[Federal Register Volume 66, Number 188 (Thursday, September 27, 2001)]
[Notices]
[Pages 49454-49475]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-23820]
[[Page 49453]]
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Part II
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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Medicare Program; Hospice Wage Index Fiscal Year 2002; Notice
Federal Register / Vol. 66, No. 188 / Thursday, September 27, 2001 /
Notices
[[Page 49454]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1175-N]
RIN 0938-ZA08
Medicare Program; Hospice Wage Index Fiscal Year 2002
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice announces the annual update to the hospice wage
index as required by statute. This update is effective October 1, 2001
through September 30, 2002. The wage index is used to reflect local
differences in wage levels. The hospice wage index methodology and
values are based on recommendations of a negotiated rulemaking advisory
committee and were originally published in the Federal Register on
August 8, 1997.
EFFECTIVE DATE: October 1, 2001.
FOR FURTHER INFORMATION CONTACT:
Lynn Riley, (410) 786-1286
Carol Blackford, (410) 786-5909
SUPPLEMENTARY INFORMATION
I. Background
A. Statute and Regulations
Hospice Care is an approach to treatment that recognizes that the
impending death of an individual warrants a change in the focus from
curative care to palliative care (relief of pain and other
uncomfortable symptoms). The goal of hospice care is to help terminally
ill individuals continue life with minimal disruption to normal
activities while remaining primarily in the home environment. A hospice
uses an interdisciplinary approach to deliver medical, social,
psychological, emotional, and spiritual services through use of a broad
spectrum of professional and other caregivers, with the goal of making
the individual as physically and emotionally comfortable as possible.
Counseling and inpatient respite services are available to the family
of the hospice patient. Hospice programs consider both the patient and
the family as a unit of care.
Section 1861(dd) of the Social Security Act (the Act) provides for
coverage of hospice care for terminally ill Medicare beneficiaries who
elect to receive care from a participating hospice. The statutory
authority for payment to hospices participating in the Medicare program
is contained in section 1814(i) of the Act.
Our existing regulations under 42 CFR Part 418 establish
eligibility requirements and payment standards and procedures, define
covered services, and delineate the conditions a hospice must meet to
be approved for participation in the Medicare program. Subpart G of
Part 418 provides for payment to hospices based on one of four
prospectively determined rates for each day in which a qualified
Medicare beneficiary is under the care of a hospice. The four rate
categories are routine home care, continuous home care, inpatient
respite care, and general inpatient care. Payment rates are established
for each category.
The regulations at Sec. 418.306(c), which require the rates to be
adjusted by a wage index, were revised in the August 8, 1997 final rule
published in the Federal Register (62 FR 42860). This rule implemented
a new methodology for calculating the hospice wage index based on the
recommendations of a negotiated rulemaking committee. The committee
reached consensus on the methodology. We included the resulting
committee statement, describing that consensus, as an appendix to the
August 8, 1997 final rule (62 FR 42883). The provisions of the final
hospice wage index rule are as follows:
The revised hospice wage index will be calculated using
the most current available hospital wage data.
The revised hospice wage index was phased in over a 3-year
transition period. For the first year of the transition period, October
1, 1997 through September 30, 1998, a blended index was calculated by
adding two-thirds of the 1983 index value for an area to one-third of
the revised wage index value for that area. During the second year of
the transition period, October 1, 1998 through September 30, 1999, the
calculation was similar, except that the blend was one-third of the
1983 index value and two-thirds of the revised wage index value for
that area. We fully implemented the revised wage index during the third
transition period, October 1, 1999 throughSeptember 30, 2000.
All hospice wage index values of 0.8 or greater are
subject to a budget-neutrality adjustment to ensure that we do not pay
more in the aggregate than we would have paid under the original 1983
wage index. The budget-neutrality adjustment is calculated by
multiplying the hospice wage index for a given area by the budget-
neutrality adjustment factor. The budget-neutrality adjustment is to be
applied annually, both during and after the transition period.
All hospice wage index values below 0.8 receive the
greater of the following adjustments: the wage index floor, a 15
percent increase, subject to a maximum wage index value of 0.8; or, the
budget-neutrality adjustment.
