DEPARTMENT OF HEA LTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412 and 413
[CMS-1498-P2]

RIN 0938-AP80
Medicare Program; Supplemental Proposed Changes to the Hospital Inpatient Prospective
Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective
Payment System and Supplemental Proposed Fiscal Year 2011 Rates

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

ACTION: Proposed rule.

SUMMARY: This proposed rule is a supplement to the fiscal year (FY) 2011 hospital inpatient
prospective payment systems (IPPS) and long-term care prospective payment system
(LTCH PPS) proposed rule published in the May 4, 2010 Federal Register . This supplemental
proposed rule would implement cer tain statutory provisions rela ting to Medicare payments to
hospitals for inpatient services that are contained in the Patient Protection and Affordable Care

Act and the Health Care and Education Reconciliati on Act of 2010 (collectively known as the
Affordable Care Act). It would also specify statutorily required changes to the amounts and

factors used to determine the rates for Medi care acute care hospital inpatient services for
operating costs and capital-related costs, a nd for long-term care hospital costs.

DATES : To be assured considera tion, comments must be receive d at one of the addresses
provided below, no later than 5 p.m. on [ O F R

- - i n s e r t d a t e 3 0 d a y s a f t e r d a t e o f p u b l i c a t i o n i n t h e Federal Register]

. ADDRESSES: In commenting, please refer to file c ode CMS-1498-P2. Becau se of staff andCMS-1498-P2 2

resource limitations, we cannot accept comme nts by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one of the ways
listed):
1. Electronically . You may submit electronic comments on this regulation to
http://www.reg ulations.gov . Follow the instructions for submitting a comment.
2. By regular mail . You may mail written comments to the following address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1498-P2,
P.O. Box 8011,
Baltimore, MD 21244-1850.

Please allow sufficient time for mailed comments to be received before the close of the
comment period.
3. By express or overnight mail . You may send written comments to the following

address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1498-P2,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier . If you prefer, you may deliver (by hand or courier) your written
comments before the close of the comment period to either of the follo wing addresses:CMS-1498-P2 3

a. For delivery in Washington, DC--
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW.,
Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building is not readily
available to persons without Fe deral government identification, commenters are encouraged to
leave their comments in the CMS drop slots located in the main lobby of the building. A stampin clock is available for persons wishing to retain a proof of filing by stamping in and retaining
an extra copy of the comments being filed.)
b. For delivery in Baltimore, MD--
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address, please call telephone
number (410) 786-7195 in advance to schedule your arrival with one of our staff members.

Comments mailed to the addresses indicated as appropriate for ha nd or courier delivery
may be delayed and receive d after the comment period.

Submission of comments on paperwork requirements . You may submit comments on
this document's paperwork requi rements by following the instructions at the end of the
"Collection of Information Requireme nts" section in this document.CMS-1498-P2 4

For information on viewing public comments, see the beginning of the

"SUPPLEMENTARY INFORMATION" section.

FOR FURTHER INFO RMATION CONTACT:
Tzvi Hefter, (410) 786-4487, and Ing-Jye Ch eng, (410) 786 4548, Operating Prospective
Payment, Wage Index, Hospital Geographic Recl assifications, Capital Prospective Payment,
Critical Access Hospital (CAH).
Michele Hudson, (410) 786-4487, and Judith Rich ter, (410) 786-2590, Long -Term Care Hospital
Prospective Payment.
Siddhartha Mazumdar, (410) 786-6673, Rural Community Hospita l Demonstration Program

Issues.

SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the close of the comment
period are available for viewing by the public , including any personally identifiable or
confidential business information that is included in a comment. We post all comments received
before the close of the comment period on the follo wing Web site as soon as possible after they
have been received: http://www.regulations.gov. Fo llow the search instructions on that Web site
to view public comments.
Comments received timely will also be ava ilable for public inspection as they are
received, generally beginning a pproximately 3 weeks after publi cation of a document, at the
headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To
schedule an appointment to view public comments, phone 1-800-743-3951.

Electronic AccessCMS-1498-P2 5

This Federal Register document is also available from the Federal Register online
database through GPO Access , a service of the U.S. Government Printing Office. Free public
access is available on a Wide Area Information Server (WAIS) through the Internet and via
asynchronous dial-in. Internet users can access th e database by using the World Wide Web, (the
Superintendent of Documents' home Web page address is http://www.gpoaccess.gov/), by using
local WAIS client software, or by telnet to swais.access.gpo.gov, then login as guest (no
password required). Dial-in user s should use communications soft ware and modem to call (202)
512-1661; type swais, then login as guest (no password required).
I. Background
On March 23, 2010, the Patient Protection a nd Affordable Care Act (Pub. L. 111-148)
was enacted. Following the enactment of P ub. L. 111-148, the Health Care and Education

Reconciliation Act of 2010 Pub. L. 111-152 (enacted on Marc h 30, 2010), amended certain
provisions of Pub. L. 111-148. These public laws are collectively known as the Affordable Care
Act. A number of the provisions of Pub. L. 111-148, affect the IPPS and the LTCH PPS and the
providers and suppliers addressed in this proposed rule. However, due to the timing of the
passage of the legislation, were unable to address those provisions in the FY 2011 IPPS and
LTCH PPS proposed rule that appeared in the May 4, 2010 Federal Register (75 FR 23852).
Therefore, the proposed policies a nd payment rates in that proposed rule did not reflect the new
legislation. We noted in that proposed rule that we would issue separate Federal Register
documents addressing the provisions of Pub. L. 111-148 that affect our proposed policies and
payment rates for FY 2010 and FY 2011 under the IPPS and the LTCH PPS. This supplementary
proposed rule addresses the followi ng provisions of the new legisla tion that affect the following
FY 2011 proposed policies:CMS-1498-P2 6

• Hospital wage index improvement related to geographic reclassification criteria for
FY 2011 (section 3137 of Pub. L. 111-148).

• National budget neutrality in the calculation of the rural floor for hospital wage index
(section 3141 of Pub. L. 111-148).

• Protections for frontier States (section 10324 of Pub. L. 111-148).

• Revisions of certain market ba sket updates (sections 3401 and 10319 of
Pub. L. 111-148 and section 1105 of Pub. L. 111-152).

• Temporary improvements to the low-vol ume hospital adjustment (sections 3125 and
10314 of Pub. L. 111-148).

• Extension of Medicare-de pendent hospitals (MDHs) (s ection 3124 of Pub. L. 111-148).

• Additional payments in FYs 2011 and 2012 for qualifying hospitals in the lowest
quartile of per capital Medi care spending (section 1109 of Pub. L. 111-152).

• Extension of the rural community hospital demonstra tion (section 3123 of
Pub. L. 111-148).

• Technical correction related to critical access hospital (CAH) services (section 3128 of
Pub. L. 111-148).

• Extension of certain payment rules fo r long-term care hospital services and of

moratorium on the establishment of certain hospitals and facilities (sections 3106 and 10312of
Pub. L. 111-148).
We also noted that we plan to issue furt her instructions impleme nting the provisions of
Pub. L. 111-148 that affect the policies and payment rates for FY 2010 under the IPPS and for
RY 2010 under the LTCH PPS in a separate document published elsewhere in this FederalCMS-1498-P2 7

Register

. II. Provisions of the Proposed Regulations
In this section of this supplementary propos ed rule, we address th e provisions of Pub. L.
111-148, that affect our proposed policies and payment rates for FY 2011 under the IPPS and the

LTCH PPS.
A. Changes to the Acute Care Hospital Wage Index
1. Plan for Reforming the Wage Index
Section 3137(b) of Pub. L. 111- 148 requires the Secretary of Health and Human Services
to submit to Congress, not later than December 31, 2011, a report that includes a plan to reform
the Medicare wage index applied under the Medicare IPPS. In developing the plan, the Secretary
of Health and Human Services must take into consideration the goals for reforming the wage
index that were set forth by the MedPAC in its June 2007 report entitled, "Report to Congress:
Promoting Greater Efficiency in Medicare", in cluding establishing a new system that –

● Uses Bureau of Labor of Statistics (BLS ) data, or other data or methodologies, to
calculate relative wages for each geographic area;

● Minimizes wage index adjustments between and within MSAs and statewide rural

areas;

● Includes methods to minimize the vola tility of wage index adjustments while
maintaining budget neutrality in applying such adjustments;

● Takes into account the effect that impleme ntation of the system would have on health
care providers and on each region of the country;

● Addresses issues re lated to occupational mix, such as staffing practices and ratios, and
any evidence on the effect on quality of care or patient safety as a result of the implementation ofCMS-1498-P2 8

the system; and

● Provides for a transition.
In addition, section 3137(b)(3) of Pub. L. 111-148 requires the Secretary of Health and Human

Services to consult with relevant affected parties in developing the plan. Although the provisions
of section 3137(b) of Pub. L. 111-148 will not have an actual impact on the FY 2011 wage, we
are notifying the public of the provisions so th at they may provide comments and suggestions on
how they may participate in developing the plan.
2. Provisions on Wage Comparability and Rural/Imputed Floor Budget Neutrality.
Sections 3137(c) and 3141 of Pub. L. 111-148 a ffect reclassification average hourly wage
comparison criteria and rural and imputed fl oor budget neutrality provisions for FY 2011.
a. Reclassification Average Hourly Wage Comparison Criteria
In the FY 2009 IPPS final rule, we adopted the policy to adjust the reclassification average
hourly wage standard, comparing a reclassifying hospital's (or county hospital group's) average
hourly wage relative to the average hourly wage of the area to which it seeks reclassification. (We
refer readers to the FY 2009 IPPS final rule for a full discussion of the basis for the proposals the
public comments received and the FY 2009 final policies.) We pr ovided for a phase-in of the
adjustment over 2 years. For applications for r eclassification for the firs t transitional year, FY 2010,
the average hourly wage standards were set at 86 percent for urban hospitals and group
reclassifications, and 84 percent fo r rural hospitals. For applicati ons for reclassification for FY 2011
(for which the application deadline was September 1, 2009) and for subsequent fiscal years, the
average hourly wage standards were 88 percent fo r urban and group reclassi fications and 86 percent
for rural hospitals. Sections 412.230, 412.232, a nd 412.234 of the regulati ons were revised
accordingly. These policies were adopted in the FY 2009 IPPS final rule and were reflected in theCMS-1498-P2 9

wage index in the Addendum to the FY 2011 IPPS proposed rule, which appeared in the Federal
Register on May 4, 2010.
However, provisions of sec tion 3137(c) of Pub. L. 111-148 recently revised the average
hourly wage standards. Specifica lly, section 3137(c) restores the av erage hourly wage standards that
were in place for FY 2008 (that is, 84 percen t for urban hospitals, 85 percent for group
reclassifications, and 82 percent fo r rural hospitals) for applications for reclassification for FY 2011
and for each subsequent fiscal year until the first fiscal year beginning on or after the date that is one
year after the Secretary of Health and Human Services submits a report to Congress on a plan for
reforming the wage index under 3137(b) of P ub. L. 111-148. Section 3137(c) of Pub. L. 111-148
also requires the revised average hourly wage standards to be app lied in a budget neutral manner.
We note that section 3137(c) of Pub. L. 111-148 doe s not provide for the revised average hourly
wage standards to be app lied retroactively, nor does it change th e statutory deadline for applications

for reclassification for FY 2011. Under section 1886(d)(10) of the Act, the Medicare Geographic
Classification Review Board (MGCRB) consider s applications by hospitals for geographic
reclassification for purposes of payment under the IPPS. Hospitals must apply to the MGCRB to
reclassify 13 months prior to the st art of the fiscal year for which reclassification is sought (generally
by September 1). For reclassifica tions for the FY 2011 wage index, the deadline for applications was
September 1, 2009 (74 FR 43838).
In implementing section 3137(c) of Pub. L. 111-148, we requested the assistance of the
MGCRB in determining, for applications r eceived by September 1, 2009, whether additional
hospitals would qualify for reclassification for FY 2011 based on the revised average hourly wage
standards of 84 percent for urban hospitals, 85 percent for group recl assifications, and 82 percent for
rural hospitals. We determined that18 additional hospitals would qua lify for reclassification for FYCMS-1498-P2 10

2011. Also, 5 hospitals, for which the MGCRB granted reclassifications to th eir secondary requested
areas for FY 2011, would qualify for reclassificati ons instead to their primary requested areas
because they now meet the average hourly wage criteri a to reclassify to thos e areas. Therefore, in
accordance with §412.278 of the regulations, in whic h paragraph (c) provide s the Administrator
discretionary authority to review any final decision of the MGCRB, we submitted a letter to the
Administrator requesting that she review a nd amend the MGCRB's decision and grant the 23
hospitals their requested recl assifications (or primary r eclassifications) for FY 2011.
The wage index in the Addendum to this supplemental FY 2011 IPPS proposed rule reflects
these changes in hospital reclassifications, althoug h the Administrator had not issued all of her
decisions by the date of this proposed rule. In calculating the wage index in this proposed rule, we
made assumptions that the Administrator would grant the 23 hospitals their requested
reclassifications (or primary r eclassifications) and that the hos pitals would not request the

Administrator to amend her decisi ons. Generally, these reclassifica tions would result in the highest
possible wage index for the hospitals. Any chan ges to the wage index, as a result of the
Administrator's actual decision issued under §412.278(c) , or an amendment of the Administrator's
decision issued under paragraph (g), will be reflected in the FY 2011 IPPS final rule.
In accordance with the requirements in secti on 3137(c) of Affordable Care Act, we are
modifying § 412.230, §412.232, and §412.234 of the regulations to codify the revised average hourly
wage standards.
b. Budget Neutrality Adjustment for the Rural and Imputed Floors
In the FY 2009 IPPS final rule (73 FR 48574 through 48575), we adopted State level budget
neutrality (rather than the nationa l budget neutrality adjustment) for the rural and imputed floors,
effective beginning with the FY 2009 wage index a nd incorporated this policy in our regulation atCMS-1498-P2 11

§412.64(e)(4). Specifically, the regulations specified that CMS makes an adjustment to the wage
index to ensure that aggregate payments after imp lementation of the rural floor under section 4410 of
the Balanced Budget Act of 1997 (Pub. L. 105- 33) and the imputed floor under §412.64(h)(4) are
made in a manner that ensures that aggregate payments to hospitals are not affected and that,
beginning October 1, 2008, we would transition fro m a nationwide adjustment to a statewide
adjustment, with a statewide adjustme nt fully in place by October 1, 2010.
These policies for the rural and imputed floors were adopted in the FY 2009 IPPS final rule
and were reflected in the wage index in the Addendum to the FY 2011 IPPS/LTCH PPS
proposed rule, published in the Federal Register on May 4, 2010. However, these policies were
recently changed by the provisions of secti on 3141 of Pub. L. 111-148. Specifically, section

3141 of Affordable Care Act re scinds our policy establishing a statewide budget neutrality
adjustment for the rural and imputed floors a nd, instead, restores it to a uniform, national
adjustment, beginning with the FY 2011 wage inde x. Additionally, the imputed floor, is set to
expire on September 30, 2011. We do not read s ection 3141 of Pub. L. 111-148 as altering this
expiration date. Section 3141 of Pub. L. 111-148 re quires that we "administer subsection (b) of
such section 4410 and paragraph (e ) of . . . section 412.64 in the same manner as the Secretary
administered such subsection (b) and paragraph (e) for discharges occurring during fiscal year
2008 (through a uniform, national adjustment to th e area wage index)." Thus, section 3141 of
Pub. L. 111-148 is governing how we apply budg et neutrality, under the authorities of §412.64(e)
and section 4410(b) of the Balanced BudgetAct, but it does not alter §412.64(h) of our
regulations (which includes the imputed floor and its expiration date). To the extent there is an
imputed floor, section 3141 of Pub. L. 111-148 gove rns budget neutrality for that floor, but it
does not continue the imputed floor beyond th e expiration date already included in ourCMS-1498-P2 12

regulations.
Therefore, the wage index in the Addendum to this supplemental FY 2011 IPPS proposed
rule reflects a uniform, national budg et neutrality adjustment for the rural and imputed floors, which

is a factor of 0.995425.
3. Frontier States Floor (§412.64)
In accordance with section 10324(a) of Afford able Care Act, beginning in FY 2011, the
statute provides for establishing an adjustment to create a wage index floor of 1.00 for all
hospitals located in States determined to be Fr ontier States. The statute defines any State as a
Frontier State if at least 50 percent of the State's counties are determined to be Frontier Counties.

The statute defines as counties that have a population density less than 6 persons per square
mile. The law requires that this provision shall not apply to hospitals in Alaska or Hawaii
receiving a non-labor related share adjustme nt under section 1886(d)(5)(H) of the Act.
To implement this provision, we propose to identify Frontier Counties by analyzing
population data and county defi nitions based upon the most r ecent annual Population Estimates
published by the U.S. Census Bureau. We w ill divide each county's population total by each
county's reported land area (according to the dece nnial census) in square miles to establish
population density. We also pr opose to update this analysis from time to time, such as upon
publication of a subsequent decenni al census, and if necessary, a dd or remove qualifying States
from the list of Frontier States based on the updated analysis.
For a State that qualifies as a Frontier St ate, in accordance with section 10324(a) of
Pub. L. 111-148, all PPS hospitals located within that State will receive either the higher of its
post-reclassification wage inde x rate, or a minimum value of 1.00. We propose that, for a
hospital that is geographically located in a Fr ontier State and is recl assified under sectionCMS-1498-P2 13

1886(d)(10) of the Act to a CBSA in a non-Frontie r State, the hospital will receive a wage index
that is the higher of the recl assified area wage index or th e minimum wage index of 1.00. In
accordance with section 10324(a) of Pub. L. 111-148, the Frontier State adjustment will not be
subject to budget neutrality under section 1886(d)(3 )(E) of the Act, and will only be extended to
hospitals geographically located within a Frontier State. We propose to calculate and apply the
Frontier State floor adjustments after rural and imputed floor budg et neutrality adjustments are
calculated for all labor market areas, so as to ensure that no hospital in a Frontier State will
receive a wage index lesser than 1.00 due to the ru ral and imputed floor adjustment. We invite
public comment on these proposals regarding our methods for determining Frontier States, and
for calculation and application of the adjustment.
For the proposed FY 2011 IPPS wage index, the Frontier States are the following:
reflected in the following table:

Table 1. Frontier States Under Section 10324(a)

State Total Counties Frontier Counties Percent Frontier Counties Montana 56 45 80% Wyoming 23 17 74% North Dakota 53 36 68% Nevada 17 11 65% South Dakota 66 34 52%
Frontier States are identified by a footnote in Ta ble 4D-2 of the Addendum to this supplemental proposed rule. Popul ation Data set: http://www.census.gov/pope st/estimates.html (2009 County Total Populati on Estimates) Land Area Dataset: http://factfinder.census.gov/ (Decennial Census Geographic Comparison Tables: "United States—County by State and for Puerto Rico")

4. Revised FY 2011 IPPS Proposed Rule Wage Index Tables
The revised IPPS proposed wage index values for FY 2011, reflecting the provisions of
sections 3137(c), 3141, and 10324 of Pub. L. 111-148, ar e included in Tables 2, 4A, 4B, 4C, andCMS-1498-P2 14

4D-2 of the Addendum to this supplemental FY 2011 IPPS/LTCH PPS proposed rule.
Table 4D-1, which listed the statewide rural and imputed floor budget neutrality factors,
is eliminated from the Addendum to this supplemental FY 2011 IPPS/LTCH PPS proposed rule
and is no longer applicable for the wage i ndex because section 3141 of Pub. L. 111-148 instead
requires the application of a national adjustment.
Table 4J, which lists the out-migration adjus tment for a qualifying c ounty, is revised due
to the above provisions of Affordab le Care Act. Additi onally, Table 9A, the list of hospitals that
are reclassified or redesign ated for FY 2011, is revised according to section 3137(c) of

Pub. L. 111-148. Both revised tables are incl uded in the Addendum to this supplemental
FY 2011 IPPS/LTCH PPS proposed rule.
Tables 3A and 3B, which list the 3-year av erage hourly wage for each labor market area
before the redesignation or recl assification of hospitals, Table 4E, the list of urban CBSAs and
constituent counties, Table 4F, the Puerto Rico wa ge index, and Table 9C, the list of hospitals
redesignated under section 1886(d)(8)(E) of the Ac t, are unaffected by the above provisions of
Affordable Care Act. Therefore, these tables are unchanged from the initial FY 2011
IPPS/LTCH PPS proposed rule and are not included in the Addendum to this supplemental
FY 2011 IPPS/LTCH PPS proposed rule.

5. Procedures for Withdrawin g Reclassifications in FY 2011
Section 1886(d)(10)(D)(v) of the Act states that th e Secretary should es tablish procedures
under which a subsection (d) hospital may elect to te rminate a reclassificati on before the end of a
3-year period, but does not contain any other sp ecifics regarding how such termination should
occur. Our rules at 42 CFR 412.273 state that hosp itals that have been reclassified by the
MGCRB are permitted to withdraw their applications within 45 da ys of the publication of CMS'sCMS-1498-P2 15

annual notice of proposed rulemaki ng. For purposes of this supplementary proposed rule, we
interpret our regulation as referring to the initial FY 2011 IPPS/LTCH PPS proposed rule (which
appeared in the May 4, 2010 Federal Register ), and our procedure for this supplementary
proposed rule is to start the time period for requesting a withdrawal or termination from
publication of that initial proposed rule. Were we not to use such a time period, requests for

termination and withdrawal would be received too late to include in our final rule. Thus, all
requests for withdrawal of an app lication for reclassification or te rmination of an existing 3-year

reclassification that would be effective in FY 2011 must be received by the MGCRB by
June 18, 2010.
We note that wage index values in the ta bles in the Addendum to this supplemental
FY 2011 IPPS/LTCH PPS proposed rule may have changed somewhat from the initial, more
comprehensive FY 2011 IPPS/LTCH PPS proposed rule (which appeared in the May 4, 2010
Federal Register ) due to the application of secti ons 3137(c), 3141, and 10324 of Affordable
Care Act. In addition, as a re sult of section 3137(c) of Afford able Care Act, there may be
additional hospitals listed as r eclassified in Table 9A in th e Addendum to this supplemental
proposed rule. Hospitals have sufficient time between the displa y or publication date of this
supplemental FY 2011 IPPS/LTCH PPS proposed rule in the Federal Register and the
June 18, 2010 deadline for withdrawals and termina tions to evaluate and make determinations
regarding their reclassification for the FY 2011 wage index. As noted in the initial FY 2011
IPPS proposed rule, the mailing address of the MG CRB is: 2520 Lord Baltimore Drive, Suite L,
Baltimore, MD 21244-2670.
B. Inpatient Hospital Market Basket Update
Below we discuss the adjustments to the FY 2010 and FY 2011 market basket as requiredCMS-1498-P2 16

by the Affordable Care Act. In this supplemen tal proposed rule we are not proposing to address
the provisions of section 3401 of Pub. L. 111-148 providing for a productivity adjustment for
FY 2012 and subsequent fiscal years; rather, this change will be addressed in future rulemaking.
1. FY 2010 Inpatient Hospital Update
In accordance with section 1886(b)(3)(B)(i) of the Act, each year we update the national
standardized amount for inpatient operating costs by a factor ca lled the "applicable percentage

increase." Prior to enactment of Pub. L. 111-148 and Pub. L. 111-152, section
1886(b)(3)(B)(i)(XX) of the Act set the applicable percentage increase equal to the rate-ofincrease in the hospital market basket for IPPS hospitals in all areas, subject to the hospital
submitting quality information under rules estab lished by the Secretary in accordance with
section 1886(b)(3)(B)(viii) of the Act. For hospitals that do not provide these data, the update is
equal to the market basket percentage increas e less an additional 2.0 percentage points. In
accordance with these statutory provisions, in the FY 2010 IPPS/LTCH PPS final rule (74 FR
43850), we finalized an applicable percentage increase equal to th e full market basket update of
2.1 percent based on IHS Global Insight, Inc. 's second quarter 2009 forecast of the FY 2010
market basket increase, provided the hospital sub mits quality data in accordance with our rules.
For hospitals that do not submit quality data, in the FY 2010 IPPS/LTCH PPS final rule we
finalized an applicable percenta ge increase equal to 0.1 percent (that is, the FY 2010 estimate of

the market basket rate-of-incr ease minus 2.0 percentage points).
Sections 3401(a) and 10319 of Pub. L. 111- 148 amend section 1886(b)(3)(B)(i) of the
Act. Specifically, sections 3401(a) a nd 10319(a)of Pub. L. 111-148 amend section
1886(b)(3)(B)(i) of the Act to set the FY 2010 applicable percentage increase for IPPS hospitals
equal to the rate-of-increase in the hospital market basket for IPPS hospitals in all areas minus aCMS-1498-P2 17

0.25 percentage point, subject to the hosp ital submitting quality in formation under rules
established by the Secretary in accordance with section 1886(b)(3)(B)(viii) of the Act. For
hospitals that do not provide thes e data, the update is equal to the market basket percentage
increase minus 0.25 percentage point less an additional 2.0 percentage points. Section
3401(a)(4) of Pub. L. 111-148 further states that th ese amendments may result in the applicable
percentage increase being less than zero. Alt hough these amendments m odify the applicable
percentage increase applicable to the FY 2010 rates under the IPPS, section 3401(p) of

Pub. L. 111-148 states that the amendments do not apply to discharges occurring prior to
April 1, 2010. In other words, for discharges o ccurring on or after October 1, 2009 and prior to
April 1, 2010, the rate for a hospital's inpatient operating costs under the IPPS will be based on
the applicable percentage increase set forth in the FY 2010 IPPS/LTCH PPS final rule.
We are proposing to revise 42 CFR 412.64(d) to reflect current law. Specifically, in
accordance with section 1886(b)(3)(B)(i) of the Act as amended by sections 3401(a) and
10319(a) of Pub. L. 111-148, we are proposing to revi se §412.64(d) to state that for the first half
of FY 2010 (that is, discharges on or af ter October 1, 2009 through March 30, 2010), the
applicable percentage change equal the market basket index for IPPS hospitals (which is defined
under §413.40(a)) in all areas for hospitals that s ubmit quality data in accordance with our rules,
and the market basket index for IPPS hospitals in all areas less 2.0 percentage for hospitals that
fail to submit quality data in accordance with our rules. As noted above, in the FY 2010
IPPS/LTCH PPS final rule, we calculated that the full market basket update equals 2.1 percent
based on IHS Global Insight, Inc.'s second quart er 2009 forecast of the FY 2010 market basket
increase. In addition, we are proposing to revise §412.64(d) to state that for the second half of
FY 2010 (discharges on or after April 1, 2010 th rough September 30, 2010), in accordance withCMS-1498-P2 18

section 3401(a), we are proposing to set the applicable percentage change equal to the market
basket index for IPPS hospitals in all areas reduced by 0.25 percentage points for hospitals that
submit quality data in accordance with our rules. For those hospitals that fail to submit quality
data, in accordance with our rules, we are propos ing to reduce the market basket index for IPPS
hospitals by an additional 2.0 per centage points (which is in addition to the 0.25 percentage point
reduction required by section 1886(b)(3)(B)(i) of the Act as amended by section 3401(a) of
Pub. L. 111-148 as amended by section 10319(a) of Pub. L. 111-148. Based on IHS Global
Insight, Inc.'s second quarter 2009 forecast of the FY 2010 market basket increase, the FY 2010
applicable percentage change th at applies to rates for inpatient hospital operating costs under the
IPPS for discharges occurring in the second half of FY 2010 is 1.85 percent (that is, the FY 2010

estimate of the market basket rate-of-increase of 2.1 percent mi nus 0.25 percentage points) for
hospitals in all areas, provided th e hospital submits quality data in accordance with our rules. For
hospitals that do not submit quality data, the payment update to the operating standardized
amount is -0.15 percent (that is, the adjust ed FY 2010 estimate of the market basket
rate-of-increase of 1.85 percent minus 2.0 percentage points).
Section 1886(b)(3)(B)(iv) of the Act provides that the applicable percentage increase
applicable to the hospital-specific rates for SCHs and MDHs equals the applicable percentage
increase set forth in section 1886(b )(3)(B)(i) of the Act (that is, the same update factor as for all
other hospitals subject to the IPPS). Because th e Act sets the update factor for SCHs and MDHs
equal to the update factor for all other IPPS hospitals, the update to the hospital specific rates for
SCHs and MDHs is also subject to the amendm ents to section 1886(b)(3)(B)(i) made by section
3401(a) of Pub. L. 111-148. Accordingly, for hospita ls paid for their inpatient operating costs on
the basis of a hospital-specific rate, the rates pa id to such hospitals for discharges occurringCMS-1498-P2 19

during the first half of FY 2010 will be based on an a nnual update estimated to be 2.1 percent for
hospitals submitting quality data or 0.1 percent for hospital that fail to submit qua lity data; and
the rates paid to such hospitals for the second ha lf of FY 2010 will be base d on an update that is
estimated to be 1.85 percent for hospitals submitting quality data or -0.15 percent for hospitals
that fail to submit quality data . Similar to that stated a bove, we are proposing to update
§§412.73(c)(15), 412.75(d), 412.77(e) , 412.78(e), 412.79(d) to reflect current law.
2. FY 2011 Inpatient Hospital Update
As with the FY 2010 applicable percentage increase, section 3401(a) of Pub. L. 111-148
as amended by section 10319(a) of Pub. L. 111- 148, amends section 1886(b)(3)(B)(i) of the Act
to provide that the FY 2011 applicable percentage increase for IPPS hospitals equals the rate-ofincrease in the hospital market basket for IPPS hospitals in all areas reduced by 0.25 percentage
point, subject to the hospital submitting quality information under rules established by the
Secretary in accordance w ith section 1886(b)(3)(B)(viii) of the Act. For hospitals that do not
provide these data, the update is equal to the market basket percentage increase minus a 0.25
percentage point less an additi onal 2.0 percentage points. S ection 3401(a)(4) of Pub. L. 111-148
further states that this amendment may result in the applicable percentage increase being less

than zero.
In Appendix B of the FY 2011 IPPS/LTCH PPS proposed rule, we announced that due to
the timing of the passage of Pub. L. 111-148, we we re unable to address those provisions in the
proposed rule. In that proposed rule, consistent with current law, base d on IHS Global Insight,
Inc.'s first quarter 2010 forecast, with histori cal data through the 2009 fourth quarter, of the
FY 2011 IPPS market basket increase, we estimated that the FY 2011 update to the operating
standardized amount would be 2.4 pe rcent (that is, the current estimate of the market basket rate-CMS-1498-P2 20

of-increase) for hospitals in all areas, provide d the hospital submits quality data in accordance
with our rules. For hospitals that do not sub mit quality data, we estimated that the update to the
operating standardized amount woul d be 0.4 percent (that is, the cu rrent estimate of the market
basket rate-of-increase minus 2.0 percentage points). Since publication of the FY 2011
IPPS/LTCH PPS proposed rule our estimate of the market basket for FY 2011 has not changed.
However, consistent with the amendments to s ection 1886(b)(3)(B)(i) of the Act made by section
3401 of Pub. L. 111-148, for FY 2011 we are require d to reduce the hospital market basket
update by 0.25 percentage points. Therefore, based on IHS Global Insight, Inc.'s first quarter

2010 forecast of the FY 2011 market basket in crease, the estimated update to the FY 2011
operating standardized amount is 2.15 percent (that is, the FY 2011 es timate of the market basket
rate-of-increase of 2.4 percent mi nus 0.25 percentage points) for hos pitals in all areas, provided
the hospital submits quality data in accordance with our rules. For hospitals that do not submit
quality data, the estimated update to the operating standardized amount is 0.15 percent (that is,
the adjusted FY 2011 estimate of the market ba sket rate-of-increase of 2.15 percent minus 2.0
percentage points). We are proposing to revise §412.64(d) to reflect the provisions of section
3401(a) of Pub. L. 111-148.
Section 1886(b)(3)(B)(iv) of the Act provides that the FY 2011 applicable percentage
increase in the hospital-specific rates for SCHs and MDHs equals the a pplicable percentage
increase set forth in section 1886(b )(3)(B)(i) of the Act (that is, the same update factor as for all
other hospitals subject to the IPPS). Similar to the FY 2010 applicable percentage increase in the
hospital-specific rates, because the Act requires us to apply to the hospital-specific rates the
update factor for all other IPPS hospitals, the update to the hospital specific rates for SCHs and
MDHs is also subject to sec tion 1886(b)(3)(B)(i) as amended by the Affordable Care Act.CMS-1498-P2 21

Accordingly, the update to the hospital-specific ra tes applicable to SCHs and MDHs is estimated
to be 2.15 for hospitals that submit quality data or 0.15 percent for hospitals that fail to submit
quality data. Similar to above, we are proposing to update §§412.73(c )(15), 412.75(d),
412.77(e), 412.78(e), 412.79(d) to imp lement this provision.
3. FY 2010 and FY 2011 Puerto Rico Hospital Update
Puerto Rico hospitals are paid a blended ra te for their inpatient operating costs based on
75 percent of the national sta ndardized amount and 25 percent of the Puerto Rico-specific

standardized amount. Section 1886(d)(9)(C)(i) of the Act is the basis for determining the
applicable percentage increase a pplied to the Puerto Rico-specifi c standardized amount. Section
1886(d)(9)(C)(i) of the Act provides that the Puerto Rico standardized amount shall be adjusted

in accordance with the final determination of th e Secretary under section 1886(d)(4) of the Act.
Section 1886(e)(4)(1) of the Act in turn direct s the Secretary to r ecommend an appropriate
change factor for Puerto Rico hospitals taking in to account amounts nece ssary for the efficient
and effective delivery of medically appropriate and necessary care of high quality, as well as the

recommendations of MedPAC. In order to maintain consistency between the portion of the rates
paid to Puerto Rico hospitals under the IPPS based on the national standardized amount and the
portion based on the Puerto Rico-specific standard ized rate, beginning in FY 2004 we have set
the update to the Puerto Rico-specific operating standardized amount equa l to the update to the
national operating standardized amount for all IPPS hospitals. This policy is reflected in our
regulations at 42 CFR 412.211.

The amendments to section 1886(b)(3)(B)(i) of the Act by sections 3401(a) and section
10319(a) of Pub. L. 111-148, affect onl y the update factor applicable to the national standardized
rate for IPPS hospitals and the hospital-specific rates; they do not mandate any revisions to theCMS-1498-P2 22

update factor applicable to the Puerto Rico-s pecific standardized am ount. Rather, as noted
above, sections 1886(d)(9)(C)(i) and (e)(4) of the Act direct us to adopt an appropriate change
factor for the FY 2010 Puerto Rico-specific st andardized amount, which we did in the FY 2010
IPPS/LTCH PPS final rule after notice and consideration of public comments. Therefore, we do

not believe we have the aut hority to now propose setting the FY 2010 update factor for the
Puerto Rico-specific operating st andardized amount for the second half of FY 2010 equal to the
update factor applicable to the national standardized amount or th e hospital-specific rates (that is
the market basket minus 0.25 percentage points). Accordingly, the FY 2010 update to the Puerto
Rico-specific operating standardiz ed amount is 2.1 percent (that is, the FY 2010 estimate of the

market basket rate-of-incr ease) for the entire FY 2010.
For FY 2011, consistent with our past practice of applying the same update factor to the
Puerto Rico-specific standardized amount as applied to the nati onal standardized amount, we are
proposing to revise §412.211(c) to set the update factor for the Puerto Rico-specific operating
standardized amount equal to th e update factor applied to the national standardized amount for
all IPPS hospitals. Therefore, we are proposing an update factor for the Puerto Rico-specific
standardized amount equal to the FY 2011 estimate of the IPPS operating market basket
rate-of-increase of 2.4 percent minus 0.25 percentage points, or 2.15 percent, for FY 2011.
C. Payment Adjustment for Low-Volume Hospitals (§ 412.101)
Section 1886(d)(12) of the Ac t, as added by section 406 of Pub. L. 108–173, provides for
a payment adjustment to account for the higher costs per discharge for low-volume hospitals
under the IPPS, effective beginning FY 2005. Sections 3215 and 10314 of Pub. L. 111-148
amend the definition of a low-volume hospital under section 1886(d)(12)(C) of the Act. It also
revises the methodology for calculating the pa yment adjustment for low-volume hospitals.CMS-1498-P2 23

1. Background
Prior to being amended by the Affordable Ca re Act, section 1886(d)(12)(C)(i) of the Act
defined a low-volume hospital as "a subsection (d ) hospital (as defined in paragraph (1)(B)) that
the Secretary determines is located more than 25 road miles from another subsection (d) hospital
and that has less than 800 discharges during the fi scal year." Section 1886(d)(12)(C)(ii) of the
Act further stipulates that "the term "discharge" means an inpatient acute care discharge of an
individual regardless of whether th e individual is entitled to benef its under Part A." Therefore,

the term refers to total disc harges, not merely Medicare disc harges. Finally, under section 406,
the provision requires the Secretary to determine an applicable percentage increase for these lowvolume hospitals based on the "emp irical relationship" between "t he standardized cost-per-case
for such hospitals and the total number of discha rges of such hospitals and the amount of the
additional incremental costs (if any) that are asso ciated with such number of discharges." The

statute thus mandates that the S ecretary develop an empirically justifiable adjustment based on
the relationship between costs and discharges fo r these low-volume hospita ls. The statute also
limits the adjustment to no more than 25 percent.
Based on an analysis we conducted for the FY 2005 IPPS final rule (69 FR 49099 through
49102), a 25 percent low-volume adjustment to all qualifying hospitals with less than 200
discharges was found to be most consistent with the statutory re quirement to provide relief to
low-volume hospitals where there is empirical evidence that higher incremental costs are

associated with low numbe rs of total discharges.
In the FY 2006 IPPS final rule (70 FR 47432 through 47434), we stated that a
multivariate analyses supported the existing lo w-volume adjustment implemented in FY 2005.
Therefore, the low-volume adjustment of an add itional 25 percent would c ontinue to be providedCMS-1498-P2 24

for qualifying hospitals with less than 200 discharges.
2. Temporary Changes for FYs 2011 and 2012
Section 1886(d)(12) of the Act was amended by sections 3125 and 10314 of
Pub. L. 111-148. These changes are effective only for FYs 2011 and 2012. Beginning with FY
2013, the pre-existing low-volume hospital paymen t adjustment and qualifying criteria, as
implemented in FY 2005, will resume.
Section 3125(3) and 10314(1) ofPub. L. 111-148 amend the qualifying criteria for lowvolume hospitals under section 1886(d)(12)(C) of the Act to make it easier for hospitals to
qualify for the low-volume adjustment. Specifically , the revised provision specifies that for FYs
2011 and 2012, a hospital qualifies as a low-volume hospital if it is "more than 15 road miles
from another subsection (d) hospita l and has less than 1,600 discharg es of individuals entitled to,
or enrolled for, benefits under Pa rt A during the fiscal year." In addition, section 1886(d)(12)(C)
of the Act, as amended, provides that the paym ent adjustment (the applicable percentage
increase) is to be determined "using a conti nuous linear sliding scale ranging from 25 percent for
low-volume hospitals with 200 or fewer discharges of individuals entitled to, or enrolled for,
benefits under Part A in the fiscal year to 0 pe rcent for low-volume hospitals with greater than
1,600 discharges of such indivi duals in the fiscal year."
Section 3125(3)(A) of Pub. L. 111-148 revises the distance requirement for FYs 2011 and

2012 from "25 road miles" to "15 road miles" such that a low volume hospital is required to be
only more than 15 road miles, rather than more than 25 road miles, from another subsection (d)
hospital for purposes of qualifying for the lo w-volume payment adjustment in FYs 2011 and
2012. We therefore are proposing to revise our regulations at 42 CFR 412.101(a)(2) to provide
that to qualify for the low volume adjustment in FYs 2011 and 2012, a hospital must be moreCMS-1498-P2 25

than 15 road miles from the nearest subsection (d) hospital. The statute specifies the 15 mile
distance in "road miles". The current regulati ons at 42 CFR 412.101 also specify the current 25
mile distance requirement in "road miles," but do not provide a definition of the term "road
miles." We are proposing to define the term "road miles" consiste nt with the term "miles" as
defined at §412.92 for purposes of determining whet her a hospital qualifies as a sole community
hospital. Specifically, the regulations at 42 CF R 412.92(c)(i) define "miles" as "the shortest
distance in miles measured over improved roads. An improved road for this purpose is any road
that is maintained by a local, State, or Federal government entity and is available for use by the
general public. An improved road includes the paved surface up to the front entrance of the
hospital." We note that while the proposed chan ge in the qualifying criteria from 25 to 15 road
miles is applicable only for FYs 2011 and 2012, th e proposed definition of "road miles" would
continue to apply even after the distance requirement reverts to 25 road miles beginning in FY

2013.
Sections 3125(3)(B) and (4)(D) and 10314(1) and (2)of Pub. L. 111-148, revise the
discharge requirement for FYs 2011 and 2012 to less than 1,600 discharges of individuals
entitled to, or enrolled for, bene fits under Part A. Based on section 406 of Pub. L. 108-173, the
discharge requirement to qualify as a low-volume hospital prior to FY 2011 and subsequent to
FY 2012 is less than 800 discharges annually. For th ese fiscal years, the num ber of discharges is

determined based on to tal discharges, which includes di scharges of both Medicare and nonMedicare patients. Howeve r, under sections 3125 and 10314 of Pub. L. 111-148, for FYs 2011
and 2012, the discharge requireme nt has been increased to less than 1,600 discharges of
individuals "entitled to, or enro lled for, benefits under Part A during the fiscal year."
Section 226(a) of the Act (42 U.S.C. 426(a)) provides that an individual is automaticallyCMS-1498-P2 26

"entitled" to Medicare Part A when the person r eaches age 65 or becomes disabled, provided that
the individual is entitled to Social Security bene fits under section 202 of the Act (42 U.S.C. 402).
Once a person becomes entitled to Medicare Part A, the individual does not lose such
entitlement simply because there is no Part A coverage of a specifi c inpatient stay. For example,
a patient does not lose entitlement to Medicare Part A simply because the individual's Part A
hospital benefits have been exhausted; other items and services (for example, skilled nursing
services) still might be covered under Part A, and the patient would qualify for an additional
90 days of Part A hospital benef its if at least 60 days elapsed between the individual's first and
second hospital stay. (See §409.60(a) and (b)(1) and §409.61(a)(1) and (c).)
In addition, beneficiaries who are enrolled in Medicare Advantage (MA) plans provided

under Medicare Part C continue to meet all of the statutory cr iteria for entitlement to Part A
benefits under section 226. First, in order to enroll in Medicare Pa rt C, a beneficiary must be

"entitled to benefits unde r Part A and enrolled under Part B, " see section 1852(a)(1)(B)(i) of the
Act. There is nothing in the Act that suggests be neficiaries who enroll in Part C plan forfeit their

entitlement to Part A bene fits. Second, once a beneficiary enrolls in Part C, the MA plan must
provide the beneficiary with the benefits to which the enrollee is entitled under Medicare Part A,
even though it may also provide for additi onal supplemental bene fits. See section
1852(a)(1)(A)of the Act. Third, under certain ci rcumstances, Medicare Pa rt A pays for care
furnished to patients enrolled in Part C plans. Fo r example, if, during the course of the year, the
scope of benefits provi ded under Medicare Part A expands bey ond a certain cost threshold due to
Congressional action or a national coverage determination, Medicare Part A will pay the provider

for the cost of the services di rectly. (See section 1852(a)(5) of the Act.) Similarly, Medicare
Part A also pays for Federally qualified health center services and hospice care furnished to MACMS-1498-P2 27

patients. See 42 U.S.C. section 1853(a)(4), (h)(2)of the Act. Thus, a patient enrolled in a Part C
plan remains entitled to bene fits under Medicare Part A.
Accordingly, for purposes of determining the number of discharges for "individuals
entitled to, or enrolled for, be nefits under Part A," we propos e to include all discharges
associated with individuals entitled to Part A, including discharges associated with individuals
whose inpatient benefits are exhausted or whose stay was not covered by Medicare and
discharges of individuals enrolled in an MA pl an under Medicare Part C. Since a hospital may
only qualify for this adjustment if the hospita l has fewer than 1600 di scharges for patients
entitled to Part A, the hospital must submit a claim to Medicare on behalf of all Part A entitled
individuals, including a no-pay cl aim for patients who are enrolle d in Part C, in order for
Medicare to assure that these discharges are incl uded in the determination of whether the hospital
has fewer than 1600 discharges fo r patients entitled to Part A.
Currently, a prior cost reporting period is used to determine if the hospital meets the
discharge criteria to receive the low-volume payment adjustment in the current year.
Finally, sections 3125(4) of Pub. L. 111-148 and 10314(2), add a new section
1886(d)(12)(D) of the Act that modifies th e methodology for calculation of the payment
adjustment under section 1886(d)(12)(A) of the Act for low-volume hospitals for discharges
occurring in FYs 2011 and 2012. Currently, secti ons 1886(d)(12)(A) and (B) of the Act require
the Secretary to determine an applicable percentage increase for low-volume hospitals based on
the "empirical relationship" betw een "the standardized cost-per- case for such hospitals and the
total number of discharges of su ch hospitals and the amount of the additional incremental costs
(if any) that are associated with such number of discharges." The st atute thus mandates the
Secretary to develop an empiri cally justifiable adjustment based on the relationship betweenCMS-1498-P2 28

costs and discharges for these low-volume hospitals. The statute also limits the adjustment to no
more than 25 percent. Based on analyses, we conducted for the FY 2005 IPPS final rule
(69 FR 49099 through 49102) and the FY 2006 IPPS final rule (70 FR 47432 through 47434), a
25 percent low-volume adjustment to all qualifying hospitals with less than 200 discharges was

found to be most consistent with the statutor y requirement to provide relief to low-volume
hospitals where there is empirical evidence that higher incremental costs are associated with low
numbers of total discharges. However, section 1886(d)(12)(D) of the Act, provides that for
discharges occurring in FYs 2011 and 2012, the Secretary shall deter mine the applicable
percentage increase using a continuous, linear slid ing scale ranging from an additional 25 percent
payment adjustment for hospitals with 200 or fe wer Medicare discharges to 0 percent additional
payment for hospitals with more than 1,600 Medi care discharges. We propose to apply this
payment adjustment based on increments of 100 discharges (beginning with 200 or fewer
discharges), with the applicab le percentage increase decreasin g linearly in equal amounts by
1.6667 percent for every additional 100 Medicare di scharges, with no payment adjustment for
hospitals with more than 1,599 Medicare discharges . We have not proposed an adjustment for a
hospital with exactly 1,600 discharges since, as specified in statute at section 1886(d)(12)(C)(i)
of the Act, as amended, a hospita l must have "less" than 1,600 disc harges in order to qualify as a
low volume hospital. The proposed payment ad justment would be as determined below:CMS-1498-P2 29

Medicare Discharge Range Payment Adjustment (Percent Add-On) 1 - 200 25.0000 201 - 301 23.3333 301 -400 21.6667 401 - 500 20.0000 501 - 600 18.3333 601 -700 16.6667 701 - 800 15.0000 801 - 900 13.3333 901 - 1000 11.6667 1001 - 1100 10.0000 1101 - 1200 8.3333 1201 - 1300 6.6667 1301 - 1400 5.0000 1401 - 1500 3.3333 1501 - 1599 1.6667 1600 or more 0.0000

While we are proposing to revi se the qualifying criteria and the payment adjustment for
low-volume hospitals for FYs 2011 and 2012, consis tent with the amendments made by the
Affordable Care Act, we note that we are not proposing to modify the process for requesting and
obtaining the low-volume hospital payment adjus tment. In order to qua lify, a hospital must
provide to its FI or MAC sufficient evidence to document that it meets the number of Medicare
discharges and distance requireme nts. The FI or MAC will dete rmine, based on the most recent
data available, if the hospital qualifies as a low-volume hospital, so that the hospital will know in
advance whether or not it will receive a payment adjustment and, if so, the add-on percentage.
The FI or MAC and CMS may review available data, in addition to the data the hospital submits
with its request for low-volume status, in order to determine whether or not the hospital meets
the qualifying criteria,
We also note that as compared to the ex isting methodology for determining the payment
adjustment for low-volume hospitals, no hospital would receive a lower payment adjustmentCMS-1498-P2 30

under our proposed methodology for FYs 2011 and 2012. Although the statute specifies that, for
years other than FYs 2011 and 2012, a hospital is a low-volume hospital if it has less than 800
discharges, currently only hospitals with fe wer than 200 discharges receive a payment
adjustment, an additional 25 percent, because the statute requires that the adjustment be
empirically based to provide re lief to low-volume hospitals where there is empirical evidence
that higher incremental costs are associated with low numbers of total di scharges. Consistent
with section 1886(d)(12)(D) of the Act, for FY s 2011 and 2012, we will conti nue to pay hospitals
with fewer than 200 discharges a payment adjus tment amount equal to an additional 25 percent.
We are proposing to revise our regulati ons at 42 CFR 412.101 to reflect our proposal

outlined above.
Currently, 42 CFR 412.101(a)(3) states that "The fiscal intermediary makes the
determination of the discharge c ount for purposes of determining a hospital's qualification for the
adjustment based on the hospital's most recent s ubmitted cost report." Th is may mistakenly be
interpreted to mean that once a hospital qua lifies as a low-volume hospital, no further
qualification is needed. We, ther efore, are proposing to clarify th at a hospital must continue to
qualify as a low-volume hospital in order to receive the payment adjustment in that year; that is,

it is not based on a one-time qualification.
D. Medicare-Dependent, Sma ll Rural Hospitals (MDHs) (§412.108)
1. Background
Medicare-dependent, small rura l hospitals (MDHs) are eligible for the higher of the
Federal rate for their inpatient hospital services or a blended rate based in part on the Federal rate
and in part on the MDH's hospital-specific rate. Section 1886(d)(5)(G)(iv) of the Act defines an
MDH as a hospital that is located in a rural area, has not more than 100 beds, is not an SCH, andCMS-1498-P2 31

has a high percentage of Medicare discharges (t hat is, not less than 60 pe rcent of its inpatient
days or discharges either in its 1987 cost reporting year or in tw o of its most recent three settled
Medicare cost reporting years). The regulations that set forth the criteria that a hospital must

meet to be classified as an MDH are at 42 CFR 412.108.
Although MDHs are paid under an adjusted payment methodology, they are still IPPS
hospitals paid under section 1886(d) of the Act. Like all IPPS hospitals paid under section
1886(d) of the Act, MDHs are paid for their discharges based on the DRG weights calculated
under section 1886(d)(4) of the Act.
Through and including FY 2006, under section 1886(d)(5)(G) of the Act, MDHs are paid

based on the Federal rate or, if higher, the Federal rate plus 50 percent of the amount by which
the Federal rate is exceeded by the updated hosp ital-specific rate based on the hospital's FY 1982
or FY 1987 costs per discharge, whichever of these hospital-speci fic rates is higher. Section
5003(b) of Pub. L. 109-171 (DRA 2005) amended section 1886(d)(5)(G ) of the Act to provide
that, for discharges occurring on or after Oc tober 1, 2006, MDHs are paid based on the Federal
rate or, if higher, the Federal rate plus 75 percent of the amount by which the Federal rate is
exceeded by the updated hospital-specific rate based on the hospital's FY 1982, FY 1987, or
FY 2002 costs per discharge, whichever of these hospital-specific rates is highest.
For each cost reporting period, the fiscal inte rmediary or MAC dete rmines which of the
payment options will yield the highest aggregate payment. Interim payments are automatically
made at the highest rate using the best data available at the time the fiscal intermediary or MAC

makes the determination. However, it may not be possible for th e fiscal intermediary or MAC to
determine in advance precisely which of the rates will yield the highest aggregate payment by
year's end. In many instances, it is not possibl e to forecast the outlier payments, the amount ofCMS-1498-P2 32

the DSH adjustment or the IME adjustment, all of which are applicable only to payments based

on the Federal rate and not to payments based on the hospita l-specific rate. The fiscal
intermediary or MAC makes a final adjustment at the settlement of the cost report after it
determines precisely which of the payment rate s would yield the highest aggregate payment to
the hospital.
If a hospital disagrees with the fiscal intermediary's or the MAC's determination regarding
the final amount of program payment to which it is entitled, it has the right to appeal the
determination in accordance with the procedures set forth in 42 CFR Part 405, Subpart R, which
govern provider payment dete rminations and appeals.
2. Extension of the MDH Program

Section 3124 of Pub. L. 111-148 extends th e MDH program, from the end of FY 2011
(that is, for discharges before October 1, 2011) to the end of FY 2012 (that is, for discharges
before October 1, 2012). Under prior law, as specified in section 5003(a) of Pub. L. 109-171
(DRA of 2005), the MDH program was to be in e ffect through the end of FY 2011 only. Section
3124 (a) of Pub. L. 111-148 amends sections 1886(d)(5 )(G)(i) and (ii)(II) of the Act to extend the
MDH program and payment methodology from the end of FY 2011 to the end of FY 2012, by
"striking "October 1, 2011" and inserting "Oct ober 1, 2012"." Section 3125(b) of Pub. L. 111-
148 also makes conforming amendments to sec tions 1886(b)(3)(D)(i) and (iv) of the Act .
Section 3124(b)(2) of Pub. L. 111-148 also am ends section 13501(e)(2) of OBRA 1993 (42
U.S.C. 1395ww note) to extend the provision permittin g hospitals to decline reclassification as
an MDH through FY 2012.
E. Additional Payments for Qualifying Hospita ls with Lowest Per Ca pita Medicare Spending
1. BackgroundCMS-1498-P2 33

Section 1109 of Pub. L. 111-152, provides for additional payments for FY 2011 and 2012
for "qualifying hospitals." S ection 1109(d) defines a "qualifying hospital" as a "subsection (d)
hospital . . . that is located in a county that ranks, based upon its ranking in age, sex and race
adjusted spending for benefits under parts A and B. . . per enroll ee within the lowest quartile of
such counties in the United States." Therefore, a "qualifying hospital" is one that meets the
following conditions: (1) a "subsection (d) hospita l" as defined in section 1886(d)(1)(B) of the
Act; and (2) located in a county that ranks with in the lowest quartile of counties based upon its
spending for benefits under Medicar e Part A and Part B per enroll ee adjusted for age, sex, and
race. Section 1109(b) of Pub. L. 111-152 make s available $400 million to qualifying hospitals
for FY 2011 and FY 2012. Section 1109(c) of Pub. L. 111-152 requires the $400 million to be
divided among each qualifying hospital in proporti on to the ratio of the individual qualifying
hospital's FY 2009 IPPS operating hospital payments to the sum of total FY 2009 IPPS operating
hospital payments made to all qualifying hospitals.
2. Eligible Counties Section 1109 of Pub. L. 111-152 provides $400 million for FYs 2011 and 2012 for
supplemental payments to qualifying hospitals lo cated in counties that rank within the lowest
quartile of counties in the United States for spending for benefits under Medicar e Part A and Part
B. The provision requires that the Medicare Pa rt A and Part B count y-level spending per
enrollee to be adjusted by age, sex and race. We are proposing our methodology for determining
the bottom quartile of coun ties with the lowest Medicare Part A and Part B spending adjusted by
age, sex, and race and invite public comment on the methodology we propose to use to adjust for
age, sex, and race described below. We furt her propose that we will determine this bottomCMS-1498-P2 34

quartile of counties one time in the FY 2011 IPPS/RY 2011 LTCH PPS final rule for the purpose of disbursing the $400 million as requi red by section 1109 of Pub. L. 111-152.
We developed an adjustment model by ag e, sex, and race, as required under the
provision. We then applied this adjustment to the county Medicare Part A and Part B spending
data to account for the demographics of the Medicar e beneficiaries in those counties. After those
adjustments are applied, we dete rmined the Medicare Part A and Part B spending by county per
enrollee. Our proposed methodology to determine the Medicare Part A and Part B spending per
enrollee by county adjusted for age, sex, and race is similar to how we calculate risk adjustment
models for Medicare Advantage (MA) ratesetting. Risk adjustment for MA ratesetting is

discussed in the annual announcem ent of calendar year MA capita tion rates and MA and Part D
payment policies. For more information on the methodology for risk adjustment used for MA
ratesetting, we refer readers to the CMS website where we announce MA rates through our
45-day notice
(http://www.cms.gov/MedicareA dvtgSpecRateStats/Downloa ds/Announcement2010.pdf).
a. Development of Risk Adjustment Model
As required by section 1109(d) of Pub. L. 111-152, we are proposing a risk adjustment

model that accounts for differentials in Medicare spending by age, se x, and race. Consistent with
how we develop our risk adju stment models for MA ratese tting as described above, we
developed a prospective risk adjustment mode l using 2006 data for bene ficiary characteristics

and 2007 data for Part A and Part B spending. However, unlike the risk adjustment mode used
for MA which includes diseases and demographi c factors, the only inde pendent variables or
prospective factors in the model for payments under section 1109 of Pub. L. 111-152 are age, sex
and race, as required by the provision. The depe ndent variable was annua lized Medicare Part ACMS-1498-P2 35

and B spending at the beneficiary level for 2007 as it is the most recent and complete data
available. The categorization of age, se x, and race variables are described below.
The age, sex, race (ASR) model(s) was es timated using the Five Percent Standard
Analytic Denominator file, a st andard 5-percent samp le from the 2007 Denominator file which is
also used to estimate CMS risk adjustment models for payment to MA organizations. We chose

to use Five Percent Standard Analytic Denominator file from 2007 in order to optimize the
amount of time after the timely claim submission dead lines and the latest av ailable data; in other
words because it is most complete data currently available. This file has the demographic and

enrollment characteristics of all Medicare beneficiaries. The Denominator File is an abbreviated
file of the Enrollment Data Base (EDB). The Denominator File contains data on all Medicare
beneficiaries enrolled and/or entitled to be enrolled in Medicare in a given year while the EDB is
the source of enrollment and entitlement information for all people who are or were ever entitled
to Medicare. The model was estimated using all beneficiaries residing in the community and
long-term institutions. The sa mple had 1,603,998 beneficiaries.
The Denominator File contains a sex variable where the beneficiaries can identify

themselves as male or female. The file also c ontains an age variable which is defined as the
beneficiary's age at the end of the prior year. Beneficiaries with an age greater than 98 are coded
as age 98. The race demographic variable in the Denominator File is popul ated by data from the
Social Security Administration (SSA). The SSA's data for this race demographic variable are
collected on form SS-5. Prior to 1980, the SS-5 form included 3 categories for race: White,
Black or Other. Since that time, Form SS-5 instructed a beneficiary to voluntarily select one of
the following 5 categories: (1) Asian, Asian-Am erican or Pacific Islander; (2) Hispanic; (3)
Black (Not Hispanic); (4) Nort h American Indian or Alaska n Native; and (5) White (NotCMS-1498-P2 36

Hispanic). Form SS-5 is completed when an individual does the following: (1) applies for a
social security number; (2) requests a replacement of the social security card; or (3) requests
changes to personal information on their record such as a name change. (Social Security

Administration Web site instructions http://ssa.gov/online/ss-5.pdf ). Each January, CMS obtains
data from SSA to update the EDB for beneficiaries who were adde d during the previous calendar
year as well as all living bene ficiaries whose race is identified as "Other" or "Unknown."
Discussed in the context of the ESRD paym ent system in the ESRD proposed rule on
September 29, 2009 (74 FR 49962), we noted concerns with using the EDB as a data source due
to missing data, and that racial and ethnic categories are not well defined. Howeve r, we believe
that the current EDB, particularly with resp ect to the more recent and ongoing updates we
perform, remains a useful source of race and et hnicity data on 46 million Me dicare beneficiaries.
Additionally, because this is our only currently available data source on the racial and ethnic
demographics of Medicare benefi ciaries, we propose to the use the EDB as our data source for
beneficiary race so that we can fulfill the requi rements of section 1109(d) of Pub. L. 111-152 to
adjust county Medicare Part A a nd Part B spending by race.

We used the MedPAR claims file as the s ource to determine Medicar e inpatient spending.
We used the National Claims History File to determine spending on DMEPOS and supplies.
The other spending under Medicare Part A and Part B was determined using the Standard
Analytic File. The Standard An alytic File and MedPAR claims file are subsets of the National
Claims History File. These data files are also used in MA ratesetting process and are our data
source for Medicare spending stored at the beneficiary level.
In order to determine annual sp ending (the dependent variab le in the risk adjustment
model), we annualized the Medicare Part A and Part B spending for beneficiaries with less than aCMS-1498-P2 37

full year of eligibility, and these am ounts were weighted in the analysis by the fraction of the year
they were in the data.
We used a linear regression model to determine the demographic adjustments. This is

consistent with how we model our risk adjustment for the MA rates. The linear regression used
24 age-sex regression categories, 12 age categories each for males and females. The age
categories are as follows; 0-34, 35-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84,
85-89, and 90+. The age-sex coefficients displaye d in the table below re flect the difference in
Medicare Part A and Part B spending per enrollee in those age-sex categories relative to national
average Part A and Part B spending based on our linear re gression model.
In addition, we used the same linear regr ession model to determine how to adjust
Medicare Part A and Part B spending for race. In addition to the age-sex regression categories
described above, we include d variables to adjust for race. We considered two methods to adjust
for race in county spending because of the wa y that the SS-5 form co llects race information,
which is then reported in the same format in the EDB. As discussed earlier, the EDB currently
categorizes race by the following five categories, as reported by the Medicare beneficiary: (1)
Asian, Asian-American or Pacifi c Islander; (2) Hispanic; (3) Bl ack (Not Hispanic); (4) North
American Indian or Alaskan Native; and (5) White (Not Hispanic). One method categorized race
by White, Black, Hispanic, and Other (WBHO). The "Other" category includes Asian/Pacific
Islander, American Indian/Alaska Native, and a ll others. The second method categorized race by
White, Black, and Other (WBO), where beneficiar ies who identified themselves as Hispanic
were categorized as Other. The race/ethnicity categories are mutually exclusive; if a beneficiary
identified themselves as Hispanic he or she was not further classifi ed as another category, such as
White or Black. In our regre ssion modeling we used the larges t group, White, as the referenceCMS-1498-P2 38

group; the coefficients on the diffe rence in spending by race, displayed in the table below, are
additive to the reference group. In other words, the coefficients for each race category represent the difference in predicted Medicar e Part A and Part B spending relative to our reference group.
Where the coefficients are positive, this implies that the predicted spending for that category is
higher than that of the reference group. Convers ely, where the coefficien ts are negative, this
implies that the predicted spending for that categ ory is lower than that of the reference group.
Below are two tables representing the coefficients used to adjust Medicare Part A and
Part B spending by county. The first table show s the coefficients for each age and sex category.

The second table shows the coeffici ents for race. These national co efficients are applied to each
counties' relative demographic for age, sex and race, so that each county has a risk score by age,

sex and race.

Age Categories (in years) Sex 0-34 35-44 45-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 Greater than 95
Female 0.67896 0.80089 0.96917 1.09810 1.18855 0.67358 0.83818 1.01599 1.189727 1.364575 1.475495 1.366515 Male 0.52664 0.70067 0.82262 0.93750 1.03792 0.71932 0.90896 1.11809 1.32812 1.50008 1.68184 1.77046

**Race Coefficient** White Baseline Black 0.17667 Hispanic 0.229 Other -0.110

We are proposing to adjust for race usin g the WBHO method where we separately

account for cost differences associ ated with Hispanic beneficiarie s. The Office of Management
and Budget (OMB) has promulgate d standards for the classificati on of federal data on race and
ethnicity. Under OMB's classification standards, the category of Hispanic is treated as an ethnicCMS-1498-P2 39

category as opposed to a race category. The cu rrent OMB Standards of 1997 require collection
of specific demographic data using a total of five race categories, plus other (62 FR 58782
through 58790). The five race categories are -- (1) Am erican Indian or Alas ka Native; (2) Asian;
(3) Black or African American; (4) Native Hawaiian or Other Pacific Islander; and (5) White. In
addition, OMB specified two separa te ethnic categories—Hispanic or Latino, and not Hispanic or
Latino. However, as explained above, Hispanic or Latino ethnicity is tr eated as a race category
by EDB, and beneficiaries can self-identify as Hispanic among mutually exclusive racial
categories. Despite the inconsis tency in reporting by the OMB a nd the EDB, we propose to treat
the category of Hispanic as a separate category for purposes of the race adjustment required by

section 1109 of Pub. L. 111-152. We found that th e coefficient for the Hispanic category is
statistically significant, suggesting that Medicare Part A and Part B spending associated with this
category of beneficiaries is diffe rent from the spending for our reference group and that it should
be a separate coefficient to ad just county spending. In addition, the EDB treats Hispanic as a
separate racial classification, c onsistent with our WBHO method, th erefore; we believe that our
proposal appropriately inte rprets the required race adjustment. Therefore, we propose to adjust
for race using the WBHO method.
For purposes of this supplemental proposed rule , we also adjusted county spending using
the WBO methodology to compare the two appr oaches. We found minimal difference in the
county rankings under the two methodologies. We found that some countie s would qualify as an
eligible county only under the WBO methodology, and others would no longer qualify as an
eligible county using this a lternative. The decision to use the WBHO methodology affects
whether 9 subsection (d) hospitals, located in 5 c ounties, would be eligible to receive a payment
under section 1109. In Table 3, we publish the diffe rences in counties, e ligible hospitals, andCMS-1498-P2 40

payments by state under the two methodologies. This is the first time we have developed an
adjustment for Medicare spending based on race, and we welcome public comment on our
proposal to use the WBHO methodology to adju st for race as required by section 1109 of
Pub. L. 111-152. We also welcome public comment on the WBO methodology to adjust for race
though we note that we are not propos ing this methodology at this time.
b. Calculation of County Level Part A and Part B Spending
In order to rank counties by Medicare Part A and B spe nding, we first calculated
Medicare Part A and Part B county level spendi ng for each county in the 50 States and the
District of Columbia using a similar methodology used to establish count y level FFS rates for
MA payments. Using a 5 year average of each county's actual spending (from 2002 to 2006),
CMS's Office of the Actuary calculated an averag e geographic adjuster (AGA), which reflects the
county's expenditure relative to the national expenditure. We believe a 5-year average is
appropriate, as it accounts fo r fluctuations in year-to-year ex penditures, which could distort the

counties' historic level of spending and is consistent with how MA rates are calculated. The
AGA was then applied to the 2009 United States Per Capita Cost estima te (USPCC), which is
the national average cost per Me dicare beneficiary, to determin e 2009 Medicare Part A and Part
B spending for each county. We welcome pub lic comment on this methodology to calculate
county-level Part A a nd Part B spending.
3. Application of the Age/Sex/Race Adjustme nt to Part A and Part B County Spending
To estimate the county level ri sk scores for 2009, beneficiar y enrollment information was

first extracted from the EDB. We chose to calcu late Medicare Part A and Part B county spending

for 2009 to be consistent with how we are required to determin e qualifying hospitals' payment
amounts, under section 1109(c) of Pub. L. 111-152. That is, section 1109(c) of Pub. L. 111-152CMS-1498-P2 41

requires that qualifying hospitals located in th e bottom quartile of coun ties with the lowest
Medicare Part and Part B spending per enroll ee will receive a portion of the allotted $400 million
based on their FY 2009 operating payments. Theref ore, we propose to calculate Medicare Part A
and Part B County spending for 2009 as well. We only include beneficiaries enrolled in

Medicare Part A and/or Part B, consistent with the lang uage of section 1109(d) of
Pub. L. 111-152, which refers to sp ending under Part A and B. Based on these criteria, there
were 30,666,295 beneficiaries in cluded in the adjustment process. To determine the age, sex and
race make-up of the Part A and/or Part B bene ficiaries for each county, we used the EDB to
identify date of birth, sex, race, and State/county of residence to cr eate a person level file with the

data needed to run the ASR model.
A county level average risk sc ore was developed for each county in the United States by
applying the ASR model to each individual in the county enrolled in Medicare Part A and/or Part
B, summing the resulting risk scores and dividi ng by the number of beneficiaries by county

enrolled in Medicare Part A and/or Part B. The county level Medicare Part A and or Part B
spending was adjusted by dividing the county le vel Medicare Part A and/or Part B spending by
the county level average risk score. The resulting spending distribution was then sorted lowest to
highest dollars the 786 counties in the lowest qua rtile of spending (tha t is, lowest adjusted
spending per enrollee) were determined to be eligible counties under section 1109 of

Pub. L. 111-152.
We invite comment on our methodology for de termining the age, sex, race adjustments
for determining adjusted Medicare Part A a nd B spending by county for the purpose of
determining eligible counties under section 1109 of Pub. L. 111-152.
3. Qualifying Hospitals and Annual Payment AmountsCMS-1498-P2 42

We have developed a methodolog y to identify the qualifying hospitals located in our list
of eligible counties. Consistent with section 1109(d) of Pub. L. 111-152, a qualifying hospital is
a "subsection (d) hospital" (as defined for purposes of section 1886(d) of the Act) that is "located
in" an eligible county (as iden tified using the methodology proposed in section B). A subsection
(d) hospital is defined in section 1886(d)(1)(B) of th e Act in part as a "hospital located in one of
the fifty States or the District of Columbia". The term "subsection (d) hospital" does not include
hospitals located in the territories or hospitals located in Puerto Rico. Section 1886(d)(9)(A) of
the Act separately defines a "subsection (d) Puerto Rico hospital" as a hospital that is located in
Puerto Rico and that "would be a subsection (d) hos pital . . . if it were located in one of the 50
States." Therefore, Puerto Rico hospitals are not eligible for these additional payments. Indian
Health Services hospitals enrolled as a Medicare provider meet the defin ition of a subsection(d)
hospital and can qualify to receive this payment if they are located in an eligible county. In
addition, hospitals that are MDHs and sole commun ity hospitals (SCHs), though they can be paid
under a hospital-specific rate instead of under the Federal standardized amount under the IPPS,
are "subsection (d)" hospitals. The statutory defi nition of a "subsection (d)" hospital in section
1886(d)(1)(B) of the Act specifically excludes hos pitals and hospital units excluded from the
IPPS, such as psychiatric, rehabilitation, long term care, children's, and cancer hospitals. In
addition, critical access hospitals (C AHs) are not considered qualifying hospitals because they do
not meet the definition of a "subsection (d) hospita l" as they are paid under section 1814(l) of the
Act. CAHs are not paid under the IPPS; rather they are paid under a reasonable cost
methodology, so they do not meet the definition of "qualifying hospital" under section 1109(d) of

Pub. L. 111-152.
For the purposes of section 1109 of Pub. L. 111-152, we are proposing to identifyCMS-1498-P2 43

"qualifying hospitals" based on their Medicare Provider number or Centers for Medicare and
Medicaid Services Certification Number (CCN), because this is also how hospitals identify
themselves when they file their Medicare cost reports. We also pr opose that in order to meet the
definition of a "qualifying hospital", the facility, as identified by the Medicare Provider Number
or CCN, must: (1) have existed as a subsec tion (d) hospital as of April 1, 2010; (2) be
geographically located in an eligible county; and (3) have received I PPS operating payments (in
accordance with section 1886(d)) of the Act unde r their Medicare provider number in FY 2009.
We used the Online Survey, Certification a nd Reporting (OSCAR) data base to determine a
hospital's county location associated with that CCN provider number. C ounty data in OSCAR is
supplied by the U.S Postal Service and is cross wa lked to the address repor ted by the provider.
Under this proposal, the address listed for a hospital's Medicare provi der number must be
currently located in a qualifying county in or der for a hospital to meet the definition of
"qualifying hospital."
We have published a list of the qualifying IPPS hospitals that we have identified based on

the factors described above in Table 3. We invite comment on our methodology for identifying
qualifying hospitals. We also invite comment on whether our list is accurate and whether any
providers are missing from this list us ing the methodology de scribed above.
4. Payment Determina tion and Distribution
As mentioned above, under sec tion 1109(b), the total pool of payments available to
qualifying hospitals for FY 2011 and FY 2012 is $400 million. The statute is not specific as to
the timing of these payments. Since Congre ss has allocated a set amount – $400 million – for
hospitals for FYs 2011 and 2012 under this provision, we believe it is consiste nt with the statute
to spread these payments over the 2-year pe riod. We are proposing to distribute $150 million forCMS-1498-P2 44

FY 2011 and $250 million for FY 2012. Because this is a new policy, we are proposing to

distribute a smaller amount of money for the first year ($150 million for FY 2011 and $250
million for FY 2012) so that the public will have an opportunity to review our proposal and
finalized policy in the FY 2011 IPPS/LTCH PPS final rule, and notify us of any possible
revisions to the list of qualifying hospitals, so that we can adjust payments for FY 2012. This
will ensure that we correctly identify qualifying hospitals and their proper payment amounts
without exceeding the program's funding. We i nvite public comment to give hospitals the
opportunity to request that we ma ke changes to the qualifying hosp ital list in order to ensure the
accuracy of the qualifying hospita l list based on the methodology se t forth in the final rule.
However, we are proposing to id entify eligible countie s, qualifying hospitals and their payment
amounts under section 1109 of Pub. L. 111-152 only once. Because Congress has allocated a
specific amount of money, we are proposing to identify eligible c ounties, qualifying hospitals and
their payment amounts once in order to ensure we do not exceed the fixed amount of money and
to ensure predictability of payments.
We propose to distribute payments through th e individual hospital's Medicare contractor
through an annual one-time pa yment during each of FY 2011 and FY 2012. We believe that
annual payments made by the FI or A/B MACs would be an expeditious way to give the
qualifying hospitals the money allotted under section 1109 of P ub. L. 111-152. Alternatively,
these payments could be distributed to qualifying hospitals at the time of cost report settlement
for the qualifying providers' fiscal year end FY 2011 and FY 2012 cost reports. However, cost
report settlement typi cally takes several year s beyond a hospital's fiscal year end. If we
distributed these additional payments at the time of cost report settlement, it may take several
years until hospitals receive thes e additional payments. Therefor e, we believe our proposal toCMS-1498-P2 45

give hospitals their section 1109 payments as annual payments during FY 2011 and FY 2012
presents the most expedient met hod to distribute these payments to hospitals, and is in the spirit
of the intent of Congress. We welcome public comment on our proposal to distribute $150 million in FY 2011 and $250 million in FY 2012 throug h an annual payment in each of those
years made to the qualifying provide rs through their FI or A/B MAC.
We propose that qualifying hos pitals report these additiona l payments on their Medicare
hospital cost report corresponding to the appropriate cost reporting period that the hospitals have
received the payments. On the Medicare Hosp ital Cost report, Form 2552 has an "other
adjustment" line on Worksheet E, Part A that can used by hospitals to report the payments

received under section 1109 of Pub. L. 111-152. We plan to issue additional cost reporting
instructions for qualifying hospita ls to report these additional pa yments on a subscripted line of
the "other adjustment" line to identify this payment. We note that we are requiring these
payments be reported on the cost report for tr acking purposes only; these additional payments
will not be adjusted or settled by the FI or A/B MAC on the cost report.
5. Hospital Weighting Factors
Section 1109(c) of Pub. L. 111-152 requires that the payment amount for a qualifying
hospital shall be dete rmined "in proportion to the portion of the amount of the aggregate
payments under section 1886(d) of the Social Security Act to th e hospital for fiscal year 2009
bears to the sum of all such payments to all qualif ying hospitals for such fiscal year." We are
proposing that the portion of a hospital's paym ent under section 1109 is based on the proportion
of their IPPS operating payments made in FY 2009 relative to the total IPPS operating payments
made to all qualifying hospitals in FY 2009. These FY 2009 IPPS operating payments made
under section 1886(d) include DRG and wage adjusted payments made under the IPPSCMS-1498-P2 46

standardized amount with add-on payments for operating DSH, operating IME, operating outliers
and new technology (collectively referred to in this proposed rule as the IPPS operating payment
amount). We are proposing to include IME MA pa yments made to IPPS hospitals because these
payments are made under sec tion 1886(d) of the Act. Under 42 CFR 412.105(g) of the
regulations and as implemented in Transmittal A-98-21 (Change Re quest 332), hospitals that are
paid under the IPPS and train residents in approved GME programs may submit claims
associated with MA enrollees to the FI/MAC for the purpose of receiving an IME payment. No
IPPS operating payment or other add-on payment is made for these MA enrollees. This is
consistent with how the IPPS includes these IME MA payments when adjusting for budget
neutrality of the IPPS standardized amounts.
In addition, we are including in the FY 2009 IPPS operating payment amount beneficiary
liabilities (coinsurance, copaymen ts, and deductibles) because th e payments made under section
1886(d) of the Act "are subject to the provisions of section 1813." That is, the payment received
by the hospital includes the amount paid by Me dicare, as well as the amount for which the
beneficiary is responsible, as set forth in section 1813 of the Act. We propose to exclude IPPS
capital payments because they are payments made under section 1886(g) of the Act. We also
propose to exclude payments for organ acquis ition costs because it is a payment made under
section 1881(d) of the Act and we propose to excl ude payments for blood clotting factor because
they are payments made under s ection 1886(a)(4) of the Act.
Consistent with our IPPS ratesetting process, we are proposing to use the FY 2009
MedPAR inpatient claims data to determine the FY 2009 IPPS operating payments amount made
to qualifying hospitals in order to set the ratio for determining a qualifying hospital's share of the $400 million payment under section 1109 of Pub. L. 111-152. Though these claim paymentsCMS-1498-P2 47

may be later changed and adjusted at cost report settlement, this settlement generally occurs after
FY 2011 and FY 2012. Furthermore, we believe that use of the FY 2009 MedPAR inpatient

claims data is consistent with our proposal to make th e payments under section 1109 of
Pub. L. 111-152 in two annual payments in FY 2011 and 2012 instead of waiting for cost report
settlement. Furthermore, we use MedPAR data in other areas of the IPPS, including calculating
IPPS relative weights, budget neutrality factors, outlier thresholds and the standardized amount.

The FY 2009 MedPAR data can be ordered to a llow the public to verify qualifying hospitals'
FY 2009 IPPS operating payments. Interested individuals may order these files through the Web
site at: http://www.cms.hhs.gov/LimitedDataSets/ by clicking on MedP AR Limited Data Set
(LDS)-Hospital (National). This Web page describes the file and provides directions and further

detailed instructions for how to order.
Persons placing an order must send the follo wing: a Letter of Request, the LDS Data Use
Agreement and Research Protocol (refer to the We b site for further instru ctions), the LDS Form,
and a check for $3,655 to:
Mailing address if using the U.S. Postal Service:
Centers for Medicare & Medicaid Services,
RDDC Account,
Accounting Division,
P.O. Box 7520,
Baltimore, MD 21207-0520.
Mailing address if using express mail:
Centers for Medicare & Medicaid Services,
OFM/Division of Accounting – RDDC,CMS-1498-P2 48

Mailstop C3-07-11,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
For this proposed rule, we used the Decem ber 2009 update to the FY 2009 MedPAR data
(which is the latest available update to the file) to determine the proposed qualifying hospitals'
IPPS operating payment amounts. For the FY 2011 IPPS/LTCH PPS final rule, we plan on using
the March 2010 update to the FY 2009 MedPAR data to determine qualifying hospitals' IPPS
operating payment amounts which will then be used to set the hospital weighting factors for

FYs 2011 and 2012

As discussed earlier in section II.E.3. of the preamble to this supplemental proposed rule,
qualifying hospitals can include SCHs and MDHs as they meet the defi nition of subsection (d)
hospitals. SCHs are paid in the interim (prior to cost report settlement) on a claim by claim basis
at the amount that is the higher of the payment based on the hospital-specific rate or the IPPS

Federal rate based on th e standardized amount. At cost report settlement , the FI or A/B MAC
determines if the hospital woul d receive higher IPPS payments in the aggregate using the
hospitals specific rate (on all claims) or the Federal rate (on all claims). The FI or A/B MAC
then assigns the hospital the higher payment am ount (either the hospital specific rate for all

claims or the Federal rate amount for all claims) for the cost re porting period. To determine the
FY 2009 operating payment amount for SCHs that m eet the definition of a qualifying hospital,
we propose to use the IPPS operating payment made on the Medicare IPPS claim in the FY 2009
MedPAR rather than the SCH's final payment rate that is determined at cost report settlement.
We believe this approach is c onsistent with the treatment of other qualifying hospitals under our
proposal, and again allows for the timely distri bution of funds in two annual payments, asCMS-1498-P2 49

discussed above. MDHs are paid the sum of the Federal paymen t amount plus 75 percent of the
amount by which the hospital specific rate exceed s the Federal payment amount. This amount is
considered their IPPS operating payment reported on their Medicare IPPS claim.
In order to calculate payment amounts cons istent with section 1109(c)of Pub. L. 111-152,
we propose to use a weighting factor for each qualif ying hospital that is equal to the qualifying
hospital's FY 2009 IPPS operating payment amount (as described above) divided by the sum of
FY 2009 IPPS operating payment amounts for all qualifying hospitals. We believe this
methodology is consistent with the requirement of section 1109(c) of Pub. L. 111-152, because
qualifying hospitals with a larg er proportion of operating payments would have a proportionately
higher weighting factor and would receive th e proportionately larger share of the $400 million,
while hospitals with a smalle r proportion of operating payments would have proportionately
smaller weighting factor and would receive proportionately sm aller shares of the $400 million.
We welcome public comment on our methodology to determine the amount of money distributed
to qualifying hospitals consis tent with the language in section 1109(c) of Pub. L. 111-152.

6. Results
In calculating county-level Medicare Part A a nd B spending, we have found that there are
3,144 counties in the United States. Therefore, there are 786 counties that rank in the lowest
quartile of countie s with regards to adjusted Medicar e Part A and Part B spending per
beneficiary. We have listed th e 786 eligible counties in Table 2. Of those 786 eligible counties,
there are only 276 counties in wh ich qualifying hospitals are lo cated, using the methodology we
proposed in section II.E.3. of the preamble to th is supplemental proposed rule. Using Medicare
provider numbers, as proposed a bove in section II.E.3. of the preamble to this supplemental
proposed rule, we have identified 415 IPPS hospitals that are currently located in those eligibleCMS-1498-P2 50

counties and received I PPS operating payments in FY 2009. We have listed the qualifying IPPS
provider numbers, their counties and their weighting factors in Table 2. We invite public
comment on our proposed methodology for adjusting spending for age, sex, and race as well as
the alternative methodology discu ssed in section II.E.2.a. of the preamble to this supplemental
proposed rule. For these two methodologies (WB HO and WBO), we list th e number of eligible
counties, the number of eligible counties in wh ich a qualifying hospital is located, the payment
amount, and the percentage of the total paym ent under section 1109 of Pub. L. 111-152 by State

in Table 3.
We invite public comment on the accuracy of the lists of eligible counties, qualifying
hospitals and qualifying hosp itals' payment weighting factors (based on the proposed
methodologies desc ribed above).CMS-1498-P2 51

7. Finalization of Eligible Coun ties, Qualifying Hospitals and Qualifying Hospitals' Weighting

Factors
Based on public comments, it is possible that we will finalize a met hodology to determine
the list of eligible coun ties and hospitals that differs from our current proposal. A change in our
methodology could, in turn, result in changes to the list of eligible counties or qualifying
hospitals. We note again that we are proposing to identify eligible countie s, qualifying providers
and their payments under section 1109 of Pub. L. 111-152 only once in the FY 2011 IPPS/LTCH
PPS final rule. Based on this proposal, the methodology for determining a final list of eligible
counties would produce the actual lis t of eligible counties that w ould be finalized in the FY 2011
IPPS final rule and would not be updated in a future fiscal year based on updated data.

Table 2: List of Eligible Counties (Note: This list is based on the pr oposed WBHO risk ad justment method)
County Code County Name State 01050 BULLOCK ALABAMA 01400 LEE ALABAMA 01430 MACON ALABAMA 01590 SUMTER ALABAMA 01650 WILCOX ALABAMA 03010 COCHISE ARIZONA 03040 GRAHAM ARIZONA 03050 GREENLEE ARIZONA 03110 SANTA CRUZ ARIZONA 03120 YAVAPAI ARIZONA 04030 BENTON ARKANSAS 04070 CARROLL ARKANSAS 04230 FRANKLIN ARKANSAS 04240 FULTON ARKANSAS 04340 JEFFERSON ARKANSAS 04380 LEE ARKANSAS 04410 LOGAN ARKANSAS 04430 MADISON ARKANSAS 04440 MARION ARKANSAS 04480 MONTGOMERY ARKANSAS 04500 NEWTON ARKANSAS 04630 SCOTT ARKANSAS 04640 SEARCY ARKANSASCMS-1498-P2 52

County Code County Name State 04710 WASHINGTON ARKANSAS 05110 HUMBOLDT CALIFORNIA 05350 MODOC CALIFORNIA 05410 PLACER CALIFORNIA 05670 YOLO CALIFORNIA 06010 ALAMOSA COLORADO 06030 ARCHULETA COLORADO 06064 BOULDER COLORADO 06070 CHAFFEE COLORADO 06110 COSTILLA COLORADO 06120 CROWLEY COLORADO 06130 CUSTER COLORADO 06160 DOLORES COLORADO 06210 FREMONT COLORADO 06250 GUNNISON COLORADO 06260 HINSDALE COLORADO 06280 JACKSON COLORADO 06350 LAS ANIMAS COLORADO 06410 MONTEZUMA COLORADO 06530 ROUTT COLORADO 06550 SAN JUAN COLORADO 06590 TELLER COLORADO 11230 CHATTAHOOCHEE GEORGIA 11260 CLARKE GEORGIA 11270 CLAY GEORGIA 11360 DECATUR GEORGIA 11430 ELBERT GEORGIA 11510 GRADY GEORGIA 11580 HARRIS GEORGIA 11730 MARION GEORGIA 11835 RANDOLPH GEORGIA 11840 RICHMOND GEORGIA 11881 TALIAFERRO GEORGIA 11890 THOMAS GEORGIA 11902 TOWNS GEORGIA 11950 WASHINGTON GEORGIA 12010 HAWAII HAWAII 12020 HONOLULU HAWAII 12040 KAUAI HAWAII 12050 MAUI HAWAII 13000 ADA IDAHO 13020 BANNOCK IDAHO 13050 BINGHAM IDAHO 13060 BLAINE IDAHO 13070 BOISE IDAHO 13080 BONNER IDAHO 13090 BONNEVILLE IDAHOCMS-1498-P2 53

County Code County Name State 13100 BOUNDARY IDAHO 13130 CANYON IDAHO 13150 CASSIA IDAHO 13160 CLARK IDAHO 13180 CUSTER IDAHO 13200 FRANKLIN IDAHO 13210 FREMONT IDAHO 13220 GEM IDAHO 13250 JEFFERSON IDAHO 13260 JEROME IDAHO 13280 LATAH IDAHO 13310 LINCOLN IDAHO 13320 MADISON IDAHO 13330 MINIDOKA IDAHO 13360 OWYHEE IDAHO 13370 PAYETTE IDAHO 13380 POWER IDAHO 13410 TWIN FALLS IDAHO 13430 WASHINGTON IDAHO 14080 CASS ILLINOIS 14150 CRAWFORD ILLINOIS 14190 DOUGLAS ILLINOIS 14320 EDWARDS ILLINOIS 14600 LEE ILLINOIS 14630 MC DONOUGH ILLINOIS 14650 MC LEAN ILLINOIS 14730 MENARD ILLINOIS 14770 MORGAN ILLINOIS 14830 PIKE ILLINOIS 14921 SCHUYLER ILLINOIS 14940 SCOTT ILLINOIS 14960 STARK ILLINOIS 14970 STEPHENSON ILLINOIS 14981 UNION ILLINOIS 14992 WOODFORD ILLINOIS 15000 ADAMS INDIANA 15060 BROWN INDIANA 15160 DE KALB INDIANA 15190 ELKHART INDIANA 15230 FRANKLIN INDIANA 15340 HUNTINGTON INDIANA 15350 JACKSON INDIANA 15420 KOSCIUSKO INDIANA 15430 LAGRANGE INDIANA 15490 MARSHALL INDIANA 15520 MONROE INDIANA 15560 NOBLE INDIANACMS-1498-P2 54

County Code County Name State 15580 ORANGE INDIANA 15840 WABASH INDIANA 15890 WELLS INDIANA 15910 WHITLEY INDIANA 16000 ADAIR IOWA 16020 ALLAMAKEE IOWA 16030 APPANOOSE IOWA 16050 BENTON IOWA 16070 BOONE IOWA 16100 BUENA VISTA IOWA 16130 CARROLL IOWA 16140 CASS IOWA 16150 CEDAR IOWA 16160 CERRO GORDO IOWA 16170 CHEROKEE IOWA 16190 CLARKE IOWA 16200 CLAY IOWA 16210 CLAYTON IOWA 16230 CRAWFORD IOWA 16240 DALLAS IOWA 16250 DAVIS IOWA 16260 DECATUR IOWA 16270 DELAWARE IOWA 16290 DICKINSON IOWA 16310 EMMET IOWA 16320 FAYETTE IOWA 16330 FLOYD IOWA 16340 FRANKLIN IOWA 16360 GREENE IOWA 16370 GRUNDY IOWA 16380 GUTHRIE IOWA 16400 HANCOCK IOWA 16410 HARDIN IOWA 16430 HENRY IOWA 16440 HOWARD IOWA 16450 HUMBOLDT IOWA 16460 IDA IOWA 16470 IOWA IOWA 16480 JACKSON IOWA 16490 JASPER IOWA 16500 JEFFERSON IOWA 16510 JOHNSON IOWA 16520 JONES IOWA 16530 KEOKUK IOWA 16540 KOSSUTH IOWA 16560 LINN IOWA 16570 LOUISA IOWACMS-1498-P2 55

County Code County Name State 16580 LUCAS IOWA 16590 LYON IOWA 16600 MADISON IOWA 16610 MAHASKA IOWA 16620 MARION IOWA 16630 MARSHALL IOWA 16650 MITCHELL IOWA 16690 MUSCATINE IOWA 16700 OBRIEN IOWA 16710 OSCEOLA IOWA 16730 PALO ALTO IOWA 16740 PLYMOUTH IOWA 16760 POLK IOWA 16780 POWESHIEK IOWA 16790 RINGGOLD IOWA 16830 SIOUX IOWA 16840 STORY IOWA 16850 TAMA IOWA 16860 TAYLOR IOWA 16870 UNION IOWA 16880 VAN BUREN IOWA 16900 WARREN IOWA 16910 WASHINGTON IOWA 16920 WAYNE IOWA 16930 WEBSTER IOWA 16940 WINNEBAGO IOWA 16950 WINNESHIEK IOWA 16960 WOODBURY IOWA 16970 WORTH IOWA 17130 CLAY KANSAS 17140 CLOUD KANSAS 17170 COWLEY KANSAS 17200 DICKINSON KANSAS 17300 GEARY KANSAS 17630 MORRIS KANSAS 17650 NEMAHA KANSAS 17680 NORTON KANSAS 17710 OTTAWA KANSAS 17780 REPUBLIC KANSAS 17840 SALINE KANSAS 17910 SMITH KANSAS 17980 WABAUNSEE KANSAS 17982 WASHINGTON KANSAS 18050 BATH KENTUCKY 18770 MARION KENTUCKY 18802 MENIFEE KENTUCKY 18860 MONTGOMERY KENTUCKYCMS-1498-P2 56

County Code County Name State 18971 POWELL KENTUCKY 18987 WASHINGTON KENTUCKY 20050 KENNEBEC MAINE 20060 KNOX MAINE 20070 LINCOLN MAINE 20080 OXFORD MAINE 20100 PISCATAQUIS MAINE 20110 SAGADAHOC MAINE 20130 WALDO MAINE 23090 BENZIE MICHIGAN 23200 DELTA MICHIGAN 23210 DICKINSON MICHIGAN 23260 GOGEBIC MICHIGAN 23350 IRON MICHIGAN 23440 LEELANAU MICHIGAN 23510 MARQUETTE MICHIGAN 23530 MECOSTA MICHIGAN 23540 MENOMINEE MICHIGAN 23560 MISSAUKEE MICHIGAN 23610 NEWAYGO MICHIGAN 23630 OCEANA MICHIGAN 23690 OTTAWA MICHIGAN 24020 BECKER MINNESOTA 24050 BIG STONE MINNESOTA 24060 BLUE EARTH MINNESOTA 24070 BROWN MINNESOTA 24080 CARLTON MINNESOTA 24100 CASS MINNESOTA 24110 CHIPPEWA MINNESOTA 24130 CLAY MINNESOTA 24140 CLEARWATER MINNESOTA 24160 COTTONWOOD MINNESOTA 24170 CROW WING MINNESOTA 24200 DOUGLAS MINNESOTA 24210 FARIBAULT MINNESOTA 24220 FILLMORE MINNESOTA 24230 FREEBORN MINNESOTA 24250 GRANT MINNESOTA 24270 HOUSTON MINNESOTA 24280 HUBBARD MINNESOTA 24310 JACKSON MINNESOTA 24330 KANDIYOHI MINNESOTA 24340 KITTSON MINNESOTA 24380 LAKE OF WOODS MINNESOTA 24390 LE SUEUR MINNESOTA 24410 LYON MINNESOTA 24450 MARTIN MINNESOTACMS-1498-P2 57

County Code County Name State 24460 MEEKER MINNESOTA 24480 MORRISON MINNESOTA 24510 NICOLLET MINNESOTA 24520 NOBLES MINNESOTA 24550 OTTER TAIL MINNESOTA 24560 PENNINGTON MINNESOTA 24580 PIPESTONE MINNESOTA 24590 POLK MINNESOTA 24600 POPE MINNESOTA 24620 RED LAKE MINNESOTA 24630 REDWOOD MINNESOTA 24640 RENVILLE MINNESOTA 24650 RICE MINNESOTA 24660 ROCK MINNESOTA 24670 ROSEAU MINNESOTA 24720 STEARNS MINNESOTA 24730 STEELE MINNESOTA 24750 SWIFT MINNESOTA 24770 TRAVERSE MINNESOTA 24780 WABASHA MINNESOTA 24790 WADENA MINNESOTA 24800 WASECA MINNESOTA 24820 WATONWAN MINNESOTA 24830 WILKIN MINNESOTA 24840 WINONA MINNESOTA 25060 CALHOUN MISSISSIPPI 25350 LAFAYETTE MISSISSIPPI 25430 LOWNDES MISSISSIPPI 25510 NOXUBEE MISSISSIPPI 25520 OKTIBBEHA MISSISSIPPI 25790 WINSTON MISSISSIPPI 26040 BARRY MISSOURI 26090 BOONE MISSOURI 26190 CEDAR MISSOURI 26210 CHRISTIAN MISSOURI 26260 COOPER MISSOURI 26280 DADE MISSOURI 26330 DOUGLAS MISSOURI 26380 GREENE MISSOURI 26450 HOWELL MISSOURI 26520 LACLEDE MISSOURI 26740 OREGON MISSOURI 26751 OZARK MISSOURI 26790 PETTIS MISSOURI 26821 POLK MISSOURI 26990 VERNON MISSOURI 26994 WEBSTER MISSOURICMS-1498-P2 58

County Code County Name State 26996 WRIGHT MISSOURI 27030 BROADWATER MONTANA 27040 CARBON MONTANA 27050 CARTER MONTANA 27080 CUSTER MONTANA 27090 DANIELS MONTANA 27100 DAWSON MONTANA 27120 FALLON MONTANA 27130 FERGUS MONTANA 27140 FLATHEAD MONTANA 27150 GALLATIN MONTANA 27160 GARFIELD MONTANA 27180 GOLDEN VALLEY MONTANA 27190 GRANITE MONTANA 27210 JEFFERSON MONTANA 27220 JUDITH BASIN MONTANA 27240 LEWIS AND CLARK MONTANA 27260 LINCOLN MONTANA 27270 MCCONE MONTANA 27280 MADISON MONTANA 27310 MISSOULA MONTANA 27340 PETROLEUM MONTANA 27350 PHILLIPS MONTANA 27370 POWDER RIVER MONTANA 27380 POWELL MONTANA 27390 PRAIRIE MONTANA 27400 RAVALLI MONTANA 27410 RICHLAND MONTANA 27430 ROSEBUD MONTANA 27440 SANDERS MONTANA 27450 SHERIDAN MONTANA 27460 SILVER BOW MONTANA 27470 STILLWATER MONTANA 27480 SWEET GRASS MONTANA 27490 TETON MONTANA 27510 TREASURE MONTANA 27520 VALLEY MONTANA 27530 WHEATLAND MONTANA 27540 WIBAUX MONTANA 27550 YELLOWSTONE MONTANA 28030 BANNER NEBRASKA 28050 BOONE NEBRASKA 28060 BOX BUTTE NEBRASKA 28090 BUFFALO NEBRASKA 28110 BUTLER NEBRASKA 28130 CEDAR NEBRASKA 28160 CHEYENNE NEBRASKACMS-1498-P2 59

County Code County Name State 28190 CUMING NEBRASKA 28210 DAKOTA NEBRASKA 28220 DAWES NEBRASKA 28240 DEUEL NEBRASKA 28250 DIXON NEBRASKA 28320 FURNAS NEBRASKA 28330 GAGE NEBRASKA 28350 GARFIELD NEBRASKA 28360 GOSPER NEBRASKA 28370 GRANT NEBRASKA 28400 HAMILTON NEBRASKA 28420 HAYES NEBRASKA 28430 HITCHCOCK NEBRASKA 28450 HOOKER NEBRASKA 28470 JEFFERSON NEBRASKA 28480 JOHNSON NEBRASKA 28490 KEARNEY NEBRASKA 28510 KEYA PAHA NEBRASKA 28530 KNOX NEBRASKA 28560 LOGAN NEBRASKA 28570 LOUP NEBRASKA 28580 MC PHERSON NEBRASKA 28590 MADISON NEBRASKA 28600 MERRICK NEBRASKA 28610 MORRILL NEBRASKA 28670 PERKINS NEBRASKA 28700 PLATTE NEBRASKA 28720 RED WILLOW NEBRASKA 28780 SCOTT BLUFF NEBRASKA 28800 SHERIDAN NEBRASKA 28820 SIOUX NEBRASKA 28830 STANTON NEBRASKA 28850 THOMAS NEBRASKA 28890 WAYNE NEBRASKA 29050 EUREKA NEVADA 30010 CARROLL NEW HAMPSHI 30090 SULLIVAN NEW HAMPSHI 32000 BERNALILLO NEW MEXICO 32010 CATRON NEW MEXICO 32025 CIBOLA NEW MEXICO 32030 COLFAX NEW MEXICO 32050 DE BACA NEW MEXICO 32060 DONA ANA NEW MEXICO 32080 GRANT NEW MEXICO 32090 GUADALUPE NEW MEXICO 32100 HARDING NEW MEXICO 32110 HIDALGO NEW MEXICOCMS-1498-P2 60

County Code County Name State 32130 LINCOLN NEW MEXICO 32131 LOS ALAMOS NEW MEXICO 32140 LUNA NEW MEXICO 32160 MORA NEW MEXICO 32170 OTERO NEW MEXICO 32180 QUAY NEW MEXICO 32190 RIO ARRIBA NEW MEXICO 32210 SANDOVAL NEW MEXICO 32230 SAN MIGUEL NEW MEXICO 32240 SANTA FE NEW MEXICO 32250 SIERRA NEW MEXICO 32260 SOCORRO NEW MEXICO 32270 TAOS NEW MEXICO 32280 TORRANCE NEW MEXICO 32300 VALENCIA NEW MEXICO 33010 ALLEGANY NEW YORK 33030 BROOME NEW YORK 33040 CATTARAUGUS NEW YORK 33050 CAYUGA NEW YORK 33060 CHAUTAUQUA NEW YORK 33070 CHEMUNG NEW YORK 33080 CHENANGO NEW YORK 33210 CORTLAND NEW YORK 33260 ESSEX NEW YORK 33270 FRANKLIN NEW YORK 33280 FULTON NEW YORK 33310 HAMILTON NEW YORK 33330 JEFFERSON NEW YORK 33340 LEWIS NEW YORK 33360 MADISON NEW YORK 33380 MONTGOMERY NEW YORK 33510 ONEIDA NEW YORK 33520 ONONDAGA NEW YORK 33530 ONTARIO NEW YORK 33550 ORLEANS NEW YORK 33570 OTSEGO NEW YORK 33630 ST. LAWRENCE NEW YORK 33640 SARATOGA NEW YORK 33650 SCHENECTADY NEW YORK 33660 SCHOHARIE NEW YORK 33670 SCHUYLER NEW YORK 33680 SENECA NEW YORK 33690 STEUBEN NEW YORK 33720 TIOGA NEW YORK 33730 TOMPKINS NEW YORK 33750 WARREN NEW YORK 33760 WASHINGTON NEW YORKCMS-1498-P2 61

County Code County Name State 33770 WAYNE NEW YORK 33900 WYOMING NEW YORK 33910 YATES NEW YORK 34040 ASHE NORTH CAROLINA 34160 CASWELL NORTH CAROLINA 34190 CHEROKEE NORTH CAROLINA 34200 CHOWAN NORTH CAROLINA 34210 CLAY NORTH CAROLINA 34370 GRAHAM NORTH CAROLINA 34380 GRANVILLE NORTH CAROLINA 34490 JACKSON NORTH CAROLINA 34550 MC DOWELL NORTH CAROLINA 34560 MACON NORTH CAROLINA 34600 MITCHELL NORTH CAROLINA 34710 PERQUIMANS NORTH CAROLINA 34720 PERSON NORTH CAROLINA 34740 POLK NORTH CAROLINA 34870 TRANSYLVANIA NORTH CAROLINA 34880 TYRRELL NORTH CAROLINA 34900 VANCE NORTH CAROLINA 34920 WARREN NORTH CAROLINA 34981 YANCEY NORTH CAROLINA 35010 BARNES NORTH DAKOTA 35030 BILLINGS NORTH DAKOTA 35060 BURKE NORTH DAKOTA 35070 BURLEIGH NORTH DAKOTA 35080 CASS NORTH DAKOTA 35090 CAVALIER NORTH DAKOTA 35100 DICKEY NORTH DAKOTA 35110 DIVIDE NORTH DAKOTA 35120 DUNN NORTH DAKOTA 35130 EDDY NORTH DAKOTA 35140 EMMONS NORTH DAKOTA 35150 FOSTER NORTH DAKOTA 35160 GOLDEN VALLEY NORTH DAKOTA 35180 GRANT NORTH DAKOTA 35190 GRIGGS NORTH DAKOTA 35200 HETTINGER NORTH DAKOTA 35210 KIDDER NORTH DAKOTA 35220 LA MOURE NORTH DAKOTA 35230 LOGAN NORTH DAKOTA 35240 MCHENRY NORTH DAKOTA 35250 MCINTOSH NORTH DAKOTA 35270 MCLEAN NORTH DAKOTA 35280 MERCER NORTH DAKOTA 35290 MORTON NORTH DAKOTA 35300 MOUNTRAIL NORTH DAKOTACMS-1498-P2 62

County Code County Name State 35320 OLIVER NORTH DAKOTA 35330 PEMBINA NORTH DAKOTA 35350 RAMSEY NORTH DAKOTA 35370 RENVILLE NORTH DAKOTA 35380 RICHLAND NORTH DAKOTA 35410 SHERIDAN NORTH DAKOTA 35440 STARK NORTH DAKOTA 35450 STEELE NORTH DAKOTA 35460 STUTSMAN NORTH DAKOTA 35470 TOWNER NORTH DAKOTA 35480 TRAILL NORTH DAKOTA 35490 WALSH NORTH DAKOTA 35500 WARD NORTH DAKOTA 35510 WELLS NORTH DAKOTA 35520 WILLIAMS NORTH DAKOTA 36020 ASHLAND OHIO 36390 HOLMES OHIO 37520 NOWATA OKLAHOMA 37730 WASHINGTON OKLAHOMA 38000 BAKER OREGON 38010 BENTON OREGON 38020 CLACKAMAS OREGON 38080 DESCHUTES OREGON 38100 GILLIAM OREGON 38130 HOOD RIVER OREGON 38150 JEFFERSON OREGON 38170 KLAMATH OREGON 38180 LAKE OREGON 38200 LINCOLN OREGON 38220 MALHEUR OREGON 38230 MARION OREGON 38250 MULTNOMAH OREGON 38260 POLK OREGON 38270 SHERMAN OREGON 38290 UMATILLA OREGON 38300 UNION OREGON 38320 WASCO OREGON 38330 WASHINGTON OREGON 38340 WHEELER OREGON 39000 ADAMS PENNSYLVANIA 39130 BRADFORD PENNSYLVANIA 39200 CENTRE PENNSYLVANIA 39240 CLINTON PENNSYLVANIA 39440 LANCASTER PENNSYLVANIA 39460 LEBANON PENNSYLVANIA 39510 LYCOMING PENNSYLVANIA 39640 POTTER PENNSYLVANIACMS-1498-P2 63

County Code County Name State 39690 SULLIVAN PENNSYLVANIA 39710 TIOGA PENNSYLVANIA 39720 UNION PENNSYLVANIA 42000 ABBEVILLE SOUTH CAROLINA 42230 GREENWOOD SOUTH CAROLINA 42320 MCCORMICK SOUTH CAROLINA 42400 SALUDA SOUTH CAROLINA 43010 AURORA SOUTH DAKOTA 43020 BEADLE SOUTH DAKOTA 43030 BENNETT SOUTH DAKOTA 43040 BON HOMME SOUTH DAKOTA 43050 BROOKINGS SOUTH DAKOTA 43060 BROWN SOUTH DAKOTA 43070 BRULE SOUTH DAKOTA 43090 BUTTE SOUTH DAKOTA 43100 CAMPBELL SOUTH DAKOTA 43110 CHARLES MIX SOUTH DAKOTA 43120 CLARK SOUTH DAKOTA 43130 CLAY SOUTH DAKOTA 43140 CODINGTON SOUTH DAKOTA 43150 CORSON SOUTH DAKOTA 43160 CUSTER SOUTH DAKOTA 43170 DAVISON SOUTH DAKOTA 43220 EDMUNDS SOUTH DAKOTA 43230 FALL RIVER SOUTH DAKOTA 43250 GRANT SOUTH DAKOTA 43270 HAAKON SOUTH DAKOTA 43280 HAMLIN SOUTH DAKOTA 43290 HAND SOUTH DAKOTA 43300 HANSON SOUTH DAKOTA 43320 HUGHES SOUTH DAKOTA 43330 HUTCHINSON SOUTH DAKOTA 43340 HYDE SOUTH DAKOTA 43350 JACKSON SOUTH DAKOTA 43360 JERAULD SOUTH DAKOTA 43370 JONES SOUTH DAKOTA 43380 KINGSBURY SOUTH DAKOTA 43390 LAKE SOUTH DAKOTA 43400 LAWRENCE SOUTH DAKOTA 43410 LINCOLN SOUTH DAKOTA 43420 LYMAN SOUTH DAKOTA 43430 MC COOK SOUTH DAKOTA 43440 MC PHERSON SOUTH DAKOTA 43450 MARSHALL SOUTH DAKOTA 43460 MEADE SOUTH DAKOTA 43470 MELLETTE SOUTH DAKOTA 43490 MINNEHAHA SOUTH DAKOTACMS-1498-P2 64

County Code County Name State 43500 MOODY SOUTH DAKOTA 43510 PENNINGTON SOUTH DAKOTA 43520 PERKINS SOUTH DAKOTA 43540 ROBERTS SOUTH DAKOTA 43550 SANBORN SOUTH DAKOTA 43580 STANLEY SOUTH DAKOTA 43590 SULLY SOUTH DAKOTA 43610 TRIPP SOUTH DAKOTA 43620 TURNER SOUTH DAKOTA 43630 UNION SOUTH DAKOTA 43640 WALWORTH SOUTH DAKOTA 43650 WASHABAUGH SOUTH DAKOTA 43670 YANKTON SOUTH DAKOTA 45200 BREWSTER TEXAS 45361 CROCKETT TEXAS 45552 GILLESPIE TEXAS 45662 HUDSPETH TEXAS 45762 LOVING TEXAS 45793 MENARD TEXAS 45831 OCHILTREE TEXAS 45861 PRESIDIO TEXAS 45912 TERRELL TEXAS 45946 VAL VERDE TEXAS 45952 WASHINGTON TEXAS 46010 BOX ELDER UTAH 46020 CACHE UTAH 46040 DAGGETT UTAH 46050 DAVIS UTAH 46060 DUCHESNE UTAH 46080 GARFIELD UTAH 46090 GRAND UTAH 46100 IRON UTAH 46120 KANE UTAH 46130 MILLARD UTAH 46140 MORGAN UTAH 46150 PIUTE UTAH 46160 RICH UTAH 46200 SEVIER UTAH 46210 SUMMIT UTAH 46230 UINTAH UTAH 46250 WASATCH UTAH 46270 WAYNE UTAH 47000 ADDISON VERMONT 47020 CALEDONIA VERMONT 47040 ESSEX VERMONT 47070 LAMOILLE VERMONT 47090 ORLEANS VERMONTCMS-1498-P2 65

County Code County Name State 47110 WASHINGTON VERMONT 47120 WINDHAM VERMONT 49030 AMELIA VIRGINIA 49050 APPOMATTOX VIRGINIA 49070 AUGUSTA VIRGINIA 49088 BEDFORD CITY VIRGINIA 49090 BEDFORD VIRGINIA 49110 BOTETOURT VIRGINIA 49120 BRUNSWICK VIRGINIA 49141 BUENA VISTA CITY VIRGINIA 49150 CAMPBELL VIRGINIA 49170 CARROLL VIRGINIA 49180 CHARLES CITY VIRGINIA 49190 CHARLOTTE VIRGINIA 49200 CHESTERFIELD VIRGINIA 49220 CRAIG VIRGINIA 49240 CUMBERLAND VIRGINIA 49241 DANVILLE CITY VIRGINIA 49260 DINWIDDIE VIRGINIA 49310 FLOYD VIRGINIA 49320 FLUVANNA VIRGINIA 49328 FRANKLIN CITY VIRGINIA 49330 FRANKLIN VIRGINIA 49343 GALAX CITY VIRGINIA 49360 GLOUCESTER VIRGINIA 49370 GOOCHLAND VIRGINIA 49380 GRAYSON VIRGINIA 49400 GREENSVILLE VIRGINIA 49410 HALIFAX VIRGINIA 49411 HAMPTON CITY VIRGINIA 49421 HARRISONBURG CITY VIRGINIA 49440 HENRY VIRGINIA 49460 ISLE OF WIGHT VIRGINIA 49470 JAMES CITY VIRGINIA 49510 LANCASTER VIRGINIA 49522 LEXINGTON CITY VIRGINIA 49550 LUNENBURG VIRGINIA 49551 LYNCHBURG CITY VIRGINIA 49560 MADISON VIRGINIA 49561 MARTINSVILLE CITY VIRGINIA 49570 MATHEWS VIRGINIA 49580 MECKLENBURG VIRGINIA 49590 MIDDLESEX VIRGINIA 49600 MONTGOMERY VIRGINIA 49622 NEWPORT NEWS CITY VIRGINIA 49660 NORTHUMBERLND VIRGINIA 49670 NOTTOWAY VIRGINIACMS-1498-P2 66

County Code County Name State 49710 PITTSYLVANIA VIRGINIA 49712 POQUOSON VIRGINIA 49720 POWHATAN VIRGINIA 49730 PRINCE EDWARD VIRGINIA 49780 RAPPAHANNOCK VIRGINIA 49800 ROANOKE VIRGINIA 49801 ROANOKE CITY VIRGINIA 49810 ROCKBRIDGE VIRGINIA 49820 ROCKINGHAM VIRGINIA 49838 SALEM CITY VIRGINIA 49850 SHENANDOAH VIRGINIA 49860 SMYTH VIRGINIA 49867 SOUTH BOSTON CITY VIRGINIA 49870 SOUTHAMPTON VIRGINIA 49891 STAUNTON CITY VIRGINIA 49900 SURRY VIRGINIA 49910 SUSSEX VIRGINIA 49950 WASHINGTON VIRGINIA 49961 WILLIAMSBURG CITY VIRGINIA 49962 WINCHESTER CITY VIRGINIA 49980 WYTHE VIRGINIA 49981 YORK VIRGINIA 50030 CHELAN WASHINGTON 50040 CLALLAM WASHINGTON 50050 CLARK WASHINGTON 50100 FRANKLIN WASHINGTON 50140 ISLAND WASHINGTON 50180 KITTITAS WASHINGTON 50190 KLICKITAT WASHINGTON 50230 OKANOGAN WASHINGTON 50270 SAN JUAN WASHINGTON 50330 THURSTON WASHINGTON 50340 WAHKIAKUM WASHINGTON 50350 WALLA WALLA WASHINGTON 50380 YAKIMA WASHINGTON 51030 BRAXTON WEST VIRGINIA 51110 GRANT WEST VIRGINIA 51150 HARDY WEST VIRGINIA 51350 PENDLETON WEST VIRGINIA 51430 ROANE WEST VIRGINIA 51480 UPSHUR WEST VIRGINIA 51510 WETZEL WEST VIRGINIA 52020 BARRON WISCONSIN 52030 BAYFIELD WISCONSIN 52040 BROWN WISCONSIN 52050 BUFFALO WISCONSIN 52060 BURNETT WISCONSINCMS-1498-P2 67

