23722 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 

the Government in Sunshine Act, 5 

U.S.C. section 552b(c), to May 23, 2012. 

DATES: The April 30, 2012, NBSB closed 

session by teleconference is being 

rescheduled to May 23, 2012, from 

1 p.m. to 3:30 p.m. The agenda and time 

are subject to change as priorities 

dictate. 

ADDRESSES: The closed session will 

occur by teleconference and will not be 

open to the public as stipulated under 

exemption 9(B) of the Government in 

Sunshine Act, 5 U.S.C. section 552b(c). 

FOR FURTHER INFORMATION CONTACT: 

NBSB Mailbox, Office of the Assistant 

Secretary for Preparedness and 

Response, U.S. Department of Health 

and Human Services; Email: 

NBSB@HHS.GOV. 

SUPPLEMENTARY INFORMATION: Pursuant 

to section 319M of the Public Health 

Service Act (42 U.S.C. 247d–7f) and 

section 222 of the Public Health Service 

Act (42 U.S.C. 217a), the Department of 

Health and Human Services established 

the National Biodefense Science Board. 

The Board shall provide expert advice 

and guidance to the Secretary on 

scientific, technical, and other matters 

of special interest to the Department of 

Health and Human Services regarding 

current and future chemical, biological, 

nuclear, and radiological agents, 

whether naturally occurring, accidental, 

or deliberate. The Board may also 

provide advice and guidance to the 

Secretary and/or the Assistant Secretary 

for Preparedness and Response on other 

matters related to public health 

emergency preparedness and response. 

Background: The Board is being asked 

to review and evaluate the 2012 Public 

Health Emergency Medical 

Countermeasures Enterprise (PHEMCE) 

Strategy and Implementation Plan (SIP). 

Until a final document is approved by 

the Secretary of the Department of 

Health and Human Services (HHS), the 

development of PHEMCE SIP requires 

consideration and discussion of 

procurement-sensitive information that 

should not be released to the public 

prior to the Secretary’s final decision. 

Premature public disclosure of the draft 

PHEMCE SIP would limit the 

Secretary’s decision-making ability to 

effectively prioritize HHS expenditures 

on critical medical countermeasures. 

Therefore, the Board’s deliberations on 

the new task are being conducted in 

closed sessions in accordance with 

provisions set forth under exemption 

9(B) of the Government in Sunshine 

Act, 5 U.S.C. section 552b(c), and with 

approval by the Assistant Secretary for 

Preparedness and Response. 

Availability of Materials: All public 

materials will be posted on the NBSB 

Web site at www.phe.gov/nbsb. 

Procedures for Providing Public Input: 

All written comments should be sent by 

email to NBSB@HHS.GOV with ‘‘NBSB 

Public Comment’’ as the subject line. 

Dated: April 13, 2012. 

Nicole Lurie, 

Assistant Secretary for Preparedness and 

Response. 

[FR Doc. 2012–9497 Filed 4–19–12; 8:45 am] 

BILLING CODE 4150–37–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1442–N] 

Medicare Program; Extension of 

Certain Wage Index Reclassifications 

and Special Exceptions for the 

Hospital Inpatient Prospective 

Payment Systems (PPS) for Acute Care 

Hospitals and the Hospital Outpatient 

PPS 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces 

changes to wage indices and hospital 

reclassifications in accordance with 

section 302 of the Temporary Payroll 

Tax Cut Continuation Act of 2011 

(TPTCCA) as amended by section 3001 

of the Middle Class Tax Relief and Job 

Creation Act of 2012 (MCTRJCA). The 

TPTCCA and MCTRJCA extend the 

expiration date for certain geographic 

reclassifications and special exception 

wage indices through March 31, 2012 

for the hospital inpatient prospective 

payment systems for acute care 

hospitals (IPPS). These geographic 

reclassifications and special exception 

wage indices are also extended under 

the hospital outpatient prospective 

payment system (OPPS). 

