### CMS

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CORRECTIONS TO TABLE S 2 and 4J OF THE FY 2012 IPPS/LT CH PPS

PROPOSED RULE

TABLE 2.

—ACUTE CARE HOSPITAL S CASE

- MIX INDEXES FOR DISCHARGES

OCCUR R ING IN FEDERAL FISCAL YEAR 20 10 ; PROPOSED HOSPITAL WAGE

INDEXES FOR FEDERAL FISCAL YEAR 2012; HOSPITAL AVERAGE HOURLY

WAG ES FOR FEDERAL FISCAL YEARS 2010 (200 6 WAGE DATA), 2011 (200 7 WAGE

DATA ), AND 20 12 (200 8 WAGE DATA); AND 3

- YEAR AVERAGE O F HOSPITAL

AVERAGE HOURLY WAGES

Provider Number Case

- Mix

Index 2 Proposed

FY 201 2

Wage

Index Average

Hourly

Wage

FY 20 10 Average

Hourly

Wage

FY 201 1 Average

Hourly

Wage

FY 201 2 1 Average

Hourly Wage **

(3 years)

010038 1.2869 0.8009 29.7948 32.5186 31.8916 31.4499

010078 1.6478 0.8009 24.5429 26.5624 28.1817 26.4254

010109 1.0641 0.7895 19.399 23.0895 21.2511 21.2756

010146 0.9271 0.8009 24.6572 25.2451 28.421 25.9923

070020 1.4208 1.1459 40.4989 40.6149 41.4434 40.8695

190184 0.9511 0.7997 22.5006 23.5623 24.9687 23.7099

190246 2.1543 0.7997 31.5003 31.9389 33.5063 32.427

210028 1.1189 0.9627 31.7636 34.3085 39.7843 35.2135

310010 1.3111 1.0195 34.1071 34.7136 38.3482 35.7402

310021 1.4953 1.0195 33.2554 32.9713 34.2243 33.4813

310022 1.3554 1.0330 32.8154 34.9947 34.0641 33.9865

310029 1.8547 1.0330 36.5179 37.3175 39.2081 37.683

310032 1.4356 1.0677 35.8019 38.5311 38.7624 37.7404

310044 1.4293 1.0195 35.9981 36.781 37.4187 36.7349

310086 1.306 1.0330 31.4837 32.6603 34.1058 32.8047

310092 1.6137 1.0195 34.8028 35.8684 36.2498 35.6389

310110 1.3882 1.0195 36.5227 34.9317 33.6239 34.9686

320011 1.1775 0.9249 30.6151 31.5873 34.2401 32.0525

330144 0.9606 0.8312 26.0623 28.4201 28.5907 27.6958

330151 1.1998 0.8312 23.4664 23.7267 24.2144 23.8031

340133 1.0466 0.8782 27.263 27.7476 30.1564 28.3574

360058 1.1707 0.8523 27.7073 27.9493 30.2787 28.6673

360070 1.6834 0.8776 30.0192 30.7743 31.7354 30.852

360084 1.6823 0.8776 29.2527 30.7638 32.4224 30.8198

360131 1.4939 0.8776 28.3618 28.7671 30.7512 29.27

360151 1.5105 0.8776 28.3917 29.2453 30.8206 29.493

370100 0.8671 0.8013 18.2493 20.4975 19.3409 19.3692

420054 1.0441 0.8286 27.158 28.2695 29.1653 28.1926

420098 1.2637 0.8299 28.2058 29.774 30.1094 29.4397

440031 1.2661 0.7830 23.0937 24.1953 23.7977 23.6997

### CMS

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Provider Number Case

- Mix

Index 2 Proposed

FY 201 2

Wage

Index Average

Hourly

Wage

FY 20 10 Average

Hourly

Wage

FY 201 1 Average

Hourly

Wage

FY 201 2 1 Average

Hourly Wage **

(3 years)

440033 1.1189 0.7841 24.3197 24.6594 24.9371 24.6396

440057 1.1274 0.7832 25.1519 22.9202 25.8949 24.568

440081 1.2858 0.7873 23.3 24.5308 25.5718 24.5004

440084 1.2559 0.7838 21.3873 21.0886 21.4011 21.2929

440180 1.2051 0.7841 26.931 28.0103 27.1482 27.3673

450565 1.2197 0.8555 28.04 20.2579 29.2758 25.1459

520059 1.5482 0.9286 32.1905 33.6499 34.436 33.4331

520096 1.57 0.9286 31.5023 37.8473 30.9614 33.2003

1. Based on salaries adjusted for occupational mix, according to the calculation in section III.C. of th is proposed

rule.