The wage index is to be updated annually, in the Federal
Register, based on the most current available hospital wage data. These
data will include any changes to the definitions of Metropolitan
Statistical Areas (MSA).
Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended
section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice
rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to
be updated by a factor equal to the market basket index, minus 1
percentage point. However, section 131(a) of the Balanced Budget
Refinement Act of 1999 (BBRA) changed the payment rates for FYs 2001
and 2002 by increasing the FY 2001 rate by 0.5 percent and the FY 2002
rate by 0.75 percent. Section 131(b) of the BBRA states that any
additional payments made under section 131(a) of the BBRA shall not be
included in updating the hospice rates after those 2 years.
Section 321(a) of the Medicare, Medicaid and State Child Health
Insurance Program (SCHIP) Benefits Improvement and Protection Act
(BIPA) amended section 814(i)(1)(C)(ii)(VI) of the Act by increasing
Medicare hospice rates for FY 2001 by 5 percentage points. This
amendment was applicable to hospice care furnished on or after April 1,
2001. Section 321(b) of BIPA further stipulated that the 5 percent
increase in Medicare hospice rates during the period beginning on April
1, 2001 through September 30, 2001 will be treated as the payment rates
in effect during the FY 2001. This means that the 5 percent increase
was made to the base that is updated annually according to a
statutorily dictated percentage of the market basket update, as
provided in section 1814(i) of the Act. The new Medicare rates for this
time period were announced through HCFA Program Memorandum A-01-04 on
January 16, 2001.
Also, section 321(d) of BIPA specified that the Secretary of Health
and Human Services use 1.0043 as the hospice wage index value for the
Wichita, Kansas MSA in calculating payments for a hospice program
providing hospice care in this MSA during FY 2000. CMS's Regional Home
Health Intermediaries were instructed, through HCFA Program Memorandum
A-01-07, to re-calculate the payment for Medicare hospice services
provided during FY 2000 by Medicare hospice providers in the Wichita,
Kansas MSA using the new wage index value of 1.0043, and to disburse a
lump sum payment reflecting
[[Page 49455]]
the difference in the two values that fiscal year.
B. Update to the Hospice Wage Index
This annual update is effective October 1, 2001 through September
30, 2002. In accordance with the agreement signed by the Centers for
Medicaid & Medicare Services (CMS) and all other members of the Hospice
Wage Index Negotiated Rulemaking Committee, we are using the most
current CMS hospital data available, including any changes to the
definitions of MSAs. The FY 2001 hospital wage index was the most
current hospital wage data available when the FY 2002 wage index values
were calculated. We used the pre-reclassified and pre-floor hospital
area wage index data.
All wage index values are adjusted by a budget-neutrality factor of
1.064726 and are subject to the wage index floor adjustment, if
applicable. We have completed all of the calculations described above
and included them in the wage index values reflected in both Tables A
and B below. A detailed description of the method used to compute the
hospice wage index is contained in both the September 4, 1996 proposed
rule published in the Federal Register (61 FR 46579) and the August 8,
1997 final rule published in the Federal Register (62 FR 42860).
1. Metropolitan Statistical Areas
As explained in the September 4, 1996 hospice wage index proposed
rule, each hospice's labor market area would be established by the MSA
definitions issued by the Office of Management and Budget (OMB) on
December 28, 1992 based on the 1990 census, and updated periodically by
OMB. Any changes to the MSA definitions would be effective annually and
announced in the final rule updating the hospice wage index.
2. MSA Wage Index Values Lower than Rural Values
As explained above, any area not included in an MSA is considered
to be nonurban and receives the statewide rural rate. We are aware that
in the past, a number of MSAs have had wage index values that were
lower than their rural statewide value. This difference is due to
variations in local wage data as compared to national wage data. The
hospice wage index is computed by dividing the hourly wage rate for an
MSA or nonurban area by a national hourly wage rate. Nonurban areas
could receive a higher wage index value than urban areas in the same
State if the hourly wage rate in the nonurban area increased at a
greater rate.