DATES: Applicability Dates: For IPPS 

payments, the revised wage indices for 

section 508, certain nonsection 508, and 

special exception providers described in 

this notice are applicable for discharges 

on or after October 1, 2011 and on or 

before March 31, 2012. For OPPS 

payments, the revised wage indices for 

section 508 providers described in this 

notice are applicable for services 

furnished on or after October 1, 2011 

and on or before March 31, 2012; and 

the revised wage indices for nonsection 

508 and special exception providers 

described in this notice are applicable 

for services furnished on or after 

January 1, 2012 and on or before June 

30, 2012. 

FOR FURTHER INFORMATION CONTACT: 

Brian Slater, (410) 786–5229, for the 

IPPS. 

Erick Chuang (410) 786–1816, for the 

OPPS. 

SUPPLEMENTARY INFORMATION: 

I. Background 

On December 23, 2011, the 

Temporary Payroll Tax Cut 

Continuation Act (TPTCCA) of 2011 

(Pub. L. 112–78) was enacted. Section 

302 of the TPTCCA 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 for 2 months, 

through November 30, 2011. On 

February 22, 2012, the Middle Class Tax 

Relief and Job Creation Act (MCTRJCA) 

of 2012 (Pub. L. 112–96) was enacted. 

Section 3001 of the MCTRJCA amended 

section 302 of the TPTCCA by extending 

section 508 reclassifications and certain 

additional special exceptions for an 

additional 4 months, through March 31, 

2012. We apply such extensions to both 

the hospital inpatient prospective 

payment systems (IPPS) (for the relevant 

part of fiscal year (FY) 2012) and the 

hospital outpatient prospective payment 

system (OPPS) (for the relevant parts of 

calendar years (CYs) 2011 and 2012) 

final wage index data. 

II. Provisions of This Notice 

A. Overview of the Section 508 

Extension 

Section 302 of the TPTCCA and 

section 3001 of the MCTRJCA, extend 

through March 31, 2012 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 August 11, 2004 

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), section 3137(a) of the Patient 

Protection and Affordable Care Act (also 

known as the Affordable Care Act) (Pub. 

L. 111–148) as amended by section 

10317 of Affordable Care Act, and 

section 102 of the Medicare and 

Medicaid Extenders Act of 2010, Public 

Law 111–309. 

Under section 508 of the MMA, a 

qualifying hospital could appeal the 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 23723 

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 described our 

implementation of section 3137(a) of the 

Affordable Care Act, as amended by 

section 10317 of Affordable Care Act, 

which further extended section 508 

reclassifications and certain special 

exceptions through the end of FY 2010. 

Section 102 of the Medicare and 

Medicaid Extenders Act of 2010 

(MMEA) (Pub. L. 111–309) further 

extended section 508 reclassifications 

and certain special exceptions through 

September 30, 2011. In the April 7, 2011 

Federal Register (76 FR 19365), we 

published a notice regarding our 

implementation of section 102 of the 

MMEA. 

Section 302 of the TPTCCA and 

section 3001 of the MCTRJCA have 

extended the hospital reclassifications 

originally received under section 508 

and certain special exceptions for 6 

months, through March 31, 2012. 

Furthermore, for the 6-month period, 

section 302 of the TPTCCA and section 

3001 of the MCTRJCA also require that 

in determining the wage index 

applicable to hospitals that qualify for 

reclassification, the Secretary shall 

remove the section 508 and special 

exception hospital’s wage data from the 

calculation of the reclassified wage 

index if doing so raises the reclassified 

wage index. As a result of these 

changes, we have recalculated certain 

wage index values to account for the 

new legislation. 

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 the TPTCCA and the 

MCTRJCA, since these laws simply 

provide a 6-month continuation from 

October 1, 2011 through March 31, 2012 

for any section 508 reclassifications and 

special exceptions wage indices that 

expired September 30, 2011. 

B. Implementation of Section 508 

Extension 

1. Under the IPPS 

The final rule setting forth the 

Medicare fiscal year (FY) 2012 IPPS and 

the long-term care hospital prospective 

payment system (LTCH PPS) 

(hereinafter referred to as the FY 2012 

IPPS/LTCH PPS final rule) appeared in 

the August 18, 2011 Federal Register 

(76 FR 51476) and we subsequently 

corrected this final rule via the 

September 26, 2011 (76 FR 59263) and 

February 1, 2012 (77 FR 4908) Federal 

Register. 

