Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Fiscal Year 2009 Wage Index Changes Following Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008, 73656-73659 [E8-28619]

Download as PDF 73656 Federal Register / Vol. 73, No. 233 / Wednesday, December 3, 2008 / Notices the nature of the matter in issue is such that an oral hearing and crossexamination are necessary for the development of an adequate record. Pursuant to the further terms of 46 CFR 502.61, the initial decision of the presiding officer in this proceeding shall be issued by November 26, 2009, and the final decision of the Commission shall be issued by March 26, 2010. Karen V. Gregory, Secretary. [FR Doc. E8–28638 Filed 12–2–08; 8:45 am] BILLING CODE 6730–01–P FEDERAL MARITIME COMMISSION [Petition No. P2–08] jlentini on PROD1PC65 with NOTICES Petition of APM Terminals Pacific Ltd., California United Terminals, Inc.; Eagle Marine Services, Ltd.; International Transportation Services, Inc.; Long Beach Container Terminal, Inc.; Seaside Transportation Service LLC; Total Terminals LLC; West Basin Container Terminal LLC; Pacific Maritime Services, LLC; SSA Terminal (Long Beach), LLC Trans Pacific Container Service Corporation; Yusen Terminals, Inc.; and SSA Terminals, LLC, (‘‘Marine Terminal Operators’’); and Portcheck LLC; Notice of Filing and Request for Comments This is to provide notice of filing and to invite comments on or before December 15, 2008, with regard to the Petition described below. The marine terminal operators as listed above and PortCheck LLC, parties to FMC Agreement No. 201199, the Port Fee Services Agreement (‘‘Petitioners’’) have petitioned the Commission pursuant to 46 CFR 502.69 of the Commission’s Rules of Practice and Procedure, for a review of a staff action taken concerning the effective date of Petitioners’ agreement filed on November 3, 2008. In particular, Commission staff found that the agreement was not eligible for an exemption from the statutory 45-day agreement waiting period under Section 40304(c) of the Shipping Act of 1984 (‘‘Shipping Act’’), and the Commission’s Rules at 46 CFR 535.308(a). Certain interested parties have already submitted comments on this Petition. One letter, submitted by counsel on behalf of licensed motor carriers Swift Transportation Company and Knight Transportation, Inc., indicate that they have been ‘‘informed by the Ports’’ of the Commission staff action thereon. Accordingly, it appears that there may be broad public interest. VerDate Aug<31>2005 13:59 Dec 02, 2008 Jkt 217001 In order for the Commission to make a thorough evaluation of the Petition, interested persons are requested to submit views or arguments in reply to the Petition no later than December 15, 2008. Replies shall consist of an original and 15 copies, be directed to the Secretary, Federal Maritime Commission, 800 North Capitol Street, NW., Washington, DC 20573–0001, and be served on Petitioner’s counsel, David F. Smith and Wayne R. Rohde, Sher and Blackwell LLP, Suite 900, 1850 M Street, NW., Washington, DC 20036. A copy of the reply shall be submitted in electronic form (Microsoft Word) by email to Secretary@fmc.gov. The Petition will be posted on the Commission’s Web site at https:// www.fmc.gov/reading/Petitions.asp. Replies filed in response to this petition also will be posted on the Commission’s Web site at this location. Parties participating in this proceeding may elect to receive service of the Commission’s issuances in this proceeding through e-mail in lieu of service by U.S. mail. A party opting for electronic service shall advise the Office of the Secretary in writing and provide an e-mail address where service can be made. Karen V. Gregory, Secretary. [FR Doc. E8–28637 Filed 12–2–08; 8:45 am] BILLING CODE 6730–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS–1390–N2] RIN 0938–AP15 Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Fiscal Year 2009 Wage Index Changes Following Implementation of Section 124 of the Medicare Improvement for Patients and Providers Act of 2008 Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. AGENCY: SUMMARY: This notice contains fiscal year (FY) 2009 revised final wage indices and hospital reclassifications for 27 hospitals. These revised final wage indices and hospital reclassifications were made according to special procedural rules set forth in the FY 2009 hospital inpatient prospective payment systems final rule (73 FR 48588–9). PO 00000 Frm 00019 Fmt 4703 Sfmt 4703 Effective Date: The provisions of this notice are effective on December 3, 2008, Applicability Date: The final wage indices