2. The case

- mix index is based on the billed MS

- DRGs in the FY 20 10 MedPAR file. It is not transfer

- adjusted.

3. CCN 140010 is part of a multi

- campus provider (MCH ) that is comprised of campuses that are located in two

different CBSAs. The provider number with a " B " in the 4 th position, 140B10, indicates the portion of the wage and

hours of the MCH that is allocated to CBSA 29404; CCN 140010 indicates the portion o f wages and hours of the

MCH that is allocated to CBSA 16974.

4. CCN 220074 is part of a MCH that is comprised of campuses that are located in two different CBSAs. The

provider number with a " B " in the 4 th position, 220B74, indicates the portion of the wage and hours of the MCH that

is allocated to CBSA 14484; CCN 220074 indicates the portion of wages and hours of the MCH that is allocated to

CBSA 39300.

5. CCN 230104 is part of a MCH that is comprised of campuses that are located in two different CBSA s. The

provider number with a " B " in the 4 th position, 230B04, indicates the portion of the wage and hours of the MCH that

is allocated to CBSA 47644; CCN 230104 indicates the portion of wages and hours of the MCH that is allocated to

CBSA 19804.

Notes:

* Denotes wage data not available for the CCN for that year.

** Based on the sum of the salaries and hours computed for Federal FYs 20 10, 2011, and 20 12

. *** Denotes MedPAR data not available for the provider for FY 2010

.



### TABLE 4J.

— PROPOSED OUTMIGRA TION ADJUSTMENT FOR ACUTE CARE

HOSPITALS FOR FY 2012

Provider

Number Reclassified

for FY 2012 Proposed

Out

- m igration

Adjustment Qualifying County

Name County

Code

010038 0.0034 CALHOUN 01070

010059 * 0.0103 LAWRENCE 01390

010078 0.0034 CALHOUN 01070

010109 0.0609 PICKENS 01530

010146 0.0034 CALHOUN 01070

050022 * 0.0059 RIVERSIDE 05430

050054 * 0.0059 RIVERSIDE 05430

050069 * 0.0073 ORANGE 05400

050102 * 0.0059 RIVERSIDE 05430

050168 * 0.0073 ORANGE 05400

050224 * 0.0073 ORANGE 05400

### CMS

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- CN2 Tables 2and 4J Page 3 of 5

