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Notice

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

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Start Preamble

AGENCY:

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

ACTION:

Notice.

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.

Start Further Info

FOR FURTHER INFORMATION CONTACT:

Brian Slater, (410) 786-5229.

End Further Info End Preamble Start Supplemental Information

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 Start Printed Page 19366done 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 Start Printed 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 Start Printed Page 19368change 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

Number of hospitalsPercent net effect of all changes for FY 2011
All Hospitals34720.2
By Geographic Location:
Urban hospitals24940.2
Large urban areas13620.2
Other urban areas11320.2
Rural hospitals9780
Bed Size (Urban):
0-99 beds6220.1
100-199 beds7850.2
200-299 beds4600.2
300-499 beds4300.2
500 or more beds1970.2
Bed Size (Rural):
0-49 beds3480
50-99 beds3680
100-149 beds1560
150-199 beds600
200 or more beds460
Urban by Region:
New England1210.3
Middle Atlantic3300.4
South Atlantic3820
East North Central4030.4
East South Central1550
West North Central1670
West South Central3360
Mountain1610
Pacific3890.1
Puerto Rico500
Rural by Region:
New England240
Middle Atlantic700.1
South Atlantic1650
East North Central1210
East South Central1760
West North Central1000.1
West South Central2190
Mountain720
Pacific310
By Payment Classification:
Urban hospitals25510.2
Large urban areas14040.2
Other urban areas11470.2
Rural areas9210
Teaching Status:
Nonteaching24290.1
Fewer than 100 residents8050.2
100 or more residents2380.3
Urban DSH:
Non-DSH7790.2
100 or more beds15310.2
Less than 100 beds3560.1
Rural DSH:
SCH4230
RRC2120
100 or more beds300.2
Less than 100 beds1410.2
Urban teaching and DSH:
Start Printed Page 19369
Both teaching and DSH8180.2
Teaching and no DSH1610.3
No teaching and DSH10690
No teaching and no DSH5030.2
Special Hospital Types:
RRC1800.1
SCH3320
MDH1940
SCH and RRC1170
MDH and RRC130
Type of Ownership:
Voluntary19900.2
Proprietary8590.1
Government5860
Medicare Utilization as a Percent of Inpatient Days:
0-253530
25-5015930.2
50-6512030.2
Over 652330.2
FY 2011 Reclassifications by the Medicare Geographic Classification Review Board:
All Reclassified Hospitals7730.3
Non-Reclassified Hospitals26990.1
Urban Hospitals Reclassified4420.4
Urban Nonreclassified Hospitals, FY 201120220.1
All Rural Hospitals Reclassified FY 20113310
Rural Nonreclassified Hospitals FY 20115850.1
All Section 401 Reclassified Hospitals:370
Other Reclassified Hospitals (Section 1886(d)(8)(B))630
Specialty Hospitals:
Cardiac Specialty Hospitals190

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

CategoryTransfers
Annualized Monetized Transfers$176 million
From Whom to WhomFederal 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)

Start Signature

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.

End Signature

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).

CMS certification No.Revised FY 2011 wage index
0101500.8567
0200081.2776
0505491.5477
0600751.1429
Start Printed Page 19370
0700051.2529
070006 *1.2867
0700101.2867
0700161.2529
0700171.2529
070018 *1.2867
0700191.2529
0700221.2529
0700281.2867
0700311.2529
070034 *1.2867
0700361.3329
0700391.2529
1500341.0386
1600400.8759
1600640.9501
1600670.8759
1601100.8759
2200461.1629
2300030.9930
2300040.9930
2300131.0781
2300191.0781
2300201.0057
2300241.0057
2300291.0781
2300361.0781
2300380.9930
2300531.0057
2300590.9930
2300660.9930
2300711.0781
2300720.9930
2300891.0057
2300970.9930
2301041.0057
2301060.9930
2301301.0781
2301351.0057
2301461.0057
2301511.0781
2301651.0057
2301740.9930
2301761.0057
2302071.0781
2302360.9930
2302541.0781
2302691.0781
2302701.0057
2302731.0057
2302771.0781
2500020.8443
250078 *0.8443
2501220.8443
3100211.2867
3100281.2867
3100501.2867
3100511.2867
3100601.2867
3101151.2867
3101201.2867
330023 *1.2867
3300491.2867
330067 *1.2867
3301061.4341
3301261.2867
3301351.2867
3302051.2867
3302641.2529
3400020.9087
3900010.9370
3900030.9370
390045 **0.9370
3900720.9370
3900950.9370
3901190.9370
3901370.9370
3901690.9370
3901850.9852
3901920.9370
3902370.9370
3902700.9852
4300051.0934
4700031.1629
4900010.8514
5300151.0577
* 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)