County Code County Name State 52070 CALUMET WISCONSIN 52080 CHIPPEWA WISCONSIN 52100 COLUMBIA WISCONSIN 52110 CRAWFORD WISCONSIN 52130 DODGE WISCONSIN 52140 DOOR WISCONSIN 52160 DUNN WISCONSIN 52170 EAU CLAIRE WISCONSIN 52180 FLORENCE WISCONSIN 52190 FOND DU LAC WISCONSIN 52200 FOREST WISCONSIN 52220 GREEN WISCONSIN 52230 GREEN LAKE WISCONSIN 52240 IOWA WISCONSIN 52250 IRON WISCONSIN 52260 JACKSON WISCONSIN 52270 JEFFERSON WISCONSIN 52280 JUNEAU WISCONSIN 52300 KEWAUNEE WISCONSIN 52310 LA CROSSE WISCONSIN 52330 LANGLADE WISCONSIN 52340 LINCOLN WISCONSIN 52350 MANITOWOC WISCONSIN 52360 MARATHON WISCONSIN 52370 MARINETTE WISCONSIN 52380 MARQUETTE WISCONSIN 52400 MONROE WISCONSIN 52410 OCONTO WISCONSIN 52420 ONEIDA WISCONSIN 52430 OUTAGAMIE WISCONSIN 52440 OZAUKEE WISCONSIN 52460 PIERCE WISCONSIN 52470 POLK WISCONSIN 52480 PORTAGE WISCONSIN 52510 RICHLAND WISCONSIN 52520 ROCK WISCONSIN 52530 RUSK WISCONSIN 52550 SAUK WISCONSIN 52560 SAWYER WISCONSIN 52570 SHAWANO WISCONSIN 52580 SHEBOYGAN WISCONSIN 52590 TAYLOR WISCONSIN 52600 TREMPEALEAU WISCONSIN 52610 VERNON WISCONSIN 52620 VILAS WISCONSIN 52640 WASHBURN WISCONSIN 52670 WAUPACA WISCONSINCMS-1498-P2 68

County Code County Name State 52680 WAUSHARA WISCONSIN 52690 WINNEBAGO WISCONSIN 52700 WOOD WISCONSIN 53010 BIG HORN WYOMING 53050 CROOK WYOMING 53070 GOSHEN WYOMING 53090 JOHNSON WYOMING 53120 NATRONA WYOMING 53140 PARK WYOMING 53160 SHERIDAN WYOMING 53220 WESTON WYOMING

Table 3: List of Qualifying Hospitals, Location, and Payment Weighting Factor (Note: This list is based on the pr oposed WBHO risk ad justment method)

Provider Number SSACD County Name State Payment Weight Factor 010029 01400 LEE ALABAMA 0.0062 010102 01650 WILCOX ALABAMA 0.0001 010110 01050 BULLOCK ALABAMA 0.0003 010138 01590 SUMTER ALABAMA 0.0001 030007 03120 YAVAPAI ARIZONA 0.0028 030012 03120 YAVAPAI ARIZONA 0.0048 030043 03010 COCHISE ARIZONA 0.0018 030068 03040 GRAHAM ARIZONA 0.0007 030118 03120 YAVAPAI ARIZONA 0.0010 040001 04030 BENTON ARKANSAS 0.0007 040004 04710 WASHINGTON ARKANSAS 0.0061 040010 04030 BENTON ARKANSAS 0.0030 040022 04710 WASHINGTON ARKANSAS 0.0055 040071 04340 JEFFERSON ARKANSAS 0.0049 040152 04710 WASHINGTON ARKANSAS 0.0000 050006 05110 HUMBOLDT CALIFORNIA 0.0044 050028 05110 HUMBOLDT CALIFORNIA 0.0007 050127 05670 YOLO CALIFORNIA 0.0011 050309 05410 PLACER CALIFORNIA 0.0056 050498 05410 PLACER CALIFORNIA 0.0018 050537 05670 YOLO CALIFORNIA 0.0008 060008 06010 ALAMOSA COLORADO 0.0008 060016 06210 FREMONT COLORADO 0.0007 060049 06530 ROUTT COLORADO 0.0004 110006 11260 CLARKE GEORGIA 0.0030 110026 11430 ELBERT GEORGIA 0.0004 110028 11840 RICHMOND GEORGIA 0.0110 110034 11840 RICHMOND GEORGIA 0.0096 110038 11890 THOMAS GEORGIA 0.0044CMS-1498-P2 69

Provider Number SSACD County Name State Payment Weight Factor 110039 11840 RICHMOND GEORGIA 0.0013 110074 11260 CLARKE GEORGIA 0.0081 110086 11950 WASHINGTON GEORGIA 0.0006 110121 11510 GRADY GEORGIA 0.0003 110132 11360 DECATUR GEORGIA 0.0006 110177 11840 RICHMOND GEORGIA 0.0053 110231 11260 CLARKE GEORGIA 0.0000 120001 12020 HONOLULU HAWAII 0.0111 120002 12050 MAUI HAWAII 0.0036 120004 12020 HONOLULU HAWAII 0.0009 120005 12010 HAWAII HAWAII 0.0024 120006 12020 HONOLULU HAWAII 0.0025 120007 12020 HONOLULU HAWAII 0.0037 120010 12020 HONOLULU HAWAII 0.0023 120011 12020 HONOLULU HAWAII 0.0005 120014 12040 KAUAI HAWAII 0.0011 120019 12010 HAWAII HAWAII 0.0006 120022 12020 HONOLULU HAWAII 0.0039 120026 12020 HONOLULU HAWAII 0.0029 120027 12020 HONOLULU HAWAII 0.0019 120028 12040 KAUAI HAWAII 0.0004 130002 13410 TWIN FALLS IDAHO 0.0029 130006 13000 ADA IDAHO 0.0070 130007 13000 ADA IDAHO 0.0060 130013 13130 CANYON IDAHO 0.0012 130014 13130 CANYON IDAHO 0.0010 130018 13090 BONNEVILLE IDAHO 0.0039 130024 13080 BONNER IDAHO 0.0006 130025 13320 MADISON IDAHO 0.0006 130028 13020 BANNOCK IDAHO 0.0031 130063 13000 ADA IDAHO 0.0001 130065 13090 BONNEVILLE IDAHO 0.0003 130067 13050 BINGHAM IDAHO 0.0000 130069 13000 ADA IDAHO 0.0000 130070 13000 ADA IDAHO 0.0001 140012 14600 LEE ILLINOIS 0.0013 140058 14770 MORGAN ILLINOIS 0.0015 140089 14630 MC DONOUGH ILLINOIS 0.0009 140127 14650 MC LEAN ILLINOIS 0.0035 140160 14970 STEPHENSON ILLINOIS 0.0020 140162 14650 MC LEAN ILLINOIS 0.0024 150018 15190 ELKHART INDIANA 0.0058 150026 15190 ELKHART INDIANA 0.0022 150045 15160 DE KALB INDIANA 0.0004 150051 15520 MONROE INDIANA 0.0056 150065 15350 JACKSON INDIANA 0.0012CMS-1498-P2 70

Provider Number SSACD County Name State Payment Weight Factor 150075 15890 WELLS INDIANA 0.0008 150076 15490 MARSHALL INDIANA 0.0008 150091 15340 HUNTINGTON INDIANA 0.0004 150101 15910 WHITLEY INDIANA 0.0003 150133 15420 KOSCIUSKO INDIANA 0.0011 150146 15560 NOBLE INDIANA 0.0005 150164 15520 MONROE INDIANA 0.0009 160001 16630 MARSHALL IOWA 0.0011 160005 16130 CARROLL IOWA 0.0007 160013 16690 MUSCATINE IOWA 0.0005 160016 16930 WEBSTER IOWA 0.0029 160024 16760 POLK IOWA 0.0032 160029 16510 JOHNSON IOWA 0.0034 160030 16840 STORY IOWA 0.0032 160032 16490 JASPER IOWA 0.0007 160045 16560 LINN IOWA 0.0053 160058 16510 JOHNSON IOWA 0.0160 160064 16160 CERRO GORDO IOWA 0.0067 160079 16560 LINN IOWA 0.0039 160082 16760 POLK IOWA 0.0114 160083 16760 POLK IOWA 0.0142 160101 16760 POLK IOWA 0.0003 160112 16200 CLAY IOWA 0.0011 160124 16290 DICKINSON IOWA 0.0005 160146 16960 WOODBURY IOWA 0.0025 160147 16780 POWESHIEK IOWA 0.0006 160153 16960 WOODBURY IOWA 0.0052 160156 16560 LINN IOWA 0.0000 170012 17840 SALINE KANSAS 0.0034 170074 17300 GEARY KANSAS 0.0005 170150 17170 COWLEY KANSAS 0.0003 170187 17840 SALINE KANSAS 0.0003 180024 18770 MARION KENTUCKY 0.0006 180064 18860 MONTGOMERY KENTUCKY 0.0006 200002 20070 LINCOLN MAINE 0.0008 200032 20080 OXFORD MAINE 0.0008 200039 20050 KENNEBEC MAINE 0.0048 200041 20050 KENNEBEC MAINE 0.0008 200063 20060 KNOX MAINE 0.0020 230003 23690 OTTAWA MICHIGAN 0.0005 230054 23510 MARQUETTE MICHIGAN 0.0052 230055 23210 DICKINSON MICHIGAN 0.0012 230072 23690 OTTAWA MICHIGAN 0.0020 230093 23530 MECOSTA MICHIGAN 0.0005 230101 23200 DELTA MICHIGAN 0.0008 230106 23610 NEWAYGO MICHIGAN 0.0007CMS-1498-P2 71

Provider Number SSACD County Name State Payment Weight Factor 230174 23690 OTTAWA MICHIGAN 0.0004 240022 24520 NOBLES MINNESOTA 0.0004 240030 24200 DOUGLAS MINNESOTA 0.0018 240036 24720 STEARNS MINNESOTA 0.0118 240043 24230 FREEBORN MINNESOTA 0.0009 240044 24840 WINONA MINNESOTA 0.0007 240052 24550 OTTER TAIL MINNESOTA 0.0010 240069 24730 STEELE MINNESOTA 0.0006 240071 24650 RICE MINNESOTA 0.0006 240075 24170 CROW WING MINNESOTA 0.0024 240088 24330 KANDIYOHI MINNESOTA 0.0013 240093 24060 BLUE EARTH MINNESOTA 0.0038 240101 24020 BECKER MINNESOTA 0.0007 240166 24450 MARTIN MINNESOTA 0.0008 250027 25790 WINSTON MISSISSIPPI 0.0002 250034 25350 LAFAYETTE MISSISSIPPI 0.0046 250050 25520 OKTIBBEHA MISSISSIPPI 0.0008 250100 25430 LOWNDES MISSISSIPPI 0.0030 250112 25060 CALHOUN MISSISSIPPI 0.0001 260004 26260 COOPER MISSOURI 0.0001 260009 26790 PETTIS MISSOURI 0.0023 260040 26380 GREENE MISSOURI 0.0111 260059 26520 LACLEDE MISSOURI 0.0009 260061 26990 VERNON MISSOURI 0.0004 260065 26380 GREENE MISSOURI 0.0128 260068 26090 BOONE MISSOURI 0.0086 260078 26450 HOWELL MISSOURI 0.0016 260141 26090 BOONE MISSOURI 0.0093 260178 26090 BOONE MISSOURI 0.0016 260195 26821 POLK MISSOURI 0.0011 260207 26380 GREENE MISSOURI 0.0004 260221 26380 GREENE MISSOURI 0.0000 270002 27080 CUSTER MONTANA 0.0006 270003 27240 LEWIS AND CLARK MONTANA 0.0014 270004 27550 YELLOWSTONE MONTANA 0.0058 270014 27310 MISSOULA MONTANA 0.0042 270017 27460 SILVER BOW MONTANA 0.0019 270023 27310 MISSOULA MONTANA 0.0018 270049 27550 YELLOWSTONE MONTANA 0.0057 270051 27140 FLATHEAD MONTANA 0.0027 270057 27150 GALLATIN MONTANA 0.0014 270087 27140 FLATHEAD MONTANA 0.0002 280009 28090 BUFFALO NEBRASKA 0.0042 280061 28780 SCOTT BLUFF NEBRASKA 0.0025 280111 28700 PLATTE NEBRASKA 0.0008 280125 28590 MADISON NEBRASKA 0.0026CMS-1498-P2 72

Provider Number SSACD County Name State Payment Weight Factor 320001 32000 BERNALILLO NEW MEXICO 0.0073 320002 32240 SANTA FE NEW MEXICO 0.0039 320003 32230 SAN MIGUEL NEW MEXICO 0.0007 320004 32170 OTERO NEW MEXICO 0.0017 320009 32000 BERNALILLO NEW MEXICO 0.0027 320011 32190 RIO ARRIBA NEW MEXICO 0.0006 320013 32270 TAOS NEW MEXICO 0.0009 320014 32140 LUNA NEW MEXICO 0.0006 320016 32080 GRANT NEW MEXICO 0.0009 320017 32000 BERNALILLO NEW MEXICO 0.0006 320018 32060 DONA ANA NEW MEXICO 0.0040 320021 32000 BERNALILLO NEW MEXICO 0.0097 320033 32131 LOS ALAMOS NEW MEXICO 0.0006 320037 32300 VALENCIA NEW MEXICO 0.0002 320057 32240 SANTA FE NEW MEXICO 0.0001 320058 32170 OTERO NEW MEXICO 0.0000 320067 32090 GUADALUPE NEW MEXICO 0.0001 320069 32030 COLFAX NEW MEXICO 0.0005 320070 32300 VALENCIA NEW MEXICO 0.0001 320074 32000 BERNALILLO NEW MEXICO 0.0005 320083 32000 BERNALILLO NEW MEXICO 0.0025 320085 32060 DONA ANA NEW MEXICO 0.0035 320087 32240 SANTA FE NEW MEXICO 0.0001 320088 32060 DONA ANA NEW MEXICO 0.0002 330008 33900 WYOMING NEW YORK 0.0005 330010 33380 MONTGOMERY NEW YORK 0.0000 330011 33030 BROOME NEW YORK 0.0033 330030 33770 WAYNE NEW YORK 0.0009 330033 33080 CHENANGO NEW YORK 0.0007 330044 33510 ONEIDA NEW YORK 0.0056 330047 33380 MONTGOMERY NEW YORK 0.0021 330053 33550 ORLEANS NEW YORK 0.0004 330058 33530 ONTARIO NEW YORK 0.0013 330074 33530 ONTARIO NEW YORK 0.0010 330079 33270 FRANKLIN NEW YORK 0.0011 330084 33270 FRANKLIN NEW YORK 0.0009 330085 33570 OTSEGO NEW YORK 0.0014 330090 33070 CHEMUNG NEW YORK 0.0043 330096 33010 ALLEGANY NEW YORK 0.0007 330103 33040 CATTARAUGUS NEW YORK 0.0020 330108 33070 CHEMUNG NEW YORK 0.0014 330115 33360 MADISON NEW YORK 0.0008 330132 33040 CATTARAUGUS NEW YORK 0.0006 330136 33570 OTSEGO NEW YORK 0.0062 330140 33520 ONONDAGA NEW YORK 0.0120 330144 33690 STEUBEN NEW YORK 0.0003CMS-1498-P2 73

Provider Number SSACD County Name State Payment Weight Factor 330151 33690 STEUBEN NEW YORK 0.0008 330153 33650 SCHENECTADY NEW YORK 0.0061 330157 33330 JEFFERSON NEW YORK 0.0026 330159 33520 ONONDAGA NEW YORK 0.0029 330166 33060 CHAUTAUQUA NEW YORK 0.0000 330175 33210 CORTLAND NEW YORK 0.0015 330177 33630 ST. LAWRENCE NEW YORK 0.0003 330191 33750 WARREN NEW YORK 0.0049 330197 33630 ST. LAWRENCE NEW YORK 0.0012 330203 33520 ONONDAGA NEW YORK 0.0075 330211 33630 ST. LAWRENCE NEW YORK 0.0012 330213 33340 LEWIS NEW YORK 0.0005 330215 33510 ONEIDA NEW YORK 0.0015 330222 33640 SARATOGA NEW YORK 0.0028 330223 33630 ST. LAWRENCE NEW YORK 0.0009 330229 33060 CHAUTAUQUA NEW YORK 0.0005 330235 33050 CAYUGA NEW YORK 0.0021 330239 33060 CHAUTAUQUA NEW YORK 0.0020 330241 33520 ONONDAGA NEW YORK 0.0091 330245 33510 ONEIDA NEW YORK 0.0056 330249 33360 MADISON NEW YORK 0.0009 330263 33330 JEFFERSON NEW YORK 0.0004 330265 33530 ONTARIO NEW YORK 0.0007 330268 33660 SCHOHARIE NEW YORK 0.0003 330276 33280 FULTON NEW YORK 0.0011 330277 33690 STEUBEN NEW YORK 0.0015 330307 33730 TOMPKINS NEW YORK 0.0019 330394 33030 BROOME NEW YORK 0.0072 330406 33650 SCHENECTADY NEW YORK 0.0002 340011 34600 MITCHELL NORTH CAROLINA 0.0009 340016 34490 JACKSON NORTH CAROLINA 0.0015 340087 34550 MC DOWELL NORTH CAROLINA 0.0007 340127 34380 GRANVILLE NORTH CAROLINA 0.0008 340132 34900 VANCE NORTH CAROLINA 0.0014 340159 34720 PERSON NORTH CAROLINA 0.0007 340160 34190 CHEROKEE NORTH CAROLINA 0.0012 350002 35070 BURLEIGH NORTH DAKOTA 0.0044 350006 35500 WARD NORTH DAKOTA 0.0038 350011 35080 CASS NORTH DAKOTA 0.0088 350015 35070 BURLEIGH NORTH DAKOTA 0.0037 350070 35080 CASS NORTH DAKOTA 0.0030 360002 36020 ASHLAND OHIO 0.0010 360148 36390 HOLMES OHIO 0.0004 370018 37730 WASHINGTON OKLAHOMA 0.0027 380001 38320 WASCO OREGON 0.0008 380004 38330 WASHINGTON OREGON 0.0067CMS-1498-P2 74

Provider Number SSACD County Name State Payment Weight Factor 380007 38250 MULTNOMAH OREGON 0.0034 380009 38250 MULTNOMAH OREGON 0.0121 380014 38010 BENTON OREGON 0.0030 380017 38250 MULTNOMAH OREGON 0.0045 380021 38330 WASHINGTON OREGON 0.0013 380025 38250 MULTNOMAH OREGON 0.0011 380029 38230 MARION OREGON 0.0004 380038 38020 CLACKAMAS OREGON 0.0006 380040 38080 DESCHUTES OREGON 0.0010 380047 38080 DESCHUTES OREGON 0.0055 380050 38170 KLAMATH OREGON 0.0023 380051 38230 MARION OREGON 0.0056 380052 38220 MALHEUR OREGON 0.0010 380056 38230 MARION OREGON 0.0002 380060 38250 MULTNOMAH OREGON 0.0021 380061 38250 MULTNOMAH OREGON 0.0055 380082 38020 CLACKAMAS OREGON 0.0006 380089 38020 CLACKAMAS OREGON 0.0021 380091 38020 CLACKAMAS OREGON 0.0001 390013 39720 UNION PENNSYLVANIA 0.0019 390043 39710 TIOGA PENNSYLVANIA 0.0008 390045 39510 LYCOMING PENNSYLVANIA 0.0048 390061 39440 LANCASTER PENNSYLVANIA 0.0014 390065 39000 ADAMS PENNSYLVANIA 0.0016 390066 39460 LEBANON PENNSYLVANIA 0.0035 390068 39440 LANCASTER PENNSYLVANIA 0.0006 390071 39240 CLINTON PENNSYLVANIA 0.0004 390079 39130 BRADFORD PENNSYLVANIA 0.0067 390100 39440 LANCASTER PENNSYLVANIA 0.0138 390225 39440 LANCASTER PENNSYLVANIA 0.0023 390236 39130 BRADFORD PENNSYLVANIA 0.0004 390268 39200 CENTRE PENNSYLVANIA 0.0032 420071 42230 GREENWOOD SOUTH CAROLINA 0.0061 430005 43140 CODINGTON SOUTH DAKOTA 0.0014 430008 43050 BROOKINGS SOUTH DAKOTA 0.0004 430012 43670 YANKTON SOUTH DAKOTA 0.0017 430013 43170 DAVISON SOUTH DAKOTA 0.0011 430014 43060 BROWN SOUTH DAKOTA 0.0025 430015 43320 HUGHES SOUTH DAKOTA 0.0007 430016 43490 MINNEHAHA SOUTH DAKOTA 0.0073 430027 43490 MINNEHAHA SOUTH DAKOTA 0.0097 430048 43400 LAWRENCE SOUTH DAKOTA 0.0005 430077 43510 PENNINGTON SOUTH DAKOTA 0.0075 430082 43510 PENNINGTON SOUTH DAKOTA 0.0000 430089 43630 UNION SOUTH DAKOTA 0.0005 430090 43490 MINNEHAHA SOUTH DAKOTA 0.0004CMS-1498-P2 75

Provider Number SSACD County Name State Payment Weight Factor 430091 43510 PENNINGTON SOUTH DAKOTA 0.0007 430092 43060 BROWN SOUTH DAKOTA 0.0002 430093 43510 PENNINGTON SOUTH DAKOTA 0.0001 430094 43400 LAWRENCE SOUTH DAKOTA 0.0000 430095 43410 LINCOLN SOUTH DAKOTA 0.0029 430096 43670 YANKTON SOUTH DAKOTA 0.0003 450154 45946 VAL VERDE TEXAS 0.0009 450187 45952 WASHINGTON TEXAS 0.0006 450604 45552 GILLESPIE TEXAS 0.0017 460007 46100 IRON UTAH 0.0006 460015 46020 CACHE UTAH 0.0010 460017 46010 BOX ELDER UTAH 0.0002 460019 46060 DUCHESNE UTAH 0.0002 460026 46200 SEVIER UTAH 0.0002 460030 46230 UINTAH UTAH 0.0003 460033 46080 GARFIELD UTAH 0.0001 460039 46010 BOX ELDER UTAH 0.0001 460041 46050 DAVIS UTAH 0.0010 460042 46050 DAVIS UTAH 0.0011 460054 46020 CACHE UTAH 0.0003 470001 47110 WASHINGTON VERMONT 0.0015 470011 47120 WINDHAM VERMONT 0.0009 490004 49421 HARRISONBURG CITY VIRGINIA 0.0056 490005 49962 WINCHESTER CITY VIRGINIA 0.0115 490013 49867 SOUTH BOSTON CITY VIRGINIA 0.0023 490021 49551 LYNCHBURG CITY VIRGINIA 0.0119 490024 49801 ROANOKE CITY VIRGINIA 0.0167 490038 49860 SMYTH VIRGINIA 0.0008 490041 49622 NEWPORT NEWS CITY VIRGINIA 0.0030 490048 49838 SALEM CITY VIRGINIA 0.0061 490052 49622 NEWPORT NEWS CITY VIRGINIA 0.0072 490053 49950 WASHINGTON VIRGINIA 0.0022 490066 49961 WILLIAMSBURG CITY VIRGINIA 0.0029 490075 49241 DANVILLE CITY VIRGINIA 0.0037 490079 49561 MARTINSVILLE CITY VIRGINIA 0.0026 490088 49088 BEDFORD CITY VIRGINIA 0.0005 490089 49330 FRANKLIN VIRGINIA 0.0007 490090 49730 PRINCE EDWARD VIRGINIA 0.0013 490092 49328 FRANKLIN CITY VIRGINIA 0.0009 490093 49411 HAMPTON CITY VIRGINIA 0.0052 490098 49580 MECKLENBURG VIRGINIA 0.0019 490105 49860 SMYTH VIRGINIA 0.0000 490106 49891 STAUNTON CITY VIRGINIA 0.0000 490109 49961 WILLIAMSBURG CITY VIRGINIA 0.0000 490110 49600 MONTGOMERY VIRGINIA 0.0022 490111 49980 WYTHE VIRGINIA 0.0010CMS-1498-P2 76

Provider Number SSACD County Name State Payment Weight Factor 490115 49343 GALAX CITY VIRGINIA 0.0013 490123 49510 LANCASTER VIRGINIA 0.0008 490130 49360 GLOUCESTER VIRGINIA 0.0013 490134 49670 NOTTOWAY VIRGINIA 0.0000 490135 49800 ROANOKE VIRGINIA 0.0001 490136 49200 CHESTERFIELD VIRGINIA 0.0031 500002 50350 WALLA WALLA WASHINGTON 0.0016 500012 50380 YAKIMA WASHINGTON 0.0034 500016 50030 CHELAN WASHINGTON 0.0049 500024 50330 THURSTON WASHINGTON 0.0082 500036 50380 YAKIMA WASHINGTON 0.0048 500037 50380 YAKIMA WASHINGTON 0.0003 500049 50350 WALLA WALLA WASHINGTON 0.0006 500050 50050 CLARK WASHINGTON 0.0071 500072 50040 CLALLAM WASHINGTON 0.0021 500139 50330 THURSTON WASHINGTON 0.0017 500143 50330 THURSTON WASHINGTON 0.0001 500148 50030 CHELAN WASHINGTON 0.0002 500150 50050 CLARK WASHINGTON 0.0027 510053 51480 UPSHUR WEST VIRGINIA 0.0002 510072 51510 WETZEL WEST VIRGINIA 0.0003 520002 52480 PORTAGE WISCONSIN 0.0013 520004 52310 LA CROSSE WISCONSIN 0.0027 520009 52430 OUTAGAMIE WISCONSIN 0.0018 520011 52020 BARRON WISCONSIN 0.0009 520013 52170 EAU CLAIRE WISCONSIN 0.0040 520017 52080 CHIPPEWA WISCONSIN 0.0006 520019 52420 ONEIDA WISCONSIN 0.0012 520027 52440 OZAUKEE WISCONSIN 0.0032 520028 52220 GREEN WISCONSIN 0.0012 520030 52360 MARATHON WISCONSIN 0.0053 520033 52700 WOOD WISCONSIN 0.0008 520034 52350 MANITOWOC WISCONSIN 0.0011 520035 52580 SHEBOYGAN WISCONSIN 0.0017 520037 52700 WOOD WISCONSIN 0.0076 520041 52100 COLUMBIA WISCONSIN 0.0006 520044 52580 SHEBOYGAN WISCONSIN 0.0011 520045 52690 WINNEBAGO WISCONSIN 0.0021 520048 52690 WINNEBAGO WISCONSIN 0.0017 520049 52040 BROWN WISCONSIN 0.0030 520057 52550 SAUK WISCONSIN 0.0006 520066 52520 ROCK WISCONSIN 0.0037 520070 52170 EAU CLAIRE WISCONSIN 0.0041 520071 52270 JEFFERSON WISCONSIN 0.0011 520075 52040 BROWN WISCONSIN 0.0047 520076 52130 DODGE WISCONSIN 0.0009CMS-1498-P2 77

Provider Number SSACD County Name State Payment Weight Factor 520087 52310 LA CROSSE WISCONSIN 0.0047 520088 52190 FOND DU LAC WISCONSIN 0.0019 520091 52420 ONEIDA WISCONSIN 0.0011 520095 52550 SAUK WISCONSIN 0.0007 520097 52040 BROWN WISCONSIN 0.0018 520100 52520 ROCK WISCONSIN 0.0020 520107 52350 MANITOWOC WISCONSIN 0.0013 520109 52280 JUNEAU WISCONSIN 0.0006 520113 52370 MARINETTE WISCONSIN 0.0017 520116 52270 JEFFERSON WISCONSIN 0.0012 520160 52430 OUTAGAMIE WISCONSIN 0.0034 520193 52040 BROWN WISCONSIN 0.0028 520196 52170 EAU CLAIRE WISCONSIN 0.0002 520198 52690 WINNEBAGO WISCONSIN 0.0013 520202 52360 MARATHON WISCONSIN 0.0020 530006 53160 SHERIDAN WYOMING 0.0010 530012 53120 NATRONA WYOMING 0.0052 530033 53120 NATRONA WYOMING 0.0004CMS-1498-P2 78Table 4: Comparison of the Proposed FY 2011 Section 1109 Payments by State Using the WBHO and WBO MethodologiesNAMENumber ofCounties withEligibleHospitalsunderWBHONumber ofEligibleHospitalsunderWBHOPayments under WBHO(in millions)Percentageof paymentNumber ofCountieswithEligibleHospitalsunderWBONumberofEligibleHospitalsunderWBOPaymentsunder WBO(in millions)PercentageofpaymentALABAMA 4 4 $0.99 0.7% 4 4 $0.98 0.7%ARIZONA 3 5 $1.65 1.1% 3 5 $1.65 1.1%ARKANSAS 3 6 $3.03 2.0% 3 6 $3.04 2.0%CALIFORNIA 3 6 $2.18 1.5% 3 6 $2.18 1.5%COLORADO 3 3 $0.29 0.2% 3 3 $0.29 0.2%GEORGIA 7 12 $6.69 4.5% 7 12 $6.67 4.4%HAWAII 4 14 $5.67 3.8% 4 14 $5.70 3.8%IDAHO 8 14 $4.02 2.7% 8 14 $4.07 2.7%ILLINOIS 5 6 $1.74 1.2% 5 6 $1.73 1.2%INDIANA 10 12 $3.00 2.0% 10 12 $2.99 2.0%IOWA 14 21 $12.52 8.3% 14 21 $12.50 8.3%KANSAS 3 4 $0.68 0.5% 3 4 $0.68 0.5%KENTUCKY 2 2 $0.18 0.1% 2 2 $0.18 0.1%MAINE 4 5 $1.37 0.9% 4 5 $1.36 0.9%MICHIGAN 6 8 $1.70 1.1% 6 8 $1.68 1.1%MINNESOTA 13 13 $4.002.7%14 14 $4.122.7%MISSISSIPPI 5 5 $1.29 0.9% 5 5 $1.28 0.9%MISSOURI 8 13 $7.52 5.0% 8 13 $7.50 5.0%MONTANA 7 10 $3.87 2.6% 7 10 $3.85 2.6%NEBRASKA 4 4 $1.53 1.0% 4 4 $1.52 1.0%NEW HAMPSHIRE Not on this list1 1 $0.31 0.2%NEW MEXICO 13 24 $6.31 4.2%13 25 $5.48 3.7%CMS-1498-P2 79NAMENumber ofCounties withEligibleHospitalsunderWBHONumber ofEligibleHospitalsunderWBHOPayments under WBHO(in millions)Percentageof paymentNumber ofCountieswithEligibleHospitalsunderWBONumberofEligibleHospitalsunderWBOPaymentsunder WBO(in millions)PercentageofpaymentNEW YORK 28 51 $17.36 11.6% 28 51 $17.38 11.6%NORTH CAROLINA 7 7 $1.08 0.7% 7 7 $1.07 0.7%NORTH DAKOTA 3 5 $3.53 2.4% 3 5 $3.52 2.3%OHIO 2 2 $0.21 0.1% 2 2 $0.20 0.1%OKLAHOMA 1 1 $0.40 0.3% 1 1 $0.40 0.3%OREGON 9 21 $8.96 6.0% 9 21 $9.31 6.2%PENNSYLVANIA 9 13 $6.24 4.2% 9 13 $6.28 4.2%SOUTH CAROLINA 1 1 $0.91 0.6% 1 1 $0.91 0.6%SOUTH DAKOTA 11 19 $5.70 3.8% 11 19 $5.67 3.8%TEXAS 3 3 $0.48 0.3% 3 3 $0.47 0.3%UTAH 8 11 $0.740.5%9 12 $0.73 0.5%VERMONT 2 2 $0.36 0.2% 2 2 $0.36 0.2%VIRGINIA 27 30 $14.54 9.7% 27 30 $14.50 9.7%WASHINGTON 6 13 $5.67 3.8% 6 13 $5.73 3.8%WEST VIRGINIA 2 2 $0.08 0.1% 2 2 $0.08 0.1%WISCONSIN 23 40 $12.52 8.3% 23 40 $12.64 8.4%WYOMING 2 3 $0.99 0.7% 2 3 $0.98 0.7%Total273 415 $150,000,000 100% 276 419 $150,000,000 100%CMS-1498-P2 80
F. Rural Community Hospital Demonstration Program
1. Background
Section 410A(a) of the Medicare Pr escription Drug, Improvement, and
Modernization Act of 2003 (MMA), Pub. L. 108-173, required the Secretary to establish
a demonstration program to test the feasibility and advisability of establishing "rural
community hospitals" to furnish covered inpatient hospital services to Medicare

beneficiaries. The demonstra tion pays rural community hospitals for such services under
cost based methodology for Medicare paymen t purposes for covere d inpatient hospital

services furnished to Medicare beneficiaries. A rural commun ity hospital, as defined in
section 410A(f)(1) of MMA, is a hospital that--

● Is located in a rural area (as defined in section 1886(d)(2)(D) of the Act) or is
treated as being located in a rural area under section 1886(d)(8)(E) of the Act;

● Has fewer than 51 beds (excluding be ds in a distinct pa rt psychiatric or
rehabilitation unit) as reported in its most recent cost report;

● Provides 24-hour emerge ncy care services; and

● Is not designated or eligible for de signation as a CAH under section 1820 of the

Act.
Subsection 410A(a)(4) of the MMA, in conjunc tion with paragraphs (2) and (3) of
subsection 410A(a), provided that the Secretary was to select for participation no more
than 15 rural community hospitals in rural areas of States that the Secretary identified as
having low population densities. Using 2002 data from the U.S Census Bureau, we

identified the 10 States with the lowest population density in which rural communityCMS-1498-P2 81
hospitals were to be located in order to participate in the demonstration: Alaska, Idaho,
Montana, Nebraska, Nevada , New Mexico, North Dakota, South Dakota, Utah, and
Wyoming. (Source: U.S. Census Bureau, Sta tistical Abstract of the United States: 2003).
We originally solicited applicants for the demonstration in May 2004; 13 hospitals
began participation with cost report years beginning on or after October 1, 2004. (Four of
these 13 hospitals withdrew from the progra m and became CAHs). In a notice published

in the Federal Register on February 6, 2008 (73 FR 6971) , we announced a solicitation
for up to 6 additional hospitals to participate in the dem onstration program. Four
additional hospitals we re selected to participate unde r this solicitation. These four
additional hospitals began under the demonstration paym ent methodology with the
hospital's first cost reporting period starting on or after July 1, 2008. Three hospitals (two
of the hospitals were among the thirteen hospitals that were original participants in the

demonstration and one of the hospitals was among the four hospitals that began the
demonstration in 2008) withdrew from the demonstration during CY 2009. (Two of
these hospitals indicated that they will be pa id more for Medicare inpatient services under
the rebasing allowed under the SCH methodol ogy allowed by the Medicare Improvement

for Patients and Providers Ac t of 2008 (Pub. L. 110-275). The other hospital restructured
to become a CAH.) For purposes of the anal yses that follow in section II.F.3 of the
preamble, we make the assumption that there are 10 currently participating hospitals (8
hospitals that are actively participating since the initial demonstration period had not yet
concluded for them at the time of the passa ge of Pub. L. 111-148 and 2 hospitals that

concluded the demonstrati on in December 2009 upon the conclusion of their initialCMS-1498-P2 82
demonstration period). For the 2 hospitals th at concluded the demonstration in December
2009, we assume that they w ill continue the demonstrati on under the 5-year extension
provided by Affordable Care Act since they participated in their entire initial 5-year
demonstration period, which we believe indicates that t hose hospitals favored the
payment rate provided in the demonstration and will continue to avail themselves of such

reimbursement.
Section 410A(a)(5) of Pub. L. 108-173 require d a 5-year demonstration period of
participation. Prior to th e enactment of Pub. L. 111-148, for the seven currently
participating hospitals that began the demonstration during FY 2005 ("originally
participating hospitals"), the demonstrati on was scheduled to end for each of these
hospitals on the last day of its cost reporting period that ends in FY 2010. The end of the
participation for the three par ticipating hospitals that bega n the demonstration in CY 2008

was scheduled to be September 30, 2010.
In addition, section 410A(c)(2) of Pub. L. 108-173 requires that, "[i]n conducting
the demonstration program unde r this section, the Secretar y shall ensure that the
aggregate payments made by the Secretary do not exceed the amount which the Secretary
would have paid if the dem onstration program under this s ection was not implemented."
This requirement is commonly referre d to as "budget neutrality".
Generally, when we imple ment a demonstration pr ogram on a budget neutral
basis, the demonstration progra m is budget neutral in its own terms; in other words, the
aggregate payments to the participating hosp itals do not exceed the amount that would be
paid to those same hospitals in the absence of the demonstration prog ram. Typically, thisCMS-1498-P2 83
form of budget neutrality is viable when, by changing payments or aligning incentives to
improve overall efficiency, or both, a demonstration program may reduce the use of some
services or eliminate the need for others, resulting in reduced expenditures for the
demonstration program's par ticipants. These reduced ex penditures offset increased
payments elsewhere under the demonstrati on program, thus ensuring that the
demonstration program as a whole is budget ne utral or yields savings. However, the

small scale of this demonstr ation program, in conjunction with the payment methodology,
makes it extremely unlikely that this demons tration program could be viable under the
usual form of budget neutrality. Specifically, cost-based payments to participating small
rural hospitals are likely to increase Medi care outlays without producing any offsetting
reduction in Medicare expenditure s elsewhere. Therefore, a rural community hospital's
participation in this demonstration program is unlikely to yield benefits to the participant
if budget neutrality were to be implemented by reducing ot her payments for these same
hospitals.
In the past six IPPS final regulations, spanning the period for which the
demonstration has been implemented, we have adjusted the national inpatient PPS rates
by an amount sufficient to account for the a dded costs of this de monstration program,
thus applying budget neutrality across the paym ent system as a whole rather than merely
across the participants in this demonstration program. As we discussed in the FY 2005,
FY 2006, FY 2007, FY 2008, FY 2009, and FY 2010 IPPS final rules (69 FR 49183;
(70 FR 47462); (71 FR 48100); (72 FR 47392); (73 FR 48670); and (74 FR 43922)), we
believe that the language of the statutor y budget neutrality requi rements permits theCMS-1498-P2 84
agency to implement the budget ne utrality provision in this manner.
In light of the statute's budget neut rality requirement, we proposed in the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24012) a methodology to
calculate a budget neutrality adjustment factor to the FY 2011 national IPPS rates. In the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, the only amount that was
identified to be offset for the FY 2011 IPPS/LTCH final rule was that by which the costs
of the demonstration program, as indicated by settled cost reports beginning in FY 2007
for hospitals participating in the demonstration during FY 2007, exceeded the amount
that was identified in the FY IPPS 2007 final rule as the budget neutrality offset for
FY 2007. No dollar amount was specified for purpos e of this offset, because of a delay in
the settlement process of FY 2007 cost reports. Due to the timing of the proposed rule in
relation to the passage of Pub. L. 111-148, we were unable to include in the proposed
budget neutrality adjustment factor to the FY 2011 national IPPS rates an offset that
would accont for the estimated financial impact that the demonstration would have for

certain time frames under the extens ion required by such Act.
In this supplemental proposed rule, we propose that such an adjustment would
incorporate the following 4 components: (1) the estimated costs that would be incurred in
FY 2011 for the 10 currently participating hosp itals as a result of the demonstration's
continuation in FY 2011; (2) the estimated cost incurred in FY 2010 for the 7 "originally
participating hospitals" that were not accounted for in the FY 2010 IPPS final rule but

that now must be accounted for as a result of the demonstration being continued by the
Affordable Care Act's 5-year extension for such hospitals; (3) the estimated FY 2011CMS-1498-P2 85
demonstration costs associated with the par ticipation of up to 20 ne w hospitals; and (4) a
factor by which the cost of the demonstr ation program in 2007, as indicated by settled
cost reports beginning in FY 2007, exceeded the amount that was identified in the
FY IPPS 2007 final rule as the budget neutrality offset for FY 2007.
2. Section 410Aof the MMA as amended by Section 3123 of the Pub. L. 111-148 and as
further amended by section 10313 of Pub. L. 111-148.
Section 410Aof the MMA as amended by section 3123 of Pub. L. 111-148, and as
further amended by section 10313 of Pub. L. 111-148, affects this demonstration in
several ways. First, the Secretary is required to conduct the demonstration for an
additional 5-year period that begins on the date immediately following the last day of the
initial 5-year period under section 410A(a)(5 ) of the MMA as amended. (Section
410A(g)(1) of the MMA as added by secti on 3123(a) of Pub. L. 111-148 and as further
amended by section 10313 of Pub. L. 111-148). Further, the Affordable Care Act
requires that in the case of a rural community hospital that is participating in the
demonstration program as of th e last day of the initial 5-y ear period, the Secretary shall
provide for the continued par ticipation of such rural hospital in the demonstration
program during the 5-year extension unless th e hospital makes an election, in such form
and manner as the Secretary may specify, to discontinue such par ticipation. (Section
410A(g)(4)(A) of MMA as added by section 3123(a) of Pub. L. 111-148 and as amended
by section 10313 of Pub. L. 111-148). In a ddition, it provides that during the 5-year
extension period, the Secretary shall expand the number of States with low population
densities determined by the Secretary to 20. (Section 410A(g)(2) of MMA as added byCMS-1498-P2 86
section 3123(a) of Pub. L. 111-148 and as amended by section 10313 of Pub. L. 111-
148.) Further, the Secretary is required to use the same criteri a and data that the Secretary

used to determine the States under section 410A(a)(2) of MMA for purposes of the initial
5-year period. It also allows not more than 30 rural community hospitals in such States to
participate in the demonstra tion during the 5-year extens ion period. (Section 410A(g)(3)
of MMA as added by section 3123(a) of Pub. L. 111-148 and as amended by section
10313 of Pub. L. 111-148.) Additionally, it pr ovides that the amount of payment under
the demonstration program for covered inpatient hos pital services furnished in a rural
community hospital, other than services furnished in a psychiatric or rehabilitation unit of
the hospital which is a distinct part, is the r easonable costs of providi ng such services for
discharges occurring in the first cost reportin g period beginning on or after the first day of
the 5-year extension period. (Section 410A (g)(4)(b) of MMA as added by section
3123(a) of Pub. L. 111-148 and as amended by section 10313 of Pub. L. 111-148.) For
discharges occurring in a subsequent cost reporting period paid under the demonstration,
the formula in section 410A(b)(1)(B) of MMA as amended would apply. In addition,
various other technical and conforming change s were made to sec tion 410A of MMA, as
amended by section 3123(a) of Pub. L. 111-148 and as amended by section 10313 of

Pub. L. 111-148.
3. Proposed FY 2011 Budget Neutrality Adjustment

In order to ensure that the demonstrati on is budget neutral as is required by the
statute, we are proposing to adjust the national IPPS rates in the FY 2011 IPPS final rule
to account for any added costs attributable to the demonstration. Specifically, theCMS-1498-P2 87
proposed budget neutrality adjustment would acc ount for: (1) the estimated costs of the
demonstration in FY 2011 for the 10 currently participating hospita ls; (2) the estimated

FY 2010 costs of the demonstration that were not accounted for in the FY 2010
IPPS/RY 2010 LTCH PPS final rule for the seven "originally participating hospitals"
because we estimated those hospitals' FY 2010 costs under the assumption that the

demonstration would be concluding before the end of FY 2010 for those hospitals; (3) the
estimated FY 2011 costs for up to 20 new hosp itals selected to participate in the
demonstration; and (4) the amount by which th e costs of the demonstration program, as
indicated by settled cost reports beginning in FY 2007 for hospitals participating in the
demonstration during FY 2007, exceeded the am ount that was identified in the FY 2007
IPPS final rule as the budget neutrality offset for FY 2007.
a. Component of the Proposed FY 2011 Budget Neutrality Adjustment that Accounts for

Estimated FY 2011 Costs of th e Demonstration of the Te n Currently Participating
Hospitals
The component of the proposed FY 2011 budget neutrality adjustment to the

national IPPS rates that accounts for the estima ted cost of the demonstration in FY 2011
for the ten currently participating hospitals would be calculated by utilizing separate
methodologies for the 7 hospitals that have pa rticipated in the demonstration since its
inception and that, as explained previously, we c onsider to be continuing to participate in
the demonstration ("originally participating hospitals"), and the 3 hospitals that are
currently participating in the demonstration that were among the 4 hospitals that joined

the demonstration in 2008. Diffe rent methods are used becau se fiscal intermediaries'CMS-1498-P2 88

most recent final settlements of cost reports are for periods beginning in FY 2006 for the
"originally participating hospitals," whereas we are relying on available submitted
documentation for the hospitals that began pa rticipation in the de monstration in 2008.
Because the hospitals that began the demons tration in 2008 have no settled cost reports
for the demonstration, we are using as sub mitted cost documents. The budget neutrality
analysis is based on the assumption that all 10 of these hospitals will continue the
demonstration under the 5-year extension period provided by th e Affordable Care Act.
We believe that this assumption is warranted since they have participated in the initial 5
year demonstration period so far, which we believe indicat es that they will choose to

continue to avail themselves of the leve ls of reimbursement under the demonstration.
The estimate of the portion of the propos ed budget neutrality adjustment that

accounts for the estimated costs of the demons tration in FY 2011 for the 7 "originally
participating hospitals" is based on data from their second y ear cost reports - that is, cost
reporting periods beginning in FY 2006. We propose to use these cost reports because
they are the most recent complete cost reports and thus we believe they enable us to
estimate FY 2011 costs as accurately as possible. In addition, we estimate the cost of the
demonstration in FY 2011 for 2 of the 4 hosp itals that joined the demonstration in 2008

based on data from each of their cost re porting periods beginning January 1, 2008.
Similarly, we propose to use these cost repor ts because they are the most recent cost
reports and thus we be lieve they enable us to estimate FY 2011 costs for these 2 hospitals
as accurately as possible. Since one of th e 4 hospitals that began in 2008 has withdrawn,
there is one hospital remaining among those that began in that year. The remainingCMS-1498-P2 89
hospital of the 4 that began in 2008 is an Indian Health Service provider. Historically, the
hospital has not filed standard Medicare cost reports. In order to estimate its costs, we are
proposing to use an analysis of Medicare i npatient costs and payments submitted by the
hospital for the cost reporting period Oc tober 1, 2005 through September 30, 2006. We
are proposing to use this data because it repr esents a detailed analysis of the hospital's
cost-payment profile, and we expect that such an account will not change appreciably
from year to year because it is a relativ ely small provider serv ing a limited population.
When we add together the estimated costs of the demonstration in FY 2011 for the 7
"originally participating hospitals" that have participated in the demonstration since its
inception and the 3 hospitals selected in 2008 that are still partic ipating, the total
estimated cost is $20,930,484. This estimated amount reflects the difference between
these 10 participating hosp itals' estimated costs in FY 2011 under the methodology set
forth in Pub. L. 108-173 as amended by Pub. L. 111-148 and the estimated amount the
hospitals would have been paid under the IPPS in FY 2011. With the exception of the
Indian Health Service provider, the estimate d costs under the demonstration are derived
from data on the hospitals' cost reports. The cost reports state the dollar amount
attributable to Medicare inpatient costs for the cost report year. They also state the dollar
amount that would be paid if the inpatient pr ospective payment system were in effect.
For each hospital, the difference between th ese two amounts is updated according to the
market basket update factors for inpatient hospital costs re ported by the CMS Office of
the Actuary for the years between the cost report year and FY 2011. In accordance with
guidance from the Office of the Actuary, we also assume a 2 percent annual volumeCMS-1498-P2 90
increase. In the FY 2011 final rule, we may revise this estimate if updated cost report

data becomes available.
b. Portion of the Proposed FY 2011 Budget Neutrality Adjustment that Accounts for

Estimated FY 2010 Costs of the Demonstration that were Not Accounted for in the FY
2010 IPPS Final Rule for the seven "originally participating hospitals."
As explained above, subsection (g)(4)(A ) of 410A of the MMA as added by
section 3123(a) of Pub. L. 111-148 as am ended by section 10313 of Pub. L. 111-148,
provided for the continued pa rticipation of rural community hospitals that were
participating in the demonstration as of the last day of the initial 5-year [demonstration]
period. One of the effects of this extension is that the seven "ori ginally participating
hospitals" (those hospitals that have participated in the de monstration since its inception
and that continue to participate in the demonstration or were participating in the
demonstration as of the last day of its initial 5-year demonstration period (that, is the 2
rural community hospitals that concluded their period of performance in December
2009)) which were scheduled to end their participation in th e demonstration before the
conclusion of FY 2010 would continue to pa rticipate for the remainder of FY 2010 and
beyond as applicable. Section II.F.3. of th e preamble, we are assuming for purposes of
our budget neutrality analysis in section II. F.3.a. of the preamble that the seven
"originally participating hospitals" are also currently participating hospitals. See for our
explanation). However, we note that the portion of the FY 2010 budget neutrality
adjustment to the national IPPS rates that was included in the FY 2010 IPPS final rule

that accounted for the estimated costs of the demonstration in FY 2010 did not take intoCMS-1498-P2 91

account costs of the demonstration for those hos pitals beyond the antic ipated end date of
their initial demonstration period. (For exam ple, for a hospital whose cost report ended
in June 30, 2010, we counted only nine months for the budget neutrality adjustment for
the FY 2010 IPPS/LTCH PPS final rule. Under this proposal, we would also adjust the

national IPPS rates to account fo r the estimated costs for this hospital for the remaining
three months of FY 2010.) We are proposin g to include a component in the FY 2011
budget neutrality adjustment to account for th e estimated costs of the demonstration in

FY 2010 that were not accounted for in th e FY 2010 IPPS/RY 2010 LTCH PPS final rule
for the seven "originally par ticipating hospitals" because we calculated the FY 2010 cost
estimate for that year's final rule assuming that the demonstration would end before the
end of that fiscal year for those hospitals . We are proposing the following methodology
to account for such estimated costs: Step one, for each of the seven "originally
participating hospitals," we di vide the number of months th at were not included in the
estimate of the FY 2010 demonstration costs included in the final IPPS FY 2010 rule by
12. This step is necessary to determine fo r each of the seven "ori ginally participating
hospitals" the fraction of FY 2010 for which the estimate of the FY 2010 demonstration
was not included. Step two, for each of the se ven "originally participating hospitals," the
percentage that results in step one is multiplied by the estimate of the cost attributable to
the demonstration in FY 2010 for the hospita l. The estimate for the fraction of the
hospital's cost for fiscal year 2010 not included in the estimate in the FY 2010 IPPS rule
is arrived at by multiplying this fraction by the estimate of costs for the entire year. The

estimate of the costs of the demonstra tion for FY 2010 for the seven "originallyCMS-1498-P2 92
participating" hospital is derived from data found in their cost reports for cost report years
beginning in FY 2006. These cost reports show dollar amounts for costs for Medicare
inpatient services (that is, the Medicare pa yment amount in that cost report year for
Medicare inpatient services) and the dollar am ount that would have been paid under the
IPPS. Since these cost report years all ended during FY 2007, this difference, respective
to each of the seven "originally participa ting hospitals", is updated according to the
market basket updates for i npatient hospital costs reporte d by the CMS Office of the
Actuary for the years from FY 2008 through FY 2011. In accordance with guidance from
the Office of the Actuary, we also assume an annual two percent volume increase. (This
calculation is not necessary for the hospitals that began participating in the demonstration
in 2008 because the portion of the FY 2010 budget neutrality adjustment that accounts for

estimated FY 2010 demonstration costs in the FY 2010 IPPS/RY 2010 LTCH PPS final
rule incorporates a cost estimate for each of these hospitals based on the entirety of the
Federal fiscal year.) The estimate of additional costs attributable to the demonstration in
FY 2010 for the 7 "originally participating hos pitals" that were not accounted for in the
FY 2010 final rule is $6,488,221. Similar to above, this estimate is based on the
assumption that the seven "ori ginally participatin g hospitals" will choose to continue
participating in the demonstration past the end of their original 5-year demonstration
periods. We believe that this assumption is valid, because they are participating in the
demonstration to this date, or, for the cas e of the two hospitals that ended active
participation in the demonstr ation program in December 2009, th ey were participating as
of the last day of th eir initial 5-year period.CMS-1498-P2 93
c. Portion of the Proposed FY 2011 Budget Neutrality Adjustment that Accounts for
Estimated FY 2011 Costs for Hospitals Newl y Selected to Participate in the

Demonstration
Section 410A(g)(3) of MMA, as added by section 3123 of Pub. L. 111-148, and as
amended by section 10313 of Pub. L. 111- 148, provides that" [n]otwithstanding
subsection (a)(4), during the 5-year extensi on period, not more than 30 rural community
hospitals may participate in the demons tration program under this section."
Consequently, up to 20 additi onal hospitals may be added to the demonstration (30
hospitals minus the 10 currently participating hospitals). In order to ensure budget
neutrality for 20 new participa ting hospitals, we are proposing to include a component in
the budget neutrality adjustment factor to the FY 2011 national IPPS rates to account for
the estimated FY 2011 costs of those new hosp itals. For purposes of estimating the FY

2011 costs of the demonstration for 20 new hos pitals, we are proposing to estimate such
costs from the average annual cost per hos pital derived from the estimate of the 10
currently participating hospita ls' costs attributable to th e demonstration for FY 2011.
Because the statute allows the potential for 20 additional hospitals for the demonstration,
we are basing this estimate on the assumption that 20 hospitals will join. Our experience
analyzing the cost reports so far for demons tration hospitals shows a wide variation in
costs among the hospitals. Given the wide vari ation in cost profiles that might occur for
additional hospitals, we believe that estimating the tota l demonstration cost for FY 2011
for 20 additional hospitals from the average annua l cost of the currently existing hospitals
yields the most accurate prediction because it is reflective of the historical trend ofCMS-1498-P2 94
participant behavior under the demonstration and should give an accurate as possible
prediction of future participan t behavior. We believe that, although there is variation in
costs, formulating an estimate from the average costs of as many as 10 hospitals gives as
good as possible a prediction of what the de monstration costs for each of 20 additional
hospitals. We are estimating the average cost for each of the 20 additional hospitals not
on a range of costs, but on an estimate of this average cost per hospital, obtained by dividing $20,930,484, the estimated cost amount for FY 2011 identified for the 10
participating hospitals in subs ection (a), by 10. The estimate for costs attributable to the

demonstration for 20 additional hospitals in FY 2011 is $41,860,968.
d. Portion of the Proposed FY 2011 Budget Neutrality Adjustment that Offsets the
Amount by which the Costs of the Demonstr ation in FY 2007 exceeded the amount that
was identified in the Final FY 2007 IPPS final rule as the Budget Neutrality Offset for

FY 2007
In addition, in order to ensure that the demonstration in FY 2007 was budget
neutral , we are proposing to incorporat e a component into the budget neutrality
adjustment factor to the FY 2011 national IPPS rates, which would offset the amount by
which the costs of the demonstration program as indicated by settled cost reports
beginning in FY 2007 for hospitals particip ating in the demonstration during FY 2007
exceeded the amount that was identified in the FY 2007 IPPS final rule as the budget
neutrality offset for FY 2007. Specifically, we are proposing the following methodology:

• Step One: Calculate the FY 2007 cost s of the demonstration program according
to the settled cost reports that began in FY 2007 for the then participating hospitalsCMS-1498-P2 95
(which represent the third year of the demonstration for each of the then participating
hospitals). (We propose to use these settled cost reports, which represent the third year of
the demonstration for each of the then par ticipating hospitals because they correspond
most precisely to FY 2007 and we therefore believe correctly repr esent FY 2007 inpatient
costs for the demonstration during that period).

• Step Two: Subtract the amount th at was offset by the budget neutrality adjustment for FY 2007 ($9,197,870) from the co sts of the demonstration in FY 2007 as
calculated in step one; and

• Step Three: The result of step tw o is a dollar amount, for which we would

calculate a factor that woul d offset such amounts and would be incorporated into the
proposed overall budget neutrality adjustment to national IPPS rates for FY 2011. This
specific component to the overall budget ne utrality adjustment for FY 2011 would

account for the difference between the costs of the demonstration in FY 2007 and the
amount of the budget neutrality adjustment published in the FY 2007 IPPS final rule and

therefore ensures that the demonstr ation is budget neutral for FY 2007.
Because the settlement process for the de monstration hospitals' third year cost
reports, that is, cost reporting periods star ting in FY 2007, has experienced a delay, for
this FY 2011 IPPS proposed rule, we are unable to state the costs of the demonstration
corresponding to FY 2007 and as a result ar e unable to propose the specific numeric
adjustment representing this offsetting process that would be applied to the national IPPS
rates. However, we expect the cost repor ts beginning in FY 2007 for hospitals that
participated during FY 2007 to be settled before the FY 2011 IPPS/LTCH final rule isCMS-1498-P2 96
published. Therefore, for the FY 2011 IPPS/LTCH PPS final rule, we expect to be able
to calculate the amount by which the co sts corresponding to FY 2007 exceeded the
amount offset by the budget neutrality adjus tment for FY 2007. Consequently, by adding
this proposed amount to the above proposed amounts estimated in subsections (a) through
(c) of section II. F. 3. a. of the preamble, we arrive at a proposed amount, from which we
would be able to calculate the proposed budget neutrality factor which we would use to
adjust the FY 2011 national IPPS rates in the FY 2011 IPPS/LTCH PPS final rule.
For this supplemental proposed FY 2011/LTCH PPS rule, the estimated amount
for the adjustment to the national IPPS rates is the sum of the amounts specified in
subsections (a) through (c) above or $69,279,673 and the amount resulting from the
proposed method in subsection (d) that we expect to be calculated in the FY 2011
IPPS/LTCHPPS final rule . Subsections (a) through (c) state dollar amounts, which
represent estimated costs attri butable to the demonstration for the respective component

of the overall estimated calcula tion of the budget neutrality factor for FY 2011. This
estimated amount is based on the specific assu mptions identified, as well as from data
sources that are used because they represent either the most recently finalized or, if as
submitted, the most recent available cost repor ts. The overall budget neutrality change in
the final FY 2011 IPPS/LTCH PPS rule, if any of these factors were to change.
G. Proposed Changes to Payment Rates for IPPS for Capital-Related Costs for FY 2011
Although the provisions of Pub. L. 111- 148, do not directly affect the payment
rates and policies for the IPPS for capital-related costs, in section II. of the Addendum of
this supplemental proposed rule we are proposing the capital IPPS standard Federal ratesCMS-1498-P2 97
for FY 2011. This is necessary because the wage index changes required by the
provisions of Pub. L. 111-148 (discussed above in section II.A. of this preamble) affect
the proposed budget neutrality adjustment fact or for changes in DRG classifications and
weights and the geographic adjustment factor (GAF) since the GAF values are derived
from the wage index values (see §412.316(a)). In addition, the provisions of Pub. L. 111-
148, (discussed above in this preamble) also necessitate a revision to the proposed outlier
payment adjustment factor since a single set of thresholds is used to identify outlier cases
for both inpatient operating a nd inpatient capital -related payments (see §412.312(c)). The
outlier thresholds are set so that operating ou tlier payments are projected to be 5.1 percent
of total operating IPPS DRG payments. Section 412.308(c)(2) provides that the standard
Federal rate for inpatient capital-related costs be reduced by an adjustment factor equal to
the estimated proportion of cap ital-related outlier paymen ts to total inpatient
capital-related PPS payments. The proposed capital IPPS standard Federal rates for

FY 2011 are discussed in section II. of the Addendum of this supplemental proposed rule.
H. Payment for Critical Access Hospital Outpatient Services and Ambulance Services
Section 1834(g) of the Act es tablishes the payment rule s for outpatient services
furnished by a critical access hospital (C AH). Section 403(d) of Pub. L. 106-113
(BBRA) amended section 1834(g) of the Act to provide for two methods of payment for
outpatient services furnished by a CAH. Sp ecifically, section 1834(g)(1) of the Act, as
amended by Pub. L. 106-113, provided that the amount of payment for outpatient services
furnished by a CAH is equal to the reasona ble costs of the CAH in providing such
services (the physician or other practitioner providing the professional service receivesCMS-1498-P2 98
payment under the Medicare Physician Fee Sche dule). In the alternative, the CAH may
make an election, under section 1834(g)(2) of th e Act, to receive amounts that are equal
to "the reasonable costs" of the CAH for facility services plus, with respect to the
professional services, the amount otherwis e paid for professional services under
Medicare, less the applicable Medicare deduc tible and coinsurance amount. The election
made under section 1834(g)(2) of the Act is so metimes referred to as "method II" or "the
optional method." Throughout this section of th is preamble, we refer to this election as
"the optional method." Section 202 of Pub. L. 106-554 (BIPA) amended section
1834(g)(2)(B) of the Act to increase the pa yment for professional services under the
optional method to 115 percent of the amount otherwise paid for professional services
under Medicare. In addition, section 405( a)(1) of Pub. L. 108-173 (MMA) amended
section 1834(g)(l) of the Act by inserting th e phrase "equal to 101 percent of" before the
phrase "the reasonable costs." However, th e MMA did not make a corresponding change
to section 1834(g)(2)(A) of the Act regarding the amount of payment for facility services
under the optional method.
Section 1834(l)(8), as added by sec tion 205 of Pub. L. 106–554, establishes the
payment methodology for ambulance services furnished by a CAH or by an entity that is
owned and operated by a CAH. This provision states that payment is made at "the

reasonable costs incurred in furn ishing ambulance services if such services are furnished
by a critical access hospital (as defined in section 1861(mm)(1) of the Act), or by an
entity that is owned and opera ted by a critical access hospital, but only if the critical
access hospital or entity is the only provider or supplier of ambulance services that isCMS-1498-P2 99

located within a 35-mile drive of such critical access hospital."
Section 3128(a) of Pub. L. 111-148 am ended sections 1834(g)(2)(A) and
1834(l)(8) of the Act by inserting "101 percen t of" before "the reasonable costs." As
such, section 3128(a) increases payment for out patient facility servi ces under the optional
method and payment for ambulance services fu rnished by a CAH or an entity owned and
operated by a CAH, to 101 per cent of reasonable costs. S ection 3128(b) states that the
amendments made under section 3128( a) shall take effect as if they were included in the
enactment of section 405(a) of Pub. L. 108 - 173. Section 405(a) of Pub. L. 108-173,
which provided that, in genera l, inpatient, outpatient, and c overed SNF services provided
by a CAH would be reimbursed at 101 percen t of reasonable cost, was applicable to
payments for services furnished during co st reporting periods be ginning on or after
January 1, 2004.
In order to implement section 3128 of Pub. L. 111-148, we are proposing to
amend the regulations at §413.70(b)(3)(ii)(A) to state that, effective for cost reporting
periods beginning on or after January 1, 2004, under the optional method, payment for
facility services will be made at 101 percent of reasonabl e cost. Accordingly, regardless
of whether a physician/practitioner has reassigned his/her billing rights to the CAH,
payment for CAH facility servi ces will be made at 101 percen t of reasonable costs. In
addition, we are proposing to implement the change in payment fo r ambulance services
provided by section 3128 of Pub. L. 111- 148 by amending the regulations at
§413.70(b)(5)(i) to state that e ffective for cost reporting pe riods beginning on or after
January 1, 2004, payment for ambulance services fu rnished by a CAH or an entity that isCMS-1498-P2 100
owned and operated by a CAH is 101 percent of the reasonable costs of the CAH or the
entity in furnishing those services, but only if the CAH or the entity is the only provider
or supplier of ambulance services located with in a 35-mile drive of the CAH or the entity.
We note that we do not believe these propos als will result in additional payments to
CAHs for prior periods because we believe in fact that CMS has paid CAHs for these
services at 101 percent of reasonabl e costs during these prior periods.
I. Extension of Certain Payment Rules for Long-Term Care Hospital Services and
Moratorium on the Establishment of Certain Hospitals and Facilities
1. Background
On December 29, 2007 the Medicare, Medi caid, and SCHIP Extension Act of
2007 (MMSEA) (Pub. L. 110-173) was enact ed. Section 114 of MMSEA, entitled
"Long-term care hospitals," made a number of changes affecting payments to LTCHs for
inpatient services. In May 6, 2008 and May 22, 2008 Federal Register (73 FR 24871
and 73 FR 29699, respectively), we issued two interim final rules (IFCs), implementing
provisions of section 114 of the MMSEA. The May 6, 2008 IFC implemented section
114(c)(3) of the MMSEA which required a 3-y ear delay in the app lication of certain
provisions of the payment adjustment for short-stay outliers (SSOs), and section
114(e)(4)(1)and (2) which specifi ed revisions to the RY 2008 standard Federal rate for
LTCHs. The May 22, 2008 IFC implemented sec tion 114(c) (1) and (c)(2), providing for
a 3-year delay in the application of the 25 percent threshold payment adjustment for
discharges from LTCHs and LTCH satellite facilities that were admitted from certain
referring hospitals in excess of various percentage thresholds. The May 22, 2008 IFCCMS-1498-P2 101
also implemented section 114(d) of the MMSEA relating to the 3-year moratorium on the

establishment of new LTCHs and LTCH satellite facilities and on increases in beds in
existing LTCHs and LTCH satellite facilities.
In addition, we revise d regulations at §412.523(d)(3 ) implementing section
114(c)(4) of MMSEA. Our regulations provide d that for a 3-year period beginning on
December 29, 2007, the Secretary shall not make the one-time prospective adjustment to
the LTCH PPS payment rates earlier than December 29, 2010 and later than December
29, 2012 (73 FR 26804). Section 4302 of the Amer ican Recovery and Reinvestment Act
of 2009 (ARRA)(Pub. L. 111-5) enacted on February 17, 2009, included several
amendments to section 114 (c) and (d) of the MMSEA. The provisions of section 4302
of the ARRA were implemented in an IFC which was published with the FY 2010
IPPS/RY 2010 LTCH PPS final rule (74 FR 43990 through 43994). In that same final
rule, we responded to comment s and finalized the MMSEA provisions in the May 6, 2008
and the May 22, 2008 IFCs that had not otherwis e modified by the ARRA. We intend to
finalize the ARRA provisions and respond to comments on the ARRA IFC, in the

FY 2011 IPPS/LTCH PPS final rule.
The discussion in section XX pertain to the specific changes to the LTCH PPS
policies that are mandated by amendments to section 114(c) and (d) of the MMSEA, as
amended by section 4302 of the ARRA a nd further amended by section 3106 of
Pub. L. 111-148 as amended by section 10312 of Pub. L. 111-148.
Section 114(c) and (d) of the MMSEA as amended by section 4302 of ARRA as
amended by section 3106 of the Pub. L. 111- 148 and as further amended by sectionCMS-1498-P2 102
10312 of Pub. L. 111-148 provides for a 2-year ex tension to payment policies relating to
long-term care hospitals (LTCHs) and LTCH satellite facilities. Specifically, these
provisions affect payment adjustments for short stay outliers (SSOs), the one-time
prospective adjustment to the standard Fe deral rate, the 25 per cent payment threshold
policy, and the moratorium on the establishment of new LTCHs and LTCH satellite
facilities. In this supplementary proposed rule for the LTCH PPS, we are implementing
the policies mandated by the amendments to section 114(c) and (d) of the MMSEA as
amended by section 4302 of the ARRA and as further amended by section 3106 of
Pub. L. 111-148, and section 10312 of Pub. L. 111-148, and are proposing to revise the
regulations accordingly to inco rporate those changes. In the sections below, we will
briefly describe each of these policies and propose to incorporat e into the regulations their
2-year extension.
2. Short-stay Outlier Policy
In the FY 2003 LTCH PPS final rule (67 FR 55995), we established a special
payment policy for SSO cases at §412.529. SSO cas es are cases with a covered LOS that
is less than or equal to five-sixths of the geometric average LOS for each LTC-DRG.
When we established the SSO policy, we explained that "[a] short stay outlier case may
occur when a beneficiary receives less than the full course of treatment at the LTCH
before being discharged" (67 FR 55995).
We later refined the SSO policy in the RY 2008 LTCH PPS final rule.
Specifically, the RY 2008 LTCH PPS final rule added an additional payment
methodology at §412.529(c)(3)(i) for a SSO case with a covered length of stay (LOS) thatCMS-1498-P2 103
is less than or equal to one standard deviation from the geometric ALOS of the same
DRG under the IPPS as the LTC-DRG to which the case had been assigned (referred to
as the "IPPS comparable threshold"). The Medicare payment for that SSO case where the

covered LOS is less than or equal to the "IPPS comparable threshold" would be based on
the least of the following:
• 100 percent of the estimated cost of the case.
• 120 percent of the LTC-DRG specifi c per diem amount multiplied by the
covered LOS of the particular case.

• The full LTC-DRG.
++ An amount comparable to the hospital IPPS per diem amount determined
under §412.529(d)(4). Under that SSO payment fo rmula, cases where the covered LOS is

greater than the "IPPS comparable threshold," the fourth payment option would be
replaced with the blend of the 120 percent of the LTC-DRG specific per diem amount and
an amount comparable to the IPPS per diem amount determined under §412.529(d)(4).
(See (72 FR 26905 through 26918).)
Section 114(c)(3) of MMSEA established a 3- year delay of the application of the
methodology at §412.529(c)(3)(i) that was added in the RY 2008 LTCH PPS final rule. It
specified that the S ecretary shall not apply the am endments finalized on May 11, 2007
(72 FR 26992) made to the short-stay ou tlier payment provision for long-term care
hospitals contained in §412.529(c)(3)(i) or an y similar provisions for the 3-year period
beginning on the date of en actment of this Act [Decembe r 29, 2007]. Section 114(c)((3)
of the MMSEA as amended by section 3106( a) of the Pub. L. 111-148, and as amendedCMS-1498-P2 104
by section 10312(a) of Pub. L. 111-148, adds an additional 2 years to the 3-year delay of
the application of §412.529(c)(3)(i). Specifically , these provisions together result in the
phrase "3-year period" being replaced with the phrase "5-year period" each place it
appears in 114(c) of MMSEA as amended by the ARRA. Thus, the reference to the
3-year period in delay of a pplication of §412.529(c)(3)(i) is ch anged to be 5-year period
of delay. Consequently, the Secretary will not apply for the 5-year period beginning on
the date of enactment of MMSEA (Decem ber 29, 2007) the policy at §412.529(c)(3)(i).
We note that this provision of the law is se lf-implementing and in this supplementary
proposed rule, we are proposing to incorpor ate existing law regarding the additional
2 year delay into the regulations at §412.529( c)(3)(i) to reflect this policy change.
3. The One-time Adjustment of the Standard Federal Rate
In the August 30, 2002 LTCH PPS final rule (67 FR 56027), we provided in
§412.523(d)(3) of the regulations, for the possi bility of making a one-time prospective
adjustment to the LTCH PPS rates by July 1, 2008, so that the effect of any significant
difference between actual payments and estimated payments for the first year of the
LTCH PPS would not be perpetuated in the LTCH PPS rates for future years.
Later, section 114(c)(4) of MMSEA was enact ed which provided a 3-year delay in the
application of §412.523(d)(3). Specifically, section 114(c)(4) of MMSEA provides that
the ''Secretary shall not, for the 3-year period beginning on the date of the enactment of
this Act, make the one time prospective adjustment to long-term care hospital prospective
payment rates provided for in section 412.523(d)(3) of title 42, Code of Federal
Regulations, or any similar provision.'' The e ffect of this provisi on was that no one-timeCMS-1498-P2 105
budget neutrality adjustment could be made earlier than December 29, 2010. (Following
the enactment of MMSEA, we modified the regulations at §412.523(d)(3) to capture the
three-year delay required by section 114(c)(4)MMSEA and our proposal to conform our
regulation to more accurately reflect the purpose of providing for a possible one-time
budget neutrality adjustment.) (See 73 FR 26800 through 26805). Now, section 3106(a)
of Pub. L. 111-148, together with secti on 10312 of Pub. L. 111-148 results in, an
additional 2 years being added to the existing 3-year delay of §412.523(d)(3).
Specifically, these amendments together result in the phrase "3-year period" being
replaced with the phrase "5-year period" each place it appears in 114(c) of MMSEA as
amended by the ARRA. Thus, the reference to the 3-year period in delay of application
§412.523(d)(3) is changed to be a 5-year period of delay. Consequently, the Secretary
shall not apply for the 5-year period beginni ng on the date of the enactment of MMSEA
(December 29, 2007) the one-time prospec tive adjustment provided for in
§412.523(d)(3). We note that this provision of the law is self-imple menting and we are
proposing to incorporate existing law regardin g this additional 2-y ear delay of the onetime budget neutrality adjustment into the regulations at §412.523(d)(3) to reflect this
policy. Thus, we are proposing to revise §412.523( d)(3) to specify that the Secretary is
precluded from making the one-time adjustment until December 29, 2012.
4. Modification of Certain Payment Adjustments to Certain LTCHs and LTCH Satellite
Discharges
The timeframes outlined in section 114(c)(1 ) and (2) of MMSEA are amended by
ARRA and section 3106(a) of Pub. L. 111- 148, and as further amended by sectionCMS-1498-P2 106
10312(a) of Pub. L. 111-148 are increased from 3 years to 5 years, thereby extending for
an additional 2 years the dela y in application of the 25 pe rcent patient threshold amount
under §412.534 and §412.536 for certain LTCHS a nd LTCH satellite facilities and the
increases in the patient thresholds outlined in section 114(c)(2) of MMSEA as they apply
to an "applicable" long-term care hospital or satellite facility as set forth in section
114(c)(2)(A) and (B) of MMSEA as amende d. Specifically, §3106(a) of Pub. L. 111-148
together with section 10312 of Pub. L. 111-148, results in the substituting of the phrase
"5-year period" for the phrase "3-year period" each time it appears in section 114(c) of
MMSEA as amended by ARRA. This provisi on of the law is self-implementing.
With respect to section 114(c)(1) of MMS EA as amended by ARRA (Delay in
Application of [the] 25 Percen t Patient Threshold Payment Adjustment), section 3106(a)

of the Pub. L. 111-148 and as further ame nded by section 10312(a) of Pub. L. 111-148
results in an additional 2-year delay being added to the existing 3-year delay in
application of the 25 percent threshold amount under §412.534 and §412.536.
Specifically, under §114(c)(1)(A) and (B) of MMS EA as amended by the ARRA and the
Affordable Care Act, the Secretary shall not apply, for cost reporting periods beginning
on or after July 1, 2007 for a 5-year pe riod—(A) §412.536 of title 42, Code of Federal
Regulations, or any similar provision, to free st anding long-term care hospitals or to a
long-term care hospital, or sa tellite facility, that as of December 29, 2007, was co-located
with an entity that is a provider-based, o ff-campus location of a subsection (d) hospital
which did not provide services payable unde r section 1886(d) of the Act at the offcampus location; and (B) such secti on or §412.534 of title 42, Code of FederalCMS-1498-P2 107
Regulations, or any similar provisions, to a long-term care hospital identified by the
amendment made by section 4417(a) of the BBA . In order to incorporate existing law
requiring that application of the above pr ovisions will not be applied prior to cost
reporting periods beginning on July 1, 2012, we are proposing to modify our regulations
at §412.534(h)(4) and §412.536(a)(1).
With respect to section 114(c)(2) of MMS EA as amended by ARRA and section
3106(a) of Pub. L. 111-148 and as amende d by section 10312 of Pub. L. 111-148 the
effective date provided in section 114(c)(2)(C) of MMSEA is amended such that the
provision specifies that subparagraphs A and B [of section 114(c)(2)] shall apply to cost
reporting periods beginning on or after October 1, 2007 (or July 1, 2007, in the case of a
satellite facility de scribed in §412.22(h)(3)(i) of title 42, C ode of Federal Regulations) for
a 5-year period.) The effect of this self-imp lementing effective date change is that under
section 114(c)(2)(A) of MMSEA the time peri od during which the increased percentage
thresholds apply to an "applicable long-term care hospital or satellite facility" which is

located in a rural area or which is co-locat ed with an urban single or MSA-dominant
hospital, under 42 CFR 412.534(d) and (e) is incr eased from a 3-year period to a 5-year
period. Thus, for the 5-year period beginning on or after October 1, 2007 , payment to an
"applicable LTCH hospital or LTCH satellite that is located in a rural area or is co-located
with a MSA-dominant hospital or urban single hospital under paragra phs (d) and (e), of
42 CFR 412.534, shall not be subject to any paym ent adjustment under such section if no
more than 75 percent of the hospital's Medi care discharges (other than discharges
described in paragraph (d)(2) or (e)(3) of such section are admitted from a co-locatedCMS-1498-P2 108
hospital. We are proposing to incorporate into our regulations at 412.534(d)(1) through
(d)(3) and (e)(1) through (e)(3); the above-des cribed self-implementing the Affordable
Care Act changes by extending the sunsetting of the threshold p ercentage increase an
additional 2 years, to cost reporting peri ods beginning on or after October 1, 2012, as
applicable, July 1, 2007 for a satellite fac ility described in 42 CFR 412.22(h)(3)(i).)
In addition, the change in the effec tive date change required in section
114(c)(2)(C) of MMSEA, as amended by ARRA a nd the Affordable Care Act , is that the
time period during which the increased percentage threshold applicable to an "applicable"
LTCH or satellite, as define d in section 114(c)(2)(ii) of the MMSEA as amended by
section 4302(a)(2)(A) of the ARRA, which is co-located with another hospital is
increased from a 3-year period to a 5-year pe riod. Thus, for the 5-year period beginning
on or after October 1, 2007, payment to an "a pplicable" LTCH or LT CH satellite facility
that is co-located with another hospital sha ll not be subject to any payment adjustment
under §412.534 if no more than 50 percent of th e hospital's Medicare discharges (other
than discharges described in paragraph (c)(3) of such section) are admitted from a colocated hospital. We are proposing to incorpor ate this self-implemen ting Affordable Care
Act change into our regulations at §412.534 (c )(1),(2)and (3) by extending the sunsetting
of the threshold percentage increase an a dditional 2 years, to cost reporting periods
beginning on or after October 1, 2012 or July 1, 2012, as applicable.CMS-1498-P2 109

5. Moratorium on the Increase in Number of Beds in Existing Long-Term Care Hospitals
or Long-Term Care Hospital Satellite Facilities
Section 114(d) of MMSEA provides for a 3- year moratorium with two distinct
aspects, one for the establishment and classification of a LTCH or a LTCH satellite
facility, other than an existing LTCH or facility, and the other for the increase of hospital
beds in existing LTCHs and LTCH satellite facilities. Specifically, section 114(d)(1)(A)
of MMSEA provides that, during the 3-year pe riod beginning on the da te of enactment of
this Act on December 29, 2007, the Secretary shall impose a moratorium "subject to
paragraph (2), on the establishment and cla ssification of a long-term care hospital or
satellite facility, other than an existing long-term care hospita l or facility." Section 114
(d)(1)(B) of MMSEA unamended, provides that, during the 3-year period beginning of
the date of enactment of this Act, the Secretary shall impose a moratorium "subject to
paragraph (3), on an increase of long-term care hospital beds in existing long-term care
hospitals or satellite facilities."
Sections 114(d)(2) of MMSEA unamende d provides for exceptions to the
moratorium on the development of a LTCH or LTCH satellite facility, other than an
existing LTCH or LTCH sate llite facility, imposed by sec tion 114(d)(1)(A) of MMSEA.
(The definition of an existing LTCH and satellite facility for purposes of this policy is
codified at §412.23(e)(7)(i).) Specifi cally, under this MMSEA provision, the
moratorium, is effective from Decembe r 29, 2007 through December 28, 2010 unless one
of the following three exceptions has been met:
• The LTCH began "its qualifying period for payment as a long-term care hospitalCMS-1498-P2 110
under section 412.23(e) of title 42, C ode of Federal Regulations, on or before the date of
enactment of this Act." (See section 114(d)(2)(A) of MMSEA).
• The LTCH has a binding written agreement with an outside, unrelated party for
the actual construction, renovation, lease, or demolition for a LTCH and has expended
before December 29, 2007 at least 10 percent of the estimated cost of the project or, if
less, $2,500,000. (See section 114(d)(2)(B) of MMSEA).
• The LTCH has obtained an approved certif icate of need in a State where one is
required on or before December 29, 2007 (see section 114(d)(2)(C) of MMSEA). (See
73 FR 29705 through 29707 and 74 FR 43985).

The moratorium on an increase of beds is subject to the exception at section
114(d)(3) of MMSEA. Specifically, section 114(d)(3) of the MMSEA unamended stated

that the moratorium on an increase in beds sh all not apply if an existing LTCH or LTCH
satellite facility is "located in a State where there is only one other long-term care
hospital; and requests an increase in beds fo llowing the closure or the decrease in the
number of beds of another long-term care hosp ital in the State." We implemented section
114(d) in the May 22, 2008 IFC (73 FR 29704 through 29707); the FY 2010
IPPS/RY 2010 LTCH PPS final rule (74 FR 43985 through 43990) and §412.23 (e)(5)
through (e)(7).

Section 4302 of the ARRA added anot her exception to the moratorium on
increases in the number of beds at existing LTCHs and LTCH satellite facilities.
Specifically, section 4302(b) of the ARRA, added an additional exception to the bedincrease moratorium in an existing hospital or satellite facility " ...if the hospital orCMS-1498-P2 111
facility obtained a certificate of need for an increase in beds that is in a State for which
such certificate of need is required and th at was issued on or after April 1, 2005, and
before December 29, 2007, ...." Accordingl y, we revised our regulations at
§412.23(e)(7)(B) to include this new exception to the moratorium on an increase in the
number of beds in existence in an existing LTCH or LTCH satellite facility beyond those
in existence on December 29, 2007. (See 74 FR 43991 and 43992)
Section 114(d) of MMSEA as amended by section 4302(b) of ARRA and section
3106(b) of Pub. L. 111-148 and section 10312(b) of Pub. L. 111-148 adds an additional
2 years to the 3-year moratorium on the development of new LTCHs and LTCH satellite
facilities and on the increase in the number of beds in existing LTCHs and LTCH
satellites promulgated by MMSEA. Specifically, it raises the length of the moratorium
specified in section 114(d) of MMSEA as am ended by ARRA from a 3-year period to a
5-year period. Therefore, the moratorium will be in effect until December 28, 2012. In
this supplementary proposed rule, we are proposing to revise §412.23(e)(6)(i) and
(e)(7)(ii) by changing the ending da te of the moratorium provisions from
December 28, 2010 to December 28, 2012 to reflect these self-implementing Affordable
Care Act changes.
J. Long-Term Care Hospital Proposed Ma rket Basket Update and Other Proposed
Changes
1. Background
In section VII. of the preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule, we discuss our proposed changes to the payment rates, factors, and specificCMS-1498-P2 112
policies under the LTCH PPS for FY 2011. Although a number of the provisions of
Pub. L. 111-148 and Pub. L. 111-152 affect the LTCH PPS, due to the timing of the
passage of the legislation, we were unable to address thos e provisions in the May 4, 2010
FY 2011 IPPS/LTCH PPS proposed rule. Therefore, the proposed policies and payment
rates in that proposed rule do not reflect the new legislation.
Below we address the provisions of Pub. L. 111-148 and Pub. L. 111-152 that affect our
proposed policies and payment rates for FY 2011 under the LTCH PPS. In addition, we
have issued further instructions impleme nting the provisions of Pub. L. 111-148, as
amended, that affect the policies and payment rates for RY 2010 under the LTCH PPS.
Specifically, we have establis hed revised RY 2010 ra tes and factors elsewhere is this
Federal Register consistent with the provisions of sections 3401(c) and (p) and 10319(b)
of Pub L. 111-148 and section 1105(b) of Pub. L. 111-152, as amended.

2. Revision of Certain Market Basket Updates as Required by Pub. L. 111-148 and

Pub. L. 111-152.
Section 1886(m)(3)(A)(ii) of the Act, as added by section 3401(c) of
Pub. L. 111-148, specifies that for each of rate years 2010 through 2019, any annual
update to the standard Federal rate shall be reduced by the other adjustment specified in
new section 1886(m)(4) of the Act. Furthe rmore, section 1886(m)(3)(A)(i) of the Act
specifies that for rate year 2012 and subse quent rate years, an y annual update to the

standard Federal rate shall be reduced by the productivity adjustment described in section
1886(b)(3)(B)(xi)(II) of the Act. Secti on 1886(m)(3)(A)(ii) and sections 1886(m)(4)(A)
and (B) of the Act, require a 0.25 percentage point reduction for rate year 2010 and a 0.50CMS-1498-P2 113
percentage point reduction for rate year 2011. Section 1886(m)(3)(B) of the Act provides
that the application of paragr aph 3 of 1886(m) of the Act may result in th e annual update
being less than zero for a rate year, and may result in payment rates for a rate year being
less than such payment rates for the preceding rate year. Furthermor e, section 3401(p) of
Pub. L. 111-148 specifies that the ame ndments made by section 3401(c) of
Pub. L. 111-148 shall not apply to discharg es occurring before April 1, 2010.
We note that in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, since
the annual update to the LTCH PPS policies, rates and factors now occurs on October 1 st

, we proposed to adopt the term "fiscal year" (FY) rather than "rate year" (RY) under the
LTCH PPS beginning October 1, 2010 to conform with the standard definition of the
Federal fiscal year (October 1 through September 30) used by other PPSs, such as the
IPPS (see 75 FR 24046 through 24027). Consequently, in that proposed rule and in this
supplemental proposed rule, for purposes of clarity, when discussing the annual update
for the LTCH PPS, we employed "FY" rather than "RY" because it is our intent that the
phrase "FY" be used prospectively in all circumstances dealing with the LTCH PPS.
Similarly, although the language of sec tion 3401(c) of Pub. L. 111-148 and section 10319
of Pub. L. 111-148, and section 1105(b) of Pub. L. 111-152 refer to years 2010 and
thereafter under the LTCH PPS as "rate year," consistent with our proposal to change the
terminology used under the LTCH PPS from "rate year" to "fiscal year," for purposes of
clarity, in this supplemental proposed rule, when discussing the annual update for the
LTCH PPS, including the provisions of the Affordable Care Act, we will continue to
employ "FY" rather than "RY" for 2011 and subs equent years because it is our intent thatCMS-1498-P2 114
"FY" be used prospectively in all circumstances dealing with the LTCH PPS.
3. Proposed Change to Reflect the Mark et Basket Update for LTCHs for RY 2010
(§412.523(c)(vi))
In the FY 2010 IPPS/RY 2010 LTCH PPS final rule appearing in the Federal
Register on August 27, 2009 (74 FR 43754), we esta blished policies, payment rates and
factors for determining payments under the LTCH PPS for RY 2010 (October 1, 2009
through September 30, 2010). The provisions of the Affordable Care Act affect some of
the policies, payment rates and factors for determining payments under the LTCH PPS for
RY 2010 (some of which are discussed elsewhere in this supplemental proposed rule). In
a separate notice published elsewhere in this Federal Register , we establish revised

RY 2010 LTCH PPS rates and factors consis tent with the provisions of section
1886(m)(3) of the Act as added by sec tion 3401(c) of Pub. L. 111-148, and section
1886(m)(4) of the Act as added by secti on 3401(c) of Pub. L. 111-148 and amended by
section 10319(b) of Pub. L. 111-148, as fu rther amended by section 1105(b) of
Pub. L. 111-152, as well as section 3401( p) of the Pub. L. 111-148. Section
1886(m)(3)(A)(ii) of the Act provides fo r each of RYs 2010 through 2019, the annual
update to the standard Federal rate is reduced by the "oth er adjustment" described in
section 1886(m)(4) of the Act. Specifically, sections 1886(m)(3)(A)(ii) and (4)(A) of the
Act require a 0.25 percentage poi nt reduction to the annual update to the standard Federal
rate for RY 2010. Section 1886(m)(3)(A) of th e Act on its face explicitly provides for a
revised annual update to the standard Federal rate be ginning RY 2010, thus resulting in a
single revised RY 2010 standa rd Federal rate. Section 3401(p) of the Pub. L. 111-148CMS-1498-P2 115
provides that, notwithstanding the previous provisions of this section, the amendments
made by subsections (a), (c ) and (d) shall not apply to discharges occurring before
April 1, 2010. When read in conjunction we believe section 1886(m)(3)(A) of the Act
and section 3401(p) of Pub. L. 111-148 provide for a single revised RY 2010 standard
Federal rate; however, for payment purposes, di scharges occurring on or after October 1,
2009 and before April 1, 2010, simply will not be based on the revi sed RY 2010 standard

Federal rate.
As discussed in a separate no tice published elsewhere in this Federal Register ,
consistent with our histor ical practice and the methodology used in the FY 2010
IPPS/RY 2010 final rule, we establish an update to the LTCH PPS standard Federal rate
for RY 2010 of 1.74 percent. This annua l update for RY 2010 is based on the full

forecasted estimated increase in the LT CH PPS market basket for RY 2010 of
2.5 percent, adjusted by the 0.25 percenta ge point reduction required by sections
1886(m)(3)(A)(ii) and (4)(A) of the Act, and an adjustment to account for the increase in
case-mix in a prior period (FY 2007) re sulting from changes in documentation and
coding practices of -0.5 percent. Therefore, in this supplemental proposed rule, under the
authority of sections 1886(m)(3)(A)(ii) and (4 )(A) of the Act, we are proposing to amend
§412.523(c)(3)(vi) to specify that the standard Federal rate for the LTCH PPS rate year
beginning October 1, 2009 and ending Septem ber 30, 2010, is the sta ndard Federal rate
for the previous rate year updated by 1.74 percen t. Furthermore, consistent with section
3401(p) of Pub. L. 111-148, we are also propos ing to revise §412.523(c)(3)(vi) to specify
that with respect to discharges occurri ng on or after Oct ober 1, 2009 and beforeCMS-1498-P2 116
April 1, 2010, payments are based on the st andard Federal rate in §412.523 (c)(v)
updated by 2.0 percent (that is, a standard Federal ra te of $39,896.65 (see 74 FR 44022)).
We note that the provisions of the law that add sections 1886(m)(3) and (4) of the Act
are self-implementing and in this supplem ental proposed rule, we are proposing to
incorporate existing law regarding the 0.25 percentage point re duction to the annual
update to the standard Federal rate for RY 2010 (including th e application of the revised

standard Federal rate that reflects that 0.25 percentage point reduction in making
payments for discharges on or after April 1, 2010) into the regulations at
§412.529(c)(3)(vi) to reflect this required policy change.
4. Proposed Market Basket Update for LTCHs for FY 2011

As discussed in section VII.C.2. of the preamble of the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule, we are proposing to continue to use the FY 2002-based
rehabilitation, psychiatric, l ong-term care (RPL) hospital market basket under the LTCH
PPS for FY 2011. Also, in that proposed rule, we stated that at this time, the most recent
estimate of the increase in the proposed LTCH PPS market basket (that is, the FY 2002-
based RPL market basket) for FY 2011 is 2.4 percent. This increase is based on IHS
Global Insight, Inc.'s first quarter 2010 for ecast, with historical data through the 2009
fourth quarter, of the FY 2002- based RPL market basket incr ease. Since publication of
the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule our estimate of the FY 2002-

based RPL market basket for FY 2011 has not ch anged. Furthermore, as also stated in
the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, consistent with our historical
practice of using market bask et estimates based on the most recent available data, weCMS-1498-P2 117
propose that if more recent data are available when we deve lop the final rule, we would
use such data, if appropriate.
Section 1886(m)(3)(A)(ii) of the Ac t as added by section 3401(c) of
Pub. L. 111-148 specifies that for each of RYs 2010 through 2019, any annual update to

the standard Federal rate sh all be reduced by the other adjustment specified in new
section 1886(m)(4) of the Act. Furtherm ore, section 1886(m)(3)(A)(i) of the Act
specifies that for rate year 2012 and each subs equent rate year, an y annual update to the

standard Federal rate shall be reduced by the productivity adjustment described in section
1866(b)(3)(B)(xi)(II) of the Act.
For FY 2011, section 1886(m)(4)(B) of the Act as added by section 3401(c) of
Pub. L. 111-148, as amended by section 10319 of Pub. L. 111-148 and as further
amended by section 1105(b) of Pub. L. 111-152, requires a 0.50 percentage point
reduction to the annual update to the standard Federal rate for rate year 2011.
Consequently, the proposed market basket update under the LTCH PPS for FY 2011 is
1.9 percent (that is, the most recent estimate of the LTCH PPS market basket of 2.4
percent minus the 0.50 percentage points requi red in section sections 1886(m)(4)(B) of
the Act. Again, we note that consistent w ith our historical practice of using market

basket estimates based on the most recent ava ilable data, we propose that if more recent

data are available when we de velop the final rule, we would use such data, if appropriate,
in determining the final market basket update under the LTCH PPS for FY 2011. (We

note that in section III.A. of the Adde ndum to this supplemental proposed rule, for FY
2011, we are proposing to update the LTCH PPS standard Federal rate by -0.59 percent.CMS-1498-P2 118
This proposed update reflects proposed market basket update under the LTCH PPS for
FY 2011 (of 1.9 percent as discussed above) a nd a proposed adjustment to account for the
increase in case-mix in the prior periods that resulted from changes in documentation and
coding practices rather than increases in patients' severity of illness (discussed in section
VII.C.3. of the preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule).)
5. Proposed Medicare Severity Long -Term Care Diagnosis-Related Group
(MS-LTC-DRG) Relative Weights
As discussed above, the proposed LTCH PPS policies and payment rates in the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule do not reflect the provisions of the
Affordable Care Act. The revised proposed standard Federal rate for FY 2011 that
incorporates the "other adjustment" require d in section 1886(m)(3)(A )(ii) as amended and
described in section 1886(m)(4) as amended is discussed in section III.A. of the
Addendum of this supplemental proposed rule. This revision to the proposed standard
Federal rate for FY 2011 require s us to revise the proposed relative weights for the MSLTC-DRGs for FY 2011. This is the case si nce our established methodology for updating
the annual update to the MS-LTC-DRG classi fications and relative weights in a budget
neutral manner requires that estimated aggregate LTCH PPS payments would be
unaffected. That is, under the budget neutra lity requirement estima ted aggregate LTCH
PPS payments would be neither greater than nor less than the estimated aggregate LTCH
PPS payments that would have been made without the MS-LTC-DRG classification and
relative weight changes.
As discussed in section VII.B.3.g. (s tep 7) of the preamble of the May 4, 2010CMS-1498-P2 119
FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24042 through 24043), we proposed to
use our established two-step budget neutrality methodology. In the first step of our
MS-LTC-DRG budget neutrality methodology, we calculate and a pply a normalization
factor to the proposed recalibra ted relative weights to ensure that estimated payments are
not influenced by changes in the compos ition of case types or the changes to the
classification system. That is, the normalization adjustment is intended to ensure that the
recalibration of the proposed MS-LTC-DRG re lative weights (that is, the process itself)
neither increases nor decreases the averag e case-mix index (CMI). The normalization
factor is calculated using the ratio average CMIs (that is, the average MS-LTC-DRG
relative weight) and is independe nt of the standard Federal ra te. (We refer readers to the
FY 2011 IPPS/LTCH PPS proposed rule for additional details on the proposed

calculation of the normalization factor applied used in de termining the proposed FY 2011
MS-LTC-DRG relative weights (75 FR 24042 thr ough 24043).) Therefore, this step was
not revised for this supplemental proposed ru le. However, in the second step of our
established two-step budget neutrality methodology (described in section VII.B.3.g.
(step 7) of the preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule), for
FY 2011 we proposed to determine a budget neutrality adjustment factor based on
simulating estimated total LTCH PPS payments. Consequently, revising the standard
Federal rate to reflect the pr ovisions of newly added secti ons 1886(m)(3)(A)(ii) and (4) of
the Act would impact the estimated aggregated LTCH PPS payments upon which we
determine the proposed budget neutrality factor applied in determining the proposed FY
2011 MS-LTC-DRG relative weights.CMS-1498-P2 120
For this supplemental proposed rule, c onsistent with the proposed methodology
described in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24042
through 24043), we are proposing to apply a budget neutrality adjustment factor of
0.987632 in determining the proposed FY 2011 MS-LTC-DRG relative weights, which
was determined based paymen ts simulations after using the proposed FY 2011 standard

Federal rate that reflects th e reductions required by secti ons 1886(m)(3)(A)(ii) and (4)(A)
and (B) of the Act (discu ssed above) and LTCH claims from the December 2009 update
of the FY 2009 MedPAR files (that is the same data used in the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule). Specifically, we determined the proposed FY 2011
budget neutrality adjustment factor using the following three steps: (2.a.) we simulate
estimated total LTCH PPS payments using the normalized proposed relative weights for
FY 2011 and GROUPER Version 28.0 (as describe d above); (2.b.) we simulate estimated
total LTCH PPS payments using the FY 2010 GROUPER (Version 27.0) and the FY
2010 MS-LTC-DRG relative weights shown in Table 11 of the FY 2010 IPPS/RY 2010
LTCH PPS final rule (74 FR 44183 through 44192); and (2.c.) we calculate the ratio of
these estimated total LTCH PPS payments by dividing the estimated total LTCH PPS
payments using the FY 2010 GROUPER (V ersion 27.0) and the FY 2010 MS-LTC-DRG
relative weights (determined in step 2.b.) by the estimated total LTCH PPS payments
using the proposed FY 2011 GROUPER (Version 28.0) and the normalized
proposed MS-LTC-DRG relative weights for FY 2011 (determined in Step 2.a.).
Therefore, under our established two-st ep budget neutrality methodology, in
determining the proposed FY 2011 MS-LTC-D RG relative weights, each normalizedCMS-1498-P2 121
proposed relative weight (determined as descri bed in section VII.C.3.g.(step 7) of the
preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule) is multiplied by a
budget neutrality factor of 0.987632 in the second step of the budget neutrality
methodology to determine the proposed budg et neutral FY 2011. (We note that in
determining the proposed FY 2011 budget neutra l MS-LTC-DRG relative weights for this
supplemental proposed rule, with the ex ception of the proposed budget neutrality
adjustment factor of 0.987632 discussed above, we used the proposed methodology as
presented in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24042
through 24043).) Consistent with our historical policy of us ing the best available data,
we are proposing to use the most recent av ailable data for determining the budget
neutrality adjustment factor in the final rule.
Accordingly, in determining the proposed FY 2011 MS-LTC-DRG relative
weights in Table 11 in the Addendum to this supplemental proposed rule, consistent with
our existing methodology, we are proposing to apply a normaliza tion factor of 1.10362
(computed as described in section VII.C.3.g . (step 7) of the preamble to the May 4, 2010
FY 2011IPPS/LTCH PPS proposed rule) and a budget neutrality factor of 0.987632
(computed as described above). Table 11 in the Addendum to this supplemental
proposed rule lists the proposed MS-LTC-D RGs and their respective proposed relative
weights, geometric mean length of stay, and five-sixths of the geometric mean length of
stay (used in determining SSO paymen ts under §412.529) for FY 2011. (We note that
there are no changes to the geometric mean length of stay and five-sixths of the geometric
mean length of stay that were publis hed in Table 11 of the May 4, 2010 FY 2011CMS-1498-P2 122
IPPS/LTCH PPS proposed rule as the calculation of these statistics is independent of the
standard Federal rate.)
III. Other Required Information

A. Collection of In formation Requirements
This document does not impose inform ation collection and recordkeeping
requirements. Consequently, it need not be reviewed by the Office of Management and
Budget under the authority of th e Paperwork Reduc tion Act of 1995
(44 U.S.C. Chapter 35).
B. Waiver of 60-Day Comment Period
We ordinarily publish a notice of proposed rulemaking in the Federal Register
and permit a 60-day comment peri od, as provided in section 1871(b)(1) of the Act. This
period, however, may be shorte ned, as provided under secti on 1871(b)(2)(C) of the Act,
when the Secretary finds good cause th at a 60-day comment period would be
impracticable, unnecessary, or cont rary to the public interest and incorporates a statement
of the finding and its reasons in the rule i ssued. For this supplemental proposed rule, we
are waiving the 60-day comment period for good cause and allowing a comment period
that coincides with the comment period provided for on the FY 2011 IPPS/LTCH PPS
proposed rule (75 FR 23852).
As we explained in the FY 2011 IPPS/LTCH PPS proposed rule (75 FR 23859),
due to the timing of the enactment of P ub. L. 111-148 and Pub. L. 111-152, the policies
and payment rates outlined in the proposed rule did not reflect the changes made by either
law to the IPPS and LTCH PPS. This supplemental proposed rule addresses the changesCMS-1498-P2 123
that affect our proposed policies and payment rates for FY 2011 under the IPPS and the

LTCH PPS.
A 60-day comment period on this supplem ental proposed rule would be both
impracticable and contrary to the public interest because it would not allow for

coordinated considera tion of the comments on this supplemental proposed rule with those
on the FY 2011 IPPS/LTCH PPS proposed rule. Because the issues raised in this
supplemental proposed rule are integral to our consideration of comments on certain
proposals in the FY 2011 IPPS/LTCH PPS proposed rule, we do not believe it would be
appropriate to review comments on the issues raised in this supplemental proposed rule in

isolation from the comments received on th e FY 2011 IPPS/LTCH PPS proposed rule.
We further note that a full 60-day comment period would end on a date that would not
allow the agency sufficient time to proce ss the comments and respond to them in a
meaningful manner by the August 1, 2010 date fo r issuing the final rule. If we allowed
for a full 60-day comment period, timely file d comments would receive a shorter period
of time for consideration by the agency, and the agency would be left with insufficient
time to properly respond to co mments and appropria tely resolve whether any of the
proposed policies should be modified in light of comments received. For all of these
reasons, we find good cause to waive the 60-da y comment period for this rule of proposed
rulemaking, and we are instead providing fo r a comment period that coincides with the
comment period provided for the FY 2011 IPPS/LTCH PPS proposed rule that appeared
in the May 4, 2010 Federal Register

.CMS-1498-P2 124
IV. Response to Comments
Because of the large number of pub lic comments we nor mally receive on Federal
Register documents, we are not able to acknowle dge or respond to them individually.

We will consider all comments we receive by the date and time specified in the "DATES"
section of this preamble, and, when we pr oceed with a subsequent document, we will
respond to the comments in the preamble to that document.CMS-1498-P2 125
List of Subjects

42 CFR Part 412
Administrative practice and procedure, H ealth facilities, Medicare, Puerto Rico,
Reporting and recordk eeping requirements.

42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Puerto Rico, Reporting and
recordkeeping requirements.CMS-1498-P2 126

For the reasons stated in the preamble of this proposed rule, the Centers for
Medicare & Medicaid Services is proposing to amend 42 CFR Chapter IV as follows:

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT

HOSPITAL SERVICES
1. The authority citation for Part 412 continues to read as follows:
Authority : Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and
1395hh), and sec. 124 of Pub. L. 106-113 (113 Stat. 1501A-332).
§ 412.23 [Amended]
2. In §412.23, paragraphs (e)(6)(i) and (e )(7)(ii) are amended by removing the
date " December 28, 2010" and adding th e date "December 28, 2012" in its place.
3. Section 412.64 is amended by--
A. Revising paragraphs (d)(1) and (e)(4).
B. Adding a new paragraph (m).
§ 412.64 Federal rates for inpa tient operating costs for Fe deral fiscal year 2005 and
subsequent fi scal years.

* * * * *
(d) Applicable percentage change for fiscal year 2005 and fo r subsequent fiscal

years

. (1) Subject to the provisions of paragr aph (d)(2) of this section, the applicable
percentage change for updating the standardized amount is---
(i) For fiscal year 2005 through fiscal year 2009, the percentage increase in the
market basket index for prospective payment hospitals (as defined in § 413.40(a) of thisCMS-1498-P2 127
subchapter) for hospitals in all areas.
(ii) For fiscal year 2010, for discharges--
(A) On or after October 1, 2009 and be fore April 1, 2010, the percentage increase
in the market basket index for prospective payment hospitals (as de fined in § 413.40(a) of
this subchapter) for hosp itals in all areas; and
(B) On or after April 1, 2010 and befo re October 1, 2010, the percentage increase
in the market basket index minus 0.25 pe rcentage points for prospective payment
hospitals (as defined in § 413.40(a) of this subchapter) for hospitals in all areas.
(iii) For fiscal year 2011, the percenta ge increase in the market basket index
minus 0.25 percentage points for prospective payment hospitals (a s defined in §413.40(a)
of this subchapter) for hospitals in all areas.

* * * * *
(e) * * *
(4) CMS makes an adjustment to the wage index to ensure that aggregate
payments after implementation of the rura l floor under section 4410 of the Balanced
Budget Act of 1997 (Pub. L. 105–33) and the imput ed floor under paragraph (h)(4) of this
section are equal to the aggregate prospective payments that would have been made in the
absence of such provisions as follows:
(i) Beginning October 1, 2008, such adjus tment is transitioned from a nationwide
to a statewide adjustment as follows:
(A) From October 1, 2008 through Septem ber 30, 2009, the wage index is a blend
of 20 percent of a wage index with a statewid e adjustment and 80 percent of a wage indexCMS-1498-P2 128
with a nationwide adjustment.
(B) From October 1, 2009 through Septem ber 30, 2010, the wage index is a blend
of 50 percent of a wage index with a statewid e adjustment and 50 percent of a wage index
with a nationwide adjustment.
(ii) Beginning October 1, 2010, such adju stment is a full nationwide adjustment.

* * * * *
(m) Adjusting the wage index to account for the Frontier State floor

. (1) General criteria

. For discharges occurring on or after October 1, 2010, CMS
adjusts the hospital wage index for hospitals located in qualifying States to recognize the
wage index floor established for frontier States. A qualifyi ng frontier State meets the
both of the following criteria:
(i) At least 50 percent of counties lo cated within the State have a reported
population density less than 6 persons per square mile.
(ii) The State does not receive a non-labor related share adjustme nt determined by
the Secretary to take into account the unique ci rcumstances of hospitals located in Alaska

and Hawaii.
(2) Amount of wage index adjustment

. A hospital located in a qualifying State
will receive a wage index value not less than 1.00.
(3) Process for determining and posting wage index adjustments. (i) CMS uses
the most recent Population Es timate data published by the U.S. Census Bureau to
determine county definitions a nd population density. This an alysis will be periodically
revised, such as for updates to the decennial census data.CMS-1498-P2 129
(ii) CMS will include a listing of qualifying Frontier States and denote the
hospitals receiving a wage index increase a ttributable to this provision in its annual
updates to the hospital inpa tient prospective payment system published in the
Federal Register

. 4. Section 412.73 is amended by--
A. Revising paragraph (c)(15).
B. Adding a new paragraph (c)(16).

The revision and addition read as follows:
§ 412.73 Determination of the ho spital specific rate based on a Federal fiscal year
1982 base period.

* * * * *
(c) * * *
(15) For Federal fiscal year 2003 through Federal fiscal year 2009

. For Federal
fiscal year 2003 through Federal fiscal year 2009, the update factor is the percentage
increase in the market basket index for pr ospective payment hosp itals (as defined in
§413.40(a) of this chapter).
(16) For Federal fiscal y ear 2010 and subsequent years . For Federal fiscal year
2010 and subsequent years, the update factor is the percen tage increase specified in
§412.64(d).

* * * * *
§ 412.75 [Amended]
5. In §412.75, paragraph (d) is am ended by removing the citationCMS-1498-P2 130
"§412.73(c)(15)" and adding the citation "§412.73(c)(15) and §412.73(c)(16)" in its
place.
§412.77 [Amended]
6. In §412.77, paragraph (e) is amended by removing the reference "(c)(15)" and
adding the reference "(c)(16)" in its place.
§412.78 [Amended]
7. In §412.78, paragraph (e) is ame nded by removing the citation
"§412.73(c)(15)" and adding the citation "§412.73(c)(15) and §412.73(c)(16)" in its
place.
§412.79 [Amended]
8. In §412.79, paragraph (d) is amended by removing the phrase "and (c)(15)"
and adding the phrase "through (c)(16)" in its place.

9. Section 412.101 is revised to read as follows:
§ 412.101 Special treatment: Inpatient hospital p ayment adjustment for
low-volume hospitals.
(a) Definitions

. Beginning in FY 2011, the terms used in this section are defined

as follows:
Medicare discharges means discharge of inpatients entitled to Medicare Part A,
including discharges associated with indivi duals whose inpatient be nefits are exhausted
or whose stay was not covered by Medicare and also discharges of individuals enrolled in
a MA organization under Medicare Part C.

Road miles means "miles" as defined in §412.92(c)(1).CMS-1498-P2 131
(b) General considerations . (1) CMS provides an additional payment to a
qualifying hospital for the higher incremental costs associated with a low volume of
discharges. The amount of any additional pa yment for a qualifying hospital is calculated
in accordance with paragraph (c) of this section.
(2) In order to qualify for this adjustment a hospital must meet the following

criteria:
(i) For FY 2005 through FY 2010, a hos pital must have less than 200 total
discharges, which includes Me dicare and non-Medicare discharg es, during the fiscal year,
as reflected in its cost report specified in pa ragraph (b)(3) of this section, and be located
more than 25 road miles (as defined in paragraph (a) of this section from the nearest
"subsection (d)" (section 1886(d) of the Act) hospital.
(ii) For FY 2011 and FY 2012, a hosp ital must have less than 1600 Medicare
discharges, as defined in paragr aph (a) of this section, during the fiscal year , as reflected
in its cost report specified in paragraph (b)(3 ) of this section, and be located more than
15 road miles, as defined in paragraph (a) of this secti on, from the nearest "subsection
(d)" (section 1886(d) of the Act) hospital.
(iii) For FY 2013 and subsequent fiscal years, a hospital must have less than 200
total discharges, which incl udes Medicare and non-Medicare, during the fiscal year, as
reflected in its cost report sp ecified in paragraph (b)(3) of this section, and be located
more than 25 road miles as defined paragraph (a) of this section from the nearest
"subsection (d)" (section 1886(d) of the Act) hospital.
(3) The fiscal intermediary or Medicare administrative contractor makes theCMS-1498-P2 132
determination of the discharg e count for purposes of deter mining a hospital's qualification
for the adjustment based on the hospital's most recent submitted cost report and for
qualification for FYs 2011 and 2012 other docum entation of Medicare discharges (as
defined in paragraph (a ) of this section).
(4) In order to qualify for the adjus tment, a hospital must provide its fiscal
intermediary or Medicare administrative contractor with sufficient evidence that it meets
the distance requirement specified under paragraph (b)(2) of this section. The fiscal
intermediary or Medicare administrative contr actor will base its determination of whether
the distance requirement is satisfied upon the evidence presented by the hospital and other
relevant evidence, such as maps, mapping software, and inquiries to State and local
police, transportation officials, or other government officials.
(c) Determination of the adjustment amount . The low-volume adjustment for
hospitals that qualify under paragr aph (b) of this section are as follows for the applicable
fiscal year:
(1) For FY 2005 through FY 2010, the adjustment is 25 percent for each
Medicare discharge.
(2) For FY 2011 and FY 2012, the adjustment is as follows:

Medicare Discharge Range Payment Adjustment (Percent Add-On) 1-200 25.0000 201-301 23.3333 301-400 21.6667 401-500 20.0000 501-600 18.3333 601-700 16.6667 701-800 15.0000CMS-1498-P2 133

Medicare Discharge Range Payment Adjustment (Percent Add-On) 801-900 13.3333 901-1000 11.6667 1001-1100 10.0000 1101-1200 8.3333 1201-1300 6.6667 1301-1400 5.0000 1401-1500 3.3333 1501-1599 1.6667 1600 or more 0.0000

(3) For FY 2013 and subsequent years, the adjustment is 25 percent for each
Medicare discharge.
(d) Eligibility of new hospitals for the adjustment

. A new hospital will be
eligible for a low-volume adjustment under this section once it has submitted a cost
report for a cost reporting period that indi cates that it meets discharge requirements
during the applicable fiscal year and has pr ovided its fiscal inte rmediary or Medicare
administrative contractor with sufficient evidence that it meets the distance requirement,
as specified under paragra ph (b)(2) of this section.
§ 412.108 [Amended]

10. Section 412.108 is amended as follows:
A. In paragraph (a)(1) introductory te xt the phrase "before October 1, 2011" is
removed and the phrase "before Oct ober 1, 2012" is added it is place.
B. In paragraph (c)(2)(iii) introductory text the phrase "before October 1, 2010" is
removed and the phrase "before Oct ober 1, 2012" is added it is place.
11. Section 412.211 is amended by revising paragraph (c) to read as follows:CMS-1498-P2 134
§ 412.211 Puerto Rico rates for Federal fiscal year 2004 and subseque nt fiscal years.