and hospital reclassifications are applicable for discharges beginning October 1, 2008. FOR FURTHER INFORMATION CONTACT: Tzvi Hefter, (410) 786–4487. SUPPLEMENTARY INFORMATION: DATES: I. Background On July 15, 2008 the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110–275) was enacted. Section 124 of Public Law 110–275 extends through FY 2009 wage index reclassifications under section 508 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108–173) and certain special exceptions (for example, those special exceptions contained in the final rule promulgated in the August 11, 2004 Federal Register (69 FR 49105 and 49107) and extended under section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110–173)). Because of the timing of the enactment of Public Law 110–275, we were not able to recompute the fiscal year (FY) 2009 wage index values for any hospital reclassified under section 508 and special exception hospitals in time for inclusion in the FY 2009 hospital inpatient prospective payment system final rule published in the August 19, 2008 Federal Register (73 FR 48434) (hereinafter referred to as the FY 2009 IPPS final rule). Instead, we stated that we would issue the final FY 2009 wage index values and other related tables, in a separate Federal Register notice published subsequent to the final rule. In the October 3, 2008 Federal Register (73 FR 57888), we published the FY 2009 IPPS final notice including the final wage indices and geographic reclassifications. The final notice reflects the reclassification withdrawal and termination decisions we made on behalf of hospitals in accordance with special procedural rules explained in the FY 2009 IPPS final rule (73 FR 48588). In accordance with such rules, hospitals had until October 20, 2008 to notify us if they wished to revise the decision that we made on their behalf. We received requests from 31 hospitals. Of these hospitals, three hospitals were ineligible for a revision because the hospitals were not reclassified to or located in areas containing hospitals whose reclassifications or special exceptions were extended by section 124 of Public Law 110–275. A fourth E:\FR\FM\03DEN1.SGM 03DEN1 73657 Federal Register / Vol. 73, No. 233 / Wednesday, December 3, 2008 / Notices hospital was ineligible because we did not make a decision on behalf of the hospital. II. Provisions of This Notice This notice provides the revisions to the final wage index values and hospital reclassifications for 27 hospitals based on hospitals’ requests. As stated in the FY 2009 IPPS final rule (73 FR 48588) and the October 3, 2008 notice (73 FR 57888), we did not further recalculate the wage indices (including any rural floors or imputed rural floors) or standardized amounts based on the revisions for these 27 hospitals. Changes based on hospitals’ requests affect the data presented in Tables 2, 4J, 9A, and 9B of the October 3, 2008 notice. Therefore, this notice provides the revisions to those tables for the specified providers. A. Wage Index Revisions for Table 2 The wage data for the listed providers are revised as follows: TABLE 2—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2007; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2009; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2007 (2003 WAGE DATA), 2008 (2004 WAGE DATA), AND 2009 (2005 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES Case mix index 050069 050168 050173 050193 050224 050226 050230 050348 050426 050526 050543 050548 050551 050567 050570 050580 050589 050603 050609 050678 050693 050720 050744 050745 050746 050747 250078 ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... ..................................................................................................... B. Revisions to Table 4J The entry in the second column titled, ‘‘Reclassified for FY 2009’’, for the FY 2009 wage index Average hourly wage FY 2007 Average hourly wage FY 2008 Average hourly wage FY 2009 Average hourly wage (3 years) 1.7315 1.5718 1.3439 1.2326 1.6646 1.5109 1.5465 1.7778 1.4602 1.1838 0.7528 0.7102 1.3450 1.5114 1.5522 1.1501 1.2415 1.4514 1.3266 1.3259 1.3935 0.9629 1.7431 1.3420 1.8199 1.5410 1.5862 Provider No. 