Medicare Program; Extension of Certain Hospital Wage Index Reclassifications, 9807-9810 [E8-2798]

Download as PDF 9807 Federal Register / Vol. 73, No. 36 / Friday, February 22, 2008 / Notices ESTIMATED ANNUALIZED BURDEN TABLE Type of respondent Number of respondents Number of responses per respondent Average burden per response (in hours) Total burden hours State, local, or tribal governments, nonprofits ................................................. 20 1 200 4,000 Terry Nicolosi, Office of the Secretary, Paperwork Reduction Act Reports Clearance Officer. [FR Doc. E8–3294 Filed 2–21–08; 8:45 am] BILLING CODE 4150–17–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention mstockstill on PROD1PC66 with NOTICES Clinical Laboratory Improvement Advisory Committee (CLIAC) In accordance with section 10(a)(2) of the Federal Advisory Committee Act (Pub. L. 92–463), the Centers for Disease Control and Prevention (CDC) announces the following meeting for the aforementioned committee: Times and Dates: 8 a.m.–5 p.m., February 20, 2008. 8 a.m.–3:30 p.m., February 21, 2008. Place: Centers for Disease Control and Prevention, 1600 Clifton Road, NE., Tom Harkin Global Communications Center, Building 19, Room 232, Auditorium B, Atlanta, Georgia 30333. Status: Open to the public, limited only by the space available. The meeting room accommodates approximately 100 people. Purpose: This Committee is charged with providing scientific and technical advice and guidance to the Secretary of Health and Human Services, the Assistant Secretary for Health, and the Director, CDC, regarding the need for, and the nature of, revisions to the standards under which clinical laboratories are regulated; the impact on medical and laboratory practice of proposed revisions to the standards; and the modification of the standards to accommodate technological advances. Matters To Be Discussed: The agenda will include updates from the CDC, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration; and presentations and discussion addressing ‘‘20 Years of CLIA: Needs for Quality Then vs. Now;’’ evidence gathered since CLIA implementation demonstrating the impact of standards/accreditation on laboratory quality; perspectives on Quality Management System implementation; and laboratory VerDate Aug<31>2005 16:38 Feb 21, 2008 Jkt 214001 biosafety. Agenda items are subject to change as priorities dictate. Due to administrative issues that had to be resolved, the Federal Register notice is being published less than fifteen days before the date of the meeting. Contact Person for More Information: Nancy Anderson, Chief, Laboratory Practice Standards Branch, Division of Laboratory Systems, National Center for Preparedness, Detection, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases, CDC, 1600 Clifton Road, NE., Mailstop F–11, Atlanta, Georgia 30333; telephone (404) 718–1025; fax (404) 718–1085; or via email at Nancy.Anderson@cdc.hhs.gov. The Director, Management Analysis and Services Office, has been delegated the authority to sign Federal Register notices pertaining to announcements of meetings and other committee management activities, for both CDC and the Agency for Toxic Substances and Disease Registry. Dated: February 19, 2008. Elaine L. Baker, Director, Management Analysis and Services Office, Centers for Disease Control and Prevention (CDC). [FR Doc. 08–824 Filed 2–20–08; 10:32 am] BILLING CODE 4163–18–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS–1491–N] Medicare Program; Extension of Certain Hospital Wage Index Reclassifications Centers for Medicare & Medicaid Services (CMS) HHS. ACTION: Notice. AGENCY: SUMMARY: This notice announces the extension of the expiration date for certain wage index geographic reclassifications and special exceptions as implemented by section 117 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (Pub. L. 110– 173). Certain geographic reclassifications and special exception PO 00000 Frm 00051 Fmt 4703 Sfmt 4703 hospitals’ wage indices that were set to expire on September 30, 2007 are now extended through September 30, 2008. In addition, for hospital reclassifications extended by Division B, Title I, section 106(a) of the Tax Relief and Health Care Act of 2006, Pub. L. 109–432, that resulted in a lower wage index for the second half of FY 2007, we will apply the higher wage index that was applicable to such hospitals during the first half of FY 2007, for the entire fiscal year. DATES: Effective date: This notice is effective on February 22, 2008. Applicability date: This notice is applicable to the hospitals identified in section II.A. of this notice