```

[Federal Register Volume 76, Number 67 (Thursday, April 7, 2011)]
[Notices]
[Pages 19365-19373]
From the Federal Register Online via the Government Printing 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.

-----------------------------------------------------------------------

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
```