DEPARTMENT OF HEALTH 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 certain statutory provisions relating 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 Reconciliation 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 Medicare acute care hospital inpatient services for 

operating costs and capital-related costs, and for long-term care hospital costs. 

DATES: To be assured consideration, comments must be received at one of the addresses 

provided below, no later than 5 p.m. on [OFR--insert date 30 days after date of publication in the

Federal Register]. 

ADDRESSES: In commenting, please refer to file code CMS-1498-P2. Because of staff and 
CMS-1498-P2 2 

resource limitations, we cannot accept comments 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.regulations.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 following 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 Federal 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 hand or courier delivery 

may be delayed and received after the comment period. 

Submission of comments on paperwork requirements. You may submit comments on 

this document's paperwork requirements by following the instructions at the end of the 

"Collection of Information Requirements" section in this document. 
CMS-1498-P2 4 

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

"SUPPLEMENTARY INFORMATION" section. 

FOR FURTHER INFORMATION CONTACT: 

Tzvi Hefter, (410) 786-4487, and Ing-Jye Cheng, (410) 786 4548, Operating Prospective 

Payment, Wage Index, Hospital Geographic Reclassifications, Capital Prospective Payment, 

Critical Access Hospital (CAH). 

Michele Hudson, (410) 786-4487, and Judith Richter, (410) 786-2590, Long-Term Care Hospital 

Prospective Payment. 

Siddhartha Mazumdar, (410) 786-6673, Rural Community Hospital 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 following Web site as soon as possible after they 

have been received: http://www.regulations.gov. Follow the search instructions on that Web site 

to view public comments. 

 Comments received timely will also be available for public inspection as they are 

received, generally beginning approximately 3 weeks after publication 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 Access
CMS-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 the 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 users should use communications software 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 and Affordable Care Act (Pub. L. 111-148) 

was enacted. Following the enactment of Pub. L. 111-148, the Health Care and Education 

Reconciliation Act of 2010 Pub. L. 111-152 (enacted on March 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 and 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 following provisions of the new legislation 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 basket updates (sections 3401 and 10319 of 

Pub. L. 111-148 and section 1105 of Pub. L. 111-152). 

• Temporary improvements to the low-volume hospital adjustment (sections 3125 and 

10314 of Pub. L. 111-148). 

• Extension of Medicare-dependent hospitals (MDHs) (section 3124 of Pub. L. 111-148). 

• Additional payments in FYs 2011 and 2012 for qualifying hospitals in the lowest 

quartile of per capital Medicare spending (section 1109 of Pub. L. 111-152). 

• Extension of the rural community hospital demonstration (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 for 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 further instructions implementing 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 Federal 
CMS-1498-P2 7 

Register. 

II. Provisions of the Proposed Regulations 

 In this section of this supplementary proposed rule, we address the 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", including 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 volatility of wage index adjustments while 

maintaining budget neutrality in applying such adjustments; 

● Takes into account the effect that implementation of the system would have on health 

care providers and on each region of the country; 

● Addresses issues related 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 of 
CMS-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 that 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 affect reclassification average hourly wage 

comparison criteria and rural and imputed floor 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 provided for a phase-in of the 

adjustment over 2 years. For applications for reclassification for the first transitional year, FY 2010, 

the average hourly wage standards were set at 86 percent for urban hospitals and group 

reclassifications, and 84 percent for rural hospitals. For applications 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 for urban and group reclassifications and 86 percent 

for rural hospitals. Sections 412.230, 412.232, and 412.234 of the regulations were revised 

accordingly. These policies were adopted in the FY 2009 IPPS final rule and were reflected in the 
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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 section 3137(c) of Pub. L. 111-148 recently revised the average 

hourly wage standards. Specifically, section 3137(c) restores the average hourly wage standards that 

were in place for FY 2008 (that is, 84 percent for urban hospitals, 85 percent for group 

reclassifications, and 82 percent for 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 Pub. L. 111-148. Section 3137(c) of Pub. L. 111-148 

also requires the revised average hourly wage standards to be applied in a budget neutral manner. 

We note that section 3137(c) of Pub. L. 111-148 does not provide for the revised average hourly 

wage standards to be applied retroactively, nor does it change the statutory deadline for applications 

for reclassification for FY 2011. Under section 1886(d)(10) of the Act, the Medicare Geographic 

Classification Review Board (MGCRB) considers 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 start of the fiscal year for which reclassification is sought (generally 

by September 1). For reclassifications 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 received 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 reclassifications, and 82 percent for 

rural hospitals. We determined that18 additional hospitals would qualify for reclassification for FY 
CMS-1498-P2 10 

2011. Also, 5 hospitals, for which the MGCRB granted reclassifications to their secondary requested 

areas for FY 2011, would qualify for reclassifications instead to their primary requested areas 

because they now meet the average hourly wage criteria to reclassify to those areas. Therefore, in 

accordance with §412.278 of the regulations, in which paragraph (c) provides the Administrator 

discretionary authority to review any final decision of the MGCRB, we submitted a letter to the 

Administrator requesting that she review and amend the MGCRB's decision and grant the 23 

hospitals their requested reclassifications (or primary reclassifications) for FY 2011. 

The wage index in the Addendum to this supplemental FY 2011 IPPS proposed rule reflects 

these changes in hospital reclassifications, although 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 reclassifications) and that the hospitals would not request the 

Administrator to amend her decisions. Generally, these reclassifications would result in the highest 

possible wage index for the hospitals. Any changes 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 section 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 national budget neutrality adjustment) for the rural and imputed floors, 

effective beginning with the FY 2009 wage index and incorporated this policy in our regulation at 
CMS-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 implementation 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 from a nationwide adjustment to a statewide 

adjustment, with a statewide adjustment 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 section 3141 of Pub. L. 111-148. Specifically, section 

3141 of Affordable Care Act rescinds our policy establishing a statewide budget neutrality 

adjustment for the rural and imputed floors and, instead, restores it to a uniform, national 

adjustment, beginning with the FY 2011 wage index. Additionally, the imputed floor, is set to 

expire on September 30, 2011. We do not read section 3141 of Pub. L. 111-148 as altering this 

expiration date. Section 3141 of Pub. L. 111-148 requires 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 the area wage index)." Thus, section 3141 of 

Pub. L. 111-148 is governing how we apply budget neutrality, under the authorities of §412.64(e) 

and section 4410(b) of the Balanced Budget Act, 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 governs budget neutrality for that floor, but it 

does not continue the imputed floor beyond the expiration date already included in our 
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regulations. 

 Therefore, the wage index in the Addendum to this supplemental FY 2011 IPPS proposed 

rule reflects a uniform, national budget 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 Affordable 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 Frontier 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 adjustment 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 definitions based upon the most recent annual Population Estimates 

published by the U.S. Census Bureau. We will divide each county's population total by each 

county's reported land area (according to the decennial census) in square miles to establish 

population density. We also propose to update this analysis from time to time, such as upon 

publication of a subsequent decennial census, and if necessary, add or remove qualifying States 

from the list of Frontier States based on the updated analysis. 

For a State that qualifies as a Frontier State, 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 index rate, or a minimum value of 1.00. We propose that, for a 

hospital that is geographically located in a Frontier State and is reclassified under section 
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1886(d)(10) of the Act to a CBSA in a non-Frontier State, the hospital will receive a wage index 

that is the higher of the reclassified area wage index or the 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 budget 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 rural 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 Table 4D-2 of the Addendum to this supplemental 

proposed rule. Population Data set: http://www.census.gov/popest/estimates.html (2009 County 

Total Population 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, are included in Tables 2, 4A, 4B, 4C, and 
CMS-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 index because section 3141 of Pub. L. 111-148 instead 

requires the application of a national adjustment. 

 Table 4J, which lists the out-migration adjustment for a qualifying county, is revised due 

to the above provisions of Affordable Care Act. Additionally, Table 9A, the list of hospitals that 

are reclassified or redesignated for FY 2011, is revised according to section 3137(c) of 

Pub. L. 111-148. Both revised tables are included in the Addendum to this supplemental 

FY 2011 IPPS/LTCH PPS proposed rule. 

Tables 3A and 3B, which list the 3-year average hourly wage for each labor market area 

before the redesignation or reclassification of hospitals, Table 4E, the list of urban CBSAs and 

constituent counties, Table 4F, the Puerto Rico wage index, and Table 9C, the list of hospitals 

redesignated under section 1886(d)(8)(E) of the Act, 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 Withdrawing Reclassifications in FY 2011 

Section 1886(d)(10)(D)(v) of the Act states that the Secretary should establish procedures 

under which a subsection (d) hospital may elect to terminate a reclassification before the end of a 

3-year period, but does not contain any other specifics regarding how such termination should 

occur. Our rules at 42 CFR 412.273 state that hospitals that have been reclassified by the 

MGCRB are permitted to withdraw their applications within 45 days of the publication of CMS's 
CMS-1498-P2 15 

annual notice of proposed rulemaking. 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 application for reclassification or termination 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 tables 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 sections 3137(c), 3141, and 10324 of Affordable 

Care Act. In addition, as a result of section 3137(c) of Affordable Care Act, there may be 

additional hospitals listed as reclassified in Table 9A in the Addendum to this supplemental 

proposed rule. Hospitals have sufficient time between the display 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 terminations 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 MGCRB 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 required 
CMS-1498-P2 16 

by the Affordable Care Act. In this supplemental 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 called 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 established 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 increase 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 the 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 submits 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 percentage increase equal to 0.1 percent (that is, the FY 2010 estimate of 

the market basket rate-of-increase 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) and 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 a 
CMS-1498-P2 17 

0.25 percentage point, subject to the hospital submitting quality information under rules 

established 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 

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 these amendments may result in the applicable 

percentage increase being less than zero. Although these amendments modify 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 occurring 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 revise §412.64(d) to state that for the first half 

of FY 2010 (that is, discharges on or after 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 submit 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 quarter 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 through September 30, 2010), in accordance with 
CMS-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 proposing to reduce the market basket index for IPPS 

hospitals by an additional 2.0 percentage 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 that 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 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 payment update to the operating standardized 

amount is -0.15 percent (that is, the adjusted 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 the 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 amendments to section 1886(b)(3)(B)(i) made by section 

3401(a) of Pub. L. 111-148. Accordingly, for hospitals paid for their inpatient operating costs on 

the basis of a hospital-specific rate, the rates paid to such hospitals for discharges occurring 
CMS-1498-P2 19 

during the first half of FY 2010 will be based on an annual update estimated to be 2.1 percent for 

hospitals submitting quality data or 0.1 percent for hospital that fail to submit quality data; and 

the rates paid to such hospitals for the second half of FY 2010 will be based 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 above, 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 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 increase minus a 0.25 

percentage point less an additional 2.0 percentage points. Section 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 were unable to address those provisions in the 

proposed rule. In that proposed rule, consistent with current law, based on IHS Global Insight, 

Inc.'s first quarter 2010 forecast, with historical 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 percent (that is, the current estimate of the market basket rate-
CMS-1498-P2 20 

of-increase) for hospitals in all areas, provided the hospital submits quality data in accordance 

with our rules. For hospitals that do not submit quality data, we estimated that the update to the 

operating standardized amount would be 0.4 percent (that is, the current 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 section 1886(b)(3)(B)(i) of the Act made by section 

3401 of Pub. L. 111-148, for FY 2011 we are required 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 increase, the estimated update to the FY 2011 

operating 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 standardized amount is 0.15 percent (that is, 

the adjusted FY 2011 estimate of the market basket 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 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). 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 section 1886(b)(3)(B)(i) as amended by the Affordable Care Act. 
CMS-1498-P2 21 

Accordingly, the update to the hospital-specific rates 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 implement this provision.

3. FY 2010 and FY 2011 Puerto Rico Hospital Update 

Puerto Rico hospitals are paid a blended rate for their inpatient operating costs based on 

75 percent of the national standardized 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 applied to the Puerto Rico-specific 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 the Secretary under section 1886(d)(4) of the Act. 

Section 1886(e)(4)(1) of the Act in turn directs the Secretary to recommend an appropriate 

change factor for Puerto Rico hospitals taking in to account amounts necessary 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 standardized rate, beginning in FY 2004 we have set 

the update to the Puerto Rico-specific operating standardized amount equal 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 only the update factor applicable to the national standardized 

rate for IPPS hospitals and the hospital-specific rates; they do not mandate any revisions to the 
CMS-1498-P2 22 

update factor applicable to the Puerto Rico-specific standardized amount. 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 standardized 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 authority to now propose setting the FY 2010 update factor for the 

Puerto Rico-specific operating standardized amount for the second half of FY 2010 equal to the 

update factor applicable to the national standardized amount or the hospital-specific rates (that is 

the market basket minus 0.25 percentage points). Accordingly, the FY 2010 update to the Puerto 

Rico-specific operating standardized amount is 2.1 percent (that is, the FY 2010 estimate of the 

market basket rate-of-increase) 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 national 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 the 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 Act, 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 payment adjustment for low-volume hospitals. 
CMS-1498-P2 23 

1. Background 

Prior to being amended by the Affordable Care 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 fiscal 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 the individual is entitled to benefits under Part A." Therefore, 

the term refers to total discharges, not merely Medicare discharges. Finally, under section 406, 

the provision requires the Secretary to determine an applicable percentage increase for these lowvolume hospitals based on the "empirical relationship" between "the standardized cost-per-case 

for such hospitals and the total number of discharges of such hospitals and the amount of the 

additional incremental costs (if any) that are associated with such number of discharges." The 

statute thus mandates that the Secretary develop an empirically justifiable adjustment based on 

the relationship between costs and discharges for these low-volume hospitals. 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 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. 

In the FY 2006 IPPS final rule (70 FR 47432 through 47434), we stated that a 

multivariate analyses supported the existing low-volume adjustment implemented in FY 2005. 

Therefore, the low-volume adjustment of an additional 25 percent would continue to be provided 
CMS-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 payment adjustment and qualifying criteria, as 

implemented in FY 2005, will resume. 

Section 3125(3) and 10314(1) of Pub. 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) hospital and has less than 1,600 discharges of individuals entitled to, 

or enrolled for, benefits under Part A during the fiscal year." In addition, section 1886(d)(12)(C) 

of the Act, as amended, provides that the payment adjustment (the applicable percentage 

increase) is to be determined "using a continuous 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 percent for low-volume hospitals with greater than 

1,600 discharges of such individuals 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 low-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 more 
CMS-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 regulations 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" consistent with the term "miles" as 

defined at §412.92 for purposes of determining whether a hospital qualifies as a sole community 

hospital. Specifically, the regulations at 42 CFR 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 change in the qualifying criteria from 25 to 15 road 

miles is applicable only for FYs 2011 and 2012, the 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, benefits 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 these fiscal years, the number of discharges is 

determined based on total discharges, which includes discharges of both Medicare and nonMedicare patients. However, under sections 3125 and 10314 of Pub. L. 111-148, for FYs 2011 

and 2012, the discharge requirement has been increased to less than 1,600 discharges of 

individuals "entitled to, or enrolled 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 automatically 
CMS-1498-P2 26 

"entitled" to Medicare Part A when the person reaches age 65 or becomes disabled, provided that 

the individual is entitled to Social Security benefits 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 specific 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 benefits 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 criteria for entitlement to Part A 

benefits under section 226. First, in order to enroll in Medicare Part C, a beneficiary must be 

"entitled to benefits under 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 beneficiaries who enroll in Part C plan forfeit their 

entitlement to Part A benefits. 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 additional supplemental benefits. See section 

1852(a)(1)(A)of the Act. Third, under certain circumstances, Medicare Part A pays for care 

furnished to patients enrolled in Part C plans. For example, if, during the course of the year, the 

scope of benefits provided under Medicare Part A expands beyond 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 directly. (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 MA 
CMS-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 benefits under Medicare Part A. 

Accordingly, for purposes of determining the number of discharges for "individuals 

entitled to, or enrolled for, benefits under Part A," we propose 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 plan under Medicare Part C. Since a hospital may 

only qualify for this adjustment if the hospital has fewer than 1600 discharges 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 claim for patients who are enrolled in Part C, in order for 

Medicare to assure that these discharges are included in the determination of whether the hospital 

has fewer than 1600 discharges for 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 the 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, sections 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" between "the standardized cost-per-case for such hospitals and the 

total number of discharges of such hospitals and the amount of the additional incremental costs 

(if any) that are associated with such number of discharges." The statute thus mandates the 

Secretary to develop an empirically justifiable adjustment based on the relationship between 
CMS-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 statutory 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 determine the applicable 

percentage increase using a continuous, linear sliding scale ranging from an additional 25 percent 

payment adjustment for hospitals with 200 or fewer Medicare discharges to 0 percent additional 

payment for hospitals with more than 1,600 Medicare discharges. We propose to apply this 

payment adjustment based on increments of 100 discharges (beginning with 200 or fewer 

discharges), with the applicable percentage increase decreasing linearly in equal amounts by 

1.6667 percent for every additional 100 Medicare discharges, 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 hospital must have "less" than 1,600 discharges in order to qualify as a 

low volume hospital. The proposed payment adjustment 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 revise the qualifying criteria and the payment adjustment for 

low-volume hospitals for FYs 2011 and 2012, consistent 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 adjustment. In order to qualify, a hospital must 

provide to its FI or MAC sufficient evidence to document that it meets the number of Medicare 

discharges and distance requirements. The FI or MAC will determine, 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 existing methodology for determining the payment 

adjustment for low-volume hospitals, no hospital would receive a lower payment adjustment 
CMS-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 fewer than 200 discharges receive a payment 

adjustment, an additional 25 percent, because the statute requires that the adjustment be 

empirically based to provide relief to low-volume hospitals where there is empirical evidence 

that higher incremental costs are associated with low numbers of total discharges. Consistent 

with section 1886(d)(12)(D) of the Act, for FYs 2011 and 2012, we will continue to pay hospitals 

with fewer than 200 discharges a payment adjustment amount equal to an additional 25 percent. 

