is corrected to read ``Nursing rehabilitation.''
Line 31 is corrected to read ``Not receiving nursing rehabilitation.''
Line 32 is corrected to read ``Nursing rehabilitation.''
Line 33 is corrected to read ``Not receiving nursing rehabilitation.''
Line 34 is corrected to read ``Nursing rehabilitation.''
Line 35 is corrected to read ``Not receiving nursing rehabilitation.''
[[Page 53302]]
Line 37 is corrected to read ``Nursing rehabilitation.''
Line 38 is corrected to read ``Not receiving nursing rehabilitation.''
Line 39 is corrected to read ``Nursing rehabilitation.''
Line 40 is corrected to read ``Not receiving nursing rehabilitation.''
Line 43 is corrected to read ``Nursing rehabilitation.''
Line 44 is corrected to read ``Not receiving nursing rehabilitation.''
Line 45 is corrected to read ``Nursing rehabilitation.''
Line 46 is corrected to read ``Not receiving nursing rehabilitation.''
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Fourth column, titled ``MDS RUG III codes''
Line 35, ``BA1,'' is removed.
The corrected table is set forth below:
BILLING CODE 4210-01-P-
[[Page 53303]]
[GRAPHIC] [TIFF OMITTED] TR05OC98.034
[[Page 53304]]
[GRAPHIC] [TIFF OMITTED] TR05OC98.035
[[Page 53305]]
[GRAPHIC] [TIFF OMITTED] TR05OC98.036
[[Page 53306]]
[GRAPHIC] [TIFF OMITTED] TR05OC98.037
BILLING CODE 4210-01-C
Page 26260
In the second column, in lines 7 to 11, the second full sentence is corrected to read as follows: ``On average, case-mix values based on MDS data are the same as analog-based values for the nursing index and 29 percent higher for the therapy index.''
Page 26265
In the third column, in lines 4 to 9, the sentence beginning ``As rehabilitation services * * *'' is removed.
Page 26266
In the third column, in lines 15 to 21, the sentence beginning ``Although the PPS rules * * *'' is corrected to read as follows: ``Although the PPS rules allow a 5-day grace period for setting the assessment reference date for the Medicare 90-day assessment, the Quarterly Review assessment must be completed within 92 days of completion of the last comprehensive assessment.''
In the third column, in lines 21 to 28, the sentence beginning ``Therefore, if a facility * * *'' is corrected to read as follows: ``Therefore, if a facility is using the Medicare 90-day assessment to also meet the requirement for the Quarterly Review assessment, the assessment must be completed within 92 days of completion of the prior comprehensive assessment and have an assessment reference date that falls within the Medicare 90-day assessment window, days 80 through 89 (plus grace days, if needed) of the Part A stay.''
In the third column, in the first full paragraph, in line 19 of that paragraph, in the sentence beginning, ``These include * * *,'' the phrase ``0 or 1 to 2 or 3'' is corrected to read ``0 to 1 or 2 to 3.''
In the third column, in the first full paragraph, in line 23, in the sentence
[[Page 53307]]
beginning ``As a complement * * *,'' the phrase ``comprehensive assessment'' is corrected to read ``full assessment.''
In the third column, in the first full paragraph, in line 32, in the sentence beginning ``For those rare instances * * *,'' the phrase ``a comprehensive assessment'' is corrected to read ``an assessment.''
Page 26267
In the first column, in line 7, the word ``comprehensive'' is removed.
In the first column, in line 9, the word ``deemed'' is replaced with ``automatically.''
In the first column, in the first full paragraph, in the first sentence, in line 2, after the word ``assessment,'' the clause ``whichever is chosen to be used as the Initial Admission Assessment'' is added.
In the first column, in the first full paragraph, the second sentence is corrected to read as follows: ``As noted above, RAPs also must be completed as part of any Significant Change in Status assessments.''
In the first column, in the second full paragraph, in the first sentence, in line 3, the words ``be completed'' are replaced with the phrase ``have an assessment reference date.''
In the first column, in the third full paragraph, in the first sentence, in line 3, the words ``day 8'' are replaced with the clause ``the first assessment has been done.''
Page 26267, Table 2.D
In the third column titled ``Assessment reference date,'' in the first line, the phrase ``Days 1-8*'' is replaced with ``Days 1-5*.''
In the first footnote ``*'' for the table, the phrase ``day 8'' is replaced with ``day 5.''
The second footnote ``**'' for the table is corrected to read as follows: ``**RAPs follow Federal rules.''
