Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2011 Final Wage Indices Implementing the Medicare and Medicaid Extenders Act, 19365-19373 [2011-8209]
Download as PDF
<![CDATA[
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
Daniel Holcomb,
Reports Clearance Officer, Centers for Disease
Control and Prevention.
[FR Doc. 2011–8272 Filed 4–6–11; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1357–N]
RIN 0938–AQ97
Medicare Program; Hospital Inpatient
Prospective Payment Systems for
Acute Care Hospitals and Fiscal Year
2011 Final Wage Indices Implementing
the Medicare and Medicaid Extenders
Act
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice contains the final
fiscal year (FY) 2011 wage indices and
hospital reclassifications and other
related tables which reflect changes
required by or resulting from the
implementation of section 102 of the
Medicare and Medicaid Extenders Act
of 2010. MMEA requires the extension
of the expiration date for certain
geographic reclassifications and special
exception wage indices through
September 30, 2011.
DATES: Applicability Date: The revised
wage indices for section 508 and special
exception providers published in this
notice are applicable for discharges on
or after October 1, 2010 and on or before
September 30, 2011. Certain hospitals
that are not section 508/special
exception providers, but that are located
in areas affected by section 102 of the
MMEA, are also identified in this
notice, and will be paid based on the
revised wage index published in this
notice for discharges on or after April 1,
2011 and on or before September 30,
2011.
FOR FURTHER INFORMATION CONTACT:
Brian Slater, (410) 786–5229.
SUPPLEMENTARY INFORMATION:
mstockstill on DSKH9S0YB1PROD with NOTICES
SUMMARY:
I. Background
The final rule setting forth the
Medicare fiscal year (FY) 2011 hospital
inpatient prospective payment systems
(IPPS) for acute care hospitals and the
long-term care hospital prospective
payment system (LTCH PPS)
(hereinafter referred to as the FY 2011
IPPS/LTCHPPS final rule) appeared in
the August 16, 2010 Federal Register
(75 FR 50042) and we subsequently
VerDate Mar<15>2010
21:42 Apr 06, 2011
Jkt 223001
corrected this final rule in an October 1,
2010 Federal Register notice (75 FR
60640).
On December 15, 2010, the Medicare
and Medicaid Extenders Act (MMEA) of
2010 (Pub. L. 111–309) was enacted.
Section 102 of the MMEA extends
section 508 of the Medicare Prescription
Drug, Improvement, and Modernization
Act of 2003 (MMA) (Pub. L. 108–173)
reclassifications and certain additional
special exceptions through September
30, 2011. This notice addresses the
provisions of the MMEA that impact the
FY 2011 IPPS final wage index tables.
II. Provisions of this Notice
A. Section 508 Extension
Section 102 of the MMEA of 2010,
extends through the end of FY 2011
wage index reclassifications under
section 508 of the MMA and certain
special exceptions (for example, those
special exceptions contained in the final
rule that appeared in the Federal
Register (69 FR 49105 and 49107)
extended under section 117 of the
Medicare, Medicaid and SCHIP
Extension Act (MMSEA) of 2007 (Pub.
L. 110–173) and further extended under
section 124 of the Medicare
Improvements for Patients and
Providers Act of 2008 (MIPPA)(Pub. L.
110–275) and section 3137(a) of the
Patient Protection and Affordable Care
Act (PPACA) (Pub. L. 111–148) as
amended by section 10317 of the Health
Care and Education Reconciliation Act
of 2010 (HCERA), (Pub. L. 111–152
enacted on March 30, 2010). (These
public laws are collectively known as
the Affordable Care Act (ACA).)
Under section 508 of MMA, a
qualifying hospital could appeal the
wage index classification otherwise
applicable to the hospital and apply for
reclassification to another area of the
State in which the hospital is located or,
at the discretion of the Secretary, to an
area within a contiguous State. We
implemented this process through
notices published in the Federal
Register on January 6, 2004 (69 FR 661),
and February 13, 2004 (69 FR 7340).
Such reclassifications were applicable
to discharges occurring during the 3year 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) extended the
geographic reclassifications of hospitals
that were made under section 508 of the
MMA. In the March 23, 2007 Federal
Register (72 FR 3799), we published a
notice that indicated how we were
implementing section 106(a) of the
PO 00000
Frm 00059
Fmt 4703
Sfmt 4703
19365
MIEA–TRHCA through September 30,
2007. Section 117 of the MMSEA further
extended section 508 reclassifications
and certain special exceptions through
September 30, 2008. On February 22,
2008 in the Federal Register (73 FR
9807), we published a notice regarding
our implementation of section 117 of
the MMSEA. In the October 3, 2008
Federal Register (73 FR 57888), we
published a notice regarding our
implementation of section 124 of
MIPPA, which extended section 508
reclassifications and certain special
exceptions through September 30, 2009.
In the June 2, 2010 Federal Register (75
FR 31118), we explained our
implementation of section 3137(a) of the
ACA, as amended by section 10317 of
ACA, which further extended section
508 reclassifications and certain special
exceptions through the end of FY 2010.
Section 102 of the MMEA has
extended the hospital reclassifications
originally received under section 508
and certain special exceptions through
September 30, 2011 (FY 2011).
Furthermore, effective April 1, 2011,
section 102 of the MMEA also requires
that in determining the wage index
applicable to hospitals that qualify for
wage index reclassification, the
Secretary shall remove the section 508
and special exception hospitals’ wage
data from the calculation of the
reclassified wage index if doing so
increases the reclassified wage index. If
the section 508 or special exception
hospital’s wage index applicable for the
period beginning on October 1, 2010,
and ending on March 30, 2011, is lower
than for the period beginning on April
1, 2011, and ending on September 30,
2011, the Secretary shall pay the
hospital an additional amount that
reflects the difference between the wage
indices for the two periods. As a result
of these changes, we have recalculated
certain wage index values to account for
the new legislation.
Hospitals receiving an extension of
their section 508 reclassifications or
special exceptions wage indices are
shown in Table 9B of the Addendum to
this notice. Please note we are not
making reclassification decisions on
behalf of hospitals in this extension as
we did with the MIPPA provision.
(Because MIPPA was enacted prior to
the finalization of the FY 2009 rates, we
were able to modify reclassifications
that had not yet taken effect. In contrast,
MMEA was enacted in the middle of the
fiscal year, and reclassifications are
already in effect). Also, as explained in
this notice, in cases where we have
removed section 508/special exception
hospital data from the reclassification
wage index (effective April 1), we have
E:\FR\FM\07APN1.SGM
07APN1
19366
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
done so only where the labor market
area includes hospitals that have 508
reclassifications/special exceptions
extended, or where an extended
hospital was reclassified to such area for
FY 2011.
When originally implementing
section 508 of the 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 MMEA, since that law
simply provides a 1 year continuation
through the end of FY 2011 for any
section 508 reclassifications and special
exceptions wage indices that expired
September 30, 2010.
mstockstill on DSKH9S0YB1PROD with NOTICES
B. FY 2011 Final Wage Indices
The FY 2011 final wage index values
and geographic adjustment factors
(GAF) for hospitals affected by section
102 of the MMEA are included in Tables
2, 4C, and 9B of the Addendum to this
notice, as well as in a Table showing the
hospitals that have been removed from
Table 9A. These tables also are posted
on our Web site at https://
www.cms.hhs.gov/AcuteInpatientPPS/.
Table 2 of the Addendum to this notice
includes the final wage index values for:
(1) Section 508 and special exception
hospitals; and (2) other hospitals
affected by the extension. Table 4C of
the Addendum to this notice lists the
revised final wage index and GAF
values for certain hospitals that are
reclassified, for hospitals that have not
had their section 508 reclassifications or
special exceptions extended, will be
effective April 1, 2011. The revised
Table 9A of the Addendum lists
hospitals removed from the table due to
the enactment of section 102 of MMEA.
In addition, Table 9B of the Addendum
to this notice lists hospitals that are
section 508 and special exception
providers that have been extended until
September 30, 2011. Please note that
some hospitals that might otherwise
qualify for an extension of their section
508 reclassification or special exception
have not been so extended for FY 2011,
because they are receiving a higher wage
index as a result of maintaining their
MGCRB reclassification or due to
section 10324 of the ACA which
provides for a floor (of 1.0) on the area
wage index for hospitals in Frontier
States. Therefore, in keeping with our
historic practice, these providers
continue to receive the wage index
published in the FY 2011 IPPS/LTCH
PPS final rule, or subsequent correction
notice (published on October 1, 2010),
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
and are neither removed from Table 9A
nor listed in Table 9B.
III. Collection of Information
Requirements
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. chapter 35).
IV. Waiver of Proposed Rulemaking
and Delay of Effective Date
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register and invite public comment
prior to a rule taking effect in
accordance with section 553(b) of the
Administrative Procedure Act (APA)
and section 1871 of the Act. In addition,
in accordance with section 553(d) of the
APA and section 1871(e)(1)(B)(i) of the
Act, we ordinarily provide a 30-day
delay to a substantive rule’s effective
date. For substantive rules that
constitute major rules, in accordance
with 5 U.S.C. 801, we ordinarily provide
a 60-day delay in the effective date.
None of the above processes or
effective date requirements apply,
however, when the rule in question is
interpretive, a general statement of
policy, or a rule of agency organization,
procedure or practice. They also do not
apply when the Congress itself has
created the rules that are to be applied,
leaving no discretion or gaps for an
agency to fill in through rulemaking.
In addition, an agency may waive
notice and comment rulemaking, as well
as any delay in effective date, when the
agency for good cause finds that notice
and public comment on the rule as well
the effective date delay are
impracticable, unnecessary, or contrary
to the public interest. In cases where an
agency finds good cause, the agency
must incorporate a statement of this
finding and its reasons in the rule
issued.