on October 1, 2007 and to the hospitals identified in section II.B. of this notice on April 1, 2007. FOR FURTHER INFORMATION CONTACT: Brian Slater, (410) 786–5229. SUPPLEMENTARY INFORMATION: I. Background Section 508 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Pub. L. 108–173) permitted a qualifying hospital to appeal the wage index classification otherwise applicable to the hospital and apply for reclassification to another area of the State in which the hospital was located (or, at the discretion of the Secretary, to an area within a contiguous State). Hospitals were required to submit their applications by February 15, 2004. In the February 13, 2004 Federal Register (69 FR 7340), we published a notice that described our implementation of section 508 of MMA. The Congress limited the reclassifications under section 508 of MMA to a 3-year period beginning April 1, 2004 and ending March 31, 2007. Section 106(a) of the Medicare Improvements and Extension Act, Division B of the Tax Relief and Health Care Act of 2006 (MIEA–TRHCA) (Pub. L. 109–432) extended any geographic reclassification that was set to expire on March 31, 2007 by 6 months until September 30, 2007. In the March 23, 2007 Federal Register (72 FR 13799), we published a notice explaining how we would implement section 106 of MIEA– TRHCA. We also explained that for a subset of hospitals whose E:\FR\FM\22FEN1.SGM 22FEN1 9808 Federal Register / Vol. 73, No. 36 / Friday, February 22, 2008 / Notices reclassifications were extended, the wage index for the second half of fiscal year (FY) 2007 would decrease from the first half of the year. II. Provisions of the Notice A. Reclassifications for Hospitals Affected by Section 117(a) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 Section 117(a) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110–173) extends through September 30, 2008 both the reclassifications that were extended by section 106 of MIEA– TRCHA as well as certain special exception wage indices referenced in the FY 2005 inpatient prospective payment system (IPPS) final rule (69 FR 49105 and 49107). Consistent with how section 508 of MMA and special exceptions were implemented in FY 2005, hospitals receiving extensions under section 117(a) of MMSEA may not receive an out-migration adjustment. Such hospitals are treated in a manner consistent to reclassified hospitals, and section 1886(d)(13) of the Act specifies that a reclassified hospital is not eligible for the out-migration adjustment. In addition, the special exceptions granted in FY 2005 provided for the complete wage index to be assigned the specified hospitals without any addition of an out-migration adjustment. Further, we mstockstill on PROD1PC66 with NOTICES Fiscal intermediary No. 52280 00322 00454 52280 52280 00308 00011 52280 00450 00450 00452 00450 00450 00452 00450 00452 00452 00450 00450 00230 52280 03201 03201 03201 03201 00390 00390 00390 00390 00390 00390 00308 00308 00308 00308 00308 00308 00308 77002 03301 03301 03301 03301 03301 03301 03301 03301 00325 00363 00363 00363 52280 Provider No. ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... VerDate Aug<31>2005 16:38 Feb 21, 2008 Jkt 214001 PO 00000 Frm 00052 only extended the reclassification or special exception in cases where it benefited the hospital. If, in FY 2008, the hospital is already receiving a reclassification or wage index that results in a higher wage index than would be received under the reclassification or special exception extension, then we did not change the hospital’s wage index value that was published in the October 10, 2007, or subsequent notice. The following table lists providers affected by section 117(a) of MMSEA, which extends certain reclassifications and special exceptions through FY 2008 (October 1, 2007 through September 30, 2008): Fmt 4703 Sfmt 4703 010150 020008 050494 050549 060075 070036 160064 220046 230003 230004 230036 230038 230059 230066 230072 230097 230106 230174 230236 250002 250122 2 270002 270023 270032 270057 310021 310028 310051 310060 310115 310120 2 330023 330049 2 330067 330106 3 330135 3 330205 3 330264 340002 350002 350003 350006 350010 350014 350015 350017 350030 380090 390001 390003 1 390045 390072 E:\FR\FM\22FEN1.SGM 22FEN1 FY 2008 wage index FY 2008 GAF 0.8588 1.2727 1.4147 1.4147 1.2164 1.3696 0.9194 1.1304 1.0147 1.0147 1.0244 1.0147 1.0147 1.0147 1.0147 1.0147 1.0147 1.0147 1.0147 0.8217 0.8217 0.8738 0.8871 0.8871 0.8871 1.3003 1.3003 1.3003 1.3003 1.3003 1.3003 1.3003 1.3003 1.3003 1.4999 1.3003 1.3003 1.3003 0.9342 0.7944 0.7944 0.7944 0.7944 0.7944 0.7944 0.7944 0.7944 1.1501 1.0004 1.0004 1.0004 1.0004 0.9010 1.1795 1.2682 1.2682 1.1436 1.2403 0.9441 1.0876 1.0100 1.0100 1.0166 1.0100 1.0100 1.0100 1.0100 1.0100 1.0100 1.0100 1.0100 0.8742 0.8742 0.9118 0.9212 0.9212 0.9212 1.1970 1.1970 1.1970 1.1970 1.1970 1.1970 1.1970 1.1970 1.1970 1.3200 1.1970 1.1970 1.1970 0.9545 0.8542 0.8542 0.8542 0.8542 0.8542 0.8542 0.8542 0.8542 1.1005 1.0003 1.0003 1.0003 1.0003 9809 Federal Register / Vol. 73, No. 36 / Friday, February 22, 2008 / Notices Fiscal intermediary No. 00363 00363 00363 00363 00363 00363 00363 00363 03401 03401 52280 03401 03401 03401 03401 03401 00400 00270 00453 03601 03601 03601 Provider No. ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... ........................................................................................................................................... 390095 390119 390137 390169 390185 390192 390237 390270 430005 2 430008 430015 3 430048 430060 430064 430077 430091 450010 470003 490001 2 530008 2 530010 530015 FY 2008 wage index FY 2008 GAF 1.0004 1.0004 1.0004 1.0004 0.9650 1.0004 1.0004 0.9650 0.8686 0.9373 0.9373 0.9373 0.9373 0.9373 0.9373 0.9373 0.9136 1.1304 0.8606 0.9271 0.9271 0.9650 1.0003 1.0003 1.0003 1.0003 0.9759 1.0003 1.0003 0.9759 0.9080 0.9566 0.9566 0.9566 0.9566 0.9566 0.9566 0.9566 0.9400 1.0876 0.9023 0.9495 0.9495 0.9759 1 This hospital has been assigned a wage index under a special exceptions policy (See the August 18, 2006 final rule (71 FR 48070)). hospitals are assigned a wage index value under a special exceptions policy (See Table 9B of the August 11, 2004 final rule (69 FR 49105) and the December 30, 2004 correction notice, (69 FR 78705)). 3 The hospital originally received an out-migration adjustment for FY 2008. However, due to the extension of the hospital’s special reclassification or exception, the hospital no longer qualifies for the out-migration adjustment for FY 2008. 2 These B. Reclassifications for Hospitals Affected by Section 117(c) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 Section 117(c) of MMSEA requires that, for hospital reclassifications extended by section 106(a) of MIEA– TRHCA that resulted in a lower wage index for the period April 1, 2007 through September 30, 2007, we will apply the higher wage index that was applicable to such hospitals during the mstockstill on PROD1PC66 with NOTICES Fiscal intermediary No. 00308 00308 00308 00308 00308 00308 00308 00308 00308 00308 00011 00011 00011 00450 00452 00450 00450 00452 00450 00450 00450 00450 00450 00450 00452 00390 00390 00390 00390 00390 00390 Provider No. ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... VerDate Aug<31>2005 16:38 Feb 21, 2008 Jkt 214001 PO 00000 Frm 00053 Current wage index 4/1/ 2007–9/30/ 2007 Current GAF 4/1/2007–9/30/ 2007 Revised wage index 4/1/ 2007–9/30/ 2007 Revised GAF 4/1/2007–9/30/ 2007 1.2730 1.2730 1.3113 1.2730 1.2730 1.2730 1.2730 1.3113 1.2730 1.2730 0.8708 0.8708 0.8708 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.0440 1.3113 1.3113 1.3113 1.3113 1.3113 1.3113 1.1797 1.1797 1.2039 1.1797 1.1797 1.1797 1.1797 1.2039 1.1797 1.1797 0.9096 0.9096 0.9096 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.0299 1.2039 1.2039 1.2039 1.2039 1.2039 1.2039 1.2971 1.2971 1.3134 1.2971 1.2971 1.2971 1.2971 1.3134 1.2971 1.2971 0.8803 0.8803 0.8803 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.0563 1.3134 1.3134 1.3134 1.3134 1.3134 1.3134 1.1950 1.1950 1.2053 1.1950 1.1950 1.1950 1.1950 1.2053 1.1950 1.1950 0.9164 0.9164 0.9164 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.0382 1.2053 1.2053 1.2053 1.2053 1.2053 1.2053 070001 070005 070010 070016 070017 070019 070022 070028 070031 070039 160040 160067 160110 230020 230024 230053 230089 230104 230119 230135 230146 230165 230176 230270 230273 310021 310028 310051 310060 310115 310120 Fmt 4703 period October 1, 2006 through March 31, 2007, for the entire FY 2007. The following table lists providers affected by section 117(c), which revises the FY 2007 wage index from April 1, 2007 through September 30, 2007: Sfmt 4703 E:\FR\FM\22FEN1.SGM 22FEN1 9810 Federal Register / Vol. 73, No. 36 / Friday, February 22, 2008 / Notices Fiscal intermediary No. 00308 00308 00308 00308 00308 00308 Provider No. ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... mstockstill on PROD1PC66 with NOTICES We have implemented these provisions through instructions to the Medicare Administrative Contractors (MAC) (CMS Joint Signature Memorandum, JSM/TDL–08149, January 28, 2008). CMS has instructed FIs/MACs to reprocess claims for the affected providers FY 2007 and FY 2008. When originally applying section 508 of MMA, we required each hospital to submit a request in writing by February 15, 2004, to the Medicare Geographic Classification Review Board (MGCRB), with a copy to CMS. We will neither require nor accept written requests for the extension required by section 117 of MMSEA, since that section, by providing a 1-year extension for certain special exceptions and reclassifications set to expire September 30, 2007, already specifies the affected hospitals. III. Regulatory Impact Statement We have examined the impact of this notice using the requirements of Executive Order 12866 (September 1993, Regulatory Planning and Review), and Executive Order 13132. Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This notice implements a statutory provision that would increase payments to hospitals by less than $100 million and is therefore, not a major rule. This notice also is not a legislative rulemaking under the Administrative Procedure Act, but rather interprets and applies a statutory mandate. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or VerDate Aug<31>2005 16:38 Feb 21, 2008 Jkt 214001 Current wage index 4/1/ 2007–9/30/ 2007 Current GAF 4/1/2007–9/30/ 2007 Revised wage index 4/1/ 2007–9/30/ 2007 Revised GAF 4/1/2007–9/30/ 2007 1.3113 1.3113 1.3113 1.3113 1.2730 1.2730 1.2039 1.2039 1.2039 1.2039 1.1797 1.1797 1.3134 1.3134 1.3134 1.3134 1.2971 1.2971 1.2053 1.2053 1.2053 1.2053 1.1950 1.1950 330049 330126 330135 330205 330209 330264 otherwise has Federalism implications. Again, although we do not consider this notice to be a substantive rule subject to notice and comment rulemaking, we note that this notice does not impose any costs on State or local governments. Therefore, the requirements of Executive Order 13132 would not be applicable. We estimate the impact of sections 117(a) and (c) of MMSEA is to increase payments to hospitals by $24 million for FY 2007 and by $57 million for FY 2008. In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget. Authority: Section 117(a) and (c) of Public Law 110–173. Section 106(a) of Division B, Title 1, Public Law 109–432. Section 508(a) of Public Law 108–173. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: February 7, 2008. Kerry Weems, Acting Administrator, Centers for Medicare & Medicaid Services. [FR Doc. E8–2798 Filed 2–21–08; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS–1395–N] Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment Classification Groups Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (DHHS). ACTION: Notice. AGENCY: SUMMARY: This notice solicits the nominations of three individuals for consideration as members on the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the Panel). PO 00000 Frm 00054 Fmt 4703 Sfmt 4703 There will be three vacancies on the Panel: One vacancy as of June 1 and two additional vacancies as of September 30, 2008. The purpose of the Panel is to review the APC groups and their associated weights and to advise the Secretary of the Department of Health and Human Services (DHHS), and the Administrator of the Centers for Medicare & Medicaid Services (CMS), concerning the clinical integrity of the APC groups and their associated weights. We consider the Panel’s advice as we prepare the annual updates of the Medicare hospital outpatient prospective payment system (OPPS). The Secretary rechartered the Panel in 2006 for a 2-year period effective through November 21, 2008. Submission Date of Nominations: Nominations will be considered if postmarked by 5 p.m. E.S.T. on April 1, 2008, and sent to the designated address provided in the ADDRESSES section of this notice. You may mail or hand deliver nominations for membership to: Center for Medicare and Medicaid Services; Attn: Shirl Ackerman-Ross, Designated Federal Official (DFO), Advisory Panel on APC Groups; Center for Medicare Management, Hospital & Ambulatory Policy Group, Division of Outpatient Care; 7500 Security Boulevard, Mail Stop C4–05–17; Baltimore, MD 21244–1850. For Additional Information: Contacts: Persons wishing to nominate individuals to serve on the Panel or to obtain further information may also contact Shirl Ackerman-Ross, the DFO, at CMSAPCPanel@ cms.hhs.gov (NOTE: There is NO underscore in this e-mail address; there is a SPACE between CMS and APCPanel.), or call 410–786–4474. (Note: Please advise couriers of the following: When delivering hardcopies of presentations to CMS, if no one answers at the above phone number, please call (410) 786–4532 or (410) 786– 9316.) News media representatives should contact the CMS Press Office at 202– 690–6145. ADDRESSES: E:\FR\FM\22FEN1.SGM 22FEN1