The FY 2012 final wage index values 

and geographic adjustment factors 

(GAF) for IPPS hospitals affected by 

section 302 of the TPTCCA and section 

3001 of the MCTRJCA for the 6-month 

period beginning on October 1, 2011 

and ending on March 31, 2012 are 

included in Tables 2, 4C, and 9B which 

are posted on our Web site at http:// 

www.cms.hhs.gov/AcuteInpatientPPS/. 

Also posted, is a Table showing the 

hospitals that have been removed from 

Table 9A for the 6-month period due to 

the enactment of section 302 of TPTCCA 

and section 3001 of the MCTRJCA, 

Table 2 includes the final wage index 

values for the 6-month period for 

section 508, nonsection 508 and special 

exception hospitals affected by the 

extension. Table 4C lists the revised 

final wage index and GAF values for the 

6-month period for hospitals that are 

reclassified. In addition, Table 9B lists 

hospitals that have section 508 and 

special exception reclassifications that 

have been extended until March 31, 

2012. 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 2012, 

because they are receiving a higher wage 

index as a result of maintaining their 

MGCRB reclassification or due to 

section 10324 of the Affordable Care Act 

which provides for a floor (of 1.0) on the 

area wage index for hospitals in Frontier 

States. Therefore, in keeping with our 

historical practice, these providers 

continue to receive the wage index 

published in the FY 2012 IPPS/LTCH 

PPS final rule, or subsequent correction 

notices (published September 26, 2011 

(76 FR 59263), February 1, 2012 (77 FR 

4908), respectively), and are neither 

removed from Table 9A nor listed in 

Table 9B. 

2. Under the OPPS 

Under the OPPS, wage indices 

applicable to providers reclassified 

under section 508 are adopted on a 

federal fiscal year timeframe. Table 2A 

at http://www.cms.gov/ 

HospitalOutpatientPPS/lists section 508 

providers and their applicable wage 

indices from October 1, 2011 through 

March 31, 2012. Please note these 

section 508 providers will revert to the 

previously scheduled January 1, 2012 

reclassification or home area wage index 

from April 1, 2012 through December 

31, 2012 as published in the FY 2012 

IPPS/LTCH PPS final rule, or 

subsequent correction notices 

(published September 26, 2011 (76 FR 

59263), February 1, 2012 (77 FR 4908), 

respectively) and adopted under the 

OPPS. The wage indices applicable to 

certain nonsection 508 OPPS providers 

and to providers that receive special 

exception wage indexes are adopted on 

a calendar year timeframe. Because the 

OPPS payments are based on the 

calendar year, the wage indices for these 

nonsection 508 providers and special 

exception providers are applied from 

January 1, 2012 through June 30, 2012 

in order for these providers to receive 

the revised wage index for 6 months, the 

same period that applies in the IPPS. 

Table 2B at http://www.cms.gov/ 

HospitalOutpatientPPS/lists these 

nonsection 508 and special exceptions 

providers and their wage indices that 

are applicable from January 1, 2012 

through June 30, 2012. 

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 


tkelley on DSK3SPTVN1PROD with NOTICES
23724 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 

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 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 

TPTCCA and MCTRJCA, 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 

October 1, 2011 through March 31, 2012 

for the IPPS and OPPS, and effective 

January 1, 2012 through June 30, 2012 

for OPPS for certain nonsection 508 and 

special exception providers. As this 

notice merely informs the public of 

these modifications to the wage index 

values under the IPPS and OPPS, 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 and 

OPPS policies or methodologies already 

in effect as a matter of law, but simply 

applies rate adjustments under the 

TPTCCA and MCTRJCA to these 

existing policies and methodologies. 

Therefore, we would be unable to 

change any of the policies governing the 

IPPS for FY 2012 and the OPPS for CY 

2011 or 2012 in response to public 

comment on this notice. As the changes 

outlined in this notice have already 

taken effect, 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 TPTCCA and 

MCTRJCA. 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 

(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). Although 

we do not consider this notice to 

constitute a substantive rule or 

regulatory action, the changes 

announced in this notice are 

‘‘economically’’ significant, under 

section 3(f)(1) of Executive Order 12866, 

and therefore 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 202 of the Unfunded 

Mandates Reform Act of 1995 (UMRA) 

(Pub. L. 104–4) also requires that 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 23725 

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 

TPTCCA and MCTRJCA 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 and providers, as 

well as other classes of hospitals and 

providers, and the effects on some 

hospitals and providers may be 

significant. The impact analysis, which 

shows the affect on all payments to IPPS 

and OPPS hospitals and providers, is 

shown in Table I of this notice. 

