Post Acute Medical at Hammond, Llc v. BurwellCross MOTION for Summary JudgmentD.D.C.May 19, 2017 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) DEFENDANT’S MOTION FOR SUMMARY JUDGMENT Defendant Thomas E. Price, M.D., in his official capacity as Secretary of Health and Human Services, respectfully moves for summary judgment under Federal Rule of Civil Procedure 56(a). The grounds for this motion are set forth in the accompanying memorandum in support of Defendant’s motion and in opposition to Plaintiff’s motion. Dated: May 19, 2017 Respectfully submitted, CHAD A. READLER Acting Assistant Attorney General CHANNING D. PHILLIPS United States Attorney JOEL McELVAIN Assistant Branch Director /s/ Daniel Halainen DANIEL HALAINEN (MA Bar 694582) Trial Attorney, Federal Programs Branch U.S. Department of Justice, Civil Division 20 Massachusetts Avenue, NW Washington, DC 20530 (202) 616-8101 (office) Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 1 of 46 -2- (202) 616-8470 (fax) daniel.j.halainen@usdoj.gov Attorneys for Defendant Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 2 of 46 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, Secretary, ) U.S. Department of Health and Human Services, ) ) Defendant. ) __________________________________________) MEMORANDUM OF POINTS AND AUTHORITIES IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND IN OPPOSITION TO PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 3 of 46 TABLE OF CONTENTS PRELIMINARY STATEMENT ........................................................................................ 1 BACKGROUND ................................................................................................................ 4 I. The Medicare program and the inpatient prospective payment system. ................. 4 II. The long-term care hospital prospective payment system. ..................................... 6 III. Labor-market areas in the wage index. ................................................................... 9 IV. Factual and procedural background. ..................................................................... 12 STANDARD OF REVIEW .............................................................................................. 14 ARGUMENT .................................................................................................................... 14 I. Plaintiff’s procedural challenges to the FY 2016 wage index fail. ....................... 14 A. The FY 2016 rulemaking satisfied notice-and-comment requirements. ........ 15 B. Plaintiff’s arguments are meritless. ................................................................ 20 1. Plaintiff had sufficient notice to meaningfully comment. .......................... 20 2. The Secretary did not withhold critical material. ........................................ 23 3. The final rule is identical to the proposed rule. .......................................... 25 II. Plaintiff’s substantive challenges to the FY 2016 wage index fail. ...................... 26 A. The Secretary reasonably applied longstanding policy. ................................. 27 B. Plaintiff’s arguments fail. ............................................................................... 28 1. The Secretary reasonably declined to create a special exception. .............. 29 2. The Secretary reasonably applied categorical policies. .............................. 33 CONCLUSION ................................................................................................................. 36 Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 4 of 46 TABLE OF AUTHORITIES Cases Agape Church, Inc. v. FCC, 738 F.3d 397 (D.C. Cir. 2013) ...................................................................................... 26 Air Transp. Ass’n of Am. v. FAA, 169 F.3d 1 (D.C. Cir. 1999) .......................................................................................... 24 Allina Health Servs. v. Sebelius, 746 F.3d 1102 (D.C. Cir. 2014) .............................................................................. 24, 26 Am. Radio Relay League, Inc. v. FCC, 524 F.3d 227 (D.C. Cir. 2008) .................................................................... 16, 19, 23, 24 Anna Jaques Hosp. v. Sebelius, 583 F.3d 1 (D.C. Cir. 2009) ............................................................................................ 5 Ariz. Pub. Serv. Co. v. EPA, 211 F.3d 1280 (D.C. Cir. 2000) .................................................................................... 26 Ark Initiative v. Tidwell, 816 F.3d 119 (D.C. Cir. 2016) ...................................................................................... 27 Auer v. Robbins, 519 U.S. 452 (1997) ...................................................................................................... 22 Banner Health v. Burwell, 55 F. Supp. 3d 1 (D.D.C. 2014) .............................................................................. 24, 25 Bellevue Hosp. Ctr. v. Leavitt, 443 F.3d 163 (2d Cir. 2006).......................................................................................... 30 Cape Cod Hosp. v. Sebelius, 630 F.3d 203 (D.C. Cir. 2011) ................................................................................ 4, 5, 6 Cement Kiln Recycling Coal. v. EPA, 493 F.3d 207 (D.C. Cir. 2007) ...................................................................................... 20 Conn. Light & Power Co. v. Nuclear Regulatory Comm’n, 673 F.2d 525 (D.C. Cir. 1982) ...................................................................................... 23 CSX Transp., Inc. v. Surface Transp. Bd., 584 F.3d 1076 (D.C. Cir. 2009) .................................................................................... 26 * * Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 5 of 46 Cty. of L.A. v. Shalala, 192 F.3d 1005 (D.C. Cir. 1999) .......................................................................... 4, 14, 33 Dignity Health v. Price, No. 15-cv-804 (RDM), 2017 WL 1066562 (D.D.C. Mar. 21, 2017) ............................. 5 EchoStar Satellite LLC v. FCC, 457 F.3d 31 (D.C. Cir. 2006) ........................................................................................ 25 Encino Motorcars, LLC v. Navarro, 136 S. Ct. 2117 (2016) ............................................................................................ 22, 29 Envtl. Integrity Project v. EPA, 425 F.3d 992 (D.C. Cir. 2005) ...................................................................................... 26 Gentiva Healthcare Corp. v. Sebelius, 857 F. Supp. 2d 1 (D.D.C. 2012) .................................................................................. 14 Good Samaritan Hosp. v. Shalala, 508 U.S. 402 (1993) ........................................................................................................ 4 Honeywell Int’l, Inc. v. EPA, 372 F.3d 441 (D.C. Cir. 2004) ...................................................................................... 16 Int’l Union, United Mine Workers of Am. v. Mine Safety & Health Admin., 407 F.3d 1250 (D.C. Cir. 2005) .................................................................................... 16 Lee Mem’l Health Sys. v. Burwell, 206 F. Supp. 3d 307 (D.D.C. 2016) .............................................................................. 25 Marshall Cty. Health Care Auth. v. Shalala, 988 F.2d 1221 (D.C. Cir. 1993) .................................................................................... 31 Methodist Hosp. of Sacramento v. Shalala, 38 F.3d 1225 (D.C. Cir. 1994) ........................................................................................ 4 Monmouth Med. Ctr. v. Thompson, 257 F.3d 807 (D.C. Cir. 2001) ...................................................................................... 15 Motor Vehicle Mfrs. Ass’n of U.S., Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29 (1983) .................................................................................................. 27, 28 Muwekma Ohlone Tribe v. Salazar, 708 F.3d 209 (D.C. Cir. 2013) ...................................................................................... 33 * Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 6 of 46 Nat’l Tel. Co-op. Ass’n v. FCC, 563 F.3d 536 (D.C. Cir. 2009) ...................................................................................... 28 Nuvio Corp. v. FCC, 473 F.3d 302 (D.C. Cir. 2006) ...................................................................................... 20 Portland Cement Ass’n v. Ruckelshaus, 486 F.2d 375 (D.C. Cir. 1973) ...................................................................................... 24 PPG Indus., Inc. v. United States, 52 F.3d 363 (D.C. Cir. 1995) ........................................................................................ 14 Saint Francis Med. Ctr. v. Price, No. 15-cv-1659 (JDB), 2017 WL 963139 (Mar. 10, 2017) ............................................ 5 Se. Ala. Med. Ctr. v. Sebelius, 572 F.3d 912 (D.C. Cir. 2009) ............................................................................... passim Sebelius v. Auburn Reg’l Med. Ctr., 133 S. Ct. 817 (2013) ...................................................................................................... 4 Select Specialty Hosp.-Akron, LLC v. Sebelius, 820 F. Supp. 2d 13 (D.D.C. 2011) ................................................................................ 16 Transitional Hosps. Corp. of La. v. Shalala, 222 F.3d 1019 (D.C. Cir. 2000) ...................................................................................... 6 U.S. Telecom Ass’n v. FCC, 825 F.3d 674 (D.C. Cir. 2016) .......................................................................... 16, 18, 21 Vermont Yankee Nuclear Power Corp. v. Natural Res. Def. Council, 435 U.S. 519 (1978) ...................................................................................................... 24 Statutes 5 U.S.C. § 553 ................................................................................................................... 15 5 U.S.C. § 553(b) ........................................................................................................ 15, 18 5 U.S.C. § 553(c) .............................................................................................................. 15 5 U.S.C. § 706 ................................................................................................................... 14 5 U.S.C. § 706(2) .............................................................................................................. 27 42 U.S.C. § 1395hh(a) ................................................................................................ 16, 26 42 U.S.C. § 1395hh(b) ................................................................................................ 15, 16 * * Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 7 of 46 42 U.S.C. § 1395oo(f) ................................................................................................. 14, 27 42 U.S.C. § 1395ww(b) ...................................................................................................... 5 42 U.S.C. § 1395ww(d) ............................................................................................. passim 42 U.S.C. §§ 1395a-1395lll ................................................................................................ 4 42 U.S.C. §§ 1395c-1395i-5 ............................................................................................... 4 42 U.S.C. § 1395x(ccc)........................................................................................................6 Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA), Pub. L. No. 106-113, 113 Stat. 1501 (1999) ....................................................... 7, 27, 29 Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), Pub. L. No. 106-554, 114 Stat. 2763 (2000) ....................................................... 7, 27, 29 Bipartisan Budget Act of 2013, Pub. L. No. 113-67, 127 Stat. 1165 ................................................................................ 7 Social Security Amendments of 1983, Pub. L. No. 98-21, 97 Stat. 65 ........................................................................................ 4 Regulations 42 C.F.R. ch. IV ........................................................................................................ 4, 7, 17 42 C.F.R. § 412.503.... ...................................................................................... 3, 27, 29, 34 42 C.F.R. § 412.513.............................................................................................................8 42 C.F.R. § 412.515.............................................................................................................8 42 C.F.R. § 412.517.............................................................................................................8 42 C.F.R. § 412.522(a)........................................................................................................ 7 42 C.F.R. § 412.522(c).........................................................................................................7 42 C.F.R. § 412.523 .......................................................................................................... 22 42 C.F.R. § 412.523(c).....................................................................................................7, 8 42 C.F.R. § 412.523(d) ....................................................................................................... 8 42 C.F.R. § 412.523(e).........................................................................................................8 42 C.F.R. § 412.525(c)............................................................................................... passim 42 C.F.R. § 412.535(c)........................................................................................................ 8 42 C.F.R. § 412.64(h) ......................................................................................................... 5 FY 1984 IPPS Rule, 49 Fed. Reg. 234 (Jan. 3, 1984) ...................................................................................... 5 * * Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 8 of 46 FY 1995 IPPS Final Rule, 59 Fed. Reg. 27,708 (May 27, 1994) ............................................................................ 31 Standards for Defining Metropolitan and Micropolitan Statistical Areas, 65 Fed. Reg. 82,228 (Dec. 27, 2000) .............................................................................. 9 FY 2003 LTCH PPS Final Rule, 67 Fed. Reg. 55,954 (Aug. 30, 2002).......................................................................... 7, 9 RY 2004 LTCH PPS Final Rule, 68 Fed. Reg. 34,122 (June 6, 2003) .............................................................................. 10 FY 2005 IPPS Final Rule, 69 Fed. Reg. 48,916 (Aug. 11, 2004).................................................................. 9, 31, 34 RY 2006 LTCH PPS Final Rule, 70 Fed. Reg. 24,168 (May 6, 2005) ............................................................ 10, 31, 33, 34 RY 2009 LTCH PPS Final Rule, 73 Fed. Reg. 26,788 (May 9, 2008) .............................................................................. 10 FY 2010 IPPS/LTCH PPS Final Rule, 74 Fed. Reg. 43,754 (Aug. 27, 2009)............................................................................ 10 FY 2011 IPPS/LTCH Final Rule, 75 Fed. Reg. 50,042 (Aug. 16, 2010)............................................................................ 10 FY 2014 IPPS/LTCH PPS Final Rule, 78 Fed. Reg. 50,496 (Aug. 19, 2013)................................................................ 10, 11, 12 FY 2015 IPPS/LTCH PPS Proposed Rule, 79 Fed. Reg. 27,978 (May 15, 2014) ............................................................................ 11 FY 2015 IPPS/LTCH PPS Final Rule, 79 Fed. Reg. 49,854 (Aug. 22, 2014)..................................................................... passim FY 2016 IPPS/LTCH PPS Proposed Rule, 80 Fed. Reg. 24,324 (Apr. 30, 2015) ..................................................................... passim FY 2016 IPPS/LTCH PPS Final Rule, 80 Fed. Reg. 49,326 (Aug. 17, 2015)..................................................................... passim Other Authorities 1 Richard J. Pierce, Jr., Administrative Law Treatise 437 (4th ed. 2002).........................25 Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 9 of 46 -1- PRELIMINARY STATEMENT For more than a decade, the Medicare program has paid long-term care hospitals for inpatient services through a payment system based on prospectively determined rates. For every Medicare beneficiary discharged, the hospital receives a standard payment regardless of the costs incurred. But because labor costs vary across the country, the payment is adjusted to reflect area wage levels using an index based on wage data from the local labor market. The higher the wage index in a hospital’s labor market, the higher the Medicare payment. Since adopting this methodology in 2002, the Secretary of Health and Human Services has updated payment rates through an annual notice-and-comment rulemaking that applies the general policy to the most current data. Plaintiff, a long-term care hospital, asks the Court to set aside the annual update to the wage index for fiscal year 2016. Plaintiff takes issue with the labor-market areas used to calculate the wage index, which are delineated using geographic classifications issued by the Office of Management and Budget (OMB). In fiscal year 2015, the Secretary updated the labor-market areas to reflect newly drawn OMB classifications. Plaintiff shifted from a rural area to an urban area, and its wage index increased. In fiscal year 2016, with no further revisions from OMB, the Secretary kept the same labor-market area delineations in place. Although Plaintiff remained in the same urban area, lower wage data caused the local wage index to decrease. Displeased with this dip in payment rates, Plaintiff asks the Court to invalidate the wage index, arguing that the Secretary’s decision to retain the new labor-market areas from the year before was procedurally improper and substantively unreasonable. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 10 of 46 -2- Plaintiff’s arguments fail across the board. Its procedural challenges focus on the notice the Secretary provided of the labor-market area delineations—that is, whether the Secretary adequately apprised the public that the index would be calculated using the same lines that were used the year before. The record could not be clearer. The Secretary expressly proposed retaining the existing lines and adopted the same policy, nearly word for word. Perhaps acknowledging as much, Plaintiff reframes the issue by accusing the Secretary of failing to inform the public of the “significance” of this decision. Pl.’s Mem. in Supp. of Mot. for Summ. J. (“Pl.’s Mem.”), at 19, ECF No. 16. To that end, Plaintiff suggests that the Secretary was obligated to warn hospitals in smaller urban areas (like Plaintiff’s) that their wage indexes could be less stable than in larger areas. This proposed obligation exceeds the notice requirements established by law. The Secretary is required only to provide sufficient information on the substance of the rule to enable meaningful participation in the rulemaking process. And here, where the Secretary’s methodology has long been a matter of public record, hospitals in the Medicare program were well-equipped to comment on any issues that might weigh against retention of the longstanding wage-index policy, including the potential for less stability in small urban areas. Indeed, this issue is evident on the face of the policy, which is designed to reflect shifts in local wage data, and sufficiently apparent that a commenter raised the issue in the fiscal year 2015 rulemaking without the prompting that Plaintiff believes is required. Plaintiff seeks the Secretary’s advice on whether the policy would benefit its bottom line, but that kind of consultation is not required under notice and comment. Plaintiff’s substantive objections fare no better. Plaintiff claims that the Secretary’s decision to continue implementing longstanding policy was unreasonable because the Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 11 of 46 -3- Secretary did not create a special exception for Plaintiff. But the Secretary’s policy is codified in lawfully promulgated regulations, 42 C.F.R. §§ 412.503, 412.525(c)(1), which Plaintiff does not challenge. Plaintiff effectively asks the Court to declare unreasonable the Secretary’s decision to implement regulations as written. And even if these regulations did not govern, there is nothing unreasonable about the Secretary’s decision to adopt categorical rules for the wage index, as courts have recognized. E.g., Se. Ala. Med. Ctr. v. Sebelius, 572 F.3d 912, 923 (D.C. Cir. 2009). Where those rules are reasonable, the Secretary’s decision not to create an exception is also reasonable. See id. Indeed, the Secretary’s decision to continue implementing well-supported policies cannot be unreasonable simply because Plaintiff’s payments are lower than it expected for one year. Lastly, Plaintiff complains that hospitals in small urban areas are treated differently than hospitals in certain rural areas that share similar qualities. A brief review of the relief Plaintiff seeks will suffice to reject this argument out of hand. While lamenting different treatment, Plaintiff expressly refuses similar treatment—that is, a rural wage index. Plaintiff believes the stability concerns that support putting certain hospitals in the rural index somehow also support giving Plaintiff a higher urban index. In fact, Plaintiff seeks to reinstate the urban wage index from fiscal year 2015, when the policy was exactly the same but payment rates were conveniently higher. In any event, the Secretary reasonably treated different hospitals differently, and the rule should not be set aside. For each of these reasons, the Court should deny Plaintiff’s motion for summary judgment and grant summary judgment to the Secretary. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 12 of 46 -4- BACKGROUND I. The Medicare program and the inpatient prospective payment system. Medicare is a federal health insurance program for people aged sixty-five or older, certain younger people with disabilities, and people with end-stage renal disease. 42 U.S.C. §§ 1395a-1395lll. Payments to hospitals for services provided to Medicare beneficiaries are governed by a “complex statutory and regulatory regime.” Good Samaritan Hosp. v. Shalala, 508 U.S. 402, 404 (1993). The Secretary administers this regime through the Centers for Medicare & Medicaid Services (CMS), a component of the Department of Health and Human Services. Medicare Part A provides insurance for inpatient hospital services. 42 U.S.C. §§ 1395c-1395i-5. Beginning in 1965, the Medicare program paid hospitals for inpatient services using the “reasonable cost” system, where “providers were reimbursed for the actual costs that they incurred.” Methodist Hosp. of Sacramento v. Shalala, 38 F.3d 1225, 1227 (D.C. Cir. 1994). This system created “inadequate incentives for hospitals to control costs,” Cape Cod Hosp. v. Sebelius, 630 F.3d 203, 205 (D.C. Cir. 2011), which led Congress to overhaul the payment program in 1983. Social Security Amendments of 1983, Pub. L. No. 98-21, § 601, 97 Stat. 65, 149. Since 1983, the Medicare program has paid acute care hospitals for inpatient services through the inpatient prospective payment system (IPPS). See 42 U.S.C. § 1395ww(d). Under IPPS, acute care hospitals receive a fixed payment for each discharge “regardless of the actual operating costs they incur.” Sebelius v. Auburn Reg’l Med. Ctr., 133 S. Ct. 817, 822 (2013). IPPS payments generally are based on a flat national rate. 42 U.S.C. § 1395ww(d)(2). See generally 42 C.F.R., ch. IV, subch. B, pt. 412; Cty. of L.A. v. Shalala, Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 13 of 46 -5- 192 F.3d 1005, 1008 (D.C. Cir. 1999). This base payment rate “roughly reflects the average cost incurred by hospitals nationwide for each patient they treat and then discharge.” Cape Cod Hosp., 630 F.3d at 205. When Congress established IPPS in 1983, it required the Secretary to set the base payment rate by “determin[ing] the allowable operating costs per discharge of inpatient hospital services,” 42 U.S.C. § 1395ww(d)(2)(A), (d)(3), which the Secretary accomplished through an analysis of cost reports submitted by hospitals. FY 1984 IPPS Rule, 49 Fed. Reg. 234, 251 (Jan. 3, 1984). Subsequently, the base payment rate has been derived from the 1983 base rate through a series of congressionally mandated updates. 42 U.S.C. § 1395ww(b)(3), (d)(2)(B)-(C), (d)(3)(A); see also Saint Francis Med. Ctr. v. Price, No. 15-cv-1659 (JDB), 2017 WL 963139, at *1-2 (Mar. 10, 2017), appeal docketed, No. 17-5098 (D.C. Cir. May 9, 2017). In calculating the payment for a particular discharge, the Secretary adjusts the base payment rate to account for local labor costs in the area where the hospital is located. 42 U.S.C. § 1395ww(d)(3)(E). See generally Anna Jaques Hosp. v. Sebelius, 583 F.3d 1, 2-3 (D.C. Cir. 2009); Dignity Health v. Price, No. 15-cv-804 (RDM), 2017 WL 1066562, at *1-3 (D.D.C. Mar. 21, 2017). The Secretary first determines the nationwide proportion of costs that are “attributable to wages and wage-related costs,” 42 U.S.C. § 1395ww(d)(3)(E)(i), and divides the base payment rate into labor-related and nonlabor shares. The labor-related share is then adjusted using a factor “reflecting the relative hospital wage level in the geographic area of the hospital compared to the national average hospital wage level.” Id. This wage index—the ratio of national wages to local wages— is updated annually through a rulemaking process and based on wage data in cost reports submitted by IPPS hospitals. See id.; 42 C.F.R. § 412.64(h). Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 14 of 46 -6- In addition to adjusting for local labor costs, the base payment rate is “modified to account for the fact that the costs of treating patients vary based on the patients’ diagnoses.” Cape Cod Hosp., 630 F.3d at 205. The Secretary classifies clinical conditions into hundreds of diagnosis-related groups (DRGs), 42 U.S.C. § 1395ww(d)(3)(D), (4), and assigns each DRG a weighting factor that “reflect[s] the average cost associated with treating a patient for a specific condition.” Transitional Hosps. Corp. of La. v. Shalala, 222 F.3d 1019, 1021 (D.C. Cir. 2000). Each discharge is assigned to a DRG, and the appropriate weighting factor is applied. As a general matter, applying this DRG weighting factor to the wage-adjusted base rate yields the basic IPPS payment rate for a discharge, see Cape Cod Hosp., 630 F.3d at 206, although other variables come into play. II. The long-term care hospital prospective payment system. When Congress created IPPS in 1983, it limited the application of the new payment scheme to short-term acute care hospitals, which the statute calls “subsection (d) hospital[s]” after the definitional provision. 42 U.S.C. § 1395ww(d)(1)(B). Because Congress “did not ‘adequately take into account special circumstances of diagnoses requiring long stays,’” it expressly excluded from IPPS “certain types of hospitals that treat atypical patient populations.” Transitional Hosps. Corp. of La., 222 F.3d at 1021 (quoting S. Rep. No. 98-23, at 54 (1983)). Hospitals excluded from IPPS, like long-term care hospitals (LTCHs)—defined as hospitals with “an average inpatient length of stay . . . of greater than 25 days,” 42 U.S.C. § 1395ww(d)(1)(B)(iv); see also id. § 1395x(ccc)— continued to receive reimbursement for inpatient services under the reasonable-cost system. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 15 of 46 -7- Congress changed course in 1999 and directed the Secretary to “develop a per discharge prospective payment system for payment for inpatient hospital services of long- term care hospitals.” Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA), Pub. L. No. 106-113, § 123, 113 Stat. 1501 (1999) (codified as a note to 42 U.S.C. § 1395ww). Congress granted the Secretary broad discretion in developing the new LTCH prospective payment system (LTCH PPS), although Congress did require that the “system shall include an adequate patient classification system that is based on diagnosis-related groups (DRGs) and that reflects the differences in patient resource use and costs.” Id. The following year, Congress further provided that the Secretary “shall examine and may provide for” other “appropriate” adjustments, including “area wage adjustments.” Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), Pub. L. No. 106-554, § 307(b)(1), 114 Stat. 2763 (2000) (codified as a note to 42 U.S.C. § 1395ww). The Secretary, through CMS, began implementing LTCH PPS on October 1, 2002, which marked the beginning of Federal fiscal year (FY) 2003. FY 2003 LTCH PPS Final Rule, 67 Fed. Reg. 55,954 (Aug. 30, 2002). The Secretary modeled LTCH PPS after IPPS. See generally 42 C.F.R. ch. IV, subch. B, pt. 412, subpt. O (setting forth the rules governing LTCH PPS). As in IPPS, the Secretary established a flat national rate for LTCH PPS, known as the “standard Federal rate.” Id. § 412.523(c)(1).1 To calculate the standard 1 In 2015, CMS adopted a new LTCH PPS payment rate—the site-neutral payment rate—for inpatient discharges that do not meet enumerated statutory criteria. See Bipartisan Budget Act of 2013, Pub. L. No. 113-67, § 1206, 127 Stat. 1165; 42 C.F.R. § 412.522(a), (c); FY 2016 IPPS/LTCH PPS Final Rule, 80 Fed. Reg. 49,326, 49,601- 49,623 (Aug. 17, 2015). However, discharges meeting these criteria are still paid using the standard Federal rate. 42 C.F.R. § 412.522(a)(2)-(b); FY 2016 IPPS/LTCH PPS Final Rule, 80 Fed. Reg. at 24,527. The site-neutral payment rate is not at issue in this case. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 16 of 46 -8- Federal rate, the Secretary set FY 2003 as a base year and “estimate[d] the payments that would have been made to each hospital” that year under the reasonable-cost system, with some changes. Id. § 412.523(c)(2)-(3), (d)(3). In subsequent years, the standard Federal rate has been updated from this base-year rate. See id. § 412.523(c)(3). In calculating payments for a particular discharge, this standard Federal rate is subject to adjustments, including a DRG weighting factor. Id. §§ 412.513, 412.515, 412.517, 412.523(e). The Secretary also adjusts the standard Federal rate to account for area wage levels. 42 C.F.R. § 412.523(d)(4). As in IPPS, the Secretary first calculates the annual labor- related share of the LTCH PPS standard Federal rate. Id. § 412.525(c)(1). The Secretary then adjusts the labor-related share “to account for geographical differences in the area wage levels using an appropriate wage index (established by CMS).” Id. The wage index “reflects the relative level of hospital wages and wage-related costs in the geographic area . . . of the hospital compared to the national average level of hospital wages and wage- related costs.” Id. This ratio between national and local wages is the same formula used to adjust the labor-related share of IPPS payments. See 42 U.S.C. § 1395ww(d)(3)(E)(i). The local wages for a given geographic area are computed using wage data from local IPPS hospitals’ cost reports from a previous year—essentially, the same data used to compute the IPPS wage index. See, e.g., FY 2016 IPPS/LTCH PPS Final Rule, 80 Fed. Reg. 49,326, 49,797 (Aug. 17, 2015), Rulemaking Record (RR) 488. The Secretary updates LTCH PPS payment rates annually through notice-and- comment rulemaking, and publishes in the Federal Register “the methodology and data” used, including the wage index. 42 C.F.R. § 412.535(c). This action challenges the FY 2016 wage index adopted through the annual updating process. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 17 of 46 -9- III. Labor-market areas in the wage index. Plaintiff’s challenge to the FY 2016 LTCH PPS wage index focuses on the geographic classifications used to determine local wage levels, known as labor-market areas. The policy underlying the Secretary’s delineation of labor-market areas in FY 2016 dates back to the original LTCH PPS rulemaking. FY 2003 LTCH PPS Final Rule, 67 Fed. Reg. at 56,015-19. In the FY 2003 final rule, the Secretary adopted the methodology of dividing labor-market areas into urban and rural areas, used in IPPS since 1983, see id. at 56,052 (citing 42 C.F.R. § 412.62(f)(1)(ii), (f)(1)(iii)), relying on geographic classifications issued by the Office of Management and Budget (OMB). See id. at 56,015- 19, 56,057-75. Labor-market areas were thus defined by reference to OMB’s Metropolitan Statistical Areas (MSAs). The Secretary generally treated each MSA as its own urban labor-market area, while all non-urban areas in a state were combined into a single rural labor-market area. See id. Wage data from IPPS hospitals in each labor-market area were then used to compute the local LTCH PPS wage index. After the 2000 census, OMB issued revised standards for delineating geographic areas, called Core-Based Statistical Areas (CBSAs). See Standards for Defining Metropolitan and Micropolitan Statistical Areas, 65 Fed. Reg. 82,228 (Dec. 27, 2000). Relying on the new census data, OMB announced delineations of new CBSAs in 2003, including MSAs and Micropolitan Statistical Areas (Micropolitan Areas). See id. at 82,236. The Secretary adopted these CBSAs to delineate IPPS labor-market areas in the FY 2005 IPPS rulemaking. FY 2005 IPPS Final Rule, 69 Fed. Reg. 48,916, 49,027 (Aug. 11, 2004). Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 18 of 46 -10- LTCH PPS followed suit and aligned the LTCH labor-market areas with the new CBSAs in the rate year (RY)2 2006 rulemaking, “consistent with [the Secretary’s] historical practice of modeling LTCH PPS policy after IPPS policy.” RY 2006 LTCH PPS Final Rule, 70 Fed. Reg. 24,168, 24,814-85 (May 6, 2005). The Secretary adapted the new CBSAs to the two-tier classification of labor-market areas: urban and rural. MSAs continued to be classified as urban and generally became their own labor-market areas. See id. at 24,185-86, 24,224-46. Micropolitan Areas and areas outside of CBSAs were classified as rural and combined into a statewide labor-market area. See id. at 24,185, 24,187, 24,247. Over the next few years, the Secretary continued to update labor-market areas in line with minor changes announced by OMB. See, e.g., FY 2011 IPPS/LTCH PPS Final Rule, 75 Fed. Reg. at 50,444 ; FY 2010 IPPS/LTCH PPS Final Rule, 74 Fed. Reg. 43,754, 44,023 (Aug. 27, 2009); RY 2009 LTCH PPS Final Rule, 73 Fed. Reg. 26,788, 26,812-14 (May 9, 2008). And in 2008, the Secretary codified the definition of urban and rural labor-market areas by reference to OMB MSAs. RY 2009 LTCH PPS Final Rule, 73 Fed. Reg. at 26,814, 26,838-39. In February 2013, OMB issued revised CBSAs based on the 2010 census. The Secretary promptly announced that the new CBSAs would be adapted for use in the LTCH PPS. See FY 2014 IPPS/LTCH PPS Final Rule, 78 Fed. Reg. 50,496, 50,994-95 (Aug. 19, 2013), RR 9591-92. But because the FY 2014 proposed rule was already well into 2 LTCH PPS payment rates were initially established on a Federal fiscal year (FY) cycle running from October 1 through September 30. In June 2003, CMS switched the payment scheme to a rate year (RY) cycle running from July 1 to June 30. See RY 2004 LTCH PPS Final Rule, 68 Fed. Reg. 34,122, 34,125 (June 6, 2003). CMS switched back to a Federal fiscal year cycle in August 2010. See FY 2011 IPPS/LTCH Final Rule, 75 Fed. Reg. 50,042, 50,396 (Aug. 16, 2010). This distinction between fiscal and rate years is immaterial to this matter. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 19 of 46 -11- development when OMB announced the revisions, the Secretary deferred adoption of the new lines until the FY 2015 rulemaking, at which time the Secretary “intend[ed] to propose the adoption of the newest CBSA designations and the corresponding changes to the wage index based on those CBSA changes.” Id. at 50,995, RR 9592. The Secretary followed through in the FY 2015 notice of proposed rulemaking. FY 2015 IPPS/LTCH PPS Proposed Rule, 79 Fed. Reg. 27,978, 28,190-93 (May 15, 2014). The Secretary proposed adopting the 2013 OMB revisions, which included establishing new CBSAs, splitting existing CBSAs, and switching some counties between urban and rural. See id. Recognizing that some LTCHs transitioning from urban to rural CBSAs would be negatively affected by the transition (as rural wages generally are lower), the Secretary proposed a one-year transitional wage index. LTCHs experiencing a decrease in their wage index would receive a one-year “blended” wage index, which averaged the new wage index with a wage index drawn using the old FY 2014 CBSA lines. Id. at 28,193- 94. The Secretary adopted these changes in the FY 2015 final rule. FY 2015 IPPS/LTCH PPS Final Rule, 79 Fed. Reg. 49,854, 50,180-85, 50,391-96 (Aug. 22, 2014), RR 8083-88, 8294-99. The Secretary proposed no further changes to the LTCH PPS labor-market areas in the FY 2016 notice of proposed rulemaking. FY 2016 IPPS/LTCH PPS Proposed Rule, 80 Fed. Reg. 24,324 (Apr. 30, 2015), RR 536. The Secretary reiterated that the existing FY 2015 labor-market delineations reflected the most recent OMB lines and proposed “to continue to use the CBSA-based labor market area delineations currently used under the LTCH PPS.” Id. at 24,643, RR 855. In the FY 2016 final rule, the Secretary adopted without change the proposed rule. 80 Fed. Reg. at 49,797-98, RR 488-89. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 20 of 46 -12- IV. Factual and procedural background. Plaintiff is a LTCH located in Tangipahoa Parish, Louisiana. Administrative Record (AR) 000002. In the FY 2014 final rule, Tangipahoa Parish was located in Louisiana’s statewide rural labor-market area, which had a wage index of 0.7585 that year. See 78 Fed. Reg. at 51,002, RR 9599; FY 2014 LTCH PPS Final Rule Wage Indexes, Table 12B, CBSA Code 19 (attached hereto as Ex. 1).3 In the FY 2015 final rule, Tangipahoa Parish shifted from the rural Louisiana labor-market area to a newly created urban CBSA centered on Hammond, Louisiana, which had a wage index of 0.9452. 79 Fed. Reg. at 50,403, RR 8306; FY 2015 LTCH PPS Final Rule Wage Indexes, Table 12A, CBSA Code 25220 (attached hereto as Ex. 2); FY 2015 Final Rule County to CBSA Crosswalk File, SSA State County Code 19520 (attached hereto as Ex. 3). That year, the Secretary also calculated an index using the FY 2014 CBSAs to create the one-year transitional wage index. The wage index in Plaintiff’s old rural CBSA was 0.7580. 79 Fed. Reg. at 50,403, RR 8306; FY 2015 LTCH PPS Final Rule Wage Indexes, Table 12D, CBSA Code 19 (attached hereto as Ex. 4). Because Plaintiff’s new wage index in the urban Hammond CBSA was significantly higher than Plaintiff’s old wage index in the rural Louisiana CBSA—in other words, Plaintiff’s wage-adjusted payment rate under the new lines was higher than it would have been under the old lines—the transitional wage index did not apply. See 79 Fed. Reg. at 50,180-85, RR 8083-88. 3 In the annual LTCH PPS rules, CMS incorporates by reference a number of tables that are not published in the Federal Register. Cf. Pl.’s Mem. at 10. These tables are available for download as Excel and text files from the CMS website at an address published in the rule. For the Court’s convenience, the relevant tables are attached as exhibits to this motion, along with links to the original files referenced in the rules. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 21 of 46 -13- In the FY 2016 notice of proposed rulemaking, the Secretary proposed a wage index of 0.6575 for the Hammond CBSA, a decrease from FY 2015. 