Federal Register, Volume 77 Issue 205 (Tuesday, October 23, 2012)

[Federal Register Volume 77, Number 205 (Tuesday, October 23, 2012)]
[Rules and Regulations]
[Pages 64755-64758]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-25975]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, and 495

[CMS-0044-CN2]
RIN-0938-AQ84

Medicare and Medicaid Programs; Electronic Health Record
Incentive Program--Stage 2; Corrections

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors and typographical
errors in the final rule entitled ``Medicare and Medicaid Programs;
Electronic Health Record Incentive Program--Stage 2'' which appeared in
the September 4, 2012 issue of the Federal Register.

DATES: Effective Date: This document is effective on November 12, 2012,
except that the correction to instruction 8.NN (77 FR 54149) is
effective October 23, 2012.

FOR FURTHER INFORMATION CONTACT: Travis Broome, (214) 767-4450.

SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 2012-21050 of September 4, 2012 (77 FR 53968), the final
rule entitled ``Medicare and Medicaid Programs; Electronic Health
Record Incentive Program--Stage 2'' there were a number of technical
errors and typographical errors that are identified in the Summary of
Errors section and corrected in the Correction of Errors section.

II. Summary of Errors

A. Summary of Errors in the Preamble

On page 54041 in our response to a public comment regarding the
meaningful use objective ``provide structured electronic lab results to
eligible professionals,'' we inadvertently did not replace a
placeholder ``ONC reference once available'' with the reference when it
became available.
On page 54051, in our discussion of the submission period for
electronic submissions, we inadvertently omitted references to the
applicable provider or supplier (that is, eligible professional (EP),
eligible hospital, and critical access hospital) that has to meet the
calendar year or fiscal year submission period requirements. Also on
this page in the footnote following Table 5, we made errors in our
description of the providers and suppliers that are in the first year
of demonstrating meaningful use for purposes of avoiding a payment
adjustment.
On page 54052 in our response to public comments regarding the
transition to electronic health record (EHR) technology certified to
the 2014 Edition EHR certification criteria, we inadvertently omitted
certain CQMs that we included in the Stage 1 final rule but are not
finalizing in the Stage 2 final rule for reporting beginning in CY 2014
after consideration of the public comments. Also on this page, in
another response to public comments regarding 2011 Edition of EHR
certification criteria, we made a grammatical error.
On page 54053, we inadvertently omitted certain CQMs that would be
excluded from an EP's option of reporting in the Stage 1 final rule.
On pages 54044, 54055, 54056, 54058, 54068, 54079, 54081, and
54120, we made inadvertent errors in the numbering and referencing of
several tables.
On page 54056, we made inadvertent errors in specifying the
providers and suppliers that would receive the annual fiscal or
calendar year updates to the clinical quality measure (CQM)
specifications.
On pages 54069, 54072, and 54073, in Table 8--CQMs Finalized for
Medicare and Medicaid EPs Beginning with CY 2014, we made several
typographical and technical errors in the titles/descriptions of
several CQMs. We also made typographical errors in referencing the
footnotes for CQM 0418.

B. Summary of Errors in the Regulations Text

On page 54149, we made a technical error in an amendatory statement
(NN)

[[Page 64756]]

for Sec. 495.6. In the amendatory statement, we erroneously stated
that we were adding paragraphs (f)(1)(ii)(B) and (C) instead of stating
that we were adding paragraph (f)(1)(ii)(B).
On pages 54155 and 54157, we made technical errors by omitting
qualifying language in Sec. 495.6(l)(6)(ii) and Sec. 495.6(m)(4)(ii).
On page 54153 (in Sec. 495.6(j)(14)(ii)(C)(1)), we made a
typographical error in the regulatory citation.

III. Waiver of Proposed Rulemaking and Delay in Effective Date

We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
In our view, this correcting document does not constitute a
rulemaking that would be subject to the APA notice and comment or
delayed effective date requirements. This correcting document corrects
technical and typographical errors in the preamble and regulations text
of the September 4, 2012 final rule and does not make substantive
changes to the policies that were adopted. As a result, this correcting
document is intended to ensure that the final rule accurately reflects
the policies adopted in that rule.
In addition, even if this were a rulemaking to which the notice and
comment and delayed effective date requirements applied, we find that
there is good cause to waive such requirements. Undertaking further
notice and comment procedures to incorporate the corrections in this
document into the final rule or delaying the effective date would be
contrary to the public interest. Furthermore, such procedures would be
unnecessary, as we are not altering the policies that were already
subject to comment and finalized in our final rule. Therefore, we
believe we have good cause to waive the notice and comment and
effective date requirements.

