I can't speak to outpatient services, but hospitals report this data, and make the call. The government doesn't do it -- which is what you'd expect. It's hard and slow to make case-by-case judgment calls when you're far from the source data. Hospitals, in turn, don't spend any more time than is absolutely required making these kinds of classifications, unless someone makes them do it.

It would not surprise me at all to find that other cities/states have the same thing happening.