[Federal Register Volume 72, Number 3 (Friday, January 5, 2007)]
[Notices]
[Pages 569-574]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-9976]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1488-CN2]
RIN 0938-A012


Medicare Program; Changes to the Hospital Inpatient Prospective 
Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage 
Indices and Payment Rates After Application of Revised Occupational Mix 
Adjustment to the Wage Index; Corrections

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

ACTION: Correction of notice.

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

SUMMARY: This document corrects wage index and technical errors that 
appeared in the notice published in the Federal Register on October 11, 
2006 entitled ``Medicare Program; Hospital Inpatient Prospective 
Payment Systems and Fiscal Year 2007 Rates.

DATES: Effective Date: Corrections listed in items 10 through 12 of 
section III. of this notice are effective as of October 1, 2006. The 
corrections to the wage index listed in items 2a, 3 through 8a, and 9a 
of section III. of this notice are effective as of November 3, 2006. 
The corrections to the wage index listed in items 1, 2b, 8b, and 9b of 
section III. of this notice are effective as of November 21, 2006.

FOR FURTHER INFORMATION CONTACT: Marc Hartstein, (410) 786-4548.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), the notice 
entitled ``Hospital Inpatient Prospective Payment Systems and Fiscal 
Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates 
After Application of Revised Occupational Mix Adjustment to Wage 
Index'' (hereinafter referred to as the ``FY 2007 IPPS notice''), there 
were a number of technical errors that are identified and corrected in 
the Correction of Errors section (items 10 through 12 of section III. 
of this notice). These technical corrections are effective October 1, 
2006.
    In addition, in October 2006, we became aware of an error in the 
calculation of the FY 2007 wage index for a number of rural areas and 
several hospitals that are reclassified to those areas. The error also 
affected some hospitals in urban areas that are assigned the statewide 
rural wage index floor. Section 412.64(k)(1) of the regulations 
requires that wage index corrections made after October 1 are effective 
prospectively for the remainder of the fiscal year from the date the 
fiscal intermediaries are informed of the correction. We recalculated 
the wage indices for the affected hospitals, and on November 3, 2006, 
sent a Joint Signature Memorandum to the fiscal intermediaries 
informing them to pay hospitals using the corrected wage indices. 
Subsequent to the November 3, 2006 Joint Signature Memorandum, 
additional errors in the wage indices were brought to our attention and 
were corrected through a November 21, 2006 Joint Signature Memorandum. 
Therefore, the corrected FY 2007 wage indices are effective beginning 
November 3, 2006 or November 21, 2006. Accordingly, the wage index 
provisions of this correction notice are corrections to the tabulation 
of the rates paid to hospitals. We note that the

[[Page 570]]

corrections to the impact analysis (item 1 of section III. of this 
notice) are effective as of November 3, 2006 since the additional 
corrections made based on the November 21, 2006 Joint Signature 
Memorandum had no significant effect on the impact analysis.

II. Summary of the Corrections to the FY 2007 IPPS Notice

    We made corrections to wage index values and geographic adjustment 
factors (GAFs) that were published in Tables 2, 4A-1, 4A-2, 4B-1, 4B-2, 
4C-1, and 4C-2. In addition, we are making technical corrections to-- 
(1) the out-migration adjustments and qualifying counties that were 
published in Table 4J; and (2) the list of diagnosis-related groups 
(DRGs), relative weighting factors, and geometric and arithmetic mean 
length of stay (LOS) that were published in Table 5.