The policies being publicized in this
notice do not constitute agency
rulemaking. Rather, the Congress, in the
MMEA, has already required that the
agency make these changes, and we are
simply notifying the public of certain
required revisions to wage index values
that are effective either October 1, 2010
(or for certain affected non-508 hospitals
April 1, 2011). As this notice merely
informs the public of these required
modifications to the wage index values
under the IPPS, it is not a rule and does
not require any notice and comment
rulemaking. To the extent any of the
policies articulated in this notice
PO 00000
Frm 00060
Fmt 4703
Sfmt 4703
constitute interpretations of the
Congress’s requirements or procedures
that will be used to implement the
Congress’s directive; they are
interpretive rules, general statements of
policy, and/or rules of agency procedure
or practice, which are not subject to
notice-and-comment rulemaking or a
delayed effective date.
However, to the extent that notice and
comment rulemaking or a delay in
effective date or both would otherwise
apply, we find good cause to waive such
requirements. Specifically, we find it
unnecessary to undertake notice and
comment rulemaking in this instance as
this notice does not propose to make
any substantive changes to IPPS policies
or methodologies already in effect as a
matter of law, but simply applies rate
adjustments required by MMEA to these
existing policies and methodologies.
Therefore, we would be unable to
change any of the policies governing the
IPPS for FY 2011 in response to public
comment on this notice. Finally, even if
any of the policies could be subject to
change, as many of the changes outlined
in this notice have already taken effect
or must take effect within a very short
period of time after enactment of the
MMEA (that is, by April 1, 2011—
approximately 3 months after
enactment), it would also be
impracticable to undertake notice and
comment rulemaking. For these reasons,
we also find that a waiver of any delay
in effective date, if it were otherwise
applicable, is necessary to comply with
the requirements of the MMEA.
Therefore, we find good cause to waive
notice and comment procedures as well
as any delay in effective date, if such
procedures or delays are required at all.
V. Regulatory Impact Analysis
A. Introduction
We have examined the impacts of this
notice as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), Executive
Order 13563 on Improving Regulation
and Regulatory Review (January 18,
2011), 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
(Pub. L. 104–4), Executive Order 13132
on Federalism (August 4, 1999), and the
Congressional Review Act (5 U.S.C.
804(2)).
Executive Orders 12866 and 13563
direct agencies to assess all costs and
benefits of available regulatory
alternatives and, if regulation is
necessary, to select regulatory
approaches that maximize net benefits
E:\FR\FM\07APN1.SGM
07APN1
mstockstill on DSKH9S0YB1PROD with NOTICES
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
(including potential economic,
environmental, public health and safety
effects, distributive impacts, and
equity). Executive Order 13563
emphasizes the importance of
quantifying both costs and benefits, of
reducing costs, of harmonizing rules,
and of promoting flexibility. A
regulatory impact analysis (RIA) must
be prepared for regulatory actions with
economically significant effects ($100
million or more in any 1 year). This
notice has been designated an
‘‘economically’’ significant regulatory
action, under section 3(f)(1) of Executive
Order 12866. Therefore, although we do
not consider this notice to constitute a
substantive rule, we have prepared a
RIA, that to the best of our ability,
presents the costs and benefits of this
notice. In accordance with Executive
Order 12866, the notice has been
reviewed by the Office of Management
and Budget.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses, if a rule has a significant
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and small
government jurisdictions. We estimate
that most hospitals and most other
providers and suppliers are small
entities as that term is used in the RFA.
The great majority of hospitals and most
other health care providers and
suppliers are small entities, either by
being nonprofit organizations or by
meeting the SBA definition of a small
business (having revenues of less than
$7.5 to $34.5 million in any 1 year). (For
details on the latest standard for health
care providers, we refer readers to page
33 of the Table of Small Business Size
Standards at the Small Business
Administration’s Web site at https://
www.sba.gov/services/
contractingopportunities/
sizestandardstopics/tableofsize/
index.html.) For purposes of the RFA,
all hospitals and other providers and
suppliers are considered to be small
entities. Individuals and States are not
included in the definition of a small
entity. We believe that this notice will
have a significant impact on small
entities. Because we acknowledge that
many of the affected entities are small
entities, the analysis discussed in this
section would fulfill any requirement
for a final regulatory flexibility analysis.
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
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
RFA. With the exception of hospitals
located in certain New England
counties, for purposes of section 1102(b)
of the Act, we now define a small rural
hospital as a hospital that is located
outside of an urban area and has fewer
than 100 beds. Section 601(g) of the
Social Security Amendments of 1983
(Pub. L. 98–21) designated hospitals in
certain New England counties as
belonging to the adjacent urban area.
Thus, for purposes of the IPPS, we
continue to classify these hospitals as
urban hospitals.
Section 202 of the Unfunded
Mandates Reform Act of 1995 (UMRA)
(Pub. L. 104–4) also requires that
agencies assess anticipated costs and
benefits before issuing any rule whose
mandates require spending in any 1 year
of $100 million in 1995 dollars, updated
annually for inflation. In 2011, that
threshold is approximately $136
million. This notice will not mandate
any requirements for State, local, or
Tribal governments, nor will it affect
private sector costs. 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. This notice will not have
a substantial effect on State and local
governments.
Although this notice merely reflects
the implementation of provisions of the
MMEA and does not constitute a
substantive rule, we are nevertheless
preparing this impact analysis in the
interest of ensuring that the impacts of
these changes are fully understood. The
following analysis, in conjunction with
the remainder of this document,
demonstrates that this notice is
consistent with the regulatory
philosophy and principles identified in
Executive Order 12866 and 13563, the
RFA, and section 1102(b) of the Act.
The notice will positively affect
payments to a substantial number of
small rural hospitals, as well as other
classes of hospitals, and the effects on
some hospitals may be significant. The
impact analysis, which shows the effect
on all payments to hospitals, is shown
in Table I of this notice.
B. Statement of Need
This notice is necessary to update the
final fiscal year (FY) 2011 wage indices
and hospital reclassifications and other
related tables to reflect changes required
by or resulting from the implementation
of section 102 of the MMEA. MMEA
requires the extension of the expiration
date for certain geographic
PO 00000
Frm 00061
Fmt 4703
Sfmt 4703
19367
reclassifications and special exception
wage indices through September 30,
2011. We note that the changes in this
notice are already in effect with changes
made to PRICER and announced
through a Joint Signature Memorandum.
C. Overall Impact
The FY 2011 IPPS final rule included
an impact analysis for the changes to the
IPPS included in that rule. This notice
updates those impacts to the IPPS
operating payment system as to reflect
certain changes required by the MMEA.
Because provisions in the MMEA were
not budget neutral, the overall estimates
for hospitals have changed from our
estimate that was published in the FY
2011 IPPS final rule (75 FR 50042). We
estimate that the changes in the FY 2011
IPPS final rule, in conjunction with the
final IPPS rates and wage index
included in this notice, will result in an
approximate $279 million decrease in
total operating payments relative to FY
2010. In the FY 2011 IPPS final rule (75
FR 50042), we had projected that total
operating payments would decrease by
$440 million relative to FY 2010.
However, the changes in this notice will
increase operating payments by $162
million relative to what was projected in
the FY 2011 IPPS final rule, resulting in
a net decrease of $279 million in total
operating payments. Capital payments
are estimated to increase by an
additional $13.6 million in FY 2011 as
a result of the changes in this notice.
D. Anticipated Effects
In Table I, we provide an impact
analysis for changes to the IPPS
operating payments in FY 2011 as a
result of the changes required by the
MMEA. The table categorizes hospitals
by various geographic and special
payment consideration groups to
illustrate the varying impacts on
different types of hospitals. The first
row of Table I shows the overall impact
on the 3,472 acute care hospitals
included in the analysis. The impact
analysis reflects the change in estimated
operating payments in FY 2011 due to
the provisions in the MMEA relative to
estimated FY 2011 operating payments
published in the FY 2011 IPPS final rule
(75 FR 50042). Overall, all hospitals will
experience an estimated 0.2 percent
increase in operating payments in FY
2011 due to the provisions in MMEA
compared to the previous estimates of
operating payments in FY 2011
published in the FY 2011 IPPS final
rule. Because the provisions in the
MMEA were not budget neutral, all
hospitals, depending on whether they
were affected by the provisions in the
MMEA, will either experience no
E:\FR\FM\07APN1.SGM
07APN1
19368
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
change or an increase in IPPS operating
payments in FY 2011 in this notice
relative to the previously published
estimates. As such, hospitals located in
urban areas will experience a 0.2
percent increase in payments while
hospitals located in rural areas will not
experience any change in payments in
FY 2011 due to the provisions in this
notice as compared to the estimated
payments provided in the FY 2011 IPPS
final rule. Among the hospitals that are
subject to the changes in this notice,
hospitals will experience a net effect
increase in payments ranging from 0.1
percent to 0.4 percent where urban
Middle Atlantic hospitals, urban East
North Central hospitals and urban
reclassified hospitals are expected to
experience the largest net increase in
operating payments of 0.4 percent in FY
2011.
TABLE I—IMPACT ANALYSIS OF CHANGES FOR FY 2011 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM
mstockstill on DSKH9S0YB1PROD with NOTICES
Number of
hospitals
All Hospitals .............................................................................................................................................................
By Geographic Location:
Urban hospitals .................................................................................................................................................
Large urban areas .....................................................................................................................................
Other urban areas .....................................................................................................................................
Rural hospitals ..................................................................................................................................................