Agencies

[Federal Register Volume 73, Number 36 (Friday, February 22, 2008)]
[Notices]
[Pages 9807-9810]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-2798]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1491-N]


Medicare Program; Extension of Certain Hospital Wage Index 
Reclassifications

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the extension of the expiration date for 
certain wage index geographic reclassifications and special exceptions 
as implemented by section 117 of the Medicare, Medicaid and SCHIP 
Extension Act of 2007 (Pub. L. 110-173). Certain geographic 
reclassifications and special exception hospitals' wage indices that 
were set to expire on September 30, 2007 are now extended through 
September 30, 2008. In addition, for hospital reclassifications 
extended by Division B, Title I, section 106(a) of the Tax Relief and 
Health Care Act of 2006, Pub. L. 109-432, that resulted in a lower wage 
index for the second half of FY 2007, we will apply the higher wage 
index that was applicable to such hospitals during the first half of FY 
2007, for the entire fiscal year.

DATES: Effective date: This notice is effective on February 22, 2008. 
Applicability date: This notice is applicable to the hospitals 
identified in section II.A. of this notice on October 1, 2007 and to 
the hospitals identified in section II.B. of this notice on April 1, 
2007.

FOR FURTHER INFORMATION CONTACT: Brian Slater, (410) 786-5229.

SUPPLEMENTARY INFORMATION: 

I. Background

    Section 508 of the Medicare Prescription Drug, Improvement and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173) permitted a 
qualifying hospital to appeal the wage index classification otherwise 
applicable to the hospital and apply for reclassification to another 
area of the State in which the hospital was located (or, at the 
discretion of the Secretary, to an area within a contiguous State). 
Hospitals were required to submit their applications by February 15, 
2004. In the February 13, 2004 Federal Register (69 FR 7340), we 
published a notice that described our implementation of section 508 of 
MMA. The Congress limited the reclassifications under section 508 of 
MMA to a 3-year period beginning April 1, 2004 and ending March 31, 
2007.
    Section 106(a) of the Medicare Improvements and Extension Act, 
Division B of the Tax Relief and Health Care Act of 2006 (MIEA-TRHCA) 
(Pub. L. 109-432) extended any geographic reclassification that was set 
to expire on March 31, 2007 by 6 months until September 30, 2007. In 
the March 23, 2007 Federal Register (72 FR 13799), we published a 
notice explaining how we would implement section 106 of MIEA-TRHCA. We 
also explained that for a subset of hospitals whose

[[Page 9808]]

reclassifications were extended, the wage index for the second half of 
fiscal year (FY) 2007 would decrease from the first half of the year.

