Federal Register, Volume 76 Issue 67 (Thursday, April 7, 2011)

[Federal Register Volume 76, Number 67 (Thursday, April 7, 2011)]
[Notices]
[Pages 19365-19373]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-8209]

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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.

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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 http://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 http://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 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 http://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 0.9370 ..............
390119........................................ .............. 10900 0.9370 ..............
390137........................................ .............. 10900 0.9370 ..............
390169........................................ .............. 10900 0.9370 ..............
390185........................................ .............. 29540 0.9852 ..............
390192........................................ .............. 10900 0.9370 ..............
390237........................................ .............. 10900 0.9370 ..............
390270........................................ .............. 29540 0.9852 ..............
430005........................................ .............. 39660 1.0934 ..............
470003........................................ .............. 14484 1.1629 ..............
490001........................................ .............. 31340 0.8514 ..............
530015........................................ .............. 53 ................ 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