1. Applying budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas
“(iv) Application of budget neutrality relating to floor on wage area index in non-rural areas
“(I) Application on a State-specific basis beginning in fiscal year 2014—Subject to subclause (II), in the case of discharges occurring on or after October 1, 2013, for purposes of applying section 4410(b) of the Balanced Budget Act of 1997, the Secretary shall administer such section 4410(b) and paragraph (e) of section 412.64 of title 42, Code of Federal Regulations, as if paragraph (e)(4)(ii) of such section 412.64 had never applied and by using the methodology promulgated in the Federal Register on August 19, 2008 (73 Fed. Reg. 48570) (applied as if such methodology had been fully implemented for fiscal year 2011 using a 100 percent State-specific adjustment to the area wage index).
“(II) Construction—Nothing in subclause (I) shall be construed as preventing the Secretary, for discharges occurring on or after October 1, 2014, from modifying the regulations under such section 412.64 in carrying out the budget neutrality requirements of such section 4410(b).”