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 1.2032 0.8418 34.6353 37.9784 29.0576 33.9520 32.5010 32.4411 34.0600 31.5156 33.2031 28.1997 29.4443 39.2234 34.0467 35.7063 34.5161 31.5806 34.5100 34.0275 41.7208 32.4473 34.5797 29.4726 * * * * 22.1243 35.3850 40.5973 31.6717 29.0623 35.7280 35.4597 35.8490 32.7107 34.9855 33.3964 24.4913 41.1075 37.2506 37.6384 38.4373 34.1531 37.6886 35.0279 39.7397 33.7633 39.6838 30.3595 * * * * 22.8430 38.1339 40.8362 32.3265 36.7240 37.3442 36.5354 38.8901 33.5276 37.6505 35.5457 32.8367 * 37.6223 39.0114 40.6761 35.0966 37.2056 35.4809 43.4555 35.8411 42.8266 32.1173 48.4951 42.5523 43.2015 44.5887 23.9598 36.1121 39.8630 30.9929 32.9059 35.2849 34.8258 36.2987 32.6288 35.2298 32.2794 28.6013 40.1570 36.3787 37.5242 37.8616 33.6235 36.5102 34.9113 41.6214 34.1151 38.9562 30.5950 48.4951 42.5523 43.2015 44.5887 22.9835 following listed providers has been revised to include an asterisk to indicate that the providers have been reclassified to CBSA 31084 Los Angeles-Long Beach-Glendale, CA for FY 2009; and, therefore, are ineligible to receive an outmigration adjustment for FY 2009: TABLE 4J—OUT-MIGRATION ADJUSTMENT—FY 2009 Reclassified for FY 2009 jlentini on PROD1PC65 with NOTICES Provider No. 050069 050168 050173 050193 050224 050226 050230 050348 050426 050526 050543 050548 050551 Outmigration adjustment * * * * * * * * * * * * * 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. VerDate Aug<31>2005 13:59 Dec 02, 2008 Jkt 217001 PO 00000 Frm 00020 Fmt 4703 Qualifying county name Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Sfmt 4703 .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. E:\FR\FM\03DEN1.SGM 03DEN1 County code 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 73658 Federal Register / Vol. 73, No. 233 / Wednesday, December 3, 2008 / Notices TABLE 4J—OUT-MIGRATION ADJUSTMENT—FY 2009—Continued Reclassified for FY 2009 Provider No. 050567 050570 050580 050589 050603 050609 050678 050693 050720 050744 050745 050746 050747 Outmigration adjustment * * * * * * * * * * * * * 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 0.0013 .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. County code Qualifying county name Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange Orange .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 05400 C. Revisions to Table 9A The geographic reclassification data for listed providers have been revised as specified in the following table: TABLE 9A—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2009 Geographic CBSA Provider No. 050069 050168 050173 050193 050224 050226 050230 050348 050426 050526 050543 050548 050551 050567 050570 050580 050589 050603 050609 050678 050693 050720 050744 050745 050746 050747 250078 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 42044 25620 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 25060 ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... ..................................................................................................................................................... D. Revisions to Table 9B jlentini on PROD1PC65 with NOTICES Reclassified CBSA III. Regulatory Impact Statement In Table 9B, entitled ‘‘Hospital Reclassifications and Redesignations by Individual Hospital under Section 508 of Public Law 108–173 and Special Exceptions Wage Index Assignments— FY 2009’’, provider 25–0078 is removed because the provider is now listed in Table 9A (see section II.C. of this notice) as reclassified to CBSA 25060, GulfportBiloxi, MS. We do not consider this notice to constitute a rule under 5 U.S.C. 553(b). The notice announces wage index values and reclassifications based upon policies already adopted in the FY 2009 IPPS final rule. Thus, we do not believe that reviews under Executive Order 12866 on Regulatory Planning and Review (September 30, 1993, as further amended), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. VerDate Aug<31>2005 13:59 Dec 02, 2008 Jkt 217001 PO 00000 Frm 00021 Fmt 4703 Sfmt 4703 LUGAR 96–354), section 1102(b) of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104–4), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)) are required. Nevertheless, we have examined the impact of this notice under the aforementioned authorities. Executive Order 12866 (as amended by Executive Orders 13258 and 13422) E:\FR\FM\03DEN1.SGM 03DEN1 jlentini on PROD1PC65 with NOTICES Federal Register / Vol. 73, No. 233 / Wednesday, December 3, 2008 / Notices 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 one year). We estimate that FY 2009 IPPS payments will increase approximately $3 million based on the changes included in this notice. Therefore, we note that not only does this notice not constitute a substantive rule, but it also does not reach the economic threshold and thus is not considered a major rule. The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $7.0 million to $34.5 million in any one year. Individuals and States are not included in the definition of a small entity. We are not preparing an analysis for the RFA because the notice is not a substantive rule, and we have determined, and the Secretary certifies, that this notice will not have a significant economic impact on a substantial number of small entities. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. We are not preparing an analysis for section 1102(b) of the Act because we have determined, and the Secretary certifies, that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any one year of $100 million in 1995 dollars, updated annually for inflation. In 2008, that threshold is approximately $130 million. This notice will have no consequential effect on State, local, or VerDate Aug<31>2005 13:59 Dec 02, 2008 Jkt 217001 tribal governments or on the private sector. 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. Since this notice does not impose any costs on State or local governments, the requirements of Executive Order 13132 are not applicable. Authority: (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare— Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program). Dated: November 20, 2008. Kerry Weems, Acting Administrator, Centers for Medicare & Medicaid Services. Approved: November 25, 2008. Michael O. Leavitt, Secretary. [FR Doc. E8–28619 Filed 12–2–08; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA–2008–D–0609] Draft Guidance for Industry on the Submission of Patent Information for Certain Old Antibiotics; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a draft guidance for industry entitled ‘‘Submission of Patent Information for Certain Old Antibiotics.’’ The draft guidance describes the agency’s current thinking on the implementation of certain provisions of the Q1 Program Supplemental Funding Act (the Q1 Act) that concern old antibiotics and addresses which sponsors of new drug applications (NDAs) must submit patent information under the Q1 Act by December 5, 2008. DATES: Although you can comment on any guidance at any time (see 21 CFR 10.115(g)(5)), to ensure that the agency considers your comment on this draft guidance before it begins work on the final version of the guidance, submit written or electronic comments on the draft guidance by February 2, 2009. PO 00000 Frm 00022 Fmt 4703 Sfmt 4703 73659 Submit written requests for single copies of the draft guidance to the Division of Drug Information, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 51, rm. 2201, Silver Spring, MD 20993–0002. Send one self-addressed adhesive label to assist that office in processing your requests. Submit written comments on the draft guidance to the Division of Dockets Management (HFA–305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852. Submit electronic comments to https:// www.regulations.gov. See the SUPPLEMENTARY INFORMATION section for electronic access to the draft guidance document. FOR FURTHER INFORMATION CONTACT: Mary Ann Holovac, Center for Drug Evaluation and Research (HFD–615), Food and Drug Administration, 7500 Standish Pl., Rockville, MD 20855, 240– 276–8971. SUPPLEMENTARY INFORMATION: ADDRESSES: I. Background FDA is announcing the availability of a draft guidance for industry entitled ‘‘Submission of Patent Information for Certain Old Antibiotics.’’ The draft guidance provides information regarding FDA’s current thinking on the implementation of section 4(b)(1) of the Q1 Act (Public Law 110–379). The Q1 Act amends section 505 of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) (21 U.S.C. 355) by adding subsection (v), which establishes, among other things, certain conditions under which the patent listing, patent certification, and marketing exclusivity provisions of sections 505(c) and (j) of the FD&C Act, and the patent term extension provisions of 35 U.S.C. 156 apply to marketing applications for drugs that contain an antibiotic that was the subject of any marketing application received by FDA on or before November 20, 1997 (an old antibiotic). The transitional rules at section 4(b) of the Q1 Act provide for the submission of the patent information by sponsors of certain NDAs, the publication of such patent information by FDA, and the certification to such patents by applicants of pending abbreviated new drug applications to be deemed ‘‘a first applicant’’ (as defined in section 505(j)(5)(B)(iv) the FD&C Act), not later than 60, 90, and 120 days after enactment of the Q1 Act, respectively. Specifically, section 4(b)(1) of the Q1 Act requires the submission to FDA of patent information by sponsors of certain NDAs for drugs (including E:\FR\FM\03DEN1.SGM 03DEN1

