Mag 3 lasix renal scan

Mag 3 lasix renal scan

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Public trust of the scientific community in the United States is as strong as ever, according to a new poll just released lasix price comparison today by the Pew Research Center, confirming polling results dating back to the 1970s. Thirty-eight percent of those polled in Pew’s survey in the U.S. Say that they have a lot of trust in lasix price comparison scientists to do what is right for the public.

Those polled also place a lot of trust in scientific institutions as compared to others in the U.S. Pew’s data show respondents only ranked the military as more trustworthy than scientific institutions, while ranking lower trust in others like the national government, news media and business leaders. That trust in science is of heightened importance right now, particularly in the U.S., where the novel hypertension continues to lasix price comparison spread and has now killed over 200,000 people.

With a lackluster government response, the public has been left on their own with the responsibility to follow guidance and advice provided by public health experts to control the spread of the lasix. It’s encouraging to see that multiple polls show the U.S. Public still lasix price comparison has trust in the scientific community and in medical and government institutions overseeing the lasix response.

General Social Survey, NORC at the University of Chicago Yet, regardless of the public’s trust in science, the U.S. Has the most hypertension cases and deaths worldwide and one of the highest rates. This raises an important question.

Is public trust in science enough to drive actions at a scale sufficient to effectively combat a nationwide emergency like that of a lasix?. The answer seems to be “no.” In some countries with far less trust in science (including Taiwan and South Korea, according to the new polling data from Pew), the novel hypertension has been better contained. It is difficult to know exactly why Taiwan’s and South Korea’s responses seem to be more effective, and it is important to note that comparing hypertension data among countries is difficult for multiple reasons.

But something is different. Taiwan, for instance, has 23 million people, but has seen only 500 cases and seven deaths. Credit.

Amanda Montañez. Sources. Science and Scientists Held in High Esteem across Global Publics.

Cary Funk, Alec Tyson, Brian Kennedy and Courtney Johnson. Pew Research Center, September 2020 (survey data). hypertension medications Dashboard, Center for Systems Science and Engineering, Johns Hopkins University (hypertension medications data) Taiwan attributes its effective response to its memory of the significant effects of the 2003 SARS outbreak in the country.

Early recognition of mysterious pneumonia cases in China and suspicions that Beijing was not being transparent about them spurred Taiwan’s government to act quickly. They setup a command center, screened all passengers coming in from Wuhan, China, put in place early travel restrictions, required a 14 day quarantine for all foreign arrivals, and implemented contact tracing and testing weeks before many other countries reacted. Taiwan also has had no problem convincing people to wear masks given the recent memory of the havoc caused by the 2003 SARS outbreak.

Of those polled in the Pew survey from Taiwan, only 17 percent of respondents said they had a lot of trust in scientists to do what is right for their country. Taiwan had the second lowest reported trust in scientists in the poll (behind South Korea at 14 percent). Among the countries polled in Pew’s data, 59 percent of those polled in India said that they trust scientists a lot to do what is right for their country—more than any other country polled in the survey.

India currently has over 5.6 million hypertension cases and is predicted to overtake the U.S. As the nation worst-hit by the lasix. A lockdown was imposed in India during March, but a study released by the Indian Council of Medical Research suggests that it was leaky, with transmission occurring as people poured out of cities into rural areas.

Low testing rates, poor social protections, and a fragile health care system also have likely led to the spread of the lasix in the country. The U.S., India, South Korea and Taiwan are not the only cases where public trust in science does not match the number of hypertension cases, deaths or rates of a country. Instead, each case seems more dependent on government response (and likely, in the case of Taiwan, a recent memory of the devastation a viral epidemic can cause).

Just as with our response to climate change, individual actions do not seem to be solely enough to solve such a large science-based issue. And if our government’s response affects the spread of the hypertension more than our individual actions, the U.S. May be in worse trouble than previously thought.

While the U.S. Public overall trusts the scientific community, many of the country’s responses have been driven by politics rather than scientific evidence. We at the Union of Concerned Scientists have now documented over 160 instances since 2017 where politics have trumped scientific evidence in decisions that affect public health and safety.

On the federal government’s response to the hypertension specifically, we have seen federal scientists ignored, censored, bullied and accused of sedition. This is all not to say that public trust in science or that wearing a mask when you leave your home are not important. They are both very important so please keep trusting in science and donning those masks!.

But if we are hoping that such trust in science will be enough to drive the huge collective actions needed to keep the novel hypertension from spreading, I’m afraid such hope may be misplaced. What we need more than ever is a coordinated and effective science-based response from government leaders. The public trusts the science, but our leaders must too.

We certainly do not have that at this moment..

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Recent diversity efforts from the Physician Assistant Studies program have resulted in a double-digit increase over the past two years in the number of students underrepresented in medicine accepted to their incoming mag 3 lasix renal scan cohorts. The HRSA grant will support an expansion of the recruiting and retention efforts of these students, to surpass the national average for physician assistant programs. Furthermore, the UAB PA program will intensify their efforts to facilitate the education of U.S. Military veterans to honor their service and mag 3 lasix renal scan the history of the program. UAB PA is the second-oldest program in the nation and was founded by military veterans in 1968.This is the second HRSA grant for the UAB Physician Assistant Studies program, which is housed in the School of Health Professions.

In 2004, the program was awarded a grant to conduct risk assessments for sexually transmitted diseases and HIV. That grant resulted in the development of curriculum on recognizing risk behaviors in patients, and the training was also offered to visiting PA mag 3 lasix renal scan students from other programs across the country.Start Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to clarify and expand the authority for certain Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under section VI of this Declaration. This amendment is effective as of August 4, 2021. Start Further mag 3 lasix renal scan Info L.

Paige Ezernack, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. 202-260-0365, paige.ezernack@hhs.gov. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered mag 3 lasix renal scan Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2.

It amended the Public Health Service (PHS) Act, adding section 319F-3, which mag 3 lasix renal scan addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively mag 3 lasix renal scan. Section 319F-3 of the PHS Act has been amended by the lasix and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013, and the hypertension Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, 2020, to expand Covered Countermeasures under the PREP Act.

On January 31, 2020, the former Secretary, Alex M. Azar II, declared a public health emergency mag 3 lasix renal scan pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the hypertension medications outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021. On March 10, 2020, former Secretary Azar issued a Declaration under the PREP Act for mag 3 lasix renal scan medical countermeasures against hypertension medications (85 FR 15198, Mar.

17, 2020) (the Declaration). On April 10, the former Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020) mag 3 lasix renal scan. On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm hypertension medications might otherwise cause. (85 FR 35100, June 8, 2020).

On August 19, the former Secretary amended the declaration to add additional categories of Qualified Persons mag 3 lasix renal scan and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures. (85 FR 52136, August 24, 2020). On December 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP Act and the Secretary's Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond. Added an additional category of qualified persons under Section mag 3 lasix renal scan V of the Declaration. Made explicit that the Declaration covers all qualified lasix and epidemic products as defined under the PREP Act.

Added a third method of distribution to provide liability protections for, among other things, private distribution channels. Made explicit that there mag 3 lasix renal scan can be Start Printed Page 41978situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests in having a unified whole-of-nation response to the hypertension medications lasix among federal, state, local, and private-sector entities. Revised the effective time period of the Declaration. And republished the declaration in mag 3 lasix renal scan full.

(85 FR 79190, December 9, 2020). On February 2, 2021, the Acting Secretary Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 7872, February 2, 2021). On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 9516, February 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and mag 3 lasix renal scan correcting the description of qualified persons added by the February 16, 2021 amendment. (86 FR 10588, February 22, 2021). On March 11, 2021, the Acting Secretary amended the Declaration to add additional Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration.

(86 FR 14462 March 16, 2021) mag 3 lasix renal scan. Secretary Xavier Becerra now amends section V of the Declaration to revise subsections (d) and (f) to clarify that qualified pharmacy technicians are Qualified Persons covered by the Declaration, and to expand the scope of authority for qualified pharmacy technicians to administer seasonal influenza treatments to adults within the state where they are authorized to practice and for interns to administer seasonal influenza treatments to adults consistent with other terms and conditions of the Declaration. Accordingly, subsection V(d) authorizes. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians mag 3 lasix renal scan who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older.

Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA. Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s).

Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V.

In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments. If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix.

The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), Start Printed Page 41979complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Further, the initial phrase of subsection V(f) is revised to state authorize “Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration. . .

.” Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under the PREP Act has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C.

247d-6d(i)(8) By this amendment to the Declaration, the Secretary clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B). First, the amendment clarifies that qualified pharmacy technicians are authorized to administer Childhood vaccinations and hypertension medications vaccinations that are Covered Countermeasures under section VI of this Declaration. The Department has authorized qualified pharmacy technicians to administer these treatments under section V(a) of the Declaration through Guidance issued by the Assistant Secretary for Health.[] This amendment adds qualified pharmacy technicians to section V(d) of the Declaration, to clarify that these healthcare professionals are authorized subject to the conditions stated in that subsection. In addition, the amendment expands the authorization for qualified pharmacy technicians and interns to administer seasonal influenza treatments under the supervision of a pharmacist to persons aged 19 and older consistent with ACIP recommendations. The Secretary anticipates that there will be a need for the adult population to receive both hypertension medications and seasonal influenza treatments throughout the 2021-2022 influenza season.

Health risks may increase for individuals who contract seasonal influenza concurrently with hypertension medications, thus expanding the scope of authorized vaccinators for seasonal influenza lessens the harm otherwise caused by hypertension medications. While influenza incidence was lower than anticipated last fall and winter, the same cannot be assumed for the 2021-2022 flu season, as states have largely lifted the community mitigation measures previously in place at the height of the hypertension medications lasix. Seasonal influenza has the potential to inflict significant burden and strain on the U.S. Healthcare system in its own right. And in conjunction with the ongoing hypertension medications lasix, a spike in influenza cases could overwhelm healthcare providers.

Like the vaccination against hypertension medications, the vaccination against influenza requires many people to be vaccinated within a short period of time, potentially creating a surge on the system. Concern also remains regarding the emergence of hypertension variants and their potential to cause disease both among vaccinated and unvaccinated populations. It is yet to be determined if hypertension medications treatment boosters will be recommended. However, if boosters become necessary, allowing pharmacy interns and technicians to administer both hypertension medications treatments and influenza treatments would allow states maximum flexibility in limiting potential impacts of both illnesses. ACIP also recently voted unanimously in favor of hypertension medications and influenza treatment co-administration.[] Like hypertension medications treatments, influenza treatments are administered as intramuscular (IM) injections, and would require minimal, if any, additional training to administer, and would not place any undue training burden on providers.

As qualified persons, these qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering hypertension medications treatments or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized hypertension medications diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” Start Printed Page 41980specified in this declaration from administering a covered countermeasure is likewise preempted.

In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law. The plain language of the PREP Act makes clear that there is preemption of state law as described above. Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by hypertension medications as it will enable States to quickly expand the vaccination workforce with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the hypertension medications countermeasure program. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against hypertension medications. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against hypertension medications, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, and as amended on February 2, 2021, and as amended March 11, 2021, is further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below.

All other sections of the Declaration remain in effect as republished at 85 FR 79190 (December 9, 2020). 1. Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. €œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an Emergency, as that term is defined in Section VII of this Declaration; [] (b) Any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) Any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act.

(d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv.

In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the Start Printed Page 41981recognition and treatment of emergency reactions to treatments. Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.

Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate. And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). (e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice.

When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice. Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services. (f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a hypertension medications vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to. (i) Documentation of completion of the Centers for Disease Control and Prevention hypertension medications (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the hypertension medications treatment(s) to be administered. (g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure.

Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met. The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph. 1. Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered.

2. Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General. 3. Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, Start Printed Page 41982podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. Subject to the following requirements.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii. Vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii.

The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention hypertension medications treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments. Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the hypertension medications treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments. V. The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi.

The healthcare professionals and students must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. And vii. The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures. 2. Effective Time Period, section XII, delete in full and replace with.

Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024. Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024. Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first. Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect. Or (b) October 1, 2024.

Whichever occurs first. Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to administer seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021. Liability protections for Qualified Persons under section V(f) of the Declaration begin on February 2, 2021, and last through October 1, 2024. Liability protections for Qualified Persons under section V(g) of the Declaration begin on February 16, 2021, and last through October 1, 2024. Liability protections for Qualified Persons who are physicians, advanced practice registered nurses, registered nurses, or practical nurses under section V(h) of the Declaration begins on February 2, 2021 and last through October 1, 2024, with additional conditions effective as of March 11, 2021and liability protections for all other Qualified persons under section V(h) begins on March 11, 2021 and last through October 1, 2024.

Authority. 42 U.S.C. 247d-6d. Start Signature Dated. July 30, 2021.

Xavier Becerra, Secretary, Department of Health and Human Services.

And decrease the stigma of mental illness, in an effort lasix price comparison to improve the cognitive, behavioral and emotional well-being of the patient population in which they will ultimately serve,” Gilford said. Recent diversity efforts from the Physician Assistant Studies program have resulted in a double-digit increase over the past two years in the number of students underrepresented in medicine accepted to their incoming cohorts. The HRSA grant will support an expansion of the recruiting and retention efforts of these students, to surpass the national average for physician assistant programs. Furthermore, the UAB PA program will lasix price comparison intensify their efforts to facilitate the education of U.S.

Military veterans to honor their service and the history of the program. UAB PA is the second-oldest program in the nation and was founded by military veterans in 1968.This is the second HRSA grant for the UAB Physician Assistant Studies program, which is housed in the School of Health Professions. In 2004, the program was awarded a lasix price comparison grant to conduct risk assessments for sexually transmitted diseases and HIV. That grant resulted in the development of curriculum on recognizing risk behaviors in patients, and the training was also offered to visiting PA students from other programs across the country.Start Preamble Notice of amendment.

The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to clarify and expand the authority for certain Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under section VI of this Declaration. This amendment is effective lasix price comparison as of August 4, 2021. Start Further Info L. Paige Ezernack, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

202-260-0365, paige.ezernack@hhs.gov lasix price comparison. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law lasix price comparison 109-148, Division C, § 2.

It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C. 247d-6d and lasix price comparison 42 U.S.C. 247d-6e, respectively.

Section 319F-3 of the PHS Act has been amended by the lasix and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013, and the hypertension Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, 2020, to expand Covered Countermeasures under the PREP Act. On January 31, lasix price comparison 2020, the former Secretary, Alex M. Azar II, declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the hypertension medications outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October lasix price comparison 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021. On March 10, 2020, former Secretary Azar issued a Declaration under the PREP Act for medical countermeasures against hypertension medications (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the former Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES lasix price comparison Act (85 FR 21012, Apr.

15, 2020). On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm hypertension medications might otherwise cause. (85 FR 35100, lasix price comparison June 8, 2020). On August 19, the former Secretary amended the declaration to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures.

(85 FR 52136, August 24, 2020). On December lasix price comparison 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP Act and the Secretary's Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond. Added an additional category of qualified persons under Section V of the Declaration. Made explicit that the Declaration covers all qualified lasix and epidemic products as defined under the PREP Act.

Added a third method of distribution to provide liability protections for, lasix price comparison among other things, private distribution channels. Made explicit that there can be Start Printed Page 41978situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests in having a unified whole-of-nation response to the hypertension medications lasix among federal, state, local, and private-sector entities. Revised the effective time period of lasix price comparison the Declaration.

And republished the declaration in full. (85 FR 79190, December 9, 2020). On February 2, 2021, the Acting Secretary lasix price comparison Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 7872, February 2, 2021). On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 9516, February 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and correcting the description of qualified persons added by the February 16, 2021 amendment.

(86 FR 10588, February 22, 2021). On March 11, 2021, the Acting Secretary amended the Declaration to add additional lasix price comparison Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration. (86 FR 14462 March 16, 2021). Secretary Xavier Becerra now amends section V of the Declaration to revise subsections (d) and (f) to clarify that qualified pharmacy technicians are Qualified Persons covered by the Declaration, and to expand the scope of authority for qualified pharmacy technicians to administer seasonal influenza treatments to adults within the state where they are authorized to practice and for interns to administer seasonal influenza treatments to adults consistent with other terms and conditions of the Declaration.

Accordingly, subsection V(d) authorizes lasix price comparison. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under lasix price comparison their supervision are qualified persons only if the following requirements are met.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s).

Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE.

This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), Start Printed Page 41979complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Further, the initial phrase of subsection V(f) is revised to state authorize “Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration. .

. .” Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under the PREP Act has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed.

Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8) By this amendment to the Declaration, the Secretary clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B). First, the amendment clarifies that qualified pharmacy technicians are authorized to administer Childhood vaccinations and hypertension medications vaccinations that are Covered Countermeasures under section VI of this Declaration.

The Department has authorized qualified pharmacy technicians to administer these treatments under section V(a) of the Declaration through Guidance issued by the Assistant Secretary for Health.[] This amendment adds qualified pharmacy technicians to section V(d) of the Declaration, to clarify that these healthcare professionals are authorized subject to the conditions stated in that subsection. In addition, the amendment expands the authorization for qualified pharmacy technicians and interns to administer seasonal influenza treatments under the supervision of a pharmacist to persons aged 19 and older consistent with ACIP recommendations. The Secretary anticipates that there will be a need for the adult population to receive both hypertension medications and seasonal influenza treatments throughout the 2021-2022 influenza season. Health risks may increase for individuals who contract seasonal influenza concurrently with hypertension medications, thus expanding the scope of authorized vaccinators for seasonal influenza lessens the harm otherwise caused by hypertension medications.

While influenza incidence was lower than anticipated last fall and winter, the same cannot be assumed for the 2021-2022 flu season, as states have largely lifted the community mitigation measures previously in place at the height of the hypertension medications lasix. Seasonal influenza has the potential to inflict significant burden and strain on the U.S. Healthcare system in its own right. And in conjunction with the ongoing hypertension medications lasix, a spike in influenza cases could overwhelm healthcare providers.

Like the vaccination against hypertension medications, the vaccination against influenza requires many people to be vaccinated within a short period of time, potentially creating a surge on the system. Concern also remains regarding the emergence of hypertension variants and their potential to cause disease both among vaccinated and unvaccinated populations. It is yet to be determined if hypertension medications treatment boosters will be recommended. However, if boosters become necessary, allowing pharmacy interns and technicians to administer both hypertension medications treatments and influenza treatments would allow states maximum flexibility in limiting potential impacts of both illnesses.

ACIP also recently voted unanimously in favor of hypertension medications and influenza treatment co-administration.[] Like hypertension medications treatments, influenza treatments are administered as intramuscular (IM) injections, and would require minimal, if any, additional training to administer, and would not place any undue training burden on providers. As qualified persons, these qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering hypertension medications treatments or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized hypertension medications diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption.

This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” Start Printed Page 41980specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law. The plain language of the PREP Act makes clear that there is preemption of state law as described above.

Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by hypertension medications as it will enable States to quickly expand the vaccination workforce with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the hypertension medications countermeasure program. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against hypertension medications. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against hypertension medications, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, and as amended on February 2, 2021, and as amended March 11, 2021, is further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as republished at 85 FR 79190 (December 9, 2020).

1. Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. €œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an Emergency, as that term is defined in Section VII of this Declaration; [] (b) Any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act.

(c) Any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s).

Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the Start Printed Page 41981recognition and treatment of emergency reactions to treatments. Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE.

This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). (e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice. When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice.

Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services. (f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a hypertension medications vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to. (i) Documentation of completion of the Centers for Disease Control and Prevention hypertension medications (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the hypertension medications treatment(s) to be administered. (g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure.

Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met. The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph. 1.

Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. 2. Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General. 3.

Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, Start Printed Page 41982podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. Subject to the following requirements. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. Vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii. The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention hypertension medications treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments.

Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the hypertension medications treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments. V. The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi.

The healthcare professionals and students must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. And vii. The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program.

Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures.

2. Effective Time Period, section XII, delete in full and replace with. Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024. Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024.

Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first. Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect. Or (b) October 1, 2024. Whichever occurs first.

Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to administer seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021. Liability protections for Qualified Persons under section V(f) of the Declaration begin on February 2, 2021, and last through October 1, 2024. Liability protections for Qualified Persons under section V(g) of the Declaration begin on February 16, 2021, and last through October 1, 2024. Liability protections for Qualified Persons who are physicians, advanced practice registered nurses, registered nurses, or practical nurses under section V(h) of the Declaration begins on February 2, 2021 and last through October 1, 2024, with additional conditions effective as of March 11, 2021and liability protections for all other Qualified persons under section V(h) begins on March 11, 2021 and last through October 1, 2024.

Authority. 42 U.S.C. 247d-6d. Start Signature Dated.

Where should I keep Lasix?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Throw away any unused medicine after the expiration date.

Lasix cost per pill

Start Preamble lasix cost per pill Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS). Agency Order. The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces a new Order under Section 361 of the lasix cost per pill Public Health Service Act to temporarily halt residential evictions in communities with substantial or high transmission of hypertension medications to prevent the further spread of hypertension medications. This Order is effective August 3, 2021 through October 3, 2021. Start Further Info Tiffany Brown, Deputy Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton lasix cost per pill Road NE, MS H21-10, Atlanta, GA 30329.

Phone. 404-639-7000. Email. Cdcregulations@cdc.gov. End Further Info End Preamble Start Supplemental Information Background On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein.

That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission. Section 502 of Title V, Division N of the Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021, and approved the Order as an exercise of the CDC's authority under Section 361 of the Public Health Service Act (42 U.S.C. 264). With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears. Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan.

The Order was extended multiple times due to the changing public health landscape and expired on July 31, 2021 after what was intended to be the final extension.[] Absent an unexpected change in the trajectory of the lasix, CDC did not plan to extend the Order further. Following the recent surge in cases brought forth by the highly transmissible Delta variant, the CDC Director now issues a new Order temporarily halting evictions for persons in counties or U.S. Territories experiencing substantial or high rates of transmission, for the reasons described herein. It is more limited in scope than prior orders, intended to target specific areas of the country where cases are rapidly increasing, which likely would be exacerbated by mass evictions. Accordingly, subject to the limitations listed in the new Order, a landlord, owner of a residential property, or [] person with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any county or U.S.

Territory while the county or territory is experiencing substantial or high levels of community transmission levels of hypertension. This Order will expire on October 3, 2021, but is subject to further extension, modification, or rescission based on public health circumstances.[] A copy of the Order is provided below. A copy of the signed Order and Declaration form can be found at https://www.cdc.gov/​hypertension/​2019-ncov/​hypertension medications-eviction-declaration.html. Start Printed Page 43245 Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 Code of Federal Regulations 70.2 Temporary Halt in Residential Evictions in Communities With Substantial or High Levels of Community Transmission of hypertension medications To Prevent the Further Spread of hypertension medications Summary The U.S.

Centers for Disease and Control (CDC) is issuing a new order temporarily halting evictions in counties with heightened levels of community transmission in order to respond to recent, unexpected developments in the trajectory of the hypertension medications lasix, including the rise of the Delta variant. It is intended to target specific areas of the country where cases are rapidly increasing, which likely would be exacerbated by mass evictions. Accordingly, subject to the limitations under “Applicability,” a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any county or U.S. Territory while the county or territory is experiencing substantial or high levels of community transmission of hypertension. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member.

“Available housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate federal, state, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. “Covered person” [] means any tenant, lessee, or resident of a residential property who provides to their landlord, the owner of the residential property, or other person with a legal right to pursue eviction or a possessory action,[] a declaration [] under penalty of perjury indicating that. (1) The individual has used best efforts to obtain all available governmental assistance for rent or housing. (2) The individual either (i) earned no more than $99,000 (or $198,000 if filing jointly) in Calendar Year 2020 or expects to earn no more than $99,000 in annual income for Calendar Year 2021 (or no more than $198,000 if filing a joint tax return),[] (ii) was not required to report any income in 2020 to the U.S. Internal Revenue Service, or (iii) received an Economic Impact Payment (stimulus check).[] (3) The individual is unable to pay the full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, a lay-off, or extraordinary [] out-of-pocket medical expenses.

(4) The individual is using best efforts to make timely partial rent payments that are as close to the full rent payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses. (5) Eviction would likely render the individual homeless—or force the individual to move into and reside in close quarters in a new congregate or shared living setting—because the individual has no other available housing options. And (6) The individual resides in a U.S. County experiencing substantial [] or high [] rates of community transmission levels of hypertension as defined by CDC. “Evict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action, to remove or cause the removal of a covered person from a Start Printed Page 43246residential property.

This definition also does not prohibit foreclosure on a home mortgage. “Residential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park,[] or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the state, territorial, tribal, or local jurisdiction. “State” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives.

Mitigating the spread of hypertension medications within crowded, congregate or shared living settings, or through unsheltered homelessness. Mitigating the further spread of hypertension medications from one state or territory into any other state or territory. Mitigating the further spread of hypertension medications by temporarily suspending the eviction of covered persons from residential property for nonpayment of rent. And Supporting response efforts to hypertension medications at the federal, state, local, territorial, and tribal levels. Background hypertension medications in the United States Since January 2020, the respiratory disease known as “hypertension medications,” caused by a novel hypertension (hypertension), has spread globally, including cases reported in all fifty states within the United States, plus the District of Columbia and U.S.

Territories. As of August 3, 2021, there have been almost 200 million cases of hypertension medications globally, resulting in over 4,240,000 deaths.[] Almost 35,000,000 cases have been identified in the United States, with new cases reported daily, and almost 610,000 deaths have been attributed to the disease.[] A renewed surge in cases in the United States began in early July 2021. Case counts rose from 19,000 cases on July 1, 2021 to 103,000 cases on July 30, 2021. Forecasted case counts predict that cases will continue to rise over the next four weeks.[] The lasix that causes hypertension medications spreads very easily and sustainably between people, particularly those who are in close contact with one another (within about 6 feet, but occasionally over longer distances), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Individuals without symptoms can also spread the lasix.[] Among adults, the risk for severe illness from hypertension medications increases with age, with older adults at highest risk.

Severe illness means that persons with hypertension medications may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal. People of any age with certain underlying medical conditions (e.g., cancer, obesity, serious heart conditions, or diabetes) are at increased risk for severe illness from hypertension medications.[] New variants of hypertension have emerged globally,[] several of which have been identified as variants of concern,[] including the Alpha, Beta, Gamma, and Delta variants. These variants of concern have evidence of an increase in transmissibility, which may lead to higher incidence.[] Currently, the Delta variant is the predominant hypertension strain circulating in the United States, estimated to account for over 82% of cases as of July 17, 2021.[] The Delta variant has demonstrated increased levels of transmissibility compared to other variants.[] Furthermore, early evidence suggests that people who are vaccinated and become infected with the Delta variant may transmit the lasix to others.[] Transmission of the Delta variant has led to accelerated community transmission in the United States. CDC recommends assessing the level of community transmission using, at a minimum, two metrics. New hypertension medications cases per 100,000 persons in the last 7 days and percentage of positive hypertension diagnostic nucleic acid amplification tests in the last 7 days.

For each of these metrics, CDC classifies transmission values as low, moderate, substantial, or high. As of August 1, 2021, over 80% of the U.S. Counties were classified as experiencing substantial or high levels of community transmission.[] In areas of substantial or high transmission, CDC recommends community leaders encourage vaccination and universal masking in indoor public spaces in addition to other layered prevention strategies to prevent further spread. hypertension medications treatments are now widely available in the United States, and vaccination is recommended for all people 12 years of age and older. Three hypertension medications treatments are currently authorized by the U.S.

Food and Drug Administration (FDA) for emergency use. Two mRNA treatments and one viral vector treatment, each of which has been determined to be safe and effective against hypertension medications. As of July 28, 2021, over 163 million people in the United States (57.6% of the population 12 years or older) have been fully vaccinated and Start Printed Page 43247over 189 million people in the United States (66.8% of the population 12 years or older) have received at least one dose.[] Changes in treatment uptake and the extreme transmissibility of the Delta variant have resulted in rising numbers of hypertension medications cases, primarily and disproportionately affecting the unvaccinated population. The hypertension medications vaccination effort has a slower rate of penetration among the populations most likely to experience eviction.[] In combination with the continued underlying hypertension medications spread, and the overlapping factors described above, this creates considerable risk for rapid transmission of hypertension medications in high-risk settings. In the context of a lasix, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease.

Eviction moratoria facilitate self-isolation and self-quarantine by people who become ill or who are at risk of transmitting hypertension medications. Congress passed the hypertension Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136) to aid individuals and businesses adversely affected by hypertension medications in March 2020. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with federal assistance or federally related mortgage financing.

These protections helped alleviate the public health consequences of tenant displacement during the hypertension medications lasix. The CARES Act eviction moratorium expired on July 24, 2020. The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and other local officials using emergency powers. Researchers estimated that this temporary federal moratorium provided relief to over one-quarter a material portion of the nation's roughly 43 million renters.[] The CARES act also provided funding streams for emergency rental assistance. Surveys estimate that this assistance became available to the public through rental assistance programs by July 2020.[] The Federal moratorium provided by the CARES Act, however, did not reach all renters.

Many renters who fell outside the scope of the Federal moratorium were instead protected under state and local moratoria. In early March 2021, the Census Household Pulse Survey estimated that 6.4 million households were behind on rent and just under half fear imminent eviction.[] In 2016, research showed that there were 3.6 million eviction filings and 1.5 million eviction judgments over the span of a whole year,[] meaning that the lasix would cause a wave of evictions on a scale that would be unprecedented in modern times. A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus becoming at higher risk of hypertension medications. On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein. That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission.

Section 502 of Title V, Division N of the Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021, and approved the Order as an exercise of the CDC's authority under Section 361 of the Public Health Service Act (42 U.S.C. 264). With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears. Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan Act of 2021. The Order was extended multiple times due to the changing public health landscape and expired on July 31, 2021 after what was intended to be the final extension.[] Absent an unexpected change in the trajectory of the lasix, CDC did not plan to extend the Order further.

Following the recent surge in cases brought forth by the highly transmissible Delta variant, the CDC Director now issues a new Order temporarily halting evictions for persons in counties experiencing substantial or high rates of transmission, for the reasons described herein. This Order will expire on October 3, 2021, but is subject to further extension, modification, or rescission based on public health circumstances. Researchers estimate that, in 2020, Federal, state, and local eviction moratoria led to over 1.5 million fewer evictions filings than the previous year.[] Additional research shows that, despite the CDC eviction moratorium leading to an estimated 50% decrease in eviction filings compared to the historical average,[] there have still been over 450,000 eviction filings during the lasix just within approximately 31 cities and six states with more readily available data. This data covers approximately 1 in 4 renter households in the country, suggesting high demand and likelihood of mass evictions nationwide.[] Eviction, Crowding, and Interstate Transmission of hypertension medications By February 10, 2021, the U.S. Department of the Treasury had paid all of the $25 billion made available by the Consolidated Appropriations Act, 2021 to states, territories, localities and tribes for the purpose of providing emergency rental assistance to eligible households in their jurisdictions.

Additionally, as directed in the Act, Treasury has also made available 40 percent—more than $8.6 billion—of the additional funding to states, territories and localities for emergency rental assistance provided in the American Rescue Plan Act of 2021. While some emergency rental assistance programs were slow to open, every State program had opened by early June. Based on data collected from grantees, Treasury reports that over 85,000 renter households received rental and utility Start Printed Page 43248assistance to support their housing stability by the end of March and this number increased to more than 100,000 in April, more than 156,000 in May and over 290,000 in June. Though emergency rental assistance has clearly started to reach increasing numbers of families over recent months, state and local agencies have hundreds of thousands of applications for assistance that currently remain outstanding as programs accelerate their activity. The level of assistance continued to increase in June, with nearly 300,000 households served.

Based on analysis of grantee reporting, Treasury believes that the monthly deployment of rental assistance by state and local emergency rental assistance programs will continue to increase from the significant deployment in June. In addition to Emergency Rental Assistance, there are coordinated efforts across Federal agencies to—in partnership with states and localities—promote eviction prevention strategies. Recent data from the U.S. Census Household Pulse Survey demonstrates that just under half of households behind on rent believe that an eviction is likely in the next two months.[] A surge in evictions could lead to the immediate and significant movement of large numbers of persons from lower density to higher density housing at a time in the United States when the highly transmissible Delta variant is driving hypertension medications cases at an unprecedented rate. Evicted renters must move, which leads to multiple outcomes that increase the risk of hypertension medications spread.

Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. These moves may require crossing state borders. According to the 2017 Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding. Studies show that hypertension medications transmission occurs readily within households. The secondary attack rate in households has been estimated to be 17%, and household contacts are estimated to be 6 times more likely to become infected by an index case of hypertension medications than other close contacts.[] A study of pregnant women in New York City showed that women in large households (greater number of residents per household) were three times as likely to test positive for hypertension than those in smaller households, and those in neighborhoods with greater household crowding (>1 resident per room) were twice as likely to test positive.[] Throughout the United States, counties with the highest proportion of crowded households have experienced hypertension medications mortality rates 2.6 times those of counties with the lowest proportion of crowded households.

Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing and domestic violence and abuse shelters. Special considerations exist for such housing because of the challenges of maintaining social distance. Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, chronic health conditions, cognitive decline, or limited access to technology, and thus may find it more difficult to take actions to protect themselves from hypertension medications.

CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms. Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures. Modeling studies and observational data from the pre-treatment phase of the hypertension medications lasix comparing incidence between states that implemented and lifted eviction moratoria indicate that evictions substantially contribute to hypertension medications transmission. In mathematical models where eviction led exclusively to sharing housing with friends or family, lifting eviction moratoria led to a 30% increased risk of contracting hypertension medications among people who were evicted and those with whom they shared housing after eviction.[] Compared to a scenario where no evictions occurred, the models also predicted a 4%-40% increased risk of , even for those who did not share housing, as a result of increased overall transmission. The authors estimated that anywhere from 1,000 to 100,000 excess cases per million population could be attributable to evictions depending on the eviction and rates.

An analysis of observational data from state-based eviction moratoria in 43 states and the District of Columbia showed significant increases in hypertension medications incidence and mortality approximately 2-3 months after eviction moratoria were lifted.[] Specifically, the authors compared the hypertension medications incidence and mortality rates in states that lifted their moratoria with the rates in states that maintained their moratoria. In these models, the authors accounted for time-varying indicators of each state's test count as well as major public-health interventions including lifting stay-at-home orders, school closures, and mask mandates. After adjusting for these other changes, they found that the incidence of hypertension medications in states that lifted their moratoria was 1.6 times that of states that did not at 10 weeks post-lifting (95% CI 1.0, 2.3), a ratio that grew to 2.1 at ≥16 weeks (CI 1.1, 3.9). Similarly, they found that mortality in states that lifted their moratoria was 1.6 times that of states that did not at 7 weeks post-lifting (CI 1.2, 2.3), a ratio that grew to 5.4 at ≥16 weeks (CI 3.1, 9.3). The authors estimated that, nationally, over 433,000 cases of hypertension medications and over 10,000 deaths could be attributed to lifting state moratoria.[] Although data are limited, available evidence suggests evictions lead to interstate spread of hypertension medications in two ways.

First, an eviction may lead the evicted members of a household to move across state lines. Of the 35 million people in America who move each year, 15% move to a new state. Second, even if a particular eviction, standing alone, would not always result in interstate displacement, the mass Start Printed Page 43249evictions that would occur in the absence of this Order would inevitably increase the interstate spread of hypertension medications. This Order cannot effectively mitigate interstate transmission of hypertension medications without covering intrastate evictions (evictions occurring within the boundaries of a state or territory), as the level of spread of hypertension resulting from these evictions can lead to hypertension transmission across state borders. Moreover, intrastate spread facilitates interstate spread in the context of communicable disease spread, given the nature of infectious disease.

In the aggregate, the mass-scale evictions that will likely occur in the absence of this Order in areas of substantial or high transmission will inevitably increase interstate spread of hypertension medications. Eviction, Homelessness, and hypertension medications Transmission Evicted individuals without access to support or other assistance options may become homeless, including older adults or those with underlying medical conditions, who are more at risk for severe illness from hypertension medications than the general population. In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Data collection by an emergency shelter in Columbus, Ohio, showed that 35.4% of families and 11.4% of single adults reported an eviction as the primary or secondary reason for their seeking shelter.[] Extensive outbreaks of hypertension medications have been identified in homeless shelters. In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members.

In Boston, Massachusetts, universal hypertension medications testing at a single shelter revealed 147 cases, representing 36% of shelter residents. hypertension medications testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested). Data from 634 universal diagnostic testing events at homeless shelters in 21 states show an average of 6% positivity among shelter clients. Data comparing the incidence or severity of hypertension medications among people experiencing homelessness directly to the general population are limited. However, during the 15-day period of the outbreak in Boston, MA, researchers estimated a cumulative incidence of 46.3 cases of hypertension medications per 1000 persons experiencing homelessness, as compared to 1.9 cases per 1000 among Massachusetts adults (pre-print).

Among other things, CDC guidance recommends increasing physical distance between beds in homeless shelters, which is likely to decrease capacity, while community transmission of hypertension medications is occurring. To adhere to this guidance, shelters have limited the number of people served throughout the United States. In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above. Application of hypertension medications Prevention Strategies Based on Community Transmission CDC recommends strengthening or adding effective hypertension medications mitigation strategies in communities with considerable transmission risk.

As discussed above, CDC guidance specifies that everyone, regardless of vaccination status, should wear masks in indoor and public settings in communities experiencing substantial or high rates of community transmission. Similarly, CDC guidance for homeless shelters recommends maintaining layered hypertension medications precautions as long as community transmission is occurring and provides options for scaling back precautions when community transmission is low.[] Eviction moratoria represent a hypertension medications transmission prevention measure that can similarly be applied when the epidemiological context is appropriate, for example in communities with substantial or high transmission of hypertension medications.[] Prevention strategies like these should only be relaxed or lifted after two weeks of continuous sustained improvement in the level of community transmission. In areas with low or no hypertension transmission and with testing capacity in place to detect early introduction or increases in spread of the lasix, layered prevention strategies might be removed one at a time while monitoring closely for any evidence that hypertension medications cases are increasing. Decisions to add or remove prevention strategies should be based on local data and public health recommendations. The emergence of more transmissible hypertension variants, including Delta, increases the urgency for public health agencies and other organizations to collaboratively monitor the status of the lasix in their communities and continue to apply layered prevention strategies.

