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CMS-1403-FC
been previously deemed urban under the IPPS in certain
circumstances as discussed below.
In the FY 2008 IPPS final rule with comment period,
for purposes of IPPS, §412.64(b)(1)(ii)(B) was amended such
that the two “New England deemed counties” that are still
considered rural under the OMB definitions (Litchfield
County, CT and Merrimack County, NH) are no longer
considered urban effective for discharges occurring on or
after October 1, 2007, and therefore, are considered rural
in accordance with §412.64(b)(1)(ii)(C). For purposes of
the ESRD wage index, we have recognized OMB’s CBSA
designations, as well as generally followed the policies
under the IPPS with regard to the definitions for “urban”
and “rural” for the wage index, but we do not to take into
account IPPS geographic reclassifications in determining
payments under the composite payment system. Accordingly,
to reflect our general policy for the ESRD wage index,
these two counties will be considered “rural” under the
ESRD composite payment system effective with the next
update of the payment rates on January 1, 2009, and will no
longer be included in urban CBSA 25540 (Hartford-West
Hartford-East Hartford, CT) and urban CBSA 31700
(Manchester-Nashua, NH), respectively.
(2) Multi-Campus Hospital Wage Index Data
189