III. Correction of Errors

    In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), make the 
following corrections:
    1. On pages 59893 and 59894, in Table I.--Impact Analysis of 
Changes for FY 2007, the figures in the last column (All FY 2007 
changes \8\) are corrected to read as follows:

   Impact Analysis of Final Changes for FY 2007 Operating Prospective
                             Payment System
                 [Percent changes in payments per case]
------------------------------------------------------------------------
                                                            All FY 2007
                                                            changes (4)
------------------------------------------------------------------------
All Hospitals...........................................             3.5
By Geographic Location:
  Urban hospitals.......................................             3.5
  Large urban areas (populations over 1 million)........             3.5
  Other urban areas (populations of 1 million or fewer).             3.4
  Rural hospitals.......................................               4
Bed Size (Urban):
  0-99 beds.............................................             3.5
  100-199 beds..........................................             3.8
  200-299 beds..........................................             3.6
  300-499 beds..........................................             3.4
  500 or more beds......................................             3.2
Bed Size (Rural):
  0-49 beds.............................................             4.7
  50-99 beds............................................             4.9
  100-149 beds..........................................             3.7
  150-199 beds..........................................             3.3
  200 or more beds......................................             3.0
Urban by Region:
  New England...........................................             3.9
  Middle Atlantic.......................................             3.9
  South Atlantic........................................             3.2
  East North Central....................................             3.4
  East South Central....................................             2.7
  West North Central....................................             2.8
  West South Central....................................             3.4
  Mountain..............................................             3.7
  Pacific...............................................             3.7
  Puerto Rico...........................................             2.0
Rural by Region:
  New England...........................................             6.3
  Middle Atlantic.......................................             5.2
  South Atlantic........................................             3.9
  East North Central....................................             3.8
  East South Central....................................             3.5
  West North Central....................................             4.3
  West South Central....................................             4.1
  Mountain..............................................             2.7
  Pacific...............................................             3.3
By Payment Classification:
  Urban hospitals.......................................             3.4
  Large urban areas (populations over 1 million)........             3.5
  Other urban areas (populations of 1 million or fewer).             3.4
  Rural areas...........................................             4.0
Teaching Status:
  Non-teaching..........................................             3.8
  Fewer than 100 Residents..............................             3.4
  100 or more Residents.................................             3.2
Urban DSH:
  Non-DSH...............................................             3.6
  100 or more beds......................................             3.4
  Less than 100 beds....................................             3.6
Rural DSH:
  SCH...................................................             4.6
  RRC...................................................             3.5
    Other Rural:
  100 or more beds......................................             3.5
  Less than 100 beds....................................             3.9
Urban teaching and DSH:
  Both teaching and DSH.................................             3.3
  Teaching and no DSH...................................             3.3
  No teaching and DSH...................................             3.7
  No teaching and no DSH................................             3.6
Rural Hospital Types:
  RRC...................................................             3.5
  SCH...................................................             3.6
  MDH...................................................             9.0
  SCH and RRC...........................................             3.1
  MDH and RRC...........................................            14.1
Unknown.................................................
Type of Ownership:
  Voluntary.............................................             3.5
  Proprietary...........................................             3.5
  Government............................................             3.4
Unknown.................................................             7.6
Medicare Utilization as a Percent of Inpatient Days:
  0-25..................................................             3.6
  25-50.................................................             3.3
  50-65.................................................             3.7
  Over 65...............................................             3.8
  Unknown...............................................             4.4
Hospitals Reclassified by the Medicare Geographic
 Classification Review Board:
  FY 2005 Reclassifications.............................
  Urban Hospitals Reclassified by the Medicare                       3.7
   Geographic Classification Review Board: First Half FY
   2007 Reclassifications...............................
  Urban Nonreclassified, First Half FY 2007.............             3.4
  All Urban Hospitals Reclassified Second Half FY 2007..             3.5
  Urban Nonreclassified Hospitals Second Half FY 2007...             3.4
  All Rural Hospitals Reclassified Second Half FY 2007..             3.6
  Rural Nonreclassified Hospitals Second Half FY 2007...             4.5
  All Section 401 Reclassified Hospitals................             5.4
  Other Reclassified Hospitals (Section 1886(d)(8)(B))..             4.5
  Section 508 Hospitals.................................               2
  Specialty Hospitals...................................              --
  Cardiac Specialty Hospitals...........................             1.2
------------------------------------------------------------------------

    2. On pages 59903 through to 59968, in Table 2.--Hospital Case-Mix 
Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital 
Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly 
Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage 
Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of 
Hospital Average Hourly Wages, for the listed providers, the wage 
indexes are corrected to read as follows:
    a. Effective November 3, 2006