Page 26268
In the first column, in the second full paragraph, in lines 3 to 10, the first sentence after the heading designated ``a.'' is corrected to read as follows: ``For a Medicare patient in a Part A covered stay, admitted in the 30 days before the SNF became subject to PPS, facility staff may choose to use the most recent full MDS assessment (within the past 30 days) for RUG-III classification.''
In the first column, in the second full paragraph, in lines 16 to 18, the last sentence is corrected, and a new sentence is added after it to read as follows: ``The next assessment will be the required Medicare 14-day assessment. This assessment must have an assessment reference date that is 11 to 14 days after the day the facility became subject to SNF PPS.''
In the third column, in line 5, the word ``completed'' is replaced with ``included.''
In the third column, in lines 9 to 10, the phrase ``admission assessment'' is replaced with ``Initial Admission Assessment.''
In the third column, in line 16, the word ``and'' is removed.
In the third column, in the second full paragraph, in lines 4 to 13, the second sentence is corrected, the third and fourth sentences are removed, and a new sentence is added after the corrected second sentence to read as follows: ``For this reason, when using the 90-day assessment as the required quarterly assessment, it must be completed accordingly. When the 90-day assessment is not also the quarterly assessment, a 5-day grace period is available for setting the assessment reference date for this assessment, as for the 30-day and 60-day assessments.''
Page 26275, Table 2.H
In the column labeled ``Labor-related'' for the RUGS-III category ``RMB,'' in line 11, the amount presented contained a typographical error. The amount is corrected to read ``$185.78''.
Page 26284
In the first column, in the second full paragraph, in line 24, the phrase ``visits and'' is added before the phrase ``order changes.''
In the first column, in the second full paragraph, in line 25, the phrase ``7 days'' is corrected to read ``14 days.''
Page 26301
In the first column, in lines 21 and 22, the reference to ``diagnostic tests (Sec. 410.32(e))'' is corrected to read ``diagnostic tests (Sec. 410.32(d)).''
Corrections to Regulatory Text
Sec. 410.32 [Corrected]
In the third column on page 26307, in the last line, and carrying over into the first column on page 26308, in the first line, in amendatory instruction number 4 for Sec. 410.32 (Diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions), the reference to ``paragraph (e)'' is corrected to read ``paragraph (d)'' and the reference to ``paragraph (e)(7)'' is corrected to read ``paragraph (d)(7).''
Also in the first column on page 26308, in the section heading to Sec. 410.32, the word ``texts'' is corrected to read ``tests''; and the paragraph designation ``(e)'' before the heading ``Diagnostic laboratory tests'' is corrected to read ``(d).''
Sec. 413.333 [Corrected]
In the second column on page 26309, in the definition of ``Resident classification system'' that appears in Sec. 413.333 (Definitions), the phrase ``as set out in the annual publication'' is corrected to read ``as set forth in the annual publication.''
Sec. 424.40 [Corrected]
In the second column on page 26311, in amendatory statement number 3 for Sec. 424.20 (Requirements for posthospital SNF care), ``paragraph (a)'' is corrected to read ``paragraph (a)(1).''
Sec. 424.32 [Corrected]
In the second column, in Sec. 424.32 (Basic requirements for all claims), revised paragraph (a)(2) is corrected to read as follows: * * * * *
(2) A claim for physician services, clinical psychologist services, or clinical social worker services must include appropriate diagnostic coding for those services using ICD-9-CM, and a claim for physician services furnished to an SNF resident under Sec. 411.15(p)(2) of this chapter must also include the SNF's Medicare provider number. * * * * *
Sec. 483.20 [Corrected]
In the third column on page 26311, amendatory instruction number 2 and the amendment to Sec. 483.20 are removed and a new amendatory instruction number 2 and amendment to Sec. 483.20 are added in their place to read as follows:
Subpart B--Requirements for Long Term Care Facilities
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In Sec. 483.20, the introductory text to paragraph (b)(2) is revised to read as follows:
Sec. 483.20 Resident assessment.
* * * * *
(b) Comprehensive assessments. * * *
(2) When required. Subject to the timeframes prescribed in Sec. 413.343(b) of this chapter, a facility must conduct a comprehensive assessment of a resident as follows: * * * * * (Authority: Section 1888 of the Social Security Act (42 U.S.C. 1395yy))
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program)
[[Page 53308]]
Dated: September 29, 1998. Neil J. Stillman, Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 98-26596Filed9-30-98; 4:28 pm]
BILLING CODE 4120-01-P