* * * * *
(c) Computing the standardized amount . CMS computes a Puerto Rico
standardized amount that is applicable to all hospitals located in all areas. The applicable
percentage change for updating the Puerto Rico specific standardized amount is as

follows:
(1) For fiscal year 2004 through fiscal year 2009, increased by the applicable
percentage change specified in §412.64(d)(1)(ii)(A).
(2) For fiscal year 2010, increased by the market basket index for prospective
payment hospitals (as defined in §413.40(a) of this subchapte r) for hospitals in all areas.
(3) For fiscal year 2011, increased by th e applicable percenta ge change specified
in §412.64(d)(1)(iii).

* * * * *
§ 412.230 [Amended]
12. In §412.230 paragraph (d)(1)(iv)(E) is am ended by removing the figures "86"
and "88" adding the figu res "82" and "84" in their place, respectively.
§ 412.232 [Amended]
13. In §412.232, paragraph (c)(3) is amended by removing the figure "88" and
adding the figure "85" in its place.
§ 412.234 [Amended]
14. In §412.234, paragraph (b)(3) is amended by removing the figure "88" and
adding the figure "85" in its place.CMS-1498-P2 135
§ 412.523 [Amended]

15. Section 412.523 is amended as follows:
A. Revise paragraph (c)(3)(vi).
B. Add paragraph (c)(3)(vii).
C. Paragraph (d)(3) is amended by removing the phrase "December 29, 2010, and
by no later than October 1, 2012" and a dding the phrase "December 29, 2012," in its
place.

The revision and addition read as follows:
§ 412.523 Methodology for calculating the Federal prospectiv e payment rates.

* * * * *
(c) * * *
(3) * * *
(vi) For long-term care hospital prospec tive payment system rate year beginning
October 1, 2009 and ending September 30, 2010

. (A) The standard Federal rate for
long-term care hospital prospective payment system rate year beginning October 1, 2009
and ending September 30, 2010 is the standard Federal rate for the previous long-term
care hospital prospective payment system rate year updated by 1.74 percent. The standard
Federal rate is adjusted, as appropriate, as descri bed in paragraph (d) of this section.
(B) With respect to discharges occurri ng on or after Oct ober 1, 2009 and before
April 1, 2010, payments are based on the standard Federal rate in pa ragraph (c)(3)(v) of
this section updated by 2.0 percent.
(vii) For long-term care hospital prospectiv e payment system fiscal year beginningCMS-1498-P2 136
October 1, 2010, and endi ng September 30, 2011. The standard Federal rate for the
long-term care hospital prospective paym ent system fiscal year beginning
October 1, 2010, and ending Se ptember 30, 2011, is the standa rd Federal rate for the
previous long-term care hospital prospectiv e payment system rate year updated by
-0.59 percent. The standard Fe deral rate is adjusted, as appropriate, as described in
paragraph (d) of this section.

* * * * *
§ 412.529 [Amended]
16. In §412.529, paragraphs (c)(2) introducto ry text and (c)(3) introductory text
are amended by removing the date "Decembe r 29, 2010" and adding in its place the date
"December 29, 2012" each time it appears.
§ 412.534 [Amended]

17. Section 412.534 is amended as follows:
A. Paragraphs (c)(1), (c)(2), (d)(1), (d )(2), (e)(1), (e)(2) are amended by removing
the date "October 1, 2010" and adding in its place the date "October 1, 2012" each time it

appears. B. Paragraphs (c)(3), (d)(3), (e)(3), (h )(4), and (h)(5) are amended by removing
the date "July 1, 2010" and adding in its place the date "July 1, 2012" each time it

appears.
412.536 [Amended]
18. In §412.536, paragraph (a)(2) introductory text is amended by removing the
date "July 1, 2010" and adding the date "July 1, 2012" in its place.CMS-1498-P2 137

PART 413--PRINCIPLES OF REAS ONABLE COST REIMBURSEMENT;
PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL

PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED

NURSING FACILITIES
19. The authority citation for Part 413 continues to read as follows:
Authority : Secs. 1102, 1812(d), 1814(b), 1815, 1833( a), (i), and (n), 1861(v),
1871, 1881, 1883, and 1886 of the Social Secu rity Act (42 U.S.C. 1302, 1395d(d),
1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww);
and sec. 124 of Pub. L. 106-133 (113 Stat. 1501A-332).

20. Section 413.70 is amended as follows:
A. Revise paragraph (b)(3)(ii)(A).
B. Redesignate paragra ph (b)(5)(i) as (b)(5)(i)(A).
C. In newly redesignated paragra ph (b)(5)(i)(A), the phrase "on or after
December 21, 2000," is removed and the phr ase "on or after December 21, 2000 and on
or before December 31, 2003," is added in its place.
D. Add a new paragraph (b)(5)(i)(B).

The revision and addition read as follows:
§413.70 Payment for services of a CAH.

* * * * *
(b) * * *
(3) * * *
(ii) * * *CMS-1498-P2 138
(A) Effective for cost reporting periods beginning on or after January 1, 2004, for
facility services not including any servi ces for which payment may be made under
paragraph (b)(3)(ii)(B) of this section, 101 per cent of the reasonable costs of the services
as determined under paragraph (b )(2)(i) of this section; and

* * * * *
(5) * * *
(i) * * *
(B) Effective for cost reporting peri ods beginning on or after January 1, 2004,
payment for ambulance services furnished by a CAH or an entity that is owned and
operated by a CAH is 101 percent of the reas onable costs of the CAH or the entity in
furnishing those services, but only if the CAH or the entity is the only provider or
supplier of ambulance services located within a 35-mile drive of the CAH or the entity.

* * * * *CMS-1498-P2
Authority: (Catalog of Federal Domestic A ssistance Program No. 93.773, Medicare--
Hospital Insurance; and Program N o. 93.774, Medicare--Supplem entary Medical
Insurance Program)

Dated: May 13, 2010

_______________________________ Marilyn Tavenner,
Acting Administrator,

Centers for Medicare & Medicaid Services.

Approved: May 18, 2010

__________________________________ Kathleen Sebelius,
Secretary.

BILLING CODE 4120-01-PCMS-1498-P2 140
[NOTE: The following A ddendum and Appendix will not appear in the Code of
Federal Regulations.]
ADDENDUM: FY 2011 Suppl emental Proposed Payment Rates
I. Supplemental Proposed FY 2011 Prospective Payment Systems Payment Rates
for Hospital Inpatient Operating and Capital Related Costs
As discussed in section II.B. of the pr eamble to this supplemental proposed rule,
changes to the applicable percentage increase, wage index, and rural community hospital
demonstration mandated by the Affordable Care Act necessitate the recalculation of the
FY 2011 proposed budget neutrality factors, ou tlier threshold and standardized amounts.
In the FY 2011 IPPS/LTCH PPS proposed rule we explained our methodology for
calculating the FY 2011 proposed budget neut rality factors (75 FR 24062 through 24073).
Except as explained below, we apply th is same methodology in recalculating these
budget neutrality adjustments to reflect the changes to the standa rdized amount required
by the Affordable Care Act. A complete discussion of our computation of the FY 2011
proposed budget neutrality factors, outlier th reshold and standardized amounts is found

below.
A. Updating the Average Standardized Amounts
As discussed section II.B. of the pream ble to this supplemental proposed rule,
sections 3401(a) and section 10319(a) of Pub. L. 111-148, amends section
1886(b)(3)(B)(i) of the Act to provide that th e FY 2011 applicable percentage increase for
IPPS hospitals equals the rate-of-increase in the hospital market basket for IPPS hospitals
in all areas minus a 0.25 percentage point , subject to the hospital submitting qualityCMS-1498-P2 141
information under rules established by th e Secretary in accordance with section
1886(b)(3)(B)(viii) of the Act. For hospitals that fail to submit qua lity data consistent
with section 1886(b)(3)(B)(viii) of the Act, th e update is equal to the market basket
percentage increase minus a 0.25 percentage point less an add itional 2.0 percentage
points. Therefore, for this supplemental proposed rule, based on IHS Global Insight,
Inc.'s first quarter 2010 forecast of the FY 2011 market basket increase, the estimated
update to the FY 2011 operatin g standardized amount is 2.15 percent (that is, the

FY 2011 estimate of the market basket rate-of-increase of 2.4 percent minus 0.25
percentage points) for hospitals in all areas, provided the hospital submits quality data in
accordance with our rules. For hospitals that do not submit quality data, the estimated
update to the operating standard ized amount is 0.15 percent (that is, the adjusted FY 2011

estimate of the market basket rate-of-inc rease of 2.15 percent minus 2.0 percentage
points).
B. Proposed Budget Neutrality Adjustment s Factors for Recalibration of DRG Weights
and Updated Wage Index
In the FY 2011 IPPS/LTCH PPS proposed rule we explained our methodology for
calculating the FY 2011 proposed DRG recla ssification and reca libration and updated
wage index budget neutrality f actor (75 FR 24064). Except as explained below, we apply
this same methodology in recalculating this budget neutrality adjustment to reflect the
changes to the standardized amount requi red by the Affordable Care Act.
As discussed above, sections 3401(a) and section 10319(a) of Pub. L. 111-148
amends section 1886(b)(3)(B)(i) of the Act, which defines the app licable percentageCMS-1498-P2 142
increase. Although these amendments modi fy the applicable percentage increase
applicable to the FY 2010 rates under the IPPS, section 3401(p) of Pub. L. 111-148 states
that the amendments do not apply to disc harges occurring prior to April 1, 2010.
Accordingly, for purposes of determining payment amounts for discharges occurring on
or after April 1, 2010, in order to comply with the statute in section 3401(p) of Pub. L.
111-148, we applied the revised FY 2010 rates effective with discharges on or after
April 1, 2010 until the end of FY 2010. However, for purposes of determining the budget
neutrality adjustments for FY 2011, the stat ute requires us to simulate the FY 2010
hospital as if hospitals were paid for all of FY 2010 base d on the FY 2010 rates that are
effective for payments for discharg es occurring on or after April 1, 2010.
For FY 2011 we are proposing a proposed DRG reclassification and recalibration
factor of 0.996867 and a proposed budget neutra lity factor of 1.000070 for changes to the
wage index. We multiplied the proposed DR G reclassification and recalibration budget
neutrality factor of 0.996867 by the proposed budget neutrality factor of 1.000070 for
changes to the wage index to determin e the proposed DRG reclassification and
recalibration and updated wage index budget neutrality fact or of 0.996937 (as required by
sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E)(i) of the Act).
C. Reclassified Hospitals-Budget Neutrality Adjustment
Due to the Affordable Care Act, it is also necessary to revise the reclassification
budget neutrality factor. As discussed in section II.A. of the preamble to this
supplemental proposed rule, section 3137(c) of Pub. L. 111-148 revised the average
hourly wage standards resultin g in our estimate that 23 a dditional hospitals will beCMS-1498-P2 143
reclassified (or receive thei r primary reclassifications. Using the methodology proposed
in the FY 2011 IPPS proposed rule, and incorporating the provision above, we computed
a factor of 0.991476 for reclassification budg et neutrality, as required by section
1886(d)(8)(D) of the Act.
D. Rural and Imputed Floor Budget Neutrality
We make an adjustment to the wage index to ensure that aggregate payments after
implementation of the rural floor under section 4410 of the BBA (Pub. L. 105-33) and the
imputed floor under §412.64(h)(4) of the regulations are made in a manner that ensures that
aggregate payments to hospitals are not affected. As discussed in section III.B. of the
preamble of the FY 2009 IPPS final rule (73 FR 48570 through 48574), we adopted as final
State level budget neutrality for the rural and imputed floors, e ffective beginning with the FY
2009 wage index. In response to the public's c oncerns and taking into account the potentially
significant payment cuts that could occur to hospitals in some States if we implemented this
change with no transition, we decided to phase in, over a 3-year period, the transition from
the national rural floor budget ne utrality adjustment on the wage index to the State level rural
floor budget neutrality adjustment on the wage index. In FY 2011 IPPS/LTCH PPS proposed
rule, in the absence of provisions of Pub. L. 111-148, the proposed adjustment would have
been completely transitioned to the State leve l methodology, such that the wage index that
was proposed in the FY 2011 IPPS/LTCH PPS proposed rule was determined by applying
100 percent of the State level budget neutra lity adjustment. However, section 3141 of
Pub. L. 111-148 restores the budget neutrality adju stment for the rural and imputed floors to a
uniform, national adjustment, beginning with the FY 2011 wage index.CMS-1498-P2 144
Using the same methodology in prior final rules to calculate th e national rural and
imputed floor budget neutrality adjustment fact or (which was part of the methodology to
calculate the blended rural and imputed floor budget neutrality adjustment factors), to
determine the proposed wage index adjusted by the national rural and imputed floor
budget neutrality adjustment, we used FY 2009 discharge data and proposed FY 2011
wage indices to simulate IPPS payments. First, we compared the national simulated
payments without the rural and imputed floors applied to national simulated payments
with the rural and imputed floors applied to determine the national rural and imputed
floor budget neutrality adjustment factor of 0.995425. This national adjustment was then
applied to the wage indices to produce a na tional rural and imputed floor budget neutral
wage index.
E. Proposed Rural Community Hospita l Demonstration Pr ogram Adjustment
As discussed in section II.F. of the pr eamble to this supplemental proposed rule,
section 410A of Pub. L. 108-173 requires the Secr etary to establish a demonstration that
will modify reimbursement for inpatient services for up to 15 small rural hospitals.
Section 410A(c)(2) of Pub. L. 108-173 require s that "in conducting the demonstration
program under this section, the Secretary shall ensure that the aggregate payments made
by the Secretary do not exceed the amount whic h the Secretary would have paid if the
demonstration program under this section was not implemented." In the proposed rule we
did not apply an adjustment to the standardiz ed amount to ensure the effects of the rural
community hospital demonstration are budget neutral. However, s ection 450(a) of the
MMA as amended by sections 3123 a nd 10313 of Pub. L. 111-148 extends theCMS-1498-P2 145
demonstration for an additional 5 years, a nd allows not more than 30 hospitals to
participate in the 20 least densely populated States.
In order to achieve budget neutrality, we are proposing to adjust the national IPPS
rates by an amount sufficient to account for th e added costs of this demonstration. In
other words, we are proposing to apply budget neutrality across the payment system as a
whole rather than merely acro ss the participants of this de monstration, consistent with
past practice. We be lieve that the language of the st atutory budget neutrality requirement
permits the agency to implement the budget neutrality provision in this manner. The
statutory language requires that "aggregate payments made by the Secretary do not exceed
the amount which the Secretary would have paid if the demonstration...was not
implemented," but does not identify the range across which aggregate payments must be
held equal. As mentioned section II.F. of the preamble to this supplemental proposed
rule, the proposed estimated amount for the adjustment to the national IPPS rates for FY 2011 is $69,279,673. Accordingly to account for the changes in the Affordable Care Act,
we computed a proposed factor of 0.999313 for the rural community hospital
demonstration program adjustme nt. We note that because the settlement process for the
demonstration hospitals' third y ear cost reports, that is, cost reporting periods starting in
FY 2007, has experienced a delay, for this FY 2011 IPPS proposed rule, we are unable to

state the costs of the demonstration corres ponding to FY 2007 and as a result are unable
to propose the specific numeric adjustment repr esenting this offsetting process that would
be applied to the national IPPS rates (as discussed above). However, we expect the cost
reports beginning in FY 2007 for hospitals th at participated durin g FY 2007 to be settledCMS-1498-P2 146
before the FY 2011 IPPS/LTCH final rule is published. Therefore, for the FY 2011
IPPS/LTCH PPS final rule, we expect to be able to calculate the amount by which the
costs corresponding to FY 2007 exceeded the amount offset by the budget neutrality
adjustment for FY 2007.
F. Proposed FY 2011 Outlier Fixed-Loss Cost Threshold
In order to compute the FY 2011 proposed outlier threshold, we used the same
methodology in this supplemental proposed rule that we used in the FY 2011 IPPS/LTCH
PPS proposed rule (75 FR 24068 through 24069; and incorporated the provisions of

Pub. L. 111-148 and Pub. L. 111-152 as discusse d above). However, as discussed in
section II.A. of the preamble to this s upplemental proposed rule, in accordance with
section 10324(a) of Pub. L. 111-148, beginning in FY 2011, we are proposing to create a
wage index floor of 1.00 for all hospitals locat ed in States determined to be Frontier
States. We noted that the Frontier State floor adjustments will be calculated and applied
after rural and imputed floor budget neutrality adjustments are calculated for all labor
market areas, so as to ensure that no hospita l in a Frontier State will receive a wage index
lesser than 1.00 due to the rural and imputed fl oor adjustment. In accordance with section
10324(a) of Pub. L. 111-148, the Frontier State ad justment will not be subject to budget
neutrality, and will only be extended to hospitals geographically located within a Frontier
State. However, for purposes of estimatin g the proposed outlier threshold for FY 2011, it
is necessary to apply this provision by adjustin g the wage index of those eligible hospitals
in a Frontier State when calculating the outlier threshold that results in outlier payments
being 5.1 percent of total payments for FY 2011. If we did not take into account thisCMS-1498-P2 147
provision, our estimate of total FY 2011 payments would be too low, and as a result, our
proposed outlier threshold would be too high, such that estimated outlier payments would
be less than our projected 5.1 pe rcent of total payments.
We are proposing an outlier fixed-loss co st threshold for FY 2011 equal to the
prospective payment rate for the DRG, plus any IME and DSH payments, and any add-on payments for new technology, plus $24,165.
G. FY 2011 Proposed Outlier Adjustment Factors
Using the same methodology in this suppl emental proposed rule that we used in
the FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24069; and incorporating the
provisions of the Affordable Care Act as di scussed above), we computed the following
proposed FY 2011 outlier adjustment factors that are applied to the proposed FY 2011
standardized amount for the pr oposed FY 2011 outlier threshold:

Operating Standardized Amounts Capital Federal Rate National 0.948995 0.943217 Puerto Rico 0.951459 0.925238

H. Proposed FY 2011 Standardized Amount
We calculated the proposed FY 2011 standardized amounts using the
methodology proposed in the FY 2011 IPPS pr oposed rule taking into account the
changes required by the provisions of Pub. L. 111-148. Tables 1A and 1B in this
supplemental proposed rule contain the propos ed national standardized amount that we
are applying to all hospitals, except hospitals in Puerto Rico. The proposed Puerto Rico-CMS-1498-P2 148
specific amounts are shown in Table 1C. The proposed amount s shown in Tables 1A and
1B differ only in that the labor-related sh are applied to the proposed standardized
amounts in Table 1A is 68.8 percent, and the labor-related share app lied to the proposed
standardized amounts in Table 1B is 62 percent.
In addition, Tables 1A and 1B incl ude the proposed standardized amounts
reflecting the adjusted marker basket update of 2.15 percent update for FY 2011, and
proposed standardized amounts reflecting the 2.0 percentage point re duction to the update
(a 0.15 percent update) applicable for hospitals that fail to submit quality data consistent
with section 1886(b)(3)(B)(viii) of the Act. Below is a revised table reflecting the
changes required by the provisions of the Affo rdable Care Act that details the calculation
of the proposed FY 2011 standardized amounts. We note that our proposed adjustment
for documentation and coding discussed at (75 FR 24065 through 24067) has not changed
since publication of the FY 2011 IPPS/LTCH proposed rule. Similar to the FY 2011
IPPS/LTCH PPS proposed rule, the adjustment of 0.957 is reflected within the table

below.CMS-1498-P2 149

COMPARISON OF FY 2010 STANDARDIZED AMOUNTS TO THE PROPOSED

FY 2011 STANDARDIZED AMOUNT WITH FULL AND REDUCED UPDATE

The proposed labor-related and nonlabor-re lated portions of the national average
standardized amounts for Puerto Rico hospitals for FY 2011 are set forth in Table 1C in
this supplemental proposed rule. (The la bor-related share applied to the Puerto
Rico-specific standardized amount is eith er 62.1 percent or 62 pe rcent, depending on Full Adjusted Update (2.15 percent); Wage index is greater than 1.0000 Full Adjusted Update (2.15 percent); Wage index is less

than or equal to 1.0000 Reduced Update (0.15 percent); Wage index is greater than 1.0000 Reduced Update (0.15 percent); Wage index is less

than or equal to 1.0000
FY 2010 Base Rate, after removing geographic reclassification budget neutrality, demonstration budget neutrality, cumulative FY 2008 and FY 2009 documentation and coding adjustment and outlier offset (based on the labor-related share percentage for FY 2010) Labor: $3,869.61 Nonlabor: $1,754.83 Labor: $3,487.15 Nonlabor: $2,137.29 Labor: $3,869.61 Nonlabor: $1,754.83 Labor: $3,487.15 Nonlabor: $2,137.29 Proposed FY 2011 Update Factor 1.0215 1.0215 1.0015 1.0015 Proposed FY 2011 DRG Recalibration and Wage Index Budget Neutrality Factor 0.996937 0.996937 0.996937 0.996937 Proposed FY 2011 Reclassification Budget Neutrality Factor 0.991476 0.991476 0.991476 0.991476 Proposed FY 2011 Outlier Factor 0.948995 0.948995 0.948995 0.948995 Proposed FY 2011 Rural Demonstration Budget Neutrality Factor 0.999313 0.999313 0.999313 0.999313 Proposed Cumulative Documentation and Coding Adjustment 0.957 0.957 0.957 0.957 Proposed Rate for FY 2011 Labor: $3,545.96 Nonlabor: $1,608.05 Labor: $3,195.49 Nonlabor:$1,958.52 Labor: $3,476.53 Nonlabor: $1,576.57 Labor: $3,132.92 Nonlabor: $1,920.18CMS-1498-P2 150
which is more advantageous to the hospital.)
I. Proposed Adjustments for Area Wage Levels
The following wage index tables were re vised in this supplemental proposed rule
as a result of the provisions of Pub. L. 111-148: Tables 2, 4A, 4B, 4C, 4D-2, 4J, and 9A.
(These tables are also av ailable on the CMS Web site.)
II. Supplemental Proposed FY 2011 Prospective Payment Systems Payment Rates
for Capital Related Costs
Although the provisions of Pub. L. 111- 148, do not directly affect the payment
rates and policies for the IPPS for capital-related costs, as discussed in section II.G. of the
preamble of this supplemental proposed rule, we are proposing the capital IPPS standard

Federal rates for FY 2011. This is necessary because the wage index changes required by
the provisions of Pub. L. 111-148 (discussed above in section II.A. of preamble to this
supplemental proposed rule) affect the proposed budget neutrality adjustment factor for
changes in DRG classifications and weights and the geographic adjustment factor (GAF)

since the GAF values are derived from th e wage index values (see §412.316(a)). In
addition, the provisions of Pub. L. 111-148, also necessitate a revision to the proposed
outlier payment adjustment factor since a single set of thresholds is used to
identify outlier cases for both inpatient operating and inpatient capital-related payments
(see §412.312(c)).
In this supplemental proposed rule, we have calculated the proposed FY 2011
capital Federal rates, offsets, and budget ne utrality factors using the same methodology
we proposed in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (CMS–1498–P)CMS-1498-P2 151
that was used to calculate the proposed rates in cluded in that rule which did not reflect the
provision of Pub. L. 111-148. For a complete de scription of this methodology, please see
the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24073 through 24082).
A. Proposed Capital Standard Federal Rate Update for FY 2011 The proposed factors used in the update framework are not affected by the
provisions of the Affordable Care Act. Therefore, the proposed update factor for
FY 2011 is not being revised from the proposed capital IPPS standard Federal rate update

factor discussed in section III.A .1. of the Addendum to the May 4, 2010 FY 2011 IPPS
proposed rule and remains at 1.5 percent for FY 2011.
A full discussion of the proposed update frame work is provided in that proposed rule
(75 FR 24074 through 24076).
B. Proposed Outlier Payment Adjustment Factor

Based on the thresholds as set forth in section III.A .6. of this Addendum, we
estimate that outlier payments for capital -related costs would equal 5.68 percent for
inpatient capital-relate d payments based on the proposed capital Federal rate in FY 2011.
Therefore, we are proposing to apply an outlier adjustment factor of 0.9432 in
determining the capital Federa l rate. For FY 2010, after taking in to account the
provisions of the Affordable Care Act, we estimated that outlier payments for capital
would equal 5.22 percent of inpa tient capital-related payments (which required an outlier
adjustment factor of 0.9478) based on the cap ital Federal rate in FY 2010 (as discussed

elsewhere in this Federal Register ). Thus, we estimate that the percentage of capital
outlier payments to total capita l standard payments for FY 2011 would be higher thanCMS-1498-P2 152
the percentage for FY 2010. This increase in capital outlier payments is primarily due to
the estimated decrease in capital IPPS payments per discharge. That is, because capital
payments per discharge are projected to be slightly lower in FY 2011 compared to
FY 2010, as shown in Table III. in section VIII. of the Appendix to this s upplemental
proposed rule, more cases woul d qualify for outlier payments.
The outlier reduction factors are not built permanently into the capital rates; that
is, they are not applied cumulatively in determining the capital Federal rate. The
proposed FY 2011 outlier adjustment of 0.9432 is a -0.49 percent change from the
FY 2010 outlier adjustment of 0.9478. Theref ore, the net change in the outlier
adjustment to the proposed capital Fede ral rate for FY 2011 is 0.9951 (0.9432/0.9478).
Thus, the proposed outlier adjustment decr eases the proposed FY 2011 capital Federal
rate by 0.49 percent compared w ith the FY 2010 outlier adjustment.
A single set of thresholds is used to identify outlier cases for both inpatient
operating and inpatient capital-related payments (see §412.312( c)). The outlier thresholds
are set so that operating outlier payments are projected to be 5.1 per cent of total operating
IPPS DRG payments. The proposed outlier thresholds for FY 2011 are in

section III.A .6. of this Addendum. For FY 2011, a case would qualify as a cost outlier if
the cost for the case plus the IME and DSH payments is greater than the prospective payment rate for the MS-DRG plus the fixed-loss amount of $24,165.
C. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications
and Weights and the GAF
Using the methodology discussed in section III.A .3. of the Addendum to theCMS-1498-P2 153
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24077 through 24079), for
FY 2011, we are proposing a GAF/DRG budget neutrality factor of 1.0015, which is the
product of the proposed incremental GAF budget neutrality factor of 1.0023 and the
proposed DRG budget neutrality factor of 0.9992 (the proposed DRG budget neutrality
factor remains unchanged from the May 4, 2010 FY 2011 IPPS proposed rule). The
GAF/DRG budget neutrality factors are built perm anently into the capital rates; that is,
they are applied cumulatively in determining the capital Federal rate. This follows the
requirement that estimated aggr egate payments each year be no more or less than they

would have been in the absence of the a nnual DRG reclassificati on and recalibration and
changes in the GAFs. The incremental change in the proposed adjustment from FY 2010
to FY 2011 is 1.0015. The cumulative change in the proposed capital Fe deral rate due to
this adjustment is 0.9926 (the product of the incremental factors for FYs 1995 though
2010 and the proposed incremental factor of 1.0015 for FY 2011). (We note that
averages of the incremental factors th at were in effect during FYs 2005 and 2006,
respectively, and the revised FY 2010 factor of 0.9994 that reflect the effect of the
provisions of the Affordable Care Ac t (as discussed elsewhere in this Federal Register )

were used in the calculation of the cumu lative adjustment of 0.9926 for FY 2011.) The
proposed cumulative adjustments for MS-DRG classifications and proposed changes in
relative weights and for proposed changes in the national GAFs through FY 2011 is
0.9926. The following table summarizes the ad justment factors for each fiscal year:CMS-1498-P2 154

BUDGET NEUTRALITY ADJUSTMENT FOR DRG RECLASSIFICATIONS AND RECALIBRATION AND THE GEOG RAPHIC ADJUSTMENT FACTORS

National Puerto Rico Incremental Adjustment Incremental Adjustment

Fiscal Year Geographic Adjustment Factor DRG Reclassifications and Recalibration Combined Cumulative Geographic Adjustment Factor DRGReclassifications and Recalibration Combined Cumulative 1992 — — — 1.00000 — — — — 1993 — — 0.99800 0.99800 — — — — 1994 — — 1.00531 1.00330 — — — — 1995 — — 0.99980 1.00310 — — — — 1996 — — 0.99940 1.00250 — — — — 1997 — — 0.99873 1.00123 — — — — 1998 — — 0.99892 1.00015 — — — 1.00000 1999 0.99944 1.00335 1.00279 1.00294 0.99898 1.00335 1.00233 1.00233 2000 0.99857 0.99991 0.99848 1.00142 0.99910 0.99991 0.99901 1.00134 2001 1 0.99782 1.00009 0.99791 0.99933 1.00365 1.00009 1.00374 1.00508 2001 2 0.99771 3 1.00009 3 0.99780 3 0.99922 1.00365 3 1.00009 3 1.00374 3 1.00508 2002 0.99666 4 0.99668 4 0.99335 4 0.99268 0.98991 4 0.99668 4 0.99662 4 0.99164 2003 5 0.99915 0.99662 0.99577 0.98848 1.00809 0.99662 1.00468 0.99628 2003 6 0.99896 7 0.99662 7 0.99558 7 0.98830 1.00809 0.99662 1.00468 0.99628 2004 8 1.00175 9 1.00081 9 1.00256 9 0.99083 1.00028 1.00081 1.00109 0.99736 2004 10 1.00164 9 1.00081 9 1.00245 9 0.99072 1.00028 1.00081 1.00109 0.99736 2005 11 0.99967 12 1.00094 1.00061 12 0.99137 0.99115 1.00094 0.99208 0.98946 2005 13 0.99946 12 1.00094 1.00040 12 0.99117 0.99115 1.00094 0.99208 0.98946 2006 1.00185 14 0.99892 1.00076 14 0.99198 1.00762 0.99892 1.00653 0.99592 2007 1.00000 0.99858 0.99858 0.99057 1.00234 0.99858 1.00092 0.99683 2008 1.00172 0.99792 0.99963 0.99021 1.00079 0.99792 0.99870 0.99554 2009 15 1.00206 0.99945 1.00150 0.99170 1.00097 0.99945 1.00041 0.99595 2010 16 0.99989 0.99953 0.99941 0.99112 1.00141 0.99953 1.00094 0.99688 2011 17 1.00230 0.99922 1.00152 0.99263 1.00036 0.99922 0.99958 0.99646

1 Factors effective for the first half of FY 2001 (October 2000 thro ugh March 2001). 2 Factors effective for the second half of FY 2001 (April 2001 thro ugh September 2001). 3 Incremental factors are applied to FY 2000 cumulative factors. 4 Incremental factors are applied to the cumulative factors for the first half of FY 2001. 5 Factors effective for the first half of FY 2003 (October 2002 thro ugh March 2003). 6 Factors effective for the second half of FY 2003 (April 2003 thro ugh September 2003). 7 Incremental factors are applied to FY 2002 cumulative factors. 8 Factors effective for the first half of FY 2004 (October 2003 thro ugh March 2004). 9 Incremental factors are applied to the cumulative factors for the second half of FY 2003. 10 Factors effective for the second half of FY 2004 (April 2004 thro ugh September 2004). 11 Factors effective for the first quarter of FY 2005 (September 2004 thro ugh December 2004). 12 Incremental factors are applied to average of the cumulative factors for the first half (October 1, 2003 thro ugh March 31, 2004) and second half (April 1, 2004 thro ugh September 30, 2004) of FY 2004. 13 Factors effective for the last three quarters of FY 2005 (January 2005 thro ugh September 2005). 14 Incremental factors are applied to average of the cumulative factors for 2005. 15 Final factors for FY 2009, including the implementation of section 124 of Pub. L. 110-275, which affectsCMS-1498-P2 155

wage indices and GAFs for FY 2009, 16 Final revised factors for FY 2010, which reflect the effect of the provisions of the Affordable Care Act (as discussed elsewhere in this Federal Register ). 17 Proposed factors for FY 2011 The proposed factor accounts for the pr oposed MS-DRG reclassifications and
recalibration and for proposed changes in th e GAFs, which include the changes to the
wage index as required by the provisions of Public Law 111-148, as amended (as
discussed in section II.A. of the preamble of this supplemental proposed rule). It also
incorporates the effects on the proposed GAFs of FY 2011 geographic reclassification
decisions made by the MGCRB compared to FY 2010 decisions. However, it does not
account for changes in payments due to change s in the DSH and IME adjustment factors.
D. Exceptions Payment Adjustment Factor
The provisions of Public Law 111-148, as amended, have no effect on capital
exceptions payments. Therefore, the special exceptions adjustment factor remains at

0.9997 as discussed in section III.A .4. of the May 4, 2010 FY 2011 IPPS proposed rule
(75 FR 24079).
E. Prospective MS-DRG Documentation and Coding Adjustment to the Capital Federal
Rates for FY 2011 and Subsequent Years
The provisions of Public Law 111-148, as amended, have no effect on the
proposed prospective documentati on and coding adjustment to the capital Federal rates.
Therefore, as discussed in greater detail in section V.E. of the preamble of the May 4,
2010 FY 2011 IPPS proposed rule (75 FR 24013 through 24015), proposed an additional
2.9 percent reduction to the na tional capital Federal payment rate in FY 2011, resulting in
a cumulative documentation and coding adjus tment factor of 0.957 for the proposed FYCMS-1498-P2 156
2011 national capital Federa l rate percent (that is, the exis ting -0.6 percent adjustment in
FY 2008 plus the -0.9 percent adjustment in FY 2009 plus the proposed additional -2.9
percent adjustment, computed as 1 divided by (1.006 x 1.009 x 1.029).
F. Proposed Capital Standa rd Federal Rate for FY 2011
As a result of the proposed 1.5 per cent update and other proposed budget
neutrality factors discussed a bove, we are proposing to estab lish a national capital Federal rate of $422.18 for FY 2011. We are providing the following chart that shows how each
of the proposed factors and adjustments fo r FY 2011 affects the computation of the
proposed FY 2011 national capita l Federal rate in compar ison to the FY 2010 national
capital Federal rate (revised to reflect the eff ect of the provisions of the Affordable Care
Act (as discussed elsewhere in this Federal Register ). The proposed FY 2011 update
factor has the effect of increasing the proposed capital Federal rate by 1.5 percent
compared to the FY 2010 capital Federal rate . The proposed GAF/DRG budget neutrality

factor of 1.0015 has the effect of increasin g the proposed capital Federal rate by 0.15
percent compared to the FY 2010 capital Fe deral rate. The proposed FY 2011 outlier
adjustment factor has the effect of decr easing the proposed capital Federal rate by 0.49
percent compared to the FY 2010 capital Fede ral rate. The proposed FY 2011 exceptions
payment adjustment factor has the effect of decreasing the proposed capital Federal rate
by 0.01 percent compared to the FY 2010 capital Federal rate. Furthermore, as shown in
the chart below, the resulting cumulative adjustment for changes in documentation and
coding that do not reflect real changes in patie nts' severity of illne ss (that is, the proposed
cumulative adjustment factor of 0.957 has the net effect of decreasing the proposed FYCMS-1498-P2 157
2011 national capital Fede ral rate by 2.8 percent as co mpared to the FY 2010 national
capital Federal rate. The combined effect of all the proposed changes would decrease the
proposed national capital Federa l rate by approx imately 1.72 percent compared to the
FY 2010 national capita l Federal rate.
Comparison of Factor s and Adjustments: FY 2010 Capital Federal Rate and Proposed FY 2011 Capital Federal Rate

FY 2010* Proposed FY 2011 Change Percent Change Update Factor 1 1.0120 1.0150 1.0150 1.50 GAF/DRG Adjustment Factor 1 0.9994 1.0015 1.0015 0.15 Outlier Adjustment Factor 2 0.9478 0.9432 0.9951 -0.49 Exceptions Adjustment Factor 2 0.9998 0.9997 0.9999 -0.01 MS-DRG Documentation and Coding Adjustment Factor 0.9850 3 0.9570 4 0.9716 5 -2.84 Capital Federal Rate $429.56 $422.18 0.9828 -1.72

1 The update factor and the GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2010 to FY 2011 resulting from the application of the proposed 1.0015 GAF/DRG budget neutrality fact or for FY 2011 is a net change of 1.0015. 2 The outlier reduction factor and the exceptio ns adjustment factor are not built perman ently into the capital rates; that is, t hese factors are not applied cumulatively in determining the capital rates. Thus, for example, the proposed net change resulting from the a pplication of the proposed FY 2011 outlier adjustment factor is 0.9432/0.9478, or 0.9951.

3 The documentation and coding adjustment factor includes the -0.6 percent in FY 2008, -0.9 percent in FY 2009, and no additional reduction in FY 2010. 4 The documentation and coding adjustment factor includes the -0.6 percent in FY 2008, -0.9 percent in FY 2009, no additional red uction in FY 2010 and the proposed -2.9 percent reduction in FY 2011. 5 The change is measured from the FY 2009 cumulative factor of 0.9850.

* The revised FY 2010 capital Federal rate, whic h reflects the effect of the provisions of the Affordable Care Act (as discussed elsewhere in this Federal Register ).

G. Proposed Special Capital Ra te for Puerto Rico Hospitals
Using the methodology discussed in the May 4, 2010 FY 2011 IPPS proposed rule
(75 FR 24081), with the changes we are propos ing to make to the factors used to
determine the capital rate, the proposed FY 2011 special capital rate for hospitals in Puerto Rico is $199.49. (See the May 4, 2010 FY 2011 IPPS proposed rule (75 FR 24015CMS-1498-P2 158
through 24016 and 24081) for additional inform ation on the calculation of the proposed
FY 2011 capital Puerto Rico specific rate.)
III. Supplemental Proposed Changes to the Payment Rates for the LTCH PPS for

FY 2011
A. Proposed LTCH PPS Standard Federal Rate for FY 2011
1. Background
In section VII. of the preamble of the May 4, 2011 FY 2011 proposed rule, we
discuss our proposed changes to the payment ra tes, factors, and specific policies under the
LTCH PPS for FY 2011. As noted previously, on March 23, 2010, the Patient Protection
and Affordable Care Act, Pub. L. 111-148, was enacted, and the Health Care and

Education Reconciliation Act of 2010, Pub. L. 111-152, which amended certain
provisions of Pub. L. 111-148, was enacted on March 30, 2010. Although a number of
the provisions of Pub. L. 111-148 and Pub. L. 111-152 affect the LTCH PPS, due to the
timing of the passage of the legi slation, we were unable to a ddress those provisions in the
May 4, 2011 FY 2011 IPPS/LTCH PPS proposed rule. Therefore, the proposed policies
and payment rates in that proposed rule do not reflect the new legislation. Below we
address the provisions of the Affordable Care Act that affect our proposed policies and
payment rates for FY 2011 under the LTCH PPS. In addition, we have issued further
instructions implementing the provisions of the Affordable Care Act, that affect the
policies and payment rates for RY 2010 under the LTCH PPS. Specifically, we have

established revised RY 2010 rate s and factors in a separate notice elsewhere is this
Federal Register consistent with the provisions of sections 1886(m)(3) and (4) of the ActCMS-1498-P2 159
and section 3401(p) of Pub. L. 111-148.

2. Revision of Certain Market Basket U pdates Incorporating the Provisions of the

Affordable Care Act
New section 1886(m)(3)(A)(ii) of the Act by specifies that for each of the rate
years 2010 through 2019, any annual update to the standard Federal ra te, for discharges
for the hospital for the rate year, shall be redu ced by the other adjustment specified in new
section 1886(m)(4) of the Act. Additionally , new 1886(m)(3)(A)(i) of the Act provides
that any annual update to the standard Federal rate, for di scharges occurring during the
rate year, shall be reduced for rate year 2012 and each subsequent rate year by the
productivity adjustment describe d in section 1866(b)(3)(B)(xi)(II) of the Act. Sections
1886(m)(3)(A)(ii) and (4)(A)-(B) require a 0.25 pe rcentage point reduction for rate year
2010 and a 0.50 percentage point reduction fo r rate year 2011. In addition, section
1886(m)(3)(B) of the Act provides that the a pplication of section 1886(m)(3) may result
in the an annual update being less than zero for a rate y ear, and may result in payment
rates for a rate year being less than such payment rates for the preceding rate year.
Furthermore, section 3401(p) of Pub. L. 111-148 specifies that the amendments made by
section 3401(c) of Pub. L. 111-148 shall not apply to discharges occurring before April 1,

2010.
We note that in the May 4, 2010 FY 2011 proposed rule, since the annual update
to the LTCH PPS policies, rates and factors now occurs on October 1 st , we proposed to
adopt the term "fiscal year" (FY) rather than "rate year" (RY) under the LTCH PPS
beginning October 1, 2010 to conf orm with the standard defin ition of the Federal fiscalCMS-1498-P2 160
year (October 1 through September 30) used by other PPSs, such as the IPPS (see 75 FR
24146 through 24147). Consequently, in that proposed rule and this supplemental
proposed rule, for purposes of clarity, when discussing the annual update for the LTCH
PPS, we employed "FY" rather than "RY" becau se it is our intent that the phrase "FY" be
used prospectively in all circumstances dealing with the LTCH PPS. Similarly, although
the language of sections 3401(c) and 10319 of Pub. L. 111-148, and section 1105(b) of
Pub. L. 111-152 refers to years 2010 and thereafter under the LTCH PPS as "rate year,"
consistent with our proposal to change the terminology used under the LTCH PPS from
"rate year" to "fiscal year," for purposes of clarity, in this supplemental proposed rule,
when discussing the annual update for the LTCH PPS, including the provisions of the
Affordable Care Act, we will continue to employed "FY" rather than "RY" for 2011 and
subsequent years because it is our intent that "FY" be used prospectively in all
circumstances dealing with the LTCH PPS.
. The proposed FY 2011 LTCH PPS standard Federal rate, discussed below in

section III.A .3. of this supplemental proposed rule, would be calculated by applying the
required 0.50 percentage point reduction to the proposed FY 2011 market basket update
consistent with sections 1886( m)(3)(A)(ii) and (4)(B) of the Act (that is, 1.9 percent) in
addition to the proposed adjustment to acc ount for any changes in documentation and
coding practices that do not reflect increased patient severity of illness discussed in
section VII.C.3. of the preamble of th e May 4, 2010 FY 2011 IPPS/LTCH PPS proposed
rule (that is, 2.5 percent).
3. Development of the Proposed FY 2011 LTCH PPS Standard Federal RateCMS-1498-P2 161
As discussed in the May 4, 2010 FY 2011 pr oposed rule, while we continue to
believe that an update to the LTCH PPS standard Federal rate should be based on the

most recent estimate of the increase in the LT CH PPS market basket, we also believe it is
appropriate that the standard Federal rate be offset by an adjustment to account for any
changes in documentation and coding practi ces that do not reflect increased patient
severity of illness. Such an adjustment protects the integr ity of the Medicare Trust Funds
by ensuring that the LTCH PPS payment rates better reflect the true costs of treating
LTCH patients.
For FY 2011, as discussed in section II.J .4. of the preamble of this proposed rule,
the proposed market basket update under the LTCH PPS for FY 2011 is 1.9 percent (that
is, the most recent estimate of the LTCH PPS market basket of 2.4 percent minus the 0.50
percentage points required by sections 1886(m)(3)(A)(ii) and (4)(B) of the Act.
Furthermore, as discussed in greater detail in section V II.C.3. of the preamble of the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, we performed a CMI analysis
using the most recent available LTCH cl aims data (FY 2009) under both the current
MS-LTC-DRG and the former CMS LTC-DRG pa tient classification systems. Based on
this evaluation, we determined that there was a cumulative increase in LTCH CMI of
2.5 percent due to changes in documentation and coding that did not reflect real changes
in patient severity of illness for LTCH discharges occurring in FY 2008 and FY 2009.
In this supplemental proposed rule, consiste nt with our historical practice, we are
proposing to update the LTCH PPS standard Federal rate for FY 2011 based on the full
proposed LTCH PPS market basket increase estimate of 2.4 percent, adjusted by the 0.50CMS-1498-P2 162
percentage point reduction requi red by sections 1886(m)(3)(A)( ii) and (4)(B) of the Act,
and an adjustment to account for the increas e in case-mix in a prior periods (FYs 2008
and 2009) that resulted from changes in documentation and codi ng practices of
-2.5 percent. Consequently, th e proposed update factor to th e standard Federal rate for
FY 2011 is –0.59 percent (that is, we are proposing to apply a factor of 0.9941 in
determining the LTCH PPS standard Federal rate for FY 2011, calculated as 1.019 x 1
divided by 1.025 = 0.9941 or -0.59 percent ( 0.9941 minus 1 equals 0.59 percent) ).
Furthermore, consistent with our historical practice of updatin g the standard Federal rate
for the previous rate year, in determining the proposed standard Federal rate for FY 2011
in this supplemental proposed rule, we are applying the proposed update factor of 0.9941

to the revised RY 2010 standard Federal rate that is being established in accordance with
the provisions of sections 1886(m)(3)(A)(ii) a nd (4)(A) of the Act, as implemented in a
separate notice publishe d elsewhere in this Federal Register

. Therefore, in this supplemental proposed rule, under the authority of sections
1886(m)(3)(A)(ii) and (4)(B) of the Act, we are proposing to amend §412.523 to add a
new paragraph (c)(3)(vii) to specify that the st andard Federal rate for discharges occurring
on or after October 1, 2010, thr ough September 30, 2011, is the st andard Federal rate for
the previous rate year update d by -0.59 percent. In dete rmining the proposed standard
Federal rate for FY 2011, we are applying the proposed 0.9941 update factor to the
RY 2010 Federal rate of $39,794.95 (as es tablished elsewhere in this Federal Register ).
Consequently, the proposed standard Fede ral rate for FY 2011 is $39,560.16. We also
are proposing that if more recent data become available, we would use those data, ifCMS-1498-P2 163
appropriate, to dete rmine the update to the standard Fe deral rate for FY 2011 in the final
rule, and, thus, the standard Fe deral rate update specified in the proposed regulation text
at §412.523(c)(3)(vii) could change accordingly.
B. Proposed Adjustment for LTCH PPS High-Cost Outlier (HCO) Cases
1. Background
When we implemented the LTCH PPS in the FY 2003 LTCH PPS final rule, in
the regulations at §412.525(a), we established an adjustment for additional payments for
outlier cases that have extraordinarily high costs relative to the costs of most
discharges(see (67 FR 56022 through 56027)). We refer to these cases as high cost
outliers (HCOs). Providing additional payments for outliers strongly improves the
accuracy of the LTCH PPS in determining resour ce costs at the patient and hospital level.
These additional payments reduce the financ ial losses that would otherwise be incurred
when treating patients who requi re more costly care and, therefore, reduce the incentives
to underserve these patients. We set the outlier threshold before the beginning of the
applicable rate year so that total estimated outlier payments are projected to equal
8 percent of total estimated payments under the LTCH PPS.
Under §412.525(a) in the regulations (in conjunction with §412.503), we make
outlier payments for any discharges if the estimated cost of a case exceeds the adjusted
LTCH PPS payment for the MS

- LTC-DRG plus a fixed-loss amount. Specifically, in
accordance with §412.525(a)(3) (in conjuncti on with §412.503), we pay outlier cases
80 percent of the difference between the estimated cost of the patient case and the outlier
threshold, which is the sum of the adjusted Federal prospective payment for theCMS-1498-P2 164

MS-LTC-DRG and the fixed-loss amount. The fixed-loss amount is the amount used to
limit the loss that a hospital will incur under the outlier policy for a case with unusually
high costs. This results in Medicare and the LTCH sharing financial risk in the treatment
of extraordinarily costly cases. Under the LTCH PPS HCO policy, the LTCH's loss is

limited to the fixed-loss amount and a fixed percentage of costs above the outlier
threshold (MS-LTC-DRG payment plus the fixe d-loss amount). The fixed percentage of
costs is called the marginal cost factor. We calculate the estimated cost of a case by
multiplying the Medicare allowable covered charge by the hospital's overall hospital costto-charge ratio (CCR).
Under the LTCH PPS, we determine a fixed-loss amount, that is, the maximum
loss that a LTCH can incur under the LTCH PPS for a case with unusually high costs
before the LTCH will receive any additiona l payments. We calculate the fixed-loss
amount by estimating aggregate payments w ith and without an outlier policy. The

fixed-loss amount results in estimated total ou tlier payments being pr ojected to be equal
to 8 percent of projected total LTCH PPS payments. Currently, MedPAR claims data and
CCRs based on data from the most recent pr ovider specific file (PSF) (or from the
applicable statewide average CCR if a LTCH's CCR data are faulty or unavailable) are

used to establish a fixed-loss threshold amount under the LTCH PPS.
As discussed previously in this secti on, the proposed policies and payment rates in
the May 4, 2011 FY 2011 proposed rule do not re flect the provisions of the Affordable
Care Act that affect LTCH PPS payments. The revised proposed standard Federal rate for
FY 2011 that was developed cons istent with the provisions of sections 1886(m)(3)(A)(ii)CMS-1498-P2 165
and (4)(B) of the Act is di scussed above in section III.A .3. of the Addendum of this
supplemental proposed rule. This revision to the proposed standard Federal rate for
FY 2011 requires us to revise the proposed high cost outlier fixed-loss amount for
FY 2011. This is necessary in order to ma intain the requirement that the fixed-loss

amount results in estimated total outlier payments being projected to be equal to 8 percent
of projected total LTCH PPS payments.
2. The Proposed LTCH PPS Fixed-Loss Amount for FY 2011
When we implemented the LTCH PPS, as discussed in the August 30, 2002
LTCH PPS final rule (67 FR 56022 through 56026), we established a fixed-loss amount
so that total estimated outlier payments are projected to equal 8 percent of total estimated
payments under the LTCH PPS. To determine the fixed-loss amount, we estimate outlier
payments and total LTCH PPS payments fo r each case using claims data from the
MedPAR files. Specifically, to determine the outlier paymen t for each case, we estimate
the cost of the case by multiplying the Medicare covered charges from the claim by the
applicable CCR. Under §412.525(a)(3) (in conjunction with §412.503), if the estimated
cost of the case exceeds the outlier threshold (t he sum of the adjusted Federal prospective
payment for the MS-LTC-DRG and the fixe d-loss amount), we pay an outlier payment
equal to 80 percent of the difference between the estimated cost of the case and the outlier
threshold (the sum of the adjusted Federa l prospective payment for the MS-LTC-DRG
and the fixed-loss amount).
As discussed in the May 4, 2010 FY 2011 proposed rule, we are proposing to
continue to use our existing methodology to calculate the proposed fixed-loss amount forCMS-1498-P2 166

FY 2011 in order to maintain estimated HCO payments at the projected 8 percent of total
estimated LTCH PPS payments. (For an explanation of our rationale for establishing an
HCO payment "target" of 8 percent of total estimated LTCH payments, we refer readers
to the August 30, 2002 LTCH PPS final rule (67 FR 56022 through 56024).) Consistent
with our historical practice of using the best data available, in determining the proposed
fixed-loss amount for FY 2011, we use the most recent available LTCH claims data and
CCR data. Specifically, for this proposed rule, we used LTCH claims data from the
December 2009 update of the FY 2009 MedPAR files and CCRs from the
December 2009 update of the PSF to determine a fixed-loss amount that would result in

estimated outlier payments projected to be equal to 8 percent of total estimated payments

in FY 2011 because these data are the most recent complete LTCH data currently
available. (We note that these are the same data used to determine the proposed FY 2011
fixed-loss amount in the May 4, 2010 FY 2011 pr oposed rule.) Consistent with the
historical practice of using th e best available data, we are proposing that if more recent
LTCH claims data become available, we will use them for determining the fixed-loss

amount for FY 2011 in the final rule. Furthe rmore, we are proposing to determine the
proposed FY 2011 fixed-loss amount based on the MS-LTC-DRG classifications and
relative weights from the version of the GROUPER that will be in effect as of the
beginning of FY 2011, that is, proposed Ve rsion 28.0 of the GROUPER (discussed in
section VII.D. of the preamble of this supplemental proposed rule).
In this proposed rule, we are proposin g to establish a fixed-loss amount of $19,254 for FY 2011. Thus, we would pay an outlier case 80 percent of the differenceCMS-1498-P2 167
between the estimated cost of the case and the outlier threshold (the sum of the adjusted
Federal LTCH payment for the MS-LTC-DRG and the fixed-loss amount of $19,254). The proposed fixed-loss amount for FY 2011 of $19,254 is slightly higher than
the revised RY 2010 fixed-loss amount of $18,615 (established elsewhere in this Federal
Register). Based on our payment simulations using the most recent available data and the
proposed 0.59 percent reduction to the standa rd Federal rate for FY 2011, the proposed

increase in the fixed-loss amount for FY 2011 would be necessary to maintain the
existing requirement that estimated outlier payments would equal 8 percent of estimated
total LTCH PPS payments. (For further information on and our rationale for the existing
8 percent HCO "target" requirement, we refer readers to the August 30, 2002 LTCH PPS
final rule (67 FR 56022 through 56024.) Mainta ining the fixed-loss amount at the current
level would result in HCO payments that are greater than the current 8 percent regulatory
requirement because a higher fixed-loss amount would result in fewer cases qualifying as

outlier cases as well as decreases the amount of the additional payment for a HCO case
because the maximum loss that a LTCH must incur before receiving an HCO payment
(that is, the fixed-loss amount) would be larg er. For these reasons, we believe that
proposing to raise the fixed-loss amount is a ppropriate and necessary to maintain that
estimated outlier payments would equal 8 percent of estimated total LTCH PPS payments
as required under §412.525(a).
As we noted in the May 4, 2010 FY 2011 proposed rule (75 FR 24089), under
some rare circumstances, a LTCH discharge could qualify as a SSO case (as defined in
the regulations at §412.529 in conjunction with §412.503) and also as a HCO case. InCMS-1498-P2 168
this scenario, a patient could be hospitalized for less than five-sixths of the geometric
average length of stay for the specific MS-LTC-DRG, and yet incur extraordinarily high
treatment costs. If the costs exceeded the HCO threshold (that is, the SSO payment plus
the fixed-loss amount), the discharge is eligib le for payment as a HCO. Thus, for a SSO
case in FY 2011, the HCO payment would be 80 percent of the difference between the

estimated cost of the case and the outlier thre shold (the sum of the proposed fixed-loss amount of $19,254 and the amount paid under the SSO policy as specified in §412.529).
C. Computing the Proposed Adjusted LTCH PPS Federal Prospective Payments for

FY 2011
In accordance with §412.525, the proposed sta ndard Federal rate is adjusted to
account for differences in area wages by mu ltiplying the proposed labor-related share of
the proposed standard Federal rate by the appropriate proposed LTCH PPS wage index
(as shown in Tables 12A and 12B of the Adde ndum of this proposed rule). The proposed

standard Federal rate is also adjusted to account for the higher costs of hospitals in Alaska
and Hawaii by multiplying the proposed nonlabo r-related share of the proposed standard
Federal rate by the a ppropriate cost-of-living factor (show n in the chart in section V.C.5.
of the Addendum of the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule). In this
proposed rule, we are proposing to establis h a standard Federal rate for FY 2011 of
$39,560.16, as discussed in section V.A.3. of the Addendum of this supplemental
proposed rule. We illustrate the methodology to adjust the proposed LTCH PPS Federal
rate for FY 2011 in the following example:CMS-1498-P2 169
Example:
During FY 2011, a Medicare patient is in a LTCH located in Chicago, Illinois
(CBSA 16974). The proposed FY 2011 LTCH PPS wage index value for CBSA 16974 is
1.0573 (Table 12A of the Addendum of this pr oposed rule). The Medicare patient is
classified into MS-LTC-DRG 28 (Spinal Pr ocedures with MCC), which has a proposed
relative weight for FY 2011 of 1.0834 (Table 11 of the Addendum of this supplemental
proposed rule).
To calculate the LTCH's total adjusted Federal prospective payment for this
Medicare patient, we compute the wage-adjus ted proposed Federal prospective payment
amount by multiplying the unadjusted proposed standard Federal rate ($39,560.16) by the
proposed labor-related share (75.407 percent) and the pr oposed wage index value
(1.0573). This wage-adjusted amount is th en added to the proposed nonlabor-related
portion of the unadjusted propos ed standard Federal rate (24.593 percent; adjusted for
cost of living, if applicable ) to determine the adjusted pr oposed Federal rate, which is
then multiplied by the proposed MS-LTC-DRG relative weight (1.0834) to calculate the
total adjusted proposed Federal LTCH PPS prospective payment for FY 2011
($45,046.57). The table below illustrates the co mponents of the calculations in this
example.CMS-1498-P2 170
Unadjusted Proposed Standard Federal Prospective Payment Rate $39,560.16
Proposed Labor-Related Share x 0.7540 7 Labor-Related Portion of the Proposed Federal Rate = $29,831.13 Proposed Wage Index (CBSA 16974) x 1.0573 Proposed Wage-Adjusted Labor Sh are of Federal Rate = $31,540.45 Proposed Nonlabor-Related Po rtion of the Federal Rate ($39,560.16 x 0.24593) + $9,729.03
Adjusted Proposed Federal Rate Amount = $41,269.48
Proposed MS-LTC-DRG 28 Relative Weight x 1.083 4 Total Adjusted Federal Prospective Payment = $44,711.36

IV. Tables

This section contains the tables refe rred to throughout the preamble to this
proposed rule and in this Addendum. Tables 1A, 1B, 1C, 1D, 1E, 2, 4A, 4B, 4C, 4D-2,
4J, 9A, 10, and 11 are presented below. Th e tables presented below are as follows:
Table 1A.—Supplemental Proposed National Adju sted Operating Standardized Amounts,
Labor/Nonlabor (68.8 Percent Labor Share/31.2 Percent Nonlabor Share
If Wage Index Is Greater Than 1)
Table 1B.—Supplemental Proposed National Adju sted Operating Standardized Amounts,
Labor/Nonlabor (62 Percent Labor Share/ 38 Percent Nonlabor Share If Wage
Index Is Less Than or Equal To 1)
Table 1C.—Supplemental Proposed Adjusted Operating Standardized Amounts for
Puerto Rico,

Labor/NonlaborCMS-1498-P2 171
Table 1D.—Supplemental Proposed Capita l Standard Federa l Payment Rate
Table 1E.—Supplemental Proposed LTCH Standa rd Federal Prospec tive Payment Rate
Table 2.—Acute Care Hospitals Case-Mix Indexes for Discha rges Occurring in Federal
Fiscal Year 2009; Proposed Hospital Wage Indexes for Federal Fiscal Year 2011;
Hospital Average Hourly Wages for Federal Fiscal Years 2009 (2005 Wage
Data), 2010 (2006 Wage Data), and 2011 ( 2007 Wage Data); and 3-Year Average
of Hospital Average Hourly Wages
Table 4A.—Proposed Wage Inde x and Capital Geographic Adju stment Factor (GAF) for
Acute Care Hospitals in Urban Areas by CBSA and by State--FY 2011
Table 4B.—Proposed Wage Index and Capital Geographic Adjustment Factor (GAF) for
Acute Care Hospitals in Rural Areas by CBSA and by State--FY 2011
Table 4C.—Proposed Wage Inde x and Capital Geographic Adju stment Factor (GAF) for
Acute Care Hospitals That Are Recla ssified by CBSA and by State--FY 2011
Table 4D-2.--Urban Areas with Acute Care Hospitals Receiving the Statewide Rural
Floor or Imputed Floor Wage Index--FY 2011
Table 4J.—Proposed Out-Migration Adjus tment for Acute Care Hospitals--FY 2011
Table 9A.--Hospital Reclassifica tions and Redesignations--FY 2011

Table 10.--Geometric Mean Plus the Le sser of .75 of the National Adjusted
Operating Standardized Payment Amount (Increased to Refl ect the Difference
Between Costs and Charges) or .75 of On e Standard Deviation of Mean Charges
by Medicare Severity Diagnosis -Related Group (MS-DRG)--April 2010
Table 11.—Supplemental Proposed MS-LTC-DRGs, Relative Weights, GeometricCMS-1498-P2 172
Average Length of Stay, and Short-Stay Outlier (SSO) Threshold for Discharges
Occurring from October 1, 2010 thr ough September 30, 2011 under the LTCH

PPS

TABLE 1A.—SUPPLEMENTAL PROP OSED NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNT S, LABOR/NONLABOR (68.8 PERCENT LABOR SHARE/31.2 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)
Full Update (2.15 Percent) Reduced Update (0.15 Percent) Labor-related Nonlabor-related Labor-related Nonlabor-related $3,545.96 $1,608.05 $3,476.53 $1,576.57

TABLE 1B.—SUPPLEMENTAL PROPOSED NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNT S, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)
Full Update (2.15 Percent) Reduced Update (0.15 Percent)
Labor-related Nonlabor-related Labor-related Nonlabor-related $3,195.49 $1,958.52 $3,132.92 $1,920.18

TABLE 1C.--SUPPLEMENTAL PROP OSED ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO, LABOR/NONLABOR

Rates if Wage Index is Greater Than 1 Rates if Wage Index is Less Than or Equal to 1 Labor Nonlabor Labor Nonlabor National $3,545.96 $1,608.05 $3,195.49 1,958.52 Puerto Rico $1,524.71 $930.54 $1,522.25 $933.00CMS-1498-P2 173

TABLE 1D.--SUPPLEMEN TAL PROPOSED CAPITAL STANDARD FEDERAL PAYMENT RATE



### Rate National $422.18 Puerto Rico $199.49

TABLE 1E.—SUPPLEMENTAL PROP OSED LTCH STANDARD FEDERAL PROSPECTIVE PAYMENT RATE

Rate
Standard Fede ral Rate $39,560.16CMS-1498-P2 174

TABLE 2.--HOSPITAL CASE-MIX INDE XES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2009; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2011; HOSPI TAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2009 ( 2005 WAGE DATA), 2010 (2006 WAGE

DATA), AND 2011 (2007 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 010001 1.6908 0.8508 25.0592 24.8712 27.6011 25.8542 010005 1.2841 0.8396 25.7771 24.9052 26.7660 25.7876 010006 1.4782 0.7998 25.1401 26.7013 27.1899 26.3024 010007 1.0377 0.7421 22.0185 20.0565 21.0524 21.0330 010008 1.1123 0.7757 23.2572 22.8443 24.6733 23.5882 010009 0.9990 0.8614 25.8420 26.1396 27.7497 26.5428 010010 1.2246 0.7736 24.8390 26.2416 27.1969 26.0938 010011 1.5830 0.8583 27.1997 28.6140 33.0361 29.6023 010012 1.1634 0.7589 26.4989 24.8944 25.4141 25.5688 010015 0.9011 0.7476 23.6821 22.9857 22.2077 22.9349 010016 1.5802 0.8583 28.9724 28.7392 30.3170 29.3596 010018 1.1555 0.8583 26.9514 26.7633 28.8087 27.5186 010019 1.3603 0.7998 25.0170 26.0567 29.0622 26.7038 010021 1.3329 0.7473 21.7601 24.3385 25.0343 23.6912 010022 0.9217 0.9528 28.7529 26.5348 30.6579 28.6538 010023 1.7864 0.8475 28.2135 30.0684 31.4256 29.9233 010024 1.6738 0.8475 26.6636 28.1766 29.2979 28.1013 010025 1.4344 0.8582 23.8617 20.1873 29.5803 23.9653 010027 0.7496 0.7447 18.2508 19.7740 22.3038 20.2061 010029 1.6510 0.8582 24.3622 28.3184 26.2864 26.2272 010032 0.8693 0.7736 20.8458 24.7706 22.5607 22.8612 010033 2.2117 0.8583 29.2036 29.3762 30.8243 29.8385 010034 1.1730 0.8475 21.3728 21.0565 23.7513 22.0213 010035 1.3475 0.8396 26.5299 28.0534 28.4993 27.6832 010036 1.1875 0.7421 23.3876 25.0011 25.7199 24.7026 010038 1.3776 0.7869 28.9646 29.7948 32.5231 30.4750 010039 1.8330 0.8961 29.8034 30.6619 31.7063 30.7533 010040 1.6522 0.7482 25.9856 25.2840 27.2842 26.1688 010043 1.2776 0.8583 25.3633 27.3636 26.3517 26.3192CMS-1498-P2 175

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 010044 1.0295 0.7421 23.4020 27.3403 28.2131 26.2653 010045 1.0535 0.7599 24.2450 25.1108 27.0851 25.4649 010046 1.5582 0.8396 25.4465 33.3112 21.9429 26.0994 010047 0.8765 0.7666 21.7349 17.0984 24.5251 21.0332 010049 1.0744 0.7447 23.1194 25.4446 27.0625 25.1500 010050 1.0266 0.8583 25.3678 27.0365 29.5491 27.2877 010051 0.8615 0.8194 20.0765 21.4140 20.9159 20.8071 010052 0.9419 0.8475 22.7571 22.1386 21.8148 22.2484 010054 1.0674 0.8614 25.4209 24.6126 24.5639 24.8520 010055 1.5928 0.7972 25.3306 26.4706 26.7456 26.1757 010056 1.6143 0.8583 25.7290 28.5668 31.1851 28.4494 010058 0.9816 0.8583 31.1865 23.6860 24.6105 25.8253 010059 1.0664 0.8614 27.8613 29.5434 26.7428 27.9872 010061 0.9602 0.8563 25.7048 26.5035 26.1463 26.1214 010062 1.0748 0.7715 22.9491 20.8224 23.0559 22.2543 010064 1.6120 0.8583 26.6333 * 23.3954 24.8292 010065 1.4982 0.8396 24.4454 25.9433 27.7120 26.0207 010066 0.8151 0.7421 25.6052 25.9301 26.7367 26.0555 010069 0.9679 0.7421 27.3438 29.4662 25.8964 27.5684 010073 0.9744 0.7421 20.7833 19.9743 21.0063 20.5785 010078 1.7376 0.7869 25.2897 24.5429 26.5654 25.4734 010079 1.3594 0.8961 23.1025 25.4118 27.2463 25.2397 010083 1.1948 0.7870 25.0422 25.2405 25.2017 25.1655 010084 *** * 27. 5069 * * 27.5069 010085 1.4769 0.8614 24.0475 25.6072 26.5909 25.3882 010086 1.1077 0.7421 26.9753 24.9468 27.4146 26.3789 010087 2.4471 0.7870 27.4929 27.2725 26.8954 27.1988 010089 1.3862 0.8583 25.9719 26.9357 27.9079 26.8958 010090 1.8308 0.7870 25.6110 26.8029 28.3744 26.9471 010091 0.8685 0.7476 23.6555 27.8571 25.1201 25.3701 010092 1.5529 0.8194 28.8433 30.3263 28.7948 29.3311 010095 0.7991 0.8194 17.8248 21.6551 23.5564 21.0352 010097 0.8060 0.8475 18.4218 19.5147 21.2996 19.7766 010099 0.9382 0.7421 22.3686 20.8632 23.5835 22.2682 010100 1.7378 0.8114 25.4357 25.8178 26.8181 26.0446 010101 1.1605 0.8396 26.2744 25.0955 26.5747 25.9872CMS-1498-P2 176

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 010102 0.9608 0.8475 26.6943 22.6883 22.4398 23.9594 010103 1.9636 0.8583 30.4032 27.9049 29.7010 29.3261 010104 1.6984 0.8583 30.4963 29.1001 30.1353 29.9264 010108 1.0545 0.8475 26.8900 27.7601 29.5101 28.1758 010109 1.0134 0.7826 21.9300 19.3990 23.0918 21.4719 010110 0.8328 0.7836 22.1175 17.9438 25.5691 21.8242 010112 0.9041 0.7421 21.3904 22.0927 20.9602 21.4581 010113 1.6548 0.7870 25.0704 25.7852 28.0528 26.3173 010114 1.5070 0.8583 25.3666 25.8015 25.6005 25.5885 010118 1.3294 0.7985 25.3689 25.7663 27.7362 26.2760 010120 0.9119 0.7421 22.8177 22.0809 * 22.4473 010125 1.1026 0.7850 23.6549 24.1942 25.4328 24.3975 010126 1.0242 0.8475 25.7254 28.8995 27.0770 27.1824 010128 0.9834 0.7476 25.9421 25.1022 25.7453 25.6021 010129 1.1598 0.7573 24.4816 25.2104 27.6767 25.7944 010130 1.0145 0.8583 25.2790 23.8895 31.2319 26.5261 010131 1.4270 0.8961 28.0487 28.6759 32.2481 29.7152 010137 1.5361 0.8583 30.4361 30.7312 33.4983 31.5313 010138 0.6398 0.7522 15.0815 16.7541 16.6144 16.1902 010139 1.6830 0.8583 29.3560 29.3626 30.7489 29.8142 010143 1.1691 0.8614 25.0871 25.1522 25.9745 25.3833 010144 1.7207 0.7870 23.8601 25.4614 26.4008 25.1949 010145 1.5795 0.8194 27.3296 30.2093 29.5558 29.0313 010146 0.9412 0.7869 23.8076 24.6572 25.2484 24.5514 010148 0.9563 0.7421 25.0960 24.8409 24.3699 24.7693 010149 1.3663 0.8475 26.8920 28.1328 29.5254 28.2683 010150 1.0187 0.7666 25.0070 26.3342 25.9401 25.7372 010152 1.3718 0.7870 26.0793 23.0248 26.8322 25.2347 010157 1.1568 0.7998 27.1793 27.5674 27.3487 27.3636 010158 1.3394 0.7555 26.2363 26.8821 27.7665 26.9653 010164 1.1777 0.8396 25.6759 24.4625 23.9304 24.6859 010167 1.5767 0.8583 * 24.7643 29.1631 26.8653 010168 1.6115 0.9077 * 30.2040 27.0185 28.8600 010169 1.0410 * * * * * 020001 1.8974 1.2578 38.1784 39.2651 40.8325 39.4363 020006 1.3723 1.2578 37.2853 40.5422 42.4838 40.2757CMS-1498-P2 177

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 020008 1.2207 1.2578 40.6783 42.8075 44.8291 42.8366 020012 1.4672 1.2578 36.1911 37.0181 38.4880 37.2462 020014 *** * 30. 6343 * * 30.6343 020017 2.2168 1.2578 38.2157 41.2448 42.1762 40.5573 020018 0.9117 1.9255 * * * * 020024 1.1323 1.2578 39.9943 35.9358 43.5298 39.9069 020026 1.5829 1.9255 * * * * 020027 0.8544 1.9255 * * * * 020028 *** * * * 42. 1568 42.1568 030001 1.5123 1.0471 35.9083 38.1204 36.9465 37.0095 030002 2.1395 1.0471 32.9094 34.2998 35.5406 34.2817 030006 1.7866 0.9648 29.1248 32.1646 32.4565 31.2997 030007 1.5010 1.2262 35.5226 38.1199 40.1726 38.0212 030010 1.6899 0.9648 31.8640 33.3049 33.9522 33.0660 030011 1.6799 0.9648 30.2096 31.8532 32.9183 31.7320 030012 1.6785 1.2262 31.3068 33.4818 50.8525 36.5891 030013 1.5846 0.9412 31.9162 31.1767 33.0103 32.0532 030014 1.6003 1.0471 30.6308 31.8529 33.7100 32.1295 030016 1.3364 1.0471 31.1878 30.6196 34.0540 31.8987 030017 *** * 34. 8488 34.9499 37.4893 35.7433 030018 *** * 31. 7240 34.2870 35.7209 33.8731 030019 *** * 33. 6553 36.3298 36.3760 35.4444 030022 1.6387 1.0471 35.0772 34.3377 34.4050 34.5355 030023 2.0211 1.2400 37.5523 41.8098 43.4901 40.9837 030024 2.1783 1.0471 35.3556 38.5575 40.6081 38.3107 030030 1.6996 1.0471 36.4772 38.9056 37.5980 37.7197 030033 1.3578 1.2093 32.0362 33.9716 35.7840 33.9594 030036 1.6971 1.0471 35.7464 37.1271 40.4842 37.7767 030037 1.9779 1.0471 35.1342 35.8129 37.1935 36.2152 030038 1.6840 1.0471 31.2928 33.8052 36.9266 34.1148 030043 1.3149 0.9078 28.3158 29.0816 31.0593 29.4840 030055 1.5838 1.0240 31.0806 37.2632 37.4315 35.3174 030061 1.7125 1.0471 33.0847 34.2000 35.3864 34.2660 030062 1.4495 0.9078 29.9359 30.3859 33.1874 31.2110 030064 2.1061 0.9648 31.6632 33.1535 35.0230 33.3240 030065 1.8343 1.0471 31.4602 33.8941 36.2534 33.8318CMS-1498-P2 178

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 030067 1.0416 0.9406 27.0784 27.4410 31.2478 28.5865 030068 1.1142 0.9078 26.0296 26.8369 28.7966 27.2639 030069 1.5878 1.1377 30.7723 35.1793 35.6421 33.9927 030071 1.0518 1.4382 * * * * 030073 1.2775 1.4382 * * * * 030074 0.9561 1.4382 * * * * 030077 0.9180 1.4382 * * * * 030078 1.2123 1.4382 * * * * 030080 *** * 30. 7682 34.2723 * 32.4902 030083 1.5477 1.0471 35.8521 39.0888 39.9707 38.3254 030084 1.0830 1.4382 * * * * 030085 1.6913 0.9648 29.0774 30.7160 33.4062 31.0315 030087 1.7697 1.0471 31.1094 33.0362 37.2751 33.9611 030088 1.4335 1.0471 30.5738 33.5408 34.6877 33.0355 030089 1.7404 1.0471 31.3179 32.8874 34.7343 33.0017 030092 1.6022 1.0471 30.4394 31.6471 33.8309 32.0855 030093 1.4573 1.0471 33.0720 33.5029 34.3015 33.6746 030094 1.6808 1.0471 34.2040 35.9213 36.9133 35.7448 030099 0.7231 * 24.9127 * * 24.9127 030100 2.2953 0.9648 35.0981 36.9783 39.5385 37.2928 030101 1.4411 1.1757 33.2139 34.1060 33.6260 33.6535 030102 2.8130 1.0471 36.9539 39.4617 36.4149 37.5421 030103 1.8002 1.0471 34.2770 41.6469 41.1210 39.1558 030105 2.2878 1.0471 33.9875 37.6952 38.6741 36.8267 030106 *** * 40. 1657 43.9022 * 41.9807 030107 2.1093 1.0471 35.4562 35.9171 37.6288 36.3377 030108 2.4034 1.0471 34.8507 33.2799 34.5124 34.1536 030110 1.7329 1.0471 36.2158 38.0468 39.0340 37.8801 030111 1.1668 0.9648 28.5146 33.3314 37.0123 33.6486 030112 2.0671 1.0471 33.4810 36.1513 40.1301 36.8711 030113 0.9505 1.4382 * * * * 030114 1.4510 0.9648 28.8466 30.2128 30.3754 29.8451 030115 1.5083 1.0471 32.5885 34.8409 36.8225 35.0086 030117 1.3318 1.0240 * 34.5349 36.6725 35.7305 030118 1.3327 1.2262 * 28.2945 32.6116 30.4114 030119 1.6200 1.0471 * 38.2362 40.7172 39.6384CMS-1498-P2 179

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 030120 0.8520 1.0471 * 39.7676 47.5037 43.8726 030121 1.6902 1.0471 * * 36.6999 36.6999 030122 1.4640 1.0471 * * 35.1781 35.1781 030123 1.4739 1.0471 * * * * 030124 1.8948 1.0471 * * * * 030125 2.0742 1.0471 * * * * 030126 1.8635 1.0471 * * * * 040001 1.0932 0.8608 24.4962 25.0147 25.5841 25.0463 040002 1.1071 0.7483 24.0487 26.2100 24.0639 24.7422 040004 1.7351 0.8608 29.2714 30.1320 31.6130 30.3580 040007 1.7451 0.8635 28.3305 29.3146 30.2051 29.2717 040010 1.4698 0.8608 28.2375 28.1618 29.2017 28.5990 040011 0.9266 0.7483 22.6327 25.6224 25.9642 24.7357 040014 1.3689 0.8451 34.8279 24.1271 24.6941 25.6001 040015 1.0662 0.7483 22.3148 23.2134 23.7403 23.0850 040016 1.7601 0.8635 26.4806 27.6568 28.6501 27.6411 040017 1.0990 0.8462 24.3772 25.3390 26.2509 25.3116 040018 1.2191 0.7707 26.2521 25.3362 26.6851 26.0819 040019 0.9918 0.7725 26.4932 25.5468 25.0491 25.6618 040020 1.6272 0.8871 26.1529 25.9754 26.6049 26.2463 040021 *** * 27. 6799 28.7690 28.8903 28.4564 040022 1.4167 0.8608 30.0250 29.5992 29.4604 29.6905 040026 1.6410 0.9253 31.8588 32.2814 34.6944 32.9479 040027 1.5093 0.8375 25.7935 27.2441 28.4743 27.1878 040029 1.4958 0.8635 27.8882 27.8412 29.1988 28.3053 040036 1.6856 0.8635 30.4906 32.0772 33.1236 31.9038 040039 1.1753 0.8109 22.9807 23.4456 23.0760 23.1655 040041 1.1592 0.8451 26.4435 27.8594 27.4448 27.2474 040042 1.3566 0.9171 23.1661 23.5768 28.3874 25.0294 040047 0.9113 0.7520 23.3557 25.0102 27.5142 25.1265 040050 1.1590 0.7483 19.6946 21.0178 22.0146 20.9063 040051 0.9936 0.7483 22.1981 23.4783 24.9308 23.5416 040055 1.7558 0.7707 26.0150 26.3370 26.5702 26.3163 040062 1.6827 0.7707 25.6554 28.5888 28.4309 27.5460 040067 1.0555 0.7528 20.9700 21.3492 22.1772 21.5146 040069 0.9730 0.8109 23.3117 23.0880 22.6987 23.0306CMS-1498-P2 180

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 040071 1.5474 0.8451 26.6645 25.0185 28.7130 26.7537 040072 1.1859 0.7483 22.9671 23.3205 24.0488 23.4429 040074 1.1781 0.8635 27.3897 27.4614 27.7915 27.5518 040076 1.0157 0.9030 24.7903 25.7464 25.0274 25.1722 040078 1.7507 0.9253 25.6886 27.9394 28.4481 27.3094 040080 1.0416 0.7797 26.5905 26.9354 26.1224 26.5524 040081 0.8641 0.7881 18.4759 18.5265 17.3969 18.1445 040084 1.3107 0.8635 28.1570 28.7379 29.9634 29.0185 040085 0.9358 0.8871 26.6987 25.4981 26.7545 26.3201 040088 1.5419 0.8085 24.7119 26.7050 28.8877 26.7762 040091 1.1940 0.7483 22.3311 27.7747 29.9029 26.3939 040100 *** * 24. 5458 24.7712 * 24.6638 040114 1.9109 0.8635 28.5702 29.1200 30.6358 29.4351 040118 1.6136 0.7483 26.5783 27.3360 30.6065 28.2493 040119 1.5157 0.8451 25.6779 26.9632 28.2765 27.0150 040132 0.8021 0.9253 21.8140 * 22.6953 22.2510 040134 2.2362 0.8635 34.9673 35.2045 36.1627 35.4829 040137 1.3325 0.8635 27.7638 28.2123 31.3247 29.2690 040138 *** * 33. 0073 31.1138 32.6001 32.2159 040141 *** * 33. 8791 34.8500 * 34.4114 040142 1.5826 0.9253 23.1302 24.4876 27.5086 25.1151 040145 1.9580 0.7797 20.3878 22.1731 22.3687 21.7125 040147 1.9130 0.8635 35.7669 33.6215 30.4256 32.7938 040148 *** * * * 35. 6031 35.6031 040149 *** * * * 29. 0721 29.0721 040152 2.5966 0.8608 * * * * 050002 1.5159 1.6178 43.1760 42.3825 45.4953 43.6748 050006 1.8102 1.3547 41.7714 43.8923 45.0094 43.5856 050007 1.5598 1.5576 49.5271 55.1636 52.2245 52.2511 050008 1.6354 1.5342 50.9569 50.4751 52.7669 51.4050 050009 1.7626 1.5482 49.7177 51.5510 53.0588 51.5292 050013 1.9184 1.5482 43.4906 46.3422 49.5453 46.5172 050014 1.2657 1.3486 42.2044 42.7255 41.0206 41.9545 050016 1.4193 1.2368 34.3863 36.3674 39.4584 36.8709 050017 2.1061 1.3486 44.4857 46.6209 48.7220 46.6321 050018 1.3007 1.2247 34.0338 34.7941 36.0324 34.9615CMS-1498-P2 181

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050022 1.7904 1.2247 36.6360 38.9203 41.5471 39.0977 050024 1.2891 1.2247 33.5247 34.6921 37.1807 34.9055 050025 1.9538 1.2247 36.9233 39.5330 42.5246 39.7669 050026 1.6191 1.2247 35.0306 36.3315 37.3290 36.2935 050028 1.2261 1.2247 28.1584 28.5839 * 28.3806 050030 1.2680 1.2247 33.5654 33.2455 34.4700 33.7632 050036 1.7457 1.2247 37.4298 39.2616 41.5393 39.4707 050038 1.7728 1.6386 55.2197 58.4851 61.3276 58.4346 050039 1.5400 1.2247 34.9262 37.8559 40.9213 37.8428 050040 1.3721 1.2247 38.1665 41.9767 44.2571 41.5266 050042 1.5785 1.3547 40.5791 45.6660 50.9908 45.8022 050043 1.7576 1.6178 51.9529 55.4677 53.5411 53.6961 050045 1.3696 1.2247 28.5952 27.8903 31.4860 29.3287 050046 1.2182 1.2247 34.2529 34.0106 37.1982 35.1676 050047 1.8545 1.5342 48.5961 51.4298 53.1141 51.0350 050054 1.2411 1.2247 27.1320 27.9082 32.4947 29.1694 050055 1.4904 1.5342 48.2796 51.9993 52.9342 51.0882 050056 1.5972 1.2247 34.7964 33.2655 39.4954 35.7797 050057 1.6940 1.2247 33.7574 35.6340 38.6138 36.0669 050058 1.8187 1.2247 38.9843 41.4811 43.4764 41.3510 050060 1.6287 1.2247 34.1183 35.3108 36.7750 35.4314 050063 1.6524 1.2247 36.6301 40.9558 43.3599 40.2753 050065 *** * 42. 0085 * * 42.0085 050067 1.3773 1.2247 41.8988 41.1549 34.0218 39.0746 050069 2.0169 1.2247 38.1339 40.0498 44.2637 40.8835 050070 1.4481 1.5576 48.9362 53.8300 55.6284 52.8293 050071 1.7718 1.6386 52.0696 55.3995 54.9153 54.1707 050072 1.5282 1.5852 51.4538 54.7774 55.8299 54.0528 050073 1.5376 1.5742 50.6523 54.2296 55.8359 53.6371 050075 1.6153 1.6178 51.1187 54.8332 56.6372 54.2184 050076 1.8135 1.5342 50.5761 53.8043 55.1835 53.2013 050077 1.6624 1.2247 37.4989 38.5242 38.0509 38.0339 050078 1.3299 1.2247 37.1940 38.9256 38.8489 38.3347 050079 1.5469 1.5852 48.3017 50.6578 65.1440 53.7676 050082 1.8234 1.2247 42.0181 41.8861 44.1069 42.6942 050084 1.6992 1.3486 41.1276 42.4418 46.0253 43.2693CMS-1498-P2 182

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050089 1.4757 1.2247 39.6297 39.9711 42.3990 40.7121 050090 1.4461 1.5742 41.6026 44.0838 44.4628 43.3851 050091 0.9802 1.2247 40.1063 34.8170 33.6732 36.0063 050093 1.5991 1.2247 37.7244 38.5686 41.6205 39.3792 050095 *** * 44. 2400 * * 44.2400 050096 1.4571 1.2247 33.3803 27.6236 33.2850 31.4278 050099 1.6444 1.2247 34.3507 35.4717 37.9297 35.9486 050100 1.8716 1.2247 34.2839 37.1606 39.4312 36.9821 050101 1.6391 1.5742 48.7495 54.5185 56.2550 53.2934 050102 1.4707 1.2247 33.2837 35.4740 35.1267 34.5871 050103 1.6949 1.2247 37.3608 38.8446 38.1720 38.1428 050104 1.5783 1.2247 37.4417 39.1121 41.8962 39.5439 050107 1.6748 1.2247 36.5843 40.5315 41.9627 39.7421 050108 2.0166 1.3486 45.3460 48.8199 53.1654 48.7805 050110 1.2043 1.2247 30.9054 32.3171 33.5933 32.2754 050111 1.0887 1.2247 31.9394 31.1160 32.2597 31.7697 050112 1.5483 1.2247 39.9951 41.8195 41.5924 41.1912 050113 1.4076 1.5576 46.3471 45.1998 42.4778 44.6111 050114 *** * 37. 5924 36.6541 * 37.1115 050115 1.5983 1.2247 33.3013 37.7614 40.4397 37.1497 050116 1.7304 1.2247 45.7510 40.6863 42.7961 43.0779 050118 1.2522 1.2247 41.8191 43.4432 46.9088 44.0974 050121 1.2757 1.2247 35.1135 36.9069 41.8043 38.1805 050122 1.7509 1.2502 36.8821 40.4510 41.5112 39.6349 050124 1.3527 1.2247 31.7690 33.3080 34.6304 33.2610 050125 1.6861 1.6386 53.6300 57.6242 60.2474 57.1280 050126 1.6064 1.2247 35.1909 34.9807 36.0294 35.4292 050127 1.5461 1.3486 42.5226 46.9648 48.0928 46.1911 050128 1.6196 1.2247 34.2364 36.6986 39.3773 36.7615 050129 1.9659 1.2247 40.3786 41.4256 44.5762 42.1957 050131 1.4681 1.5742 52.8228 56.6586 53.6221 54.3340 050132 1.6276 1.2247 43.6747 42.8187 45.1737 43.9116 050133 1.4848 1.2412 35.2433 36.8254 37.6504 36.6555 050135 1.0726 1.2247 25.4431 28.5118 30.6553 28.0980 050136 1.4481 1.5742 51.8508 52.5398 57.3918 53.8780 050137 1.3773 1.2247 43.5305 45.2088 49.1420 45.8667CMS-1498-P2 183

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050138 1.9128 1.2247 45.1011 47.3839 51.2980 47.9183 050139 1.4368 1.2247 43.0734 44.5753 48.6963 45.4255 050140 1.4087 1.2247 42.7590 44.8911 46.8652 44.8787 050144 *** * 40. 4760 * * 40.4760 050145 1.6332 1.5827 49.4479 54.8909 58.5220 54.4145 050146 1.8322 * * * * * 050149 1.5052 1.2247 43.1926 42.8003 45.3498 43.7950 050150 1.3011 1.3486 43.5937 44.3354 48.0733 45.3350 050152 1.6955 1.5742 54.7176 55.9738 57.1905 55.9904 050153 1.5690 1.6386 50.4884 53.5925 57.8841 54.0652 050158 1.5055 1.2247 42.7874 42.9454 44.0747 43.2830 050159 1.3444 1.2247 35.0153 40.4701 42.5924 39.5664 050167 1.4923 1.2502 38.0742 39.9946 41.8816 40.0050 050168 1.6873 1.2247 40.8362 37.9746 43.4951 40.7650 050169 1.6805 1.2247 33.1130 35.4836 41.1246 36.5888 050173 1.3930 1.2247 32.3265 31.5434 32.8423 32.2554 050174 1.7399 1.5742 53.7113 54.7960 59.7549 56.0844 050179 1.2738 1.2247 34.6558 36.2060 33.9197 34.8615 050180 1.7149 1.5852 48.7425 51.1836 53.5567 51.2533 050188 1.4966 1.6386 45.8501 49.6669 54.1865 49.5983 050189 0.9575 1.5827 31.5805 27.5311 29.3459 29.4661 050191 1.6765 1.2247 41.7185 40.0694 41.5164 41.0746 050192 0.9069 1.2247 27.4611 29.4203 33.2102 30.1271 050193 1.2942 1.2247 36.7240 39.0111 43.0282 39.5133 050194 1.3701 1.6386 49.8539 49.9857 55.1169 51.6953 050195 1.6650 1.6178 57.6563 61.8312 65.0039 61.5445 050196 1.2008 1.2247 41.1300 43.7415 41.0270 41.9842 050197 1.9331 1.6178 55.3173 59.0280 63.2066 59.2051 050204 1.5451 1.2247 38.8689 37.5591 41.0566 39.2215 050205 1.5945 1.2247 30.6117 30.2818 31.5240 30.7776 050211 1.3252 1.6178 42.9254 44.8773 46.1770 44.5820 050219 1.3542 1.2247 26.7061 26.9022 26.0523 26.5448 050222 1.7729 1.2247 35.4045 36.0221 37.6975 36.4283 050224 1.7191 1.2247 37.3442 39.7119 41.8790 39.6769 050225 1.5650 1.2247 37.5252 38.9288 42.8450 39.8661 050226 1.5718 1.2247 36.5354 38.4952 39.4194 38.1228CMS-1498-P2 184

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050228 1.4239 1.5342 49.9063 54.5580 57.3422 54.0697 050230 1.7061 1.2247 38.8901 39.8582 42.1567 40.3322 050231 1.8460 1.2247 37.0245 38.7280 40.2191 38.7139 050232 1.7131 1.2368 35.4055 39.4290 42.5544 39.2518 050234 1.5381 1.2247 37.7125 37.6811 38.9602 38.1603 050235 1.7383 1.2247 39.1744 40.0962 40.2265 39.8347 050236 1.5208 1.2247 34.4257 42.5939 44.3842 40.4072 050238 1.7269 1.2247 35.1268 36.4272 37.0926 36.2576 050239 1.6695 1.2247 36.3257 37.2939 38.5937 37.4489 050242 1.4892 1.6386 53.8385 58.5684 59.7332 57.3859 050243 1.6103 1.2247 37.8538 40.0490 42.5305 40.1509 050245 1.3766 1.2247 34.7153 36.9270 37.1180 36.2906 050248 1.1998 1.5827 46.0329 47.7637 51.0500 48.2742 050254 1.3843 1.3486 33.5069 34.8262 39.7976 36.0829 050256 *** * 32. 6841 * * 32.6841 050257 0.8947 1.2247 29.2651 30.7766 29.8486 29.9463 050261 1.3026 1.2247 33.7196 34.8188 39.3041 36.0518 050262 2.3736 1.2247 43.7709 40.8071 44.0453 42.8188 050264 1.4655 1.6178 50.1691 54.4052 57.0188 53.7398 050272 1.5454 1.2247 32.2584 35.0624 37.3015 34.8914 050276 1.1140 1.5852 47.2432 53.7552 55.4715 52.2517 050277 1.2258 1.2247 * 48.9698 47.5707 48.2343 050278 1.7099 1.2247 38.5689 39.5929 42.8799 40.4121 050279 1.3099 1.2247 32.1695 31.0888 31.6803 31.6436 050280 1.8248 1.3547 43.6243 46.2628 50.0266 46.6861 050281 1.5342 1.2247 31.0706 31.4166 32.8623 31.7857 050283 1.7021 1.6178 45.1132 50.3066 51.3746 48.9680 050289 1.6807 1.5576 52.0918 53.8571 58.3774 54.8745 050290 1.7520 1.2247 42.0099 42.2249 42.6314 42.2987 050291 2.0918 1.5742 44.6102 49.6427 52.1353 48.7155 050292 1.1648 1.2247 35.0372 34.6404 39.9841 36.7557 050295 1.5834 1.2247 39.7399 39.3961 42.9356 40.7188 050296 1.1416 1.6371 44.8135 48.2583 50.4082 47.9062 050298 1.2079 1.2258 33.6947 31.7374 34.0150 33.1345 050300 1.4557 1.2247 37.1275 39.2722 43.0474 40.0013 050301 1.3483 1.2247 36.3681 36.7568 39.9485 37.7770CMS-1498-P2 185

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050305 1.5667 1.6178 56.9756 55.7229 54.6309 55.7281 050308 1.5864 1.6386 49.0132 51.0183 54.0475 51.4737 050309 1.5729 1.3486 42.9280 46.6901 47.4734 45.7112 050313 1.2453 1.2502 39.0663 42.3998 43.8913 41.8600 050315 1.4388 1.2247 37.3560 40.3132 47.1318 41.7255 050320 1.2324 1.6178 50.6708 50.9692 55.3663 52.3385 050324 1.8098 1.2247 37.1883 38.9511 41.1149 39.1426 050325 0.7767 1.2247 34.0343 * 47.6656 36.0502 050327 1.8597 1.2247 36.9550 37.7681 39.6815 38.2025 050329 1.3249 1.2247 36.7669 37.6975 37.0324 37.1628 050334 1.7820 1.6178 50.9834 54.9338 59.6727 55.2808 050335 1.4895 1.2247 37.2347 37.1670 39.1873 37.9135 050336 1.2295 1.2502 33.0325 35.3658 38.7257 35.7910 050342 1.2591 1.2247 29.8389 31.6852 33.8443 31.8494 050348 1.7579 1.2247 33.5276 35.1080 37.4660 35.3772 050349 0.7643 1.2247 23.1095 23.5190 24.5969 23.7436 050350 1.5328 1.2247 34.6747 36.1856 37.1989 35.9750 050351 1.5646 1.2247 35.0042 35.6083 34.8470 35.1393 050352 1.4182 1.3486 38.6265 41.5370 41.4294 40.5216 050353 1.5266 1.2247 37.1716 37.4560 38.3124 37.6445 050357 1.4556 1.2247 38.9244 40.9999 41.8008 40.6080 050359 1.1943 1.2247 30.3988 30.9732 33.5096 31.6303 050360 1.6360 1.5742 55.3738 59.2147 57.2879 57.3315 050366 1.1199 1.3486 41.8324 43.0169 43.1165 42.6581 050367 1.6146 1.5742 40.0453 41.1059 44.3506 41.9320 050369 *** * 33. 3357 34.7337 37.3679 35.1733 050373 1.4497 1.2247 37.6695 40.8506 43.5055 40.7260 050376 1.6492 1.2247 36.7270 40.0354 42.4754 39.8599 050378 1.1137 1.2247 42.0480 50.0875 51.5092 47.5470 050380 1.8224 1.6386 52.5804 58.6395 60.9625 57.5372 050382 1.6019 1.2247 32.9248 34.3636 36.6641 34.7208 050385 1.4871 1.5742 36.5644 38.9773 44.3026 40.0228 050390 1.2847 1.2247 33.0463 31.4134 33.7927 32.7377 050393 1.4304 1.2247 35.1887 35.5678 38.9873 36.6236 050394 1.7929 1.2247 32.9572 37.2557 40.0176 36.7479 050396 1.5923 1.2247 38.9944 41.2602 41.6933 40.7032CMS-1498-P2 186

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050397 0.8415 1.2247 31.1621 32.3700 36.0861 33.4783 050407 1.2178 1.5342 47.5591 47.7943 48.9123 48.1149 050411 1.4376 1.2247 42.9884 44.3404 47.5402 44.9714 050414 1.3420 1.3486 45.1621 48.5863 51.1532 48.4113 050417 1.3322 1.2247 37.9951 38.8418 38.4087 38.4269 050423 1.0535 1.2247 32.4108 41.3130 43.7795 38.6501 050424 1.9481 1.2247 37.5246 39.8802 42.7414 40.2044 050425 1.4308 1.3486 45.3743 52.0378 53.7887 50.3034 050426 1.7182 1.2247 37.6505 * 37.1444 37.3893 050430 1.0514 * 25.9368 28.7102 * 27.6338 050433 *** * 23. 0949 * * 23.0949 050434 0.9730 1.2247 35.4807 34.4698 36.3651 35.4609 050435 1.2470 1.2247 35.7427 35.3040 36.3716 35.8152 050438 1.6093 1.2247 38.2855 36.8507 37.7652 37.6241 050441 2.0773 1.6386 49.2129 50.0652 56.1662 51.9914 050444 1.4821 1.2247 39.3947 39.4231 41.6899 40.2059 050447 *** * 27. 1271 * * 27.1271 050448 1.2055 1.2247 32.6682 32.9244 35.5744 33.7517 050454 2.1384 1.5342 43.5230 46.9602 50.6105 47.1838 050455 1.5674 1.2247 35.0232 38.9871 39.4869 37.8773 050456 *** * 27. 9702 28.1444 * 28.0651 050457 1.7524 1.5342 53.3175 54.6802 57.1259 55.0565 050464 1.8533 1.2247 42.6699 44.9128 46.6301 44.6843 050468 1.5593 1.2247 37.3416 35.7136 37.0600 36.6946 050470 *** * 32. 5041 * * 32.5041 050471 1.6569 1.2247 36.8185 37.6641 40.5399 38.3240 050476 *** * 41. 7566 * * 41.7566 050478 0.9581 1.2247 41.5635 44.3775 46.6521 44.3460 050481 1.6201 1.2247 42.8536 47.2326 50.1977 46.8143 050485 1.7165 1.2247 34.7078 37.4203 39.3266 37.2228 050488 1.5157 1.6178 49.3604 53.8013 53.3366 52.2027 050492 1.4172 1.2247 32.6609 35.6838 39.4538 36.0641 050496 1.8243 1.5852 56.7446 57.1030 61.4808 58.5059 050498 1.4628 1.3486 45.3508 46.6560 47.6863 46.5454 050502 1.7474 1.2247 32.9791 40.2876 37.2580 36.7036 050503 1.5401 1.2247 37.7210 40.7324 43.1770 40.6385CMS-1498-P2 187

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050506 1.5155 1.2368 40.6534 42.3670 45.0204 42.6481 050510 1.4186 1.5742 51.3143 54.8690 55.9873 54.0800 050512 1.4447 1.6178 50.1470 53.9292 55.7732 53.3348 050515 1.4010 1.2247 42.0106 45.0972 48.0118 45.0227 050516 1.6158 1.3486 45.6228 48.5267 48.0618 47.4427 050517 1.4708 1.2247 29.3694 29.8385 27.5129 28.8628 050523 1.3871 1.5852 46.9870 49.5029 53.7305 50.2368 050526 1.4939 1.2247 35.5457 * 36.5894 36.0188 050528 1.1577 1.2247 38.3051 41.9922 43.2318 41.2013 050531 1.1682 1.2247 28.4890 28.4921 31.0366 29.3122 050534 1.6008 1.2247 38.1892 39.7655 42.3047 40.1251 050537 1.6440 1.3486 41.5275 43.1765 45.7187 43.4999 050541 1.6420 1.6178 51.4545 55.2594 56.3321 54.3652 050543 0.7871 1.2247 32.8367 29.0470 31.0801 30.9554 050545 0.9027 1.2247 * 27.4889 * 27.4889 050547 1.0068 1.5742 * * * * 050548 0.7480 1.2247 * * * * 050549 1.6820 1.2247 40.6796 44.6715 46.9107 44.1208 050550 *** * 39. 2163 * * 39.2163 050551 1.3889 1.2247 37.6223 39.4047 42.2041 39.7598 050552 0.9442 1.2247 35.3468 38.6658 41.1173 38.3633 050557 1.6479 1.2247 39.2224 41.9292 43.9916 41.7837 050561 1.3989 1.2247 40.1567 43.1147 46.9113 43.3701 050567 1.5237 1.2247 39.0114 41.7247 46.3879 42.4571 050568 1.1903 1.2247 26.7733 28.7691 30.1104 28.6056 050570 1.7113 1.2247 40.6761 40.3411 42.9671 41.3473 050573 1.6162 1.2247 36.8561 38.0175 41.0463 38.7328 050575 1.5692 1.2247 22.1018 32.1046 33.5745 29.0057 050578 *** * 43. 4917 * * 43.4917 050580 1.3315 1.2247 35.0966 36.7968 33.1767 35.0893 050581 1.6333 1.2247 40.0909 41.9698 45.2924 42.4394 050583 *** * 40. 5845 41.3920 * 40.9835 050584 *** * 31. 9910 30.8650 * 31.4271 050586 1.6278 1.2247 31.1932 32.7348 32.8095 32.2361 050588 1.4763 1.2247 39.4251 39.0347 41.0641 39.8351 050589 1.2827 1.2247 37.2056 39.2646 40.8842 39.1776CMS-1498-P2 188

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050590 1.4972 1.3486 44.3382 50.0371 49.7328 48.1461 050592 *** * 32. 2376 * * 32.2376 050597 1.4581 1.2247 32.8987 35.6567 37.5208 35.3960 050599 2.0012 1.3486 36.6146 38.9877 39.8105 38.5379 050601 *** * 43. 2404 43.3329 46.0784 44.2186 050603 1.5047 1.2247 35.4809 37.4348 38.3834 37.1447 050604 1.6291 1.6386 49.6068 54.1687 55.6773 53.0805 050608 1.3872 1.2247 30.7280 28.3794 30.7212 29.9386 050609 1.4301 1.2247 43.4555 45.2475 49.1701 45.9890 050616 1.4949 1.2247 40.7388 45.2614 43.3018 43.0759 050618 0.9683 1.2247 34.9177 34.0584 35.2789 34.7493 050624 1.5075 1.2247 39.2553 40.2253 41.9206 40.5628 050625 1.8425 1.2247 44.8482 48.1826 46.7270 46.6153 050633 1.2030 1.2368 40.7383 41.1786 44.7463 42.2532 050636 1.4438 1.2247 35.4565 38.8844 39.6096 38.0088 050641 1.3049 1.2247 32.0508 33.1417 34.1849 33.1406 050644 1.0475 1.2247 33.2777 32.1513 32.5153 32.6132 050660 1.6423 * * * * * 050662 1.1129 1.6386 * * * * 050663 1.3695 1.2247 17.7252 30.4117 33.0151 26.4022 050667 0.8006 1.4295 25.8460 30.1039 32.0624 28.9596 050668 1.0786 1.5742 52.7011 62.7714 65.4231 60.6295 050674 1.4993 1.3486 48.6880 51.3517 53.4854 51.2273 050677 1.5581 1.2247 41.8130 44.4567 47.7267 44.6382 050678 1.4527 1.2247 35.8411 38.3361 39.9167 38.1597 050680 1.4613 1.5742 39.0389 40.7514 44.0282 41.3411 050682 0.6944 1.2247 22.3903 22.4419 * 22.4133 050684 1.2570 1.2247 33.5915 33.0982 35.4682 34.0341 050686 1.3750 1.2247 42.1444 45.2231 48.0040 45.1124 050688 1.3358 1.6386 53.2741 54.5423 56.6466 54.9010 050689 1.5695 1.5852 48.9935 50.2942 53.7493 51.0590 050690 1.3287 1.5742 51.6179 55.1002 55.3847 54.0619 050693 1.4804 1.2247 42.8266 41.9594 44.4380 43.0972 050694 1.2375 1.2247 34.8486 33.8553 35.2422 34.6536 050696 2.5549 1.2247 39.4353 41.2315 44.0844 41.4935 050697 1.1148 1.3547 26.7600 29.0854 30.2726 28.7053CMS-1498-P2 189

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050701 1.3546 1.2247 37.2839 38.4382 42.7575 39.6135 050704 1.1342 1.2247 32.2017 31.7051 32.1670 32.0293 050707 *** * 44. 0254 49.4684 * 46.9800 050708 1.8358 1.2247 28.3074 34.4063 34.8907 31.9717 050709 1.6404 1.2247 29.5364 30.4570 28.8514 29.5817 050710 1.4205 1.2247 46.2533 51.1460 52.8041 50.0857 050714 1.5922 1.6386 42.9797 45.2746 47.4228 45.3980 050717 1.5965 1.2247 37.0875 42.2736 41.8557 40.5623 050720 *** * 32. 1173 33.8712 34.7221 33.4577 050722 0.9563 1.2247 35.6741 35.2177 37.3302 36.1210 050723 1.5436 1.2247 42.1571 43.3875 47.0388 44.1779 050724 1.9468 1.2247 35.1020 35.5224 39.0539 36.5017 050725 0.9517 1.2247 28.8389 27.8565 * 28.3307 050726 1.6175 1.2247 30.6105 35.3964 36.4404 34.1918 050727 1.3740 1.2247 33.0932 29.0789 35.3258 32.5219 050732 2.3923 1.2247 34.3475 37.4333 37.9684 36.6936 050733 1.7727 1.3547 40.6320 44.7509 44.5719 43.2177 050735 1.4534 1.2247 36.6081 34.3859 34.2886 35.0721 050736 1.3576 1.2247 41.8938 38.0913 36.6220 38.8361 050737 1.7443 1.2247 38.0424 36.4535 38.0483 37.5164 050738 1.6053 1.2247 43.9259 40.3081 39.1266 41.0361 050739 1.6999 1.2247 57.2480 44.0540 40.0074 45.3865 050740 1.7415 1.2247 54.0370 44.8439 37.0976 43.5160 050741 *** * 51. 1526 44.0305 * 47.5915 050742 1.6473 1.2247 39.2532 41.0036 44.3972 41.4615 050744 1.7380 1.2247 48.4951 56.5911 54.9148 53.1646 050745 1.4481 1.2247 42.5523 48.2903 48.8922 46.5732 050746 1.8123 1.2247 43.2015 46.3622 45.1988 44.9325 050747 1.8632 1.2247 44.5887 47.8242 47.3968 46.5482 050748 1.2527 1.2247 43.1008 50.6390 54.1242 49.3277 050749 1.3796 1.2247 28.2000 39.6030 41.4811 35.7689 050750 *** * 33. 9915 * * 33.9915 050751 3.5931 1.2247 29.5488 34.0436 36.5150 33.0527 050752 1.4901 1.2247 39.8035 41.3783 42.4687 41.1950 050754 1.2220 1.5576 * 56.3628 * 56.3628 050755 1.6182 1.2247 * 36.5212 36.5251 36.5232CMS-1498-P2 190

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 050756 *** * * 33. 4951 * 33.4951 050757 1.7470 1.2247 * * 42.3546 42.3546 050758 1.5779 1.2247 * 17.6509 27.8366 21.8706 050759 *** * * * 36. 7495 36.7495 050760 1.3958 1.5852 * * * * 050761 1.6126 1.2247 * * * * 050762 1.4125 1.2247 * * * * 050763 0.9992 1.2247 * * * * 050764 1.6615 1.3547 * * * * 050765 1.1291 1.2247 * * * * 050766 1.5412 1.2247 * * * * 060001 1.4318 1.0393 32.4226 32.5239 33.5009 32.8211 060003 1.5346 1.0393 31.8637 33.6264 34.9819 33.5098 060004 1.2485 1.0576 34.8428 34.5727 36.3214 35.2917 060006 1.2988 0.9665 27.6453 30.5664 30.7361 29.6331 060008 1.5166 0.9665 27.2071 26.0851 28.6913 27.3573 060009 1.6004 1.0576 34.0151 35.8398 36.9037 35.5950 060010 1.5399 0.9665 30.6424 33.5549 32.9241 32.3981 060011 1.5301 1.0576 34.4171 34.6239 36.6800 35.2356 060012 1.5328 0.9665 29.4365 29.6957 31.4807 30.2506 060013 1.6156 0.9665 28.0800 29.5100 30.9706 29.5285 060014 2.0318 1.0576 33.0366 35.6231 36.9360 35.1981 060015 2.1471 1.0576 36.3296 36.6824 38.2231 37.1141 060016 1.1827 0.9665 28.3055 30.0601 30.4208 29.6098 060018 1.0992 * 26.5788 * * 26.5788 060020 1.6397 0.9665 26.7362 27.3823 29.0073 27.7438 060022 1.6431 0.9665 31.9376 32.0594 31.6915 31.8828 060023 1.6909 1.0393 32.7922 33.4798 34.9894 33.7723 060024 1.9110 1.0576 32.8206 36.1736 37.9233 35.6626 060027 1.5428 1.0393 31.6134 33.4869 33.6616 32.8750 060028 1.6913 1.0576 33.4966 35.8222 37.1167 35.5436 060030 1.4475 0.9665 31.2932 31.2752 32.9330 31.8568 060031 1.5069 1.0393 30.7381 32.0153 33.2299 32.0027 060032 1.6656 1.0576 34.6447 35.6500 37.4582 35.9181 060034 1.8224 1.0576 33.3656 34.6615 36.1706 34.7283 060036 1.1704 0.9665 20.9370 24.8220 25.3568 23.6418CMS-1498-P2 191

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 060041 *** * 31. 4739 * * 31.4739 060043 0.8976 0.9665 23.3908 19.9611 20.3282 21.2601 060044 1.2481 0.9665 28.9200 32.0455 32.7653 31.1835 060049 1.4153 0.9665 32.1589 34.5262 35.5353 34.0821 060054 1.4909 1.0138 24.6721 29.2998 32.8197 29.3593 060064 1.8838 1.0576 37.2407 34.7448 36.3099 36.0591 060065 1.4593 1.0576 34.9205 36.2377 37.7892 36.3163 060071 1.1608 0.9665 31.5388 32.1367 32.4497 32.0600 060075 1.4614 1.0138 35.8081 37.3019 40.1016 37.8404 060076 1.3290 0.9665 31.6044 31.5032 31.8373 31.6524 060096 1.8302 1.0393 38.2249 39.9302 42.6189 40.4330 060100 1.7950 1.0576 33.5356 35.7861 36.6803 35.3368 060103 1.4229 1.0393 33.7542 34.9964 36.7528 35.2095 060104 1.5478 1.0576 37.1434 37.4598 39.0604 37.9751 060107 2.0677 1.0576 30.3991 30.0308 30.5898 30.3552 060112 1.7503 1.0576 35.1308 36.4093 37.9928 36.6034 060113 1.5005 1.0576 35.2097 36.0794 38.0309 36.4956 060114 1.6645 1.0576 35.3056 37.1394 37.6554 36.8077 060115 0.9083 0.9665 * * * * 060116 1.4913 1.0393 33.1547 36.3560 36.9071 35.6457 060117 1.3581 0.9665 28.3112 31.6734 31.3013 30.6152 060118 1.4926 1.0393 * 40.2136 39.9922 40.0904 060119 1.9646 0.9665 * * 34.0822 34.0822 060121 2.1298 1.0393 * * 38.3284 38.3284 060123 1.8589 1.0576 * * * * 070001 1.6363 1.2242 37.9438 38.4864 39.3014 38.5781 070002 1.7996 1.1257 36.4269 36.6624 39.3490 37.4818 070003 1.1819 1.1257 36.0524 36.6553 37.6699 36.7817 070004 1.1875 1.1257 31.2115 34.3803 35.1037 33.5419 070005 1.6586 1.2242 36.5502 37.3430 38.3363 37.4209 070006 1.6560 1.2825 41.2165 41.9550 43.2602 42.1481 070007 1.4209 1.1360 37.0984 38.9830 40.3319 38.8215 070008 1.3351 1.1257 35.4969 34.0603 35.8161 35.1073 070009 *** * 36. 6382 38.1380 * 37.4141 070010 1.6960 1.2825 38.6114 38.7345 41.3102 39.5949 070011 1.4801 1.1257 32.6835 33.7313 36.9466 34.4150CMS-1498-P2 192