Agencies

[Federal Register Volume 73, Number 233 (Wednesday, December 3, 2008)]
[Notices]
[Pages 73656-73659]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-28619]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1390-N2]
RIN 0938-AP15


Medicare Program; Hospital Inpatient Prospective Payment Systems 
and Fiscal Year 2009 Rates: Fiscal Year 2009 Wage Index Changes 
Following Implementation of Section 124 of the Medicare Improvement for 
Patients and Providers Act of 2008

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

ACTION: Notice.

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

SUMMARY: This notice contains fiscal year (FY) 2009 revised final wage 
indices and hospital reclassifications for 27 hospitals. These revised 
final wage indices and hospital reclassifications were made according 
to special procedural rules set forth in the FY 2009 hospital inpatient 
prospective payment systems final rule (73 FR 48588-9).

DATES: Effective Date: The provisions of this notice are effective on 
December 3, 2008,
    Applicability Date: The final wage indices and hospital 
reclassifications are applicable for discharges beginning October 1, 
2008.

FOR FURTHER INFORMATION CONTACT: Tzvi Hefter, (410) 786-4487.

SUPPLEMENTARY INFORMATION: 

I. Background

    On July 15, 2008 the Medicare Improvement for Patients and 
Providers Act of 2008 (MIPPA) (Pub. L. 110-275) was enacted. Section 
124 of Public Law 110-275 extends through FY 2009 wage index 
reclassifications under section 508 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) and 
certain special exceptions (for example, those special exceptions 
contained in the final rule promulgated in the August 11, 2004 Federal 
Register (69 FR 49105 and 49107) and extended under section 117 of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 
110-173)). Because of the timing of the enactment of Public Law 110-
275, we were not able to recompute the fiscal year (FY) 2009 wage index 
values for any hospital reclassified under section 508 and special 
exception hospitals in time for inclusion in the FY 2009 hospital 
inpatient prospective payment system final rule published in the August 
19, 2008 Federal Register (73 FR 48434) (hereinafter referred to as the 
FY 2009 IPPS final rule). Instead, we stated that we would issue the 
final FY 2009 wage index values and other related tables, in a separate 
Federal Register notice published subsequent to the final rule.
    In the October 3, 2008 Federal Register (73 FR 57888), we published 
the FY 2009 IPPS final notice including the final wage indices and 
geographic reclassifications. The final notice reflects the 
reclassification withdrawal and termination decisions we made on behalf 
of hospitals in accordance with special procedural rules explained in 
the FY 2009 IPPS final rule (73 FR 48588).
    In accordance with such rules, hospitals had until October 20, 2008 
to notify us if they wished to revise the decision that we made on 
their behalf. We received requests from 31 hospitals. Of these 
hospitals, three hospitals were ineligible for a revision because the 
hospitals were not reclassified to or located in areas containing 
hospitals whose reclassifications or special exceptions were extended 
by section 124 of Public Law 110-275. A fourth

[[Page 73657]]

hospital was ineligible because we did not make a decision on behalf of 
the hospital.

II. Provisions of This Notice

    This notice provides the revisions to the final wage index values 
and hospital reclassifications for 27 hospitals based on hospitals' 
requests. As stated in the FY 2009 IPPS final rule (73 FR 48588) and 
the October 3, 2008 notice (73 FR 57888), we did not further 
recalculate the wage indices (including any rural floors or imputed 
rural floors) or standardized amounts based on the revisions for these 
27 hospitals. Changes based on hospitals' requests affect the data 
presented in Tables 2, 4J, 9A, and 9B of the October 3, 2008 notice. 
Therefore, this notice provides the revisions to those tables for the 
specified providers.

A. Wage Index Revisions for Table 2

    The wage data for the listed providers are revised as follows:

 Table 2--Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2007; Hospital Wage Indexes
for Federal Fiscal Year 2009; Hospital Average Hourly Wages for Federal Fiscal Years 2007 (2003 Wage Data), 2008
        (2004 Wage Data), and 2009 (2005 Wage Data); and 3-Year Average of Hospital Average Hourly Wages
----------------------------------------------------------------------------------------------------------------
                                                                       Average    Average    Average    Average
                                                 Case mix   FY 2009     hourly     hourly     hourly     hourly
                 Provider No.                     index       wage     wage FY    wage FY    wage FY    wage  (3
                                                             index       2007       2008       2009      years)
----------------------------------------------------------------------------------------------------------------
050069........................................     1.7315     1.2032    34.6353    35.3850    38.1339    36.1121
050168........................................     1.5718     1.2032    37.9784    40.5973    40.8362    39.8630
050173........................................     1.3439     1.2032    29.0576    31.6717    32.3265    30.9929
050193........................................     1.2326     1.2032    33.9520    29.0623    36.7240    32.9059
050224........................................     1.6646     1.2032    32.5010    35.7280    37.3442    35.2849
050226........................................     1.5109     1.2032    32.4411    35.4597    36.5354    34.8258
050230........................................     1.5465     1.2032    34.0600    35.8490    38.8901    36.2987
050348........................................     1.7778     1.2032    31.5156    32.7107    33.5276    32.6288
050426........................................     1.4602     1.2032    33.2031    34.9855    37.6505    35.2298
050526........................................     1.1838     1.2032    28.1997    33.3964    35.5457    32.2794
050543........................................     0.7528     1.2032    29.4443    24.4913    32.8367    28.6013
050548........................................     0.7102     1.2032    39.2234    41.1075          *    40.1570
050551........................................     1.3450     1.2032    34.0467    37.2506    37.6223    36.3787
050567........................................     1.5114     1.2032    35.7063    37.6384    39.0114    37.5242
050570........................................     1.5522     1.2032    34.5161    38.4373    40.6761    37.8616
050580........................................     1.1501     1.2032    31.5806    34.1531    35.0966    33.6235
050589........................................     1.2415     1.2032    34.5100    37.6886    37.2056    36.5102
050603........................................     1.4514     1.2032    34.0275    35.0279    35.4809    34.9113
050609........................................     1.3266     1.2032    41.7208    39.7397    43.4555    41.6214
050678........................................     1.3259     1.2032    32.4473    33.7633    35.8411    34.1151
050693........................................     1.3935     1.2032    34.5797    39.6838    42.8266    38.9562
050720........................................     0.9629     1.2032    29.4726    30.3595    32.1173    30.5950
050744........................................     1.7431     1.2032          *          *    48.4951    48.4951
050745........................................     1.3420     1.2032          *          *    42.5523    42.5523
050746........................................     1.8199     1.2032          *          *    43.2015    43.2015
050747........................................     1.5410     1.2032          *          *    44.5887    44.5887
250078........................................     1.5862     0.8418    22.1243    22.8430    23.9598    22.9835
----------------------------------------------------------------------------------------------------------------

B. Revisions to Table 4J

    The entry in the second column titled, ``Reclassified for FY 
2009'', for the following listed providers has been revised to include 
an asterisk to indicate that the providers have been reclassified to 
CBSA 31084 Los Angeles-Long Beach-Glendale, CA for FY 2009; and, 
therefore, are ineligible to receive an outmigration adjustment for FY 
2009:

                                   Table 4J--Out-migration Adjustment--FY 2009
----------------------------------------------------------------------------------------------------------------
                                                              Out-
               Provider No.                 Reclassified   migration      Qualifying county name     County code
                                             for FY 2009   adjustment
----------------------------------------------------------------------------------------------------------------
050069....................................             *       0.0013  Orange......................        05400
050168....................................             *       0.0013  Orange......................        05400
050173....................................             *       0.0013  Orange......................        05400
050193....................................             *       0.0013  Orange......................        05400
050224....................................             *       0.0013  Orange......................        05400
050226....................................             *       0.0013  Orange......................        05400
050230....................................             *       0.0013  Orange......................        05400
050348....................................             *       0.0013  Orange......................        05400
050426....................................             *       0.0013  Orange......................        05400
050526....................................             *       0.0013  Orange......................        05400
050543....................................             *       0.0013  Orange......................        05400
050548....................................             *       0.0013  Orange......................        05400
050551....................................             *       0.0013  Orange......................        05400

[[Page 73658]]