We are proposing to revise our regulations 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 count for purposes of determining a hospital's qualification for the 

adjustment based on the hospital's most recent submitted cost report." This may mistakenly be 

interpreted to mean that once a hospital qualifies as a low-volume hospital, no further 

qualification is needed. We, therefore, are proposing to clarify that 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, Small Rural Hospitals (MDHs) (§412.108)

1. Background 

 Medicare-dependent, small rural 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, and 
CMS-1498-P2 31 

has a high percentage of Medicare discharges (that is, not less than 60 percent of its inpatient 

days or discharges either in its 1987 cost reporting year or in two 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 hospital-specific rate based on the hospital's FY 1982 

or FY 1987 costs per discharge, whichever of these hospital-specific 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 October 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 intermediary or MAC determines 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 the 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 possible to forecast the outlier payments, the amount of 
CMS-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 hospital-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 rates 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 determinations and appeals. 

2. Extension of the MDH Program 

 Section 3124 of Pub. L. 111-148 extends the 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 effect 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 "October 1, 2012"." Section 3125(b) of Pub. L. 111-

148 also makes conforming amendments to sections 1886(b)(3)(D)(i) and (iv) of the Act . 

Section 3124(b)(2) of Pub. L. 111-148 also amends section 13501(e)(2) of OBRA 1993 (42 

U.S.C. 1395ww note) to extend the provision permitting hospitals to decline reclassification as 

an MDH through FY 2012. 

E. Additional Payments for Qualifying Hospitals with Lowest Per Capita Medicare Spending

1. Background 
CMS-1498-P2 33 

Section 1109 of Pub. L. 111-152, provides for additional payments for FY 2011 and 2012 

for "qualifying hospitals." Section 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 enrollee 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) hospital" as defined in section 1886(d)(1)(B) of the 

Act; and (2) located in a county that ranks within the lowest quartile of counties based upon its 

spending for benefits under Medicare Part A and Part B per enrollee adjusted for age, sex, and 

race. Section 1109(b) of Pub. L. 111-152 makes 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 proportion 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 located in counties that rank within the lowest 

quartile of counties in the United States for spending for benefits under Medicare Part A and Part 

B. The provision requires that the Medicare Part A and Part B county-level spending per 

enrollee to be adjusted by age, sex and race. We are proposing our methodology for determining 

the bottom quartile of counties 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 further propose that we will determine this bottom 
CMS-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 required by section 1109 of Pub. L. 111-152. 

We developed an adjustment model by age, 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 Medicare beneficiaries in those counties. After those 

adjustments are applied, we determined 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 announcement of calendar year MA capitation 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/MedicareAdvtgSpecRateStats/Downloads/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, sex, and race. Consistent with 

how we develop our risk adjustment models for MA ratesetting as described above, we 

developed a prospective risk adjustment model using 2006 data for beneficiary characteristics 

and 2007 data for Part A and Part B spending. However, unlike the risk adjustment mode used 

for MA which includes diseases and demographic factors, the only independent 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 dependent variable was annualized Medicare Part A 
CMS-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, sex, and race variables are described below. 

The age, sex, race (ASR) model(s) was estimated using the Five Percent Standard 

Analytic Denominator file, a standard 5-percent sample 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 deadlines and the latest available 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 sample 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 contains 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 populated 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-American or Pacific Islander; (2) Hispanic; (3) 

Black (Not Hispanic); (4) North American Indian or Alaskan Native; and (5) White (Not 
CMS-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 added during the previous calendar 

year as well as all living beneficiaries whose race is identified as "Other" or "Unknown." 

Discussed in the context of the ESRD payment 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. However, we believe 

that the current EDB, particularly with respect to the more recent and ongoing updates we 

perform, remains a useful source of race and ethnicity data on 46 million Medicare beneficiaries. 

 Additionally, because this is our only currently available data source on the racial and ethnic 

demographics of Medicare beneficiaries, we propose to the use the EDB as our data source for 

beneficiary race so that we can fulfill the requirements of section 1109(d) of Pub. L. 111-152 to 

adjust county Medicare Part A and Part B spending by race. 

We used the MedPAR claims file as the source to determine Medicare 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 Analytic 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 spending (the dependent variable in the risk adjustment 

model), we annualized the Medicare Part A and Part B spending for beneficiaries with less than a 
CMS-1498-P2 37 

full year of eligibility, and these amounts 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 displayed in the table below reflect 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 regression model. 

In addition, we used the same linear regression 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 included variables to adjust for race. We considered two methods to adjust 

for race in county spending because of the way that the SS-5 form collects 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 Pacific Islander; (2) Hispanic; (3) Black (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 all others. The second method categorized race by 

White, Black, and Other (WBO), where beneficiaries 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 classified as another category, such as 

White or Black. In our regression modeling we used the largest group, White, as the reference 
CMS-1498-P2 38 

group; the coefficients on the difference 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 Medicare 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. Conversely, where the coefficients are negative, this 

implies that the predicted spending for that category 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 shows the coefficients for each age and sex category. 

The second table shows the coefficients for race. These national coefficients 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. 

Sex Age Categories (in years) 

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 using the WBHO method where we separately 

account for cost differences associated with Hispanic beneficiaries. The Office of Management 

and Budget (OMB) has promulgated standards for the classification of federal data on race and 

ethnicity. Under OMB's classification standards, the category of Hispanic is treated as an ethnic 
CMS-1498-P2 39 

category as opposed to a race category. The current 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) American Indian or Alaska Native; (2) Asian; 

(3) Black or African American; (4) Native Hawaiian or Other Pacific Islander; and (5) White. In 

addition, OMB specified two separate ethnic categories—Hispanic or Latino, and not Hispanic or 

Latino. However, as explained above, Hispanic or Latino ethnicity is treated as a race category 

by EDB, and beneficiaries can self-identify as Hispanic among mutually exclusive racial 

categories. Despite the inconsistency in reporting by the OMB and 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 the coefficient for the Hispanic category is 

statistically significant, suggesting that Medicare Part A and Part B spending associated with this 

category of beneficiaries is different from the spending for our reference group and that it should 

be a separate coefficient to adjust county spending. In addition, the EDB treats Hispanic as a 

separate racial classification, consistent with our WBHO method, therefore; we believe that our 

proposal appropriately interprets 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 approaches. We found minimal difference in the 

county rankings under the two methodologies. We found that some counties would qualify as an 

eligible county only under the WBO methodology, and others would no longer qualify as an 

eligible county using this alternative. The decision to use the WBHO methodology affects 

whether 9 subsection (d) hospitals, located in 5 counties, would be eligible to receive a payment 

under section 1109. In Table 3, we publish the differences in counties, eligible hospitals, and 
CMS-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 adjust 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 proposing 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 spending, we first calculated 

Medicare Part A and Part B county level spending for each county in the 50 States and the 

District of Columbia using a similar methodology used to establish county 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 average 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 for fluctuations in year-to-year expenditures, 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 estimate (USPCC), which is 

the national average cost per Medicare beneficiary, to determine 2009 Medicare Part A and Part 

B spending for each county. We welcome public comment on this methodology to calculate 

county-level Part A and Part B spending. 

3. Application of the Age/Sex/Race Adjustment to Part A and Part B County Spending 

To estimate the county level risk scores for 2009, beneficiary enrollment information was 

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

for 2009 to be consistent with how we are required to determine qualifying hospitals' payment 

amounts, under section 1109(c) of Pub. L. 111-152. That is, section 1109(c) of Pub. L. 111-152 
CMS-1498-P2 41 

requires that qualifying hospitals located in the bottom quartile of counties with the lowest 

Medicare Part and Part B spending per enrollee will receive a portion of the allotted $400 million 

based on their FY 2009 operating payments. Therefore, 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 language of section 1109(d) of 

Pub. L. 111-152, which refers to spending under Part A and B. Based on these criteria, there 

were 30,666,295 beneficiaries included in the adjustment process. To determine the age, sex and 

race make-up of the Part A and/or Part B beneficiaries for each county, we used the EDB to 

identify date of birth, sex, race, and State/county of residence to create a person level file with the 

data needed to run the ASR model. 

A county level average risk score 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 dividing 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 level 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 quartile of spending (that 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 determining the age, sex, race adjustments 

for determining adjusted Medicare Part A and 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 Amounts 
CMS-1498-P2 42 

We have developed a methodology 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 identified using the methodology proposed in section B). A subsection 

(d) hospital is defined in section 1886(d)(1)(B) of the 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) hospital . . . 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 definition 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 community 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 definition of a "subsection (d)" hospital in section 

1886(d)(1)(B) of the Act specifically excludes hospitals and hospital units excluded from the 

IPPS, such as psychiatric, rehabilitation, long term care, children's, and cancer hospitals. In 

addition, critical access hospitals (CAHs) are not considered qualifying hospitals because they do 

not meet the definition of a "subsection (d) hospital" 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 identify 
CMS-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 propose 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 subsection (d) hospital as of April 1, 2010; (2) be 

geographically located in an eligible county; and (3) have received IPPS operating payments (in 

accordance with section 1886(d)) of the Act under their Medicare provider number in FY 2009. 

We used the Online Survey, Certification and Reporting (OSCAR) database to determine a 

hospital's county location associated with that CCN provider number. County data in OSCAR is 

supplied by the U.S Postal Service and is cross walked to the address reported by the provider. 

Under this proposal, the address listed for a hospital's Medicare provider number must be 

currently located in a qualifying county in order 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 using the methodology described above. 

4. Payment Determination and Distribution 

As mentioned above, under section 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 Congress has allocated a set amount – $400 million – for 

hospitals for FYs 2011 and 2012 under this provision, we believe it is consistent with the statute 

to spread these payments over the 2-year period. We are proposing to distribute $150 million for 
CMS-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 invite public comment to give hospitals the 

opportunity to request that we make changes to the qualifying hospital list in order to ensure the 

accuracy of the qualifying hospital list based on the methodology set forth in the final rule. 

However, we are proposing to identify eligible counties, 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 counties, 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 the individual hospital's Medicare contractor 

through an annual one-time payment 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 Pub. 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 typically takes several years 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 these additional payments. Therefore, we believe our proposal to 
CMS-1498-P2 45 

give hospitals their section 1109 payments as annual payments during FY 2011 and FY 2012 

presents the most expedient method 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 through an annual payment in each of those 

years made to the qualifying providers through their FI or A/B MAC. 

We propose that qualifying hospitals report these additional payments on their Medicare 

hospital cost report corresponding to the appropriate cost reporting period that the hospitals have 

received the payments. On the Medicare Hospital 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 hospitals to report these additional payments 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 tracking 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 determined "in proportion to the portion of the amount of the aggregate 

payments under section 1886(d) of the Social Security Act to the hospital for fiscal year 2009 

bears to the sum of all such payments to all qualifying hospitals for such fiscal year." We are 

proposing that the portion of a hospital's payment 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 IPPS 
CMS-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 payments made to IPPS hospitals because these 

payments are made under section 1886(d) of the Act. Under 42 CFR 412.105(g) of the 

regulations and as implemented in Transmittal A-98-21 (Change Request 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, copayments, and deductibles) because the 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 Medicare, 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 acquisition costs because it is a payment made under 

section 1881(d) of the Act and we propose to exclude payments for blood clotting factor because 

they are payments made under section 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 payments 
CMS-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 the 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 allow 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 MedPAR 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 following: a Letter of Request, the LDS Data Use 

Agreement and Research Protocol (refer to the Web site for further instructions), 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 December 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 definition 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 the standardized amount. At cost report settlement, the FI or A/B MAC 

determines if the hospital would 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 amount (either the hospital specific rate for all 

claims or the Federal rate amount for all claims) for the cost reporting period. To determine the 

FY 2009 operating payment amount for SCHs that meet 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 consistent with the treatment of other qualifying hospitals under our 

proposal, and again allows for the timely distribution of funds in two annual payments, as 
CMS-1498-P2 49 

discussed above. MDHs are paid the sum of the Federal payment amount plus 75 percent of the 

amount by which the hospital specific rate exceeds the Federal payment amount. This amount is 

considered their IPPS operating payment reported on their Medicare IPPS claim. 

In order to calculate payment amounts consistent with section 1109(c)of Pub. L. 111-152, 

we propose to use a weighting factor for each qualifying 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 larger proportion of operating payments would have a proportionately 

higher weighting factor and would receive the proportionately larger share of the $400 million, 

while hospitals with a smaller proportion of operating payments would have proportionately 

smaller weighting factor and would receive proportionately smaller shares of the $400 million. 

We welcome public comment on our methodology to determine the amount of money distributed 

to qualifying hospitals consistent with the language in section 1109(c) of Pub. L. 111-152. 

6. Results 

 In calculating county-level Medicare Part A and 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 counties with regards to adjusted Medicare Part A and Part B spending per 

beneficiary. We have listed the 786 eligible counties in Table 2. Of those 786 eligible counties, 

there are only 276 counties in which qualifying hospitals are located, using the methodology we 

proposed in section II.E.3. of the preamble to this supplemental proposed rule. Using Medicare 

provider numbers, as proposed above 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 eligible 
CMS-1498-P2 50 

counties and received IPPS 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 discussed in section II.E.2.a. of the preamble to this supplemental 

proposed rule. For these two methodologies (WBHO and WBO), we list the number of eligible 

counties, the number of eligible counties in which a qualifying hospital is located, the payment 

amount, and the percentage of the total payment 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 hospitals' payment weighting factors (based on the proposed 

methodologies described above). 
CMS-1498-P2 51 

7. Finalization of Eligible Counties, Qualifying Hospitals and Qualifying Hospitals' Weighting 

Factors 

Based on public comments, it is possible that we will finalize a methodology to determine 

the list of eligible counties 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 counties, 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 list of eligible counties that would 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 proposed WBHO risk adjustment 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 ARKANSAS 
CMS-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 IDAHO 
CMS-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 INDIANA 
CMS-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 IOWA 
CMS-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 KENTUCKY 
CMS-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 MINNESOTA 
CMS-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 MISSOURI 
CMS-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 NEBRASKA 
CMS-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 MEXICO 
CMS-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 YORK 
CMS-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 DAKOTA 
CMS-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 PENNSYLVANIA 
CMS-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 DAKOTA 
CMS-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 VERMONT 
CMS-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 VIRGINIA 
CMS-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 WISCONSIN 
CMS-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 WISCONSIN 
CMS-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 proposed WBHO risk adjustment 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 0.0044
CMS-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 0.0012
CMS-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 0.0007
CMS-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 0.0026
CMS-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 0.0003
CMS-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 0.0067
CMS-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 0.0004
CMS-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 0.0010
CMS-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 0.0009
CMS-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 0.0004
CMS-1498-P2 78 

Table 4: Comparison of the Proposed FY 2011 Section 1109 Payments by State Using the WBHO and WB

NAME 

Number of 

Counties with 

Eligible 

Hospitals 

under 

WBHO 

Number of 

Eligible 

Hospitals 

under 

WBHO 

Payments under WBHO 

(in millions) 

Percentage 

of payment 

Number of 

Counties 

with 

Eligible 

Hospitals 

under 

WBO 

Number 

of 

Eligible 

Hospitals 

under 

WBO 

u

(

ALABAMA 4 4 $0.99 0.7% 4 4 ARIZONA 3 5 $1.65 1.1% 3 5 ARKANSAS 3 6 $3.03 2.0% 3 6 CALIFORNIA 3 6 $2.18 1.5% 3 6 COLORADO 3 3 $0.29 0.2% 3 3 GEORGIA 7 12 $6.69 4.5% 7 12 HAWAII 4 14 $5.67 3.8% 4 14 IDAHO 8 14 $4.02 2.7% 8 14 ILLINOIS 5 6 $1.74 1.2% 5 6 INDIANA 10 12 $3.00 2.0% 10 12 IOWA 14 21 $12.52 8.3% 14 21 KANSAS 3 4 $0.68 0.5% 3 4 KENTUCKY 2 2 $0.18 0.1% 2 2 MAINE 4 5 $1.37 0.9% 4 5 MICHIGAN 6 8 $1.70 1.1% 6 8 MINNESOTA 13 13 $4.00 2.7% 14 14 MISSISSIPPI 5 5 $1.29 0.9% 5 5 MISSOURI 8 13 $7.52 5.0% 8 13 MONTANA 7 10 $3.87 2.6% 7 10 NEBRASKA 4 4 $1.53 1.0% 4 4 NEW HAMPSHIRE Not on this list 1 1 NEW MEXICO 13 24 $6.31 4.2

% 13 25 
CMS-1498-P2 79 

NAME 

Number of 

Counties with 

Eligible 

Hospitals 

under 

WBHO 

Number of 

Eligible 

Hospitals 

under 

WBHO 

Payments under WBHO 

(in millions) 

Percentage 

of payment 

Number of 

Counties 

with 

Eligible 

Hospitals 

under 

WBO 

Number 

of 

Eligible 

Hospitals 

under 

WBO 

u

(

NEW YORK 28 51 $17.36 11.6% 28 51 NORTH CAROLINA 7 7 $1.08 0.7% 7 7 NORTH DAKOTA 3 5 $3.53 2.4% 3 5 OHIO 2 2 $0.21 0.1% 2 2 OKLAHOMA 1 1 $0.40 0.3% 1 1 OREGON 9 21 $8.96 6.0% 9 21 PENNSYLVANIA 9 13 $6.24 4.2% 9 13 SOUTH CAROLINA 1 1 $0.91 0.6% 1 1 SOUTH DAKOTA 11 19 $5.70 3.8% 11 19 TEXAS 3 3 $0.48 0.3% 3 3 UTAH 8 11 $0.74 0.5% 9 12 VERMONT 2 2 $0.36 0.2% 2 2 VIRGINIA 27 30 $14.54 9.7% 27 30 WASHINGTON 6 13 $5.67 3.8% 6 13 WEST VIRGINIA 2 2 $0.08 0.1% 2 2 WISCONSIN 23 40 $12.52 8.3% 23 40 WYOMING 2 3 $0.99 0.7% 2 3 Total 273 415 $150,000,000 100% 276 419 $
CMS-1498-P2 80 

F. Rural Community Hospital Demonstration Program

1. Background 

Section 410A(a) of the Medicare Prescription 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 demonstration pays rural community hospitals for such services under 

 cost based methodology for Medicare payment purposes for covered inpatient hospital 

services furnished to Medicare beneficiaries. A rural community 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 beds in a distinct part psychiatric or 

rehabilitation unit) as reported in its most recent cost report; 

● Provides 24-hour emergency care services; and 

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

Act. 