B. Statement of Need 

This notice is necessary to update the 

IPPS final fiscal year (FY) 2012 and 

OPPS final calendar years (CYs) 2011 

and 2012 wage indices and hospital 

reclassifications and other related tables 

to reflect changes required by or 

resulting from the implementation of 

section 302 of the TPTCCA and section 

3001 of the MCTRJCA. The TPTCCA 

and MCTRJCA require the extension of 

the expiration date for certain 

geographic reclassifications and special 

exception wage indices through March 

31, 2012 We note that the changes in 

this notice are already in effect with 

changes made to PRICER in February 

2012. Thus, the issuance of this notice 

does not result in additional changes in 

payments. 

C. Overall Impact 

1. Under the IPPS 

The FY 2012 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 section 302 

of the TPTCCA and section 3001 of the 

MCTRJCA. Because these provisions in 

the TPTCCA and the MCTRJCA were 

not budget neutral, the overall estimates 

for hospitals have changed from our 

estimate that was published in the FY 

2012 IPPS final rule (76 FR 51814). We 

estimate that the changes in the FY 2012 

IPPS final rule, in conjunction with the 

final IPPS rates and wage index 

included in this notice, will result in an 

approximate $1.22 billion increase in 

total operating payments relative to FY 

2011. In the FY 2012 IPPS final rule (76 

FR 51814), we had projected that total 

operating payments would increase by 

$1.13 billion relative to FY 2011. 

However, since the changes in this 

notice will increase operating payments 

by $90 million relative to what was 

projected in the FY 2012 IPPS final rule, 

these changes will result in a net 

increase of $1.22 billion in total 

operating payments, as mentioned 

previously. Capital payments are 

estimated to increase by an additional 

$7.6 million in FY 2012 relative to FY 

2011 as a result of the changes in this 

notice. 

2. Under the OPPS 

The CY 2012 OPPS final rule 

included an impact analysis for the 

changes to the OPPS included in that 

rule. This notice updates those impacts 

to the OPPS to reflect certain changes 

we are announcing as a result of section 

302 of the TPTCCA and section 3001 of 

the MCTRJCA. The overall estimates for 

hospitals have changed from our 

estimate that was published in the CY 

2012 OPPS final rule (76 FR 74562). We 

estimate that the changes to the CY 2011 

wage indexes included in this notice 

will increase the OPPS payments in CY 

2011 by $11 million, relative to what 

was estimated in the CY 2012 OPPS 

final rule. We estimate that the changes 

to the CY 2012 OPPS wage indexes will 

increase OPPS payments by $15 million 

relative to what was projected in the CY 

2012 OPPS final rule, resulting in a net 

increase of $650 million in OPPS 

operating payments in CY 2012 relative 

to CY 2011. 

D. Anticipated Effects 

1. Under the IPPS 

In the Table I, we provide an impact 

analysis for changes to the IPPS 

operating payments in FY 2012 as a 

result of the changes required by section 

302 of the TPTCCA and section 3001 of 

the MCTRJCA. 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 the Table I shows the overall 

impact on the 3,423 acute care hospitals 

included in the analysis. The impact 

analysis reflects the change in estimated 

operating payments in FY 2012 due to 

section 302 of the TPTCCA and section 

3001 of the MCTRJCA relative to 

estimated FY 2012 operating payments 

published in the FY 2012 IPPS final rule 

(76 FR 51817). Overall, all hospitals 

paid under the IPPS will experience an 

estimated 0.1 percent increase in 

operating payments in FY 2012 due to 

these provisions in the TPTCCA and 

MCTRJCA compared to the previous 

estimates of operating payments in FY 

2012 published in the FY 2012 IPPS 

final rule. Because section 302 of the 

TPTCCA and section 3001 of the 

MCTRJCA were not budget neutral, all 

hospitals, depending on whether they 

were affected by these provisions, will 

either experience no change or an 

increase in IPPS operating payments in 

FY 2012 in this notice relative to the 

previously published estimates. As 

such, hospitals located in urban areas 

will experience a 0.1 percent increase in 

payments while hospitals located in 

rural areas will not experience any 

change in payments in FY 2012 due to 

the provisions in this notice as 

compared to the estimated payments 

provided in the FY 2012 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 

0.3 percent where urban New England 

hospitals and urban reclassified 

hospitals are expected to experience the 

largest net increase in operating 

payments of 0.3 percent in FY 2012. 