------------------------------------------------------------------------
                                                           FY 2007 wage
                      Provider No.                             index
------------------------------------------------------------------------
040039..................................................          0.8341
040047..................................................          0.8431
070002..................................................          1.2452
070003..................................................          1.2461
070004..................................................          1.2452
070007..................................................          1.2452
070008..................................................          1.2452
070009..................................................          1.2452
070011..................................................          1.2452
070012..................................................          1.2452
070015..................................................          1.2452
070020..................................................          1.2525
070021..................................................          1.2461
070024..................................................          1.2452
070025..................................................          1.2452
070027..................................................          1.2452
070029..................................................          1.2452
070035..................................................          1.2452

[[Page 571]]

 
070038..................................................          1.2452
100025..................................................          0.8847
100026..................................................          0.8847
100027..................................................          0.8847
100048..................................................          0.8847
100054..................................................          0.8847
100062..................................................          0.8907
100081..................................................          0.8847
100093..................................................          0.8847
100102..................................................          0.8972
100106..................................................          0.8847
100108..................................................          0.8847
100118..................................................          0.9245
100122..................................................          0.8847
100124..................................................          0.8847
100134..................................................          0.8847
100142..................................................          0.8847
100156..................................................          0.8972
100160..................................................          0.8847
100175..................................................          0.9078
100212..................................................          0.8907
100223..................................................          0.8847
100231..................................................          0.8847
100242..................................................          0.8847
100266..................................................          0.8847
100290..................................................          0.9429
100292..................................................          0.8847
230254..................................................          1.0381
230257..................................................          1.0381
230264..................................................          1.0381
230269..................................................          1.0381
230277..................................................          1.0381
260004..................................................          0.8341
260006..................................................          0.8341
260015..................................................          0.8345
260022..................................................          0.8615
260024..................................................          0.8341
260047..................................................          0.8348
260059..................................................          0.8341
260061..................................................          0.8341
260070..................................................          0.8341
260074..................................................          0.8499
260078..................................................          0.8341
260080..................................................          0.8341
260097..................................................          0.8766
260113..................................................          0.8341
260116..................................................          0.8341
260119..................................................          0.8345
260142..................................................          0.8341
260147..................................................          0.8341
260160..................................................          0.8341
260163..................................................          0.8341
260195..................................................          0.8341
280061..................................................          0.9048
340073..................................................          0.9828
380002..................................................          1.0282
380040..................................................          1.0152
380052..................................................          1.0152
380081..................................................          1.0152
390044..................................................          1.1196
390096..................................................          1.1196
430094..................................................          0.9048
470001..................................................          1.0770
470005..................................................          1.0383
470012..................................................          1.0383
470024..................................................          1.0383
500002..................................................          1.0390
500007..................................................          1.0598
500012..................................................          1.0390
500019..................................................          1.0603
500031..................................................          1.0390
500033..................................................          1.0390
500036..................................................          1.0390
500037..................................................          1.0390
500049..................................................          1.0390
500053..................................................          1.0390
500058..................................................          1.0390
500148..................................................          1.0390
530002..................................................          0.9128
530006..................................................          0.9128
530008..................................................          0.9128
530009..................................................          0.9128
530010..................................................          0.9128
530011..................................................          0.9128
530014..................................................          0.9128
530017..................................................          0.9128
530032..................................................          0.9128
530008..................................................          0.9057
530009..................................................          0.9057
530010..................................................          0.9057
530011..................................................          0.9057
530014..................................................          0.9057
530017..................................................          0.9057
530032..................................................          0.9057
------------------------------------------------------------------------

    b. Effective November 21, 2006.