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 070012 1.4730 1.1257 33.2477 35.4738 37.5683 35.3833 070015 1.5810 1.2825 39.9249 42.4738 43.1481 41.8469 070016 1.5918 1.2242 34.1266 34.5418 36.2707 34.9884 070017 1.4503 1.2242 37.5855 38.1713 41.0077 38.9339 070018 1.4031 1.2825 42.4771 44.1370 45.8974 44.2078 070019 1.5997 1.2242 35.8618 37.0666 39.8743 37.6317 070020 1.3867 1.1358 35.6542 40.4989 40.6182 39.0618 070021 1.1794 1.1257 39.7793 41.9076 43.8622 41.8599 070022 1.7333 1.2242 41.4721 41.5553 43.2394 42.1299 070024 1.5050 1.1360 36.8997 38.6301 39.2511 38.2737 070025 1.7003 1.1257 36.1322 38.7067 38.9328 37.9080 070027 1.5868 1.1257 33.5979 35.7677 36.5223 35.3536 070028 1.5644 1.2825 40.9645 41.2950 42.0488 41.4517 070029 1.3443 1.1257 32.8504 35.4716 36.0406 34.8141 070031 1.3419 1.2242 30.5924 33.2618 33.5139 32.4882 070033 1.4782 1.2825 44.6717 46.5982 47.7688 46.3583 070034 1.5225 1.2825 42.4111 45.7694 44.0374 44.0855 070035 1.4095 1.1257 33.4047 38.2298 35.3357 35.6697 070036 1.7475 1.1661 43.6374 44.0756 46.4609 44.7773 070038 0.9441 1.2242 29.9516 33.5109 31.4454 31.4773 070039 1.0971 1.2242 32.7153 35.9137 36.2927 35.1271 070040 1.0743 1.1257 * 26.3824 30.5486 28.3408 080001 1.6907 1.0797 34.9507 37.4441 39.1835 37.2540 080002 *** * 33. 0404 33.3472 35.2276 33.8892 080003 1.5403 1.0797 30.5132 29.0166 31.5225 30.4059 080004 1.6748 1.0641 34.3854 33.6190 35.0266 34.3423 080006 1.5520 1.0044 31.0327 30.7985 29.2411 30.3636 080007 1.7565 1.0853 33.4782 35.5425 37.5631 35.5927 090001 1.7104 1.0546 40.1658 38.3876 39.8134 39.3691 090003 1.3090 1.0546 34.4430 37.2088 37.3982 36.3730 090004 2.0589 1.0496 38.5681 39.9027 40.6216 39.7496 090005 1.3805 1.0546 35.2884 35.1327 36.9545 35.7927 090006 1.4341 1.0546 32.3654 32.5988 34.9946 33.3147 090008 1.5880 1.0546 36.6633 40.3260 41.7318 39.2644 090011 2.1681 1.0546 39.0111 39.5389 41.3036 39.9493 100001 1.6225 0.8875 27.8526 30.5213 30.2446 29.5877CMS-1498-P2 193

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100002 1.5581 1.0333 30.6668 33.1103 34.4039 32.7223 100006 1.6837 0.9150 28.9769 29.2697 31.1090 29.8250 100007 1.6560 0.9150 30.3379 30.6689 32.7648 31.2751 100008 1.6404 1.0191 32.1679 32.3397 34.9341 33.1587 100009 1.6764 1.0191 30.0492 32.0145 33.5623 31.8710 100012 1.6726 0.9139 30.8626 30.2066 32.0081 31.0290 100014 1.5567 0.9150 27.4064 28.8679 32.2443 29.5972 100015 *** * 28. 6825 29.9757 31.5936 30.0347 100017 1.6037 0.9150 29.8705 31.2313 32.0601 31.0930 100018 1.7857 0.9779 32.8642 34.2077 34.9524 34.0313 100019 1.7306 0.9303 31.4549 32.2496 34.2627 32.6917 100022 1.7695 1.0333 36.3355 40.4664 42.4881 39.7952 100023 1.6827 0.9066 27.1032 27.7860 27.8953 27.6060 100024 1.2216 1.0191 29.8918 31.5160 30.5545 30.6338 100025 1.8056 0.8432 27.1665 28.7604 29.6928 28.5823 100026 1.6151 0.8432 27.3044 28.5877 27.8367 27.9162 100028 1.4448 0.9303 28.7801 28.1509 31.9846 29.6732 100029 1.3707 1.0191 31.6006 33.2920 34.8161 33.2424 100030 1.4694 0.9150 26.3113 27.0977 30.8824 28.0853 100032 1.7391 0.9066 27.8942 29.3641 30.3253 29.1887 100034 1.8674 1.0191 28.9387 29.8997 29.6114 29.4885 100035 1.5772 0.9237 32.5593 31.2325 31.4578 31.7203 100038 1.6264 1.0333 32.8392 37.0928 37.1884 35.7516 100039 1.9693 1.0333 29.0236 32.6863 32.2419 31.3704 100040 1.7070 0.8875 28.3366 29.8029 29.6297 29.2510 100043 1.4166 0.9066 26.8417 29.1014 31.1972 28.9417 100044 1.5653 1.0729 34.3920 34.4743 41.7922 37.0061 100045 1.3103 0.9150 25.5621 27.8526 28.1643 27.2127 100046 1.5558 0.9066 27.7878 29.7844 30.9730 29.5992 100047 1.6811 0.9237 31.4072 31.8998 32.2047 31.8452 100048 0.9614 0.8432 21.7693 22.7260 23.5379 22.6813 100049 1.3320 0.8601 27.6316 26.9145 27.7020 27.4184 100050 1.2458 1.0191 23.5222 23.7419 24.5868 23.9540 100051 1.4875 0.9150 30.1492 28.7367 30.6461 29.8530 100052 1.4003 0.8601 25.1110 27.6591 28.4807 27.1112 100053 1.4162 1.0191 31.9268 33.6936 35.2550 33.5895CMS-1498-P2 194

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100054 1.4027 0.8735 30.9840 33.2237 36.2168 33.5037 100055 1.4759 0.9066 29.7027 28.5830 30.4298 29.5982 100057 1.4780 0.9150 27.7045 30.4258 30.5235 29.5810 100061 1.5789 1.0191 31.9174 33.9803 34.8482 33.5811 100062 1.7148 0.8552 26.3067 28.0821 29.2949 27.9112 100063 1.4087 0.9066 27.0769 29.5864 31.2488 29.3363 100067 1.5488 0.9066 27.5501 30.0555 31.5618 29.6772 100068 1.7784 0.9150 27.7707 28.5177 28.0307 28.1041 100069 1.8450 0.9066 29.0486 33.4008 32.7796 31.7251 100070 1.6892 0.9237 29.1117 27.1313 27.9973 28.0427 100071 1.3529 0.9066 25.1883 25.6870 27.8655 26.2748 100072 1.4518 0.9150 27.6947 28.6435 29.6882 28.7088 100073 1.7399 1.0333 31.0395 33.8783 33.7457 32.8947 100075 1.5788 0.9066 26.7571 29.2992 31.2004 29.0714 100076 1.2234 1.0191 24.0280 23.7078 26.3433 24.4935 100077 1.3992 0.9237 27.9783 28.0178 29.5962 28.5634 100079 1.5106 * * * * * 100080 1.6204 1.0333 31.0516 33.2091 35.4485 33.2130 100081 1.0281 0.8539 19.7406 17.2548 17.7222 18.2774 100084 1.6551 0.9150 30.6301 30.7165 35.1858 32.1812 100086 1.5751 1.0333 31.3187 33.0726 33.7048 32.7154 100087 1.8405 0.9237 32.1314 33.4104 33.2328 32.9255 100088 1.7052 0.8875 29.4952 30.3481 30.9148 30.2877 100090 1.4563 0.8875 28.9581 27.4996 28.2012 28.2140 100092 1.5558 0.9303 28.6782 29.1433 29.6087 29.1462 100093 1.7452 0.8432 23.4847 24.9505 25.8345 24.7522 100099 1.1448 0.8601 28.0688 28.2871 30.0337 28.8423 100102 1.0551 0.8432 29.0396 30.0754 28.5248 29.1936 100105 1.5943 1.0252 30.8936 31.5294 33.0707 31.8950 100106 1.0979 0.8432 25.6288 20.6449 26.2560 24.0768 100107 1.2712 0.9139 31.2954 30.9662 32.4297 31.5714 100108 *** * 22. 8153 17.9561 17.5426 19.1444 100109 1.3854 0.9150 26.7380 29.1403 29.2478 28.3934 100110 1.6147 0.9150 30.3758 32.4083 32.8616 31.9067 100113 2.0648 0.9377 30.6037 30.9741 33.2418 31.6327 100114 *** * 32. 3956 34.3630 * 33.3214CMS-1498-P2 195

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100117 1.1720 0.8875 30.0281 30.6894 31.4492 30.7465 100118 1.4486 0.8432 28.3201 31.3833 28.6480 29.3969 100121 1.1958 0.8601 25.0320 20.0814 27.6294 24.2372 100122 1.2388 0.8735 27.6178 27.9970 28.5222 28.0534 100124 1.1993 0.8432 26.2329 28.2667 28.9298 27.8069 100125 1.2299 1.0191 33.3499 35.2588 37.2705 35.4531 100126 1.3809 0.9066 28.9164 30.3912 31.2105 30.1653 100127 1.6431 0.9066 27.0686 29.3856 31.1177 29.1793 100128 2.2037 0.9066 30.6202 29.6793 31.2298 30.5186 100130 1.3212 1.0333 29.5763 29.9727 29.8339 29.7970 100131 1.3800 1.0191 30.9614 32.2086 33.9594 32.3908 100132 1.3499 0.9066 27.6632 29.3380 30.9567 29.3475 100134 0.8526 0.8432 22.9635 24.7863 23.0684 23.5589 100135 1.6829 0.8954 29.8452 30.2093 34.2492 31.4439 100137 1.4023 0.8601 28.3000 27.8783 28.6777 28.2947 100139 0.9036 0.9377 21.4418 22.1683 21.4572 21.6824 100140 1.1241 0.8875 28.5485 29.7482 30.7155 29.6963 100142 1.2138 0.8432 26.8995 26.8829 25.1309 26.3144 100150 1.2062 1.0191 29.3711 33.0132 32.5785 31.6449 100151 1.9703 0.8875 31.3846 33.1725 34.9557 33.1543 100154 1.7005 1.0191 31.3640 32.3793 34.9899 32.9507 100156 1.1212 0.8432 28.3060 29.9029 31.1552 29.8254 100157 1.5825 0.9066 30.3359 30.4870 31.8594 30.8981 100160 1.1017 1.0191 32.3136 33.8433 35.2448 33.8503 100161 1.6418 0.9150 30.8984 32.6427 33.0240 32.1874 100166 1.6290 0.9237 31.9072 33.0019 34.8424 33.2088 100167 1.5548 1.0333 32.4740 34.8085 36.1348 34.4179 100168 1.7112 1.0333 28.0543 31.1427 32.5053 30.6385 100172 *** * 20. 5518 * * 20.5518 100173 1.7179 0.9066 30.2491 30.3599 30.9982 30.5313 100175 1.0188 0.8432 26.1723 26.8828 30.6970 27.8555 100176 1.7599 1.0333 35.5849 35.7433 37.0046 36.1156 100177 1.4618 0.9303 31.0085 31.3830 32.8491 31.7568 100179 1.7363 0.8875 30.5439 31.8790 33.3430 31.9272 100180 1.4792 0.9066 31.5485 32.3796 34.6817 32.8425 100181 1.4002 1.0191 26.0682 26.0880 26.4568 26.2189CMS-1498-P2 196

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100183 1.3902 1.0191 32.9893 31.6760 33.2466 32.6280 100187 1.4893 1.0191 31.6660 31.8020 34.2328 32.5967 100189 1.4419 1.0333 30.5516 32.8847 34.2447 32.5432 100191 1.3645 0.9066 30.9212 31.6024 33.7871 32.0675 100200 1.5295 1.0333 29.0731 32.5611 33.7050 31.7495 100204 1.6164 0.9377 29.9334 30.6252 31.4765 30.6899 100206 1.3259 0.9066 28.8625 30.4576 31.2653 30.2061 100209 1.6863 1.0191 29.0462 30.5582 32.8523 30.8033 100210 1.6173 1.0333 32.4566 33.3016 34.2993 33.3096 100211 1.2867 0.9066 28.8328 30.5902 31.6079 30.3679 100212 1.5679 0.8552 29.2500 30.5141 31.1368 30.3163 100213 1.5727 0.9237 30.2271 31.4309 33.1230 31.5995 100217 1.2905 1.0252 30.3325 33.5767 30.5641 31.4346 100220 1.6269 0.9139 30.8292 31.8393 33.1625 32.0038 100223 1.6223 0.8735 27.6775 28.6449 30.3741 28.8695 100224 1.3813 1.0333 29.2008 31.0307 33.6361 31.2128 100225 *** * 32. 6906 31.8048 * 32.2587 100226 1.3734 0.8875 30.2857 30.8904 31.4361 30.8818 100228 1.4519 1.0333 31.0222 32.2672 34.6713 32.6412 100230 1.4348 1.0333 34.6133 35.9319 36.1673 35.6194 100231 1.6148 0.8432 28.3652 28.8912 29.8895 29.0352 100232 1.4309 0.9377 29.3797 30.3768 30.7940 30.1690 100234 1.3292 1.0333 29.7818 33.1508 35.3677 32.6857 100236 1.4897 0.9237 30.5719 31.4385 33.2992 31.8165 100237 *** * 33. 9626 33.9696 34.7138 34.1878 100238 1.6561 0.9066 31.6353 32.8745 35.1867 33.2711 100239 1.5075 0.9066 30.3234 32.7150 33.9579 32.2861 100240 1.1030 1.0191 31.0951 35.3888 36.6032 34.5027 100242 1.5952 0.8432 27.8169 28.5034 29.7347 28.6980 100243 1.5542 0.9066 29.8323 31.4863 32.5227 31.3056 100244 1.4331 0.9139 29.8287 29.1611 30.3453 29.7743 100246 1.5614 1.0729 30.0467 32.5063 33.5469 32.0515 100248 1.5668 0.9066 32.4725 33.7659 36.0601 34.0862 100249 1.3514 0.9066 28.5117 29.7981 30.5240 29.6388 100252 1.2169 1.0252 29.1448 31.5631 33.8245 31.4852 100253 1.4998 1.0333 28.5617 29.4959 31.3059 29.8138CMS-1498-P2 197

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100254 1.5108 0.8954 28.5262 28.9095 30.8142 29.4282 100255 1.3545 0.9066 29.5172 30.0466 31.9271 30.4950 100256 1.6224 0.9066 33.3936 34.6637 34.8304 34.2928 100258 1.6613 1.0333 35.2225 34.2862 36.3146 35.2877 100259 1.2922 0.9066 29.9294 32.2273 33.8210 31.9723 100260 1.5192 1.0729 29.4907 31.5667 33.8328 31.6747 100264 1.5444 0.9066 30.1980 31.5050 33.9279 31.9530 100265 1.4504 0.9066 26.6940 28.6915 30.9790 28.8513 100266 1.4224 0.8432 25.6382 26.4488 27.7418 26.6590 100267 1.2849 0.9237 30.6051 32.3955 33.7231 32.2103 100268 1.2089 1.0333 33.6225 33.5314 34.5858 33.9080 100269 1.4107 1.0333 28.3745 30.9572 33.5064 30.8897 100271 2.2229 * * * * * 100275 1.3264 1.0333 31.0487 31.5424 33.3199 32.0064 100276 1.3326 1.0333 31.7067 32.3992 34.3287 32.8345 100277 1.3799 1.0191 25.5926 27.0942 28.4949 27.0616 100279 *** * 31. 1951 31.6691 33.9735 32.3443 100281 1.4063 1.0333 32.8840 36.3173 36.3681 35.2827 100284 1.1512 1.0191 21.4420 24.4155 25.5819 23.7595 100285 1.2393 1.0333 34.7999 36.2107 37.2874 36.2349 100286 1.6176 0.9779 26.5809 26.1494 32.3293 29.0001 100287 1.4754 1.0333 30.3085 32.3704 34.0899 32.1810 100288 1.7381 1.0333 32.9587 35.3363 36.0630 34.7728 100289 1.5892 1.0333 31.4727 31.7699 33.2012 32.2125 100290 1.2699 0.9150 29.7588 31.7110 32.8039 31.5893 100291 1.2805 0.9303 28.3780 28.3455 28.7323 28.4870 100292 1.4540 0.8539 28.5807 29.8156 30.8473 29.8365 100296 1.4038 1.0191 31.1475 31.8730 34.2725 32.5067 100298 0.8558 0.8954 21.9247 17.8678 19.4952 19.4589 100299 1.4576 0.9237 31.6840 31.5048 31.4297 31.5278 100300 *** * 33. 1693 * * 33.1693 100301 *** * * 33. 6261 * 33.6261 100302 1.1221 0.9150 * 27.9362 29.7289 28.8052 100303 *** * * * 24. 9650 24.9650 100307 1.5052 0.8875 * * * * 100308 1.8792 0.9066 * * * *CMS-1498-P2 198

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 100309 2.7432 0.9794 * * * * 100310 3.4842 0.9794 * * * * 100311 2.4626 0.9066 * * * * 110001 1.4636 0.8563 27.6480 28.5465 29.5684 28.6101 110002 1.3129 0.8929 28.9013 32.2910 31.4618 30.8489 110003 1.3324 0.7746 25.0089 26.0330 25.4762 25.5083 110004 1.3418 0.8754 27.2528 26.8828 29.0667 27.7197 110005 1.4382 0.9528 29.6009 30.4924 30.9276 30.4128 110006 1.6178 0.9305 30.8495 32.2597 34.4102 32.5400 110007 1.7505 0.9056 28.0684 29.8618 31.7901 29.9011 110008 1.4810 0.9528 31.8387 33.5616 31.8787 32.4273 110010 2.4555 0.9528 33.9848 33.7073 37.5179 35.0462 110011 1.4340 0.9528 30.3534 32.2028 34.6167 32.4547 110015 1.0789 0.9528 30.5016 31.7245 32.9437 31.7570 110016 1.3214 0.8582 25.9209 26.3449 27.9587 26.7064 110018 1.4095 0.9528 30.9422 30.8295 32.9879 31.5762 110020 *** * 29. 4641 30.4725 31.6465 30.4885 110023 1.4384 0.9528 29.2018 31.1890 31.5376 30.6943 110024 1.5142 0.8817 28.5660 30.7207 31.0718 30.1390 110025 1.4691 0.9309 31.8968 31.0532 32.4958 31.8053 110026 1.1774 0.7746 24.3863 25.6943 25.5958 25.1969 110027 1.0792 0.7746 25.6532 26.2689 26.5342 26.1268 110028 1.8270 0.9527 32.8706 34.0699 34.0976 33.6914 110029 1.8427 0.9528 30.1146 31.6425 33.8978 31.8764 110030 1.4738 0.9528 32.0275 33.2158 35.3984 33.6145 110031 1.2980 0.9528 30.7462 30.4811 31.6496 30.9694 110032 1.2257 0.7746 24.4968 23.1156 25.3848 24.3265 110033 *** * 32. 7039 31.9373 * 32.3312 110034 1.8212 0.9527 29.6819 30.4053 34.1394 31.4559 110035 1.6957 0.9528 31.5737 31.8545 33.7827 32.4229 110036 1.9192 0.8817 28.4041 29.4915 30.6530 29.5209 110038 1.6353 0.7804 23.3669 24.2742 26.0470 24.6113 110039 1.3610 0.9527 28.4376 28.9594 29.2688 28.9113 110040 1.0861 0.9528 21.5762 21.1939 23.4093 22.0778 110041 1.4490 0.9305 27.6609 29.2068 29.6983 28.8467 110042 1.0433 0.9528 34.5137 34.0568 35.6003 34.7521CMS-1498-P2 199

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 110043 1.8463 0.8817 30.3728 31.1628 31.4697 31.0207 110044 1.1492 0.7746 27.0431 25.0449 25.2725 25.8029 110045 1.0749 0.9528 28.2232 31.6766 31.6090 30.4800 110046 1.1860 0.9528 28.6286 28.4212 30.3845 29.1786 110050 1.0846 0.8444 27.1533 29.2759 30.0217 28.7933 110051 1.1636 0.7746 22.1491 23.3866 25.5805 23.8633 110054 1.5235 0.9528 31.5798 27.9775 28.7220 29.3745 110059 1.1670 0.7746 24.9271 24.4436 25.3086 24.8831 110064 1.7636 0.9077 28.7296 30.0182 33.6996 30.7770 110069 1.4012 0.8929 30.6465 31.0168 29.2608 30.2522 110071 1.0603 0.7746 23.6499 22.6384 22.8137 23.0100 110073 1.1093 0.7746 23.0072 23.4570 24.6046 23.6849 110074 1.6250 0.9305 29.0310 30.4310 32.0070 30.5025 110075 1.3248 0.8817 26.1089 26.7302 27.8478 26.9319 110076 1.6273 0.9528 31.0661 30.4815 31.6821 31.0859 110078 2.1377 0.9528 32.0516 35.8457 34.2909 34.0297 110079 1.5730 0.9528 29.0905 28.9872 29.4495 29.1738 110082 2.0493 0.9528 31.1478 33.1144 35.7031 33.2771 110083 2.0957 0.9528 34.5798 34.7446 35.7676 35.0417 110086 1.3316 0.7746 23.4772 23.1298 23.4255 23.3429 110087 1.6146 0.9528 32.8029 33.9036 33.1508 33.2981 110089 1.0939 0.7746 26.0116 25.4960 27.7584 26.4217 110091 1.4186 0.9528 28.0637 29.4898 30.4058 29.2918 110092 1.1014 0.7746 22.8602 24.5262 28.2182 24.9164 110095 1.4911 0.8508 28.0480 31.2298 30.8338 30.0970 110100 0.9291 0.8556 20.0638 22.9014 22.3608 21.8873 110101 1.0901 0.7814 23.8601 25.5998 27.0115 25.5015 110104 1.2299 0.7746 22.2596 22.3707 22.3377 22.3206 110105 1.3045 0.8508 23.7752 24.6128 25.9808 24.8167 110107 1.9862 0.9325 31.5783 34.3508 31.8817 32.6134 110109 0.9841 0.7746 21.6019 22.5719 24.1377 22.7275 110111 1.2997 0.9527 27.6501 25.7188 26.1218 26.4751 110112 1.0053 0.8508 24.2935 23.2426 23.9046 23.7940 110113 0.9056 0.9527 22.0472 24.2980 23.8703 23.3793 110115 1.8784 0.9528 33.3902 34.4864 35.7096 34.5483 110121 1.0235 0.7746 24.5653 27.4406 28.0044 26.6723CMS-1498-P2 200

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 110122 1.5890 0.8755 26.3071 28.0334 29.0791 27.8028 110124 0.9766 0.7746 24.8552 28.7544 30.2200 27.9406 110125 1.3181 0.8929 26.5006 29.4103 30.8516 28.8615 110128 1.3499 0.7746 24.5284 27.1987 29.1767 26.8886 110129 1.6241 0.9077 29.7332 26.8229 29.6690 28.7891 110130 0.8616 0.7746 21.7089 21.0352 21.7302 21.5091 110132 0.9942 0.7746 21.6039 22.3816 23.0261 22.3425 110135 1.4233 0.7746 25.1027 25.6594 25.4541 25.3958 110142 0.9519 0.7939 22.2164 21.2836 23.4220 22.2520 110143 1.4910 0.9528 30.9621 31.3623 33.8251 32.0572 110146 0.9949 0.9309 30.1181 32.7307 33.2928 32.0816 110150 1.3556 0.8929 27.7920 28.7549 25.9718 27.3903 110153 1.2669 0.8929 30.5108 30.2843 29.0378 29.9181 110161 1.6539 0.9528 32.0002 32.9894 34.2402 33.1043 110163 1.5743 0.9056 29.5693 30.7798 31.5968 30.6951 110164 1.7796 0.9325 31.2830 32.7865 34.6876 32.9571 110165 1.5814 0.9528 28.7925 28.4324 29.6512 28.9468 110168 1.8987 0.9528 30.8750 31.8921 32.9718 31.9136 110172 *** * 33. 0452 34.0243 * 33.5073 110177 1.9707 0.9527 30.5526 31.9338 34.1139 32.1851 110183 1.3243 0.9528 29.6622 32.0200 32.3945 31.3716 110184 1.2816 0.9528 30.2920 30.8380 33.5282 31.6112 110186 1.3175 0.9077 29.6503 32.0599 32.7164 31.3889 110187 1.2145 0.9528 31.0164 27.6729 30.2062 29.5462 110189 1.0743 0.9528 27.4207 28.9465 30.6935 29.0587 110190 1.0617 0.8431 29.4198 28.7747 35.0710 30.9664 110191 1.4803 0.9528 28.7505 30.0142 32.1599 30.3011 110192 1.5471 0.9528 31.6627 32.6403 33.8949 32.7867 110194 0.8287 0.7746 20.5267 23.2382 22.8941 22.2276 110198 1.4509 0.9528 34.0050 33.2450 34.3576 33.8700 110200 2.3051 0.9077 29.4633 29.6256 31.9920 30.3302 110201 1.5909 0.9325 33.4292 35.8335 37.5429 35.6404 110203 1.0033 0.9528 32.0594 33.0119 39.2026 34.2394 110205 1.1254 0.8212 26.1973 25.5319 25.5795 25.7616 110209 0.8544 0.7746 22.4549 21.6681 24.1927 22.7937 110212 1.1580 0.8094 * 23.4398 24.7805 24.1197CMS-1498-P2 201

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 110215 1.5772 0.9528 30.1793 31.2779 34.0438 31.9379 110219 1.5092 0.9528 33.4481 34.8875 35.5795 34.5964 110225 1.4407 0.9528 28.9773 29.6272 31.3111 30.0865 110226 1.2984 0.9528 32.1840 30.2150 31.1969 31.1849 110229 1.5914 0.9528 * * 30.3562 30.3562 110230 1.4559 0.9528 * * 35.0804 35.0804 110231 2.6459 0.9305 * * * * 120001 1.9654 1.1582 39.0371 39.2838 41.7842 40.0704 120002 1.3903 1.1240 37.7287 38.3420 40.8461 39.0696 120004 1.4516 1.1582 32.5164 33.3874 34.8788 33.5345 120005 1.4037 1.1240 35.1996 38.2915 39.9388 37.8326 120006 1.3827 1.1582 35.7089 37.6360 38.8087 37.4368 120007 1.6959 1.1582 35.0193 34.8231 35.1439 34.9953 120010 2.0707 1.1582 34.3371 37.3680 38.3032 36.3762 120011 1.6395 1.1582 43.7527 45.9848 46.1156 45.3395 120014 1.3862 1.1240 34.2127 38.1372 37.5329 36.5854 120019 1.1857 1.1240 36.1879 37.4564 39.5249 37.7583 120022 1.8805 1.1582 34.9048 35.3877 38.3908 36.2596 120026 1.4967 1.1582 35.8413 38.2128 40.8061 38.3647 120027 1.4876 1.1582 31.8177 32.7112 36.4792 33.4996 120028 1.3976 1.1240 34.6354 34.7783 35.3970 34.9858 130002 1.4862 0.9027 24.3501 26.4728 25.9204 25.6067 130003 1.7141 0.9615 29.8793 31.4275 32.0498 31.1265 130006 1.7583 0.9262 29.0504 30.0002 31.6998 30.3256 130007 1.8904 0.9262 31.2268 33.4536 33.5741 32.8364 130013 1.4315 0.9262 33.8928 33.6160 34.7966 34.1028 130014 1.2836 0.9262 28.2831 29.1200 31.1589 29.5140 130018 1.7913 0.9632 30.2047 31.8735 34.0700 32.0682 130024 1.2438 0.8240 25.3197 24.4757 27.9247 25.9223 130025 1.2892 0.7552 23.8592 24.2424 25.4832 24.5583 130028 1.7322 0.9336 29.3374 30.5090 32.7435 30.8806 130049 1.6650 1.0336 29.7211 30.8293 32.3219 31.0108 130062 *** * 28. 3419 38.1416 38.2016 35.1513 130063 1.5471 0.9262 27.7697 28.8897 30.6360 29.0590 130065 2.0187 0.9632 25.8998 29.4957 31.7109 28.7350 130066 2.3072 0.9539 28.1502 29.3049 30.2156 29.2289CMS-1498-P2 202

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 130067 3.0407 0.9632 26.8285 28.6474 * 27.6699 130068 *** * * 25. 8399 * 25.8399 130069 2.8776 0.9262 * * * * 130070 2.9727 0.9262 * * * * 140001 1.2495 0.8663 23.2233 23.7481 24.5618 23.9087 140002 1.5362 0.9019 29.1097 29.6312 30.7187 29.8279 140007 1.5429 1.0455 32.4449 34.2607 34.4024 33.7444 140008 1.5089 1.0467 32.7618 33.2563 33.8475 33.2685 140010 1.5525 1.0467 39.3727 39.7245 41.6706 40.3259 140B10 3 *** * 39. 3727 39.7245 41.6706 40.3212 140011 1.1871 0.8342 26.2135 27.0019 27.8999 27.0776 140012 1.1826 1.0323 31.9613 33.0198 33.9621 33.0388 140013 1.3956 0.9247 26.4199 28.2787 29.7601 28.1742 140015 1.3818 0.8914 25.2504 25.8304 27.2800 26.1224 140018 1.4659 1.0467 31.5624 31.2535 32.8781 31.9237 140019 0.9025 0.8342 22.2907 22.9179 22.1774 22.4623 140026 1.2390 0.8638 28.1718 28.5497 28.8965 28.5453 140029 1.6147 1.0455 34.8938 37.7285 39.2923 37.4109 140030 1.6091 1.0455 32.1135 32.8927 34.5324 33.1540 140032 1.2724 0.8914 28.5242 28.4605 28.8062 28.6026 140033 0.8477 1.0687 31.4347 32.3417 37.3159 32.3454 140034 1.2373 0.8914 26.7250 27.6121 29.4226 27.8956 140040 1.2933 0.9137 28.5016 30.5814 29.5659 29.5161 140043 1.2977 0.8618 31.3754 34.4429 36.6352 34.1714 140046 1.5473 0.8914 25.7925 26.8384 27.7909 26.8011 140048 1.3808 1.0467 31.6290 34.4373 35.6153 33.9229 140049 1.5889 1.0467 32.0239 33.6104 35.1305 33.5575 140051 1.6022 1.0467 32.6517 32.7898 35.9661 33.8131 140052 1.4729 0.9019 26.7916 27.7932 28.3571 27.6322 140053 1.8431 0.8907 29.9487 32.7126 32.7073 31.7542 140054 1.5563 1.0467 34.5369 36.9786 37.5300 36.3814 140058 1.2163 0.8907 26.5671 28.6945 29.4589 28.2825 140059 1.1060 0.9019 22.8597 24.6248 27.1293 24.8684 140062 1.4327 1.0467 36.6718 38.3407 40.0353 38.3865 140063 1.5742 1.0467 31.1266 34.4732 34.2888 33.3236CMS-1498-P2 203

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 140064 1.2440 0.9137 26.6249 28.5964 28.7175 28.0100 140065 1.5255 1.0467 32.4661 34.3988 34.8576 33.9264 140066 0.8358 0.9019 23.6304 24.3856 25.8813 24.6266 140067 1.8100 0.9247 30.6911 31.9470 33.6485 32.1175 140068 1.3473 1.0467 31.3463 32.8724 34.3346 32.8242 140075 *** * 33. 6872 34.9376 37.0601 35.1205 140077 1.1765 0.9019 22.5074 24.2006 27.9915 24.7807 140080 1.6004 1.0467 30.3788 33.0275 33.9568 32.4504 140082 1.6828 1.0467 32.0562 33.4686 33.5580 33.0486 140083 1.0840 1.0467 26.1639 29.5034 26.0278 27.1377 140084 1.4066 1.0687 31.3307 32.1286 34.0802 32.4884 140088 2.0925 1.0467 34.4137 36.6991 39.5656 36.8355 140089 1.1697 0.8342 26.6955 27.5295 28.0437 27.4281 140091 1.7821 1.0115 29.7381 33.7851 35.7416 33.1415 140093 1.3604 0.9678 31.2973 29.3377 33.9418 31.5446 140094 0.7328 1.0467 28.8621 28.0819 31.7652 29.3420 140095 1.3861 1.0467 29.9626 35.7876 34.5168 33.4434 140100 1.5029 1.0687 37.3044 39.0405 53.2763 43.9761 140101 1.2867 1.0455 31.0070 32.4260 33.9464 32.5018 140103 1.1752 1.0467 25.3630 26.4236 27.1901 26.3291 140105 *** * 30. 7154 * * 30.7154 140110 1.0816 1.0323 31.3486 33.7263 37.0537 34.0414 140113 1.5438 1.0115 31.6191 33.2262 34.9622 33.3322 140114 1.5369 1.0467 31.1412 31.7038 31.4289 31.4242 140115 1.1726 1.0467 26.2606 30.2062 33.4032 29.8398 140116 1.4871 1.0467 34.2519 35.6726 37.3731 35.8074 140117 1.6529 1.0467 28.5809 34.6766 33.8389 32.2626 140118 1.5189 1.0467 33.8168 34.9352 35.7829 34.8477 140119 1.9388 1.0467 34.6543 35.5146 39.1814 36.4476 140120 1.2850 0.9247 26.2418 27.0681 28.1509 27.1802 140122 1.6620 1.0455 32.4750 34.2512 35.7240 34.1638 140124 1.2545 1.0467 38.8976 39.9267 42.6211 40.3601 140125 1.1748 0.9019 27.6352 28.3533 30.1443 28.6668 140127 1.5604 0.9523 29.3352 30.9124 32.7929 30.9550 140130 1.3285 1.0687 34.9907 35.8275 36.5321 35.7850 140133 1.3550 1.0467 32.8941 34.0222 33.5193 33.4793CMS-1498-P2 204

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 140135 1.4489 0.9112 25.9057 26.6854 27.2912 26.6118 140137 1.0866 0.9019 * 27.0616 26.9569 27.0094 140143 1.1048 0.8342 27.0312 27.2878 28.8821 27.7646 140145 1.3204 0.9019 26.9344 28.3622 29.2121 28.2021 140147 1.0814 0.8342 22.1035 22.6508 23.5511 22.7827 140148 1.7060 0.8907 28.9471 30.1467 30.0605 29.7419 140150 1.6603 1.0467 39.0316 41.6125 42.0035 40.9013 140151 0.9472 1.0467 27.3552 28.0758 27.9212 27.7895 140152 *** * 32. 2803 * * 32.2803 140155 1.3206 1.0323 35.0825 36.2360 42.9342 38.0739 140158 1.4480 1.0467 32.0137 31.7570 32.5513 32.1276 140160 1.3230 0.9829 28.9043 30.0100 29.7281 29.5556 140161 1.4829 1.0323 28.8150 33.5158 34.2463 32.1524 140162 1.6404 0.9523 33.0995 33.2372 34.3289 33.5598 140164 1.7410 0.8342 27.3133 27.5981 28.8827 27.9483 140166 1.2438 0.9112 27.6725 27.5406 28.8318 28.0436 140167 1.1637 0.8342 24.2749 21.2479 26.4163 23.8760 140172 1.4264 1.0467 33.4616 36.8394 37.7898 35.9979 140174 1.6817 1.0455 33.9382 35.1535 37.2213 35.4862 140176 1.2563 1.0467 33.2235 34.3901 35.2474 34.3194 140177 1.0534 1.0467 26.0727 28.0720 30.3713 28.2119 140179 1.4032 1.0467 31.3624 30.6997 31.6593 31.2406 140180 1.4341 1.0467 29.8009 31.4683 33.1831 31.5677 140181 1.2767 1.0467 27.5414 29.0862 28.5827 28.4001 140182 1.5270 1.0467 26.4103 34.4971 35.0847 31.5371 140184 1.4579 0.8342 27.5858 28.2155 30.8810 28.8696 140185 1.4880 0.9019 27.9433 29.7742 31.1163 29.6209 140186 1.5823 1.0323 32.8063 32.5128 33.6497 32.9984 140187 1.5586 0.9019 26.9265 29.2345 29.0150 28.4359 140189 1.2512 0.8342 29.1371 25.9192 29.7443 28.2279 140191 1.4166 1.0467 29.7684 31.4076 32.4757 31.2541 140197 1.0537 1.0467 24.8715 26.9930 26.0614 25.9598 140200 1.5345 1.0455 31.3712 33.2897 34.0868 32.9105 140202 1.4834 1.0687 34.3789 38.4323 37.4214 36.7750 140206 1.1584 1.0467 31.1406 31.5212 27.6427 29.9651 140207 1.2953 1.0467 31.6818 25.8073 32.4874 29.9202CMS-1498-P2 205

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 140208 1.8222 1.0467 26.1749 26.2434 36.5625 29.1083 140209 1.6452 0.9247 28.8774 31.5349 31.8673 30.7293 140210 1.0405 0.8342 22.2512 24.1193 24.7376 23.7498 140211 1.4102 1.0455 34.5917 36.0400 37.0954 35.9438 140213 1.2807 1.0455 33.3932 33.6351 35.2016 34.1074 140217 1.5985 1.0455 33.2172 34.8475 36.7916 35.0335 140223 1.6066 1.0467 34.6997 36.6437 38.4099 36.5719 140224 1.4303 1.0467 30.2241 34.4001 32.1594 32.1531 140228 1.4921 1.0006 28.7462 30.7381 33.1724 30.9914 140231 1.5719 1.0455 35.6724 36.3601 38.3032 36.8493 140233 1.7853 1.0006 32.3376 35.7752 36.3886 34.8790 140234 1.0863 0.8638 25.7660 26.9670 27.9382 26.9002 140239 1.7231 1.0006 33.7264 35.6391 35.7029 35.0237 140240 1.4344 1.0467 28.0986 32.9491 34.4714 31.9066 140242 1.6355 1.0455 36.8032 40.7474 41.8148 39.8954 140250 1.2990 1.0467 32.9414 33.7382 35.9552 34.1583 140251 1.4663 1.0467 29.5941 31.5378 33.9137 31.6519 140252 1.5144 1.0467 36.1531 37.6031 38.6010 37.4880 140258 1.7431 1.0467 34.5696 34.9198 36.5007 35.3489 140275 1.4119 0.8618 26.7394 26.7114 28.4089 27.3093 140276 2.0654 1.0467 32.7073 33.1620 35.5860 33.8463 140280 1.4890 0.8618 26.9835 28.0388 28.9833 28.0224 140281 1.7722 1.0467 37.5700 38.6663 40.3035 38.8921 140286 1.2278 1.0455 32.2246 38.2039 37.1421 35.9395 140288 1.6334 1.0455 32.5472 34.1167 37.2937 34.6391 140289 1.3772 0.9019 26.0872 26.7573 27.9748 26.9787 140290 1.5455 1.0467 35.9679 34.5766 36.0910 35.5293 140291 1.6451 1.0687 32.7884 34.2987 37.6820 34.9828 140292 1.3397 1.0455 32.4496 32.9675 34.8169 33.4335 140294 1.2039 0.8342 26.9789 27.4105 29.1291 27.8159 140300 1.0783 1.0467 37.4508 35.5837 50.8399 41.0132 140301 0.9779 1.0467 35.9742 * 25.6069 29.8693 140303 2.2113 1.0467 33.0359 31.4718 27.9269 30.4360 140304 1.4263 1.0455 * * * * 150001 1.2764 0.9511 32.9804 32.5348 32.6297 32.7148 150002 1.6234 1.0323 28.1076 28.3271 29.6905 28.6820CMS-1498-P2 206

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 150003 1.7222 0.9211 29.3660 30.1317 33.7073 30.8984 150004 1.5661 1.0323 31.7867 34.4889 35.7071 34.0029 150005 1.3511 0.9511 31.6090 32.6541 33.1179 32.4681 150006 1.4802 0.9445 28.3403 29.7289 30.6306 29.5973 150007 1.5994 0.8969 31.0384 32.4836 32.2298 31.9370 150008 1.4456 1.0323 29.1492 30.9426 33.9870 31.5695 150009 1.5710 0.8810 26.1517 25.9625 26.7891 26.3075 150010 1.6352 0.8969 28.2616 32.8116 30.3873 30.4161 150011 1.3841 0.9511 27.7870 27.8089 29.9431 28.4970 150012 1.5535 0.9844 31.6762 32.0116 33.6506 32.4574 150015 1.4932 0.9028 30.2516 32.6995 36.4154 32.8813 150017 1.7290 0.9203 27.1262 27.4538 30.5938 28.4044 150018 1.6443 0.9445 30.0928 30.9511 32.3280 31.1271 150021 1.7703 0.9203 31.1158 33.1505 34.1233 32.7891 150022 1.0676 0.8612 26.9525 29.7752 29.6975 28.8110 150023 1.5976 0.9511 30.3667 30.8457 32.8854 31.3908 150024 1.6680 0.9511 30.6154 32.1844 32.4374 31.8086 150026 1.2688 0.9445 31.9397 33.1225 34.1049 33.0885 150029 *** * 31. 0692 32.1154 34.7470 32.5698 150030 1.1399 0.9511 31.1986 34.5137 33.5357 33.0658 150033 1.4780 0.9511 32.9469 31.7314 32.8768 32.5228 150034 1.5129 1.0323 30.0048 30.9961 32.0665 31.0341 150035 1.4857 0.9028 29.2039 27.9432 28.4279 28.5206 150037 1.4116 0.9511 30.4640 32.2960 34.2666 32.3692 150038 1.2551 0.9511 31.9552 32.2545 32.5543 32.2583 150042 1.3233 0.8687 25.2456 25.2218 26.7161 25.7175 150044 1.5944 0.8810 25.9284 26.6389 28.1622 26.9147 150045 0.9713 0.8361 29.4323 30.0052 30.9207 30.1025 150046 1.5593 0.9212 27.6228 29.7184 30.9654 29.3854 150047 1.6689 0.9203 27.1847 27.9365 31.6507 28.8997 150048 1.5145 0.9593 29.5588 30.5008 32.3958 30.8298 150051 1.6271 0.9511 30.3764 31.2746 32.2657 31.3278 150056 2.0215 0.9511 30.5777 30.8461 32.4031 31.2946 150057 1.8617 0.9511 29.2358 30.4490 32.1298 30.5843 150058 1.6714 0.9844 31.7558 32.4036 35.0250 33.0649 150059 1.4935 0.9511 36.2570 30.4189 32.7391 32.9236CMS-1498-P2 207

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 150061 1.1637 0.8361 23.2427 24.7808 25.5354 24.5382 150064 1.1633 0.9511 28.9430 29.7898 31.2189 29.8692 150065 1.2812 0.9511 30.7970 31.7556 30.5764 31.0263 150069 1.1856 0.9593 27.0740 28.6514 29.6637 28.4852 150072 1.1231 0.8453 23.0619 24.6596 25.9259 24.5284 150074 1.4197 0.9511 29.4135 31.6043 32.2693 31.1351 150075 1.1147 0.9203 26.5987 27.1412 29.3253 27.5816 150076 1.3188 0.9445 30.2972 29.4643 30.9772 30.2388 150082 1.5964 0.8361 28.1302 28.0003 28.9121 28.3718 150084 1.8928 0.9511 35.0288 35.4818 35.6641 35.4130 150086 1.1942 0.9593 27.2580 28.8279 29.7408 28.6114 150088 1.3132 0.9511 30.2396 31.9171 33.4869 31.8591 150089 1.7163 0.8696 26.7290 28.0389 28.6143 27.7655 150090 1.4939 1.0323 30.9274 33.6812 32.6472 32.3780 150091 1.1504 0.9203 33.0421 32.9027 32.9069 32.9497 150097 1.2299 0.9511 29.4797 29.9967 31.3599 30.2962 150100 1.6908 0.8361 27.6339 30.0246 30.5792 29.4364 150101 1.0091 0.9203 31.6031 32.5860 33.5799 32.5996 150102 1.0478 0.9028 25.4717 30.4952 30.6858 28.7323 150104 1.2531 0.9511 30.8984 31.2245 32.6367 31.6520 150109 1.6020 0.9211 29.0076 31.0757 31.1542 30.3473 150112 1.5048 0.9511 31.7966 32.0659 33.0833 32.3322 150113 1.2748 0.9511 26.9098 29.0485 31.1284 29.0331 150115 1.3849 0.8361 22.3571 25.0221 22.3911 23.2176 150125 1.5510 1.0323 30.7113 31.6959 31.3249 31.2479 150126 1.3388 1.0323 32.6488 34.5086 34.8705 34.0137 150128 1.4381 0.9511 31.1071 30.7549 33.5421 31.8223 150129 1.4581 0.9511 32.9629 36.4709 35.4468 35.0559 150133 1.1372 0.9445 23.0662 25.1415 27.9662 25.3965 150134 *** * 27. 3983 30.4440 * 28.8978 150146 1.1222 0.9414 31.8757 32.9491 33.5246 32.8186 150147 *** * 28. 9269 28.9204 25.8261 28.0014 150149 0.9508 0.8361 25.3350 26.4595 28.5387 26.8755 150150 1.3103 0.9203 26.5984 26.5020 30.8735 28.0119 150153 2.2954 0.9511 37.3948 38.6948 40.7215 38.9628 150154 2.2826 0.9511 30.5775 32.3383 33.4212 32.1347CMS-1498-P2 208

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 150157 1.7623 0.9511 32.9167 35.4134 36.4550 34.9919 150158 1.3123 0.9511 30.4355 31.5245 33.9116 32.0793 150159 *** * 27. 5595 * * 27.5595 150160 2.0703 0.9511 27.6375 31.2957 35.6878 31.9424 150161 1.6991 0.9511 * 32.3409 32.7880 32.5716 150162 1.8807 0.9511 * 32.2317 34.3034 33.2490 150163 1.0317 0.8810 * 26.0437 25.0146 25.4847 150164 1.2919 0.9245 * * 34.3607 34.3607 150165 1.4820 1.0323 * * 29.3019 29.3019 150166 0.9623 1.0323 * * 22.9271 22.9271 150167 2.3686 0.9203 * * * * 150168 2.1247 0.9203 * * * * 150169 1.6356 0.9511 * * * * 150170 1.3876 1.0323 * * * * 150172 1.6329 0.8810 * * * * 150173 1.6384 0.9211 * * * * 150174 0.9714 0.9028 * * * * 150175 2.3255 0.8361 * * * * 150176 2.7334 0.8810 * * * * 160001 1.3311 0.9485 25.8686 27.4207 28.7099 27.3326 160005 1.2769 0.8498 24.8597 25.6204 27.4917 26.1096 160008 0.9769 0.8498 24.1282 24.3704 24.4497 24.3155 160013 1.2219 0.8685 25.5162 26.6913 28.1891 26.7376 160016 1.5478 0.9235 26.6537 27.9879 28.8021 27.8144 160024 1.5796 0.9485 32.4253 32.7762 34.4365 33.1992 160028 1.4350 0.9510 29.8343 32.4639 33.7785 32.0904 160029 1.5442 0.9510 32.2035 33.7679 34.1917 33.3869 160030 1.3905 1.0016 30.4779 32.0333 35.0846 32.5833 160032 0.9942 0.8839 28.5645 29.0326 31.8085 29.8300 160033 1.6046 0.8618 27.4810 27.6537 29.9665 28.3732 160040 1.4565 0.8498 28.2982 27.9810 28.9805 28.4165 160045 1.7963 0.8763 28.1681 30.0063 30.1557 29.4747 160047 1.2816 0.9510 29.4286 31.2897 32.5410 31.0812 160057 1.5524 0.9383 27.7969 28.3640 29.9080 28.7095 160058 2.0933 0.9510 29.8975 31.2742 33.2320 31.5155 160064 1.4740 0.9104 33.6082 32.7787 33.3370 33.2334CMS-1498-P2 209

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 160067 1.4190 0.8498 26.7679 27.2055 27.9863 27.3213 160069 1.5388 0.8527 28.4081 29.0981 30.1739 29.2235 160079 1.5326 0.8763 28.5034 29.8338 31.5836 30.0015 160080 1.2455 0.8618 27.8745 27.4136 29.4683 28.2508 160082 1.8108 0.9485 31.7508 34.0609 34.3141 33.3856 160083 1.7250 0.9485 29.9489 31.0514 33.2497 31.4494 160089 1.3913 0.8498 23.9194 25.0810 26.2942 25.0591 160101 1.1089 0.9485 26.8515 27.1889 27.7523 27.2723 160104 1.6136 0.8618 27.0538 27.8486 29.6187 28.2439 160110 1.5439 0.8498 29.9094 30.8876 32.2713 31.0216 160112 1.2738 0.8498 26.1721 26.7136 28.5427 27.1637 160117 1.4386 0.8527 24.3326 28.8434 29.5419 27.4138 160122 1.1901 0.8498 25.3192 26.6212 27.6209 26.5321 160124 1.0341 0.8498 25.5048 27.2937 27.7842 26.8757 160146 1.5275 0.8927 25.1834 27.1213 27.6992 26.6860 160147 1.1959 0.9235 33.6394 37.2058 33.7922 34.8361 160153 1.7431 0.8927 30.4356 32.1357 33.9188 32.1398 160155 *** * * 30. 2301 * 30.2301 160156 1.6040 0.8763 * * * * 170001 1.1336 0.7990 24.5942 26.2914 27.4924 26.1347 170006 1.3107 0.8409 28.3527 30.5591 29.7039 29.5405 170009 1.1982 0.9514 32.2847 29.3342 35.8139 32.4214 170010 1.2280 0.7990 28.1802 28.6734 28.0225 28.2857 170012 1.6238 0.7990 28.7878 30.0388 31.3285 30.0679 170013 1.8476 0.8845 28.3051 29.6511 29.3136 29.1030 170014 1.0892 0.9514 25.8165 27.2909 28.6642 27.2564 170016 1.7045 0.9096 28.6817 31.9998 32.2154 30.9367 170017 1.1853 0.8819 29.1463 29.5447 30.5545 29.7618 170020 1.5234 0.8716 25.0561 26.1258 27.5267 26.2659 170023 1.4396 0.7990 24.8827 24.9932 23.5945 24.4631 170027 1.4459 0.7990 24.1133 24.6748 28.0618 25.5280 170033 1.2736 0.8716 25.0404 26.9830 28.5416 26.8290 170039 1.0418 0.8819 23.5975 24.1339 25.9946 24.6007 170040 1.9930 0.9514 30.0828 33.3813 34.7542 32.6359 170049 1.5816 0.9514 31.8595 34.8212 36.0453 34.2790 170058 1.0032 0.9514 28.1330 28.6239 28.3939 28.3847CMS-1498-P2 210

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 170068 1.1495 0.8399 23.8509 25.6803 26.5991 25.3770 170074 1.1194 0.7990 24.8871 26.7280 27.0989 26.2418 170075 0.8374 0.7990 21.1965 20.9091 23.3361 21.8104 170086 1.5306 0.9096 28.5260 30.0102 31.6797 30.1229 170094 0.9016 0.7990 17.1719 26.4808 26.5182 22.5983 170103 1.4110 0.8819 25.5671 26.2628 27.2927 26.3968 170104 1.5054 0.9514 29.7793 31.7058 33.9851 31.8232 170105 1.0539 0.7990 23.4332 24.4249 25.3842 24.4229 170109 1.2001 0.9514 29.0197 33.0257 35.5902 32.6026 170110 0.9742 0.7990 24.7927 26.7359 27.8054 26.4654 170120 1.5992 0.7990 23.5287 24.9819 25.5442 24.7148 170122 1.7938 0.8819 29.6337 31.0839 31.6953 30.8189 170123 1.8214 0.8819 28.7627 29.1591 30.2106 29.3841 170133 1.0783 0.9514 25.7129 27.6138 29.6857 27.6809 170137 1.5460 0.7990 26.8029 28.6556 29.7218 28.4175 170142 1.4422 0.8907 25.5567 26.4060 27.8156 26.6242 170145 1.2223 0.7990 25.3745 26.5981 26.7895 26.2826 170146 1.6495 0.9514 31.7023 31.6451 33.8549 32.3707 170147 *** * 21. 4581 * * 21.4581 170150 1.1460 0.8133 22.0265 22.2379 22.4168 22.2250 170166 0.9627 0.7990 24.1079 24.4570 25.1569 24.5747 170175 1.2714 0.8716 31.7600 30.1456 32.3747 31.4397 170176 1.6710 0.9514 30.1135 31.4048 32.9892 31.5099 170182 1.4837 0.9514 30.3805 32.3903 32.5488 31.7971 170183 2.0144 0.8819 27.7207 27.5559 27.2280 27.4870 170185 1.3885 0.9514 29.3226 31.0813 31.8944 30.8239 170186 2.5662 0.8819 30.7673 36.3546 37.5555 34.8719 170187 1.8179 0.7990 24.6419 26.2236 27.0072 25.9990 170188 2.0192 0.9514 33.7247 34.0134 35.3969 34.4593 170190 1.0539 0.7990 27.3041 28.7392 29.4546 28.5196 170191 1.6762 0.7990 26.0305 26.2347 26.3239 26.2056 170192 1.8218 0.8819 30.9230 31.7531 31.2301 31.3156 170193 *** * 24. 4131 21.9349 * 23.1732 170194 1.3210 0.9514 28.2004 29.8055 35.7190 31.0251 170195 2.6049 0.9514 29.1787 31.0187 31.1434 30.5894 170196 2.4657 0.8819 29.9671 29.9241 30.4796 30.1295CMS-1498-P2 211

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 170197 2.3696 0.8819 * * 33.5871 33.5871 170198 1.9628 0.7990 * * 21.2698 21.2698 180001 1.3332 0.9593 29.9674 29.7832 30.9838 30.2388 180002 1.0159 0.8025 27.3344 28.4044 31.5452 29.0298 180004 1.1704 0.7957 22.0626 25.7454 24.9532 24.2670 180005 1.1872 0.7957 27.4317 27.9687 27.9438 27.7826 180007 *** * 26. 9440 29.3465 27.5457 27.8795 180009 1.7787 0.8880 28.7048 28.9804 29.4309 29.0610 180010 2.0260 0.8760 28.2168 29.8818 30.7775 29.6381 180011 1.7841 0.8626 25.0372 26.6072 27.6650 26.5198 180012 1.5168 0.8810 27.2851 27.8386 29.2425 28.1376 180013 1.5078 0.9280 26.8108 28.6307 30.5698 28.7209 180016 1.3865 0.7957 26.9539 28.2975 29.3722 28.1740 180017 1.3206 0.8311 25.4174 26.0927 26.1053 25.8753 180018 1.4264 0.8626 24.9874 25.0082 26.1033 25.3849 180019 1.1841 0.7957 27.6801 27.5969 28.3775 27.8968 180020 1.0587 0.8025 26.8865 29.8100 32.2271 29.5397 180021 0.9701 0.7957 22.3768 24.2127 25.2066 23.9245 180024 1.2076 0.8353 26.9553 27.8181 29.6250 28.1394 180025 1.4648 0.8810 28.4172 30.2576 30.4293 29.7381 180027 1.1926 0.7957 23.3881 24.0032 25.5862 24.3439 180029 1.3851 0.8626 26.3907 29.1400 33.4416 29.5244 180035 1.5342 0.9593 34.0370 36.6577 38.6645 36.4402 180036 1.4322 0.8880 30.2643 31.9987 31.3634 31.1868 180037 *** * 33. 1897 28.5734 * 30.8765 180038 1.6881 0.7957 28.2430 28.5219 29.7930 28.8753 180040 1.8998 0.8810 30.2471 28.9562 29.2132 29.3762 180043 1.0208 0.7957 24.0582 25.0444 25.3256 24.8642 180044 1.7655 0.8729 25.7990 27.7934 29.8308 27.8637 180045 1.4112 0.9593 29.9366 29.9395 30.5356 30.1379 180046 1.1858 0.8760 28.5568 30.0536 32.2894 30.3563 180048 1.3799 0.8810 24.6800 25.3490 26.8313 25.6487 180049 1.5640 0.8626 23.5756 25.8921 26.3445 25.2345 180050 1.0789 0.7957 26.7726 29.9911 31.6423 29.3799 180051 1.3473 0.7957 25.2369 26.2560 27.0283 26.1992 180053 0.9345 0.7957 23.0302 24.6694 23.9194 23.8815CMS-1498-P2 212

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 180056 1.1784 0.8357 26.3973 26.6223 27.8825 26.9638 180064 1.3127 0.8168 21.9517 22.5090 22.7958 22.4385 180066 1.0981 0.8474 24.9542 27.2184 27.9417 26.6868 180067 2.0349 0.8760 29.6053 28.9896 30.0550 29.5697 180069 1.0562 0.8729 27.6785 29.9406 32.9994 30.0147 180070 1.3985 0.8078 21.3707 22.8450 24.2407 22.8589 180078 1.1477 0.8729 29.2136 27.4672 28.5438 28.3969 180079 1.1129 0.8131 24.9911 27.2710 26.6427 26.2944 180080 1.2983 0.7957 25.3013 27.2402 28.8798 27.1688 180087 1.3935 0.7957 22.1063 23.2617 24.6628 23.3436 180088 1.8784 0.8810 30.7954 31.8151 32.8838 31.8430 180092 1.2199 0.8760 25.2900 27.0330 26.1035 26.1598 180093 1.6163 0.8116 22.3330 23.5805 24.2302 23.4008 180095 0.9817 0.7957 21.2162 23.9869 25.2742 23.4675 180101 1.3075 0.8760 28.8772 29.6176 31.3685 30.0013 180102 1.5096 0.8325 27.3901 28.3445 26.8886 27.5244 180103 1.8987 0.8760 29.7648 31.7171 33.5024 31.6641 180104 1.5028 0.8325 27.1292 28.7669 29.7545 28.5731 180105 0.9798 0.7957 24.3663 22.9902 23.8783 23.7503 180106 0.8418 0.7957 21.2271 20.1899 21.6369 21.0328 180115 0.9093 0.7957 22.7095 24.9627 24.7222 24.1589 180116 1.3811 0.8325 26.8850 26.9052 28.8350 27.5313 180117 0.8909 0.7957 24.9571 25.9593 32.4322 27.4620 180124 1.4443 0.9280 27.1359 28.2511 30.0346 28.4149 180127 1.3104 0.9593 28.3635 29.8610 30.7333 29.6661 180128 0.9465 0.7957 23.7778 23.9098 25.5746 24.4176 180130 1.6650 0.8810 29.6751 31.2746 32.7395 31.2576 180132 1.3644 0.8626 29.0563 29.5884 29.0754 29.2355 180138 1.2014 0.8810 29.2603 30.7144 32.5413 30.8691 180139 1.0292 0.7957 26.2450 28.3450 28.6303 27.6831 180141 1.9520 0.8810 28.7329 29.5347 30.4173 29.5803 180143 1.7482 0.8760 28.0780 29.0323 30.9817 29.3864 180149 1.0602 0.7957 16.4918 16.3670 21.0293 17.8136 180150 *** * * 27. 9388 * 27.9388 180151 *** * * * 30. 5548 30.5548 190001 1.2286 0.7910 22.5331 25.3862 29.4366 25.9390CMS-1498-P2 213

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 190002 1.6804 0.8434 25.9387 27.1770 27.9755 27.0325 190003 1.4192 0.8434 28.0899 30.5381 32.3943 30.3019 190004 1.5130 0.7955 24.6563 27.0776 27.9541 26.6299 190005 1.6165 0.8964 28.3308 32.9927 37.7220 33.1294 190006 1.3802 0.8434 25.4826 28.9179 29.0341 27.9150 190007 1.1745 0.7910 24.0538 24.6117 25.6561 24.7757 190008 1.7700 0.7955 27.2683 28.1194 28.2325 27.8874 190009 1.0153 0.8127 25.0269 24.8263 26.5888 25.4978 190011 1.0472 0.8085 21.9174 24.2068 26.6802 24.1700 190013 1.5009 0.8164 22.8380 25.2468 25.4352 24.5312 190014 1.1793 0.7910 24.5410 25.6064 40.7501 28.3699 190015 1.4420 0.8964 26.9591 29.5241 30.0800 28.8947 190017 1.4652 0.8434 25.5477 26.9640 25.4720 25.9802 190019 1.7524 0.8127 27.6057 28.6311 28.7429 28.3536 190020 1.3278 0.8686 24.2361 25.9262 28.0273 26.1642 190025 1.3326 0.7910 26.5949 26.6296 28.3544 27.1661 190026 1.7583 0.8127 25.3752 27.0875 28.8897 27.0946 190027 1.6967 0.8164 31.5047 29.4789 30.4014 30.3905 190034 1.1283 0.8045 22.9920 24.3969 26.3116 24.6129 190036 1.7818 0.8964 29.1818 27.7969 28.4731 28.4470 190037 0.7254 0.8164 28.0463 19.5982 18.7972 23.3675 190039 1.6259 0.8964 24.6848 29.0738 29.9665 27.9939 190040 1.4743 0.8964 28.2444 29.0914 29.9696 29.1339 190041 1.5169 0.8611 28.7702 29.3296 30.0940 29.3847 190044 1.2801 0.8095 22.2462 23.1701 24.3770 23.2873 190045 1.5746 0.8964 27.5873 29.2569 30.1234 29.0388 190046 1.6328 0.8964 25.1890 30.9760 30.5410 29.0312 190050 1.2653 0.7966 22.7962 23.6921 25.5258 24.0045 190053 1.2074 0.8012 20.6289 22.1404 23.5988 22.1805 190054 1.3179 0.7971 23.5137 26.5586 26.1148 25.4390 190060 1.4983 0.8164 19.8911 25.1496 27.7720 23.8818 190064 1.7058 0.8686 26.9960 28.6273 31.9836 29.2661 190065 1.7366 0.8686 22.9861 24.3651 27.9398 25.1110 190078 1.1497 0.8044 25.6943 26.0185 29.3271 27.0437 190079 1.1235 0.8964 25.3344 28.0268 29.1127 27.5269 190081 0.8388 0.7910 20.4111 21.2224 19.7228 20.4547CMS-1498-P2 214

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 190086 1.3020 0.8085 22.2852 24.2040 26.9719 24.3187 190088 1.0754 0.8191 24.7450 29.5999 28.2045 27.5180 190090 0.9838 0.7910 25.8610 25.0681 27.3204 26.0691 190098 1.7167 0.8611 27.5058 27.8846 30.6530 28.7025 190099 1.0253 0.8015 25.7488 25.7136 28.4919 26.6705 190102 1.5099 0.8434 28.3090 28.6165 29.3771 28.7633 190106 1.1005 0.8127 24.2759 25.5188 28.9361 26.2131 190111 1.7590 0.8611 27.3192 28.8406 30.5678 28.9640 190114 1.0703 0.7910 20.3651 21.1463 21.6231 21.0606 190115 *** * 26. 0285 25.7014 26.8130 26.0523 190116 1.0753 0.7962 24.2154 24.4439 24.8437 24.4763 190118 1.0876 0.8611 22.6572 22.3386 23.2836 22.7652 190122 1.0958 0.8686 22.8681 24.5686 31.3913 26.4871 190124 *** * 28. 6713 * * 28.6713 190125 1.6466 0.8085 26.6269 26.9761 28.3593 27.4096 190128 1.0737 0.8686 31.1819 32.2095 33.7971 32.4200 190131 1.0333 0.8686 28.5946 29.9837 * 29.2828 190133 0.9268 0.7991 23.9550 27.2643 30.2477 27.1223 190135 1.4976 0.8964 35.0547 43.3956 30.1783 34.5478 190140 0.9443 0.7931 23.6713 23.2346 24.0204 23.6404 190144 1.3143 0.8611 24.8866 25.8501 28.3036 26.4021 190145 0.9783 0.7960 21.3988 22.1298 23.2156 22.2666 190146 1.5988 0.8964 28.5984 29.8336 31.9250 30.1773 190151 0.8796 0.7910 20.6970 23.0032 23.1695 22.2541 190152 *** * 34. 6508 34.6962 * 34.6751 190158 *** * 21. 5594 * * 21.5594 190160 1.5857 0.8085 25.8646 26.4460 30.4379 27.3739 190161 1.1145 0.8164 23.8073 24.8249 29.2908 26.0454 190164 1.1621 0.7985 27.7265 28.2630 29.1501 28.3895 190167 1.1858 0.8434 27.1981 29.3971 31.7116 29.4476 190175 1.4156 0.8964 30.5948 31.4039 32.4181 31.4544 190176 1.8915 0.8964 28.2192 32.2906 33.3670 31.0851 190177 1.8394 0.8964 29.7252 30.9158 33.1157 31.2414 190182 *** * 30. 7058 * * 30.7058 190183 1.3719 0.7955 23.3462 25.0395 27.3509 25.2419 190184 0.9910 0.7985 22.6144 22.5006 23.5652 22.8901CMS-1498-P2 215

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 190185 *** * 36. 7317 * * 36.7317 190190 0.9500 0.8085 27.5051 27.5875 28.9875 28.1199 190191 1.2692 0.8044 26.9656 28.1116 32.0257 28.8862 190196 0.8810 0.8434 27.7824 28.4697 30.6579 29.0035 190197 *** * 28. 7044 29.4072 * 29.0218 190199 1.0401 0.8686 36.7128 29.8286 28.2996 31.3500 190201 1.1431 0.8164 26.8550 27.8244 29.9264 28.1877 190202 1.6103 0.8686 27.6463 27.8790 27.6445 27.7278 190204 1.5181 0.8964 32.9140 31.9034 33.9644 32.9173 190205 1.7463 0.8434 30.1687 31.6103 32.4248 31.3896 190206 *** * 32. 0180 30.4228 * 31.2019 190208 0.8027 0.7910 24.9405 27.5238 30.0154 27.5723 190218 0.8614 0.8611 26.5251 26.9305 28.1252 27.1844 190236 1.4843 0.8611 26.9059 28.6472 30.3119 28.6612 190241 1.3729 0.7955 26.5320 27.5130 28.2954 27.5238 190242 1.3789 0.8686 26.9729 28.7307 28.2808 28.0344 190245 1.4118 0.8085 26.4166 26.6403 28.0180 26.9888 190246 2.1718 0.7985 31.7158 31.5003 31.9438 31.7321 190249 *** * 27. 0975 28.3211 25.9997 26.9704 190250 2.2150 0.8964 32.8381 35.2699 34.8604 34.3606 190251 1.3719 0.8686 25.1594 27.3657 22.3853 24.6260 190253 *** * 22. 2227 * * 22.2227 190255 0.8263 0.8434 23.8035 27.8066 29.2058 26.9371 190256 1.0879 0.8964 25.9365 28.7148 28.7915 27.9122 190257 1.7222 0.8085 22.7512 24.2936 25.5176 24.1258 190258 1.8369 0.8611 25.1993 27.7948 22.8748 24.8290 190259 2.1986 0.8434 27.5518 28.9188 32.6301 29.7424 190260 *** * 33. 6227 * * 33.6227 190261 1.5307 0.8085 25.4757 28.7987 29.7560 28.0746 190263 2.3305 0.8434 29.7063 36.3082 35.0861 33.5957 190265 *** * 30. 9260 * * 30.9260 190266 2.9075 0.8686 24.3809 32.3423 32.8535 29.9624 190267 1.4667 0.8964 24.2794 27.6254 30.2475 27.6505 190268 1.5022 0.8434 29.1425 25.8619 27.3050 27.2594 190270 1.8564 0.8964 * 28.5382 29.0574 28.8214 190272 1.3915 0.8434 28.4558 28.4184 23.0702 27.0083CMS-1498-P2 216

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 190273 1.8338 0.8686 * 22.7627 21.7837 22.2231 190274 1.8427 0.8964 * * 28.1128 28.1128 190275 *** * * * 29. 8209 29.8209 190278 2.3634 0.8611 * * 23.8972 23.8972 190297 1.1631 0.7910 * * * * 200001 1.3741 0.9651 28.1145 28.9839 29.1670 28.7667 200002 1.2267 0.9465 33.2695 30.4965 27.7502 29.9690 200008 1.4018 0.9885 29.3538 32.3955 34.1427 32.0121 200009 1.9252 0.9885 35.0743 36.9995 36.6216 36.2321 200018 1.3541 0.8550 24.6790 25.4228 25.7060 25.2725 200019 1.4200 0.9885 28.3413 30.1233 30.4156 29.6126 200020 1.2880 1.0171 34.5762 36.9185 40.2167 37.3309 200021 1.2139 0.9885 28.7614 31.8322 32.8539 31.2416 200024 1.6897 0.9465 31.0799 31.6913 31.9731 31.6024 200025 1.0822 0.9885 29.3607 30.2866 27.5904 29.0492 200031 1.2922 0.8550 23.7553 25.5973 25.9030 25.1172 200032 1.0966 0.8917 27.2276 27.8426 29.5270 28.2308 200033 1.8148 0.9651 33.6293 34.8017 34.8344 34.4346 200034 1.5798 0.9465 28.0417 28.5612 29.9180 28.9063 200037 1.1561 0.8550 26.7815 27.9167 29.6936 28.2024 200039 1.3319 0.9465 28.8043 29.9958 31.1083 30.0137 200040 1.0262 0.9885 25.5519 29.6104 29.7535 28.2949 200041 1.2990 0.8550 27.5067 28.7604 34.7992 30.1914 200050 1.1681 0.9651 30.1473 32.0363 34.1295 32.1599 200052 1.0602 0.8550 25.6238 24.4545 27.8885 25.8956 200063 1.1945 0.8550 28.2203 29.6832 30.0507 29.3664 210001 1.5177 0.9572 31.2355 30.9218 34.1438 32.0935 210002 2.0643 1.0151 36.0252 36.8782 37.3977 36.7890 210003 1.5893 1.0513 28.2566 34.4117 33.3073 31.8002 210004 1.4458 1.0496 33.9037 32.4548 34.4088 33.6063 210005 1.4195 1.0496 32.4081 32.2224 36.0013 33.5795 210006 1.1291 1.0151 27.9859 31.8510 33.3367 31.1101 210007 1.7980 1.0151 31.4125 35.3019 40.3645 35.4047 210008 1.4858 1.0151 31.8535 33.0343 33.6017 32.8716 210009 1.8265 1.0151 31.8273 34.4385 37.6659 34.7016 210011 1.4747 1.0151 30.7547 29.7694 28.5986 29.6638CMS-1498-P2 217

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 210012 1.7244 1.0151 32.5327 33.8099 34.9535 33.8058 210013 1.3276 1.0151 32.1180 35.6347 35.7358 34.5777 210015 1.3298 1.0151 31.6903 34.7961 35.0662 33.9077 210016 1.8075 1.0496 35.3253 37.1478 38.1774 36.9059 210017 1.1984 0.9262 26.6208 27.9652 27.6553 27.4194 210018 1.2329 1.0496 31.5460 33.7284 36.4156 33.9785 210019 1.7439 0.9262 30.5485 30.8121 31.7957 31.0539 210022 1.5465 1.0496 36.1833 35.8394 37.6708 36.5871 210023 1.5697 1.0189 34.1664 35.8243 37.3156 35.8033 210024 1.7983 1.0151 34.5548 36.7920 36.9018 36.1089 210025 1.3682 0.9262 23.5175 28.3956 29.8053 27.1446 210027 1.4746 0.9262 25.2143 25.6339 27.5980 26.1526 210028 0.9952 0.9645 28.5214 31.7636 34.3131 31.6983 210029 1.3475 1.0151 32.9100 33.9139 34.5075 33.8223 210030 1.1460 0.9262 29.1790 33.8729 34.4330 32.5402 210032 1.2840 1.0753 29.2785 31.6516 32.2034 31.0732 210033 1.2494 1.0151 28.4350 33.0982 34.9230 32.1677 210034 1.3548 1.0151 33.0407 35.1533 36.2172 34.8437 210035 1.3316 1.0513 30.6692 28.7165 34.0007 31.1344 210037 1.2971 0.9262 28.8708 31.0096 32.7661 30.9387 210038 1.3568 1.0151 31.1563 32.7411 36.1404 33.3841 210039 1.1580 1.0513 35.1172 33.7557 36.9817 35.3260 210040 1.2899 1.0151 31.0882 30.5834 32.5361 31.4068 210043 1.3938 1.0189 29.2762 31.9196 36.7035 32.5832 210044 1.3943 1.0151 31.5463 31.9067 33.9671 32.5153 210045 0.9460 0.9262 19.6112 23.8454 23.8643 22.3580 210048 1.4049 1.0151 29.2464 30.6650 32.7111 30.9342 210049 1.3689 1.0151 28.5970 31.5740 32.8713 31.1060 210051 1.3877 1.0513 30.7954 33.0355 33.8704 32.6204 210054 1.3042 1.0513 28.6905 32.3079 30.9544 30.6912 210055 1.3146 1.0513 30.2010 36.7615 34.9377 33.7047 210056 1.4309 1.0151 33.2271 35.5593 36.1736 34.9799 210057 1.4422 1.0496 33.7287 34.3643 36.7381 34.9642 210058 1.3962 1.0151 32.0669 32.9569 31.3100 32.0828 210060 1.1535 1.0513 32.5141 34.1974 35.0184 33.9386 210061 1.3663 0.9450 26.6842 28.6561 29.3158 28.2516CMS-1498-P2 218

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 220001 1.3129 1.1560 32.0843 34.3993 36.2517 34.3061 220002 1.3674 1.1560 35.9765 37.9204 41.2350 38.3812 220008 1.3871 1.1560 35.8680 37.3794 38.4715 37.2430 220010 1.2534 1.1560 33.7392 36.1759 37.2035 35.7194 220011 1.1936 1.1560 39.1234 41.0183 43.4600 41.2510 220012 1.4849 1.2766 41.7080 43.0551 45.5643 43.4397 220015 1.2957 1.0314 35.2373 36.6427 36.3548 36.1085 220016 1.1444 1.0314 33.1424 34.9714 36.4237 34.8489 220017 1.3175 1.2286 34.6575 38.0626 37.7006 36.8223 220019 1.1234 1.1560 26.3018 28.0084 29.0921 27.8076 220020 1.2029 1.1560 32.1528 33.6332 35.4990 33.7696 220024 1.3423 1.0314 33.0415 33.8692 34.5389 33.8318 220025 0.9616 1.1560 27.6973 26.6082 29.5458 27.9060 220029 1.2117 1.1560 32.6792 34.8311 36.1946 34.5999 220030 1.0618 1.0314 29.3714 28.8797 29.5814 29.2776 220031 1.5941 1.2286 39.4214 43.7983 46.0432 43.1210 220033 1.2423 1.1560 34.7005 36.1938 40.1729 37.0696 220035 1.4532 1.1560 36.1799 37.2879 39.7370 37.7407 220036 1.5744 1.2286 37.7301 37.0998 37.8321 37.5495 220046 1.5340 1.0435 33.8604 36.3356 37.2026 35.8565 220049 1.2222 1.1560 35.1134 35.7550 37.2433 36.0618 220050 1.1147 1.0314 30.3176 32.4636 33.3155 32.0704 220051 1.4962 0.9627 32.8693 34.7850 33.7650 33.7771 220052 1.2183 1.2286 34.9151 34.9505 36.2809 35.4000 220058 0.9958 1.1560 30.0344 31.9532 34.4760 32.1059 220060 1.1949 1.2286 36.8668 39.1180 41.3006 39.2150 220062 0.7353 1.1560 27.4755 27.3983 28.6128 27.8434 220063 1.3010 1.1560 32.2442 34.6004 35.5788 34.2281 220065 1.2968 1.0314 32.3814 33.6328 34.7541 33.5673 220066 1.4186 1.0314 * 32.6289 35.0834 33.8457 220067 1.2573 1.2286 33.9836 35.7611 37.4704 35.7586 220070 1.1469 1.1560 35.6271 37.4036 39.9838 37.7577 220071 1.8988 1.2286 40.0313 44.2752 46.1244 43.5120 220073 1.2200 1.1560 37.4249 38.9942 39.6789 38.7046 220074 1.3861 1.1560 33.2081 34.5531 36.8098 34.8867CMS-1498-P2 219

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 220B74 4 *** * 33. 2082 34.5530 36.8098 34.8283 220075 1.6785 1.2286 33.3578 33.9698 34.7027 34.0072 220077 1.7243 1.1066 34.7345 36.4382 37.4924 36.2651 220080 1.2906 1.1560 33.1640 36.8086 36.4484 35.4648 220082 1.4119 1.1560 32.2124 33.0780 34.8104 33.3699 220083 1.1280 1.2286 35.2758 37.6415 40.5366 37.8780 220084 1.3987 1.1560 34.6275 36.1148 37.5379 36.1306 220086 1.8041 1.2286 36.2385 38.7853 41.1551 38.7907 220088 2.0559 1.2286 37.0840 37.3891 39.2279 37.9115 220090 1.2951 1.1560 35.8969 36.8628 39.5926 37.5164 220095 1.1067 1.1560 31.1644 34.1504 35.3675 33.6005 220098 1.1646 1.1560 31.1288 32.1864 33.5413 32.2804 220100 1.3340 1.2286 35.7309 36.5606 38.7440 37.0351 220101 1.4456 1.1560 37.7292 39.3939 41.7554 39.6905 220105 1.2292 1.1560 35.8179 36.6444 39.1029 37.2192 220108 1.2101 1.2286 35.7009 37.1981 38.4718 37.1647 220110 2.0616 1.2286 43.8444 45.3683 47.3232 45.5499 220111 1.2935 1.2286 35.6223 36.8788 39.2865 37.3009 220116 1.8798 1.2286 40.0982 44.6345 47.0582 43.9023 220119 1.1259 1.2286 33.7200 36.2751 37.4673 35.8320 220126 1.2307 1.2286 35.6278 40.5321 38.0733 38.0049 220135 1.4968 1.2766 39.0296 40.3011 42.8827 40.7443 220153 *** * 20. 5063 17.4773 19.0273 19.2029 220154 *** * * * 43. 7359 43.7359 220162 1.7710 * * * * * 220163 1.6759 1.1560 39.4893 41.6485 42.2659 41.1896 220171 1.6535 1.1560 36.4567 39.7385 38.8272 38.4029 220174 1.2280 1.1560 32.9140 35.8880 34.9007 34.5714 220175 1.3204 1.1560 34.1572 36.6376 38.0801 36.2674 220176 1.5591 1.1560 31.4220 36.2759 38.1158 35.1359 220177 0.9796 0.9627 * * * * 230002 1.4172 0.9804 33.9708 34.2904 35.4085 34.5484 230003 1.4546 0.9343 28.9886 28.5041 30.5808 29.4057 230004 1.7665 0.9784 33.4644 33.1555 34.1260 33.5840 230005 1.3107 0.9054 29.0634 30.5550 31.3029 30.3037CMS-1498-P2 220

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 230013 1.3464 1.0088 28.6430 29.9019 31.7651 29.9529 230015 1.1276 0.8880 28.9601 29.8884 32.5133 30.4506 230017 1.7269 1.0266 36.8045 35.5276 37.9122 36.7658 230019 1.6780 1.0088 35.1440 34.8302 36.2716 35.4350 230020 1.7393 0.9804 29.9492 30.4302 31.1906 30.5265 230021 1.6302 0.9933 29.5414 30.4315 31.6153 30.5478 230022 1.1397 0.9714 25.7846 29.5713 32.6757 29.2761 230024 1.7276 0.9804 34.5278 35.1416 35.9913 35.2122 230029 1.7576 1.0088 33.1482 35.5257 33.5106 34.0740 230030 1.3448 0.9060 25.1929 27.8555 29.6479 27.5704 230031 1.5302 0.9681 30.8870 30.9321 31.8722 31.2241 230034 1.3190 0.8566 29.1098 29.8711 29.1077 29.3790 230035 1.3229 0.9272 25.7099 27.0372 27.3075 26.6792 230036 1.4412 0.8850 31.0938 31.9872 32.2768 31.7900 230037 1.2616 0.9804 28.8547 31.4423 32.0467 30.7793 230038 1.7841 0.9343 30.1040 31.5536 32.5264 31.4308 230040 1.1548 0.9272 27.2850 27.6894 27.5684 27.5177 230041 1.6226 0.9438 30.3082 31.7229 32.9174 31.6784 230046 1.9829 1.0061 33.5304 34.3952 35.9760 34.6925 230047 1.6075 0.9731 32.0248 33.2300 33.7264 32.9936 230053 1.7703 0.9804 33.5440 34.1884 35.6490 34.5004 230054 1.8298 0.9207 28.1229 28.5274 28.7117 28.4479 230055 1.3352 0.8566 28.1881 28.2657 29.6910 28.7240 230058 1.2321 0.8566 27.9643 29.2185 29.8956 29.0455 230059 1.6857 0.9343 28.3602 30.3935 32.7833 30.4889 230060 1.2298 * 28.7760 30.7515 * 29.7837 230066 1.2837 0.9784 32.3582 32.8383 34.5386 33.2625 230069 1.2686 0.9804 31.9675 33.3136 33.1722 32.8338 230070 1.6133 0.9168 28.0366 32.2151 31.6902 30.6210 230071 1.2460 1.0088 28.8879 29.6172 29.7855 29.4320 230072 1.4884 0.9343 28.8024 29.3214 30.4713 29.5569 230075 1.5124 0.9781 32.1166 33.2981 33.0856 32.8458 230077 1.8634 1.0088 31.0123 32.2274 33.2565 32.1576 230078 1.1159 0.8566 27.0069 27.7143 28.9163 27.8714 230080 1.1863 0.8566 25.6204 25.9082 27.1896 26.2395 230081 1.3269 0.8566 27.8106 27.9649 28.8068 28.1980CMS-1498-P2 221

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 230085 1.1525 1.0266 27.6474 28.1395 28.6603 28.1833 230089 1.4386 0.9804 32.2311 34.4092 * 33.3212 230092 1.4241 0.9423 30.5417 29.5262 32.3303 30.8026 230093 1.1780 0.8654 27.0572 27.7275 27.1808 27.3255 230095 1.1846 0.8850 25.9210 25.9787 26.7295 26.2107 230096 1.1720 0.9933 29.7225 30.9326 35.3084 32.0067 230097 1.6800 0.9272 31.5174 32.2990 31.8133 31.8763 230099 1.2400 0.9804 29.0975 30.7388 31.3316 30.3938 230100 1.4065 0.8566 25.6594 25.9480 27.1021 26.2240 230101 1.1279 0.8566 28.8608 29.4146 30.2722 29.5256 230104 1.7305 0.9804 34.0195 34.0176 35.3943 34.4648 230B04 5 *** * 34. 0195 34.0176 35.3943 34.4605 230106 1.1686 0.9343 30.0223 29.0344 31.2500 30.1013 230108 1.2433 0.8566 25.7477 25.4728 26.0197 25.7525 230110 1.3362 0.8566 27.0280 29.0921 30.1801 28.7817 230117 1.8114 1.0266 33.9176 33.6962 34.2863 33.9717 230118 1.2950 0.8566 24.8638 27.1359 28.4445 26.8191 230119 *** * 33. 2050 33.6503 * 33.4472 230121 1.3766 1.0098 27.7512 28.9511 30.8615 29.1524 230130 1.7250 1.0088 32.5613 33.6704 34.9198 33.7273 230132 1.6023 1.1330 38.2454 39.2894 39.7151 39.0892 230133 1.3475 0.8566 25.8537 26.1806 25.7151 25.9203 230135 1.0031 0.9804 31.5194 32.6527 * 32.0720 230141 1.6878 1.1330 36.3124 36.2647 40.7648 37.7993 230142 1.4114 0.9804 29.9911 30.2157 31.2257 30.4794 230146 1.4359 0.9804 29.0218 29.3346 30.5060 29.6420 230151 1.4202 1.0088 28.6724 28.6413 30.4839 29.2693 230156 1.7070 1.0061 34.7865 35.1696 34.0537 34.6666 230165 1.6917 0.9804 32.2855 31.9887 33.4514 32.6026 230167 1.6598 1.0222 32.8092 35.8019 36.9076 35.1687 230174 1.4021 0.9343 31.2469 31.6387 31.5781 31.4917 230176 1.4667 0.9804 29.2688 29.5281 30.9173 29.9026 230180 1.2683 0.8566 24.6007 28.1401 29.3516 27.1906 230190 *** * 33. 6724 30.7924 36.7558 33.6260 230193 1.4023 0.9681 28.4641 29.1474 31.5897 29.7561CMS-1498-P2 222

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 230195 1.5647 0.9731 32.5549 33.4975 33.4337 33.2184 230197 1.7706 1.1330 34.8066 36.4129 39.0787 36.8022 230204 1.4815 0.9731 30.1982 31.5389 34.3475 31.9741 230207 1.4333 1.0088 26.8231 27.2054 27.4081 27.1461 230208 1.2571 0.9272 25.2481 25.8892 27.8814 26.3666 230212 1.0316 1.0061 33.4379 34.3917 34.3170 34.0488 230216 1.5184 0.9681 28.9586 30.7478 30.8494 30.1826 230217 1.5091 0.9781 33.0839 35.4957 36.9025 35.2407 230222 1.6616 0.8850 32.4404 30.6277 29.6522 30.8343 230223 *** * 31. 8146 34.2971 * 33.0613 230227 1.5877 0.9731 34.2762 35.4364 37.2215 35.5888 230230 1.4717 1.0222 31.4953 31.2614 35.4132 32.7682 230236 1.5236 0.9343 31.9100 32.1973 33.9442 32.7342 230239 1.4068 0.8566 23.5461 26.8301 25.7446 25.3678 230241 1.2282 0.9681 30.0248 28.4771 28.1985 28.8297 230244 1.4335 0.9804 32.5586 33.0082 34.3841 33.3260 230254 1.5845 1.0088 31.6332 33.3035 35.0125 33.2978 230257 0.9982 0.9731 30.0674 32.6298 33.3636 32.2062 230259 1.4407 1.0061 27.9572 28.7672 29.1866 28.6444 230264 2.1717 0.9731 29.2202 35.0990 32.8671 32.3761 230269 1.4542 1.0088 34.2694 34.4514 35.2440 34.6832 230270 1.4328 0.9804 29.2408 29.0416 30.1197 29.4618 230273 1.5702 0.9804 32.5730 32.6874 34.8800 33.4102 230275 0.5916 0.9168 22.3740 * 22.6311 22.5224 230277 1.6115 1.0088 32.2545 33.8036 33.9308 33.3444 230279 0.6904 0.9804 26.8552 26.8567 28.8581 27.5609 230297 1.8559 0.9804 * 35.4246 38.9109 37.1670 230300 *** * * 40. 1731 * 40.1731 230301 1.2227 1.0088 * * 29.1394 29.1394 230302 1.4906 1.0088 * * * * 240001 1.5641 1.0976 37.2211 38.3979 41.1376 38.9343 240002 1.8190 1.0633 34.6368 36.8748 39.2785 37.0047 240004 1.8454 1.0976 33.4596 36.5476 38.0780 36.0985 240006 1.2478 1.0710 32.8229 29.6609 33.3951 31.7330 240010 2.0987 1.0710 35.9131 37.5473 37.9757 37.1825 240014 1.0711 1.0976 33.4492 35.0675 34.9155 34.4959CMS-1498-P2 223

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 240018 1.3136 1.0027 30.5645 32.3271 33.2201 32.0521 240019 1.1884 1.0633 34.2547 36.7033 37.3681 36.1294 240020 1.1431 1.0976 34.5703 34.6135 36.6782 35.2976 240022 1.0184 0.9104 28.5905 29.9313 31.1852 29.9071 240030 1.5777 0.9104 27.6596 29.4253 30.4810 29.1808 240036 1.5881 1.0976 37.2207 39.2407 40.6853 39.1270 240038 1.5960 1.0976 34.7357 35.8365 37.8663 36.2048 240040 1.0412 1.0633 30.0255 31.3287 34.0437 31.7765 240043 1.2674 0.9104 25.7424 27.1539 28.4042 27.1230 240044 1.0396 0.9837 28.5705 29.8375 29.2879 29.2433 240047 1.5709 1.0633 35.6763 36.7122 36.2255 36.2136 240050 1.2531 1.0976 33.7964 34.6160 36.3370 34.9328 240052 1.2601 0.9104 31.0934 33.1438 33.8454 32.7273 240053 1.6040 1.0976 34.4210 35.4738 36.3414 35.4352 240056 1.3478 1.0976 35.8603 36.1085 32.7052 34.7799 240057 1.9154 1.0976 34.8374 35.4436 38.0303 36.0623 240059 1.1327 1.0976 32.5958 33.5784 33.2499 33.1597 240061 1.8971 1.0710 34.6031 36.2545 37.5561 36.1385 240063 1.6747 1.0976 36.9822 38.3735 38.3869 37.9467 240064 1.2584 0.9316 29.9917 34.2284 35.6462 33.1970 240066 1.6077 1.0976 39.6609 38.4941 39.9654 39.3787 240069 1.2417 1.0976 31.1673 31.6325 35.5345 32.8398 240071 1.1899 1.0976 32.5460 33.1094 35.2567 33.6586 240075 1.2925 1.1001 30.3230 31.5984 32.9126 31.6235 240076 1.1549 1.0976 33.7950 35.4135 37.1723 35.5183 240078 1.7615 1.0976 36.2276 37.3608 39.4962 37.7013 240080 2.0360 1.0976 36.5390 37.7353 39.9460 38.0844 240084 1.1431 1.0633 29.0275 30.3789 32.3263 30.5812 240088 1.2605 1.1001 30.7240 31.4165 32.7525 31.5969 240093 1.5139 1.0976 30.4744 31.3517 32.3639 31.4358 240100 1.3557 0.9104 30.9481 32.5307 33.0821 32.1908 240101 1.1930 0.9249 28.5503 28.7121 29.5095 28.9269 240104 1.3000 1.0976 35.8839 36.0711 40.4033 37.5188 240106 1.6415 1.0976 33.9984 36.8942 39.4450 36.7952 240115 1.5182 1.0976 36.2788 37.5802 38.9388 37.6716 240117 1.2305 0.9719 29.0894 30.4437 29.6594 29.7231CMS-1498-P2 224

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 240132 1.4186 1.0976 36.4252 37.0941 37.9072 37.1624 240141 1.1176 1.0976 34.2473 35.8696 37.1809 35.6971 240166 1.2510 0.9104 26.1732 27.3184 28.1765 27.2416 240187 1.2545 1.0976 30.9646 33.5186 33.4717 32.6497 240196 0.8864 1.0976 35.0345 35.4472 38.7978 36.4399 240206 0.8428 1.4382 * * * * 240207 1.3525 1.0976 36.4569 37.7179 39.4085 37.8940 240210 1.3728 1.0976 36.5950 37.7064 38.2195 37.5323 240211 0.6922 1.0108 16.6158 16.1460 16.5163 16.4219 240213 1.4249 1.0976 37.4608 38.4222 39.6158 38.5555 250001 2.1543 0.8088 24.3404 26.7079 28.0700 26.4339 250002 0.9292 0.7998 25.0342 31.2353 32.6776 29.5266 250004 1.8180 0.8871 24.8086 29.1096 30.0764 27.9177 250006 1.1385 0.8871 27.0511 26.9193 29.3899 27.7903 250007 1.1775 0.8882 29.3479 32.6672 31.9040 31.2803 250009 1.4344 0.8341 24.9118 25.9247 27.4133 26.1295 250010 1.0254 0.7703 22.7988 23.8749 24.5667 23.7460 250012 0.9436 0.9171 26.4110 29.8873 27.8154 28.0019 250015 1.3891 0.7703 22.3685 22.7775 24.6835 23.2714 250017 0.9972 0.7703 25.7404 25.5007 22.3075 24.4789 250018 0.7464 0.7703 19.1108 19.5527 20.4538 19.7094 250019 1.6160 0.8882 27.7230 28.4743 30.6079 28.9597 250020 0.9777 0.7703 23.1521 26.9602 27.3319 25.8108 250023 0.8903 0.8312 19.5081 22.2932 17.2321 19.5475 250025 1.1249 0.7703 23.0555 26.0579 25.2972 24.7574 250027 0.9255 0.7703 32.5451 26.7593 26.0044 28.1387 250031 1.3465 0.8088 26.7507 28.6356 29.2948 28.1906 250034 1.6373 0.8871 27.9279 29.3365 30.0088 29.1234 250035 0.7907 0.7703 20.5251 24.0653 21.6802 22.1592 250036 0.9473 0.8145 22.5676 22.6781 24.7319 23.3935 250038 0.8901 0.8088 30.7960 27.1958 27.6152 28.2419 250040 1.6037 0.8312 26.2268 28.4423 29.0586 27.8924 250042 1.2263 0.8871 27.4610 25.8791 30.3623 27.9247 250043 1.0488 0.7703 21.1265 22.4618 22.6912 22.0994 250044 0.9899 0.7703 26.1732 26.9451 27.9188 27.0217 250048 1.5964 0.8088 27.6339 27.4186 27.6442 27.5667CMS-1498-P2 225

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 250049 0.9434 0.7703 24.2227 24.2129 21.5835 23.2761 250050 1.2840 0.7703 22.4429 22.6843 23.7790 23.0068 250051 0.7692 0.7703 14.1662 15.6982 15.7373 15.2520 250057 1.2695 0.7703 22.9683 22.5524 25.9738 23.8179 250058 1.2848 0.7703 19.6720 20.4748 22.1248 20.7697 250059 0.9412 0.7703 25.5982 24.8145 23.7995 24.7437 250060 0.8138 0.7703 27.0354 31.0689 32.3114 29.8012 250061 0.8353 0.7703 25.1495 23.3006 22.9622 23.7108 250067 1.1274 0.7703 23.8027 28.2894 27.2284 26.3793 250069 1.6226 0.7985 23.4495 25.8456 27.7173 25.6762 250072 1.7556 0.8088 27.5791 30.5382 33.2443 30.4790 250077 0.9612 0.7703 19.6333 19.3962 20.7217 19.9362 250078 1.7165 0.8312 23.9598 26.5481 27.5440 26.0252 250079 0.8236 0.8088 46.0349 32.3758 33.2547 37.9283 250081 1.4366 0.7985 24.8281 23.1385 25.6748 24.4935 250082 1.5383 0.8273 25.6218 27.8096 29.4889 27.6785 250084 1.1549 0.7703 19.5694 20.1192 21.2261 20.3028 250085 0.9389 0.7703 24.6757 24.5765 25.8783 25.0289 250093 1.2675 0.7703 26.4351 27.0937 28.9844 27.5340 250094 1.6566 0.8312 25.4232 26.1331 28.4550 26.7033 250095 1.1011 0.8088 25.9021 30.7505 25.2111 27.0637 250096 1.2779 0.8088 27.7291 27.5206 29.1993 28.1437 250097 1.5766 0.8541 22.7916 23.6607 24.1451 23.5520 250099 1.4358 0.8088 27.5757 25.0076 26.7877 26.4479 250100 1.4971 0.7985 27.5484 28.2019 29.4874 28.4283 250102 1.5878 0.8088 25.5327 27.8758 27.2188 26.8670 250104 1.4298 0.7985 25.4008 26.3140 25.7731 25.8274 250112 0.9397 0.7703 27.4162 29.6978 23.5300 26.6029 250117 1.0807 0.8312 24.5706 26.0965 24.8866 25.2046 250122 1.1551 0.7703 23.4908 27.3606 31.2642 27.3826 250123 1.3700 0.8882 29.8299 29.5520 32.4487 30.5969 250124 0.8592 0.8088 21.9420 22.4247 23.9262 22.8076 250125 *** * 32. 7411 29.0819 31.9629 31.3858 250126 1.0391 0.9171 25.2581 26.8712 26.7811 26.3514 250127 0.8051 1.4382 * * * * 250128 1.0195 0.8122 23.5918 24.7051 26.7124 25.1932CMS-1498-P2 226

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 250134 0.9778 0.8088 22.0846 40.7995 30.5066 30.6943 250136 1.0796 0.8088 27.1479 27.8270 30.6565 28.5419 250138 1.3635 0.8088 27.3132 27.0688 29.2021 27.8594 250141 1.5961 0.9171 33.4413 32.1496 31.6915 32.3561 250149 0.8744 0.7703 17.0964 17.2423 20.1488 18.0903 250151 0.6315 0.7703 * 17.3962 25.0894 22.4010 250152 0.9097 0.8088 28.5526 29.8216 30.9016 29.7410 250161 *** * * 26. 0070 * 26.0070 250162 1.0038 0.8893 * * 31.4828 31.4828 260001 1.7887 0.8409 31.1866 28.6690 30.0120 29.9052 260004 0.9453 0.8109 23.9584 24.1764 25.5508 24.5784 260005 1.6662 0.9019 31.1050 33.1020 35.2618 33.2207 260006 1.5176 0.8109 33.8253 34.3548 36.2278 34.8344 260009 1.1928 0.8566 26.6685 26.2248 26.1705 26.3503 260011 1.6596 0.8566 31.2612 31.4415 31.7034 31.4717 260015 1.1557 0.8109 25.0250 25.1585 26.2721 25.5036 260017 1.3354 0.8566 26.2621 27.4586 29.5743 27.7703 260020 1.7611 0.9019 30.9599 32.0889 31.9904 31.7069 260021 1.4447 0.9019 19.5810 19.3770 32.4283 21.7242 260022 1.4859 0.8223 25.9391 25.6866 26.7028 26.0941 260023 1.5492 0.9019 25.5899 26.7586 27.4201 26.6186 260024 1.1778 0.8109 20.7136 22.4347 22.9479 22.0397 260025 1.4225 0.8914 24.5042 24.4959 24.4546 24.4847 260027 1.8912 0.9514 31.0236 32.3066 33.7779 32.3722 260032 1.9415 0.9019 28.7183 29.8257 30.8428 29.7999 260034 0.9685 0.8109 28.7736 29.7821 29.4705 29.3435 260040 1.7603 0.8375 27.3680 28.5035 29.9909 28.6335 260047 1.4981 0.8109 27.2667 27.1986 27.8259 27.4384 260048 1.2788 0.9514 29.6969 30.1691 30.8650 30.2475 260050 1.0775 0.8109 27.8065 27.6085 33.8795 29.6615 260052 1.3299 0.9019 29.6998 31.5722 32.2076 31.2112 260057 1.0671 0.9514 23.8181 27.0128 27.1389 26.1324 260059 1.2757 0.8141 25.3025 26.9521 27.3419 26.5876 260061 1.1228 0.8109 23.6717 24.7824 27.0467 25.1434 260062 1.3726 0.9514 29.6156 30.7159 32.0976 30.8722 260064 1.4339 0.8149 21.4932 23.6002 25.8393 23.6092CMS-1498-P2 227

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 260065 1.7126 0.8375 28.3411 29.9325 29.6384 29.3273 260068 1.7723 0.8223 28.1246 29.3972 29.5631 29.0347 260070 0.8779 0.8109 25.2997 26.2370 25.8550 25.8217 260074 1.2943 0.8223 28.6216 28.4171 29.3367 28.7901 260077 1.7066 0.9019 28.7204 28.9940 29.4958 29.0802 260078 1.2849 0.8109 23.1785 24.7794 25.1259 24.3417 260080 1.0588 0.8109 18.6813 19.0041 19.1541 18.9629 260081 1.6605 0.9019 32.0799 34.8761 40.1198 35.5606 260085 1.6239 0.9514 29.6514 30.4727 31.6239 30.5668 260091 1.5674 0.9019 30.2636 32.9623 33.9609 32.4273 260094 1.6223 0.8375 25.1491 27.0127 27.2078 26.4777 260095 1.5411 0.9514 29.9090 30.9142 30.5602 30.4766 260096 1.6341 0.9514 32.9383 33.1804 34.9570 33.7008 260097 1.1617 0.8471 27.3129 28.2444 28.5379 28.0218 260102 1.0526 0.9514 30.7678 29.1467 30.1752 29.9874 260104 1.7078 0.9019 29.5891 32.0122 33.6904 31.7812 260105 1.8595 0.9019 32.4292 33.4278 35.1672 33.6282 260107 *** * 29. 7775 38.3668 * 33.8526 260108 1.8751 0.9019 28.5654 30.1064 31.5495 30.0747 260110 1.6558 0.8770 28.0381 28.5364 30.1062 28.9080 260113 1.2656 0.8342 23.0826 23.6758 25.6538 24.1544 260115 1.2365 0.9019 25.5658 26.5268 27.1964 26.4347 260116 1.0191 0.8342 22.5536 25.1758 27.7471 24.8978 260119 1.3362 0.8325 31.5003 26.4382 26.5894 27.9902 260137 1.7978 0.8409 31.4091 28.3521 29.0069 29.4979 260138 2.0048 0.9514 31.7582 33.4156 34.9809 33.4163 260141 2.0499 0.8223 26.6684 28.3492 28.1099 27.7524 260142 1.2469 0.8109 22.8205 25.0940 24.1327 24.0438 260147 0.8251 0.8109 22.9689 22.8326 25.3191 23.5737 260159 *** * 24. 3027 25.5039 26.0684 25.2758 260160 1.0383 0.8253 26.6715 27.9585 25.0259 26.6874 260162 1.4325 0.9019 30.5761 32.3673 33.0717 32.0297 260163 1.2350 0.8204 23.8644 25.0443 26.1076 25.0496 260166 *** * 29. 5259 30.6020 * 30.0575 260175 1.0460 0.9514 25.7069 26.5767 28.1661 26.8058 260176 1.7475 0.9019 30.6205 32.4957 33.1495 32.1198CMS-1498-P2 228

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 260177 1.3018 0.9514 29.0815 31.1662 33.9925 31.4147 260178 1.9849 0.8223 26.9902 28.9170 29.8616 28.6265 260179 1.5711 0.9019 29.6316 30.3276 30.8119 30.2731 260180 1.7531 0.9019 30.7336 31.4721 32.7989 31.6539 260183 1.6167 0.8770 31.4916 32.2621 31.3742 31.7100 260186 1.5186 0.8566 29.1874 30.8706 32.4493 30.8711 260190 1.3538 0.9514 30.9003 32.2069 34.1815 32.3839 260191 1.5869 0.9019 27.8648 28.7185 29.0100 28.5516 260193 1.3548 0.9514 29.5436 30.5190 31.7196 30.5601 260195 1.4152 0.8109 25.0294 25.6697 26.6828 25.8073 260198 *** * 27. 9093 31.4660 * 29.5529 260200 1.4152 0.9019 30.5032 32.0910 35.5276 32.9288 260207 1.1898 0.8375 23.6392 22.8308 22.7884 23.0797 260209 1.0738 0.8566 26.4203 33.7185 32.9213 30.8380 260210 1.2999 0.9019 36.4055 33.5701 35.4741 35.1652 260211 1.3016 0.9514 37.1557 42.4297 36.1850 38.3836 260214 1.3113 0.9514 31.0175 31.7957 34.1199 32.2663 260216 1.3206 0.9514 * 32.4039 33.4387 32.9968 260217 *** * * 12. 2879 * 12.2879 260219 1.3400 0.9019 * * 30.7118 30.7118 260220 *** * * * 28. 4885 28.4885 260221 2.0760 0.8375 * * * * 260222 3.1344 0.9514 * * * * 260223 2.1186 1.0330 * * * * 270002 1.1098 1.0000 28.3379 26.9419 28.2480 27.8202 270003 1.2908 1.0000 28.0543 28.5127 29.8638 28.8333 270004 1.7281 1.0000 28.5869 29.4694 31.2252 29.8125 270012 1.6404 1.0000 28.0672 27.9087 28.8521 28.2738 270014 2.0243 1.0000 28.2582 30.1101 30.2981 29.5713 270017 1.3880 1.0000 29.3542 29.4260 31.2231 30.0045 270023 1.6600 1.0000 28.1896 30.9908 31.5012 30.2124 270032 1.0183 1.0000 21.6360 21.5106 23.5705 22.2266 270049 1.8451 1.0000 29.8891 31.3941 31.2349 30.8507 270051 1.4506 1.0000 29.3941 29.1163 30.1070 29.5459 270057 1.4282 1.0000 28.3627 29.5317 31.6476 29.8918 270074 0.9307 1.4382 * * * *CMS-1498-P2 229

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 270086 1.4090 1.0000 21.9017 27.3995 29.1257 26.4704 270087 1.5197 1.0000 24.9197 24.2168 24.9946 24.6957 280003 1.8427 0.9447 32.3780 33.7700 34.2000 33.4257 280009 1.8904 0.9447 28.1559 31.9280 33.6269 31.2504 280013 1.7682 0.9510 30.3120 31.9793 32.8493 31.7431 280020 1.6813 0.9447 29.4831 30.3731 32.3597 30.7314 280023 1.4338 0.9447 30.0717 31.9420 31.3884 31.1400 280030 1.8814 0.9510 31.8758 33.4544 34.0104 33.0874 280032 1.4305 0.8845 25.6549 25.8707 27.6089 26.3994 280040 1.6949 0.9510 30.7406 32.1005 32.7707 31.9093 280060 1.7924 0.9510 30.4625 32.0607 33.5256 32.0484 280061 1.4381 0.8845 28.9591 29.2231 30.8542 29.7095 280065 1.2973 0.9375 29.5470 30.1143 30.8900 30.1783 280077 1.3795 0.9447 29.9223 29.7362 31.3194 30.3231 280081 1.6286 0.9510 28.9696 31.0768 35.8382 31.9389 280105 1.2687 0.9510 30.0472 33.3196 33.1407 32.1834 280111 1.1463 0.8845 28.3541 29.0865 29.9691 29.1189 280119 0.8685 1.4382 * * * * 280123 *** * 20. 2741 20.6384 29.1514 22.7020 280125 1.5076 0.8927 24.7466 25.1212 30.7311 26.8386 280127 1.9295 0.9447 26.5659 28.4607 27.8198 27.6863 280128 2.7835 0.9447 27.1024 19.2781 30.1879 25.4888 280129 2.0282 0.9510 27.9511 30.4258 30.9589 29.8728 280130 1.4549 0.9510 29.9645 32.4243 33.1336 31.9744 280131 2.1542 0.9510 * * * * 290001 1.7980 1.0391 33.3318 32.3610 34.3377 33.3434 290002 0.8656 1.0000 22.7362 25.4458 22.9980 23.6418 290003 1.8020 1.1757 34.6433 36.8494 40.5365 37.2945 290005 1.5573 1.1757 34.2373 34.2514 36.3971 34.9747 290006 1.1041 1.0391 33.3243 32.9232 35.2729 33.8405 290007 1.8733 1.1757 41.2395 44.0851 42.0134 42.4287 290008 1.2259 1.0000 33.2473 36.1620 38.0995 35.8471 290009 1.8183 1.0391 34.2103 38.6692 40.9685 37.9159 290012 1.3732 1.1757 38.3731 38.1494 39.8936 38.8324 290019 1.6158 1.0391 32.2817 34.3215 35.6893 34.1535 290020 0.9789 1.0000 27.2908 25.3592 28.1710 26.9891CMS-1498-P2 230

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 290021 1.6573 1.1757 36.8728 39.5976 41.5629 39.3340 290022 1.7355 1.1757 38.8262 40.9896 41.3493 40.4278 290027 0.8303 1.0000 29.1123 25.1315 17.5194 22.5706 290032 1.4270 1.0391 36.9175 38.9632 37.5999 37.8103 290039 1.6578 1.1757 34.6359 37.5722 41.3057 37.8449 290041 1.4861 1.1757 38.4445 40.0602 42.8383 40.5654 290045 1.7861 1.1757 38.2560 38.5440 40.6077 39.1861 290046 1.5403 1.1757 38.3112 41.5550 42.1303 40.8035 290047 1.7100 1.1757 35.6381 38.6892 41.6528 38.6969 290049 1.4003 1.0391 33.4278 33.2014 34.9166 33.8543 290051 2.0280 1.0235 32.5277 37.2727 37.4812 35.6526 290053 1.7043 1.1757 * * 41.7596 41.7596 290054 1.3973 1.1757 * * * * 290055 1.5038 1.0235 * * * * 300001 1.4814 1.0008 31.0122 31.4533 31.9222 31.4790 300003 2.0987 1.0008 37.7246 37.3007 37.8482 37.6390 300005 1.4367 1.0008 28.8402 29.4927 32.0379 30.1494 300011 1.3554 1.0940 33.0785 32.7459 35.9010 33.9466 300012 1.4793 1.0940 33.0569 34.8519 34.3089 34.0963 300014 1.2376 1.0171 30.7735 32.8211 33.7545 32.5359 300017 1.4332 1.0971 33.4164 35.2028 37.5444 35.3995 300018 1.3748 1.0171 31.5028 32.7008 33.9529 32.7460 300019 1.3351 1.0211 28.3114 30.5332 31.7382 30.2375 300020 1.4207 1.0940 32.4655 34.7678 36.3083 34.5838 300023 1.4607 1.0008 32.3202 34.2636 35.1291 33.9582 300029 1.8966 1.0971 32.0033 35.3112 36.0190 34.4466 300034 1.8501 1.0940 33.5537 33.7397 32.8443 33.3569 310001 1.8394 1.3094 41.4946 44.8619 50.6238 45.4383 310002 1.8317 1.2825 37.9484 39.7599 41.2456 39.6858 310003 1.3084 1.3094 40.1543 39.8679 42.8065 40.9664 310005 1.3923 1.1280 34.7657 34.4087 36.0844 35.0992 310006 1.4947 1.3094 30.4296 29.1025 36.9201 33.0307 310008 1.4134 1.3094 34.3268 36.2903 37.2702 35.9673 310009 1.4910 1.2825 35.4624 37.9098 37.8328 37.0580 310010 1.3390 1.1249 36.0823 34.1071 34.7174 34.9269 310011 1.3734 1.1249 37.4855 34.0850 38.0642 36.5086CMS-1498-P2 231

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 310012 1.5578 1.3094 41.9630 41.3814 44.1956 42.5328 310013 *** * 32. 9488 * * 32.9488 310014 1.9878 1.1249 35.0124 39.7527 42.5981 39.1445 310015 1.9757 1.2825 40.8229 39.5076 41.0862 40.4747 310016 1.3519 1.3094 41.0363 39.7563 42.6321 41.1071 310017 1.3342 1.2825 35.9806 34.8881 36.6814 35.8577 310018 *** * 32. 6956 33.5069 33.6869 33.3032 310019 1.5578 1.3094 31.8930 34.6618 36.9116 34.4783 310020 *** * 38. 4266 34.8440 33.1591 35.6399 310021 1.5817 1.1249 32.2064 33.2554 32.9745 32.8103 310022 1.3683 1.1249 32.8079 32.8154 35.0037 33.5940 310024 1.4947 1.1280 36.8666 34.7011 38.7731 36.8133 310025 1.4049 1.3094 32.1481 35.2564 40.8475 35.5411 310026 *** * 30. 1321 31.9905 * 31.0489 310027 1.5531 1.1280 34.6471 34.1653 35.4202 34.7452 310028 1.2605 1.1280 34.8332 37.2987 38.5629 36.9482 310029 1.7816 1.1249 35.2084 36.5179 37.3225 36.3377 310031 2.6733 1.1249 39.5911 38.2643 39.1387 39.0033 310032 1.4461 1.1249 35.2402 35.8019 38.1019 36.3949 310034 1.4950 1.1249 36.8614 37.1191 38.7316 37.5645 310037 *** * 40. 4642 44.3134 40.6768 41.8620 310038 1.8962 1.2825 39.8707 40.7395 41.0737 40.5745 310039 1.3494 1.2825 32.6425 33.4253 37.6948 34.5052 310040 1.2885 1.3094 41.2246 38.3232 42.0647 40.5945 310041 1.3677 1.1249 35.2009 34.4308 35.9905 35.2159 310044 1.4058 1.1249 33.5868 35.9981 36.7851 35.4384 310045 1.6751 1.3094 39.2097 40.3222 39.4667 39.6718 310047 1.3605 1.1249 37.7220 38.1213 38.6544 38.1625 310048 1.3744 1.1280 34.5256 33.9641 35.1089 34.5372 310050 1.3717 1.2825 37.9214 32.5213 36.1607 35.4032 310051 1.5361 1.1280 39.7671 37.9104 41.4326 39.7291 310052 1.4235 1.1249 36.5494 36.2042 36.6736 36.4774 310054 1.3353 1.2825 38.2432 37.2851 38.6073 38.0262 310057 1.4774 1.1249 34.2052 32.8649 33.3760 33.4433 310058 1.0417 1.3094 30.4436 32.1349 27.4856 30.0784 310060 1.4272 1.1249 27.9134 30.4626 31.0602 29.7917CMS-1498-P2 232