Persons at Higher Risk of Eviction May Also Be at Higher Risk of Being Unvaccinated Communities with high rates of eviction have been shown to have lower coverage of hypertension medications vaccination—a focus for current vaccination campaigns. A study in the spring of 2021 showed that counties with high social vulnerability (i.e., social and structural factors associated with adverse health outcome inclusive of socioeconomic indicators related to risk of eviction) had lower levels of hypertension medications vaccination.[] CDC Eviction Moratorium The Department of the Treasury has made funding available to states, territories, localities, and Tribal governments, which continue to distribute emergency rental assistance funds that may help mitigate spikes in hypertension medications transmission due to increases in evictions. Alongside other federal and state efforts to prevent evictions, these funds are expected to make a meaningful difference for hundreds of thousands of people who are expected to receive the rental assistance.[] On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein. That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission. Section 502 of Title V, Division N of the Start Printed Page 43250Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021.

With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears. Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan. On January 29, 2021, following an assessment of the ongoing lasix, the CDC Director renewed the Order until March 31, 2021. On March 28, the CDC Director renewed the Order until June 30, 2021. On June 24, the CDC Director renewed the Order until July 31, 2021 (July Order).

The CDC Director indicated that the July Order would be the final extension of the nationwide eviction moratorium absent an unexpected change in the trajectory of the lasix. Unfortunately, the rise of the Delta variant and corresponding rise in cases in numerous counties in the United States have altered the trajectory of the lasix. As a result, CDC is issuing this narrower, more targeted Order to temporarily halt evictions in the hardest hit areas. Without this Order, evictions in these areas would likely exacerbate the increase in cases. To the extent any provision of this Order conflicts with prior Orders, this Order is controlling.

Applicability This Order applies in U.S. Counties [] experiencing substantial [] and high [] levels of community transmission levels of hypertension as defined by CDC, as of August 3, 2021. If a U.S. County that is not covered by this Order as of August 3, 2021 later experiences substantial or high levels of community transmission while this Order is in effect, then that county will become subject to this Order as of the date the county begins experiencing substantial or high levels of community transmission. If a U.S.

County that is covered by this Order no longer experiences substantial or high levels of community transmission for 14 consecutive days, then this Order will no longer apply in that county, unless and until the county again experiences substantial or high levels of community transmission while this Order is in effect. This Order does not apply in any state, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order or to the extent its application is prohibited by Federal court order. In accordance with 42 U.S.C. 264(e), this Order does not preclude state, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order. This Order is a temporary eviction moratorium to prevent the further spread of hypertension medications.

This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Nothing in this Order precludes evictions based on a tenant, lessee, or resident. (1) Engaging in criminal activity while on the premises. (2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property.

(4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Any evictions for nonpayment of rent initiated prior to issuance of this Order but not yet completed, are subject to this Order. Any tenant, lessee, or resident of a residential property who previously submitted a Declaration, still qualifies as a “Covered Person” and is still present in a rental unit is entitled to protections under this Order. Any eviction that was completed before issuance of this Order including from August 1 through August 3, 2021 is not subject to this Order, as it does not operate retroactively.

Under this Order, covered persons may be evicted for engaging in criminal activity while on the premises. But covered persons may not be evicted on the sole basis that they are alleged to have committed the crime of trespass (or similar state-law offense) where the underlying activity is a covered person remaining in a residential property for nonpayment of rent. Permitting such evictions would result in substantially more evictions overall, thus increasing the risk of disease transmission as otherwise covered persons move into congregate settings or experience homelessness. This result would be contrary to the stated objectives of this Order, and therefore would diminish their effectiveness. Moreover, to the extent such criminal trespass laws are invoked to establish criminal activity solely based on a tenant, lessee, or resident of a residential property remaining in a residential property despite the nonpayment of rent, such invocation conflicts with this Order and is preempted pursuant to 42 U.S.C.

264(e). Individuals who are confirmed to have, who have been exposed to, or who might have hypertension medications and take reasonable precautions to not spread the disease may not be evicted on grounds that they may pose a health or safety threat to other residents. This Order is in effect through October 3, 2021, based on the current and projected epidemiological context of hypertension transmission throughout the United States. This timeframe will allow the assessment of natural changes to hypertension medications incidence, the influences of new variants, additional distribution of emergency rental assistance funds, and the expansion of hypertension medications treatment uptake. Declaration Forms To qualify for the protections of this Order, a tenant, lessee, or resident of a residential property must provide a completed and signed copy of a declaration with the elements listed in the definition of “Covered person” to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live.

To assist tenants and landlords, the CDC created a standardized declaration form that can be downloaded here. Https://www.cdc.gov/​hypertension/​2019-ncov/​downloads/​declaration-form.pdf. Tenants, lessees, and residents of residential property are not obligated to use the CDC form. Any written document that an eligible tenant, lessee, or resident of residential property presents to their landlord will comply with this Order, as long as it contains the required elements of “Covered person” as described in this Order. In Start Printed Page 43251addition, tenants, lessees, and residents of residential property are allowed to declare in writing that they meet the elements of “Covered person” in other languages.

All declarations, regardless of form used, must be signed, and must include a statement that the tenant, lessee, or resident of a residential property understands that they could be liable for perjury for any false or misleading statements or omissions in the declaration. This Order does not preclude a landlord challenging the truthfulness of a tenant's, lessee's, or resident's declaration in court, as permitted under state or local law. In certain circumstances, such as individuals filing a joint tax return, it may be appropriate for one member of the residence to provide an executed declaration on behalf of the other adult residents party to the lease, rental agreement, or housing contract. The declaration may be signed and transmitted either electronically or by hard copy. As long as the information in a previously signed declaration submitted under a previous order remains truthful and accurate, covered persons do not need to submit a new declaration under this Order.

However, eligibility for protection will be based on the terms of this Order. Findings and Action Determination For the reasons described herein, I have determined based on the information below that issuing a temporary halt in evictions in counties experiencing substantial or high levels of hypertension medications transmission constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of hypertension medications throughout the United States. I have further determined that measures by states, localities, or territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of hypertension medications. State and local jurisdictions continue to distribute emergency rental assistance funds, provided by the Department of Treasury, that will help avert a spate of evictions and thus mitigate corresponding spikes in hypertension medications transmission. Trends have dramatically worsened since June 2021 and transmission is rapidly accelerating in the United States.[] Congress has appropriated approximately $46 billion—of which almost three-quarters is currently available to state and local grantees—to help pay rent and rental arrears for tenants who may otherwise be at high risk of eviction.

According to estimates based on the U.S. Census Household Pulse Survey, approximately 6.9 million renter households were behind on their rent in late June. At that time, about 4.6 million renter households were concerned that they could not pay next month's rent. The successful delivery of those funds by states and localities should greatly reduce the incidence of eviction that would occur in the absence of that support. However, many states and localities are still ramping up the collection and processing of applications and the delivery of assistance and putting in place other eviction prevention strategies.

It was only in the beginning of June that all state-run emergency rental assistance programs had opened for applications. If the moratorium is not in place, a wave of evictions, on the order of hundreds of thousands, could occur in late summer and early fall, exacerbating the spread of hypertension medications among the significant percentage of the population that remains unvaccinated. In appropriating these emergency rental assistance funds, Congress intended that the funding would work in concert with the eviction moratorium, providing time for rental assistance to reach eligible tenants and landlords to sustainably reduce the threat of an eviction wave after an eviction moratorium was no longer in effect. While the pace of assistance is continuing to increase, without additional time for states and localities to deliver this needed relief and engage in other efforts to prevent evictions, a surge of evictions would occur upon the conclusion of the national moratorium. A surge in evictions would lead to immediate movement, crowding, and increased stress on the homeless service system.

In combination with surging hypertension medications rates across the country, and the overlapping factors described above, this would create considerable risk for the rapid transmission of hypertension medications in high-risk settings. Based on the convergence of these issues, I have determined that issuing a new Order temporarily halting evictions is appropriate. Accordingly, a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action shall not evict any covered person from any residential property in any county or U.S. Territory while hypertension medications transmission is substantial or high and the relevant state, county, locality, or territory has provided a level of public-health protections below the requirements listed in this Order. This Order is not a rule within the meaning of the Administrative Procedure Act (APA) but rather an emergency action taken under the existing authority of 42 CFR 70.2.

The purpose of section 70.2, which was promulgated through notice-and-comment rulemaking, is to enable CDC to take swift steps to prevent contagion without having to seek a second round of public comments and without a delay in effective date.[] Good Cause In the event this Order qualifies as a rule under the APA, there is good cause to dispense with prior public notice and comment and a delay in effective date. See 5 U.S.C. 553(b)(B), (d)(3). Good cause exists, in sum, because the public health emergency caused by the hypertension medications lasix and the unpredictability of the trajectory of the lasix make it impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. I have determined that good cause exists because the public health emergency caused by hypertension medications makes it impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of the Order.

A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that would have potentially significant public health consequences. I conclude that the delay in the effective date of the Order would defeat the purpose of the Order and endanger the public health and, therefore, determine that immediate action is necessary. The rapidly changing nature of the lasix requires not only that CDC act swiftly, but also deftly to ensure that its actions are commensurate with the threat. This necessarily involves assessing evolving conditions that inform CDC's determinations. Despite promising trends in the spring of 2021, the surge of cases spurred by the Delta variant has confirmed that the fundamental public health threat—of the risk of large numbers of residential evictions contributing to the spread of hypertension medications throughout the United States—continues to exist.

Without this Order, there is every reason to expect that evictions will increase dramatically Start Printed Page 43252at a time when hypertension medications s in the United States are increasing sharply. It is imperative that public health authorities act quickly to mitigate such an increase of evictions, which could increase the likelihood of new spikes in hypertension transmission. Such mass evictions and the attendant public health consequences would be very difficult to reverse. For all of these reasons, I hereby conclude that immediate action is again necessary and that notice-and-comment rulemaking and a delay in effective date would be impracticable and contrary to the public interest. Miscellaneous Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs (OIRA) has determined that it would be an economically significant regulatory action pursuant to Executive Order 12866 and a major rule under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (the Congressional Review Act or CRA), 5 U.S.C.

804(2). Thus, this action has been reviewed by OIRA. CDC has determined that for the same reasons given above, there would be good cause under the CRA to make the requirements herein effective immediately. 5 U.S.C. 808(2).

If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by federal authorities and cooperating state and local authorities through the provisions of 18 U.S.C. 3559, 3571. 42 U.S.C. 243, 268, 271.

And 42 CFR 70.18. However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Criminal Penalties Under 18 U.S.C. 3559, 3571. 42 U.S.C.

271. And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 or one year in jail, or both, if the violation does not result in a death, or a fine of no more than $250,000 or one year in jail, or both if the violation results in a death, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law. The U.S. Department of Justice may initiate criminal proceedings as appropriate seeking imposition of these criminal penalties.

Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid state and local authorities in the enforcement of their quarantine and other health regulations and to accept state and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order. Notice of Available Federal Resources While this Order to prevent eviction is effectuated to protect the public health, the states and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the lasix, including housing assistance. The Department of Housing and Urban Development (HUD), the Department of Agriculture, and the Department of the Treasury have informed CDC that unprecedented emergency resources have been appropriated through various Federal agencies that assist renters and landlords during the lasix, including $46.55 billion to the Treasury through the Consolidated Appropriations Act of 2021 and the American Rescue Plan (ARP).

Furthermore, in 2020 44 states and 310 local jurisdictions allocated about $3.9 billion toward emergency rental assistance, largely from funds appropriated to HUD from the hypertension Aid, Relief, and Economic Security (CARES).[] These three rounds of federal appropriations also provided substantial resources for homeless services, homeowner assistance, and supplemental stimulus and unemployment benefits that low-income renters used to pay rent. Visit https://hypertension medications.cdc.gov/​hypertension medications-data-tracker/​#county-view for an integrated, county view of levels of community transmission for monitoring the hypertension medications lasix in the United States. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information about the hypertension Relief Fund and https://home.treasury.gov/​policy-issues/​cares/​emergency-rental-assistance-program for more information about the Emergency Rental Assistance Program. Visit www.consumerfinance.gov/​renthelp to access the Rental Assistance Finder that connects renters and landlords with the state and local programs that are distributing billions of dollars in federal assistance. Relevant agencies have informed CDC that forbearance policies for mortgages backed by the federal government provide many landlords, especially smaller landlords, with temporary relief as new emergency rental assistance programs are deployed.

Treasury, HUD, and USDA grantees and program participants play a critical role in prioritizing efforts to support this goal. All communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households. Treasury, HUD, and USDA stand at the ready to support American communities in taking these steps to reduce the spread of hypertension medications and maintain economic prosperity. For program support, including technical assistance, please visit www.hudexchange.info/​program-support. For further information on HUD resources, tools, and guidance available to respond to the hypertension medications lasix, state and local officials are directed to visit https://www.hud.gov/​hypertension.

These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties. Furthermore, tenants can visit consumerfinance.gov/housing for up-to-date information on rent relief options, protections, and key deadlines. Effective Date This Order is effective on August 3, 2021 and will remain in effect through October 3, 2021, subject to revision based on the changing public health landscape. Authority. The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C.

264) and 42 CFR 70.2. Start Signature Sherri Berger, Chief of Staff, Centers for Disease Control and Prevention. End Signature End Supplemental Information [FR Doc. 2021-16945 Filed 8-4-21. 2:00 pm]BILLING CODE 4163-18-P.

Start Preamble Centers for Disease Control and Prevention (CDC), Buy azithromycin zithromax or doxycycline Department lasix price comparison of Health and Human Services (HHS). Agency Order. The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces a new Order under Section 361 of the Public Health Service Act lasix price comparison to temporarily halt residential evictions in communities with substantial or high transmission of hypertension medications to prevent the further spread of hypertension medications. This Order is effective August 3, 2021 through October 3, 2021.

Start Further Info Tiffany Brown, Deputy Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H21-10, Atlanta, GA 30329 lasix price comparison. Phone. 404-639-7000. Email.

Cdcregulations@cdc.gov. End Further Info End Preamble Start Supplemental Information Background On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein. That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission. Section 502 of Title V, Division N of the Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021, and approved the Order as an exercise of the CDC's authority under Section 361 of the Public Health Service Act (42 U.S.C.

264). With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears. Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan. The Order was extended multiple times due to the changing public health landscape and expired on July 31, 2021 after what was intended to be the final extension.[] Absent an unexpected change in the trajectory of the lasix, CDC did not plan to extend the Order further.

Following the recent surge in cases brought forth by the highly transmissible Delta variant, the CDC Director now issues a new Order temporarily halting evictions for persons in counties or U.S. Territories experiencing substantial or high rates of transmission, for the reasons described herein. It is more limited in scope than prior orders, intended to target specific areas of the country where cases are rapidly increasing, which likely would be exacerbated by mass evictions. Accordingly, subject to the limitations listed in the new Order, a landlord, owner of a residential property, or [] person with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any county or U.S.

Territory while the county or territory is experiencing substantial or high levels of community transmission levels of hypertension. This Order will expire on October 3, 2021, but is subject to further extension, modification, or rescission based on public health circumstances.[] A copy of the Order is provided below. A copy of the signed Order and Declaration form can be found at https://www.cdc.gov/​hypertension/​2019-ncov/​hypertension medications-eviction-declaration.html. Start Printed Page 43245 Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C.

264) and 42 Code of Federal Regulations 70.2 Temporary Halt in Residential Evictions in Communities With Substantial or High Levels of Community Transmission of hypertension medications To Prevent the Further Spread of hypertension medications Summary The U.S. Centers for Disease and Control (CDC) is issuing a new order temporarily halting evictions in counties with heightened levels of community transmission in order to respond to recent, unexpected developments in the trajectory of the hypertension medications lasix, including the rise of the Delta variant. It is intended to target specific areas of the country where cases are rapidly increasing, which likely would be exacerbated by mass evictions. Accordingly, subject to the limitations under “Applicability,” a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any county or U.S.

Territory while the county or territory is experiencing substantial or high levels of community transmission of hypertension. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member. “Available housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate federal, state, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. “Covered person” [] means any tenant, lessee, or resident of a residential property who provides to their landlord, the owner of the residential property, or other person with a legal right to pursue eviction or a possessory action,[] a declaration [] under penalty of perjury indicating that.

(1) The individual has used best efforts to obtain all available governmental assistance for rent or housing. (2) The individual either (i) earned no more than $99,000 (or $198,000 if filing jointly) in Calendar Year 2020 or expects to earn no more than $99,000 in annual income for Calendar Year 2021 (or no more than $198,000 if filing a joint tax return),[] (ii) was not required to report any income in 2020 to the U.S. Internal Revenue Service, or (iii) received an Economic Impact Payment (stimulus check).[] (3) The individual is unable to pay the full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, a lay-off, or extraordinary [] out-of-pocket medical expenses. (4) The individual is using best efforts to make timely partial rent payments that are as close to the full rent payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses.

(5) Eviction would likely render the individual homeless—or force the individual to move into and reside in close quarters in a new congregate or shared living setting—because the individual has no other available housing options. And (6) The individual resides in a U.S. County experiencing substantial [] or high [] rates of community transmission levels of hypertension as defined by CDC. “Evict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action, to remove or cause the removal of a covered person from a Start Printed Page 43246residential property.

This definition also does not prohibit foreclosure on a home mortgage. “Residential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park,[] or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the state, territorial, tribal, or local jurisdiction. “State” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S.

Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives. Mitigating the spread of hypertension medications within crowded, congregate or shared living settings, or through unsheltered homelessness. Mitigating the further spread of hypertension medications from one state or territory into any other state or territory. Mitigating the further spread of hypertension medications by temporarily suspending the eviction of covered persons from residential property for nonpayment of rent.

And Supporting response efforts to hypertension medications at the federal, state, local, territorial, and tribal levels. Background hypertension medications in the United States Since January 2020, the respiratory disease known as “hypertension medications,” caused by a novel hypertension (hypertension), has spread globally, including cases reported in all fifty states within the United States, plus the District of Columbia and U.S. Territories. As of August 3, 2021, there have been almost 200 million cases of hypertension medications globally, resulting in over 4,240,000 deaths.[] Almost 35,000,000 cases have been identified in the United States, with new cases reported daily, and almost 610,000 deaths have been attributed to the disease.[] A renewed surge in cases in the United States began in early July 2021.

Case counts rose from 19,000 cases on July 1, 2021 to 103,000 cases on July 30, 2021. Forecasted case counts predict that cases will continue to rise over the next four weeks.[] The lasix that causes hypertension medications spreads very easily and sustainably between people, particularly those who are in close contact with one another (within about 6 feet, but occasionally over longer distances), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Individuals without symptoms can also spread the lasix.[] Among adults, the risk for severe illness from hypertension medications increases with age, with older adults at highest risk. Severe illness means that persons with hypertension medications may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal.

People of any age with certain underlying medical conditions (e.g., cancer, obesity, serious heart conditions, or diabetes) are at increased risk for severe illness from hypertension medications.[] New variants of hypertension have emerged globally,[] several of which have been identified as variants of concern,[] including the Alpha, Beta, Gamma, and Delta variants. These variants of concern have evidence of an increase in transmissibility, which may lead to higher incidence.[] Currently, the Delta variant is the predominant hypertension strain circulating in the United States, estimated to account for over 82% of cases as of July 17, 2021.[] The Delta variant has demonstrated increased levels of transmissibility compared to other variants.[] Furthermore, early evidence suggests that people who are vaccinated and become infected with the Delta variant may transmit the lasix to others.[] Transmission of the Delta variant has led to accelerated community transmission in the United States. CDC recommends assessing the level of community transmission using, at a minimum, two metrics. New hypertension medications cases per 100,000 persons in the last 7 days and percentage of positive hypertension diagnostic nucleic acid amplification tests in the last 7 days.