Provider

Number Reclassified

for FY 2012 Proposed

Out

- m igration

Adjustment Qualifying County

Name County

Code

050226 * 0.0073 ORANGE 05400

050230 * 0.0073 ORANGE 05400

050243 * 0.0059 RIVERSIDE 05430

050292 * 0.0059 RIVERSIDE 05430

050329 * 0.0059 RIVERSIDE 05430

050348 * 0.0073 ORANGE 05400

050390 * 0.0059 RIVERSIDE 05430

050423 * 0.0059 RIVERSIDE 05430

050426 * 0.0073 ORANGE 05400

050526 * 0.0073 ORANGE 05400

050534 * 0.0059 RIVERSIDE 05430

050543 * 0.0073 ORANGE 05400

050548 * 0.0073 ORANGE 05400

050551 * 0.0073 ORANGE 05400

050567 * 0.0073 ORANGE 05400

050570 * 0.0073 ORANGE 05400

050573 * 0.0059 RIVERSIDE 05430

050580 * 0.0073 ORANGE 05400

050589 * 0.0073 ORANGE 05400

050603 * 0.0073 ORANGE 05400

050609 * 0.0073 ORANGE 05400

050678 * 0.0073 ORANGE 05400

050684 * 0.0059 RIVERSIDE 05430

050686 * 0.0059 RIVERSIDE 05430

050701 * 0.0059 RIVERSIDE 05430

050709 * 0.0059 RIVERSIDE 05430

050744 * 0.0073 ORANGE 05400

050745 * 0.0073 ORANGE 05400

050746 * 0.0073 ORANGE 05400

050747 * 0.0073 ORANGE 05400

050765 * 0.0059 RIVERSIDE 05430

070003 * 0.0258 WINDHAM 07070

070004 * 0.0081 LITCHFIELD 07020

070011 * 0.0081 LITCHFIELD 07020

070015 * 0.0081 LITCHFIELD 07020

070020 0.0043 MIDDLESEX 07030

070021 * 0.0258 WINDHAM 07070

100081 * 0.0171 WALTON 10650

100290 * 0.0467 SUMTER 10590

100292 * 0.0171 WALTON 10650

170137 * 0.0238 DOUGLAS 17220

190184 0.0033 CALDWELL 19100

190190 * 0.0033 CALDWELL 19100

190246 0.0033 CALDWELL 19100

### CMS

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Provider

Number Reclassified

for FY 2012 Proposed

Out

- m igration

Adjustment Qualifying County

Name County

Code

210028 0.0249 ST. MARYS 21180

300011 * 0.0405 HILLSBOROUGH 30050

300012 * 0.0405 HILLSBOROUGH 30050

300017 * 0.0919 ROCKINGHAM 30070

300020 * 0.0405 HILLSBOROUGH 30050

300023 * 0.0919 ROCKINGHAM 30070

300029 * 0.0919 ROCKINGHAM 30070

300034 * 0.0405 HILLSBOROUGH 30050

310010 0.0254 MERCER 31260

310014 * 0.0205 CAMDEN 31160

310021 0.0254 MERCER 31260

310022 0.0205 CAMDEN 31160

310029 0.0205 CAMDEN 31160

310032 0.0018 CUMBERLAND 31190

310044 0.0254 MERCER 31260

310086 0.0205 CAMDEN 31160

310092 0.0254 MERCER 31260

310110 0.0254 MERCER 31260

320003 * 0.0451 SAN MIGUEL 32230

320011 0.0317 RIO ARRIBA 32190

330144 0.0063 STEUBEN 33690

330151 0.0063 STEUBEN 33690

330277 * 0.0063 STEUBEN 33690

340069 * 0.0024 WAKE 34910

340073 * 0.0024 WAKE 34910

340114 * 0.0024 WAKE 34910

340133 0.045 MARTIN 34580

340173 * 0.0024 WAKE 34910

360058 0.0071 MERCER 36550

360070 0.0004 STARK 36770

360084 0.0004 STARK 36770

360131 0.0004 STARK 36770

360151 0.0004 STARK 36770

370100 0.0025 CHOCTAW 37110

420020 * 0.003 GEORGETOWN 42210

420039 * 0.0229 UNION 42430

420054 0.0017 MARLBORO 42340

420070 * 0.0075 SUMTER 42420

420098 0.003 GEORGETOWN 42210

440031 0.0025 ROANE 44720

440033 0.0036 CAMPBELL 44060

440056 * 0.006 JEFFERSON 44440

440057 0.0027 CLAIBORNE 44120

440081 0.0068 SEVIER 44770

### CMS

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Provider

Number Reclassified

for FY 2012 Proposed

Out

- m igration

Adjustment Qualifying County

Name County

Code

440084 0.0033 MONROE 44610

440180 0.0036 CAMPBELL 44060

450565 0.0442 PALO PINTO 45841

520059 0.0303 RACINE 52500

520096 0.0303 RACINE 52500

The preceding list represents the additional hospitals that are eligible

, for the FY 2012 IPPS

- LTCH proposed rule

, to

have their wage index increased by the out

- migration adjustment listed in this table. The adjustment is effective for 3

years. Hospitals cannot receive the out

- migration adjustment if they are reclassified under section 1886(d)(10) of the

Act or redesignated under section 1886(d)(8)(B) o f the Act. Hospitals that have already been reclassified under

section 1886(d)(10) of the Act or redesignated under section 1886(d)(8)(B) of the Act are designated with an asterisk.

We will automatically assume that hospitals that have already been recla ssified under section 1886(d)(10) of the Act

or redesignated under section 1886(d)(8)(B) of the Act wish to retain their reclassification/redesignation status and

w aive the application of the out

- migration adjustment. Section 1886(d)(10) hospitals that wi sh to receive the out

migration adjustment, rather than their reclassification, must follow the termination/withdrawal procedures specifie d in

the Correction Notice (CMS

- 1518

- CN2; to be displayed in the Federal Register sometime during the week of July 4,

2011)

. Specifically, such hospital s must notify the MGCRB and CMS that they elected to receive the out

- migration

adjustment instead of their section 1886(d)(10) reclassification within 7 days of the display date of th e Correction

Notice

. Otherwise, they will be deemed to have waived the out

- migration adjustment. Hospitals redesignated under

section 1886(d)(8)(B) of the Act will be deemed to have waiv ed the out

- migration adjustment, unless they explicitly

notify CMS that they elected to receive the out

- migration adjustment instead within 7 days of the display of th e

Correction Notice.