CMS certification No.Revised FY 2011 wage index
0700151.2867
0700331.2867
0700381.2529
1400121.0386
1401101.0386
1401611.0386
1500021.0386
1500041.0386
1500081.0386
1500901.0386
1501251.0386
1501261.0386
1501651.0386
1501661.0386
1501701.0386
2300021.0057
2300371.0057
2300691.0781
2300771.0781
2300991.0057
2301421.0057
2302441.0057
2302791.0781
2302971.0057
2303011.0781
2303021.0781
2500230.8443
2500400.8443
2500940.8443
2501170.8443
3100021.2867
3100091.2867
3100151.2867
3100171.2867
3100381.2867
3100391.2867
3100541.2867
3100701.2867
3100761.2867
3100831.2867
3100961.2867
3101081.2867
3101191.2867
3300271.2867
3301671.2867
3301811.2867
3301821.2867
3301981.2867
3302251.2867
3302591.2867
3303311.2867
3303321.2867
3303721.2867

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 codeAreaStateRevised wage indexRevised GAF
11460Ann Arbor, MIMI1.00571.0039
16974Chicago-Joliet-Naperville, ILIL1.03861.0263
22420Flint, MIMI1.07811.0528
25060Gulfport-Biloxi, MSMS0.84430.8906
Start Printed Page 19371
35004Nassau-Suffolk, NYNY1.25291.1670
35644New York-White Plains-Wayne, CTCT1.28671.1884
35644New York-White Plains-Wayne, NJNJ1.28671.1884
35644New York-White Plains-Wayne, NYNY1.28671.1884

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

CCNGeographic CBSAReclassified CBSALUGAR
0200080211260
0600750624300
0700053530035004
0700061486035644
0700101486035644
0700163530035004
0700173530035004
0700181486035644
0700193530035004
0700223530035004
0700281486035644
0700313530035004
0700341486035644
0700362554035300
0700393530035004
1500342384416974
1600641624
2300032610034740
2300134764422420
2300194764422420
2300201980411460
2300241980411460
2300294764422420
2300362313020
2300382434034740
2300531980411460
2300714764422420
2300722610034740
2300891980411460
2300972324340
2301041980411460
2301062434034740
2301304764422420
2301351980411460
2301461980411460
2301514764422420
2301651980411460
2301742610034740
2301761980411460
2302074764422420
2302362434034740
2302544764422420
2302694764422420
2302701980411460
2302731980411460
2302774764422420
2500022522520
2500782562025060
3100503508435644
3300233910035644
3301063500435644
3301263910035644
3901854254010900
Start Printed Page 19372

Table 9B.—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Public Law 108-173—FY 2011

CCNNoteGeographic CBSAWage index CBSA section 508 reclassificationOwn wage index
010150179800.8567
020008021.2776
050549422201.5477
060075061.1429
070005350041.2529
070006*356441.2867
070010356441.2867
070016350041.2529
070017350041.2529
070018*356441.2867
070019350041.2529
070022350041.2529
070028356441.2867
070031350041.2529
070034*356441.2867
070036255401.3329
070039350041.2529
150034169741.0386
160040163000.8759
160064160.9501
160067163000.8759
160110163000.8759
220046144841.1629
230003280200.9930
230004280200.9930
230013224201.0781
230019224201.0781
230020114601.0057
230024114601.0057
230029224201.0781
230036224201.0781
230038280200.9930
230053114601.0057
230059280200.9930
230066280200.9930
230071224201.0781
230072280200.9930
230089114601.0057
230097280200.9930
230104114601.0057
230106280200.9930
230130224201.0781
230135114601.0057
230146114601.0057
230151224201.0781
230165114601.0057
230174280200.9930
230176114601.0057
230207224201.0781
230236280200.9930
230254224201.0781
230269224201.0781
230270114601.0057
230273114601.0057
230277224201.0781
250002250600.8443
250078*250600.8443
250122250600.8443
310021356441.2867
310028356441.2867
310050356441.2867
310051356441.2867
310060356441.2867
310115356441.2867
310120356441.2867
330023*356441.2867
330049356441.2867
330067*356441.2867
Start Printed Page 19373
330106350041.4341
330126356441.2867
330135356441.2867
330205356441.2867
330264350041.2529
340002167400.9087
390001109000.9370
390003109000.9370
390045**109000.9370
390072109000.9370
390095109000.9370
390119109000.9370
390137109000.9370
390169109000.9370
390185295400.9852
390192109000.9370
390237109000.9370
390270295400.9852
430005396601.0934
470003144841.1629
490001313400.8514
530015531.0577
* 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).
End Supplemental Information

[FR Doc. 2011-8209 Filed 4-6-11; 8:45 am]

BILLING CODE 4120-01-P