CMS must issue Transmittal 22 for the 2552-96, to incorporate changes required by the Patient Protection and Affordable Care Act (ACA).  The TOPS extension for small rural hospitals, and Sole Community hospitals, through 12/31/2010 is the most significant change.  CMS is also changing the “effective date” for the use of line 29, on S-3 part I, for the Labor/Delivery Days, which need to be included in the DSH calculation, per the CMS 1498R Ruling.  FI/MAC will be able to use line 29 for FY prior to 10/1/2009 (currently line 29 can only be used for FY Begin 10/1/2009 and after).  There are also 22 new RUGs for hospital based SNFs.  These are effective for Services on or after 10/1/2010.  When we receive T.22, I will post the details.