C. Tables
Table A.--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
Urban area (constituent
MSA Code No. counties or county Wage index \2\
equivalents) \1\
------------------------------------------------------------------------
0040..................... Abilene, TX.................. 0.8773
Taylor, TX
0060..................... Aguadilla, PR................ 0.5050
Aguada, PR
Aguadilla, PR
Moca, PR
0080..................... Akron, OH.................... 1.0366
Portage, OH
Summit, OH
0120..................... Albany, GA................... 1.0576
Dougherty, GA
Lee, GA
0160..................... Albany-Schenectady-Troy, NY.. 0.9102
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200..................... Albuquerque, NM.............. 0.9727
Bernalillo, NM
Sandoval, NM
Valencia, NM
0220..................... Alexandria, LA............... 0.8649
Rapides, LA
0240..................... Allentown-Bethlehem-Easton, 1.0567
PA.
Carbon, PA
Lehigh, PA
Northampton, PA
0280..................... Altoona, PA.................. 0.9951
Blair, PA
0320..................... Amarillo, TX................. 0.9279
Potter, TX
Randall, TX
0380..................... Anchorage, AK................ 1.3621
Anchorage, AK
0440..................... Ann Arbor, MI................ 1.1982
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450..................... Anniston, AL................. 0.8820
Calhoun, AL
0460..................... Appleton-Oshkosh-Neenah, WI.. 0.9638
Calumet, WI
[[Page 49456]]
Outagamie, WI
Winnebago, WI
0470..................... Arecibo, PR.................. 0.8518
Arecibo, PR
Camuy, PR
Hatillo, PR
0480..................... Asheville, NC................ 1.0132
Buncombe, NC
Madison, NC
0500..................... Athens, GA................... 1.0369
Clarke, GA
Madison, GA
Oconee, GA
0520..................... Atlanta, GA.................. 1.0749
Barrow, GA
Bartow, GA
Carroll, GA
Cherokee, GA
Clayton, GA
Cobb, GA
Coweta, GA
DeKalb, GA
Douglas, GA
Fayette, GA
Forsyth, GA
Fulton, GA
Gwinnett, GA
Henry, GA
Newton, GA
Paulding, GA
Pickens, GA
Rockdale, GA
Spalding, GA
Walton, GA
0560..................... Atlantic-Cape May, NJ........ 1.1906
Atlantic, NJ
Cape May, NJ
0580..................... Aubrn-Opelika, AL............ 0.8631
Lee, AL
0600..................... Augusta-Aiken, GA-SC......... 0.9753
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640..................... Austin-San Marcos, TX........ 1.0197
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX
Williamson, TX
0680..................... Bakersfield, CA.............. 1.0304
Kern, CA
0720..................... Baltimore, MD................ 0.9971
Anne Arundel, MD
Baltimore, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Anne's, MD
0733..................... Bangor, ME................... 1.0180
Penobscot, ME
0743..................... Barnstable-Yarmouth, MA...... 1.4735
Barnstable, MA
0760..................... Baton Rouge, LA.............. 0.9414
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840..................... Beaumont-Port Arthur, TX..... 0.9310
[[Page 49457]]
Hardin, TX
Jefferson, TX
Orange, TX
0860..................... Bellingham, WA............... 1.2179
Whatcom, WA
0870..................... Benton Harbor, MI............ 0.9232
Berrien, MI
0875..................... Bergen-Passaic, NJ........... 1.2615
Bergen, NJ
Passaic, NJ
0880..................... Billings, MT................. 1.0205
Yellowstone, MT
0920..................... Biloxi-Gulfport-Pascagoula, 0.8769
MS.
Hancock, MS
Harrison, MS
Jackson, MS
0960..................... Binghamton, NY............... 0.9252
Broome, NY
Tioga, NY
1000..................... Birmingham, AL............... 0.8999
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010..................... Bismarck, ND................. 0.8204
Burleigh, ND
Morton, ND
1020..................... Bloomington, IN.............. 0.9298
Monroe, IN
1040..................... Bloomington-Normal, IL....... 0.9684
McLean, IL
1080..................... Boise City, ID............... 0.9589
Ada, ID
Canyon, ID
1123..................... Boston-Worcester-Lawrence- 1.1882
Lowell-Brockton, MA-NH.