IV. Correction of Errors

In FR Doc. 2012-21050 of September 4, 2012 (77 FR 53968), make the
following corrections:

A. Correction of Errors in the Preamble

1. On page 54041, second column, third paragraph, line 17, the
phrase ``criteria at (ONC reference once available)'' is corrected to
read ``criteria at 45 CFR 170.314(b)(6)''.
2. On page 54044, lower half of the page, in the table heading for
Table B5--Stage 2 Objectives and Measures, the table number ``Table
B5'' is corrected to read ``Table 4A''.
3. On page 54051--
a. Top quarter of the page, second column, first full paragraph,
line 4, the phrase ``CY or FY respectively.'' is corrected to read ``CY
or FY for EPs, eligible hospitals, and CAHs, respectively.''.
b. Second quarter of the page, in Table 5 Reporting and Submission
Periods for EPs, Eligible Hospitals and CAHs in Their First Year of
Meaningful Use Submitting CQMs Via Attestation Beginning With CY/FY
2014, the footnote following the table, line 1, the phrase ``Medicare
EPs and eligible hospitals'' is corrected to read ``EPs, eligible
hospitals, and CAHs in the Medicare EHR Incentive Program''.
4. On page 54052, third column--
a. First partial paragraph, line 1, the phrase ``0013, 0027,
0084).'' is corrected to read ``0013, 0027, 0084) as well as 9 CQMs
that we included in the Stage 1 final rule but are not finalizing in
this Stage 2 final rule for reporting beginning in CY 2014 (NQF 0001,
0012, 0014, 0047, 0061, 0067, 0073, 0074, 0575)).''.
b. Last paragraph, lines 2 and 3, the phrase ``EHR technology
should based'' is corrected to read ``EHR technology should be based''.
5. On page 54053, first column, last bulleted paragraph, line 9,
the phrase ``reporting NQF 0013, 0027, 0084'' is corrected to read
``reporting NQF 0013, 0027, 0084, 0001, 0012, 0014, 0047, 0061, 0067,
0073, 0074, 0575''.
6. On page 54055, first column, first full paragraph, lines 22 and
23, the phrase ``MAP in Tables 7 (EPs) and 8 (eligible hospitals and
CAHs)'' is corrected to read ``MAP in Tables 8 (EPs) (77 FR 13749
through 13757 and 9 (eligible hospitals and CAHs) (77 FR 13760 through
13763)''.
7. On page 54056, second column, fourth full paragraph--
a. Line 7, the phrase ``FY/CY for hospitals and EPs respectively.''
is corrected to read ``FY and CY for eligible hospitals and CAHs, and
EPs, respectively.''.
b. Line 29, the reference ``Table 7'' is corrected to read ``Table
8''.
c. Line 32, the reference ``Table 8'' is corrected to read ``Table
10''.
8. On page 54058--
a. Second column, fourth full paragraph, line 4, the reference
``Table 7'' is corrected to read ``Table 8''.
b. Third column, first partial paragraph, line 2, the reference
``Table 7'' is corrected to read ``Table 8''.
9. On page 54068,
a. First column, first full paragraph--
(1) Line 5, the reference ``Table 7'' is corrected to read ``Table
8''.
(2) Line 7, the reference ``Table 7'' is corrected to read ``Table
8 ``.
(b) First column, second full paragraph, line 3, ``Table 7'' is
corrected to read ``Table 8''.
c. Third column, first full paragraph, line 3, the reference
``Table 7'' is corrected to read ``Table 8''.
10. On pages 54069 through 54075, in Table 8--CQMs Finalized for
Medicare and Medicaid EPs Beginning with CY 2014, we make the following
corrections:
a. Column 2 (CQM title and description) is corrected for the
following entries:

[[Page 64757]]

