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


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1390-N2]
RIN 0938-AP15


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

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

ACTION: Notice.

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

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

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

SUPPLEMENTARY INFORMATION: 

I. Background

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

[[Page 73657]]

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

II. Provisions of This Notice

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

A. Wage Index Revisions for Table 2

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

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

B. Revisions to Table 4J

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

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

[[Page 73658]]

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

C. Revisions to Table 9A

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

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

D. Revisions to Table 9B

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

III. Regulatory Impact Statement

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

[[Page 73659]]

directs agencies to assess all costs and benefits of available 
regulatory alternatives and, if regulation is necessary, to select 
regulatory approaches that maximize net benefits (including potential 
economic, environmental, public health and safety effects, distributive 
impacts, and equity). A regulatory impact analysis (RIA) must be 
prepared for major rules with economically significant effects ($100 
million or more in any one year). We estimate that FY 2009 IPPS 
payments will increase approximately $3 million based on the changes 
included in this notice. Therefore, we note that not only does this 
notice not constitute a substantive rule, but it also does not reach 
the economic threshold and thus is not considered a major rule.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$7.0 million to $34.5 million in any one year. Individuals and States 
are not included in the definition of a small entity. We are not 
preparing an analysis for the RFA because the notice is not a 
substantive rule, and we have determined, and the Secretary certifies, 
that this notice will not have a significant economic impact on a 
substantial number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area for Medicare payment regulations and has fewer than 
100 beds. We are not preparing an analysis for section 1102(b) of the 
Act because we have determined, and the Secretary certifies, that this 
notice will not have a significant impact on the operations of a 
substantial number of small rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any one year of 
$100 million in 1995 dollars, updated annually for inflation. In 2008, 
that threshold is approximately $130 million. This notice will have no 
consequential effect on State, local, or tribal governments or on the 
private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. Since this notice does not impose any costs on State or 
local governments, the requirements of Executive Order 13132 are not 
applicable.

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

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