tkelley on DSK3SPTVN1PROD with NOTICES
23726 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 

TABLE I—IMPACT ANALYSIS OF CHANGES FOR FY 2012 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT

SYSTEM

Number of 

hospitals 

Percent net effect of all 

changes for FY 

2012 

All Hospitals ........................................................................................................................................................... 3423 0 .1 

By Geographic Location: 

Urban hospitals ....................................................................................................................................... 2499 0 .1 

Large urban areas ................................................................................................................................... 1371 0 .1 

Other urban areas ................................................................................................................................... 1128 0 .1 

Rural hospitals ................................................................................................................................................ 924 0 

Bed Size (Urban): 

0–99 beds ....................................................................................................................................................... 633 0 

100–199 beds ................................................................................................................................................. 782 0 .1 

200–299 beds ................................................................................................................................................. 449 0 .1 

300–499 beds ................................................................................................................................................. 430 0 .1 

500 or more beds ........................................................................................................................................... 205 0 .1 

Bed Size (Rural): 

0–49 beds ....................................................................................................................................................... 319 0 

50–99 beds ..................................................................................................................................................... 348 0 

100–149 beds ................................................................................................................................................. 152 0 

150–199 beds ................................................................................................................................................. 58 0 

200 or more beds ........................................................................................................................................... 47 0 

Urban by Region: 

New England .................................................................................................................................................. 120 0 .3 

Middle Atlantic ................................................................................................................................................ 320 0 .2 

South Atlantic ................................................................................................................................................. 380 0 

East North Central .......................................................................................................................................... 401 0 .2 

East South Central ......................................................................................................................................... 153 0 

West North Central ......................................................................................................................................... 169 0 

West South Central ........................................................................................................................................ 367 0 

Mountain ......................................................................................................................................................... 159 0 

Pacific ............................................................................................................................................................. 380 0 

Puerto Rico ..................................................................................................................................................... 50 0 

Rural by Region: 

New England .................................................................................................................................................. 23 0 

Middle Atlantic ................................................................................................................................................ 69 0 

South Atlantic ................................................................................................................................................. 165 0 

East North Central .......................................................................................................................................... 120 0 

East South Central ......................................................................................................................................... 170 0 

West North Central ......................................................................................................................................... 99 0 .1 

West South Central ........................................................................................................................................ 182 0 

Mountain ......................................................................................................................................................... 66 0 

Pacific ............................................................................................................................................................. 29 0 

Puerto Rico ..................................................................................................................................................... 1 0 

By Payment Classification: 

Urban hospitals ............................................................................................................................................... 2520 0 .1 

Large urban areas .......................................................................................................................................... 1384 0 .1 

Other urban areas .......................................................................................................................................... 1136 0 .1 

Rural areas ..................................................................................................................................................... 903 0 

Teaching Status: 

Nonteaching .................................................................................................................................................... 2391 0 

Fewer than 100 residents ............................................................................................................................... 792 0 .1 

100 or more residents .................................................................................................................................... 240 0 .2 

Urban DSH: 

Non-DSH ........................................................................................................................................................ 739 0 .1 

100 or more beds ........................................................................................................................................... 1547 0 .1 

Less than 100 beds ........................................................................................................................................ 337 0 

Rural DSH: 

SCH ................................................................................................................................................................ 417 0 

RRC ................................................................................................................................................................ 222 0 

100 or more beds ........................................................................................................................................... 27 0 .1 

Less than 100 beds ........................................................................................................................................ 134 0 .1 

Urban teaching and DSH: 

Both teaching and DSH .................................................................................................................................. 827 0 .1 