For each of these metrics, CDC classifies transmission values as low, moderate, substantial, or high. As of August 1, 2021, over 80% of the U.S. Counties were classified as experiencing substantial or high levels of community transmission.[] In areas of substantial or high transmission, CDC recommends community leaders encourage vaccination and universal masking in indoor public spaces in addition to other layered prevention strategies to prevent further spread. hypertension medications treatments are now widely available in the United States, and vaccination is recommended for all people 12 years of age and older.

Three hypertension medications treatments are currently authorized by the U.S. Food and Drug Administration (FDA) for emergency use. Two mRNA treatments and one viral vector treatment, each of which has been determined to be safe and effective against hypertension medications. As of July 28, 2021, over 163 million people in the United States (57.6% of the population 12 years or older) have been fully vaccinated and Start Printed Page 43247over 189 million people in the United States (66.8% of the population 12 years or older) have received at least one dose.[] Changes in treatment uptake and the extreme transmissibility of the Delta variant have resulted in rising numbers of hypertension medications cases, primarily and disproportionately affecting the unvaccinated population.

The hypertension medications vaccination effort has a slower rate of penetration among the populations most likely to experience eviction.[] In combination with the continued underlying hypertension medications spread, and the overlapping factors described above, this creates considerable risk for rapid transmission of hypertension medications in high-risk settings. In the context of a lasix, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation and self-quarantine by people who become ill or who are at risk of transmitting hypertension medications. Congress passed the hypertension Aid, Relief, and Economic Security (CARES) Act (Pub.

L. 116-136) to aid individuals and businesses adversely affected by hypertension medications in March 2020. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with federal assistance or federally related mortgage financing. These protections helped alleviate the public health consequences of tenant displacement during the hypertension medications lasix.

The CARES Act eviction moratorium expired on July 24, 2020. The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and other local officials using emergency powers. Researchers estimated that this temporary federal moratorium provided relief to over one-quarter a material portion of the nation's roughly 43 million renters.[] The CARES act also provided funding streams for emergency rental assistance. Surveys estimate that this assistance became available to the public through rental assistance programs by July 2020.[] The Federal moratorium provided by the CARES Act, however, did not reach all renters.

Many renters who fell outside the scope of the Federal moratorium were instead protected under state and local moratoria. In early March 2021, the Census Household Pulse Survey estimated that 6.4 million households were behind on rent and just under half fear imminent eviction.[] In 2016, research showed that there were 3.6 million eviction filings and 1.5 million eviction judgments over the span of a whole year,[] meaning that the lasix would cause a wave of evictions on a scale that would be unprecedented in modern times. A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus becoming at higher risk of hypertension medications. On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein.

That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission. Section 502 of Title V, Division N of the Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021, and approved the Order as an exercise of the CDC's authority under Section 361 of the Public Health Service Act (42 U.S.C. 264). With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears.

Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan Act of 2021. The Order was extended multiple times due to the changing public health landscape and expired on July 31, 2021 after what was intended to be the final extension.[] Absent an unexpected change in the trajectory of the lasix, CDC did not plan to extend the Order further. Following the recent surge in cases brought forth by the highly transmissible Delta variant, the CDC Director now issues a new Order temporarily halting evictions for persons in counties experiencing substantial or high rates of transmission, for the reasons described herein. This Order will expire on October 3, 2021, but is subject to further extension, modification, or rescission based on public health circumstances.

Researchers estimate that, in 2020, Federal, state, and local eviction moratoria led to over 1.5 million fewer evictions filings than the previous year.[] Additional research shows that, despite the CDC eviction moratorium leading to an estimated 50% decrease in eviction filings compared to the historical average,[] there have still been over 450,000 eviction filings during the lasix just within approximately 31 cities and six states with more readily available data. This data covers approximately 1 in 4 renter households in the country, suggesting high demand and likelihood of mass evictions nationwide.[] Eviction, Crowding, and Interstate Transmission of hypertension medications By February 10, 2021, the U.S. Department of the Treasury had paid all of the $25 billion made available by the Consolidated Appropriations Act, 2021 to states, territories, localities and tribes for the purpose of providing emergency rental assistance to eligible households in their jurisdictions. Additionally, as directed in the Act, Treasury has also made available 40 percent—more than $8.6 billion—of the additional funding to states, territories and localities for emergency rental assistance provided in the American Rescue Plan Act of 2021.

While some emergency rental assistance programs were slow to open, every State program had opened by early June. Based on data collected from grantees, Treasury reports that over 85,000 renter households received rental and utility Start Printed Page 43248assistance to support their housing stability by the end of March and this number increased to more than 100,000 in April, more than 156,000 in May and over 290,000 in June. Though emergency rental assistance has clearly started to reach increasing numbers of families over recent months, state and local agencies have hundreds of thousands of applications for assistance that currently remain outstanding as programs accelerate their activity. The level of assistance continued to increase in June, with nearly 300,000 households served.

Based on analysis of grantee reporting, Treasury believes that the monthly deployment of rental assistance by state and local emergency rental assistance programs will continue to increase from the significant deployment in June. In addition to Emergency Rental Assistance, there are coordinated efforts across Federal agencies to—in partnership with states and localities—promote eviction prevention strategies. Recent data from the U.S. Census Household Pulse Survey demonstrates that just under half of households behind on rent believe that an eviction is likely in the next two months.[] A surge in evictions could lead to the immediate and significant movement of large numbers of persons from lower density to higher density housing at a time in the United States when the highly transmissible Delta variant is driving hypertension medications cases at an unprecedented rate.

Evicted renters must move, which leads to multiple outcomes that increase the risk of hypertension medications spread. Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. These moves may require crossing state borders. According to the 2017 Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding.

Studies show that hypertension medications transmission occurs readily within households. The secondary attack rate in households has been estimated to be 17%, and household contacts are estimated to be 6 times more likely to become infected by an index case of hypertension medications than other close contacts.[] A study of pregnant women in New York City showed that women in large households (greater number of residents per household) were three times as likely to test positive for hypertension than those in smaller households, and those in neighborhoods with greater household crowding (>1 resident per room) were twice as likely to test positive.[] Throughout the United States, counties with the highest proportion of crowded households have experienced hypertension medications mortality rates 2.6 times those of counties with the lowest proportion of crowded households. Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing and domestic violence and abuse shelters.

Special considerations exist for such housing because of the challenges of maintaining social distance. Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, chronic health conditions, cognitive decline, or limited access to technology, and thus may find it more difficult to take actions to protect themselves from hypertension medications. CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms.

Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures. Modeling studies and observational data from the pre-treatment phase of the hypertension medications lasix comparing incidence between states that implemented and lifted eviction moratoria indicate that evictions substantially contribute to hypertension medications transmission. In mathematical models where eviction led exclusively to sharing housing with friends or family, lifting eviction moratoria led to a 30% increased risk of contracting hypertension medications among people who were evicted and those with whom they shared housing after eviction.[] Compared to a scenario where no evictions occurred, the models also predicted a 4%-40% increased risk of , even for those who did not share housing, as a result of increased overall transmission. The authors estimated that anywhere from 1,000 to 100,000 excess cases per million population could be attributable to evictions depending on the eviction and rates.

An analysis of observational data from state-based eviction moratoria in 43 states and the District of Columbia showed significant increases in hypertension medications incidence and mortality approximately 2-3 months after eviction moratoria were lifted.[] Specifically, the authors compared the hypertension medications incidence and mortality rates in states that lifted their moratoria with the rates in states that maintained their moratoria. In these models, the authors accounted for time-varying indicators of each state's test count as well as major public-health interventions including lifting stay-at-home orders, school closures, and mask mandates. After adjusting for these other changes, they found that the incidence of hypertension medications in states that lifted their moratoria was 1.6 times that of states that did not at 10 weeks post-lifting (95% CI 1.0, 2.3), a ratio that grew to 2.1 at ≥16 weeks (CI 1.1, 3.9). Similarly, they found that mortality in states that lifted their moratoria was 1.6 times that of states that did not at 7 weeks post-lifting (CI 1.2, 2.3), a ratio that grew to 5.4 at ≥16 weeks (CI 3.1, 9.3).

The authors estimated that, nationally, over 433,000 cases of hypertension medications and over 10,000 deaths could be attributed to lifting state moratoria.[] Although data are limited, available evidence suggests evictions lead to interstate spread of hypertension medications in two ways. First, an eviction may lead the evicted members of a household to move across state lines. Of the 35 million people in America who move each year, 15% move to a new state. Second, even if a particular eviction, standing alone, would not always result in interstate displacement, the mass Start Printed Page 43249evictions that would occur in the absence of this Order would inevitably increase the interstate spread of hypertension medications.

This Order cannot effectively mitigate interstate transmission of hypertension medications without covering intrastate evictions (evictions occurring within the boundaries of a state or territory), as the level of spread of hypertension resulting from these evictions can lead to hypertension transmission across state borders. Moreover, intrastate spread facilitates interstate spread in the context of communicable disease spread, given the nature of infectious disease. In the aggregate, the mass-scale evictions that will likely occur in the absence of this Order in areas of substantial or high transmission will inevitably increase interstate spread of hypertension medications. Eviction, Homelessness, and hypertension medications Transmission Evicted individuals without access to support or other assistance options may become homeless, including older adults or those with underlying medical conditions, who are more at risk for severe illness from hypertension medications than the general population.

In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Data collection by an emergency shelter in Columbus, Ohio, showed that 35.4% of families and 11.4% of single adults reported an eviction as the primary or secondary reason for their seeking shelter.[] Extensive outbreaks of hypertension medications have been identified in homeless shelters. In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members. In Boston, Massachusetts, universal hypertension medications testing at a single shelter revealed 147 cases, representing 36% of shelter residents.

hypertension medications testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested). Data from 634 universal diagnostic testing events at homeless shelters in 21 states show an average of 6% positivity among shelter clients. Data comparing the incidence or severity of hypertension medications among people experiencing homelessness directly to the general population are limited. However, during the 15-day period of the outbreak in Boston, MA, researchers estimated a cumulative incidence of 46.3 cases of hypertension medications per 1000 persons experiencing homelessness, as compared to 1.9 cases per 1000 among Massachusetts adults (pre-print).

Among other things, CDC guidance recommends increasing physical distance between beds in homeless shelters, which is likely to decrease capacity, while community transmission of hypertension medications is occurring. To adhere to this guidance, shelters have limited the number of people served throughout the United States. In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above.

Application of hypertension medications Prevention Strategies Based on Community Transmission CDC recommends strengthening or adding effective hypertension medications mitigation strategies in communities with considerable transmission risk. As discussed above, CDC guidance specifies that everyone, regardless of vaccination status, should wear masks in indoor and public settings in communities experiencing substantial or high rates of community transmission. Similarly, CDC guidance for homeless shelters recommends maintaining layered hypertension medications precautions as long as community transmission is occurring and provides options for scaling back precautions when community transmission is low.[] Eviction moratoria represent a hypertension medications transmission prevention measure that can similarly be applied when the epidemiological context is appropriate, for example in communities with substantial or high transmission of hypertension medications.[] Prevention strategies like these should only be relaxed or lifted after two weeks of continuous sustained improvement in the level of community transmission. In areas with low or no hypertension transmission and with testing capacity in place to detect early introduction or increases in spread of the lasix, layered prevention strategies might be removed one at a time while monitoring closely for any evidence that hypertension medications cases are increasing.

Decisions to add or remove prevention strategies should be based on local data and public health recommendations. The emergence of more transmissible hypertension variants, including Delta, increases the urgency for public health agencies and other organizations to collaboratively monitor the status of the lasix in their communities and continue to apply layered prevention strategies. Persons at Higher Risk of Eviction May Also Be at Higher Risk of Being Unvaccinated Communities with high rates of eviction have been shown to have lower coverage of hypertension medications vaccination—a focus for current vaccination campaigns. A study in the spring of 2021 showed that counties with high social vulnerability (i.e., social and structural factors associated with adverse health outcome inclusive of socioeconomic indicators related to risk of eviction) had lower levels of hypertension medications vaccination.[] CDC Eviction Moratorium The Department of the Treasury has made funding available to states, territories, localities, and Tribal governments, which continue to distribute emergency rental assistance funds that may help mitigate spikes in hypertension medications transmission due to increases in evictions.

Alongside other federal and state efforts to prevent evictions, these funds are expected to make a meaningful difference for hundreds of thousands of people who are expected to receive the rental assistance.[] On September 4, 2020, the CDC Director issued an Order temporarily halting evictions in the United States for the reasons described therein. That Order was set to expire on December 31, 2020, subject to further extension, modification, or rescission. Section 502 of Title V, Division N of the Start Printed Page 43250Consolidated Appropriations Act, 2021 extended the Order until January 31, 2021. With the extension of the Order, Congress also provided $25 billion for emergency rental assistance for the payment of rent and rental arrears.

Congress later provided an additional $21.55 billion in emergency rental assistance when it passed the American Rescue Plan. On January 29, 2021, following an assessment of the ongoing lasix, the CDC Director renewed the Order until March 31, 2021. On March 28, the CDC Director renewed the Order until June 30, 2021. On June 24, the CDC Director renewed the Order until July 31, 2021 (July Order).

The CDC Director indicated that the July Order would be the final extension of the nationwide eviction moratorium absent an unexpected change in the trajectory of the lasix. Unfortunately, the rise of the Delta variant and corresponding rise in cases in numerous counties in the United States have altered the trajectory of the lasix. As a result, CDC is issuing this narrower, more targeted Order to temporarily halt evictions in the hardest hit areas. Without this Order, evictions in these areas would likely exacerbate the increase in cases.

To the extent any provision of this Order conflicts with prior Orders, this Order is controlling. Applicability This Order applies in U.S. Counties [] experiencing substantial [] and high [] levels of community transmission levels of hypertension as defined by CDC, as of August 3, 2021. If a U.S.

County that is not covered by this Order as of August 3, 2021 later experiences substantial or high levels of community transmission while this Order is in effect, then that county will become subject to this Order as of the date the county begins experiencing substantial or high levels of community transmission. If a U.S. County that is covered by this Order no longer experiences substantial or high levels of community transmission for 14 consecutive days, then this Order will no longer apply in that county, unless and until the county again experiences substantial or high levels of community transmission while this Order is in effect. This Order does not apply in any state, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order or to the extent its application is prohibited by Federal court order.

In accordance with 42 U.S.C. 264(e), this Order does not preclude state, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order. This Order is a temporary eviction moratorium to prevent the further spread of hypertension medications. This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract.

Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Nothing in this Order precludes evictions based on a tenant, lessee, or resident. (1) Engaging in criminal activity while on the premises. (2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property.

(4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Any evictions for nonpayment of rent initiated prior to issuance of this Order but not yet completed, are subject to this Order. Any tenant, lessee, or resident of a residential property who previously submitted a Declaration, still qualifies as a “Covered Person” and is still present in a rental unit is entitled to protections under this Order.

Any eviction that was completed before issuance of this Order including from August 1 through August 3, 2021 is not subject to this Order, as it does not operate retroactively. Under this Order, covered persons may be evicted for engaging in criminal activity while on the premises. But covered persons may not be evicted on the sole basis that they are alleged to have committed the crime of trespass (or similar state-law offense) where the underlying activity is a covered person remaining in a residential property for nonpayment of rent. Permitting such evictions would result in substantially more evictions overall, thus increasing the risk of disease transmission as otherwise covered persons move into congregate settings or experience homelessness.

This result would be contrary to the stated objectives of this Order, and therefore would diminish their effectiveness. Moreover, to the extent such criminal trespass laws are invoked to establish criminal activity solely based on a tenant, lessee, or resident of a residential property remaining in a residential property despite the nonpayment of rent, such invocation conflicts with this Order and is preempted pursuant to 42 U.S.C. 264(e). Individuals who are confirmed to have, who have been exposed to, or who might have hypertension medications and take reasonable precautions to not spread the disease may not be evicted on grounds that they may pose a health or safety threat to other residents.

This Order is in effect through October 3, 2021, based on the current and projected epidemiological context of hypertension transmission throughout the United States. This timeframe will allow the assessment of natural changes to hypertension medications incidence, the influences of new variants, additional distribution of emergency rental assistance funds, and the expansion of hypertension medications treatment uptake. Declaration Forms To qualify for the protections of this Order, a tenant, lessee, or resident of a residential property must provide a completed and signed copy of a declaration with the elements listed in the definition of “Covered person” to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live. To assist tenants and landlords, the CDC created a standardized declaration form that can be downloaded here.

Https://www.cdc.gov/​hypertension/​2019-ncov/​downloads/​declaration-form.pdf. Tenants, lessees, and residents of residential property are not obligated to use the CDC form. Any written document that an eligible tenant, lessee, or resident of residential property presents to their landlord will comply with this Order, as long as it contains the required elements of “Covered person” as described in this Order. In Start Printed Page 43251addition, tenants, lessees, and residents of residential property are allowed to declare in writing that they meet the elements of “Covered person” in other languages.

All declarations, regardless of form used, must be signed, and must include a statement that the tenant, lessee, or resident of a residential property understands that they could be liable for perjury for any false or misleading statements or omissions in the declaration. This Order does not preclude a landlord challenging the truthfulness of a tenant's, lessee's, or resident's declaration in court, as permitted under state or local law. In certain circumstances, such as individuals filing a joint tax return, it may be appropriate for one member of the residence to provide an executed declaration on behalf of the other adult residents party to the lease, rental agreement, or housing contract. The declaration may be signed and transmitted either electronically or by hard copy.

As long as the information in a previously signed declaration submitted under a previous order remains truthful and accurate, covered persons do not need to submit a new declaration under this Order. However, eligibility for protection will be based on the terms of this Order. Findings and Action Determination For the reasons described herein, I have determined based on the information below that issuing a temporary halt in evictions in counties experiencing substantial or high levels of hypertension medications transmission constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of hypertension medications throughout the United States. I have further determined that measures by states, localities, or territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of hypertension medications.

State and local jurisdictions continue to distribute emergency rental assistance funds, provided by the Department of Treasury, that will help avert a spate of evictions and thus mitigate corresponding spikes in hypertension medications transmission. Trends have dramatically worsened since June 2021 and transmission is rapidly accelerating in the United States.[] Congress has appropriated approximately $46 billion—of which almost three-quarters is currently available to state and local grantees—to help pay rent and rental arrears for tenants who may otherwise be at high risk of eviction. According to estimates based on the U.S. Census Household Pulse Survey, approximately 6.9 million renter households were behind on their rent in late June.

At that time, about 4.6 million renter households were concerned that they could not pay next month's rent. The successful delivery of those funds by states and localities should greatly reduce the incidence of eviction that would occur in the absence of that support. However, many states and localities are still ramping up the collection and processing of applications and the delivery of assistance and putting in place other eviction prevention strategies. It was only in the beginning of June that all state-run emergency rental assistance programs had opened for applications.