II. Provisions of the Notice

A. Reclassifications for Hospitals Affected by Section 117(a) of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007

    Section 117(a) of the Medicare, Medicaid, and SCHIP Extension Act 
of 2007 (MMSEA) (Pub. L. 110-173) extends through September 30, 2008 
both the reclassifications that were extended by section 106 of MIEA-
TRCHA as well as certain special exception wage indices referenced in 
the FY 2005 inpatient prospective payment system (IPPS) final rule (69 
FR 49105 and 49107). Consistent with how section 508 of MMA and special 
exceptions were implemented in FY 2005, hospitals receiving extensions 
under section 117(a) of MMSEA may not receive an out-migration 
adjustment. Such hospitals are treated in a manner consistent to 
reclassified hospitals, and section 1886(d)(13) of the Act specifies 
that a reclassified hospital is not eligible for the out-migration 
adjustment. In addition, the special exceptions granted in FY 2005 
provided for the complete wage index to be assigned the specified 
hospitals without any addition of an out-migration adjustment. Further, 
we only extended the reclassification or special exception in cases 
where it benefited the hospital. If, in FY 2008, the hospital is 
already receiving a reclassification or wage index that results in a 
higher wage index than would be received under the reclassification or 
special exception extension, then we did not change the hospital's wage 
index value that was published in the October 10, 2007, or subsequent 
notice.
    The following table lists providers affected by section 117(a) of 
MMSEA, which extends certain reclassifications and special exceptions 
through FY 2008 (October 1, 2007 through September 30, 2008):

----------------------------------------------------------------------------------------------------------------
                                                                                   FY 2008 wage
                     Fiscal intermediary No.                       Provider No.        index        FY 2008 GAF
----------------------------------------------------------------------------------------------------------------
52280...........................................................          010150          0.8588          0.9010
00322...........................................................          020008          1.2727          1.1795
00454...........................................................          050494          1.4147          1.2682
52280...........................................................          050549          1.4147          1.2682
52280...........................................................          060075          1.2164          1.1436
00308...........................................................          070036          1.3696          1.2403
00011...........................................................          160064          0.9194          0.9441
52280...........................................................          220046          1.1304          1.0876
00450...........................................................          230003          1.0147          1.0100
00450...........................................................          230004          1.0147          1.0100
00452...........................................................          230036          1.0244          1.0166
00450...........................................................          230038          1.0147          1.0100
00450...........................................................          230059          1.0147          1.0100
00452...........................................................          230066          1.0147          1.0100
00450...........................................................          230072          1.0147          1.0100
00452...........................................................          230097          1.0147          1.0100
00452...........................................................          230106          1.0147          1.0100
00450...........................................................          230174          1.0147          1.0100
00450...........................................................          230236          1.0147          1.0100
00230...........................................................          250002          0.8217          0.8742
52280...........................................................          250122          0.8217          0.8742
03201...........................................................      \2\ 270002          0.8738          0.9118
03201...........................................................          270023          0.8871          0.9212
03201...........................................................          270032          0.8871          0.9212
03201...........................................................          270057          0.8871          0.9212
00390...........................................................          310021          1.3003          1.1970
00390...........................................................          310028          1.3003          1.1970
00390...........................................................          310051          1.3003          1.1970
00390...........................................................          310060          1.3003          1.1970
00390...........................................................          310115          1.3003          1.1970
00390...........................................................          310120          1.3003          1.1970
00308...........................................................      \2\ 330023          1.3003          1.1970
00308...........................................................          330049          1.3003          1.1970
00308...........................................................      \2\ 330067          1.3003          1.1970
00308...........................................................          330106          1.4999          1.3200
00308...........................................................      \3\ 330135          1.3003          1.1970
00308...........................................................      \3\ 330205          1.3003          1.1970
00308...........................................................      \3\ 330264          1.3003          1.1970
77002...........................................................          340002          0.9342          0.9545
03301...........................................................          350002          0.7944          0.8542
03301...........................................................          350003          0.7944          0.8542
03301...........................................................          350006          0.7944          0.8542
03301...........................................................          350010          0.7944          0.8542
03301...........................................................          350014          0.7944          0.8542
03301...........................................................          350015          0.7944          0.8542
03301...........................................................          350017          0.7944          0.8542
03301...........................................................          350030          0.7944          0.8542
00325...........................................................          380090          1.1501          1.1005
00363...........................................................          390001          1.0004          1.0003
00363...........................................................          390003          1.0004          1.0003
00363...........................................................      \1\ 390045          1.0004          1.0003
52280...........................................................          390072          1.0004          1.0003