Bristol, MA
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
Worcester, MA
Hillsborough, NH
Merrimack, NH
Rockingham, NH
Strafford, NH
1125..................... Boulder-Longmont, CO......... 1.0361
Boulder, CO
1145..................... Brazoria, TX................. 0.9218
Brazoria, TX
1150..................... Bremerton, WA................ 1.1685
Kitsap, WA
1240..................... Brownsville-Harlingen-San 0.9287
Benito, TX.
Cameron, TX
1260..................... Bryan-College Station, TX.... 0.8770
Brazos, TX
1280..................... Buffalo-Niagara Falls, NY.... 1.0200
Erie, NY
Niagara, NY
1303..................... Burlington, VT............... 1.1430
Chittenden, VT
Franklin, VT
Grand Isle, VT
1310..................... Caguas, PR................... 0.5246
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320..................... Canton-Massillon, OH......... 0.9140
Carroll, OH
[[Page 49458]]
Stark, OH
1350..................... Casper, WY................... 0.9289
Natrona, WY
1360..................... Cedar Rapids, IA............. 0.9301
Linn, IA
1400..................... Champaign-Urbana, IL......... 0.9793
Champaign, IL
1440..................... Charleston-North Charleston, 0.9623
SC.
Berkeley, SC
Charleston, SC
Dorchester, SC
1480..................... Charleston, WV............... 0.9838
Kanawha, WV
Putnam, WV
1520..................... Charlotte-Gastonia-Rock Hill, 0.9999
NC-SC.
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Stanly, NC
Union, NC
York, SC
1540..................... Charlottesville, VA.......... 1.1487
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560..................... Chattanooga, TN-GA........... 1.0469
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580..................... Cheyenne, WY................. 0.8846
Laramie, WY
1600..................... Chicago, IL.................. 1.1867
Cook, IL
DeKalb, IL
Du Page, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620..................... Chico-Paradise, CA........... 1.0560
Butte, CA
1640..................... Cincinnati, OH-KY-IN......... 1.0024
Brown, OH
Clermont, OH
Hamilton, OH
Warren, OH
Boone, KY
Campbell, KY
Gallatin, KY
Grant, KY
Kenton, KY
Pendleton, KY
Dearborn, IN
Ohio, IN
1660..................... Clarksville-Hopkinsville, TN- 0.8735
KY.
Christian, KY
Montgomery, TN
1680..................... Cleveland-Lorain-Elyria, OH.. 1.0218
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
Lake, OH
Lorain, OH
Medina, OH
[[Page 49459]]
1720..................... Colorado Springs, CO......... 1.0325
El Paso, CO
1740..................... Columbia, MO................. 0.9541
Boone, MO
1760..................... Columbia, SC................. 1.0172
Lexington, SC
Richland, SC
1800..................... Columbus, GA-AL.............. 0.9123
Chattahochee, GA
Harris, GA
Muscogee, GA
Russell, AL
1840..................... Columbus, OH................. 1.0242
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880..................... Corpus Christi, TX........... 0.9291
Nueces, TX
San Patricio, TX
1890..................... Corvallis, Oregon............ 1.2059
Benton, OR
1900..................... Cumberland, MD-WV............ 0.8911
Allegany, MD
Mineral, WV
1920..................... Dallas, TX................... 1.0555
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950..................... Danville, VA................. 0.9145
Danville City, VA
Pittsylvania, VA
1960..................... Davenport-Moline-Rock Island, 0.9474
IA-IL.