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 310061 1.3306 1.1249 33.5586 33.6084 36.9685 34.7294 310063 *** * 38. 1481 36.7131 40.5744 38.4253 310064 1.6138 1.1249 39.8091 39.9456 39.4518 39.7314 310069 1.2782 1.1249 35.1376 36.9367 38.6358 36.8960 310070 1.4374 1.2825 36.9999 36.8951 38.3936 37.4045 310073 1.8090 1.1249 36.9249 37.5317 38.0676 37.5047 310074 1.3788 1.3094 39.0729 35.9044 36.5051 37.2159 310075 1.3708 1.1249 33.5253 33.8979 36.8738 34.7688 310076 1.7422 1.2825 38.1671 39.0325 41.7283 39.6466 310081 1.4281 1.1249 31.7981 32.1241 34.1491 32.7041 310083 1.5302 1.2825 28.3406 28.2875 32.3793 29.6429 310084 1.2977 1.1249 34.9626 34.3130 35.9514 35.1066 310086 1.2760 1.1249 30.9467 31.4837 32.6634 31.7177 310088 1.1089 1.1249 31.2437 28.1703 30.2907 29.8993 310090 *** * 33. 9174 36.2502 39.0484 36.2524 310091 1.2160 1.1249 35.2913 34.8679 36.3009 35.4738 310092 1.5401 1.1249 32.8431 34.8028 35.8723 34.4902 310093 *** * 32. 3860 33.4460 31.7831 32.5380 310096 1.7501 1.2825 34.2014 36.3201 35.9746 35.5053 310105 *** * 32. 0277 31.3423 38.1225 33.7325 310108 1.5387 1.2825 36.2848 38.3403 40.4235 38.3602 310110 1.3629 1.1249 35.6825 36.5227 34.9354 35.6895 310111 1.3887 1.1249 36.0748 38.3519 38.6478 37.7170 310112 1.3763 1.1249 34.5337 33.6207 34.5131 34.2210 310113 1.3519 1.1249 35.0245 38.0066 38.4702 37.2154 310115 1.4081 1.1249 32.1197 33.7061 34.3696 33.4228 310116 1.3231 1.3094 27.8677 35.3805 35.7518 32.7295 310118 1.3491 1.3094 32.8286 33.2234 33.7344 33.2605 310119 1.9233 1.2825 41.2997 46.1339 47.1035 44.7858 310120 1.0481 1.1280 35.1661 36.3365 37.6331 36.3759 310126 *** * 34. 3189 * * 34.3189 310127 *** * * 40. 1255 * 40.1255 320001 1.8271 0.9594 31.4193 33.6433 35.9775 33.8378 320002 1.5849 1.0739 34.1610 35.6036 37.4477 35.7737 320003 1.0965 1.0352 31.5792 31.4445 34.6790 32.5200 320004 1.3353 0.8989 28.2407 30.5543 31.0096 29.9078CMS-1498-P2 233

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 320005 1.6317 0.9462 25.2168 26.4658 27.9464 26.5665 320006 1.2566 0.9462 28.5177 31.6888 35.2623 31.7638 320009 1.7026 0.9594 31.3296 31.7240 33.1269 32.2269 320011 1.1092 0.9326 28.9951 30.6151 31.5915 30.3549 320013 1.2176 1.0352 31.2890 31.7159 31.8550 31.6268 320014 1.0148 0.9141 30.4803 29.8578 33.1461 31.2305 320016 1.1858 0.8989 26.6392 27.7121 27.8593 27.4337 320017 1.3865 0.9594 30.5787 30.9261 28.3807 29.6659 320018 1.5868 0.9141 28.3465 29.9038 32.8908 30.3587 320019 *** * 28. 7067 31.8205 34.4963 30.4182 320021 1.5923 0.9594 29.6464 31.3577 32.8369 31.4496 320022 1.1128 0.8989 27.5152 28.7195 30.9229 28.9228 320030 0.9864 0.8989 25.5267 28.5145 29.5507 27.9621 320033 1.2665 1.0352 30.1846 32.8631 36.8262 33.1229 320037 1.1970 0.9594 27.8982 28.6968 29.0394 28.5512 320038 1.2537 0.8989 31.6526 33.2147 34.1644 33.0257 320057 0.8901 1.4382 * * * * 320058 0.7912 1.4382 * * * * 320059 1.0293 1.4382 * * * * 320060 1.0719 1.4382 * * * * 320061 1.0731 1.4382 * * * * 320062 0.8817 1.4382 * * * * 320063 1.2855 0.9233 27.4946 30.2997 31.3336 29.7847 320065 1.2319 0.9233 26.9130 27.9999 31.2804 28.6457 320067 0.8536 0.8989 25.4121 23.6677 26.3413 25.1468 320069 1.0613 0.8989 25.3151 26.5521 25.6533 25.8355 320070 0.9578 1.4382 * * * * 320074 1.3254 0.9594 28.8088 29.8317 31.0548 30.0014 320079 *** * 31. 5661 30.3600 * 30.9560 320083 2.2519 0.9594 32.9476 35.1125 33.6069 33.8474 320084 0.8797 0.8989 24.2902 25.9161 27.1350 25.8609 320085 1.7238 0.9141 28.4537 28.7114 30.1280 29.0969 320086 1.3497 0.8989 * * 25.1198 25.1198 320087 1.6719 1.0739 * * 42.5428 42.5428 320088 2.4348 0.9141 * * 34.8348 34.8348 330002 1.7166 1.3094 34.7270 35.3553 37.0389 35.6963CMS-1498-P2 234

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330003 1.4425 0.8668 26.8363 27.7173 28.8520 27.8126 330004 1.3751 1.1022 30.3221 30.8305 31.6848 30.9524 330005 1.6498 0.9584 33.2851 34.1763 35.4979 34.3373 330006 1.4087 1.3094 36.3305 38.6645 38.8190 37.9639 330008 1.1596 0.9584 26.2141 26.7882 28.4993 27.1558 330009 1.4682 1.3094 41.3797 42.4137 43.3382 42.4122 330010 1.1603 0.8441 20.5805 24.3033 * 22.4266 330011 1.2668 0.8891 26.8269 29.2672 30.3716 28.8455 330013 1.9518 0.8668 28.8039 29.2399 30.3522 29.4870 330014 1.4172 1.3094 46.3170 48.1054 48.9173 47.8284 330019 1.2184 1.3094 44.5669 46.8153 47.5751 46.3311 330023 1.5195 1.2825 37.5135 40.9595 42.7458 40.4809 330024 1.8856 1.3094 44.8070 46.2954 46.9066 46.0301 330025 1.1126 0.9584 24.2702 26.5550 27.7959 26.2089 330027 1.3420 1.2825 45.9571 49.0573 51.4887 48.8103 330028 1.5496 1.3094 38.0149 38.7770 44.2973 40.0572 330029 0.6085 0.9584 22.9332 23.7555 23.2845 23.3244 330030 1.2366 0.8668 25.5089 27.4344 29.0646 27.3460 330033 1.1516 0.8560 25.0215 26.7551 25.6393 25.7911 330036 1.2446 1.3094 30.4659 31.2701 33.0839 31.6283 330037 1.1595 0.8668 23.4915 24.4428 25.1766 24.3854 330041 1.3783 1.3094 37.1651 41.2299 45.4010 40.9876 330043 1.5215 1.2533 40.6094 42.4560 43.3176 42.1465 330044 1.3451 0.8697 28.2638 29.4872 31.0628 29.6090 330045 1.5074 1.2533 41.6565 44.7551 43.4805 43.2898 330046 1.5094 1.3094 52.2397 53.4532 55.0516 53.5982 330047 1.3009 0.8441 22.9948 27.4392 27.9776 26.2104 330049 1.6219 1.1366 34.9740 38.0110 39.1050 37.4092 330053 1.0453 0.8668 20.1303 21.4837 22.9142 21.4899 330055 1.6466 1.3094 44.2343 44.6905 45.0891 44.6857 330056 1.5790 1.3094 39.9662 40.5499 43.3731 41.2870 330057 1.8056 0.8668 30.1821 30.5006 31.3091 30.6714 330058 1.4159 0.8668 23.6296 25.3712 26.6416 25.2427 330059 1.6093 1.3094 45.3691 47.7115 48.5102 47.2325 330061 1.2404 1.3094 37.8649 38.8790 38.2257 38.3275 330064 1.4200 1.3094 41.5737 39.5994 39.7532 40.3486CMS-1498-P2 235

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330065 1.1305 0.9584 26.2288 28.6809 29.2490 28.0535 330066 *** * 27. 2085 30.7011 31.6665 29.8079 330067 1.4686 1.1366 30.7537 31.5572 33.4719 31.8968 330072 *** * 41. 4605 40.5965 41.2397 41.0975 330073 1.1842 0.8668 25.1392 24.8055 27.0827 25.6766 330074 1.1789 0.8668 23.1016 24.6973 24.5262 24.0899 330075 1.1415 0.9666 23.7522 27.5360 29.7333 26.9519 330078 1.4769 0.9584 27.6682 30.8157 31.7996 30.0981 330079 1.4095 0.9285 27.9479 28.7349 30.3415 29.0021 330080 1.2278 1.3094 40.2067 47.4529 47.6661 45.2191 330084 1.0795 0.8381 27.3434 28.8661 32.3490 29.4885 330085 1.1543 0.8381 27.1707 27.7050 29.8188 28.2639 330086 1.4037 1.3094 40.9768 44.0362 43.8907 42.9617 330088 1.0424 1.2533 37.4716 41.8635 40.8115 40.0302 330090 1.5852 0.9145 27.7306 29.5626 31.1822 29.4923 330091 1.3864 0.9584 28.3034 30.9457 31.7515 30.3752 330094 1.2966 1.0112 28.6213 33.0706 34.7858 32.0911 330096 1.2839 0.8381 24.7895 24.8667 25.8292 25.1613 330100 1.0060 1.3094 39.3170 38.6625 42.2645 40.0975 330101 1.9953 1.3094 45.5412 49.6431 49.8588 48.3746 330102 1.5567 0.9584 27.2543 31.6270 31.8101 30.2074 330103 1.2588 0.8517 25.4919 26.1064 27.2392 26.3017 330104 1.4546 1.3094 36.5894 38.4254 39.2321 38.0457 330106 1.7129 1.2825 48.2903 47.2240 50.3199 48.5977 330107 1.2256 1.2533 38.0262 40.2541 42.4304 40.1994 330108 1.1028 0.8501 25.3023 25.5480 26.9810 25.9259 330111 0.9381 0.9584 23.2134 25.1572 26.0179 24.6747 330115 1.1378 0.9666 24.3898 27.0362 25.4507 25.6316 330119 1.8188 1.3094 41.2365 43.8894 44.0249 43.0193 330125 1.7757 0.8668 29.4817 30.4389 30.4103 30.1168 330126 1.3867 1.2825 37.7807 40.0542 41.7981 39.8971 330127 1.4712 1.3094 45.2554 51.8817 48.5274 48.5452 330128 1.2873 1.3094 43.3437 41.7875 46.9809 44.0332 330132 1.0753 0.8517 22.1452 23.4437 23.9298 23.1468 330133 *** * 39. 9025 * * 39.9025 330135 1.2525 1.1854 33.2314 35.3624 39.4523 36.0995CMS-1498-P2 236

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330136 1.6306 0.8668 25.4198 27.9525 28.3358 27.2668 330140 1.8705 0.9666 31.1333 32.7905 33.3826 32.4461 330141 1.3455 1.2533 39.1733 41.4127 44.4198 41.7713 330144 0.9644 0.8437 24.9304 26.0623 28.4224 26.4223 330151 1.2456 0.8437 21.6339 23.4664 23.7227 22.9394 330152 1.4485 1.3094 39.5754 45.9310 54.7885 46.5567 330153 1.7004 0.8668 28.9944 31.7611 31.6854 30.8216 330154 1.5936 * * * * * 330157 1.3987 0.9666 29.7622 30.2745 31.5462 30.5482 330158 1.8465 1.3094 39.5946 41.6800 45.4100 42.4088 330159 1.3174 0.9666 33.8484 35.6944 36.1910 35.2789 330160 1.5849 1.3094 39.0970 42.1789 42.6001 41.2794 330162 1.2954 1.3094 38.7638 39.3460 39.3481 39.1620 330163 1.0935 0.9584 28.6252 26.3050 28.3979 27.7803 330164 1.5397 0.8668 29.8458 30.3023 31.3949 30.5335 330166 0.8986 0.8381 22.8506 23.2773 24.1281 23.4282 330167 1.6650 1.2825 39.2421 40.8753 40.4764 40.2069 330169 1.4020 1.3094 47.5404 49.7924 52.6481 49.9729 330175 1.1395 0.8603 26.7883 28.2085 29.0736 28.0498 330177 0.9519 0.8381 23.4299 26.0397 26.3552 25.2331 330180 1.3073 0.8668 26.8658 28.0975 28.8360 27.9626 330181 1.4442 1.2825 46.2181 47.2523 47.5998 47.0087 330182 2.3077 1.2825 42.7962 46.6346 47.1719 45.5399 330184 1.4461 1.3094 39.7242 41.3935 44.1215 41.7428 330185 1.3245 1.2533 39.6724 41.3543 42.6846 41.2528 330188 1.3394 0.9584 29.7318 30.7222 31.9349 30.8079 330189 0.9639 0.8668 25.8125 26.4233 27.1290 26.4668 330191 1.3966 0.8668 28.2949 29.3753 30.8219 29.5362 330193 1.5971 1.3094 40.0280 40.7257 41.4653 40.7612 330194 1.7160 1.3094 49.8886 49.9208 51.5125 50.4577 330195 1.6426 1.3094 43.3213 46.0878 46.8783 45.3774 330196 1.3574 1.3094 38.6949 42.8106 47.1254 42.9572 330197 1.1361 0.8381 26.5525 27.6437 28.8743 27.7160 330198 1.5031 1.2825 35.8715 37.9641 39.0864 37.7000 330199 1.1339 1.3094 39.4076 47.5059 46.3505 44.4308 330201 1.8227 1.3094 46.5114 51.2179 54.5822 50.6852CMS-1498-P2 237

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330202 1.3722 1.3094 38.7624 42.1074 46.7852 42.6301 330203 1.5060 0.9666 34.6525 33.9161 34.8968 34.4914 330204 1.3905 1.3094 39.5324 44.8153 45.9057 43.4038 330205 1.3126 1.1854 35.3792 37.0171 39.7040 37.4547 330208 1.2411 1.3094 37.1735 38.7279 40.4900 38.7610 330211 1.2386 0.8381 24.9432 25.6929 25.1977 25.2864 330213 1.0549 0.8697 28.5370 30.0957 30.7737 29.8133 330214 1.9522 1.3094 43.3229 43.6872 45.3214 44.1777 330215 1.3738 0.8381 26.3978 28.0026 29.8652 28.0726 330218 1.1081 0.9666 28.4113 28.4369 28.6896 28.5177 330219 1.7911 0.9584 33.2147 38.3321 35.2787 35.5523 330221 1.6164 1.3094 42.5486 40.5201 40.5359 41.2446 330222 1.4126 0.8684 28.7858 30.5142 30.9231 30.1149 330223 0.9881 0.8381 27.1970 28.2638 29.7060 28.4078 330224 1.3051 1.1022 30.4784 32.4518 32.2402 31.7207 330225 1.2507 1.2825 32.9036 33.7052 32.9394 33.1790 330226 1.5413 0.8668 26.3685 25.7981 25.8056 25.9824 330229 1.2515 0.8381 23.9243 24.9977 25.8926 24.9413 330230 *** * 39. 3863 39.5043 38.2724 39.1655 330231 1.1081 1.3094 48.9021 49.1983 55.0629 51.0168 330232 1.3400 0.8668 27.9615 28.7263 30.4424 29.0437 330233 1.7151 1.3094 40.8539 43.4873 45.0313 43.1279 330234 2.3642 1.3094 49.8804 55.2159 52.8431 52.7054 330235 1.1918 0.8381 30.8034 31.2218 32.2728 31.3938 330236 1.5342 1.3094 42.6205 45.0321 46.2233 44.6274 330238 1.1263 0.8668 23.3953 24.7086 25.0088 24.3863 330239 1.2644 0.8381 24.6391 24.7255 25.3756 24.9143 330240 1.2759 1.3094 41.6132 42.5871 39.9681 41.3705 330241 1.8864 0.9666 32.9275 34.7013 35.6452 34.4408 330242 *** * 38. 7875 40.2224 38.6084 39.2370 330245 1.7049 0.8697 28.6698 29.3183 29.9976 29.3388 330246 1.4001 1.2533 35.9577 39.4705 37.8934 37.7571 330247 *** * 41. 3465 39.8390 41.3991 40.8503 330249 1.3877 0.9666 26.9856 29.4003 31.3898 29.2579 330250 1.4215 1.0025 29.6186 32.1740 32.6642 31.4918 330259 1.4278 1.2825 39.0213 38.5914 37.9733 38.5494CMS-1498-P2 238

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330261 1.2872 1.3094 38.0216 37.9563 43.0206 39.7053 330263 0.9364 0.8381 24.2125 25.5991 27.1890 25.6737 330264 1.4015 1.1854 32.5050 35.1876 37.0730 34.9405 330265 1.2783 0.8668 22.7433 22.8141 23.4393 23.0082 330267 1.5186 1.3094 35.3907 38.1619 39.3105 37.7127 330268 0.9270 0.8381 23.9135 25.7738 27.2044 25.6557 330270 2.1604 1.3094 52.3154 55.7360 54.4915 54.2881 330273 1.4195 1.3094 39.7880 41.3568 43.8576 41.7263 330276 1.0974 0.8413 27.0445 28.5781 29.1322 28.2518 330277 1.3453 0.9145 30.8156 30.8543 30.9283 30.8668 330279 1.6990 0.9584 31.2393 33.7210 34.1573 33.0755 330285 1.9158 0.8668 31.8987 33.0830 34.8538 33.3318 330286 1.3682 1.2533 38.8556 40.3250 42.5791 40.6255 330290 1.6635 1.3094 39.8036 43.2989 45.9549 43.0520 330304 1.3128 1.3094 39.4632 39.7987 39.8891 39.7160 330306 1.5933 1.3094 39.0409 40.3216 43.4869 40.9711 330307 1.3162 0.9732 30.8121 33.6277 34.1345 32.8690 330314 *** * 22. 6885 38.7241 * 24.3594 330316 1.3911 1.3094 37.9357 40.3783 41.6082 39.9746 330331 1.3669 1.2825 44.1734 44.3947 46.9048 45.1731 330332 1.3212 1.2825 38.6932 40.8557 43.4228 41.0514 330339 *** * 25. 0057 26.8982 28.5075 26.7655 330340 1.2054 1.2533 38.4726 38.4180 42.2175 39.7075 330350 1.5307 1.3094 44.2389 47.8575 48.0009 46.7458 330353 1.4414 1.3094 46.0215 45.8432 49.5882 47.1722 330354 1.9646 * * * * * 330357 1.5294 1.3094 40.2132 45.4617 46.6428 43.1989 330372 1.3511 1.2825 37.0323 40.3348 43.4028 40.1441 330385 1.1384 1.3094 47.4017 51.5393 45.1489 48.1275 330386 1.3008 1.1280 32.9990 35.2560 36.5454 34.8018 330389 *** * 37. 5908 39.3586 * 38.5126 330390 1.5026 1.3094 38.7652 35.4546 38.7532 37.4670 330393 1.7670 1.2533 38.9324 40.1511 41.2486 40.1584 330394 1.6358 0.8891 28.8074 30.5684 31.6244 30.3603 330395 1.3609 1.3094 50.1316 41.6484 45.4826 45.3889 330396 1.5484 1.3094 39.1956 41.6293 44.4691 41.8352CMS-1498-P2 239

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 330397 1.4662 1.3094 41.1682 41.0651 42.6933 41.6049 330399 1.2742 1.3094 39.8023 41.7487 43.7557 41.7446 330401 1.3844 1.2533 41.7839 47.0780 45.2281 44.6412 330403 0.8761 0.8668 28.7282 26.7473 23.7571 26.0020 330404 1.1578 1.3094 36.1069 36.8792 36.7400 36.5676 330405 1.1290 1.3094 35.2720 38.6588 39.7124 37.3537 330406 1.1795 0.8668 28.2733 28.0950 29.0800 28.3975 330407 *** * * * 22. 8305 22.8305 340001 1.5740 0.9257 29.9718 30.6910 31.4272 30.7359 340002 1.8308 0.9015 30.7403 31.6973 32.7669 31.7640 340003 1.4893 0.8438 26.6831 28.0732 28.5497 27.8127 340004 1.5876 0.8976 27.9200 30.6110 31.1689 29.9152 340008 1.2878 0.8729 29.0661 30.7569 34.1051 31.2995 340010 1.4897 0.8438 29.5232 31.0327 32.4035 31.0271 340011 1.1201 0.8438 22.5152 23.6040 24.0602 23.4067 340012 1.2071 * 24.9271 * * 24.9271 340013 1.2699 0.9099 26.9152 29.2509 27.6445 27.9355 340014 1.6864 0.8976 29.5350 29.4771 30.8373 29.9760 340015 1.4756 0.9099 30.0979 30.7573 28.8959 29.8838 340016 1.4468 0.8438 27.9651 27.2226 28.5561 27.9443 340017 1.4517 0.9015 28.4866 28.4785 30.0523 29.0201 340020 1.2373 0.8601 28.3461 30.5510 32.0755 30.2875 340021 1.5313 0.9099 31.3630 32.5625 31.4752 31.8018 340023 1.4538 0.9086 27.6921 29.5911 30.1104 29.1815 340024 1.3148 0.8581 26.9001 27.4770 28.5059 27.6241 340025 *** * 25. 2846 25.8195 27.0389 26.0605 340027 1.2773 0.9151 26.6528 27.2788 27.9469 27.2947 340028 1.5908 0.9411 31.9872 31.7634 33.0069 32.2702 340030 2.1669 0.9619 31.2051 31.5786 33.0418 31.9615 340032 1.5602 0.9257 29.2080 29.3927 31.1516 29.9329 340035 1.0454 0.8438 26.0846 26.8821 28.5418 27.1710 340036 1.1481 0.9670 29.0646 29.9160 32.2510 30.4372 340037 1.3488 0.9099 30.5362 32.0484 32.2585 31.6367 340038 1.2142 0.8767 26.2600 26.9487 27.5626 26.9249 340039 1.3643 0.8976 29.5069 30.2952 30.5891 30.1244 340040 1.9443 0.9301 30.1280 31.3866 32.6226 31.4428CMS-1498-P2 240

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 340041 1.5949 0.8611 27.1285 27.8408 26.9709 27.3113 340042 1.2562 0.8438 27.0597 27.0729 27.4651 27.2070 340047 1.8790 0.8976 28.7620 30.6701 31.8492 30.4241 340049 1.9406 0.9619 31.5555 35.4171 37.3166 34.8797 340050 1.3906 0.9197 29.2290 30.4447 30.6267 30.1189 340051 1.3116 0.8499 25.4981 25.4162 27.3196 26.0657 340053 1.6844 0.9257 30.8342 30.9274 32.3100 31.3844 340055 1.3835 0.8611 29.0116 29.5040 29.9587 29.5167 340060 1.1756 0.8956 26.8387 27.3403 27.6220 27.2840 340061 1.8918 0.9619 31.2910 33.4821 35.0126 33.3710 340064 1.3481 0.8438 25.0814 27.2184 23.8863 25.2967 340068 1.3615 0.8641 24.7409 27.3499 29.9975 27.4065 340069 1.8686 0.9619 32.2171 32.5361 34.5413 33.1296 340070 1.3306 0.8807 27.7679 29.0391 30.6796 29.1889 340071 1.1590 0.9670 29.7343 31.3756 33.3407 31.6507 340073 1.8342 0.9619 33.1054 33.2705 35.0550 33.8504 340075 1.4189 0.8611 26.8315 29.1504 29.2000 28.3921 340084 1.2918 0.9257 25.6885 27.4289 28.6175 27.2158 340085 1.3401 0.8807 29.1095 29.9176 30.6564 29.9103 340087 1.2638 0.8438 23.8360 25.0091 24.8627 24.5696 340090 1.4562 0.9670 28.3615 28.6805 30.2246 29.1062 340091 1.6471 0.8976 30.4371 31.2643 32.1069 31.2828 340096 1.2936 0.8807 26.5814 26.8103 28.8274 27.3932 340097 1.2417 0.8438 27.9810 29.8702 31.1005 29.7098 340098 1.6521 0.9257 31.3916 31.8472 32.6891 31.9928 340099 1.3129 0.8438 26.0077 28.1143 27.2332 27.0988 340104 *** * 19. 9492 20.2901 22.6845 20.9674 340106 1.1483 0.8438 24.5154 24.4254 24.4668 24.4681 340107 1.1997 0.9082 27.3565 28.5859 31.3986 29.1909 340109 1.3875 0.8914 26.6479 28.6310 29.6145 28.2997 340113 2.0509 0.9257 32.3786 32.4983 33.7477 32.8917 340114 1.6329 0.9619 30.1207 32.3730 33.9019 32.1940 340115 1.6196 0.9619 28.0974 28.9265 30.1329 29.0563 340116 1.6601 0.8611 29.9447 30.8834 31.7109 30.8405 340119 1.5385 0.9257 27.2938 28.1090 27.5712 27.6658 340120 1.1905 0.8438 26.1465 26.6358 25.4889 26.0896CMS-1498-P2 241

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 340121 1.2056 0.8438 25.1577 25.7488 27.4932 26.1656 340123 1.4033 0.8956 28.7150 29.9077 30.2556 29.6505 340124 *** * 25. 7294 25.2498 * 25.5286 340126 1.4018 0.9670 30.6902 31.7266 32.8511 31.7775 340127 1.3442 0.9619 28.8675 30.8152 29.2765 29.6601 340129 1.4724 0.9099 31.7863 27.7470 28.6231 29.2827 340130 1.3943 0.9257 29.5294 30.4887 31.5667 30.5985 340131 1.5012 0.9151 29.6571 32.1743 32.7180 31.5487 340132 1.2123 0.8438 25.3264 25.9153 27.9450 26.4203 340133 1.0352 0.8698 26.8850 27.2630 27.7506 27.3138 340137 *** * 27. 0874 28.8723 * 27.9808 340138 0.7851 0.9619 * * * * 340141 1.7657 0.9223 29.3372 30.8628 32.7734 31.0073 340142 1.3540 0.8438 28.2413 28.4951 28.8034 28.5181 340143 1.6608 0.8611 29.3861 30.7162 30.7369 30.3039 340144 1.3389 0.9099 27.6548 26.5581 28.9693 27.6935 340145 1.3578 0.9099 28.0647 28.4230 30.2759 28.9487 340147 1.4283 0.9670 29.6960 30.2620 31.9805 30.6482 340148 1.5162 0.8976 27.9136 28.6607 29.4141 28.6790 340151 1.2488 0.8522 24.5782 25.9633 27.4868 26.0151 340153 2.2501 0.9257 29.8278 30.9065 31.9428 30.9177 340155 1.5111 0.9619 31.7570 31.6719 33.3228 32.2613 340156 0.9566 1.4382 * * * * 340158 1.2800 0.9223 29.4110 29.2570 30.5810 29.7971 340159 1.2531 0.9619 28.1706 27.8427 28.4492 28.1630 340160 1.3305 0.8438 24.2016 24.9127 26.6329 25.2921 340166 1.4619 0.9257 29.9122 31.0779 32.0934 31.0482 340168 0.6198 0.9223 * * * * 340171 1.2836 0.9257 31.1954 31.7831 32.9707 32.0444 340173 1.3664 0.9619 30.9843 30.9025 33.6286 31.9191 340183 1.4456 0.9257 30.1261 31.4691 33.8741 32.0540 340184 1.2205 0.9015 * * * * 350002 1.9786 1.0000 23.6051 25.2966 25.6152 24.8333 350003 1.3396 * 24.5812 27.3546 * 25.9392 350006 1.5896 1.0000 23.4343 26.6508 24.5023 24.8210 350009 1.1530 * 23.9795 * * 23.9795CMS-1498-P2 242

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 350011 1.9178 1.0000 26.0201 27.3884 28.6631 27.4053 350015 1.7512 1.0000 22.9120 27.6960 27.5676 26.0667 350017 *** * 24. 0968 * * 24.0968 350019 1.7575 1.0000 24.9890 27.0960 28.0496 26.7628 350030 *** * 23. 1023 * * 23.1023 350063 0.9324 1.4382 * * * * 350064 0.7461 1.4382 * * * * 350070 1.7884 1.0000 26.2871 28.1430 27.2743 27.2399 360001 1.6025 0.9593 30.1038 31.8522 32.7842 31.5960 360002 1.4501 0.8629 25.2209 26.7549 28.6674 26.8773 360003 1.8677 0.9593 31.8976 31.9294 33.1679 32.3384 360006 1.9087 1.0130 31.8814 35.3579 37.9929 35.0514 360008 1.5052 0.8729 28.0202 28.5988 29.5464 28.7459 360009 1.6126 0.9225 28.2423 30.2452 30.8841 29.8023 360010 1.3386 0.8585 26.6040 27.3194 29.0985 27.6697 360011 1.4401 0.9993 29.9882 31.3142 31.2797 30.8745 360012 1.4610 1.0130 31.9837 32.9127 33.7117 32.8731 360013 1.1783 0.9225 30.2406 30.9331 32.0183 31.0838 360014 1.2374 0.9993 28.1811 28.9635 31.9691 29.7242 360016 1.5885 0.9593 30.2190 30.5892 31.9656 30.9288 360017 1.8785 1.0130 32.6006 34.8774 37.9269 35.0847 360019 1.3519 0.9052 28.8568 29.3536 29.9006 29.3780 360020 1.5714 0.9052 27.8079 29.5312 30.6901 29.3408 360025 1.4669 0.9217 28.4761 29.5329 30.0999 29.3797 360026 1.6064 0.9142 27.5757 27.3618 26.3380 27.0570 360027 1.5697 0.9052 29.9449 30.8898 32.5281 31.0972 360029 1.1553 0.9344 28.0191 29.0633 29.4172 28.8392 360032 1.3121 0.8528 27.2636 27.4896 29.0836 27.9439 360035 1.7082 1.0130 32.0858 32.5622 33.7737 32.7945 360036 1.2891 0.8888 29.9410 31.5027 32.2558 31.2400 360037 1.6216 0.9052 30.6552 31.5221 32.0751 31.4189 360038 1.7378 0.9593 31.3776 32.3095 34.0962 32.4982 360039 1.5460 0.8528 25.8216 27.3636 28.7284 27.2681 360040 1.2153 0.8984 26.7450 28.4404 29.8190 28.4196 360041 1.3782 0.9052 28.4439 29.3331 29.9816 29.2239 360044 1.2307 0.8662 24.7698 25.7011 25.6594 25.3785CMS-1498-P2 243

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 360046 1.3090 0.9593 28.2972 28.5624 28.9068 28.5940 360048 1.8571 0.9344 30.0390 33.3273 39.7450 34.2489 360051 1.7630 0.9142 29.4434 30.5937 31.1421 30.4107 360052 1.6740 0.9142 28.4731 29.8072 31.5097 29.8835 360054 1.5310 0.8729 23.6606 26.8828 27.5188 25.9621 360055 1.4571 0.9052 31.4794 31.2738 32.8952 31.8741 360056 1.5298 0.9593 31.3936 31.8378 33.3691 32.2230 360058 1.1411 0.8528 25.9295 27.7073 27.9521 27.1876 360059 1.7410 0.9052 30.6294 31.3956 32.6539 31.5860 360062 *** * 32. 9025 35.2065 * 34.0497 360064 1.6958 0.8600 28.6101 28.5325 29.7002 28.9332 360065 1.2957 0.9052 31.5066 31.6781 32.9311 32.0490 360066 1.4780 0.9225 30.9652 32.1991 33.3925 32.2022 360068 1.9074 0.9344 28.6335 30.0212 30.0149 29.5525 360070 1.7211 0.8590 28.8739 30.0192 30.7774 29.8917 360071 1.1589 0.8597 25.7956 26.6139 29.0698 27.1686 360072 1.4371 1.0130 29.1514 29.8851 29.9298 29.6482 360074 1.4181 0.9344 28.0283 30.1333 30.4801 29.5360 360075 1.3041 0.9052 28.3930 29.8181 31.5315 29.9856 360076 1.6207 0.9593 29.5342 28.8462 39.7210 32.3956 360077 1.6129 0.9052 28.3022 26.2961 29.4388 28.0016 360078 1.3461 0.9052 27.3652 28.2973 29.8163 28.5296 360079 1.9369 0.9142 31.3132 32.0935 34.0345 32.4653 360080 1.2318 0.8528 21.8806 22.9825 23.4889 22.7871 360081 1.3978 0.9344 31.4293 33.2532 33.2079 32.6352 360082 1.3923 0.9052 30.5837 29.7447 31.0704 30.4761 360084 1.6721 0.8590 29.2489 29.2527 30.7559 29.7670 360085 1.9801 1.0130 33.1295 35.9664 36.9965 35.5221 360086 1.6162 0.9142 29.1579 31.9690 31.4898 30.8314 360087 1.5016 0.9052 28.6336 30.0084 31.6840 30.0619 360089 1.1498 0.8528 28.0779 28.5192 31.2561 29.2567 360090 1.4048 0.9344 29.2662 30.3175 30.9528 30.1599 360091 1.3254 0.9052 28.2009 29.6324 30.4266 29.4199 360092 1.3143 1.0130 28.0813 28.3576 30.1497 28.8462 360095 1.5618 0.9217 30.2138 30.0996 29.4352 29.8848 360096 1.1693 0.8551 27.9514 29.8687 30.9621 29.5853CMS-1498-P2 244

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 360098 1.4382 0.9052 26.5839 27.6752 29.8125 28.0156 360100 *** * 25. 8143 25.9628 25.6754 25.8206 360101 1.4306 0.9052 30.6650 29.4661 30.1728 30.0962 360107 1.0926 0.8698 26.8180 29.9869 30.3832 29.1302 360109 1.1223 0.9993 30.4643 30.7873 32.3056 31.1780 360112 1.8127 0.9622 32.4403 34.6063 34.7090 33.9241 360113 1.3049 0.9593 30.3914 33.3293 33.4370 32.4622 360115 1.4149 0.9052 27.9711 29.0971 30.1635 29.1065 360116 1.2562 0.9593 26.8632 29.3122 29.7886 28.5973 360118 1.5008 0.8888 29.9823 30.1189 30.7835 30.3015 360121 1.3059 0.9217 31.6766 22.1967 32.9106 28.0639 360123 1.5042 0.9052 28.5435 30.0862 31.5149 30.0236 360125 1.2614 0.8528 27.1776 28.8237 28.0379 28.0071 360130 1.3605 0.9052 28.1811 28.5433 29.7395 28.7979 360131 1.4918 0.8590 27.3426 28.3618 28.7700 28.1660 360132 1.4508 0.9593 29.8411 29.5751 31.5629 30.3076 360133 1.7092 0.9593 33.1812 33.9534 34.8154 33.9938 360134 1.7893 0.9593 29.9198 31.9438 32.3503 31.4241 360137 1.8571 0.9052 30.3116 32.2727 33.2378 32.0143 360141 1.7533 0.8600 31.9397 32.0733 32.7782 32.2474 360143 1.4331 0.9052 28.0693 27.0053 28.0817 27.7280 360144 1.4492 0.9052 29.6547 29.5081 31.0418 30.0723 360145 1.5767 0.9052 29.3271 29.8688 30.7653 29.9946 360147 1.4745 0.8528 29.2371 28.0794 29.5821 28.9716 360148 1.2665 0.8528 25.7460 28.4538 29.4819 27.8748 360150 1.4450 0.9052 27.8840 27.8860 28.7383 28.1724 360151 1.3858 0.8590 26.9672 28.3917 29.2479 28.3557 360152 1.6437 1.0130 33.1017 35.3636 38.6208 35.6295 360153 1.0408 0.8528 21.8416 22.3028 22.2992 22.1453 360155 1.5129 0.9052 29.1711 30.0263 31.6318 30.2212 360156 1.2161 0.8698 26.2268 27.4185 28.7732 27.4930 360159 1.5048 0.9993 29.0187 29.1683 31.7186 29.9873 360161 1.4352 0.8611 27.7423 29.4713 29.7974 29.0175 360163 1.8520 0.9593 31.2087 31.1214 35.9313 32.7672 360170 1.3566 1.0130 30.0688 30.9891 30.4758 30.5174 360172 1.4106 0.9052 30.2330 31.2620 33.1946 31.5024CMS-1498-P2 245

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 360174 1.4016 0.9142 28.3769 29.2419 29.6556 29.0991 360175 1.3096 0.9993 29.7499 31.8340 31.7026 31.1036 360179 1.6158 0.9593 31.3540 30.6820 31.6922 31.2533 360180 2.5220 0.9052 32.0225 30.3025 32.9705 31.8017 360185 1.4175 0.8528 26.4210 27.4008 27.6522 27.1534 360187 *** * 27. 3745 28.2630 31.4188 28.8678 360189 1.1225 1.0130 28.3738 28.8931 29.4708 28.9364 360192 1.4530 0.9052 29.1999 31.7957 32.2091 31.1258 360195 1.1421 0.9052 27.2630 28.4907 29.0980 28.3002 360197 1.3514 0.8528 28.5267 30.3316 31.0116 29.9915 360203 1.1956 0.8528 27.7569 28.7975 29.7199 28.7550 360210 1.4152 1.0130 31.8182 35.1678 37.5771 34.9693 360211 1.6242 0.8528 27.5081 26.9504 26.8677 27.1117 360212 1.4042 0.9052 28.5882 28.8865 31.1956 29.5446 360218 1.3838 1.0130 31.1641 31.4458 31.3310 31.3170 360230 1.5862 0.9052 30.5995 29.9181 31.6669 30.7266 360234 1.4362 0.9593 30.7926 29.5412 33.3664 31.1901 360236 1.4186 0.9593 29.9367 31.7585 32.1567 31.3134 360239 1.4331 0.9142 31.7938 32.3401 33.2718 32.5127 360241 *** * 25. 8137 28.0304 29.5279 27.8946 360242 1.9199 * * * * * 360245 0.8463 0.9052 20.4589 20.8560 21.7637 21.1049 360247 0.6198 1.0130 * * 20.0037 20.0037 360253 *** * 34. 6887 33.3121 37.3905 35.0706 360259 1.3694 0.9344 28.0886 29.3681 31.0669 29.4823 360261 1.2686 0.8880 26.6262 28.2317 32.7931 29.2218 360262 1.3275 0.9344 31.5637 33.1908 34.1099 32.9417 360263 1.9512 0.9225 28.1671 25.5127 26.8628 26.7667 360266 2.2686 1.0130 29.8385 31.3706 33.4559 31.8486 360269 1.9619 0.9593 25.5191 26.3965 34.8464 29.0819 360270 1.1560 0.8528 28.8677 30.0580 32.1049 30.6384 360271 1.4738 0.9593 28.4353 30.8070 32.9727 30.7694 360272 *** * 38. 1014 * * 38.1014 360273 *** * 37. 6645 * * 37.6645 360274 1.6329 0.9142 * * 41.5894 41.5894 360275 *** * * * 35. 3416 35.3416CMS-1498-P2 246

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 360276 1.3571 0.8600 * * 30.8602 30.8602 360347 1.2052 1.0130 * * * * 360348 1.6182 1.0130 * * * * 360349 1.4026 0.9344 * * * * 360350 1.8062 0.9593 * * * * 360351 1.9867 0.8821 * * * * 360352 1.0842 0.8600 * * * * 360354 1.4011 0.9593 * * * * 360355 1.5439 0.9054 * * * * 370001 1.6993 0.8864 28.4907 27.2881 29.2907 28.3843 370002 1.2418 0.8017 26.2486 26.5804 28.5178 27.1335 370004 1.1751 0.8409 28.2804 27.2378 29.4714 28.3160 370006 1.2115 0.8760 25.2307 27.5299 28.6399 27.1064 370007 0.9619 0.8017 21.1260 25.7680 29.2831 25.4572 370008 1.4129 0.8861 27.9944 29.1467 29.2458 28.8413 370011 0.9562 0.8861 23.1761 24.5886 26.7301 24.8297 370013 1.4968 0.8861 28.3502 29.7899 32.8050 30.3615 370014 1.2150 0.8408 28.8962 29.3407 28.8058 29.0123 370015 0.9979 0.8760 27.8061 27.6086 27.9015 27.7724 370016 1.5857 0.8861 30.4672 29.6737 30.9822 30.3796 370018 1.5379 0.8760 31.2335 29.3285 29.9348 30.1154 370019 1.1741 0.8017 26.7613 30.4599 30.9046 29.3782 370020 1.5729 0.8861 24.7520 24.7484 26.5784 25.3619 370022 1.3858 0.8270 26.4836 24.4735 26.1508 25.6663 370023 1.3323 0.8089 24.9580 27.4272 27.9018 26.8583 370025 1.3829 0.8760 24.8336 27.0211 27.6951 26.4528 370026 1.4507 0.8861 26.0203 26.8057 28.1146 26.9937 370028 2.0270 0.8861 29.9849 31.9029 33.9521 31.9991 370029 1.1511 0.8017 30.0134 30.3712 31.0013 30.4602 370030 0.9910 0.8760 26.0831 26.5853 27.9552 26.8681 370032 1.4856 0.8861 28.0739 30.2497 29.6486 29.2901 370034 1.2867 0.8017 23.2192 23.9679 29.5364 25.5443 370036 1.0370 0.8017 21.1544 22.1686 21.3785 21.5609 370037 1.8563 0.8861 26.8992 28.9215 30.8721 28.8559 370039 1.1530 0.8864 25.3422 26.7579 27.7301 26.6250 370040 0.9917 0.8017 19.7644 21.6739 23.4331 21.6824CMS-1498-P2 247

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 370041 0.8609 0.8864 29.5074 26.4346 25.4871 27.1154 370047 1.4945 0.8861 27.8937 29.6739 32.3165 30.0356 370048 0.9653 0.8017 23.4848 24.2668 24.1343 23.9599 370049 1.4371 0.8861 24.2099 22.8526 28.2783 25.0600 370051 1.0771 0.8017 21.8716 22.8411 25.2437 23.3375 370054 1.2593 0.8017 23.4644 25.4821 31.2786 26.7359 370056 1.7795 0.8579 27.6178 26.9562 31.0225 28.6018 370057 0.9892 0.8864 23.1814 21.0790 21.6866 21.9676 370060 *** * 25. 5571 29.0333 * 27.1132 370065 1.0374 0.8119 24.0062 23.7889 27.6147 25.2679 370072 0.7840 0.8017 22.8598 17.3061 22.6081 20.6800 370078 1.6690 0.8864 30.4837 28.7496 30.0395 29.7756 370080 0.9537 0.8017 23.7231 22.4258 20.5624 22.2160 370083 0.8441 0.8017 21.9162 21.3677 19.0707 20.7313 370084 1.0783 0.8017 17.4202 17.7119 16.9006 17.3311 370089 1.5651 0.8017 22.0607 23.8318 25.9159 24.0554 370091 1.7197 0.8864 28.0487 28.3945 29.9801 28.8357 370093 1.9314 0.8861 26.7272 29.0161 30.3405 28.6784 370094 1.4661 0.8861 28.3512 29.5931 29.7407 29.2592 370097 1.3617 0.8579 28.0911 28.1234 28.0485 28.0899 370099 1.0863 0.8861 30.5437 28.8908 29.8196 29.7121 370100 0.8879 0.8017 20.6298 18.2493 20.4983 19.7870 370103 1.0503 0.8017 22.2675 23.4746 23.9559 23.2347 370105 2.1142 0.8861 30.5438 30.9068 36.1174 32.0645 370106 1.5245 0.8861 29.6797 31.4433 32.4747 31.2193 370112 1.0149 0.8017 19.0130 20.2239 20.4699 19.9447 370113 1.1529 0.8462 30.0061 28.3511 28.2888 28.8884 370114 1.7327 0.8864 27.1348 32.9928 34.7611 31.4511 370138 1.0298 0.8017 23.6348 24.7631 28.4293 25.7195 370139 0.9194 0.8017 21.0759 19.3691 22.7663 21.0194 370148 1.5057 0.8861 29.3447 30.8781 32.6383 30.9688 370149 1.3740 0.8861 23.0764 25.0025 27.3475 25.0933 370153 1.0947 0.8017 25.9238 30.0891 28.8427 28.2741 370156 1.0078 0.8114 22.7140 22.3940 23.9498 23.0193 370158 0.9116 0.8861 22.0056 22.2823 23.6271 22.6383 370166 0.9198 0.8864 26.3420 22.9735 24.2071 24.5055CMS-1498-P2 248

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 370169 0.7920 0.8190 24.5389 20.5348 20.0430 21.8109 370170 0.9052 1.4382 * * * * 370171 1.0000 1.4382 * * * * 370172 0.8044 1.4382 * * * * 370173 1.0007 1.4382 * * * * 370176 *** * 26. 6687 27.2899 * 26.9843 370178 0.9180 0.8017 15.6720 17.3536 21.1275 17.9568 370180 1.2523 1.4382 * * * * 370183 0.9346 0.8864 30.3850 25.4218 25.6096 27.0506 370190 1.6477 0.8864 32.5635 35.6046 42.6067 37.1583 370192 1.9251 0.8861 19.1346 28.9574 32.6197 27.3274 370196 *** * 24. 6984 * * 24.6984 370199 0.9552 0.8861 23.9376 25.9775 26.7845 25.6708 370200 *** * 19. 7060 27.9940 35.8719 26.8170 370201 1.5046 0.8861 25.5882 30.4213 30.9026 28.9180 370202 1.4666 0.8864 25.8261 29.3845 30.9936 28.8532 370203 1.8920 0.8861 30.3641 31.6266 32.1871 31.6717 370206 1.9178 0.8861 30.8151 28.9491 30.0585 29.9057 370210 1.9062 0.8864 25.7905 29.4082 29.9079 28.4566 370211 1.1934 0.8861 30.9656 32.7888 34.6101 32.9440 370212 1.9722 0.8861 20.0919 23.4166 27.1375 23.5295 370214 0.8377 0.8114 20.1495 22.3796 25.0447 22.5261 370215 2.2825 0.8861 32.0950 32.7257 33.2373 32.7263 370216 2.1658 0.8864 29.6658 29.1189 26.1707 28.1248 370218 1.4156 0.8864 23.7517 29.6378 28.7572 27.2714 370219 *** * 41. 4392 * * 41.4392 370220 2.2137 0.8861 21.3168 22.2077 20.9298 21.4203 370222 1.9360 0.8861 26.9175 28.6123 28.3453 27.9656 370223 *** * 24. 0154 * 19.6604 21.4670 370224 *** * * 21. 5542 * 21.5542 370225 1.1413 0.8861 * * * * 370226 *** * * * 37. 1390 37.1390 370227 1.0250 0.8864 * * 25.9830 25.9830 370228 1.1823 0.8864 * * 29.2557 29.2557 370229 1.0257 0.8017 * * * * 370231 0.9969 0.8864 * * * *CMS-1498-P2 249

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 370232 1.1109 0.8017 * * * * 380001 1.2530 1.1173 33.8490 36.3316 37.7584 36.0275 380002 1.3507 1.0046 32.6830 32.7006 33.7907 33.0702 380004 1.6902 1.1173 36.1021 37.7310 38.7848 37.5392 380005 1.4128 1.0046 33.5765 33.5424 36.4765 34.5241 380007 1.9680 1.1173 36.4222 37.9358 39.2842 37.8818 380009 2.1862 1.1173 36.5688 36.8442 39.1393 37.5615 380014 1.9778 1.0296 35.7101 36.4373 36.1111 36.0952 380017 1.7902 1.1173 36.8103 37.5098 38.6492 37.6722 380018 2.0193 1.0046 32.4884 32.3945 33.4301 32.7883 380020 1.4677 1.1282 35.7392 37.4343 42.4903 38.6506 380021 1.5246 1.1173 33.0628 33.3855 35.2942 33.9333 380022 1.4159 1.0106 30.9181 32.6138 34.0849 32.6081 380025 1.2343 1.1173 38.1507 38.7401 40.2542 39.0981 380027 1.4336 1.0985 31.4398 33.7027 35.3681 33.5331 380029 1.3160 1.1071 33.3368 34.4907 36.3780 34.8151 380033 1.1325 1.1282 36.0798 36.6589 38.9026 37.2572 380037 1.4089 1.1173 34.0321 36.0715 37.8397 36.1223 380038 1.3228 1.1173 35.0350 36.3586 37.3367 36.2465 380040 1.5283 1.0046 34.4500 37.3200 39.0280 37.0491 380047 1.8942 1.0985 35.8165 37.9901 39.2864 37.8086 380050 1.4662 1.0046 31.3088 32.4377 35.5034 33.1746 380051 1.8579 1.1173 35.0114 37.3363 39.5771 37.3333 380052 1.2455 1.0046 27.7656 29.1449 30.5763 29.1627 380056 1.2401 1.1071 31.0210 31.9034 32.2946 31.7201 380060 1.5979 1.1173 35.1106 36.9581 37.6168 36.6196 380061 1.6961 1.1173 35.8922 37.9554 39.8524 37.8861 380071 1.5130 1.1173 31.6821 32.7466 36.1630 33.5296 380075 1.4781 1.0046 34.0197 36.0119 37.8963 35.9417 380082 1.3415 1.1173 37.7268 38.8914 40.5892 39.0683 380089 1.3650 1.1173 37.0017 37.7878 39.3331 38.0936 380090 1.3301 1.0985 41.4540 41.3541 36.1957 39.4825 380091 1.6124 1.1173 39.7431 47.7003 43.5979 43.8371 380100 *** * 45. 3882 * * 45.3882 380102 1.8467 1.1282 * * * * 390001 1.5928 0.8509 25.4188 27.9772 27.1369 26.8091CMS-1498-P2 250

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 390002 1.4560 0.8567 25.9827 26.9670 28.0217 26.9883 390003 1.1897 0.8509 26.2872 26.6558 28.5550 27.1598 390004 1.7151 0.9161 26.5054 29.3249 30.1116 28.6336 390006 1.9048 0.9161 30.9914 32.8108 34.0319 32.6975 390008 1.1052 0.8523 22.9417 25.0200 23.3722 23.7761 390009 1.7909 0.8509 29.0286 29.4416 29.4788 29.3179 390010 *** * 26. 0966 27.8944 * 26.9767 390012 1.2900 1.0765 34.2004 35.6251 36.5075 35.4492 390013 1.4998 0.9161 28.3039 26.8792 28.6128 27.9375 390016 1.3710 0.8509 26.1802 25.6660 28.0791 26.6336 390019 1.2656 0.9405 25.3185 25.2047 27.4886 25.9672 390023 1.2198 1.0765 36.2618 37.9254 40.0307 38.0623 390024 *** * 37. 4815 * * 37.4815 390025 0.5715 1.0765 * * * * 390026 1.2953 1.0765 36.0608 36.6927 37.8982 36.8748 390027 1.8176 1.0765 40.9110 42.5592 43.2863 42.2614 390028 1.7616 0.8567 29.6218 31.3868 29.7659 30.2416 390030 1.1774 0.9405 26.5678 26.9684 29.2589 27.6203 390031 1.2218 0.8843 26.1258 27.5747 30.8796 28.1344 390032 1.3312 0.8567 25.3756 27.3294 28.0123 26.9158 390035 1.2342 1.0765 27.2130 27.6331 30.9600 28.6617 390036 1.5866 0.8567 26.1956 30.1286 32.9773 29.7227 390037 1.4602 0.8567 27.0788 31.6832 31.5443 30.0435 390039 1.3655 0.8546 22.1531 23.3456 24.9694 23.4740 390041 1.2656 0.8567 25.1190 26.4415 26.5753 26.0714 390042 1.5148 0.8567 29.6213 30.6691 30.9971 30.4337 390043 1.2296 0.8509 24.3590 26.4451 27.6266 26.1527 390044 1.6128 1.0530 29.9959 30.6946 30.4850 30.4001 390045 1.4760 0.8509 25.8800 26.4450 25.4029 25.8954 390046 1.8301 0.9746 32.5273 32.1156 34.3559 33.0452 390048 1.1692 0.9161 28.4563 29.0278 30.0870 29.1884 390049 1.5518 0.9405 31.0290 32.7809 33.9546 32.6141 390050 2.1229 0.8567 29.6715 32.0935 32.6719 31.5014 390052 1.1984 0.8529 26.3700 27.4028 28.0662 27.3003 390054 *** * 27. 5696 * * 27.5696 390056 1.1238 0.8529 24.7038 25.5903 26.0944 25.4676CMS-1498-P2 251

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 390057 1.3731 1.0765 31.0279 33.9576 34.1227 33.0166 390058 1.4268 0.9161 29.6620 29.4647 31.4346 30.2160 390061 1.5125 0.9746 30.9208 30.2319 33.2839 31.3678 390062 1.1590 0.8517 22.8856 37.2849 24.7403 28.3031 390063 1.9432 0.8509 28.3987 30.3687 29.6085 29.4599 390065 1.3869 1.0496 31.8841 31.2628 34.1509 32.4868 390066 1.4935 0.9161 29.0033 28.3747 28.4545 28.6018 390067 1.8047 0.9746 32.2891 30.5601 32.7009 31.8523 390068 1.2866 0.9746 29.6984 28.2183 31.3686 29.7350 390070 1.3814 1.0765 34.5501 33.4969 34.5022 34.1840 390071 1.0479 0.8509 26.3830 27.8695 29.4067 27.8637 390072 1.0365 0.8509 28.8145 28.0714 29.3008 28.7479 390073 1.7549 0.8517 27.0876 28.8519 30.4073 28.7640 390076 1.3590 1.0765 33.9908 34.0355 36.0337 34.6436 390079 1.8713 0.8750 26.0199 26.9676 29.0245 27.3480 390080 1.4522 1.0765 31.6210 33.0003 34.7963 33.0758 390081 1.3314 1.0765 36.4788 37.7643 37.7381 37.3396 390084 1.2793 0.8509 24.3191 24.8010 26.7795 25.2800 390086 1.5945 0.8509 24.7454 25.3096 25.8212 25.3007 390090 1.8764 0.8567 30.1256 31.9282 33.7323 31.8674 390091 1.2620 0.8509 23.2118 23.9434 24.9895 24.0598 390093 1.2290 0.8509 23.8846 23.5291 23.4916 23.6341 390095 1.2005 0.8509 25.3859 25.9594 25.8271 25.7150 390096 1.6264 1.0530 30.3910 31.7443 32.9599 31.7312 390097 1.2966 1.0765 28.1285 30.4946 31.2933 29.9565 390100 1.6541 0.9746 32.7836 32.8949 33.8098 33.1901 390101 1.3191 0.9526 25.9850 28.6622 30.5652 28.4498 390102 1.4762 0.8567 25.5336 26.3716 27.4078 26.4615 390104 1.0256 0.8509 20.4552 26.8407 25.5500 24.5842 390107 1.7718 0.8567 25.6790 26.6305 27.5113 26.6481 390108 1.3264 1.0765 34.3066 33.3017 33.0812 33.5657 390110 1.6616 0.8509 25.7159 28.5314 29.2114 27.8372 390111 2.3297 1.0765 37.7322 34.5571 37.4034 36.5385 390112 1.1114 0.8546 18.4185 19.5361 21.7618 19.8898 390113 1.3636 0.8509 24.8669 25.9952 27.3239 26.1026 390114 1.5335 0.8567 28.5336 28.2039 31.1727 29.3417CMS-1498-P2 252

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 390115 1.4010 1.0765 32.5058 32.8427 32.4906 32.6138 390116 1.4090 1.0765 33.9295 34.5119 35.8124 34.7722 390117 1.2284 0.8510 22.2327 26.0642 29.4532 25.9021 390118 1.2756 0.8509 23.6535 23.7128 24.9150 24.0866 390119 1.3599 0.8509 25.3907 25.9784 27.7668 26.4246 390122 1.0543 0.8509 24.6434 24.0424 25.6753 24.7750 390123 1.2379 1.0765 35.1244 34.1121 36.2907 35.1769 390125 1.2563 0.8509 24.0199 24.4654 28.2329 25.5409 390127 1.5706 1.0765 33.1227 34.6488 37.2911 35.0077 390128 1.2760 0.8567 25.1858 26.0441 26.6048 25.9610 390130 1.2073 0.8509 30.7083 26.7324 27.8831 28.3944 390131 1.4113 0.8567 27.7146 26.9190 27.7765 27.4675 390132 1.6245 1.0765 30.0751 33.1853 34.6686 32.6204 390133 1.8571 1.0530 33.0604 35.0046 33.5858 33.8932 390137 1.5065 0.8509 26.9156 27.9033 28.8768 27.9121 390138 1.3244 1.0496 27.7565 29.0224 31.9340 29.6092 390139 1.3858 1.0765 36.5001 36.8337 38.9715 37.4666 390142 1.5812 1.0765 33.3509 38.1793 41.7965 37.8882 390145 1.4739 0.8567 26.9212 27.6510 28.4472 27.7026 390146 1.1970 0.8509 23.9878 27.5267 28.5944 26.6700 390147 1.4098 0.8567 29.0995 30.4797 29.9003 29.8258 390150 1.1325 0.8515 22.6483 27.2922 29.5097 26.6124 390151 1.4533 1.0496 31.8967 35.0627 36.1838 34.4568 390153 1.3662 1.0765 36.0287 37.0995 38.6509 37.2968 390154 1.2217 0.8509 23.9785 24.6857 26.5297 25.0858 390156 1.3617 1.0765 33.7057 34.9903 37.3076 35.3187 390157 1.2496 0.8567 23.0989 23.7167 25.3304 24.0528 390160 1.4641 0.8567 25.2043 27.5196 28.6869 27.1706 390162 1.5709 1.1280 35.1844 36.7008 37.4703 36.4185 390163 1.3306 0.8567 24.8761 25.4594 26.9809 25.7955 390164 2.2789 0.8567 29.7778 29.0556 30.3482 29.7279 390166 *** * 28. 2178 * * 28.2178 390168 1.6857 0.8567 27.3674 28.2578 30.9235 28.8822 390169 1.1762 0.8509 26.6063 28.4619 28.7411 27.9870 390173 1.3215 0.8546 27.6039 28.0999 29.4695 28.4211 390174 1.8138 1.0765 35.1118 36.5352 38.5670 36.7628CMS-1498-P2 253

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 390176 1.0420 0.8567 * 27.5270 32.1051 29.5889 390178 1.4445 0.8600 23.9166 25.2325 26.0853 25.0756 390179 1.4701 1.0765 31.5498 33.9916 35.7591 33.8296 390180 1.4303 1.0765 38.2997 37.8677 39.2901 38.4851 390181 *** * 27. 8833 * * 27.8833 390183 1.1887 0.8509 28.2211 28.8361 29.9287 29.0390 390184 1.0458 0.8567 23.9973 24.1461 24.6116 24.2542 390185 1.3942 0.9405 25.5318 28.1346 29.5155 27.8683 390189 1.0954 0.8509 23.4902 25.3686 26.8189 25.2753 390192 1.0196 0.8509 23.7958 24.7427 25.0085 24.5203 390194 1.2336 0.9405 23.7367 27.8231 27.5260 26.2940 390195 1.6061 1.0765 37.2504 36.8626 39.5226 37.8846 390196 1.5301 * * * * * 390197 1.3716 0.9405 27.7303 28.1999 28.4855 28.1347 390198 1.0016 0.8509 21.0861 21.3574 23.6249 22.0336 390199 1.1525 0.8509 24.5469 24.9642 25.6275 25.0628 390201 1.5511 0.9460 28.5668 28.7755 33.2321 30.2676 390203 1.5230 1.0765 30.7244 33.0056 39.2667 34.4792 390204 1.3951 1.0765 32.0242 33.8120 31.6920 32.4668 390211 1.4122 0.8600 27.7875 28.0796 29.5567 28.4769 390217 1.2688 0.8567 26.2706 25.6917 27.0886 26.3518 390219 1.3817 0.8567 26.3263 27.2812 28.9463 27.5217 390220 1.2574 1.0765 32.0891 33.0323 34.0933 33.0447 390222 1.4380 1.0765 32.7077 34.5835 35.0162 34.1313 390223 2.1413 1.0765 36.5784 35.8030 36.4686 36.2827 390225 1.3671 0.9746 26.3642 * 37.2003 31.3972 390226 1.7682 1.0765 35.4683 35.5564 37.7252 36.2815 390228 1.5300 0.8567 25.5120 28.4321 28.7341 27.5570 390231 1.4535 1.0765 35.2312 35.0675 35.2479 35.1832 390233 1.4332 0.8509 28.3660 29.5938 31.2920 29.7908 390236 1.0294 0.8509 24.5574 25.1866 26.6442 25.4333 390237 1.6878 0.8509 29.9748 29.6917 29.3123 29.6520 390256 1.9907 0.9161 28.5887 31.6455 32.5650 30.9753 390258 1.4564 1.0765 32.0551 33.7330 37.1156 34.3523 390263 1.6615 0.9405 30.2069 31.1718 31.3913 30.9524 390265 1.6237 0.8567 27.7795 27.8241 30.8343 28.8119CMS-1498-P2 254

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 390266 1.1383 0.8600 23.0142 23.5248 24.2255 23.5948 390267 1.5021 0.8567 25.7571 28.4250 30.7224 28.2795 390268 1.4705 0.8628 28.4200 30.0652 30.2637 29.6045 390270 1.7441 0.8509 27.0301 29.3622 31.2862 29.3404 390272 0.6330 1.0765 32.9918 29.4836 28.9815 30.3399 390278 0.7864 1.0765 28.8318 33.9596 32.6176 31.7776 390285 *** * 38. 4703 43.0793 42.6411 41.2248 390286 *** * 31. 7337 32.6998 34.3467 32.9330 390290 1.8432 1.0765 47.7663 41.9121 45.5855 45.0203 390304 1.4348 1.0765 33.4134 35.0741 31.4118 33.2717 390307 1.9281 0.8600 22.9474 27.2053 28.6025 26.1219 390311 *** * 49. 9027 * * 49.9027 390312 1.4452 1.0765 51.3372 42.3481 47.4912 46.6973 390313 1.1402 0.8843 * 27.3018 28.2730 27.7674 390314 1.9104 0.9405 * * 31.2627 31.2627 390315 *** * * * 33. 7886 33.7886 390316 2.1098 1.0530 * * 27.5474 27.5474 390317 0.8038 1.0765 * * 40.0462 40.0462 390318 1.4192 0.9405 * * 28.8744 28.8744 390319 0.9481 0.8567 * * * * 390320 2.7965 1.0765 * * * * 390321 1.7804 0.9405 * * * * 400001 1.3274 0.4282 15.4249 15.9192 16.7467 16.0408 400002 *** * 12. 9793 14.2946 * 13.6163 400003 1.4027 0.4258 14.6859 15.8816 16.1022 15.5378 400004 1.1337 0.4282 13.5197 14.5542 15.6128 14.5649 400005 1.1494 0.4282 11.7590 12.6516 13.5902 12.6912 400006 1.2753 0.4282 * * 11.3150 11.3150 400007 1.3194 0.4282 10.4934 10.7767 12.4403 11.1611 400009 1.0496 0.3561 10.1212 14.0016 12.1371 11.8594 400010 0.8029 0.3369 10.4206 12.8584 9.9686 10.7816 400011 1.2081 0.4282 9.4068 10.7620 11.2889 10.4922 400012 1.6634 0.4282 * 11.1553 12.3642 11.7247 400013 1.3877 0.4282 12.3073 12.7900 13.8665 13.0128 400014 1.4610 0.3595 12.3301 11.0722 11.8099 11.7048 400015 1.2566 0.4282 21.9225 17.6943 20.6014 19.9015CMS-1498-P2 255

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 400016 1.5854 0.4282 17.9107 19.1577 18.3119 18.4599 400017 *** * 10. 0590 * * 10.0590 400018 1.3636 0.4282 13.1572 13.6091 14.0267 13.6205 400019 1.5566 0.4282 15.2364 15.0604 15.9353 15.3872 400021 1.5607 0.4549 14.9779 16.3677 16.9832 16.1033 400022 1.4793 0.4258 15.2124 15.3660 16.3760 15.6441 400024 0.7732 0.3595 13.7215 14.2708 12.9549 13.5783 400026 1.2407 0.3561 8.9064 9.8155 10.7169 9.7988 400028 *** * 9. 6941 11.1923 10.2934 10.3638 400032 1.1343 0.4282 10.7844 11.9013 12.2669 11.6859 400044 1.7300 0.4258 12.1393 13.4579 14.6579 13.6085 400048 1.2979 0.3561 10.5176 11.5766 13.1850 11.7959 400061 2.1704 0.4282 17.4504 18.5327 20.5087 18.8372 400079 1.5588 0.3369 10.6127 11.3550 11.9824 11.3404 400087 1.2640 0.4282 12.0034 12.6233 13.4288 12.6871 400098 1.2431 0.4282 12.8756 13.2365 13.3671 13.1717 400102 1.2316 0.4282 12.1257 12.6314 10.9542 11.7721 400103 2.0761 0.3595 11.3314 12.7285 11.9853 12.0090 400104 1.3358 0.4282 12.6934 12.9616 11.8195 12.5011 400105 1.0711 0.4282 17.0463 25.3823 19.6129 19.9057 400106 1.1191 0.4282 14.8544 14.1766 15.1456 14.7145 400109 1.4847 0.4282 14.5713 15.4910 16.2304 15.4433 400110 1.2368 0.3528 10.8214 11.2311 12.3738 11.4462 400111 1.2060 0.3369 10.7892 11.0467 12.0683 11.3123 400112 1.2379 0.4282 11.2303 9.6181 13.0534 11.1342 400113 1.3390 0.4258 11.5948 11.9672 12.8788 12.1619 400114 1.2113 0.4282 11.6872 11.5514 12.7842 12.0298 400115 1.0598 0.4282 10.6809 12.0201 10.9564 11.2441 400117 1.0324 0.4282 12.1540 12.2159 13.0609 12.4850 400118 1.3323 0.4282 12.6199 13.3983 14.0618 13.3770 400120 1.4734 0.4282 14.5205 14.6591 15.3683 14.8571 400121 1.0669 0.4282 9.9713 11.7462 11.7441 11.2726 400122 2.2443 0.4282 10.0966 13.1851 13.6602 12.0852 400123 1.2369 0.3595 13.8601 13.4317 14.3030 13.8583 400124 2.8599 0.4282 19.1704 21.9082 22.0619 21.0750 400125 1.2425 0.3874 13.1078 12.7141 13.5864 13.1629CMS-1498-P2 256

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 400126 1.2276 0.4549 * 14.2108 13.0372 13.5539 400127 2.2024 0.4282 * 12.0796 10.6621 11.1995 400128 1.0442 0.4282 * 23.6366 14.1088 17.2092 410001 1.3296 1.1560 30.5865 30.8038 33.6421 31.6567 410004 1.3994 1.1560 35.2384 33.7118 35.8403 34.9238 410005 1.2979 1.1560 34.2846 38.2842 38.0619 36.9368 410006 1.4558 1.0702 33.9961 35.4462 36.1985 35.2228 410007 1.7064 1.1560 34.4774 37.0287 38.3867 36.7006 410008 1.3757 1.0702 33.6384 34.6138 35.3809 34.5644 410009 1.3355 1.0702 34.3427 36.0892 36.4091 35.6362 410010 1.1199 1.1560 34.9330 38.4603 39.9638 37.7769 410011 1.4645 1.1560 36.7668 38.5007 37.6589 37.6665 410012 1.6248 1.1560 36.5207 37.5223 38.6851 37.5744 410013 1.2620 1.1360 39.8659 38.2253 38.6414 38.8940 420002 1.6629 0.9258 31.2247 32.3569 33.2952 32.2569 420004 2.1010 0.9252 30.0764 31.8610 34.1012 32.1498 420005 1.2940 0.8411 26.5044 28.0173 29.8412 28.1181 420006 2.1518 * 29.1404 31.5368 32.2965 30.9655 420007 1.7111 0.9086 28.9557 31.1080 31.3033 30.4861 420009 1.4017 0.9086 28.6648 29.1084 29.6808 29.1549 420010 1.1694 0.8439 26.5523 27.0435 27.8709 27.1665 420011 1.1720 0.9314 26.0585 25.9484 25.1689 25.7394 420015 1.3418 0.9314 27.4929 27.9759 29.5582 28.3316 420016 1.0027 0.8399 23.4323 23.2125 23.4618 23.3687 420018 1.9284 0.8759 29.0923 28.9660 30.2579 29.4553 420019 1.1621 0.8568 25.8119 23.7910 26.9977 25.5119 420020 1.3033 0.9252 29.2935 28.9093 30.9488 29.7089 420023 1.8241 0.9314 30.4492 31.2602 32.2488 31.4072 420026 1.9124 0.8759 29.5066 31.2504 32.5572 31.1347 420027 1.6300 0.9086 31.3797 30.6779 * 31.0258 420030 1.4921 0.9252 30.3424 31.3260 33.0987 31.5744 420033 1.3463 0.9314 32.4287 33.8157 33.5699 33.2702 420036 1.2688 0.9099 26.3480 27.1715 28.0250 27.1767 420037 1.4064 0.9314 32.7124 33.5291 34.1076 33.4635 420038 1.2847 0.9314 27.1524 29.5673 31.5388 29.4623 420039 1.0619 0.8929 26.3127 24.5270 26.0489 25.6075CMS-1498-P2 257

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 420043 1.1861 0.8551 25.8366 24.2727 25.6018 25.2202 420048 1.3049 0.8759 27.4353 29.9094 30.5167 29.3111 420049 1.3260 0.8641 28.0920 28.4801 29.1163 28.5669 420051 1.8299 0.8439 27.6130 28.0711 29.6261 28.4477 420053 1.2963 0.8502 25.4820 26.4997 27.1081 26.3512 420054 1.1210 0.8401 26.7900 27.1580 28.2725 27.4120 420055 1.1416 0.8427 25.3144 25.9899 26.0255 25.7592 420056 1.3094 0.8399 29.7774 27.8175 29.3188 28.9542 420057 1.2963 0.8439 27.7137 29.5662 29.8897 29.0709 420062 1.0833 0.8524 27.2263 28.3129 29.4726 28.3826 420064 1.5616 0.8641 25.0654 26.4352 28.3216 26.6452 420065 1.5441 0.9252 28.1896 28.2922 28.9626 28.4895 420066 0.9570 0.8439 20.5743 26.0307 27.0504 24.3154 420067 1.4142 0.8817 27.7167 29.0379 29.2066 28.6526 420068 1.5378 0.9527 28.0316 28.1555 30.0666 28.7169 420069 1.2850 0.8399 24.4656 25.1993 25.9447 25.2155 420070 1.4122 0.8759 27.6431 28.4000 28.5579 28.2053 420071 1.5208 0.9086 28.1099 28.6098 30.2531 29.0105 420072 1.1647 0.8399 20.7716 24.4951 25.2077 23.5012 420073 1.4865 0.8759 28.2671 29.5999 30.4941 29.4818 420078 1.9867 0.9314 32.8731 34.3181 33.3691 33.5209 420079 1.5363 0.9252 30.5981 31.7686 32.4626 31.6252 420080 1.4096 0.8817 32.8712 33.8785 35.2949 34.0334 420082 1.5126 0.9529 34.8864 33.5290 33.6670 33.9910 420083 1.4791 0.9086 29.6587 29.2264 33.5329 30.7160 420085 1.5196 0.9223 29.9085 31.3391 32.5361 31.2837 420086 1.5308 0.8759 29.6349 30.1406 30.5884 30.1347 420087 1.8321 0.9252 28.4632 28.8860 29.6136 29.0043 420089 1.6898 0.9252 31.7367 33.0906 35.2407 33.3707 420091 1.5567 0.8439 27.9062 28.0471 30.7482 28.8706 420098 1.1976 0.8407 27.6722 28.2058 29.6500 28.5992 420100 *** * 29. 2979 * * 29.2979 420101 1.0052 0.8817 33.1995 33.5957 33.0451 33.2696 420102 1.8906 0.9314 * * 34.3207 34.3207 420103 1.2387 0.9314 * * * * 430005 1.4208 1.0000 25.4385 27.1759 29.2386 27.2448CMS-1498-P2 258

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 430008 1.1323 1.0000 27.2275 27.2961 28.1278 27.5654 430012 1.3663 1.0000 27.0195 28.5808 28.9595 28.1941 430013 1.2067 1.0000 28.4962 28.3679 29.7388 28.8759 430014 1.5187 1.0000 28.9295 29.2921 30.3630 29.5359 430015 1.3611 1.0000 28.0414 28.0093 28.9296 28.3270 430016 1.6144 1.0000 31.1336 31.5894 34.2610 32.4635 430027 1.7295 1.0000 29.2617 29.2432 31.1835 29.9366 430048 1.2480 1.0355 25.6428 26.9537 28.6697 27.1026 430060 0.9026 1.0000 * 11.7801 * 11.7801 430064 0.9703 * 17.7334 * * 17.7334 430077 1.7929 1.0940 31.1945 35.3480 39.6547 35.4000 430081 1.0199 1.4382 * * * * 430082 0.7513 1.4382 * * * * 430083 1.0550 1.4382 * * * * 430084 0.8832 1.4382 * * * * 430089 2.2827 1.0000 24.9060 28.3217 28.7338 27.4480 430090 2.0301 1.0000 32.7395 33.8350 34.0212 33.5658 430091 2.0885 1.0940 26.7258 28.3496 29.0916 28.0819 430092 2.0494 1.0000 23.2527 26.6750 28.3015 26.0017 430093 0.9808 1.0940 24.7426 30.7398 30.2337 28.4605 430094 1.7420 1.0355 23.6624 23.9005 24.9804 24.2133 430095 2.3107 1.0000 32.5881 31.8141 38.2085 34.0836 430096 2.3728 1.0000 24.9623 28.0608 28.3796 27.0773 440001 1.1423 0.7948 25.4855 23.9380 25.8019 25.0735 440002 1.7402 0.8871 26.9133 28.4828 28.7976 28.0851 440003 1.3257 0.9280 26.0115 31.4162 31.1666 29.3051 440006 1.6645 0.9280 31.7394 32.6924 33.2995 32.6609 440007 1.1248 0.8119 22.7571 23.4825 23.6870 23.3271 440008 1.0281 0.8210 26.8857 26.2003 28.2870 27.1392 440009 1.1708 0.7948 24.4423 25.1184 26.0040 25.1835 440010 0.9243 0.7948 20.2497 23.8087 24.9022 22.8411 440011 1.4425 0.7948 24.8300 25.7912 27.1600 25.9502 440012 1.5952 0.7957 24.9261 26.2076 26.5953 25.9396 440015 1.9977 0.7948 27.1603 28.1389 28.4467 27.9223 440016 1.0765 0.8032 25.2512 25.4197 27.4924 26.0451 440017 1.8177 0.7957 26.1820 28.6110 27.1081 27.3237CMS-1498-P2 259

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 440018 1.1740 0.7948 24.8568 26.0748 26.3363 25.7740 440019 *** * 26. 2464 28.0387 30.1931 28.0787 440020 1.0657 0.7948 27.5626 28.0269 28.6636 28.0709 440024 *** * 26. 2534 25.4398 * 25.8750 440025 1.2561 0.8438 24.0289 25.5605 26.7642 25.4762 440026 *** * 28. 4615 26.5911 29.9514 28.3617 440029 1.4714 0.9280 31.4652 31.8872 32.1072 31.8356 440030 1.3554 0.7948 22.3144 23.1116 23.2575 22.8992 440031 1.2845 0.7948 22.0711 23.0937 24.1851 23.1142 440032 1.2903 0.7948 23.8030 25.4122 25.3202 24.8770 440033 1.1176 0.7948 23.9792 24.3197 24.4996 24.2751 440034 1.7491 0.7948 25.9138 26.7987 27.0736 26.5997 440035 1.3762 0.9280 27.9217 26.8725 27.7533 27.5134 440039 2.2785 0.9280 30.1918 32.4190 32.3384 31.6681 440040 0.8602 0.7948 21.1288 21.3795 23.0134 21.8153 440046 1.5007 0.9280 30.7334 31.5146 32.8764 31.6731 440047 0.9783 0.8145 25.2150 26.8032 28.6702 26.9106 440048 1.8888 0.9171 30.6725 31.5584 32.5404 31.5872 440049 1.7063 0.9171 29.8623 31.7148 32.6356 31.4058 440050 1.4510 0.7957 26.3825 27.1284 29.3303 27.5657 440051 0.9297 0.7996 23.6560 23.1773 24.8037 23.8861 440052 1.0648 * 24.4071 28.1868 * 26.2378 440053 1.3950 0.9280 30.3907 31.3189 32.4503 31.4080 440054 1.2435 0.7948 21.9641 25.7785 25.9377 24.4630 440056 1.2204 0.7948 24.0635 25.2050 25.9743 25.0917 440057 1.1740 0.7948 19.3546 25.1519 22.9222 22.2785 440058 1.1492 0.8614 29.1184 28.5093 28.0299 28.5506 440059 1.5321 0.9280 29.4532 30.4489 30.5995 30.1903 440060 1.3363 0.8145 26.5867 26.5518 27.3024 26.8209 440061 1.1152 0.7948 25.4134 25.9969 26.5212 25.9931 440063 1.7344 0.7981 26.0763 25.4344 24.7803 25.4192 440064 0.9734 0.8754 26.7957 26.9014 28.9331 27.5492 440065 1.4389 0.9280 25.6111 27.3501 27.6328 26.8707 440067 1.0879 0.7948 26.0866 26.5062 27.4606 26.6924 440068 1.1836 0.8563 27.9082 27.2646 28.3925 27.8565 440070 0.9667 0.8011 23.2228 24.4477 23.7568 23.8061CMS-1498-P2 260

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 440072 1.1077 0.7948 26.1661 27.6990 29.4625 27.8065 440073 1.4586 0.9280 27.5133 28.3950 33.8232 29.7943 440081 1.3267 0.7948 21.9681 23.3000 24.5259 23.2799 440082 1.9820 0.9280 32.8941 34.4535 34.2270 33.8164 440083 0.9678 0.7948 25.7074 25.5397 31.8133 27.4028 440084 1.1913 0.7948 19.8950 21.3873 22.1562 21.1576 440091 1.8112 0.8754 28.9697 30.0650 31.3375 30.1465 440102 1.0781 0.7948 22.1114 23.5525 24.5121 23.3354 440104 2.0266 0.8754 28.0905 29.7326 30.2301 29.3691 440105 0.9050 0.7981 23.7154 24.6039 25.1558 24.4882 440109 1.0319 0.7989 22.5878 23.8465 25.0329 23.8752 440110 1.2059 0.7948 23.6275 23.8010 25.2412 24.2401 440111 1.3708 0.9280 29.7461 33.0828 34.8033 32.5048 440115 1.0246 0.8145 24.9778 25.2508 26.5072 25.5829 440120 1.5835 0.7948 26.0621 28.0271 29.3067 27.8170 440125 1.7354 0.7948 24.0934 24.7908 25.9494 24.9465 440130 1.1307 0.7948 26.3192 27.5525 29.7509 27.8864 440131 1.1097 0.9171 28.3162 29.0546 29.2776 28.8882 440132 1.2404 0.7948 29.3377 26.1823 26.0031 27.0744 440133 1.7764 0.9280 32.5726 33.2319 32.4641 32.7486 440135 *** * 27. 2094 28.7658 * 27.7843 440137 1.1024 0.8526 24.6143 25.6931 26.9374 25.7242 440141 1.0666 0.7948 24.8737 24.3575 26.3678 25.1500 440144 1.2612 0.8563 26.3225 26.6282 28.1527 27.0256 440147 *** * 36. 6978 33.5900 37.8346 36.1793 440148 1.2607 0.8180 28.0708 26.2483 26.9352 27.0789 440150 1.5299 0.9280 30.5513 32.9854 32.8334 32.1424 440151 1.2054 0.9280 28.6585 28.8412 29.7082 29.0660 440152 2.5625 0.9171 29.0588 28.7357 30.1779 29.3307 440153 1.0707 0.7948 23.3790 23.8797 25.5049 24.2283 440156 1.6720 0.8754 30.5161 31.0506 31.6017 31.0718 440159 1.4664 0.9171 27.2785 26.2728 29.3516 27.6174 440161 2.1078 0.9280 31.0667 32.2343 33.4813 32.2916 440162 *** * 24. 6425 27.8605 32.8708 28.2006 440168 0.9044 0.9171 31.3316 37.0865 35.6076 34.6194 440173 1.5174 0.7948 23.1370 23.5486 24.5617 23.7711CMS-1498-P2 261

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 440174 0.9085 0.8871 27.4579 27.4578 29.2147 28.0222 440175 1.0307 0.7948 26.7705 29.2713 28.1637 28.0598 440176 1.4968 0.7957 24.9420 26.1477 25.8830 25.6676 440180 1.1625 0.7948 24.3376 26.9310 28.0126 26.4469 440181 1.1717 0.8244 26.4763 26.2247 26.8006 26.5057 440182 0.9173 0.8032 24.9899 24.4173 26.1132 25.1673 440183 1.5613 0.9171 30.9923 31.9159 33.2870 32.0523 440184 1.1262 0.7981 26.9086 25.3287 23.3322 25.0223 440185 1.2332 0.8563 26.3974 25.6005 27.2121 26.4383 440186 0.9656 0.9280 28.2840 30.0775 29.4231 29.3781 440187 1.1201 0.7948 27.4034 27.2669 29.4492 28.0330 440189 1.3670 0.8341 30.5786 29.9065 32.4791 31.0665 440192 1.1026 0.9280 30.6533 32.0772 30.4030 31.0183 440193 1.4241 0.9280 25.9726 27.8132 29.2015 27.6576 440194 1.3855 0.9280 32.3020 32.1073 33.3464 32.6095 440197 1.5649 0.9280 31.4317 32.3241 33.1604 32.2961 440200 1.1684 0.9280 23.8288 23.3049 25.6800 24.2881 440217 *** * 31. 6650 33.8684 33.5264 33.0112 440218 2.3018 0.9280 36.9273 31.7847 34.8600 34.3070 440222 *** * 30. 5148 32.4230 33.4779 32.1341 440225 0.8351 0.7948 26.9687 29.8273 31.2189 29.5476 440226 1.8051 0.7948 28.3199 28.4491 31.2423 29.3511 440227 1.4445 0.9280 31.9119 32.1862 33.3005 32.4840 440228 1.5313 0.9171 29.5372 31.2049 32.7230 31.2589 450002 1.5584 0.8559 29.7180 30.0562 31.6279 30.4327 450005 1.2589 0.8421 27.3473 27.9825 28.6433 28.0242 450007 1.2745 0.9033 24.4630 26.2568 27.9008 26.2410 450008 1.3007 0.8739 24.4372 26.1215 28.5492 26.3295 450010 1.6966 0.9888 30.1034 32.9053 35.9573 32.9324 450011 1.6446 0.9206 29.9302 30.9903 32.9877 31.3013 450015 1.7472 0.9693 30.3168 30.3228 30.4911 30.3779 450018 1.7997 0.9904 31.3131 32.9922 35.5712 33.2965 450021 2.0024 0.9693 31.7360 34.5462 35.7307 34.0291 450023 1.3908 0.8005 25.1683 25.6361 27.9984 26.2980 450024 1.7757 0.8559 27.3814 27.8816 27.1925 27.4827 450028 1.6425 0.9447 29.5689 29.8049 34.0997 31.2123CMS-1498-P2 262

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450029 1.5534 0.8278 28.6465 27.2662 28.3780 28.0928 450031 *** * 29. 2141 28.8891 34.0104 30.5763 450032 1.3782 0.8558 26.3159 25.7989 24.7722 25.5859 450033 1.6415 0.9447 29.7668 31.6557 32.7706 31.4322 450034 1.5659 0.8421 29.6309 28.2761 30.5057 29.4205 450035 1.7041 0.9904 30.3369 30.8574 * 30.5883 450037 1.5611 0.8558 28.2622 26.8661 31.6332 28.8487 450039 1.6804 0.9547 29.8145 29.5097 31.1550 30.1911 450040 1.7943 0.8903 28.5469 30.0844 31.7878 30.1162 450042 1.7837 0.8612 27.6131 28.3649 29.9591 28.7245 450044 1.7955 0.9693 32.9921 36.3786 36.8350 35.4324 450046 1.6799 0.8541 27.2439 28.4297 29.1115 28.2783 450047 *** * 24. 9670 24.6290 * 24.8091 450051 2.0476 0.9693 30.3976 31.0740 32.5581 31.3450 450052 1.1232 0.7985 24.3964 25.8142 26.8780 25.6896 450054 1.8685 0.8739 30.2211 30.7196 31.8152 30.9786 450055 0.9581 0.7985 24.1418 24.6436 24.1331 24.3059 450056 1.7335 0.9483 32.0902 33.7634 35.1758 33.7275 450058 1.6760 0.9033 27.7318 27.8963 29.3038 28.3582 450059 *** * 28. 5645 29.9336 30.4251 29.6617 450064 1.6215 0.9547 29.0495 30.6704 31.2918 30.3637 450068 2.2983 0.9904 32.0372 34.9179 36.0902 34.3951 450072 1.2590 0.9904 28.0921 28.7063 30.1911 29.0674 450073 0.8084 0.7985 22.2322 23.1471 27.3607 24.1130 450076 1.7389 * * * * * 450078 0.9125 0.7985 20.7800 21.0876 22.8792 21.5781 450079 1.5567 0.9693 36.8936 34.1533 35.0924 35.3302 450080 1.2802 0.9547 26.8111 28.6334 28.2834 27.9102 450082 1.2045 0.7985 25.5654 27.1314 28.0686 26.8222 450083 1.8349 0.8225 30.2054 28.6628 27.8743 28.9055 450085 1.1963 0.7985 26.3610 28.1669 28.9441 27.8191 450087 1.5252 0.9547 32.6556 34.2493 35.5922 34.2084 450090 1.3411 0.8684 22.7822 22.2148 21.7004 22.2188 450092 1.4103 0.8278 28.2278 28.3891 30.5314 29.0936 450097 1.5643 0.9904 31.9782 33.8910 34.3604 33.4331 450099 1.3224 0.8399 29.8491 25.5799 25.4382 26.8735CMS-1498-P2 263

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450101 1.6811 0.8612 28.4220 29.3777 30.4843 29.3988 450102 1.7949 0.8225 27.3364 27.5145 28.5283 27.8122 450104 1.2249 0.9033 27.7851 30.4631 31.5834 29.9121 450107 1.7114 0.8559 29.0328 29.6790 31.5472 30.1274 450108 1.1643 0.9033 22.4293 21.7619 23.4651 22.5508 450119 1.6775 0.8851 34.4161 31.0699 34.4231 33.3604 450123 1.0012 0.8421 24.0433 27.6445 25.6415 25.8683 450124 1.8454 0.9483 31.9797 32.9774 34.3913 33.0155 450126 *** * 32. 0370 32.9729 33.9635 33.0184 450128 1.3469 0.8851 28.3171 28.9733 25.6071 27.5150 450130 1.2316 0.9033 26.9208 28.3786 29.5020 28.2589 450132 1.6455 0.9387 31.1361 34.8719 33.2761 33.1083 450133 1.6806 0.9514 30.9622 31.3911 33.3058 31.9181 450135 1.7157 0.9547 30.7909 30.8734 32.1719 31.2968 450137 1.6678 0.9547 35.7775 33.8235 36.3832 35.3104 450143 1.0086 0.9483 24.4346 25.1702 26.2306 25.2759 450144 0.8810 0.9514 31.1552 31.4041 33.9298 32.1350 450147 1.4830 0.8541 26.3032 27.3607 28.1864 27.2675 450148 1.3368 0.9547 30.0542 29.9522 32.0315 30.7189 450151 *** * 22. 8768 * * 22.8768 450152 1.2507 0.8739 24.3442 25.7523 27.2981 25.8872 450154 1.3577 0.7985 24.2582 23.2210 26.8036 24.6426 450155 0.9518 0.7985 24.8773 25.2546 27.0261 25.7426 450162 1.1826 0.8903 33.7823 27.1453 27.1885 29.3979 450163 1.0821 0.8100 27.0967 27.6273 28.6735 27.8002 450165 1.1390 0.9033 30.2236 30.3796 31.6216 30.7510 450176 1.6011 0.8851 25.8587 28.4561 29.1369 27.9379 450177 1.1127 0.7985 26.0895 27.7791 28.5027 27.4708 450178 0.9348 0.9233 28.5990 27.5779 28.9534 28.3711 450184 1.7708 0.9904 30.9726 32.7090 34.0933 32.6058 450187 1.1680 0.9904 29.2749 29.3048 32.4972 30.4075 450188 0.9030 0.7985 24.6823 23.0844 23.5026 23.7701 450191 1.2449 0.9483 31.1339 30.0686 32.6122 31.2546 450192 1.0167 0.8299 26.9884 27.5539 29.0941 27.8974 450193 2.2410 0.9904 37.1906 38.2891 38.8688 38.1249 450194 1.2453 0.8037 30.4381 28.6816 28.5747 29.3155CMS-1498-P2 264

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450196 1.4787 0.9547 25.4842 29.8107 34.5610 29.7868 450200 1.5357 0.7985 27.9843 27.5112 27.4356 27.6508 450201 *** * 22. 5464 * * 22.5464 450203 1.3080 0.9388 28.0986 29.4706 30.6946 29.4199 450209 1.8635 0.8539 31.9882 30.4150 32.0113 31.4497 450210 1.0230 0.8113 22.9055 23.7777 24.1082 23.5571 450211 1.4423 0.8558 28.8485 27.7427 28.6208 28.3857 450213 1.9743 0.9033 28.0307 29.2061 31.8766 29.7730 450214 1.2952 0.9904 28.2261 27.0761 29.7013 28.2460 450219 0.9672 0.7985 24.7274 28.0584 26.5426 26.4061 450221 1.0166 0.7985 20.7118 23.9462 26.0548 23.4307 450222 1.8038 0.9904 31.9255 33.2164 35.4314 33.5503 450224 1.3332 0.8225 28.7931 29.8428 34.2896 30.7490 450229 1.6776 0.8381 26.8039 27.2189 28.6814 27.5782 450231 1.7396 0.8539 27.0545 27.7289 29.0463 27.9560 450234 1.1803 0.7985 21.6799 23.2715 24.5744 23.0923 450235 0.9372 0.7985 23.8001 24.3335 26.5480 24.8876 450236 1.2391 0.8403 24.5942 24.1409 24.7381 24.4954 450237 1.6644 0.9033 31.2197 36.8412 38.6993 35.7648 450239 0.9838 0.8739 18.4234 19.1203 20.1484 19.2749 450241 1.0529 0.7985 28.4948 24.3518 23.6473 25.3644 450243 1.0338 0.7985 19.0180 19.9804 19.3327 19.4422 450253 0.8658 0.9904 22.9918 24.3618 24.8454 24.0810 450270 1.2977 0.8299 12.9999 19.0341 23.1601 17.6868 450271 1.3816 0.9388 23.9534 27.4614 27.2326 26.3228 450272 1.2457 0.9483 29.0917 29.5124 30.9357 29.8687 450280 1.6447 0.9693 34.9349 33.8297 36.7763 35.1896 450283 1.1064 0.9547 28.2094 24.3428 26.0914 26.1061 450289 1.5582 0.9904 32.6137 32.4591 33.0717 32.7210 450292 1.2182 0.9693 29.0243 29.2485 29.9357 29.4213 450293 0.7961 0.7985 24.1556 23.7577 24.0607 23.9932 450296 1.0761 0.9904 33.4545 34.1708 36.4604 34.6820 450299 1.6942 0.9206 29.4593 30.3493 31.1239 30.4022 450306 0.8749 0.8381 22.6818 25.9877 26.8169 25.0749 450315 2.1271 0.9693 31.4227 32.3840 33.7842 32.7212 450324 1.6326 0.9547 27.9899 26.8023 29.4539 28.0902CMS-1498-P2 265

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450330 1.3508 0.9904 27.7419 29.4471 30.3251 29.1461 450340 1.4176 0.8444 29.6617 28.7672 30.5815 29.6840 450346 1.5986 0.8421 24.8434 26.7809 28.3085 26.7155 450347 1.2930 0.9904 28.5789 30.0644 39.0879 31.7620 450348 0.8857 0.7985 22.6828 23.1190 24.9786 23.5721 450351 1.1747 0.9388 29.9598 30.3441 31.5335 30.6264 450352 1.1455 0.9693 27.6480 29.3516 30.7631 29.2850 450358 2.1150 0.9904 33.9103 36.9859 37.7186 36.2668 450369 0.8990 0.7985 24.1953 22.7433 26.2247 24.2072 450370 1.1848 0.9904 29.0816 28.8348 29.9689 29.2856 450372 1.3896 0.9693 30.9345 33.7023 35.7078 33.4644 450373 0.8488 0.7985 27.4251 25.3691 24.2932 25.7191 450378 *** * 33. 0583 33.9891 36.4075 34.4205 450379 1.4175 0.9693 35.0637 35.9067 32.6271 34.4741 450388 1.7639 0.9033 29.5386 30.3720 31.6070 30.5182 450389 1.2142 0.9547 26.8499 24.6733 25.7364 25.7517 450393 *** * 39. 0266 12.9286 27.1107 24.0530 450395 1.1582 0.8455 28.4272 27.2714 29.8846 28.5726 450399 0.8847 0.7985 20.6307 23.2716 22.6787 22.2015 450400 1.0362 0.9206 29.5020 29.8965 30.9996 30.1497 450403 1.5366 0.9693 31.7065 33.1710 35.4782 33.5113 450411 1.0111 0.7985 21.7877 20.9108 22.4110 21.7020 450419 1.3410 0.9547 34.9972 33.6834 34.9747 34.5445 450422 1.2762 0.9693 32.4669 36.7309 34.1134 34.3580 450424 1.5450 0.9904 29.8290 32.4674 34.5569 32.3014 450431 1.7403 0.9483 28.5289 29.6446 30.6654 29.6328 450438 1.3139 0.9904 27.7734 25.1006 25.4692 26.1366 450446 0.8334 0.9904 15.4641 12.4405 15.5216 14.4421 450447 1.1936 0.9547 28.3724 29.9936 31.8935 29.9931 450451 1.0730 0.8507 25.8836 26.5422 31.4824 27.8675 450460 0.8984 0.8040 25.2165 27.6224 25.4765 26.1120 450462 1.7382 0.9693 30.6516 31.7311 33.7989 32.0439 450465 1.2421 0.9904 28.1853 28.0105 30.1955 28.8001 450469 1.5261 0.9547 31.1348 29.2172 29.6203 29.9824 450475 1.1705 0.8558 24.7037 25.0642 25.7533 25.1909 450484 1.5134 0.8558 27.7792 29.4306 31.9711 29.7496CMS-1498-P2 266

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450488 1.1850 0.8558 24.9109 26.6089 19.2414 24.1030 450489 1.0148 0.7985 26.9543 25.3695 27.9844 26.7321 450497 1.0021 0.8496 23.0712 24.6056 25.5912 24.4315 450498 0.9124 0.7985 20.6873 19.3077 20.7519 20.2120 450508 1.4192 0.8558 29.1519 30.4829 31.5816 30.4268 450514 *** * 26. 4196 * * 26.4196 450518 1.4458 0.8421 27.5880 28.9969 30.5901 29.0765 450530 1.3988 0.9904 30.7745 31.5033 33.7675 32.0278 450537 1.6268 0.9693 30.9167 33.1500 33.2793 32.4461 450539 1.2570 0.8123 25.0191 25.5268 27.9134 26.1684 450547 0.9127 0.9547 25.4140 24.6575 25.2773 25.1206 450558 1.7520 0.8381 28.7747 30.9433 32.3359 30.6894 450563 1.5978 0.9547 32.6875 35.8856 35.5273 34.6996 450565 1.3413 0.9388 27.4774 28.0400 20.2604 24.6775 450571 1.6736 0.8444 26.5313 26.2046 29.0276 27.1996 450573 1.0624 0.8116 24.6750 28.8508 27.5686 27.0771 450578 0.9388 0.7985 25.2478 25.7938 24.6928 25.2301 450580 0.9863 0.7985 25.9881 23.7932 24.3360 24.7329 450584 1.0404 0.7985 23.6044 23.7329 23.9279 23.7525 450586 1.0322 0.7985 18.3289 19.8656 21.2418 19.8421 450587 1.1286 0.7985 25.9364 27.1505 29.0095 27.3368 450591 1.2132 0.9904 27.9867 26.8802 27.3228 27.3932 450596 1.3215 0.9388 31.6590 30.9701 32.6451 31.7682 450597 0.9543 0.7988 24.8443 26.3300 28.5346 26.5850 450604 1.5282 0.9033 29.1543 27.9983 29.6711 28.9317 450605 1.0389 0.8541 14.8039 23.3169 25.9294 19.8604 450610 1.6708 0.9904 30.5977 32.1314 33.4177 32.0231 450615 0.9227 0.8018 22.6331 25.1269 24.9073 24.2185 450617 1.6748 0.9904 30.2923 31.5691 32.8524 31.6194 450620 0.8835 0.7985 21.2535 21.7871 21.8114 21.6178 450630 1.5995 0.9904 31.8014 32.3195 33.9731 32.6640 450634 1.6926 0.9693 31.8008 31.9667 35.0494 32.9472 450638 1.7216 0.9904 33.3237 34.1802 33.8596 33.7803 450639 1.5533 0.9547 34.3754 33.3962 35.2238 34.3245 450641 0.9255 0.8496 21.7292 20.0231 21.9208 21.2237 450643 1.4481 0.8278 27.2538 28.7747 28.9744 28.3464CMS-1498-P2 267

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450644 1.6896 0.9904 31.6874 33.5265 34.8463 33.3746 450646 1.6538 0.8559 27.4631 27.8352 29.9319 28.4242 450647 1.9676 0.9693 34.1016 35.2696 36.5367 35.3425 450651 1.6423 0.9693 33.6498 34.9917 35.6621 34.7071 450653 1.1352 0.7985 26.5361 27.8569 30.2644 28.1938 450654 0.9530 0.7985 25.0755 23.5856 24.5622 24.3772 450656 1.4433 0.8558 29.7290 30.0651 32.2787 30.6407 450658 1.0226 0.7985 22.7090 21.8183 23.5451 22.6654 450659 1.6318 0.9904 34.2657 35.0007 37.4041 35.4287 450661 1.6239 0.9387 29.2381 29.1701 32.8505 30.5685 450662 1.7067 0.9447 30.9630 32.8936 34.5875 32.8475 450668 1.5975 0.8559 30.2083 30.7673 32.0366 30.9613 450669 1.2140 0.9693 32.1244 32.6777 35.4345 33.3993 450670 1.6341 0.9904 26.2954 28.8285 30.3037 28.5168 450672 1.8489 0.9547 33.0858 34.5171 35.3309 34.3346 450674 0.9275 0.9904 31.9316 33.4719 34.3708 33.2937 450675 1.5462 0.9547 32.6380 34.4049 35.3618 34.1567 450677 1.3956 0.9547 27.1603 29.5819 31.0723 29.3313 450678 1.6140 0.9693 33.5513 33.6167 35.4020 34.2062 450683 1.2254 0.9693 24.8440 28.7984 29.3788 27.6756 450684 1.5209 0.9904 31.2765 31.8794 35.0768 32.7040 450686 1.7733 0.8903 26.4871 28.8211 30.3945 28.6469 450688 1.5690 0.9693 29.4393 30.4156 39.5212 33.4935 450690 1.4264 0.8225 30.0577 31.8607 33.2142 31.5431 450694 1.1250 0.7985 27.0862 28.3456 29.6365 28.3309 450697 1.6210 0.9033 28.3002 29.0148 30.4461 29.3085 450698 0.9036 0.8247 23.3062 21.5450 22.3625 22.2982 450702 1.6646 0.8558 27.1318 26.9753 30.2610 28.1063 450709 1.5374 0.9904 31.3239 31.0331 32.2101 31.5528 450711 1.6479 0.8851 28.1040 29.2934 31.1833 29.5133 450713 1.7474 0.9483 30.4933 31.3274 32.4793 31.4789 450715 *** * * 27. 0982 * 27.0982 450716 1.4846 0.9904 33.9926 33.4960 35.7265 34.4031 450718 1.6829 0.9483 29.7609 30.6623 32.6777 31.1373 450723 1.5586 0.9693 31.0481 32.1316 32.6655 31.9568 450730 1.5137 0.9693 32.8920 34.9137 33.1903 33.6228CMS-1498-P2 268

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450742 1.2662 0.9693 30.4204 31.4270 33.0463 31.6358 450743 1.4816 0.9693 29.5098 30.3302 31.3249 30.4344 450746 1.1292 0.7985 23.3484 22.7535 25.0694 23.7092 450747 1.2515 0.8225 28.3935 27.1975 28.8858 28.1491 450749 0.9107 0.7985 23.9269 23.0265 23.2733 23.4142 450754 0.9768 0.7985 22.8572 23.4607 24.3117 23.5585 450755 1.0767 0.8556 24.7428 22.4195 31.3204 25.7528 450758 *** * 28. 3305 29.5013 28.2010 28.6514 450760 *** * 23. 7157 24.0691 25.7775 24.3542 450766 1.9556 0.9693 31.2084 33.3435 35.1683 33.2474 450770 1.3684 0.9483 23.6093 25.5863 18.0459 22.2518 450771 1.6045 0.9693 32.5014 32.6206 33.7565 32.9584 450774 1.6654 0.9904 27.5065 29.1151 * 28.3542 450775 1.5260 0.9904 31.6656 33.1582 34.3654 33.1091 450779 1.4365 0.9547 32.0770 31.4350 31.9592 31.8179 450780 2.1639 0.9033 28.5560 29.4960 31.6556 29.8709 450788 1.6154 0.8541 29.7667 31.5593 32.7687 31.3701 450795 1.1190 0.9904 43.8574 31.1871 28.4802 34.7233 450796 2.6228 0.8539 39.4762 31.6590 33.6154 34.7499 450797 1.7663 0.9904 26.0302 29.7074 31.7739 29.3070 450801 1.6105 0.7985 25.6379 27.2635 26.6634 26.5192 450803 1.3194 0.9904 28.7041 28.4345 33.0146 29.9070 450804 2.0163 0.9904 31.1891 33.2767 34.1951 32.9236 450808 2.3057 0.9483 29.6476 27.4132 29.9055 29.0173 450809 1.7258 0.9483 29.4696 30.4031 31.4588 30.4836 450811 *** * 31. 3007 32.5513 31.9859 31.9444 450813 1.1372 0.8016 26.5803 24.0804 20.6715 23.5616 450820 1.7477 0.9904 34.7445 36.4796 38.2108 36.6079 450822 1.3504 0.9693 34.4060 34.7760 36.6675 35.3212 450824 2.6197 0.9483 31.8413 34.8301 39.0190 35.1987 450825 1.6530 0.8851 25.8006 23.6674 24.3308 24.5730 450827 1.4304 0.9888 24.3659 23.6628 23.9496 23.9877 450828 1.3734 0.7985 26.9553 26.3231 28.2632 27.1681 450830 0.9681 * 28.4007 * * 28.4007 450831 1.7089 0.9904 24.4141 24.2732 29.1549 25.8378 450832 1.5453 0.9904 28.1389 31.2830 32.4824 30.7550CMS-1498-P2 269

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450833 1.1420 0.9693 29.0256 30.3604 32.5010 30.7618 450834 1.7933 0.9206 26.7253 28.1564 29.1031 27.9224 450838 *** * 19. 2949 20.3039 19.0487 19.5634 450839 1.0081 0.7985 27.5330 28.0060 28.5894 28.0255 450840 1.2748 0.9693 32.4162 34.1412 35.8725 34.2963 450841 1.6187 0.9447 24.4389 24.6321 23.9682 24.3370 450844 1.4764 0.9904 33.0758 34.7070 36.5371 34.8354 450845 1.8367 0.8559 28.5039 30.9556 31.2402 30.2207 450847 1.3939 0.9904 30.7431 31.6028 32.1869 31.6098 450848 1.4727 0.9904 31.1476 32.0471 33.4153 32.3022 450850 *** * 27. 2653 * * 27.2653 450851 2.0867 0.9693 32.8377 35.2085 38.8802 35.5622 450853 2.0083 0.9693 38.3600 37.5237 36.5101 37.2120 450855 1.8608 0.9447 30.7353 33.0196 32.9107 32.1835 450856 2.5479 0.9033 35.5006 35.5221 33.9274 34.9300 450860 1.8566 0.9904 33.3404 36.0060 39.5352 36.4526 450862 1.8415 0.9904 33.7962 34.2163 35.3982 34.5218 450864 2.6098 0.8225 25.3535 26.6579 27.1210 26.4353 450865 1.1060 0.9483 31.9200 34.6338 35.8513 34.1920 450867 1.2922 0.9483 31.4953 33.8712 34.7654 33.3974 450868 *** * 27. 7501 28.4524 30.9119 29.0597 450869 1.9926 0.8851 28.7422 27.9532 33.2135 30.1400 450871 1.9451 0.9483 32.3990 35.2470 37.9738 35.1792 450872 1.3983 0.9547 31.7345 30.7510 30.9726 31.1239 450874 1.8676 0.9693 35.6839 37.4432 36.9974 36.7518 450875 1.9516 0.8539 23.2962 26.9904 20.1676 22.8117 450876 1.7122 0.8903 30.3515 30.7721 30.9806 30.7060 450877 1.5299 0.8559 29.2353 28.0504 28.0186 28.4103 450878 2.5973 0.9033 33.6269 33.5225 36.1310 34.4610 450879 *** * 36. 4874 31.1510 33.9546 33.6692 450880 1.9228 0.9547 32.6713 32.1245 34.4319 33.1600 450883 1.9373 0.9693 37.1525 38.5954 37.3049 37.6847 450884 1.0402 0.8558 23.5799 25.0230 25.7645 24.7956 450885 1.5264 0.9693 36.0954 33.7612 36.0679 35.3127 450886 2.1922 0.9547 30.1571 33.2011 34.2513 32.5780 450887 *** * 25. 5590 * * 25.5590CMS-1498-P2 270

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 450888 1.9205 0.9437 28.5995 26.3027 33.6718 29.5947 450889 1.3218 0.9693 35.6151 29.1149 37.7768 33.7885 450890 1.6403 0.9693 32.2000 33.9068 30.5718 32.1704 450891 1.8038 0.9693 39.0890 29.7832 28.6689 31.5429 450892 *** * 39. 5333 * * 39.5333 450893 1.6541 0.9693 36.2660 37.8279 38.4890 37.6102 450894 2.5125 0.9693 25.9441 34.3388 30.1201 30.2587 460001 2.0520 0.9231 30.7040 32.3262 33.1209 32.1021 460003 1.6576 0.9319 29.6450 31.8128 33.2304 31.5395 460004 1.8788 0.9319 29.8773 32.2759 33.1810 31.8222 460005 1.5680 0.9319 29.4188 29.6947 32.5526 30.5747 460006 1.7333 0.9319 28.9653 30.3798 31.5156 30.3358 460007 1.3358 0.9268 29.1191 30.8583 31.3963 30.5244 460008 *** * 27. 6906 30.5351 31.2708 29.8198 460009 2.0509 0.9319 29.4705 31.5120 32.4915 31.2060 460010 2.0371 0.9319 30.9813 32.8157 33.5686 32.4990 460011 1.3290 0.8674 26.5486 27.0189 29.7484 27.7675 460013 1.5423 0.9231 29.7252 31.2945 33.2639 31.4115 460014 1.1697 0.9319 30.6450 30.0229 31.5876 30.7603 460015 1.4935 0.8803 28.8014 30.7369 31.4843 30.3806 460017 1.3823 0.8903 28.7126 29.8556 32.9922 30.5250 460018 1.0014 * 22.0935 24.7761 * 23.4535 460019 1.1788 0.8674 25.1615 24.9579 29.0338 26.4222 460021 1.9540 0.9268 29.7397 31.5207 32.5066 31.3092 460023 1.4134 0.9231 28.9473 30.5888 31.3338 30.3465 460026 0.9596 0.9230 29.2775 31.3552 32.2647 30.9963 460030 1.1661 0.8674 26.8979 30.0714 29.9269 28.9836 460033 0.9059 0.8674 27.9108 29.0346 30.0615 29.0242 460035 0.9434 0.8674 23.8682 23.4736 25.1957 24.1858 460039 1.1592 0.9311 30.0677 32.8010 35.0008 32.6853 460041 1.4984 0.9319 26.7356 29.4568 30.8887 29.0180 460042 1.5807 0.9319 36.2903 35.5686 32.3029 34.4949 460043 0.8631 0.9231 29.5660 31.2717 32.7481 31.2613 460044 1.4132 0.9319 29.5079 31.4469 32.6644 31.2589 460047 1.7647 0.9319 31.0020 33.0291 35.1263 33.0272 460049 2.1169 0.9319 28.6267 32.0329 32.9633 31.2669CMS-1498-P2 271

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 460051 1.5507 0.9319 28.1140 28.6559 29.4759 28.9591 460052 1.7033 0.9231 28.7455 30.2613 31.8515 30.3626 460054 1.5710 0.8803 26.3939 28.1478 28.0120 27.5238 460055 *** * * * 23. 1431 23.1431 460056 0.8224 0.8674 * * * * 470001 1.3548 1.0025 32.2887 34.5891 33.5241 33.3804 470003 1.7940 1.0293 30.0535 35.8753 36.7362 34.6784 470005 1.3682 0.9422 33.9969 32.1087 32.9379 33.0059 470011 1.2239 0.9422 30.8742 32.1668 33.3394 32.1525 470012 1.2953 1.0112 29.8259 30.9839 32.7025 31.2202 470024 1.3785 1.0293 27.3106 28.9203 29.2657 28.4919 490001 1.1846 0.8025 24.6883 25.2705 26.8850 25.6328 490002 0.9564 0.8028 24.0672 26.2533 27.6367 26.0235 490004 1.4283 0.9203 28.8660 30.6657 32.4538 30.6807 490005 1.7029 1.0513 31.4909 32.7159 34.9053 33.0668 490007 2.0623 0.8914 30.7411 31.5954 32.4614 31.6048 490009 2.0440 0.9203 31.4260 30.5748 31.9496 31.3136 490011 1.7060 0.8914 28.8780 30.5522 31.9508 30.4122 490012 1.1797 0.8025 21.8322 22.3339 24.4301 22.9678 490013 1.3615 0.9619 27.3486 27.4108 28.5324 27.7697 490017 1.6019 0.8914 29.6784 29.5853 30.9047 30.0811 490018 1.3937 0.9203 27.8682 28.8491 29.5589 28.7713 490019 1.3345 1.0513 29.8891 33.5636 33.7765 32.4062 490020 1.3546 0.9494 30.6013 32.5621 33.3461 32.1198 490021 1.4713 0.8490 28.1254 28.1343 30.0869 28.7596 490022 1.5783 1.0513 31.7985 34.5366 33.3639 33.2694 490023 1.4038 1.0513 32.6308 33.4561 35.6316 33.9527 490024 1.7367 0.8981 29.0407 29.9188 31.4854 30.2069 490027 1.4257 0.8025 24.3834 23.6876 25.1699 24.4425 490032 2.0641 0.9494 28.0120 30.0331 32.8661 30.3741 490033 1.2418 1.0513 30.9910 32.1854 35.3543 32.8355 490037 1.1921 0.8025 26.2951 28.9020 27.7807 27.6377 490038 1.1365 0.8028 24.0852 25.7219 26.5823 25.5525 490040 1.6870 1.0513 35.6822 36.5546 38.2247 36.8591 490041 1.7419 0.8914 29.1244 30.4198 31.6506 30.4422 490042 1.3852 0.8825 26.6078 28.1989 28.6351 27.8261CMS-1498-P2 272