If the moratorium is not in place, a wave of evictions, on the order of hundreds of thousands, could occur in late summer and early fall, exacerbating the spread of hypertension medications among the significant percentage of the population that remains unvaccinated. In appropriating these emergency rental assistance funds, Congress intended that the funding would work in concert with the eviction moratorium, providing time for rental assistance to reach eligible tenants and landlords to sustainably reduce the threat of an eviction wave after an eviction moratorium was no longer in effect. While the pace of assistance is continuing to increase, without additional time for states and localities to deliver this needed relief and engage in other efforts to prevent evictions, a surge of evictions would occur upon the conclusion of the national moratorium. A surge in evictions would lead to immediate movement, crowding, and increased stress on the homeless service system.

In combination with surging hypertension medications rates across the country, and the overlapping factors described above, this would create considerable risk for the rapid transmission of hypertension medications in high-risk settings. Based on the convergence of these issues, I have determined that issuing a new Order temporarily halting evictions is appropriate. Accordingly, a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action shall not evict any covered person from any residential property in any county or U.S. Territory while hypertension medications transmission is substantial or high and the relevant state, county, locality, or territory has provided a level of public-health protections below the requirements listed in this Order.

This Order is not a rule within the meaning of the Administrative Procedure Act (APA) but rather an emergency action taken under the existing authority of 42 CFR 70.2. The purpose of section 70.2, which was promulgated through notice-and-comment rulemaking, is to enable CDC to take swift steps to prevent contagion without having to seek a second round of public comments and without a delay in effective date.[] Good Cause In the event this Order qualifies as a rule under the APA, there is good cause to dispense with prior public notice and comment and a delay in effective date. See 5 U.S.C. 553(b)(B), (d)(3).

Good cause exists, in sum, because the public health emergency caused by the hypertension medications lasix and the unpredictability of the trajectory of the lasix make it impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. I have determined that good cause exists because the public health emergency caused by hypertension medications makes it impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of the Order. A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that would have potentially significant public health consequences. I conclude that the delay in the effective date of the Order would defeat the purpose of the Order and endanger the public health and, therefore, determine that immediate action is necessary.

The rapidly changing nature of the lasix requires not only that CDC act swiftly, but also deftly to ensure that its actions are commensurate with the threat. This necessarily involves assessing evolving conditions that inform CDC's determinations. Despite promising trends in the spring of 2021, the surge of cases spurred by the Delta variant has confirmed that the fundamental public health threat—of the risk of large numbers of residential evictions contributing to the spread of hypertension medications throughout the United States—continues to exist. Without this Order, there is every reason to expect that evictions will increase dramatically Start Printed Page 43252at a time when hypertension medications s in the United States are increasing sharply.

It is imperative that public health authorities act quickly to mitigate such an increase of evictions, which could increase the likelihood of new spikes in hypertension transmission. Such mass evictions and the attendant public health consequences would be very difficult to reverse. For all of these reasons, I hereby conclude that immediate action is again necessary and that notice-and-comment rulemaking and a delay in effective date would be impracticable and contrary to the public interest. Miscellaneous Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs (OIRA) has determined that it would be an economically significant regulatory action pursuant to Executive Order 12866 and a major rule under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (the Congressional Review Act or CRA), 5 U.S.C.

804(2). Thus, this action has been reviewed by OIRA. CDC has determined that for the same reasons given above, there would be good cause under the CRA to make the requirements herein effective immediately. 5 U.S.C.

808(2). If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by federal authorities and cooperating state and local authorities through the provisions of 18 U.S.C. 3559, 3571.

42 U.S.C. 243, 268, 271. And 42 CFR 70.18. However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract.

Criminal Penalties Under 18 U.S.C. 3559, 3571. 42 U.S.C. 271.

And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 or one year in jail, or both, if the violation does not result in a death, or a fine of no more than $250,000 or one year in jail, or both if the violation results in a death, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law. The U.S. Department of Justice may initiate criminal proceedings as appropriate seeking imposition of these criminal penalties.

Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid state and local authorities in the enforcement of their quarantine and other health regulations and to accept state and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order. Notice of Available Federal Resources While this Order to prevent eviction is effectuated to protect the public health, the states and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the lasix, including housing assistance.

The Department of Housing and Urban Development (HUD), the Department of Agriculture, and the Department of the Treasury have informed CDC that unprecedented emergency resources have been appropriated through various Federal agencies that assist renters and landlords during the lasix, including $46.55 billion to the Treasury through the Consolidated Appropriations Act of 2021 and the American Rescue Plan (ARP). Furthermore, in 2020 44 states and 310 local jurisdictions allocated about $3.9 billion toward emergency rental assistance, largely from funds appropriated to HUD from the hypertension Aid, Relief, and Economic Security (CARES).[] These three rounds of federal appropriations also provided substantial resources for homeless services, homeowner assistance, and supplemental stimulus and unemployment benefits that low-income renters used to pay rent. Visit https://hypertension medications.cdc.gov/​hypertension medications-data-tracker/​#county-view for an integrated, county view of levels of community transmission for monitoring the hypertension medications lasix in the United States. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information about the hypertension Relief Fund and https://home.treasury.gov/​policy-issues/​cares/​emergency-rental-assistance-program for more information about the Emergency Rental Assistance Program.

Visit www.consumerfinance.gov/​renthelp to access the Rental Assistance Finder that connects renters and landlords with the state and local programs that are distributing billions of dollars in federal assistance. Relevant agencies have informed CDC that forbearance policies for mortgages backed by the federal government provide many landlords, especially smaller landlords, with temporary relief as new emergency rental assistance programs are deployed. Treasury, HUD, and USDA grantees and program participants play a critical role in prioritizing efforts to support this goal. All communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households.

Treasury, HUD, and USDA stand at the ready to support American communities in taking these steps to reduce the spread of hypertension medications and maintain economic prosperity. For program support, including technical assistance, please visit www.hudexchange.info/​program-support. For further information on HUD resources, tools, and guidance available to respond to the hypertension medications lasix, state and local officials are directed to visit https://www.hud.gov/​hypertension. These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties.

Furthermore, tenants can visit consumerfinance.gov/housing for up-to-date information on rent relief options, protections, and key deadlines. Effective Date This Order is effective on August 3, 2021 and will remain in effect through October 3, 2021, subject to revision based on the changing public health landscape. Authority. The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C.

264) and 42 CFR 70.2. Start Signature Sherri Berger, Chief of Staff, Centers for Disease Control and Prevention. End Signature End Supplemental Information [FR Doc. 2021-16945 Filed 8-4-21.

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Vestibular therapy and exercises can help with these conditions. Occupational Therapist Dawn Wylie, O.T.R.L., is a vestibular and balance specialist and part of MidMichigan Health’s Rehabilitation Services team. She sees patients in Alma.There are four key phases for a wound to heal successfully:[click image to enlarge] Specialized Wound Treatment Centers have better outcomes because they bring together many disciplines to not only treat wounds, but also to address the underlying barriers to healing.Hemostasis – clotting to control bleeding.Inflammation – swelling occurs as helpful materials are transported to the wound site and invasive microbes are pushed out.Proliferation – a protective layer of tissue is formed.Remodeling – rebuilding of tissue and revascularization and reorganization of the new tissue to function like lasix price comparison the surrounding tissue.Any factors that interfere with one or more of these phases can prevent wounds from healing. Some of the most common factors include:Poor Circulation – Oxygen and materials needed for healing can’t get to the wound site.

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SAMHSA publishes guidelines, toolkit to strengthen buy lasix furosemide crisis care in America's communities | SAMHSA Skip to main contentStart Preamble Centers for Medicare &. Medicaid Services buy lasix furosemide (CMS), Health and Human Services (HHS). Final rule buy lasix furosemide. Correction.

This document corrects technical and typographical errors in the final rule that appeared in the September 18, 2020 issue of the Federal Register titled buy lasix furosemide “Medicare Program. Hospital Inpatient Prospective buy lasix furosemide Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates. Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical buy lasix furosemide Access Hospitals”. Effective Date.

This correcting buy lasix furosemide document is effective on December 1, 2020. Applicability Date buy lasix furosemide. The corrections in this correcting document are buy lasix furosemide applicable to discharges occurring on or after October 1, 2020. Start Further Info Donald Thompson and Michele Hudson, (410) 786-4487.

End Further buy lasix furosemide Info End Preamble Start Supplemental Information I. Background In buy lasix furosemide FR Doc. 2020-19637 of September 18, 2020 (85 FR 58432) there were a number of technical buy lasix furosemide and typographical errors that are identified and corrected in the Correction of Errors section of this correcting document. The corrections in this correcting document are applicable to discharges occurring on or after October 1, 2020, as if they had been included in the document that appeared in the September 18, 2020 Federal Register.

II. Summary of Errors A. Summary of Errors in the Preamble On the following pages. 58435 through 58436, 58448, 58451, 58453, 58459, 58464, 58471, 58479, 58487, 58495, 58506, 58509, 58520, 58529, 58531 through 58532, 58537, 58540 through 58541, 58553 through 58556, 58559 through 58560, 58580 through 58583, 58585 through 58588, 58596, 58599, 58603 through 58604, 58606 through 58607, 58610, 58719, 58734, 58736 through 58737, 58739, 58741, 58842, 58876, 58893, and 58898 through 58900, we are correcting inadvertent typographical errors in the internal section references.

On page 58596, we are correcting an inadvertent typographical error in the date of the MedPAR data used for developing the Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights. On pages 58716 and 58717, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the BAROSTIM NEO® System technology. On pages 58721 and 58723, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the Cefiderocol technology. On page 58768, due to a conforming change to the Rural Floor Budget Neutrality adjustment (listed in the table titled “Summary of FY 2021 Budget Neutrality Factors” on page 59034) as discussed in section II.B.

Of this correcting document and the conforming changes to the Out-Migration Adjustment discussed in section II. D of this correcting document (with regard to Table 4A), we are correcting the 25th percentile wage index value across all hospitals. On page 59006, in the discussion of Medicare bad debt policy, we are correcting inadvertent errors in the regulatory citations and descriptions. B.

Summary of Errors in the Addendum On pages 59031 and 59037, we are correcting inadvertent typographical errors in the internal section references. We are correcting an error in the version 38 ICD-10 MS-DRG assignment for some cases in the historical claims data in the FY 2019 MedPAR files used in the ratesetting for the FY 2021 IPPS/LTCH PPS final rule, which resulted in inadvertent errors in the MS-DRG relative weights (and associated average length-of-stay (LOS)). Additionally, the version 38 MS-DRG assignment and relative weights are used when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the corrections to the MS-DRG assignment under the ICD-10 MS-DRG GROUPER version 38 for some cases in the historical claims data in the FY 2019 MedPAR files and the recalculation of the relative weights directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold.

In addition, as discussed in section II.D. Of this correcting document, we made updates to the calculation of Factor 3 of the uncompensated care payment methodology to reflect updated information on hospital mergers received in response to the final rule. Factor 3 determines the total amount of the uncompensated care payment a hospital is eligible to receive for a fiscal year. This hospital-specific payment amount is then used to calculate the amount of the interim uncompensated care payments a hospital receives per discharge.

Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the revisions made to the calculation of Factor 3 to address additional merger information directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. We made an inadvertent error in the Medicare Geographic Classification Review Board (MGCRB) reclassification status of one hospital in the FY 2021 IPPS/LTCH PPS final rule. Specifically, CCN 050481 is incorrectly listed in Table 2 as reclassified to its geographic “home” of CBSA 31084.

The correct reclassification area is to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100 and affected the final FY 2021 wage index with reclassification. The final FY 2021 IPPS wage index with reclassification is used when determining total payments for purposes of all budget neutrality factors (except for the MS-DRG reclassification and recalibration budget neutrality factor and the wage index budget neutrality adjustment factor) and the final outlier threshold. Due to the correction of the combination of errors listed previously (corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, revisions to Factor 3 of the uncompensated care payment methodology, and the correction to the MGCRB reclassification status of one hospital), we recalculated all IPPS budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes (and geographic adjustment factors (GAFs)), the national operating standardized amounts and capital Federal rate.

Therefore, we made conforming changes to the following. On page 59034, the table titled “Summary of FY 2021 Budget Neutrality Factors”. On page 59037, the estimated total Federal capital payments and the estimated capital outlier payments. On page 59040, the calculation of the outlier fixed-loss cost threshold, total operating Federal payments, total operating outlier payments, the outlier adjustment to the capital Federal rate and the related discussion of the percentage estimates of operating and capital outlier payments.

On page 59042, the table titled “Changes from FY 2020 Standardized Amounts to the FY 2021 Standardized Amounts”. On page 59039, we are correcting a typographical error in the total cases from October 1, 2018 through September 31, 2019 used to calculate the average covered charge per case, which is then used to calculate the charge inflation factor. On pages 59047 through 59048, in our discussion of the determination of the Federal hospital inpatient capital-related prospective payment rate update, due to the recalculation of the GAFs as well as corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, we have made conforming corrections to the capital Federal rate, the incremental budget neutrality adjustment factor for changes in the GAFs, and the outlier threshold (as discussed previously). As a result of these changes, we also made conforming corrections in the table showing the comparison of factors and adjustments for the FY 2020 capital Federal rate and FY 2021 capital Federal rate.

As we noted in the final rule, the capital Federal rate is calculated using unrounded budget neutrality and outlier Start Printed Page 78750adjustment factors. The unrounded GAF/DRG budget neutrality factors and the unrounded outlier adjustment to the capital Federal rate were revised because of these errors. However, after rounding these factors to 4 decimal places as displayed in the final rule, the rounded factors were unchanged from the final rule. On page 59057, we are making conforming changes to the fixed-loss amount for FY 2021 site neutral payment rate discharges, and the high cost outlier (HCO) threshold (based on the corrections to the IPPS fixed-loss amount discussed previously).

On pages 59060 and 59061, we are making conforming corrections to the national adjusted operating standardized amounts and capital standard Federal payment rate (which also include the rates payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming corrections to certain budget neutrality factors and the outlier threshold previously described. C. Summary of Errors in the Appendices On pages 59062, 59070, 59074 through 59076, and 59085 we are correcting inadvertent typographical errors in the internal section references. On pages 59064 through 59071, 59073 and 59074, and 59092 and 59093, in our regulatory impact analyses, we have made conforming corrections to the factors, values, and tables and accompanying discussion of the changes in operating and capital IPPS payments for FY 2021 and the effects of certain IPPS budget neutrality factors as a result of the technical errors that lead to changes in our calculation of the operating and capital IPPS budget neutrality factors, outlier threshold, final wage indexes, operating standardized amounts, and capital Federal rate (as described in section II.B.

Of this correcting document). These conforming corrections include changes to the following tables. On pages 59065 through 59069, the table titled “Table I—Impact Analysis of Changes to the IPPS for Operating Costs for FY 2021”. On pages 59073 and 59074, the table titled “Table II—Impact Analysis of Changes for FY 2021 Acute Care Hospital Operating Prospective Payment System (Payments per discharge)”.

On pages 59092 and 59093, the table titled “Table III—Comparison of Total Payments per Case [FY 2020 Payments Compared to Final FY 2021 payments]”. On pages 59076 through 59079, we are correcting the discussion of the “Effects of the Changes to Uncompensated Care Payments for FY 2021” for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule, including the table titled “Modeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type. Uncompensated Care Payments ($ in Millions)*—from FY 2020 to FY 2021” on pages 59077 and 59078, in light of the corrections discussed in section II.D. Of this correcting document.

D. Summary of Errors in and Corrections to Files and Tables Posted on the CMS Website We are correcting the errors in the following IPPS tables that are listed on pages 59059 and 59060 of the FY 2021 IPPS/LTCH PPS final rule and are available on the internet on the CMS website at https://www.cms.gov/​Medicare/​Medicare-Fee-for-Service-Payment/​AcuteInpatientPPS/​index.html. The tables that are available on the internet have been updated to reflect the revisions discussed in this correcting document. Table 2—Case-Mix Index and Wage Index Table by CCN-FY 2021 Final Rule.

As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed as reclassified to its home geographic area of CBSA 31084. In this table, we are correcting the columns titled “Wage Index Payment CBSA” and “MGCRB Reclass” to accurately reflect its reclassification to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes listed in Table 2. In addition, as also discussed later in this section, because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed.

Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 2. Also, as discussed in section II.A of this correcting document, we made a conforming change to the 25th percentile wage index value across all hospitals. Accordingly, we are making corresponding changes to the values for hospitals in the columns titled “FY 2021 Wage Index Prior to Quartile and Transition”, “FY 2021 Wage Index With Quartile”, “FY 2021 Wage Index With Quartile and Cap” and “Out-Migration Adjustment”. We also updated footnote number 6 to reflect the conforming change to the 25th percentile wage index value across all hospitals.

Table 3.—Wage Index Table by CBSA—FY 2021 Final Rule. As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes and GAFs of all CBSAs listed in Table 3. Specifically, we are correcting the values and flags in the columns titled “Wage Index”, “GAF”, “Reclassified Wage Index”, “Reclassified GAF”, “State Rural Floor”, “Eligible for Rural Floor Wage Index”, “Pre-Frontier and/or Pre-Rural Floor Wage Index”, “Reclassified Wage Index Eligible for Frontier Wage Index”, “Reclassified Wage Index Eligible for Rural Floor Wage Index”, and “Reclassified Wage Index Pre-Frontier and/or Pre-Rural Floor”.

Table 4A.— List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act—FY 2021 Final Rule. As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, corrections to the version 38 MS-DRG assignment for some cases Start Printed Page 78751in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. As a result, as discussed previously, we are making corresponding changes to the FY 2021 wage indexes. Because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed.

Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 4A. Specifically, we are correcting the values in the column titled “FY 2021 Out Migration Adjustment”. Table 5.—List of Medicare Severity Diagnosis-Related Groups (MS-DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay—FY 2021. We are correcting this table to reflect the recalculation of the relative weights, geometric average length-of-stay (LOS), and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B.

Of this correcting document). Table 7B.—Medicare Prospective Payment System Selected Percentile Lengths of Stay. FY 2019 MedPAR Update—March 2020 GROUPER Version 38 MS-DRGs. We are correcting this table to reflect the recalculation of the relative weights, geometric average LOS, and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B.

Of this correcting document). Table 18.—FY 2021 Medicare DSH Uncompensated Care Payment Factor 3. For the FY 2021 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals projected to be eligible to receive uncompensated care interim payments for FY 2021. As stated in the FY 2021 IPPS/LTCH PPS final rule (85 FR 58834 and 58835), we allowed the public an additional period after the issuance of the final rule to review and submit comments on the accuracy of the list of mergers that we identified in the final rule.

Based on the comments received during this additional period, we are updating this table to reflect the merger information received in response to the final rule and to revise the Factor 3 calculations for purposes of determining uncompensated care payments for the FY 2021 IPPS/LTCH PPS final rule. We are revising Factor 3 for all hospitals to reflect the updated merger information received in response to the final rule. We are also revising the amount of the total uncompensated care payment calculated for each DSH-eligible hospital. The total uncompensated care payment that a hospital receives is used to calculate the amount of the interim uncompensated care payments the hospital receives per discharge.

Accordingly, we have also revised these amounts for all DSH-eligible hospitals. These corrections will be reflected in Table 18 and the Medicare DSH Supplemental Data File. Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, these corrections to uncompensated care payments impacted the calculation of all the budget neutrality factors as well as the outlier fixed-loss cost threshold.

In section IV.C. Of this correcting document, we have made corresponding revisions to the discussion of the “Effects of the Changes to Medicare DSH and Uncompensated Care Payments for FY 2021” for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule to reflect the corrections discussed previously and to correct minor typographical errors. The files that are available on the internet have been updated to reflect the corrections discussed in this correcting document. III.

Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay in Effective Date Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rulemaking in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rulemaking in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule.

Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the notice and comment and delay in effective date APA requirements. In cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal rulemaking requirements for good cause if the agency makes a finding that the notice and comment process are impracticable, unnecessary, or contrary to the public interest. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and an agency includes a statement of support.

We believe that this correcting document does not constitute a rule that would be subject to the notice and comment or delayed effective date requirements. This document corrects technical and typographical errors in the preamble, addendum, payment rates, tables, and appendices included or referenced in the FY 2021 IPPS/LTCH PPS final rule, but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, this correcting document is intended to ensure that the information in the FY 2021 IPPS/LTCH PPS final rule accurately reflects the policies adopted in that document. In addition, even if this were a rule to which the notice and comment procedures 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 because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the methodologies and policies that we previously proposed, requested comment on, and subsequently finalized. This correcting document is intended solely to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive Start Printed Page 78752the notice and comment and effective date requirements.

Moreover, even if these corrections were considered to be retroactive rulemaking, they would be authorized under section 1871(e)(1)(A)(ii) of the Act, which permits the Secretary to issue a rule for the Medicare program with retroactive effect if the failure to do so would be contrary to the public interest. As we have explained previously, we believe it would be contrary to the public interest not to implement the corrections in this correcting document because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. IV. Correction of Errors In FR Doc.

2020-19637 of September 18, 2020 (85 FR 58432), we are making the following corrections. A. Corrections of Errors in the Preamble 1. On page 58435, third column, third full paragraph, line 1, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”.

2. On page 58436, first column, first full paragraph, line 10, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”. 3. On page 58448, lower half of the page, second column, first partial paragraph, lines 19 and 20, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

4. On page 58451, first column, first full paragraph, line 12, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 5. On page 58453, third column, third full paragraph, line 13, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

6. On page 58459, first column, fourth paragraph, line 3, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 7. On page 58464, bottom quarter of the page, second column, partial paragraph, lines 4 and 5, the phrase “and section II.E.15.

Of this final rule,” is corrected to read “and this final rule,”. 8. On page 58471, first column, first partial paragraph, lines 12 and 13, the reference, “section II.E.15.” is corrected to read “section II.D.15.”. 9.

On page 58479, first column, first partial paragraph. A. Line 6, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. B.

Line 15, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 10. On page 58487, first column, first full paragraph, lines 20 through 21, the reference, “section II.E.12.b.” is corrected to read “section II.D.12.b.”. 11.

On page 58495, middle of the page, third column, first full paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 12. On page 58506. A.

Top half of the page, second column, first full paragraph, line 8, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. B. Bottom half of the page. (1) First column, first paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”.

(2) Second column, third full paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 13. On page 58509. A.

First column, last paragraph, last line, the reference, “section II.E.2.” is corrected to read “section II.D.2.”. B. Third column, last paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 14.

On page 58520, second column, second full paragraph, line 22, the reference, “section II.E.11.” is corrected to read “section II.D.11.”. 15. On page 58529, bottom half of the page, first column, last paragraph, lines 11 and 12, the reference, “section II.E.12.a.” is corrected to read “section II.D.12.a.”. 16.

On page 58531. A. Top of the page, second column, last paragraph, line 3, the reference, “section II.E.4.” is corrected to read “section II.D.4.”. B.

Bottom of the page, first column, last paragraph, line 3, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 17. On page 58532, top of the page, second column, first partial paragraph, line 5, the reference, “section II.E.4.” is corrected to read “section II.D.4.”. 18.

On page 58537. A. Second column, last paragraph, line 6, the reference, “section II.E.11.c.5.” is corrected to read “section II.D.11.c.(5).”. B.

Third column, fifth paragraph. (1) Lines 8 and 9, the reference, “section II.E.11.c.1.” is corrected to read “section II.D.11.c.(1).”. (2) Line 29, the reference, “section II.E.11.c.1.” is corrected to read “section II.D.11.c.(1).”. 19.

On page 58540, first column, first partial paragraph, line 19, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 20. On page 58541, second column, first partial paragraph, lines 9 and 10, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 21.

On page 58553, second column, third full paragraph, line 20, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 22. On page 58554, first column, fifth full paragraph, line 1, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 23.

On page 58555, second column, fifth full paragraph, lines 8 and 9, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 24. On page 58556. A.

First column, first partial paragraph, line 5, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. B. Second column, first full paragraph. (1) Line 6, the reference, “section II.E.16.” is corrected to read “section II.D.16.”.

(2) Line 38, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 25. On page 58559, bottom half of the page, third column, first full paragraph, line 21, the reference, “section II.E.12.c.” is corrected to read “section II.D.12.c.”. 26.

On page 58560, first column, first full paragraph, line 14, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 27. On page 58580, third column, last paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

(1) First column, first paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”. (2) Third column, last paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

B. Bottom of the page, third column, last paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”. 29.

On page 58582. A. Middle of the page. (1) First column, first paragraph, line 3, the reference, “section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. (2) Third column, first full paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”. B.

Bottom of the page, second column, first full paragraph, lines 2 and 3, the reference, “in section II.E.13. Of this final rule,” is corrected to read “this final rule,”. 30. On page 58583.

A. Top of the page, second column, last paragraph, line 3, the reference, Start Printed Page 78753“section II.E.13. Of this final rule,” is corrected to read “this final rule,”. B.

Bottom of the page. (1) First column, last paragraph, line 3, the reference, “in section II.E.13. Of this final rule,” is corrected to read “this final rule,”. (2) Third column, last paragraph, line 3, the reference, “section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. 31. On page 58585, top of the page, third column, last paragraph, lines 3 and 4, the reference, “in section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

32. On page 58586. A. Second column, last partial paragraph, line 4, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

B. Third column. (1) First partial paragraph. (a) Lines 12 and 13, the reference, “in section II.E.2.b.

Of this final rule,” is corrected to read “this final rule,”. (b) Lines 20 and 21, the reference, “in section II.E.8.a. Of this final rule,” is corrected to read “this final rule,”. (2) Last partial paragraph.

(a) Line 3, the reference, “section II.E.4. Of this final rule,” is corrected to read “this final rule,”. (b) Line 38, the reference, “section II.E.7.b. Of this final rule,” is corrected to read “this final rule,”.

33. On page 58587. A. Top of the page, second column, partial paragraph, line 7, the reference, “section II.E.8.a.

Of this final rule,” is corrected to read “this final rule,”. B. Bottom of the page. (1) Second column, last partial paragraph, line 3, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

(2) Third column, first partial paragraph, line 1, the reference, “section II.E.8.a.” is corrected to read “section II.D.8.a.”. 34. On page 58588, first column. A.

First full paragraph, line 3, the reference, “section II.E.4.” is corrected to read “section II.D.4.”. B. Third full paragraph, line 3, the reference, “section II.E.7.b.” is corrected to read “section II.D.7.b.”. C.

Fifth full paragraph, line 3, the reference, “section II.E.8.a.” is corrected to read “section II.D.8.a.”. 35. On page 58596. A.

First column. (1) First full paragraph, line 1, the reference, “section II.E.5.a.” is corrected to read “section II.D.5.a.”. (2) Last paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. C.

Second column, first full paragraph, line 14, the date “March 31, 2019” is corrected to read “March 31, 2020”. 36. On page 58599, first column, second full paragraph, line 1, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 37.

On page 58603, first column. A. First partial paragraph, line 13, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2).b.”. B.

Last partial paragraph, line 21, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2).b.”. 38. On page 58604, third column, first partial paragraph, line 38, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 39.

On page 58606. A. First column, second partial paragraph, line 13, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. B.

Second column. (1) First partial paragraph, line 3, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. (2) First full paragraph. (a) Line 29, the reference, “section II.G.8.” is corrected to read “section II.F.8.”.

(b) Line 36, “section II.G.8.” is corrected to read “section II.F.8.”. E. Third column, first full paragraph. (1) Lines 4 and 5, the reference, “section II.G.9.b.” is corrected to read section “II.F.9.b.”.

(2) Line 13, the reference “section II.G.9.b.” is corrected to read “section II.F.9.b.”. 40. On page 58607. A.

First column, first full paragraph. (1) Line 7, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. (2) Line 13, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. C.

Second column, first partial paragraph. (1) Line 20, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”. (2) Line 33, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”. 41.

On page 58610. A. Second column, last partial paragraph, lines 1 and 16, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. B.

Third column, first partial paragraph. (1) Line 6, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2)b.” (2) Lines 20 and 21, the reference, “section II.G.1.a.(2)b.” is corrected to read “section II.F.1.a.(2)b.”. 42. On page 58716, first column, second full paragraph, lines 14 through 19, the phrase, “with 03HK0MZ (Insertion of stimulator lead into right internal carotid artery, open approach) or 03HL0MZ (Insertion of stimulator lead into left internal carotid artery, open approach)” is corrected to read “with 03HK3MZ (Insertion of stimulator lead into right internal carotid artery, percutaneous approach) or 03HL3MZ (Insertion of stimulator lead into left internal carotid artery, percutaneous approach).”.

43. On page 58717, first column, first partial paragraph, line 5, the phrase, “with 03HK0MZ or 03HL0MZ” is corrected to read “with 03HK3MZ or 03HL3MZ.” 44. On page 58719. A.

First column, last partial paragraph, line 12, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. B. Third column, first partial paragraph, line 15, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. 45.

On page 58721, third column, second full paragraph, line 17, the phrase, “XW03366 or XW04366” is corrected to read “XW033A6 (Introduction of cefiderocol anti-infective into peripheral vein, percutaneous approach, new technology group 6) or XW043A6 (Introduction of cefiderocol anti-infective into central vein, percutaneous approach, new technology group 6).”. 46. On page 58723, second column, first partial paragraph, line 14, the phrase, “procedure codes XW03366 or XW04366” is corrected to read “procedure codes XW033A6 or XW043A6.” 47. On page 58734, third column, second full paragraph, line 26, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”.

48. On page 58736, second column, first full paragraph, line 27, the reference, “II.G.9.b.” is corrected to read “II.F.9.b.”. 49. On page 58737, third column, first partial paragraph, line 5, the reference, “section II.G.1.d.” is corrected to read “section II.F.1.d.”.

50. On page 58739, third column, first full paragraph, line 21, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. 51. On page 58741, third column, second partial paragraph, line 17, the reference, “section II.G.9.a.” is corrected to read “section II.F.9.a.”.Start Printed Page 78754 52.

On page 58768, third column, first partial paragraph, line 3, the figure “0.8465” is corrected to read “0.8469”. 53. On page 58842, second column, first full paragraph, lines 19 and 35, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 54.

On page 58876, first column, first full paragraph, line 18, the reference, “section II.E.” is corrected to read “section II.D.”. 55. On page 58893, first column, second full paragraph, line 5, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 56.

On page 58898, third column, first full paragraph, line 9, the reference, “section II.E.” is corrected to read “section II.D.”. 57. On page 58899, third column, first full paragraph, line 24, the reference, “section II.E.1.” is corrected to read “section II.D.1.”. 58.

On page 58900, first column, third paragraph, line 26, the reference, “section II.E.” is corrected to read “section II.D.”. 59. On page 59006, second column, second full paragraph. A.

Line 4, the regulation citation, “(c)(3)(i)” is corrected to read “(c)(1)(ii)”. B. Line 12, the regulation citation, “(c)(3)(ii)” is corrected to read “(c)(2)(ii)”. C.

Lines 17 and 18, the phrase “charged to an uncollectible receivables account” is corrected to read, “recorded as an implicit price concession”. B. Correction of Errors in the Addendum 1. On page 59031.

A. First column. (1) First full paragraph, line 7, the reference, “section “II.G.” is corrected to read “section II.E.”. (2) Second partial paragraph, lines 26 and 27, the reference, “section II.G.” is corrected to read “section II.E.”.

B. Second column, first partial paragraph. (1) Line 5, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. (2) Line 22, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

2. On page 59034, at the top of the page, the table titled “Summary of FY 2021 Budget Neutrality Factors” is corrected to read. 3. On page 59037, second column.

A. First full paragraph, line 4, the phrase “(estimated capital outlier payments of $429,431,834 divided by (estimated capital outlier payments of $429,431,834 plus the estimated total capital Federal payment of $7,577,697,269))” is corrected to read. €œ(estimated capital outlier payments of $429,147,874 divided by (estimated capital outlier payments of $429,147,874 plus the estimated total capital Federal payment of $7,577,975,637))” b. Last partial paragraph, line 8, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

4. On page 59039, third column, last paragraph, lines 18 and 19, the phrase “9,519,120 cases” is corrected to “9,221,466 cases”. 5. On page 59040.

A. Top of the page, third column. (1) First partial paragraph. (a) Line 9, the figure “$29,051” is corrected to read “$29,064”.

(b) Line 11, the figure “$4,955,813,978” is corrected to read “$4,951,017,650” (c) Line 12, the figure “$92,027,177,037” is corrected to read “$91,937,666,182”. (d) Line 26, the figure “$29,108” is corrected to read “$29,121”. Start Printed Page 78755 (e) Line 33, the figure “$29,051” is corrected to read “$29,064”. (2) First full paragraph, line 11, the phrase “threshold for FY 2021 (which reflects our” is corrected to read “threshold for FY 2021 of $29,064 (which reflects our”.

B. Bottom of the page, the untitled table is corrected to read as follows. 6. On pages 59042, the table titled “CHANGES FROM FY 2020 STANDARDIZED AMOUNTS TO THE FY 2021 STANDARDIZED AMOUNTS” is corrected to read as follows.

Start Printed Page 78756 7. On page 59047. A. Second column.

(1) Second full paragraph, line 43, the figure “0.9984” is corrected to read “0.9983”. (2) Last paragraph. (a) Line 17, the figure “0.9984” is corrected to read “0.9983”. (b) Line 18, the figure “0.9984” is corrected to read “0.9983”.

B. Third column. (1) Third paragraph, line 4, the figure “0.9984” is corrected to read “0.9983”. (2) Last paragraph, line 9, the figure “$466.22” is corrected to read “$466.21”.

8. On page 59048. A. The chart titled “COMPARISON OF FACTORS AND ADJUSTMENTS.

FY 2020 CAPITAL FEDERAL RATE AND THE FY 2021 CAPITAL FEDERAL RATE” is corrected to read as follows. b. Lower half of the page, first column, second full paragraph, last line, the figure “$29,051” is corrected to read “$29,064”. 9.

On page 59057, second column, second full paragraph. A. Line 11, the figure “$29,051” is corrected to read “$29,064”. B.

Last line, the figure “$29,051” is corrected to read “$29,064”. 10. On page 59060, the table titled “TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (68.3 PERCENT LABOR SHARE/31.7 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1) —FY 2021” is corrected to read as follows. 11.

On page 59061, top of the page. A. The table titled “TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2021” is corrected to read as follows. Start Printed Page 78757 b.

The table titled “Table 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL. 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2021” is corrected to read as follows. c. The table titled “TABLE 1D—CAPITAL STANDARD FEDERAL PAYMENT RATE—FY 2021” is corrected to read as follows.

C. Corrections of Errors in the Appendices 1. On page 59062, first column, second full paragraph. A.

Line 9, the reference “sections II.G.5. And 6.” is corrected to read “sections II.F.5. And 6.” b. Line 11, the reference “section II.G.6.” is corrected to read “section II.F.6.” 3.

On page 59064, third column, second full paragraph, last line, the figures “2,049, and 1,152” are corrected to read “2,050 and 1,151”. 4. On page 59065 through 59069, the table and table notes for the table titled “TABLE I.—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2021” are corrected to read as follows. Start Printed Page 78758 Start Printed Page 78759 Start Printed Page 78760 Start Printed Page 78761 Start Printed Page 78762 5.

On page 59070. A. First column. (1) Third full paragraph.

(a) Line 1, the reference, “section II.E.” is corrected to read “section II.D.”. (b) Line 11, the section reference “II.G.” is corrected to read “II.E.”. (2) Fourth full paragraph, line 6, the figure “0.99798” is corrected to read “0.997975”. B.

Third column, first full paragraph, line 26, the figure “1.000426” is corrected to read “1.000447”. 6. On page 59071, lower half of the page. A.

First column, third full paragraph, line 6, the figure “0.986583” is corrected to read “0.986616”. B. Second column, second full paragraph, line 5, the figure “0.993433” is corrected to read “0.993446”. C.

Third column, first partial paragraph, line 2, the figure “0.993433” is corrected to read “0.993446”. 7. On page 59073 and 59074, the table titled “TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2021 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM (PAYMENTS PER DISCHARGE)” is corrected to read as follows. Start Printed Page 78763 Start Printed Page 78764 Start Printed Page 78765 8.

On page 59074, bottom of the page, second column, last partial paragraph, line 1, the reference “section II.G.9.b.” is corrected to read “section II.F.9.b.”. 9. On page 59075. A.

First column. (1) First full paragraph, line 1, the reference “section II.G.9.c.” is corrected to read “section II.F.9.c.”. (2) Last partial paragraph. (i) Line 1, the reference “section II.G.4.” is corrected to read “section II.F.4.”.

(ii) Line 11, the reference “section II.G.4.” is corrected to read “section II.F.4.”. B. Third column. (1) First full paragraph.

(i) Line 1, the reference “sections II.G.5. And 6.” is corrected to read “sections II.F.5. And 6.”. (ii) Line 12, the reference “section II.H.6.” is corrected to read “section II.F.6.”.

(2) Last paragraph, line 1, the reference “section II.G.6.” is corrected to read “section II.F.6.”. 10. On page 59076, first column, first partial paragraph, lines 2 and 3, the reference “section II.G.9.c.” is corrected to read “section II.F.9.c.”. 11.

On pages 59077 and 59078 the table titled “Modeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type. Uncompensated Care Payments ($ in Millions)—from FY 2020 to FY 2021” is corrected to read as follows. Start Printed Page 78766 Start Printed Page 78767 12. On pages 59078 and 59079 in the section titled “Effects of the Changes to Uncompensated Care Payments for FY 2021”, the section's language (beginning with the phrase “Rural hospitals, in general, are projected to experience” and ending with the sentence “Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.62 percent.”) is corrected to read as follows.

€œRural hospitals, in general, are projected to experience larger decreases in uncompensated care payments than their urban counterparts. Overall, rural hospitals are projected to receive a 7.19 percent decrease in uncompensated care payments, while urban hospitals are projected to receive a 0.29 percent decrease in uncompensated care payments. However, hospitals in large urban areas are projected to receive a 0.75 percent increase in uncompensated care payments and hospitals in other urban areas a 1.94 percent decrease. By bed size, smaller rural hospitals are projected to receive the largest decreases in uncompensated care payments.

Rural hospitals with 0-99 beds are projected to receive a 9.46 percent payment decrease, and rural hospitals with 100-249 beds are projected to receive a 7.44 percent decrease. These decreases for smaller rural hospitals are greater than the overall hospital average. However, larger rural hospitals with 250+ beds are projected to receive a 7.64 percent payment increase. In contrast, the smallest urban hospitals (0-99 beds) are projected to receive an increase in uncompensated care payments of 2.61 percent, while urban hospitals with 100-249 beds are projected to receive a decrease of 1.05 percent, and larger urban hospitals with 250+ beds are projected to receive a 0.18 percent decrease in uncompensated care payments, which is less than the overall hospital average.