80 Fed. Reg. at 24,651, RR 863; FY 2016 LTCH PPS Proposed Rule Wage Indexes, Table 12A, CBSA Code 25220 (attached hereto as Ex. 5). After obtaining more wage data, the Secretary ultimately adopted a higher wage index of 0.8167 in the final rule, albeit still lower than FY 2015. 80 Fed. Reg. at 49,808, RR 499; FY 2016 LTCH PPS Final Rule Wage Indexes, Table 12A, CBSA Code 25220 (attached hereto as Ex. 6). In contrast, the rural Louisiana wage index was 0.6959. 80 Fed. Reg. at 49,808, RR 499; FY 2016 LTCH PPS Final Rule Wage Indexes, Table 12B, CBSA Code 19 (attached hereto as Ex. 7). The wage index in FY 2016 was calculated using IPPS wage data from FY 2012, 80 Fed. Reg. at 49,799, RR 490, and the Secretary published the relevant 2012 IPPS wage data in relation to the corresponding FY 2016 IPPS rule. In the Hammond CBSA, the Secretary based the index on wage data from two IPPS hospitals: North Oaks Medical Center and Hammond Surgical L.L.C. See FY 2016 IPPS Wage Index Public Use Files, Final S-3 Data, PROV Nos. 190015 and 190303 (attached hereto as Ex. 8).4 Plaintiff incorrectly asserts that the Hammond CBSA (25220) contains only two hospitals in total, Plaintiff and North Oaks Medical Center,5 Pl.’s Mem. at 10, but this issue is not material to the resolution of this matter in the government’s favor. 4 The cited worksheet shows wage data by provider. North Oaks Medical Center is shown at line 1256 (PROV No. 190015), and Hammond Surgical L.L.C. is shown at line 1335 (PROV No. 190303). See Ex. 8. The CBSA is shown in the column labeled “CBSAGEO”—in each case, CBSA 25220. 5 Plaintiff relies on a table from the FY 2015 IPPS wage index files, an excerpt of which is attached as Ex. 9. North Oaks Medical Center is shown at line 1283 (PROV No. 190015), and Hammond Surgical L.L.C. is shown at line 1365 (PROV No. 190303). The column labeled “# of provs in cbsa_new” expressly notes that there are two IPPS providers in CBSA 25220. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 22 of 46 -14- On October 6, 2015, Plaintiff submitted an appeal to the Provider Reimbursement Review Board (PRRB), a Department of Health and Human Services tribunal responsible for hearing Medicare hospital reimbursement disputes, in which Plaintiff challenged the FY 2016 LTCH PPS wage index. AR 000268, AR 000307-10. On March 19, 2016, Plaintiff submitted a request for expedited judicial review under 42 U.S.C. § 1395oo(f)(1), which the PRRB granted in a decision dated April 18, 2016. AR 000001-05. STANDARD OF REVIEW In this action proceeding under the Medicare statute, 42 U.S.C. § 1395oo(f)(1), judicial review is governed by the standards of the Administrative Procedure Act (APA), 5 U.S.C. § 706, and decided on an administrative record. Se. Ala. Med. Ctr., 572 F.3d at 916-17. Accordingly, “‘the district court does not perform its normal role’ but instead ‘sits as an appellate tribunal’” resolving legal questions. Cty. of L.A., 192 F.3d at 1011 (quoting PPG Indus., Inc. v. United States, 52 F.3d 363, 365 (D.C. Cir. 1995)). Although the parties move for summary judgment, the “standard set forth in Rule 56(c) . . . does not apply.” Gentiva Healthcare Corp. v. Sebelius, 857 F. Supp. 2d 1, 6 (D.D.C. 2012) aff'd, 723 F.3d 292 (D.C. Cir. 2013). Rather, summary judgment “serves as the mechanism for deciding, as a matter of law, whether the agency action is supported by the administrative record and otherwise consistent with the APA standard of review.” Id. ARGUMENT I. Plaintiff’s procedural challenges to the FY 2016 wage index fail. Plaintiff first contends that the Secretary’s adoption of the FY 2016 wage index was procedurally defective. Pl.’s Mem. at 18-32. According to Plaintiff, the Secretary provided insufficient notice of the “significance of [the] decision to retain for FY 2016 the revised Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 23 of 46 -15- labor market delineations,” and thus failed to satisfy the notice-and-comment requirements of the APA, 5 U.S.C. § 553, and the Medicare statute, 42 U.S.C. § 1395hh(b)(1). Pl.’s Mem. at 19. This argument fails for a number of reasons, not least because the Secretary proposed and adopted an existing policy without change. Plaintiff evidently is disappointed with the FY 2016 wage index in the Hammond CBSA, but the Secretary provided more than sufficient notice of how the wage index would be computed, using the same methodology that the Secretary has employed since the advent of IPPS in 1983. A. The FY 2016 rulemaking satisfied notice-and-comment requirements. The APA requires agencies to undertake notice and comment before issuing legislative rules. 5 U.S.C. § 553(b). Where this requirement applies, the agency must publish a notice of proposed rulemaking that includes “either the terms or substance of the rule or a description of the subjects and issues involved.” Id. § 553(b)(3). The agency then must “give interested persons an opportunity to participate in the rule making through submission of written data, views, or arguments with or without opportunity for oral presentation.” Id. § 553(c). After considering “the relevant matter presented, the agency shall incorporate in the rules adopted a concise general statement of their basis and purpose.” Id. The Medicare statute “places notice and comment requirements on the Secretary’s substantive rulemaking similar to those created by the APA.” Monmouth Med. Ctr. v. Thompson, 257 F.3d 807, 814 (D.C. Cir. 2001). The Secretary must “provide for notice of [a] proposed regulation in the Federal Register and a period of not less than 60 days for public comment” before issuing a “rule, requirement, or other statement of policy (other than a national coverage determination) that establishes or changes a substantive legal Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 24 of 46 -16- standard governing the scope of benefits, the payment for services, or the eligibility . . . to furnish or receive services or benefits.” 42 U.S.C. § 1395hh(a)(2), (b)(1). For purposes of the claims raised in this action, the obligations imposed by the APA and the Medicare statute are not materially different. See, e.g., Select Specialty Hosp.-Akron, LLC v. Sebelius, 820 F. Supp. 2d 13, 22-24 (D.D.C. 2011) (employing the same standards to analyze notice requirements under both statutes). These notice requirements “are designed (1) to ensure that agency regulations are tested via exposure to diverse public comment, (2) to ensure fairness to affected parties, and (3) to give affected parties an opportunity to develop evidence in the record to support their objections to the rule and thereby enhance the quality of judicial review.” Int’l Union, United Mine Workers of Am. v. Mine Safety & Health Admin., 407 F.3d 1250, 1259 (D.C. Cir. 2005). Thus, the notice “must ‘provide sufficient factual detail and rationale for the rule to permit interested parties to comment meaningfully.’” U.S. Telecom Ass’n v. FCC, 825 F.3d 674, 700 (D.C. Cir. 2016) (quoting Honeywell Int’l, Inc. v. EPA, 372 F.3d 441, 445 (D.C. Cir. 2004)). A notice is sufficient if “it affords interested parties a reasonable opportunity to participate in the rulemaking process, and if the parties have not been deprived of the opportunity to present relevant information by lack of notice that the issue was there.” Am. Radio Relay League, Inc. v. FCC, 524 F.3d 227, 236 (D.C. Cir. 2008). The Secretary fully complied with these requirements in promulgating the FY 2016 wage index, including the labor-market delineations. In the proposed rule, the Secretary provided detailed notice of LTCH PPS policies for the upcoming fiscal year, including existing policies that would remain in effect and proposed changes to those policies. 80 Fed. Reg. at 24,525, RR 737. In the preamble, the Secretary recited the origins of LTCH Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 25 of 46 -17- PPS in the FY 2003 final rule and referred readers to the FY 2012 final rule for a fuller discussion of the longstanding policies undergirding the payment system. Id. The Secretary then proposed a number of substantive changes, but no revisions to the labor- market delineations used to calculate the wage index. See id. at 24,525-24,554, RR 737- 66. Accordingly, the Secretary’s proposed changes to 42 C.F.R. chapter IV contain no revisions to the wage-index provisions. See id. at 24,621-24625, RR 833-37. In the addendum, the Secretary laid out existing policies that would be retained. 80 Fed. Reg. at 24,643, RR 855. The Secretary observed that the geographic classifications “currently used under the LTCH PPS” were “based on the new OMB labor market area delineations based on the 2010 Decennial Census Data.” Id. The Secretary explained that “these OMB delineations are based on the best available data that reflect the local economies and area wage levels of the hospitals that are currently located in these geographic areas.” Id. In addition, CBSAs “ensure that the LTCH PPS area wage level adjustment most appropriately accounts for and reflects the relative hospital wage levels in the geographic area of the hospital as compared to the national average hospital wage level.” Id. The Secretary referred readers to the FY 2015 final rule for a history of labor- market area delineations and a lengthier discussion of the current LTCH PPS policy, as well as a discussion of the IPPS policy on which the LTCH PPS policy was modeled. Id. The Secretary then explained why the agency proposed retaining the existing policy from FY 2015. 80 Fed. Reg. at 24,643, RR 855. There was a “historical practice to update the CBSA-based labor market area delineations annually based on the most recent updates issued by OMB,” but “OMB had not issued any further updates” subsequent to the 2013 announcement of new CBSAs based on the 2010 census. Id. Thus, the Secretary proposed Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 26 of 46 -18- “to continue to use the CBSA-based labor market area delineations currently used under the LTCH PPS,” as adopted in the FY 2015 final rule. Id. These delineations, the Secretary explained, will ensure that the LTCH PPS area wage level adjustment most appropriately accounts for and reflects the relative hospital wage levels in the geographic area of the hospital as compared to the national average hospital wage level based on the best available data that reflect the local economies and area wage levels of the hospitals that are currently located in these geographic areas. Id. This notice of proposed rulemaking provided more than sufficient notice of the labor-market area policy that the Secretary adopted, which was identical. 80 Fed. Reg. at 49,797, RR 488. The Secretary thoroughly explained the “substance of the proposed rule,” 5 U.S.C. § 553(b)(3), which was simply the retention of an existing policy. And given this continuity, any LTCH participating in the Medicare program had sufficient information to “comment meaningfully” on the question whether the Secretary should continue to use the existing lines to calculate the wage index going forward. U.S. Telecom Ass’n, 825 F.3d at 700. The rationale for retaining the policy—that the OMB delineations reflect the best available data about local labor markets—was equally clear, supported by reference to lengthier explanations of relevant aspects of LTCH PPS provided over a decade of rulemaking. Beyond just the labor-market delineations, the methodology and data used to compute the wage index were all noticed in the proposed rule and available for public inspection. See, e.g., 80 Fed. Reg. at 24,644, RR 856. In particular, CMS notified readers that a wealth of data was available in tables published online through the CMS website to aid in hospitals’ understanding of how the existing policy would be implemented for FY Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 27 of 46 -19- 2016. Id. at 24,644, 24651, RR 856, 863. And importantly, these tables included the proposed LTCH PPS wage index for each CBSA, allowing LTCHs to view their proposed wage index for the coming year and provide feedback as they saw fit. See id. Thus, LTCHs were not “deprived of the opportunity to present relevant information” about the labor- market areas used to calculate the index. Am. Radio Relay League, Inc., 524 F.3d at 236. The sufficiency of the notice provided in the FY 2016 proposed rule is borne out by public comments acknowledging the continuity in the labor-market area delineations from FY 2015 and providing feedback about the FY 2016 wage index under these lines. For example, the Kentucky Hospital Association, which includes seven LTCHs, submitted a comment acknowledging CMS’s proposal for LTCH PPS “to continue to use the updated labor market boundaries that were implemented in FY 2015 and based on 2010 census data,” and noting that “[t]he proposed FY 2016 wage index values [were] provided on CMS’s web page.” RR 3678-87. The association also submitted critical feedback, contending that Kentucky hospitals were paid less than hospitals in adjacent states even though they “must compete regionally for skilled employees.” Id. at 3681. Similarly, the National Rural Health Association commented on the policy’s effect on rural IPPS hospitals, which were also subject to the revised CBSA lines, asserting that “wide and varied impacts” were “felt throughout the rural health landscape” as a result of “the implementation of MSA changes as defined by the Office of Management and Budget.” RR 1944-47, 4265-68. And a number of IPPS hospital expressed general approval for the new lines. See, e.g., RR 2031, 2512, 2569, 3388, 4296, 4484, 4514, 4761. These examples illustrate that hospitals had sufficient notice that CMS would compute the wage index using the FY 2015 labor-market area delineations going forward Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 28 of 46 -20- and were well-equipped to provide critical feedback about the significance of that decision. See, e.g., Cement Kiln Recycling Coal. v. EPA, 493 F.3d 207 (D.C. Cir. 2007) (citing comments as evidence that notice was sufficient); Nuvio Corp. v. FCC, 473 F.3d 302, 310 (D.C. Cir. 2006) (same). Given this response, the clear explanation for the rule, the decade of reasoning in support, and the publication of abundant data, the Secretary more than satisfied the procedural requirements of the APA and the Medicare statute. B. Plaintiff’s arguments are meritless. Plaintiff nonetheless contends that the FY 2016 wage index was procedurally defective. The arguments to this effect fall into three main categories: first, the Secretary improperly “neglected to disclose the adverse consequences that hospitals moved to CBSAs with few providers would face,” Pl.’s Mem. at 20; second, the Secretary improperly failed to disclose “the facts or analysis supporting” the decision to retain the FY 2015 labor- market area delineations, Pl’s Mem. at 25; and third, the final rule is “not a logical outgrowth” of the proposed rule, Pl’s Mem. at 31. All three arguments are inconsistent with the Secretary’s obligations under the statutes and accordingly must fail. 1. Plaintiff had sufficient notice to meaningfully comment. Plaintiff first argues that the Secretary was required to provide express notice that retention of the FY 2015 labor-market areas could result in year-to-year variability in areas where the wage index is based on wage data from a relatively small number of IPPS hospitals. Pl.’s Mem. at 19-23. As an initial matter, this complaint is more properly directed at the FY 2015 rule, not the FY 2016 rule. Indeed, Plaintiff’s brief roots this claim in alleged flaws in the FY 2015 rulemaking, when the Secretary first adopted the relevant policy. Id. at 19-22. Yet Plaintiff’s proposed solution to this purported defect common to Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 29 of 46 -21- the FY 2015 and FY 2016 rules is for the Court to replace the FY 2016 wage index with the FY 2015 wage index, id. at 28, and not, say, the FY 2014 wage index. Plaintiff understandably prefers the higher FY 2015 index to the lower FY 2106 index, but Plaintiff’s procedural argument is conveniently inconsistent in its application. Regardless, the FY 2016 rulemaking provided sufficient notice for LTCHs to comment meaningfully on any possible concerns about year-to-year index stability in labor-market areas with small numbers of IPPS hospitals. For one thing, these concerns were raised in the FY 2015 rulemaking and addressed in the FY 2015 final rule, which is expressly cited in the FY 2016 proposed rule. 80 Fed. Reg. at 24,643, RR 1225. In the FY 2015 final rule, the Secretary noted that a commenter raised the issue of a “significant change” in the proposed LTCH PPS wage index for a few specific CBSAs, even though there had been “no change in the constituent of hospitals used to compute the wage index values for these areas” from FY 2014. 79 Fed. Reg. at 50,394, RR 8297. The Secretary observed that labor-market areas “with fewer providers are generally subject to less stability in year-to-year wage index values because there is less of an averaging effect.” Id. at 50,395, RR 8298. But although the wage index in some CBSAs decreased, the Secretary reasoned, these decreases accurately reflected changes in local wage data, id., as required by regulation. See 42 C.F.R. § 412.525(c). In addition to providing actual notice of the year-to-year variability that Plaintiff raises in this lawsuit, this passage in the FY 2015 final rule illustrates two flaws in Plaintiff’s notice argument. First, the comment belies Plaintiff’s claim that the Secretary provided insufficient notice for readers to “comment meaningfully” on the question of year-to-year variability. U.S. Telecom Ass’n, 825 F.3d at 700. The commenter did just Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 30 of 46 -22- that. If hospitals had sufficient notice to raise the issue in FY 2015, surely hospitals had sufficient notice of the issue in FY 2016, which retained the same policy. Plaintiff in particular had more than enough information to raise the questions presented in this lawsuit at the time of the FY 2016 notice of proposed rulemaking. The Secretary proposed a wage index that was, in fact, lower than the index adopted, and that would have marked a greater change from FY 2015. Compare Ex. 5 with Ex. 6. To the extent Plaintiff is concerned about index stability, the proposed rule put that issue in even starker relief than the final rule. The Secretary also made clear how the index was computed, using local IPPS wage data from the Hammond CBSA—just as it had been the year before. 80 Fed. Reg. at 24,644, RR 1226. If Plaintiff had concerns about the change in its wage-index value based on changes in local IPPS wage data, its failure to raise those issues in the FY 2016 rulemaking cannot be attributed to lack of notice. The information available to Plaintiff about the FY 2016 index policy was the same at the time of the notice of proposed rulemaking as it was at the time Plaintiff began these proceedings. Second, the FY 2015 comment illustrates that Plaintiff’s quarrel is not actually with the notice of the new lines, but instead with the basic methodology employed by the Secretary under 42 C.F.R. § 412.523, which Plaintiff has not challenged here.6 The FY 2015 commenter noted that the constituent IPPS hospitals in the relevant CBSA did not change from FY 2014 to FY 2015, meaning that the wage data did not change on account of the new FY 2015 lines. 79 Fed. Reg. at 50,394, RR 8297. In other words, any issue 6 Nor could Plaintiff successfully bring such a claim now. It could not bring a claim that the Secretary somehow erred in failing to amend the regulations establishing his methodology for wage index adjustments in LTCH PPS without first seeking this relief from the agency, which Plaintiff has not done. See Encino Motorcars, LLC v. Navarro, 136 S. Ct. 2117, 2125 (2016) (citing Auer v. Robbins, 519 U.S. 452, 458-59 (1997)). Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 31 of 46 -23- with year-to-year index stability in smaller CBSAs does not arise from the new OMB lines, as Plaintiff suggests, because the index has always been responsive to changes in local wage data. The same question could be raised in any rulemaking that applied the Secretary’s longstanding methodology to wage data in CBSAs with small constituencies of IPPS hospitals. Plaintiff’s argument suggests that every LTCH PPS rulemaking since 2002 might be procedurally invalid for lack of notice. Indeed, Plaintiff is asking for something more than adequate or fair notice. Plaintiff would have the Court impose on the Secretary an affirmative obligation to flag any potentially adverse consequences for individual LTCHs resulting from the normal application of accepted methodology in each of the hundreds of CBSAs across the country. In effect, the Secretary would be required to conduct a case-by-case analysis to determine whether a generally applicable rule would be favorable or unfavorable to a particular hospital whenever the Secretary proposes an annual update to the wage index. It is not clear what limiting principle would apply to this new obligation, and how the Secretary might satisfy it. But wherever the line might be drawn, it would fall far beyond the obligations established by law under the APA and the Medicare statute, which require only notice of the substance of a proposed rule sufficient to allow for meaningful comment. 2. The Secretary did not withhold critical material. Plaintiff’s second set of arguments concern notice of the record relied on by the Secretary in promulgating the FY 2016 wage index. Pl.’s Mem. at 24-26. Plaintiff invokes a line of cases from the D.C. Circuit requiring agencies to make available for comment the “technical studies and data” or “staff reports” that the agency relies on. Am. Radio Relay League, Inc., 524 F.3d at 236-37; see also Conn. Light & Power Co. v. Nuclear Regulatory Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 32 of 46 -24- Comm’n, 673 F.2d 525, 530 (D.C. Cir. 1982); Portland Cement Ass’n v. Ruckelshaus, 486 F.2d 375, 392-94 (D.C. Cir. 1973). Under this line of cases, “an agency’s failure to disclose critical material, on which it relies, deprives commenters of a right under § 553 ‘to participate in rulemaking.’” Allina Health Servs. v. Sebelius, 746 F.3d 1102, 1110 (D.C. Cir. 2014) (quoting Air Transp. Ass’n of Am. v. FAA, 169 F.3d 1, 7 (D.C. Cir. 1999)). Some caution is appropriate when considering this disclosure obligation. There is “considerable debate as to whether this doctrine conflicts with the Supreme Court’s decision in Vermont Yankee Nuclear Power Corp. v. Natural Res. Def. Council, 435 U.S. 519 (1978), which limited a court’s power to order additional procedures in rulemaking beyond those imposed by the Administrative Procedures Act.” Banner Health v. Burwell, 55 F. Supp. 3d 1, 9 n.10 (D.D.C. 2014), appeal pending, No. 16-5129 (D.C. Cir. argued Apr. 13, 2017); see also, e.g., Am. Radio Relay League, Inc., 524 F.3d at 246 (Kavanaugh, J., dissenting) (arguing that the critical-material doctrine “stands on a shaky legal foundation” and “cannot be squared with the text of § 553”). Recognizing this “possible tension between Vermont Yankee and [the] critical material doctrine,” the D.C. Circuit has tread cautiously. Allina Health Servs., 746 F.3d at 1110. For example, the Court has “more carefully examined whether a failure to disclose such material actually harmed” a plaintiff. Id.; see also, e.g., Am. Radio Relay League, Inc., 524 F.3d at 239 (emphasizing the “narrowness” of its holding under this doctrine). Here, the critical-material doctrine is inapposite because the disclosure obligation extends only to materials that the agency actually relied on in promulgating the rule. See, e.g., Allina Health Servs., 746 F.3d at 1110 (describing the agency’s obligation to disclose material “on which it relies”); Am. Radio Relay League, Inc., 524 F.3d at 240 (noting that Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 33 of 46 -25- the Circuit’s cases are “not inconsistent with the view that ‘the [critical material] doctrine should be limited to studies on which the agency actually relies to support its final rule’” (quoting 1 Richard J. Pierce, Jr., Administrative Law Treatise 437 (4th ed. 2002))); Lee Mem’l Health Sys. v. Burwell, 206 F. Supp. 3d 307, 335 (D.D.C. 2016) (concluding that “the Circuit’s rule is centered upon the principle that only those studies and materials relied upon must be disclosed”), appeal docketed, No. 17-5006 (D.C. Cir. Jan. 11, 2017); Banner Health, 55 F. Supp. 3d at 10 (observing that the “focal point of this analysis” is “reliance on materials that were undisclosed”). Plaintiff points to no technical studies or data that the Secretary relied on but failed to disclose in the notice of proposed rulemaking. And a review of the rulemaking record, which contains the materials the Secretary relied on, reveals no undisclosed critical material that would fall within the obligation articulated by the D.C. Circuit. See, e.g., EchoStar Satellite LLC v. FCC, 457 F.3d 31, 40 (D.C. Cir. 2006). To succeed on this claim, Plaintiff would need to identify critical materials that the agency relied on but improperly omitted from the administrative record, then move this Court to order their inclusion. And even then, Plaintiff would still bear the burden of demonstrating that the Secretary relied on these undisclosed critical materials when promulgating the rule. See, e.g., Lee Mem. Health Sys., 206 F. Supp. at 334-35; Banner Health, 55 F. Supp. 3d at 12. Plaintiff has made no such showing, only broad and unsupported assertions. 3. The final rule is identical to the proposed rule. Plaintiff’s third argument is that the final rule adopted by the Secretary was insufficiently related to the proposed rule. Pl.’s Mem. at 31-32. Both the APA and the Medicare statute require that a final rule is a “logical outgrowth” of the notice provided by Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 34 of 46 -26- the Secretary. 42 U.S.C. § 1395hh(a)(4); Agape Church, Inc. v. FCC, 738 F.3d 397, 401 (D.C. Cir. 2013). But the proposed rule and the final rule “need not be identical.” CSX Transp., Inc. v. Surface Transp. Bd., 584 F.3d 1076, 1079 (D.C. Cir. 2009). Rather, a “final rule is a logical outgrowth if affected parties should have anticipated that the relevant modification was possible.” Allina Health Servs., 746 F.3d at 1107. Here, the proposed and final rules were identical—the text is nearly word for word. Compare 80 Fed. Reg. at 24,643, RR 855, with 80 Fed. Reg. at 49,797, RR 488. Given this identity between the two versions, Plaintiff’s argument that the final rule is not a logical outgrowth of the proposed rule amounts to a category error. The logical-outgrowth rule guards against a “surprise switcheroo,” Envtl. Integrity Project v. EPA, 425 F.3d 992, 996 (D.C. Cir. 2005), where the final rule is “wholly unrelated or surprisingly distant” from the proposed rule, Ariz. Pub. Serv. Co. v. EPA, 211 F.3d 1280, 1299 (D.C. Cir. 2000), but here there was no switch, no surprise, and no distance whatsoever. Because there was no modification, the question whether affected parties could anticipate a modification is beside the point. See Allina Health Servs., 746 F.3d at 1107. Plaintiff’s argument is implausible on its face. II. Plaintiff’s substantive challenges to the FY 2016 wage index fail. Plaintiff also posits that the Secretary’s decision to adopt the FY 2016 wage index was substantively unreasonable and accordingly must be set aside. Pl.’s Mem. at 32-43. Plaintiff would have the Court conclude that the decision to continue using the FY 2015 labor-market area delineations to compute the wage index, in line with longstanding policy, could not have been a reasonable choice. None of the arguments that Plaintiff marshals in Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 35 of 46 -27- support of this conclusion—which generally amount to a request for a sui generis exception to ensure Plaintiff a more favorable payment rate—withstand scrutiny. Importantly, none of these arguments call into question the Secretary’s authority. Plaintiff does not challenge the Secretary’s discretion under BBRA § 123, 113 Stat. at 1501A-331, as amended by BIPA § 307(b), 114 Stat. at 2763A-496, to adjust the payment rate to account for local wages. And Plaintiff also does not challenge the regulations establishing the Secretary’s methodology. 42 C.F.R. §§ 412.503, 412.525(c). Thus, as a baseline, there is no question in this case that the Secretary must promulgate a wage index that “reflects the relative level of hospital wages and wage-related costs in the geographic area . . . of the hospital.” 42 C.F.R. § 412.525(c)(1). There is no question that the Secretary must designate geographic areas as “urban or rural.” Id. And there is no question that an urban area is “a Metropolitan Statistical Area, as defined by the Executive Office of Management and Budget,” while a rural area is “any area outside an urban area.” Id. § 412.503. The Secretary’s decision must be viewed against this backdrop. A. The Secretary reasonably applied longstanding policy. Under the APA, agency action may be set aside as substantively unreasonable only if the Court concludes that the action was “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law.” 5 U.S.C. § 706(2)(A). The Medicare statute incorporates this standard. 42 U.S.C. § 1395oo(f)(1); see, e.g., Se. Ala. Med. Ctr. 572 F.3d at 916-17. The Court’s review is “narrow,” limited to determining whether the agency “examine[d] the relevant data and articulate[d] a satisfactory explanation for its action including a rational connection between the facts found and the choice made.” Ark Initiative v. Tidwell, 816 F.3d 119, 127 (D.C. Cir. 2016) (quoting Motor Vehicle Mfrs. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 36 of 46 -28- Ass’n of U.S., Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43 (1983)), cert. denied, 137 S. Ct. 301 (2016). And the Court must uphold a decision where “the agency’s path may be reasonably discerned.” Id. (quoting State Farm, 463 U.S. at 43). In short, the question before the Court is whether the agency’s decision “was the product of reasoned decisionmaking.” State Farm, 463 U.S. at 52; see also, e.g., Nat’l Tel. Co-op. Ass’n v. FCC, 563 F.3d 536, 540 (D.C. Cir. 2009) (“The APA’s arbitrary-and-capricious standard requires that agency rules be reasonable and reasonably explained.”). Here, the Secretary’s decision to adopt the FY 2016 wage index—more specifically, to retain the FY 2015 labor-market area delineations, and to compute the index based on local IPPS wage data from these areas—was eminently reasonable, and the Secretary’s path to this decision can be discerned readily from a brief recapitulation of the rulemaking. Under the established regulatory regime, the Secretary examined the relevant OMB data and determined that the FY 2015 labor-market area delineations reflected the most current MSA designations. 80 Fed. Reg. at 49,797-98. Using these lines, the Secretary computed a wage index reflecting local wage levels with data from local IPPS hospitals. Id. at 49,797-99. The Secretary then adopted this wage index for FY 2016. Id. Far from arbitrary, the Secretary’s decision reflects a faithful implementation of the established methodology using the most current available data. B. Plaintiff’s arguments fail. Plaintiff makes two arguments to the contrary: first, that the Secretary’s decision to adopt the FY 2016 wage index was unreasonable in light of the potential for year-to- year instability in the index value, Pl.’s Mem. at 32-37; and second, that the Secretary’s Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 37 of 46 -29- decision was unreasonable when compared to the Secretary’s wage-index policy for LTCHs in Micropolitan Areas, Pl.’s Mem. at 38-43. Both arguments are meritless. 1. The Secretary reasonably declined to create a special exception. Plaintiff contends that the Secretary’s implementation of the longstanding wage- index policy was unreasonable in FY 2016 because the wage data in Plaintiff’s labor- market area reflected a drop in local wages between FY 2015 and FY 2016. For Plaintiff, this decrease is a mark of intolerable instability in the Hammond wage index, and the decision not to create a special wage index for Plaintiff therefore was unreasonable. See Pl.’s Mem. at 32-37. Properly understood, this argument is a challenge to the Secretary’s basic methodology, not the particular implementation of that methodology in FY 2016. Plaintiff does not argue, for example, that the FY 2015 labor-market area delineations did not reflect the geographic area, or that the FY 2016 wage level for Hammond was improperly calculated. Rather, Plaintiff is arguing that the Secretary’s general policy of relying on wage data from labor-market areas based on OMB delineations—or, perhaps, doing so without further accommodations—is unreasonable. But the Secretary’s general policy, which has been employed since the outset of LTCH PPS (and much earlier in IPPS), is lawfully codified. See 42 C.F.R. §§ 412.503, 412.525(c)(1). Plaintiff does not challenge those regulations, which were promulgated through notice-and-comment under the Secretary’s broad statutory authority to develop the LTCH PPS and make adjustments for wages. See BIPA § 307(b), 114 Stat. at 2763A-496; BBRA § 123, 113 Stat. at 1501A-331. Nor could it bring a challenge to those regulations for the first time in this lawsuit. See Encino Motorcars, LLC, 136 S. Ct. at 2125. Plaintiff challenges only the implementation of those regulations in the FY 2016 rulemaking, which Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 38 of 46 -30- did not deviate from the general policy. In effect, Plaintiff suggests that the Secretary’s decision to implement a lawfully codified policy as written was unreasonable, an argument the Court should reject. In any event, the decision to continue implementing the longstanding policy— calculating the wage index based on OMB-defined labor-market areas—was reasonable. The D.C. Circuit agrees. In Southeast Alabama Medical Center v. Sebelius, the court considered a claim that the Secretary improperly failed to account for interstate commuting in calculating the parallel IPPS wage index. 572 F.3d at 922-23. The court noted that the Secretary’s only obligation under the IPPS statute, 42 U.S.C. § 1395ww(d)(3)(E), which mirrors the LTCH PPS regulation, 42 C.F.R. § 412.525(c)(1), is to compile a wage index that “reflects the relative hospital wage level in the geographic area of the hospital.” Id. at 923. Concluding that “geographic area” is ambiguous, the Court held that the Secretary’s “longstanding policy of using Metropolitan Statistical Areas (MSAs) . . . to define those ‘geographic areas’ is a reasonable response.” Id.; see also Bellevue Hosp. Ctr. v. Leavitt, 443 F.3d 163, 175 (2d Cir. 2006) (reaching the same conclusion). Even setting aside regulations and straightforward decisional law, the Secretary’s decision was supported by careful and extensive reasoning across decades of rulemakings. In the FY 2016 final rule, the Secretary explained that the wage index would continue to be calculated using the existing methodology, including the FY 2015 lines, and referred readers to the FY 2015 rule for further information. 80 Fed. Reg. at 49,797, RR 488. That year, the Secretary had explained why there were no “changes to the existing regulations under this policy,” noting that “CMS and other stakeholders ha[d] explored potential alternatives to the current CBSA-based labor market system” but “no consensus ha[d] been Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 39 of 46 -31- achieved regarding how to implement a replacement system.” 79 Fed. Reg. at 50,181, RR 8084. The Secretary referred readers to the parallel discussion in the IPPS section of the rule, which included a link to a CMS webpage presenting the Secretary’s research on wage- index reform, part of a 2012 report to Congress on the subject. Id. at 49,951, RR 7854. The Secretary’s FY 2015 final rule also referred readers to the RY 2006 final rule for further background on the LTCH PPS wage index. In that rulemaking, the Secretary considered alternatives to CBSAs as the measure for establishing labor-market areas but ultimately decided to retain MSAs as the standard. RY 2006 LTCH PPS Final Rule, 70 Fed. Reg. at 24,184. The Secretary explained that CBSAs “represent a reasonable and appropriate proxy” for defining labor-market areas “because they are based upon characteristics [the Secretary] believe[d] also generally reflect the characteristics of unified labor market areas.” Id. The Secretary noted, for example, that CBSAs “reflect a core population plus an adjacent territory that reflects a high degree of social and economic integration,” which “is measured by commuting ties.” Id. The parallel FY 2005 IPPS final rule, which the Secretary referenced in the RY 2006 LTCH PPS final rule, also covered much of this territory. 69 Fed. Reg. at 49,027; see also, e.g., FY 1995 IPPS Final Rule, 59 Fed. Reg. 27,708, 27,724 (May 27, 1994); Marshall Cty. Health Care Auth. v. Shalala, 988 F.2d 1221, 1223 (D.C. Cir. 1993). In short, the Secretary has frequently and carefully considered alternatives but determined that retention of the longstanding CBSA standard is the best option on the table. The Secretary also reasonably decided to implement the existing policy without creating an additional or separate rule based on the IPPS hospital constituency of an urban labor-market area. As the D.C. Circuit explained in Southeast Alabama Medical Center, Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 40 of 46 -32- where the plaintiffs sought a further adjustment to the MSA-based wage level to account for interstate commuting, “[i]f it was reasonable for HHS to define ‘geographic area’ in the [wage index] by reference to the MSA classifications, it was likewise reasonable for the agency to decline to complicate matters by layering in a dynamic model of migratory and commuting patterns.” 572 F.3d at 923. The court concluded: “Whether or not it would have been desirable for the Department to adjust the [wage index] on the basis of inter-area employment, it was reasonable for it to decline to do so.” Id. Here, whether or not Plaintiff would have preferred that the Secretary further adjust the wage index, it was reasonable for the Secretary to decline to complicate matters by layering in a variable based on the number of constituent IPPS hospitals or by creating an entirely new policy. Further, in the FY 2015 final rule, the Secretary specifically explained the decision to implement the general policy for urban areas even where the constituency of IPPS hospitals may be small. The Secretary recognized that smaller provider pools may yield year-to-year instability in the index value, but observed that these changes in the index value “are appropriate because these values are based on the most recent data available that reflect the relative hospital wage level in a geographic area (CBSA).” 79 Fed. Reg. at 50,394-95, RR 8297-98. In other words, in order to accurately reflect local wage levels within a geographic area, the wage-index policy must be responsive to annual changes in local wage data within a CBSA. Although that responsiveness could lead to significant variations in the wage index from year to year in some smaller urban areas, the labor- market area policy fulfills the purpose of the wage index, which is to accurately measure wage levels in a given location at a given time. Thus, the Secretary reasonably declined to Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 41 of 46 -33- layer in further complications, and instead implemented longstanding policy and codified regulations. 