Scott, IA
Henry, IL
Rock Island, IL
2000..................... Dayton-Springfield, OH....... 1.0053
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020..................... Daytona Beach, FL............ 0.9795
Flagler, FL
Volusia, FL
2030..................... Decatur, AL.................. 0.9086
Lawrence, AL
Morgan, AL
2040..................... Decatur, IL.................. 0.8651
Macon, IL
2080..................... Denver, CO................... 1.0840
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120..................... Des Moines, IA............... 0.9708
Dallas, IA
Polk, IA
Warren, IA
2160..................... Detroit, MI.................. 1.1190
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
[[Page 49460]]
St. Clair, MI
Wayne, MI
2180..................... Dothan, AL................... 0.8457
Dale, AL
Houston, AL
2190..................... Dover, DE.................... 1.0730
Kent, DE
2200..................... Dubuque, IA.................. 0.9312
Dubuque, IA
2240..................... Duluth-Superior, MN-WI....... 1.0681
St. Louis, MN
Douglas, WI
2281..................... Dutchess County, NY.......... 1.0912
Dutchess, NY
2290..................... Eau Claire, WI............... 0.9359
Chippewa, WI
Eau Claire, WI
2320..................... El Paso, TX.................. 0.9951
El Paso, TX
2330..................... Elkhart-Goshen, IN........... 0.9737
Elkhart, IN
2335..................... Elmira, NY................... 0.9099
Chemung, NY
2340..................... Enid, OK..................... 0.9167
Garfield, OK
2360..................... Erie, PA..................... 0.9567
Erie, PA
2400..................... Eugene-Springfield, OR....... 1.1675
Lane, OR
2440..................... Evansville-Henderson, IN-KY.. 0.8702
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520..................... Fargo-Moorhead, ND-MN........ 0.9315
Clay, MN
Cass, ND
2560..................... Fayetteville, NC............. 0.9215
Cumberland, NC
2580..................... Fayetteville-Springdale- 0.8422
Rogers, AR.
Benton, AR
Washington, AR
2620..................... Flagstaff, AZ-UT............. 1.1378
Coconino, AZ
Kane, UT
2640..................... Flint, MI.................... 1.1930
Genesee, MI
2650..................... Florence, AL................. 0.8109
Colbert, AL
Lauderdale, AL
2655..................... Florence, SC................. 0.9345
Florence, SC
2670..................... Fort Collins-Loveland, CO.... 1.1336
Larimer, CO
2680..................... Ft. Lauderdale, FL........... 1.0776
Broward, FL
2700..................... Fort Myers-Cape Coral, FL.... 0.9846
Lee, FL
2710..................... Fort Pierce-Port St. Lucie, 1.0155
FL.
Martin, FL
St. Lucie, FL
2720..................... Fort Smith, AR-OK............ 0.8573
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750..................... Fort Walton Beach, FL........ 1.0229
Okaloosa, FL
2760..................... Fort Wayne, IN............... 0.9226
Adams, IN
Allen, IN
De Kalb, IN
[[Page 49461]]
Huntington, IN
Wells, IN
Whitley, IN
2800..................... Forth Worth-Arlington, TX.... 1.0144
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840..................... Fresno, CA................... 1.0758
Fresno, CA
Madera, CA
2880..................... Gadsden, AL.................. 0.8968
Etowah, AL
2900..................... Gainesville, FL.............. 1.0726
Alachua, FL
2920..................... Galveston-Texas City, TX..... 1.0560
Galveston, TX
2960..................... Gary, IN..................... 1.0066
Lake, IN
Porter, IN
2975..................... Glens Falls, NY.............. 0.8902
Warren, NY
Washington, NY
2980..................... Goldsboro, NC................ 0.8968
Wayne, NC
2985..................... Grand Forks, ND-MN........... 0.9387
Grand Forks, ND
Polk, MN
2995..................... Grand Junction, CO........... 0.9699
Mesa, CO
3000..................... Grand Rapids-Muskegon- 1.0911
Holland, MI.
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040..................... Great Falls, MT.............. 0.9652
Cascade, MT
3060..................... Greeley, CO.................. 1.0449
Weld, CO
3080..................... Green Bay, WI................ 0.9822
Brown, WI
3120..................... Greensboro-Winston-Salem-High 0.9722
Point, NC.
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
3150..................... Greenville, NC............... 0.9991
Pitt, NC
3160..................... Greenville-Spartanburg- 0.9586
Anderson, SC.
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180..................... Hagerstown, MD............... 1.0018
Washington, MD
3200..................... Hamilton-Middletown, OH...... 0.9648
Butler, OH
3240..................... Harrisburg-Lebanon-Carlisle, 0.9994
PA.