Teaching and no DSH .................................................................................................................................... 144 0 .2 

No teaching and DSH .................................................................................................................................... 1057 0 

No teaching and no DSH ............................................................................................................................... 492 0 .1 

Special Hospital Types: 

RRC ................................................................................................................................................................ 175 0 

SCH ................................................................................................................................................................ 320 0 

MDH ................................................................................................................................................................ 193 0 

SCH and RRC ......................................................................................................................................... 120 0 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 23727 

TABLE I—IMPACT ANALYSIS OF CHANGES FOR FY 2012 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT

SYSTEM—Continued 

Number of 

hospitals 

Percent net effect of all 

changes for FY 

2012 

MDH and RRC ........................................................................................................................................ 18 0 

Type of Ownership: 

Voluntary ......................................................................................................................................................... 1985 0 .1 

Proprietary ...................................................................................................................................................... 870 0 .1 

Government .................................................................................................................................................... 566 0 

Medicare Utilization as a Percent of Inpatient Days: 

0–25 ................................................................................................................................................................ 358 0 

25–50 .............................................................................................................................................................. 1695 0 .1 

50–65 .............................................................................................................................................................. 1081 0 .1 

Over 65 ........................................................................................................................................................... 198 0 .1 

FY 2012 Reclassifications by the Medicare Geographic Classification Review Board: 

All Reclassified Hospitals ............................................................................................................................... 655 0 .2 

Non-Reclassified Hospitals ............................................................................................................................. 2768 0 

Urban Hospitals Reclassified ......................................................................................................................... 323 0 .3 

Urban Nonreclassified Hospitals, FY 2012 .................................................................................................... 2142 0 

All Rural Hospitals Reclassified FY 2012 ...................................................................................................... 332 0 

Rural Nonreclassified Hospitals FY 2012 ...................................................................................................... 532 0 

All Section 401 Reclassified Hospitals ........................................................................................................... 40 0 

Other Reclassified Hospitals (Section 1886(d)(8)(B)) .................................................................................... 62 0 

Specialty Hospitals: 

Cardiac specialty Hospitals ............................................................................................................................ 19 0 

2. Under the OPPS 

In the Table II, we provide an impact 

analysis for changes to the OPPS 

payments in CYs 2011 and 2012 as a 

result of the changes under section 302 

of the TPTCCA and section 3001 of the 

MCTRJCA. 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 II shows the overall impact 

on the 3,894 hospitals included in the 

analysis. The impact analysis reflects 

the change in estimated OPPS payments 

in CYs 2011 and 2012 due to section 

302 of the TPTCCA and section 3001 of 

the MCTRJCA relative to estimated 

OPPS payments published in the CY 

2011 OPPS final rule (75 FR 72268) and 

promulgated in the CY 2012 OPPS final 

rule. Overall, all hospitals will 

experience an estimated 0.0 percent 

increase in OPPS payments in CYs 2011 

and 2012 due to these provisions 

compared to the previous estimates of 

OPPS payments published in the CY 

2012 OPPS final rule. Because the 

changes are not budget neutral, all 

hospitals, depending on whether they 

were affected by these provisions, will 

either experience no change or an 

increase in OPPS payments in CYs 2011 

and 2012 in this notice relative to the 

previously published estimates. As 

such, hospitals located in urban areas 

will generally not experience any 

change in payments while hospitals 

located in rural areas will generally not 

experience any change in payments in 

CY 2012 due to the provisions in this 

notice as compared to the estimated 

payments provided in the CY 2012 

OPPS 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 

0.0 percent to 0.1 percent. 

TABLE II—IMPACT ANALYSIS OF CHANGES FOR CYS 2011 AND 2012 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT

SYSTEM

Number of 

hospitals 

Percent net 

effect of all 

changes for 

CY 2011 

Percent net 

effect of all 

changes for 

CY 2012 

All Hospitals (excludes hospitals held harmless and CMHCs) ................................................... 3,894 0.0 0.0 

Urban Hospitals ........................................................................................................................... 2,945 0.0 0.0 

Large urban (>1 Million) ....................................................................................................... 1,607 0.0 0.0 

Other urban (≤1 Million) ....................................................................................................... 1,338 0.0 0.0 