Subsection 410A(a)(4) of the MMA, in conjunction 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 community 
CMS-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, Statistical 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 program 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 demonstration program. Four 

additional hospitals were selected to participate under this solicitation. These four 

additional hospitals began under the demonstration payment 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 paid more for Medicare inpatient services under 

the rebasing allowed under the SCH methodology allowed by the Medicare Improvement 

for Patients and Providers Act of 2008 (Pub. L. 110-275). The other hospital restructured 

to become a CAH.) For purposes of the analyses 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 passage of Pub. L. 111-148 and 2 hospitals that 

concluded the demonstration in December 2009 upon the conclusion of their initial 
CMS-1498-P2 82 

demonstration period). For the 2 hospitals that concluded the demonstration in December 

2009, we assume that they will continue the demonstration 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 those 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 required a 5-year demonstration period of 

participation. Prior to the enactment of Pub. L. 111-148, for the seven currently 

participating hospitals that began the demonstration during FY 2005 ("originally 

participating hospitals"), the demonstration 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 participating hospitals that began 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 under this section, the Secretary shall ensure that the 

aggregate payments made by the Secretary do not exceed the amount which the Secretary 

would have paid if the demonstration program under this section was not implemented." 

This requirement is commonly referred to as "budget neutrality". 

 Generally, when we implement a demonstration program on a budget neutral 

basis, the demonstration program is budget neutral in its own terms; in other words, the 

aggregate payments to the participating hospitals do not exceed the amount that would be 

paid to those same hospitals in the absence of the demonstration program. Typically, this 
CMS-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 participants. These reduced expenditures offset increased 

payments elsewhere under the demonstration program, thus ensuring that the 

demonstration program as a whole is budget neutral or yields savings. However, the 

small scale of this demonstration program, in conjunction with the payment methodology, 

makes it extremely unlikely that this demonstration program could be viable under the 

usual form of budget neutrality. Specifically, cost-based payments to participating small 

rural hospitals are likely to increase Medicare outlays without producing any offsetting 

reduction in Medicare expenditures 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 other 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 added costs of this demonstration program, 

thus applying budget neutrality across the payment 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 statutory budget neutrality requirements permits the 
CMS-1498-P2 84 

agency to implement the budget neutrality provision in this manner. 

In light of the statute's budget neutrality 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 purpose 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 extension 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 hospitals 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 2011 
CMS-1498-P2 85 

demonstration costs associated with the participation of up to 20 new hospitals; and (4) a 

factor by which the cost of the demonstration 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 section 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 the last day of the initial 5-year period, the Secretary shall 

provide for the continued participation of such rural hospital in the demonstration 

program during the 5-year extension unless the hospital makes an election, in such form 

and manner as the Secretary may specify, to discontinue such participation. (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 addition, 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 by 
CMS-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 criteria 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 demonstration during the 5-year extension 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 provides that the amount of payment under 

the demonstration program for covered inpatient hospital 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 reasonable costs of providing such services for 

discharges occurring in the first cost reporting 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 changes were made to section 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 demonstration 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, the 
CMS-1498-P2 87 

proposed budget neutrality adjustment would account for: (1) the estimated costs of the 

demonstration in FY 2011 for the 10 currently participating hospitals; (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 hospitals selected to participate in the 

demonstration; and (4) the amount 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 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 the Demonstration of the Ten Currently Participating 

Hospitals 

The component of the proposed FY 2011 budget neutrality adjustment to the 

national IPPS rates that accounts for the estimated 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 participated in the demonstration since its 

inception and that, as explained previously, we consider 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. Different methods are used because 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 participation in the demonstration in 2008. 

Because the hospitals that began the demonstration in 2008 have no settled cost reports 

for the demonstration, we are using as submitted 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 the 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 indicates that they will choose to 

continue to avail themselves of the levels of reimbursement under the demonstration. 

The estimate of the portion of the proposed budget neutrality adjustment that 

accounts for the estimated costs of the demonstration in FY 2011 for the 7 "originally 

participating hospitals" is based on data from their second year 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 hospitals that joined the demonstration in 2008 

based on data from each of their cost reporting periods beginning January 1, 2008. 

Similarly, we propose to use these cost reports because they are the most recent cost 

reports and thus we believe they enable us to estimate FY 2011 costs for these 2 hospitals 

as accurately as possible. Since one of the 4 hospitals that began in 2008 has withdrawn, 

there is one hospital remaining among those that began in that year. The remaining 
CMS-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 inpatient costs and payments submitted by the 

hospital for the cost reporting period October 1, 2005 through September 30, 2006. We 

are proposing to use this data because it represents 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 relatively small provider serving 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 participating, the total 

estimated cost is $20,930,484. This estimated amount reflects the difference between 

these 10 participating hospitals' 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 estimated 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 prospective payment system were in effect. 

For each hospital, the difference between these two amounts is updated according to the 

market basket update factors for inpatient hospital costs reported 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 volume 
CMS-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 amended by section 10313 of Pub. L. 111-148, 

provided for the continued participation 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 "originally participating 

hospitals" (those hospitals that have participated in the demonstration 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 the demonstration before the 

conclusion of FY 2010 would continue to participate for the remainder of FY 2010 and 

beyond as applicable. Section II.F.3. of the 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 into 
CMS-1498-P2 91 

account costs of the demonstration for those hospitals beyond the anticipated end date of 

their initial demonstration period. (For example, 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 for the estimated costs for this hospital for the remaining 

three months of FY 2010.) We are proposing to include a component in the FY 2011 

budget neutrality adjustment to account for the estimated costs of the demonstration in 

FY 2010 that were not accounted for in the FY 2010 IPPS/RY 2010 LTCH PPS final rule 

for the seven "originally participating 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 divide the number of months that 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 for each of the seven "originally 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 seven "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 hospital. 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 demonstration for FY 2010 for the seven "originally 
CMS-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 payment amount in that cost report year for 

Medicare inpatient services) and the dollar amount 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 participating hospitals", is updated according to the 

market basket updates for inpatient hospital costs reported 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 hospitals" 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 "originally participating 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 case of the two hospitals that ended active 

participation in the demonstration program in December 2009, they were participating as 

of the last day of their 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 Newly 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 extension period, not more than 30 rural community 

hospitals may participate in the demonstration program under this section." 

Consequently, up to 20 additional hospitals may be added to the demonstration (30 

hospitals minus the 10 currently participating hospitals). In order to ensure budget 

neutrality for 20 new participating 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 hospitals. For purposes of estimating the FY 

2011 costs of the demonstration for 20 new hospitals, we are proposing to estimate such 

costs from the average annual cost per hospital derived from the estimate of the 10 

currently participating hospitals' costs attributable to the 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 demonstration hospitals shows a wide variation in 

costs among the hospitals. Given the wide variation in cost profiles that might occur for 

additional hospitals, we believe that estimating the total demonstration cost for FY 2011 

for 20 additional hospitals from the average annual cost of the currently existing hospitals 

yields the most accurate prediction because it is reflective of the historical trend of 
CMS-1498-P2 94 

participant behavior under the demonstration and should give an accurate as possible 

prediction of future participant 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 demonstration 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 subsection (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 Demonstration 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 incorporate 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 participating 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 costs of the demonstration program according 

to the settled cost reports that began in FY 2007 for the then participating hospitals 
CMS-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 participating hospitals because they correspond 

most precisely to FY 2007 and we therefore believe correctly represent FY 2007 inpatient 

costs for the demonstration during that period). 

• Step Two: Subtract the amount that was offset by the budget neutrality 

adjustment for FY 2007 ($9,197,870) from the costs of the demonstration in FY 2007 as 

calculated in step one; and 

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

calculate a factor that would 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 neutrality 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 demonstration is budget neutral for FY 2007. 

 Because the settlement process for the demonstration hospitals' third year 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 

corresponding to FY 2007 and as a result are 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 reports beginning in FY 2007 for hospitals that 

participated during FY 2007 to be settled before the FY 2011 IPPS/LTCH final rule is 
CMS-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 costs corresponding to FY 2007 exceeded the 

amount offset by the budget neutrality adjustment 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 attributable to the demonstration for the respective component 

of the overall estimated calculation of the budget neutrality factor for FY 2011. This 

estimated amount is based on the specific assumptions 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 reports. 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 rates 
CMS-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 factor 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 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 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 capital-related outlier payments 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 establishes the payment rules for outpatient services 

furnished by a critical access hospital (CAH). 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. Specifically, 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 reasonable costs of the CAH in providing such 

services (the physician or other practitioner providing the professional service receives 
CMS-1498-P2 98 

payment under the Medicare Physician Fee Schedule). In the alternative, the CAH may 

make an election, under section 1834(g)(2) of the 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 otherwise paid for professional services under 

Medicare, less the applicable Medicare deductible and coinsurance amount. The election 

made under section 1834(g)(2) of the Act is sometimes referred to as "method II" or "the 

optional method." Throughout this section of this 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 payment 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 the phrase "equal to 101 percent of" before the 

phrase "the reasonable costs." However, the 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 section 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 furnishing 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 operated by a critical access hospital, but only if the critical 

access hospital or entity is the only provider or supplier of ambulance services that is 
CMS-1498-P2 99 

located within a 35-mile drive of such critical access hospital." 

Section 3128(a) of Pub. L. 111-148 amended sections 1834(g)(2)(A) and 

1834(l)(8) of the Act by inserting "101 percent of" before "the reasonable costs." As 

such, section 3128(a) increases payment for outpatient facility services under the optional 

method and payment for ambulance services furnished by a CAH or an entity owned and 

operated by a CAH, to 101 percent of reasonable costs. Section 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 general, inpatient, outpatient, and covered SNF services provided 

by a CAH would be reimbursed at 101 percent of reasonable cost, was applicable to 

payments for services furnished during cost reporting periods beginning 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 reasonable cost. Accordingly, regardless 

of whether a physician/practitioner has reassigned his/her billing rights to the CAH, 

payment for CAH facility services will be made at 101 percent of reasonable costs. In 

addition, we are proposing to implement the change in payment for ambulance services 

provided by section 3128 of Pub. L. 111-148 by amending 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 ambulance services furnished by a CAH or an entity that is 
CMS-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 within a 35-mile drive of the CAH or the entity. 

 We note that we do not believe these proposals 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 reasonable 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, Medicaid, and SCHIP Extension Act of 

2007 (MMSEA) (Pub. L. 110-173) was enacted. 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-year delay in the application of certain 

provisions of the payment adjustment for short-stay outliers (SSOs), and section 

114(e)(4)(1)and (2) which specified revisions to the RY 2008 standard Federal rate for 

LTCHs. The May 22, 2008 IFC implemented section 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 IFC 
CMS-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 revised regulations at §412.523(d)(3) implementing section 

114(c)(4) of MMSEA. Our regulations provided 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 American 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 comments and finalized the MMSEA provisions in the May 6, 2008 

and the May 22, 2008 IFCs that had not otherwise 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 and 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 section 
CMS-1498-P2 102 

10312 of Pub. L. 111-148 provides for a 2-year extension 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 Federal rate, the 25 percent 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 incorporate those changes. In the sections below, we will 

briefly describe each of these policies and propose to incorporate 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 cases 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) that 
CMS-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 specific 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 formula, 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 Secretary shall not apply the amendments finalized on May 11, 2007 

(72 FR 26992) made to the short-stay outlier payment provision for long-term care 

hospitals contained in §412.529(c)(3)(i) or any similar provisions for the 3-year period 

beginning on the date of enactment of this Act [December 29, 2007]. Section 114(c)((3) 

of the MMSEA as amended by section 3106(a) of the Pub. L. 111-148, and as amended 
CMS-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 application of §412.529(c)(3)(i) is changed 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 (December 29, 2007) the policy at §412.529(c)(3)(i). 

We note that this provision of the law is self-implementing and in this supplementary 

proposed rule, we are proposing to incorporate 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 possibility 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 enacted 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 effect of this provision was that no one-time 
CMS-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 section 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 beginning on the date of the enactment of MMSEA 

(December 29, 2007) the one-time prospective adjustment provided for in 

§412.523(d)(3). We note that this provision of the law is self-implementing and we are 

proposing to incorporate existing law regarding this additional 2-year 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 section 
CMS-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 delay in application of the 25 percent patient threshold amount 

under §412.534 and §412.536 for certain LTCHS and 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 amended. 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 provision of the law is self-implementing. 

With respect to section 114(c)(1) of MMSEA as amended by ARRA (Delay in 

Application of [the] 25 Percent Patient Threshold Payment Adjustment), section 3106(a) 

of the Pub. L. 111-148 and as further amended 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 MMSEA 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 period—(A) §412.536 of title 42, Code of Federal 

Regulations, or any similar provision, to free standing long-term care hospitals or to a 

long-term care hospital, or satellite facility, that as of December 29, 2007, was co-located 

with an entity that is a provider-based, off-campus location of a subsection (d) hospital 

which did not provide services payable under section 1886(d) of the Act at the offcampus location; and (B) such section or §412.534 of title 42, Code of Federal 
CMS-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 provisions 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 MMSEA as amended by ARRA and section 

3106(a) of Pub. L. 111-148 and as amended 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 described in §412.22(h)(3)(i) of title 42, Code of Federal Regulations) for 

a 5-year period.) The effect of this self-implementing effective date change is that under 

section 114(c)(2)(A) of MMSEA the time period 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-located with an urban single or MSA-dominant 

hospital, under 42 CFR 412.534(d) and (e) is increased 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 paragraphs (d) and (e), of 

42 CFR 412.534, shall not be subject to any payment adjustment under such section if no 

more than 75 percent of the hospital's Medicare discharges (other than discharges 

described in paragraph (d)(2) or (e)(3) of such section are admitted from a co-located 
CMS-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-described self-implementing the Affordable 

Care Act changes by extending the sunsetting of the threshold percentage increase an 

additional 2 years, to cost reporting periods beginning on or after October 1, 2012, as 

applicable, July 1, 2007 for a satellite facility described in 42 CFR 412.22(h)(3)(i).) 

In addition, the change in the effective date change required in section 

114(c)(2)(C) of MMSEA, as amended by ARRA and the Affordable Care Act , is that the 

time period during which the increased percentage threshold applicable to an "applicable" 

LTCH or satellite, as defined 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 period. Thus, for the 5-year period beginning 

on or after October 1, 2007, payment to an "applicable" LTCH or LTCH satellite facility 

that is co-located with another hospital shall not be subject to any payment adjustment 

under §412.534 if no more than 50 percent of the 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 incorporate this self-implementing 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 additional 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 period beginning on the date of enactment of 

this Act on December 29, 2007, the Secretary shall impose a moratorium "subject to 

paragraph (2), on the establishment and classification of a long-term care hospital or 

satellite facility, other than an existing long-term care hospital 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 unamended provides for exceptions to the 

moratorium on the development of a LTCH or LTCH satellite facility, other than an 

existing LTCH or LTCH satellite facility, imposed by section 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).) Specifically, under this MMSEA provision, the 

moratorium, is effective from December 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 hospital 
CMS-1498-P2 110 

under section 412.23(e) of title 42, Code 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 certificate 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 shall 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 following the closure or the decrease in the 

number of beds of another long-term care hospital 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 another 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 or 
CMS-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 that was issued on or after April 1, 2005, and 

before December 29, 2007, ...." Accordingly, 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 amended 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 date 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 Market 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 specific 
CMS-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 those 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 implementing 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 established revised RY 2010 rates 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. Furthermore, section 1886(m)(3)(A)(i) of the Act 

specifies that for rate year 2012 and subsequent rate years, any 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. Section 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 0.50 
CMS-1498-P2 113 

percentage point reduction for rate year 2011. Section 1886(m)(3)(B) of the Act provides 

that the application of paragraph 3 of 1886(m) of the Act may result in the 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. 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 IPPS/LTCH PPS proposed rule, since 

the annual update to the LTCH PPS policies, rates and factors now occurs on October 1st

, 

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 section 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 subsequent years because it is our intent that 
CMS-1498-P2 114 

"FY" be used prospectively in all circumstances dealing with the LTCH PPS. 