By region, rural hospitals are expected to receive larger than average decreases in uncompensated care payments in all Regions, except for rural hospitals in the Pacific Region, which are projected to receive an increase in uncompensated care payments of 9.14 percent. Urban hospitals are projected to receive a more varied range of payment changes. Urban hospitals in the New England, the Middle Atlantic, West South Central, and Mountain Regions, as well as urban hospitals in Puerto Rico, are projected to receive larger than average decreases in uncompensated care payments, while urban hospitals in the South Atlantic, East North Central, East South Central, West North Central, and Pacific Regions are projected to receive increases in uncompensated care payments. By payment classification, hospitals in urban areas overall are expected to receive a 0.18 percent increase in uncompensated care payments, with hospitals in large urban areas expected to see an increase in uncompensated care payments of 1.15 percent, while hospitals in other urban areas are expected to receive a decrease of 1.60 percent.

In contrast, hospitals in rural areas are projected to receive a decrease in uncompensated care payments of 3.18 percent. Nonteaching hospitals are projected to receive a payment decrease of 0.99 percent, teaching hospitals with fewer than 100 residents are projected to receive a payment decrease of 0.83 percent, and teaching hospitals with 100+ residents have a projected payment decrease of 0.41 percent. All of these decreases are consistent with the overall hospital average. Proprietary and government hospitals are projected to receive larger than average decreases of 2.42 and 1.14 percent respectively, while voluntary hospitals are expected to receive a payment decrease of 0.03 percent.

Hospitals with less than 50 percent Medicare utilization are projected to receive decreases in uncompensated care payments consistent with the overall hospital average percent change, while hospitals with 50 to 65 percent Medicare utilization are projected to receive a larger than average decrease of 4.12 percent. Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.80 percent.” 13. On page 59085, lower half of the page, second column, last partial paragraph, line 20, the section reference “II.H.” is corrected to read “IV.H.”. 14.

On pages 59092 and 59093, the table titled “TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2020 PAYMENTS COMPARED TO FINAL FY 2021 PAYMENTS] is corrected to read as. Start Printed Page 78768 Start Printed Page 78769 Start Signature Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information BILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-P[FR Doc.

2020-26698 Filed 12-1-20. 4:15 pm]BILLING CODE 4120-01-C.

SAMHSA publishes guidelines, toolkit to strengthen crisis care in America's communities | SAMHSA Skip to main contentStart Preamble Centers for lasix price comparison Medicare &. Medicaid Services lasix price comparison (CMS), Health and Human Services (HHS). Final rule lasix price comparison.

Correction. This document corrects technical and typographical errors in the final rule that appeared in the September 18, 2020 issue of the Federal Register titled “Medicare Program lasix price comparison. Hospital Inpatient Prospective Payment lasix price comparison Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates.

Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible lasix price comparison Hospitals and Critical Access Hospitals”. Effective Date. This correcting document is effective on December lasix price comparison 1, 2020.

Applicability Date lasix price comparison. The corrections in this correcting document lasix price comparison are applicable to discharges occurring on or after October 1, 2020. Start Further Info Donald Thompson and Michele Hudson, (410) 786-4487.

End Further lasix price comparison Info End Preamble Start Supplemental Information I. Background In FR Doc lasix price comparison. 2020-19637 of September 18, 2020 (85 FR 58432) there were a number of technical and typographical errors that are identified and corrected in the Correction of Errors section lasix price comparison of this correcting document.

The corrections in this correcting document are applicable to discharges occurring on or after October 1, 2020, as if they had been included in the document that appeared in the September 18, 2020 Federal Register. II. Summary of Errors A.

Summary of Errors in the Preamble On the following pages. 58435 through 58436, 58448, 58451, 58453, 58459, 58464, 58471, 58479, 58487, 58495, 58506, 58509, 58520, 58529, 58531 through 58532, 58537, 58540 through 58541, 58553 through 58556, 58559 through 58560, 58580 through 58583, 58585 through 58588, 58596, 58599, 58603 through 58604, 58606 through 58607, 58610, 58719, 58734, 58736 through 58737, 58739, 58741, 58842, 58876, 58893, and 58898 through 58900, we are correcting inadvertent typographical errors in the internal section references. On page 58596, we are correcting an inadvertent typographical error in the date of the MedPAR data used for developing the Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights.

On pages 58716 and 58717, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the BAROSTIM NEO® System technology. On pages 58721 and 58723, we are correcting inadvertent errors in the ICD-10-PCS procedure codes describing the Cefiderocol technology. On page 58768, due to a conforming change to the Rural Floor Budget Neutrality adjustment (listed in the table titled “Summary of FY 2021 Budget Neutrality Factors” on page 59034) as discussed in section II.B.

Of this correcting document and the conforming changes to the Out-Migration Adjustment discussed in section II. D of this correcting document (with regard to Table 4A), we are correcting the 25th percentile wage index value across all hospitals. On page 59006, in the discussion of Medicare bad debt policy, we are correcting inadvertent errors in the regulatory citations and descriptions.

B. Summary of Errors in the Addendum On pages 59031 and 59037, we are correcting inadvertent typographical errors in the internal section references. We are correcting an error in the version 38 ICD-10 MS-DRG assignment for some cases in the historical claims data in the FY 2019 MedPAR files used in the ratesetting for the FY 2021 IPPS/LTCH PPS final rule, which resulted in inadvertent errors in the MS-DRG relative weights (and associated average length-of-stay (LOS)).

Additionally, the version 38 MS-DRG assignment and relative weights are used when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the corrections to the MS-DRG assignment under the ICD-10 MS-DRG GROUPER version 38 for some cases in the historical claims data in the FY 2019 MedPAR files and the recalculation of the relative weights directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. In addition, as discussed in section II.D.

Of this correcting document, we made updates to the calculation of Factor 3 of the uncompensated care payment methodology to reflect updated information on hospital mergers received in response to the final rule. Factor 3 determines the total amount of the uncompensated care payment a hospital is eligible to receive for a fiscal year. This hospital-specific payment amount is then used to calculate the amount of the interim uncompensated care payments a hospital receives per discharge.

Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, the revisions made to the calculation of Factor 3 to address additional merger information directly affected the calculation of total payments and required the recalculation of all the budget neutrality factors and the final outlier threshold. We made an inadvertent error in the Medicare Geographic Classification Review Board (MGCRB) reclassification status of one hospital in the FY 2021 IPPS/LTCH PPS final rule.

Specifically, CCN 050481 is incorrectly listed in Table 2 as reclassified to its geographic “home” of CBSA 31084. The correct reclassification area is to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100 and affected the final FY 2021 wage index with reclassification.

The final FY 2021 IPPS wage index with reclassification is used when determining total payments for purposes of all budget neutrality factors (except for the MS-DRG reclassification and recalibration budget neutrality factor and the wage index budget neutrality adjustment factor) and the final outlier threshold. Due to the correction of the combination of errors listed previously (corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, revisions to Factor 3 of the uncompensated care payment methodology, and the correction to the MGCRB reclassification status of one hospital), we recalculated all IPPS budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes (and geographic adjustment factors (GAFs)), the national operating standardized amounts and capital Federal rate. Therefore, we made conforming changes to the following.

On page 59034, the table titled “Summary of FY 2021 Budget Neutrality Factors”. On page 59037, the estimated total Federal capital payments and the estimated capital outlier payments. On page 59040, the calculation of the outlier fixed-loss cost threshold, total operating Federal payments, total operating outlier payments, the outlier adjustment to the capital Federal rate and the related discussion of the percentage estimates of operating and capital outlier payments.

On page 59042, the table titled “Changes from FY 2020 Standardized Amounts to the FY 2021 Standardized Amounts”. On page 59039, we are correcting a typographical error in the total cases from October 1, 2018 through September 31, 2019 used to calculate the average covered charge per case, which is then used to calculate the charge inflation factor. On pages 59047 through 59048, in our discussion of the determination of the Federal hospital inpatient capital-related prospective payment rate update, due to the recalculation of the GAFs as well as corrections to the MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and average length of stay, we have made conforming corrections to the capital Federal rate, the incremental budget neutrality adjustment factor for changes in the GAFs, and the outlier threshold (as discussed previously).

As a result of these changes, we also made conforming corrections in the table showing the comparison of factors and adjustments for the FY 2020 capital Federal rate and FY 2021 capital Federal rate. As we noted in the final rule, the capital Federal rate is calculated using unrounded budget neutrality and outlier Start Printed Page 78750adjustment factors. The unrounded GAF/DRG budget neutrality factors and the unrounded outlier adjustment to the capital Federal rate were revised because of these errors.

However, after rounding these factors to 4 decimal places as displayed in the final rule, the rounded factors were unchanged from the final rule. On page 59057, we are making conforming changes to the fixed-loss amount for FY 2021 site neutral payment rate discharges, and the high cost outlier (HCO) threshold (based on the corrections to the IPPS fixed-loss amount discussed previously). On pages 59060 and 59061, we are making conforming corrections to the national adjusted operating standardized amounts and capital standard Federal payment rate (which also include the rates payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming corrections to certain budget neutrality factors and the outlier threshold previously described.

C. Summary of Errors in the Appendices On pages 59062, 59070, 59074 through 59076, and 59085 we are correcting inadvertent typographical errors in the internal section references. On pages 59064 through 59071, 59073 and 59074, and 59092 and 59093, in our regulatory impact analyses, we have made conforming corrections to the factors, values, and tables and accompanying discussion of the changes in operating and capital IPPS payments for FY 2021 and the effects of certain IPPS budget neutrality factors as a result of the technical errors that lead to changes in our calculation of the operating and capital IPPS budget neutrality factors, outlier threshold, final wage indexes, operating standardized amounts, and capital Federal rate (as described in section II.B.

Of this correcting document). These conforming corrections include changes to the following tables. On pages 59065 through 59069, the table titled “Table I—Impact Analysis of Changes to the IPPS for Operating Costs for FY 2021”.

On pages 59073 and 59074, the table titled “Table II—Impact Analysis of Changes for FY 2021 Acute Care Hospital Operating Prospective Payment System (Payments per discharge)”. On pages 59092 and 59093, the table titled “Table III—Comparison of Total Payments per Case [FY 2020 Payments Compared to Final FY 2021 payments]”. On pages 59076 through 59079, we are correcting the discussion of the “Effects of the Changes to Uncompensated Care Payments for FY 2021” for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule, including the table titled “Modeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type.

Uncompensated Care Payments ($ in Millions)*—from FY 2020 to FY 2021” on pages 59077 and 59078, in light of the corrections discussed in section II.D. Of this correcting document. D.

Summary of Errors in and Corrections to Files and Tables Posted on the CMS Website We are correcting the errors in the following IPPS tables that are listed on pages 59059 and 59060 of the FY 2021 IPPS/LTCH PPS final rule and are available on the internet on the CMS website at https://www.cms.gov/​Medicare/​Medicare-Fee-for-Service-Payment/​AcuteInpatientPPS/​index.html. The tables that are available on the internet have been updated to reflect the revisions discussed in this correcting document. Table 2—Case-Mix Index and Wage Index Table by CCN-FY 2021 Final Rule.

As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed as reclassified to its home geographic area of CBSA 31084. In this table, we are correcting the columns titled “Wage Index Payment CBSA” and “MGCRB Reclass” to accurately reflect its reclassification to CBSA 37100.

This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100. Also, the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes.

Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes listed in Table 2. In addition, as also discussed later in this section, because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed. Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 2.

Also, as discussed in section II.A of this correcting document, we made a conforming change to the 25th percentile wage index value across all hospitals. Accordingly, we are making corresponding changes to the values for hospitals in the columns titled “FY 2021 Wage Index Prior to Quartile and Transition”, “FY 2021 Wage Index With Quartile”, “FY 2021 Wage Index With Quartile and Cap” and “Out-Migration Adjustment”. We also updated footnote number 6 to reflect the conforming change to the 25th percentile wage index value across all hospitals.

Table 3.—Wage Index Table by CBSA—FY 2021 Final Rule. As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100.

This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100. Also, corrections to the version 38 MS-DRG assignment for some cases in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes.

Because the rural floor budget neutrality factor is applied to the FY 2021 wage indexes, we are making corresponding changes to the wage indexes and GAFs of all CBSAs listed in Table 3. Specifically, we are correcting the values and flags in the columns titled “Wage Index”, “GAF”, “Reclassified Wage Index”, “Reclassified GAF”, “State Rural Floor”, “Eligible for Rural Floor Wage Index”, “Pre-Frontier and/or Pre-Rural Floor Wage Index”, “Reclassified Wage Index Eligible for Frontier Wage Index”, “Reclassified Wage Index Eligible for Rural Floor Wage Index”, and “Reclassified Wage Index Pre-Frontier and/or Pre-Rural Floor”. Table 4A.— List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act—FY 2021 Final Rule.

As discussed in section II.B. Of this correcting document, CCN 050481 is incorrectly listed in Table 2 as reclassified to its home geographic area of CBSA 31084 instead of reclassified to CBSA 37100. This correction necessitated the recalculation of the FY 2021 wage index for CBSA 37100.

Also, corrections to the version 38 MS-DRG assignment for some cases Start Printed Page 78751in the historical claims data and the resulting recalculation of the relative weights and ALOS, corrections to Factor 3 of the uncompensated care payment methodology, and the recalculation of all of the budget neutrality adjustments (as discussed in section II.B. Of this correcting document) necessitated the recalculation of the rural floor budget neutrality factor which is the only budget neutrality factor applied to the FY 2021 wage indexes. As a result, as discussed previously, we are making corresponding changes to the FY 2021 wage indexes.

Because the wage indexes are one of the inputs used to determine the out-migration adjustment, some of the out migration adjustments changed. Therefore, we are making corresponding changes to some of the out-migration adjustments listed in Table 4A. Specifically, we are correcting the values in the column titled “FY 2021 Out Migration Adjustment”.

Table 5.—List of Medicare Severity Diagnosis-Related Groups (MS-DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay—FY 2021. We are correcting this table to reflect the recalculation of the relative weights, geometric average length-of-stay (LOS), and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B. Of this correcting document).

Table 7B.—Medicare Prospective Payment System Selected Percentile Lengths of Stay. FY 2019 MedPAR Update—March 2020 GROUPER Version 38 MS-DRGs. We are correcting this table to reflect the recalculation of the relative weights, geometric average LOS, and arithmetic mean LOS as a result of the corrections to the version 38 MS-DRG assignment for some cases in the historical claims data used in the calculations (as discussed in section II.B.

Of this correcting document). Table 18.—FY 2021 Medicare DSH Uncompensated Care Payment Factor 3. For the FY 2021 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals projected to be eligible to receive uncompensated care interim payments for FY 2021.

As stated in the FY 2021 IPPS/LTCH PPS final rule (85 FR 58834 and 58835), we allowed the public an additional period after the issuance of the final rule to review and submit comments on the accuracy of the list of mergers that we identified in the final rule. Based on the comments received during this additional period, we are updating this table to reflect the merger information received in response to the final rule and to revise the Factor 3 calculations for purposes of determining uncompensated care payments for the FY 2021 IPPS/LTCH PPS final rule. We are revising Factor 3 for all hospitals to reflect the updated merger information received in response to the final rule.

We are also revising the amount of the total uncompensated care payment calculated for each DSH-eligible hospital. The total uncompensated care payment that a hospital receives is used to calculate the amount of the interim uncompensated care payments the hospital receives per discharge. Accordingly, we have also revised these amounts for all DSH-eligible hospitals.

These corrections will be reflected in Table 18 and the Medicare DSH Supplemental Data File. Per discharge uncompensated care payments are included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. As a result, these corrections to uncompensated care payments impacted the calculation of all the budget neutrality factors as well as the outlier fixed-loss cost threshold.

In section IV.C. Of this correcting document, we have made corresponding revisions to the discussion of the “Effects of the Changes to Medicare DSH and Uncompensated Care Payments for FY 2021” for purposes of the Regulatory Impact Analysis in Appendix A of the FY 2021 IPPS/LTCH PPS final rule to reflect the corrections discussed previously and to correct minor typographical errors. The files that are available on the internet have been updated to reflect the corrections discussed in this correcting document.

III. Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay in Effective Date Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rulemaking in the Federal Register before the provisions of a rule take effect.

Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rulemaking in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the notice and comment and delay in effective date APA requirements.

In cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal rulemaking requirements for good cause if the agency makes a finding that the notice and comment process are impracticable, unnecessary, or contrary to the public interest. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and an agency includes a statement of support.

We believe that this correcting document does not constitute a rule that would be subject to the notice and comment or delayed effective date requirements. This document corrects technical and typographical errors in the preamble, addendum, payment rates, tables, and appendices included or referenced in the FY 2021 IPPS/LTCH PPS final rule, but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, this correcting document is intended to ensure that the information in the FY 2021 IPPS/LTCH PPS final rule accurately reflects the policies adopted in that document.

In addition, even if this were a rule to which the notice and comment procedures 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 because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the methodologies and policies that we previously proposed, requested comment on, and subsequently finalized.

This correcting document is intended solely to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive Start Printed Page 78752the notice and comment and effective date requirements. Moreover, even if these corrections were considered to be retroactive rulemaking, they would be authorized under section 1871(e)(1)(A)(ii) of the Act, which permits the Secretary to issue a rule for the Medicare program with retroactive effect if the failure to do so would be contrary to the public interest.

As we have explained previously, we believe it would be contrary to the public interest not to implement the corrections in this correcting document because it is in the public's interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2021 IPPS/LTCH PPS final rule accurately reflects our policies. IV. Correction of Errors In FR Doc.

2020-19637 of September 18, 2020 (85 FR 58432), we are making the following corrections. A. Corrections of Errors in the Preamble 1.

On page 58435, third column, third full paragraph, line 1, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. 2. On page 58436, first column, first full paragraph, line 10, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”.

3. On page 58448, lower half of the page, second column, first partial paragraph, lines 19 and 20, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 4.

On page 58451, first column, first full paragraph, line 12, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 5. On page 58453, third column, third full paragraph, line 13, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

6. On page 58459, first column, fourth paragraph, line 3, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 7.

On page 58464, bottom quarter of the page, second column, partial paragraph, lines 4 and 5, the phrase “and section II.E.15. Of this final rule,” is corrected to read “and this final rule,”. 8.

On page 58471, first column, first partial paragraph, lines 12 and 13, the reference, “section II.E.15.” is corrected to read “section II.D.15.”. 9. On page 58479, first column, first partial paragraph.

A. Line 6, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. B.

Line 15, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 10. On page 58487, first column, first full paragraph, lines 20 through 21, the reference, “section II.E.12.b.” is corrected to read “section II.D.12.b.”.

11. On page 58495, middle of the page, third column, first full paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 12.

On page 58506. A. Top half of the page, second column, first full paragraph, line 8, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”.

B. Bottom half of the page. (1) First column, first paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”.

(2) Second column, third full paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 13. On page 58509.

A. First column, last paragraph, last line, the reference, “section II.E.2.” is corrected to read “section II.D.2.”. B.

Third column, last paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 14. On page 58520, second column, second full paragraph, line 22, the reference, “section II.E.11.” is corrected to read “section II.D.11.”.

15. On page 58529, bottom half of the page, first column, last paragraph, lines 11 and 12, the reference, “section II.E.12.a.” is corrected to read “section II.D.12.a.”. 16.