 
050567....................................             *       0.0013  Orange......................        05400
050570....................................             *       0.0013  Orange......................        05400
050580....................................             *       0.0013  Orange......................        05400
050589....................................             *       0.0013  Orange......................        05400
050603....................................             *       0.0013  Orange......................        05400
050609....................................             *       0.0013  Orange......................        05400
050678....................................             *       0.0013  Orange......................        05400
050693....................................             *       0.0013  Orange......................        05400
050720....................................             *       0.0013  Orange......................        05400
050744....................................             *       0.0013  Orange......................        05400
050745....................................             *       0.0013  Orange......................        05400
050746....................................             *       0.0013  Orange......................        05400
050747....................................             *       0.0013  Orange......................        05400
----------------------------------------------------------------------------------------------------------------

C. Revisions to Table 9A

    The geographic reclassification data for listed providers have been 
revised as specified in the following table:

    Table 9A--Hospital Reclassifications and Redesignations--FY 2009
------------------------------------------------------------------------
                                   Geographic  Reclassified
          Provider No.                CBSA         CBSA         LUGAR
------------------------------------------------------------------------
050069..........................        42044         31084
050168..........................        42044         31084
050173..........................        42044         31084
050193..........................        42044         31084
050224..........................        42044         31084
050226..........................        42044         31084
050230..........................        42044         31084
050348..........................        42044         31084
050426..........................        42044         31084
050526..........................        42044         31084
050543..........................        42044         31084
050548..........................        42044         31084
050551..........................        42044         31084
050567..........................        42044         31084
050570..........................        42044         31084
050580..........................        42044         31084
050589..........................        42044         31084
050603..........................        42044         31084
050609..........................        42044         31084
050678..........................        42044         31084
050693..........................        42044         31084
050720..........................        42044         31084
050744..........................        42044         31084
050745..........................        42044         31084
050746..........................        42044         31084
050747..........................        42044         31084
250078..........................        25620         25060
------------------------------------------------------------------------

D. Revisions to Table 9B

    In Table 9B, entitled ``Hospital Reclassifications and 
Redesignations by Individual Hospital under Section 508 of Public Law 
108-173 and Special Exceptions Wage Index Assignments--FY 2009'', 
provider 25-0078 is removed because the provider is now listed in Table 
9A (see section II.C. of this notice) as reclassified to CBSA 25060, 
Gulfport-Biloxi, MS.

III. Regulatory Impact Statement

    We do not consider this notice to constitute a rule under 5 U.S.C. 
553(b). The notice announces wage index values and reclassifications 
based upon policies already adopted in the FY 2009 IPPS final rule. 
Thus, we do not believe that reviews under Executive Order 12866 on 
Regulatory Planning and Review (September 30, 1993, as further 
amended), the Regulatory Flexibility Act (RFA) (September 19, 1980, 
Pub. L. 96-354), section 1102(b) of the Social Security Act, section 
202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. 
L. 104-4), Executive Order 13132 on Federalism (August 4, 1999) and the 
Congressional Review Act (5 U.S.C. 804(2)) are required. Nevertheless, 
we have examined the impact of this notice under the aforementioned 
authorities.
    Executive Order 12866 (as amended by Executive Orders 13258 and 
13422)

[[Page 73659]]

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 one year). We estimate that FY 2009 IPPS 
payments will increase approximately $3 million based on the changes 
included in this notice. Therefore, we note that not only does this 
notice not constitute a substantive rule, but it also does not reach 
the economic threshold and thus is not considered a major rule.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$7.0 million to $34.5 million in any one year. Individuals and States 
are not included in the definition of a small entity. We are not 
preparing an analysis for the RFA because the notice is not a 
substantive rule, and we have determined, and the Secretary certifies, 
that this notice will not have a significant economic impact on a 
substantial number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area for Medicare payment regulations and has fewer than 
100 beds. We are not preparing an analysis for section 1102(b) of the 
Act because we have determined, and the Secretary certifies, that this 
notice will not have a significant impact on the operations of a 
substantial number of small rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any one year of 
$100 million in 1995 dollars, updated annually for inflation. In 2008, 
that threshold is approximately $130 million. This notice will have no 
consequential effect on State, local, or tribal governments or on the 
private sector.
    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. Since this notice does not impose any costs on State or 
local governments, the requirements of Executive Order 13132 are not 
applicable.

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

    Dated: November 20, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: November 25, 2008.
Michael O. Leavitt,
Secretary.
[FR Doc. E8-28619 Filed 12-2-08; 8:45 am]
BILLING CODE 4120-01-P
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