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CMS-1403-FC
We noted in the CY 2009 PFS proposed rule (73 FR 38513),
that the physician work GPCIs we calculated did not reflect
the 1.000 floor that was in place during CY 2006 through
June 30, 2008. However, as discussed in section III. of
this preamble, section 134 of the MIPPA of 2008 extended
the 1.000 work GPCI floor from July 1, 2008, through
December 31, 2009. Additionally, section 134(b) of the
MIPPA sets a permanent 1.500 work GPCI floor in Alaska for
services furnished beginning January 1, 2009. As such, the
CY 2009 GPCIs and summarized GAFs reflect these statutorily
mandated work GPCI floors.
See Addenda D and E for the CY 2009 GPCIs and
summarized geographic adjustment factors (GAFs).
For a detailed explanation of how the GPCI update was
developed, see the CY 2008 PFS final rule with comment
period (72 FR 66244).
2. Payment Localities
a. Background
As stated above in this section, section 1848(e)(1)(A)
of the Act requires us to develop separate GPCIs to measure
resource cost differences among localities compared to the
national average for each of the three fee schedule
components (work, PE, and malpractice). Payments under the
PFS are based on the relative resources required to provide
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