Bed Size (Urban):
0–99 beds .........................................................................................................................................................
100–199 beds ...................................................................................................................................................
200–299 beds ...................................................................................................................................................
300–499 beds ...................................................................................................................................................
500 or more beds .............................................................................................................................................
Bed Size (Rural):
0–49 beds .........................................................................................................................................................
50–99 beds .......................................................................................................................................................
100–149 beds ...................................................................................................................................................
150–199 beds ...................................................................................................................................................
200 or more beds .............................................................................................................................................
Urban by Region:
New England ....................................................................................................................................................
Middle Atlantic ..................................................................................................................................................
South Atlantic ...................................................................................................................................................
East North Central ............................................................................................................................................
East South Central ...........................................................................................................................................
West North Central ...........................................................................................................................................
West South Central ..........................................................................................................................................
Mountain ...........................................................................................................................................................
Pacific ...............................................................................................................................................................
Puerto Rico .......................................................................................................................................................
Rural by Region:
New England ....................................................................................................................................................
Middle Atlantic ..................................................................................................................................................
South Atlantic ...................................................................................................................................................
East North Central ............................................................................................................................................
East South Central ...........................................................................................................................................
West North Central ...........................................................................................................................................
West South Central ..........................................................................................................................................
Mountain ...........................................................................................................................................................
Pacific ...............................................................................................................................................................
By Payment Classification:
Urban hospitals .................................................................................................................................................
Large urban areas ............................................................................................................................................
Other urban areas ............................................................................................................................................
Rural areas .......................................................................................................................................................
Teaching Status:
Nonteaching ......................................................................................................................................................
Fewer than 100 residents .................................................................................................................................
100 or more residents ......................................................................................................................................
Urban DSH:
Non-DSH ..........................................................................................................................................................
100 or more beds .............................................................................................................................................
Less than 100 beds ..........................................................................................................................................
Rural DSH:
SCH ..................................................................................................................................................................
RRC ..................................................................................................................................................................
100 or more beds .............................................................................................................................................
Less than 100 beds ..........................................................................................................................................
Urban teaching and DSH:
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
PO 00000
Frm 00062
Fmt 4703
Sfmt 4703
E:\FR\FM\07APN1.SGM
07APN1
Percent net
effect of all
changes for
FY 2011
3472
0.2
2494
1362
1132
978
0.2
0.2
0.2
0
622
785
460
430
197
0.1
0.2
0.2
0.2
0.2
348
368
156
60
46
0
0
0
0
0
121
330
382
403
155
167
336
161
389
50
0.3
0.4
0
0.4
0
0
0
0
0.1
0
24
70
165
121
176
100
219
72
31
0
0.1
0
0
0
0.1
0
0
0
2551
1404
1147
921
0.2
0.2
0.2
0
2429
805
238
0.1
0.2
0.3
779
1531
356
0.2
0.2
0.1
423
212
30
141
0
0
0.2
0.2
19369
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
TABLE I—IMPACT ANALYSIS OF CHANGES FOR FY 2011 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM—Continued
Number of
hospitals
Both teaching and DSH ....................................................................................................................................
Teaching and no DSH ......................................................................................................................................
No teaching and DSH ......................................................................................................................................
No teaching and no DSH .................................................................................................................................
Special Hospital Types:
RRC ..................................................................................................................................................................
SCH ..................................................................................................................................................................
MDH ..................................................................................................................................................................
SCH and RRC ...........................................................................................................................................
MDH and RRC ..........................................................................................................................................
Type of Ownership:
Voluntary ...........................................................................................................................................................
Proprietary ........................................................................................................................................................
Government ......................................................................................................................................................
Medicare Utilization as a Percent of Inpatient Days:
0–25 ..................................................................................................................................................................
25–50 ................................................................................................................................................................
50–65 ................................................................................................................................................................
Over 65 .............................................................................................................................................................
FY 2011 Reclassifications by the Medicare Geographic Classification Review Board:
All Reclassified Hospitals .................................................................................................................................
Non-Reclassified Hospitals ...............................................................................................................................
Urban Hospitals Reclassified ...........................................................................................................................
Urban Nonreclassified Hospitals, FY 2011 ......................................................................................................
All Rural Hospitals Reclassified FY 2011 ........................................................................................................
Rural Nonreclassified Hospitals FY 2011 ........................................................................................................
All Section 401 Reclassified Hospitals: ............................................................................................................
Other Reclassified Hospitals (Section 1886(d)(8)(B)) ......................................................................................
Specialty Hospitals:
Cardiac Specialty Hospitals ..............................................................................................................................
E. Alternatives Considered
This notice provides descriptions of
the statutory provisions that are
addressed and identifies policies for
implementing these provisions. Due to
the prescriptive nature of the statutory
provisions, no alternatives were
considered.
million and capital payments by $14
million. Thus, the total increase in
Federal expenditures for FY 2011 is
approximately $176 million.
mstockstill on DSKH9S0YB1PROD with NOTICES
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
818
161
1069
503
0.2
0.3
0
0.2
180
332
194
117
13
0.1
0
0
0
0
1990
859
586
0.2
0.1
0
353
1593
1203
233
0
0.2
0.2
0.2
773
2699
442
2022
331
585
37
63
0.3
0.1
0.4
0.1
0
0.1
0
0
19
0
Dated: March 3, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: April 1, 2011.
Kathleen Sebelius,
Secretary, Department of Health and Human
Services.
TABLE II—ACCOUNTING STATEMENT:
CLASSIFICATION OF ESTIMATED EXPENDITURES
UNDER THE IPPS
FROM PUBLISHED FY 2011 TO RE- Addendum
VISED FY 2011
F. Accounting Statement and Table
1. Acute Care Hospitals
As required by OMB Circular A–4
(available at https://
www.whitehouse.gov/omb/circulars/
a004/a-4.pdf), in Table II, we have
prepared an accounting statement
showing the classification of
expenditures associated with the
provisions of this notice as they relate
to acute care hospitals. This table
provides our best estimate of the change
in Medicare payments to providers as a
result of the changes to the IPPS
presented in this notice. All
expenditures are classified as transfers
from the Federal government to
Medicare providers. As previously
discussed, relative to what was
projected in the FY 2011 IPPS final rule,
the changes in this notice will increase
FY 2011 operating payments by $162
Percent net
effect of all
changes for
FY 2011
Category
Transfers
Annualized
Monetized
Transfers.
From Whom to
Whom.
Total ........
$176 million
Federal Government to IPPS
Medicare Providers
$176 million
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
PO 00000
This addendum includes tables
referred to throughout the notice which
contain data relating to the final FY
2010 wage indices and the hospital
reclassifications and payment amounts
for operating costs discussed in section
II. of this notice.
TABLE 2A—REVISED FY 2011 WAGE
INDEX VALUES FOR SECTION 508/
SPECIAL EXCEPTION HOSPITALS
(Effective October 1, 2010 through September
30, 2011).
CMS certification No.
010150
020008
050549
060075
Frm 00063
Fmt 4703
Sfmt 4703
E:\FR\FM\07APN1.SGM
......................................
......................................
......................................
......................................
07APN1
Revised FY
2011 wage
index
0.8567
1.2776
1.5477
1.1429
19370
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
TABLE 2A—REVISED FY 2011 WAGE
INDEX VALUES FOR SECTION 508/
SPECIAL EXCEPTION HOSPITALS—
Continued
TABLE 2A—REVISED FY 2011 WAGE
INDEX VALUES FOR SECTION 508/
SPECIAL EXCEPTION HOSPITALS—
Continued
(Effective October 1, 2010 through September
30, 2011).
(Effective October 1, 2010 through September
30, 2011).
Revised FY
2011 wage
index
Revised FY
2011 wage
index
CMS certification No.
mstockstill on DSKH9S0YB1PROD with NOTICES
070005 ......................................
070006 * ....................................
070010 ......................................
070016 ......................................
070017 ......................................
070018 * ....................................
070019 ......................................
070022 ......................................
070028 ......................................
070031 ......................................
070034 * ....................................
070036 ......................................
070039 ......................................
150034 ......................................
160040 ......................................
160064 ......................................
160067 ......................................
160110 ......................................
220046 ......................................
230003 ......................................
230004 ......................................
230013 ......................................
230019 ......................................
230020 ......................................
230024 ......................................
230029 ......................................
230036 ......................................
230038 ......................................
230053 ......................................
230059 ......................................
230066 ......................................
230071 ......................................
230072 ......................................
230089 ......................................
230097 ......................................
230104 ......................................
230106 ......................................
230130 ......................................
230135 ......................................
230146 ......................................
230151 ......................................
230165 ......................................
230174 ......................................
230176 ......................................
230207 ......................................
230236 ......................................
230254 ......................................
230269 ......................................
230270 ......................................
230273 ......................................
230277 ......................................
250002 ......................................
250078 * ....................................
1.2529
1.2867
1.2867
1.2529
1.2529
1.2867
1.2529
1.2529
1.2867
1.2529
1.2867
1.3329
1.2529
1.0386
0.8759
0.9501
0.8759
0.8759
1.1629
0.9930
0.9930
1.0781
1.0781
1.0057
1.0057
1.0781
1.0781
0.9930
1.0057
0.9930
0.9930
1.0781
0.9930
1.0057
0.9930
1.0057
0.9930
1.0781
1.0057
1.0057
1.0781
1.0057
0.9930
1.0057
1.0781
0.9930
1.0781
1.0781
1.0057
1.0057
1.0781
0.8443
0.8443
CMS certification No.
250122 ......................................
310021 ......................................
310028 ......................................
310050 ......................................
310051 ......................................
310060 ......................................
310115 ......................................
310120 ......................................