3. Proposed Change to Reflect the Market 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 established 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 consistent with the provisions of section 

1886(m)(3) of the Act as added by section 3401(c) of Pub. L. 111-148, and section 

1886(m)(4) of the Act as added by section 3401(c) of Pub. L. 111-148 and amended by 

section 10319(b) of Pub. L. 111-148, as further 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 for each of RYs 2010 through 2019, the annual 

update to the standard Federal rate is reduced by the "other 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 point reduction to the annual update to the standard Federal 

rate for RY 2010. Section 1886(m)(3)(A) of the Act on its face explicitly provides for a 

revised annual update to the standard Federal rate beginning RY 2010, thus resulting in a 

single revised RY 2010 standard Federal rate. Section 3401(p) of the Pub. L. 111-148 
CMS-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, discharges occurring on or after October 1, 

2009 and before April 1, 2010, simply will not be based on the revised RY 2010 standard 

Federal rate. 

As discussed in a separate notice published elsewhere in this Federal Register, 

consistent with our historical 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 annual update for RY 2010 is based on the full 

forecasted estimated increase in the LTCH PPS market basket for RY 2010 of 

2.5 percent, adjusted by the 0.25 percentage 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) resulting 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 September 30, 2010, is the standard Federal rate 

for the previous rate year updated by 1.74 percent. Furthermore, consistent with section 

3401(p) of Pub. L. 111-148, we are also proposing to revise §412.523(c)(3)(vi) to specify 

that with respect to discharges occurring on or after October 1, 2009 and before 
CMS-1498-P2 116 

April 1, 2010, payments are based on the standard Federal rate in §412.523 (c)(v) 

updated by 2.0 percent (that is, a standard Federal rate 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 supplemental proposed rule, we are proposing to 

incorporate existing law regarding the 0.25 percentage point reduction to the annual 

update to the standard Federal rate for RY 2010 (including the 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, long-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 forecast, with historical data through the 2009 

fourth quarter, of the FY 2002-based RPL market basket increase. 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 changed. Furthermore, as also stated in 

the May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, consistent with our historical 

practice of using market basket estimates based on the most recent available data, we 
CMS-1498-P2 117 

propose that if more recent data are available when we develop the final rule, we would 

use such data, if appropriate. 

 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 RYs 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. Furthermore, section 1886(m)(3)(A)(i) of the Act 

specifies that for rate year 2012 and each subsequent rate year, any 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 required in section sections 1886(m)(4)(B) of 

the Act. Again, we note that consistent with our historical practice of using market 

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

data are available when we develop 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 Addendum 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) and 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" required 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 requires us to revise the proposed relative weights for the MSLTC-DRGs for FY 2011. This is the case since our established methodology for updating 

the annual update to the MS-LTC-DRG classifications and relative weights in a budget 

neutral manner requires that estimated aggregate LTCH PPS payments would be 

unaffected. That is, under the budget neutrality requirement estimated 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. (step 7) of the preamble of the May 4, 2010 
CMS-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 apply a normalization 

factor to the proposed recalibrated relative weights to ensure that estimated payments are 

not influenced by changes in the composition 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 relative weights (that is, the process itself) 

neither increases nor decreases the average 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 independent of the standard Federal rate. (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 determining the proposed FY 2011 

MS-LTC-DRG relative weights (75 FR 24042 through 24043).) Therefore, this step was 

not revised for this supplemental proposed rule. 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 provisions of newly added sections 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, consistent 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 payments simulations after using the proposed FY 2011 standard 

Federal rate that reflects the reductions required by sections 1886(m)(3)(A)(ii) and (4)(A) 

and (B) of the Act (discussed 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 described 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 (Version 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-step budget neutrality methodology, in 

determining the proposed FY 2011 MS-LTC-DRG relative weights, each normalized 
CMS-1498-P2 121 

proposed relative weight (determined as described 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 budget neutral FY 2011. (We note that in 

determining the proposed FY 2011 budget neutral MS-LTC-DRG relative weights for this 

supplemental proposed rule, with the exception 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 using the best available data, 

we are proposing to use the most recent available 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 normalization 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-DRGs 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 payments 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 published in Table 11 of the May 4, 2010 FY 2011 
CMS-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 Information Requirements

 This document does not impose information collection and recordkeeping 

requirements. Consequently, it need not be reviewed by the Office of Management and 

Budget under the authority of the Paperwork Reduction Act of 1995 

(44 U.S.C. Chapter 35). 

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 period, as provided in section 1871(b)(1) of the Act. This 

period, however, may be shortened, as provided under section 1871(b)(2)(C) of the Act, 

when the Secretary finds good cause that a 60-day comment period would be 

impracticable, unnecessary, or contrary to the public interest and incorporates a statement 

of the finding and its reasons in the rule issued. 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 Pub. 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 changes 
CMS-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 supplemental proposed rule would be both 

impracticable and contrary to the public interest because it would not allow for 

coordinated consideration 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 the 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 process the comments and respond to them in a 

meaningful manner by the August 1, 2010 date for issuing the final rule. If we allowed 

for a full 60-day comment period, timely filed 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 comments and appropriately 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-day comment period for this rule of proposed 

rulemaking, and we are instead providing for 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 public comments we normally receive on Federal 

Register documents, we are not able to acknowledge 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 proceed 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, Health facilities, Medicare, Puerto Rico, 

Reporting and recordkeeping 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 the 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 inpatient operating costs for Federal fiscal year 2005 and 

subsequent fiscal years. 

* * * * * 

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

years. 

 (1) Subject to the provisions of paragraph (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 this 
CMS-1498-P2 127 

subchapter) for hospitals in all areas. 

 (ii) For fiscal year 2010, for discharges-- 

 (A) On or after October 1, 2009 and before April 1, 2010, the percentage increase 

in the market basket index for prospective payment hospitals (as defined in § 413.40(a) of 

this subchapter) for hospitals in all areas; and 

 (B) On or after April 1, 2010 and before October 1, 2010, the percentage increase 

in the market basket index minus 0.25 percentage 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 percentage increase in the market basket index 

minus 0.25 percentage points for prospective payment hospitals (as 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 rural floor under section 4410 of the Balanced 

Budget Act of 1997 (Pub. L. 105–33) and the imputed 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 adjustment is transitioned from a nationwide 

to a statewide adjustment as follows: 

(A) From October 1, 2008 through September 30, 2009, the wage index is a blend 

of 20 percent of a wage index with a statewide adjustment and 80 percent of a wage index 
CMS-1498-P2 128 

with a nationwide adjustment. 

(B) From October 1, 2009 through September 30, 2010, the wage index is a blend 

of 50 percent of a wage index with a statewide adjustment and 50 percent of a wage index 

with a nationwide adjustment. 

(ii) Beginning October 1, 2010, such adjustment 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 qualifying frontier State meets the 

both of the following criteria: 

(i) At least 50 percent of counties located 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 adjustment determined by 

the Secretary to take into account the unique circumstances 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 Estimate data published by the U.S. Census Bureau to 

determine county definitions and population density. This analysis 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 attributable to this provision in its annual 

updates to the hospital inpatient 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 hospital 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 prospective payment hospitals (as defined in 

§413.40(a) of this chapter). 

(16) For Federal fiscal year 2010 and subsequent years. For Federal fiscal year 

2010 and subsequent years, the update factor is the percentage increase specified in 

§412.64(d). 

* * * * * 

§ 412.75 [Amended] 

 5. In §412.75, paragraph (d) is amended by removing the citation 
CMS-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 amended 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 payment 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 individuals whose inpatient benefits 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 payment 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 hospital must have less than 200 total 

discharges, which includes Medicare and non-Medicare discharges, during the fiscal year, 

as reflected in its cost report specified in paragraph (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 hospital must have less than 1600 Medicare 

discharges, as defined in paragraph (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 section, 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 includes Medicare and non-Medicare, during the fiscal year, as 

reflected in its cost report specified 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 the 
CMS-1498-P2 132 

determination of the discharge count for purposes of determining 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 documentation of Medicare discharges (as 

defined in paragraph (a) of this section). 

 (4) In order to qualify for the adjustment, 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 contractor 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 paragraph (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 15.0000
CMS-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 indicates that it meets discharge requirements 

during the applicable fiscal year and has provided its fiscal intermediary or Medicare 

administrative contractor with sufficient evidence that it meets the distance requirement, 

as specified under paragraph (b)(2) of this section. 

§ 412.108 [Amended] 

10. Section 412.108 is amended as follows: 

A. In paragraph (a)(1) introductory text the phrase "before October 1, 2011" is 

removed and the phrase "before October 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 October 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 subsequent 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 subchapter) for hospitals in all areas. 

 (3) For fiscal year 2011, increased by the applicable percentage change specified 

in §412.64(d)(1)(iii). 

* * * * * 

§ 412.230 [Amended] 

 12. In §412.230 paragraph (d)(1)(iv)(E) is amended by removing the figures "86" 

and "88" adding the figures "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 adding the phrase "December 29, 2012," in its 

place. 

The revision and addition read as follows: 

§ 412.523 Methodology for calculating the Federal prospective payment rates. 

* * * * * 

(c) * * * 

(3) * * * 

(vi) For long-term care hospital prospective 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 described in paragraph (d) of this section. 

(B) With respect to discharges occurring on or after October 1, 2009 and before 

April 1, 2010, payments are based on the standard Federal rate in paragraph (c)(3)(v) of 

this section updated by 2.0 percent. 

(vii) For long-term care hospital prospective payment system fiscal year beginning 
CMS-1498-P2 136 

October 1, 2010, and ending September 30, 2011. The standard Federal rate for the 

long-term care hospital prospective payment system fiscal year beginning 

October 1, 2010, and ending September 30, 2011, is the standard Federal rate for the 

previous long-term care hospital prospective payment system rate year updated by 

-0.59 percent. The standard Federal rate is adjusted, as appropriate, as described in 

paragraph (d) of this section. 

* * * * * 

§ 412.529 [Amended] 

 16. In §412.529, paragraphs (c)(2) introductory text and (c)(3) introductory text 

are amended by removing the date "December 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 REASONABLE 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 Security 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 paragraph (b)(5)(i) as (b)(5)(i)(A). 

 C. In newly redesignated paragraph (b)(5)(i)(A), the phrase "on or after 

December 21, 2000," is removed and the phrase "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 services for which payment may be made under 

paragraph (b)(3)(ii)(B) of this section, 101 percent 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 periods 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 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 within a 35-mile drive of the CAH or the entity. 

* * * * * 
CMS-1498-P2 

Authority: (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare--

Hospital Insurance; and Program No. 93.774, Medicare--Supplementary 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-P
CMS-1498-P2 140 

[NOTE: The following Addendum and Appendix will not appear in the Code of 

Federal Regulations.] 

ADDENDUM: FY 2011 Supplemental 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 preamble 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, outlier threshold and standardized amounts. 

In the FY 2011 IPPS/LTCH PPS proposed rule we explained our methodology for 

calculating the FY 2011 proposed budget neutrality factors (75 FR 24062 through 24073). 

 Except as explained below, we apply this same methodology in recalculating these 

budget neutrality adjustments to reflect the changes to the standardized amount required 

by the Affordable Care Act. A complete discussion of our computation of the FY 2011 

proposed budget neutrality factors, outlier threshold and standardized amounts is found 

below. 

A. Updating the Average Standardized Amounts

As discussed section II.B. of the preamble 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 the 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 quality 
CMS-1498-P2 141 

information under rules established by the Secretary in accordance with section 

1886(b)(3)(B)(viii) of the Act. For hospitals that fail to submit quality data consistent 

with section 1886(b)(3)(B)(viii) of the Act, the update is equal to the market basket 

percentage increase minus a 0.25 percentage point less an additional 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 operating 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 standardized amount is 0.15 percent (that is, the adjusted FY 2011 

estimate of the market basket rate-of-increase of 2.15 percent minus 2.0 percentage 

points). 

B. Proposed Budget Neutrality Adjustments 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 reclassification and recalibration and updated 

wage index budget neutrality factor (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 required 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 applicable percentage 
CMS-1498-P2 142 

increase. Although these amendments modify 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. 

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 statute requires us to simulate the FY 2010 

hospital as if hospitals were paid for all of FY 2010 based on the FY 2010 rates that are 

effective for payments for discharges 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 neutrality factor of 1.000070 for changes to the 

wage index. We multiplied the proposed DRG 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 determine the proposed DRG reclassification and 

recalibration and updated wage index budget neutrality factor 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 resulting in our estimate that 23 additional hospitals will be 
CMS-1498-P2 143 

reclassified (or receive their 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 budget 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, effective beginning with the FY 

2009 wage index. In response to the public's concerns 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 neutrality 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 level 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 neutrality adjustment. However, section 3141 of 

Pub. L. 111-148 restores the budget neutrality adjustment 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 the national rural and 

imputed floor budget neutrality adjustment factor (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 national rural and imputed floor budget neutral 

wage index. 

E. Proposed Rural Community Hospital Demonstration Program Adjustment 

As discussed in section II.F. of the preamble to this supplemental proposed rule, 

section 410A of Pub. L. 108-173 requires the Secretary 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 requires 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 which 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 standardized amount to ensure the effects of the rural 

community hospital demonstration are budget neutral. However, section 450(a) of the 

MMA as amended by sections 3123 and 10313 of Pub. L. 111-148 extends the 
CMS-1498-P2 145 

demonstration for an additional 5 years, and 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 the 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 across the participants of this demonstration, consistent with 

past practice. We believe that the language of the statutory 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 adjustment. We note that because the settlement process for the 

demonstration hospitals' third year 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 corresponding to FY 2007 and as a result are unable 

to propose the specific numeric adjustment representing 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 that participated during FY 2007 to be settled 
CMS-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 discussed above). However, as discussed in 

section II.A. of the preamble to this supplemental 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 located 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 hospital in a Frontier State will receive a wage index 

lesser than 1.00 due to the rural and imputed floor adjustment. In accordance with section 

10324(a) of Pub. L. 111-148, the Frontier State adjustment will not be subject to budget 

neutrality, and will only be extended to hospitals geographically located within a Frontier 

State. However, for purposes of estimating the proposed outlier threshold for FY 2011, it 

is necessary to apply this provision by adjusting 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 this 
CMS-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 percent of total payments. 

 We are proposing an outlier fixed-loss cost 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 supplemental 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 discussed above), we computed the following 

proposed FY 2011 outlier adjustment factors that are applied to the proposed FY 2011 

standardized amount for the proposed 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 proposed 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 proposed 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 amounts shown in Tables 1A and 

1B differ only in that the labor-related share applied to the proposed standardized 

amounts in Table 1A is 68.8 percent, and the labor-related share applied to the proposed 

standardized amounts in Table 1B is 62 percent. 

 In addition, Tables 1A and 1B include 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 reduction 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 Affordable 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-related 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 labor-related share applied to the Puerto 

Rico-specific standardized amount is either 62.1 percent or 62 percent, 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: $1,920.18 
CMS-1498-P2 150 

which is more advantageous to the hospital.) 

I. Proposed Adjustments for Area Wage Levels

 The following wage index tables were revised 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 available 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 the 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 neutrality 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 included in that rule which did not reflect the 

provision of Pub. L. 111-148. For a complete description 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 framework 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-related 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 Federal 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 inpatient capital-related payments (which required an outlier 

adjustment factor of 0.9478) based on the capital Federal rate in FY 2010 (as discussed 

elsewhere in this Federal Register). Thus, we estimate that the percentage of capital 

outlier payments to total capital standard payments for FY 2011 would be higher than 
CMS-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 supplemental 

proposed rule, more cases would 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. Therefore, the net change in the outlier 

adjustment to the proposed capital Federal rate for FY 2011 is 0.9951 (0.9432/0.9478). 

