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Instructions and Applications

Instructions and Applications for 2008 Appeals (for FY 2010 to FY 2012)

The following instructions and corresponding applications in the "Downloads" below are being printed and distributed before the Final Hospital IPPS Rule is issued. The Final IPPS Rule should be published in the Federal Register on or about August 1, 2008. This application reflects the Proposed Hospital IPPS Rule found in the April 30, 2008 Federal Register ( Vol. 73, No. 84). Applicants are encouraged to review the Final Hospital IPPS Rule for changes or clarifications prior to filing an application as the Board will base its decisions on the Final Hospital IPPS Rule. The Board will be unable to issue further instructions prior to the date by which hospitals must submit an application for geographic reclassification (September 2, 2008).

Update to Individual and Group Applications and Instructions:

On July 31, 2008, the  Final Hospital IPPS Rule was put on display on the CMS website. This final rule modifies the average hourly wage threshold limits as set forth in the Proposed Hospital IPPS Rule found in the April 30, 2008 Federal Register (Vol. 73, No. 84). For individual hospitals the threshold under 42 CFR Section 412.230(d)(1) is raised to 84% for rural hospitals and 86% for urban hospitals. For hospital groups applying under 42 CFR Sections 412.232 and 412.234 the threshold is increased to 86%. As noted above, applicants should review the Final Hospital IPPS Rule before preparing their application. (See CMS-1390-F, Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates at the website included below.) These final rule threshold changes were not reflected in the Individual and Group Applications. You should use the appropriate final rule threshold when completing your application rather than the threshold printed in the application.

 

Also included in the "Downloads" section are current listings of the Urban and Non-Urban (Rural) areas.

NOTE: The application forms are now in Adobe fill-able format.  You may complete the application online, but you must print it out, sign and submit the hard copy to the Board.

Downloads
Individual Application for 2010 Reclassification [PDF, 163 KB]

Individual Instructions for 2010 Reclassification [PDF, 37 KB]

Group Application for 2010 Reclassification [PDF, 112 KB]

Group Instructions for 2010 Reclassification [PDF, 32 KB]

Statewide Application for 2010 Reclassification [PDF, 45 KB]

Statewide Instructions for 2010 Reclassification [PDF, 23 KB]

Listing of Urban Areas for 2008 [PDF, 21 KB]

Listing of Non-Urban (Rural) Areas for 2008 [PDF, 10 KB]
Related Links Inside CMS
Site of Final Hospital IPPS Rule Display Copy [List]
Related Links Outside CMSExternal Linking Policy

Corrected OMB Listing of CBSAs and CSAs [PDF, 976 KB]

 

Page Last Modified: 08/01/2008 3:46:38 PM
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