330023 * ....................................
330049 ......................................
330067 * ....................................
330106 ......................................
330126 ......................................
330135 ......................................
330205 ......................................
330264 ......................................
340002 ......................................
390001 ......................................
390003 ......................................
390045 ** ..................................
390072 ......................................
390095 ......................................
390119 ......................................
390137 ......................................
390169 ......................................
390185 ......................................
390192 ......................................
390237 ......................................
390270 ......................................
430005 ......................................
470003 ......................................
490001 ......................................
530015 ......................................
0.8443
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.4341
1.2867
1.2867
1.2867
1.2529
0.9087
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9852
0.9370
0.9370
0.9852
1.0934
1.1629
0.8514
1.0577
* These hospitals are assigned a wage
index value under a special exceptions policy
(see the FY 2005 IPPS final rule, 69 FR
49105).
** This hospital has been assigned a wage
index under a special exceptions policy (see
the FY 2007 IPPS final rule, 71 FR 48070).
TABLE 2B—REVISED FY 2011 WAGE
INDEX VALUES FOR OTHER AFFECTED HOSPITALS
(Effective April 1, 2011 through September 30,
2011)
CMS certification No.
070015 ..................................
Revised FY
2011 wage
index
1.2867
TABLE 2B—REVISED FY 2011 WAGE
INDEX VALUES FOR OTHER AFFECTED HOSPITALS—Continued
(Effective April 1, 2011 through September 30,
2011)
CMS certification No.
070033
070038
140012
140110
140161
150002
150004
150008
150090
150125
150126
150165
150166
150170
230002
230037
230069
230077
230099
230142
230244
230279
230297
230301
230302
250023
250040
250094
250117
310002
310009
310015
310017
310038
310039
310054
310070
310076
310083
310096
310108
310119
330027
330167
330181
330182
330198
330225
330259
330331
330332
330372
Revised FY
2011 wage
index
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
1.2867
1.2529
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0386
1.0057
1.0057
1.0781
1.0781
1.0057
1.0057
1.0057
1.0781
1.0057
1.0781
1.0781
0.8443
0.8443
0.8443
0.8443
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
TABLE 4C.—REVISED WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTORS (GAF) FOR ACUTE CARE
HOSPITALS THAT ARE RECLASSIFIED BY CBSA AND BY STATE—FY 2011
[Wage index includes rural floor budget neutrality adjustment]
CBSA code
11460
16974
22420
25060
........
........
........
........
VerDate Mar<15>2010
Area
State
Ann Arbor, MI ....................................................
Chicago-Joliet-Naperville, IL ..............................
Flint, MI ..............................................................
Gulfport-Biloxi, MS .............................................
19:53 Apr 06, 2011
Jkt 223001
PO 00000
Frm 00064
Revised wage index
MI
IL
MI
MS
Fmt 4703
1.0057
1.0386
1.0781
0.8443
Sfmt 4703
E:\FR\FM\07APN1.SGM
07APN1
Revised GAF
1.0039
1.0263
1.0528
0.8906
19371
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
TABLE 4C.—REVISED WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTORS (GAF) FOR ACUTE CARE
HOSPITALS THAT ARE RECLASSIFIED BY CBSA AND BY STATE—FY 2011—Continued
[Wage index includes rural floor budget neutrality adjustment]
CBSA code
35004
35644
35644
35644
........
........
........
........
Area
State
Nassau-Suffolk, NY ...........................................
New York-White Plains-Wayne, CT ..................
New York-White Plains-Wayne, NJ ...................
New York-White Plains-Wayne, NY ..................
The following providers have been
removed from Table 9A published in
the FY 2011 IPPS/LTCH final rule (or in
Revised wage index
NY
CT
NJ
NY
Revised GAF
1.2529
1.2867
1.2867
1.2867
the October 1, 2010 correction notice to
that final rule) due to the
1.1670
1.1884
1.1884
1.1884
implementation of section 102 of the
MMEA:
TABLE 9A—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS WITHDRAWN/TERMINATED DUE TO SECTION 102 OF THE
MMEA—FY 2011
mstockstill on DSKH9S0YB1PROD with NOTICES
CCN
020008
060075
070005
070006
070010
070016
070017
070018
070019
070022
070028
070031
070034
070036
070039
150034
160064
230003
230013
230019
230020
230024
230029
230036
230038
230053
230071
230072
230089
230097
230104
230106
230130
230135
230146
230151
230165
230174
230176
230207
230236
230254
230269
230270
230273
230277
250002
250078
310050
330023
330106
330126
390185
Geographic CBSA
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
PO 00000
Reclassified CBSA
02
06
35300
14860
14860
35300
35300
14860
35300
35300
14860
35300
14860
25540
35300
23844
16
26100
47644
47644
19804
19804
47644
23
24340
19804
47644
26100
19804
23
19804
24340
47644
19804
19804
47644
19804
26100
19804
47644
24340
47644
47644
19804
19804
47644
25
25620
35084
39100
35004
39100
42540
Frm 00065
Fmt 4703
Sfmt 4703
11260
24300
35004
35644
35644
35004
35004
35644
35004
35004
35644
35004
35644
35300
35004
16974
24
34740
22420
22420
11460
11460
22420
13020
34740
11460
22420
34740
11460
24340
11460
34740
22420
11460
11460
22420
11460
34740
11460
22420
34740
22420
22420
11460
11460
22420
22520
25060
35644
35644
35644
35644
10900
E:\FR\FM\07APN1.SGM
07APN1
LUGAR
19372
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF
PUBLIC LAW 108–173—FY 2011
mstockstill on DSKH9S0YB1PROD with NOTICES
CCN
010150
020008
050549
060075
070005
070006
070010
070016
070017
070018
070019
070022
070028
070031
070034
070036
070039
150034
160040
160064
160067
160110
220046
230003
230004
230013
230019
230020
230024
230029
230036
230038
230053
230059
230066
230071
230072
230089
230097
230104
230106
230130
230135
230146
230151
230165
230174
230176
230207
230236
230254
230269
230270
230273
230277
250002
250078
250122
310021
310028
310050
310051
310060
310115
310120
330023
330049
330067
Note
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
PO 00000
Frm 00066
Fmt 4703
Geographic
CBSA
........................
........................
........................
........................
........................
*
........................
........................
........................
*
........................
........................
........................
........................
*
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
*
........................
........................
........................
........................
........................
........................
........................
........................
*
........................
*
Sfmt 4703
E:\FR\FM\07APN1.SGM
17980
02
42220
06
35004
35644
35644
35004
35004
35644
35004
35004
35644
35004
35644
25540
35004
16974
16300
16
16300
16300
14484
28020
28020
22420
22420
11460
11460
22420
22420
28020
11460
28020
28020
22420
28020
11460
28020
11460
28020
22420
11460
11460
22420
11460
28020
11460
22420
28020
22420
22420
11460
11460
22420
25060
25060
25060
35644
35644
35644
35644
35644
35644
35644
35644
35644
35644
07APN1
Wage index
CBSA section
508 reclassification
Own wage
index
0.8567
........................
1.5477
........................
1.2529
1.2867
1.2867
1.2529
1.2529
1.2867
1.2529
1.2529
1.2867
1.2529
1.2867
........................
1.2529
1.0386
0.8759
........................
0.8759
0.8759
1.1629
0.9930
0.9930
1.0781
1.0781
1.0057
1.0057
1.0781
1.0781
0.9930
1.0057
0.9930
0.9930
1.0781
0.9930
1.0057
0.9930
1.0057
0.9930
1.0781
1.0057
1.0057
1.0781
1.0057
0.9930
1.0057
1.0781
0.9930
1.0781
1.0781
1.0057
1.0057
1.0781
0.8443
0.8443
0.8443
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
1.2867
........................
1.2776
........................
1.1429
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
1.3329
........................
........................
........................
0.9501
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
19373
Federal Register / Vol. 76, No. 67 / Thursday, April 7, 2011 / Notices
TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF
PUBLIC LAW 108–173—FY 2011—Continued
CCN
330106
330126
330135
330205
330264
340002
390001
390003
390045
390072
390095
390119
390137
390169
390185
390192
390237
390270
430005
470003
490001
530015
Note
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
Geographic
CBSA
........................
........................
........................
........................
........................
........................
........................
........................
**
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
35004
35644
35644
35644
35004
16740
10900
10900
10900
10900
10900
10900
10900
10900
29540
10900
10900
29540
39660
14484
31340
53
Wage index
CBSA section
508 reclassification
Own wage
index
........................
1.2867
1.2867
1.2867
1.2529
0.9087
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9370
0.9852
0.9370
0.9370
0.9852
1.0934
1.1629
0.8514
........................
1.4341
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
1.0577
* These hospitals are assigned a wage index value under a special exceptions policy (see FY 2005 IPPS final rule, 69 FR 49105).
** This hospital has been assigned a wage index under a special exceptions policy (see FY 2007 IPPS final rule, 71 FR 48070).
[FR Doc. 2011–8209 Filed 4–6–11; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2011–N–0002]
The 14th Annual Food and Drug
Administration-Orange County
Regulatory Affairs Educational
Conference in Irvine, California: New
Regulatory Challenges
AGENCY:
Food and Drug Administration,
HHS.
mstockstill on DSKH9S0YB1PROD with NOTICES
ACTION:
Notice of conference.