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 490043 1.4528 1.0496 36.5982 33.4364 35.4380 35.1246 490044 1.5021 0.8914 24.1763 30.3606 31.1639 28.6723 490045 1.4362 1.0513 32.8774 34.0289 33.2301 33.3822 490046 1.5611 0.8914 29.3882 30.5445 32.0244 30.6581 490048 1.5181 0.8981 28.0320 29.1952 32.3457 29.8101 490050 1.6932 1.0513 31.1370 33.3979 35.3441 33.2738 490052 1.7570 0.8914 25.4179 26.5858 27.5800 26.5238 490053 1.2123 0.8025 24.6206 25.5300 27.6516 26.0148 490057 1.6341 0.8914 29.0700 30.5163 31.4342 30.3581 490059 1.7476 0.9494 32.1031 32.7894 33.7315 32.8906 490060 1.0988 0.8025 25.7765 26.2620 26.8764 26.2885 490063 1.9288 1.0496 34.1179 35.7722 36.5676 35.5145 490066 1.3993 0.9494 31.4298 31.1949 32.8018 31.8232 490067 1.3116 0.9494 26.7802 27.5172 28.6635 27.6322 490069 1.7572 0.9494 30.1482 33.1140 33.7580 32.4106 490071 *** * 33. 7118 36.1311 37.5474 35.7436 490073 *** * 46. 4210 * * 46.4210 490075 1.4728 0.8133 27.3424 27.8663 28.5221 27.8788 490077 1.4245 0.9203 31.0016 33.5266 33.9868 32.8758 490079 1.2258 0.8807 24.2066 25.3814 26.8381 25.4605 490084 1.1514 0.8262 26.3234 28.0861 29.2001 27.8967 490088 1.0343 0.8490 26.0285 26.5138 27.3105 26.6200 490089 1.0904 0.8981 27.4587 28.7200 28.6746 28.3003 490090 1.1170 0.8025 27.0760 28.1280 30.1159 28.4491 490092 1.0905 0.8025 27.5277 26.9546 27.9480 27.4786 490093 1.5805 0.8914 28.7122 29.2159 30.8707 29.6194 490094 1.0446 0.9494 29.7990 33.4960 35.2427 32.9163 490097 1.1213 0.8025 27.4608 27.3832 30.3702 28.3815 490098 1.2490 0.8025 26.7152 29.1195 30.2724 28.7604 490101 1.5529 1.0496 32.9516 36.2501 37.1100 35.5137 490104 0.8635 0.9494 19.0056 21.5140 25.4797 21.5647 490105 0.7752 0.8028 * * * * 490106 0.7217 * 26.2318 28.0073 29.6648 27.8955 490107 1.5612 1.0496 35.0272 36.5156 37.8948 36.4952 490108 0.9350 0.8490 27.8717 26.8474 28.1422 27.6252 490109 0.8360 0.8914 21.6711 26.3100 35.3956 26.6243CMS-1498-P2 273

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 490110 1.4981 0.8433 26.3089 28.6114 30.4140 28.4403 490111 1.3002 0.8025 26.4297 25.9801 25.5933 26.0180 490112 1.8616 0.9494 31.2549 32.6940 34.4483 32.7850 490113 1.3453 1.0513 34.7841 34.3609 35.7020 34.9658 490114 1.2877 0.8025 23.0533 23.6217 24.3756 23.7176 490115 1.1261 0.8025 23.2118 24.2056 24.5732 24.0079 490116 1.1200 0.8025 25.0351 26.8981 27.6062 26.5245 490117 1.1400 0.8025 20.3038 19.0627 21.2554 20.2023 490118 1.7126 0.9494 31.2407 32.7697 34.4087 32.7699 490119 1.3791 0.8914 29.5222 30.2401 31.8001 30.5988 490120 1.5447 0.8914 27.1990 29.8199 31.3588 29.5073 490122 1.6804 1.0496 35.2234 36.8356 37.2409 36.4506 490123 1.1733 0.8025 24.6011 25.9018 26.5759 25.6908 490126 1.2835 0.8025 25.3294 26.4277 28.1112 26.5960 490127 1.1572 0.8025 23.1399 23.5161 25.8521 24.1618 490130 1.3539 0.8914 25.9782 27.8912 28.5506 27.5060 490134 0.8484 0.8025 31.1495 36.6290 38.4799 35.3431 490135 0.8329 0.8981 27.2795 29.4817 30.6983 29.1252 490136 1.5986 0.9494 31.2911 33.2256 33.6199 32.9138 490137 *** * * 33. 7203 * 33.7203 490138 *** * * * 29. 6062 29.6062 490140 1.1707 1.0513 * * * * 500001 1.6920 1.1353 37.5323 34.4057 36.7516 36.1864 500002 1.4064 1.0072 30.1872 32.8317 34.4481 32.6052 500003 1.3883 1.1232 32.7983 34.5869 35.4284 34.3657 500005 1.9139 1.1353 36.0918 36.7598 34.3832 35.6947 500007 1.3046 1.1232 31.0313 32.8189 34.5520 32.8250 500008 2.0942 1.1353 34.7810 37.6578 39.2151 37.2339 500011 1.5112 1.1353 38.3979 35.9571 39.3411 37.8813 500012 1.6682 1.0072 33.1685 34.1650 36.8979 34.8623 500014 1.7774 1.1353 37.2698 36.3915 39.1505 37.5950 500015 1.4145 1.1353 40.8683 41.8914 37.7765 39.9793 500016 1.7006 1.1232 34.2828 35.1946 36.9961 35.5244 500019 1.2954 1.0238 33.8882 33.3151 33.7113 33.6367 500021 1.2735 1.1232 33.5610 34.1696 35.5039 34.4442 500024 1.6970 1.1041 37.4529 38.1144 38.4388 38.0019CMS-1498-P2 274

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 500025 2.0660 1.1353 44.7105 45.7929 46.4667 45.6979 500026 1.5246 1.1353 35.5080 38.9294 39.8935 38.0803 500027 1.5514 1.1353 42.4974 43.3521 46.0534 43.9702 500030 1.6107 1.1262 36.9489 37.8938 39.5003 38.1941 500031 1.3816 1.0977 34.1651 37.1418 39.3882 37.0143 500033 1.3025 1.0072 32.6753 33.5611 34.6180 33.6561 500036 1.3062 1.0072 31.9164 33.0937 34.4581 33.2430 500037 1.0522 1.0072 29.1773 31.5221 33.5698 31.4598 500039 1.6290 1.1232 34.5739 35.7525 36.9804 35.8188 500041 1.4539 1.1173 36.9273 37.1754 37.2841 37.1483 500044 1.8709 1.0552 32.0743 32.9066 37.2547 34.2357 500049 1.3589 1.0072 30.8135 32.9904 35.3710 33.0668 500050 1.6841 1.1173 35.7254 35.8576 38.7771 36.8297 500051 1.7983 1.1353 36.4764 38.1805 40.4444 38.4149 500052 0.5257 1.1353 * * * * 500053 1.2927 1.0072 28.5664 35.5776 32.3889 32.3866 500054 2.0439 1.0552 34.8114 36.0163 37.0037 35.9970 500058 1.7819 1.0072 32.6843 33.9116 35.3683 34.0086 500060 1.3839 1.1353 40.3040 33.4139 36.1561 36.3222 500064 2.1038 1.1353 34.7925 36.5889 38.6388 36.7061 500072 1.2795 1.0362 33.1148 33.7689 34.6614 33.8664 500077 1.6554 1.0552 34.3114 35.6352 36.5941 35.5623 500079 1.4615 1.1232 34.2420 35.0285 39.6971 36.2958 500084 1.2299 1.1353 33.3072 35.9603 37.4223 35.5895 500088 1.5216 1.1353 38.5194 39.5328 42.2213 40.1754 500108 1.7135 1.1232 35.8918 36.9874 38.4486 37.1566 500119 1.3965 1.0552 31.7125 33.2862 37.1560 34.2985 500124 1.5615 1.1353 36.3338 36.2555 38.4951 37.0807 500129 1.7301 1.1232 37.3189 39.0479 40.9416 39.1501 500134 *** * 28. 9759 27.6000 * 28.2473 500139 1.5940 1.1041 37.5709 37.3065 40.1626 38.3039 500141 1.3018 1.1353 34.2384 35.0996 36.5770 35.3417 500143 0.8345 1.1041 26.3893 27.6976 27.0786 27.0516 500148 1.2582 1.0072 24.6347 29.1435 29.3580 27.8028 500150 1.3469 1.1173 34.8480 37.1238 39.5124 37.2763 500151 1.2724 1.1224 * * * *CMS-1498-P2 275

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 510001 1.9015 0.8271 26.7924 27.6648 28.5579 27.6991 510002 1.3699 0.8825 24.8846 25.3769 26.9879 25.7394 510006 1.3756 0.8271 26.6421 27.5033 28.3986 27.5167 510007 1.7093 0.8880 28.5783 29.7125 31.3109 29.8649 510008 1.4922 0.9462 27.4709 30.6397 31.5292 29.9314 510012 0.9949 0.7650 22.9038 23.9222 23.9062 23.5707 510013 1.1575 0.7540 22.9612 22.1864 22.8779 22.6690 510018 1.1130 0.8098 23.7736 22.6582 24.2196 23.5313 510022 1.8567 0.8098 27.6119 28.4911 28.9389 28.3550 510023 1.1934 0.7540 23.1461 21.1483 23.2098 22.4635 510024 1.6521 0.8271 31.1327 32.3022 29.9740 31.1328 510026 1.0087 * 17.8275 18.6662 * 18.2486 510029 1.4261 0.8098 25.3925 24.6743 25.6860 25.2487 510030 1.1745 0.7540 25.5600 26.0174 26.6707 26.0891 510031 1.6207 0.8098 26.7872 29.5993 29.4024 28.5765 510033 1.5597 0.7540 24.2839 24.4150 24.9115 24.5148 510038 1.1536 0.7540 21.7545 21.1103 22.4112 21.7748 510039 1.3776 0.7540 21.3819 21.7158 22.0335 21.7116 510046 1.4481 0.8025 24.7187 23.2634 24.7177 24.2383 510047 1.2916 0.8271 28.8794 30.0461 31.1243 30.0454 510048 1.3054 0.7540 23.6396 25.0987 26.5418 25.1357 510050 1.8089 0.8446 23.5794 24.3081 24.5207 24.1225 510053 1.0042 0.7540 22.6288 24.3853 25.0147 24.0222 510055 1.6973 0.8880 30.7382 32.3284 33.3163 32.1773 510058 1.3980 0.7540 24.8770 24.9360 23.8781 24.5564 510059 *** * 21. 9053 20.5651 23.5300 22.1135 510062 1.2221 0.8098 27.7971 30.4515 32.4834 30.2773 510067 *** * 25. 2248 25.4499 * 25.3238 510070 1.3121 0.8098 25.4981 26.1227 28.1871 26.6091 510071 1.3504 0.7751 23.4553 21.7085 23.4390 22.8860 510072 1.0600 0.7540 20.2387 20.1981 21.4895 20.6336 510077 1.0537 0.8729 27.1611 24.7849 27.0319 26.3370 510082 1.2339 0.7540 21.1665 24.7558 22.7658 22.9281 510085 1.4818 0.8098 26.8133 27.6206 24.4240 26.3575 510086 1.1482 0.7540 20.1965 21.2628 20.3576 20.5850 510090 *** * 39. 0787 * * 39.0787CMS-1498-P2 276

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 520002 1.3482 0.9071 28.3413 28.2765 26.7116 27.7254 520004 1.4996 0.9819 30.9212 32.9848 34.1865 32.6654 520008 1.6075 1.0179 33.6774 36.6697 38.2815 36.3308 520009 1.8579 0.9332 29.6290 31.0683 31.6106 30.8052 520011 1.3433 0.8978 29.5024 31.8421 33.2873 31.5935 520013 1.6336 1.0976 32.1721 33.9209 34.9944 33.6882 520017 1.2107 0.9556 31.0537 31.8512 33.6624 32.2031 520019 1.2522 0.8978 30.2189 28.8256 25.1409 27.9904 520021 1.3391 1.0323 29.7809 29.0525 30.3673 29.7460 520027 1.4301 1.0179 33.5836 33.5264 35.9033 34.3676 520028 1.3940 1.1045 29.4694 28.1055 30.4362 29.3795 520030 1.7246 0.9537 31.6807 32.0646 34.2167 32.6070 520033 1.3879 0.8978 30.2631 29.5690 31.1389 30.3366 520034 1.3078 0.8978 28.1819 30.4913 31.6386 30.1603 520035 1.5330 0.9367 29.4076 31.0972 32.7626 31.1082 520037 1.7279 0.9071 32.2206 33.1606 33.0449 32.8212 520038 1.2914 1.0179 30.5267 32.6502 32.9167 32.0875 520040 *** * 35. 9652 * * 35.9652 520041 1.0128 1.1264 26.1586 28.3889 30.2068 28.2350 520044 1.5130 0.9367 28.6620 * 31.9599 30.2726 520045 1.7890 0.9492 30.0856 29.6250 33.3652 30.9444 520048 1.6586 0.9492 30.1483 31.8604 33.1944 31.7313 520049 1.9727 0.9400 29.4238 29.8707 30.8224 30.0316 520051 1.5852 1.0179 32.4131 32.5510 35.4345 33.4292 520057 1.2057 0.9274 29.1597 31.7777 34.0671 31.7455 520059 1.4262 1.0179 31.1798 32.1905 33.6526 32.3663 520062 1.3557 1.0179 32.7015 37.5630 37.0520 35.8645 520063 1.2023 1.0179 31.5200 32.6383 34.1781 32.7561 520064 1.6643 1.0179 33.1269 34.1899 36.0924 34.4301 520066 1.4525 0.9650 31.6793 31.2257 33.7033 32.1994 520070 1.8311 0.9556 30.0475 30.2454 32.1644 30.8209 520071 1.2720 1.0179 31.5452 32.9974 33.3852 32.6894 520075 1.8243 0.9400 32.2773 33.5393 34.0973 33.3083 520076 1.2579 1.0179 26.8943 28.0857 30.1903 28.4165 520078 1.6147 1.0179 32.0200 32.8377 33.6214 32.8336 520083 1.6732 1.1264 34.7230 36.8165 38.2281 36.6451CMS-1498-P2 277

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 520087 1.6998 0.9819 31.9771 33.5759 34.5519 33.3848 520088 1.3791 0.9427 30.7482 32.9061 32.7670 32.1576 520089 1.5783 1.1264 34.9357 36.3819 38.0516 36.4973 520091 1.3243 0.8978 28.7180 29.9318 31.2611 29.9703 520095 1.2864 1.1045 33.2426 33.3298 35.6079 34.0578 520096 1.4255 1.0179 29.2895 31.5023 37.8499 32.7151 520097 1.4507 0.9400 30.5442 32.2225 34.3493 32.3376 520098 2.0458 1.1264 38.0993 39.1444 41.0919 39.4919 520100 1.3212 0.9650 31.7772 32.4038 34.0159 32.7405 520102 1.2714 1.0179 31.5756 31.9275 34.1568 32.5763 520103 1.5487 1.0179 34.5640 35.3825 36.9411 35.6386 520107 1.3724 0.9136 30.0354 31.6500 31.1976 30.9724 520109 1.0287 0.8978 25.9740 27.2739 28.4742 27.2711 520113 1.4088 0.9207 33.3040 34.9718 35.6843 34.6401 520116 1.2781 1.0179 31.6702 32.7105 34.6508 33.0184 520136 1.8091 1.0179 32.3504 32.8906 33.7189 32.9955 520138 1.9849 1.0179 32.5677 33.5487 36.0676 34.0683 520139 1.4138 1.0179 31.7086 32.9369 34.1039 32.9713 520160 1.7449 0.9332 30.3052 31.0392 33.4129 31.5467 520170 1.6326 1.0179 31.7610 35.2627 33.8589 33.5756 520177 1.7357 1.0179 33.1243 34.6960 35.6005 34.5408 520189 1.3474 1.0323 29.2229 29.0333 31.6752 29.9942 520193 1.7818 0.9400 29.4737 30.8077 32.6949 31.0673 520194 1.7194 1.0179 31.0015 36.9520 35.9064 34.6592 520195 *** * 41. 6120 37.8891 * 39.7179 520196 1.7921 0.9556 33.4890 32.0197 35.9711 33.8028 520198 1.4018 0.9492 29.9803 30.6303 32.9887 31.2354 520199 2.1323 1.0179 37.0128 45.5967 46.6518 43.7293 520202 1.7481 0.9537 * 33.6427 30.8076 32.2276 520203 *** * * * 44. 8123 44.8123 520204 1.0509 1.0179 * * * * 520205 2.1096 1.0179 * * * * 530002 1.1686 1.0000 29.2418 32.5654 34.0190 32.0426 530006 1.2785 1.0000 30.3724 32.8615 33.0523 32.1254 530008 1.1051 1.0000 30.6010 30.6600 30.9960 30.7519 530009 0.8427 1.0000 27.0555 27.3359 30.2467 28.1948CMS-1498-P2 278

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 530010 1.2811 1.0000 28.5534 30.1134 32.0732 30.2646 530011 1.1057 1.0000 31.1329 31.8923 31.4146 31.4720 530012 1.6294 1.0000 30.6109 31.1738 32.9710 31.6237 530014 1.4706 1.0000 29.6724 31.2573 32.7666 31.2186 530015 1.2800 1.0000 33.4903 36.0871 37.1114 35.5281 530017 1.1557 * 25.8183 24.0911 * 24.8262 530025 1.2173 1.0000 28.8963 31.4614 30.9906 30.4574 530032 1.1632 1.0000 25.4267 26.7025 31.0922 27.6747 530033 2.0646 1.0000 * * * * 640001 0.8536 * * * * * 650001 1.4006 * * * * * 660001 1.0796 * * * * * 670002 1.0505 0.9693 29.1376 29.9545 30.5438 29.8867 670003 *** * 33. 8986 33.4713 33.2183 33.4927 670004 1.1660 0.7985 25.3706 25.5671 26.9631 25.9396 670005 1.7721 0.9904 31.9464 41.2085 29.7605 33.4908 670006 1.9552 0.9483 27.1064 34.6785 36.8199 32.5839 670007 *** * * 29. 5985 30.3445 30.0121 670008 1.5966 0.9904 * 30.3978 30.7957 30.6253 670009 *** * * 31. 8096 29.0715 30.1581 670010 0.8338 0.9693 * 35.6620 29.6612 31.5941 670011 1.0270 0.9483 * 32.1855 30.2158 30.9733 670012 2.2140 0.9904 * 24.1597 24.2305 24.1941 670013 *** * * 29. 4886 * 29.4886 670014 *** * * 34. 6108 * 34.6108 670015 *** * * 35. 3054 * 35.3054 670016 *** * * * 30. 9543 30.9543 670017 *** * * * 30. 4743 30.4743 670018 0.9687 0.9904 * * 34.7939 34.7939 670019 1.5202 0.9904 * * 42.1599 42.1599 670020 *** * * * 39. 6181 39.6181 670022 *** * * 32. 9889 34.0570 33.5229 670023 1.4036 0.9388 * * 32.5158 32.5158 670024 1.6178 0.9904 * * 30.0165 30.0165 670025 3.0845 0.9693 * * 39.9558 39.9558 670026 *** * * * 21. 8681 21.8681CMS-1498-P2 279

Provider Number Case-Mix Index 2 FY 2011 Wage Index Average Hourly Wage FY 2009 Average Hourly Wage FY 2010 Average Hourly Wage FY 2011 1 Average Hourly Wage** (3

years) 670027 1.9240 0.9904 * * 19.3451 19.3451 670028 *** * * * 43. 4052 43.4052 670029 1.7447 0.9904 * * 24.7438 24.7438 670030 *** * * * 32. 0527 32.0527 670031 1.3908 0.9904 * * 32.9130 32.9130 670033 1.1449 0.9693 * * * * 670034 1.4385 0.9483 * * 31.7770 31.7770 670040 0.8256 0.9904 * * 20.5126 20.5126 670041 1.5612 0.9483 * * * * 670042 1.7645 0.9388 * * * * 670043 1.2712 0.9483 * * * * 670044 1.2345 0.9693 * * * * 670046 1.2291 0.9388 * * * * 670047 1.4178 0.8559 * * * * 670048 1.2701 0.9904 * * * * 670049 1.4828 0.9693 * * * * 670050 1.2258 0.8903 * * * * 670051 1.7132 0.9206 * * * * 670052 0.9734 0.9388 * * * * 670053 1.5075 0.9904 * * * * 670054 2.1510 0.9033 * * * * 670055 1.4073 0.9033 * * * * 1. Based on salaries adjusted for occupational mix, according to the calculation in section XX of this proposed rule. 2. The case-mix index is based on the billed MS-DRGs in the FY 2009 MedPAR file. It is not transfer-adjusted. 3. Provider 140010 is part of a multi-campus provider (MCH) that is comprised of campuses that are located in two different CBSAs. The provider number with a "B" in the 4 th position, 140B10, indicates the portion of the wage and hours of the MCH that is allocated to CBSA 29404; provider number 140010 indicates the portion of wages and hours of the MCH that is allocated to CBSA 16974. 4. Provider 220074 is part of a MCH that is comprised of campuses that are located in two different CBSAs. The provider number with a "B" in the 4 th position, 220B74, indicates the portion of the wage and hours of the MCH that is allocated to CBSA 14484; provider number 220074 indicates the portion of wages and hours of the MCH that is allocated to CBSA 39300. 5. Provider 230104 is part of a MCH that is comprised of campuses that are located in two different CBSAs. The provider number with a "B" in the 4 th position, 230B04, indicates the portion of the wage and hours of the MCH that is allocated to CBSA 47644; provider number 230104 indicates the portion of wages and hours of the MCH that is allocated to CBSA 19804.

Notes:CMS-1498-P2 280

* Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2009, 2010, and 2011. *** Denotes MedPAR data not available for the provider for FY 2009.

TABLE 4A.—PROPOSED WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR ACUTE CARE HOSPITALS IN URBAN AREAS BY CBSA AND BY STATE--FY 2011 [Constituent counties are listed in Table 4E.]
(Wage Index Includes National Rural Floor Budget Neutrality Adjustment)

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 10180 Abilene, TX TX 0.8381 0.8861 10380 Aguadilla-Isabela-San Sebastián, PR PR 0.3369 0.4747 10420 Akron, OH OH 0.8821 0.9177 10500 Albany, GA GA 0.9056 0.9344 10580 Albany-Schenectady-Troy, NY NY 0.8668 0.9067 10740 Albuquerque, NM NM 0.9594 0.9720 10780 Alexandria, LA LA 0.8127 0.8676 10900 Allentown-Bethlehem- Easton, PA-NJ NJ 1.1249 1.0839 10900 Allentown-Bethlehem- Easton, PA-NJ PA 0.9405 0.9589 11020 Altoona, PA PA 0.8517 0.8959 11100 Amarillo, TX TX 0.8539 0.8975 11180 Ames, IA IA 1.0003 1.0002 11260 Anchorage, AK AK 1.2578 1.1701 11300 Anderson, IN IN 0.9245 0.9477 11340 Anderson, SC SC 0.8399 0.8874 11460 Ann Arbor, MI MI 1.0061 1.0042 11500 Anniston-Oxford, AL AL 0.7869 0.8486 11540 Appleton, WI WI 0.9305 0.9519 11700 Asheville, NC NC 0.9015 0.9315 12020 Athens-Clarke County, GA GA 0.9305 0.9519 12060 Atlanta-Sandy Spring s-Marietta, GA GA 0.9528 0.9674 12100 Atlantic City-Hammonton, NJ NJ 1.1249 1.0839 12220 Auburn-Opelika, AL AL 0.7495 0.8208 12260 Augusta-Richmond County, GA-SC GA 0.9527 0.9674 12260 Augusta-Richmond County, GA-SC SC 0.9527 0.9674 12420 Austin-Round Rock-San Marcos, TX TX 0.9483 0.9643 12540 Bakersfield-Delano, CA CA 1.2247 1.1489 12580 Baltimore-Towson, MD MD 1.0151 1.0103 12620 Bangor, ME ME 0.9651 0.9760CMS-1498-P2 281

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 12700 Barnstable Town, MA MA 1.2766 1.1820 12940 Baton Rouge, LA LA 0.8686 0.9080 12980 Battle Creek, MI MI 0.9714 0.9803 13020 Bay City, MI MI 0.9386 0.9575 13140 Beaumont-Port Arthur, TX TX 0.8421 0.8890 13380 Bellingham, WA WA 1.1262 1.0848 13460 Bend, OR OR 1.1191 1.0801 13644 Bethesda-Rockville-Fre derick, MD MD 1.0496 1.0337 13740 Billings, MT MT 1.0000 1.0000 13780 Binghamton, NY NY 0.8891 0.9227 13820 Birmingham-Hoover, AL AL 0.8583 0.9007 13900 Bismarck, ND ND 1.0000 1.0000 13980 Blacksburg-Christiansburg-Radford, VA VA 0.8257 0.8771 14020 Bloomington, IN IN 0.9245 0.9477 14060 Bloomington-Normal, IL IL 0.9523 0.9671 14260 Boise City-Nampa, ID ID 0.9262 0.9489 14484 Boston-Quincy, MA MA 1.2286 1.1514 14500 Boulder, CO CO 1.0071 1.0049 14540 Bowling Green, KY KY 0.8684 0.9079 14740 Bremerton-Silverdale, WA WA 1.0544 1.0369 14860 Bridgeport-Stamford-Norwalk, CT CT 1.2582 1.1703 15180 Brownsville-Harlingen, TX TX 0.9447 0.9618 15260 Brunswick, GA GA 0.9309 0.9521 15380 Buffalo-Niagara Falls, NY NY 0.9584 0.9713 15500 Burlington, NC NC 0.8748 0.9125 15540 Burlington-South Burlington, VT VT 1.0293 1.0200 15764 Cambridge-Newton-Framingham, MA MA 1.1242 1.0835 15804 Camden, NJ NJ 1.1249 1.0839 15940 Canton-Massillon, OH OH 0.8585 0.9008 15980 Cape Coral-Fort Myers, FL FL 0.9139 0.9402 16020 Cape Girardeau-Jackson, MO-IL IL 0.8770 0.9140 16020 Cape Girardeau-Jackson, MO-IL MO 0.8770 0.9140 16180 Carson City, NV NV 1.0235 1.0160 16220 Casper, WY WY 1.0000 1.0000 16300 Cedar Rapids, IA IA 0.8763 0.9135 16580 Champaign-Urbana, IL IL 1.0115 1.0079 16620 Charleston, WV WV 0.8098 0.8655 16700 Charleston-North Charlest on-Summerville, SC SC 0.9252 0.9482 16740 Charlotte-Gastonia-Rock Hill, NC-SC NC 0.9257 0.9485CMS-1498-P2 282

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 16740 Charlotte-Gastonia-Rock Hill, NC-SC SC 0.9257 0.9485 16820 Charlottesville, VA VA 0.9203 0.9447 16860 Chattanooga, TN-GA GA 0.8754 0.9129 16860 Chattanooga, TN-GA TN 0.8754 0.9129 16940 Cheyenne, WY WY 1.0000 1.0000 16974 Chicago-Joliet-Naperville, IL IL 1.0455 1.0309 17020 Chico, CA CA 1.2247 1.1489 17140 Cincinnati-Middletown, OH-KY-IN IN 0.9593 0.9719 17140 Cincinnati-Middletown, OH-KY-IN KY 0.9593 0.9719 17140 Cincinnati-Middletown, OH-KY-IN OH 0.9593 0.9719 17300 Clarksville, TN-KY KY 0.7957 0.8551 17300 Clarksville, TN-KY TN 0.7948 0.8545 17420 Cleveland, TN TN 0.7948 0.8545 17460 Cleveland-Elyria-Mentor, OH OH 0.9052 0.9341 17660 Coeur d'Alene, ID ID 0.9174 0.9427 17780 College Station-Bryan, TX TX 0.9206 0.9449 17820 Colorado Springs, CO CO 0.9665 0.9769 17860 Columbia, MO MO 0.8223 0.8746 17900 Columbia, SC SC 0.8759 0.9133 17980 Columbus, GA-AL AL 0.9077 0.9358 17980 Columbus, GA-AL GA 0.9077 0.9358 18020 Columbus, IN IN 0.9433 0.9608 18140 Columbus, OH OH 1.0130 1.0089 18580 Corpus Christi, TX TX 0.8541 0.8976 18700 Corvallis, OR OR 1.0296 1.0202 18880 Crestview-Fort Walton Beach-Destin, FL FL 0.8735 0.9115 19060 Cumberland, MD-WV MD 0.9262 0.9489 19060 Cumberland, MD-WV WV 0.8201 0.8730 19124 Dallas-Plano-Irving, TX TX 0.9693 0.9789 19140 Dalton, GA GA 0.8444 0.8906 19180 Danville, IL IL 0.9678 0.9778 19260 Danville, VA VA 0.8133 0.8680 19340 Davenport-Moline-Rock Island, IA-IL IL 0.8618 0.9032 19340 Davenport-Moline-Rock Island, IA-IL IA 0.8618 0.9032 19380 Dayton, OH OH 0.9142 0.9404 19460 Decatur, AL AL 0.7555 0.8253 19500 Decatur, IL IL 0.8342 0.8833 19660 Deltona-Daytona Beach-O rmond Beach, FL FL 0.8746 0.9123 19740 Denver-Aurora-Broomfield, CO CO 1.0576 1.0391CMS-1498-P2 283

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 19780 Des Moines-West Des Moines, IA IA 0.9485 0.9644 19804 Detroit-Livonia-Dearborn, MI MI 0.9731 0.9815 20020 Dothan, AL AL 0.7715 0.8372 20100 Dover, DE DE 1.0044 1.0030 20220 Dubuque, IA IA 0.8527 0.8966 20260 Duluth, MN-WI MN 1.0633 1.0429 20260 Duluth, MN-WI WI 1.0633 1.0429 20500 Durham-Chapel Hill, NC NC 0.9619 0.9737 20740 Eau Claire, WI WI 0.9556 0.9694 20764 Edison-New Brunswick, NJ NJ 1.1249 1.0839 20940 El Centro, CA CA 1.2247 1.1489 21060 Elizabethtown, KY KY 0.8353 0.8841 21140 Elkhart-Goshen, IN IN 0.9414 0.9595 21300 Elmira, NY NY 0.8501 0.8947 21340 El Paso, TX TX 0.8559 0.8989 21500 Erie, PA PA 0.8509 0.8953 21660 Eugene-Springfield, OR OR 1.1282 1.0861 21780 Evansville, IN-KY IN 0.8361 0.8846 21780 Evansville, IN-KY KY 0.8357 0.8843 21820 Fairbanks, AK AK 1.2578 1.1701 21940 Fajardo, PR PR 0.3874 0.5224 22020 Fargo, ND-MN MN 0.9104 0.9377 22020 Fargo, ND-MN ND 1.0000 1.0000 22140 Farmington, NM NM 0.8989 0.9296 22180 Fayetteville, NC NC 0.9411 0.9593 22220 Fayetteville-Springdale-Rogers, AR-MO AR 0.8608 0.9024 22220 Fayetteville-Springdale-Rogers, AR-MO MO 0.8608 0.9024 22380 Flagstaff, AZ AZ 1.2400 1.1587 22420 Flint, MI MI 1.1330 1.0893 22500 Florence, SC SC 0.8439 0.8903 22520 Florence-Muscle Shoals, AL AL 0.7998 0.8581 22540 Fond du Lac, WI WI 0.9343 0.9545 22660 Fort Collins-Loveland, CO CO 0.9665 0.9769

22744 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL FL 1.0333 1.0227 22900 Fort Smith, AR-OK AR 0.7707 0.8366 22900 Fort Smith, AR-OK OK 0.8017 0.8595 23060 Fort Wayne, IN IN 0.9203 0.9447 23104 Fort Worth-Arlington, TX TX 0.9388 0.9577CMS-1498-P2 284

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 23420 Fresno, CA CA 1.2247 1.1489 23460 Gadsden, AL AL 0.7421 0.8153 23540 Gainesville, FL FL 0.9377 0.9569 23580 Gainesville, GA GA 0.9665 0.9769 23844 Gary, IN IN 0.9028 0.9324 24020 Glens Falls, NY NY 0.8788 0.9153 24140 Goldsboro, NC NC 0.9239 0.9472 24220 Grand Forks, ND-MN MN 0.9104 0.9377 24220 Grand Forks, ND-MN ND 1.0000 1.0000 24300 Grand Junction, CO CO 1.0138 1.0094 24340 Grand Rapids-Wyoming, MI MI 0.9272 0.9496 24500 Great Falls, MT MT 1.0000 1.0000 24540 Greeley, CO CO 0.9665 0.9769 24580 Green Bay, WI WI 0.9400 0.9585 24660 Greensboro-High Point, NC NC 0.8956 0.9273 24780 Greenville, NC NC 0.9301 0.9516 24860 Greenville-Mauldin-Easley, SC SC 0.9314 0.9525 25020 Guayama, PR PR 0.3561 0.4931 25060 Gulfport-Biloxi, MS MS 0.8882 0.9220 25180 Hagerstown-Martinsburg, MD-WV MD 0.9462 0.9628 25180 Hagerstown-Martinsburg, MD-WV WV 0.9462 0.9628 25260 Hanford-Corcor an, CA CA 1.2247 1.1489 25420 Harrisburg-Carlis le, PA PA 0.9161 0.9418 25500 Harrisonburg, VA VA 0.9253 0.9482 25540 Hartford-West Hartford-East Hartford, CT CT 1.1257 1.0845 25620 Hattiesburg, MS MS 0.7914 0.8520 25860 Hickory-Lenoir-Morganton, NC NC 0.8611 0.9027 26100 Holland-Grand Haven, MI MI 0.8756 0.9130 26180 Honolulu, HI HI 1.1582 1.1058 26300 Hot Springs, AR AR 0.9253 0.9482 26380 Houma-Bayou Cane-Thibodaux, LA LA 0.7955 0.8550 26420 Houston-Sugar Land-Baytown, TX TX 0.9904 0.9934 26580 Huntington-Ashland, WV-KY-OH KY 0.8880 0.9219 26580 Huntington-Ashland, WV-KY-OH OH 0.8880 0.9219 26580 Huntington-Ashland, WV-KY-OH WV 0.8880 0.9219 26620 Huntsville, AL AL 0.8961 0.9276 26820 Idaho Falls, ID ID 0.9632 0.9747 26900 Indianapolis-Carmel, IN IN 0.9511 0.9662 26980 Iowa City, IA IA 0.9510 0.9662CMS-1498-P2 285

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 27060 Ithaca, NY NY 0.9732 0.9816 27100 Jackson, MI MI 0.9218 0.9458 27140 Jackson, MS MS 0.8088 0.8647 27180 Jackson, TN TN 0.8341 0.8832 27260 Jacksonville, FL FL 0.8875 0.9215 27340 Jacksonville, NC NC 0.8438 0.8902 27500 Janesville, WI WI 0.9650 0.9759 27620 Jefferson City, MO MO 0.8566 0.8994 27740 Johnson City, TN TN 0.7948 0.8545 27780 Johnstown, PA PA 0.8509 0.8953 27860 Jonesboro, AR AR 0.7797 0.8433 27900 Joplin, MO MO 0.8409 0.8881 28020 Kalamazoo-Portage, MI MI 1.0266 1.0181 28100 Kankakee-Bradley, IL IL 1.0523 1.0355 28140 Kansas City, MO-KS KS 0.9514 0.9665 28140 Kansas City, MO-KS MO 0.9514 0.9665 28420 Kennewick-Pasco-Richland, WA WA 1.0072 1.0049 28660 Killeen-Temple-Fort Hood, TX TX 0.8739 0.9118 28700 Kingsport-Bristol-Bristol, TN-VA TN 0.7948 0.8545 28700 Kingsport-Bristol-Bristol, TN-VA VA 0.8025 0.8601 28740 Kingston, NY NY 0.9110 0.9382 28940 Knoxville, TN TN 0.7948 0.8545 29020 Kokomo, IN IN 0.8969 0.9282 29100 La Crosse, WI-MN MN 0.9819 0.9876 29100 La Crosse, WI-MN WI 0.9819 0.9876 29140 Lafayette, IN IN 0.9211 0.9453 29180 Lafayette, LA LA 0.8434 0.8899 29340 Lake Charles, LA LA 0.8164 0.8703 29404 Lake County-Kenosha County, IL-WI IL 1.0687 1.0466 29404 Lake County-Kenosha County, IL-WI WI 1.0687 1.0466 29420 Lake Havasu City-Kingman, AZ AZ 1.0240 1.0164 29460 Lakeland-Winter Haven, FL FL 0.8601 0.9019 29540 Lancaster, PA PA 0.9746 0.9825 29620 Lansing-East Lansing, MI MI 1.0222 1.0151 29700 Laredo, TX TX 0.8278 0.8786 29740 Las Cruces, NM NM 0.9141 0.9403 29820 Las Vegas-Paradise, NV NV 1.1757 1.1172 29940 Lawrence, KS KS 0.8474 0.8928 30020 Lawton, OK OK 0.8579 0.9004CMS-1498-P2 286

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 30140 Lebanon, PA PA 0.8509 0.8953 30300 Lewiston, ID-WA ID 0.9138 0.9401 30300 Lewiston, ID-WA WA 1.0072 1.0049 30340 Lewiston-Auburn, ME ME 0.8915 0.9244 30460 Lexington-Fayette, KY KY 0.8760 0.9133 30620 Lima, OH OH 0.9225 0.9463 30700 Lincoln, NE NE 0.9447 0.9618 30780 Little Rock-North Little Rock-Conway, AR AR 0.8635 0.9044 30860 Logan, UT-ID ID 0.8803 0.9164 30860 Logan, UT-ID UT 0.8803 0.9164 30980 Longview, TX TX 0.8558 0.8989 31020 Longview, WA WA 1.0630 1.0427 31084 Los Angeles-Long Beach -Glendale, CA CA 1.2247 1.1489 31140 Louisville-Jefferson County, KY-IN IN 0.8810 0.9169 31140 Louisville-Jefferson County, KY-IN KY 0.8810 0.9169 31180 Lubbock, TX TX 0.8903 0.9235 31340 Lynchburg, VA VA 0.8490 0.8940 31420 Macon, GA GA 0.9325 0.9533 31460 Madera-Chowchilla, CA CA 1.2247 1.1489 31540 Madison, WI WI 1.1264 1.0849 31700 Manchester-Nashua, NH NH 1.0008 1.0005 31740 Manhattan, KS KS 0.7990 0.8576 31860 Mankato-North Ma nkato, MN MN 0.9228 0.9465 31900 Mansfield, OH OH 0.8888 0.9224 32420 Mayagüez, PR PR 0.3595 0.4963 32580 McAllen-Edinburg-Mission, TX TX 0.8851 0.9198 32780 Medford, OR OR 1.0046 1.0031 32820 Memphis, TN-MS-AR AR 0.9171 0.9425 32820 Memphis, TN-MS-AR MS 0.9171 0.9425 32820 Memphis, TN-MS-AR TN 0.9171 0.9425 32900 Merced, CA CA 1.2247 1.1489 33124 Miami-Miami Beach-K endall, FL FL 1.0191 1.0130 33140 Michigan City-La Porte, IN IN 0.9356 0.9554 33260 Midland, TX TX 0.9514 0.9665 33340 Milwaukee-Waukesha-We st Allis, WI WI 1.0179 1.0122 33460 Minneapolis-St. Paul-Bloomington, MN-WI MN 1.0976 1.0659 33460 Minneapolis-St. Paul-Bloomington, MN-WI WI 1.0976 1.0659 33540 Missoula, MT MT 1.0000 1.0000 33660 Mobile, AL AL 0.7870 0.8487CMS-1498-P2 287

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 33700 Modesto, CA CA 1.2247 1.1489 33740 Monroe, LA LA 0.8085 0.8645 33780 Monroe, MI MI 0.9622 0.9740 33860 Montgomery, AL AL 0.8475 0.8929 34060 Morgantown, WV WV 0.8271 0.8781 34100 Morristown, TN TN 0.7948 0.8545 34580 Mount Vernon-Anacortes, WA WA 1.0072 1.0049 34620 Muncie, IN IN 0.8361 0.8846 34740 Muskegon-Norton Shores, MI MI 0.9784 0.9852 34820 Myrtle Beach-North Myrtle Beach-Conway, SC SC 0.8641 0.9048 34900 Napa, CA CA 1.4432 1.2856 34940 Naples-Marco Island, FL FL 0.9779 0.9848 34980 Nashville-Davidson-Murfrees boro-Franklin, TN TN 0.9280 0.9501 35004 Nassau-Suffolk, NY NY 1.2533 1.1672 35084 Newark-Union, NJ-PA NJ 1.1280 1.0860 35084 Newark-Union, NJ-PA PA 1.1280 1.0860 35300 New Haven-Milford, CT CT 1.1661 1.1110 35380 New Orleans-Metairie -Kenner, LA LA 0.8964 0.9278 35644 New York-White Plains-Wayne, NY-NJ NJ 1.3094 1.2027 35644 New York-White Plains-Wayne, NY-NJ NY 1.3094 1.2027 35660 Niles-Benton Harbor, MI MI 0.8949 0.9268 35840 North Port-Bradenton-Sara sota-Venice, FL FL 0.9237 0.9471 35980 Norwich-New London, CT CT 1.1360 1.0912 36084 Oakland-Fremont-Hayward, CA CA 1.5852 1.3709 36100 Ocala, FL FL 0.8552 0.8984 36140 Ocean City, NJ NJ 1.1249 1.0839 36220 Odessa, TX TX 0.9387 0.9576 36260 Ogden-Clearfield, UT UT 0.9311 0.9523 36420 Oklahoma City, OK OK 0.8861 0.9205 36500 Olympia, WA WA 1.0977 1.0659 36540 Omaha-Council Bluffs, NE-IA IA 0.9510 0.9662 36540 Omaha-Council Bluffs, NE-IA NE 0.9510 0.9662 36740 Orlando-Kissimmee-Sa nford, FL FL 0.9150 0.9410 36780 Oshkosh-Neenah, WI WI 0.9470 0.9634 36980 Owensboro, KY KY 0.8495 0.8943 37100 Oxnard-Thousand Oaks-Ventura, CA CA 1.2323 1.1538 37340 Palm Bay-Melbourne-Titusville, FL FL 0.9303 0.9517 37380 Palm Coast, FL FL 0.8432 0.8898 37460 Panama City-Lynn Haven-Pana ma City Beach, FL FL 0.8432 0.8898CMS-1498-P2 288

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 37620 Parkersburg-Marietta -Vienna, WV-OH OH 0.8528 0.8967 37620 Parkersburg-Marietta -Vienna, WV-OH WV 0.7540 0.8242 37700 Pascagoula, MS MS 0.8145 0.8689 37764 Peabody, MA MA 1.0971 1.0655 37860 Pensacola-Ferry Pass-Brent, FL FL 0.8432 0.8898 37900 Peoria, IL IL 0.9247 0.9478 37964 Philadelphia, PA PA 1.0765 1.0518 38060 Phoenix-Mesa-Gle ndale, AZ AZ 1.0471 1.0320 38220 Pine Bluff, AR AR 0.8273 0.8782 38300 Pittsburgh, PA PA 0.8567 0.8995 38340 Pittsfield, MA MA 1.0435 1.0296 38540 Pocatello, ID ID 0.9336 0.9540 38660 Ponce, PR PR 0.4258 0.5573 38860 Portland-South Portland- Biddeford, ME ME 0.9885 0.9921 38900 Portland-Vanc ouver-Hillsboro, OR-WA OR 1.1173 1.0789 38900 Portland-Vanc ouver-Hillsboro, OR-WA WA 1.1173 1.0789 38940 Port St. Lucie, FL FL 1.0729 1.0494 39100 Poughkeepsie-Newburgh-Middletown, NY NY 1.1366 1.0916 39140 Prescott, AZ AZ 1.2262 1.1499 39300 Providence-New Bedford-Fa ll River, RI-MA MA 1.0702 1.0476 39300 Providence-New Bedford-Fa ll River, RI-MA RI 1.0702 1.0476 39340 Provo-Orem, UT UT 0.9230 0.9466 39380 Pueblo, CO CO 0.9665 0.9769 39460 Punta Gorda, FL FL 0.9042 0.9334 39540 Racine, WI WI 1.0602 1.0408 39580 Raleigh-Cary, NC NC 0.9670 0.9773 39660 Rapid City, SD SD 1.0940 1.0635 39740 Reading, PA PA 0.8843 0.9192 39820 Redding, CA CA 1.3547 1.2311 39900 Reno-Sparks, NV NV 1.0391 1.0266 40060 Richmond, VA VA 0.9494 0.9651 40140 Riverside-San Bernardi no-Ontario, CA CA 1.2247 1.1489 40220 Roanoke, VA VA 0.8981 0.9290 40340 Rochester, MN MN 1.0710 1.0481 40380 Rochester, NY NY 0.8668 0.9067 40420 Rockford, IL IL 1.0006 1.0004 40484 Rockingham County-Strafford County, NH NH 1.0171 1.0117 40580 Rocky Mount, NC NC 0.9082 0.9362 40660 Rome, GA GA 0.8720 0.9105CMS-1498-P2 289

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 40900 Sacramento-Arden-Arcade-Roseville, CA CA 1.3486 1.2273 40980 Saginaw-Saginaw Township North, MI MI 0.9168 0.9422 41060 St. Cloud, MN MN 1.1601 1.1070 41100 St. George, UT UT 0.9268 0.9493 41140 St. Joseph, MO-KS KS 1.0330 1.0225 41140 St. Joseph, MO-KS MO 1.0330 1.0225 41180 St. Louis, MO-IL IL 0.9019 0.9317 41180 St. Louis, MO-IL MO 0.9019 0.9317 41420 Salem, OR OR 1.1071 1.0722 41500 Salinas, CA CA 1.5827 1.3695 41540 Salisbury, MD MD 0.9262 0.9489 41620 Salt Lake City, UT UT 0.9319 0.9528 41660 San Angelo, TX TX 0.8444 0.8906 41700 San Antonio-New Braunfels, TX TX 0.9033 0.9327 41740 San Diego-Carlsbad-San Marcos, CA CA 1.2247 1.1489 41780 Sandusky, OH OH 0.8583 0.9007 41884 San Francisco-San Mateo- Redwood City, CA CA 1.5342 1.3406 41900 San Germán-Cabo Rojo, PR PR 0.4549 0.5831 41940 San Jose-Sunnyvale-Santa Clara, CA CA 1.6371 1.4015 41980 San Juan-Caguas-Guaynabo, PR PR 0.4282 0.5594 42020 San Luis Obispo-Paso Robles, CA CA 1.2368 1.1567 42044 Santa Ana-Anaheim-Irvine, CA CA 1.2247 1.1489 42060 Santa Barbara-Santa Ma ria-Goleta, CA CA 1.2247 1.1489 42100 Santa Cruz-Watsonville, CA CA 1.6386 1.4024 42140 Santa Fe, NM NM 1.0739 1.0500 42220 Santa Rosa-Petaluma, CA CA 1.5770 1.3661 42340 Savannah, GA GA 0.8817 0.9174 42540 Scranton--Wilkes-Barre, PA PA 0.8509 0.8953 42644 Seattle-Bellevue-Eve rett, WA WA 1.1353 1.0908 42680 Sebastian-Vero Beach, FL FL 0.9247 0.9478 43100 Sheboygan, WI WI 0.9256 0.9484 43300 Sherman-Denison, TX TX 0.8408 0.8880 43340 Shreveport-Bossier City, LA LA 0.8611 0.9027 43580 Sioux City, IA-NE-SD IA 0.8927 0.9252 43580 Sioux City, IA-NE-SD NE 0.8927 0.9252 43580 Sioux City, IA-NE-SD SD 1.0000 1.0000 43620 Sioux Falls, SD SD 1.0000 1.0000 43780 South Bend-Mishawaka, IN-MI IN 0.9844 0.9893 43780 South Bend-Mishawaka, IN-MI MI 0.9844 0.9893CMS-1498-P2 290

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 43900 Spartanburg, SC SC 0.9044 0.9335 44060 Spokane, WA WA 1.0552 1.0375 44100 Springfield, IL IL 0.8907 0.9238 44140 Springfield, MA MA 1.0314 1.0214 44180 Springfield, MO MO 0.8375 0.8856 44220 Springfield, OH OH 0.8968 0.9281 44300 State College, PA PA 0.8628 0.9039 44600 Steubenville-Weirton, OH-WV OH 0.8528 0.8967 44600 Steubenville-Weirton, OH-WV WV 0.7540 0.8242 44700 Stockton, CA CA 1.2502 1.1652 44940 Sumter, SC SC 0.8399 0.8874 45060 Syracuse, NY NY 0.9666 0.9770 45104 Tacoma, WA WA 1.1224 1.0823 45220 Tallahassee, FL FL 0.8954 0.9271 45300 Tampa-St. Petersburg-Cl earwater, FL FL 0.9066 0.9351 45460 Terre Haute, IN IN 0.9212 0.9453 45500 Texarkana, TX-Texarkana, AR AR 0.7668 0.8337 45500 Texarkana, TX-Texarkana, AR TX 0.7985 0.8572 45780 Toledo, OH OH 0.9344 0.9546 45820 Topeka, KS KS 0.9096 0.9372 45940 Trenton-Ewing, NJ NJ 1.1249 1.0839 46060 Tucson, AZ AZ 0.9648 0.9758 46140 Tulsa, OK OK 0.8864 0.9207 46220 Tuscaloosa, AL AL 0.8194 0.8725 46340 Tyler, TX TX 0.8225 0.8748 46540 Utica-Rome, NY NY 0.8697 0.9088 46660 Valdosta, GA GA 0.8094 0.8652 46700 Vallejo-Fairfield, CA CA 1.4496 1.2895 47020 Victoria, TX TX 0.8005 0.8587 47220 Vineland-Millville-Bridgeton, NJ NJ 1.1249 1.0839 47260 Virginia Beach-Norfolk-Newport News, VA NC 0.8914 0.9243 47260 Virginia Beach-Norfolk-Newport News, VA VA 0.8914 0.9243 47300 Visalia-Porterv ille, CA CA 1.2247 1.1489 47380 Waco, TX TX 0.8612 0.9027 47580 Warner Robins, GA GA 0.8431 0.8897 47644 Warren-Troy-Farmington-Hills, MI MI 0.9681 0.9780 47894 Washington-Arlington-Alexandria, DC-VA DC 1.0513 1.0349 47894 Washington-Arlington-Alex andria, DC-VA MD 1.0513 1.0349 47894 Washington-Arlington-Alexandria, DC-VA VA 1.0513 1.0349CMS-1498-P2 291

CBSA Code Urban Area State Proposed Wage Index Proposed GAF 47894 Washington-Arlington-Alexandria, DC-VA WV 1.0513 1.0349 47940 Waterloo-Cedar Falls, IA IA 0.8498 0.8945 48140 Wausau, WI WI 0.9537 0.9681 48300 Wenatchee-East Wenatchee, WA WA 1.0072 1.0049 48424 West Palm Beach-Boca Raton- Boynton Beach, FL FL 0.9794 0.9858 48540 Wheeling, WV-OH OH 0.8528 0.8967 48540 Wheeling, WV-OH WV 0.7540 0.8242 48620 Wichita, KS KS 0.8819 0.9175 48660 Wichita Falls, TX TX 0.9888 0.9923 48700 Williamsport, PA PA 0.8509 0.8953 48864 Wilmington, DE-MD-NJ DE 1.0753 1.0510 48864 Wilmington, DE-MD-NJ MD 1.0753 1.0510 48864 Wilmington, DE-MD-NJ NJ 1.1249 1.0839 48900 Wilmington, NC NC 0.9223 0.9461 49020 Winchester, VA-WV VA 0.9952 0.9967 49020 Winchester, VA-WV WV 0.9952 0.9967 49180 Winston-Salem, NC NC 0.8976 0.9287 49340 Worcester, MA MA 1.1159 1.0780 49420 Yakima, WA WA 1.0072 1.0049 49500 Yauco, PR PR 0.3528 0.4899 49620 York-Hanover, PA PA 0.9526 0.9673 49660 Youngstown-Warren-Boardman, OH-PA OH 0.8600 0.9019 49660 Youngstown-Warren-Boar dman, OH-PA PA 0.8600 0.9019 49700 Yuba City, CA CA 1.2247 1.1489 49740 Yuma, AZ AZ 0.9412 0.9594

TABLE 4B.—PROPOSED WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR ACUTE CARE HOSPITALS IN RURAL AREAS BY CBSA AND BY STATE--FY 2011

(Wage Index Includes National Rural Floor Budget Neutrality Adjustment)

CBSA Code Rural Area State Proposed Wage Index Proposed GAF 01 Alabama AL 0.7421 0.8153 02 Alaska AK 1.2578 1.1701 03 Arizona AZ 0.9078 0.9359CMS-1498-P2 292

CBSA Code Rural Area State Proposed Wage Index Proposed GAF 04 Arkansas AR 0.7483 0.8199 05 California CA 1.2247 1.1489 06 Colorado CO 0.9665 0.9769 07 Connecticut CT 1.1257 1.0845 08 Delaware DE 1.0044 1.0030 10 Florida FL 0.8432 0.8898 11 Georgia GA 0.7746 0.8395 12 Hawaii HI 1.1240 1.0833 13 Idaho ID 0.7552 0.8251 14 Illinois IL 0.8342 0.8833 15 Indiana IN 0.8361 0.8846 16 Iowa IA 0.8498 0.8945 17 Kansas KS 0.7990 0.8576 18 Kentucky KY 0.7957 0.8551 19 Louisiana LA 0.7910 0.8517 20 Maine ME 0.8550 0.8983 21 Maryland MD 0.9262 0.9489 22 Massachusetts MA 0.9627 0.9743 23 Michigan MI 0.8566 0.8994 24 Minnesota MN 0.9104 0.9377 25 Mississippi MS 0.7703 0.8363 26 Missouri MO 0.8109 0.8663 27 Montana MT 1.0000 1.0000 28 Nebraska NE 0.8845 0.9194 29 Nevada NV 1.0000 1.0000 30 New Hampshire NH 1.0008 1.0005 31 New Jersey 1 NJ 1.1249 1.0839 32 New Mexico NM 0.8989 0.9296 33 New York NY 0.8381 0.8861 34 North Carolina NC 0.8438 0.8902 35 North Dakota ND 1.0000 1.0000 36 Ohio OH 0.8528 0.8967 37 Oklahoma OK 0.8017 0.8595 38 Oregon OR 1.0046 1.0031 39 Pennsylvania PA 0.8509 0.8953 40 Puerto Rico 1 PR ------ ------ 41 Rhode Island 1 RI ------ ------ 42 South Carolina SC 0.8399 0.8874 43 South Dakota SD 1.0000 1.0000CMS-1498-P2 293

CBSA Code Rural Area State Proposed Wage Index Proposed GAF 44 Tennessee TN 0.7948 0.8545 45 Texas TX 0.7985 0.8572 46 Utah UT 0.8674 0.9072 47 Vermont VT 0.9422 0.9600 49 Virginia VA 0.8025 0.8601 50 Washington WA 1.0072 1.0049 51 West Virginia WV 0.7540 0.8242 52 Wisconsin WI 0.8978 0.9288 53 Wyoming WY 1.0000 1.0000
1 All counties in the State or Territory are classified as urban. The New Jersey floor is imputed as specified in §412.64 (h)(4) and discussed in the FY 2005 IPPS final rule (69 FR 49109).

TABLE 4C.—PROPOSED WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR ACUTE CARE HOSPITALS THAT ARE RECLASSIFIED BY CBSA AND BY STATE--FY 2011

(Wage Index Includes National Rural Floor Budget Neutrality Adjustment)

CBSA Code Area State Proposed Wage Index Proposed GAF 04 Arkansas AR 0.7483 0.8199 05 California CA 1.2247 1.1489 07 Connecticut CT 1.1257 1.0845 10 Florida FL 0.8432 0.8898 14 Illinois IL 0.8342 0.8833 14 Illinois MO 0.8342 0.8833 17 Kansas KS 0.7990 0.8576 18 Kentucky KY 0.7957 0.8551 22 Massachusetts MA 0.9627 0.9743 23 Michigan MI 0.8566 0.8994 24 Minnesota IA 0.9104 0.9377 26 Missouri AR 0.8109 0.8663 26 Missouri MO 0.8109 0.8663 28 Nebraska KS 0.8845 0.9194 33 New York NH 1.0008 1.0005 33 New York NY 0.8381 0.8861 34 North Carolina NC 0.8438 0.8902 34 North Carolina TN 0.8438 0.8902 36 Ohio OH 0.8528 0.8967CMS-1498-P2 294

CBSA Code Area State Proposed Wage Index Proposed GAF 37 Oklahoma OK 0.8017 0.8595 38 Oregon OR 1.0046 1.0031 39 Pennsylvania PA 0.8509 0.8953 44 Tennessee KY 0.7957 0.8551 45 Texas LA 0.7985 0.8572 45 Texas OK 0.8017 0.8595 45 Texas TX 0.7985 0.8572 47 Vermont NY 0.9285 0.9505 49 Virginia KY 0.8025 0.8601 49 Virginia VA 0.8025 0.8601 49 Virginia WV 0.8025 0.8601 50 Washington WA 1.0072 1.0049 10500 Albany, GA AL 0.8508 0.8953 10500 Albany, GA GA 0.8508 0.8953 10580 Albany-Schenectady-Troy, NY NY 0.8668 0.9067 10740 Albuquerque, NM NM 0.9462 0.9628 10780 Alexandria, LA LA 0.8127 0.8676 10900 Allentown-Bethlehem- Easton, PA-NJ PA 0.9405 0.9589 11100 Amarillo, TX KS 0.8399 0.8874 11100 Amarillo, TX TX 0.8399 0.8874 11180 Ames, IA IA 0.9235 0.9470 11260 Anchorage, AK AK 1.2578 1.1701 11300 Anderson, IN IN 0.8696 0.9088 11460 Ann Arbor, MI MI 0.9804 0.9865 12020 Athens-Clarke County, GA GA 0.9305 0.9519 12060 Atlanta-Sandy Spring s-Marietta, GA AL 0.9528 0.9674 12060 Atlanta-Sandy Spring s-Marietta, GA GA 0.9528 0.9674 12260 Augusta-Richmond County, GA-SC SC 0.9527 0.9674 12420 Austin-Round Rock-San Marcos, TX TX 0.9483 0.9643 12620 Bangor, ME ME 0.9651 0.9760 12940 Baton Rouge, LA MS 0.8541 0.8976 12980 Battle Creek, MI MI 0.9714 0.9803 13020 Bay City, MI MI 0.8850 0.9197 13644 Bethesda-Rockville-Fre derick, MD DC 1.0496 1.0337 13644 Bethesda-Rockville-Fre derick, MD PA 1.0496 1.0337 13644 Bethesda-Rockville-F rederick, MD VA 1.0496 1.0337 13780 Binghamton, NY PA 0.8750 0.9126 13820 Birmingham-Hoover, AL AL 0.8396 0.8872 13900 Bismarck, ND ND 1.0000 1.0000CMS-1498-P2 295

CBSA Code Area State Proposed Wage Index Proposed GAF 13980 Blacksburg-Christiansburg-Radford, VA WV 0.7751 0.8399 14020 Bloomington, IN IN 0.8687 0.9081 14260 Boise City-Nampa, ID ID 0.9027 0.9323 14484 Boston-Quincy, MA MA 1.1560 1.1044 14484 Boston-Quincy, MA RI 1.1560 1.1044 14540 Bowling Green, KY KY 0.8311 0.8810 14740 Bremerton-Silverdale, WA WA 1.0362 1.0247 15260 Brunswick, GA GA 0.9309 0.9521 15380 Buffalo-Niagara Falls, NY NY 0.9584 0.9713 15540 Burlington-South Burlington, VT NY 1.0025 1.0017 15540 Burlington-South Burlington, VT VT 1.0025 1.0017 15764 Cambridge-Newton-Framingham, MA NH 1.0940 1.0635 15940 Canton-Massillon, OH OH 0.8585 0.9008 16020 Cape Girardeau-Jackson, MO-IL IL 0.8342 0.8833 16020 Cape Girardeau-Jackson, MO-IL KY 0.8325 0.8820 16020 Cape Girardeau-Jackson, MO-IL MO 0.8325 0.8820 16180 Carson City, NV NV 1.0000 1.0000 16580 Champaign-Urbana, IL IL 0.9112 0.9383 16620 Charleston, WV WV 0.8098 0.8655

16700 Charleston-North Charleston-Summerville, SC SC 0.9252 0.9482 16740 Charlotte-Gastonia-Rock Hill, NC-SC NC 0.9099 0.9374 16740 Charlotte-Gastonia-Rock Hill, NC-SC SC 0.9099 0.9374 16820 Charlottesville, VA VA 0.9203 0.9447 16860 Chattanooga, TN-GA AL 0.8563 0.8992 16860 Chattanooga, TN-GA GA 0.8563 0.8992 16860 Chattanooga, TN-GA TN 0.8563 0.8992 16974 Chicago-Joliet-Naperville, IL IL 1.0323 1.0220 16974 Chicago-Joliet-Naperville, IL IN 1.0323 1.0220 16974 Chicago-Joliet-Nape rville, IL WI 1.0323 1.0220 17140 Cincinnati-Middletown, OH-KY-IN IN 0.9593 0.9719 17140 Cincinnati-Middletown, OH-KY-IN KY 0.9593 0.9719 17140 Cincinnati-Middletown, OH-KY-IN OH 0.9593 0.9719 17300 Clarksville, TN-KY KY 0.7957 0.8551 17460 Cleveland-Elyria-Mentor, OH OH 0.9052 0.9341 17780 College Station-Bryan, TX TX 0.9206 0.9449 17860 Columbia, MO MO 0.8223 0.8746 17900 Columbia, SC SC 0.8759 0.9133 17980 Columbus, GA-AL AL 0.8582 0.9006CMS-1498-P2 296

CBSA Code Area State Proposed Wage Index Proposed GAF 17980 Columbus, GA-AL GA 0.8582 0.9006 18140 Columbus, OH OH 0.9993 0.9995 18580 Corpus Christi, TX TX 0.8541 0.8976 18700 Corvallis, OR OR 1.0106 1.0072 18880 Crestview-Fort Walton Beach-Destin, FL FL 0.8539 0.8975 19124 Dallas-Plano-Irving, TX TX 0.9547 0.9688 19340 Davenport-Moline-Rock Island, IA-IL IL 0.8618 0.9032 19340 Davenport-Moline-Rock Island, IA-IL IA 0.8618 0.9032 19380 Dayton, OH OH 0.9142 0.9404 19460 Decatur, AL AL 0.7555 0.8253 19740 Denver-Aurora-Broomfield, CO CO 1.0393 1.0267 19780 Des Moines-West Des Moines, IA IA 0.9485 0.9644 19804 Detroit-Livonia-Dearborn, MI MI 0.9731 0.9815 20100 Dover, DE DE 1.0044 1.0030 20500 Durham-Chapel Hill, NC NC 0.9619 0.9737 20500 Durham-Chapel Hill, NC VA 0.9619 0.9737 20764 Edison-New Brunswick, NJ NJ 1.1249 1.0839 21060 Elizabethtown, KY KY 0.8353 0.8841 21140 Elkhart-Goshen, IN IN 0.9414 0.9595 21500 Erie, PA NY 0.8381 0.8861 21500 Erie, PA PA 0.8509 0.8953 21660 Eugene-Springfield, OR OR 1.0985 1.0664 21780 Evansville, IN-KY KY 0.8116 0.8668 22180 Fayetteville, NC NC 0.9197 0.9443 22220 Fayetteville-Springdale-Rogers, AR-MO AR 0.8462 0.8919 22220 Fayetteville-Springdale-Rogers, AR-MO OK 0.8462 0.8919 22380 Flagstaff, AZ AZ 1.2093 1.1390 22420 Flint, MI MI 1.0088 1.0060 22520 Florence-Muscle Shoals, AL MS 0.7998 0.8581 22540 Fond du Lac, WI WI 0.9136 0.9400 22660 Fort Collins-Loveland, CO CO 0.9665 0.9769

22744 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL FL 1.0333 1.0227 23060 Fort Wayne, IN IN 0.9203 0.9447 23104 Fort Worth-Arlington, TX TX 0.9388 0.9577 23540 Gainesville, FL FL 0.9377 0.9569 23844 Gary, IN IN 0.9028 0.9324 24300 Grand Junction, CO CO 1.0138 1.0094 24340 Grand Rapids-Wyoming, MI MI 0.9272 0.9496CMS-1498-P2 297

CBSA Code Area State Proposed Wage Index Proposed GAF 24500 Great Falls, MT MT 1.0000 1.0000 24540 Greeley, CO NE 0.9375 0.9568 24540 Greeley, CO WY 1.0000 1.0000 24580 Green Bay, WI MI 0.9207 0.9450 24580 Green Bay, WI WI 0.9207 0.9450 24660 Greensboro-High Point, NC NC 0.8807 0.9167 24660 Greensboro-High Point, NC VA 0.8807 0.9167 24780 Greenville, NC NC 0.9151 0.9411 24860 Greenville-Mauldin-Easley, SC NC 0.9086 0.9365 24860 Greenville-Mauldin-Easley, SC SC 0.9086 0.9365 25060 Gulfport-Biloxi, MS MS 0.8312 0.8811 25420 Harrisburg-Carlis le, PA PA 0.9161 0.9418 25540 Hartford-West Hartford-East Hartford, CT CT 1.1257 1.0845 25540 Hartford-West Hartford-East Hartford, CT MA 1.1066 1.0718 25860 Hickory-Lenoir-Morganton, NC NC 0.8499 0.8946 26300 Hot Springs, AR AR 0.9030 0.9325 26420 Houston-Sugar Land-Baytown, TX TX 0.9904 0.9934 26580 Huntington-Ashland, WV-KY-OH KY 0.8729 0.9111 26580 Huntington-Ashland, WV-KY-OH NC 0.8729 0.9111 26580 Huntington-Ashland, WV-KY-OH OH 0.8729 0.9111 26580 Huntington-Ashland, WV-KY-OH WV 0.8729 0.9111 26620 Huntsville, AL AL 0.8614 0.9029 26620 Huntsville, AL TN 0.8614 0.9029 26820 Idaho Falls, ID ID 0.9632 0.9747 26900 Indianapolis-Carmel, IN IN 0.9511 0.9662 26980 Iowa City, IA IA 0.9383 0.9573 27060 Ithaca, NY NY 0.9145 0.9406 27140 Jackson, MS MS 0.8088 0.8647 27180 Jackson, TN MS 0.8341 0.8832 27620 Jefferson City, MO MO 0.8566 0.8994 27860 Jonesboro, AR AR 0.7797 0.8433 27900 Joplin, MO KS 0.8409 0.8881 27900 Joplin, MO OK 0.8409 0.8881 28020 Kalamazoo-Portage, MI MI 0.9933 0.9954 28140 Kansas City, MO-KS KS 0.9514 0.9665 28140 Kansas City, MO-KS MO 0.9514 0.9665 28420 Kennewick-Pasco-Richland, WA ID 0.9615 0.9735 28700 Kingsport-Bristol-Bristol, TN-VA KY 0.7957 0.8551 28700 Kingsport-Bristol-Bristol, TN-VA TN 0.7948 0.8545CMS-1498-P2 298

CBSA Code Area State Proposed Wage Index Proposed GAF 28940 Knoxville, TN KY 0.7957 0.8551 28940 Knoxville, TN TN 0.7948 0.8545 29180 Lafayette, LA LA 0.8434 0.8899 29404 Lake County-Kenosha County, IL-WI IL 1.0467 1.0317 29460 Lakeland-Winter Haven, FL FL 0.8601 0.9019 29540 Lancaster, PA PA 0.9746 0.9825 29620 Lansing-East Lansing, MI MI 1.0098 1.0067 29700 Laredo, TX TX 0.8278 0.8786 29740 Las Cruces, NM NM 0.9141 0.9403 29820 Las Vegas-Paradise, NV AZ 1.1757 1.1172 30020 Lawton, OK OK 0.8270 0.8780 30460 Lexington-Fayette, KY KY 0.8626 0.9037 30620 Lima, OH OH 0.9225 0.9463 30700 Lincoln, NE NE 0.9447 0.9618 30780 Little Rock-North Little Rock-Conway, AR AR 0.8451 0.8911 30980 Longview, TX TX 0.8558 0.8989 31084 Los Angeles-Long Beach -Glendale, CA CA 1.2247 1.1489 31140 Louisville-Jefferson County, KY-IN KY 0.8810 0.9169 31420 Macon, GA GA 0.8929 0.9254 31540 Madison, WI WI 1.1045 1.0704 31900 Mansfield, OH OH 0.8888 0.9224 32780 Medford, OR OR 1.0046 1.0031 32820 Memphis, TN-MS-AR AR 0.8871 0.9212 32820 Memphis, TN-MS-AR MS 0.8871 0.9212 32820 Memphis, TN-MS-AR TN 0.8871 0.9212 33124 Miami-Miami Beach-K endall, FL FL 1.0191 1.0130 33260 Midland, TX TX 0.9514 0.9665 33340 Milwaukee-Waukesha-We st Allis, WI WI 1.0179 1.0122 33460 Minneapolis-St. Paul-Bloomington, MN-WI MN 1.0976 1.0659 33460 Minneapolis-St. Paul-Bloomington, MN-WI WI 1.0976 1.0659 33540 Missoula, MT MT 1.0000 1.0000 33660 Mobile, AL AL 0.7870 0.8487 33700 Modesto, CA CA 1.2247 1.1489 33740 Monroe, LA AR 0.8085 0.8645 33740 Monroe, LA LA 0.8085 0.8645 33780 Monroe, MI OH 0.9622 0.9740 33860 Montgomery, AL AL 0.8475 0.8929 34060 Morgantown, WV WV 0.8271 0.8781 34740 Muskegon-Norton Shores, MI MI 0.9343 0.9545CMS-1498-P2 299

CBSA Code Area State Proposed Wage Index Proposed GAF

34820 Myrtle Beach-North Myrtle Beach-Conway, SC NC 0.8641 0.9048

34980 Nashville-Davidson-Murfreesboro-Franklin, TN KY 0.9280 0.9501

34980 Nashville-Davidson-Murfreesboro-Franklin, TN TN 0.9280 0.9501 35004 Nassau-Suffolk, NY CT 1.2242 1.1486 35084 Newark-Union, NJ-PA NJ 1.1280 1.0860 35084 Newark-Union, NJ-PA NY 1.1280 1.0860 35084 Newark-Union, NJ-PA PA 1.1280 1.0860 35300 New Haven-Milford, CT CT 1.1661 1.1110 35380 New Orleans-Metairie -Kenner, LA LA 0.8964 0.9278 35644 New York-White Plains-Wayne, NY-NJ CT 1.2825 1.1858 35644 New York-White Plains-Wayne, NY-NJ NJ 1.2825 1.1858 35644 New York-White Plains-Wayne, NY-NJ NY 1.2825 1.1858 35840 North Port-Bradenton-Sara sota-Venice, FL FL 0.9237 0.9471 35980 Norwich-New London, CT RI 1.1360 1.0912 36084 Oakland-Fremont-Hayward, CA CA 1.5742 1.3644 36140 Ocean City, NJ DE 1.0853 1.0577 36220 Odessa, TX NM 0.9233 0.9468 36220 Odessa, TX TX 0.9233 0.9468 36260 Ogden-Clearfield, UT UT 0.9311 0.9523 36420 Oklahoma City, OK OK 0.8861 0.9205 36500 Olympia, WA WA 1.0977 1.0659 36740 Orlando-Kissimmee-Sa nford, FL FL 0.9150 0.9410

37460 Panama City-Lynn Ha ven-Panama City Beach, FL AL 0.7972 0.8562 37764 Peabody, MA NH 1.0971 1.0655 37860 Pensacola-Ferry Pass-Brent, FL AL 0.8114 0.8667 37900 Peoria, IL IL 0.9137 0.9401 37964 Philadelphia, PA NJ 1.1249 1.0839 37964 Philadelphia, PA PA 1.0530 1.0360 38220 Pine Bluff, AR MS 0.8273 0.8782 38300 Pittsburgh, PA OH 0.8528 0.8967 38300 Pittsburgh, PA PA 0.8509 0.8953 38300 Pittsburgh, PA WV 0.8446 0.8908 38340 Pittsfield, MA NY 1.0112 1.0077 38340 Pittsfield, MA VT 1.0112 1.0077 38860 Portland-South Portland- Biddeford, ME ME 0.9465 0.9630CMS-1498-P2 300

CBSA Code Area State Proposed Wage Index Proposed GAF 38900 Portland-Vanc ouver-Hillsboro, OR-WA OR 1.1173 1.0789 38900 Portland-Vanc ouver-Hillsboro, OR-WA WA 1.1173 1.0789 38940 Port St. Lucie, FL FL 1.0252 1.0172 39100 Poughkeepsie-Newburgh-Middletown, NY NY 1.1022 1.0689 39340 Provo-Orem, UT UT 0.9230 0.9466 39580 Raleigh-Cary, NC NC 0.9670 0.9773 39740 Reading, PA PA 0.8843 0.9192 39820 Redding, CA CA 1.3547 1.2311 39900 Reno-Sparks, NV NV 1.0391 1.0266 40060 Richmond, VA VA 0.9494 0.9651 40140 Riverside-San Bernardi no-Ontario, CA AZ 1.1377 1.0924 40220 Roanoke, VA VA 0.8825 0.9180 40220 Roanoke, VA WV 0.8825 0.9180 40380 Rochester, NY NY 0.8668 0.9067 40420 Rockford, IL IL 0.9829 0.9883 40484 Rockingham County-Strafford County, NH ME 1.0171 1.0117 40900 Sacramento-Arden-Arcade-Roseville, CA CA 1.3486 1.2273 40980 Saginaw-Saginaw Township North, MI MI 0.9060 0.9346 41060 St. Cloud, MN MN 1.1001 1.0675 41100 St. George, UT UT 0.9268 0.9493 41180 St. Louis, MO-IL IL 0.8914 0.9243 41180 St. Louis, MO-IL MO 0.8914 0.9243 41620 Salt Lake City, UT UT 0.9319 0.9528 41700 San Antonio-New Braunfels, TX TX 0.9033 0.9327 41940 San Jose-Sunnyvale-Santa Clara, CA CA 1.6178 1.3902 42044 Santa Ana-Anaheim-Irvine, CA CA 1.2247 1.1489 42100 Santa Cruz-Watsonville, CA CA 1.6386 1.4024 42140 Santa Fe, NM NM 1.0352 1.0240 42220 Santa Rosa-Petaluma, CA CA 1.5482 1.3489 42340 Savannah, GA GA 0.8817 0.9174 42340 Savannah, GA SC 0.8817 0.9174 42644 Seattle-Bellevue-Eve rett, WA WA 1.1232 1.0828 43300 Sherman-Denison, TX OK 0.8408 0.8880 43340 Shreveport-Bossier City, LA LA 0.8611 0.9027 43580 Sioux City, IA-NE-SD NE 0.8927 0.9252 43620 Sioux Falls, SD SD 1.0000 1.0000 43780 South Bend-Mishawaka, IN-MI IN 0.9445 0.9617 43900 Spartanburg, SC SC 0.8929 0.9254 44060 Spokane, WA ID 1.0336 1.0229CMS-1498-P2 301

CBSA Code Area State Proposed Wage Index Proposed GAF 44100 Springfield, IL IL 0.8907 0.9238 44140 Springfield, MA NH 1.0211 1.0144 44180 Springfield, MO AR 0.8375 0.8856 44180 Springfield, MO MO 0.8375 0.8856 44940 Sumter, SC SC 0.8399 0.8874 45060 Syracuse, NY NY 0.9666 0.9770 45220 Tallahassee, FL GA 0.8755 0.9130 45300 Tampa-St. Petersburg-Cl earwater, FL FL 0.9066 0.9351 45780 Toledo, OH OH 0.9217 0.9457 45820 Topeka, KS KS 0.8907 0.9238 46140 Tulsa, OK OK 0.8760 0.9133 46220 Tuscaloosa, AL AL 0.7985 0.8572 46220 Tuscaloosa, AL MS 0.7985 0.8572 46340 Tyler, TX TX 0.8225 0.8748 46540 Utica-Rome, NY NY 0.8697 0.9088 46660 Valdosta, GA GA 0.7804 0.8438 46700 Vallejo-Fairfield, CA CA 1.4295 1.2772 47260 Virginia Beach-Norfolk-Newport News, VA NC 0.8914 0.9243 47580 Warner Robins, GA GA 0.8431 0.8897 47894 Washington-Arlington-Alexandria, DC-VA VA 1.0513 1.0349 48140 Wausau, WI WI 0.9071 0.9354 48620 Wichita, KS KS 0.8716 0.9102 48700 Williamsport, PA PA 0.8509 0.8953 48864 Wilmington, DE-MD-NJ DE 1.0641 1.0435 48900 Wilmington, NC SC 0.9223 0.9461 49180 Winston-Salem, NC NC 0.8976 0.9287 49660 Youngstown-Warren-Boardman, OH-PA OH 0.8528 0.8967 49660 Youngstown-Warren-Boar dman, OH-PA PA 0.8509 0.8953

TABLE 4D-2.--URBAN AREAS WITH ACUTE CARE HOSPITALS RECEIVING THE PROPOSED STATEWIDE RURAL FLOOR OR IMPUTED FLOOR WAGE INDEX--FY 2011 [*Only hospitals that are geographically located in the specified State receive the State's rural or imputed floor wage index.]
(Wage Index Includes National Rural Floor Budget Neutrality Adjustment)CMS-1498-P2 302

CBSA Code Urban Area State* Proposed Rural or Imputed

Floor Wage Index 27 Montana 1 MT 1.0000 29 Nevada 1 NV 1.0000 35 North Dakota 1 ND 1.0000 43 South Dakota 1 SD 1.0000 53 Wyoming 1 WY 1.0000 10900 Allentown-Bethlehe m-Easton, PA-NJ NJ 1.1249 11260 Anchorage, AK AK 1.2578 12100 Atlantic City-Hammonton, NJ NJ 1.1249 12540 Bakersfield-Delano, CA CA 1.2247 13740 Billings, MT MT 1.0000 13900 Bismarck, ND ND 1.0000 15804 Camden, NJ NJ 1.1249 16220 Casper, WY WY 1.0000 16940 Cheyenne, WY WY 1.0000 17020 Chico, CA CA 1.2247 17300 Clarksville, TN-KY KY 0.7957 17300 Clarksville, TN-KY TN 0.7948 17420 Cleveland, TN TN 0.7948 17820 Colorado Springs, CO CO 0.9665 19060 Cumberland, MD-WV MD 0.9262 19500 Decatur, IL IL 0.8342 20100 Dover, DE DE 1.0044 20764 Edison-New Brunswick, NJ NJ 1.1249 20940 El Centro, CA CA 1.2247 21500 Erie, PA PA 0.8509 21780 Evansville, IN-KY IN 0.8361 21820 Fairbanks, AK AK 1.2578 22020 Fargo, ND-MN MN 0.9104 22020 Fargo, ND-MN ND 1.0000 22140 Farmington, NM NM 0.8989 22660 Fort Collins-Loveland, CO CO 0.9665 22900 Fort Smith, AR-OK OK 0.8017 23420 Fresno, CA CA 1.2247 23460 Gadsden, AL AL 0.7421 24220 Grand Forks, ND-MN MN 0.9104 24220 Grand Forks, ND-MN ND 1.0000CMS-1498-P2 303

CBSA Code Urban Area State* Proposed Rural or Imputed

Floor Wage Index 24500 Great Falls, MT MT 1.0000 24540 Greeley, CO CO 0.9665 25260 Hanford-Corcor an, CA CA 1.2247 25540 Hartford-West Hartford-East Hartford, CT CT 1.1257 27340 Jacksonville, NC NC 0.8438 27740 Johnson City, TN TN 0.7948 27780 Johnstown, PA PA 0.8509 28420 Kennewick-Pasco-Richland, WA WA 1.0072 28700 Kingsport-Bristol-Bristol, TN-VA TN 0.7948 28700 Kingsport-Bristol-Bristol, TN-VA VA 0.8025 28940 Knoxville, TN TN 0.7948 30140 Lebanon, PA PA 0.8509 30300 Lewiston, ID-WA WA 1.0072 31084 Los Angeles-Long B each-Glendale, CA CA 1.2247 31460 Madera-Chowchilla, CA CA 1.2247 31700 Manchester-Nashua, NH NH 1.0008 31740 Manhattan, KS KS 0.7990 32780 Medford, OR OR 1.0046 32900 Merced, CA CA 1.2247 33540 Missoula, MT MT 1.0000 33700 Modesto, CA CA 1.2247 34100 Morristown, TN TN 0.7948 34580 Mount Vernon-Anacortes, WA WA 1.0072 34620 Muncie, IN IN 0.8361 36140 Ocean City, NJ NJ 1.1249 37380 Palm Coast, FL FL 0.8432 37460 Panama City-Lynn Haven-Pa nama City Beach, FL FL 0.8432 37620 Parkersburg-Marie tta-Vienna, WV-OH OH 0.8528 37620 Parkersburg-Marietta -Vienna, WV-OH WV 0.7540 37860 Pensacola-Ferry Pass-Brent, FL FL 0.8432 39380 Pueblo, CO CO 0.9665 40140 Riverside-San Bernar dino-Ontario, CA CA 1.2247 41540 Salisbury, MD MD 0.9262 41740 San Diego-Carlsbad-San Marcos, CA CA 1.2247 42044 Santa Ana-Anaheim-Irvine, CA CA 1.2247 42060 Santa Barbara-Santa Ma ria-Goleta, CA CA 1.2247CMS-1498-P2 304

CBSA Code Urban Area State* Proposed Rural or Imputed

Floor Wage Index 42540 Scranton--Wilkes-Barre, PA PA 0.8509 43580 Sioux City, IA-NE-SD SD 1.0000 43620 Sioux Falls, SD SD 1.0000 44600 Steubenville-Weirton, OH-WV OH 0.8528 44600 Steubenville-Weirton, OH-WV WV 0.7540 44940 Sumter, SC SC 0.8399 45500 Texarkana, TX-Texarkana, AR TX 0.7985 45940 Trenton-Ewing, NJ NJ 1.1249 47220 Vineland-Millville-Bridgeton, NJ NJ 1.1249 47300 Visalia-Porterv ille, CA CA 1.2247 47940 Waterloo-Cedar Falls, IA IA 0.8498 48300 Wenatchee-East Wenatchee, WA WA 1.0072 48540 Wheeling, WV-OH OH 0.8528 48540 Wheeling, WV-OH WV 0.7540 48700 Williamsport, PA PA 0.8509 48864 Wilmington, DE-MD-NJ NJ 1.1249 49420 Yakima, WA WA 1.0072 49700 Yuba City, CA CA 1.2247

1 Hospitals in the State receive a wage index floor of 1.0000 under section 10324 of Pub. L. 111-148.

TABLE 4J.—PROPOSED OUT-MIGRATION ADJUSTMENT FOR ACUTE CARE HOSPITALS--FY 2011
The following list represents all hospitals that are eligible to have their wage index increased by the out-migration adjustment listed in this table. Hospitals cannot receive the out-migration adjustment if they are reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8 )(B) of the Act. Hospitals that have already been reclassified under section 1886(d)(10) of th e Act or redesignated under section 1886(d)(8)(B) of the Act are designated with an asterisk. We automatically assume that hospitals that have already been reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8 )(B) of the Act wish to retain their reclassification/redesignati on status and waive the app lication of the out-migration adjustment. Section 1886(d)(10) hospitals that wish to receive the out-migration adjustment, rather than thei r reclassification, must follow the termination/withdrawal procedures specified in 42 CFR 412.273 and section III.I .3. of the preamble of theCMS-1498-P2 305
May 4, 2010 proposed rule (that is, notification by June 18, 2010). Otherwise, they are deemed to have waived the out-migration adjustment. Hospitals redesignated under section 1886(d)(8)(B) of the Act will be d eemed to have waived the out-migration adjustment, unless they explicitly notify CMS th at they elect to receive the out-migration adjustment instead within 45 days from th e publication of the May 4, 2010 proposed rule (that is by June 18, 2010). Notifications are se nt to the address listed in Table 4J of the May 4, 2010 proposed rule.

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 010005 * 0.0315 MARSHALL 01470 010008 0.0336 CRENSHAW 01200 010010 0.0315 MARSHALL 01470 010012 0.0168 DE KALB 01240 010015 0.0055 CLARKE 01120 010021 0.0052 DALE 01220 010022 * 0.0695 CHEROKEE 01090 010025 * 0.0389 CHAMBERS 01080 010027 0.0026 COFFEE 01150 010029 * 0.0504 LEE 01400 010032 0.0315 RANDOLPH 01550 010035 * 0.0226 CULLMAN 01210 010040 0.0061 ETOWAH 01270 010045 0.0178 FAYETTE 01280 010046 * 0.0061 ETOWAH 01270 010047 0.0245 BUTLER 01060 010049 0.0026 COFFEE 01150 010052 * 0.0245 TALLAPOOSA 01610 010059 * 0.0071 LAWRENCE 01390 010061 * 0.0552 JACKSON 01350 010065 * 0.0245 TALLAPOOSA 01610 010083 * 0.0152 BALDWIN 01010 010091 0.0055 CLARKE 01120 010100 * 0.0152 BALDWIN 01010 010101 * 0.019 TALLADEGA 01600 010109 0.0405 PICKENS 01530 010110 0.0415 BULLOCK 01050 010125 0.0429 WINSTON 01660 010128 0.0055 CLARKE 01120 010129 0.0152 BALDWIN 01010 010138 0.0101 SUMTER 01590CMS-1498-P2 306

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 010143 * 0.0226 CULLMAN 01210 010150 0.0245 BUTLER 01060 010158 * 0.0103 FRANKLIN 01290 010164 * 0.019 TALLADEGA 01600 030067 0.0328 LAPAZ 03055 040014 * 0.0158 WHITE 04720 040019 0.0242 ST. FRANCIS 04610 040039 * 0.0055 GREENE 04270 040047 0.0037 RANDOLPH 04600 040067 0.0045 COLUMBIA 04130 040071 * 0.0067 JEFFERSON 04340 040076 * 0.0975 HOT SPRING 04290 040081 0.0398 PIKE 04540 050002 * 0.0056 ALAMEDA 05000 050007 0.0234 SAN MATEO 05510 050009 * 0.0174 NAPA 05380 050013 * 0.0174 NAPA 05380 050014 * 0.0138 AMADOR 05020 050042 * 0.0196 TEHAMA 05620 050043 * 0.0056 ALAMEDA 05000 050069 * 0.0013 ORANGE 05400 050070 0.0234 SAN MATEO 05510 050073 * 0.0297 SOLANO 05580 050075 * 0.0056 ALAMEDA 05000 050089 * 0.0011 SAN BERNARDINO 05460 050099 * 0.0011 SAN BERNARDINO 05460 050101 * 0.0297 SOLANO 05580 050113 0.0234 SAN MATEO 05510 050129 * 0.0011 SAN BERNARDINO 05460 050133 0.0165 YUBA 05680 050140 * 0.0011 SAN BERNARDINO 05460 050150 * 0.0318 NEVADA 05390 050168 * 0.0013 ORANGE 05400 050173 * 0.0013 ORANGE 05400 050193 * 0.0013 ORANGE 05400 050195 * 0.0056 ALAMEDA 05000 050197 * 0.0234 SAN MATEO 05510 050211 * 0.0056 ALAMEDA 05000 050224 * 0.0013 ORANGE 05400 050226 * 0.0013 ORANGE 05400 050230 * 0.0013 ORANGE 05400CMS-1498-P2 307

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 050245 * 0.0011 SAN BERNARDINO 05460 050264 * 0.0056 ALAMEDA 05000 050272 * 0.0011 SAN BERNARDINO 05460 050279 * 0.0011 SAN BERNARDINO 05460 050283 * 0.0056 ALAMEDA 05000 050289 0.0234 SAN MATEO 05510 050298 0.0011 SAN BERNARDINO 05460 050300 * 0.0011 SAN BERNARDINO 05460 050305 * 0.0056 ALAMEDA 05000 050320 * 0.0056 ALAMEDA 05000 050327 * 0.0011 SAN BERNARDINO 05460 050348 * 0.0013 ORANGE 05400 050366 * 0.005 CALAVERAS 05040 050367 * 0.0297 SOLANO 05580 050426 * 0.0013 ORANGE 05400 050488 * 0.0056 ALAMEDA 05000 050512 * 0.0056 ALAMEDA 05000 050517 * 0.0011 SAN BERNARDINO 05460 050526 * 0.0013 ORANGE 05400 050541 * 0.0234 SAN MATEO 05510 050543 * 0.0013 ORANGE 05400 050548 * 0.0013 ORANGE 05400 050551 * 0.0013 ORANGE 05400 050567 * 0.0013 ORANGE 05400 050570 * 0.0013 ORANGE 05400 050580 * 0.0013 ORANGE 05400 050586 * 0.0011 SAN BERNARDINO 05460 050589 * 0.0013 ORANGE 05400 050603 * 0.0013 ORANGE 05400 050609 * 0.0013 ORANGE 05400 050618 * 0.0011 SAN BERNARDINO 05460 050667 * 0.0174 NAPA 05380 050678 * 0.0013 ORANGE 05400 050680 * 0.0297 SOLANO 05580 050693 * 0.0013 ORANGE 05400 050744 * 0.0013 ORANGE 05400 050745 * 0.0013 ORANGE 05400 050746 * 0.0013 ORANGE 05400 050747 * 0.0013 ORANGE 05400 050754 0.0234 SAN MATEO 05510 050758 * 0.0011 SAN BERNARDINO 05460 060001 * 0.0096 WELD 06610CMS-1498-P2 308

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 060003 * 0.0101 BOULDER 06060 060027 * 0.0101 BOULDER 06060 060103 * 0.0101 BOULDER 06060 060116 * 0.0101 BOULDER 06060 060121 * 0.0096 WELD 06610 070003 * 0.002 WINDHAM 07070 070004 * 0.0134 LITCHFIELD 07020 070011 * 0.0134 LITCHFIELD 07020 070015 * 0.0134 LITCHFIELD 07020 070020 0.0101 MIDDLESEX 07030 070021 * 0.002 WINDHAM 07070 080001 0.0044 NEW CASTLE 08010 080003 0.0044 NEW CASTLE 08010 090001 0.0033 THE DISTRICT 09000 090003 0.0033 THE DISTRICT 09000 090004 * 0.0033 THE DISTRICT 09000 090005 0.0033 THE DISTRICT 09000 090006 0.0033 THE DISTRICT 09000 090008 0.0033 THE DISTRICT 09000 090011 0.0033 THE DISTRICT 09000 100014 * 0.0055 VOLUSIA 10630 100017 * 0.0055 VOLUSIA 10630 100023 * 0.0031 CITRUS 10080 100045 * 0.0055 VOLUSIA 10630 100047 * 0.0028 CHARLOTTE 10070 100068 * 0.0055 VOLUSIA 10630 100072 * 0.0055 VOLUSIA 10630 100077 * 0.0028 CHARLOTTE 10070 100081 * 0.0022 WALTON 10650 100118 * 0.0251 FLAGLER 10170 100139 * 0.0006 LEVY 10370 100232 * 0.0068 PUTNAM 10530 100236 * 0.0028 CHARLOTTE 10070 100249 * 0.0031 CITRUS 10080 100252 * 0.0258 OKEECHOBEE 10460 100290 * 0.0338 SUMTER 10590 100292 * 0.0022 WALTON 10650 110023 * 0.0277 GORDON 11500 110040 * 0.1172 JACKSON 11610 110041 * 0.0768 HABERSHAM 11540 110100 0.081 JEFFERSON 11620CMS-1498-P2 309

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 110101 0.0068 COOK 11311 110142 0.0193 EVANS 11441 110146 * 0.0364 CAMDEN 11170 110150 * 0.019 BALDWIN 11030 110187 * 0.0792 LUMPKIN 11701 110189 * 0.0043 FANNIN 11450 110190 * 0.0094 MACON 11710 110205 0.0466 GILMER 11471 130003 * 0.0165 NEZ PERCE 13340 130024 0.0688 BONNER 13080 130049 * 0.0365 KOOTENAI 13270 130066 0.0365 KOOTENAI 13270 130067 * 0.1032 BINGHAM 13050 140001 0.0321 FULTON 14370 140026 0.0296 LA SALLE 14580 140043 * 0.0038 WHITESIDE 14988 140058 * 0.0119 MORGAN 14770 140110 * 0.0296 LA SALLE 14580 140116 * 0.0014 MC HENRY 14640 140160 * 0.0316 STEPHENSON 14970 140161 * 0.0178 LIVINGSTON 14610 140167 * 0.0768 IROQUOIS 14460 140176 * 0.0014 MC HENRY 14640 140234 0.0296 LA SALLE 14580 150022 0.0251 MONTGOMERY 15530 150030 * 0.0242 HENRY 15320 150072 0.0092 CASS 15080 150076 * 0.0297 MARSHALL 15490 150088 * 0.0038 MADISON 15470 150091 * 0.0089 HUNTINGTON 15340 150102 * 0.0174 STARKE 15740 150113 * 0.0038 MADISON 15470 150133 * 0.0212 KOSCIUSKO 15420 150146 * 0.0087 NOBLE 15560 160013 0.0187 MUSCATINE 16690 160030 0.0013 STORY 16840 160032 0.0341 JASPER 16490 160080 * 0.0019 CLINTON 16220 170137 * 0.0421 DOUGLAS 17220 170150 0.0143 COWLEY 17170 180012 * 0.0089 HARDIN 18460CMS-1498-P2 310

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 180017 * 0.0092 BARREN 18040 180049 * 0.0329 MADISON 18750 180064 0.0211 MONTGOMERY 18860 180066 0.0517 LOGAN 18700 180070 0.0121 GRAYSON 18420 180079 0.0174 HARRISON 18480 190003 * 0.0061 IBERIA 19220 190015 * 0.0238 TANGIPAHOA 19520 190017 * 0.0134 ST. LANDRY 19480 190034 0.0135 VERMILION 19560 190044 0.0185 ACADIA 19000 190050 0.0056 BEAUREGARD 19050 190053 0.0102 JEFFRSON DAVIS 19260 190054 0.0061 IBERIA 19220 190078 0.0134 ST. LANDRY 19480 190086 * 0.0038 LINCOLN 19300 190088 0.0281 WEBSTER 19590 190099 0.0105 AVOYELLES 19040 190106 * 0.0081 ALLEN 19010 190116 0.0052 MOREHOUSE 19330 190133 0.0081 ALLEN 19010 190140 0.0021 FRANKLIN 19200 190144 * 0.0281 WEBSTER 19590 190145 0.005 LA SALLE 19290 190184 0.0075 CALDWELL 19100 190190 * 0.0075 CALDWELL 19100 190191 0.0134 ST. LANDRY 19480 190246 0.0075 CALDWELL 19100 190257 * 0.0038 LINCOLN 19300 200024 * 0.013 ANDROSCOGGIN 20000 200032 0.0367 OXFORD 20080 200034 * 0.013 ANDROSCOGGIN 20000 200050 * 0.017 HANCOCK 20040 210001 0.011 WASHINGTON 21210 210023 0.0038 ANNE ARUNDEL 21010 210028 0.0383 ST. MARYS 21180 210043 0.0038 ANNE ARUNDEL 21010 210061 0.0188 WORCESTER 21230 220001 * 0.0072 WORCESTER 22170 220002 * 0.0446 MIDDLESEX 22090CMS-1498-P2 311

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 220010 * 0.031 ESSEX 22040 220011 * 0.0446 MIDDLESEX 22090 220019 * 0.0072 WORCESTER 22170 220025 * 0.0072 WORCESTER 22170 220029 * 0.031 ESSEX 22040 220033 * 0.031 ESSEX 22040 220035 * 0.031 ESSEX 22040 220049 * 0.0446 MIDDLESEX 22090 220058 * 0.0072 WORCESTER 22170 220062 * 0.0072 WORCESTER 22170 220063 * 0.0446 MIDDLESEX 22090 220070 * 0.0446 MIDDLESEX 22090 220080 * 0.031 ESSEX 22040 220082 * 0.0446 MIDDLESEX 22090 220084 * 0.0446 MIDDLESEX 22090 220090 * 0.0072 WORCESTER 22170 220095 * 0.0072 WORCESTER 22170 220098 * 0.0446 MIDDLESEX 22090 220101 * 0.0446 MIDDLESEX 22090 220105 * 0.0446 MIDDLESEX 22090 220163 * 0.0072 WORCESTER 22170 220171 * 0.0446 MIDDLESEX 22090 220174 * 0.031 ESSEX 22040 220175 * 0.0446 MIDDLESEX 22090 220176 * 0.0072 WORCESTER 22170 230002 * 0.0043 WAYNE 23810 230003 * 0.0314 OTTAWA 23690 230005 0.0488 LENAWEE 23450 230013 * 0.0021 OAKLAND 23620 230015 0.0314 ST. JOSEPH 23740 230019 * 0.0021 OAKLAND 23620 230020 * 0.0043 WAYNE 23810 230021 * 0.0159 BERRIEN 23100 230022 * 0.0213 BRANCH 23110 230024 * 0.0043 WAYNE 23810 230029 * 0.0021 OAKLAND 23620 230035 * 0.0143 MONTCALM 23580 230037 * 0.0235 HILLSDALE 23290 230041 0.0052 BAY 23080 230047 * 0.0017 MACOMB 23490 230053 * 0.0043 WAYNE 23810 230071 * 0.0021 OAKLAND 23620CMS-1498-P2 312

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 230072 * 0.0314 OTTAWA 23690 230075 0.0067 CALHOUN 23120 230078 * 0.0159 BERRIEN 23100 230089 * 0.0043 WAYNE 23810 230092 0.0205 JACKSON 23370 230093 0.0088 MECOSTA 23530 230096 * 0.0314 ST. JOSEPH 23740 230099 * 0.0074 MONROE 23570 230104 * 0.0043 WAYNE 23810 230121 * 0.0922 SHIAWASSEE 23770 230130 * 0.0021 OAKLAND 23620 230135 * 0.0043 WAYNE 23810 230142 * 0.0043 WAYNE 23810 230146 * 0.0043 WAYNE 23810 230151 * 0.0021 OAKLAND 23620 230165 * 0.0043 WAYNE 23810 230174 * 0.0314 OTTAWA 23690 230176 * 0.0043 WAYNE 23810 230195 * 0.0017 MACOMB 23490 230204 * 0.0017 MACOMB 23490 230207 * 0.0021 OAKLAND 23620 230208 * 0.0143 MONTCALM 23580 230217 0.0067 CALHOUN 23120 230222 * 0.0098 MIDLAND 23550 230227 * 0.0017 MACOMB 23490 230244 * 0.0043 WAYNE 23810 230254 * 0.0021 OAKLAND 23620 230257 * 0.0017 MACOMB 23490 230264 * 0.0017 MACOMB 23490 230269 * 0.0021 OAKLAND 23620 230270 * 0.0043 WAYNE 23810 230273 * 0.0043 WAYNE 23810 230277 * 0.0021 OAKLAND 23620 230297 * 0.0043 WAYNE 23810 230301 * 0.0021 OAKLAND 23620 230302 * 0.0021 OAKLAND 23620 240018 0.0923 GOODHUE 24240 240044 0.0733 WINONA 24840 240064 0.0212 ITASCA 24300 240069 * 0.0312 STEELE 24730 240071 * 0.0404 RICE 24650CMS-1498-P2 313

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 240101 0.0145 BECKER 24020 240117 0.0615 MOWER 24490 240211 0.1004 PINE 24570 250023 * 0.0722 PEARL RIVER 25540 250040 * 0.0225 JACKSON 25290 250117 * 0.0722 PEARL RIVER 25540 250128 0.0419 PANOLA 25530 250162 0.0011 HANCOCK 25220 260059 0.0032 LACLEDE 26520 260064 0.004 AUDRAIN 26030 260097 0.0362 JOHNSON 26500 260116 * 0.0095 ST. FRANCOIS 26930 260160 0.0144 STODDARD 26985 260163 0.0095 ST. FRANCOIS 26930 280077 * 0.0085 DODGE 28260 290002 * 0.015 LYON 29090 300011 * 0.0049 HILLSBOROUGH 30050 300012 * 0.0049 HILLSBOROUGH 30050 300017 * 0.0075 ROCKINGHAM 30070 300020 * 0.0049 HILLSBOROUGH 30050 300023 * 0.0075 ROCKINGHAM 30070 300029 * 0.0075 ROCKINGHAM 30070 300034 * 0.0049 HILLSBOROUGH 30050 310002 * 0.0312 ESSEX 31200 310009 * 0.0312 ESSEX 31200 310015 * 0.0199 MORRIS 31300 310017 * 0.0199 MORRIS 31300 310038 * 0.0232 MIDDLESEX 31270 310039 * 0.0232 MIDDLESEX 31270 310050 * 0.0199 MORRIS 31300 310054 * 0.0312 ESSEX 31200 310070 * 0.0232 MIDDLESEX 31270 310076 * 0.0312 ESSEX 31200 310083 * 0.0312 ESSEX 31200 310096 * 0.0312 ESSEX 31200 310108 * 0.0232 MIDDLESEX 31270 310119 * 0.0312 ESSEX 31200 320003 * 0.048 SAN MIGUEL 32230 320011 0.0337 RIO ARRIBA 32190 330004 * 0.0908 ULSTER 33740 330008 * 0.0064 WYOMING 33900CMS-1498-P2 314

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 330010 0.006 MONTGOMERY 33380 330027 * 0.0196 NASSAU 33400 330033 0.0179 CHENANGO 33080 330047 0.006 MONTGOMERY 33380 330073 * 0.0078 GENESEE 33290 330094 * 0.054 COLUMBIA 33200 330103 0.0136 CATTARAUGUS 33040 330106 * 0.0196 NASSAU 33400 330126 * 0.0488 ORANGE 33540 330132 0.0136 CATTARAUGUS 33040 330135 0.0488 ORANGE 33540 330144 0.0056 STEUBEN 33690 330151 0.0056 STEUBEN 33690 330167 * 0.0196 NASSAU 33400 330175 0.0222 CORTLAND 33210 330181 * 0.0196 NASSAU 33400 330182 * 0.0196 NASSAU 33400 330198 * 0.0196 NASSAU 33400 330205 0.0488 ORANGE 33540 330222 0.0016 SARATOGA 33640 330224 * 0.0908 ULSTER 33740 330225 * 0.0196 NASSAU 33400 330235 * 0.0246 CAYUGA 33050 330259 * 0.0196 NASSAU 33400 330264 0.0488 ORANGE 33540 330276 0.0032 FULTON 33280 330277 * 0.0056 STEUBEN 33690 330331 * 0.0196 NASSAU 33400 330332 * 0.0196 NASSAU 33400 330372 * 0.0196 NASSAU 33400 330386 * 0.082 SULLIVAN 33710 340020 0.0163 LEE 34520 340021 * 0.0143 CLEVELAND 34220 340024 0.0143 SAMPSON 34810 340027 * 0.0164 LENOIR 34530 340037 * 0.0143 CLEVELAND 34220 340038 0.0329 BEAUFORT 34060 340039 * 0.0091 IREDELL 34480 340068 * 0.0102 COLUMBUS 34230 340070 * 0.0289 ALAMANCE 34000 340071 * 0.0261 HARNETT 34420CMS-1498-P2 315

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 340085 * 0.027 DAVIDSON 34280 340096 * 0.027 DAVIDSON 34280 340126 * 0.013 WILSON 34970 340129 * 0.0091 IREDELL 34480 340133 0.026 MARTIN 34580 340144 * 0.0091 IREDELL 34480 340145 * 0.0305 LINCOLN 34540 340151 0.0084 HALIFAX 34410 360002 0.0101 ASHLAND 36020 360010 * 0.0023 TUSCARAWAS 36800 360013 * 0.0143 SHELBY 36760 360025 * 0.0065 ERIE 36220 360036 * 0.0164 WAYNE 36860 360040 0.0456 KNOX 36430 360044 0.0134 DARKE 36190 360055 * 0.0011 TRUMBULL 36790 360065 * 0.0061 HURON 36400 360070 0.0005 STARK 36770 360071 0.0069 VAN WERT 36820 360084 0.0005 STARK 36770 360086 * 0.0086 CLARK 36110 360096 0.0023 COLUMBIANA 36140 360107 0.017 SANDUSKY 36730 360125 * 0.0106 ASHTABULA 36030 360131 0.0005 STARK 36770 360151 0.0005 STARK 36770 360156 0.017 SANDUSKY 36730 360161 0.0011 TRUMBULL 36790 360175 * 0.02 CLINTON 36130 360185 * 0.0023 COLUMBIANA 36140 360245 * 0.0106 ASHTABULA 36030 360355 0.0086 CLARK 36110 370014 * 0.017 BRYAN 37060 370015 * 0.039 MAYES 37480 370023 0.0072 STEPHENS 37680 370065 0.0102 CRAIG 37170 370149 * 0.0242 POTTAWATOMIE 37620 370156 0.0097 GARVIN 37240 370169 0.0173 MCINTOSH 37450 370214 0.0097 GARVIN 37240CMS-1498-P2 316

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 380022 * 0.0126 LINN 38210 390008 0.0014 LAWRENCE 39450 390016 * 0.0014 LAWRENCE 39450 390030 * 0.0147 SCHUYLKILL 39650 390031 * 0.0147 SCHUYLKILL 39650 390039 0.0037 SOMERSET 39680 390044 * 0.025 BERKS 39110 390052 0.002 CLEARFIELD 39230 390056 0.002 HUNTINGDON 39380 390065 * 0.0471 ADAMS 39000 390066 * 0.0274 LEBANON 39460 390086 * 0.002 CLEARFIELD 39230 390096 * 0.025 BERKS 39110 390110 * 0.0002 CAMBRIA 39160 390112 0.0037 SOMERSET 39680 390117 0.0001 BEDFORD 39100 390130 * 0.0002 CAMBRIA 39160 390138 * 0.0208 FRANKLIN 39350 390150 0.0006 GREENE 39370 390151 * 0.0208 FRANKLIN 39350 390162 * 0.0217 NORTHAMPTON 39590 390173 0.0037 INDIANA 39390 390183 * 0.0147 SCHUYLKILL 39650 390201 0.0951 MONROE 39550 390313 * 0.0147 SCHUYLKILL 39650 390316 * 0.025 BERKS 39110 420002 0.0001 YORK 42450 420005 0.0012 DILLON 42160 420007 * 0.003 SPARTANBURG 42410 420019 0.0169 CHESTER 42110 420020 * 0.0008 GEORGETOWN 42210 420027 * 0.0231 ANDERSON 42030 420030 * 0.0148 COLLETON 42140 420036 * 0.0075 LANCASTER 42280 420039 * 0.011 UNION 42430 420043 0.0152 CHEROKEE 42100 420053 0.0103 NEWBERRY 42350 420054 0.0002 MARLBORO 42340 420055 0.0028 MARION 42330 420062 0.0125 CHESTERFIELD 42120CMS-1498-P2 317

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 420068 * 0.0068 ORANGEBURG 42370 420069 * 0.0005 CLARENDON 42130 420070 * 0.0051 SUMTER 42420 420082 0.0002 AIKEN 42010 420083 * 0.003 SPARTANBURG 42410 420098 0.0008 GEORGETOWN 42210 430048 0.0355 LAWRENCE 43400 430094 0.0355 LAWRENCE 43400 440007 0.0171 COFFEE 44150 440008 0.0262 HENDERSON 44380 440012 0.0009 SULLIVAN 44810 440016 0.0084 CARROLL 44080 440017 0.0009 SULLIVAN 44810 440025 * 0.0009 GREENE 44290 440035 * 0.0287 MONTGOMERY 44620 440047 0.0197 GIBSON 44260 440050 0.0009 GREENE 44290 440051 0.0048 MC NAIRY 44540 440060 0.0197 GIBSON 44260 440063 0.0033 WASHINGTON 44890 440070 0.0063 DECATUR 44190 440105 0.0033 WASHINGTON 44890 440109 0.0041 HARDIN 44350 440115 0.0197 GIBSON 44260 440137 0.0578 BEDFORD 44010 440144 * 0.0171 COFFEE 44150 440148 0.0232 DE KALB 44200 440174 * 0.0232 HAYWOOD 44370 440176 0.0009 SULLIVAN 44810 440181 0.0296 HARDEMAN 44340 440182 0.0084 CARROLL 44080 440184 0.0033 WASHINGTON 44890 440185 * 0.0234 BRADLEY 44050 450032 * 0.0216 HARRISON 45620 450039 * 0.0049 TARRANT 45910 450052 * 0.033 BOSQUE 45160 450064 * 0.0049 TARRANT 45910 450087 * 0.0049 TARRANT 45910 450090 0.0699 COOKE 45340 450099 * 0.0084 GRAY 45563CMS-1498-P2 318

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 450135 * 0.0049 TARRANT 45910 450137 * 0.0049 TARRANT 45910 450144 * 0.0446 ANDREWS 45010 450163 0.0115 KLEBERG 45743 450192 0.0314 HILL 45651 450194 0.0052 CHEROKEE 45281 450210 0.0128 PANOLA 45842 450224 * 0.0055 WOOD 45974 450236 0.0418 HOPKINS 45654 450270 0.0314 HILL 45651 450283 * 0.0415 VAN ZANDT 45947 450347 * 0.0395 WALKER 45949 450348 * 0.0093 FALLS 45500 450370 * 0.025 COLORADO 45312 450389 * 0.0405 HENDERSON 45640 450395 0.047 POLK 45850 450419 * 0.0049 TARRANT 45910 450438 * 0.025 COLORADO 45312 450451 0.0522 SOMERVELL 45893 450460 0.0055 TYLER 45942 450497 0.0511 MONTAGUE 45800 450539 0.0138 HALE 45582 450547 * 0.0055 WOOD 45974 450563 * 0.0049 TARRANT 45910 450565 * 0.0509 PALO PINTO 45841 450573 0.0131 JASPER 45690 450596 * 0.0724 HOOD 45653 450597 0.0003 DE WITT 45420 450615 0.0033 CASS 45260 450639 * 0.0049 TARRANT 45910 450641 0.0511 MONTAGUE 45800 450672 * 0.0049 TARRANT 45910 450675 * 0.0049 TARRANT 45910 450677 * 0.0049 TARRANT 45910 450698 0.0262 LAMB 45751 450747 * 0.0031 ANDERSON 45000 450755 0.0571 HOCKLEY 45652 450770 * 0.0218 MILAM 45795 450779 * 0.0049 TARRANT 45910 450813 0.0031 ANDERSON 45000CMS-1498-P2 319

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 450872 * 0.0049 TARRANT 45910 450880 * 0.0049 TARRANT 45910 450886 * 0.0049 TARRANT 45910 450888 0.0049 TARRANT 45910 460001 0.0001 UTAH 46240 460013 0.0001 UTAH 46240 460017 0.0229 BOX ELDER 46010 460023 0.0001 UTAH 46240 460039 * 0.0229 BOX ELDER 46010 460043 0.0001 UTAH 46240 460052 0.0001 UTAH 46240 490002 0.0003 RUSSELL 49830 490019 * 0.1041 CULPEPER 49230 490038 0.0003 SMYTH 49860 490084 0.0237 ESSEX 49280 490105 0.0003 SMYTH 49860 490110 0.0176 MONTGOMERY 49600 500003 * 0.027 SKAGIT 50280 500007 * 0.027 SKAGIT 50280 500019 0.0166 LEWIS 50200 500024 0.0064 THURSTON 50330 500039 * 0.0182 KITSAP 50170 500041 * 0.0055 COWLITZ 50070 500139 0.0064 THURSTON 50330 500143 0.0064 THURSTON 50330 510012 0.011 MASON 51260 510018 * 0.0107 JACKSON 51170 510047 * 0.0234 MARION 51240 520009 0.0027 OUTAGAMIE 52430 520028 * 0.0473 GREEN 52220 520035 0.0111 SHEBOYGAN 52580 520044 0.0111 SHEBOYGAN 52580 520045 0.0022 WINNEBAGO 52690 520048 0.0022 WINNEBAGO 52690 520057 0.0296 SAUK 52550 520071 * 0.0332 JEFFERSON 52270 520076 * 0.0275 DODGE 52130 520088 0.0084 FOND DU LAC 52190 520095 * 0.0296 SAUK 52550 520102 * 0.0714 WALWORTH 52630CMS-1498-P2 320

Provider Number Reclassified for FY 2010 ProposedOutMigration Adjustment Qualifying County Name County Code 520116 * 0.0332 JEFFERSON 52270 520160 0.0027 OUTAGAMIE 52430 520198 0.0022 WINNEBAGO 52690

TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS--FY 2011

Provider Number Geographic CBSA Reclassified CBSA LUGAR 010001 20020 10500 010005 01 13820 010009 19460 26620 010022 01 12060 010025 01 17980 010029 12220 17980 010035 01 13820 010046 23460 13820 010052 01 33860 010054 19460 26620 010055 20020 37460 010059 19460 26620 010061 01 16860 010065 01 13820 010083 01 33660 010085 19460 26620 010100 01 37860 010101 01 13820 010102 01 33860 010118 01 46220 010126 01 33860 010143 01 26620 010158 01 19460 010164 01 13820 020008 02 11260 030033 03 22380 030069 29420 40140CMS-1498-P2 321