--------------------------------------------------------------------------------------------------------------------------------------------------------
Other quality
Measure steward & measure programs
CQM No. CQM title & description contact information that use the same New CQM Domain
CQM ***
--------------------------------------------------------------------------------------------------------------------------------------------------------
NQF 0018 *......................... Title: Controlling High NCQA................. EHR PQRS, ACO, Group ..................... Clinical Process/
Blood Pressure. Contact Information: Reporting PQRS, UDS. Effectiveness.
Description: Percentage www.ncqa.org..
of patients 18[dash]85
years of age who had a
diagnosis of
hypertension and whose
blood pressure was
adequately controlled
(<140/90mmHg) during
the measurement period.
NQF 0385........................... Title: Colon Cancer: AMA-PCPI............. EHR PQRS............. ..................... Clinical Process/
Chemotherapy for AJCC Contact Information: Effectiveness.
Stage III Colon Cancer cpe@ama[dash]assn.or
Patients. g;.
Description: Percentage American Society of
of patients aged 18 Clinical Oncology
through 80 years with (ASCO):
AJCC Stage III colon www.asco.org;.
cancer who are National
referred for adjuvant Comprehensive Cancer
chemotherapy, Network (NCCN):
prescribed adjuvant www.nccn.org..
chemotherapy, or have
previously received
adjuvant chemotherapy
within the
12[dash]month
reporting period.
NQF 0403........................... Title: HIV/AIDS: AMA-PCPI............. ..................... New.................. Clinical Process/
Medical Visit. Contact Information:. Effectiveness.
Description: Percentage cpe@ama[dash]assn.or
of patients, g;.
regardless of age, NCQA................
with a diagnosis of Contact Information:
HIV/AIDS with at least www.ncqa.org..
two medical visits
during the measurement
year with a minimum of
90 days between each
visit.
TBD (proposed as NQF 0407)......... Title: HIV/AIDS: RNA NCQA................. PQRS................. New.................. Clinical Process/
control for Patients Contact Information: Effectiveness.
with HIV. www.ncqa.org..
Description: Percentage
of patients aged 13
years and older with a
diagnosis of HIV/AIDS,
with at least two
visits during the
measurement year, with
at least 90 days
between each visit,
whose most recent HIV
RNA level is <200
copies/mL.
NQF 0421 *......................... Title: Preventive Care Centers for Medicare EHR PQRS, ACO, Group ..................... Population/Public
and Screening: Body and Medicaid Reporting PQRS, UDS. Health.
Mass Index (BMI) Services (CMS), 1-
Screening and 888-734-6433 or
Follow[dash]Up. http://
Description: Percentage questions.cms.hhs.go
of patients aged 18 v/app/ask/p/
years and older with 21,26,1139;
an encounter during QIP..................
the reporting period Contact Information:
with a documented www.usqualitymeasure
calculated BMI during s.org..
the encounter or
during the previous
six months AND when
the BMI is outside of
normal parameters,
follow[dash]up plan is
documented during the
encounter or during
the previous 6 months
of the encounter with
the BMI outside of
normal parameters.
Normal Parameters: Age
65 years and older BMI
>= 23 and < 30.
Age 18[dash]64 years
BMI >= 18.5 and < 25.
--------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 64758]]

b. Column 1 (CQM number) is corrected for the following entry:

11. On page 54079, in the third column, second full paragraph--
a. Line 3, the reference ``Table 8'' is corrected to read ``Table
10''.
b. Line 24, the reference ``Table 8''is corrected to read ``Table
10''.
12. On page 54081, first column, second full paragraph, line 2, the
reference ``Table 8'' is corrected to read ``Table 10''.
13. On page 54120, middle of the page, in the table heading Table
E1--Determination of Net Average Allowable Costs for the First Payment
Year, the table number ``Table E1'' is corrected to read ``Table 19A''.

B. Correction of Errors in the Regulations Text

Sec. 495.6 [Corrected]

1. On page 54149, third column, lines 60 and 61, the sentence ``NN.
Adding paragraphs (f)(1)(ii)(B) and (C).'' is corrected to read ``NN.
Adding paragraph (f)(1)(ii)(B).''
2. On page 54153, third column, fourth full paragraph (Sec.
495.6(j)(14)(ii)(C)(1)), line 10, the reference ``CFR 107.314(b)(2)''
is corrected to read ``CFR 170.314(b)(2)''.
3. On page 54155, second column, 14th paragraph (Sec.
495.6(l)(6)(ii)), line 1, the phrase ``More than 55 percent of'' is
corrected to read ``Subject to paragraph (c) of this section, more than
55 percent of''.
3. On page 54157, first column, seventh paragraph (Sec.
495.6(m)(4)(ii)), line 1, the phrase ``More than 10 percent of'' is
corrected to read ``Subject to paragraph (c) of this section, more than
10 percent of''.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)

(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

Dated: October 16, 2012.
Oliver Potts,
Deputy Executive Secretary to the Department, Department of Health and
Human Services.
[FR Doc. 2012-25975 Filed 10-22-12; 8:45 am]
BILLING CODE 4120-01-P