Thus, the proposed outlier adjustment decreases the proposed FY 2011 capital Federal 

rate by 0.49 percent compared with 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 percent 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 the 
CMS-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 permanently into the capital rates; that is, 

they are applied cumulatively in determining the capital Federal rate. This follows the 

requirement that estimated aggregate payments each year be no more or less than they 

would have been in the absence of the annual DRG reclassification 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 Federal 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 that 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 Act (as discussed elsewhere in this Federal Register) 

were used in the calculation of the cumulative 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 adjustment factors for each fiscal year: 
CMS-1498-P2 154 

BUDGET NEUTRALITY ADJUSTMENT FOR DRG RECLASSIFICATIONS 

AND RECALIBRATION AND THE GEOGRAPHIC ADJUSTMENT FACTORS 

National Puerto Rico 

Incremental Adjustment Incremental Adjustment 

Fiscal 

Year 

Geographic 

Adjustment 

Factor 

DRG Reclassifications 

and 

Recalibration Combined Cumulative

Geographic 

Adjustment 

Factor 

DRG 

Reclassifications 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

20011 0.99782 1.00009 0.99791 0.99933 1.00365 1.00009 1.00374 1.00508

20012 0.997713 1.000093 0.997803 0.99922 1.003653 1.000093 1.003743 1.00508

2002 0.996664 0.996684 0.993354 0.99268 0.989914 0.996684 0.996624 0.99164

20035 0.99915 0.99662 0.99577 0.98848 1.00809 0.99662 1.00468 0.99628

20036 0.998967 0.996627 0.995587 0.98830 1.00809 0.99662 1.00468 0.99628

20048 1.001759 1.000819 1.002569 0.99083 1.00028 1.00081 1.00109 0.99736

200410 1.001649 1.000819 1.002459 0.99072 1.00028 1.00081 1.00109 0.99736

200511 0.9996712 1.00094 1.0006112 0.99137 0.99115 1.00094 0.99208 0.98946

200513 0.9994612 1.00094 1.0004012 0.99117 0.99115 1.00094 0.99208 0.98946

2006 1.0018514 0.99892 1.0007614 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

200915 1.00206 0.99945 1.00150 0.99170 1.00097 0.99945 1.00041 0.99595

201016 0.99989 0.99953 0.99941 0.99112 1.00141 0.99953 1.00094 0.99688

201117 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 through March 2001). 2 Factors effective for the second half of FY 2001 (April 2001 through 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 through March 2003). 6

Factors effective for the second half of FY 2003 (April 2003 through September 2003). 7

Incremental factors are applied to FY 2002 cumulative factors. 

8

Factors effective for the first half of FY 2004 (October 2003 through March 2004). 9

Incremental factors are applied to the cumulative factors for the second half of FY 2003. 

10Factors effective for the second half of FY 2004 (April 2004 through September 2004). 11Factors effective for the first quarter of FY 2005 (September 2004 through December 2004). 12Incremental factors are applied to average of the cumulative factors for the first half 

(October 1, 2003 through March 31, 2004) and second half (April 1, 2004 through September 30, 2004) of 

FY 2004. 

13Factors effective for the last three quarters of FY 2005 (January 2005 through September 2005). 14Incremental factors are applied to average of the cumulative factors for 2005. 

15Final factors for FY 2009, including the implementation of section 124 of Pub. L. 110-275, which affects 
CMS-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 proposed MS-DRG reclassifications and 

recalibration and for proposed changes in the 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 changes 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 documentation 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 national capital Federal payment rate in FY 2011, resulting in 

a cumulative documentation and coding adjustment factor of 0.957 for the proposed FY 
CMS-1498-P2 156 

2011 national capital Federal rate percent (that is, the existing -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 Standard Federal Rate for FY 2011

 As a result of the proposed 1.5 percent update and other proposed budget 

neutrality factors discussed above, we are proposing to establish 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 for FY 2011 affects the computation of the 

proposed FY 2011 national capital Federal rate in comparison to the FY 2010 national 

capital Federal rate (revised to reflect the effect 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 increasing the proposed capital Federal rate by 0.15 

percent compared to the FY 2010 capital Federal rate. The proposed FY 2011 outlier 

adjustment factor has the effect of decreasing the proposed capital Federal rate by 0.49 

percent compared to the FY 2010 capital Federal 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 patients' severity of illness (that is, the proposed 

cumulative adjustment factor of 0.957 has the net effect of decreasing the proposed FY 
CMS-1498-P2 157 

2011 national capital Federal rate by 2.8 percent as compared to the FY 2010 national 

capital Federal rate. The combined effect of all the proposed changes would decrease the 

proposed national capital Federal rate by approximately 1.72 percent compared to the 

FY 2010 national capital Federal rate. 

Comparison of Factors and Adjustments: 

FY 2010 Capital Federal Rate and 

Proposed FY 2011 Capital Federal Rate 

FY 2010* 

Proposed 

FY 2011 Change 

Percent 

Change 

Update Factor1 1.0120 1.0150 1.0150 1.50

GAF/DRG Adjustment Factor1 0.9994 1.0015 1.0015 0.15

Outlier Adjustment Factor2 0.9478 0.9432 0.9951 -0.49

Exceptions Adjustment Factor2 0.9998 0.9997 0.9999 -0.01

MS-DRG Documentation and 

Coding Adjustment Factor 0.98503 0.95704 0.97165 -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 factor 

for FY 2011 is a net change of 1.0015. 

2

 The outlier reduction factor and the exceptions adjustment factor are not built permanently into the capital rates; that is, these factors 

are not applied cumulatively in determining the capital rates. Thus, for example, the proposed net change resulting from the application 

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 reduction 

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, which reflects the effect of the provisions of the Affordable Care Act (as discussed

elsewhere in this Federal Register). 

G. Proposed Special Capital Rate 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 proposing 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 24015 
CMS-1498-P2 158 

through 24016 and 24081) for additional information 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 rates, 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 legislation, we were unable to address 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 rates and factors in a separate notice elsewhere is this 

Federal Register consistent with the provisions of sections 1886(m)(3) and (4) of the Act 
CMS-1498-P2 159 

and section 3401(p) of Pub. L. 111-148. 

2. Revision of Certain Market Basket Updates 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 rate, for discharges 

for the hospital for the rate year, shall be reduced 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 discharges occurring during the 

rate year, shall be reduced for rate year 2012 and each subsequent rate year by the 

productivity adjustment described 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 percentage point reduction for rate year 

2010 and a 0.50 percentage point reduction for rate year 2011. In addition, section 

1886(m)(3)(B) of the Act provides that the application of section 1886(m)(3) may result 

in the an 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. 

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 1st, 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 
CMS-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" 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 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 account 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 the 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 Rate 
CMS-1498-P2 161 

As discussed in the May 4, 2010 FY 2011 proposed 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 LTCH 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 practices that do not reflect increased patient 

severity of illness. Such an adjustment protects the integrity 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 VII.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 claims data (FY 2009) under both the current 

MS-LTC-DRG and the former CMS LTC-DRG patient 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, consistent 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 0.50 
CMS-1498-P2 162 

percentage point reduction required by sections 1886(m)(3)(A)(ii) and (4)(B) of the Act, 

and an adjustment to account for the increase in case-mix in a prior periods (FYs 2008 

and 2009) that resulted from changes in documentation and coding practices of 

-2.5 percent. Consequently, the proposed update factor to the 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 updating 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) and (4)(A) of the Act, as implemented in a 

separate notice published 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 standard Federal rate for discharges occurring 

on or after October 1, 2010, through September 30, 2011, is the standard Federal rate for 

the previous rate year updated by -0.59 percent. In determining 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 established elsewhere in this Federal Register). 

Consequently, the proposed standard Federal rate for FY 2011 is $39,560.16. We also 

are proposing that if more recent data become available, we would use those data, if 
CMS-1498-P2 163 

appropriate, to determine the update to the standard Federal rate for FY 2011 in the final 

rule, and, thus, the standard Federal 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 resource costs at the patient and hospital level. 

 These additional payments reduce the financial losses that would otherwise be incurred 

when treating patients who require 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 conjunction 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 the 
CMS-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 fixed-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 additional payments. We calculate the fixed-loss 

amount by estimating aggregate payments with and without an outlier policy. The 

fixed-loss amount results in estimated total outlier payments being projected 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 provider 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 section, the proposed policies and payment rates in 

the May 4, 2011 FY 2011 proposed rule do not reflect the provisions of the Affordable 

Care Act that affect LTCH PPS payments. The revised proposed standard Federal rate for 

FY 2011 that was developed consistent with the provisions of sections 1886(m)(3)(A)(ii) 
CMS-1498-P2 165 

and (4)(B) of the Act is discussed 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 maintain 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 for each case using claims data from the 

MedPAR files. Specifically, to determine the outlier payment 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 (the sum of the adjusted Federal prospective 

payment for the MS-LTC-DRG and the fixed-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 Federal 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 for 
CMS-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 proposed rule.) Consistent with the 

historical practice of using the 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. Furthermore, 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 Version 28.0 of the GROUPER (discussed in 

section VII.D. of the preamble of this supplemental proposed rule). 

In this proposed rule, we are proposing to establish a fixed-loss amount of 

$19,254 for FY 2011. Thus, we would pay an outlier case 80 percent of the difference 
CMS-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 standard 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.) Maintaining 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 larger. For these reasons, we believe that 

proposing to raise the fixed-loss amount is appropriate 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. In 
CMS-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 eligible 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 threshold (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 standard Federal rate is adjusted to 

account for differences in area wages by multiplying 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 Addendum 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 nonlabor-related share of the proposed standard 

Federal rate by the appropriate cost-of-living factor (shown 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 establish 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 proposed rule). The Medicare patient is 

classified into MS-LTC-DRG 28 (Spinal Procedures 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-adjusted 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 proposed wage index value 

(1.0573). This wage-adjusted amount is then added to the proposed nonlabor-related 

portion of the unadjusted proposed standard Federal rate (24.593 percent; adjusted for 

cost of living, if applicable) to determine the adjusted proposed 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 components 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 0.75407 

Labor-Related Portion of the Proposed Federal Rate = $29,831.13

Proposed Wage Index (CBSA 16974) x 1.0573

Proposed Wage-Adjusted Labor Share of Federal Rate = $31,540.45

Proposed Nonlabor-Related Portion 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 1.0834 

Total Adjusted Federal Prospective Payment = $44,711.36

IV. Tables 

 This section contains the tables referred 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. The tables presented below are as follows: 

Table 1A.—Supplemental Proposed National Adjusted 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 Adjusted 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/Nonlabor 
CMS-1498-P2 171 

Table 1D.—Supplemental Proposed Capital Standard Federal Payment Rate 

Table 1E.—Supplemental Proposed LTCH Standard Federal Prospective Payment Rate 

Table 2.—Acute Care Hospitals Case-Mix Indexes for Discharges 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 Index and Capital Geographic Adjustment 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 Index and Capital Geographic Adjustment Factor (GAF) for 

 Acute Care Hospitals That Are Reclassified 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 Adjustment for Acute Care Hospitals--FY 2011 

Table 9A.--Hospital Reclassifications and Redesignations--FY 2011 

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 

Table 11.—Supplemental Proposed MS-LTC-DRGs, Relative Weights, Geometric 
CMS-1498-P2 172 

 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 

TABLE 1A.—SUPPLEMENTAL PROPOSED NATIONAL ADJUSTED 

OPERATING STANDARDIZED AMOUNTS, 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 AMOUNTS, 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 PROPOSED 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 $933.00
CMS-1498-P2 173 

TABLE 1D.--SUPPLEMENTAL PROPOSED CAPITAL STANDARD FEDERAL 

PAYMENT RATE 

Rate 

National $422.18

Puerto Rico $199.49

TABLE 1E.—SUPPLEMENTAL PROPOSED LTCH STANDARD FEDERAL 

PROSPECTIVE PAYMENT RATE 

Rate 

Standard Federal Rate $39,560.16
CMS-1498-P2 174 

TABLE 2.--HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING 

IN FEDERAL FISCAL YEAR 2009; 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 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.3192 
CMS-1498-P2 175 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.9872 
CMS-1498-P2 176 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 40.2757 
CMS-1498-P2 177 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 33.8318 
CMS-1498-P2 178 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 39.6384 
CMS-1498-P2 179 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.0306 
CMS-1498-P2 180 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 34.9615 
CMS-1498-P2 181 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 43.2693 
CMS-1498-P2 182 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 45.8667 
CMS-1498-P2 183 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 38.1228 
CMS-1498-P2 184 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 37.7770 
CMS-1498-P2 185 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 40.7032 
CMS-1498-P2 186 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 40.6385 
CMS-1498-P2 187 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 39.1776 
CMS-1498-P2 188 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.7053 
CMS-1498-P2 189 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 36.5232 
CMS-1498-P2 190 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.6418 
CMS-1498-P2 191 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 34.4150 
CMS-1498-P2 192 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.5877 
CMS-1498-P2 193 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 33.5895 
CMS-1498-P2 194 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 * 33.3214 
CMS-1498-P2 195 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.2189 
CMS-1498-P2 196 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.8138 
CMS-1498-P2 197 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 34.7521 
CMS-1498-P2 199 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.6723 
CMS-1498-P2 200 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 24.1197 
CMS-1498-P2 201 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.2289 
CMS-1498-P2 202 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

140B103 *** * 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 33.3236 
CMS-1498-P2 203 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 33.4793 
CMS-1498-P2 204 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.9202 
CMS-1498-P2 205 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.6820 
CMS-1498-P2 206 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 32.9236 
CMS-1498-P2 207 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 32.1347 
CMS-1498-P2 208 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 33.2334 
CMS-1498-P2 209 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.3847 
CMS-1498-P2 210 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 30.1295 
CMS-1498-P2 211 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.8815 
CMS-1498-P2 212 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.9390 
CMS-1498-P2 213 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 20.4547 
CMS-1498-P2 214 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 22.8901 
CMS-1498-P2 215 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 27.0083 
CMS-1498-P2 216 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.6638 
CMS-1498-P2 217 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.2516 
CMS-1498-P2 218 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 34.8867 
CMS-1498-P2 219 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

Average 

Hourly 

Wage** (3 

years) 

220B744 *** * 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 30.3037 
CMS-1498-P2 220 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.1980 
CMS-1498-P2 221 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

230B045 *** * 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 29.7561 
CMS-1498-P2 222 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 34.4959 
CMS-1498-P2 223 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.7231 
CMS-1498-P2 224 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 27.5667 
CMS-1498-P2 225 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.1932 
CMS-1498-P2 226 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.6092 
CMS-1498-P2 227 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 32.1198 
CMS-1498-P2 228 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.9891 
CMS-1498-P2 230 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 36.5086 
CMS-1498-P2 231 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.7917 
CMS-1498-P2 232 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.9078 
CMS-1498-P2 233 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 35.6963 
CMS-1498-P2 234 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 40.3486 
CMS-1498-P2 235 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 36.0995 
CMS-1498-P2 236 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 50.6852 
CMS-1498-P2 237 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 38.5494 
CMS-1498-P2 238 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 41.8352 
CMS-1498-P2 239 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 31.4428 
CMS-1498-P2 240 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.0896 
CMS-1498-P2 241 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 * * 23.9795 
CMS-1498-P2 242 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.3785 
CMS-1498-P2 243 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.5853 
CMS-1498-P2 244 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 31.5024 
CMS-1498-P2 245 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 35.3416 
CMS-1498-P2 246 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 21.6824 
CMS-1498-P2 247 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 24.5055 
CMS-1498-P2 248 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.8091 
CMS-1498-P2 250 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.4676 
CMS-1498-P2 251 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.3417 
CMS-1498-P2 252 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 36.7628 
CMS-1498-P2 253 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.8119 
CMS-1498-P2 254 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 19.9015 
CMS-1498-P2 255 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 13.1629 
CMS-1498-P2 256 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 25.6075 
CMS-1498-P2 257 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 27.2448 
CMS-1498-P2 258 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 27.3237 
CMS-1498-P2 259 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.8061 
CMS-1498-P2 260 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 23.7711 
CMS-1498-P2 261 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 31.2123 
CMS-1498-P2 262 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.8735 
CMS-1498-P2 263 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.3155 
CMS-1498-P2 264 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.0902 
CMS-1498-P2 265 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 29.7496 
CMS-1498-P2 266 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.3464 
CMS-1498-P2 267 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 33.6228 
CMS-1498-P2 268 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 30.7550 
CMS-1498-P2 269 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 * * 25.5590 
CMS-1498-P2 270 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 31.2669 
CMS-1498-P2 271 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 27.8261 
CMS-1498-P2 272 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 26.6243 
CMS-1498-P2 273 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 38.0019 
CMS-1498-P2 274 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 * * 39.0787 
CMS-1498-P2 276 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 36.6451 
CMS-1498-P2 277 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 28.1948 
CMS-1498-P2 278 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 21.8681 
CMS-1498-P2 279 

Provider Number 

Case-Mix 

Index2

FY 2011 

Wage Index 

Average 

Hourly Wage 

FY 2009 

Average 

Hourly 

Wage 

FY 2010 

Average 

Hourly 

Wage 

FY 20111 

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 4th 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 4th 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 4th 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 Springs-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 0.9760 
CMS-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-Frederick, 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 Charleston-Summerville, SC SC 0.9252 0.9482 

16740 Charlotte-Gastonia-Rock Hill, NC-SC NC 0.9257 0.9485 
CMS-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-Ormond Beach, FL FL 0.8746 0.9123 

19740 Denver-Aurora-Broomfield, CO CO 1.0576 1.0391 
CMS-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 0.9577 
CMS-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-Corcoran, CA CA 1.2247 1.1489 

25420 Harrisburg-Carlisle, 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 0.9662 
CMS-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 0.9004 
CMS-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 Mankato, 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-Kendall, 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-West 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 
CMS-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-Murfreesboro-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-Sarasota-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-Sanford, 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-Panama City Beach, FL FL 0.8432 0.8898 
CMS-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-Glendale, 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-Vancouver-Hillsboro, OR-WA OR 1.1173 1.0789 