2. The Secretary reasonably applied categorical policies. Plaintiff also claims that the Secretary’s decision to continue implementing the wage-index policy without creating a special index for Plaintiff was unreasonable in light of the wage-index policy for Micropolitan Areas. See Muwekma Ohlone Tribe v. Salazar, 708 F.3d 209, 216 (D.C. Cir. 2013) (“Agency action is arbitrary and capricious if ‘the agency offers insufficient reasons for treating similar situations differently.’” (quoting Cty. of L.A., 192 F.3d at 1022)). As an initial matter, the Secretary did not create this policy in the challenged FY 2016 rule; Plaintiff’s complaint is, again, better directed at the FY 2015 rule cited throughout Plaintiff’s argument, see Pl.’s Mem. at 38-43, than the FY 2016 rule, which merely retained and implemented the existing policy. In fact, the Micropolitan Area policy dates back a decade before the challenged FY 2016 rule. In the RY 2006 final rule, the Secretary observed that OMB recently had created a new category of CBSA. 70 Fed. Reg. at 24,183. Whereas CBSAs historically were divided into two main groups—MSAs and areas outside MSAs—OMB created a third type of CBSA called a Micropolitan Area after the 2000 census. Id. Micropolitan Areas were based on areas with populations of 10,000 to 50,000; for comparison, MSAs were based on areas with populations of 50,000 or more. Id. The introduction of Micropolitan Areas complicated the LTCH PPS policy of designating urban and rural labor-market areas by reference to MSAs, and the Secretary considered whether to treat Micropolitan Areas as urban or rural when calculating the RY 2006 wage index. Id. at 24,187. Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 42 of 46 -34- The Secretary ultimately proposed including Micropolitan Areas in the rural statewide areas, following the lead of the FY 2005 IPPS final rule. 70 Fed. Reg. at 24,187 (citing 69 Fed. Reg. at 49,029-49,032). The Secretary noted that “because Micropolitan Areas encompass smaller populations than MSAs, they tend to include fewer hospitals per Micropolitan Area.” Id. For example, at the time of the RY 2006 final rule there were 49 MSAs with only one hospital, whereas there were 373 Micropolitan Areas with one hospital. Id. And because Micropolitan Areas had far fewer hospitals as a general matter, there was “increased potential for dramatic shifts in the wage indexes from 1 year to the next,” creating instability and reducing the averaging effect. Id. The Secretary received no comments on this proposal and adopted the policy. Id. In the FY 2015 rulemaking, which adopted the CBSAs based on the new census, the Secretary revisited the issue, proposed retaining the policy for the same reasons, again received no comments, and adopted the policy. 79 Fed. Reg. at 50,182, RR 8085. Nothing changed in FY 2016. Plaintiff argues that the Secretary unreasonably treated LTCHs in urban areas with three or fewer hospitals differently than LTCHs in Micropolitan Areas. This argument fails for three reasons. First, any difference in treatment is consistent with unchallenged regulations, and the Secretary’s compliance with lawful regulations is reasonable. Since first encountering Micropolitan Areas in the RY 2006 rulemaking, the Secretary promulgated regulations that define urban areas as MSAs and rural areas as everything else. 42 C.F.R. § 412.503. LTCHs like Plaintiff are located in MSAs; ergo, they are urban, and subject to the urban-area policy. LTCHs in Micropolitan Areas are not in MSAs; ergo, they are rural, and subject to the rural-area policy. See id. §§ 412.503, 412.525(c)(1). Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 43 of 46 -35- Second, even setting aside the regulations, the Secretary’s treatment of Plaintiff vis- à-vis LTCHs in Micropolitan Areas is reasonable. To implement a complex Medicare payment system, the Secretary divides hospitals into categories and devises policies on a categorical basis. Although some urban labor-market areas may share qualities with Micropolitan Areas—as relevant here, a small number of constituent IPPS hospitals— Micropolitan Areas are categorically different because of their lower population centers, as defined by OMB. Plaintiff, on other hand, effectively asks for ad hoc consideration of selected urban hospitals meeting certain criteria. But analyzing each CBSA on a case-by- case basis and devising special policies defeats the purpose of creating categorical rules. The Secretary must draw a line somewhere. The longstanding categorical use of CBSAs is reasonable, Se. Ala. Med. Ctr., 572 F.3d at 923, and any difference in treatment based on those categories therefore is also reasonable. Lastly, Plaintiff complains about different treatment while refusing similar treatment. Pl.’s Mem. at 42-43. If applying the urban-area policy to Plaintiff is unreasonable, the other available option is the rural-area policy that applies to Micropolitan Areas. Indeed, given that the Secretary cited the issues Plaintiff raises in deciding to treat Micropolitan Areas as rural, applying the rural-area policy to Plaintiff is the most logical result of Plaintiff’s argument. Plaintiff, however, shifted from a rural area to an urban area in FY 2015 and apparently favors the higher wage index that accompanied that change. Even the FY 2016 Hammond wage index that Plaintiff decries in this lawsuit is higher than the rural Louisiana wage index under the old lines in FY 2014. Ex. 1; Ex. 5. Accordingly, Plaintiff asks the Court to create an exception from the urban and rural policies that, by regulation, apply to all LTCHs, including Micropolitan Areas. Rather Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 44 of 46 -36- than a return to the rural Louisiana wage area, Plaintiff seeks reinstatement of the Hammond CBSA’s FY 2015 urban wage index or application of the wage index from a different urban CBSA. Pl.’s Mem. at 43-44. Plaintiff seeks the former form of relief even though the FY 2015 wage index suffers from the same purported flaws as the FY 2016 wage index—the difference being that the FY 2015 wage index is higher. And Plaintiff’s only justification for this sui generis treatment is that “it would not be appropriate to apply the exact same wage index policy to the Plaintiff because the Plaintiff is located in a Metropolitan Statistical Area . . . not a Micropolitan Statistical Area.” Pl.’s Mem. at 42- 43. The Secretary treated Plaintiff differently than a Micropolitan Area even though they’re similar, Plaintiff argues, but the Court shouldn’t treat them similarly because they’re different. This contradictory reasoning cannot support vacatur of a routine rule implementing a longstanding policy. CONCLUSION For these reasons, the Secretary respectfully requests that the Court grant his motion, deny Plaintiff’s motion, and enter judgment for the Secretary on all claims. Dated: May 19, 2017 Respectfully submitted, CHAD A. READLER Acting Assistant Attorney General CHANNING D. PHILLIPS United States Attorney JOEL McELVAIN Assistant Branch Director /s/ Daniel Halainen DANIEL HALAINEN (MA Bar 694582) Trial Attorney, Federal Programs Branch U.S. Department of Justice, Civil Division Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 45 of 46 -37- 20 Massachusetts Avenue, NW Washington, DC 20530 (202) 616-8101 (office) (202) 616-8470 (fax) daniel.j.halainen@usdoj.gov Attorneys for Defendant Case 1:16-cv-01257-JDB Document 17 Filed 05/19/17 Page 46 of 46 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 1: Table 12B, FY 2014 LTCH PPS Final Rule This file is available for download at the FY 2014 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1599-F.html. The webpage provides a link to a ZIP archive titled “FY 2014 LTCH PPS Wage Indexes – Tables 12A & 12B (updated January 2014).” Within this ZIP file is a Microsoft Excel workbook named “CMS-1599 LTCH FY 2014 Tables 12A and 12B_with corrections_Jan2014.xlsx.” The fourth worksheet, titled “Table 12B (rural)-FR14,” is Table 12B as cited in the FY 2014 LTCH PPS final rule. Case 1:16-cv-01257-JDB Document 17-1 Filed 05/19/17 Page 1 of 3 CBSA Code CBSA Title LTCH Wage Index 01 ALABAMA 0.7147 02 ALASKA 1.3662 03 ARIZONA 0.9166 04 ARKANSAS 0.7343 05 CALIFORNIA 1.2788 06 COLORADO 0.9802 07 CONNECTICUT 1.1311 08 DELAWARE 1.0092 10 FLORIDA 0.7985 11 GEORGIA 0.7459 12 HAWAII 1.0739 13 IDAHO 0.7605 14 ILLINOIS 0.8434 15 INDIANA 0.8513 16 IOWA 0.8434 17 KANSAS 0.7929 18 KENTUCKY 0.7784 19 LOUISIANA 0.7585 20 MAINE 0.8238 21 MARYLAND 0.8696 22 MASSACHUSETTS 1.3614 23 MICHIGAN 0.8270 24 MINNESOTA 0.9133 25 MISSISSIPPI 0.7568 26 MISSOURI 0.7775 27 MONTANA 0.9098 28 NEBRASKA 0.8855 29 NEVADA 0.9781 30 NEW HAMPSHIRE 1.0339 31 NEW JERSEY -------- 32 NEW MEXICO 0.8922 33 NEW YORK 0.8220 34 NORTH CAROLINA 0.8100 35 NORTH DAKOTA 0.6785 36 OHIO 0.8377 37 OKLAHOMA 0.7704 38 OREGON 0.9435 39 PENNSYLVANIA 0.8430 41 RHODE ISLAND* -------- Table 12B - LTCH PPS Wage Index for Rural Areas for Discharges Occurring from October 1, 2013 through September 30, 2014 Case 1:16-cv-01257-JDB Document 17-1 Filed 05/19/17 Page 2 of 3 42 SOUTH CAROLINA 0.8329 43 SOUTH DAKOTA 0.8164 44 TENNESSEE 0.7444 45 TEXAS 0.7874 46 UTAH 0.8732 47 VERMONT 0.9740 49 VIRGINIA 0.7758 50 WASHINGTON 1.0529 51 WEST VIRGINIA 0.7407 52 WISCONSIN 0.8904 53 WYOMING 0.9243 * States have no rural areas. Case 1:16-cv-01257-JDB Document 17-1 Filed 05/19/17 Page 3 of 3 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 2: Table 12A, FY 2015 LTCH PPS Final Rule This file is available for download at the FY 2015 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1607-F.html. The webpage provides a link to a ZIP archive titled “FY 2015 LTCH PPS Wage Indexes (Tables 12A – 12D).” Within this ZIP file is a Microsoft Excel workbook named “CMS-1607-F Tables 12A – 12D.xlsx.” The first worksheet, titled “Table 12A (urban new CBSA)-FR15,” is Table 12A as cited in the FY 2015 LTCH PPS final rule. Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 1 of 10 CBSA Code CBSA Title LTCH PPS Wage Index 10180 Abilene, TX 0.7440 10380 Aguadilla-Isabela, PR 0.3586 10420 Akron, OH 0.8539 10500 Albany, GA 0.8128 10540 Albany, OR 1.0879 10580 Albany-Schenectady-Troy, NY 0.8453 10740 Albuquerque, NM 0.9478 10780 Alexandria, LA 0.7813 10900 Allentown-Bethlehem-Easton, PA-NJ 0.9121 11020 Altoona, PA 0.9345 11100 Amarillo, TX 0.8277 11180 Ames, IA 0.9331 11244 Anaheim-Santa Ana-Irvine, CA 1.2010 11260 Anchorage, AK 1.2419 11460 Ann Arbor, MI 1.0219 11500 Anniston-Oxford-Jacksonville, AL 0.7466 11540 Appleton, WI 0.9626 11640 Arecibo, PR 0.4213 11700 Asheville, NC 0.8531 12020 Athens-Clarke County, GA 0.8774 12060 Atlanta-Sandy Springs-Roswell, GA 0.9369 12100 Atlantic City-Hammonton, NJ 1.1692 12220 Auburn-Opelika, AL 0.8071 12260 Augusta-Richmond County, GA-SC 0.9225 12420 Austin-Round Rock, TX 0.9545 12540 Bakersfield, CA 1.1944 12580 Baltimore-Columbia-Towson, MD 0.9950 12620 Bangor, ME 0.9825 12700 Barnstable Town, MA 1.3124 12940 Baton Rouge, LA 0.7976 12980 Battle Creek, MI 1.0112 13020 Bay City, MI 0.9630 13140 Beaumont-Port Arthur, TX 0.8508 13220 Beckley, WV 0.8024 13380 Bellingham, WA 1.2403 13460 Bend-Redmond, OR 1.1710 13740 Billings, MT 0.8686 13780 Binghamton, NY 0.8476 13820 Birmingham-Hoover, AL 0.8189 Table 12A- LTCH PPS Wage Index for Urban Areas Under the New CBSA Delineations for Discharges Occurring from October 1, 2014 through September 30, 2015 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 2 of 10 13900 Bismarck, ND 0.7216 13980 Blacksburg-Christiansburg-Radford, VA 0.8473 14010 Bloomington, IL 0.9165 14020 Bloomington, IN 0.9062 14100 Bloomsburg-Berwick, PA 0.9347 14260 Boise City, ID 0.9205 14454 Boston, MA 1.2679 14500 Boulder, CO 0.9907 14540 Bowling Green, KY 0.8410 14740 Bremerton-Silverdale, WA 1.0836 14860 Bridgeport-Stamford-Norwalk, CT 1.3289 15180 Brownsville-Harlingen, TX 0.7876 15260 Brunswick, GA 0.8486 15380 Buffalo-Cheektowaga-Niagara Falls, NY 1.0240 15500 Burlington, NC 0.8590 15540 Burlington-South Burlington, VT 1.0121 15680 California-Lexington Park, MD 0.8593 15764 Cambridge-Newton-Framingham, MA 1.1159 15804 Camden, NJ 1.0287 15940 Canton-Massillon, OH 0.8521 15980 Cape Coral-Fort Myers, FL 0.9253 16020 Cape Girardeau, MO-IL 0.9094 16060 Carbondale-Marion, IL 0.8324 16180 Carson City, NV 1.0679 16220 Casper, WY 1.0860 16300 Cedar Rapids, IA 0.8850 16540 Chambersburg-Waynesboro, PA 1.0957 16580 Champaign-Urbana, IL 0.9076 16620 Charleston, WV 0.7982 16700 Charleston-North Charleston, SC 0.8968 16740 Charlotte-Concord-Gastonia, NC-SC 0.9073 16820 Charlottesville, VA 0.9053 16860 Chattanooga, TN-GA 0.8711 16940 Cheyenne, WY 0.9798 16974 Chicago-Naperville-Arlington Heights, IL 1.0419 17020 Chico, CA 1.1631 17140 Cincinnati, OH-KY-IN 0.9473 17300 Clarksville, TN-KY 0.7526 17420 Cleveland, TN 0.7468 17460 Cleveland-Elyria, OH 0.9233 17660 Coeur d'Alene, ID 0.9125 17780 College Station-Bryan, TX 0.9289 17820 Colorado Springs, CO 0.9441 17860 Columbia, MO 0.8319 17900 Columbia, SC 0.8392 17980 Columbus, GA-AL 0.8293 18020 Columbus, IN 0.9881 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 3 of 10 18140 Columbus, OH 0.9539 18580 Corpus Christi, TX 0.8740 18700 Corvallis, OR 1.1404 18880 Crestview-Fort Walton Beach-Destin, FL 0.8156 19060 Cumberland, MD-WV 0.8374 19124 Dallas-Plano-Irving, TX 0.9703 19140 Dalton, GA 0.8386 19180 Danville, IL 0.9751 19300 Daphne-Fairhope-Foley, AL 0.7248 19340 Davenport-Moline-Rock Island, IA-IL 0.9717 19380 Dayton, OH 0.8938 19460 Decatur, AL 0.7029 19500 Decatur, IL 0.7908 19660 Deltona-Daytona Beach-Ormond Beach, FL 0.8376 19740 Denver-Aurora-Lakewood, CO 1.0429 19780 Des Moines-West Des Moines, IA 0.9168 19804 Detroit-Dearborn-Livonia, MI 0.9296 20020 Dothan, AL 0.7163 20100 Dover, DE 1.0291 20220 Dubuque, IA 0.8942 20260 Duluth, MN-WI 1.0107 20500 Durham-Chapel Hill, NC 0.9808 20524 Dutchess County-Putnam County, NY 1.1345 20700 East Stroudsburg, PA 0.9372 20740 Eau Claire, WI 0.9724 20940 El Centro, CA 0.9162 20994 Elgin, IL 1.0299 21060 Elizabethtown-Fort Knox, KY 0.7701 21140 Elkhart-Goshen, IN 0.9013 21300 Elmira, NY 0.8690 21340 El Paso, TX 0.8139 21500 Erie, PA 0.7785 21660 Eugene, OR 1.1622 21780 Evansville, IN-KY 0.8537 21820 Fairbanks, AK 1.1092 22020 Fargo, ND-MN 0.7640 22140 Farmington, NM 0.9778 22180 Fayetteville, NC 0.8042 22220 Fayetteville-Springdale-Rogers, AR-MO 0.8598 22380 Flagstaff, AZ 1.2423 22420 Flint, MI 1.1148 22500 Florence, SC 0.8016 22520 Florence-Muscle Shoals, AL 0.7577 22540 Fond du Lac, WI 0.9084 22660 Fort Collins, CO 0.9454 22744 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL 0.9952 22900 Fort Smith, AR-OK 0.7593 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 4 of 10 23060 Fort Wayne, IN 0.9423 23104 Fort Worth-Arlington, TX 0.9386 23420 Fresno, CA 1.1754 23460 Gadsden, AL 0.7517 23540 Gainesville, FL 0.8891 23580 Gainesville, GA 0.9185 23844 Gary, IN 0.9443 23900 Gettysburg, PA 1.0104 24020 Glens Falls, NY 0.8450 24140 Goldsboro, NC 0.8733 24220 Grand Forks, ND-MN 0.7047 24260 Grand Island, NE 0.9219 24300 Grand Junction, CO 0.9768 24340 Grand Rapids-Wyoming, MI 0.8799 24420 Grants Pass, OR 1.0086 24500 Great Falls, MT 0.9102 24540 Greeley, CO 0.9649 24580 Green Bay, WI 0.9426 24660 Greensboro-High Point, NC 0.8535 24780 Greenville, NC 0.9371 24860 Greenville-Anderson-Mauldin, SC 0.9161 25020 Guayama, PR 0.3660 25060 Gulfport-Biloxi-Pascagoula, MS 0.7896 25180 Hagerstown-Martinsburg, MD-WV 0.9080 25220 Hammond, LA 0.9452 25260 Hanford-Corcoran, CA 1.1251 25420 Harrisburg-Carlisle, PA 0.9734 25500 Harrisonburg, VA 0.8946 25540 Hartford-West Hartford-East Hartford, CT 1.1119 25620 Hattiesburg, MS 0.7761 25860 Hickory-Lenoir-Morganton, NC 0.8517 25940 Hilton Head Island-Bluffton-Beaufort, SC 0.8708 25980 Hinesville, Ga 0.8568 26140 Homosassa Springs, FL 0.7625 26300 Hot Springs, AR 0.8700 26380 Houma-Thibodaux, LA 0.7381 26420 Houston-The Woodlands-Sugar Land, TX 0.9734 26580 Huntington-Ashland, WV-KY-OH 0.8846 26620 Huntsville, AL 0.8609 26820 Idaho Falls, ID 0.8933 26900 Indianapolis-Carmel-Anderson, IN 1.0133 26980 Iowa City, IA 0.9882 27060 Ithaca, NY 0.9441 27100 Jackson, MI 0.9345 27140 Jackson, MS 0.7891 27180 Jackson, TN 0.7747 27260 Jacksonville, FL 0.9117 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 5 of 10 27340 Jacksonville, NC 0.7549 27500 Janesville-Beloit, WI 0.9079 27620 Jefferson City, MO 0.8359 27740 Johnson City, TN 0.7436 27780 Johnstown, PA 0.8540 27860 Jonesboro, AR 0.7786 27900 Joplin, MO 0.8306 27980 Kahului-Wailuku-Lahaina, HI 1.0561 28020 Kalamazoo-Portage, MI 1.0048 28100 Kankakee, IL 0.9568 28140 Kansas City, MO-KS 0.9430 28420 Kennewick-Richland, WA 0.9617 28660 Killeen-Temple, TX 0.9133 28700 Kingsport-Bristol-Bristol, TN-VA 0.7192 28740 Kingston, NY 0.9034 28940 Knoxville, TN 0.7015 29020 Kokomo, IN 0.8990 29100 La Crosse-Onalaska, WI-MN 0.9533 29180 Lafayette, LA 0.7869 29200 Lafayette-West Lafayette, IN 0.9638 29340 Lake Charles, LA 0.7536 29404 Lake County-Kenosha County, IL-WI 1.0465 29420 Lake Havasu City-Kingman, AZ 0.9199 29460 Lakeland-Winter Haven, FL 0.8246 29540 Lancaster, PA 0.9514 29620 Lansing-East Lansing, MI 1.0778 29700 Laredo, TX 0.7471 29740 Las Cruces, NM 0.8739 29820 Las Vegas-Henderson-Paradise, NV 1.1900 29940 Lawrence, KS 0.8890 30020 Lawton, OK 0.7918 30140 Lebanon, PA 0.8453 30300 Lewiston, ID-WA 0.9430 30340 Lewiston-Auburn, ME 0.8740 30460 Lexington-Fayette, KY 0.8972 30620 Lima, OH 0.9342 30700 Lincoln, NE 0.9704 30780 Little Rock-North Little Rock-Conway, AR 0.8374 30860 Logan, UT-ID 0.8819 30980 Longview, TX 0.8211 31020 Longview, WA 0.9824 31084 Los Angeles-Long Beach-Glendale, CA 1.2424 31140 Louisville/Jefferson County, KY-IN 0.8605 31180 Lubbock, TX 0.8830 31340 Lynchburg, VA 0.8830 31420 Macon, GA 0.9129 31460 Madera, CA 0.7789 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 6 of 10 31540 Madison, WI 1.1130 31700 Manchester-Nashua, NH 1.0049 31740 Manhattan, KS 0.9271 31860 Mankato-North Mankato, MN 0.9084 31900 Mansfield, OH 0.8771 32420 Mayagüez, PR 0.3767 32580 McAllen-Edinburg-Mission, TX 0.8175 32780 Medford, OR 1.0492 32820 Memphis, TN-MS-AR 0.8991 32900 Merced, CA 1.2713 33124 Miami-Miami Beach-Kendall, FL 0.9673 33140 Michigan City-La Porte, IN 0.9472 33220 Midland, MI 0.7935 33260 Midland, TX 0.8940 33340 Milwaukee-Waukesha-West Allis, WI 0.9892 33460 Minneapolis-St. Paul-Bloomington, MN-WI 1.1196 33540 Missoula, MT 0.8860 33660 Mobile, AL 0.7539 33700 Modesto, CA 1.3136 33740 Monroe, LA 0.7434 33780 Monroe, MI 0.9217 33860 Montgomery, AL 0.7678 33874 Montgomery County-Bucks County-Chester County, PA 1.0157 34060 Morgantown, WV 0.8270 34100 Morristown, TN 0.6983 34580 Mount Vernon-Anacortes, WA 0.9792 34620 Muncie, IN 0.9174 34740 Muskegon, MI 0.9670 34820 Myrtle Beach-Conway-North Myrtle Beach, SC-NC 0.8620 34900 Napa, CA 1.6066 34940 Naples-Immokalee-Marco Island, FL 0.8752 34980 Nashville-Davidson--Murfreesboro--Franklin, TN 0.8969 35004 Nassau County-Suffolk County, NY 1.2655 35084 Newark, NJ-PA 1.1233 35100 New Bern, NC 0.8994 35300 New Haven-Milford, CT 1.2207 35380 New Orleans-Metairie, LA 0.8821 35614 New York-Jersey City-White Plains, NY-NJ 1.2837 35660 Niles-Benton Harbor, MI 0.8705 35840 North Port-Sarasota-Bradenton, FL 0.9478 35980 Norwich-New London, CT 1.1813 36084 Oakland-Hayward-Berkeley, CA 1.7109 36100 Ocala, FL 0.8302 36140 Ocean City, NJ 1.0584 36220 Odessa, TX 0.9867 36260 Ogden-Clearfield, UT 0.9225 36420 Oklahoma City, OK 0.8955 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 7 of 10 36500 Olympia-Tumwater, WA 1.2018 36540 Omaha-Council Bluffs, NE-IA 0.9661 36740 Orlando-Kissimmee-Sanford, FL 0.9115 36780 Oshkosh-Neenah, WI 0.9656 36980 Owensboro, KY 0.7348 37100 Oxnard-Thousand Oaks-Ventura, CA 1.2822 37340 Palm Bay-Melbourne-Titusville, FL 0.8971 37460 Panama City, FL 0.7906 37620 Parkersburg-Vienna, WV 0.7556 37860 Pensacola-Ferry Pass-Brent, FL 0.7898 37900 Peoria, IL 0.8566 37964 Philadelphia, PA 1.1187 38060 Phoenix-Mesa-Scottsdale, AZ 1.0383 38220 Pine Bluff, AR 0.8021 38300 Pittsburgh, PA 0.8639 38340 Pittsfield, MA 1.0807 38540 Pocatello, ID 0.9672 38660 Ponce, PR 0.4154 38860 Portland-South Portland, ME 1.0053 38900 Portland-Vancouver-Hillsboro, OR-WA 1.1936 38940 Port St. Lucie, FL 0.9159 39140 Prescott, AZ 1.0922 39300 Providence-Warwick, RI-MA 1.0634 39340 Provo-Orem, UT 0.9503 39380 Pueblo, CO 0.8434 39460 Punta Gorda, FL 0.8821 39540 