------------------------------------------------------------------------
                                                           FY 2007 wage
                      Provider No.                             index
------------------------------------------------------------------------
230013..................................................          1.0381
230019..................................................          1.0381
230029..................................................          1.0381
230047..................................................          1.0381
230071..................................................          1.0381
230130..................................................          1.0381
230151..................................................          1.0381
230195..................................................          1.0381
230204..................................................          1.0381
230207..................................................          1.0381
230223..................................................          1.0381
230227..................................................          1.0381
230254..................................................          1.0381
230257..................................................          1.0381
230264..................................................          1.0381
230269..................................................          1.0381
230277..................................................          1.0381
390065..................................................          1.0977
390138..................................................          1.0977
490005..................................................          1.0977
------------------------------------------------------------------------

    3. On page 59968 in Table 2.--Hospital Case-Mix Indexes for 
Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes 
for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal 
Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 
(2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average 
Hourly Wages, the table is corrected by adding a note to the end of the 
table to read as follows:

    Note: Due to the expiration of section 508 of the MMA, the wage 
index values for some hospitals will change in the second half of 
the fiscal year. The wage index values in this table reflect an 
average of the first half of FY 2007 (October 1, 2006-March 31, 
2007) and second half of FY 2007 (April 1-September 30, 2007).

    4. On pages 59975 through to 59998, in Table 4A-1.--Wage Index and 
Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA, for 
the listed CBSAs, the wage indexes and GAFs are corrected to read as 
follows:

----------------------------------------------------------------------------------------------------------------
                                                                                               Wage
                 CBSA code                         Urban area (constituent counties)          index       GAF
----------------------------------------------------------------------------------------------------------------
15540......................................  Burlington-South Burlington, VT..............     1.0383     1.0261
                                             Chittenden County, VT \2\....................
                                             Franklin County, VT..........................
                                             Grand Isle County, VT........................
23020......................................  Fort Walton Beach-Crestview-Destin, FL\2\....     0.8847     0.9195
                                             Okaloosa County, FL..........................
25540......................................  Hartford-West Hartford-East Hartford, CT \1\      1.2452     1.1620
                                              \2\.
                                             Hartford County, CT..........................
                                             Litchfield County, CT........................
                                             Middlesex County, CT.........................
                                             Tolland County, CT...........................
28420......................................  Kennewick-Richland-Pasco, WA\2\..............     1.0390     1.0265
                                             Benton County, WA............................
                                             Franklin County, WA..........................
30300......................................  Lewiston, ID-WA (WA Hospitals) \2\...........     1.0390     1.0265
                                             Nez Perce County, ID.........................
                                             Asotin County, WA............................

[[Page 572]]

 
31020......................................  Longview, WA.................................     1.0390     1.0265
                                             Cowlitz County, WA...........................
34580......................................  Mount Vernon-Anacortes, WA...................     1.0390     1.0265
                                             Skagit County, WA............................
35300......................................  New Haven-Milford, CT \3\....................     1.2452     1.1620
                                             New Haven County, CT.........................
35980......................................  Norwich-New London, CT.......................     1.2452     1.1620
                                             New London County, CT........................
36100......................................  Ocala, FL\2\.................................     0.8847     0.9195
                                             Marion County, FL............................
37460......................................  Panama City-Lynn Haven, FL...................     0.8847     0.9195
                                             Bay County, Fl...............................
37860......................................  Pensacola-Ferry Pass-Brent, FL...............     0.8847     0.9195
                                             Escambia County, FL..........................
                                             Santa Rosa County, FL........................
48300......................................  Wenatchee, WA................................     1.0390     1.0265
                                             Chelan County, WA............................
                                             Douglas County, WA...........................
49420......................................  Yakima, WA...................................     1.0390     1.0265
                                             Yakima County, WA............................
----------------------------------------------------------------------------------------------------------------
\1\ Large urban area.
\2\ Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2007.
\3\ For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March
  31, 2007. See Table 4A-2 for the values that are effective from April 1 through September 30, 2007.