38900 Portland-Vancouver-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-Fall River, RI-MA MA 1.0702 1.0476 

39300 Providence-New Bedford-Fall 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 Bernardino-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 0.9105 
CMS-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 Maria-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-Everett, 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 0.9893 
CMS-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-Clearwater, 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-Porterville, 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-Alexandria, DC-VA MD 1.0513 1.0349 

47894 Washington-Arlington-Alexandria, DC-VA VA 1.0513 1.0349 
CMS-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-Boardman, 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 0.9359 
CMS-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 Jersey1 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 Rico1 PR ------ ------ 

41 Rhode Island1 RI ------ ------ 

42 South Carolina SC 0.8399 0.8874 

43 South Dakota SD 1.0000 1.0000 
CMS-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 0.8967 
CMS-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 Springs-Marietta, GA AL 0.9528 0.9674 

12060 Atlanta-Sandy Springs-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-Frederick, MD DC 1.0496 1.0337 

13644 Bethesda-Rockville-Frederick, MD PA 1.0496 1.0337 

13644 Bethesda-Rockville-Frederick, 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 1.0000 
CMS-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-Naperville, 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 0.9006 
CMS-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 0.9496 
CMS-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-Carlisle, 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 0.8545 
CMS-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-Kendall, FL FL 1.0191 1.0130 

33260 Midland, TX TX 0.9514 0.9665 

33340 Milwaukee-Waukesha-West 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 0.9545 
CMS-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-Sarasota-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-Sanford, FL FL 0.9150 0.9410 

37460 

Panama City-Lynn Haven-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 0.9630 
CMS-1498-P2 300 

CBSA 

Code Area State 

Proposed 

Wage 

Index 

Proposed 

GAF 

38900 Portland-Vancouver-Hillsboro, OR-WA OR 1.1173 1.0789 

38900 Portland-Vancouver-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 Bernardino-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-Everett, 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 1.0229 
CMS-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-Clearwater, 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-Boardman, 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 Montana1 MT 1.0000 

29 Nevada1 NV 1.0000 

35 North Dakota1 ND 1.0000 

43 South Dakota1 SD 1.0000 

53 Wyoming1 WY 1.0000 

10900 Allentown-Bethlehem-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 1.0000 
CMS-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-Corcoran, 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 Beach-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-Panama City Beach, FL FL 0.8432 

37620 Parkersburg-Marietta-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 Bernardino-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 Maria-Goleta, CA CA 1.2247 
CMS-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-Porterville, 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 the 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/redesignation status and waive the application of the out-migration 

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

adjustment, rather than their reclassification, must follow the termination/withdrawal 

procedures specified in 42 CFR 412.273 and section III.I.3. of the preamble of the 
CMS-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 deemed to have waived the out-migration 

adjustment, unless they explicitly notify CMS that they elect to receive the out-migration 

adjustment instead within 45 days from the publication of the May 4, 2010 proposed rule 

(that is by June 18, 2010). Notifications are sent to the address listed in Table 4J of the 

May 4, 2010 proposed rule. 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 01590
CMS-1498-P2 306 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 05400
CMS-1498-P2 307 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 06610
CMS-1498-P2 308 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 11620
CMS-1498-P2 309 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 18460
CMS-1498-P2 310 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 22090
CMS-1498-P2 311 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 23620
CMS-1498-P2 312 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 24650
CMS-1498-P2 313 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 33900
CMS-1498-P2 314 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 34420
CMS-1498-P2 315 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 37240
CMS-1498-P2 316 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 42120
CMS-1498-P2 317 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 45563
CMS-1498-P2 318 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 45000
CMS-1498-P2 319 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 52630
CMS-1498-P2 320 

Provider 

Number

Reclassified for 

FY 2010

Proposed 

OutMigration 

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 40140
CMS-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 33700
CMS-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 33700
CMS-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 31084
CMS-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 35004
CMS-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 22744
CMS-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 LUGAR
CMS-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 29404
CMS-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 29404
CMS-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 11180
CMS-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 30460
CMS-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 14484
CMS-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 28020
CMS-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 33460
CMS-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 27620
CMS-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 37964
CMS-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 35644
CMS-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 15940
CMS-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 36420
CMS-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 37964
CMS-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 34980
CMS-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 19124
CMS-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 13644
CMS-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 24540
CMS-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 20101 

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 $57,235
CMS-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 $29,387
CMS-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 $28,097
CMS-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 $34,115
CMS-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 $68,433
CMS-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 $29,798
CMS-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 $37,377
CMS-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 $25,167
CMS-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 $93,614
CMS-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 $52,061
CMS-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 $18,033
CMS-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 $30,509
CMS-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 $55,947
CMS-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 $37,965
CMS-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 $15,945
CMS-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 $31,412
CMS-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 $19,248
CMS-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 $70,268
CMS-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 $21,513
CMS-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 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 364 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 19.4 
CMS-1498-P2 365 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 366 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 30.3 
CMS-1498-P2 367 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 14.3 
CMS-1498-P2 368 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 25.3 
CMS-1498-P2 369 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 17.4 
CMS-1498-P2 370 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 20.5 

248 248 PERC CARDIOVASC PROC W NON-DRUGELUTING STENT W MCC OR 4+ VES/STENTS 1 1.6496 36.4 30.3 

249 248 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 17.4 
CMS-1498-P2 371 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 20.3 
CMS-1498-P2 372 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 18.3 
CMS-1498-P2 373 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 374 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 30.3 
CMS-1498-P2 375 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 30.3 
CMS-1498-P2 376 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 31.8 
CMS-1498-P2 377 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 30.3 
CMS-1498-P2 378 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 18.4 
CMS-1498-P2 379 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 23.3 
CMS-1498-P2 380 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 20.5 
CMS-1498-P2 381 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 24.1 
CMS-1498-P2 382 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 

659 659 KIDNEY & URETER PROCEDURES FOR NONNEOPLASM W MCC* 4 1.0834 28.9 24.1 

660 659 KIDNEY & URETER PROCEDURES FOR NONNEOPLASM W CC 4 1.0834 28.9 24.1 

661 659 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 16.1 
CMS-1498-P2 383 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 17.4 
CMS-1498-P2 384 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 17.4 

739 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W MCC 0 1.2314 32.7 27.3 

740 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W CC* 0 0.9743 28.6 23.8 

741 739 UTERINE,ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W/O CC/MCC 0 0.8667 24.6 20.5 

742 742 UTERINE & ADNEXA PROC FOR NONMALIGNANCY W CC/MCC* 0 0.9743 28.6 23.8 

743 742 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 24.1 
CMS-1498-P2 385 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 386 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 387 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 31.3 
CMS-1498-P2 388 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 15.1 
CMS-1498-P2 389 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 17.4 
CMS-1498-P2 390 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 25.6 
CMS-1498-P2 391 

MSLTCDRG 

Base 

MSLTCDRG MS-LTC-DRG Title 

FY 

2009 

LTCH 

Cases 

Proposed 

Relative 

Weight 

Proposed 

Geometric 

Average 

Length of 

Stay 

Proposed 

Short-Stay 

Outlier 

(SSO) 

Threshold1

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 5/6th 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 Planning 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 Mandates Reform Act of 1995 (Pub. L. 104-4), 

Executive Order 13132 on Federalism, and the Congressional Review Act 

(5 U.S.C. 804(2)). 

 Executive Order 12866 directs agencies to assess all costs and benefits of 

available regulatory alternatives and, if regulation is necessary, to select regulatory 

approaches that maximize net benefits (including potential economic, environmental, 

public health and safety effects, distributive impacts, and equity). 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 proposed changes for FY 2011 acute care hospital 

operating and capital payments will redistribute in excess of $100 million among 

different types of inpatient cases. 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 increase), and an estimated $20 million decrease in 

FY 2011 capital payments (or -0.2 percent change). The impact analysis of the capital 
CMS-1498-P2 393 

payments can be found in section VIII. of this Appendix. In addition, 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 hospital-specific rates, the proposed -2.4 percent 

documentation and coding adjustment 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 update 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 admissions 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, small entities include small businesses, nonprofit 

organizations, and small government jurisdictions. Most hospitals and most other 

providers and suppliers are considered to be small entities, either by being nonprofit 

organizations or by meeting the Small Business 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 care providers, we refer readers to the Table of Small Business 

Size Standards for NAIC 622 found on the Small Business Administration Office of Size 
CMS-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. Because we lack data on individual hospital 

receipts, we cannot determine the 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 discussed throughout the preamble of this proposed 

rule constitutes our proposed regulatory 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 Enforcement 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 group 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 adapting to changes in Medicare regulations and 
CMS-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 requires 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 number 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 located outside of an urban area and has fewer 

than 100 beds. Section 601(g) of the Social Security Amendments of 1983 

(Pub. L. 98-21) designated hospitals in certain New England counties as belonging to the 

adjacent urban area. Thus, for purposes of the IPPS and the LTCH PPS, we continue to 

classify these hospitals as urban hospitals. (We 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 Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also 

requires that agencies assess anticipated costs and benefits before issuing any rule whose 

mandates require spending in any 1 year of $100 million in 1995 dollars, updated 

annually for inflation. That threshold level is currently approximately $133 million. This 

proposed rule would not mandate any requirements for State, local, or tribal governments, 

nor would it affect private sector costs. 

 Executive Order 13132 establishes certain requirements that an agency must meet 

when it promulgates a proposed rule (and subsequent final rule) that imposes substantial 
CMS-1498-P2 396 

direct requirement costs on State and local governments, preempts State law, or otherwise 

has Federalism implications. As stated above, this proposed rule would not have a 

substantial effect on State and local governments. 

 The following analysis, in conjunction with the remainder of this document, 

demonstrates that this proposed rule is consistent with the regulatory philosophy and 

principles identified in Executive Order 12866, the 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 hospitals, 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 hospitals 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 financial viability of the hospital industry and ensuring access 

to high quality health care for Medicare beneficiaries. 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 changes effective for FY 2011, on various hospital 

groups. We estimate the effects of individual policy changes by estimating payments per 
CMS-1498-P2 397 

case while holding all other payment policies constant. We use the best data available, 

but, generally, we do not attempt 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 for hospital inpatient operating and 

capital-related costs of acute care hospitals encompass most general short-term, acute care 

hospitals that participate in the Medicare program. There were 33 Indian Health Service 

hospitals in our database, which we excluded from the analysis due to the special 

characteristics of the prospective payment methodology for these hospitals. Among other 

short-term, acute care hospitals, only the 46 such 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-participating hospitals. The 

majority of this impact analysis focuses on this set of hospitals. There are also 

approximately 1,338 CAHs. These small, limited service hospitals 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 the 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 hospitals, which are paid 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 hospitals 
CMS-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 Hospital Units Excluded From the IPPS 

 As of March 2010, there were 3,439 hospitals 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 rehabilitation 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 discussed in this proposed rule. The impacts of the changes 

to LTCHs are discussed in section 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). Cancer and children's hospitals continue to 

be paid on a reasonable cost basis subject 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 rule (74 FR 43930), we replaced the 

FY 2002-based IPPS operating and capital market baskets with the revised and rebased 
CMS-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 forecast, with historical 

data through the 2009 fourth quarter, we are 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) which 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 basket update resulting in a proposed 2.15 percent applicable 

percentage increase for IPPS hospitals. RNCHIs, children's hospitals and cancer hospitals 

are not subject to the reduction in the applicable 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, the 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 increases 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-increase 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 increases above the cumulative update in their 

rate-of-increase limits, the major effect is the amount of excess costs that will not be 
CMS-1498-P2 400 

reimbursed. 

 We note that, under §413.40(d)(3), an excluded 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 difference between its reasonable 

costs and 110 percent of the limit, not to exceed 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 announcing 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 documentation and coding adjustments 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 affect 
CMS-1498-P2 401 

overall payment changes. 

 We have prepared separate impact analyses 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 impacts on payments per case of certain proposed 

changes in this proposed rule. However, there 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 have attempted to predict the payment impacts 

based upon our experience and 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 analysis, we do not make adjustments for future 

changes in such variables as admissions, lengths 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 variation in the data from 

different sources. We have attempted to construct these variables with the best available 

source overall. However, for individual hospitals, some miscategorizations are possible. 
CMS-1498-P2 402 

 Using cases from the FY 2009 MedPAR file, 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 VIII. of this Appendix. 

 The changes discussed separately below are the following: 

● The effects of the proposed annual reclassification of diagnoses and 

procedures, full implementation of the MS-DRG system and 100 percent cost-based 

MS-DRG relative weights. 

● The effects of the proposed changes in hospitals' wage index values reflecting 

wage data from hospitals' cost reporting periods beginning during FY 2007, compared to 

the FY 2006 wage data. 

● The effects of the recalibration of the 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 states 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 and 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 qualifies by meeting a threshold percentage of 

residents of the county where the hospital is located who commute to work at hospitals in 

counties with higher wage indexes. 

● The total estimated change in payments 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 percent market basket with a 0.25 percentage 

reduction, as required under the Affordable Care Act). The FY 2010 operating payments 

also account for provisions under the Affordable 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; the FY 2010 MS-DRG GROUPER (Version 27.0); 

the most current CBSA designations for hospitals based on OMB's MSA definitions; the 

FY 2010 wage index; and no MGCRB reclassifications. 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 subsequent years, the update factor will 

be reduced by 2.0 percentage points for any hospital that does not submit quality data in a 
CMS-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 simulations 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 which hospitals will not 

receive the full market basket rate-of-increase for FY 2011. 

 Each policy change, statutory or otherwise, is then added incrementally to this 

baseline, finally arriving at an FY 2011 model incorporating all of the changes. This 

simulation allows us to isolate the 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 percentage increase of 2.15 percent. In 

addition, we are updating the Puerto Rico specific amount by an applicable percentage 

increase of 2.15 percent. This includes our forecasted 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 requirements to receive the 

full update will receive an update 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 for MDHs are also equal to the market basket percentage 
CMS-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 hospital'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 total 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 final 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 were offset correspondingly. The effects of the lower than 

expected outlier payments during FY 2010 (as 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 payments 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 analysis 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 different 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 their 
CMS-1498-P2 406 

geographic location: all urban, which is further divided into large urban 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 areas. 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, also shown separately for urban and rural 

hospitals. 

 The second part of Table I shows hospital groups based on hospitals' FY 2011 

payment classifications, including any reclassifications under 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 these categorizations after consideration of 

geographic reclassifications (including reclassifications under sections 1886(d)(8)(B) and 

1886(d)(8)(E) of the Act that have implications 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 residency programs (teaching hospitals that 

receive an IME adjustment) or receive DSH payments, or some combination of these two 

adjustments. There are 2,434 nonteaching hospitals 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 are grouped according to their DSH payment 
CMS-1498-P2 407 

status, and whether they are considered urban 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 impacts 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 geographic reclassification status 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 408 

TABLE I.--IMPACT ANALYSIS OF PROPOSED CHANGES TO THE IPPS FOR OPERATING COSTS FOR 

No. of 

Hospitals 

Proposed 

FY 2011 

Weights 

& MSDRG 

Changes 

(1) 

Applicatio

n 

of 

Recalibrati

on Budget 

Neutrality 

(2) 

Propos

ed FY 

2011 

Wage 

Data 

(3) 

Application 

of Wage 

Budget 

Neutrality 

(4) 

Proposed 

FY 2011 

MS-DRG, 

Relative 

Weights & 

Wage Index 

Changes, with 

Wage & 

Recalibration 

Budget 

Neutrality 

(5) 

FY 2011 

MGCRB 

Reclassifi

cations 

(6) 

Proposed 

Rural 

Floor 

Budget 

Neutrality 

and 

Within 

State 

Rural 

Floor 

Budget 

Neutrality 

(7) 

Proposed 

Applicatio

n of the 

Frontier 

Wage 

Index 

(8) 

Pro

FY 

O

Mig

Adju

All Hospitals 3472 0.3 0 0 0 0 0 0 0 By Geographic Location: Urban hospitals 2502 0.3 0 0 0 0 -0.2 0 0 Large urban areas 1365 0.2 0 0 0.1 0 -0.3 0 0 Other urban areas 1137 0.4 0.1 -0.1 -0.1 0 0 0.1 0.1 Rural hospitals 970 0.3 0 0 0 0 1.6 -0.1 0 Bed Size (Urban): 0-99 beds 635 0.6 0.2 0 0 0.3 -0.5 0 0.1 100-199 beds 791 0.2 -0.1 0 0 0 0 0.2 0.1 200-299 beds 461 0.3 0 0 0 0 -0.1 0 0.1 300-499 beds 425 0.3 0 0 0 0 -0.2 0.1 0.1 500 or more beds 190 0.3 0 -0.1 -0.1 0 -0.3 -0.2 0 Bed Size (Rural): 0-49 beds 337 0.6 0.3 0.1 0.1 0.3 0.6 -0.1 0.1 50-99 beds 366 0.3 0 0 0 0 0.6 -0.1 0 100-149 beds 164 0.3 0 0 0 0 2.2 -0.2 0 150-199 beds 61 0.3 0 0 0 0.1 2.5 -0.2 0 200 or more beds 42 0.2 -0.1 0 0.1 -0.1 2.4 -0.1 0 Urban by Region: New England 121 0.1 -0.2 -0.4 -0.4 -0.6 0.9 -0.2 0 Middle Atlantic 330 0.3 0 -0.3 -0.3 -0.3 0.3 0.1 0 
CMS-1498-P2 409 

