42 CFR §412.212

1. (a)General rule. For purposes of payment to hospitals located in Puerto Rico, the national prospective payment rate for inpatient operating costs is determined as described in paragraphs (b) through (d) of this section.
2. (b)Computing Puerto Rico standardized amounts.
   1. (1)For Federal fiscal years before FY 2004, CMS computes a discharge-weighted average of the—
      1. (i)National urban adjusted standardized amount determined under § 412.63(j)(1); and
      2. (ii)National rural adjusted average standardized amount determined under § 412.63(j)(2)(i).
   2. (2)For fiscal years 2004 and subsequent fiscal years, CMS computes a discharge-weighted average of the national adjusted standardized amount determined under § 412.64(e).
3. (c)Computing a national rate. For each discharge classified within a DRG, the national rate equals the product of—
   1. (1)The national average standardized amount computed under paragraph (b) of this section; and
   2. (2)The weighting factor (determined under § 412.60(b)) for that DRG.
4. (d)Adjusting for different area wage levels. CMS adjusts the proportion (as estimated by CMS from time to time) of the national rate computed under paragraph (c) of this section that is attributable to wages and labor-related costs for area differences in hospital wage levels by a factor (established by CMS) reflecting the relative hospital wage level in the geographic area of the hospital compared to the national average hospital wage level.