The Secretary argues that this section does not address how it will work with the MGCRB and is thus ambiguous.
Hospitals apply to the MGCRB to be reclassified from rural to urban, or vice-versa, for wage index purposes.
1991) (noting that Secretary has statutory requirement to make MGCRB reclassifications budget neutral); 42 C.F.R.
Similar to Lawrence, Geisinger Medical Center received reclassification as a rural hospital and designation as an RRC through section 401 and further sought to reclassify to the Allentown urban area through MGCRB reclassification.
The court held that although Congress did not expressly permit hospitals to utilize reclassification through MGCRB at the same time as seeking reclassification as rural, Congress did not expressly prohibit it either.
"[W]e hold that the text of the statute unambiguously supports Lawrence's position that the MGCRB must review reclassification applications by Section 401 hospitals according to the standards applied to hospitals geographically located in a rural area." Id.
Therefore, a hospital taking advantage of reclassification to a rural area under subsection (d)(8)(E), then attempting to reclassify through the MGCRB with all of the benefits afforded to rural hospitals places the Secretary's budget neutrality in jeopardy and affects the rates of other urban hospitals that cannot take advantage of the process.
As summarized in Table 2, after MGCRB reclassifications were introduced in 1992, there is increasingly little difference in the predictive abilities of the index from either period.
The accuracy of rural labor market definition is improved by the MGCRB decisions, in that the number of identifiable rural submarkets is reduced.
Because reclassifications are generally granted for individual institutions rather than geographic areas, expanding MGCRB decisions to non-hospital providers could be administratively complex.