Rural Hospitals ............................................................................................................................ 949 0.0 0.0 

Sole Community ................................................................................................................... 384 0.1 0.1 

Other Rural ........................................................................................................................... 565 0.0 0.0 

Beds (Urban) 

0–99 Beds ............................................................................................................................ 1,028 0.0 0.0 

100–199 Beds ...................................................................................................................... 841 0.0 0.0 

200–299 Beds ...................................................................................................................... 454 0.0 0.0 

300–499 Beds ...................................................................................................................... 419 0.0 0.1 

500 + Beds ........................................................................................................................... 203 0.0 0.0 

Beds (Rural) 

0–49 Beds ............................................................................................................................ 349 0.0 0.0 

50–100 Beds ........................................................................................................................ 355 0.0 0.1 

101–149 Beds ...................................................................................................................... 140 0.0 0.0 


tkelley on DSK3SPTVN1PROD with NOTICES
23728 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 

TABLE II—IMPACT ANALYSIS OF CHANGES FOR CYS 2011 AND 2012 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT

SYSTEM—Continued 

Number of 

hospitals 

Percent net 

effect of all 

changes for 

CY 2011 

Percent net 

effect of all 

changes for 

CY 2012 

150–199 Beds ...................................................................................................................... 57 0.0 0.0 

200 + Beds ........................................................................................................................... 48 0.0 0.1 

Volume (Urban) 

<5,000 lines .......................................................................................................................... 597 0.0 0.0 

5,000–10,999 lines ............................................................................................................... 146 0.0 0.0 

11,000–20,999 lines ............................................................................................................. 235 0.0 0.0 

21,000–42,999 lines ............................................................................................................. 477 0.0 0.0 

42,999–89,999 lines ............................................................................................................. 713 0.0 0.0 

>89,999 lines ........................................................................................................................ 777 0.0 0.0 

Volume (Rural) 

<5,000 lines .......................................................................................................................... 67 0.0 0.0 

5,000–10,999 lines ............................................................................................................... 71 0.0 0.0 

11,000–20,999 lines ............................................................................................................. 174 0.0 0.0 

21,000–42,999 lines ............................................................................................................. 282 0.0 0.0 

>42,999 lines ........................................................................................................................ 355 0.0 0.0 

Region (Urban) 

New England ........................................................................................................................ 150 0.1 0.1 

Middle Atlantic ...................................................................................................................... 355 0.1 0.1 

South Atlantic ....................................................................................................................... 449 0.0 0.0 

East North Cent .................................................................................................................... 472 0.1 0.1 

East South Cent ................................................................................................................... 183 0.0 0.0 

West North Cent ................................................................................................................... 190 0.0 0.0 

West South Cent .................................................................................................................. 498 0.0 0.0 

Mountain ............................................................................................................................... 208 0.0 0.0 

Pacific ................................................................................................................................... 394 0.0 0.0 

Puerto Rico ........................................................................................................................... 46 0.0 0.0 

Region (Rural) 

New England ........................................................................................................................ 25 0.0 0.0 

Middle Atlantic ...................................................................................................................... 67 0.0 0.0 

South Atlantic ....................................................................................................................... 162 0.0 0.0 

East North Cent .................................................................................................................... 128 0.1 0.1 

East South Cent ................................................................................................................... 170 0.0 0.0 

West North Cent ................................................................................................................... 101 0.1 0.1 

West South Cent .................................................................................................................. 200 0.0 0.0 

Mountain ............................................................................................................................... 67 0.0 0.1 

Pacific ................................................................................................................................... 29 0.1 0.1 

Teaching Status 

Non-Teaching ....................................................................................................................... 2,895 0.0 0.0 

Minor ..................................................................................................................................... 708 0.0 0.0 

Major ..................................................................................................................................... 291 0.1 0.1 

DSH Patient Percent 

0 ............................................................................................................................................ 11 0.0 0.0 

>0–0.10 ................................................................................................................................. 353 0.0 0.0 

0.10–0.16 .............................................................................................................................. 357 0.1 0.1 

0.16–0.23 .............................................................................................................................. 734 0.0 0.1 

0.23–0.35 .............................................................................................................................. 1,040 0.0 0.0 