Racine, WI 0.9597 39580 Raleigh, NC 0.9003 39660 Rapid City, SD 0.8989 39740 Reading, PA 0.8706 39820 Redding, CA 1.4791 39900 Reno, NV 1.0266 40060 Richmond, VA 0.9625 40140 Riverside-San Bernardino-Ontario, CA 1.1554 40220 Roanoke, VA 0.9233 40340 Rochester, MN 1.1398 40380 Rochester, NY 0.8750 40420 Rockford, IL 0.9768 40484 Rockingham County-Strafford County, NH 1.0168 40580 Rocky Mount, NC 0.8781 40660 Rome, GA 0.8577 40900 Sacramento--Roseville--Arden-Arcade, CA 1.5885 40980 Saginaw, MI 0.8638 41060 St. Cloud, MN 1.0524 41100 St. George, UT 0.9569 41140 St. Joseph, MO-KS 0.9837 41180 St. Louis, MO-IL 0.9366 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 8 of 10 41420 Salem, OR 1.1275 41500 Salinas, CA 1.5715 41540 Salisbury, MD-DE 0.9289 41620 Salt Lake City, UT 0.9501 41660 San Angelo, TX 0.8416 41700 San Antonio-New Braunfels, TX 0.8858 41740 San Diego-Carlsbad, CA 1.2355 41884 San Francisco-Redwood City-South San Francisco, CA 1.7260 41900 San Germán, PR 0.4723 41940 San Jose-Sunnyvale-Santa Clara, CA 1.7840 41980 San Juan-Carolina-Caguas, PR 0.4438 42020 San Luis Obispo-Paso Robles-Arroyo Grande, CA 1.3144 42034 San Rafael, CA 1.7260 42100 Santa Cruz-Watsonville, CA 1.7908 42140 Santa Fe, NM 0.9894 42200 Santa Maria-Santa Barbara, CA 1.2895 42220 Santa Rosa, CA 1.6778 42340 Savannah, GA 0.8770 42540 Scranton--Wilkes-Barre--Hazleton, PA 0.8049 42644 Seattle-Bellevue-Everett, WA 1.1771 42680 Sebastian-Vero Beach, FL 0.8821 42700 Sebring, FL 0.7982 43100 Sheboygan, WI 0.9421 43300 Sherman-Denison, TX 0.8633 43340 Shreveport-Bossier City, LA 0.8325 43420 Sierra Vista-Douglas, AZ 0.8937 43524 Silver Spring-Frederick-Rockville, MD 1.0198 43580 Sioux City, IA-NE-SD 0.8915 43620 Sioux Falls, SD 0.8347 43780 South Bend-Mishawaka, IN-MI 0.9172 43900 Spartanburg, SC 0.8277 44060 Spokane-Spokane Valley, WA 1.1425 44100 Springfield, IL 0.9119 44140 Springfield, MA 1.0226 44180 Springfield, MO 0.8334 44220 Springfield, OH 0.8692 44300 State College, PA 0.9833 44420 Staunton-Waynesboro, VA 0.8326 44700 Stockton-Lodi, CA 1.3902 44940 Sumter, SC 0.7293 45060 Syracuse, NY 0.9999 45104 Tacoma-Lakewood, WA 1.1544 45220 Tallahassee, FL 0.7911 45300 Tampa-St. Petersburg-Clearwater, FL 0.9076 45460 Terre Haute, IN 0.9145 45500 Texarkana, TX-AR 0.7362 45540 The Villages, FL 0.8095 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 9 of 10 45780 Toledo, OH 0.9129 45820 Topeka, KS 0.8756 45940 Trenton, NJ 1.0241 46060 Tucson, AZ 0.8604 46140 Tulsa, OK 0.7943 46220 Tuscaloosa, AL 0.8337 46340 Tyler, TX 0.8293 46520 Urban Honolulu, HI 1.2468 46540 Utica-Rome, NY 0.8980 46660 Valdosta, GA 0.7379 46700 Vallejo-Fairfield, CA 1.6703 47020 Victoria, TX 0.8473 47220 Vineland-Bridgeton, NJ 1.0503 47260 Virginia Beach-Norfolk-Newport News, VA-NC 0.9223 47300 Visalia-Porterville, CA 0.9682 47380 Waco, TX 0.8137 47460 Walla Walla, WA 1.0934 47580 Warner Robins, GA 0.7542 47664 Warren-Troy-Farmington Hills, MI 0.9433 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.0403 47940 Waterloo-Cedar Falls, IA 0.8473 48060 Watertown-Fort Drum, NY 0.8386 48140 Wausau, WI 0.9191 48260 Weirton-Steubenville, WV-OH 0.7729 48300 Wenatchee, WA 0.9843 48424 West Palm Beach-Boca Raton-Delray Beach, FL 0.9277 48540 Wheeling, WV-OH 0.6390 48620 Wichita, KS 0.8472 48660 Wichita Falls, TX 0.9075 48700 Williamsport, PA 0.8517 48864 Wilmington, DE-MD-NJ 1.0432 48900 Wilmington, NC 0.8880 49020 Winchester, VA-WV 0.8864 49180 Winston-Salem, NC 0.8679 49340 Worcester, MA-CT 1.1493 49420 Yakima, WA 1.0294 49620 York-Hanover, PA 0.9746 49660 Youngstown-Warren-Boardman, OH-PA 0.7986 49700 Yuba City, CA 1.1793 49740 Yuma, AZ 1.0029 Case 1:16-cv-01257-JDB Document 17-2 Filed 05/19/17 Page 10 of 10 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 3: Excerpt of County to CBSA Crosswalk File, FY 2015 LTCH PPS Final Rule This file is available for download at the FY 2015 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1607-F.html. The webpage provides a link to a ZIP archive titled “County to CBSA Crosswalk File – FY 2015.” Within this ZIP file is a Microsoft Excel workbook named “County to CBSA Crosswalk_FY15.xlsx.” The sole worksheet, titled “County- CBSA Xwalk – FR15,” tabulates the CBSA of each county (or, in Louisiana, parish) in the United States. Because the worksheet is large, the exhibit is an excerpt of the larger file. Case 1:16-cv-01257-JDB Document 17-3 Filed 05/19/17 Page 1 of 2 Co un ty St at e SS A St at e co un ty co de FI PS S ta te co un ty co de O LD CB SA * (B la nk s a re Ru ra l) "O LD " CB SA N AM E* (B la nk s a re Ru ra l) "N ew " CB SA * (B la nk s a re Ru ra l) "N ew " CB SA N AM E* (B la nk s a re R ur al ) ST . J O HN B AP TI ST LA 19 47 0 22 09 5 35 38 0 N ew O rle an s- M et ai rie -K en ne r, LA 35 38 0 N ew O rle an s- M et ai rie , L A ST . L AN DR Y LA 19 48 0 22 09 7 ST . M AR TI N LA 19 49 0 22 09 9 29 18 0 La fa ye tt e, L A 29 18 0 La fa ye tt e, L A ST . M AR Y LA 19 50 0 22 10 1 ST . T AM M AN Y LA 19 51 0 22 10 3 35 38 0 N ew O rle an s- M et ai rie -K en ne r, LA 35 38 0 N ew O rle an s- M et ai rie , L A TA N GI PA HO A LA 19 52 0 22 10 5 25 22 0 Ha m m on d, L A TE N SA S LA 19 53 0 22 10 7 TE RR EB O N N E LA 19 54 0 22 10 9 26 38 0 Ho um a- Ba yo u Ca ne -T hi bo da ux , L A 26 38 0 Ho um a- Th ib od au x, L A U N IO N LA 19 55 0 22 11 1 33 74 0 M on ro e, L A 33 74 0 M on ro e, L A VE RM IL IO N LA 19 56 0 22 11 3 29 18 0 La fa ye tt e, L A VE RN O N LA 19 57 0 22 11 5 W AS HI N GT O N LA 19 58 0 22 11 7 W EB ST ER LA 19 59 0 22 11 9 43 34 0 Sh re ve po rt -B os sie r C ity , L A W . B AT O N R O U GE LA 19 60 0 22 12 1 12 94 0 Ba to n Ro ug e, L A 12 94 0 Ba to n Ro ug e, L A W ES T CA RR O LL LA 19 61 0 22 12 3 W ES T FE LI CI AN A LA 19 62 0 22 12 5 12 94 0 Ba to n Ro ug e, L A 12 94 0 Ba to n Ro ug e, L A W IN N LA 19 63 0 22 12 7 ST AT EW ID E LA 19 99 9 22 99 0 AN DR O SC O GG IN M E 20 00 0 23 00 1 30 34 0 Le w ist on -A ub ur n, M E 30 34 0 Le w ist on -A ub ur n, M E AR O O ST O O K M E 20 01 0 23 00 3 CU M BE RL AN D M E 20 02 0 23 00 5 38 86 0 Po rt la nd -S ou th P or tla nd -B id de fo r d 38 86 0 Po rt la nd -S ou th P or tla nd , M E FR AN KL IN M E 20 03 0 23 00 7 HA N CO CK M E 20 04 0 23 00 9 KE N N EB EC M E 20 05 0 23 01 1 KN O X M E 20 06 0 23 01 3 LI N CO LN M E 20 07 0 23 01 5 O XF O RD M E 20 08 0 23 01 7 PE N O BS CO T M E 20 09 0 23 01 9 12 62 0 Ba ng or , M E 12 62 0 Ba ng or , M E PI SC AT AQ U IS M E 20 10 0 23 02 1 SA GA DA HO C M E 20 11 0 23 02 3 38 86 0 Po rt la nd -S ou th P or tla nd -B id de fo r d 38 86 0 Po rt la nd -S ou th P or tla nd , M E SO M ER SE T M E 20 12 0 23 02 5 Case 1:16-cv-01257-JDB Document 17-3 Filed 05/19/17 Page 2 of 2 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 4: Table 12D, FY 2015 LTCH PPS Final Rule This file is available for download at the FY 2015 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1607-F.html. The webpage provides a link to a ZIP archive titled “FY 2015 LTCH PPS Wage Indexes (Tables 12A – 12D).” Within this ZIP file is a Microsoft Excel workbook named “CMS-1607-F Tables 12A – 12D.xlsx.” The fourth worksheet, titled “Table 12D (rural old CBSA)-FR15,” is Table 12D as cited in the FY 2015 LTCH PPS final rule. Case 1:16-cv-01257-JDB Document 17-4 Filed 05/19/17 Page 1 of 3 CBSA Code CBSA Title LTCH PPS Wage Index 01 ALABAMA 0.6963 02 ALASKA 1.3175 03 ARIZONA 0.9125 04 ARKANSAS 0.7311 05 CALIFORNIA 1.3215 06 COLORADO 0.9646 07 CONNECTICUT 1.1251 08 DELAWARE 1.0261 10 FLORIDA 0.8006 11 GEORGIA 0.7425 12 HAWAII 1.0741 13 IDAHO 0.7398 14 ILLINOIS 0.8362 15 INDIANA 0.8416 16 IOWA 0.8451 17 KANSAS 0.7806 18 KENTUCKY 0.7744 19 LOUISIANA 0.7580 20 MAINE 0.8583 21 MARYLAND 0.8554 22 MASSACHUSETTS 1.3920 23 MICHIGAN 0.8207 24 MINNESOTA 0.9124 25 MISSISSIPPI 0.7589 26 MISSOURI 0.7725 27 MONTANA 0.9024 28 NEBRASKA 0.8924 29 NEVADA 0.9516 30 NEW HAMPSHIRE 1.0386 31 NEW JERSEY* -------- 32 NEW MEXICO 0.8811 33 NEW YORK 0.8208 34 NORTH CAROLINA 0.7995 35 NORTH DAKOTA 0.7099 36 OHIO 0.8329 37 OKLAHOMA 0.7799 38 OREGON 1.0083 39 PENNSYLVANIA 0.8719 41 RHODE ISLAND* -------- Table 12D - LTCH PPS Wage Index for Rural Areas Under the Prior CBSA Delineations for Discharges Occurring from October 1, 2014 through September 30, 2015 Case 1:16-cv-01257-JDB Document 17-4 Filed 05/19/17 Page 2 of 3 42 SOUTH CAROLINA 0.8374 43 SOUTH DAKOTA 0.8312 44 TENNESSEE 0.7365 45 TEXAS 0.7855 46 UTAH 0.8891 47 VERMONT 0.9527 49 VIRGINIA 0.7674 50 WASHINGTON 1.0892 51 WEST VIRGINIA 0.7410 52 WISCONSIN 0.9041 53 WYOMING 0.9291 * States have no rural areas. Case 1:16-cv-01257-JDB Document 17-4 Filed 05/19/17 Page 3 of 3 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 5: Table 12A, FY 2016 LTCH PPS Proposed Rule This file is available for download at the FY 2016 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1632-P.html. The webpage provides a link to a ZIP archive titled “FY 2016 LTCH PPS Wage Indexes (Tables 12A - 12B) – Updated Sept. 2015.” Within this ZIP file is a Microsoft Excel workbook named “CMS-1632-P Tables 12 A and B.xlsx.” The first worksheet, titled “Table 12A-CN16,” is Table 12A as cited in the FY 2016 LTCH PPS proposed rule. Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 1 of 10 CBSA Code CBSA Title Proposed LTCH PPS Wage Index 10180 Abilene, TX 0.8240 10380 Aguadilla-Isabela, PR 0.3447 10420 Akron, OH 0.8502 10500 Albany, GA 0.9221 10540 Albany, OR 1.0809 10580 Albany-Schenectady-Troy, NY 0.8430 10740 Albuquerque, NM 0.9300 10780 Alexandria, LA 0.8145 10900 Allentown-Bethlehem-Easton, PA-NJ 0.9091 11020 Altoona, PA 1.0481 11100 Amarillo, TX 0.8224 11180 Ames, IA 0.9416 11244 Anaheim-Santa Ana-Irvine, CA 1.1844 11260 Anchorage, AK 1.3333 11460 Ann Arbor, MI 0.9892 11500 Anniston-Oxford-Jacksonville, AL 0.7103 11540 Appleton, WI 0.9437 11640 Arecibo, PR 0.4146 11700 Asheville, NC 0.8630 12020 Athens-Clarke County, GA 0.9021 12060 Atlanta-Sandy Springs-Roswell, GA 0.9315 12100 Atlantic City-Hammonton, NJ 1.1728 12220 Auburn-Opelika, AL 0.7665 12260 Augusta-Richmond County, GA-SC 0.9412 12420 Austin-Round Rock, TX 0.9710 12540 Bakersfield, CA 1.2253 12580 Baltimore-Columbia-Towson, MD 0.9769 12620 Bangor, ME 0.9887 12700 Barnstable Town, MA 1.3450 12940 Baton Rouge, LA 0.7884 12980 Battle Creek, MI 1.0551 13020 Bay City, MI 0.9826 13140 Beaumont-Port Arthur, TX 0.8322 13220 Beckley, WV 0.7933 13380 Bellingham, WA 1.2750 13460 Bend-Redmond, OR 1.2022 13740 Billings, MT 0.8794 13780 Binghamton, NY 0.8193 13820 Birmingham-Hoover, AL 0.8280 13900 Bismarck, ND 0.7091 13980 Blacksburg-Christiansburg-Radford, VA 0.8540 Table 12A- Proposed LTCH PPS Wage Index for Urban Areas for Discharges Occurring from October 1, 2015 through September 30, 2016 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 2 of 10 14010 Bloomington, IL 0.9124 14020 Bloomington, IN 0.9208 14100 Bloomsburg-Berwick, PA 0.9029 14260 Boise City, ID 0.9369 14454 Boston, MA 1.3085 14500 Boulder, CO 0.9815 14540 Bowling Green, KY 0.8062 14740 Bremerton-Silverdale, WA 1.1147 14860 Bridgeport-Stamford-Norwalk, CT 1.3405 15180 Brownsville-Harlingen, TX 0.8409 15260 Brunswick, GA 0.8578 15380 Buffalo-Cheektowaga-Niagara Falls, NY 1.0480 15500 Burlington, NC 0.8576 15540 Burlington-South Burlington, VT 1.0198 15680 California-Lexington Park, MD 0.9407 15764 Cambridge-Newton-Framingham, MA 1.1191 15804 Camden, NJ 1.0151 15940 Canton-Massillon, OH 0.8492 15980 Cape Coral-Fort Myers, FL 0.9497 16020 Cape Girardeau, MO-IL 0.8665 16060 Carbondale-Marion, IL 0.8459 16180 Carson City, NV 1.0806 16220 Casper, WY 1.0121 16300 Cedar Rapids, IA 0.8749 16540 Chambersburg-Waynesboro, PA 1.1050 16580 Champaign-Urbana, IL 0.9931 16620 Charleston, WV 0.8026 16700 Charleston-North Charleston, SC 0.8889 16740 Charlotte-Concord-Gastonia, NC-SC 0.9089 16820 Charlottesville, VA 0.9510 16860 Chattanooga, TN-GA 0.8851 16940 Cheyenne, WY 0.9696 16974 Chicago-Naperville-Arlington Heights, IL 1.0295 17020 Chico, CA 1.1654 17140 Cincinnati, OH-KY-IN 0.9430 17300 Clarksville, TN-KY 0.7511 17420 Cleveland, TN 0.7577 17460 Cleveland-Elyria, OH 0.9176 17660 Coeur d'Alene, ID 0.8975 17780 College Station-Bryan, TX 0.9609 17820 Colorado Springs, CO 0.9169 17860 Columbia, MO 0.8475 17900 Columbia, SC 0.8444 17980 Columbus, GA-AL 0.8391 18020 Columbus, IN 1.0349 18140 Columbus, OH 0.9695 18580 Corpus Christi, TX 0.8569 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 3 of 10 18700 Corvallis, OR 1.1337 18880 Crestview-Fort Walton Beach-Destin, FL 0.8620 19060 Cumberland, MD-WV 0.8826 19124 Dallas-Plano-Irving, TX 0.9816 19140 Dalton, GA 0.8409 19180 Danville, IL 0.9629 19300 Daphne-Fairhope-Foley, AL 0.7318 19340 Davenport-Moline-Rock Island, IA-IL 0.9772 19380 Dayton, OH 0.9121 19460 Decatur, AL 0.7315 19500 Decatur, IL 0.8223 19660 Deltona-Daytona Beach-Ormond Beach, FL 0.8479 19740 Denver-Aurora-Lakewood, CO 1.0239 19780 Des Moines-West Des Moines, IA 0.9370 19804 Detroit-Dearborn-Livonia, MI 0.9174 20020 Dothan, AL 0.6937 20100 Dover, DE 1.0266 20220 Dubuque, IA 0.8903 20260 Duluth, MN-WI 1.0550 20500 Durham-Chapel Hill, NC 0.9848 20524 Dutchess County-Putnam County, NY 1.1521 20700 East Stroudsburg, PA 0.9162 20740 Eau Claire, WI 0.9738 20940 El Centro, CA 0.8444 20994 Elgin, IL 1.0350 21060 Elizabethtown-Fort Knox, KY 0.7458 21140 Elkhart-Goshen, IN 0.9276 21300 Elmira, NY 0.8633 21340 El Paso, TX 0.8064 21500 Erie, PA 0.7745 21660 Eugene, OR 1.1921 21780 Evansville, IN-KY 0.8912 21820 Fairbanks, AK 1.1111 22020 Fargo, ND-MN 0.7738 22140 Farmington, NM 0.9602 22180 Fayetteville, NC 0.8369 22220 Fayetteville-Springdale-Rogers, AR-MO 0.8540 22380 Flagstaff, AZ 1.2229 22420 Flint, MI 1.1372 22500 Florence, SC 0.7786 22520 Florence-Muscle Shoals, AL 0.6831 22540 Fond du Lac, WI 0.9051 22660 Fort Collins, CO 1.0193 22744 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL 0.9831 22900 Fort Smith, AR-OK 0.6754 23060 Fort Wayne, IN 0.8935 23104 Fort Worth-Arlington, TX 0.9567 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 4 of 10 23420 Fresno, CA 1.1005 23460 Gadsden, AL 0.7332 23540 Gainesville, FL 0.8554 23580 Gainesville, GA 0.9089 23844 Gary, IN 0.9553 23900 Gettysburg, PA 1.0359 24020 Glens Falls, NY 0.8172 24140 Goldsboro, NC 0.8661 24220 Grand Forks, ND-MN 0.7382 24260 Grand Island, NE 0.8763 24300 Grand Junction, CO 0.9656 24340 Grand Rapids-Wyoming, MI 0.8885 24420 Grants Pass, OR 1.0722 24500 Great Falls, MT 0.9860 24540 Greeley, CO 0.9443 24580 Green Bay, WI 0.9401 24660 Greensboro-High Point, NC 0.8566 24780 Greenville, NC 0.9489 24860 Greenville-Anderson-Mauldin, SC 0.8994 25020 Guayama, PR 0.3610 25060 Gulfport-Biloxi-Pascagoula, MS 0.7864 25180 Hagerstown-Martinsburg, MD-WV 0.9132 25220 Hammond, LA 0.6575 25260 Hanford-Corcoran, CA 1.1213 25420 Harrisburg-Carlisle, PA 0.9517 25500 Harrisonburg, VA 0.8918 25540 Hartford-West Hartford-East Hartford, CT 1.1116 25620 Hattiesburg, MS 0.7553 25860 Hickory-Lenoir-Morganton, NC 0.8463 25940 Hilton Head Island-Bluffton-Beaufort, SC 0.8682 25980 Hinesville, GA 0.8699 26140 Homosassa Springs, FL 0.7203 26300 Hot Springs, AR 0.8267 26380 Houma-Thibodaux, LA 0.7139 26420 Houston-The Woodlands-Sugar Land, TX 0.9714 26580 Huntington-Ashland, WV-KY-OH 0.8859 26620 Huntsville, AL 0.8745 26820 Idaho Falls, ID 0.9015 26900 Indianapolis-Carmel-Anderson, IN 1.0092 26980 Iowa City, IA 0.9894 27060 Ithaca, NY 0.9372 27100 Jackson, MI 0.8967 27140 Jackson, MS 0.7994 27180 Jackson, TN 0.7618 27260 Jacksonville, FL 0.9120 27340 Jacksonville, NC 0.7646 27500 Janesville-Beloit, WI 0.8891 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 5 of 10 27620 Jefferson City, MO 0.8341 27740 Johnson City, TN 0.7281 27780 Johnstown, PA 0.8380 27860 Jonesboro, AR 0.7851 27900 Joplin, MO 0.7910 27980 Kahului-Wailuku-Lahaina, HI 0.9895 28020 Kalamazoo-Portage, MI 1.0439 28100 Kankakee, IL 0.8789 28140 Kansas City, MO-KS 0.9502 28420 Kennewick-Richland, WA 0.9823 28660 Killeen-Temple, TX 0.9103 28700 Kingsport-Bristol-Bristol, TN-VA 0.7321 28740 Kingston, NY 0.9025 28940 Knoxville, TN 0.7365 29020 Kokomo, IN 0.8996 29100 La Crosse-Onalaska, WI-MN 0.9935 29180 Lafayette, LA 0.7962 29200 Lafayette-West Lafayette, IN 0.9927 29340 Lake Charles, LA 0.7670 29404 Lake County-Kenosha County, IL-WI 1.0420 29420 Lake Havasu City-Kingman, AZ 0.9114 29460 Lakeland-Winter Haven, FL 0.8113 29540 Lancaster, PA 0.9482 29620 Lansing-East Lansing, MI 1.0725 29700 Laredo, TX 0.7758 29740 Las Cruces, NM 0.8744 29820 Las Vegas-Henderson-Paradise, NV 1.2132 29940 Lawrence, KS 0.9084 30020 Lawton, OK 0.7606 30140 Lebanon, PA 0.8206 30300 Lewiston, ID-WA 0.9677 30340 Lewiston-Auburn, ME 0.8517 30460 Lexington-Fayette, KY 0.8893 30620 Lima, OH 0.9149 30700 Lincoln, NE 0.9612 30780 Little Rock-North Little Rock-Conway, AR 0.8427 30860 Logan, UT-ID 0.8954 30980 Longview, TX 0.8308 31020 Longview, WA 1.0856 31084 Los Angeles-Long Beach-Glendale, CA 1.2620 31140 Louisville/Jefferson County, KY-IN 0.8747 31180 Lubbock, TX 0.8493 31340 Lynchburg, VA 0.8980 31420 Macon, GA 0.8902 31460 Madera, CA 0.7523 31540 Madison, WI 1.1085 31700 Manchester-Nashua, NH 1.0117 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 6 of 10 31740 Manhattan, KS 0.8468 31860 Mankato-North Mankato, MN 0.9136 31900 Mansfield, OH 0.8437 32420 Mayagüez, PR 0.3696 32580 McAllen-Edinburg-Mission, TX 0.8091 32780 Medford, OR 1.1177 32820 Memphis, TN-MS-AR 0.8852 32900 Merced, CA 1.3611 33124 Miami-Miami Beach-Kendall, FL 0.9694 33140 Michigan City-La Porte, IN 0.9553 33220 Midland, MI 0.8655 33260 Midland, TX 0.9235 33340 Milwaukee-Waukesha-West Allis, WI 0.9810 33460 Minneapolis-St. Paul-Bloomington, MN-WI 1.1200 33540 Missoula, MT 0.9490 33660 Mobile, AL 0.7381 33700 Modesto, CA 1.3287 33740 Monroe, LA 0.7677 33780 Monroe, MI 0.8803 33860 Montgomery, AL 0.7598 33874 Montgomery County-Bucks County-Chester County, PA 1.0326 34060 Morgantown, WV 0.8042 34100 Morristown, TN 0.7281 34580 Mount Vernon-Anacortes, WA 0.9466 34620 Muncie, IN 0.9412 34740 Muskegon, MI 0.9344 34820 Myrtle Beach-Conway-North Myrtle Beach, SC-NC 0.8572 34900 Napa, CA 1.5870 34940 Naples-Immokalee-Marco Island, FL 0.8640 34980 Nashville-Davidson--Murfreesboro--Franklin, TN 0.8949 35004 Nassau County-Suffolk County, NY 1.3019 35084 Newark, NJ-PA 1.1157 35100 New Bern, NC 0.8795 35300 New Haven-Milford, CT 1.2526 35380 New Orleans-Metairie, LA 0.8687 35614 New York-Jersey City-White Plains, NY-NJ 1.2966 35660 Niles-Benton Harbor, MI 0.8222 35840 North Port-Sarasota-Bradenton, FL 0.9732 35980 Norwich-New London, CT 1.2056 36084 Oakland-Hayward-Berkeley, CA 1.7709 36100 Ocala, FL 0.8226 36140 Ocean City, NJ 1.0674 36220 Odessa, TX 0.9547 36260 Ogden-Clearfield, UT 0.9268 36420 Oklahoma City, OK 0.8824 36500 Olympia-Tumwater, WA 1.2358 36540 Omaha-Council Bluffs, NE-IA 0.9579 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 7 of 10 36740 Orlando-Kissimmee-Sanford, FL 0.9024 36780 Oshkosh-Neenah, WI 0.9492 36980 Owensboro, KY 0.7998 37100 Oxnard-Thousand Oaks-Ventura, CA 1.2735 37340 Palm Bay-Melbourne-Titusville, FL 0.8921 37460 Panama City, FL 0.8731 37620 Parkersburg-Vienna, WV 0.6776 37860 Pensacola-Ferry Pass-Brent, FL 0.7569 37900 Peoria, IL 0.8786 37964 Philadelphia, PA 1.1198 38060 Phoenix-Mesa-Scottsdale, AZ 1.0350 38220 Pine Bluff, AR 0.7674 38300 Pittsburgh, PA 0.8621 38340 Pittsfield, MA 1.0584 38540 Pocatello, ID 0.9750 38660 Ponce, PR 0.4315 38860 Portland-South Portland, ME 1.0116 38900 Portland-Vancouver-Hillsboro, OR-WA 1.2171 38940 Port St. Lucie, FL 0.9390 39140 Prescott, AZ 1.1664 39300 Providence-Warwick, RI-MA 1.0662 39340 Provo-Orem, UT 0.9633 39380 Pueblo, CO 0.8336 39460 Punta Gorda, FL 0.9169 39540 Racine, WI 1.0754 39580 Raleigh, NC 0.9591 39660 Rapid City, SD 0.8879 39740 Reading, PA 0.8949 39820 Redding, CA 1.0052 39900 Reno, NV 0.9637 40060 Richmond, VA 0.9668 40140 Riverside-San Bernardino-Ontario, CA 1.1355 40220 Roanoke, VA 0.9226 40340 Rochester, MN 1.1266 40380 Rochester, NY 0.8669 40420 Rockford, IL 0.9872 40484 Rockingham County-Strafford County, NH 0.9989 40580 Rocky Mount, NC 0.8804 40660 Rome, GA 0.8589 40900 Sacramento--Roseville--Arden-Arcade, CA 1.6040 40980 Saginaw, MI 0.8593 41060 St. Cloud, MN 1.0319 