The Food and Drug Administration
(FDA) is announcing the following
conference: 14th Annual Educational
Conference co-sponsored with the
Orange County Regulatory Affairs
Discussion Group (OCRA). The
conference is intended to provide the
drug, device, biologics, and dietary
supplement industries with an
opportunity to interact with FDA
reviewers and compliance officers from
the centers and District Offices, as well
as from other industry experts. The
main focus of this interactive conference
will be product approval, compliance,
and risk management in the three
medical product areas. Industry
speakers, interactive Q & A, and
VerDate Mar<15>2010
19:53 Apr 06, 2011
Jkt 223001
workshop sessions will also be included
to assure open exchange and dialogue
on the relevant regulatory issues.
Date and Time: The conference will
be held on June 8 and 9, 2011, from 7:30
a.m. to 5 p.m.
Location: The conference will be held
at the Irvine Marriott Hotel, 18000 Von
Karman Ave., Irvine, CA 92612.
Contact: Linda Hartley, Office of
Regulatory Affairs, Food and Drug
Administration, 19701 Fairchild, Irvine,
CA 92612, Voice: 949–608–4413, Fax:
949–608–4417; or Orange County
Regulatory Affairs Discussion Group,
Attention to Detail, 5319 University Dr.,
suite 641, Irvine, CA 92612, Voice: 949–
387–9046, Fax: 949–387–9047, Web site:
https://www.ocra-dg.org. (FDA has
verified the Web site address, but FDA
is not responsible for any subsequent
changes to the Web site after this
document publishes in the Federal
Register.)
Registration and Meeting Information:
See OCRA’s Web site at https://
www.ocra-dg.org. Contact Attention to
Detail at 949–387–9046.
Before May 1, 2011, registrations fees
are as follows: $675.00 for members,
$725.00 for non-members and $475.00
for FDA/Government/Students.* After
May 1, 2011, $725.00 for members,
$775.00 for non-members, and $475.00
for FDA/Government/Students.*
* OCRA student rate applies to those
individuals enrolled in a regulatory or
PO 00000
Frm 00067
Fmt 4703
Sfmt 4703
quality-related academic program at an
accredited institution. Proof of
enrollment required.
The registration fee will cover actual
expenses including refreshments, lunch,
materials, parking, and speaker
expenses.
If you need special accommodations
due to a disability, please contact Linda
Hartley (see Contact) at least 10 days in
advance.
Transcripts: Transcripts will not be
available for the conference.
Dated: April 1, 2011.
Leslie Kux,
Acting Assistant Commissioner for Policy.
[FR Doc. 2011–8283 Filed 4–6–11; 8:45 am]
BILLING CODE 4160–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2010–N–0443]
Cathryn Lyn Chatman (also known as
Cathryn Lyn Garcia): Debarment Order
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
The Food and Drug
Administration (FDA) is issuing an
order under the Federal Food, Drug, and
Cosmetic Act (the FD&C Act) debarring
SUMMARY:
E:\FR\FM\07APN1.SGM
07APN1
]]>Agencies
[Federal Register Volume 76, Number 67 (Thursday, April 7, 2011)]
[Notices]
[Pages 19365-19373]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-8209]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1357-N]
RIN 0938-AQ97
Medicare Program; Hospital Inpatient Prospective Payment Systems
for Acute Care Hospitals and Fiscal Year 2011 Final Wage Indices
Implementing the Medicare and Medicaid Extenders Act
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice contains the final fiscal year (FY) 2011 wage
indices and hospital reclassifications and other related tables which
reflect changes required by or resulting from the implementation of
section 102 of the Medicare and Medicaid Extenders Act of 2010. MMEA
requires the extension of the expiration date for certain geographic
reclassifications and special exception wage indices through September
30, 2011.
DATES: Applicability Date: The revised wage indices for section 508 and
special exception providers published in this notice are applicable for
discharges on or after October 1, 2010 and on or before September 30,
2011. Certain hospitals that are not section 508/special exception
providers, but that are located in areas affected by section 102 of the
MMEA, are also identified in this notice, and will be paid based on the
revised wage index published in this notice for discharges on or after
April 1, 2011 and on or before September 30, 2011.
FOR FURTHER INFORMATION CONTACT: Brian Slater, (410) 786-5229.
SUPPLEMENTARY INFORMATION:
I. Background
The final rule setting forth the Medicare fiscal year (FY) 2011
hospital inpatient prospective payment systems (IPPS) for acute care
hospitals and the long-term care hospital prospective payment system
(LTCH PPS) (hereinafter referred to as the FY 2011 IPPS/LTCHPPS final
rule) appeared in the August 16, 2010 Federal Register (75 FR 50042)
and we subsequently corrected this final rule in an October 1, 2010
Federal Register notice (75 FR 60640).
On December 15, 2010, the Medicare and Medicaid Extenders Act
(MMEA) of 2010 (Pub. L. 111-309) was enacted. Section 102 of the MMEA
extends section 508 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173) reclassifications and
certain additional special exceptions through September 30, 2011. This
notice addresses the provisions of the MMEA that impact the FY 2011
IPPS final wage index tables.
II. Provisions of this Notice
A. Section 508 Extension
Section 102 of the MMEA of 2010, extends through the end of FY 2011
wage index reclassifications under section 508 of the MMA and certain
special exceptions (for example, those special exceptions contained in
the final rule that appeared in the Federal Register (69 FR 49105 and
49107) extended under section 117 of the Medicare, Medicaid and SCHIP
Extension Act (MMSEA) of 2007 (Pub. L. 110-173) and further extended
under section 124 of the Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA)(Pub. L. 110-275) and section 3137(a) of
the Patient Protection and Affordable Care Act (PPACA) (Pub. L. 111-
148) as amended by section 10317 of the Health Care and Education
Reconciliation Act of 2010 (HCERA), (Pub. L. 111-152 enacted on March
30, 2010). (These public laws are collectively known as the Affordable
Care Act (ACA).)
Under section 508 of MMA, a qualifying hospital could appeal the
wage index classification otherwise applicable to the hospital and
apply for reclassification to another area of the State in which the
hospital is located or, at the discretion of the Secretary, to an area
within a contiguous State. We implemented this process through notices
published in the Federal Register on January 6, 2004 (69 FR 661), and
February 13, 2004 (69 FR 7340). Such reclassifications were applicable
to discharges occurring during the 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) extended the geographic reclassifications
of hospitals that were made under section 508 of the MMA. In the March
23, 2007 Federal Register (72 FR 3799), we published a notice that
indicated how we were implementing section 106(a) of the MIEA-TRHCA
through September 30, 2007. Section 117 of the MMSEA further extended
section 508 reclassifications and certain special exceptions through
September 30, 2008. On February 22, 2008 in the Federal Register (73 FR
9807), we published a notice regarding our implementation of section
117 of the MMSEA. In the October 3, 2008 Federal Register (73 FR
57888), we published a notice regarding our implementation of section
124 of MIPPA, which extended section 508 reclassifications and certain
special exceptions through September 30, 2009. In the June 2, 2010
Federal Register (75 FR 31118), we explained our implementation of
section 3137(a) of the ACA, as amended by section 10317 of ACA, which
further extended section 508 reclassifications and certain special
exceptions through the end of FY 2010.
Section 102 of the MMEA has extended the hospital reclassifications
originally received under section 508 and certain special exceptions
through September 30, 2011 (FY 2011). Furthermore, effective April 1,
2011, section 102 of the MMEA also requires that in determining the
wage index applicable to hospitals that qualify for wage index
reclassification, the Secretary shall remove the section 508 and
special exception hospitals' wage data from the calculation of the
reclassified wage index if doing so increases the reclassified wage
index. If the section 508 or special exception hospital's wage index
applicable for the period beginning on October 1, 2010, and ending on
March 30, 2011, is lower than for the period beginning on April 1,
2011, and ending on September 30, 2011, the Secretary shall pay the
hospital an additional amount that reflects the difference between the
wage indices for the two periods. As a result of these changes, we have
recalculated certain wage index values to account for the new
legislation.
Hospitals receiving an extension of their section 508
reclassifications or special exceptions wage indices are shown in Table
9B of the Addendum to this notice. Please note we are not making
reclassification decisions on behalf of hospitals in this extension as
we did with the MIPPA provision. (Because MIPPA was enacted prior to
the finalization of the FY 2009 rates, we were able to modify
reclassifications that had not yet taken effect. In contrast, MMEA was
enacted in the middle of the fiscal year, and reclassifications are
already in effect). Also, as explained in this notice, in cases where
we have removed section 508/special exception hospital data from the
reclassification wage index (effective April 1), we have
[[Page 19366]]
done so only where the labor market area includes hospitals that have
508 reclassifications/special exceptions extended, or where an extended
hospital was reclassified to such area for FY 2011.
When originally implementing section 508 of the 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 MMEA, since that law simply provides a 1 year
continuation through the end of FY 2011 for any section 508
reclassifications and special exceptions wage indices that expired
September 30, 2010.
B. FY 2011 Final Wage Indices
The FY 2011 final wage index values and geographic adjustment
factors (GAF) for hospitals affected by section 102 of the MMEA are
included in Tables 2, 4C, and 9B of the Addendum to this notice, as
well as in a Table showing the hospitals that have been removed from
Table 9A. These tables also are posted on our Web site at https://www.cms.hhs.gov/AcuteInpatientPPS/. Table 2 of the Addendum to this
notice includes the final wage index values for: (1) Section 508 and
special exception hospitals; and (2) other hospitals affected by the
extension. Table 4C of the Addendum to this notice lists the revised
final wage index and GAF values for certain hospitals that are
reclassified, for hospitals that have not had their section 508
reclassifications or special exceptions extended, will be effective
April 1, 2011. The revised Table 9A of the Addendum lists hospitals
removed from the table due to the enactment of section 102 of MMEA. In
addition, Table 9B of the Addendum to this notice lists hospitals that
are section 508 and special exception providers that have been extended
until September 30, 2011. Please note that some hospitals that might
otherwise qualify for an extension of their section 508
reclassification or special exception have not been so extended for FY
2011, because they are receiving a higher wage index as a result of
maintaining their MGCRB reclassification or due to section 10324 of the
ACA which provides for a floor (of 1.0) on the area wage index for
hospitals in Frontier States. Therefore, in keeping with our historic
practice, these providers continue to receive the wage index published
in the FY 2011 IPPS/LTCH PPS final rule, or subsequent correction
notice (published on October 1, 2010), and are neither removed from
Table 9A nor listed in Table 9B.