Provider Number Geographic CBSA Reclassified CBSA LUGAR 030101 29420 29820 040014 04 30780 040017 04 22220 040020 27860 32820 040027 04 44180 040039 04 26 040041 04 30780 040069 04 26 040071 38220 30780 040076 04 26300 LUGAR 040080 04 27860 040085 04 32820 040088 04 33740 040119 04 30780 050002 36084 41940 050006 05 39820 050009 34900 42220 050013 34900 42220 050014 05 40900 050022 40140 42044 050038 41940 42100 050042 05 39820 050043 36084 41940 050046 37100 31084 050054 40140 42044 050069 42044 31084 050071 41940 42100 050073 46700 36084 050075 36084 41940 050082 37100 31084 050084 44700 40900 050089 40140 31084 050090 42220 36084 050099 40140 31084 050101 46700 36084 050102 40140 42044 050118 44700 33700CMS-1498-P2 322

Provider Number Geographic CBSA Reclassified CBSA LUGAR 050125 41940 42100 050129 40140 31084 050131 41884 36084 050136 42220 36084 050140 40140 31084 050150 05 40900 050152 41884 36084 050153 41940 42100 050159 37100 31084 050168 42044 31084 050173 42044 31084 050174 42220 36084 050188 41940 42100 050193 42044 31084 050195 36084 41940 050197 41884 41940 050211 36084 41940 050224 42044 31084 050226 42044 31084 050230 42044 31084 050236 37100 31084 050243 40140 42044 050245 40140 31084 050264 36084 41940 050272 40140 31084 050279 40140 31084 050283 36084 41940 050291 42220 36084 050292 40140 42044 050300 40140 31084 050305 36084 41940 050308 41940 42100 050320 36084 41940 050327 40140 31084 050329 40140 42044 050334 41500 41940 050335 05 33700CMS-1498-P2 323

Provider Number Geographic CBSA Reclassified CBSA LUGAR 050348 42044 31084 050360 41884 36084 050366 05 40900 050367 46700 36084 050380 41940 42100 050385 42220 36084 050390 40140 42044 050394 37100 31084 050423 40140 42044 050426 42044 31084 050441 41940 42100 050488 36084 41940 050510 41884 36084 050512 36084 41940 050517 40140 31084 050526 42044 31084 050534 40140 42044 050541 41884 41940 050543 42044 31084 050547 42220 36084 050548 42044 31084 050549 37100 31084 050551 42044 31084 050567 42044 31084 050570 42044 31084 050573 40140 42044 050580 42044 31084 050586 40140 31084 050589 42044 31084 050603 42044 31084 050604 41940 42100 050609 42044 31084 050616 37100 31084 050662 41940 42100 050667 34900 46700 050668 41884 36084 050678 42044 31084CMS-1498-P2 324

Provider Number Geographic CBSA Reclassified CBSA LUGAR 050680 46700 36084 050684 40140 42044 050686 40140 42044 050688 41940 42100 050690 42220 36084 050693 42044 31084 050694 40140 42044 050701 40140 42044 050709 40140 31084 050744 42044 31084 050745 42044 31084 050746 42044 31084 050747 42044 31084 050748 44700 33700 050749 37100 31084 050758 40140 31084 060001 24540 19740 060003 14500 19740 060023 24300 19740 060027 14500 19740 060031 17820 19740 060049 06 22660 060075 06 24300 060096 06 19740 060103 14500 19740 060116 14500 19740 060118 06 19740 060121 24540 19740 070001 35300 35004 070003 07 25540 LUGAR 070005 35300 35004 070006 14860 35644 070010 14860 35644 070011 07 25540 LUGAR 070015 07 35644 070016 35300 35004 070017 35300 35004CMS-1498-P2 325

Provider Number Geographic CBSA Reclassified CBSA LUGAR 070018 14860 35644 070019 35300 35004 070021 07 25540 LUGAR 070022 35300 35004 070028 14860 35644 070031 35300 35004 070033 14860 35644 070034 14860 35644 070036 25540 35300 070038 35300 35004 070039 35300 35004 080004 20100 48864 080006 08 20100 080007 08 36140 090004 47894 13644 100002 48424 22744 100014 19660 36740 100017 19660 36740 100022 33124 22744 100023 10 45300 100024 10 33124 100045 19660 36740 100047 39460 35840 100049 10 29460 100068 19660 36740 100072 19660 36740 100077 39460 35840 100080 48424 22744 100081 10 18880 LUGAR 100105 42680 38940 100109 10 36740 100130 48424 22744 100139 10 23540 LUGAR 100150 10 33124 100157 29460 45300 100160 10 33124 100168 48424 22744CMS-1498-P2 326

Provider Number Geographic CBSA Reclassified CBSA LUGAR 100176 48424 22744 100217 42680 38940 100232 10 23540 100234 48424 22744 100236 39460 35840 100249 10 45300 100252 10 38940 100253 48424 22744 100258 48424 22744 100268 48424 22744 100269 48424 22744 100275 48424 22744 100287 48424 22744 100288 48424 22744 100290 10 36740 100292 10 18880 LUGAR 110001 19140 16860 110002 11 31420 110016 11 17980 110023 11 12060 110029 23580 12060 110038 11 46660 110040 11 12060 LUGAR 110041 11 12020 110054 40660 12060 110069 47580 31420 110075 11 42340 110095 11 10500 110105 11 10500 110112 11 10500 110122 46660 45220 110125 11 31420 110146 11 15260 110150 11 31420 110153 47580 31420 110168 40660 12060 110187 11 12060 LUGARCMS-1498-P2 327

Provider Number Geographic CBSA Reclassified CBSA LUGAR 110189 11 12060 110190 11 47580 130002 13 14260 130003 30300 28420 130049 17660 44060 130067 13 26820 LUGAR 140008 16974 29404 140010 16974 29404 140012 14 16974 140015 14 41180 140018 16974 29404 140032 14 41180 140034 14 41180 140040 14 37900 140043 14 19340 140046 14 41180 140048 16974 29404 140049 16974 29404 140051 16974 29404 140054 16974 29404 140058 14 44100 140062 16974 29404 140063 16974 29404 140064 14 37900 140065 16974 29404 140068 16974 29404 140080 16974 29404 140082 16974 29404 140083 16974 29404 140088 16974 29404 140094 16974 29404 140095 16974 29404 140103 16974 29404 140110 14 16974 140114 16974 29404 140115 16974 29404 140116 16974 29404CMS-1498-P2 328

Provider Number Geographic CBSA Reclassified CBSA LUGAR 140117 16974 29404 140118 16974 29404 140119 16974 29404 140124 16974 29404 140133 16974 29404 140135 19500 16580 140150 16974 29404 140151 16974 29404 140155 28100 16974 140158 16974 29404 140160 14 40420 140161 14 16974 140164 14 16020 140166 19500 16580 140172 16974 29404 140176 16974 29404 140177 16974 29404 140179 16974 29404 140180 16974 29404 140181 16974 29404 140182 16974 29404 140186 28100 16974 140191 16974 29404 140197 16974 29404 140206 16974 29404 140207 16974 29404 140208 16974 29404 140223 16974 29404 140224 16974 29404 140240 16974 29404 140250 16974 29404 140251 16974 29404 140252 16974 29404 140258 16974 29404 140276 16974 29404 140281 16974 29404 140290 16974 29404CMS-1498-P2 329

Provider Number Geographic CBSA Reclassified CBSA LUGAR 140300 16974 29404 140301 16974 29404 140303 16974 29404 150002 23844 16974 150004 23844 16974 150006 33140 43780 150008 23844 16974 150011 15 26900 150015 33140 23844 150018 21140 43780 150023 45460 26900 150026 21140 43780 150030 15 26900 LUGAR 150034 23844 16974 150042 15 14020 150048 15 17140 150051 14020 26900 150064 15 26900 150065 15 26900 150069 15 17140 150076 15 43780 150088 11300 26900 150089 34620 11300 150090 23844 16974 150091 15 23060 150102 15 23844 LUGAR 150112 18020 26900 150113 11300 26900 150125 23844 16974 150126 23844 16974 150133 15 43780 150146 15 21140 150165 23844 16974 150166 23844 16974 150170 23844 16974 160001 16 19780 160016 16 11180CMS-1498-P2 330

Provider Number Geographic CBSA Reclassified CBSA LUGAR 160057 16 26980 160064 16 24 160080 16 19340 160147 16 11180 170006 17 27900 170013 17 28 170020 17 48620 170033 17 48620 170058 17 28140 170068 17 11100 170142 31740 45820 170175 17 48620 180002 18 49 180011 18 30460 180012 21060 31140 180013 14540 34980 180017 18 14540 180018 18 30460 180020 18 49 180024 18 21060 180027 18 17300 180029 18 30460 180043 18 44 180044 18 26580 180048 18 31140 180049 18 30460 180050 18 28700 180069 18 26580 180078 18 26580 180080 18 28940 180093 18 21780 180102 18 16020 180104 18 16020 180116 18 16020 180124 14540 34980 180127 18 17140 180132 18 30460CMS-1498-P2 331

Provider Number Geographic CBSA Reclassified CBSA LUGAR 190003 19 29180 190015 19 35380 190017 19 29180 190086 19 33740 190106 19 10780 190144 19 43340 190164 19 45 190167 19 29180 190190 19 33740 190218 19 43340 190257 19 33740 200002 20 38860 200020 38860 40484 200024 30340 38860 200034 30340 38860 200039 20 38860 200050 20 12620 220001 49340 14484 220002 15764 14484 220008 39300 14484 220010 37764 14484 220011 15764 14484 220019 49340 14484 220020 39300 14484 220025 49340 14484 220029 37764 14484 220033 37764 14484 220035 37764 14484 220049 15764 14484 220058 49340 14484 220062 49340 14484 220063 15764 14484 220070 15764 14484 220073 39300 14484 220074 39300 14484 220077 44140 25540 220080 37764 14484CMS-1498-P2 332

Provider Number Geographic CBSA Reclassified CBSA LUGAR 220082 15764 14484 220084 15764 14484 220090 49340 14484 220095 49340 14484 220098 15764 14484 220101 15764 14484 220105 15764 14484 220163 49340 14484 220171 15764 14484 220174 37764 14484 220175 15764 14484 220176 49340 14484 230002 19804 11460 230003 26100 34740 230013 47644 22420 230019 47644 22420 230020 19804 11460 230021 35660 28020 230022 23 12980 230024 19804 11460 230029 47644 22420 230030 23 40980 230035 23 24340 LUGAR 230036 23 13020 230037 23 11460 230038 24340 34740 230047 47644 19804 230053 19804 11460 230054 23 24580 230059 24340 34740 230069 47644 11460 230071 47644 22420 230072 26100 34740 230077 40980 22420 230089 19804 11460 230095 23 13020 230096 23 28020CMS-1498-P2 333

Provider Number Geographic CBSA Reclassified CBSA LUGAR 230097 23 24340 230099 33780 11460 230104 19804 11460 230105 23 24340 230106 24340 34740 230121 23 29620 LUGAR 230130 47644 22420 230135 19804 11460 230142 19804 11460 230146 19804 11460 230151 47644 22420 230165 19804 11460 230174 26100 34740 230176 19804 11460 230195 47644 19804 230204 47644 19804 230207 47644 22420 230208 23 24340 LUGAR 230222 23 13020 230227 47644 19804 230236 24340 34740 230244 19804 11460 230254 47644 22420 230257 47644 19804 230264 47644 19804 230269 47644 22420 230270 19804 11460 230273 19804 11460 230277 47644 22420 230279 47644 11460 230297 19804 11460 230301 47644 22420 230302 47644 22420 230B04 47644 22420 230B95 19804 11460 240036 41060 33460 240069 24 33460CMS-1498-P2 334

Provider Number Geographic CBSA Reclassified CBSA LUGAR 240071 24 33460 240075 24 41060 240088 24 41060 240093 31860 33460 240187 24 33460 250002 25 22520 250004 25 32820 250006 25 32820 250009 25 27180 250023 25 25060 LUGAR 250031 25 27140 250034 25 32820 250040 37700 25060 250042 25 32820 250069 25 46220 250078 25620 25060 250079 25 27140 250081 25 46220 250082 25 38220 250094 25620 25060 250095 25 27140 250097 25 12940 250099 25 27140 250100 25 46220 250104 25 46220 250117 25 25060 LUGAR 260009 26 27620 260017 26 27620 260022 26 17860 260025 26 41180 260074 26 17860 260094 26 44180 260113 26 14 260116 26 14 260119 26 16020 260175 26 28140 260186 26 27620CMS-1498-P2 335

Provider Number Geographic CBSA Reclassified CBSA LUGAR 270003 27 24500 270012 24500 33540 270017 27 33540 270051 27 33540 280009 28 30700 280023 28 30700 280065 28 24540 280077 28 30700 280125 28 43580 290002 29 16180 LUGAR 290006 29 39900 290019 16180 39900 300011 31700 15764 300012 31700 15764 300017 40484 37764 300019 30 44140 300020 31700 15764 300029 40484 37764 300034 31700 15764 310002 35084 35644 310009 35084 35644 310014 15804 37964 310015 35084 35644 310017 35084 35644 310022 15804 37964 310029 15804 37964 310031 15804 20764 310038 20764 35644 310039 20764 35644 310048 20764 35084 310050 35084 35644 310054 35084 35644 310070 20764 35644 310076 35084 35644 310081 15804 37964 310083 35084 35644 310086 15804 37964CMS-1498-P2 336

Provider Number Geographic CBSA Reclassified CBSA LUGAR 310096 35084 35644 310108 20764 35644 310119 35084 35644 320003 32 42140 320005 22140 10740 320006 32 10740 320013 32 42140 320014 32 29740 320033 32 42140 LUGAR 320063 32 36220 320065 32 36220 330004 28740 39100 330008 33 15380 LUGAR 330023 39100 35644 330027 35004 35644 330073 33 40380 LUGAR 330079 33 47 330090 21300 27060 330094 33 38340 330106 35004 35644 330126 39100 35644 330136 33 10580 330157 33 45060 330167 35004 35644 330181 35004 35644 330182 35004 35644 330191 24020 10580 330198 35004 35644 330213 33 46540 330224 28740 39100 330225 35004 35644 330229 33 21500 330239 33 21500 330250 33 15540 330259 35004 35644 330277 33 27060 330331 35004 35644CMS-1498-P2 337

Provider Number Geographic CBSA Reclassified CBSA LUGAR 330332 35004 35644 330372 35004 35644 330386 33 35084 340004 24660 49180 340008 34 26580 340013 34 16740 340015 34 16740 340021 34 16740 340023 11700 24860 340027 34 24780 340037 34 16740 340039 34 49180 340050 34 22180 340051 34 25860 340068 34 34820 340069 39580 20500 340070 15500 24660 340071 34 39580 LUGAR 340073 39580 20500 340085 34 24660 LUGAR 340091 24660 49180 340096 34 24660 LUGAR 340109 34 47260 340114 39580 20500 340115 34 20500 340126 34 39580 340127 34 20500 LUGAR 340129 34 16740 340131 34 24780 340138 39580 20500 340144 34 16740 340145 34 16740 LUGAR 340147 40580 39580 340173 39580 20500 350006 35 13900 360008 36 26580 360010 36 15940CMS-1498-P2 338

Provider Number Geographic CBSA Reclassified CBSA LUGAR 360011 36 18140 360013 36 30620 360014 36 18140 360019 10420 17460 360020 10420 17460 360025 41780 45780 360027 10420 17460 360036 36 31900 360054 36 26580 360055 49660 17460 360065 36 17460 360078 10420 17460 360086 44220 19380 360095 36 45780 360109 36 18140 360112 45780 33780 360121 36 45780 360133 19380 17140 360150 10420 17460 360159 36 18140 360175 36 18140 360185 36 49660 LUGAR 360211 44600 38300 360245 36 17460 LUGAR 370004 37 27900 370006 37 46140 370014 37 43300 370015 37 46140 370016 37 36420 370018 37 46140 370019 37 45 370020 37 36420 370022 37 30020 370025 37 46140 370026 37 36420 370030 37 46140 370047 37 36420CMS-1498-P2 339

Provider Number Geographic CBSA Reclassified CBSA LUGAR 370049 37 36420 370099 37 36420 370113 37 22220 370149 37 36420 380001 38 38900 380022 38 18700 LUGAR 380027 38 21660 380047 13460 21660 380050 38 32780 380051 41420 38900 380090 38 21660 390006 39 25420 390013 39 25420 390016 39 38300 390030 39 10900 390031 39 39740 LUGAR 390044 39740 37964 390046 49620 29540 390048 39 25420 390065 39 13644 390066 30140 25420 390067 25420 29540 390071 39 48700 LUGAR 390079 39 13780 390086 39 38300 390091 39 49660 390093 39 49660 390096 39740 37964 390110 27780 38300 390113 39 21500 390133 10900 37964 390138 39 13644 390151 39 13644 390162 10900 35084 390185 42540 10900 390313 39 39740 LUGAR 390316 39740 37964CMS-1498-P2 340

Provider Number Geographic CBSA Reclassified CBSA LUGAR 410001 39300 14484 410004 39300 14484 410005 39300 14484 410007 39300 14484 410010 39300 14484 410011 39300 14484 410012 39300 14484 410013 39300 35980 420007 43900 24860 420009 42 24860 LUGAR 420020 42 16700 420027 11340 24860 420030 42 16700 420036 42 16740 420039 42 43900 LUGAR 420067 42 42340 420068 42 12260 420069 42 44940 LUGAR 420070 44940 17900 420071 42 24860 420080 42 42340 420083 43900 24860 420085 34820 48900 420101 42 42340 430012 43 43620 440002 27180 32820 440018 27740 28700 440025 44 34 440035 17300 34980 440056 34100 28940 440058 44 26620 440059 44 34980 440067 34100 28700 440068 44 16860 440073 44 34980 440144 44 16860 440151 44 34980CMS-1498-P2 341

Provider Number Geographic CBSA Reclassified CBSA LUGAR 440174 44 32820 440185 17420 16860 440192 44 34980 450007 45 41700 450032 45 30980 LUGAR 450039 23104 19124 450064 23104 19124 450080 45 19124 450087 23104 19124 450092 45 29700 450099 45 11100 450135 23104 19124 450137 23104 19124 450144 45 33260 450147 47020 18580 450148 23104 19124 450178 45 36220 450187 45 26420 450196 45 19124 450211 45 30980 450214 45 26420 450224 45 46340 450283 45 19124 LUGAR 450324 43300 19124 450347 45 26420 450351 45 23104 450370 45 26420 450389 45 19124 LUGAR 450400 45 17780 450419 23104 19124 450438 45 26420 450447 45 19124 450465 45 26420 450469 43300 19124 450484 45 30980 450508 45 30980 450547 45 19124CMS-1498-P2 342

Provider Number Geographic CBSA Reclassified CBSA LUGAR 450563 23104 19124 450565 45 23104 450596 45 23104 450604 45 41700 450639 23104 19124 450656 45 30980 450672 23104 19124 450675 23104 19124 450677 23104 19124 450747 45 46340 450770 45 12420 LUGAR 450779 23104 19124 450872 23104 19124 450880 23104 19124 450886 23104 19124 460004 36260 41620 460005 36260 41620 460007 46 41100 460026 46 39340 460039 46 36260 460041 36260 41620 460042 36260 41620 470001 47 15540 470012 47 38340 490004 25500 16820 490005 49020 47894 490013 49 20500 490018 49 16820 490019 49 47894 490042 13980 40220 490043 47894 13644 490063 47894 13644 490066 47260 40060 490079 49 24660 490101 47894 13644 490107 47894 13644 490122 47894 13644CMS-1498-P2 343

Provider Number Geographic CBSA Reclassified CBSA LUGAR 500003 34580 42644 500007 34580 42644 500016 48300 42644 500021 45104 42644 500031 50 36500 500039 14740 42644 500041 31020 38900 500072 50 14740 500079 45104 42644 500108 45104 42644 500129 45104 42644 510002 51 40220 510006 51 34060 510018 51 16620 LUGAR 510046 51 49 510047 51 34060 510050 48540 38300 510062 51 16620 510070 51 16620 510071 51 13980 510077 51 26580 520002 52 48140 520013 20740 33460 520021 29404 16974 520028 52 31540 LUGAR 520037 52 48140 520059 39540 33340 520071 52 33340 LUGAR 520076 52 33340 520095 52 31540 520096 39540 33340 520102 52 33340 LUGAR 520107 52 22540 520113 52 24580 520116 52 33340 LUGAR 520189 29404 16974 530014 16940 24540CMS-1498-P2 344

TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES

BY MEDICARE SEVERITY DIAGNOSIS-RELATED GROUP (MS-DRG)— April 2010 1

MS-DRG Number of Cases Threshold 1 865 $389,002 2 233 $195,055 3 23,101 $271,584 4 21,861 $164,651 5 933 $173,584 6 380 $103,557 7 406 $170,029 8 511 $105,156 9 1,567 $109,488 10 141 $90,875 11 1,384 $80,142 12 1,989 $58,972 13 1,062 $40,489 20 1,047 $157,823 21 487 $119,128 22 156 $85,632 23 4,272 $91,581 24 2,066 $63,368 25 10,196 $84,164 26 11,484 $58,591 27 12,446 $47,033 28 1,737 $83,542 29 3,431 $52,824 30 3,394 $34,633 31 1,089 $69,986 32 2,750 $40,237 33 3,263 $32,975 34 847 $63,512 35 2,388 $46,937 36 5,878 $40,712 37 5,356 $57,235CMS-1498-P2 345

MS-DRG Number of Cases Threshold 38 14,284 $36,825 39 46,412 $27,494 40 4,979 $65,463 41 7,598 $43,513 42 4,110 $37,771 52 1,391 $33,029 53 571 $22,196 54 6,584 $33,288 55 14,332 $28,166 56 10,308 $32,309 57 45,636 $21,051 58 869 $32,675 59 3,214 $24,364 60 3,702 $18,278 61 2,000 $59,680 62 2,944 $46,665 63 1,171 $41,261 64 63,659 $37,295 65 108,572 $29,516 66 71,747 $22,397 67 1,926 $32,904 68 11,692 $24,825 69 96,409 $20,405 70 10,189 $36,456 71 11,517 $28,259 72 5,232 $21,046 73 10,681 $29,802 74 31,053 $22,361 75 1,287 $37,876 76 694 $23,662 77 1,632 $36,701 78 1,688 $26,558 79 862 $20,557 80 1,706 $28,205 81 5,753 $18,865 82 2,249 $38,321 83 2,381 $31,174 84 2,569 $23,039 85 7,108 $38,811 86 12,830 $29,387CMS-1498-P2 346

MS-DRG Number of Cases Threshold 87 12,297 $20,266 88 1,000 $33,298 89 2,949 $25,227 90 2,821 $19,387 91 9,861 $32,610 92 18,526 $23,203 93 14,820 $17,999 94 1,517 $60,965 95 1,163 $44,844 96 603 $39,770 97 1,317 $57,346 98 1,019 $39,110 99 508 $30,997 100 19,094 $31,833 101 55,560 $20,167 102 1,277 $26,479 103 12,792 $18,026 113 640 $38,393 114 462 $23,767 115 1,019 $29,721 116 532 $29,249 117 826 $18,459 121 752 $24,718 122 502 $16,035 123 2,794 $20,642 124 860 $27,880 125 4,051 $17,572 129 1,521 $44,659 130 939 $32,940 131 989 $42,025 132 826 $30,709 133 2,161 $34,737 134 2,857 $22,176 135 385 $40,095 136 414 $25,091 137 839 $32,424 138 798 $20,224 139 1,441 $22,174 146 825 $39,688 147 1,474 $28,097CMS-1498-P2 347

MS-DRG Number of Cases Threshold 148 704 $18,711 149 35,070 $17,386 150 1,272 $28,072 151 6,133 $14,750 152 3,460 $24,044 153 16,897 $16,059 154 2,435 $31,064 155 5,504 $23,142 156 4,142 $16,627 157 1,414 $31,530 158 3,633 $23,578 159 1,885 $15,750 163 13,934 $86,849 164 18,517 $52,978 165 10,712 $42,098 166 24,135 $65,383 167 19,905 $43,668 168 4,947 $33,163 175 15,001 $36,971 176 36,290 $27,485 177 71,329 $40,597 178 72,866 $33,081 179 19,697 $25,265 180 22,810 $36,938 181 28,116 $29,874 182 3,624 $22,658 183 2,647 $33,447 184 4,846 $24,630 185 2,217 $17,427 186 10,555 $34,992 187 10,193 $27,682 188 3,657 $20,141 189 129,179 $32,232 190 125,804 $29,828 191 138,603 $24,810 192 152,980 $18,644 193 103,110 $32,561 194 217,767 $25,507 195 105,641 $18,329 196 6,665 $34,115CMS-1498-P2 348

MS-DRG Number of Cases Threshold 197 6,890 $27,608 198 3,484 $21,389 199 3,757 $38,083 200 8,432 $25,132 201 2,979 $18,052 202 37,472 $21,725 203 34,621 $15,784 204 24,686 $18,264 205 6,810 $29,155 206 20,742 $19,694 207 38,118 $92,691 208 77,115 $46,531 215 138 $192,886 216 9,880 $176,137 217 6,447 $124,922 218 1,401 $107,186 219 12,500 $141,426 220 14,385 $102,673 221 4,929 $91,188 222 3,272 $160,691 223 4,418 $122,914 224 2,933 $145,113 225 4,763 $116,684 226 8,032 $120,871 227 33,159 $97,856 228 3,210 $137,160 229 3,325 $98,362 230 1,169 $80,433 231 1,566 $156,409 232 1,256 $122,233 233 17,622 $130,933 234 27,918 $98,208 235 10,517 $104,978 236 25,885 $77,822 237 23,974 $92,323 238 39,313 $61,432 239 11,664 $69,045 240 10,718 $44,505 241 1,917 $32,845 242 20,888 $68,433CMS-1498-P2 349

MS-DRG Number of Cases Threshold 243 38,043 $55,177 244 50,838 $46,291 245 4,079 $78,539 246 30,411 $69,977 247 147,952 $51,453 248 19,736 $64,840 249 67,964 $47,426 250 8,184 $59,956 251 38,091 $45,146 252 44,196 $54,868 253 43,034 $49,388 254 44,467 $39,821 255 2,524 $44,250 256 3,032 $33,270 257 493 $23,340 258 829 $55,674 259 6,169 $40,146 260 1,763 $56,906 261 3,844 $33,612 262 2,818 $27,572 263 563 $32,196 264 24,723 $43,850 265 2,093 $44,334 280 78,326 $37,817 281 50,932 $30,379 282 40,796 $23,085 283 15,365 $34,174 284 3,208 $22,535 285 1,782 $16,046 286 29,351 $44,721 287 140,845 $31,560 288 3,008 $52,687 289 1,165 $38,592 290 299 $29,363 291 202,108 $32,007 292 207,580 $24,223 293 138,456 $17,654 294 1,558 $24,579 295 1,012 $14,868 296 2,158 $29,798CMS-1498-P2 350

MS-DRG Number of Cases Threshold 297 721 $19,111 298 476 $12,936 299 23,052 $30,899 300 45,558 $22,596 301 31,295 $15,992 302 8,576 $25,387 303 58,979 $15,820 304 2,704 $27,043 305 31,624 $16,270 306 2,531 $29,095 307 5,817 $19,647 308 56,369 $29,328 309 92,446 $21,355 310 136,366 $15,302 311 18,509 $14,403 312 163,512 $19,476 313 187,903 $15,879 314 65,724 $34,098 315 30,253 $24,606 316 15,094 $16,812 326 11,455 $94,093 327 10,124 $53,346 328 7,997 $35,139 329 49,835 $87,713 330 60,038 $51,490 331 25,381 $38,779 332 1,999 $82,243 333 5,637 $50,536 334 3,306 $38,002 335 7,885 $75,081 336 12,356 $48,202 337 7,787 $36,303 338 1,610 $62,604 339 3,077 $43,706 340 3,324 $32,810 341 991 $47,740 342 2,722 $35,886 343 6,674 $26,294 344 1,004 $57,410 345 2,955 $37,377CMS-1498-P2 351

MS-DRG Number of Cases Threshold 346 2,780 $29,277 347 1,626 $42,423 348 4,221 $31,942 349 4,416 $20,331 350 1,895 $46,247 351 4,428 $32,695 352 7,044 $21,873 353 3,646 $50,439 354 8,794 $35,573 355 13,646 $25,587 356 8,505 $67,077 357 7,508 $44,590 358 2,085 $33,785 368 3,735 $36,175 369 5,521 $27,556 370 2,222 $20,185 371 27,790 $36,388 372 28,853 $29,873 373 12,523 $21,164 374 9,731 $39,148 375 17,353 $30,128 376 3,102 $23,904 377 60,356 $34,387 378 123,093 $24,985 379 61,670 $18,619 380 3,316 $36,962 381 5,855 $28,390 382 3,184 $21,165 383 1,573 $31,850 384 7,276 $23,263 385 2,870 $35,732 386 7,834 $27,516 387 4,285 $21,199 388 22,261 $32,883 389 48,548 $24,225 390 42,991 $17,129 391 49,223 $27,759 392 243,035 $19,259 393 24,676 $33,183 394 48,045 $25,167CMS-1498-P2 352

MS-DRG Number of Cases Threshold 395 21,085 $18,104 405 4,264 $90,728 406 5,198 $54,119 407 1,940 $40,799 408 1,579 $73,001 409 1,385 $49,902 410 494 $38,897 411 897 $75,484 412 865 $53,809 413 607 $40,589 414 5,219 $65,688 415 5,620 $44,561 416 4,525 $33,802 417 19,305 $51,931 418 25,675 $41,118 419 31,110 $31,502 420 797 $70,221 421 1,008 $39,140 422 247 $31,294 423 1,573 $72,588 424 790 $47,341 425 88 $37,270 432 14,494 $34,529 433 8,905 $24,409 434 582 $18,029 435 13,630 $37,203 436 12,090 $29,801 437 2,756 $25,102 438 17,093 $35,405 439 24,725 $27,440 440 20,936 $19,391 441 14,282 $34,046 442 15,240 $24,134 443 5,392 $17,965 444 13,747 $34,485 445 17,233 $28,729 446 13,796 $20,917 453 1,103 $174,699 454 2,376 $123,857 455 2,020 $93,614CMS-1498-P2 353

MS-DRG Number of Cases Threshold 456 1,111 $152,504 457 2,826 $106,896 458 1,446 $89,213 459 4,130 $104,714 460 55,432 $71,392 461 990 $86,571 462 12,260 $66,379 463 5,234 $73,851 464 9,387 $49,906 465 3,238 $38,061 466 4,164 $80,194 467 17,434 $61,472 468 17,171 $52,558 469 33,437 $62,532 470 405,607 $47,182 471 2,762 $83,984 472 7,773 $56,834 473 23,363 $46,340 474 2,725 $56,667 475 3,450 $38,188 476 1,299 $26,054 477 2,908 $60,925 478 9,193 $47,455 479 9,268 $38,241 480 28,778 $56,381 481 75,926 $42,752 482 38,532 $36,612 483 9,156 $50,964 484 16,998 $44,087 485 1,106 $59,361 486 1,981 $45,599 487 1,096 $36,036 488 2,927 $37,774 489 5,313 $29,696 490 23,821 $39,912 491 48,360 $25,460 492 5,867 $55,234 493 18,534 $41,196 494 26,815 $32,105 495 1,394 $52,061CMS-1498-P2 354

MS-DRG Number of Cases Threshold 496 4,662 $36,908 497 5,476 $27,045 498 1,330 $40,071 499 976 $22,908 500 1,791 $53,085 501 4,415 $35,105 502 5,864 $25,212 503 863 $43,136 504 2,363 $34,921 505 2,503 $26,368 506 725 $29,466 507 966 $40,240 508 2,043 $32,400 509 435 $30,513 510 1,183 $45,296 511 4,260 $35,239 512 9,343 $26,439 513 1,252 $31,396 514 1,014 $20,554 515 4,257 $56,742 516 11,688 $42,011 517 14,158 $34,589 533 863 $30,805 534 3,272 $16,944 535 8,149 $28,765 536 32,791 $16,530 537 838 $21,960 538 889 $14,522 539 2,724 $40,306 540 5,011 $30,395 541 1,457 $22,494 542 6,322 $37,535 543 16,638 $27,734 544 8,409 $18,768 545 4,398 $38,700 546 5,591 $27,325 547 3,906 $19,238 548 639 $37,106 549 1,145 $28,282 550 600 $18,033CMS-1498-P2 355

MS-DRG Number of Cases Threshold 551 12,224 $33,082 552 78,714 $20,306 553 3,387 $26,679 554 17,367 $15,998 555 2,163 $24,276 556 16,208 $15,807 557 6,151 $32,945 558 16,353 $21,183 559 2,005 $32,817 560 5,078 $22,973 561 6,250 $14,590 562 6,665 $29,774 563 33,686 $16,574 564 1,861 $31,628 565 3,813 $22,875 566 2,157 $16,134 573 5,129 $50,163 574 10,013 $35,479 575 4,156 $26,619 576 604 $53,475 577 2,322 $36,026 578 2,806 $25,986 579 3,893 $48,735 580 10,376 $32,910 581 11,069 $23,619 582 5,398 $27,405 583 8,117 $21,470 584 777 $33,485 585 1,260 $23,632 592 5,008 $33,301 593 11,623 $24,271 594 1,978 $16,813 595 1,376 $32,998 596 4,982 $20,187 597 586 $33,406 598 1,329 $26,711 599 246 $16,205 600 955 $23,588 601 844 $14,665 602 24,663 $30,509CMS-1498-P2 356

MS-DRG Number of Cases Threshold 603 129,540 $19,396 604 3,167 $28,218 605 20,019 $17,476 606 1,545 $26,520 607 6,551 $15,695 614 1,575 $51,040 615 1,442 $36,993 616 989 $72,716 617 6,847 $40,290 618 172 $30,496 619 799 $61,176 620 2,599 $42,714 621 9,718 $37,202 622 809 $56,692 623 3,190 $36,949 624 344 $24,840 625 1,341 $44,938 626 2,820 $30,681 627 13,010 $20,965 628 3,326 $58,340 629 4,419 $44,514 630 455 $34,307 637 21,119 $29,645 638 47,885 $20,408 639 29,351 $14,074 640 61,837 $26,159 641 187,535 $17,306 642 1,563 $25,170 643 6,566 $34,055 644 12,257 $26,452 645 7,099 $18,903 652 10,051 $65,236 653 1,843 $94,153 654 3,671 $58,851 655 1,336 $43,728 656 4,444 $62,458 657 7,561 $43,358 658 7,243 $35,012 659 4,953 $55,947CMS-1498-P2 357

MS-DRG Number of Cases Threshold 660 7,085 $40,160 661 3,952 $34,109 662 954 $49,155 663 1,933 $32,617 664 3,709 $26,578 665 771 $52,781 666 2,122 $34,277 667 3,117 $19,813 668 4,635 $44,590 669 12,516 $31,500 670 10,021 $20,142 671 871 $33,039 672 765 $20,538 673 12,544 $49,448 674 10,170 $42,806 675 5,147 $35,918 682 97,609 $33,358 683 135,093 $26,095 684 33,583 $17,342 685 2,366 $21,566 686 1,953 $33,422 687 3,060 $27,399 688 921 $19,138 689 60,360 $28,626 690 201,231 $19,233 691 977 $36,052 692 416 $27,497 693 3,192 $29,780 694 16,029 $18,924 695 1,010 $27,707 696 9,929 $16,041 697 562 $21,291 698 26,265 $31,468 699 25,718 $23,792 700 10,193 $16,867 707 5,784 $40,132 708 17,747 $32,659 709 787 $37,965CMS-1498-P2 358

MS-DRG Number of Cases Threshold 710 1,711 $32,470 711 757 $37,242 712 507 $20,275 713 10,501 $28,617 714 25,392 $16,607 715 523 $39,066 716 1,033 $31,946 717 790 $34,884 718 537 $20,367 722 846 $32,607 723 1,792 $25,510 724 386 $17,126 725 947 $25,634 726 3,285 $17,762 727 1,466 $29,718 728 5,687 $18,770 729 741 $24,092 730 343 $15,065 734 1,596 $47,611 735 1,032 $30,387 736 950 $78,765 737 3,230 $44,033 738 743 $30,874 739 1,074 $57,033 740 4,420 $36,843 741 5,510 $27,799 742 10,825 $33,779 743 29,288 $23,322 744 1,673 $33,440 745 1,389 $22,208 746 2,659 $31,489 747 8,067 $22,591 748 19,014 $23,182 749 1,018 $46,594 750 395 $27,294 754 1,267 $35,940 755 3,125 $27,616 756 528 $15,945CMS-1498-P2 359

MS-DRG Number of Cases Threshold 757 1,533 $35,983 758 1,915 $28,019 759 1,238 $19,930 760 1,811 $20,574 761 1,317 $13,597 765 3,126 $21,732 766 2,802 $14,572 767 142 $17,038 768 9 $11,871 769 86 $33,922 770 225 $14,870 774 1,636 $13,499 775 5,854 $9,411 776 561 $16,686 777 232 $21,795 778 445 $8,995 779 130 $10,883 780 44 $4,578 781 3,131 $14,290 782 180 $10,164 799 613 $90,541 800 674 $52,255 801 399 $38,586 802 886 $59,143 803 1,136 $39,196 804 814 $28,065 808 7,551 $40,002 809 13,393 $28,993 810 2,471 $22,975 811 27,117 $28,363 812 90,161 $19,562 813 13,097 $29,154 814 1,861 $33,121 815 3,668 $26,057 816 1,821 $19,224 820 1,353 $94,032 821 2,170 $46,484 822 1,836 $31,412CMS-1498-P2 360

MS-DRG Number of Cases Threshold 823 2,354 $70,969 824 2,894 $45,971 825 1,579 $32,071 826 637 $80,598 827 1,286 $43,877 828 785 $32,630 829 1,325 $48,015 830 399 $27,124 834 4,125 $61,164 835 2,720 $38,891 836 1,333 $26,678 837 1,196 $102,784 838 1,441 $51,401 839 1,413 $30,394 840 9,724 $47,069 841 9,715 $33,444 842 4,341 $26,409 843 1,795 $36,121 844 2,642 $29,302 845 586 $22,306 846 2,586 $41,103 847 22,609 $27,909 848 1,385 $23,861 849 1,077 $31,032 853 38,089 $87,911 854 8,081 $51,332 855 432 $38,188 856 5,807 $70,660 857 9,306 $39,484 858 2,623 $31,564 862 9,159 $36,191 863 21,321 $23,361 864 17,572 $21,559 865 2,846 $29,453 866 9,130 $17,839 867 5,370 $41,476 868 2,762 $26,597 869 953 $19,248CMS-1498-P2 361

MS-DRG Number of Cases Threshold 870 24,761 $101,840 871 256,093 $37,509 872 90,163 $27,946 876 684 $44,822 880 8,529 $16,598 881 4,578 $12,659 882 1,690 $13,471 883 896 $20,508 884 19,075 $20,749 885 84,180 $16,352 886 500 $15,664 887 571 $19,686 894 4,259 $8,723 895 6,544 $17,041 896 6,711 $29,396 897 35,191 $14,348 901 916 $59,423 902 1,944 $35,534 903 1,109 $25,200 904 1,474 $46,815 905 824 $26,780 906 691 $25,655 907 8,699 $61,340 908 8,619 $38,851 909 4,982 $29,005 913 1,041 $29,478 914 5,773 $17,668 915 1,334 $27,602 916 5,203 $11,317 917 19,652 $31,716 918 34,844 $15,140 919 11,273 $32,228 920 14,556 $23,797 921 8,230 $15,851 922 1,257 $29,349 923 3,269 $16,721 927 167 $198,460 928 857 $70,268CMS-1498-P2 362

MS-DRG Number of Cases Threshold 929 416 $37,400 933 153 $34,085 934 690 $26,282 935 2,055 $24,343 939 764 $49,622 940 1,674 $35,957 941 1,719 $30,016 945 6,545 $20,406 946 3,005 $18,303 947 12,021 $26,904 948 52,796 $17,145 949 704 $22,198 950 296 $12,931 951 903 $16,292 955 485 $99,347 956 4,236 $61,511 957 1,519 $109,945 958 1,177 $70,133 959 230 $48,166 963 1,892 $51,646 964 2,803 $34,903 965 961 $25,958 969 633 $85,446 970 122 $49,858 974 6,060 $43,025 975 4,375 $30,620 976 1,933 $23,242 977 3,968 $26,172 981 29,313 $83,501 982 19,558 $55,364 983 5,621 $39,841 984 752 $62,176 985 909 $41,122 986 539 $28,495 987 8,729 $57,928 988 10,785 $38,675 989 4,639 $27,294 999 26 $21,513CMS-1498-P2 363

1 Cases taken from the FY 2008 MedPAR file; MS-DRGs are from GROUPER Version 27.0.

TABLE 11.—PROPOSED MS-LTC-DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND SHORT-STAY OUTLIER (SSO) THRESHOLD FOR DISCHARGES OCCURRING FROM OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 UNDER THE LTCH PPS

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 1 1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 0 0.0000 0.0 0.0 2 1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 0 0.0000 0.0 0.0 3 3 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. 270 4.6423 65.4 54.5 4 4 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. 1,536 2.9399 43.7 36.4 5 5 LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT 0 0.0000 0.0 0.0 6 5 LIVER TRANSPLANT W/O MCC 0 0.0000 0.0 0.0 7 7 LUNG TRANSPLANT 0 0.0000 0.0 0.0 8 8 SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT 0 0.0000 0.0 0.0 10 10 PANCREAS TRANSPLANT 0 0.0000 0.0 0.0 11 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC 1 1.0834 28.9 24.1 12 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC 0 0.8745 23.3 19.4 13 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W/O CC/MCC 0 0.4878 18.1 15.1 14 14 ALLOGENEIC BONE MARROW TRANSPLANT 0 0.5579 19.4 16.2 15 15 AUTOLOGOUS BONE MARROW TRANSPLANT 0 0.5579 19.4 16.2 20 20 INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC 1 1.6496 36.4 30.3 21 20 INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC 0 0.6041 22.1 18.4 22 20 INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC 0 0.4878 18.1 15.1 23 23 CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W MCC OR CHEMO IMPLANT 0 1.0834 28.9 24.1 24 23 CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC 0 0.4878 18.1 15.1CMS-1498-P2 364

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 25 25 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC 2 1.0834 28.9 24.1 26 25 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC 1 0.4878 18.1 15.1 27 25 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC 0 0.4878 18.1 15.1 28 28 SPINAL PROCEDURES W MCC 11 1.0834 28.9 24.1 29 28 SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS 16 0.8667 24.6 20.5 30 28 SPINAL PROCEDURES W/O CC/MCC 0 0.8667 24.6 20.5 31 31 VENTRICULAR SHUNT PROCEDURES W MCC 1 1.0834 28.9 24.1 32 31 VENTRICULAR SHUNT PROCEDURES W CC 0 1.0834 28.9 24.1 33 31 VENTRICULAR SHUNT PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 34 34 CAROTID ARTERY STENT PROCEDURE W MCC 0 1.6496 36.4 30.3 35 34 CAROTID ARTERY STENT PROCEDURE W CC 0 1.6496 36.4 30.3 36 34 CAROTID ARTERY STENT PROCEDURE W/O CC/MCC 0 1.6496 36.4 30.3 37 37 EXTRACRANIAL PROCEDURES W MCC* 13 1.6496 36.4 30.3 38 37 EXTRACRANIAL PROCEDURES W CC 4 1.6496 36.4 30.3 39 37 EXTRACRANIAL PROCEDURES W/O CC/MCC 0 1.6496 36.4 30.3 40 40 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC 116 1.2681 34.0 28.3 41 40 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM 82 0.8898 29.0 24.2 42 40 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC 3 0.4878 18.1 15.1 52 52 SPINAL DISORDERS & INJURIES W CC/MCC* 64 1.1124 41.2 34.3 53 52 SPINAL DISORDERS & INJURIES W/O CC/MCC 6 1.1124 41.2 34.3 54 54 NERVOUS SYSTEM NEOPLASMS W MCC 32 0.7989 27.3 22.8 55 54 NERVOUS SYSTEM NEOPLASMS W/O MCC 35 0.5858 19.2 16.0 56 56 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 1,122 0.8047 25.6 21.3 57 56 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 1,142 0.5744 23.7 19.8 58 58 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC 11 1.6496 36.4 30.3 59 58 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 14 0.6280 20.9 17.4 60 58 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC 4 0.4878 18.1 15.1 61 61 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC 0 0.9205 23.3 19.4CMS-1498-P2 365

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 62 61 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC 0 0.6172 22.1 18.4 63 61 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC 0 0.6172 22.1 18.4 64 64 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC 145 0.8378 24.2 20.2 65 64 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC 52 0.6041 22.1 18.4 66 64 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC 9 0.4878 18.1 15.1 67 67 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC 0 0.4878 18.1 15.1 68 67 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC 3 0.4878 18.1 15.1 69 69 TRANSIENT ISCHEMIA 2 1.0834 28.9 24.1 70 70 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC 182 0.9205 23.3 19.4 71 70 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC* 92 0.6172 22.1 18.4 72 70 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 9 0.6172 22.1 18.4 73 73 CRANIAL & PERIPHERAL NERVE DISORDERS W MCC 112 0.8684 24.9 20.8 74 73 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 111 0.6375 21.9 18.3 75 75 VIRAL MENINGITIS W CC/MCC 9 0.8667 24.6 20.5 76 75 VIRAL MENINGITIS W/O CC/MCC 0 0.8667 24.6 20.5 77 77 HYPERTENSIVE ENCEPHALOPATHY W MCC 2 0.8667 24.6 20.5 78 77 HYPERTENSIVE ENCEPHALOPATHY W CC 2 0.8667 24.6 20.5 79 77 HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC 0 0.6280 20.9 17.4 80 80 NONTRAUMATIC STUPOR & COMA W MCC 8 1.0834 28.9 24.1 81 80 NONTRAUMATIC STUPOR & COMA W/O MCC 6 0.4878 18.1 15.1 82 82 TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC 15 0.8667 24.6 20.5 83 82 TRAUMATIC STUPOR & COMA, COMA >1 HR W CC 9 0.6280 20.9 17.4 84 82 TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC 1 0.4878 18.1 15.1 85 85 TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC 92 0.9280 25.1 20.9 86 85 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC 56 0.6866 23.9 19.9 87 85 TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC 8 0.4878 18.1 15.1CMS-1498-P2 366

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 88 88 CONCUSSION W MCC 0 1.0834 28.9 24.1 89 88 CONCUSSION W CC 1 1.0834 28.9 24.1 90 88 CONCUSSION W/O CC/MCC 1 0.8667 24.6 20.5 91 91 OTHER DISORDERS OF NERVOUS SYSTEM W MCC 264 0.8776 24.3 20.3 92 91 OTHER DISORDERS OF NERVOUS SYSTEM W CC 98 0.7483 24.2 20.2 93 91 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC 7 0.4878 18.1 15.1 94 94 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC 247 1.1111 29.4 24.5 95 94 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC* 99 0.8204 25.3 21.1 96 94 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC 22 0.8204 25.3 21.1 97 97 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC 70 0.9187 24.6 20.5 98 97 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC 23 0.6280 20.9 17.4 99 97 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC 4 0.4878 18.1 15.1 100 100 SEIZURES W MCC 32 0.7249 21.5 17.9 101 100 SEIZURES W/O MCC 36 0.6180 21.8 18.2 102 102 HEADACHES W MCC 2 0.8667 24.6 20.5 103 102 HEADACHES W/O MCC 0 0.4878 18.1 15.1 113 113 ORBITAL PROCEDURES W CC/MCC 1 1.0834 28.9 24.1 114 113 ORBITAL PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 115 115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 0 1.0834 28.9 24.1 116 116 INTRAOCULAR PROCEDURES W CC/MCC 0 1.0834 28.9 24.1 117 116 INTRAOCULAR PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 121 121 ACUTE MAJOR EYE INFECTIONS W CC/MCC 9 0.6280 20.9 17.4 122 121 ACUTE MAJOR EYE INFECTIONS W/O CC/MCC 3 0.4878 18.1 15.1 123 123 NEUROLOGICAL EYE DISORDERS 0 1.0834 28.9 24.1 124 124 OTHER DISORDERS OF THE EYE W MCC* 6 1.0834 28.9 24.1 125 124 OTHER DISORDERS OF THE EYE W/O MCC 3 1.0834 28.9 24.1 129 129 MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE 0 1.2635 27.1 22.6 130 129 MAJOR HEAD & NECK PROCEDURES W/O CC/MCC 0 0.4878 18.1 15.1 131 131 CRANIAL/FACIAL PROCEDURES W CC/MCC 1 1.6496 36.4 30.3 132 131 CRANIAL/FACIAL PROCEDURES W/O CC/MCC 0 0.8204 25.3 21.1 133 133 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC 9 1.6496 36.4 30.3CMS-1498-P2 367

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 134 133 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC 0 0.4878 18.1 15.1 135 135 SINUS & MASTOID PROCEDURES W CC/MCC 0 1.6496 36.4 30.3 136 135 SINUS & MASTOID PROCEDURES W/O CC/MCC 0 0.4878 18.1 15.1 137 137 MOUTH PROCEDURES W CC/MCC 0 0.6280 20.9 17.4 138 137 MOUTH PROCEDURES W/O CC/MCC 0 0.6280 20.9 17.4 139 139 SALIVARY GLAND PROCEDURES 0 0.6280 20.9 17.4 146 146 EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC 39 1.2635 27.1 22.6 147 146 EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC 31 0.8745 23.3 19.4 148 146 EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC 3 0.4878 18.1 15.1 149 149 DYSEQUILIBRIUM 2 0.4878 18.1 15.1 150 150 EPISTAXIS W MCC 0 0.8588 25.4 21.2 151 150 EPISTAXIS W/O MCC 1 0.4878 18.1 15.1 152 152 OTITIS MEDIA & URI W MCC 31 0.8588 25.4 21.2 153 152 OTITIS MEDIA & URI W/O MCC 28 0.5982 19.9 16.6 154 154 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC 49 1.0727 26.3 21.9 155 154 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC* 42 0.8204 25.3 21.1 156 154 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC 8 0.8204 25.3 21.1 157 157 DENTAL & ORAL DISEASES W MCC 9 1.0834 28.9 24.1 158 157 DENTAL & ORAL DISEASES W CC 24 0.6280 20.9 17.4 159 157 DENTAL & ORAL DISEASES W/O CC/MCC 4 0.6280 20.9 17.4 163 163 MAJOR CHEST PROCEDURES W MCC 28 2.4303 42.0 35.0 164 163 MAJOR CHEST PROCEDURES W CC 5 1.6496 36.4 30.3 165 163 MAJOR CHEST PROCEDURES W/O CC/MCC 0 1.5464 31.4 26.2 166 166 OTHER RESP SYSTEM O.R. PROCEDURES W MCC 1,742 2.5491 42.0 35.0 167 166 OTHER RESP SYSTEM O.R. PROCEDURES W CC* 174 1.5464 31.4 26.2 168 166 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 8 1.5464 31.4 26.2 175 175 PULMONARY EMBOLISM W MCC 105 0.7522 22.7 18.9 176 175 PULMONARY EMBOLISM W/O MCC 72 0.5489 18.8 15.7 177 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 4,071 0.8896 22.9 19.1 178 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 1,912 0.7194 20.8 17.3 179 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 143 0.6009 17.1 14.3CMS-1498-P2 368

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 180 180 RESPIRATORY NEOPLASMS W MCC 117 0.7511 20.1 16.8 181 180 RESPIRATORY NEOPLASMS W CC 64 0.6641 19.9 16.6 182 180 RESPIRATORY NEOPLASMS W/O CC/MCC 2 0.6280 20.9 17.4 183 183 MAJOR CHEST TRAUMA W MCC 0 2.4303 42.0 35.0 184 183 MAJOR CHEST TRAUMA W CC 0 1.6496 36.4 30.3 185 183 MAJOR CHEST TRAUMA W/O CC/MCC 0 1.5464 31.4 26.2 186 186 PLEURAL EFFUSION W MCC 147 0.7405 20.7 17.3 187 186 PLEURAL EFFUSION W CC 41 0.5700 18.8 15.7 188 186 PLEURAL EFFUSION W/O CC/MCC 3 0.4878 18.1 15.1 189 189 PULMONARY EDEMA & RESPIRATORY FAILURE 8,376 0.9738 23.5 19.6 190 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 2,365 0.7422 20.2 16.8 191 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 1,129 0.6316 18.4 15.3 192 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 286 0.5081 16.4 13.7 193 193 SIMPLE PNEUMONIA & PLEURISY W MCC 2,120 0.7645 20.9 17.4 194 193 SIMPLE PNEUMONIA & PLEURISY W CC 1,554 0.6153 18.9 15.8 195 193 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 162 0.4881 16.7 13.9 196 196 INTERSTITIAL LUNG DISEASE W MCC 96 0.7049 20.4 17.0 197 196 INTERSTITIAL LUNG DISEASE W CC 71 0.6056 18.6 15.5 198 196 INTERSTITIAL LUNG DISEASE W/O CC/MCC 20 0.4878 18.1 15.1 199 199 PNEUMOTHORAX W MCC 80 0.7749 21.5 17.9 200 199 PNEUMOTHORAX W CC 15 0.6280 20.9 17.4 201 199 PNEUMOTHORAX W/O CC/MCC 4 0.4878 18.1 15.1 202 202 BRONCHITIS & ASTHMA W CC/MCC 114 0.7237 20.9 17.4 203 202 BRONCHITIS & ASTHMA W/O CC/MCC 10 0.6280 20.9 17.4 204 204 RESPIRATORY SIGNS & SYMPTOMS 144 0.7769 21.1 17.6 205 205 OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC 376 0.8291 22.1 18.4 206 205 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 145 0.7031 20.7 17.3 207 207 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 14,744 2.0242 33.3 27.8 208 208 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS 1,828 1.0949 22.2 18.5 215 215 OTHER HEART ASSIST SYSTEM IMPLANT 0 0.6280 20.9 17.4 216 216 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC 0 1.6496 36.4 30.3 217 216 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC 0 1.2501 30.4 25.3CMS-1498-P2 369

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 218 216 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC 0 0.6280 20.9 17.4 219 219 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC 0 1.6496 36.4 30.3 220 219 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC 1 1.6496 36.4 30.3 221 219 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC 0 0.6280 20.9 17.4 222 222 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC 0 1.6496 36.4 30.3 223 222 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC 0 0.8667 24.6 20.5 224 224 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC 0 1.6496 36.4 30.3 225 224 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC 1 0.6280 20.9 17.4 226 226 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC 6 1.6496 36.4 30.3 227 226 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC 2 1.6496 36.4 30.3 228 228 OTHER CARDIOTHORACIC PROCEDURES W MCC 0 1.3831 30.1 25.1 229 228 OTHER CARDIOTHORACIC PROCEDURES W CC 0 1.2501 30.4 25.3 230 228 OTHER CARDIOTHORACIC PROCEDURES W/O CC/MCC 0 0.6280 20.9 17.4 231 231 CORONARY BYPASS W PTCA W MCC 0 1.6496 36.4 30.3 232 231 CORONARY BYPASS W PTCA W/O MCC 0 0.6280 20.9 17.4 233 233 CORONARY BYPASS W CARDIAC CATH W MCC 0 1.6496 36.4 30.3 234 233 CORONARY BYPASS W CARDIAC CATH W/O MCC 0 0.6280 20.9 17.4 235 235 CORONARY BYPASS W/O CARDIAC CATH W MCC 0 1.6496 36.4 30.3 236 235 CORONARY BYPASS W/O CARDIAC CATH W/O MCC 1 0.6280 20.9 17.4 237 237 MAJOR CARDIOVASC PROCEDURES W MCC OR THORACIC AORTIC ANEURYSM REPAIR 6 1.6496 36.4 30.3 238 237 MAJOR CARDIOVASC PROCEDURES W/O MCC 0 0.6280 20.9 17.4CMS-1498-P2 370

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 239 239 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC 142 1.5509 36.9 30.8 240 239 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC 55 1.3459 35.0 29.2 241 239 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC 0 0.6280 20.9 17.4 242 242 PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 3 1.6496 36.4 30.3 243 242 PERMANENT CARDIAC PACEMAKER IMPLANT W CC 6 0.8667 24.6 20.5 244 242 PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC 1 0.4878 18.1 15.1 245 245 AICD GENERATOR PROCEDURES 0 0.4878 18.1 15.1 246 246 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS 0 1.3831 30.1 25.1 247 246 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 2 0.8667 24.6 20.5248 248 PERC CARDIOVASC PROC W NON-DRUGELUTING STENT W MCC OR 4+ VES/STENTS 1 1.6496 36.4 30.3249 248 PERC CARDIOVASC PROC W NON-DRUGELUTING STENT W/O MCC 1 0.6280 20.9 17.4 250 250 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC 3 1.0834 28.9 24.1 251 250 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC 0 1.0834 28.9 24.1 252 252 OTHER VASCULAR PROCEDURES W MCC 110 1.3831 30.1 25.1 253 252 OTHER VASCULAR PROCEDURES W CC 46 1.2501 30.4 25.3 254 252 OTHER VASCULAR PROCEDURES W/O CC/MCC 2 0.6280 20.9 17.4 255 255 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC 37 1.2192 33.9 28.3 256 255 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC 22 1.0834 28.9 24.1 257 255 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC 0 0.6280 20.9 17.4 258 258 CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC 1 0.8667 24.6 20.5 259 258 CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 0 0.6280 20.9 17.4 260 260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 2 1.6496 36.4 30.3 261 260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC 3 1.0834 28.9 24.1 262 260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC 1 0.6280 20.9 17.4CMS-1498-P2 371

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 263 263 VEIN LIGATION & STRIPPING 2 1.6496 36.4 30.3 264 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 594 1.0442 30.6 25.5 265 265 AICD LEAD PROCEDURES 0 1.0442 30.6 25.5 280 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC 271 0.7703 22.2 18.5 281 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 105 0.6663 20.9 17.4 282 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC 12 0.4878 18.1 15.1 283 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 46 0.9091 17.2 14.3 284 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC 6 0.6280 20.9 17.4 285 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC 0 0.6280 20.9 17.4 286 286 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 11 1.6496 36.4 30.3 287 286 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 5 0.8667 24.6 20.5 288 288 ACUTE & SUBACUTE ENDOCARDITIS W MCC 646 1.0264 26.3 21.9 289 288 ACUTE & SUBACUTE ENDOCARDITIS W CC 240 0.8452 26.2 21.8 290 288 ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC 25 0.7600 27.8 23.2 291 291 HEART FAILURE & SHOCK W MCC 1,436 0.7773 21.5 17.9 292 291 HEART FAILURE & SHOCK W CC 872 0.6121 19.5 16.3 293 291 HEART FAILURE & SHOCK W/O CC/MCC 83 0.4418 16.9 14.1 294 294 DEEP VEIN THROMBOPHLEBITIS W CC/MCC 8 1.6496 36.4 30.3 295 294 DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC 0 0.5157 20.0 16.7 296 296 CARDIAC ARREST, UNEXPLAINED W MCC 0 0.7773 21.5 17.9 297 296 CARDIAC ARREST, UNEXPLAINED W CC 0 0.6121 19.5 16.3 298 296 CARDIAC ARREST, UNEXPLAINED W/O CC/MCC 0 0.4418 16.9 14.1 299 299 PERIPHERAL VASCULAR DISORDERS W MCC 735 0.7977 23.7 19.8 300 299 PERIPHERAL VASCULAR DISORDERS W CC 696 0.5846 21.6 18.0 301 299 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 39 0.5157 20.0 16.7 302 302 ATHEROSCLEROSIS W MCC 49 0.8801 22.6 18.8 303 302 ATHEROSCLEROSIS W/O MCC 38 0.5651 21.5 17.9 304 304 HYPERTENSION W MCC 3 1.6496 36.4 30.3 305 304 HYPERTENSION W/O MCC 14 0.6280 20.9 17.4 306 306 CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 58 0.8633 24.3 20.3CMS-1498-P2 372

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 307 306 CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 37 0.8144 24.4 20.3 308 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 131 0.7120 20.7 17.3 309 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 55 0.5307 19.3 16.1 310 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 11 0.4878 18.1 15.1 311 311 ANGINA PECTORIS 1 0.8667 24.6 20.5 312 312 SYNCOPE & COLLAPSE 29 0.4995 17.3 14.4 313 313 CHEST PAIN 3 0.8667 24.6 20.5 314 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 1,566 0.9069 23.1 19.3 315 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 314 0.6812 21.5 17.9 316 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC 26 0.5395 19.2 16.0 326 326 STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 24 1.6496 36.4 30.3 327 326 STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 3 0.8667 24.6 20.5 328 326 STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC 1 0.8667 24.6 20.5 329 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 28 1.7889 41.2 34.3 330 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 8 1.6496 36.4 30.3 331 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 332 332 RECTAL RESECTION W MCC 0 1.0834 28.9 24.1 333 332 RECTAL RESECTION W CC 0 0.8667 24.6 20.5 334 332 RECTAL RESECTION W/O CC/MCC 0 0.8667 24.6 20.5 335 335 PERITONEAL ADHESIOLYSIS W MCC 10 1.6496 36.4 30.3 336 335 PERITONEAL ADHESIOLYSIS W CC 1 1.0834 28.9 24.1 337 335 PERITONEAL ADHESIOLYSIS W/O CC/MCC 0 1.0834 28.9 24.1 338 338 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC 0 0.7255 22.0 18.3 339 338 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 0 0.7255 22.0 18.3 340 338 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC 0 0.5065 17.1 14.3 341 341 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC 0 0.9537 24.3 20.3 342 341 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC 0 0.7255 22.0 18.3CMS-1498-P2 373

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 343 341 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC 0 0.5065 17.1 14.3 344 344 MINOR SMALL & LARGE BOWEL PROCEDURES W MCC* 1 1.0834 28.9 24.1 345 344 MINOR SMALL & LARGE BOWEL PROCEDURES W CC* 1 1.0834 28.9 24.1 346 344 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 347 347 ANAL & STOMAL PROCEDURES W MCC 3 1.0834 28.9 24.1 348 347 ANAL & STOMAL PROCEDURES W CC 2 0.8667 24.6 20.5 349 347 ANAL & STOMAL PROCEDURES W/O CC/MCC 0 0.8667 24.6 20.5 350 350 INGUINAL & FEMORAL HERNIA PROCEDURES W MCC 1 1.6496 36.4 30.3 351 350 INGUINAL & FEMORAL HERNIA PROCEDURES W CC 0 0.4878 18.1 15.1 352 350 INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC 0 0.4878 18.1 15.1 353 353 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC 3 1.0834 28.9 24.1 354 353 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 1 0.4878 18.1 15.1 355 353 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC 0 0.4878 18.1 15.1 356 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC 141 1.7107 35.6 29.7 357 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 26 1.1301 29.0 24.2 358 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 3 1.0834 28.9 24.1 368 368 MAJOR ESOPHAGEAL DISORDERS W MCC 34 1.0401 22.4 18.7 369 368 MAJOR ESOPHAGEAL DISORDERS W CC 12 0.6280 20.9 17.4 370 368 MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC* 1 0.6280 20.9 17.4 371 371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC 949 0.9537 24.3 20.3 372 371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC 342 0.7255 22.0 18.3 373 371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC 31 0.5065 17.1 14.3 374 374 DIGESTIVE MALIGNANCY W MCC 101 0.8269 21.0 17.5 375 374 DIGESTIVE MALIGNANCY W CC 56 0.6771 21.3 17.8 376 374 DIGESTIVE MALIGNANCY W/O CC/MCC 3 0.4878 18.1 15.1 377 377 G.I. HEMORRHAGE W MCC 88 0.7979 22.5 18.8 378 377 G.I. HEMORRHAGE W CC 43 0.6164 21.3 17.8 379 377 G.I. HEMORRHAGE W/O CC/MCC 8 0.4878 18.1 15.1CMS-1498-P2 374

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 380 380 COMPLICATED PEPTIC ULCER W MCC 22 1.0834 28.9 24.1 381 380 COMPLICATED PEPTIC ULCER W CC 17 0.8667 24.6 20.5 382 380 COMPLICATED PEPTIC ULCER W/O CC/MCC 1 0.8667 24.6 20.5 383 383 UNCOMPLICATED PEPTIC ULCER W MCC 9 0.4878 18.1 15.1 384 383 UNCOMPLICATED PEPTIC ULCER W/O MCC* 5 0.4878 18.1 15.1 385 385 INFLAMMATORY BOWEL DISEASE W MCC 32 0.9126 23.3 19.4 386 385 INFLAMMATORY BOWEL DISEASE W CC 26 0.7395 25.5 21.3 387 385 INFLAMMATORY BOWEL DISEASE W/O CC/MCC 2 0.4878 18.1 15.1 388 388 G.I. OBSTRUCTION W MCC 218 0.9444 23.4 19.5 389 388 G.I. OBSTRUCTION W CC 83 0.6325 19.8 16.5 390 388 G.I. OBSTRUCTION W/O CC/MCC 10 0.4878 18.1 15.1 391 391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC 342 0.9299 23.1 19.3 392 391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 194 0.6310 19.9 16.6 393 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 970 1.0711 25.8 21.5 394 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 389 0.7561 21.8 18.2 395 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 17 0.6280 20.9 17.4 405 405 PANCREAS, LIVER & SHUNT PROCEDURES W MCC 17 1.6496 36.4 30.3 406 405 PANCREAS, LIVER & SHUNT PROCEDURES W CC 2 1.0834 28.9 24.1 407 405 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 0 0.6280 20.9 17.4 408 408 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC 1 1.6496 36.4 30.3 409 408 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 1 1.0834 28.9 24.1 410 408 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC 0 0.6280 20.9 17.4 411 411 CHOLECYSTECTOMY W C.D.E. W MCC 1 1.6496 36.4 30.3 412 411 CHOLECYSTECTOMY W C.D.E. W CC 0 1.6496 36.4 30.3 413 411 CHOLECYSTECTOMY W C.D.E. W/O CC/MCC 0 0.6280 20.9 17.4 414 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC 0 1.6496 36.4 30.3 415 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 0 1.6496 36.4 30.3 416 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC 1 1.6496 36.4 30.3 417 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 10 1.6496 36.4 30.3CMS-1498-P2 375

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 418 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 2 1.6496 36.4 30.3 419 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 1 0.6280 20.9 17.4 420 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC 0 1.6496 36.4 30.3 421 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC 0 1.6496 36.4 30.3 422 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC 0 1.6496 36.4 30.3 423 423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC 17 1.6496 36.4 30.3 424 423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC 3 1.6496 36.4 30.3 425 423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC 0 1.6496 36.4 30.3 432 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 80 0.6675 20.3 16.9 433 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 11 0.6280 20.9 17.4 434 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC 0 0.6280 20.9 17.4 435 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC 41 0.8842 20.1 16.8 436 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 11 0.6280 20.9 17.4 437 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC 1 0.4878 18.1 15.1 438 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 310 1.0514 23.8 19.8 439 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 122 0.7551 21.1 17.6 440 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 13 0.4878 18.1 15.1 441 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 228 0.8012 22.2 18.5 442 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC* 72 0.7091 23.1 19.3 443 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 8 0.7091 23.1 19.3 444 444 DISORDERS OF THE BILIARY TRACT W MCC 127 0.7729 21.5 17.9 445 444 DISORDERS OF THE BILIARY TRACT W CC* 47 0.5847 20.7 17.3 446 444 DISORDERS OF THE BILIARY TRACT W/O CC/MCC 12 0.5847 20.7 17.3 453 453 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC 0 1.6496 36.4 30.3CMS-1498-P2 376

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 454 453 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 0 1.6496 36.4 30.3 455 453 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC 0 1.0834 28.9 24.1 456 456 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W MCC 2 1.6496 36.4 30.3 457 456 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W CC 0 1.6496 36.4 30.3 458 456 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/O CC/MCC 0 1.0834 28.9 24.1 459 459 SPINAL FUSION EXCEPT CERVICAL W MCC 2 1.6496 36.4 30.3 460 459 SPINAL FUSION EXCEPT CERVICAL W/O MCC 1 1.0834 28.9 24.1 461 461 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC 0 1.6496 36.4 30.3 462 461 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC 0 1.6496 36.4 30.3 463 463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC 845 1.4194 39.1 32.6 464 463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC 306 1.0953 34.3 28.6 465 463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC 23 0.8667 24.6 20.5 466 466 REVISION OF HIP OR KNEE REPLACEMENT W MCC 4 1.6496 36.4 30.3 467 466 REVISION OF HIP OR KNEE REPLACEMENT W CC 1 0.8667 24.6 20.5 468 466 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC* 0 0.8667 24.6 20.5 469 469 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC 2 1.6496 36.4 30.3 470 469 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 2 1.6496 36.4 30.3 471 471 CERVICAL SPINAL FUSION W MCC 0 1.0834 28.9 24.1 472 471 CERVICAL SPINAL FUSION W CC 1 1.0834 28.9 24.1 473 471 CERVICAL SPINAL FUSION W/O CC/MCC 0 1.0834 28.9 24.1 474 474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC 140 1.3861 36.9 30.8 475 474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 51 1.0994 34.1 28.4 476 474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC 4 0.6280 20.9 17.4 477 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 32 1.3917 38.2 31.8CMS-1498-P2 377

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 478 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 13 1.0834 28.9 24.1 479 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC* 1 1.0834 28.9 24.1 480 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC* 13 1.6496 36.4 30.3 481 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 6 1.6496 36.4 30.3 482 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC 1 1.6496 36.4 30.3 483 483 MAJOR JOINT & LIMB REATTACHMENT PROC OF UPPER EXTREMITY W CC/MCC 0 1.6496 36.4 30.3 484 483 MAJOR JOINT & LIMB REATTACHMENT PROC OF UPPER EXTREMITY W/O CC/MCC 0 1.6496 36.4 30.3 485 485 KNEE PROCEDURES W PDX OF INFECTION W MCC 11 1.0834 28.9 24.1 486 485 KNEE PROCEDURES W PDX OF INFECTION W CC 9 1.0834 28.9 24.1 487 485 KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC 2 0.6280 20.9 17.4 488 488 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC 0 1.0834 28.9 24.1 489 488 KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC 0 0.6280 20.9 17.4 490 490 BACK & NECK PROC EXC SPINAL FUSION W CC/MCC OR DISC DEVICE/NEUROSTIM 9 1.0834 28.9 24.1 491 490 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 2 0.4878 18.1 15.1 492 492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC 11 1.6496 36.4 30.3 493 492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC 17 1.6496 36.4 30.3 494 492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC 1 0.8667 24.6 20.5 495 495 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC 81 1.4625 37.6 31.3 496 495 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC 22 1.0834 28.9 24.1 497 495 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 1 1.0834 28.9 24.1 498 498 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC 18 1.6496 36.4 30.3 499 498 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 1 0.8667 24.6 20.5 500 500 SOFT TISSUE PROCEDURES W MCC 129 1.3545 36.4 30.3CMS-1498-P2 378

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 501 500 SOFT TISSUE PROCEDURES W CC 38 0.9665 30.7 25.6 502 500 SOFT TISSUE PROCEDURES W/O CC/MCC 5 0.6280 20.9 17.4 503 503 FOOT PROCEDURES W MCC* 33 1.0106 31.5 26.3 504 503 FOOT PROCEDURES W CC 22 1.0106 31.5 26.3 505 503 FOOT PROCEDURES W/O CC/MCC 2 1.0106 31.5 26.3 506 506 MAJOR THUMB OR JOINT PROCEDURES 1 0.8667 24.6 20.5 507 507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC 2 1.6496 36.4 30.3 508 507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W/O CC/MCC 0 0.8667 24.6 20.5 509 509 ARTHROSCOPY 2 1.6496 36.4 30.3 510 510 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC 0 1.3469 31.7 26.4 511 510 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC 0 0.8667 24.6 20.5 512 510 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC 0 0.8667 24.6 20.5 513 513 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC 8 1.0834 28.9 24.1 514 513 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC 0 0.8667 24.6 20.5 515 515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 83 1.3469 31.7 26.4 516 515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 23 0.8667 24.6 20.5 517 515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC* 5 0.8667 24.6 20.5 533 533 FRACTURES OF FEMUR W MCC 3 1.0834 28.9 24.1 534 533 FRACTURES OF FEMUR W/O MCC 1 1.0834 28.9 24.1 535 535 FRACTURES OF HIP & PELVIS W MCC 26 0.7421 25.4 21.2 536 535 FRACTURES OF HIP & PELVIS W/O MCC 13 0.6280 20.9 17.4 537 537 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC 1 0.4878 18.1 15.1 538 537 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC 0 0.4878 18.1 15.1 539 539 OSTEOMYELITIS W MCC 1,932 1.0094 30.7 25.6 540 539 OSTEOMYELITIS W CC 962 0.7937 27.5 22.9 541 539 OSTEOMYELITIS W/O CC/MCC 148 0.6821 24.4 20.3 542 542 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC 37 0.9293 21.9 18.3 543 542 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC 25 0.6938 22.1 18.4CMS-1498-P2 379

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 544 542 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC 4 0.6280 20.9 17.4 545 545 CONNECTIVE TISSUE DISORDERS W MCC 61 0.8812 21.8 18.2 546 545 CONNECTIVE TISSUE DISORDERS W CC 47 0.7162 24.1 20.1 547 545 CONNECTIVE TISSUE DISORDERS W/O CC/MCC 2 0.4878 18.1 15.1 548 548 SEPTIC ARTHRITIS W MCC 260 0.9215 27.2 22.7 549 548 SEPTIC ARTHRITIS W CC 214 0.7473 26.6 22.2 550 548 SEPTIC ARTHRITIS W/O CC/MCC 39 0.5740 25.1 20.9 551 551 MEDICAL BACK PROBLEMS W MCC 130 0.9178 26.4 22.0 552 551 MEDICAL BACK PROBLEMS W/O MCC 116 0.5947 21.7 18.1 553 553 BONE DISEASES & ARTHROPATHIES W MCC 6 0.4878 18.1 15.1 554 553 BONE DISEASES & ARTHROPATHIES W/O MCC* 17 0.4878 18.1 15.1 555 555 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC* 15 0.6280 20.9 17.4 556 555 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC 12 0.6280 20.9 17.4 557 557 TENDONITIS, MYOSITIS & BURSITIS W MCC 114 0.8794 26.1 21.8 558 557 TENDONITIS, MYOSITIS & BURSITIS W/O MCC 109 0.6295 21.9 18.3 559 559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 1,722 0.8472 25.6 21.3 560 559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 1,411 0.6950 24.9 20.8 561 559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 243 0.5789 23.0 19.2 562 562 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC 13 0.8667 24.6 20.5 563 562 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC 14 0.8667 24.6 20.5 564 564 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC 384 0.8675 23.5 19.6 565 564 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC 207 0.6727 22.6 18.8 566 564 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC 25 0.5465 19.5 16.3 573 573 SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W MCC 1,862 1.3703 38.2 31.8 574 573 SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC 1,163 1.0313 34.5 28.8 575 573 SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC/MCC 77 0.7628 28.0 23.3CMS-1498-P2 380

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 576 576 SKIN GRAFT &/OR DEBRID EXC FOR SKIN ULCER OR CELLULITIS W MCC 44 1.4532 38.4 32.0 577 576 SKIN GRAFT &/OR DEBRID EXC FOR SKIN ULCER OR CELLULITIS W CC 26 0.9545 30.8 25.7 578 576 SKIN GRAFT &/OR DEBRID EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC 3 0.4878 18.1 15.1 579 579 OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC 626 1.3096 35.4 29.5 580 579 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 315 0.9380 31.5 26.3 581 579 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC 12 0.8667 24.6 20.5 582 582 MASTECTOMY FOR MALIGNANCY W CC/MCC 0 1.6496 36.4 30.3 583 582 MASTECTOMY FOR MALIGNANCY W/O CC/MCC 0 0.5998 20.1 16.8 584 584 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC 4 0.6280 20.9 17.4 585 584 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC 0 0.6016 22.3 18.6 592 592 SKIN ULCERS W MCC 3,450 0.9187 26.5 22.1 593 592 SKIN ULCERS W CC 2,181 0.6858 25.1 20.9 594 592 SKIN ULCERS W/O CC/MCC 151 0.5644 23.1 19.3 595 595 MAJOR SKIN DISORDERS W MCC 48 0.9096 24.7 20.6 596 595 MAJOR SKIN DISORDERS W/O MCC 33 0.5998 20.1 16.8 597 597 MALIGNANT BREAST DISORDERS W MCC 15 1.6496 36.4 30.3 598 597 MALIGNANT BREAST DISORDERS W CC 11 0.6280 20.9 17.4 599 597 MALIGNANT BREAST DISORDERS W/O CC/MCC 0 0.4878 18.1 15.1 600 600 NON-MALIGNANT BREAST DISORDERS W CC/MCC 29 0.6626 24.0 20.0 601 600 NON-MALIGNANT BREAST DISORDERS W/O CC/MCC 5 0.4878 18.1 15.1 602 602 CELLULITIS W MCC 1,133 0.7277 22.1 18.4 603 602 CELLULITIS W/O MCC 1,519 0.5291 19.1 15.9 604 604 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC 37 0.6494 23.4 19.5 605 604 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 50 0.6016 22.3 18.6 606 606 MINOR SKIN DISORDERS W MCC 94 0.8381 22.8 19.0 607 606 MINOR SKIN DISORDERS W/O MCC 98 0.5684 20.2 16.8 614 614 ADRENAL & PITUITARY PROCEDURES W CC/MCC 0 0.9744 28.6 23.8 615 614 ADRENAL & PITUITARY PROCEDURES W/O CC/MCC 0 0.8667 24.6 20.5CMS-1498-P2 381

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 616 616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC 104 1.5786 39.7 33.1 617 616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC 115 1.0153 31.1 25.9 618 616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC 0 1.0153 31.1 25.9 619 619 O.R. PROCEDURES FOR OBESITY W MCC 3 1.0834 28.9 24.1 620 619 O.R. PROCEDURES FOR OBESITY W CC 0 1.0834 28.9 24.1 621 619 O.R. PROCEDURES FOR OBESITY W/O CC/MCC 0 1.0834 28.9 24.1 622 622 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC 261 1.2545 35.9 29.9 623 622 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC 352 0.9978 30.8 25.7 624 622 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC 9 0.6280 20.9 17.4 625 625 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC 1 0.6280 20.9 17.4 626 625 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC* 0 0.6280 20.9 17.4 627 625 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC* 0 0.6280 20.9 17.4 628 628 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC 68 1.2314 32.7 27.3 629 628 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC 108 0.9744 28.6 23.8 630 628 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC 3 0.8667 24.6 20.5 637 637 DIABETES W MCC 687 0.8950 26.2 21.8 638 637 DIABETES W CC 1,035 0.7071 23.4 19.5 639 637 DIABETES W/O CC/MCC 32 0.4679 20.0 16.7 640 640 NUTRITIONAL & MISC METABOLIC DISORDERS W MCC 678 0.8741 23.1 19.3 641 640 NUTRITIONAL & MISC METABOLIC DISORDERS W/O MCC 465 0.6222 20.6 17.2 642 642 INBORN ERRORS OF METABOLISM 5 1.0834 28.9 24.1 643 643 ENDOCRINE DISORDERS W MCC 17 0.6280 20.9 17.4 644 643 ENDOCRINE DISORDERS W CC 18 0.6280 20.9 17.4 645 643 ENDOCRINE DISORDERS W/O CC/MCC 4 0.4878 18.1 15.1 652 652 KIDNEY TRANSPLANT 0 0.0000 0.0 0.0 653 653 MAJOR BLADDER PROCEDURES W MCC 1 1.6496 36.4 30.3 654 653 MAJOR BLADDER PROCEDURES W CC 0 1.0834 28.9 24.1 655 653 MAJOR BLADDER PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1CMS-1498-P2 382

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 656 656 KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC 1 0.4878 18.1 15.1 657 656 KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 0 0.4878 18.1 15.1 658 656 KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 0 0.4878 18.1 15.1659 659 KIDNEY & URETER PROCEDURES FOR NONNEOPLASM W MCC* 4 1.0834 28.9 24.1660 659 KIDNEY & URETER PROCEDURES FOR NONNEOPLASM W CC 4 1.0834 28.9 24.1661 659 KIDNEY & URETER PROCEDURES FOR NONNEOPLASM W/O CC/MCC 0 1.0834 28.9 24.1 662 662 MINOR BLADDER PROCEDURES W MCC 0 1.0834 28.9 24.1 663 662 MINOR BLADDER PROCEDURES W CC 1 1.0834 28.9 24.1 664 662 MINOR BLADDER PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 665 665 PROSTATECTOMY W MCC 2 1.0834 28.9 24.1 666 665 PROSTATECTOMY W CC 0 1.0834 28.9 24.1 667 665 PROSTATECTOMY W/O CC/MCC 0 1.0834 28.9 24.1 668 668 TRANSURETHRAL PROCEDURES W MCC 9 1.0834 28.9 24.1 669 668 TRANSURETHRAL PROCEDURES W CC 1 0.6280 20.9 17.4 670 668 TRANSURETHRAL PROCEDURES W/O CC/MCC 0 0.6280 20.9 17.4 671 671 URETHRAL PROCEDURES W CC/MCC 3 0.8667 24.6 20.5 672 671 URETHRAL PROCEDURES W/O CC/MCC 0 0.8667 24.6 20.5 673 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC 212 1.3837 32.9 27.4 674 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 44 0.9783 27.9 23.3 675 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC 3 0.8667 24.6 20.5 682 682 RENAL FAILURE W MCC 1,584 0.9086 23.1 19.3 683 682 RENAL FAILURE W CC 538 0.6892 21.0 17.5 684 682 RENAL FAILURE W/O CC/MCC 28 0.6200 17.1 14.3 685 685 ADMIT FOR RENAL DIALYSIS 1 1.0834 28.9 24.1 686 686 KIDNEY & URINARY TRACT NEOPLASMS W MCC 15 0.8667 24.6 20.5 687 686 KIDNEY & URINARY TRACT NEOPLASMS W CC 14 0.6280 20.9 17.4 688 686 KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC 0 0.6280 20.9 17.4 689 689 KIDNEY & URINARY TRACT INFECTIONS W MCC 942 0.6715 21.7 18.1 690 689 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 682 0.5198 19.3 16.1CMS-1498-P2 383

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 691 691 URINARY STONES W ESW LITHOTRIPSY W CC/MCC 0 0.8667 24.6 20.5 692 691 URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC 0 0.4878 18.1 15.1 693 693 URINARY STONES W/O ESW LITHOTRIPSY W MCC 11 0.8667 24.6 20.5 694 693 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 1 0.4878 18.1 15.1 695 695 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC 5 0.8667 24.6 20.5 696 695 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC 4 0.4878 18.1 15.1 697 697 URETHRAL STRICTURE 1 0.8667 24.6 20.5 698 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 345 0.8847 22.9 19.1 699 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 134 0.6314 20.2 16.8 700 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 11 0.6280 20.9 17.4 707 707 MAJOR MALE PELVIC PROCEDURES W CC/MCC 0 1.0834 28.9 24.1 708 707 MAJOR MALE PELVIC PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 709 709 PENIS PROCEDURES W CC/MCC 5 1.0834 28.9 24.1 710 709 PENIS PROCEDURES W/O CC/MCC 1 0.6280 20.9 17.4 711 711 TESTES PROCEDURES W CC/MCC 5 1.0834 28.9 24.1 712 711 TESTES PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 713 713 TRANSURETHRAL PROSTATECTOMY W CC/MCC 4 0.8667 24.6 20.5 714 713 TRANSURETHRAL PROSTATECTOMY W/O CC/MCC 0 0.6280 20.9 17.4 715 715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC 0 1.6496 36.4 30.3 716 715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC 0 1.0834 28.9 24.1 717 717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC 11 1.6496 36.4 30.3 718 717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC 1 1.0834 28.9 24.1 722 722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC 8 1.0834 28.9 24.1 723 722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC 9 0.6280 20.9 17.4 724 722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC 0 0.6280 20.9 17.4CMS-1498-P2 384

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 725 725 BENIGN PROSTATIC HYPERTROPHY W MCC 2 1.6496 36.4 30.3 726 725 BENIGN PROSTATIC HYPERTROPHY W/O MCC 1 0.8667 24.6 20.5 727 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC 75 0.8106 22.6 18.8 728 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC 57 0.5026 17.3 14.4 729 729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC 68 0.8981 26.5 22.1 730 729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC 3 0.4878 18.1 15.1 734 734 PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC 0 1.0834 28.9 24.1 735 734 PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC 0 1.0834 28.9 24.1 736 736 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC 0 1.0834 28.9 24.1 737 736 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC 0 0.6280 20.9 17.4 738 736 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC 0 0.6280 20.9 17.4739 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W MCC 0 1.2314 32.7 27.3740 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W CC* 0 0.9743 28.6 23.8741 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W/O CC/MCC 0 0.8667 24.6 20.5742 742 UTERINE & ADNEXA PROC FOR NONMALIGNANCY W CC/MCC* 0 0.9743 28.6 23.8743 742 UTERINE & ADNEXA PROC FOR NONMALIGNANCY W/O CC/MCC 0 0.8667 24.6 20.5 744 744 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC 0 1.0834 28.9 24.1 745 744 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC 0 1.0834 28.9 24.1 746 746 VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC 4 1.0834 28.9 24.1 747 746 VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 748 748 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 0 1.0834 28.9 24.1 749 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC 7 1.0834 28.9 24.1CMS-1498-P2 385

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 750 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC 0 1.0834 28.9 24.1 754 754 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC 17 1.0834 28.9 24.1 755 754 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC 11 0.6280 20.9 17.4 756 754 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC* 0 0.6279 20.9 17.4 757 757 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC 72 0.7745 24.6 20.5 758 757 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC 40 0.6839 23.9 19.9 759 757 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC 7 0.4878 18.1 15.1 760 760 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC* 4 0.8667 24.6 20.5 761 760 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC* 2 0.8667 24.6 20.5 765 765 CESAREAN SECTION W CC/MCC 0 1.0834 28.9 24.1 766 765 CESAREAN SECTION W/O CC/MCC 0 1.0834 28.9 24.1 767 767 VAGINAL DELIVERY W STERILIZATION &/OR D&C 0 1.0834 28.9 24.1 768 768 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 0 1.0834 28.9 24.1 769 769 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 2 1.6496 36.4 30.3 770 770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 0 1.0834 28.9 24.1 774 774 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 0 1.0834 28.9 24.1 775 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 0 1.0834 28.9 24.1 776 776 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 1 0.6280 20.9 17.4 777 777 ECTOPIC PREGNANCY 0 0.6280 20.9 17.4 778 778 THREATENED ABORTION 0 0.6280 20.9 17.4 779 779 ABORTION W/O D&C 0 0.6280 20.9 17.4 780 780 FALSE LABOR 0 0.6280 20.9 17.4 781 781 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 3 0.4878 18.1 15.1 782 782 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS 0 0.4878 18.1 15.1CMS-1498-P2 386

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 789 789 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 0 0.4878 18.1 15.1 790 790 EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 0 0.4878 18.1 15.1 791 791 PREMATURITY W MAJOR PROBLEMS 0 0.4878 18.1 15.1 792 792 PREMATURITY W/O MAJOR PROBLEMS 0 0.4878 18.1 15.1 793 793 FULL TERM NEONATE W MAJOR PROBLEMS 0 0.4878 18.1 15.1 794 794 NEONATE W OTHER SIGNIFICANT PROBLEMS 0 0.4878 18.1 15.1 795 795 NORMAL NEWBORN 0 0.4878 18.1 15.1 799 799 SPLENECTOMY W MCC 0 1.0834 28.9 24.1 800 799 SPLENECTOMY W CC 0 1.0834 28.9 24.1 801 799 SPLENECTOMY W/O CC/MCC 0 1.0834 28.9 24.1 802 802 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC 1 1.0834 28.9 24.1 803 802 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC 0 1.0834 28.9 24.1 804 802 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC 0 1.0834 28.9 24.1 808 808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC 12 0.8667 24.6 20.5 809 808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC 14 0.6280 20.9 17.4 810 808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC 0 0.5579 19.4 16.2 811 811 RED BLOOD CELL DISORDERS W MCC 65 0.8442 21.1 17.6 812 811 RED BLOOD CELL DISORDERS W/O MCC 38 0.5579 19.4 16.2 813 813 COAGULATION DISORDERS 35 0.7444 20.8 17.3 814 814 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC 29 0.8804 24.8 20.7 815 814 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 14 0.6280 20.9 17.4 816 814 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC 0 0.6280 20.9 17.4 820 820 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC 0 0.4878 18.1 15.1 821 820 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC 1 0.4878 18.1 15.1 822 820 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC 0 0.4878 18.1 15.1 823 823 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W MCC 3 1.6496 36.4 30.3 824 823 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC 1 0.4878 18.1 15.1CMS-1498-P2 387

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 825 823 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC 0 0.4878 18.1 15.1 826 826 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC 0 0.8667 24.6 20.5 827 826 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC 1 0.8667 24.6 20.5 828 826 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC/MCC 0 0.8667 24.6 20.5 829 829 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W CC/MCC 7 1.6496 36.4 30.3 830 829 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W/O CC/MCC 0 1.6496 36.4 30.3 834 834 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC 22 0.8667 24.6 20.5 835 834 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC 12 0.8667 24.6 20.5 836 834 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC 1 0.6280 20.9 17.4 837 837 CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC 0 1.3821 29.1 24.3 838 837 CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT 0 1.3026 28.6 23.8 839 837 CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC 0 1.3026 28.6 23.8 840 840 LYMPHOMA & NON-ACUTE LEUKEMIA W MCC 91 0.8902 22.1 18.4 841 840 LYMPHOMA & NON-ACUTE LEUKEMIA W CC 38 0.6737 18.8 15.7 842 840 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC 4 0.4878 18.1 15.1 843 843 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC 7 0.8667 24.6 20.5 844 843 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 7 0.8667 24.6 20.5 845 843 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC 1 0.4878 18.1 15.1 846 846 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC 57 1.3821 29.1 24.3 847 846 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC 54 1.3026 28.6 23.8 848 846 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC 0 1.3026 28.6 23.8 849 849 RADIOTHERAPY 119 0.7731 22.7 18.9 853 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC 1,059 1.7414 37.6 31.3CMS-1498-P2 388

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 854 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC 96 1.1086 30.2 25.2 855 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC 2 0.8667 24.6 20.5 856 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC 361 1.4572 34.1 28.4 857 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC 194 1.0416 30.5 25.4 858 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC 10 0.8667 24.6 20.5 862 862 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC 1,722 0.9662 25.3 21.1 863 862 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 1,019 0.6985 23.0 19.2 864 864 FEVER 3 0.4878 18.1 15.1 865 865 VIRAL ILLNESS W MCC 26 0.8013 21.3 17.8 866 865 VIRAL ILLNESS W/O MCC* 13 0.8013 21.3 17.8 867 867 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC 450 1.0444 23.7 19.8 868 867 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 64 0.6882 19.5 16.3 869 867 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC 2 0.4878 18.1 15.1 870 870 SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS 1,282 2.1406 31.7 26.4 871 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 5,885 0.8725 23.1 19.3 872 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W/O MCC 1,275 0.6256 20.3 16.9 876 876 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 3 1.6496 36.4 30.3 880 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 9 0.6280 20.9 17.4 881 881 DEPRESSIVE NEUROSES 34 0.3912 21.9 18.3 882 882 NEUROSES EXCEPT DEPRESSIVE 10 0.4878 18.1 15.1 883 883 DISORDERS OF PERSONALITY & IMPULSE CONTROL 7 0.6280 20.9 17.4 884 884 ORGANIC DISTURBANCES & MENTAL RETARDATION 76 0.5154 25.7 21.4 885 885 PSYCHOSES 877 0.3977 24.2 20.2 886 886 BEHAVIORAL & DEVELOPMENTAL DISORDERS 38 0.4205 24.7 20.6 887 887 OTHER MENTAL DISORDER DIAGNOSES 2 0.4878 18.1 15.1 894 894 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA 0 0.4878 18.1 15.1CMS-1498-P2 389

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 895 895 ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY 0 0.4878 18.1 15.1 896 896 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC 12 0.8667 24.6 20.5 897 896 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC 8 0.4878 18.1 15.1 901 901 WOUND DEBRIDEMENTS FOR INJURIES W MCC 292 1.3897 34.4 28.7 902 901 WOUND DEBRIDEMENTS FOR INJURIES W CC 138 1.0411 29.9 24.9 903 901 WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC 6 0.6280 20.9 17.4 904 904 SKIN GRAFTS FOR INJURIES W CC/MCC 100 1.3724 38.3 31.9 905 904 SKIN GRAFTS FOR INJURIES W/O CC/MCC 2 0.8667 24.6 20.5 906 906 HAND PROCEDURES FOR INJURIES 3 0.6280 20.9 17.4 907 907 OTHER O.R. PROCEDURES FOR INJURIES W MCC 135 1.4581 34.3 28.6 908 907 OTHER O.R. PROCEDURES FOR INJURIES W CC 57 0.9544 28.7 23.9 909 907 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 4 0.6280 20.9 17.4 913 913 TRAUMATIC INJURY W MCC 49 0.7653 24.3 20.3 914 913 TRAUMATIC INJURY W/O MCC 79 0.5688 20.1 16.8 915 915 ALLERGIC REACTIONS W MCC 1 0.4878 18.1 15.1 916 915 ALLERGIC REACTIONS W/O MCC 0 0.4878 18.1 15.1 917 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC 8 1.0834 28.9 24.1 918 917 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 3 0.4878 18.1 15.1 919 919 COMPLICATIONS OF TREATMENT W MCC 1,547 1.0957 26.7 22.3 920 919 COMPLICATIONS OF TREATMENT W CC 888 0.8190 24.9 20.8 921 919 COMPLICATIONS OF TREATMENT W/O CC/MCC 53 0.5150 18.4 15.3 922 922 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC 7 0.8667 24.6 20.5 923 922 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC 11 0.4878 18.1 15.1 927 927 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W SKIN GRAFT 0 1.0834 28.9 24.1 928 928 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC 11 1.0834 28.9 24.1 929 928 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/O CC/MCC 1 1.0834 28.9 24.1 933 933 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W/O SKIN GRAFT 11 0.6280 20.9 17.4CMS-1498-P2 390

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 934 934 FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ 31 0.6455 23.9 19.9 935 935 NON-EXTENSIVE BURNS 64 0.6801 22.2 18.5 939 939 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC 225 1.4033 33.6 28.0 940 939 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 98 1.0076 31.1 25.9 941 939 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC 9 0.6280 20.9 17.4 945 945 REHABILITATION W CC/MCC 1,338 0.6483 21.1 17.6 946 945 REHABILITATION W/O CC/MCC 89 0.4068 17.2 14.3 947 947 SIGNS & SYMPTOMS W MCC 41 0.8226 23.5 19.6 948 947 SIGNS & SYMPTOMS W/O MCC 51 0.4846 19.9 16.6 949 949 AFTERCARE W CC/MCC 3,264 0.7152 22.1 18.4 950 949 AFTERCARE W/O CC/MCC 194 0.4500 17.1 14.3 951 951 OTHER FACTORS INFLUENCING HEALTH STATUS 66 1.5230 27.2 22.7 955 955 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 0 1.0834 28.9 24.1 956 956 LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA 0 1.6496 36.4 30.3 957 957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC 1 0.6280 20.9 17.4 958 957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC* 0 0.6280 20.9 17.4 959 957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC* 0 0.6280 20.9 17.4 963 963 OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC* 8 1.0834 28.9 24.1 964 963 OTHER MULTIPLE SIGNIFICANT TRAUMA W CC 8 1.0834 28.9 24.1 965 963 OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC 1 0.4878 18.1 15.1 969 969 HIV W EXTENSIVE O.R. PROCEDURE W MCC 12 1.6496 36.4 30.3 970 969 HIV W EXTENSIVE O.R. PROCEDURE W/O MCC 2 0.8667 24.6 20.5 974 974 HIV W MAJOR RELATED CONDITION W MCC 210 1.0513 23.2 19.3 975 974 HIV W MAJOR RELATED CONDITION W CC 58 0.6394 18.6 15.5 976 974 HIV W MAJOR RELATED CONDITION W/O CC/MCC 7 0.4878 18.1 15.1 977 977 HIV W OR W/O OTHER RELATED CONDITION 30 0.6746 19.9 16.6 981 981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 1,045 2.1789 41.6 34.7 982 981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC 219 1.1315 30.7 25.6CMS-1498-P2 391

MSLTCDRG BaseMSLTCDRG MS-LTC-DRG Title FY 2009 LTCH Cases Proposed Relative Weight Proposed Geometric

Average Length of Stay Proposed Short-Stay

Outlier (SSO) Threshold 1 983 981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 6 0.6280 20.9 17.4 984 984 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 19 1.6496 36.4 30.3 985 984 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC 8 1.0834 28.9 24.1 986 984 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 0 1.0834 28.9 24.1 987 987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC 467 1.8331 38.5 32.1 988 987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC 172 1.0343 30.2 25.2 989 987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC 4 0.6280 20.9 17.4 998 998 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS 0 0.0000 0.0 0.0 999 999 UNGROUPABLE 0 0.0000 0.0 0.0

1 The SSO Threshold is calculated as 5/6 th of the geometric average length of stay of the MS-LTC-DRG (as specified in §412.529(a) in conjunction with §412.503). * In determining the proposed MS-LTC-DRG relative weights for FY 2011, these MS-LTC-DRGs were adjusted for

nonmonotonicity as discussed in section VII.B.3.g. (step 6) of the preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24042).CMS-1498-P2 392
Appendix: Regulatory Impact Analysis
I. Overall Impact
We have examined the impacts of this proposed rule as required by Executive
Order 12866 (September 1993, Regulatory Pla nning and Review) and the Regulatory
Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the
Social Security Act, the Unfunded Ma ndates Reform Act of 1995 (Pub. L. 104-4),
Executive Order 13132 on Federalism, a nd the Congressional Review Act
(5 U.S.C. 804(2)).
Executive Order 12866 directs agencies to assess all costs and benefits of
available regulatory a lternatives and, if regu lation is necessary, to select regulatory
approaches that maximize ne t benefits (including poten tial economic, e nvironmental,
public health and safety effect s, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year).
We have determined that this proposed rule is a major rule as defined in
5 U.S.C. 804(2). We estimate that the pr oposed changes for FY 2011 acute care hospital
operating and capital paymen ts will redistribute in excess of $100 million among
different types of inpatient cas es. The proposed applicable percentage increase to the
IPPS rates required by the statute, in conjunction with other proposed payment changes in
this proposed rule, would result in an estimated $929 million decrease in FY 2011
operating payments (or -0.9 percent increas e), and an estimated $20 million decrease in
FY 2011 capital payments (or -0.2 percent chan ge). The impact analysis of the capitalCMS-1498-P2 393
payments can be found in section V III. of this Appendix. In add ition, as described in
section IX. of this Appendix, LTCHs are expected to experience an increase in payments by $12.9 million (or 0.3 percent).
Our operating impact estimate includes the proposed -2.9 percent documentation
and coding adjustment applied to the hosp ital-specific rates, the proposed -2.4 percent
documentation and coding adjus tment applied to the Puerto Rico-specific rates and the
proposed -2.9 percent adjustment for documentation and coding changes to the IPPS
standardized amounts, which was discussed in the May 4, 2010 FY 2011 IPPS/LTCH
PPS proposed rule (75 FR 24288). In addition, our operating impact estimate includes
the proposed 2.15 percent market basket upda te to the standardized amount (which
includes the proposed 2.4 percent update with the 0.25 reduction required under the
Affordable Care Act). The estimates of IPPS operating payments to acute care hospitals
do not reflect any changes in hospital admissi ons or real case-mix intensity, which would
also affect overall payment changes.
The RFA requires agencies to analyze options for regulatory relief of small
businesses. For purposes of the RFA, sm all entities include sma ll businesses, nonprofit
organizations, and small government jurisd ictions. Most hospitals and most other
providers and suppliers are considered to be small entities, eith er by being nonprofit
organizations or by meeting the Small Bu siness Administration definition of a small
business (having revenues of $34.5 million or less in any 1 year). (For details on the

latest standards for health car e providers, we refer readers to the Table of Small Business

Size Standards for NAIC 622 found on the Sma ll Business Administration Office of SizeCMS-1498-P2 394

Standards Web site at: http://www.sba.gov/contractingopportunities/officials/size/GCSMALL-BUS-SIZE-STANDARDS.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 the provisions of this
proposed rule relating to acute care hospitals would have a significant impact on small
entities as explained in this Appendix. B ecause we lack data on individual hospital
receipts, we cannot determine th e number of small proprietary LTCHs. Therefore, we are
assuming that all LTCHs are considered small entities for the purpose of the analysis in
section IX. of this Appendix. Medicare fiscal intermediaries and MACs are not

considered to be small entities. Because we acknowledge that many of the affected
entities are small entities, the analysis discu ssed throughout the preamble of this proposed
rule constitutes our proposed re gulatory flexibility analysis. Therefore, we are soliciting
public comments on our estimates and analysis of the impact of this proposed rule on

those small entities.
The Small Business Regulatory Enfo rcement Fairness Act of 1996 (SBREFA),
Pub. L. 104-121, as amended by section 8302 of Pub. L. 110-28, requires an agency to
provide compliance guides for each rule or gr oup of related rules for which an agency is
required to prepare a final regulatory flexibility analysis. The compliance guides
associated with this proposed rule are available on the CMS IPPS Web page at
http://www.cms.hhs.gov/AcuteInpatientPPS/01_overview.asp . We also note that the
Hospital Center Web page at http://www.cms.hhs.gov/center/hospital.asp was developed
to assist hospitals in understanding and adap ting to changes in Medicare regulations andCMS-1498-P2 395
in billing and payment procedures. This Web page provides hospitals with substantial
downloadable explanatory materials.
In addition, section 1102(b) of the Act re quires us to prepare a regulatory impact
analysis for any proposed or final rule that may have a significant impact on the
operations of a substantial numbe r of small rural hospitals. This analysis must conform
to the provisions of section 603 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 lo cated 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 and the LTCH PPS, we continue to
classify these hospitals as urban hospitals. (W e refer readers to Table 1 and section VI. of
this Appendix for the quantitative effects of the proposed policy changes under the IPPS
for operating costs.)

Section 202 of the Unfunde d Mandates Reform Act of 1995 (Pub. L. 104-4) also
requires that agencies assess anticipated costs and benefits before i ssuing any rule whose
mandates require spending in any 1 year of $100 million in 1995 dollars, updated
annually for inflation. That threshold leve l is currently approximately $133 million. This
proposed rule would not mandate any requirements for State, lo cal, or tribal governments,
nor would it affect private sector costs.

Executive Order 13132 establishes certain re quirements that an agency must meet
when it promulgates a proposed rule (and subse quent final rule) that imposes substantialCMS-1498-P2 396
direct requirement costs on Stat e and local governments, preem pts State law, or otherwise
has Federalism implications. As stated a bove, this proposed rule would not have a

substantial effect on Stat e and local governments.
The following analysis, in conjunction with the remainder of this document,
demonstrates that this proposed rule is c onsistent with the regulatory philosophy and
principles identified in Executive Order 12866, th e RFA, and section 1102(b) of the Act.
The proposed rule would affect payments to a substantial number of small rural hospitals,

as well as other classes of hos pitals, and the effects on some hospitals may be significant.
II. Objectives of the IPPS
The primary objective of the IPPS is to create incentives for hospitals to operate
efficiently and minimize unnecessary costs while at the same time ensuring that payments
are sufficient to adequately compensate hospita ls for their legitimate costs. In addition,
we share national goals of preserving the Medicare Hospital Insurance Trust Fund.
We believe the proposed changes in this proposed rule would further each of these
goals while maintaining the fi nancial viability of the hospita l industry and ensuring access
to high quality health care for Medicare benefi ciaries. We expect that these proposed
changes would ensure that the outcomes of the prospective payment systems are
reasonable and equitable while avoiding or minimizing unintended adverse consequences.
III. Limitations of Our Analysis
The following quantitative analysis presents the projected effects of our proposed
policy changes, as well as statutory chan ges effective for FY 2011, on various hospital
groups. We estimate the effects of individua l policy changes by estimating payments perCMS-1498-P2 397
case while holding all other paym ent policies constant. We us e the best data available,
but, generally, we do not atte mpt to make adjustments for future changes in such
variables as admissions, lengths of stay, or case-mix.
IV. Hospitals Included in and Excluded from the IPPS
The prospective payment systems fo r hospital inpatie nt operating and
capital-related costs of acute care hospitals encompass most general short-term, acute care
hospitals that participate in the Medicare prog ram. There were 33 Indian Health Service
hospitals in our data base, which we excluded from the analysis due to the special
characteristics of the prospective payment me thodology for these hospitals. Among other
short-term, acute care hospitals, only the 46 su ch hospitals in Maryland remain excluded
from the IPPS pursuant to the waiver under section 1814(b)(3) of the Act.
As of March 2010, there are 3,472 IPPS acute care hospitals to be included in our
analysis. This represents about 64 percent of all Medicare-particip ating hospitals. The
majority of this impact analysis focuses on this set of hospitals. There are also
approximately 1,338 CAHs. Thes e small, limited service hospita ls are paid on the basis
of reasonable costs rather than under the IPPS. (We refer readers to section VII. of this
Appendix for a further description of th e impact of CAH-related proposed policy
changes.) There are also 1,270 IPPS-excluded hospitals and 2,169 IPPS-excluded
hospital units. These IPPS-excluded hospitals and units include IPFs, IRFs, LTCHs,
RNHCIs, children's hospitals, and cancer hos pitals, which are pa id under separate
payment systems. Changes in the prospective payment systems for IPFs and IRFs are
made through separate rulemaking. Payment impacts for these IPPS-excluded hospitalsCMS-1498-P2 398
and units are not included in this proposed rule. The impact of the proposed update and
policy changes to the LTCH PPS for FY 2011 are discussed in section IX. of this
Appendix.
V. Effects on Hospitals and Hosp ital Units Excluded From the IPPS
As of March 2010, there were 3,439 hosp itals and hospital units excluded from
the IPPS. Of these, 78 children's hospitals, 11 cancer hospitals, and 17 RNHCIs are being
paid on a reasonable cost basis subject to the rate-of-increase ceiling under §413.40. The
remaining providers, 228 re habilitation hospitals and 961 rehabilitation units, and
429 LTCHs, are paid the Federal prospective per discharge rate under the IRF PPS and
the LTCH PPS, respectively, and 507 psychiatric hospitals and 1,208 psychiatric units are
paid the Federal per diem amount under the IPF PPS. As stated above, IRFs and IPFs are
not affected by rate updates di scussed in this proposed rule. The impacts of the changes

to LTCHs are discussed in s ection IX. of this Appendix.
In the past, certain hospitals and units excluded from the IPPS have been paid
based on their reasonable costs subject to limits as established by the Tax Equity and
Fiscal Responsibility Act of 1982 (TEFRA). Ca ncer and children's hos pitals continue to
be paid on a reasonable cost basis subj ect to TEFRA limits for FY 2011. For these
hospitals (cancer and children's hospitals), consistent with the authority provided in
section 1886(b)(3)(B)(ii) of the Act, the update is the percentage increase in the FY 2011
IPPS operating market basket. In compliance with section 404 of the MMA, in the

FY 2010 IPPS/RY 2010 LTCH PPS final ru le (74 FR 43930), we replaced the
FY 2002-based IPPS operating and capital market baskets with the revised and rebasedCMS-1498-P2 399
FY 2006-based IPPS operating and capital market baskets. Therefore, consistent with
current law, based on IHS Global Insight, Inc.'s 2010 first quarter forecas t, with historical
data through the 2009 fourth quarter, we ar e estimating that the proposed FY 2011 update
to the IPPS operating market basket would be 2.4 percent (that is, the current estimate of
the market basket rate-of-increase) wh ich was included in the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule. However, the Affordable Care Act requires a 0.25

reduction to the market bask et update resulting in a propos ed 2.15 percent applicable
percentage increase for IPPS hospitals. RNCHIs, children's hospitals and cancer hospitals
are not subject to the reduction in the app licable percentage increase required under the

Affordable Care Act. In accordance with §403.752(a) of the regulations, RNHCIs are
paid under §413.40. Therefore, for RNHCIs, th e proposed update is the same as for
children's and cancer hospitals, which is the percentage increase in the FY 2011 IPPS
operating market basket increase (which was included in the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule) without the reductions required under the Affordable
Care Act, estimated to be 2.4 percent.
The impact of the proposed update in the rate-of-increase limit on those excluded
hospitals depends on the cumulative cost incr eases experienced by each excluded hospital
since its applicable base period. For excluded hospitals that have maintained their cost

increases at a level below the rate-of-incr ease limits since their base period, the major
effect is on the level of incentive payments these excluded hospitals receive. Conversely,
for excluded hospitals with per-case cost in creases above the cumulative update in their
rate-of-increase limits, the major effect is th e amount of excess costs that will not beCMS-1498-P2 400

reimbursed.
We note that, under §413.40(d)(3), an exclude d hospital that continues to be paid
under the TEFRA system, whose costs exceed 110 percent of its rate-of-increase limit

receives its rate-of-increase limit plus 50 percent of the diffe rence between its reasonable
costs and 110 percent of the limit, not to ex ceed 110 percent of its limit. In addition,
under the various provisions set forth in §413.40, cancer and children's hospitals can
obtain payment adjustments for justifiable increases in operating costs that exceed the

limit.
VI. Quantitative Effects of the Policy Changes Under the IPPS for Operating Costs
A. Basis and Methodology of Estimates
In this proposed rule, we are announc ing proposed policy changes and payment
rate updates for the IPPS for operating costs of acute care hospitals. Updates to the
capital payments to acute care hospitals are discussed in section VIII. of this Appendix.
Based on the overall percentage change in payments per case estimated using our
payment simulation model, we estimate that total FY 2011 operating payments would
decrease by 0.9 percent compared to FY 2010, largely due to the documentation and
coding adjustments and the applicable percentage increase applied to the IPPS rates. This
amount reflects the proposed FY 2011 documenta tion and coding adju stments described
in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule: -2.9 percent for the IPPS
national standardized amounts, -2.9 percent for the IPPS hospital-specific rates, and -2.4
percent for the IPPS Puerto Rico-specific standardized amount. The impacts do not
illustrate changes in hospital admissions or real case-mix intensity, which will also affectCMS-1498-P2 401
overall payment changes.
We have prepared separate impact an alyses of the proposed changes to each
system. This section deals with changes to the operating prospective payment system for
acute care hospitals. Our payment simulation model relies on the most recent available
data to enable us to estimate the impact s on payments per case of certain proposed
changes in this proposed rule. However, th ere are other proposed changes for which we
do not have data available that would allow us to estimate the payment impacts using this
model. For those proposed changes, we ha ve attempted to pred ict the payment impacts
based upon our experience a nd other more limited data.
The data used in developing the quantitative analyses of changes in payments per
case presented below are taken from the FY 2009 MedPAR file and the most current
Provider-Specific File that is used for payment purposes. Although the analyses of the
proposed changes to the operating PPS do not incorporate cost data, data from the most
recently available hospital cost report were used to categorize hospitals. Our analysis has
several qualifications. First, in this anal ysis, we do not make adjustments for future
changes in such variables as admissions, leng ths of stay, or underlying growth in real
case-mix. Second, due to the interdependent nature of the IPPS payment components, it
is very difficult to precisely quantify the impact associated with each change. Third, we

use various sources for the data used to categorize hospitals in the tables. In some cases,
particularly the number of beds, there is a fair degree of varia tion in the data from

different sources. We have a ttempted to construct these variables with the best available
source overall. However, for individual hosp itals, some miscategorizations are possible.CMS-1498-P2 402
Using cases from the FY 2009 MedPAR f ile, we simulated payments under the
operating IPPS given various combinations of payment parameters. Any short-term,
acute care hospitals not paid under the IPPS (Indian Health Service hospitals and
hospitals in Maryland) were excluded from the simulations. The impact of payments
under the capital IPPS, or the impact of payments for costs other than inpatient operating
costs, are not analyzed in this section. Estimated payment impacts of the capital IPPS for

FY 2011 are discussed in section V III. of this Appendix.
The changes discussed separately below are the following:

● The effects of the proposed annua l reclassification of diagnoses and
procedures, full implementati on of the MS-DRG system and 100 percent cost-based
MS-DRG relative weights.