No. of 

Hospitals 

Proposed 

FY 2011 

Weights 

& MSDRG 

Changes 

(1) 

Applicatio

n 

of 

Recalibrati

on Budget 

Neutrality 

(2) 

Propos

ed FY 

2011 

Wage 

Data 

(3) 

Application 

of Wage 

Budget 

Neutrality 

(4) 

Proposed 

FY 2011 

MS-DRG, 

Relative 

Weights & 

Wage Index 

Changes, with 

Wage & 

Recalibration 

Budget 

Neutrality 

(5) 

FY 2011 

MGCRB 

Reclassifi

cations 

(6) 

Proposed 

Rural 

Floor 

Budget 

Neutrality 

and 

Within 

State 

Rural 

Floor 

Budget 

Neutrality 

(7) 

Proposed 

Applicatio

n of the 

Frontier 

Wage 

Index 

(8) 

Pro

FY 

O

Mig

Adju

South Atlantic 383 0.1 -0.2 0 0 -0.2 -0.4 -0.2 0 East North Central 403 0.1 -0.1 0.2 0.2 0.1 -0.3 -0.2 0 East South Central 155 0.4 0.2 -0.5 -0.6 -0.4 -0.2 0 0 West North Central 166 0.5 0.2 -0.1 -0.1 0.1 -0.7 -0.2 0.5 West South Central 342 0.5 0.2 0.2 0.2 0.4 -0.6 -0.2 0 Mountain 162 0.3 0 0 0 0 -0.3 -0.1 0.2 Pacific 390 0.6 0.2 0.4 0.4 0.5 -0.3 0.9 0 Puerto Rico 50 0.9 0.7 -0.3 -0.3 0.4 -0.8 -0.1 0 Rural by Region: New England 24 0.2 -0.2 0 0 -0.2 0.5 -0.1 0 Middle Atlantic 70 -0.1 -0.4 0.4 0.4 0 1.5 -0.1 0 South Atlantic 165 -0.2 -0.5 -0.3 -0.4 -0.9 2.1 -0.2 0 East North Central 120 0.3 0 -0.1 -0.1 -0.2 1.3 -0.1 0 East South Central 175 0.6 0.3 0.2 0.2 0.5 2.3 -0.2 0 West North Central 100 0.7 0.4 0 0 0.4 0.5 -0.1 0.1 West South Central 214 0.7 0.5 0.3 0.4 0.8 2.2 -0.2 0 Mountain 71 0.7 0.4 0 0 0.4 0.3 -0.1 0.5 Pacific 31 0 -0.4 0.3 0.3 -0.1 0.9 -0.1 0 By Payment Classification: Urban hospitals 2555 0.3 0 0 0 0 -0.2 0 0 Large urban areas 1403 0.2 0 0 0.1 0 -0.3 0 0 Other urban areas 1152 0.4 0.1 -0.1 -0.1 0 0 0.1 0.1 Rural areas 917 0.3 0 0 0 0 1.4 -0.1 0 Teaching Status: Nonteaching 2434 0.4 0 0.1 0.1 0.2 0.2 0.1 0 
CMS-1498-P2 410 

No. of 

Hospitals 

Proposed 

FY 2011 

Weights 

& MSDRG 

Changes 

(1) 

Applicatio

n 

of 

Recalibrati

on Budget 

Neutrality 

(2) 

Propos

ed FY 

2011 

Wage 

Data 

(3) 

Application 

of Wage 

Budget 

Neutrality 

(4) 

Proposed 

FY 2011 

MS-DRG, 

Relative 

Weights & 

Wage Index 

Changes, with 

Wage & 

Recalibration 

Budget 

Neutrality 

(5) 

FY 2011 

MGCRB 

Reclassifi

cations 

(6) 

Proposed 

Rural 

Floor 

Budget 

Neutrality 

and 

Within 

State 

Rural 

Floor 

Budget 

Neutrality 

(7) 

Proposed 

Applicatio

n of the 

Frontier 

Wage 

Index 

(8) 

Pro

FY 

O

Mig

Adju

Fewer than 100 residents 798 0.3 0 -0.1 -0.1 -0.1 -0.1 0 0.1 100 or more residents 240 0.3 0 -0.1 -0.1 -0.1 -0.2 -0.1 0 Urban DSH: Non-DSH 834 0.5 0.1 0 0 0 0.1 0 0.1 100 or more beds 1510 0.3 0 0 0 0 -0.2 0 0 Less than 100 beds 340 0.2 -0.1 0 0 0 -0.3 0 0.2 Rural DSH: SCH 407 0.3 0 0 0 0 0.2 -0.1 0 RRC 209 0.2 -0.1 0.1 0.1 0 2.4 -0.2 0 100 or more beds 30 0.1 -0.2 -0.3 -0.3 -0.5 1.1 -0.2 0 Less than 100 beds 142 0.4 0.2 0 0.1 0.2 1 -0.2 0 Urban teaching and DSH: Both teaching and DSH 806 0.3 0 -0.1 -0.1 -0.1 -0.3 -0.1 0.1 Teaching and no DSH 169 0.3 -0.1 -0.2 -0.2 -0.2 0.4 0 0.1 No teaching and DSH 1044 0.3 0 0.2 0.2 0.2 0 0.2 0 No teaching and no DSH 536 0.6 0.2 0 0 0.2 -0.2 0 0 Special Hospital Types: RRC 183 0.4 0.1 0 0 0.2 3.1 -0.2 0.1 
CMS-1498-P2 411 

No. of 

Hospitals 

Proposed 

FY 2011 

Weights 

& MSDRG 

Changes 

(1) 

Applicatio

n 

of 

Recalibrati

on Budget 

Neutrality 

(2) 

Propos

ed FY 

2011 

Wage 

Data 

(3) 

Application 

of Wage 

Budget 

Neutrality 

(4) 

Proposed 

FY 2011 

MS-DRG, 

Relative 

Weights & 

Wage Index 

Changes, with 

Wage & 

Recalibration 

Budget 

Neutrality 

(5) 

FY 2011 

MGCRB 

Reclassifi

cations 

(6) 

Proposed 

Rural 

Floor 

Budget 

Neutrality 

and 

Within 

State 

Rural 

Floor 

Budget 

Neutrality 

(7) 

Proposed 

Applicatio

n of the 

Frontier 

Wage 

Index 

(8) 

Pro

FY 

O

Mig

Adju

SCH 340 0.3 0 0 0 0 0.1 0 0.1 MDH 187 0.2 -0.1 0 0 -0.1 0.4 -0.1 0  SCH and RRC 108 0.2 -0.2 -0.1 -0.1 -0.2 0.7 0 0  MDH and RRC 13 0.4 0 0.2 0.2 0.2 0.3 -0.1 0 Type of Ownership: Voluntary 1978 0.3 0 0 0 0 0 0 0.1 Proprietary 837 0.4 0.1 0.2 0.2 0.3 -0.1 0 0 Government 577 0.3 0 -0.1 -0.1 0 0 0.1 0 Medicare Utilization as a Percent of Inpatient Days: 0-25 353 0.2 -0.1 0 0 0 -0.4 0 0 25-50 1593 0.3 0 0 0 0 -0.3 0 0.1 50-65 1202 0.3 0 0 -0.1 -0.1 0.6 0 0 Over 65 237 0.4 0.2 -0.1 -0.2 0 0.7 0.1 0 FY 2011 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals 825 0.3 0 0 0 0 1.8 -0.1 0 
CMS-1498-P2 412 

No. of 

Hospitals 

Proposed 

FY 2011 

Weights 

& MSDRG 

Changes 

(1) 

Applicatio

n 

of 

Recalibrati

on Budget 

Neutrality 

(2) 

Propos

ed FY 

2011 

Wage 

Data 

(3) 

Application 

of Wage 

Budget 

Neutrality 

(4) 

Proposed 

FY 2011 

MS-DRG, 

Relative 

Weights & 

Wage Index 

Changes, with 

Wage & 

Recalibration 

Budget 

Neutrality 

(5) 

FY 2011 

MGCRB 

Reclassifi

cations 

(6) 

Proposed 

Rural 

Floor 

Budget 

Neutrality 

and 

Within 

State 

Rural 

Floor 

Budget 

Neutrality 

(7) 

Proposed 

Applicatio

n of the 

Frontier 

Wage 

Index 

(8) 

Pro

FY 

O

Mig

Adju

Non-Reclassified Hospitals 2647 0.3 0 0 0 0 -0.7 0 0.1 

Urban Hospitals Reclassified 494 0.3 0 0 0 0 1.6 -0.1 0 Urban Nonreclassified Hospitals, FY 2011: 1979 0.3 0 0 0 0 -0.7 0.1 0.1 All Rural Hospitals Reclassified FY 2011: 331 0.3 0 0.1 0.1 0.1 2.7 -0.2 0 Rural Nonreclassified Hospitals FY 2011: 576 0.3 0 0 0 0 -0.3 -0.1 0 All Section 401 Reclassified Hospitals: 37 -0.1 -0.4 -0.1 -0.1 -0.5 -0.3 0 0 Other Reclassified Hospitals (Section 1886(d)(8)(B)) 63 -0.2 -0.5 -0.2 -0.2 -0.6 2.9 -0.2 0 Specialty Hospitals Cardiac specialty Hospitals 19 1.1 0.8 0.3 0.3 1.1 -0.8 -0.1 0.2 

1 Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge dat

cost report data are from reporting periods beginning in FY 2008 and FY 2007. 2 This column displays the payment impact of the proposed changes to the Version 28 GROUPER and the recalibration of the MS-DRG weights based on FY 2009 MedPA

section 1886(d)(4)(C)(iii) of the Act. 

3 This 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 413 

4 This column displays the proposed payment impact of the update to wage index data using FY 2007 cost report data. 5 This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality facaccordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000070. 6 This 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 awith section 1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act. The cumulative wage and recalibration budget neutrality factor of 0.996937is the product o

factor and the recalibration budget neutrality factor. 

7 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2011 pay

reclassifications to the reclassifications scheduled to be in effect for FY 2011. Reclassification for prior years has no bearing on the payment impacts shown here. This col

budget neutrality factor of 0.991476 8 This column displays the effects of the rural floor and the imputed floor, including the Affordable Care Act requirement that the floor budget neutrality is at a 100 percent 

rural and imputed floor budget neutrality factor is 0.995425.

9 This 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 tha

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 thresh

county where the hospital is located who commute to work at hospitals in counties with higher wage indexes. 

11 This 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 

standardized amount due to the documentation and coding effect. The proposed FY 2011 documentation and coding adjustment is -2.9 percent to the IPPS standardized am

hospital-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 

changes 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 the pe

to rounding and interactive effects..
CMS-1498-P2 414 

C. Effects of the Proposed Changes to the MS-DRG Reclassifications and Relative 

Cost-Based Weights (Column 1)

 In Column 1 of Table I, we present 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 requires us annually to make appropriate 

classification changes in order to reflect changes in treatment patterns, technology, and 

any other factors that may change the 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 Version 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 the relative weights and MS-DRGs shown in 

Column 2 are prior to any offset for budget neutrality. Overall, hospitals will experience 

a 0.3 percent increase in payments due to the changes in the MS-DRGs and relative 

weights prior to budget neutrality. Urban hospitals and rural hospitals will experience a 

0.3 percent increase in payments under the updates to the relative weights 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 budget neutrality factor to the standardized 
CMS-1498-P2 415 

amounts. Consistent with section 1886(d)(4)(C)(iii) of the Act, we are calculating a 

recalibration budget neutrality factor 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 factor in this notice because we applied a 0.25 reduction 

to the market basket update to the standardized 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 neutrality 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 weights and classification 

is somewhat lower than the figures shown in Column 1 (approximately 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 requires 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 acute care hospitals for FY 2011 is based on 

data submitted for hospital cost reporting periods beginning on or after October 1, 2006 

and before October 1, 2007. The estimated impact of the updated wage data on hospital 

payments is isolated in Column 3 by holding the other payment parameters constant in 
CMS-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 data, and having a 

100-percent occupational mix adjustment applied, to a model using the FY 2011 

pre-reclassification wage index , also having a 100-percent occupational mix adjustment 

applied, based on FY 2007 wage data (while holding other payment parameters such as 

use of the Version 28.0 MS-DRG GROUPER constant). The occupational mix 

adjustment is based on the FY 2008/2009 occupational mix survey. The wage data was 

not affected by any of the provisions under 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 percent 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 applying 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 separate wage budget 

neutrality and recalibration budget neutrality factors, in accordance with section 

1886(d)(3)(E) of the Act, which specifies that budget neutrality to account for wage 

changes or updates made under that subparagraph must be made without regard to the 62 
CMS-1498-P2 417 

percent labor-related share guaranteed under 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 without regard to the lower 

labor-related share of 62 percent applied to hospitals with a wage index less than or equal 

to 1. In other words, the wage budget neutrality is calculated under the assumption that 

all hospitals receive the higher labor-related share of the standardized amount. The wage 

budget neutrality factor is revised because the market basket update to the standardized 

amount was reduced by 0.25 percent under the Affordable 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 relative weights cannot increase or decrease aggregate payments. 

 In addition, section 1886(d)(3)(E) of the Act specifies 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 recalibration budget neutrality factor of 0.996867 

(which is applied to the Puerto Rico specific standardized amount and the hospitalspecific rates). The product of the two budget neutrality factors is the cumulative wage 

and recalibration budget neutrality factor. The proposed cumulative wage and 

recalibration budget neutrality adjustment is 0.996937, or approximately -0.3 percent, 

which is applied to the national standardized amounts. Because the wage budget 
CMS-1498-P2 418 

neutrality and the recalibration budget neutrality are calculated under different 

methodologies according to the statute, when the two budget neutralities are combined 

and applied to the standardized amount, the 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 and updated wage data with 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 updated 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 payments 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 payment (-0.9 percent) primarily due to the 

changes to MS-DRGs and the relative cost weights. 

H. Effects of MGCRB Reclassifications (Column 6)

 Our impact analysis to this point has assumed acute care hospitals are paid on the 

basis of their actual geographic location (with 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 for 
CMS-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 reclassification request for the purpose of using another area's wage 

index value. Hospitals may appeal denials 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. Provisions in the Affordable Care Act required us 

to revert to FY 2008 average hourly wage reclassification criteria for reclassifications 

effective in FY 2011. Therefore, additional hospitals will qualify for MGCRB 

reclassification compared to the FY 2011 IPPS/LTCH PPS proposed rule (or will qualify 

for their primary reclassification), published on May 4, 2010. This column reflects an 

expectation that these additional hospitals will qualify for geographic reclassification. 

 The overall effect of geographic reclassification 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) reclassifications 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 rural 
CMS-1498-P2 420 

hospitals in the Mountain region will experience 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 the State level rural and imputed floor budget 

neutrality adjustment and 80 percent of a wage index with the national budget neutrality 

adjustment. In FY 2010, hospitals received a blended wage index that is 50 percent of a 

wage index with the State level rural and imputed floor budget neutrality and 50 percent 

of a wage index with the national budget neutrality adjustment. For FY 2011, the 
CMS-1498-P2 421 

Affordable Care Act requires that 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 established 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 applied rural floor budget neutrality at the State-level. 

However, the Affordable Care Act requires that, effective 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 the rural floor and the imputed floor with 

the national rural and imputed floor budget neutrality 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 and imputed floor adjustment. Only urban 

hospitals can benefit from the rural floor provision. Because the provision is budget 

neutral, all other hospitals (that is, all rural hospitals and those urban hospitals to which 
CMS-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, rural hospitals will experience a 0.1 percent 

decrease in payments as a result of the application of rural floor budget neutrality because 

the rural hospitals located in States with a rural floor do not benefit from the rural floor, 

but have their wage indexes downwardly adjusted to ensure that the application of the 

rural floor is budget neutral overall 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 from 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 hospitals in all regions 

can expect a 0.1 to 0.2 percent decrease in payments because the rural and imputed floors 

only benefit urban hospitals. 

J. Effects of the Proposed Application of the Frontier Wage Index (Column 8) 

 Section 10324(a) of Affordable Care Act requires that we establish a minimum 

post-reclassified wage-index of 1.00 for all hospitals 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. Based on these criteria, five 

states (Montana, North Dakota, Nevada, South Dakota, and Wyoming) are considered 
CMS-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 North Central region and urban hospitals 

located in the Mountain region will experience an increase in payments by 0.5 percent 

and 0.2 respectively because many of the hospitals 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 percentage of hospital employees who 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 difference between the wage index of the resident 

county, post-reclassification and 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 rural providers with less 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 Prior 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. The 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 Act). In addition, it reflects the estimated 0.2 

percentage point difference between the projected outlier payments in FY 20101 

(5.1 percent of total MS-DRG payments), 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 reclassifications 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 the 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 estimates account for the provisions under the 

Affordable Care Act that affected the FY 2010 operating payments. Specifically, the 

FY 2010 baseline payment estimates account for the additional -0.25 reduction in the 

applicable percentage increase applied to discharges for FY 2010 discharges occurring on 

or after April 1, 2010 and accounts for the extension 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 and coding adjustment of -2.9 percent on 

the national standardized amount, -2.9 percent on the hospital-specific rates, and –2.4 

percent on the Puerto Rico-specific standardized 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 percent. 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 the 
CMS-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 Section 508 reclassifications that had been extended 

for FY 2010 under the Affordable Care Act. Section 508 reclassification 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 attributed 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 wage data and due to 

the -2.9 percent documentation and coding adjustment applied to the national 

standardized amount and the -2.9 percent documentation and coding adjustment to the 

hospital-specific rate applied to SCHs and MDHs, which generally are classified as rural 
CMS-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 benefited 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 percent) because urban providers in this region 

will benefit from the rural floor and application of a national 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 percent) because of the expiration of Section 508 

reclassifications while rural hospitals in the Mountain region 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 Frontier wage index provision, required under the 

Affordable Care Act. 