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35).
IV. Waiver of Proposed Rulemaking and Delay of Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment prior to a rule taking
effect in accordance with section 553(b) of the Administrative
Procedure Act (APA) and section 1871 of the Act. In addition, in
accordance with section 553(d) of the APA and section 1871(e)(1)(B)(i)
of the Act, we ordinarily provide a 30-day delay to a substantive
rule's effective date. For substantive rules that constitute major
rules, in accordance with 5 U.S.C. 801, we ordinarily provide a 60-day
delay in the effective date.
None of the above processes or effective date requirements apply,
however, when the rule in question is interpretive, a general statement
of policy, or a rule of agency organization, procedure or practice.
They also do not apply when the Congress itself has created the rules
that are to be applied, leaving no discretion or gaps for an agency to
fill in through rulemaking.
In addition, an agency may waive notice and comment rulemaking, as
well as any delay in effective date, when the agency for good cause
finds that notice and public comment on the rule as well the effective
date delay are impracticable, unnecessary, or contrary to the public
interest. In cases where an agency finds good cause, the agency must
incorporate a statement of this finding and its reasons in the rule
issued.
The policies being publicized in this notice do not constitute
agency rulemaking. Rather, the Congress, in the MMEA, has already
required that the agency make these changes, and we are simply
notifying the public of certain required revisions to wage index values
that are effective either October 1, 2010 (or for certain affected non-
508 hospitals April 1, 2011). As this notice merely informs the public
of these required modifications to the wage index values under the
IPPS, it is not a rule and does not require any notice and comment
rulemaking. To the extent any of the policies articulated in this
notice constitute interpretations of the Congress's requirements or
procedures that will be used to implement the Congress's directive;
they are interpretive rules, general statements of policy, and/or rules
of agency procedure or practice, which are not subject to notice-and-
comment rulemaking or a delayed effective date.
However, to the extent that notice and comment rulemaking or a
delay in effective date or both would otherwise apply, we find good
cause to waive such requirements. Specifically, we find it unnecessary
to undertake notice and comment rulemaking in this instance as this
notice does not propose to make any substantive changes to IPPS
policies or methodologies already in effect as a matter of law, but
simply applies rate adjustments required by MMEA to these existing
policies and methodologies. Therefore, we would be unable to change any
of the policies governing the IPPS for FY 2011 in response to public
comment on this notice. Finally, even if any of the policies could be
subject to change, as many of the changes outlined in this notice have
already taken effect or must take effect within a very short period of
time after enactment of the MMEA (that is, by April 1, 2011--
approximately 3 months after enactment), it would also be impracticable
to undertake notice and comment rulemaking. For these reasons, we also
find that a waiver of any delay in effective date, if it were otherwise
applicable, is necessary to comply with the requirements of the MMEA.
Therefore, we find good cause to waive notice and comment procedures as
well as any delay in effective date, if such procedures or delays are
required at all.
V. Regulatory Impact Analysis
A. Introduction
We have examined the impacts of this notice as required by
Executive Order 12866 on Regulatory Planning and Review (September 30,
1993), Executive Order 13563 on Improving Regulation and Regulatory
Review (January 18, 2011), 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
(Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999),
and the Congressional Review Act (5 U.S.C. 804(2)).
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits
[[Page 19367]]
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). Executive Order 13563
emphasizes the importance of quantifying both costs and benefits, of
reducing costs, of harmonizing rules, and of promoting flexibility. A
regulatory impact analysis (RIA) must be prepared for regulatory
actions with economically significant effects ($100 million or more in
any 1 year). This notice has been designated an ``economically''
significant regulatory action, under section 3(f)(1) of Executive Order
12866. Therefore, although we do not consider this notice to constitute
a substantive rule, we have prepared a RIA, that to the best of our
ability, presents the costs and benefits of this notice. In accordance
with Executive Order 12866, the notice has been reviewed by the Office
of Management and Budget.
The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule has a significant impact on a
substantial number of small entities. For purposes of the RFA, small
entities include small businesses, nonprofit organizations, and small
government jurisdictions. We estimate that most hospitals and most
other providers and suppliers are small entities as that term is used
in the RFA. The great majority of hospitals and most other health care
providers and suppliers are small entities, either by being nonprofit
organizations or by meeting the SBA definition of a small business
(having revenues of less than $7.5 to $34.5 million in any 1 year).
(For details on the latest standard for health care providers, we refer
readers to page 33 of the Table of Small Business Size Standards at the
Small Business Administration's Web site at https://www.sba.gov/services/contractingopportunities/sizestandardstopics/tableofsize/.) For purposes of the RFA, all hospitals and other providers
and suppliers are considered to be small entities. Individuals and
States are not included in the definition of a small entity. We believe
that this notice will have a significant impact on small entities.
Because we acknowledge that many of the affected entities are small
entities, the analysis discussed in this section would fulfill any
requirement for a final regulatory flexibility analysis.
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. With
the exception of hospitals located in certain New England counties, for
purposes of section 1102(b) of the Act, we now define a small rural
hospital as a hospital that is located outside of an urban area and has
fewer than 100 beds. Section 601(g) of the Social Security Amendments
of 1983 (Pub. L. 98-21) designated hospitals in certain New England
counties as belonging to the adjacent urban area. Thus, for purposes of
the IPPS, we continue to classify these hospitals as urban hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA)
(Pub. L. 104-4) also requires that agencies assess anticipated costs
and benefits before issuing any rule whose mandates require spending in
any 1 year of $100 million in 1995 dollars, updated annually for
inflation. In 2011, that threshold is approximately $136 million. This
notice will not mandate any requirements for State, local, or Tribal
governments, nor will it affect private sector costs. 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. This
notice will not have a substantial effect on State and local
governments.
Although this notice merely reflects the implementation of
provisions of the MMEA and does not constitute a substantive rule, we
are nevertheless preparing this impact analysis in the interest of
ensuring that the impacts of these changes are fully understood. The
following analysis, in conjunction with the remainder of this document,
demonstrates that this notice is consistent with the regulatory
philosophy and principles identified in Executive Order 12866 and
13563, the RFA, and section 1102(b) of the Act. The notice will
positively affect payments to a substantial number of small rural
hospitals, as well as other classes of hospitals, and the effects on
some hospitals may be significant. The impact analysis, which shows the
effect on all payments to hospitals, is shown in Table I of this
notice.
B. Statement of Need
This notice is necessary to update the final fiscal year (FY) 2011
wage indices and hospital reclassifications and other related tables to
reflect changes required by or resulting from the implementation of
section 102 of the MMEA. MMEA requires the extension of the expiration
date for certain geographic reclassifications and special exception
wage indices through September 30, 2011. We note that the changes in
this notice are already in effect with changes made to PRICER and
announced through a Joint Signature Memorandum.
C. Overall Impact
The FY 2011 IPPS final rule included an impact analysis for the
changes to the IPPS included in that rule. This notice updates those
impacts to the IPPS operating payment system as to reflect certain
changes required by the MMEA. Because provisions in the MMEA were not
budget neutral, the overall estimates for hospitals have changed from
our estimate that was published in the FY 2011 IPPS final rule (75 FR
50042). We estimate that the changes in the FY 2011 IPPS final rule, in
conjunction with the final IPPS rates and wage index included in this
notice, will result in an approximate $279 million decrease in total
operating payments relative to FY 2010. In the FY 2011 IPPS final rule
(75 FR 50042), we had projected that total operating payments would
decrease by $440 million relative to FY 2010. However, the changes in
this notice will increase operating payments by $162 million relative
to what was projected in the FY 2011 IPPS final rule, resulting in a
net decrease of $279 million in total operating payments. Capital
payments are estimated to increase by an additional $13.6 million in FY
2011 as a result of the changes in this notice.
D. Anticipated Effects
In Table I, we provide an impact analysis for changes to the IPPS
operating payments in FY 2011 as a result of the changes required by
the MMEA. The table categorizes hospitals by various geographic and
special payment consideration groups to illustrate the varying impacts
on different types of hospitals. The first row of Table I shows the
overall impact on the 3,472 acute care hospitals included in the
analysis. The impact analysis reflects the change in estimated
operating payments in FY 2011 due to the provisions in the MMEA
relative to estimated FY 2011 operating payments published in the FY
2011 IPPS final rule (75 FR 50042). Overall, all hospitals will
experience an estimated 0.2 percent increase in operating payments in
FY 2011 due to the provisions in MMEA compared to the previous
estimates of operating payments in FY 2011 published in the FY 2011
IPPS final rule. Because the provisions in the MMEA were not budget
neutral, all hospitals, depending on whether they were affected by the
provisions in the MMEA, will either experience no
[[Page 19368]]
change or an increase in IPPS operating payments in FY 2011 in this
notice relative to the previously published estimates. As such,
hospitals located in urban areas will experience a 0.2 percent increase
in payments while hospitals located in rural areas will not experience
any change in payments in FY 2011 due to the provisions in this notice
as compared to the estimated payments provided in the FY 2011 IPPS
final rule. Among the hospitals that are subject to the changes in this
notice, hospitals will experience a net effect increase in payments
ranging from 0.1 percent to 0.4 percent where urban Middle Atlantic
hospitals, urban East North Central hospitals and urban reclassified
hospitals are expected to experience the largest net increase in
operating payments of 0.4 percent in FY 2011.