● The effects of the proposed changes in hospitals' wage inde x values reflecting
wage data from hospitals' cost reporting pe riods beginning during FY 2007, compared to
the FY 2006 wage data.

● The effects of the recalibration of th e MS-DRG relative weights as required by
section 1886(d)(4)(C) of the Act, including the proposed wage and recalibration budget
neutrality factors.

● The effects of geographic reclassifications by the MGCRB that will be

effective in FY 2011.
The effects of the Frontier wage index provision that requires that hospitals
located in states that qualify as frontier st ates cannot have a wage index less than 1.0.
This is a nonbudget neutral provision.CMS-1498-P2 403

● The effects of the rural floor a nd imputed floor with a national budget
neutrality applied to the wage index, as required by the Affordable Care Act the

Affordable Care Act.

● The effects of section 505 of Pub. L. 108-173, which provides for an increase
in a hospital's wage index if the hospital qua lifies by meeting a thre shold percentage of
residents of the county where the hospital is lo cated who commute to work at hospitals in
counties with higher wage indexes.

● The total estimated change in pa yments based on the proposed FY 2011
policies relative to payments based on FY 2010 policies that include the applicable
percentage increase of 2.15 ( or 2.4 percen t market basket with a 0.25 percentage
reduction, as required under the Affordable Ca re Act). The FY 2010 operating payments
also account for provisions under the Affordab le Care Act that were effective for

FY 2010.
To illustrate the impacts of the proposed FY 2011 changes, our analysis begins

with a FY 2010 baseline simulation model using: the proposed FY 2011 applicable
percentage increase of 2.15 percent; th e FY 2010 MS-DRG GROUPER (Version 27.0);
the most current CBSA designations for hos pitals based on OMB's MSA definitions; the
FY 2010 wage index; and no MGCRB reclassifi cations. Outlier payments are set at 5.1
percent of total operating MS-DRG and outlier payments.
Section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a) of
Pub. L. 109-171, provides that, for FY 2007 and s ubsequent years, th e update factor will
be reduced by 2.0 percentage points for any hos pital that does not s ubmit quality data in aCMS-1498-P2 404
form and manner and at a time specified by the Secretary. At the time that this impact
was prepared, 104 hospitals did not receive the full market basket rate-of-increase for
FY 2010 because they failed the quality data submission process or did not choose to
participate. For purposes of the simulati ons shown below, we modeled the proposed
payment changes for FY 2011 using a reduced update for these 104 hospitals. However,
we do not have enough information at this time to determine whic h hospitals will not

receive the full market basket rate-of-increase for FY 2011.
Each policy change, statutory or otherwis e, is then added incrementally to this
baseline, finally arriving at an FY 2011 mode l incorporating all of the changes. This

simulation allows us to isolate th e effects of each proposed change.
Our final comparison illustrates the proposed percent change in payments per case

from FY 2010 to FY 2011. Three factors not discussed separately have significant
impacts here. The first factor is the update to the standardized amount. In accordance
with section 1886(b)(3)(B)(i) of the Act, we are proposing to update the standardized
amounts for FY 2011 using an applicable per centage increase of 2.15 percent. In
addition, we are updating the Puerto Rico speci fic amount by an applicable percentage
increase of 2.15 percent. This includes our fo recasted hospital market basket increase of
2.4 percent with a 0.25 percentage reduction as required under the Affordable Care Act.
(Hospitals that fail to comply with the quality data submission require ments to receive the
full update will receive an upda te reduced by 2.0 percentage points from 2.15 percent to
0.15 percent.) Under section 1886(b)(3)(B)(iv) of the Act, the updates to the hospitalspecific amounts for SCHs and fo r MDHs are also equal to th e market basket percentageCMS-1498-P2 405
increase, or 2.15 percent.
A second significant factor that affects the changes in hospitals' payments per case
from FY 2010 to FY 2011 is the change in a hos pital's geographic reclassification status
from one year to the next. That is, payments may be reduced for hospitals reclassified in
FY 2010 that are no longer reclassified in FY 2011. Conversely, payments may increase
for hospitals not reclassified in FY 2010 that are reclassified in FY 2011.
A third significant factor is that we currently estimate that actual outlier payments
during FY 2010 will be 4.9 percent of tota l MS-DRG payments. Our FY 2010 outlier
estimate accounts for changes to the FY 2010 IPPS payments required under the

Affordable Care Act. When the FY 2010 fi nal rule was published, we projected FY 2010
outlier payments would be 5.1 percent of total MS-DRG plus outlier payments; the
average standardized amounts we re offset correspondingly. Th e effects of the lower than
expected outlier payments during FY 2010 (a s discussed in the Addendum to this
proposed rule) are reflected in the analyses below comparing our current estimates of FY
2010 payments per case to estimated FY 2011 pa yments per case (with outlier payments
projected to equal 5.1 percent of total MS-DRG payments).
B. Analysis of Table I
Table I displays the results of our anal ysis of the proposed changes for FY 2011.
The table categorizes hospitals by various geographic and special payment consideration
groups to illustrate the varying impacts on differe nt types of hospitals. The top row of the
table shows the overall impact on the 3,472 acute care hospitals included in the analysis.
The next four rows of Table I contain hospitals categorized according to theirCMS-1498-P2 406
geographic location: all urban, which is furthe r divided into large ur ban and other urban;
and rural. There are 2,502 hospitals located in urban areas included in our analysis.
Among these, there are 1,365 hospitals located in large urban areas (populations over
1 million), and 1,137 hospitals in other urban areas (populations of 1 million or fewer).
In addition, there are 970 hospitals in rural ar eas. The next two groupings are by bed-size
categories, shown separately for urban and rural hospitals. The final groupings by
geographic location are by census divisions, al so shown separately for urban and rural
hospitals.
The second part of Table I shows hos pital groups based on hospitals' FY 2011
payment classifications, includi ng any reclassifications unde r section 1886(d)(10) of the
Act. For example, the rows labeled urban, large urban, other urban, and rural show that
the numbers of hospitals paid based on thes e categorizations after consideration of
geographic reclassifications (i ncluding reclassifications under sections 1886(d)(8)(B) and
1886(d)(8)(E) of the Act that have implica tions for capital payments) are 2,555; 1,403;
1,152; and 917, respectively.
The next three groupings examine the impacts of the changes on hospitals
grouped by whether or not they have GME re sidency programs (teaching hospitals that
receive an IME adjustment) or receive DSH payments, or some combination of these two
adjustments. There are 2,434 nonteaching hos pitals in our analysis, 798 teaching
hospitals with fewer than 100 residents, and 240 teaching hospitals with 100 or more

residents.
In the DSH categories, hospitals ar e grouped according to their DSH paymentCMS-1498-P2 407
status, and whether they are considered ur ban or rural for DSH purposes. The next
category groups together hospitals considered urban or rural, in terms of whether they
receive the IME adjustment, the DSH adjustment, both, or neither.
The next five rows examine the impact s of the changes on rural hospitals by
special payment groups (SCHs, RRCs, and MDHs). There were 183 RRCs, 340 SCHs,
187 MDHs, and 108 hospitals that are both SCHs and RRCs, and 13 hospitals that are

both an MDH and an RRC.
The next series of groupings are based on the type of ownership and the hospital's
Medicare utilization expressed as a percent of total patient days. These data were taken
from the FY 2008 or FY 2007 Medicare cost reports.
The next two groupings concern the geogra phic reclassification st atus of hospitals.
The first grouping displays all urban hospitals that were reclassified by the MGCRB for
FY 2011. The second grouping shows the MGCRB rural reclassifications. These
groupings account for the change in the MGCRB reclassification policy as required under

the Affordable Care Act
The final category shows the impact of the proposed policy changes on the
19 cardiac hospitals in our analysis.CMS-1498-P2 408TABLE I.--IMPACT ANALYSIS OF PROPOSED CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2011No. ofHospitalsProposedFY 2011Weights& MSDRGChanges(1)ApplicationofRecalibration BudgetNeutrality(2)Proposed FY2011WageData(3)Applicationof WageBudgetNeutrality(4)ProposedFY 2011MS-DRG,RelativeWeights &Wage IndexChanges, withWage &RecalibrationBudgetNeutrality(5)FY 2011MGCRBReclassifications(6)ProposedRuralFloorBudgetNeutralityandWithinStateRuralFloorBudgetNeutrality(7)ProposedApplication of theFrontierWageIndex(8)ProposedFY 2011OutMigrationAdjustment(9)AllProposedFY 2011ChangesPrior to theCMIAdjustment(10)AllProposedFY 2011Changesw/CMIAdjustment(11)All Hospitals 3472 0.3 0 0 0 0 0 0 0 0 2 -0.9By GeographicLocation:Urban hospitals 2502 0.3 0 0 0 0 -0.2 0 0 0 2.1 -0.8Large urban areas 1365 0.2 0 0 0.1 0 -0.3 0 0 0 2.1 -0.8Other urban areas 1137 0.4 0.1 -0.1 -0.1 0 0 0.1 0.1 0 2.1 -0.8Rural hospitals 970 0.3 0 0 0 0 1.6 -0.1 0 0.1 1.5 -1.4Bed Size (Urban):0-99 beds 635 0.6 0.2 0 0 0.3 -0.5 0 0.1 0 2.2 -0.7100-199 beds 791 0.2 -0.1 0 0 0 0 0.2 0.1 0 2 -0.9200-299 beds 461 0.3 0 0 0 0 -0.1 0 0.1 0 2.2 -0.7300-499 beds 425 0.3 0 0 0 0 -0.2 0.1 0.1 0 2.1 -0.8500 or more beds 190 0.3 0 -0.1 -0.1 0 -0.3 -0.2 0 0 2 -0.9Bed Size (Rural):0-49 beds 337 0.6 0.3 0.1 0.1 0.3 0.6 -0.1 0.1 0.2 1.8 -1.150-99 beds 366 0.3 0 0 0 0 0.6 -0.1 0 0.1 1.1 -1.8100-149 beds 164 0.3 0 0 0 0 2.2 -0.2 0 0 1.7 -1.1150-199 beds 61 0.3 0 0 0 0.1 2.5 -0.2 0 0 1.8 -1.1200 or more beds 42 0.2 -0.1 0 0.1 -0.1 2.4 -0.1 0 0 1.5 -1.3Urban by Region:New England 121 0.1 -0.2 -0.4 -0.4 -0.6 0.9 -0.2 0 0 0.9 -2Middle Atlantic 330 0.3 0 -0.3 -0.3 -0.3 0.3 0.1 0 0 1.5 -1.4CMS-1498-P2 409No. ofHospitalsProposedFY 2011Weights& MSDRGChanges(1)ApplicationofRecalibration BudgetNeutrality(2)Proposed FY2011WageData(3)Applicationof WageBudgetNeutrality(4)ProposedFY 2011MS-DRG,RelativeWeights &Wage IndexChanges, withWage &RecalibrationBudgetNeutrality(5)FY 2011MGCRBReclassifications(6)ProposedRuralFloorBudgetNeutralityandWithinStateRuralFloorBudgetNeutrality(7)ProposedApplication of theFrontierWageIndex(8)ProposedFY 2011OutMigrationAdjustment(9)AllProposedFY 2011ChangesPrior to theCMIAdjustment(10)AllProposedFY 2011Changesw/CMIAdjustment(11)South Atlantic 383 0.1 -0.2 0 0 -0.2 -0.4 -0.2 0 0 1.9 -1East North Central 403 0.1 -0.1 0.2 0.2 0.1 -0.3 -0.2 0 0 1.8 -1.1East South Central 155 0.4 0.2 -0.5 -0.6 -0.4 -0.2 0 0 0 1.8 -1.1West North Central166 0.5 0.2 -0.1 -0.1 0.1 -0.7 -0.2 0.5 0 2.5 -0.4West South Central342 0.5 0.2 0.2 0.2 0.4 -0.6 -0.2 0 0 2.4 -0.5Mountain 162 0.3 0 0 0 0 -0.3 -0.1 0.2 0 2.4 -0.5Pacific 390 0.6 0.2 0.4 0.40.5 -0.3 0.9 0 0 3.6 0.6Puerto Rico 50 0.9 0.7 -0.3 -0.3 0.4 -0.8 -0.1 0 0 2.4 -0.4Rural by Region:New England 24 0.2 -0.2 0 0 -0.2 0.5 -0.1 0 0 0.6 -2.3Middle Atlantic 70 -0.1 -0.4 0.4 0.4 0 1.5 -0.1 0 0 1.5 -1.4South Atlantic 165 -0.2 -0.5 -0.3 -0.4 -0.9 2.1 -0.2 0 0.1 1.1 -1.8East North Central 120 0.3 0 -0.1 -0.1 -0.2 1.3 -0.1 0 0.1 1.6 -1.3East South Central 175 0.6 0.3 0.20.2 0.5 2.3 -0.2 0 0.1 1.1 -1.7West North Central100 0.7 0.4 0 0 0.4 0.5 -0.1 0.1 0 2.3 -0.6West South Central214 0.7 0.5 0.3 0.4 0.8 2.2 -0.2 0 0.1 2 -0.9Mountain 71 0.7 0.4 0 0 0.40.3 -0.1 0.5 0 2.5 -0.4Pacific 31 0 -0.4 0.3 0.3 -0.1 0.9 -0.1 0 0 1 -1.9By PaymentClassification:Urban hospitals 2555 0.3 0 0 0 0 -0.2 0 0 0 2.1 -0.8Large urban areas 1403 0.2 0 0 0.1 0 -0.3 0 0 0 2.1 -0.8Other urban areas 1152 0.4 0.1 -0.1 -0.1 0 0 0.1 0.1 0 2.1 -0.8Rural areas 917 0.3 0 0 0 0 1.4 -0.1 0 0.1 1.5 -1.4Teaching Status:Nonteaching2434 0.4 0 0.1 0.1 0.2 0.2 0.1 0 0 2.1 -0.8CMS-1498-P2 410No. ofHospitalsProposedFY 2011Weights& MSDRGChanges(1)ApplicationofRecalibration BudgetNeutrality(2)Proposed FY2011WageData(3)Applicationof WageBudgetNeutrality(4)ProposedFY 2011MS-DRG,RelativeWeights &Wage IndexChanges, withWage &RecalibrationBudgetNeutrality(5)FY 2011MGCRBReclassifications(6)ProposedRuralFloorBudgetNeutralityandWithinStateRuralFloorBudgetNeutrality(7)ProposedApplication of theFrontierWageIndex(8)ProposedFY 2011OutMigrationAdjustment(9)AllProposedFY 2011ChangesPrior to theCMIAdjustment(10)AllProposedFY 2011Changesw/CMIAdjustment(11)Fewer than 100residents 798 0.3 0 -0.1 -0.1 -0.1 -0.1 0 0.1 0 2 -0.9100 or moreresidents 240 0.3 0 -0.1 -0.1 -0.1 -0.2 -0.1 0 0 1.9 -1Urban DSH:Non-DSH 834 0.5 0.1 0 0 0 0.1 0 0.1 0 2.1 -0.8100 or more beds 1510 0.3 0 0 0 0 -0.2 0 0 0 2.1 -0.8Less than 100 beds 340 0.2 -0.1 0 0 0 -0.3 0 0.2 0 2 -0.9Rural DSH:SCH 407 0.3 0 0 0 0 0.2 -0.1 0 0.1 0.9 -2RRC 209 0.2 -0.1 0.1 0.1 0 2.4 -0.2 0 0 1.7 -1.2100 or more beds 30 0.1 -0.2 -0.3 -0.3 -0.5 1.1 -0.2 0 0.3 1.2 -1.6Less than 100 beds 142 0.4 0.2 0 0.1 0.2 1 -0.2 0 0.4 1.4 -1.5Urban teaching andDSH:Both teaching andDSH 806 0.3 0 -0.1 -0.1 -0.1 -0.3 -0.1 0.1 0 2 -0.9Teaching and noDSH 169 0.3 -0.1 -0.2 -0.2 -0.2 0.4 0 0.1 0 1.7 -1.1No teaching andDSH 1044 0.3 0 0.2 0.2 0.2 0 0.2 0 0 2.3 -0.6No teaching and noDSH 536 0.6 0.2 0 0 0.2 -0.2 0 0 0 2.3 -0.6Special HospitalTypes:RRC 183 0.4 0.1 0 0 0.2 3.1 -0.2 0.1 0 2 -0.9CMS-1498-P2 411No. ofHospitalsProposedFY 2011Weights& MSDRGChanges(1)ApplicationofRecalibration BudgetNeutrality(2)Proposed FY2011WageData(3)Applicationof WageBudgetNeutrality(4)ProposedFY 2011MS-DRG,RelativeWeights &Wage IndexChanges, withWage &RecalibrationBudgetNeutrality(5)FY 2011MGCRBReclassifications(6)ProposedRuralFloorBudgetNeutralityandWithinStateRuralFloorBudgetNeutrality(7)ProposedApplication of theFrontierWageIndex(8)ProposedFY 2011OutMigrationAdjustment(9)AllProposedFY 2011ChangesPrior to theCMIAdjustment(10)AllProposedFY 2011Changesw/CMIAdjustment(11)SCH 340 0.3 0 0 0 0 0.1 0 0.1 0 1 -1.8MDH 187 0.2 -0.1 0 0 -0.1 0.4 -0.1 0 0.2 1.7 -1.1SCH and RRC 108 0.2 -0.2 -0.1-0.1 -0.2 0.7 0 0 0 1.7 -1.2MDH and RRC 13 0.4 0 0.2 0.2 0.2 0.3 -0.1 0 0 1.8 -1.1Type ofOwnership:Voluntary 1978 0.3 0 0 0 0 0 0 0.1 0 1.9 -1Proprietary 837 0.4 0.1 0.2 0.2 0.3 -0.1 0 0 0 2.4 -0.5Government 577 0.3 0 -0.1 -0.1 0 0 0.1 0 0 2.1 -0.8MedicareUtilization as aPercent ofInpatient Days:0-25 353 0.2 -0.1 0 0 0 -0.4 0 0 0 2.3 -0.625-50 1593 0.3 0 0 0 0 -0.3 0 0.1 0 2.1 -0.850-65 1202 0.3 0 0 -0.1 -0.1 0.6 0 0 0 1.7 -1.2Over 65 237 0.4 0.2 -0.1 -0.2 0 0.7 0.1 0 0 2.1 -0.8FY 2011Reclassificationsby the MedicareGeographicClassificationReview Board:All ReclassifiedHospitals 825 0.3 0 0 0 0 1.8 -0.1 0 0 1.9 -1CMS-1498-P2 412No. ofHospitalsProposedFY 2011Weights& MSDRGChanges(1)ApplicationofRecalibration BudgetNeutrality(2)Proposed FY2011WageData(3)Applicationof WageBudgetNeutrality(4)ProposedFY 2011MS-DRG,RelativeWeights &Wage IndexChanges, withWage &RecalibrationBudgetNeutrality(5)FY 2011MGCRBReclassifications(6)ProposedRuralFloorBudgetNeutralityandWithinStateRuralFloorBudgetNeutrality(7)ProposedApplication of theFrontierWageIndex(8)ProposedFY 2011OutMigrationAdjustment(9)AllProposedFY 2011ChangesPrior to theCMIAdjustment(10)AllProposedFY 2011Changesw/CMIAdjustment(11)Non-ReclassifiedHospitals 2647 0.3 0 0 0 0 -0.7 0 0.1 0 2.1 -0.8Urban HospitalsReclassified 4940.300001.6-0.1002-0.9UrbanNonreclassifiedHospitals, FY 2011: 19790.30000-0.70.10.102.1-0.8All Rural HospitalsReclassified FY2011: 3310.300.10.10.12.7-0.2001.9-1Rural NonreclassifiedHospitals FY 2011: 5760.30000-0.3-0.100.21-1.9All Section 401ReclassifiedHospitals: 37-0.1-0.4-0.1-0.1-0.5-0.30001.3-1.5Other ReclassifiedHospitals (Section1886(d)(8)(B)) 63-0.2-0.5-0.2-0.2-0.62.9-0.2001.1-1.8Specialty HospitalsCardiac specialtyHospitals 191.10.80.30.31.1-0.8-0.10.203.20.31Because data necessary to classifysome hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2009, and hospitalcost report data are from reportingperiods beginning in FY 2008 and FY 2007.2This column displays the payment impactof the proposed changes to the Version 28GROUPER and the recalibration of the MS-DRGweights based on FY 2009 MedPAR data in accordance withsection 1886(d)(4)(C)(iii) of the Act.3This column displays the application of the recalibration budget neutrality factor of 0.996867, in accordance with section 1886(d)(4)(C)(iii) of the Act.CMS-1498-P2 4134This column displays the proposed payment impact of the update to wage index data using FY 2007 cost report data.5This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separatelyfrom the recalibration budget neutrality factor, and will be calculated inaccordance with section 1886(d)(3)(E)(i) of the Act.The wage budget neutrality factor is 1.000070.6This column displays the combined payment impact of the proposed changes in Columns 1 through 4 and the proposed cumulative budget neutrality factor for MS-DRG and wage changes in accordancewith section 1886(d)(4)(C)(iii) of the Actand section 1886(d)(3)(E) of the Act. The cumulative wage and recalibration budgetneutrality factor of 0.996937is the product of the wage budget neutralityfactor and the recalibration budget neutrality factor.7Shown here are the effects of geographic reclassifications bythe Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2011 payment impact of going from noreclassifications to the reclassificationsscheduled to be in effect for FY 2011.Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographicbudget neutrality factor of 0.9914768This column displays the effects of the rural floor and the imputed floor, including the Affordable Care Act requirement thatthe floor budget neutrality is at a 100 percent national level adjustment. Therural and imputed floor budget neutrality factor is 0.995425.9This column shows the impact of the new proposal required under Section 10324 of Pub. L. 111-148 that hospitals located in Frontier states have a wage index no less than 1.0 beginning in FY 2011.10.This column displays the impact of section 505 of Pub. L.108-173, which provides for an increase in a hospital's wage index if the hospital qualifies by meeting a threshold percentage of residents of thecounty where the hospital is located who commute to work at hospitals in counties with higher wage indexes.11This column shows the proposed changes in payments from FY 2010 to FY 2011. It reflects the impact of the proposed FY 2011 market basket update, and the proposed reductions to the FY 2011standardized amount due to the documentation and coding effect.The proposed FY 2011 documentation and coding adjustment is -2.9 percent to the IPPS standardized amounts, -2.9 percent to thehospital-specific rates, and -2.4 percent to the Puerto Rico-specific amount. It also reflects changes in hospitals' reclassification status in FY 2011 compared to FY 2010.It incorporates all of the proposedchanges displayed in Columns 5, 6, 7, and 8 (the changes displayed in Columns 2 and 4 are included in Column 5). The sum of these impacts may be different from thepercentage changes shown here dueto rounding and interactive effects..CMS-1498-P2 414

C. Effects of the Proposed Changes to the MS-DRG Reclassifi cations and Relative
Cost-Based Weights (Column 1)
In Column 1 of Table I, we presen t the effects of the proposed MS-DRG
reclassifications, as discussed in section II. of the preamble to this supplemental proposed
rule. Section 1886(d)(4)(C)(i) of the Act re quires us annually to make appropriate
classification changes in order to reflect changes in treatme nt patterns, technology, and
any other factors that may change th e relative use of hospital resources.
As discussed in the preamble of the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule, the proposed FY 2011 MS-DRG relative weights will be 100 percent costbased and 100 percent MS-DRGs. For FY 2011, the MS-DRGs are calculated using the
FY 2009 MedPAR data grouped to the Vers ion 28.0 (FY 2011) MS-DRGs. The methods
of calculating the proposed relative weights and the reclassification changes to the
grouper are described in more detail in the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule. The proposed changes to th e relative weights and MS-DRGs shown in
Column 2 are prior to any offset for budget neutrality. Overall, hos pitals will experience
a 0.3 percent increase in payments due to the changes in the MS-DRGs and relative
weights prior to budget neutra lity. Urban hospitals and rura l hospitals will experience a
0.3 percent increase in payments under the upda tes to the relative we ights and MS-DRGs.
D. Effects of the Application of Recalibration Budget Neutrality (Column 2)
Column 2 shows the effects of the changes to the MS-DRGs and relative weights
with the application of the recalibration budg et neutrality factor to the standardizedCMS-1498-P2 415
amounts. Consistent with section 1886(d)(4 )(C)(iii) of the Act, we are calculating a
recalibration budget neutrality f actor to account for the changes in MS-DRGs and relative
weights to ensure that the overall payment impact is budget neutral. We revised the
recalibration budget neutrality f actor in this notice because we applied a 0.25 reduction
to the market basket update to the standard ized amount as required under the Affordable

Care Act.
The "All Hospitals" line in Column 1 indicates that proposed changes due to
MS-DRGs and relative weights will increase payments by 0.3 percent before application
of the budget neutrality factor. The proposed recalibration budget ne utrality factor is
0.996867, which is applied to the standardized amount. Thus, the impact after accounting
only for budget neutrality for changes to the MS-DRG relative weight s and classification
is somewhat lower than the figures shown in Column 1 (approxima tely 0.3 percent).
Consequentially, urban and rural hospitals will not experience a change in payments
when recalibration budget neutrality is applied.
E. Effects of Proposed Wage Index Changes (Column 3)
Section 1886(d)(3)(E) of the Act requi res that, beginning October 1, 1993, we
annually update the wage data used to calculate the wage index. In accordance with this
requirement, the proposed wage index for acu te care hospitals for FY 2011 is based on
data submitted for hospital co st reporting periods beginning on or after October 1, 2006
and before October 1, 2007. Th e estimated impact of the upda ted wage data on hospital
payments is isolated in Column 3 by holding the other payment para meters constant inCMS-1498-P2 416
this simulation. That is, Column 3 shows the percentage change in payments when going
from a model using the FY 2010 wage index, based on FY 2006 wage da ta, and having a
100-percent occupational mix adjustment applied, to a model using the FY 2011
pre-reclassification wage inde x , also having a 100-percent occupational mix adjustment
applied, based on FY 2007 wage da ta (while holding other pa yment parameters such as

use of the Version 28.0 MS-DRG GROUPER constant). The occupational mix
adjustment is based on the FY 2008/2009 occupa tional mix survey. The wage data was
not affected by any of the provisions unde r the Affordable Care Act for FY 2011.
Column 3 shows the impacts of updating the wage data using FY 2007 cost
reports. Overall, the new wage data will lead to a 0.0 per cent change for all hospitals
before being combined with the wage budget neutrality adjustment shown in Column 5.
Among the regions, the largest increase is in the rural Middle Atlantic region, which
experiences a 0.4 percent increase before appl ying an adjustment for budget neutrality.
The largest decline from updating the wage data is seen in Urban East South Central
(0.5 percent decrease).
F. Application of the Wage Budget Neutrality Factor (Column 4)
Column 4 shows the impact of the new wage data with the application of the wage
budget neutrality factor. In FY 2010, we began calculating sepa rate wage budget
neutrality and recalibration budget neutrality factors, in accordance with section
1886(d)(3)(E) of the Act, which specifies th at budget neutrality to account for wage
changes or updates made under th at subparagraph must be made without regard to the 62CMS-1498-P2 417
percent labor-related share guaranteed unde r section 1886(d)(3)(E)(ii) of the Act.
Therefore, for FY 2011, we are calculating the wage budget neutrality factor to ensure
that payments under updated wage data are budget neutral w ithout regard to the lower
labor-related share of 62 percent applied to hospitals with a wa ge index less than or equal
to 1. In other words, the wage budget neut rality is calculated under the assumption that
all hospitals receive the higher labor-related share of the st andardized amount. The wage
budget neutrality factor is revi sed because the market basket update to the standardized
amount was reduced by 0.25 percent under the A ffordable Care Act. Because the wage
data changes did not change overall payments (displayed in Column 3), the revised wage
budget neutrality factor is 1.00007, and the overall payment change is 0.0 percent.
G. Combined Effects of Proposed MS-DRG and Wage Index Changes (Column 5)
Section 1886(d)(4)(C)(iii) of the Act requires that changes to MS-DRG

reclassifications and the rela tive weights cannot increase or decrease aggregate payments.
In addition, section 1886(d)(3)(E) of the Act sp ecifies that any updates or adjustments to
the wage index are to be budget neutral. We computed a proposed wage budget neutrality
factor of 1.00007, and a proposed recalibra tion budget neutrality factor of 0.996867
(which is applied to the Puerto Rico sp ecific standardized amount and the hospitalspecific rates). The product of the two budget neutrality factors is the cumulative wage
and recalibration budget neut rality factor. The proposed cumulative wage and
recalibration budget neutrality adjustment is 0.996937, or a pproximately -0.3 percent,
which is applied to the na tional standardized amounts. Because the wage budgetCMS-1498-P2 418
neutrality and the recalibration budget ne utrality are calculated under different
methodologies according to the statute, when the two budget neutralities are combined
and applied to the standardized amount, th e overall payment impact is not necessarily
budget neutral. However, in this proposed rule, we are estimating that the proposed
changes in the MS-DRG relative weights a nd updated wage data w ith wage and budget
neutrality applied will result in a 0.0 change in payments.
We estimate that the combined impact of the proposed changes to the relative
weights and MS-DRGs and the proposed upda ted wage data with budget neutrality
applied will result in no change in payments for urban or rural hospitals. Urban New
England would experience a 0.6 decrease in paym ents due to reductions in their case-mix
and wages compared to the national average, while the urban Pacific area would
experience a 0.5 percent increase in payments because of above average increases in
wages and case-mix. Among the rural hospital categories, rural South Atlantic hospitals
would experience the greatest decline in pa yment (-0.9 percent) pr imarily due to the
changes to MS-DRGs and the relative cost weights.

H. Effects of MGCRB R eclassifications (Column 6)
Our impact analysis to this point has a ssumed acute care hospitals are paid on the
basis of their actual geographic location (w ith the exception of ongoing policies that
provide that certain hospitals receive payments on other bases than where they are
geographically located). The changes in Column 6 reflect the per case payment impact of
moving from this baseline to a simulation incorporating the MGCRB decisions forCMS-1498-P2 419
FY 2011 which affect hospitals' wage index area assignments.
By spring of each year, the MGCRB makes reclassification determinations that
will be effective for the next fiscal year, which begins on October 1. The MGCRB may
approve a hospital's reclassifi cation request for the purpose of using another area's wage
index value. Hospitals may appeal de nials of MGCRB decisions to the CMS
Administrator. Further, hospitals have 45 days from publication of the IPPS rule in the
Federal Register to decide whether to withdraw or terminate an approved geographic
reclassification for the following year. Provisi ons in the Affordable Care Act required us
to revert to FY 2008 average hourly wage r eclassification criteria for reclassifications
effective in FY 2011. Therefore, add itional hospitals w ill qualify for MGCRB
reclassification compared to the FY 2011 IPPS/LTCH PPS proposed rule (or will qualify
for their primary reclassification), publis hed on May 4, 2010. This column reflects an
expectation that these additional hospitals will qualify for geographic reclassification.
The overall effect of geographic recl assification is required by section
1886(d)(8)(D) of the Act to be budget neutral. Therefore, for the purposes of this impact
analysis, we are applying an adjustment of 0.995425 to ensure that the effects of the
section 1886(d)(10) reclassifica tions are budget neutral (section II.A. of the Addendum to
this supplemental proposed rule). Geographic reclassification generally benefits hospitals
in rural areas. We estimate that geographic reclassification will increase payments to
rural hospitals by an average of 1.6 percent. By region, all the rural hospital categories
will experience increases in payments due to MGCRB reclassification where ruralCMS-1498-P2 420
hospitals in the Mountain region will experi ence a 0.1 percent increase in payments and
rural hospitals in the East South Central region will experience a 2.4 percent increase in

payments.

Table 9A of the Addendum to this proposed rule reflects the approved

reclassifications for FY 2011.
I. Effects of the Rural Floor and Imputed Floor, Including Application of National
Budget Neutrality (Column 7)
As discussed in section III.B. of the preamble of the FY 2009 IPPS final rule, the
FY 2010 IPPS/RY 2010 LTCH final rule and this proposed rule,

section 4410 of Pub. L. 105-33 established the rural floor by requiring that the wage
index for a hospital in any urban area cannot be less than the wage index received by rural
hospitals in the same State. In FY 2008, we changed how we applied budget neutrality to
the rural floor. Rather than applying a budget neutrality adjustment to the standardized
amount, a uniform budget neutrality adjustment is applied to the wage index. In the
FY 2009 final rule, we finalized the policy to apply the rural floor budget neutrality at the
State level with a 3-year transition. In FY 2009, hospitals received a blended wage index
that is 20 percent of a wage index with th e State level rural and imputed floor budget
neutrality adjustment and 80 pe rcent of a wage index with the national budget neutrality
adjustment. In FY 2010, hospitals received a bl ended wage index that is 50 percent of a
wage index with the State le vel rural and imputed floor budg et neutrality and 50 percent
of a wage index with the national budget neutrality adjustment. For FY 2011, theCMS-1498-P2 421
Affordable Care Act requires th at we apply one rural floor budget neutrality to the wage
index, nationally. The proposed FY 2011 rural floor budget neutrality factor applied to
the wage index is 0.995425.
Furthermore, the FY 2005 IPPS final rule (69 FR 49109) established a temporary
imputed floor for all urban States from FY 2005 to FY 2007. The rural floor requires that
an urban wage index cannot be lower than the wage index for any rural hospital in that
State. Therefore, an imputed floor was estab lished for States that do not have rural areas
or rural IPPS hospitals. In the FY 2008 IPPS final rule with comment period
(72 FR 47321), we finalized our proposal to extend the imputed floor for 1 additional
year. In the FY 2009 IPPS final rule (73 FR 48573), we extended the imputed floor for
an additional 3 years through FY 2011. In the FY 2011 IPPS/LTCH PPS proposed rule
published on May 4, 2010, we applie d rural floor budget neutrality at the State-level.
However, the Affordable Care Act requires that, effectiv e for FY 2011, we apply rural
floor and imputed floor budget neutrality at the national level, as we did in FY 2008.
Column 7 shows the projected impact of th e rural floor and the imputed floor with
the national rural and imputed floor budget neut rality factor applied to the wage index.
The column compares the proposed post -reclassification FY 2011 wage index of
providers before the rural floor adjustment and the post-reclassification FY 2011 wage
index of providers with the rural floor a nd imputed floor adjustment. Only urban
hospitals can benefit from the rural floor provision. Because the provision is budget
neutral, all other hospitals (t hat is, all rural hospitals and those urban hospitals to whichCMS-1498-P2 422
the adjustment is not made) experience a decrease in payments due to the budget
neutrality adjustment applied nationally to their wage index.
We project that, in aggregate, rura l hospitals will experience a 0.1 percent
decrease in payments as a result of the appli cation of rural floor budg et neutrality because
the rural hospitals located in States with a rural floor do not benef it from the rural floor,
but have their wage indexes downwardly adjust ed to ensure that the application of the
rural floor is budget neutral overa ll within the State. We project hospitals located in other
urban areas (populations of 1 million or fewer) will experience a 0.1 percent increase in
payments because those providers benefit fro m the rural floor. Urban hospitals in the
Pacific region can expect 0.9 percent increase in payments because a large percentage of
hospitals in this region receive the rural floor. Urban hospital in the Middle Atlantic can
expect a 0.1 percent increase in payments because New Jersey hospitals receive the
imputed floor with a national budget neutrality adjustment. Rural hosp itals in all regions
can expect a 0.1 to 0.2 percent decrease in pa yments because the rural and imputed floors
only benefit urba n hospitals.
J. Effects of the Proposed Application of the Frontier Wage Index (Column 8)
Section 10324(a) of Affordable Care Ac t requires that we establish a minimum
post-reclassified wage-index of 1.00 for all hosp itals located in Frontier States. Frontier
States are defined in the statute as States with at least 50 percent of its counties with a
population density lesser than 6 persons per square mile. Ba sed on these criteria, five
states (Montana, North Dakot a, Nevada, South Dakota, a nd Wyoming) are consideredCMS-1498-P2 423
frontier states and 51 hospitals located in those states would receive a frontier wage index
of 1.0. This provision is not budget neutral and is estimated to increase IPPS operating payments by approximately $48 million.
Urban hospitals located in the West No rth Central region a nd urban hospitals
located in the Mountain region will experien ce an increase in payments by 0.5 percent
and 0.2 respectively because many of the hosp itals located in this region are frontier
hospitals. Similarly, rural hospitals located in the West North Central and rural hospitals
in the Mountain region will experience an increase in payments by 0.1 and 0.5,
respectively.
K. Effects of the Proposed Wage Index Adjustment for Out-Migration (Column 9)
Section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108-173,
provides for an increase in the wage index for hospitals located in certain counties that
have a relatively high percen tage of hospital employees w ho reside in the county, but
work in a different area with a higher wage index. Hospitals located in counties that
qualify for the payment adjustment are to receive an increase in the wage index that is
equal to a weighted average of the differen ce between the wage index of the resident
county, post-reclassification a nd the higher wage index work area(s), weighted by the
overall percentage of workers who are employed in an area with a higher wage index.
With the out-migration adjustment, small ru ral providers with le ss than 100 beds will
experience a 0.5 percent increase in payments in FY 2011 relative to no adjustment at all.
We included these additional payments to providers in the impact table shown above,CMS-1498-P2 424
and we estimate the impact of these providers receiving the out-migration increase to be approximately $20 million.
L. Effects of All Proposed Changes Prio r to Documentation and Coding (or CMI)
Adjustment (Column 10)
Column 10 shows our estimate of the changes in payments per discharge from
FY 2010 and FY 2011, resulting from all proposed changes reflected in this supplemental
rule and the May 4, 2010 IPPS/LTCH PPS proposed rule for FY 2011 (including
statutory changes), other than the proposed documentation and coding adjustment.
Column 10 reflects the impact of all other FY 2011 changes relative to FY 2010,
including those shown in Columns 1 through 9. We note that our baseline FY 2010
operating estimates account for the provisions under the Affordable Care Act that
affected the FY 2010 operating payments. Th e average increase in payments under the
IPPS for all hospitals is approximately 2.0 percent. This includes the 2.15 percent
applicable percentage increase (including the -0.25 reduction to the market basket
increase required under the Affordable Care Ac t). In addition, it reflects the estimated 0.2
percentage point difference between th e projected outlier payments in FY 20101
(5.1 percent of total MS-DRG pa yments), the current estimate of the percentage of actual
outlier payments in FY 2010 (4.9 percent) as described in the introduction to this
Appendix and the Addendum to this proposed rule. Finally, it accounts for -0.2 percent
decrease in payments due to the expiration of Section 508 reclassifica tions that had been

extended for FY 2010 under the Affordable Care Act.CMS-1498-P2 425
There might also be interactive effects among the various factors comprising the
payment system that we are not able to isolate. For these reasons, the values in
Column 10 may not equal the sum of th e percentage changes described above.
M. Effects of All FY 2011 Proposed Changes With CMI Adjustment (Column 11)
Column 11 shows our estimate of the changes in payments per discharge from
FY 2010 and FY 2011, resulting from all proposed changes reflected in the May 4, 2010
IPPS/LTCH PPS proposed rule for FY 2011 and provisions described in this
supplemental proposed rule required under the Affordable Care (including statutory
changes). The FY 2010 baseline estimate s account for the provisions under the

Affordable Care Act that affected the FY 2010 operating payments. Specifically, the
FY 2010 baseline payment estimates account fo r the additional -0.25 reduction in the
applicable percentage increas e applied to discharges for FY 2010 discharges occurring on
or after April 1, 2010 and accounts for the exte nsion of Section 508 reclassifications for
FY 2010. As discussed in the FY 2011 IPPS/LTCH PPS proposed rule, this column
includes the proposed FY 2011 documentation a nd coding adjustment of -2.9 percent on
the national standardized amount, -2.9 per cent on the hospital-specific rates, and –2.4
percent on the Puerto Rico-specific standa rdized amount, which overall accounts for a 2.9
percent decrease in payments.
The average decrease in payments under the IPPS for all hospitals is
approximately -0.9 per cent. As described in Column 10, this average decrease includes
the effects of the 2.15 percent market basket update (including the -0.25 reduction in theCMS-1498-P2 426
applicable percentage increase required under the Affordable Care Act), the 0.2
percentage point difference between the projected outlier payments in FY 2011 (5.1
percent of total MS-DRG payments), and the current estimate of the percentage of actual
outlier payments in FY 2010 (4.9 percent). In addition, it includes a -0.2 percent decrease
in payments due to the expiration of Secti on 508 reclassifications that had been extended

for FY 2010 under the Affordable Care Act. Section 508 recla ssification was not a
budget-neutral provision. There might also be interactive effects among the various
factors comprising the payment system that we are not able to isolate. For these reasons,
the values in Column 11 may not equal the sum of the percentage changes described

above.
The overall proposed change in payments per discharge for hospitals paid under
the IPPS in FY 2011 is estimated to decrease by 0.9 percent. The payment decreases
among the hospital categories are largely a ttributed to the proposed documentation and
coding adjustments. Hospitals in urban areas would experience an estimated 0.8 percent
decrease in payments per discharge in FY 2011 compared to FY 2010. Hospital
payments per discharge in rural areas are estimated to decrease by 1.4 percent in FY 2011
as compared to FY 2010. The decreases larger than the national average for rural areas
are largely attributed to the differential impact of the MS-DRGs and wa ge data and due to
the -2.9 percent documentati on and coding adjustment applied to the national
standardized amount and the -2.9 percent doc umentation and coding adjustment to the
hospital-specific rate applied to SCHs and MDHs, which genera lly are classified as ruralCMS-1498-P2 427
hospitals.
Among urban census divisions, the largest estimated payment decreases will be
2.0 percent in the New England region and 1.4 percent in the Middle Atlantic region
because many of the urban providers in these regions had bene fited from Section 508
reclassification in FY 2010 that has expired for FY 2011. Urban hospitals in the Pacific
will see the largest payment increases (0.6 per cent) because urban providers in this region

will benefit from the rural floor and application of a nationa l rural floor budget neutrality
factor. Among the rural regions, the providers in the New England region will experience
the largest decrease in payments (2.3 percen t) because of the expiration of Section 508

reclassifications while rural hospitals in the Mountain regi on will experience the smallest
decreases an in payments by 0.4 percent because the rural providers in this region benefit

from MGCRB reclassification and the Frontie r wage index provision, required under the

Affordable Care Act.
Among special categories of rural hos pitals, MDHs will receive an estimated
payment decrease of 1.1 percent. MDHs are paid the higher of the IPPS rate based on the
national standardized amount, that is, the Fede ral rate, or, if the hospital-specific rate
exceeds the Federal rate, the Federal rate pl us 75 percent of the difference between the
Federal rate and the hospital-specific rate. MDHs will experience a decrease in payments
because of the proposed documentation and coding adjustments applied to both the
hospital-specific rate and the Federal rate. SCHs are also paid the higher of their
hospital-specific rate or the federal rate. Overall, SCHs will experience an estimatedCMS-1498-P2 428
decrease in payments by 1.8 percent due to the proposed documentation and coding
adjustments to the national standardized amount and the hospital-specific rates.
Rural hospitals reclassified for FY 2011 are anticipated to receive a 1.0 percent
payment decrease, and rural hospitals that ar e not reclassifying are estimated to receive a
payment decrease of 1.9 percent.
Cardiac hospitals are expected to expe rience a payment increase of 0.3 percent in

FY 2011 relative to FY 2010 due to increases in payments attributable to changes in the
MS-DRGs and relative weights.
N. Impact Analysis of Table II
Table II presents the projected impact of the proposed changes for FY 2011 as
published in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule and the provisions
required under the Affordable Care Act in this notice for urba n and rural hospitals and for
the different categories of hospitals shown in Table I. It compares the estimated average
payments per discharge for FY 2010 with the proposed payments per discharge for
FY 2011, as calculated under our models. The estimated FY 2010 payments per
discharge incorporate the provisions in the Affordable Care Act. Thus, this table
presents, in terms of the average dollar amount s paid per discharge, the combined effects
of the proposed changes presented in Table I. The estimated percentage changes shown
in the last column of Table II equal the estimated percentage changes in average payments
per discharge from Column 11 of Table I.CMS-1498-P2 429

TABLE II.--IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2011 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM (PAYMENTS PER DISCHARGE )

Number of Hospitals Average FY 2010 Payment Per Discharge (2) Average Proposed FY 2011 Payment Per Discharge (3) All Proposed FY 2011 Changes (4) All hospitals 3472 10,203 10,114 -0.9 By Geographic Location: Urban hospitals 2502 10,631 10,544 -0.8 Large urban areas (populations over 1 million) 1365 11,215 11,125 -0.8 Other urban areas (populations of 1 million or fewer) 1137 9,915 9,832 -0.8 Rural hospitals 970 7,597 7,493 -1.4 Bed Size (Urban): 0-99 beds 635 8,076 8,019 -0.7 100-199 beds 791 8,949 8,866 -0.9 200-299 beds 461 9,876 9,804 -0.7 300-499 beds 425 11,022 10,934 -0.8 500 or more beds 190 13,138 13,026 -0.9 Bed Size (Rural): 0-49 beds 337 6,176 6,108 -1.1 50-99 beds 366 7,118 6,990 -1.8 100-149 beds 164 7,498 7,412 -1.1 150-199 beds 61 8,291 8,198 -1.1 200 or more beds 42 9,405 9,279 -1.3 Urban by Region: New England 121 11,075 10,854 -2 Middle Atlantic 330 11,725 11,561 -1.4 South Atlantic 383 9,853 9,753 -1 East North Central 403 10,001 9,894 -1.1 East South Central 155 9,517 9,415 -1.1 West North Central 166 10,151 10,110 -0.4 West South Central 342 9,939 9,887 -0.5 Mountain 162 10,851 10,793 -0.5 Pacific 390 13,054 13,137 0.6 Puerto Rico 50 5,137 5,114 -0.4 Rural by Region: New England 24 9,989 9,761 -2.3 Middle Atlantic 70 7,943 7,832 -1.4 South Atlantic 165 7,354 7,223 -1.8 East North Central 120 7,851 7,751 -1.3 East South Central 175 6,922 6,802 -1.7 West North Central 100 8,008 7,964 -0.6CMS-1498-P2 430

Number of Hospitals Average FY 2010 Payment Per Discharge (2) Average Proposed FY 2011 Payment Per Discharge (3) All Proposed FY 2011 Changes (4) West South Central 214 6,861 6,801 -0.9 Mountain 71 8,225 8,196 -0.4 Pacific 31 10,346 10,154 -1.9 By Payment Classification : Urban hospitals 2555 10,608 10,521 -0.8 Large urban areas (populations over 1 million) 1403 11,193 11,103 -0.8 Other urban areas (populations of 1 million or fewer) 1152 9,885 9,803 -0.8 Rural areas 917 7,659 7,553 -1.4 Teaching Status: Non-teaching 2434 8,562 8,496 -0.8 Fewer than 100 Residents 798 10,114 10,020 -0.9 100 or more Residents 240 15,083 14,938 -1 Urban DSH: Non-DSH 834 8,894 8,821 -0.8 100 or more beds 1510 11,187 11,096 -0.8 Less than 100 beds 340 7,598 7,528 -0.9 Rural DSH: SCH 407 7,087 6,947 -2 RRC 209 8,413 8,314 -1.2 100 or more beds 30 6,603 6,495 -1.6 Less than 100 beds 142 5,907 5,816 -1.5 Urban teaching and DSH: Both teaching and DSH 806 12,220 12,109 -0.9 Teaching and no DSH 169 9,750 9,638 -1.1 No teaching and DSH 1044 9,139 9,083 -0.6 No teaching and no DSH 536 8,490 8,437 -0.6 Rural Hospital Types: RRC 183 8,532 8,456 -0.9 SCH 340 8,069 7,923 -1.8 MDH 187 6,320 6,248 -1.1 SCH and RRC 108 9,472 9,362 -1.2 MDH and RRC 13 8, 003 7,914 -1.1 Type of Ownership : Voluntary 1978 10,359 10,259 -1 Proprietary 837 9,136 9,086 -0.5 Government 577 10,702 10,620 -0.8 Medicare Utilization as a Percent of Inpatient Days:CMS-1498-P2 431

Number of Hospitals Average FY 2010 Payment Per Discharge (2) Average Proposed FY 2011 Payment Per Discharge (3) All Proposed FY 2011 Changes (4) 0-25 353 13,597 13,515 -0.6 25-50 1593 11,119 11,035 -0.8 50-65 1202 8,536 8,433 -1.2 Over 65 237 7,462 7,404 -0.8 Hospitals Reclassified by the Medicare Geographic Cla ssification Review Board: FY 2011 Reclassifications: All Reclassified Hospitals FY 2011 825 9,920 9,825 -1 All Non-Reclassified Hospitals FY 2011 2647 10,311 10,224 -0.8 Urban Reclassified Hospitals FY 2011: 494 10,585 10,486 -0.9 Urban Non-reclassified Hospitals FY 2011 :1979 10,656 10,573 -0.8 Rural Reclassified Hospitals FY 2011 331 8,183 8,100 -1 Rural Nonreclassified Hospitals FY 2011: 576 6,868 6,738 -1.9 All Section 401 Reclassified Hospitals: 37 8,915 8,778 -1.5 Other Reclassified Hospitals (Section 1886(d)(8)(B)) 63 7,274 7,145 -1.8 Specialty Hospitals Cardiac Hospitals 19 11,488 11,523 0.3

VII. Effects of Other Supplemental Proposed Policy Changes
In addition to those supplemental proposed policy changes discussed above that
we are able to model using our IPPS payment simulation model, we are proposing to
make various other changes in this supplem ental proposed rule. Generally, we have
limited or no specific data available with which to estimate the impacts of these changes.
Our estimates of the likely impacts associat ed with these other supplemental proposed
changes are discussed below.
A. Effects of the Supplemental Proposed Low-Volume Hospital Pa yment Adjustment:
Changes for FYs 2011 and 2012CMS-1498-P2 432
The low-volume hospital payment adjustment changes for FYs 2011 and 2012, as
discussed in section II.C. of the preamble to this supplemental proposed rule, expands
eligibility for the low-volume hospital payment adjustment to hospitals with less than
1,600 Medicare discharges (instead of the pr ior requirement of less than 800 total,
Medicare and non-Medicare, discharges) and more than 15 miles from other IPPS
hospitals (rather than the prior requirement of more than 25 miles). The payment
adjustment is changed also, from an empi rically determined (69 FR 49099 through 49102
and 70 FR 47432 through 47434) a dditional 25 percent payment adjustment to qualifying
hospitals with less than 200 total discharges, to a continuous, linear sliding scale
adjustment ranging from an additional 25 percent payment adjustment to hospitals with
200 or less Medicare discharges to no additional payment to hospitals with 1,600 or more
Medicare discharges.
We estimate, based on FY 2009 claims (MedPAR) data, an additional 1,524
hospitals would meet the Medicare discha rges criterion to qualify as a low-volume
hospital. However, we are not able to es timate the number of these 1,524 hospitals that

would also meet the distance criterion. The actual number of hospitals that would also
meet the distance criterion to qualify as a lo w-volume hospital would be less, very likely
much less, than the estimated 1,524 maximum number of potential low-volume hospitals
for FY 2011. If all 1,524 hospitals that meet the Medicare discharg e requirement also
meet the distance requirement, the additional Medicare IPPS dollars the temporary
change to the low-volume hospital payment ad justment would require , at most, based onCMS-1498-P2 433
each hospital's number of Medicare disc harges and the corresponding payment adjustment amount, an estimated $877 million for FY 2011. At this time, we are not able
to estimate the impact of the change for FY 2012.
B. Effects of the Supplemental Proposed Change for Medicare-De pendent, Small Rural
Hospitals
As discussed in section II.D. of the pr eamble to this supplemental proposed rule,

section 3124 of Pub. L. 111-148 extends the MDH program for 1 additional year, from
the end of FY 2011 (that is, for discharges before October 1, 2011) to the end of FY 2012
(that is, for discharges before Octobe r 1, 2012). The extension has no impact on
FY 2011. For FY 2012, the extension allows the continuation of MDH status and the
payment methodology, for an MDH to be pa id its hospital-specifi c rate, based on its
FY 1982, 1987, or 2002 costs per discharge, rather th an the Federal rate, if this results in
a greater aggregate payment (section II.D. of the preamble to this supplemental proposed
rule). Therefore, the impact of the extensi on is one additional year of hospital-specific
rate payments for MDHs rather than Federal rate payments for IPPS hospitals without
special treatment as an MDH.
C. Effects of the Supplemental Proposed Add itional Payments to Qua lifying Hospitals in
Low Medicare Spending Counties
Under section 1109 of Pub. L. 111-152, C ongress has allocated $400 million to be
spent for FYs 2011 and 2012 to qualifying hosp itals located in the bottom quartile of

counties with the lowest Medicare Part A a nd Part B spending per enrollee. In ourCMS-1498-P2 434
proposal described in section II.E. of the pr eamble to this supplemental proposed rule, we
have identified the list of eligible counties and the qualifying hospitals located in those
counties that would receive the $400 million. We are proposing to spend $200 million in
FY 2011 and $200 million in FY 2012. This m oney will be given to the qualifying
hospitals by the FI or A/B MAC through a one -time annual payment. In section II.E. of
the preamble to this supplemental proposed rule, Table 2 lists the distribution of
payments among the proposed list of qualifying hospitals. In addition, Table 3 in section
II.E. of the preamble to this supplemental pr oposed rule lists the distribution of payment
by State for FY 2011.
D. Effects of the Supplemental Proposed Implementation of the Rural Community
Hospital Demonstration Program
In section II.F. of the preamble of this supplemental rule, we discuss our
implementation of section 410A of Pub. L. 108-173, which required the Secretary to
establish a demonstration that would modify reimbursement for inpa tient services for up
to 15 small rural hospitals. Section 410A (c)(2) Pub. L. 108-173 requires that "[i]n
conducting the demonstration prog ram under this section, the S ecretary shall ensure that
the aggregate payments made by the S ecretary do not exceed the amount which the
Secretary would have paid if the demons tration program under th is section was not
implemented." As discussed in section II.F. of the preamble of this supplemental rule, in
the IPPS final rule for each of the previous 6 fiscal years, we have estimated the
additional payments as a result of the de monstration for each of the participatingCMS-1498-P2 435
hospitals. In order to achieve budget neutra lity, we are proposing to adjust the national
IPPS rates by an amount sufficient to account fo r the added costs of this demonstration.
In other words, we are proposing to apply budg et neutrality across the payment system as
a whole rather than merely across the participan ts of this demonstra tion. We believe that
the language of the statutory budget neut rality requirement permits the agency to
implement the budget neutrality provision in this manner. The statutory language
requires that "aggregate payments made by the Secretary do not exceed the amount which
the Secretary would have paid if the dem onstration . . . was not implemented" but does
not identify the range across which aggreg ate payments must be held equal.

An extension of this demonstration ha s been mandated by the Affordable Care
Act. The demonstration will be extended for an additional 5 years and expanded to up to
30 hospitals. We are proposing to make an adjustment in the FY 2011 IPPS/LTCH PPS
final rule of $69,279,673 to the national I PPS rates. This amount ($69,279,673) accounts
for the following: (1) an estimate of th e demonstration cost for FY 2011 for the 10
hospitals that are currently participating in the demonstration; (2) an estimate of the cost
of the continuation of the 7 hospitals that have participated in the demonstration since its
inception and that are still participating - for the portions of their cost reporting periods in

FY 2010 that are not covered in the estimated cost of the demonstration in the FY 2010

IPPS final rule because we formulated th ese estimates under the assumption that the

demonstration would end in FY 2010; and(3) an estimate of th e cost of participation in

the demonstration for 20 additi onal hospitals in FY 2011. Not included in this amount isCMS-1498-P2 436
an adjustment that we proposed to make in addition for the FY 2011 IPPS/LTCH PPS
final rule to account for any differences betw een the cost of the demonstration program
for hospitals participating in the demonstration during FY 2007, as indicated by their
settled cost reports beginning in FY 2007, and the amount that was offset by the budget
neutrality adjustment for FY 2007. The speci fic numeric value associated with this
component of the proposed adjustment to the national IPPS rates cannot be known until
cost reports beginning in FY 2007 for the hos pitals participating during FY 2007 in the
demonstration are settled. We expect those cost reports to be settled prior to the
publication of the FY 2011 IPPS/LTCH PPS final rule, and that we will be able to
incorporate the estimated amount in the FY 2011 IPPS/LTCH PPS final rule.
E. Effects of the Supplemental Propos ed Payment for Critical Access Hospital
Outpatient Services and Ambulance Services
In section II.H. of the preamble of this supplemental proposed rule, we discuss our
proposal to implement section 3128 of Pub. L. 111–148 by amending the regulations at
§413.70(b)(3)(ii)(A) to state that, effective for cost reporting periods beginning on or after
January 1, 2004, payment for outpatient facility services under the optional method will
also be made at 101 percent of reasonable co sts. We are also proposing to amend the
regulations at §413.70(b)(5)(i) to state that effective for cost reporting periods beginning
on or after January 1, 2004, payment for ambulan ce services furnished by a CAH or an
entity that is owned and operated by a CAH is 101 percent of the reasonable costs of the
CAH or the entity in furnishing those services, but only if the CAH or the entity is theCMS-1498-P2 437
only provider or supplier of ambulance services located within a 35-mile drive of the
CAH or the entity. We do not believe these proposals will result in additional payments
to CAHs for prior periods because we believe that in fact we have paid CAHs for these
services at 101 percent of reasonabl e costs during these prior periods.
VIII. Effects of Proposed Changes in the Capital IPPS

A. General Considerations

Provisions of Pub. L. 111-148 necess itated revising the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule. While the proposed IPPS payment rates for
capital-related costs were not directly affected by provisions of Pub. L. 111-148, changes
to the wage index as well as to the outlier payment adjustment factor were required by the
law. Changes to the wage index affect th e geographic adjustment factor (GAF) under the
capital IPPS which is used in conjunction with a factor for changes in DRG
classifications and weights to determine a proposed budget neut rality adjustment factor in
calculating the proposed capital IPPS rate. A revision of the proposed outlier payment
adjustment factor was required because bot h inpatient operating and inpatient capitalrelated payments use a single set of thresholds to identify outlier cases. Changes resulting
from the provisions of Pub. L. 111-148 are discusse d in more detail in section II.A. of the
preamble of this supplemental proposed rule.
The data used in developing the impact analysis presented below are the same as
that used for the impact analysis in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed
rule - the December 2009 update of the FY 2009 MedPAR file and the December 2009CMS-1498-P2 438
update of the Provider-Specific File (PSF) that is used for payment purposes. Although
the analyses of the changes to the capital prospective payment system do not incorporate
cost data, we used the December 2009 update of the most recently available hospital cost
report data (FYs 2006 and 2007) to categoriz e hospitals. Our analysis has several
qualifications. We use the be st data available and make assumptions about case-mix and
beneficiary enrollment as descri bed below. In addition, as di scussed in section V.E. of
the Preamble to the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, we are
proposing a -2.9 percent documenta tion and coding adjustment to the national capital rate
for FY 2011 in addition to the -0.6 percent ad justment established for FY 2008, and the -
0.9 percent adjustment for FY 2009. This resu lts in a cumulative adjustment factor of
0.957 that we are proposing to apply to the national capital rate to account for
improvements in documentati on and coding under the MS-DRGs in FY 2011. We also
are proposing to adjust the Puerto Rico-sp ecific capital rate in FY 2011 to account for
changes in documentation and coding resultin g from the adoption of the MS-DRGs.
Due to the interdependent nature of the IPPS, it is very difficult to precisely
quantify the impact associated with each ch ange. In addition, we draw upon various
sources for the data used to categorize hospitals in the tables. In some cases (for instance,
the number of beds), there is a fair degree of variation in the data from different sources.
We have attempted to construct these variable s with the best available sources overall.
However, for individual hospitals, so me miscategorizations are possible.
Using cases from the December 2009 update of the FY 2009 MedPAR file, weCMS-1498-P2 439
simulated payments under the capital IPPS for revised FY 2010 and revised FY 2011
(both years have been revised to account for provisions in the Affordable Care Act that
required changes to the wage index and outlie r threshold, as discussed above in this
section) for a comparison of total payments pe r case. Any short-term, acute care hospitals
not paid under the general IPPS (Indian Health Service hospitals and hospitals in
Maryland) are excluded from the simulations.
The basic methodology for determining a capital IPPS payment is set forth at
§412.312. The basic methodology for calculating capital IPPS payments in FY 2011 is as

follows:
(Standard Federal Rate) x (DRG weight ) x (GAF) x (COLA for hospitals located
in Alaska and Hawaii) x (1 + DSH Adjustme nt Factor + IME adjustment factor, if
applicable).
In addition to the other adjustments, hos pitals may also receive outlier payments
for those cases that qualify under the threshol d established for each fiscal year. We
modeled payments for each hospital by multip lying the capital Federa l rate by the GAF
and the hospital's case-mix. We then added estimated payments for indirect medical
education, disproportionate share, and outliers, if applicable. For purposes of this impact
analysis, the model includes the following assumptions (we note that these are the same
assumptions used for the impact analysis in the FY 2011 IPPS/LTCH PPS proposed rule
(75 FR 24310):

● We estimate that the Medicare case-mix index will increase by 1.0 percent inCMS-1498-P2 440

both FYs 2010 and 2011.

● We estimate that the Medicare discha rges will be approx imately 11.8 million in

FY 2010 and 12 million FY 2011.

● The capital Federal rate was updated beginning in FY 1996 by an analytical
framework that considers changes in the prices associated with capital-related costs and
adjustments to account for forecast error, changes in the case-mix index, allowable
changes in intensity, and other factors. The proposed factors used in the update
framework are not affected by the pr ovisions of Pub.L.111-148, as amended, and
therefore, remains at the proposed 1.5 per cent for FY 2011, as discussed in section

III.A .1. of the May 4, 2010 FY 2011 I PPS/LTCH PPS proposed rule.

● In addition to the proposed FY 2011 update factor, the proposed FY 2011
capital Federal rate was cal culated based on a proposed GAF/DRG budget neutrality
factor of 1.0015, a proposed outlier adjustment factor of 0.9432, and a proposed (special)
exceptions adjustment factor of 0.9997 .

● For FY 2011, as discussed above and in section V.E. of the preamble to the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, we are proposing to apply a 0.957
adjustment to the proposed FY 2011 national capital rate for changes in documentation
and coding that are expected to in crease case-mix under the MS-DRGs.

B. Results

We used the actuarial model described above to estimate th e potential impact of
our proposed changes for FY 2011 on total capita l payments per case, using a universe ofCMS-1498-P2 441
3,472 hospitals. As described above, the individual hospita l payment parameters are

taken from the best availabl e data, including the December 2009 update of the FY 2009
MedPAR file, the December 2009 update to the PSF, and the most recent cost report data
from the December 2009 update of HCRIS. In Table III, we present a comparison of
estimated total payments per case for FY 2010, as revised per the Affordable Care Act,
compared to FY 2011 based on the proposed FY 2011 payment policies. Column 2
shows estimates of payments per case under our model for FY 2010 (as revised). Column
3 shows estimates of payments per case unde r our model for FY 2011. Column 4 shows
the total percentage change in payments from revised FY 2010 to FY 2011. The change
represented in Column 4 includes the propos ed 1.5 percent update to the capital Federal
rate and other proposed changes in the adju stments to the capital Federal rate. The
comparisons are provided by: (1) geographi c location; (2) region; and (3) payment

classification.
The simulation results show that, on average, capital payments per case in
FY 2011 are expected to decreas e as compared to capital payments per case in FY 2010.
The proposed capital rate for FY 2011 would increase 1.5 percent as compared to the
FY 2010 capital rate. The proposed changes to the GAFs are expected to result, on
average, in a slight decrease in capital paymen ts, although, for rural regions, it is more of
a contributing factor to the overall decrease in capital payments than to urban areas
mostly due to the application of the rural floor to the wage index. We also are estimating
an increase in outlier payments from FY 2010 to FY 2011 due primar ily to an estimatedCMS-1498-P2 442
decrease in capital IPPS payments per discharge. Since capital payments per discharge
are projected to be slightly lower in FY 2011 compared to FY 2010, more cases would
qualify for outlier payments. Because our impact analysis includes actuarial assumptions
of growth from FY 2010 to FY 2011, the analysis shows a slight increase in capital
payments. However, the net impact of these proposed changes is an estimated -
0.2 percent change in capital payments pe r discharge from FY 2010 to FY 2011 for all
hospitals (as shown below in Table III).
The geographic comparison shows that, on av erage, all urban hospitals, as well as
hospitals in large urban areas, are expected to experience a 0.1 percent decrease in capital
IPPS payments per case in FY 2011 as compared to FY 2010. Capital IPPS payments per
case for rural hospitals are exp ected to decrease 0.6 percent.
The change comparisons by regions s how some regions experiencing slight
increases in total capital payments, while other regions are estimated to experience slight
decreases in capital payments from FY 2010 to FY 2011. For the urban regions, changes
in capital payments range from a -1.6 percent in the New England region to an increase of
1.4 percent for the Pacific region. The rura l regions show estimate s of a -2.4 percent
change in capital payments from FY 2010 to FY 2011 in the New England rural region to
a 2.1 percent increase for the Mountain rural region.
By type of ownership, pr oprietary hospitals are es timated to experience a 0.2
percent change in capital payments, voluntar y hospitals are estimated to experience a 0.3
percent decrease in capital payments per case, while there is no change estimated forCMS-1498-P2 443
government hospitals in capital paymen ts per case from FY 2010 to FY 2011.
Section 1886(d)(10) of the Act establis hed the MGCRB. Hospitals may apply for
reclassification for purposes of the wage i ndex for FY 2011. Reclassification for wage
index purposes also affects the GAFs because th at factor is constructed from the hospital
wage index.
To present the effects of the hospitals being reclassified for FY 2011, we show
the average capital payments per case for recl assified hospitals for FY 2010, as revised
per the Affordable Care Act. All classifications of reclassified hospitals are expected to
experience a decrease in capital payments in FY 2011 as compared to FY 2010. Urban
reclassified and rural reclassified hospitals are expected to have a decrease in capital
payments of -0.4 percent and - 0.3 percent, respectively. No change is estimated in capital
payments for urban non-reclassified hospitals , while rural non-reclassified hospital capital
payments are estimated to decrease 0.9 percent. Other reclassified hospitals (that is,
hospitals reclassified under s ection 1886(d)(8)(B) of the Act) are expected to experience a
decrease of 1.6 percent in capital payments from FY 2010 to FY 2011.

T ABLE III.—C OMPARISON OF T OTAL P AYMENTS P ER C ASE

[FY 2010 Payments Compared To FY 2011 Payments]

Number of hospitals Average FY 2010 payments/ case Average FY 2011 payments/
case Change
By Geographic Location: All hospitals ................................................................................................

..................... 3,472 793 791 -0.2 Large urban areas (populations over 1 million)................................................................

. 1,365 874 873 -0.1 Other urban areas (populations of 1 million of fewer) ................................

...................... 1,137 782 781 -0.2 Rural areas ................................................................................................

....................... 970 550 547 -0.6 Urban hospitals ................................................................................................

................ 2,502 833 832 -0.1 0-99 beds ................................................................................................

..................... 635 657 657 0.0 100-199 beds

................................................................................................ ............... 791 716 713 -0.3 200-299 beds

................................................................................................ ............... 461 783 782 -0.2 300-499 beds

................................................................................................ ............... 425 856 855 -0.1 500 or mo re be ds ................................................................................................

......... 190 1,007 1,007 0.0CMS-1498-P2 444

T ABLE III.—C OMPARISON OF T OTAL P AYMENTS P ER C ASE

[FY 2010 Payments Compared To FY 2011 Payments]

Number of hospitals Average FY 2010 payments/ case Average FY 2011 payments/
case Change
Rural hospitals ................................................................................................

................. 970 550 547 -0.6 0-49 beds ................................................................................................

..................... 337 443 444 0.2 50-99 beds ................................................................................................

................... 366 511 505 -1.1 100-149 beds

................................................................................................ ............... 164 555 553 -0.3 150-199 beds

................................................................................................ ............... 61 601 601 0.0 200 or mo re be ds ................................................................................................

......... 42 672 664 -1.2 By Region: Urban by Region................................................................................................

.............. 2,502 833 832 -0.1 New England ................................................................................................

............... 121 866 852 -1.6 Middle Atlantic................................................................................................

............ 330 890 883 -0.8 South Atlantic................................................................................................

.............. 383 784 781 -0.3 East North Central ................................................................................................

....... 403 809 806 -0.4 East South Central ................................................................................................

....... 155 743 740 -0.5 West North Central................................................................................................

...... 166 818 822 0.5 West South Central................................................................................................

...... 342 776 778 0.3 Mountain ................................................................................................

..................... 162 857 859 0.3 Pacific................................................................................................

.......................... 390 988 1,001 1.4 Puerto Rico................................................................................................

.................. 50 373 375 0.3 Rural by Region ................................................................................................

............... 970 550 547 -0.6 New England ................................................................................................

............... 24 725 708 -2.4 Middle Atlantic................................................................................................

............ 70 566 559 -1.2 South Atlantic................................................................................................

.............. 165 541 534 -1.1 East North Central ................................................................................................

....... 120 576 569 -1.3 East South Central ................................................................................................

....... 175 498 495 -0.6 West North Central................................................................................................

...... 100 565 566 0.2 West South Central................................................................................................

...... 214 515 519 0.8 Mountain ................................................................................................

..................... 71 554 566 2.1 Pacific................................................................................................

.......................... 31 697 689 -1.2 By Payment Classification: All hospitals ................................................................................................

..................... 3,472 793 791 -0.2 Large urban areas (populations over 1 million)................................................................

. 1,403 873 872 -0.1 Other urban areas (populations of 1 million of fewer) ................................

...................... 1,152 781 780 -0.2 Rural areas ................................................................................................

....................... 917 547 544 -0.6 Teaching Status: Non-teaching

................................................................................................ ............... 2,434 675 674 -0.1 Fewer than 100 Reside nts ................................................................

............................ 798 796 793 -0.3 100 or more Residents 240 1,124 1,123 -0.1 Urban DSH: 100 or more beds

................................................................................................ ..... 1,510 861 860 -0.1 Less th an 100 beds

................................................................................................ .. 340 594 592 -0.4 Rural DSH: Sole Community (SCH/EACH) ................................................................

............... 407 481 480 -0.3 Referral Cent er (RRC/ EACH) ................................................................

................. 209 604 599 -0.8 Other Rural: 100 or more beds

................................................................................................ . 30 502 495 -1.3 Less th an 100 beds

................................................................ .............................. 142 455 449 -1.3 Urban teaching and DSH: Both teaching and DSH

................................................................ ............................... 806 932 931 -0.1 Teaching and no DSH

................................................................................................ .. 169 810 806 -0.5 No teaching and DSH

................................................................................................ .. 1,044 718 718 0.0 No teaching and no DSH

................................................................ ............................. 536 733 733 0.0 Rural Hospital Types: Non special status hospitals ................................................................

......................... 2,435 836 835 -0.1CMS-1498-P2 445

T ABLE III.—C OMPARISON OF T OTAL P AYMENTS P ER C ASE

[FY 2010 Payments Compared To FY 2011 Payments]

Number of hospitals Average FY 2010 payments/ case Average FY 2011 payments/
case Change

RRC/ EACH................................................................................................

................. 59 748 748 0.1 SCH/EACH ................................................................................................

................. 38 690 703 1.9 Medicare-dependent hospitals (MDH) ................................................................

......... 10 473 468 -1.0 SCH, RRC and EA CH................................................................................................

. 13 830 825 -0.7 Hospitals Reclassified by the Medicare Geogr aphic Classification Review Board: FY2011 Reclassifications: All Urban Reclassified................................................................................................

. 494 838 835 -0.4 All Urban Non-Reclassified ................................................................

......................... 1,979 833 832 0.0 All Rural Reclassified ................................................................................................

.. 331 592 590 -0.3 All Rural Non-Reclassified ................................................................

.......................... 576 494 490 -0.9 Other Reclassified Hosp itals (Section 1886(d)(8 )(B))

................................ .................. 55 557 548 -1.6 Type of Ownership: Voluntary................................................................................................

..................... 1,978 809 807 -0.3 Proprietary................................................................................................

................... 837 720 721 0.2 Government................................................................................................

................. 577 795 796 0.0 Medicare Utilization as a Percent of Inpatient Days: 0-25 ................................................................................................

............................. 353 967 970 0.3 25-50 ................................................................................................

........................... 1,593 861 861 0.0 50-65 ................................................................................................

........................... 1,202 680 676 -0.6 Over 65................................................................................................

........................ 237 585 582 -0.4

IX. Effects of Supplemental Proposed Payment Rate Changes and Policy Changes

under the LTCH PPS

A. Introduction and Ge neral Considerations
In section II.J. of the preamble and section III. of the Adde ndum of this proposed
rule, we are setting forth the proposed annual update to the payment rates for the LTCH
PPS for FY 2011. In the preamble, we specify the statutory authority for the proposed
provisions that are presented, identify those proposed policies and pr esent rationale for

our decisions as well as alternatives that were considered. In this section IX. of Appendix
to this supplemental proposed rule, we discu ss the impact of the proposed changes to the
payment rates, factors, and other payment rate policies related to the LTCH PPS that are
presented in the preamble of this proposed ru le in terms of their estimated fiscal impactCMS-1498-P2 446
on the Medicare budget and on LTCHs.
A number of the provisions of the Affordable Care Act affect the IPPS and the
LTCH PPS and the providers and suppliers addressed in the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule and this supplemental proposed rule. The impacts the
Appendix to this supplemental proposed rule include the provisions from these laws

effective for FY 2011.
Currently, our database of 421 LTCHs includes the data for 77 nonprofit
(voluntary ownership control) LTCHs and 301 proprietary LT CHs. Of the remaining
43 LTCHs, 12 LTCHs are government-owned a nd operated and the owne rship type of the
other 31 LTCHs is unknown. In the impact anal ysis, we are using the proposed rates,
factors, and policies presen ted in this supplemental proposed rule, including the 0.50
percentage point reduction to the market ba sket update required by sections 1886(m)(3)
and (4) of the Act and the proposed updated wage index values and the labor-related
share (presented in the May 4, 2010 FY 2010 IPPS/LTCH PPS proposed rule), and the
best available claims and CCR data to estimate the change in payments for FY 2011. The

standard Federal rate fo r RY 2010 is $39,794.95, which reflects the 0.25 percentage point
reduction applied to the RY 2010 market basket update requi red under sections
1886(m)(3) and (4) of the Act (as established in a separate notice published elsewhere in

this Federal Register ). Discharges in RY 2010 occurring on or after April 1, 2010 are

aid under the revised RY 2010 sta ndard Federal rate consiste nt with section 3401(p) of
Pub. L. 111-148. Discharges in RY 2010 occu rring on or after October 1, 2009 and on orCMS-1498-P2 447
before March 31, 2010 are paid under the standard Federal rate of $ 39,896.65 (see
74 FR 44022).

As discussed in section III.A .3. of the Addendum to this proposed rule, consistent
with our historical practice, we are proposin g to update the standa rd Federal rate for
FY 2011 by -0.59 percent in order to estab lish the proposed FY 2011 standard Federal rate at $39,560.16. This includes a proposed mark et basket update of 2.4 percent with a
0.50 percentage point reduction as required under sections 1886( m)(3) and (4) of the Act,
and a proposed documentation and coding ad justment of -2.5 percent to account for
increases in case-mix associated with the adoption of the MS-LTC-DRGs. Based on the

best available data for the 421 LTCHs in our database, we estimate that the proposed
update to the standard Federal rate for FY 2011 (discussed in section III.A .3. of the
Addendum of this supplemental proposed ru le) and the proposed changes to the area
wage adjustment for FY 2011 (discussed in section V.B. of the Addendum to the
May 4, 2010 IPPS/LTCH PPS FY 2011 IPPS/LTCH PPS proposed rule (75 FR 24085
through 24086)), in addition to an estimated increase in HCO payments and an estimated
increase in SSO payments, would result in an increase in estimated payments from RY 2010 of approximately $12.9 million (or about 0.3 percent). Based on the
421 LTCHs in our database, we estimate RY 2011 LTCH PPS payments to be approximately $4.913 billion, an increase from FY 2010 LTCH PPS payments of approximately $4.901 billion. Because the comb ined distributional effects and estimated
changes to the Medicare program payments would be greater than $100 million, thisCMS-1498-P2 448
proposed rule, in conjunction with the May 4, 2010 IPPS/LTCH PPS FY 2011
IPPS/LTCH PPS proposed rule, is considered a major economic rule, as defined in this
section. We note the approx imately $12.9 million for the projected increase in estimated
aggregate LTCH PPS payments from RY 2010 to FY 2011 does not reflect changes in
LTCH admissions or case-mix intensity in estimated LTCH PPS payments, which also
would affect overall payment changes.
The projected 0.3 percent increase in estimated payments per discharge from

RY 2010 to FY 2011 is attributable to seve ral factors, including the proposed -0.59
percent decrease to the standard Federal rate , proposed changes in the wage index values
(including the proposed change to the labo r-related share) presen ted in the May 4, 2010
FY 2011 IPPS/LTCH PPS proposed rule ( 75 FR 24085 through 24086) and projected
increases in estimated HCO and SSO paymen ts. As Table IV shows, the proposed
change attributable solely to the standard Federal rate is projected to result in an decrease
of 0.5 percent in estimated payments per discharge from RY 2010 to FY 2011, on
average, for all LTCHs, while the proposed changes to the area wage adjustment are
projected to result in an increase in estimated payments of 0.1 percent, on average, for all

LTCHs.
As discussed in the May 4, 2010 FY 2011 IPPS/LTCH proposed rule (75 FR
24085 through 24086), we are proposing to update the wage index values for FY 2011

based on the most recent availa ble data. In addition, we are proposing to decrease the
labor-related share slightly from 75.779 pe rcent to 75.407 percent under the LTCH PPSCMS-1498-P2 449

for FY 2011 based on the most recent availabl e data on the relative importance of the
labor-related share of operating and capital costs of the RPL market basket. Consistent
with the May 4, 2010 FY 2011 IPPS/LTCH proposed rule, the wage data and the
labor-related share is expected to increas e LTCH PPS payments by 0.1 percent (75 FR
24317 through 27318).
Table IV below shows the impact of th e proposed payment rate and proposed
policy changes on LTCH PPS payments for FY 2011 presented in this supplemental
proposed rule, in conjunction with the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed
rule, by comparing RY 2010 estimated paymen ts to FY 2011 estimated payments. The
projected increase in payments per disc harge from RY 2010 to FY 2011 is 0.3 percent
(shown in Column 8). This projected increase in payments is attributable to the impacts
of the proposed change to the standard Fede ral rate (-0.5 percent in Column 6) and the
proposed change due to the area wage adjustment (0. percent in Column 7), as well as the
effect of the estimated increase in payments for HCO cases and SSO cases in FY 2011 as
compared to RY 2010 (0.5 percent and 0.3 percen t, respectively). That is, estimated total
HCO payments are projected to increase from RY 2010 to FY 2011 in order to ensure
that estimated HCO payments will be 8 percent of total estimated LTCH PPS payments in
FY 2011. An analysis of the most recent av ailable LTCH PPS claims data (that is, FY
2009 claims from the December 2009 update of the MedPAR files) indicates that the RY
2010 HCO threshold of $18,615 (as established in a separate notice published elsewhere

in this Federal Register ) may result in HCO payments in RY 2010 that fall below theCMS-1498-P2 450
estimated 8 percent. Specifically, we currently estimate that HCO payments will be
approximately 7.5 percent of estimated total LTCH PPS payments in RY 2010. We note
that the RY 2010 outlier payment estimate in th is impact analysis takes into account for

the revised RY 2010 rate and outlier threshold determined consistent with sections
1886(m)(3) and (4) of the Act and section 3401( p) of Pub. L. 111-148 that are used to
make payments for discharges in RY 2010 that occur on or after April 1, 2010.
Consistent with our estimate in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule,
we estimate that the impact of the increase in HCO payments would result in
approximately a 0.5 percent increase in es timated payments from RY 2010 to FY 2011 on
average for all LTCHs. Furthermore, in calculating the estimated increase in payments
from RY 2010 to FY 2011 for HCO and SSO cases, we increased estimated costs by the
applicable market basket percentage incr ease as projected by our actuaries, which
increases payments by 0.3 percent relative to last year. We note that estimated payments
for all SSO cases comprise approximately 14 percent of estimated total LTCH PPS
payments, and estimated payments for HCO cases comprise approximately 8 percent of
estimated total LTCH PPS payments. Payments for HCO cases are based on 80 percent

of the estimated cost of the case above the HCO threshold, while the majority of the
payments for SSO cases (over 65 percent) are based on the estimated cost of the SSO

case. As we discuss in detail throughout this supplemental proposed rule, based on the
most recent available data, we believe that the provisions of this supplemental proposedCMS-1498-P2 451
rule in conjunction with the provisions of the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule, relating to the LTCH PPS will result in an increase in estimated aggregate
LTCH PPS payments and that the resulting LTCH PPS payment amounts result in
appropriate Medicare payments.
B. Impact on Rural Hospitals
For purposes of section 1102(b) of the Act, we define a small rural hospital as a
hospital that is located outside of an urba n area and has fewer than 100 beds. As shown
in Table IV, we are projecting a 0.7 percent increase in estimated payments per discharge
for FY 2011 as compared to RY 2010 for rural LTCHs that would result from the
proposed changes presented in this supplemen tal proposed rule and those changes in the
May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule as well as the effect of estimated
changes to HCO and SSO payments. This estimated impact is based on the data for the

26 rural LTCHs in our database of 421 LTCHs, for which comp lete data were available.
The RY 2010 average payment per case in Tabl e IV accounts for the changes required by
sections 1886(m)(3) and (4) of the Act a nd section 3401 (p) of Pub. L. 111-148 which
affects payments for discharges occurring on or after April 1, 2010, as described below in
section IX.C.3. of the Appendix to th is supplemental proposed rule.
Consistent with the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, the
estimated increase in LTCH PPS payments from RY 2010 to FY 2011 for rural LTCHs is
primarily due to the higher than average impacts from the proposed changes to the area
wage adjustment and the proposed reducti on in the labor-related share from 75.779 toCMS-1498-P2 452
75.407, which results in a an estimated 0.6 percent increase in payments.
C. Anticipated Effects of Proposed LT CH PPS Payment Rate Change and Policy
Changes
We discuss the impact of the proposed chan ges to the payment rates, factors, and
other payment rate policies under the LTCH PPS for FY 2011 (in terms of their estimated
fiscal impact on the Medicare budget and on LTCH s) in section II.I. of the preamble of
this supplemental proposed rule.
1. Budgetary Impact
Section 123(a)(1) of the BBRA requires that the PPS developed for LTCHs
"maintain budget neutrality." We believe that the statute' s mandate for budget neutrality
applies only to the first year of the implementation of the LTCH PPS (that is, FY 2003).
Therefore, in calculating the FY 2003 standa rd Federal rate unde r §412.523(d)(2), we set
total estimated payments for FY 2003 under the LTCH PPS so that estimated aggregate
payments under the LTCH PPS were estimated to equal the amount that would have been
paid if the LTCH PPS had not been implemented.

As discussed in section IX.A. of this Appendix, we project an increase in aggregate LTCH PPS payments in FY 2011 of approximately $12.9 million (or
0.3 percent) based on the 421 LTCHs in our database.
2. Impact of Moratorium and Other Provisions
Section 114(c) and (d) of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (MMSEA) as amended by section 4302 of the American Recovery andCMS-1498-P2 453
Reinvestment Act of 2009 (A RRA) provided for a 3-year delay in certain payment
policies relating to LTCH s and LTCH satellite fac ilities. Section 3106 of

Pub. L. 111-148 and section 10312 of Pub. L. 111-148 together provide for a 2-year
extension of the 3-year delay in implementation of certain payment policies relating to
LTCHs and LTCH satellite facilities. Specifically, these provisions affect payment
adjustments for "very" short stay outliers (SSO s), the one-time adjustment to the standard
Federal rate, the 25 percent payment thre shold policy, and the moratorium on the

establishment of new LTCHs and LTCH satellite facilities and the moratorium on the
increase on LTCH beds in existing LTCHs or satellite facilities.

Sections 3106 and 10312 of Pub. L. 111- 148 together provide for a 2-year
extension of the 3-year delay in implement ation of the revision to the SSO policy at
§412.529(c)(3)(i) that was finalized in the RY 2008 final rule. We estimate that the
extension of the SSO provision will result in a projected increase in estimated aggregate LTCH PPS payments of approximately $20 million in FY 2011. Sections 3106 and
10312 of Pub. L. 111-148 together provide for a 2- year extension to several modifications
to the regulations at §412.534 and §412.536 requi red by section 114(c) of MMSEA as
amended by section 4302 of the ARRA, whic h addressed the per centage thresholds
between referring hospitals and LTCHs and satellites of LTCHs. We estimate that the
implementation of this extension of the MMSEA provisions, as amended by the ARRA,
pertaining to §412.534 and §412.536 will result in a projected increase in estimated aggregate LTCH PPS payments of approximately $20 million for FY 2011.CMS-1498-P2 454
Regarding the 2-year extension of th e moratorium on the development of new
LTCHs and LTCH satellites and the increase in beds in existing LTCHs and LTCH
satellites, as we noted in the May 22, 2008 inte rim final rule with comment period when
the original 3-year delay required by sec tion 114(d) of the MMSEA as amended by the
ARRA, was implemented, we ar e unable to quantify the impact of the additional 2 year
moratorium on the establishment of LTCHs, LTCH satellite facilities, and on the increase
of LTCH beds in existing LTCHs or sate llite facilities with limited exceptions. We are
unable to provide an estimate of the impact of the 2-year extension of this provision
because we have no way of determining how many LTCHs would have opened in the
absence of the moratorium, nor do we have sufficient information at this time to
determine how many new LTCHs will meet the exceptions criteria provided for in the

statute. 3. Impact on Providers
The basic methodology for determining a per discharge LTCH PPS payment is set
forth in §412.515 through §412.536. In addition to the basic MS-LTC-DRG payment
(standard Federal rate multiplied by the MS-LTC-DRG relative weight), we make
adjustments for differences in area wage leve ls, COLA for Alaska and Hawaii, and SSOs.
Furthermore, LTCHs may also receive HCO payments for those cases that qualify based
on the threshold established each year.
To understand the impact of the proposed changes to the LTCH PPS payments
presented in this supplemental proposed ru le on different categories of LTCHs forCMS-1498-P2 455
FY 2011, it is necessary to estimate payments per discharge for RY 2010 using the rates,
factors, including the FY 2010 GROUPER (Version 27.0) and rela tive weights, and
policies established in the FY 2010 IPPS/RY 2010 LTCH PPS final rule (74 FR 43945
through 43994 and 44021 through 44030) and to incl ude any changes to payments due to
the provisions under sections 1886(m)(3) and (4) of the Act and section 3401(p) of
Pub. L. 111-148 which affects payments fo r discharges occurring on or after
April 1, 2010 in RY 2010 (as established in a se parate notice published elsewhere in this
Federal Register). It is also necessary to estimate the payments per discharge that would
be made under the proposed revised LTCH PPS rates, factors, policies, and GROUPER
(Version 28.0) for FY 2011 (as discussed in II.J. of the preamble and section III.A. of the
Addendum to this supplemental proposed rule and section VII. of the preamble and
section V. of the Addendum of the May 4, 2011 IPPS/LTCH PPS FY 2011 proposed
rule). These estimates of RY 2010 and FY 2011 LTCH PPS payments are based on the

best available LTCH claims da ta and other factors, such as the application of inflation

factors to estimate costs for SSO and HCO cas es in each year. We also evaluated the
change in estimated RY 2010 payments to estimated FY 2011 payments (on a per
discharge basis) for each category of LTCHs.
Hospital groups were based on character istics provided in the OSCAR data,
FY 2006 through FY 2007 cost report data in HCRIS, and PSF data . Hospitals with
incomplete characteristics we re grouped into the "unknown" category. Hospital groups
include the following:CMS-1498-P2 456

● Location: large urba n/other urban/rural.

● Participation date.

● Ownership control.

● Census region.

● Bed size.
To estimate the impacts of the payment rates and policy changes among the
various categories of existing providers , we used LTCH cases from the FY 2009
MedPAR file to estimate pa yments for RY 2010 and to estimate payments for FY 2011

for 421 LTCHs. We believe that the discha rges based on the FY 2009 MedPAR data for

the 421 LTCHs in our databa se, which includes 301 propr ietary LTCHs, provide
sufficient representation in the MS-LTC-DRG s containing discharges for patients who
received LTCH care for the most commonly treated LTCH patients' diagnoses.

4. Calculation of Pr ospective Payments
For purposes of this impact analysis, to estimate per discharge payments under the
LTCH PPS, we simulated payments on a case-by-case basis using LTCH claims from the
FY 2009 MedPAR files. For modeling estimated LTCH PPS payments for RY 2010, we
calculated a blended RY 2010 payment to account for changes in the rate in accordance
with sections 1886(m)(3) and (4) of the Act and section 3401(p) of Pub. L. 111-148.
Specifically, we applied the RY 2010 sta ndard Federal rate (that is, $39,896.65, under
which LTCH discharges occurring on or after October 1, 2009, and through March 31, 2010 are paid, and $39,794.95, under which LTCH discharges occurring on or afterCMS-1498-P2 457
April 1, 2010 to September 30, 2010 are paid). For modeling estimated LTCH PPS
payments for FY 2011, we applied the propos ed FY 2011 standard Federal rate of
$39,560.16, which would be effective for LTCH discharges occurring on or after
October 1, 2010, and through September 30, 2011.
Furthermore, in modeling estimated LTCH PPS payments for both RY 2010 and
FY 2011 in this impact analysis, we applied the RY 2010 and proposed FY 2011
adjustments for area wage differences a nd the COLA for Alaska and Hawaii.
Specifically, we adjusted for area wage differences for estimated RY 2010 payments
using the current LTCH PPS labor-related share of 75.779 percent (74 FR 43968), the
wage index values established in the Ta bles 12A and 12B of the Addendum to the
FY 2010 IPPS/RY 2010 LTCH PPS final rule (74 FR 44192 through 44213) and the

RY 2010 COLA factors shown in the table in section V. of the Addendum to that final
rule (74 FR 44026). Similarly, we adjusted for area wage differences for estimated
FY 2011 payments using the proposed LT CH PPS FY 2011 labor-re lated share of
75.407 percent (section VII.C.2.d. in the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule), the FY 2011 proposed wage i ndex values presented in Tables 12A and
12B of the Addendum to this proposed rule, and the FY 2011 COLA factors shown in the
table in section V.B.5. of the Addendum to the May 4, 2010 FY 2011 IPPS/LTCH PPS
proposed rule.
As discussed above, our impact analysis re flects an estimated change in payments
for SSO cases as well as an estimated increase in payments for HCO cases (as describedCMS-1498-P2 458
in section V.C. of the Addendum to this pr oposed rule). In modeling proposed payments
for SSO and HCO cases in RY 2010, we app lied an inflation factor of 1.024 percent
(determined by OACT) to the estimated cost s of each case determined from the charges
reported on the claims in the FY 2009 MedPAR files and the best available CCRs from
the December 2009 update of the PSF. In modeling proposed payments for SSO and
HCO cases in FY 2011, we applied an inflati on factor of 1.049 (determined by OACT) to

the estimated costs of each case determined fro m the charges reported on the claims in the

FY 2009 MedPAR files and the best ava ilable CCRs from the December 2009 update of
the PSF. Furthermore, in modeling estimated LTCH PPS payments for both RY 2010
and FY 2011 in this impact analysis, we a pplied the RY 2010 HCO fixed-loss amount of
$18,425 (74 FR 44029) for the first half ofRY 2010, the revised RY 2010 HCO fixedloss amount of $18,615 established in conjuncti on with implementing the provisions of
sections 1886(m)(3) and (4) of the Act a nd section 3401(p) of Pub. L. 111-148 for the
second half of RY 2010, and the proposed FY 2011 fixed loss amount of $19,254 (as

discussed in section III.A. of the Adde ndum of this supplemental proposed rule).
These impacts reflect the estimated "losses" or "gains" among the various

classifications of LTCHs from the RY 2010 to FY 2011 based on the proposed payment
rates and policy changes presented in this proposed rule. Table IV illustrates the
estimated aggregate impact of the LTCH PPS among various classifications of LTCHs.

● The first column, LTCH Classifi cation, identifies the type of LTCH.

● The second column lists the number of LTCHs of each classification type.CMS-1498-P2 459

● The third column identifies the number of LTCH cases.

● The fourth column shows the estimate d payment per discharge for RY 2010 (as
described above).

● The fifth column shows the estimate d payment per discharge for FY 2011 (as
described above).

● The sixth column shows the percentage change in estimated payments per
discharge from RY 2010 to FY 2011 for proposed ch anges to the standard Federal rate (as

discussed in section III.A .3. of the Addendum to this supplemental proposed rule).

● The seventh column shows the percentage change in estimated payments per
discharge from RY 2010 to FY 2011 for proposed changes to the area wage adjustment at
§412.525(c) (as discussed in section V.B. of the Addendum to the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule).

● The eighth column shows the percentage change in estimated payments per
discharge from RY 2010 (Column 4) to FY 2011 (Column 5) for all proposed and
statutory changes (and includes the effect of estimated changes to HCO and SSO
payments).CMS-1498-P2 460
TABLE IV: Impact of Proposed Payment Rate and Policy Changes to LTCH PPS Payments for FY 2011 (Estimated RY 2010 Payments Compared to Estimated FY 2011 Payments * )

LTCH Classification (1) Number of LTCHs

(2) Number of LTCH PPS Cases (3) Average RY 2010 LTCH

PPS Rate

Year Payment Per Case 1

(4) Average FY 2011 LTCH

PPS Rate

Year Proposed Payment Per Case 2 (5) Percent Change in Estimated Payments Per Discharge from RY 2010 to FY

2011 for Proposed Changes to the Federal

Rate 3

(6) Percent Change in Estimated Payments Per Discharge from RY 2010 to FY

2011 for Proposed Changes to

the Area

Wage Adjustment 4 (7) Percent Change in Payments Per Discharge from RY 2010 to FY

2011 for

All Proposed Changes 5 (8) ALL PROVIDERS 421 131,490 $37,271 $37,369 -0.5 0.1 0.3

BY LOCATION: RURAL 26 5,610 $31,666 $31,900 -0.6 0.6 0.7
URBAN 395 125,880 $37,521 $37,613 -0.5 0.1 0.2
LARGE 204 75,855 $38,990 $39,111 -0.5 0.1 0.3
OTHER 191 50,025 $35,292 $35,341 -0.5 0.1 0.1

BY PARTICIPATION DATE: BEFORE OCT. 1983 17 6,244 $32,031 $32,218 -0.5 0.2 0.6
OCT. 1983 - SEPT. 1993 44 16,824 $38,180 $38,331 -0.5 0.1 0.4
OCT. 1993 - SEPT. 2002 189 63,987 $36,747 $36,808 -0.5 0.1 0.2
AFTER OCTOBER 2002 161 41,657 $38,467 $38,574 -0.5 0.1 0.3 UNKNOWN PARTICIPATION DATE 10 2,778 $37,678 $37,966 -0.6 0.4 0.8

BY OWNERSHIP TYPE: VOLUNTARY 77 19,922 $37,363 $37,579 -0.5 0.2 0.6
PROPRIETARY 301 105,986 $37,178 $37,246 -0.5 0.1 0.2
GOVERNMENT 12 1,588 $38,931 $39,194 -0.5 -0.2 0.7 UNKNOWN OWNERSHIP TYPE 31 3,994 $38,609 $38,866 -0.5 0.1 0.7

BY REGION: NEW ENGLAND 15 7,584 $32,820 $33,006 -0.5 0.1 0.6
MIDDLE ATLANTIC 29 7,742 $38,051 $38,074 -0.5 -0.2 0.1
SOUTH ATLANTIC 55 14,665 $40,487 $40,505 -0.5 -0.2 0.0
EAST NORTH CENTRAL 68 19,194 $40,268 $40,389 -0.5 0.2 0.3
EAST SOUTH CENTRAL 31 7,909 $37,348 $37,319 -0.5 -0.2 -0.1
WEST NORTH CENTRAL 24 5,178 $38,573 $38,582 -0.5 0.0 0.0
WEST SOUTH CENTRAL 142 50,537 $32,893 $33,010 -0.6 0.3 0.4CMS-1498-P2 461

LTCH Classification (1) Number of LTCHs

(2) Number of LTCH PPS Cases (3) Average RY 2010 LTCH

PPS Rate

Year Payment Per Case 1

(4) Average FY 2011 LTCH

PPS Rate

Year Proposed Payment Per Case 2 (5) Percent Change in Estimated Payments Per Discharge from RY 2010 to FY

2011 for Proposed Changes to the Federal

Rate 3

(6) Percent Change in Estimated Payments Per Discharge from RY 2010 to FY

2011 for Proposed Changes to

the Area

Wage Adjustment 4 (7) Percent Change in Payments Per Discharge from RY 2010 to FY

2011 for

All Proposed Changes 5 (8) MOUNTAIN 32 6,268 $40,324 $40,464 -0.5 0.0 0.3
PACIFIC 25 12,413 $46,758 $46,929 -0.5 0.3 0.4

BY BED SIZE: BEDS: 0-24 42 5,288 $32,939 $33,207 -0.6 0.6 0.8
BEDS: 25-49 192 41,372 $37,047 $37,049 -0.5 0.1 0.0
BEDS: 50-74 101 32,024 $38,196 $38,312 -0.5 0.1 0.3
BEDS: 75-124 50 22,652 $39,478 $39,699 -0.5 0.3 0.6
BEDS: 125-199 21 15,145 $35,265 $35,433 -0.5 0.2 0.5
BEDS: 200 + 15 15,009 $36,134 $36,144 -0.5 0.0 0.0

1 Estimated RY 2010 payments based on a blend of the rates, factors and policies established in the FY 2010 IPPS/RY 2010 LTCH PP S final rule (74 FR 43945 through 43994 and 44021 through 44030), including the FY 2010 GROUPER (Version 27.0) and relative weights, and the RY 2010 rates and factors that reflect the prov isions of sections 1886(m)(3) a nd (4) of the Act and section 34 01(p) of Pub. L. 111-148 established in a separa te notice published elsewhere in this Federal Register

. 2 Estimated FY 2011 LTCH PPS payments based on the proposed payment rates and policy changes presented in the preamble and the Addendum of this supplemental proposed rule, in conjunction with those presented in the May 4, 2010 IPPS/LTCH PPS FY 2001 proposed rule (75 FR 23852). 3 Percent change in estimated payments per discharge from RY 2010 to FY 2011 for the proposed changes to the standard Federal ra te, as discussed in section III.A.3. of the Adde ndum to this supplemental proposed rule. 4 Percent change in estimated payments per discharge from RY 2010 to FY 2011 for proposed changes to the area wage adjustment at §412.525(c) (as discussed in section V.B. of the Addendum to the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule). 5 Percent change in estimated payments per discharge from RY 2010 LTCH PPS (shown in Column 4) to FY 2011 LTCH PPS (shown in Column 5), including all of the proposed changes presented in the preamble of this supplemental proposed rule, in conjunctio n with those presented in the May 4, 2010 IPPS/LTCH PPS FY 2001 proposed rule. Note, this column, which shows the percent change in estimated payments per discharge for all proposed changes, does not equal the sum of the percent changes in estimated payments per discharge for proposed changes to the standa rd Federal rate (column 6) and the proposed changes to the area wage adjustment (Co lumn 7) due to the effect of estimated changes in both estimated payments to SSO cases th at are paid based on estimated costs and ag gregate HCO payments (as discussed in this impact analysis), as well as other interactive effects that cannot be isolated.

5. Results

Based on the most recent available data (as described previously for 421 LTCHs,
we have prepared the following summary of the impact (as shown in Table IV) of the
proposed LTCH PPS payment rate and policy changes presented in this supplemental
proposed rule. The impact analysis in Ta ble IV shows that estimated payments perCMS-1498-P2 462
discharge are expected to increase approxima tely 0.3 percent, on average, for all LTCHs

from RY 2010 to FY 2011 as a result of the proposed payment rate and policy changes
presented in this supplemental proposed rule and the May 4, 2010 FY 2011 IPPS/LTCH
PPS proposed rule, as well as estimated increases in HCO and SSO payments. We note
that we are proposing a -0.59 percent increase to the standard Federal rate for FY 2011,
based on the latest proposed market basket estimate (2.4 percent), the -0.50 percent
reduction to the annual update required under of sections 1886( m)(3) and (4) of the Act ,
and the proposed adjustment for the cumulativ e effect of changes in documentation and
coding in FYs 2008 and 2009 (-2.5 percent). We noted earlier in this section that for
most categories of LTCHs, as shown in Tabl e IV (Column 6), the impact of the proposed
decrease of approximately -0.6 pe rcent to the standard Federal rate is projected to result
in approximately a -0.5 percent decrease in estimated payments pe r discharge for all
LTCHs from RY 2010 to FY 2011. Because payments to cost-based SSO cases and a
portion of payments to SSO cases that are paid based on the "blend" option of the SSO
payment formula at §412.529(c)(2)(iv) are not affected by the proposed update to the
standard Federal rate, we es timate that the effect of th e proposed 0.59 percent reduction

to the standard Federal rate would result in a 0.5 percent reduction on estimated aggregate
LTCH PPS payments to all LTCH PPS cases, including SSO cases. Furthermore, as
discussed previously in this regulatory impact analysis, the average increase in estimated
payments per discharge from the RY 2010 to FY 2011 for all LTCH s of approximately
0.3 percent (as shown in Table IV) was de termined by comparing estimated FY 2011CMS-1498-P2 463
LTCH PPS payments (using the proposed rates, proposed policies and statutory changes
discussed in this supplemental propos ed rule and in the May 4, 2010 FY 2011
IPPS/LTCH PPS proposed rule) to estimated RY 2010 LTCH PPS payments (as

described above in section IX.C.3. of this Appendix).

a. Location
Based on the most recent available data, the vast majority of LTCHs are located in
urban areas. Only approximate ly 6 percent of the LTCHs are identified as being located
in a rural area, and approximately 4 percent of all LTCH cases are treated in these rural
hospitals. The impact analysis presented in Table IV shows that the average percent
increase in estimated payments per discharg e from RY 2010 to FY 2011 for all hospitals
is 0.3 percent for all proposed changes. Fo r rural LTCHs, the percent change for all
proposed changes is estimated to be 0.7 percen t, while for urban LT CHs, we estimate the
increase to be 0.2 percent. Large urban LTCH s are projected to expe rience an increase of
0.3 percent in estimated payments per disc harge from RY 2010 to FY 2011, while other
urban LTCHs are projected to experience an increase of 0.1 percent in estimated
payments per discharge from RY 2010 to FY 2011, as shown in Table IV.
b. Participation Date
LTCHs are grouped by partic ipation date into four categories: (1) before
October 1983; (2) between October 1983 and September 1993; (3) between October 1993
and September 2002; and (4) after October 2002. Based on the most recent available
data, the majority (approximately 49 percent) of the LTCH cases are in hospitals thatCMS-1498-P2 464
began participating between October 1993 and September 2002, and are projected to
experience nearly the average increase (0.2 pe rcent) in estimated pa yments per discharge
from RY 2010 to FY 2011, as shown in Table IV.
In the participation category where LTCHs began participating in Medicare before
October 1983, LTCHs are projected to experien ce a higher than average percent increase
(0.6 percent) in estimated pa yments per discharge from RY 2010 to FY 2011, as shown in
Table IV. Approximately 4 pe rcent of LTCHs began partic ipating in Medicare before
October 1983. The LTCHs in this category ar e projected to experi ence a higher than
average increase in estimated payments because of increases in their wage data, increase
under the proposed MS-LTC-DRG GROUPER (Version 28) a nd relative weights, and

also because of estimated increases in th eir SSO payments relative to last year.
Approximately 10 percent of LTCHs began participa ting in Medicare between
October 1983 and September 1993. These LTCHs are projected to experience a slightly
above average increase (0.4 percent) in estimated payments from RY 2010 to FY 2011.
LTCHs that began participa ting in Medicare after Oct ober 2002 currently represent
approximately 38 percent of all LTCHs, and are projected to experience an average
increase (0.3 percent) in estimate d payments from RY 2010 to FY 2011.
c. Ownership Control
Other than LTCHs whose ownership control type is unknown, LTCHs are
grouped into three categories based on ownershi p control type: voluntar y, proprietary, and
government. Based on the most recent ava ilable data, approximately 18 percent ofCMS-1498-P2 465
LTCHs are identified as voluntary (Table IV). We expect that, for these LTCHs in the
voluntary category, estimated FY 2011 LTCH payments per discharge will increase
higher than the average (0.6 percent) in comparison to estimated payments in RY 2010
primarily because we project an increase in estimated HCO payments and SSO payments
to be higher than the average for these LTCHs. The majority (71 percent) of LTCHs are
identified as proprietary and these LTCHs are projected to experience an average increase
(0.2 percent) in estimated pa yments per discharge from RY 2010 to FY 2011. Finally,
government-owned and operated LTCHs (3 percent) are expected to experience a higher
than the average increase (0.7 percent) in es timated payments primar ily due to a larger
than the average increase in estimated HCO payments and increases under the proposed
MS-LTC-DRG GROUPER (Version 28) and relative weights.
d. Census Region
Estimated payments per discharge for FY 2011 are projected to increase for
LTCHs located in all regions in comparis on to RY 2010. Of the 9 census regions, we
project that the increase in estimated payments per discharge will have the largest positive
impact on LTCHs in the New England region (0.6 percent, as shown in Table IV). The
estimated percent increase in payments pe r discharge from RY 2010 to FY 2011 for New
England is largely attributable to the projected increase in estimated HCO and SSO
payments (explained in great er detail above in section IX.A. of this Appendix).
In contrast, LTCHs located in the East South Central region are projected to
experience a slight decrease in estimated pa yments per discharge from RY 2010 to FYCMS-1498-P2 466
2011. The average estimated decrease in paymen ts of 0.1 percent for LTCHs in the East
South Central region is primarily due to estimated decreases in payments associated with
the proposed wage index because 50 percent of LTCHs located in this region will have a
proposed FY 2011 wage index value that is le ss than their RY 2010 wage index value.
Similarly, LTCHs in the South Atlantic and West North Central are expect to experience
no change in payments primarily due to an estimated decrease in payment because of the
proposed FY 2011 wage index changes a nd the decrease in the Federal rate.

e. Bed Size
LTCHs were grouped into six categorie s based on bed size : 0-24 beds; 25-49
beds; 50-74 beds; 75-124 be ds; 125-199 beds; and greater than 200 beds.
We project that payments for small LTCH s (0-24 beds) would experience a 0.8 percent
increase in payments due to increases in th eir wage index while large LTCHs (200+ beds)
would experience no change in payments. LTCHs with between 75 and 124 beds and
between 125 and 199 beds are expected to experience an above average increase in
payments per discharge from RY 2010 to FY 2011 (0.6 percent and 0.5 percent,
respectively) primarily due to a larger than average estimated increase in payments from
the proposed FY 2011 changes to the area wage adjustment.
D. Effect on the Medicare Program
As noted previously, we project that th e provisions of this supplemental proposed
rule would result in an increase in estimated aggregate LTCH PPS payments in FY 2011 of approximately $12.9 million (or about 0.3 percent) for the 421 LTCHs in our database.CMS-1498-P2 467

E. Effect on Medicare Beneficiaries
Under the LTCH PPS, hospitals receive payment based on the average resources
consumed by patients for each diagnosis. We do not expect any changes in the quality of

care or access to services for Medicare benefi ciaries under the LTCH PPS, but we expect
that paying prospectively for LTCH servi ces would enhance the efficiency of the
Medicare program.

X. Alternatives Considered
This supplemental proposed rule contains a range of policies. The preamble of
this supplemental proposed rule provides descriptions of the statutory provisions that are
addressed, identifies policies and presents rationale s for our decisions and, where
relevant, alternatives that were considered.

XI. Overall Conclusion
A. Acute Care Hospitals
Table I of section VI. of this Appendix demonstrates the estimated distributional
impact of the IPPS budget neutrality requirements for the proposed MS-DRG and wage
index changes, and for the wage index recl assifications under the MGCRB. Table I also
shows an overall decrease of 0.9 percent in operating payments. We estimate that
operating payments will decrease by a pproximately $929 million in FY 2011. In
addition, we estimates the repor ting of hospital quality data program costs at $2.4 million, a savings of $23 million associated with th e proposed HACs policies discussed in the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, an additional $150 million toCMS-1498-P2 468
hospitals that qualify for an additional payment as provided under section 1109 of
Pub. L. 111-152, and all other pr oposed operating payment polic ies described in section
VII. of this Appendix . These estimates added to our FY 2011 ope rating estimate of -
$929 million results in a decrease of $800 million for FY 2011. We estimate that capital
payments will experience -0.2 percent change in payments per case, as shown in Table III
of section VIII. of this Appendix. We project that there w ill be a $20 million decrease in
capital payments in FY 2011 compared to FY 2010. The proposed cumulative operating and capital payments should result in a net decrease of $820 million to IPPS providers.
The discussions presented in the previous page s, in combination with the rest of this
proposed rule and the May 10, 2010 FY 2011 IPPS/LTCH PPS proposed rule, constitute
a regulatory impact analysis.

B. LTCHs
Overall, LTCHs are projected to experience an increase in estimated payments per
discharge in FY 2011. In the impact analysis, we are using the proposed rates, factors,
and policies presented in this supplementa l proposed rule, including proposed updated
wage index values and relative weights, and the best available claims and CCR data to
estimate the change in payments under the LTCH PPS for FY 2011. Accordingly, based

on the best available data for the 421 LTCHs in our database, we estimate that FY 2011 LTCH PPS payments will increase approximately $13 million (or about 0.3 percent).CMS-1498-P2 469
XII. Accounting Statements
A. Acute Care Hospitals
As required by OMB Circ ular A-4 (available at
http://www.whitehousegov/om b/circulars/a004/a-4.pdf ), in Table V below, we have
prepared an accounting statement showing the classification of the expenditures
associated with the provisions of this proposed rule 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 proposed changes to the IPPS presented in this supplemental proposed rule
and the May 10, 2010 FY 2011 IPPS/LTCH PPS proposed rule. All expenditures are
classified as transfers to Medicare providers.

Table V.—Accounting Statement: Classification of Estimated Expenditures under the IPPS from FY 2010 to FY 2011
Category Transfers Annualized Monetized Transfers -$820 million From Whom to Whom Federal Government to IPPS Medicare Providers Total -$820 million

B. LTCHs
As discussed in section IX. of this Appe ndix, the impact analysis for the proposed
changes under the LTCH PPS for this proposed rule projects an increase in estimated
aggregate payments of approximately $13 million (or about 0.3 percent) for the
421 LTCHs in our database that are subject to payment under the LTCH PPS. Therefore,
as required by OMB Circ ular A-4 (available atCMS-1498-P2 470
http://www.whitehouse.gov/om b/circulars/a004/a-4.pdf ) , in Table VI below, we have
prepared an accounting statement showing the classification of the expenditures
associated with the provisions of this supplemental proposed rule and the May 10, 2010
FY 2011 IPPS/LTCH PPS proposed rule as they relate to changes to the LTCH PPS.
Table VI provides our best es timate of the proposed increas e in Medicare payments under
the LTCH PPS as a result of the proposed provisions presented in this proposed rule

based on the data for the 421 LT CHs in our database. All ex penditures are classified as
transfers to Medicare provi ders (that is, LTCHs).
TABLE VI.—Accounting Statement: Classification of Estimated Expenditures from the 2010 LTCH PPS Rate Year to the FY 2011 LTCH PPS
Category Transfers Annualized Monetized Transfers Pos itive transfer--Estimated increase in expenditures: $13 million From Whom to Whom Federal Government to LTCH PPS Medicare Providers Total $13 million

XIII. Executive Order 12866
In accordance with the provisions of Executive Order 12866, the Executive Office
of Management and Budget re viewed this proposed rule.

[FR Doc. 2010-12567 Filed 05/21/2010 at 4:15 pm; Publication Date: 06/02/2010]