Skip to Content

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

Document Details

Information about this document as published in the Federal Register.

Enhanced Content

Relevant information about this document from Regulations.gov provides additional context. This information is not part of the official Federal Register document.

Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble

AGENCY:

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

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).

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.

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Tzvi Hefter, (410) 786-4487.

End Further Info End Preamble Start Supplemental Information

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 Start Printed Page 73657hospital 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

Provider No.Case mix indexFY 2009 wage indexAverage hourly wage FY 2007Average hourly wage FY 2008Average hourly wage FY 2009Average hourly wage (3 years)
0500691.73151.203234.635335.385038.133936.1121
0501681.57181.203237.978440.597340.836239.8630
0501731.34391.203229.057631.671732.326530.9929
0501931.23261.203233.952029.062336.724032.9059
0502241.66461.203232.501035.728037.344235.2849
0502261.51091.203232.441135.459736.535434.8258
0502301.54651.203234.060035.849038.890136.2987
0503481.77781.203231.515632.710733.527632.6288
0504261.46021.203233.203134.985537.650535.2298
0505261.18381.203228.199733.396435.545732.2794
0505430.75281.203229.444324.491332.836728.6013
0505480.71021.203239.223441.1075*40.1570
0505511.34501.203234.046737.250637.622336.3787
0505671.51141.203235.706337.638439.011437.5242
0505701.55221.203234.516138.437340.676137.8616
0505801.15011.203231.580634.153135.096633.6235
0505891.24151.203234.510037.688637.205636.5102
0506031.45141.203234.027535.027935.480934.9113
0506091.32661.203241.720839.739743.455541.6214
0506781.32591.203232.447333.763335.841134.1151
0506931.39351.203234.579739.683842.826638.9562
0507200.96291.203229.472630.359532.117330.5950
0507441.74311.2032**48.495148.4951
0507451.34201.2032**42.552342.5523
0507461.81991.2032**43.201543.2015
0507471.54101.2032**44.588744.5887
2500781.58620.841822.124322.843023.959822.9835

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

Provider No.Reclassified for FY 2009Out- migration adjustmentQualifying county nameCounty code
050069*0.0013Orange05400
050168*0.0013Orange05400
050173*0.0013Orange05400
050193*0.0013Orange05400
050224*0.0013Orange05400
050226*0.0013Orange05400
050230*0.0013Orange05400
050348*0.0013Orange05400
050426*0.0013Orange05400
050526*0.0013Orange05400
050543*0.0013Orange05400
050548*0.0013Orange05400
050551*0.0013Orange05400
Start Printed Page 73658
050567*0.0013Orange05400
050570*0.0013Orange05400
050580*0.0013Orange05400
050589*0.0013Orange05400
050603*0.0013Orange05400
050609*0.0013Orange05400
050678*0.0013Orange05400
050693*0.0013Orange05400
050720*0.0013Orange05400
050744*0.0013Orange05400
050745*0.0013Orange05400
050746*0.0013Orange05400
050747*0.0013Orange05400

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

Provider No.Geographic CBSAReclassified CBSALUGAR
0500694204431084
0501684204431084
0501734204431084
0501934204431084
0502244204431084
0502264204431084
0502304204431084
0503484204431084
0504264204431084
0505264204431084
0505434204431084
0505484204431084
0505514204431084
0505674204431084
0505704204431084
0505804204431084
0505894204431084
0506034204431084
0506094204431084
0506784204431084
0506934204431084
0507204204431084
0507444204431084
0507454204431084
0507464204431084
0507474204431084
2500782562025060

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) Start Printed Page 73659directs 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.

Start Authority

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

End Authority Start Signature

Dated: November 20, 2008.

Kerry Weems,

Acting Administrator, Centers for Medicare & Medicaid Services.

Approved: November 25, 2008.

Michael O. Leavitt,

Secretary.

End Signature End Supplemental Information

[FR Doc. E8-28619 Filed 12-2-08; 8:45 am]

BILLING CODE 4120-01-P