Table I--Impact Analysis of Changes for FY 2011 Acute Care Hospital
Operating Prospective Payment System
------------------------------------------------------------------------
Percent net
Number of effect of all
hospitals changes for FY
2011
------------------------------------------------------------------------
All Hospitals........................... 3472 0.2
By Geographic Location:
Urban hospitals..................... 2494 0.2
Large urban areas............... 1362 0.2
Other urban areas............... 1132 0.2
Rural hospitals..................... 978 0
Bed Size (Urban):
0-99 beds........................... 622 0.1
100-199 beds........................ 785 0.2
200-299 beds........................ 460 0.2
300-499 beds........................ 430 0.2
500 or more beds.................... 197 0.2
Bed Size (Rural):
0-49 beds........................... 348 0
50-99 beds.......................... 368 0
100-149 beds........................ 156 0
150-199 beds........................ 60 0
200 or more beds.................... 46 0
Urban by Region:
New England......................... 121 0.3
Middle Atlantic..................... 330 0.4
South Atlantic...................... 382 0
East North Central.................. 403 0.4
East South Central.................. 155 0
West North Central.................. 167 0
West South Central.................. 336 0
Mountain............................ 161 0
Pacific............................. 389 0.1
Puerto Rico......................... 50 0
Rural by Region:
New England......................... 24 0
Middle Atlantic..................... 70 0.1
South Atlantic...................... 165 0
East North Central.................. 121 0
East South Central.................. 176 0
West North Central.................. 100 0.1
West South Central.................. 219 0
Mountain............................ 72 0
Pacific............................. 31 0
By Payment Classification:
Urban hospitals..................... 2551 0.2
Large urban areas................... 1404 0.2
Other urban areas................... 1147 0.2
Rural areas......................... 921 0
Teaching Status:
Nonteaching......................... 2429 0.1
Fewer than 100 residents............ 805 0.2
100 or more residents............... 238 0.3
Urban DSH:
Non-DSH............................. 779 0.2
100 or more beds.................... 1531 0.2
Less than 100 beds.................. 356 0.1
Rural DSH:
SCH................................. 423 0
RRC................................. 212 0
100 or more beds.................... 30 0.2
Less than 100 beds.................. 141 0.2
Urban teaching and DSH:
[[Page 19369]]
Both teaching and DSH............... 818 0.2
Teaching and no DSH................. 161 0.3
No teaching and DSH................. 1069 0
No teaching and no DSH.............. 503 0.2
Special Hospital Types:
RRC................................. 180 0.1
SCH................................. 332 0
MDH................................. 194 0
SCH and RRC..................... 117 0
MDH and RRC..................... 13 0
Type of Ownership:
Voluntary........................... 1990 0.2
Proprietary......................... 859 0.1
Government.......................... 586 0
Medicare Utilization as a Percent of
Inpatient Days:
0-25................................ 353 0
25-50............................... 1593 0.2
50-65............................... 1203 0.2
Over 65............................. 233 0.2
FY 2011 Reclassifications by the
Medicare Geographic Classification
Review Board:
All Reclassified Hospitals.......... 773 0.3
Non-Reclassified Hospitals.......... 2699 0.1
Urban Hospitals Reclassified........ 442 0.4
Urban Nonreclassified Hospitals, FY 2022 0.1
2011...............................
All Rural Hospitals Reclassified FY 331 0
2011...............................
Rural Nonreclassified Hospitals FY 585 0.1
2011...............................
All Section 401 Reclassified 37 0
Hospitals:.........................
Other Reclassified Hospitals 63 0
(Section 1886(d)(8)(B))............
Specialty Hospitals:
Cardiac Specialty Hospitals......... 19 0
------------------------------------------------------------------------
E. Alternatives Considered
This notice provides descriptions of the statutory provisions that
are addressed and identifies policies for implementing these
provisions. Due to the prescriptive nature of the statutory provisions,
no alternatives were considered.
F. Accounting Statement and Table
1. Acute Care Hospitals
As required by OMB Circular A-4 (available at https://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table II, we have
prepared an accounting statement showing the classification of
expenditures associated with the provisions of this notice as they
relate to acute care hospitals. This table provides our best estimate
of the change in Medicare payments to providers as a result of the
changes to the IPPS presented in this notice. All expenditures are
classified as transfers from the Federal government to Medicare
providers. As previously discussed, relative to what was projected in
the FY 2011 IPPS final rule, the changes in this notice will increase
FY 2011 operating payments by $162 million and capital payments by $14
million. Thus, the total increase in Federal expenditures for FY 2011
is approximately $176 million.
Table II--Accounting Statement: Classification of Estimated Expenditures
Under the IPPS From Published FY 2011 to Revised FY 2011
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers......... $176 million
From Whom to Whom...................... Federal Government to IPPS
Medicare Providers
Total.............................. $176 million
------------------------------------------------------------------------
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: March 3, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Approved: April 1, 2011.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
Addendum
This addendum includes tables referred to throughout the notice
which contain data relating to the final FY 2010 wage indices and the
hospital reclassifications and payment amounts for operating costs
discussed in section II. of this notice.
Table 2A--Revised FY 2011 Wage Index Values for Section 508/Special
Exception Hospitals
(Effective October 1, 2010 through September 30, 2011).
------------------------------------------------------------------------
Revised FY
CMS certification No. 2011 wage
index
------------------------------------------------------------------------
010150..................................................... 0.8567
020008..................................................... 1.2776
050549..................................................... 1.5477
060075..................................................... 1.1429
[[Page 19370]]
070005..................................................... 1.2529
070006 *................................................... 1.2867
070010..................................................... 1.2867
070016..................................................... 1.2529
070017..................................................... 1.2529
070018 *................................................... 1.2867
070019..................................................... 1.2529
070022..................................................... 1.2529
070028..................................................... 1.2867
070031..................................................... 1.2529
070034 *................................................... 1.2867
070036..................................................... 1.3329
070039..................................................... 1.2529
150034..................................................... 1.0386
160040..................................................... 0.8759
160064..................................................... 0.9501
160067..................................................... 0.8759
160110..................................................... 0.8759
220046..................................................... 1.1629
230003..................................................... 0.9930
230004..................................................... 0.9930
230013..................................................... 1.0781
230019..................................................... 1.0781
230020..................................................... 1.0057
230024..................................................... 1.0057
230029..................................................... 1.0781
230036..................................................... 1.0781
230038..................................................... 0.9930
230053..................................................... 1.0057
230059..................................................... 0.9930
230066..................................................... 0.9930
230071..................................................... 1.0781
230072..................................................... 0.9930
230089..................................................... 1.0057
230097..................................................... 0.9930
230104..................................................... 1.0057
230106..................................................... 0.9930
230130..................................................... 1.0781
230135..................................................... 1.0057
230146..................................................... 1.0057
230151..................................................... 1.0781
230165..................................................... 1.0057
230174..................................................... 0.9930
230176..................................................... 1.0057
230207..................................................... 1.0781
230236..................................................... 0.9930
230254..................................................... 1.0781
230269..................................................... 1.0781
230270..................................................... 1.0057
230273..................................................... 1.0057
230277..................................................... 1.0781
250002..................................................... 0.8443
250078 *................................................... 0.8443
250122..................................................... 0.8443
310021..................................................... 1.2867
310028..................................................... 1.2867
310050..................................................... 1.2867
310051..................................................... 1.2867
310060..................................................... 1.2867
310115..................................................... 1.2867
310120..................................................... 1.2867
330023 *................................................... 1.2867
330049..................................................... 1.2867
330067 *................................................... 1.2867
330106..................................................... 1.4341
330126..................................................... 1.2867
330135..................................................... 1.2867
330205..................................................... 1.2867
330264..................................................... 1.2529
340002..................................................... 0.9087
390001..................................................... 0.9370
390003..................................................... 0.9370
390045 **.................................................. 0.9370
390072..................................................... 0.9370
390095..................................................... 0.9370
390119..................................................... 0.9370
390137..................................................... 0.9370
390169..................................................... 0.9370
390185..................................................... 0.9852
390192..................................................... 0.9370
390237..................................................... 0.9370
390270..................................................... 0.9852
430005..................................................... 1.0934
470003..................................................... 1.1629
490001..................................................... 0.8514
530015..................................................... 1.0577
------------------------------------------------------------------------
* These hospitals are assigned a wage index value under a special
exceptions policy (see the FY 2005 IPPS final rule, 69 FR 49105).
** This hospital has been assigned a wage index under a special
exceptions policy (see the FY 2007 IPPS final rule, 71 FR 48070).
