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


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1491-N]


Medicare Program; Extension of Certain Hospital Wage Index 
Reclassifications

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

ACTION: Notice.

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

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

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

SUPPLEMENTARY INFORMATION: 

I. Background

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

[[Page 9808]]

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

II. Provisions of the Notice

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

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

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

[[Page 9809]]

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

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

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

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

[[Page 9810]]

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

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

III. Regulatory Impact Statement

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

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

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

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