[[Page 9809]]

 
00363...........................................................          390095          1.0004          1.0003
00363...........................................................          390119          1.0004          1.0003
00363...........................................................          390137          1.0004          1.0003
00363...........................................................          390169          1.0004          1.0003
00363...........................................................          390185          0.9650          0.9759
00363...........................................................          390192          1.0004          1.0003
00363...........................................................          390237          1.0004          1.0003
00363...........................................................          390270          0.9650          0.9759
03401...........................................................          430005          0.8686          0.9080
03401...........................................................      \2\ 430008          0.9373          0.9566
52280...........................................................          430015          0.9373          0.9566
03401...........................................................      \3\ 430048          0.9373          0.9566
03401...........................................................          430060          0.9373          0.9566
03401...........................................................          430064          0.9373          0.9566
03401...........................................................          430077          0.9373          0.9566
03401...........................................................          430091          0.9373          0.9566
00400...........................................................          450010          0.9136          0.9400
00270...........................................................          470003          1.1304          1.0876
00453...........................................................          490001          0.8606          0.9023
03601...........................................................      \2\ 530008          0.9271          0.9495
03601...........................................................      \2\ 530010          0.9271          0.9495
03601...........................................................          530015          0.9650         0.9759
----------------------------------------------------------------------------------------------------------------
\1\ This hospital has been assigned a wage index under a special exceptions policy (See the August 18, 2006
  final rule (71 FR 48070)).
\2\ These hospitals are assigned a wage index value under a special exceptions policy (See Table 9B of the
  August 11, 2004 final rule (69 FR 49105) and the December 30, 2004 correction notice, (69 FR 78705)).
\3\ The hospital originally received an out-migration adjustment for FY 2008. However, due to the extension of
  the hospital's special reclassification or exception, the hospital no longer qualifies for the out-migration
  adjustment for FY 2008.

B. Reclassifications for Hospitals Affected by Section 117(c) of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007

    Section 117(c) of MMSEA requires that, for hospital 
reclassifications extended by section 106(a) of MIEA-TRHCA that 
resulted in a lower wage index for the period April 1, 2007 through 
September 30, 2007, we will apply the higher wage index that was 
applicable to such hospitals during the period October 1, 2006 through 
March 31, 2007, for the entire FY 2007.
    The following table lists providers affected by section 117(c), 
which revises the FY 2007 wage index from April 1, 2007 through 
September 30, 2007:

----------------------------------------------------------------------------------------------------------------
                                                   Current wage   Current GAF 4/   Revised wage   Revised GAF 4/
     Fiscal intermediary No.       Provider No.   index 4/1/2007-  1/2007-9/30/   index 4/1/2007-  1/2007-9/30/
                                                     9/30/2007         2007          9/30/2007         2007
----------------------------------------------------------------------------------------------------------------
00308...........................          070001          1.2730          1.1797          1.2971          1.1950
00308...........................          070005          1.2730          1.1797          1.2971          1.1950
00308...........................          070010          1.3113          1.2039          1.3134          1.2053
00308...........................          070016          1.2730          1.1797          1.2971          1.1950
00308...........................          070017          1.2730          1.1797          1.2971          1.1950
00308...........................          070019          1.2730          1.1797          1.2971          1.1950
00308...........................          070022          1.2730          1.1797          1.2971          1.1950
00308...........................          070028          1.3113          1.2039          1.3134          1.2053
00308...........................          070031          1.2730          1.1797          1.2971          1.1950
00308...........................          070039          1.2730          1.1797          1.2971          1.1950
00011...........................          160040          0.8708          0.9096          0.8803          0.9164
00011...........................          160067          0.8708          0.9096          0.8803          0.9164
00011...........................          160110          0.8708          0.9096          0.8803          0.9164
00450...........................          230020          1.0440          1.0299          1.0563          1.0382
00452...........................          230024          1.0440          1.0299          1.0563          1.0382
00450...........................          230053          1.0440          1.0299          1.0563          1.0382
00450...........................          230089          1.0440          1.0299          1.0563          1.0382
00452...........................          230104          1.0440          1.0299          1.0563          1.0382
00450...........................          230119          1.0440          1.0299          1.0563          1.0382
00450...........................          230135          1.0440          1.0299          1.0563          1.0382
00450...........................          230146          1.0440          1.0299          1.0563          1.0382
00450...........................          230165          1.0440          1.0299          1.0563          1.0382
00450...........................          230176          1.0440          1.0299          1.0563          1.0382
00450...........................          230270          1.0440          1.0299          1.0563          1.0382
00452...........................          230273          1.0440          1.0299          1.0563          1.0382
00390...........................          310021          1.3113          1.2039          1.3134          1.2053
00390...........................          310028          1.3113          1.2039          1.3134          1.2053
00390...........................          310051          1.3113          1.2039          1.3134          1.2053
00390...........................          310060          1.3113          1.2039          1.3134          1.2053
00390...........................          310115          1.3113          1.2039          1.3134          1.2053
00390...........................          310120          1.3113          1.2039          1.3134          1.2053

[[Page 9810]]

 
00308...........................          330049          1.3113          1.2039          1.3134          1.2053
00308...........................          330126          1.3113          1.2039          1.3134          1.2053
00308...........................          330135          1.3113          1.2039          1.3134          1.2053
00308...........................          330205          1.3113          1.2039          1.3134          1.2053
00308...........................          330209          1.2730          1.1797          1.2971          1.1950
00308...........................          330264          1.2730          1.1797          1.2971          1.1950
----------------------------------------------------------------------------------------------------------------

    We have implemented these provisions through instructions to the 
Medicare Administrative Contractors (MAC) (CMS Joint Signature 
Memorandum, JSM/TDL-08149, January 28, 2008). CMS has instructed FIs/
MACs to reprocess claims for the affected providers FY 2007 and FY 
2008.
    When originally applying section 508 of MMA, we required each 
hospital to submit a request in writing by February 15, 2004, to the 
Medicare Geographic Classification Review Board (MGCRB), with a copy to 
CMS. We will neither require nor accept written requests for the 
extension required by section 117 of MMSEA, since that section, by 
providing a 1-year extension for certain special exceptions and 
reclassifications set to expire September 30, 2007, already specifies 
the affected hospitals.

III. Regulatory Impact Statement

    We have examined the impact of this notice using the requirements 
of Executive Order 12866 (September 1993, Regulatory Planning and 
Review), and Executive Order 13132.
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more in any 1 year). This notice 
implements a statutory provision that would increase payments to 
hospitals by less than $100 million and is therefore, not a major rule. 
This notice also is not a legislative rulemaking under the 
Administrative Procedure Act, but rather interprets and applies a 
statutory mandate.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. Again, although we do not consider this notice to be a 
substantive rule subject to notice and comment rulemaking, we note that 
this notice does not impose any costs on State or local governments. 
Therefore, the requirements of Executive Order 13132 would not be 
applicable.
    We estimate the impact of sections 117(a) and (c) of MMSEA is to 
increase payments to hospitals by $24 million for FY 2007 and by $57 
million for FY 2008.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.

    Authority: Section 117(a) and (c) of Public Law 110-173. Section 
106(a) of Division B, Title 1, Public Law 109-432. Section 508(a) of 
Public Law 108-173.

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

    Dated: February 7, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E8-2798 Filed 2-21-08; 8:45 am]
BILLING CODE 4120-01-P
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