Table 2B--Revised FY 2011 Wage Index Values for Other Affected Hospitals
(Effective April 1, 2011 through September 30, 2011)
------------------------------------------------------------------------
Revised FY
CMS certification No. 2011 wage
index
------------------------------------------------------------------------
070015.................................................. 1.2867
070033.................................................. 1.2867
070038.................................................. 1.2529
140012.................................................. 1.0386
140110.................................................. 1.0386
140161.................................................. 1.0386
150002.................................................. 1.0386
150004.................................................. 1.0386
150008.................................................. 1.0386
150090.................................................. 1.0386
150125.................................................. 1.0386
150126.................................................. 1.0386
150165.................................................. 1.0386
150166.................................................. 1.0386
150170.................................................. 1.0386
230002.................................................. 1.0057
230037.................................................. 1.0057
230069.................................................. 1.0781
230077.................................................. 1.0781
230099.................................................. 1.0057
230142.................................................. 1.0057
230244.................................................. 1.0057
230279.................................................. 1.0781
230297.................................................. 1.0057
230301.................................................. 1.0781
230302.................................................. 1.0781
250023.................................................. 0.8443
250040.................................................. 0.8443
250094.................................................. 0.8443
250117.................................................. 0.8443
310002.................................................. 1.2867
310009.................................................. 1.2867
310015.................................................. 1.2867
310017.................................................. 1.2867
310038.................................................. 1.2867
310039.................................................. 1.2867
310054.................................................. 1.2867
310070.................................................. 1.2867
310076.................................................. 1.2867
310083.................................................. 1.2867
310096.................................................. 1.2867
310108.................................................. 1.2867
310119.................................................. 1.2867
330027.................................................. 1.2867
330167.................................................. 1.2867
330181.................................................. 1.2867
330182.................................................. 1.2867
330198.................................................. 1.2867
330225.................................................. 1.2867
330259.................................................. 1.2867
330331.................................................. 1.2867
330332.................................................. 1.2867
330372.................................................. 1.2867
------------------------------------------------------------------------
Table 4C.--Revised Wage Index and Capital Geographic Adjustment Factors (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and by State--FY
2011
[Wage index includes rural floor budget neutrality adjustment]
--------------------------------------------------------------------------------------------------------------------------------------------------------
CBSA code Area State Revised wage index Revised GAF
--------------------------------------------------------------------------------------------------------------------------------------------------------
11460............................... Ann Arbor, MI............... MI 1.0057 1.0039
16974............................... Chicago-Joliet-Naperville, IL 1.0386 1.0263
IL.
22420............................... Flint, MI................... MI 1.0781 1.0528
25060............................... Gulfport-Biloxi, MS......... MS 0.8443 0.8906
[[Page 19371]]
35004............................... Nassau-Suffolk, NY.......... NY 1.2529 1.1670
35644............................... New York-White Plains-Wayne, CT 1.2867 1.1884
CT.
35644............................... New York-White Plains-Wayne, NJ 1.2867 1.1884
NJ.
35644............................... New York-White Plains-Wayne, NY 1.2867 1.1884
NY.
--------------------------------------------------------------------------------------------------------------------------------------------------------
The following providers have been removed from Table 9A published
in the FY 2011 IPPS/LTCH final rule (or in the October 1, 2010
correction notice to that final rule) due to the implementation of
section 102 of the MMEA:
Table 9A--Hospital Reclassifications and Redesignations Withdrawn/Terminated due to Section 102 of the MMEA--FY 2011
--------------------------------------------------------------------------------------------------------------------------------------------------------
CCN Geographic CBSA Reclassified CBSA LUGAR
--------------------------------------------------------------------------------------------------------------------------------------------------------
020008........................................................ 02 11260 ............................
060075........................................................ 06 24300 ............................
070005........................................................ 35300 35004 ............................
070006........................................................ 14860 35644 ............................
070010........................................................ 14860 35644 ............................
070016........................................................ 35300 35004 ............................
070017........................................................ 35300 35004 ............................
070018........................................................ 14860 35644 ............................
070019........................................................ 35300 35004 ............................
070022........................................................ 35300 35004 ............................
070028........................................................ 14860 35644 ............................
070031........................................................ 35300 35004 ............................
070034........................................................ 14860 35644 ............................
070036........................................................ 25540 35300 ............................
070039........................................................ 35300 35004 ............................
150034........................................................ 23844 16974 ............................
160064........................................................ 16 24 ............................
230003........................................................ 26100 34740 ............................
230013........................................................ 47644 22420 ............................
230019........................................................ 47644 22420 ............................
230020........................................................ 19804 11460 ............................
230024........................................................ 19804 11460 ............................
230029........................................................ 47644 22420 ............................
230036........................................................ 23 13020 ............................
230038........................................................ 24340 34740 ............................
230053........................................................ 19804 11460 ............................
230071........................................................ 47644 22420 ............................
230072........................................................ 26100 34740 ............................
230089........................................................ 19804 11460 ............................
230097........................................................ 23 24340 ............................
230104........................................................ 19804 11460 ............................
230106........................................................ 24340 34740 ............................
230130........................................................ 47644 22420 ............................
230135........................................................ 19804 11460 ............................
230146........................................................ 19804 11460 ............................
230151........................................................ 47644 22420 ............................
230165........................................................ 19804 11460 ............................
230174........................................................ 26100 34740 ............................
230176........................................................ 19804 11460 ............................
230207........................................................ 47644 22420 ............................
230236........................................................ 24340 34740 ............................
230254........................................................ 47644 22420 ............................
230269........................................................ 47644 22420 ............................
230270........................................................ 19804 11460 ............................
230273........................................................ 19804 11460 ............................
230277........................................................ 47644 22420 ............................
250002........................................................ 25 22520 ............................
250078........................................................ 25620 25060 ............................
310050........................................................ 35084 35644 ............................
330023........................................................ 39100 35644 ............................
330106........................................................ 35004 35644 ............................
330126........................................................ 39100 35644 ............................
390185........................................................ 42540 10900 ............................
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 19372]]
Table 9B.--Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Public Law
108-173--FY 2011
----------------------------------------------------------------------------------------------------------------
Wage index CBSA
CCN Note Geographic section 508 Own wage index
CBSA reclassification
----------------------------------------------------------------------------------------------------------------
010150........................................ .............. 17980 0.8567 ..............
020008........................................ .............. 02 ................ 1.2776
050549........................................ .............. 42220 1.5477 ..............
060075........................................ .............. 06 ................ 1.1429
070005........................................ .............. 35004 1.2529 ..............
070006........................................ * 35644 1.2867 ..............
070010........................................ .............. 35644 1.2867 ..............
070016........................................ .............. 35004 1.2529 ..............
070017........................................ .............. 35004 1.2529 ..............
070018........................................ * 35644 1.2867 ..............
070019........................................ .............. 35004 1.2529 ..............
070022........................................ .............. 35004 1.2529 ..............
070028........................................ .............. 35644 1.2867 ..............
070031........................................ .............. 35004 1.2529 ..............
070034........................................ * 35644 1.2867 ..............
070036........................................ .............. 25540 ................ 1.3329
070039........................................ .............. 35004 1.2529 ..............
150034........................................ .............. 16974 1.0386 ..............
160040........................................ .............. 16300 0.8759 ..............
160064........................................ .............. 16 ................ 0.9501
160067........................................ .............. 16300 0.8759 ..............
160110........................................ .............. 16300 0.8759 ..............
220046........................................ .............. 14484 1.1629 ..............
230003........................................ .............. 28020 0.9930 ..............
230004........................................ .............. 28020 0.9930 ..............
230013........................................ .............. 22420 1.0781 ..............
230019........................................ .............. 22420 1.0781 ..............
230020........................................ .............. 11460 1.0057 ..............
230024........................................ .............. 11460 1.0057 ..............
230029........................................ .............. 22420 1.0781 ..............
230036........................................ .............. 22420 1.0781 ..............
230038........................................ .............. 28020 0.9930 ..............
230053........................................ .............. 11460 1.0057 ..............
230059........................................ .............. 28020 0.9930 ..............
230066........................................ .............. 28020 0.9930 ..............
230071........................................ .............. 22420 1.0781 ..............
230072........................................ .............. 28020 0.9930 ..............
230089........................................ .............. 11460 1.0057 ..............
230097........................................ .............. 28020 0.9930 ..............
230104........................................ .............. 11460 1.0057 ..............
230106........................................ .............. 28020 0.9930 ..............
230130........................................ .............. 22420 1.0781 ..............
230135........................................ .............. 11460 1.0057 ..............
230146........................................ .............. 11460 1.0057 ..............
230151........................................ .............. 22420 1.0781 ..............
230165........................................ .............. 11460 1.0057 ..............
230174........................................ .............. 28020 0.9930 ..............
230176........................................ .............. 11460 1.0057 ..............
230207........................................ .............. 22420 1.0781 ..............
230236........................................ .............. 28020 0.9930 ..............
230254........................................ .............. 22420 1.0781 ..............
230269........................................ .............. 22420 1.0781 ..............
230270........................................ .............. 11460 1.0057 ..............
230273........................................ .............. 11460 1.0057 ..............
230277........................................ .............. 22420 1.0781 ..............
250002........................................ .............. 25060 0.8443 ..............
250078........................................ * 25060 0.8443 ..............
250122........................................ .............. 25060 0.8443 ..............
310021........................................ .............. 35644 1.2867 ..............
310028........................................ .............. 35644 1.2867 ..............
310050........................................ .............. 35644 1.2867 ..............
310051........................................ .............. 35644 1.2867 ..............
310060........................................ .............. 35644 1.2867 ..............
310115........................................ .............. 35644 1.2867 ..............
310120........................................ .............. 35644 1.2867 ..............
330023........................................ * 35644 1.2867 ..............
330049........................................ .............. 35644 1.2867 ..............
330067........................................ * 35644 1.2867 ..............
[[Page 19373]]
330106........................................ .............. 35004 ................ 1.4341
330126........................................ .............. 35644 1.2867 ..............
330135........................................ .............. 35644 1.2867 ..............
330205........................................ .............. 35644 1.2867 ..............
330264........................................ .............. 35004 1.2529 ..............
340002........................................ .............. 16740 0.9087 ..............
390001........................................ .............. 10900 0.9370 ..............
390003........................................ .............. 10900 0.9370 ..............
390045........................................ ** 10900 0.9370 ..............
390072........................................ .............. 10900 0.9370 ..............
390095........................................ .............. 10900
