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Federal Register / Vol. 86, No. 88 / Monday, May 10, 2021 / Rules and Regulations Inert ingredients
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid Services 42 CFR Part 412
CMS1762IFC
RIN 0938AU56

Medicare Program; Modification of Limitations on Redesignation by the Medicare Geographic Classification Review Board MGCRB
Centers for Medicare &
Medicaid Services CMS, Health and Human Services, HHS.
ACTION: Interim final rule with comment period.
AGENCY:

This interim final rule with comment period IFC amends our current regulations to allow hospitals with a rural redesignation under the Social Security Act the Act to reclassify through the Medicare Geographic Classification Review Board MGCRB using the rural reclassified area as the geographic area in which the hospital is located. These regulatory changes align our policy with the decision in Bates County Memorial Hospital v. Azar, effective with reclassifications beginning with fiscal year FY 2023. We would also apply the policy in this IFC when deciding timely appeals before the Administrator of applications for reclassifications beginning with FY 2022 that were denied by the MGCRB due to the current policy, which does not permit hospitals with rural redesignations to use the rural areas wage data for purposes of reclassifying under the MGCRB.

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SUMMARY:

DATES:

Effective date: These regulations are effective on May 10, 2021.
Comment date: To be assured consideration, comments must be received at one of the addresses provided below by June 28, 2021.

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In commenting, please refer to file code CMS1762IFC. Because of staff and resource limitations, we cannot accept comments by facsimile FAX
transmission.
Comments, including mass comment submissions, must be submitted in one of the following three ways please choose only one of the ways listed:
1. Electronically. You may and we encourage you to submit electronic comments on this regulation to http
www.regulations.gov. Follow the instructions under the submit a comment tab.
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:
CMS1762IFC, P.O. Box 8013, Baltimore, MD 212441850.
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 via express or overnight mail to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS1762IFC, Mail Stop C42605, 7500 Security Boulevard, Baltimore, MD
212441850.
For information on viewing public comments, we refer readers to the beginning of the SUPPLEMENTARY
INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Tehila Lipschutz, 410 7861344 or Dan Schroder, 410 7867452.
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 website as soon as possible after they have been received: http
regulations.gov. Follow the search instructions on that website to view public comments.
Comments received timely will be also available for public inspection as they are received, generally beginning ADDRESSES:

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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 18007433951.
I. Background A. Wage Index for Acute Care Hospitals Paid Under the Hospital Inpatient Prospective Payment System IPPS
Under section 1886d of the Social Security Act the Act, hospitals are paid based on prospectively set rates. To account for geographic area wage level differences, section 1886d3E of the Act requires that the Secretary of the Department of Health and Human Services the Secretary adjust the standardized amounts by a factor established by the Secretary reflecting the relative hospital wage level in the geographic area of the hospital, as compared to the national average hospital wage level. We currently define hospital labor market areas based on the delineations of statistical areas established by the Office of Management and Budget OMB. The current statistical areas which were implemented beginning with FY 2015
are based on revised OMB delineations issued on February 28, 2013, in OMB
Bulletin No. 1301, with updates as reflected in OMB Bulletins Nos. 1501, 1701, and 1804. We refer readers to the FY 2015 IPPS/LTCH PPS final rule 79 FR 49951 through 49963 for a full discussion of our implementation of the new OMB labor market area delineations beginning with the FY
2015 wage index, and to the FY 2021
IPPS/LTCH PPS final rule 85 FR 58743
through 58755 for a discussion of the latest updates to these delineations.
Section 1886d3E of the Act requires the Secretary to update the wage index of hospitals annually, and to base the update on a survey of wages and wage-related costs of short-term, acute care hospitals. Under section 1886d8D of the Act, the Secretary is required to adjust the standardized amounts so as to ensure that aggregate payments under the IPPS, after
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