On page 58531. A. Top of the page, second column, last paragraph, line 3, the reference, “section II.E.4.” is corrected to read “section II.D.4.”.

B. Bottom of the page, first column, last paragraph, line 3, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 17.

On page 58532, top of the page, second column, first partial paragraph, line 5, the reference, “section II.E.4.” is corrected to read “section II.D.4.”. 18. On page 58537.

A. Second column, last paragraph, line 6, the reference, “section II.E.11.c.5.” is corrected to read “section II.D.11.c.(5).”. B.

Third column, fifth paragraph. (1) Lines 8 and 9, the reference, “section II.E.11.c.1.” is corrected to read “section II.D.11.c.(1).”. (2) Line 29, the reference, “section II.E.11.c.1.” is corrected to read “section II.D.11.c.(1).”.

19. On page 58540, first column, first partial paragraph, line 19, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 20.

On page 58541, second column, first partial paragraph, lines 9 and 10, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. 21. On page 58553, second column, third full paragraph, line 20, the reference, “section II.E.16.” is corrected to read “section II.D.16.”.

22. On page 58554, first column, fifth full paragraph, line 1, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 23.

On page 58555, second column, fifth full paragraph, lines 8 and 9, the reference, “section II.E.13.” is corrected to read “section II.D.13.”. 24. On page 58556.

A. First column, first partial paragraph, line 5, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. B.

Second column, first full paragraph. (1) Line 6, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. (2) Line 38, the reference, “section II.E.16.” is corrected to read “section II.D.16.”.

25. On page 58559, bottom half of the page, third column, first full paragraph, line 21, the reference, “section II.E.12.c.” is corrected to read “section II.D.12.c.”. 26.

On page 58560, first column, first full paragraph, line 14, the reference, “section II.E.16.” is corrected to read “section II.D.16.”. 27. On page 58580, third column, last paragraph, line 3, the reference, “section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. 28. On page 58581.

A. Middle of the page. (1) First column, first paragraph, line 3, the reference, “section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. (2) Third column, last paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

B. Bottom of the page, third column, last paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

Middle of the page. (1) First column, first paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”.

(2) Third column, first full paragraph, line 3, the reference, “section II.E.13. Of this final rule,” is corrected to read “this final rule,”. B.

Bottom of the page, second column, first full paragraph, lines 2 and 3, the reference, “in section II.E.13. Of this final rule,” is corrected to read “this final rule,”. 30.

On page 58583. A. Top of the page, second column, last paragraph, line 3, the reference, Start Printed Page 78753“section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. B. Bottom of the page.

(1) First column, last paragraph, line 3, the reference, “in section II.E.13. Of this final rule,” is corrected to read “this final rule,”. (2) Third column, last paragraph, line 3, the reference, “section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. 31. On page 58585, top of the page, third column, last paragraph, lines 3 and 4, the reference, “in section II.E.13.

Of this final rule,” is corrected to read “this final rule,”. 32. On page 58586.

A. Second column, last partial paragraph, line 4, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. B.

Third column. (1) First partial paragraph. (a) Lines 12 and 13, the reference, “in section II.E.2.b.

Of this final rule,” is corrected to read “this final rule,”. (b) Lines 20 and 21, the reference, “in section II.E.8.a. Of this final rule,” is corrected to read “this final rule,”.

(2) Last partial paragraph. (a) Line 3, the reference, “section II.E.4. Of this final rule,” is corrected to read “this final rule,”.

(b) Line 38, the reference, “section II.E.7.b. Of this final rule,” is corrected to read “this final rule,”. 33.

On page 58587. A. Top of the page, second column, partial paragraph, line 7, the reference, “section II.E.8.a.

Of this final rule,” is corrected to read “this final rule,”. B. Bottom of the page.

(1) Second column, last partial paragraph, line 3, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. (2) Third column, first partial paragraph, line 1, the reference, “section II.E.8.a.” is corrected to read “section II.D.8.a.”. 34.

On page 58588, first column. A. First full paragraph, line 3, the reference, “section II.E.4.” is corrected to read “section II.D.4.”.

B. Third full paragraph, line 3, the reference, “section II.E.7.b.” is corrected to read “section II.D.7.b.”. C.

Fifth full paragraph, line 3, the reference, “section II.E.8.a.” is corrected to read “section II.D.8.a.”. 35. On page 58596.

A. First column. (1) First full paragraph, line 1, the reference, “section II.E.5.a.” is corrected to read “section II.D.5.a.”.

(2) Last paragraph, line 5, the reference, “section II.E.1.b.” is corrected to read “section II.D.1.b.”. C. Second column, first full paragraph, line 14, the date “March 31, 2019” is corrected to read “March 31, 2020”.

36. On page 58599, first column, second full paragraph, line 1, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 37.

On page 58603, first column. A. First partial paragraph, line 13, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2).b.”.

B. Last partial paragraph, line 21, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2).b.”. 38.

On page 58604, third column, first partial paragraph, line 38, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 39. On page 58606.

A. First column, second partial paragraph, line 13, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. B.

Second column. (1) First partial paragraph, line 3, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. (2) First full paragraph.

(a) Line 29, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. (b) Line 36, “section II.G.8.” is corrected to read “section II.F.8.”. E.

Third column, first full paragraph. (1) Lines 4 and 5, the reference, “section II.G.9.b.” is corrected to read section “II.F.9.b.”. (2) Line 13, the reference “section II.G.9.b.” is corrected to read “section II.F.9.b.”.

First column, first full paragraph. (1) Line 7, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. (2) Line 13, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”.

C. Second column, first partial paragraph. (1) Line 20, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”.

(2) Line 33, the reference, “section II.G.9.c.” is corrected to read “section II.F.9.c.”. 41. On page 58610.

A. Second column, last partial paragraph, lines 1 and 16, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. B.

Third column, first partial paragraph. (1) Line 6, the reference, “section II.G.1.a.(2).b.” is corrected to read “section II.F.1.a.(2)b.” (2) Lines 20 and 21, the reference, “section II.G.1.a.(2)b.” is corrected to read “section II.F.1.a.(2)b.”. 42.

On page 58716, first column, second full paragraph, lines 14 through 19, the phrase, “with 03HK0MZ (Insertion of stimulator lead into right internal carotid artery, open approach) or 03HL0MZ (Insertion of stimulator lead into left internal carotid artery, open approach)” is corrected to read “with 03HK3MZ (Insertion of stimulator lead into right internal carotid artery, percutaneous approach) or 03HL3MZ (Insertion of stimulator lead into left internal carotid artery, percutaneous approach).”. 43. On page 58717, first column, first partial paragraph, line 5, the phrase, “with 03HK0MZ or 03HL0MZ” is corrected to read “with 03HK3MZ or 03HL3MZ.” 44.

On page 58719. A. First column, last partial paragraph, line 12, the reference, “section II.G.8.” is corrected to read “section II.F.8.”.

B. Third column, first partial paragraph, line 15, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. 45.

On page 58721, third column, second full paragraph, line 17, the phrase, “XW03366 or XW04366” is corrected to read “XW033A6 (Introduction of cefiderocol anti-infective into peripheral vein, percutaneous approach, new technology group 6) or XW043A6 (Introduction of cefiderocol anti-infective into central vein, percutaneous approach, new technology group 6).”. 46. On page 58723, second column, first partial paragraph, line 14, the phrase, “procedure codes XW03366 or XW04366” is corrected to read “procedure codes XW033A6 or XW043A6.” 47.

On page 58734, third column, second full paragraph, line 26, the reference, “section II.G.9.b.” is corrected to read “section II.F.9.b.”. 48. On page 58736, second column, first full paragraph, line 27, the reference, “II.G.9.b.” is corrected to read “II.F.9.b.”.

49. On page 58737, third column, first partial paragraph, line 5, the reference, “section II.G.1.d.” is corrected to read “section II.F.1.d.”. 50.

On page 58739, third column, first full paragraph, line 21, the reference, “section II.G.8.” is corrected to read “section II.F.8.”. 51. On page 58741, third column, second partial paragraph, line 17, the reference, “section II.G.9.a.” is corrected to read “section II.F.9.a.”.Start Printed Page 78754 52.

On page 58768, third column, first partial paragraph, line 3, the figure “0.8465” is corrected to read “0.8469”. 53. On page 58842, second column, first full paragraph, lines 19 and 35, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”.

54. On page 58876, first column, first full paragraph, line 18, the reference, “section II.E.” is corrected to read “section II.D.”. 55.

On page 58893, first column, second full paragraph, line 5, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 56. On page 58898, third column, first full paragraph, line 9, the reference, “section II.E.” is corrected to read “section II.D.”.

57. On page 58899, third column, first full paragraph, line 24, the reference, “section II.E.1.” is corrected to read “section II.D.1.”. 58.

On page 58900, first column, third paragraph, line 26, the reference, “section II.E.” is corrected to read “section II.D.”. 59. On page 59006, second column, second full paragraph.

A. Line 4, the regulation citation, “(c)(3)(i)” is corrected to read “(c)(1)(ii)”. B.

Line 12, the regulation citation, “(c)(3)(ii)” is corrected to read “(c)(2)(ii)”. C. Lines 17 and 18, the phrase “charged to an uncollectible receivables account” is corrected to read, “recorded as an implicit price concession”.

B. Correction of Errors in the Addendum 1. On page 59031.

A. First column. (1) First full paragraph, line 7, the reference, “section “II.G.” is corrected to read “section II.E.”.

(2) Second partial paragraph, lines 26 and 27, the reference, “section II.G.” is corrected to read “section II.E.”. B. Second column, first partial paragraph.

(1) Line 5, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. (2) Line 22, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 2.

On page 59034, at the top of the page, the table titled “Summary of FY 2021 Budget Neutrality Factors” is corrected to read. 3. On page 59037, second column.

A. First full paragraph, line 4, the phrase “(estimated capital outlier payments of $429,431,834 divided by (estimated capital outlier payments of $429,431,834 plus the estimated total capital Federal payment of $7,577,697,269))” is corrected to read. €œ(estimated capital outlier payments of $429,147,874 divided by (estimated capital outlier payments of $429,147,874 plus the estimated total capital Federal payment of $7,577,975,637))” b.

Last partial paragraph, line 8, the reference, “section II.E.2.b.” is corrected to read “section II.D.2.b.”. 4. On page 59039, third column, last paragraph, lines 18 and 19, the phrase “9,519,120 cases” is corrected to “9,221,466 cases”.

Top of the page, third column. (1) First partial paragraph. (a) Line 9, the figure “$29,051” is corrected to read “$29,064”.

(b) Line 11, the figure “$4,955,813,978” is corrected to read “$4,951,017,650” (c) Line 12, the figure “$92,027,177,037” is corrected to read “$91,937,666,182”. (d) Line 26, the figure “$29,108” is corrected to read “$29,121”. Start Printed Page 78755 (e) Line 33, the figure “$29,051” is corrected to read “$29,064”.

(2) First full paragraph, line 11, the phrase “threshold for FY 2021 (which reflects our” is corrected to read “threshold for FY 2021 of $29,064 (which reflects our”. B. Bottom of the page, the untitled table is corrected to read as follows.

6. On pages 59042, the table titled “CHANGES FROM FY 2020 STANDARDIZED AMOUNTS TO THE FY 2021 STANDARDIZED AMOUNTS” is corrected to read as follows. Start Printed Page 78756 7.

(1) Second full paragraph, line 43, the figure “0.9984” is corrected to read “0.9983”. (2) Last paragraph. (a) Line 17, the figure “0.9984” is corrected to read “0.9983”.

(b) Line 18, the figure “0.9984” is corrected to read “0.9983”. B. Third column.

(1) Third paragraph, line 4, the figure “0.9984” is corrected to read “0.9983”. (2) Last paragraph, line 9, the figure “$466.22” is corrected to read “$466.21”. 8.

On page 59048. A. The chart titled “COMPARISON OF FACTORS AND ADJUSTMENTS.

FY 2020 CAPITAL FEDERAL RATE AND THE FY 2021 CAPITAL FEDERAL RATE” is corrected to read as follows. b. Lower half of the page, first column, second full paragraph, last line, the figure “$29,051” is corrected to read “$29,064”.

9. On page 59057, second column, second full paragraph. A.

Line 11, the figure “$29,051” is corrected to read “$29,064”. B. Last line, the figure “$29,051” is corrected to read “$29,064”.

10. On page 59060, the table titled “TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (68.3 PERCENT LABOR SHARE/31.7 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1) —FY 2021” is corrected to read as follows. 11.

On page 59061, top of the page. A. The table titled “TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2021” is corrected to read as follows.

Start Printed Page 78757 b. The table titled “Table 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL. 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2021” is corrected to read as follows.

c. The table titled “TABLE 1D—CAPITAL STANDARD FEDERAL PAYMENT RATE—FY 2021” is corrected to read as follows. C.

Corrections of Errors in the Appendices 1. On page 59062, first column, second full paragraph. A.

Line 9, the reference “sections II.G.5. And 6.” is corrected to read “sections II.F.5. And 6.” b.

Line 11, the reference “section II.G.6.” is corrected to read “section II.F.6.” 3. On page 59064, third column, second full paragraph, last line, the figures “2,049, and 1,152” are corrected to read “2,050 and 1,151”. 4.

On page 59065 through 59069, the table and table notes for the table titled “TABLE I.—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2021” are corrected to read as follows. Start Printed Page 78758 Start Printed Page 78759 Start Printed Page 78760 Start Printed Page 78761 Start Printed Page 78762 5. On page 59070.

(a) Line 1, the reference, “section II.E.” is corrected to read “section II.D.”. (b) Line 11, the section reference “II.G.” is corrected to read “II.E.”. (2) Fourth full paragraph, line 6, the figure “0.99798” is corrected to read “0.997975”.

B. Third column, first full paragraph, line 26, the figure “1.000426” is corrected to read “1.000447”. 6.

On page 59071, lower half of the page. A. First column, third full paragraph, line 6, the figure “0.986583” is corrected to read “0.986616”.

B. Second column, second full paragraph, line 5, the figure “0.993433” is corrected to read “0.993446”. C.

Third column, first partial paragraph, line 2, the figure “0.993433” is corrected to read “0.993446”. 7. On page 59073 and 59074, the table titled “TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2021 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM (PAYMENTS PER DISCHARGE)” is corrected to read as follows.

Start Printed Page 78763 Start Printed Page 78764 Start Printed Page 78765 8. On page 59074, bottom of the page, second column, last partial paragraph, line 1, the reference “section II.G.9.b.” is corrected to read “section II.F.9.b.”. 9.

(1) First full paragraph, line 1, the reference “section II.G.9.c.” is corrected to read “section II.F.9.c.”. (2) Last partial paragraph. (i) Line 1, the reference “section II.G.4.” is corrected to read “section II.F.4.”.

(ii) Line 11, the reference “section II.G.4.” is corrected to read “section II.F.4.”. B. Third column.

(1) First full paragraph. (i) Line 1, the reference “sections II.G.5. And 6.” is corrected to read “sections II.F.5.

And 6.”. (ii) Line 12, the reference “section II.H.6.” is corrected to read “section II.F.6.”. (2) Last paragraph, line 1, the reference “section II.G.6.” is corrected to read “section II.F.6.”.

10. On page 59076, first column, first partial paragraph, lines 2 and 3, the reference “section II.G.9.c.” is corrected to read “section II.F.9.c.”. 11.

On pages 59077 and 59078 the table titled “Modeled Uncompensated Care Payments for Estimated FY 2021 DSHs by Hospital Type. Uncompensated Care Payments ($ in Millions)—from FY 2020 to FY 2021” is corrected to read as follows. Start Printed Page 78766 Start Printed Page 78767 12.

On pages 59078 and 59079 in the section titled “Effects of the Changes to Uncompensated Care Payments for FY 2021”, the section's language (beginning with the phrase “Rural hospitals, in general, are projected to experience” and ending with the sentence “Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.62 percent.”) is corrected to read as follows. €œRural hospitals, in general, are projected to experience larger decreases in uncompensated care payments than their urban counterparts. Overall, rural hospitals are projected to receive a 7.19 percent decrease in uncompensated care payments, while urban hospitals are projected to receive a 0.29 percent decrease in uncompensated care payments.

However, hospitals in large urban areas are projected to receive a 0.75 percent increase in uncompensated care payments and hospitals in other urban areas a 1.94 percent decrease. By bed size, smaller rural hospitals are projected to receive the largest decreases in uncompensated care payments. Rural hospitals with 0-99 beds are projected to receive a 9.46 percent payment decrease, and rural hospitals with 100-249 beds are projected to receive a 7.44 percent decrease.

These decreases for smaller rural hospitals are greater than the overall hospital average. However, larger rural hospitals with 250+ beds are projected to receive a 7.64 percent payment increase. In contrast, the smallest urban hospitals (0-99 beds) are projected to receive an increase in uncompensated care payments of 2.61 percent, while urban hospitals with 100-249 beds are projected to receive a decrease of 1.05 percent, and larger urban hospitals with 250+ beds are projected to receive a 0.18 percent decrease in uncompensated care payments, which is less than the overall hospital average.

By region, rural hospitals are expected to receive larger than average decreases in uncompensated care payments in all Regions, except for rural hospitals in the Pacific Region, which are projected to receive an increase in uncompensated care payments of 9.14 percent. Urban hospitals are projected to receive a more varied range of payment changes. Urban hospitals in the New England, the Middle Atlantic, West South Central, and Mountain Regions, as well as urban hospitals in Puerto Rico, are projected to receive larger than average decreases in uncompensated care payments, while urban hospitals in the South Atlantic, East North Central, East South Central, West North Central, and Pacific Regions are projected to receive increases in uncompensated care payments.

By payment classification, hospitals in urban areas overall are expected to receive a 0.18 percent increase in uncompensated care payments, with hospitals in large urban areas expected to see an increase in uncompensated care payments of 1.15 percent, while hospitals in other urban areas are expected to receive a decrease of 1.60 percent. In contrast, hospitals in rural areas are projected to receive a decrease in uncompensated care payments of 3.18 percent. Nonteaching hospitals are projected to receive a payment decrease of 0.99 percent, teaching hospitals with fewer than 100 residents are projected to receive a payment decrease of 0.83 percent, and teaching hospitals with 100+ residents have a projected payment decrease of 0.41 percent.

All of these decreases are consistent with the overall hospital average. Proprietary and government hospitals are projected to receive larger than average decreases of 2.42 and 1.14 percent respectively, while voluntary hospitals are expected to receive a payment decrease of 0.03 percent. Hospitals with less than 50 percent Medicare utilization are projected to receive decreases in uncompensated care payments consistent with the overall hospital average percent change, while hospitals with 50 to 65 percent Medicare utilization are projected to receive a larger than average decrease of 4.12 percent.

Hospitals with greater than 65 percent Medicare utilization are projected to receive an increase of 0.80 percent.” 13. On page 59085, lower half of the page, second column, last partial paragraph, line 20, the section reference “II.H.” is corrected to read “IV.H.”. 14.

On pages 59092 and 59093, the table titled “TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2020 PAYMENTS COMPARED TO FINAL FY 2021 PAYMENTS] is corrected to read as. Start Printed Page 78768 Start Printed Page 78769 Start Signature Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services.

End Signature End Supplemental Information BILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-PBILLING CODE 4120-01-CBILLING CODE 4120-01-P[FR Doc. 2020-26698 Filed 12-1-20. 4:15 pm]BILLING CODE 4120-01-C.

;

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