 Among special categories of rural hospitals, 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 Federal rate, or, if the hospital-specific rate 

exceeds the Federal rate, the Federal rate plus 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 estimated 
CMS-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 are not reclassifying are estimated to receive a 

payment decrease of 1.9 percent. 

 Cardiac hospitals are expected to experience 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 urban 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 amounts 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 -0.6 
CMS-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 Classification 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 supplemental 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 associated with these other supplemental proposed 

changes are discussed below. 

A. Effects of the Supplemental Proposed Low-Volume Hospital Payment Adjustment: 

Changes for FYs 2011 and 2012
CMS-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 prior 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 empirically determined (69 FR 49099 through 49102 

and 70 FR 47432 through 47434) additional 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 discharges criterion to qualify as a low-volume 

hospital. However, we are not able to estimate 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 low-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 discharge requirement also 

meet the distance requirement, the additional Medicare IPPS dollars the temporary 

change to the low-volume hospital payment adjustment would require, at most, based on 
CMS-1498-P2 433 

each hospital's number of Medicare discharges 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-Dependent, Small Rural 

Hospitals

 As discussed in section II.D. of the preamble 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 October 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 paid its hospital-specific rate, based on its 

FY 1982, 1987, or 2002 costs per discharge, rather than 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 extension 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 Additional Payments to Qualifying Hospitals in 

Low Medicare Spending Counties

 Under section 1109 of Pub. L. 111-152, Congress has allocated $400 million to be 

spent for FYs 2011 and 2012 to qualifying hospitals located in the bottom quartile of 

counties with the lowest Medicare Part A and Part B spending per enrollee. In our 
CMS-1498-P2 434 

proposal described in section II.E. of the preamble 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 money 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 proposed 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 inpatient services for up 

to 15 small rural hospitals. Section 410A(c)(2) Pub. L. 108-173 requires that "[i]n 

conducting the demonstration program under this section, the Secretary shall ensure that 

the aggregate payments made by the Secretary do not exceed the amount which the 

Secretary would have paid if the demonstration program under this 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 demonstration for each of the participating 
CMS-1498-P2 435 

hospitals. In order to achieve budget neutrality, we are proposing to adjust the national 

IPPS rates by an amount sufficient to account for the 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 across the participants of this demonstration. We believe that 

the language of the statutory 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. 

 An extension of this demonstration has 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 IPPS rates. This amount ($69,279,673) accounts 

for the following: (1) an estimate of the 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 these estimates under the assumption that the 

demonstration would end in FY 2010; and(3) an estimate of the cost of participation in 

the demonstration for 20 additional hospitals in FY 2011. Not included in this amount is 
CMS-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 between 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 specific 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 hospitals 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 Proposed 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 costs. 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 ambulance 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 the 
CMS-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 reasonable costs during these prior periods. 

VIII. Effects of Proposed Changes in the Capital IPPS 

A. General Considerations

 Provisions of Pub. L. 111-148 necessitated 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 the 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 neutrality adjustment factor in 

calculating the proposed capital IPPS rate. A revision of the proposed outlier payment 

adjustment factor was required because both 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 discussed 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 2009 
CMS-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 categorize hospitals. Our analysis has several 

qualifications. We use the best data available and make assumptions about case-mix and 

beneficiary enrollment as described below. In addition, as discussed 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 documentation and coding adjustment to the national capital rate 

for FY 2011 in addition to the -0.6 percent adjustment established for FY 2008, and the -

0.9 percent adjustment for FY 2009. This results in a cumulative adjustment factor of 

0.957 that we are proposing to apply to the national capital rate to account for 

improvements in documentation and coding under the MS-DRGs in FY 2011. We also 

are proposing to adjust the Puerto Rico-specific capital rate in FY 2011 to account for 

changes in documentation and coding resulting 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 change. 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 variables with the best available sources overall. 

However, for individual hospitals, some miscategorizations are possible. 

 Using cases from the December 2009 update of the FY 2009 MedPAR file, we 
CMS-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 outlier threshold, as discussed above in this 

section) for a comparison of total payments per 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 Adjustment Factor + IME adjustment factor, if 

applicable). 

 In addition to the other adjustments, hospitals may also receive outlier payments 

for those cases that qualify under the threshold established for each fiscal year. We 

modeled payments for each hospital by multiplying the capital Federal 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 in 
CMS-1498-P2 440 

both FYs 2010 and 2011. 

● We estimate that the Medicare discharges will be approximately 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 provisions of Pub.L.111-148, as amended, and 

therefore, remains at the proposed 1.5 percent 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 calculated 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 increase case-mix under the MS-DRGs. 

B. Results

 We used the actuarial model described above to estimate the potential impact of 

our proposed changes for FY 2011 on total capital payments per case, using a universe of 
CMS-1498-P2 441 

3,472 hospitals. As described above, the individual hospital payment parameters are 

taken from the best available 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 under 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 proposed 1.5 percent update to the capital Federal 

rate and other proposed changes in the adjustments to the capital Federal rate. The 

comparisons are provided by: (1) geographic location; (2) region; and (3) payment 

classification. 

 The simulation results show that, on average, capital payments per case in 

FY 2011 are expected to decrease 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 payments, 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 primarily to an estimated 
CMS-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 per discharge from FY 2010 to FY 2011 for all 

hospitals (as shown below in Table III). 

The geographic comparison shows that, on average, 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 expected to decrease 0.6 percent. 

 The change comparisons by regions show 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 rural regions show estimates 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, proprietary hospitals are estimated to experience a 0.2 

percent change in capital payments, voluntary hospitals are estimated to experience a 0.3 

percent decrease in capital payments per case, while there is no change estimated for 
CMS-1498-P2 443 

government hospitals in capital payments per case from FY 2010 to FY 2011. 

 Section 1886(d)(10) of the Act established the MGCRB. Hospitals may apply for 

reclassification for purposes of the wage index for FY 2011. Reclassification for wage 

index purposes also affects the GAFs because that 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 reclassified 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 section 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. 

TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE 

[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 more beds ......................................................................................................... 190 1,007 1,007 0.0 
CMS-1498-P2 444 

TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE 

[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 more beds ......................................................................................................... 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 Residents ............................................................................................ 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 than 100 beds .................................................................................................. 340 594 592 -0.4 

 Rural DSH: 

 Sole Community (SCH/EACH) ............................................................................... 407 481 480 -0.3 

 Referral Center (RRC/EACH) ................................................................................. 209 604 599 -0.8 

 Other Rural: 

 100 or more beds................................................................................................. 30 502 495 -1.3 

 Less than 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 -0.1 
CMS-1498-P2 445 

TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE 

[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 EACH................................................................................................. 13 830 825 -0.7 

Hospitals Reclassified by the Medicare Geographic 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 Hospitals (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 General Considerations

 In section II.J. of the preamble and section III. of the Addendum 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 present rationale for 

our decisions as well as alternatives that were considered. In this section IX. of Appendix 

to this supplemental proposed rule, we discuss 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 rule in terms of their estimated fiscal impact 
CMS-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 LTCHs. Of the remaining 

43 LTCHs, 12 LTCHs are government-owned and operated and the ownership type of the 

other 31 LTCHs is unknown. In the impact analysis, we are using the proposed rates, 

factors, and policies presented in this supplemental proposed rule, including the 0.50 

percentage point reduction to the market basket 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 for RY 2010 is $39,794.95, which reflects the 0.25 percentage point 

reduction applied to the RY 2010 market basket update required 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 standard Federal rate consistent with section 3401(p) of 

Pub. L. 111-148. Discharges in RY 2010 occurring on or after October 1, 2009 and on or 
CMS-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 proposing to update the standard Federal rate for 

FY 2011 by -0.59 percent in order to establish the proposed FY 2011 standard Federal 

rate at $39,560.16. This includes a proposed market 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 adjustment 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 rule) 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 combined distributional effects and estimated 

changes to the Medicare program payments would be greater than $100 million, this 
CMS-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 approximately $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 several 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 labor-related share) presented 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 payments. 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 available data. In addition, we are proposing to decrease the 

labor-related share slightly from 75.779 percent to 75.407 percent under the LTCH PPS 
CMS-1498-P2 449 

for FY 2011 based on the most recent available 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 increase LTCH PPS payments by 0.1 percent (75 FR 

24317 through 27318). 

Table IV below shows the impact of the 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 payments to FY 2011 estimated payments. The 

projected increase in payments per discharge 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 Federal 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 percent, 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 available 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 the 
CMS-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 this 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 estimated 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 increase 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 proposed 
CMS-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 urban 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 supplemental 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 complete data were available. 

The RY 2010 average payment per case in Table IV accounts for the changes required by 

sections 1886(m)(3) and (4) of the Act and 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 this 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 reduction in the labor-related share from 75.779 to 
CMS-1498-P2 452 

75.407, which results in a an estimated 0.6 percent increase in payments. 

C. Anticipated Effects of Proposed LTCH PPS Payment Rate Change and Policy 

Changes

 We discuss the impact of the proposed changes 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 LTCHs) 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 standard Federal rate under §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 and 
CMS-1498-P2 453 

Reinvestment Act of 2009 (ARRA) provided for a 3-year delay in certain payment 

policies relating to LTCHs and LTCH satellite facilities. 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 (SSOs), the one-time adjustment to the standard 

Federal rate, the 25 percent payment threshold 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 implementation 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 required by section 114(c) of MMSEA as 

amended by section 4302 of the ARRA, which addressed the percentage 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 the 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 interim final rule with comment period when 

the original 3-year delay required by section 114(d) of the MMSEA as amended by the 

ARRA, was implemented, we are 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 satellite 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 levels, 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 rule on different categories of LTCHs for 
CMS-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 relative 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 include 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 for discharges occurring on or after 

April 1, 2010 in RY 2010 (as established in a separate 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 data and other factors, such as the application of inflation 

factors to estimate costs for SSO and HCO cases 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 characteristics provided in the OSCAR data, 

FY 2006 through FY 2007 cost report data in HCRIS, and PSF data. Hospitals with 

incomplete characteristics were grouped into the "unknown" category. Hospital groups 

include the following: 
CMS-1498-P2 456 

● Location: large urban/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 payments for RY 2010 and to estimate payments for FY 2011 

for 421 LTCHs. We believe that the discharges based on the FY 2009 MedPAR data for 

the 421 LTCHs in our database, which includes 301 proprietary LTCHs, provide 

sufficient representation in the MS-LTC-DRGs containing discharges for patients who 

received LTCH care for the most commonly treated LTCH patients' diagnoses. 

4. Calculation of Prospective 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 standard 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 after 
CMS-1498-P2 457 

April 1, 2010 to September 30, 2010 are paid). For modeling estimated LTCH PPS 

payments for FY 2011, we applied the proposed 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 and 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 Tables 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 LTCH PPS FY 2011 labor-related 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 index 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 reflects an estimated change in payments 

for SSO cases as well as an estimated increase in payments for HCO cases (as described 
CMS-1498-P2 458 

in section V.C. of the Addendum to this proposed rule). In modeling proposed payments 

for SSO and HCO cases in RY 2010, we applied an inflation factor of 1.024 percent 

(determined by OACT) to the estimated costs 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 inflation factor of 1.049 (determined by OACT) to 

the estimated costs 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. Furthermore, in modeling estimated LTCH PPS payments for both RY 2010 

and FY 2011 in this impact analysis, we applied the RY 2010 HCO fixed-loss amount of 

$18,425 (74 FR 44029) for the first half of RY 2010, the revised RY 2010 HCO fixedloss amount of $18,615 established in conjunction with implementing the provisions of 

sections 1886(m)(3) and (4) of the Act and 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 Addendum 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 Classification, 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 estimated payment per discharge for RY 2010 (as 

described above). 

● The fifth column shows the estimated 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 changes 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 Paymentsfor 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 

Case1 

(4) 

Average FY 

2011 LTCH 

PPS Rate 

Year 

Proposed 

Payment 

Per Case2 

(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 

Adjustment4 

(7) 

Percent 

Change in 

Payments 

Per 

Discharge 

from RY 

2010 to FY 

2011 for 

All 

Proposed 

Changes5 

(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 0.4
CMS-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 

Case1 

(4) 

Average FY 

2011 LTCH 

PPS Rate 

Year 

Proposed 

Payment 

Per Case2 

(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 

Adjustment4 

(7) 

Percent 

Change in 

Payments 

Per 

Discharge 

from RY 

2010 to FY 

2011 for 

All 

Proposed 

Changes5 

(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 PPS 

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 provisions of sections 1886(m)(3) and (4) of the Act and section 3401(p) of 

Pub. L. 111-148 established in a separate 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 rate, 

as discussed in section III.A.3. of the Addendum 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 conjunction 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 standard Federal rate (column 6) and the proposed changes to the area wage adjustment (Column 

7) due to the effect of estimated changes in both estimated payments to SSO cases that are paid based on estimated costs and aggregate 

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 Table IV shows that estimated payments per 
CMS-1498-P2 462 

discharge are expected to increase approximately 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 cumulative 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 Table IV (Column 6), the impact of the proposed 

decrease of approximately -0.6 percent to the standard Federal rate is projected to result 

in approximately a -0.5 percent decrease in estimated payments per 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 estimate that the effect of the 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 LTCHs of approximately 

0.3 percent (as shown in Table IV) was determined by comparing estimated FY 2011 
CMS-1498-P2 463 

LTCH PPS payments (using the proposed rates, proposed policies and statutory changes 

discussed in this supplemental proposed 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 approximately 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 discharge from RY 2010 to FY 2011 for all hospitals 

is 0.3 percent for all proposed changes. For rural LTCHs, the percent change for all 

proposed changes is estimated to be 0.7 percent, while for urban LTCHs, we estimate the 

increase to be 0.2 percent. Large urban LTCHs are projected to experience an increase of 

0.3 percent in estimated payments per discharge 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 participation 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 that 
CMS-1498-P2 464 

began participating between October 1993 and September 2002, and are projected to 

experience nearly the average increase (0.2 percent) in estimated payments 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 experience a higher than average percent increase 

(0.6 percent) in estimated payments per discharge from RY 2010 to FY 2011, as shown in 

Table IV. Approximately 4 percent of LTCHs began participating in Medicare before 

October 1983. The LTCHs in this category are projected to experience 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) and relative weights, and 

also because of estimated increases in their SSO payments relative to last year. 

Approximately 10 percent of LTCHs began participating 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 participating in Medicare after October 2002 currently represent 

approximately 38 percent of all LTCHs, and are projected to experience an average 

increase (0.3 percent) in estimated 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 ownership control type: voluntary, proprietary, and 

government. Based on the most recent available data, approximately 18 percent of 
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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 payments 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 estimated payments primarily 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 comparison 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 per 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 greater 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 payments per discharge from RY 2010 to FY 
CMS-1498-P2 466 

2011. The average estimated decrease in payments 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 less 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 and the decrease in the Federal rate. 

e. Bed Size 

 LTCHs were grouped into six categories based on bed size: 0-24 beds; 25-49 

beds; 50-74 beds; 75-124 beds; 125-199 beds; and greater than 200 beds. 

We project that payments for small LTCHs (0-24 beds) would experience a 0.8 percent 

increase in payments due to increases in their 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 the 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 beneficiaries under the LTCH PPS, but we expect 

that paying prospectively for LTCH services 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 rationales 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 reclassifications 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 approximately $929 million in FY 2011. In 

addition, we estimates the reporting of hospital quality data program costs at $2.4 million, 

a savings of $23 million associated with the proposed HACs policies discussed in the 

May 4, 2010 FY 2011 IPPS/LTCH PPS proposed rule, an additional $150 million to 
CMS-1498-P2 468 

hospitals that qualify for an additional payment as provided under section 1109 of 

Pub. L. 111-152, and all other proposed operating payment policies described in section 

VII. of this Appendix . These estimates added to our FY 2011 operating 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 will 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 pages, 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 supplemental 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 Circular A-4 (available at 

http://www.whitehousegov/omb/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 Appendix, 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 Circular A-4 (available at 
CMS-1498-P2 470 

http://www.whitehouse.gov/omb/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 estimate of the proposed increase 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 LTCHs in our database. All expenditures are classified as 

transfers to Medicare providers (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 Positive 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 reviewed this proposed rule. 

[FR Doc. 2010-12567 Filed 05/21/2010 at 4:15 pm; Publication Date: 06/02/2010]