≥0.35 ..................................................................................................................................... 785 0.0 0.0 

DSH Not Available * .............................................................................................................. 614 0.0 0.0 

Urban Teaching/DSH 

Teaching & DSH ................................................................................................................... 903 0.0 0.1 

No Teaching/DSH ................................................................................................................. 1,456 0.0 0.0 

No teaching/No DSH ............................................................................................................ 10 0.0 0.0 

DSH not Available ................................................................................................................ 576 0.0 0.0 

Type Of Ownership 

Voluntary ............................................................................................................................... 2,061 0.0 0.0 

Proprietary ............................................................................................................................ 1,272 0.0 0.0 

Government .......................................................................................................................... 561 0.0 0.0 

** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care 

hospitals. 

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 

As required by OMB Circular A–4 

(available at http://www.whitehousegov/ 

omb/circulars/a004/a-4.pdf), in Table 

III, we have prepared an accounting 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Notices 23729 

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 2012 IPPS final rule, 

the changes in this notice are projected 

to increase FY 2012 IPPS operating 

payments by $90 million and IPPS 

capital payments by $ 8 million. As 

previously discussed, relative to what 

was projected in the CY 2012 OPPS 

final rule, the changes in this notice will 

increase CY 2011 OPPS payments by 

$11 million, and will increase CY 2012 

OPPS payments by $15 million. Thus, 

the total increase in Federal 

expenditures for implementing section 

302 of the TPTCCA and section 3001 of 

the MCTRJCA under the IPPS and the 

OPPS is approximately $124 million. 

TABLE III—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM PUBLISHED

FY 2012 TO REVISED FY 2012 AND UNDER THE OPPS FROM PUBLISHED CYS 2011 AND 2012 TO REVISED CYS

2011 AND 2012 

Category Transfers 

Annualized Monetized Transfers .............................................................. $124 million. 

From Whom to Whom .............................................................................. Federal Government to IPPS and OPPS Medicare Providers. 

Total ................................................................................................... $124 million. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: March 1, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: March 23, 2012. 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2012–9598 Filed 4–19–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Tribal Personal Responsibility 

Education Program (Tribal PREP) 

Implementation Plan and PPR. 

OMB No: New Collection. 

Description: Description: The Patient 

Protection and Affordable Care Act, 

2010, also known as health care reform, 

amends Title V of the Social Security 

Act (42 U.S.C. 701 et seq.) as amended 

by sections 2951 and 2952(c), by adding 

section 513, authorizing the Personal 

Responsibility Education Program 

(PREP). The President signed into law 

the Patient Protection and Affordable 

Care Act on March 23, 2010, Public Law 

111–148, which adds the new PREP 

program and provisions for a 5% setaside for Tribes and tribal organizations. 

The purpose of this program is to: 

Educate adolescents on both abstinence 

and contraception; to prevent pregnancy 

and sexually transmitted infections; and 

at least three adulthood preparation 

subjects. The PREP grant funding is 

authorized from FY 2010 through FY 

2014. 

A request is being made to solicit 

comments from the public on 

paperwork reduction as it relates to 

ACYF’s receipt of the following 

documents from awardees: 

Respondents: 16 Tribal PREP 

grantees. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per 

response 

Total 

burden hours 

Tribal PREP Implementation Plan ................................................................... 16 1 50 800 

Performance Progress Reports ....................................................................... 16 2 30 960 

Estimated Total Annual Burden 

Hours: 1760. 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Planning, Research and Evaluation, 370 

L’Enfant Promenade SW., Washington, 

DC 20447, Attn: ACF Reports Clearance 

Officer. All requests should be 

identified by the title of the information 

collection. Email address: 

infocollection@acf.hhs.gov. 

OMB Comment: OMB is required to 

make a decision concerning the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: Office 

of Management and Budget, Paperwork 

Reduction Project, Email: 

OIRA_SUBMISSION@OMB.EOP.GOV, 

Attn: Desk Officer for the 

Administration for Children and 

Families. 

Robert Sargis, 

Reports Clearance Officer. 

[FR Doc. 2012–9544 Filed 4–19–12; 8:45 am] 

BILLING CODE 4184–01–P 


tkelley on DSK3SPTVN1PROD with NOTICES