41100 St. George, UT 0.9671 41140 St. Joseph, MO-KS 0.9546 41180 St. Louis, MO-IL 0.9270 41420 Salem, OR 1.0769 41500 Salinas, CA 1.6282 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 8 of 10 41540 Salisbury, MD-DE 0.9299 41620 Salt Lake City, UT 0.9539 41660 San Angelo, TX 0.8056 41700 San Antonio-New Braunfels, TX 0.8697 41740 San Diego-Carlsbad, CA 1.2097 41884 San Francisco-Redwood City-South San Francisco, CA 1.7143 41900 San Germán, PR 0.4676 41940 San Jose-Sunnyvale-Santa Clara, CA 1.7849 41980 San Juan-Carolina-Caguas, PR 0.4224 42020 San Luis Obispo-Paso Robles-Arroyo Grande, CA 1.3276 42034 San Rafael, CA 1.7492 42100 Santa Cruz-Watsonville, CA 1.8642 42140 Santa Fe, NM 1.0279 42200 Santa Maria-Santa Barbara, CA 1.3291 42220 Santa Rosa, CA 1.7094 42340 Savannah, GA 0.8750 42540 Scranton--Wilkes-Barre--Hazleton, PA 0.8346 42644 Seattle-Bellevue-Everett, WA 1.2011 42680 Sebastian-Vero Beach, FL 0.8875 42700 Sebring, FL 0.7475 43100 Sheboygan, WI 0.9275 43300 Sherman-Denison, TX 0.8944 43340 Shreveport-Bossier City, LA 0.8317 43420 Sierra Vista-Douglas, AZ 0.9082 43524 Silver Spring-Frederick-Rockville, MD 0.9681 43580 Sioux City, IA-NE-SD 0.8658 43620 Sioux Falls, SD 0.7917 43780 South Bend-Mishawaka, IN-MI 0.9276 43900 Spartanburg, SC 0.8469 44060 Spokane-Spokane Valley, WA 1.2076 44100 Springfield, IL 0.9120 44140 Springfield, MA 1.0285 44180 Springfield, MO 0.8080 44220 Springfield, OH 0.8553 44300 State College, PA 0.9847 44420 Staunton-Waynesboro, VA 0.8374 44700 Stockton-Lodi, CA 1.3350 44940 Sumter, SC 0.7222 45060 Syracuse, NY 0.9849 45104 Tacoma-Lakewood, WA 1.1705 45220 Tallahassee, FL 0.8433 45300 Tampa-St. Petersburg-Clearwater, FL 0.9019 45460 Terre Haute, IN 0.9179 45500 Texarkana, TX-AR 0.7520 45540 The Villages, FL 0.8217 45780 Toledo, OH 0.9178 45820 Topeka, KS 0.8331 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 9 of 10 45940 Trenton, NJ 1.0006 46060 Tucson, AZ 0.8887 46140 Tulsa, OK 0.7832 46220 Tuscaloosa, AL 0.8058 46340 Tyler, TX 0.8361 46520 Urban Honolulu, HI 1.2029 46540 Utica-Rome, NY 0.9055 46660 Valdosta, GA 0.7632 46700 Vallejo-Fairfield, CA 1.6848 47020 Victoria, TX 0.8485 47220 Vineland-Bridgeton, NJ 1.0867 47260 Virginia Beach-Norfolk-Newport News, VA-NC 0.9240 47300 Visalia-Porterville, CA 0.9661 47380 Waco, TX 0.8038 47460 Walla Walla, WA 1.1695 47580 Warner Robins, GA 0.7632 47664 Warren-Troy-Farmington Hills, MI 0.9477 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.0428 47940 Waterloo-Cedar Falls, IA 0.8434 48060 Watertown-Fort Drum, NY 0.9181 48140 Wausau, WI 0.9013 48260 Weirton-Steubenville, WV-OH 0.7524 48300 Wenatchee, WA 1.0017 48424 West Palm Beach-Boca Raton-Delray Beach, FL 0.9414 48540 Wheeling, WV-OH 0.6650 48620 Wichita, KS 0.8514 48660 Wichita Falls, TX 0.9089 48700 Williamsport, PA 0.8698 48864 Wilmington, DE-MD-NJ 1.0688 48900 Wilmington, NC 0.8481 49020 Winchester, VA-WV 0.8736 49180 Winston-Salem, NC 0.8544 49340 Worcester, MA-CT 1.1667 49420 Yakima, WA 0.9808 49620 York-Hanover, PA 1.0078 49660 Youngstown-Warren-Boardman, OH-PA 0.7975 49700 Yuba City, CA 1.2029 49740 Yuma, AZ 1.0270 Case 1:16-cv-01257-JDB Document 17-5 Filed 05/19/17 Page 10 of 10 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 6: Table 12A, FY 2016 LTCH PPS Final Rule This file is available for download at the FY 2016 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1632-F.html. The webpage provides a link to a ZIP archive titled “FY 2016 LTCH PPS Wage Indexes (Tables 12A - 12B) – Updated Sept. 2015.” Within this ZIP file is a Microsoft Excel workbook named “FY 2016 Tables 12 A and B (CMS-1632-FR and CN).xlsx.” The first worksheet, titled “Table 12A-CN16,” is Table 12A as cited in the FY 2016 LTCH PPS final rule. Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 1 of 10 CBSA Code CBSA Title LTCH PPS Wage Index 10180 Abilene, TX 0.8205 10380 Aguadilla-Isabela, PR 0.3433 10420 Akron, OH 0.8487 10500 Albany, GA 0.9182 10540 Albany, OR 1.0764 10580 Albany-Schenectady-Troy, NY 0.8400 10740 Albuquerque, NM 0.9261 10780 Alexandria, LA 0.8110 10900 Allentown-Bethlehem-Easton, PA-NJ 0.9074 11020 Altoona, PA 1.0436 11100 Amarillo, TX 0.8189 11180 Ames, IA 0.9376 11244 Anaheim-Santa Ana-Irvine, CA 1.1794 11260 Anchorage, AK 1.3277 11460 Ann Arbor, MI 0.9959 11500 Anniston-Oxford-Jacksonville, AL 0.7073 11540 Appleton, WI 0.9390 11640 Arecibo, PR 0.4128 11700 Asheville, NC 0.8593 12020 Athens-Clarke County, GA 0.8986 12060 Atlanta-Sandy Springs-Roswell, GA 0.9281 12100 Atlantic City-Hammonton, NJ 1.1679 12220 Auburn-Opelika, AL 0.7633 12260 Augusta-Richmond County, GA-SC 0.9372 12420 Austin-Round Rock, TX 0.9608 12540 Bakersfield, CA 1.2201 12580 Baltimore-Columbia-Towson, MD 0.9725 12620 Bangor, ME 0.9845 12700 Barnstable Town, MA 1.3393 12940 Baton Rouge, LA 0.8061 12980 Battle Creek, MI 1.0506 13020 Bay City, MI 0.9785 13140 Beaumont-Port Arthur, TX 0.8287 13220 Beckley, WV 0.7921 13380 Bellingham, WA 1.2696 13460 Bend-Redmond, OR 1.1971 13740 Billings, MT 0.8757 13780 Binghamton, NY 0.8158 13820 Birmingham-Hoover, AL 0.8246 13900 Bismarck, ND 0.7110 13980 Blacksburg-Christiansburg-Radford, VA 0.8503 Table 12A- LTCH PPS Wage Index for Urban Areas for Discharges Occurring from October 1, 2015 through September 30, 2016 - Corrected Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 2 of 10 14010 Bloomington, IL 0.9086 14020 Bloomington, IN 0.9169 14100 Bloomsburg-Berwick, PA 0.8991 14260 Boise City, ID 0.9329 14454 Boston, MA 1.3028 14500 Boulder, CO 0.9774 14540 Bowling Green, KY 0.8244 14740 Bremerton-Silverdale, WA 1.1100 14860 Bridgeport-Stamford-Norwalk, CT 1.3346 15180 Brownsville-Harlingen, TX 0.8373 15260 Brunswick, GA 0.8541 15380 Buffalo-Cheektowaga-Niagara Falls, NY 1.0435 15500 Burlington, NC 0.8539 15540 Burlington-South Burlington, VT 1.0154 15680 California-Lexington Park, MD 0.9367 15764 Cambridge-Newton-Framingham, MA 1.1143 15804 Camden, NJ 1.0117 15940 Canton-Massillon, OH 0.8469 15980 Cape Coral-Fort Myers, FL 0.9456 16020 Cape Girardeau, MO-IL 0.8628 16060 Carbondale-Marion, IL 0.8424 16180 Carson City, NV 1.0761 16220 Casper, WY 1.0078 16300 Cedar Rapids, IA 0.8712 16540 Chambersburg-Waynesboro, PA 1.1003 16580 Champaign-Urbana, IL 0.9948 16620 Charleston, WV 0.7992 16700 Charleston-North Charleston, SC 0.8884 16740 Charlotte-Concord-Gastonia, NC-SC 0.9073 16820 Charlottesville, VA 0.9470 16860 Chattanooga, TN-GA 0.8814 16940 Cheyenne, WY 0.9654 16974 Chicago-Naperville-Arlington Heights, IL 1.0401 17020 Chico, CA 1.1605 17140 Cincinnati, OH-KY-IN 0.9439 17300 Clarksville, TN-KY 0.7479 17420 Cleveland, TN 0.7544 17460 Cleveland-Elyria, OH 0.9376 17660 Coeur d'Alene, ID 0.8937 17780 College Station-Bryan, TX 0.9569 17820 Colorado Springs, CO 0.9130 17860 Columbia, MO 0.8440 17900 Columbia, SC 0.8387 17980 Columbus, GA-AL 0.8355 18020 Columbus, IN 1.0305 18140 Columbus, OH 0.9678 18580 Corpus Christi, TX 0.8533 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 3 of 10 18700 Corvallis, OR 1.1289 18880 Crestview-Fort Walton Beach-Destin, FL 0.8583 19060 Cumberland, MD-WV 0.8788 19124 Dallas-Plano-Irving, TX 0.9847 19140 Dalton, GA 0.8373 19180 Danville, IL 0.9588 19300 Daphne-Fairhope-Foley, AL 0.7287 19340 Davenport-Moline-Rock Island, IA-IL 0.9730 19380 Dayton, OH 0.9035 19460 Decatur, AL 0.7284 19500 Decatur, IL 0.8188 19660 Deltona-Daytona Beach-Ormond Beach, FL 0.8519 19740 Denver-Aurora-Lakewood, CO 1.0198 19780 Des Moines-West Des Moines, IA 0.9331 19804 Detroit-Dearborn-Livonia, MI 0.9135 20020 Dothan, AL 0.6908 20100 Dover, DE 1.0222 20220 Dubuque, IA 0.8866 20260 Duluth, MN-WI 1.0333 20500 Durham-Chapel Hill, NC 0.9816 20524 Dutchess County-Putnam County, NY 1.1472 20700 East Stroudsburg, PA 0.9124 20740 Eau Claire, WI 0.9696 20940 El Centro, CA 0.8408 20994 Elgin, IL 1.0306 21060 Elizabethtown-Fort Knox, KY 0.7426 21140 Elkhart-Goshen, IN 0.9236 21300 Elmira, NY 0.8596 21340 El Paso, TX 0.8030 21500 Erie, PA 0.7768 21660 Eugene, OR 1.1871 21780 Evansville, IN-KY 0.8875 21820 Fairbanks, AK 1.1064 22020 Fargo, ND-MN 0.7705 22140 Farmington, NM 0.9561 22180 Fayetteville, NC 0.8878 22220 Fayetteville-Springdale-Rogers, AR-MO 0.8503 22380 Flagstaff, AZ 1.2223 22420 Flint, MI 1.1327 22500 Florence, SC 0.7753 22520 Florence-Muscle Shoals, AL 0.6802 22540 Fond du Lac, WI 0.9012 22660 Fort Collins, CO 1.0149 22744 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL 0.9776 22900 Fort Smith, AR-OK 0.7382 23060 Fort Wayne, IN 0.8898 23104 Fort Worth-Arlington, TX 0.9526 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 4 of 10 23420 Fresno, CA 1.1009 23460 Gadsden, AL 0.7301 23540 Gainesville, FL 0.9672 23580 Gainesville, GA 0.9007 23844 Gary, IN 0.9513 23900 Gettysburg, PA 1.0315 24020 Glens Falls, NY 0.8138 24140 Goldsboro, NC 0.8625 24220 Grand Forks, ND-MN 0.7351 24260 Grand Island, NE 0.8726 24300 Grand Junction, CO 0.9615 24340 Grand Rapids-Wyoming, MI 0.8848 24420 Grants Pass, OR 1.0676 24500 Great Falls, MT 0.9818 24540 Greeley, CO 0.9403 24580 Green Bay, WI 0.9361 24660 Greensboro-High Point, NC 0.8530 24780 Greenville, NC 0.9448 24860 Greenville-Anderson-Mauldin, SC 0.9014 25020 Guayama, PR 0.3595 25060 Gulfport-Biloxi-Pascagoula, MS 0.7830 25180 Hagerstown-Martinsburg, MD-WV 0.9093 25220 Hammond, LA 0.8167 25260 Hanford-Corcoran, CA 1.1170 25420 Harrisburg-Carlisle, PA 0.9542 25500 Harrisonburg, VA 0.8880 25540 Hartford-West Hartford-East Hartford, CT 1.1110 25620 Hattiesburg, MS 0.7521 25860 Hickory-Lenoir-Morganton, NC 0.8455 25940 Hilton Head Island-Bluffton-Beaufort, SC 0.8645 25980 Hinesville, GA 0.8666 26140 Homosassa Springs, FL 0.7173 26300 Hot Springs, AR 0.8432 26380 Houma-Thibodaux, LA 0.7015 26420 Houston-The Woodlands-Sugar Land, TX 0.9674 26580 Huntington-Ashland, WV-KY-OH 0.8838 26620 Huntsville, AL 0.8706 26820 Idaho Falls, ID 0.8976 26900 Indianapolis-Carmel-Anderson, IN 1.0050 26980 Iowa City, IA 0.9852 27060 Ithaca, NY 0.9332 27100 Jackson, MI 0.8929 27140 Jackson, MS 0.7963 27180 Jackson, TN 0.7586 27260 Jacksonville, FL 0.9082 27340 Jacksonville, NC 0.7614 27500 Janesville-Beloit, WI 0.9035 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 5 of 10 27620 Jefferson City, MO 0.8567 27740 Johnson City, TN 0.7250 27780 Johnstown, PA 0.8345 27860 Jonesboro, AR 0.7818 27900 Joplin, MO 0.8008 27980 Kahului-Wailuku-Lahaina, HI 1.0682 28020 Kalamazoo-Portage, MI 1.0395 28100 Kankakee, IL 0.8751 28140 Kansas City, MO-KS 0.9462 28420 Kennewick-Richland, WA 0.9781 28660 Killeen-Temple, TX 0.9065 28700 Kingsport-Bristol-Bristol, TN-VA 0.7290 28740 Kingston, NY 0.8987 28940 Knoxville, TN 0.7522 29020 Kokomo, IN 0.8958 29100 La Crosse-Onalaska, WI-MN 0.9893 29180 Lafayette, LA 0.7972 29200 Lafayette-West Lafayette, IN 0.9885 29340 Lake Charles, LA 0.7594 29404 Lake County-Kenosha County, IL-WI 1.0376 29420 Lake Havasu City-Kingman, AZ 0.9075 29460 Lakeland-Winter Haven, FL 0.8078 29540 Lancaster, PA 0.9440 29620 Lansing-East Lansing, MI 1.0683 29700 Laredo, TX 0.7726 29740 Las Cruces, NM 0.8707 29820 Las Vegas-Henderson-Paradise, NV 1.2080 29940 Lawrence, KS 0.9046 30020 Lawton, OK 0.7367 30140 Lebanon, PA 0.8176 30300 Lewiston, ID-WA 0.9636 30340 Lewiston-Auburn, ME 0.8481 30460 Lexington-Fayette, KY 0.8865 30620 Lima, OH 0.9110 30700 Lincoln, NE 0.9571 30780 Little Rock-North Little Rock-Conway, AR 0.8361 30860 Logan, UT-ID 0.8916 30980 Longview, TX 0.8311 31020 Longview, WA 1.0810 31084 Los Angeles-Long Beach-Glendale, CA 1.2664 31140 Louisville/Jefferson County, KY-IN 0.8756 31180 Lubbock, TX 0.8457 31340 Lynchburg, VA 0.8942 31420 Macon, GA 0.8935 31460 Madera, CA 0.7491 31540 Madison, WI 1.1042 31700 Manchester-Nashua, NH 1.0074 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 6 of 10 31740 Manhattan, KS 0.8432 31860 Mankato-North Mankato, MN 0.9097 31900 Mansfield, OH 0.8401 32420 Mayagüez, PR 0.3680 32580 McAllen-Edinburg-Mission, TX 0.8057 32780 Medford, OR 1.1130 32820 Memphis, TN-MS-AR 0.8815 32900 Merced, CA 1.3554 33124 Miami-Miami Beach-Kendall, FL 0.9653 33140 Michigan City-La Porte, IN 0.9513 33220 Midland, MI 0.8618 33260 Midland, TX 0.9196 33340 Milwaukee-Waukesha-West Allis, WI 0.9768 33460 Minneapolis-St. Paul-Bloomington, MN-WI 1.1144 33540 Missoula, MT 0.9450 33660 Mobile, AL 0.7346 33700 Modesto, CA 1.3230 33740 Monroe, LA 0.7645 33780 Monroe, MI 0.8766 33860 Montgomery, AL 0.7566 33874 Montgomery County-Bucks County-Chester County, PA 1.0279 34060 Morgantown, WV 0.8008 34100 Morristown, TN 0.7282 34580 Mount Vernon-Anacortes, WA 0.9426 34620 Muncie, IN 0.9372 34740 Muskegon, MI 0.9150 34820 Myrtle Beach-Conway-North Myrtle Beach, SC-NC 0.8496 34900 Napa, CA 1.5803 34940 Naples-Immokalee-Marco Island, FL 0.8603 34980 Nashville-Davidson--Murfreesboro--Franklin, TN 0.8913 35004 Nassau County-Suffolk County, NY 1.2967 35084 Newark, NJ-PA 1.1174 35100 New Bern, NC 0.8795 35300 New Haven-Milford, CT 1.2456 35380 New Orleans-Metairie, LA 0.8651 35614 New York-Jersey City-White Plains, NY-NJ 1.2961 35660 Niles-Benton Harbor, MI 0.8187 35840 North Port-Sarasota-Bradenton, FL 0.9690 35980 Norwich-New London, CT 1.2005 36084 Oakland-Hayward-Berkeley, CA 1.7598 36100 Ocala, FL 0.8191 36140 Ocean City, NJ 1.0629 36220 Odessa, TX 0.9507 36260 Ogden-Clearfield, UT 0.9228 36420 Oklahoma City, OK 0.8787 36500 Olympia-Tumwater, WA 1.2306 36540 Omaha-Council Bluffs, NE-IA 0.9576 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 7 of 10 36740 Orlando-Kissimmee-Sanford, FL 0.8986 36780 Oshkosh-Neenah, WI 0.9451 36980 Owensboro, KY 0.7964 37100 Oxnard-Thousand Oaks-Ventura, CA 1.2710 37340 Palm Bay-Melbourne-Titusville, FL 0.8885 37460 Panama City, FL 0.8694 37620 Parkersburg-Vienna, WV 0.6747 37860 Pensacola-Ferry Pass-Brent, FL 0.7537 37900 Peoria, IL 0.8749 37964 Philadelphia, PA 1.1133 38060 Phoenix-Mesa-Scottsdale, AZ 1.0304 38220 Pine Bluff, AR 0.7750 38300 Pittsburgh, PA 0.8584 38340 Pittsfield, MA 1.0802 38540 Pocatello, ID 0.9708 38660 Ponce, PR 0.4297 38860 Portland-South Portland, ME 1.0073 38900 Portland-Vancouver-Hillsboro, OR-WA 1.2315 38940 Port St. Lucie, FL 0.9350 39140 Prescott, AZ 1.0911 39300 Providence-Warwick, RI-MA 1.0617 39340 Provo-Orem, UT 0.9592 39380 Pueblo, CO 0.8301 39460 Punta Gorda, FL 0.9125 39540 Racine, WI 1.0708 39580 Raleigh, NC 0.9556 39660 Rapid City, SD 0.8841 39740 Reading, PA 0.9005 39820 Redding, CA 1.4869 39900 Reno, NV 0.9605 40060 Richmond, VA 0.9634 40140 Riverside-San Bernardino-Ontario, CA 1.1684 40220 Roanoke, VA 0.9187 40340 Rochester, MN 1.1219 40380 Rochester, NY 0.8633 40420 Rockford, IL 0.9898 40484 Rockingham County-Strafford County, NH 0.9946 40580 Rocky Mount, NC 0.8767 40660 Rome, GA 0.8553 40900 Sacramento--Roseville--Arden-Arcade, CA 1.6314 40980 Saginaw, MI 0.8557 41060 St. Cloud, MN 1.0275 41100 St. George, UT 0.9630 41140 St. Joseph, MO-KS 0.9505 41180 St. Louis, MO-IL 0.9256 41420 Salem, OR 1.0724 41500 Salinas, CA 1.6213 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 8 of 10 41540 Salisbury, MD-DE 0.9309 41620 Salt Lake City, UT 0.9496 41660 San Angelo, TX 0.8888 41700 San Antonio-New Braunfels, TX 0.8660 41740 San Diego-Carlsbad, CA 1.2060 41884 San Francisco-Redwood City-South San Francisco, CA 1.7354 41900 San Germán, PR 0.4656 41940 San Jose-Sunnyvale-Santa Clara, CA 1.7792 41980 San Juan-Carolina-Caguas, PR 0.4272 42020 San Luis Obispo-Paso Robles-Arroyo Grande, CA 1.3351 42034 San Rafael, CA 1.7418 42100 Santa Cruz-Watsonville, CA 1.8563 42140 Santa Fe, NM 1.0235 42200 Santa Maria-Santa Barbara, CA 1.3235 42220 Santa Rosa, CA 1.7099 42340 Savannah, GA 0.8724 42540 Scranton--Wilkes-Barre--Hazleton, PA 0.8321 42644 Seattle-Bellevue-Everett, WA 1.1965 42680 Sebastian-Vero Beach, FL 0.8838 42700 Sebring, FL 0.7846 43100 Sheboygan, WI 0.9235 43300 Sherman-Denison, TX 0.8906 43340 Shreveport-Bossier City, LA 0.8282 43420 Sierra Vista-Douglas, AZ 0.9044 43524 Silver Spring-Frederick-Rockville, MD 0.9640 43580 Sioux City, IA-NE-SD 0.8622 43620 Sioux Falls, SD 0.7884 43780 South Bend-Mishawaka, IN-MI 0.9240 43900 Spartanburg, SC 0.8447 44060 Spokane-Spokane Valley, WA 1.2024 44100 Springfield, IL 0.9081 44140 Springfield, MA 1.0242 44180 Springfield, MO 0.8046 44220 Springfield, OH 0.8517 44300 State College, PA 0.9805 44420 Staunton-Waynesboro, VA 0.8339 44700 Stockton-Lodi, CA 1.3273 44940 Sumter, SC 0.7192 45060 Syracuse, NY 0.9818 45104 Tacoma-Lakewood, WA 1.1776 45220 Tallahassee, FL 0.8397 45300 Tampa-St. Petersburg-Clearwater, FL 0.8980 45460 Terre Haute, IN 0.9140 45500 Texarkana, TX-AR 0.7488 45540 The Villages, FL 0.8173 45780 Toledo, OH 0.9139 45820 Topeka, KS 0.8295 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 9 of 10 45940 Trenton, NJ 0.9964 46060 Tucson, AZ 0.8876 46140 Tulsa, OK 0.7799 46220 Tuscaloosa, AL 0.8245 46340 Tyler, TX 0.8326 46520 Urban Honolulu, HI 1.2243 46540 Utica-Rome, NY 0.9017 46660 Valdosta, GA 0.7600 46700 Vallejo-Fairfield, CA 1.6777 47020 Victoria, TX 0.8449 47220 Vineland-Bridgeton, NJ 1.0820 47260 Virginia Beach-Norfolk-Newport News, VA-NC 0.9201 47300 Visalia-Porterville, CA 0.9620 47380 Waco, TX 0.8035 47460 Walla Walla, WA 1.1645 47580 Warner Robins, GA 0.7600 47664 Warren-Troy-Farmington Hills, MI 0.9445 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.0384 47940 Waterloo-Cedar Falls, IA 0.8398 48060 Watertown-Fort Drum, NY 0.9142 48140 Wausau, WI 0.9075 48260 Weirton-Steubenville, WV-OH 0.7492 48300 Wenatchee, WA 0.9975 48424 West Palm Beach-Boca Raton-Delray Beach, FL 0.9376 48540 Wheeling, WV-OH 0.6620 48620 Wichita, KS 0.8478 48660 Wichita Falls, TX 0.9050 48700 Williamsport, PA 0.8661 48864 Wilmington, DE-MD-NJ 1.0642 48900 Wilmington, NC 0.8445 49020 Winchester, VA-WV 0.8699 49180 Winston-Salem, NC 0.8539 49340 Worcester, MA-CT 1.1618 49420 Yakima, WA 0.9767 49620 York-Hanover, PA 1.0035 49660 Youngstown-Warren-Boardman, OH-PA 0.7942 49700 Yuba City, CA 1.1978 49740 Yuma, AZ 1.0282 Case 1:16-cv-01257-JDB Document 17-6 Filed 05/19/17 Page 10 of 10 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 7: Table 12B, FY 2016 LTCH PPS Final Rule This file is available for download at the FY 2016 LTCH PPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHPPS- Regulations-and-Notices-Items/LTCH-PPS-CMS-1632-F.html. The webpage provides a link to a ZIP archive titled “FY 2016 LTCH PPS Wage Indexes (Tables 12A - 12B) – Updated Sept. 2015.” Within this ZIP file is a Microsoft Excel workbook named “FY 2016 Tables 12 A and B (CMS-1632-FR and CN).xlsx.” The second worksheet, titled “Table 12B-CN16,” is Table 12B as cited in the FY 2016 LTCH PPS final rule. Case 1:16-cv-01257-JDB Document 17-7 Filed 05/19/17 Page 1 of 3 CBSA Code CBSA Title LTCH PPS Wage Index 01 ALABAMA 0.6910 02 ALASKA 1.3214 03 ARIZONA 0.9034 04 ARKANSAS 0.7219 05 CALIFORNIA 1.3291 06 COLORADO 0.9746 07 CONNECTICUT 1.1149 08 DELAWARE* ------ 10 FLORIDA 0.8294 11 GEORGIA 0.7433 12 HAWAII 1.0937 13 IDAHO 0.6872 14 ILLINOIS 0.8488 15 INDIANA 0.8297 16 IOWA 0.8412 17 KANSAS 0.7688 18 KENTUCKY 0.7742 19 LOUISIANA 0.6959 20 MAINE 0.8477 21 MARYLAND 0.8673 22 MASSACHUSETTS 1.1235 23 MICHIGAN 0.8380 24 MINNESOTA 0.9020 25 MISSISSIPPI 0.7420 26 MISSOURI 0.7732 27 MONTANA 0.9211 28 NEBRASKA 0.8451 29 NEVADA 0.9299 30 NEW HAMPSHIRE 1.0041 31 NEW JERSEY* ------ 32 NEW MEXICO 0.8513 33 NEW YORK 0.8247 34 NORTH CAROLINA 0.7963 35 NORTH DAKOTA 0.7409 36 OHIO 0.8307 37 OKLAHOMA 0.7632 38 OREGON 1.0103 39 PENNSYLVANIA 0.8087 41 RHODE ISLAND* ------ 42 SOUTH CAROLINA 0.8242 Table 12B - LTCH PPS Wage Index for Rural Areas for Discharges Occurring from October 1, 2015 through September 30, 2016 - Corrected Case 1:16-cv-01257-JDB Document 17-7 Filed 05/19/17 Page 2 of 3 43 SOUTH DAKOTA 0.8032 44 TENNESSEE 0.7329 45 TEXAS 0.7766 46 UTAH 0.9259 47 VERMONT 0.9680 49 VIRGINIA 0.7609 50 WASHINGTON 1.0878 51 WEST VIRGINIA 0.7368 52 WISCONSIN 0.8884 53 WYOMING 0.9140 * States have no rural areas. Case 1:16-cv-01257-JDB Document 17-7 Filed 05/19/17 Page 3 of 3 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 8: Excerpt of Final S-3 Data from IPPS Public Use Files FY 2016 IPPS Final Rule This file is available for download at the FY 2016 LTCH IPPS Final Rule webpage: https://www.cms.gov/Medicare/Medicare- Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final- Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Data-Files.html. The webpage provides a link to a ZIP archive titled “FY 2016 Final Rule and Correction Notice Wage Index Public Use Files.” Within this ZIP file is another ZIP archive named “FY2016-CMS- 1632-FR-Wage-Index.zip,” which contains yet another ZIP archive named “FY_2016_Final_S3_and_OCCMIX_PUF.zip.” Within this ZIP file is a Microsoft Excel workbook named “FY_2016_Final_S3_OCCMIX_PUF_07242015.xlsx.” The third worksheet, titled “FY16 Final S3 Data,” contains the wage data used to calculate the wage index. Because the worksheet is large, the exhibit is an excerpt of the larger file. Case 1:16-cv-01257-JDB Document 17-8 Filed 05/19/17 Page 1 of 3 PR O V N A M E FY B FY E FC _D A TE M A C M C R _T YP E C B SA G EO 19 00 15 N O R TH O A K S M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 15 04 06 07 00 1 1 25 22 0 19 00 17 O P E LO U S A S G E N E R A L H O S P IT A L 20 12 07 01 20 13 06 30 20 15 04 07 07 00 1 1 19 19 00 19 S T. F R A N C E S C A B R IN I H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 13 04 01 1 1 10 78 0 19 00 20 LA N E R E G IO N A L M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 14 12 12 07 00 1 1 12 94 0 19 00 25 S A V O Y M E D IC A L M A N A G E M E N T G R O U P , I N C . 