    5. On page 59998, in Table 4A-2.--Wage Index and Capital Geographic 
Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period 
April 1 Through September 30, 2007, for the listed CBSAs, the wage 
indexes and GAFs are corrected to read as follows:

----------------------------------------------------------------------------------------------------------------
                   CBSA code                      Urban area (constituent counties)      Wage index       GAF
----------------------------------------------------------------------------------------------------------------
16940.........................................  Cheyenne, WY.........................          0.9057     0.9344
35300.........................................  New Haven-Milford, CT................          1.2452     1.1620
----------------------------------------------------------------------------------------------------------------

    6. On pages 59998 and 59999, in Table 4B-1.--Wage Index and Capital 
Geographic Adjustment Factor (GAF) for Rural Areas by CBSA--FY 2007, 
for the listed CBSAs, the wage indexes and GAFs are corrected to read 
as follows:

------------------------------------------------------------------------
          CBSA code            Nonurban area     Wage index       GAF
------------------------------------------------------------------------
07..........................  Connecticut....          1.2452     1.1620
10..........................  Florida........          0.8847     0.9195
26..........................  Missouri.......          0.8341     0.8832
38..........................  Oregon \2\.....          1.0152     1.0104
47..........................  Vermont........          1.0383     1.0261
50..........................  Washington.....          1.0390     1.0265
------------------------------------------------------------------------

    7. On page 59999, in Table 4B-2.--Wage Index and Capital Geographic 
Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period 
April 1 Through September 30, 2007, for the listed CBSA, the wage index 
and GAF is corrected to read as follows:

------------------------------------------------------------------------
          CBSA code            Nonurban area     Wage index       GAF
------------------------------------------------------------------------
53..........................  Wyoming........          0.9057     0.9344
------------------------------------------------------------------------

    8. On pages 59999 through to 60003, in Table 4C-1.--Wage Index and 
Capital Geographic Adjustment Factor (GAF) for Hospitals That Are 
Reclassified by CBSA, for the listed CBSAs, the wage indexes and GAFs 
are corrected to read as follows:
    a. Effective November 3, 2006.

----------------------------------------------------------------------------------------------------------------
                CBSA code                                     Area                       Wage index       GAF
----------------------------------------------------------------------------------------------------------------
23020....................................  Fort Walton Beach-Crestview-Destin, FL....          0.8847     0.9195
25540....................................  Hartford-West Hartford-East Hartford, CT            1.2452     1.1620
                                            (CT Hospitals).
27860....................................  Jonesboro, AR (MO Hospitals)..............          0.8345     0.8835
28420....................................  Kennewick-Richland-Pasco, WA..............          1.0390     1.0265
38340....................................  Pittsfield, MA............................          1.0383     1.0261

[[Page 573]]

 
07.......................................  Connecticut...............................          1.2452     1.1620
10.......................................  Florida (FL Hospitals)....................          0.8847     0.9195
14.......................................  Illinois (MO Hospitals)...................          0.8341     0.8832
16.......................................  Iowa......................................          0.8615     0.9029
26.......................................  Missouri..................................          0.8341     0.8832
30.......................................  New Hampshire.............................          1.0770     1.0521
38.......................................  Oregon....................................          1.0152     1.0104
50.......................................  Washington (WA Hospitals).................          1.0390     1.0265
53.......................................  Wyoming...................................          0.9048     0.9338
----------------------------------------------------------------------------------------------------------------

    b. Effective November 21, 2006.

----------------------------------------------------------------------------------------------------------------
                CBSA code                                     Area                       Wage index       GAF
----------------------------------------------------------------------------------------------------------------
47894....................................  Washington-Arlington-Alexandria, DC-VA-MD-          1.0977     1.0659
                                            WV.
----------------------------------------------------------------------------------------------------------------

    9. On page 60003, in Table 4C-2.--Wage Index and Capital Geographic 
Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by 
CBSA for the Period April 1 Through September 30, 2007*, CBSAs 35300 
and 19804 are corrected and CBSA 47894 is added. The wage indexes and 
GAFs are corrected to read as follows:
    a. Effective November 3, 2006.

----------------------------------------------------------------------------------------------------------------
                   CBSA code                                     Area                    Wage index       GAF
----------------------------------------------------------------------------------------------------------------
19804.........................................  Detroit-Livonia-Dearborn, MI.........          1.0381     1.0192
35300.........................................  New Haven-Milford, CT................          1.2452     1.1620
----------------------------------------------------------------------------------------------------------------

    b. Effective November 21, 2006.

