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Notice

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

Action

Notice.

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).

Unified Agenda

 

Table of Contents Back to Top

Tables Back to Top

DATES: Back to Top

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: Back to Top

Tzvi Hefter, (410) 786-4487.

SUPPLEMENTARY INFORMATION: Back to Top

I. Background Back to Top

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

II. Provisions of This Notice Back to Top

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 Back to Top
Provider No. Case mix index FY 2009 wage index Average hourly wage FY 2007 Average hourly wage FY 2008 Average hourly wage FY 2009 Average hourly wage (3 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 Back to Top
Provider No. Reclassified for FY 2009 Out-migration adjustment Qualifying county name County code
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
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 Back to Top
Provider No. Geographic CBSA Reclassified 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 Back to Top

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, 96), 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) 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: Back to Top

(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]

BILLING CODE 4120-01-P

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