20 12 01 01 20 12 12 31 20 14 12 08 07 00 1 1 19 19 00 26 R A P ID E S R E G IO N A L M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 12 15 07 00 1 1 10 78 0 19 00 27 S T. P A TR IC K H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 04 01 1 1 29 34 0 19 00 34 A B B E V IL LE G E N E R A L H O S P IT A L 20 12 01 01 20 12 12 31 20 13 06 20 05 90 1 1 29 18 0 19 00 36 O C H S N E R C LI N IC F O U N D A TI O N 20 12 01 01 20 12 12 31 20 14 12 15 07 00 1 1 35 38 0 19 00 39 W E S T JE FF E R S O N M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 12 11 07 00 1 1 35 38 0 19 00 40 S LI D E LL M E M O R IA L H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 12 07 00 1 1 35 38 0 19 00 41 S C H U M P E R T M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 14 12 08 04 01 1 1 43 34 0 19 00 44 A M E R IC A N L E G IO N H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 11 07 00 1 1 29 18 0 19 00 45 S T. T A M M A N Y P A R IS H H O S P IT A L 20 12 01 01 20 12 12 31 20 13 08 19 05 90 1 1 35 38 0 19 00 46 TO U R O IN FI R M A R Y 20 12 01 01 20 12 12 31 20 14 11 17 05 90 1 1 35 38 0 19 00 50 B E A U R E G A R D M E M O R IA L H O S P IT A L, IN C . 20 11 11 01 20 12 10 31 20 14 12 15 07 00 1 1 19 19 00 53 JE N N IN G S A M E R IC A N L E G IO N H O S P IT A L 20 11 12 01 20 12 11 30 20 14 12 15 07 00 1 1 19 19 00 54 IB E R IA M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 15 04 07 07 00 1 1 29 18 0 19 00 60 LA K E C H A R LE S M E M O R IA L H O S P IT A L 20 12 01 01 20 12 12 31 20 14 11 10 05 90 1 1 29 34 0 19 00 64 O U R L A D Y O F TH E L A K E R M C 20 12 07 01 20 13 06 30 20 14 12 15 07 00 1 1 12 94 0 19 00 65 B A TO N R O U G E G E N E R A L 20 11 10 01 20 12 09 30 20 14 12 12 07 00 1 1 12 94 0 19 00 79 S T. C H A R LE S P A R IS H H O S P IT A L 20 12 08 01 20 13 07 31 20 14 12 12 05 90 1 1 35 38 0 19 00 81 W E S T C A R R O LL H E A LT H S Y S TE M S , L LC 20 12 01 01 20 12 12 31 20 14 12 15 07 00 1 1 19 19 00 86 N O R TH E R N L O U IS IA N A M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 14 12 15 07 00 1 1 19 19 00 88 S P R IN G H IL L M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 12 01 05 90 1 1 43 34 0 19 00 90 W IN N P A R IS H M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 11 12 05 90 1 1 19 19 00 98 LS U -H S C -S H R E V E P O R T 20 12 07 01 20 13 06 30 20 14 12 12 07 00 1 1 43 34 0 19 00 99 A V O Y E LL E S H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 12 05 90 1 1 19 19 01 06 O A K D A LE C O M M U N IT Y H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 12 05 90 1 1 19 19 01 11 W IL LI S -K N IG H TO N H E A LT H S Y S TE M S 20 11 10 01 20 12 09 30 20 14 12 09 07 00 1 1 43 34 0 19 01 14 H O M E R M E M O R IA L H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 07 00 1 1 19 19 01 16 M O R E H O U S E G E N E R A L H O S P IT A L 20 12 06 01 20 13 05 31 20 14 12 12 05 90 1 1 19 19 01 18 D E S O TO R E G IO N A L H E A LT H S Y S TE M 20 11 10 01 20 12 09 30 20 14 12 11 07 00 1 1 43 34 0 19 01 25 S T. F R A N C IS M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 15 01 26 07 00 1 1 33 74 0 19 01 28 W O M A N S H O S P IT A L 20 11 10 01 20 12 09 30 20 15 04 07 07 00 1 1 12 94 0 19 01 33 A LL E N P A R IS H H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 07 00 1 1 19 19 01 35 O C H S N E R B A P TI S T M E D IC A L C E N TE R 20 12 06 01 20 13 03 09 20 15 04 07 07 00 1 1 35 38 0 19 01 40 FR A N K LI N M E D IC A L C E N TE R 20 12 05 01 20 13 04 30 20 14 12 15 07 00 1 1 19 Case 1:16-cv-01257-JDB Document 17-8 Filed 05/19/17 Page 2 of 3 PR O V N A M E FY B FY E FC _D A TE M A C M C R _T YP E C B SA G EO 19 02 78 S P E C IA LI S TS H O S P IT A L O F S H R E V E P O R T 20 12 01 01 20 12 12 31 20 14 12 15 07 00 1 1 43 34 0 19 02 97 D O C TO R S H O S P IT A L A T D E E R C R E E K 20 12 01 01 20 12 12 31 20 15 02 03 07 00 1 1 19 19 02 98 C E N TR A L LO U IS IA N A S U R G IC A L H O S P IT A L 20 12 06 01 20 13 05 31 20 14 12 15 07 00 1 1 10 78 0 19 03 03 H A M M O N D S U R G IC A L L. L. C . 20 12 01 01 20 12 12 31 20 14 12 15 07 00 1 1 25 22 0 19 03 04 TE C H E S P E C IA LT Y H O S P IT A L 20 12 06 01 20 13 05 31 20 14 12 13 05 90 1 1 29 18 0 19 03 07 S O U TH C A M E R O N M E M O R IA L H O S P 20 12 01 01 20 12 12 31 20 14 12 12 07 00 1 1 29 34 0 19 03 08 S T. B E R N A R D P A R IS H H O S P IT A L 20 12 09 14 20 12 12 31 20 14 12 15 07 00 1 1 35 38 0 20 00 01 S T JO S E P H H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 15 14 01 1 1 12 62 0 20 00 02 M IL E S M E M O R IA L H O S P IT A L 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 20 20 00 08 M E R C Y H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 15 14 01 1 1 38 86 0 20 00 09 M A IN E M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 38 86 0 20 00 18 TH E A R O O S TO O K M E D IC A L C E N TE R 20 12 09 30 20 13 09 28 20 14 12 15 14 01 1 1 20 20 00 19 S O U TH E R N M A IN E M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 38 86 0 20 00 20 Y O R K H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 14 01 1 1 38 86 0 20 00 21 M ID C O A S T H O S P IT A L 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 38 86 0 20 00 24 C E N TR A L M A IN E M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 14 12 15 14 01 1 1 30 34 0 20 00 25 P A R K V IE W A D V E N TI S T M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 15 01 23 14 01 1 1 38 86 0 20 00 31 C A R Y M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 12 15 14 01 1 1 20 20 00 33 E A S TE R N M A IN E M E D IC A L C E N TE R 20 12 09 30 20 13 09 28 20 14 12 15 14 01 1 1 12 62 0 20 00 34 S T. M A R Y S R E G IO N A L M E D IC A L C E N TE R 20 12 01 01 20 12 12 31 20 14 12 15 14 01 1 1 30 34 0 20 00 37 FR A N K LI N M E M O R IA L H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 14 01 1 1 20 20 00 39 M A IN E G E N E R A L M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 14 12 15 14 01 1 1 20 20 00 40 H . D . G O O D A LL H O S P IT A L 20 12 06 01 20 13 05 31 20 14 12 15 14 01 1 1 38 86 0 20 00 41 IN LA N D H O S P IT A L 20 12 09 30 20 13 09 28 20 14 12 15 14 01 1 1 20 20 00 50 M A IN E C O A S T M E M O R IA L H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 14 01 1 1 20 20 00 52 N O R TH E R N M A IN E M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 20 20 00 63 P E N O B S C O T B A Y M E D IC A L C E N TE R 20 11 10 01 20 12 09 30 20 14 12 15 14 01 1 1 20 21 00 01 M E R IT U S M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 25 18 0 21 00 02 U N IV E R S IT Y O F M A R Y LA N D M E D S Y S 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 12 58 0 21 00 03 P R IN C E G E O R G E S H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 47 89 4 21 00 04 H O LY C R O S S H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 43 52 4 21 00 05 FR E D E R IC K M E M O R IA L H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 43 52 4 21 00 06 H A R FO R D M E M O R IA L H O S P IT A L 20 12 01 01 20 12 12 31 20 14 12 02 12 00 1 1 12 58 0 21 00 08 M E R C Y M E D IC A L C E N TE R 20 12 07 01 20 13 06 30 20 15 03 02 12 00 1 1 12 58 0 21 00 09 TH E J O H N S H O P K IN S H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 15 12 00 1 1 12 58 0 21 00 11 S T. A G N E S H O S P IT A L 20 12 07 01 20 13 06 30 20 14 12 12 12 00 1 1 12 58 0 21 00 12 S IN A I H O S P IT A L O F B A LT IM O R E , I N C . 20 12 07 01 20 13 06 30 20 15 03 02 12 00 1 1 12 58 0 21 00 13 B O N S E C O U R S H O S P IT A L 20 12 09 01 20 13 08 31 20 14 12 12 12 00 1 1 12 58 0 Case 1:16-cv-01257-JDB Document 17-8 Filed 05/19/17 Page 3 of 3 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) EXHIBIT IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MEMORANDUM IN OPPOSITION Exhibit 9: Excerpt of Hourly Wage Data from IPPS Public Use Files FY 2015 IPPS Final Rule This file is available for download at the FY 2015 LTCH IPPS Final Rule webpage: https://www.cms.gov/Medicare/ Medicare- Fee-for-Service-Payment/AcuteInpatientPPS/FY2015-IPPS-Final- Rule-Home-Page-Items/FY2015-Final-Rule-Data-Files.html. The webpage provides a link to a ZIP archive titled “FY 2015 Final Rule Wage Index Public Use Files.” Within this ZIP file is another ZIP archive named “FY_2015_FINAL_provcbsaahw.zip.” Within this ZIP file is a Microsoft Excel workbook named “FY_2015_FR_provcbsaahw_25072014.xlsx.” The sole worksheet, named “Provider_CBSA_AHW,” contains the average hourly wage by provider and CBSA. Because the worksheet is large, the exhibit is an excerpt of the larger file. Case 1:16-cv-01257-JDB Document 17-9 Filed 05/19/17 Page 1 of 3 P ro vi de r_ C B S A _A H W PR O V cb sa _ ol d # of p ro vs in c bs a_ ol d pr ov o cc m ix w ag es _o ld pr ov h ou r pr ov oc cm ix ah w _o ld cb sa _o ld o cc m ix w ag es cb sa _o ld h ou r cb sa _o ld oc cm ix a hw cb sa _o ld oc cm ix w ag e in de x cb sa _n ew # of pr ov s in cb sa _n e w 18 01 05 18 40 $8 ,6 04 ,7 26 .3 8 32 6, 25 9. 73 $2 6. 37 39 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 06 18 40 $7 ,5 19 ,7 76 .2 8 30 7, 91 7. 83 $2 4. 42 14 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 15 18 40 $1 0, 22 1, 14 9. 62 47 5, 06 2. 70 $2 1. 51 54 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 16 18 40 $2 3, 57 8, 21 2. 44 79 6, 82 6. 37 $2 9. 59 02 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 17 18 40 $7 ,6 86 ,6 95 .3 3 24 2, 03 6. 14 $3 1. 75 85 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 24 14 54 0 2 $2 9, 81 2, 56 7. 10 93 3, 95 8. 25 $3 1. 92 07 $1 50 ,0 81 ,3 54 .3 3 4, 50 2, 01 8. 73 $3 3. 33 65 0. 84 91 14 54 0 2 18 01 27 18 40 $3 5, 99 2, 30 7. 44 1, 05 3, 16 8. 00 $3 4. 17 53 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 28 18 40 $1 3, 68 2, 28 8. 51 47 4, 74 3. 23 $2 8. 82 04 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 30 31 14 0 11 $2 04 ,1 93 ,4 31 .1 2 5, 94 1, 54 6. 28 $3 4. 36 71 $1 ,4 72 ,1 22 ,6 61 .0 0 43 ,5 42 ,2 17 .9 7 $3 3. 80 91 0. 86 12 31 14 0 10 18 01 32 18 40 $6 0, 48 3, 01 9. 42 1, 95 5, 70 3. 58 $3 0. 92 65 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 38 31 14 0 11 $2 4, 92 4, 47 7. 17 73 1, 91 5. 03 $3 4. 05 38 $1 ,4 72 ,1 22 ,6 61 .0 0 43 ,5 42 ,2 17 .9 7 $3 3. 80 91 0. 86 12 31 14 0 10 18 01 39 18 40 $1 5, 00 4, 58 2. 69 46 6, 75 1. 31 $3 2. 14 68 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 18 01 41 31 14 0 11 $1 86 ,2 71 ,0 07 .8 8 5, 39 8, 98 0. 41 $3 4. 50 11 $1 ,4 72 ,1 22 ,6 61 .0 0 43 ,5 42 ,2 17 .9 7 $3 3. 80 91 0. 86 12 31 14 0 10 18 01 43 30 46 0 7 $5 9, 88 5, 13 3. 36 1, 78 0, 71 2. 42 $3 3. 62 99 $7 43 ,7 42 ,8 69 .2 4 21 ,1 53 ,2 13 .6 1 $3 5. 15 98 0. 89 56 30 46 0 7 18 01 49 18 40 $1 0, 54 0, 60 7. 33 49 7, 51 5. 00 $2 1. 18 65 $1 ,2 13 ,5 15 ,9 63 .2 0 39 ,6 37 ,9 65 .9 5 $3 0. 61 50 0. 77 98 18 41 19 00 01 19 35 $3 3, 16 3, 46 7. 89 1, 08 4, 59 8. 45 $3 0. 57 67 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 00 02 29 18 0 8 $8 4, 95 9, 51 5. 60 2, 92 9, 68 2. 33 $2 8. 99 96 $3 22 ,9 97 ,1 00 .6 4 10 ,3 48 ,3 60 .6 2 $3 1. 21 24 0. 79 50 29 18 0 13 19 00 03 19 35 $2 2, 46 9, 08 7. 58 63 3, 12 5. 86 $3 5. 48 91 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 29 18 0 13 19 00 04 26 38 0 4 $4 3, 47 3, 64 6. 73 1, 44 8, 94 6. 04 $3 0. 00 36 $1 75 ,8 25 ,3 57 .9 5 5, 95 9, 41 9. 27 $2 9. 50 38 0. 75 15 26 38 0 4 19 00 05 35 38 0 18 $1 69 ,0 60 ,7 77 .3 8 4, 42 4, 50 8. 16 $3 8. 21 01 $1 ,2 61 ,6 23 ,3 04 .1 0 36 ,8 05 ,5 31 .5 9 $3 4. 27 81 0. 87 31 35 38 0 18 19 00 06 29 18 0 8 $5 8, 80 2, 30 8. 27 1, 90 5, 39 1. 96 $3 0. 86 10 $3 22 ,9 97 ,1 00 .6 4 10 ,3 48 ,3 60 .6 2 $3 1. 21 24 0. 79 50 29 18 0 13 19 00 07 19 35 $1 5, 09 6, 06 7. 24 52 7, 60 1. 59 $2 8. 61 26 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 00 08 26 38 0 4 $7 2, 51 2, 14 0. 82 2, 47 1, 62 5. 50 $2 9. 33 78 $1 75 ,8 25 ,3 57 .9 5 5, 95 9, 41 9. 27 $2 9. 50 38 0. 75 15 26 38 0 4 19 00 09 10 78 0 4 $2 5, 61 9, 77 7. 46 93 3, 14 5. 06 $2 7. 45 53 $2 30 ,9 28 ,1 46 .7 8 7, 40 6, 25 9. 09 $3 1. 18 01 0. 79 42 10 78 0 4 19 00 11 33 74 0 6 $4 3, 71 5, 83 3. 85 1, 53 2, 38 0. 21 $2 8. 52 81 $2 22 ,1 85 ,9 69 .4 1 7, 34 7, 84 2. 35 $3 0. 23 83 0. 77 02 33 74 0 6 19 00 13 29 34 0 5 $2 6, 55 3, 17 9. 48 1, 01 4, 79 4. 85 $2 6. 16 61 $1 97 ,0 61 ,8 07 .7 6 6, 57 8, 56 6. 51 $2 9. 95 51 0. 76 30 29 34 0 5 19 00 14 19 35 $1 7, 24 0, 83 2. 46 53 4, 39 3. 74 $3 2. 26 24 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 00 15 19 35 $1 19 ,9 37 ,3 08 .9 5 3, 18 2, 37 3. 53 $3 7. 68 80 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 25 22 0 2 19 00 17 19 35 $5 4, 13 5, 52 5. 04 2, 01 2, 20 6. 53 $2 6. 90 36 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 00 19 10 78 0 4 $8 6, 04 7, 04 6. 11 2, 70 8, 90 9. 32 $3 1. 76 45 $2 30 ,9 28 ,1 46 .7 8 7, 40 6, 25 9. 09 $3 1. 18 01 0. 79 42 10 78 0 4 19 00 20 12 94 0 10 $2 8, 73 0, 33 9. 23 97 2, 11 7. 19 $2 9. 55 44 $6 39 ,4 25 ,6 24 .5 9 20 ,3 70 ,8 25 .0 4 $3 1. 38 93 0. 79 95 12 94 0 10 19 00 25 19 35 $1 4, 01 0, 20 7. 92 47 3, 15 2. 96 $2 9. 61 03 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 00 26 10 78 0 4 $1 06 ,8 91 ,5 61 .3 7 3, 25 1, 57 8. 16 $3 2. 87 37 $2 30 ,9 28 ,1 46 .7 8 7, 40 6, 25 9. 09 $3 1. 18 01 0. 79 42 10 78 0 4 P ag e 39 Case 1:16-cv-01257-JDB Document 17-9 Filed 05/19/17 Page 2 of 3 P ro vi de r_ C B S A _A H W PR O V cb sa _ ol d # of p ro vs in c bs a_ ol d pr ov o cc m ix w ag es _o ld pr ov h ou r pr ov oc cm ix ah w _o ld cb sa _o ld o cc m ix w ag es cb sa _o ld h ou r cb sa _o ld oc cm ix a hw cb sa _o ld oc cm ix w ag e in de x cb sa _n ew # of pr ov s in cb sa _n e w 19 02 63 29 18 0 8 $1 2, 54 7, 10 9. 92 38 2, 33 7. 00 $3 2. 81 69 $3 22 ,9 97 ,1 00 .6 4 10 ,3 48 ,3 60 .6 2 $3 1. 21 24 0. 79 50 29 18 0 13 19 02 66 12 94 0 10 $6 ,1 89 ,2 89 .6 8 18 3, 35 9. 80 $3 3. 75 49 $6 39 ,4 25 ,6 24 .5 9 20 ,3 70 ,8 25 .0 4 $3 1. 38 93 0. 79 95 12 94 0 10 19 02 67 35 38 0 18 $5 ,4 96 ,0 72 .0 0 18 1, 04 6. 92 $3 0. 35 72 $1 ,2 61 ,6 23 ,3 04 .1 0 36 ,8 05 ,5 31 .5 9 $3 4. 27 81 0. 87 31 35 38 0 18 19 02 68 29 18 0 8 $3 ,8 09 ,0 72 .9 2 11 5, 17 9. 00 $3 3. 07 09 $3 22 ,9 97 ,1 00 .6 4 10 ,3 48 ,3 60 .6 2 $3 1. 21 24 0. 79 50 29 18 0 13 19 02 70 35 38 0 18 $8 ,1 36 ,0 94 .1 7 24 0, 74 7. 00 $3 3. 79 52 $1 ,2 61 ,6 23 ,3 04 .1 0 36 ,8 05 ,5 31 .5 9 $3 4. 27 81 0. 87 31 35 38 0 18 19 02 73 12 94 0 10 $3 ,0 87 ,6 56 .0 6 10 2, 07 5. 00 $3 0. 24 89 $6 39 ,4 25 ,6 24 .5 9 20 ,3 70 ,8 25 .0 4 $3 1. 38 93 0. 79 95 12 94 0 10 19 02 74 35 38 0 18 $4 5, 41 9, 46 4. 61 1, 51 5, 14 6. 00 $2 9. 97 70 $1 ,2 61 ,6 23 ,3 04 .1 0 36 ,8 05 ,5 31 .5 9 $3 4. 27 81 0. 87 31 35 38 0 18 19 02 78 43 34 0 6 $6 ,8 26 ,8 17 .8 9 26 9, 29 1. 81 $2 5. 35 10 $5 65 ,6 12 ,8 66 .4 9 17 ,1 43 ,2 27 .0 3 $3 2. 99 34 0. 84 04 43 34 0 8 19 02 97 19 35 $2 ,5 46 ,0 17 .6 9 11 4, 79 7. 00 $2 2. 17 84 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 19 26 19 02 98 10 78 0 4 $1 2, 36 9, 76 1. 84 51 2, 62 6. 55 $2 4. 13 02 $2 30 ,9 28 ,1 46 .7 8 7, 40 6, 25 9. 09 $3 1. 18 01 0. 79 42 10 78 0 4 19 03 03 19 35 $8 ,2 82 ,8 16 .3 0 27 8, 30 0. 79 $2 9. 76 21 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 25 22 0 2 19 03 04 19 35 $5 66 ,3 39 .8 4 15 ,0 43 .2 2 $3 7. 64 75 $5 98 ,1 00 ,2 77 .6 2 19 ,6 57 ,4 61 .8 1 $3 0. 42 61 0. 77 50 29 18 0 13 20 00 01 12 62 0 2 $4 2, 82 3, 42 0. 38 1, 34 7, 88 2. 44 $3 1. 77 09 $2 92 ,8 27 ,2 58 .1 3 7, 63 6, 88 2. 38 $3 8. 34 38 0. 97 67 12 62 0 2 20 00 02 20 9 $2 1, 64 5, 49 7. 06 60 3, 66 6. 00 $3 5. 85 67 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 08 38 86 0 7 $9 4, 73 5, 48 2. 00 2, 49 2, 15 9. 77 $3 8. 01 34 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 09 38 86 0 7 $3 82 ,8 72 ,5 20 .2 6 8, 62 4, 14 2. 34 $4 4. 39 54 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 18 20 9 $4 0, 25 0, 97 0. 06 1, 40 5, 35 4. 79 $2 8. 64 11 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 19 38 86 0 7 $7 0, 20 0, 80 6. 27 2, 05 3, 47 4. 95 $3 4. 18 63 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 20 38 86 0 7 $4 5, 62 2, 49 7. 39 1, 14 0, 79 8. 40 $3 9. 99 17 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 21 38 86 0 7 $5 1, 45 2, 76 5. 74 1, 47 8, 32 0. 03 $3 4. 80 49 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 24 30 34 0 2 $1 20 ,5 58 ,8 65 .5 8 3, 40 6, 07 8. 83 $3 5. 39 52 $1 87 ,9 46 ,2 04 .7 1 5, 41 7, 54 0. 41 $3 4. 69 22 0. 88 37 30 34 0 2 20 00 25 38 86 0 7 $1 4, 92 1, 66 8. 51 44 3, 96 3. 37 $3 3. 61 01 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 31 20 9 $1 7, 02 4, 50 6. 79 64 4, 99 3. 05 $2 6. 39 49 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 33 12 62 0 2 $2 50 ,0 03 ,8 37 .7 5 6, 28 8, 99 9. 94 $3 9. 75 26 $2 92 ,8 27 ,2 58 .1 3 7, 63 6, 88 2. 38 $3 8. 34 38 0. 97 67 12 62 0 2 20 00 34 30 34 0 2 $6 7, 38 7, 33 9. 13 2, 01 1, 46 1. 58 $3 3. 50 17 $1 87 ,9 46 ,2 04 .7 1 5, 41 7, 54 0. 41 $3 4. 69 22 0. 88 37 30 34 0 2 20 00 37 20 9 $3 8, 22 7, 02 0. 09 1, 14 1, 11 5. 60 $3 3. 49 97 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 39 20 9 $1 72 ,2 67 ,0 33 .1 6 4, 79 6, 94 8. 54 $3 5. 91 18 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 40 38 86 0 7 $3 3, 93 1, 23 1. 34 1, 05 1, 25 8. 43 $3 2. 27 68 $6 93 ,7 36 ,9 71 .5 1 17 ,2 84 ,1 17 .2 9 $4 0. 13 73 1. 02 24 38 86 0 7 20 00 41 20 9 $3 0, 05 0, 30 0. 52 88 4, 19 9. 68 $3 3. 98 59 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 50 20 9 $3 8, 31 6, 32 0. 49 1, 07 3, 69 9. 86 $3 5. 68 62 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 52 20 9 $1 3, 06 6, 05 6. 84 44 8, 88 3. 69 $2 9. 10 79 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 20 00 63 20 9 $5 2, 96 0, 81 6. 78 1, 48 5, 49 0. 66 $3 5. 65 21 $4 23 ,8 08 ,5 21 .7 9 12 ,4 84 ,3 51 .8 7 $3 3. 94 72 0. 86 47 20 9 21 00 01 25 18 0 2 $1 23 ,3 38 ,1 78 .5 9 3, 32 6, 74 9. 22 $3 7. 07 47 $1 82 ,5 67 ,1 87 .0 9 5, 07 0, 96 6. 32 $3 6. 00 24 0. 91 70 25 18 0 2 P ag e 42 Case 1:16-cv-01257-JDB Document 17-9 Filed 05/19/17 Page 3 of 3 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ ) POST ACUTE MEDICAL AT HAMMOND, LLC ) d/b/a Post Acute Specialty Hospital of Hammond, ) ) Plaintiff, ) ) v. ) No. 1:16-cv-1257-JDB ) THOMAS E. PRICE, M.D., in his official capacity ) as Secretary of Health and Human Services, ) ) Defendant. ) __________________________________________) [PROPOSED] ORDER Upon consideration of the motion for summary judgment of Plaintiff Post Acute Medical at Hammond, LLC, and the cross-motion for summary judgment of Defendant Thomas E. Price, M.D., in his official capacity as Secretary of Health and Human Services, it is hereby ORDERED that: Plaintiff’s motion for summary judgment is DENIED, and Defendant’s cross-motion for summary judgment is GRANTED. Date: ___________________________ The Honorable John D. Bates United States District Judge Case 1:16-cv-01257-JDB Document 17-10 Filed 05/19/17 Page 1 of 1