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However, given that the Courts have repeatedly held unlawful CMS policies that do not treat 412.103 hospitals the same as geographically rural hospitals based on section 1886(d)(8)(E)(i) of the Act, the ongoing risk of the pending lawsuits cited previously, and the recognition of the challenge should we need to implement any future remedy in a budget neutral manner, we determined that it was necessary to propose to include hospitals with 412.103 reclassification along with geographically rural hospitals in all rural wage index calculations, and to exclude dual reclass hospitals (hospitals with simultaneous 412.103 and MGCRB reclassifications) implicated by the hold harmless provision at section 1886(d)(8)(C)(ii) of the Act, with the resulting changes to the rural floor and the calculation of the wage index for rural areas in the State in which the county is located as referred to in section 1886(d)(8)(C)(iii) of the Act

doi: 10.2174/1573399810666140606111745 51 DateK