----------------------------------------------------------------------------------------------------------------
                   CBSA code                                     Area                    Wage index       GAF
----------------------------------------------------------------------------------------------------------------
47894.........................................  Washington-Arlington-Alexandria, DC-           1.0977     1.0659
                                                 VA-MD-WV.
----------------------------------------------------------------------------------------------------------------

    10. On pages 60004 through to 60012, in Table 4J.--Out-Migration 
Adjustment--FY 2007, provider number 010009 is corrected and provider 
number 010010 is added to read as follows:
    a. Effective October 1, 2006.

----------------------------------------------------------------------------------------------------------------
                                      Reclassified        Reclassified
           Provider No.              between 10/1/06     between 4/1/07     Out-migration    Qualifying  county
                                       and 3/31/07        and 9/30/07        adjustment             name
----------------------------------------------------------------------------------------------------------------
010009...........................                   *                  *            0.0092  MORGAN.
010010...........................                   *                  *            0.0259  MARSHALL.
----------------------------------------------------------------------------------------------------------------

    11. On pages 60013 through to 60025, in Table 5.--List of 
Diagnosis-Related Groups (DRGS), Relative Weighting Factors, and 
Geometric and Arithmetic Mean Length of Stay (LOS), DRGs 525, 544, and 
572 are corrected to read as follows:
    a. Effective October 1, 2006.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                               FY 07 final rule
             DRG                post-acute care  FY 07 final rule    MDC          Type             DRG title        Weights     Geometric    Arithmetic
                                      DRG         special pay DRG                                                               mean LOS      mean LOS
--------------------------------------------------------------------------------------------------------------------------------------------------------
525..........................  No..............  No..............       05  SURG...........  Other Heart Assist       2.2268           7.7          14.3
                                                                                              System Implant.
544..........................  Yes.............  Yes.............       08  SURG...........  Major Joint              1.9878           4.0           4.4
                                                                                              Replacement or
                                                                                              Reattachment of
                                                                                              Lower Extremity.
572..........................  Yes.............  No..............       06  MED............  Major                    1.3378           5.6           7.1
                                                                                              Gastrointestinal
                                                                                              Disorders and
                                                                                              Peritoneal
                                                                                              Infections.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    12. On page 60025 in Table 5.--List of Diagnosis-Related Groups 
(DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean 
Length of Stay (LOS), the table is corrected by adding the following 
notes to the end of the table:
    a. Effective October 1, 2006.

    Note: If there is an asterisk in the ``Type'' column this means 
that data is unavailable to calculate weights for these low volume 
DRGs. Therefore, last year's weights have been updated based on the 
percent change in

[[Page 574]]

normalization factors between FY 2006 and FY 2007.


    Note: If there is no value or dashes (that is, ``----'') in 
either the geometric mean LOS or the arithmetic mean LOS columns, 
the volume of cases is insufficient to determine a meaningful 
computation of these statistics.

IV. Discussion of Effective Date and Notice and Comment Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). In addition, 
a final rule would ordinarily require a 30-day delay in effective date 
after the date of publication in the Federal Register. This correction 
of the rates published in the FY 2007 IPPS notice does not constitute a 
rule under the Administrative Procedure Act, because, in our FY 2007 
IPPS final rule (71 FR 47870, August 18, 2006), we already published 
the methodologies and formulas we use for determining the wage index, 
geographic adjustment factors, and other rates. This notice does not 
change our methodology or formulas, but merely ensures that our rules 
are implemented correctly. As this notice is not a rule under the 
Administrative Procedure Act, no notice of proposed rulemaking or delay 
in effective date is necessary.

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

    Dated: December 28, 2006.
Ashley Files Flory,
Deputy Executive Secretary to the Department.
[FR Doc. 06-9976 Filed 12-29-06; 1:29 pm]
BILLING CODE 4120-01-P