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283..................... Hartford, CT................. 1.2109
Hartford, CT
Litchfield, CT
Middlesex, CT
[[Page 49462]]
Tolland, CT
3285..................... Hattiesburg, MS.............. 0.8000
Forrest, MS
Lamar, MS
3290..................... Hickory-Morganton-Lenoir, NC. 0.9591
Alexander, NC
Burke, NC
Caldwell, NC
Catawba, NC
3320..................... Honolulu, HI................. 1.2631
Honolulu, HI
3350..................... Houma, LA.................... 0.8609
Lafourche, LA
Terrebonne, LA
3360..................... Houston, TX.................. 1.0362
Chambers, TX
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
3400..................... Huntington-Ashland, WV-KY-OH. 1.0515
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440..................... Huntsville, AL............... 0.9510
Limestone, AL
Madison, AL
3480..................... Indianapolis, IN............. 1.0420
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500..................... Iowa City, IA................ 1.0282
Johnson, IA
3520..................... Jackson, MI.................. 0.9725
Jackson, MI
3560..................... Jackson, MS.................. 0.9382
Hinds, MS
Madison, MS
Rankin, MS
3580..................... Jackson, TN.................. 0.9365
Madison, TN
Chester, TN
3600..................... Jacksonville, FL............. 0.9804
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605..................... Jacksonville, NC............. 0.8280
Onslow, NC
3610..................... Jamestown, NY................ 0.8324
Chautauqua, NY
3620..................... Janesville-Beloit, WI........ 1.0205
Rock, WI
3640..................... Jersey City, NJ.............. 1.2246
Hudson, NJ
3660..................... Johnson City-Kingsport- 0.8807
Bristol, TN-VA.
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
[[Page 49463]]
Bristol City, VA
Scott, VA
Washington, VA
3680..................... Johnstown, PA................ 0.9419
Cambria, PA
Somerset, PA
3700..................... Jonesboro, AR................ 0.8339
Craighead, AR
3710..................... Joplin, MO................... 0.8675
Jasper, MO
Newton, MO
3720..................... Kalamazoo-Battlecreek, MI.... 1.1130
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740..................... Kankakee, IL................. 1.05423
Kankakee, IL
3760..................... Kansas City, KS-MO........... 1.0144
Johnson, KS
Leavenworth, KS
Miami, KS
Wyandotte, KS
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
LaFayette, MO
Platte, MO
Ray, MO
3800..................... Kenosha, WI.................. 1.0233
Kenosha, WI
3810..................... Kileen-Temple, TX............ 1.0774
Bell, TX
Coryell, TX
3840..................... Knoxville, TN................ 0.8880
Anderson, TN
Blount, TN
Loudon, TN
Sevier, TN
Union, TN
3850..................... Kokomo, IN................... 1.0134
Howard, IN
Tipton, IN
3870..................... La Crosse, WI-MN............. 0.9807
Houston, MN
La Crosse, WI
3880..................... Lafayette, LA................ 0.9040
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920..................... Lafayette, IN................ 0.9406
Clinton, IN
Tippecanoe, IN
3960..................... Lake Charles, LA............. 0.8000
Calcasieu, LA
3980..................... Lakeland-Winter Haven, FL.... 0.9837
Polk, FL
4000..................... Lancater, PA................. 0.9858
Lancaster, PA
4040..................... Lansing-East Lansing, MI..... 1.0577
Clinton, MI
Eaton, MI
Ingham, MI
4080..................... Laredo, TX................... 0.8697
Webb, TX
4100..................... Las Cruces, NM............... 0.9218
Dona Ana, NM
4120..................... Las Vegas, NV-AZ............. 1.1495
Mohave, AZ
Clarke, NV
[[Page 49464]]
Nye, NV
4150..................... Lawrence, KS................. 0.8720
Douglas, KS
4200..................... Lawton, OK 0.9578
Comanche, OK
4243..................... Lewiston-Auburn, ME.......... 0.9621
Androscoggin, ME
4280..................... Lexington, KY................ 0.9440
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320..................... Lima, OH..................... 0.9923
Allen, OH
Auglaize, OH
4360..................... Lincoln, NE.................. 1.0249
Lancaster, NE
4400..................... Little Rock-North Little 0.9482
Rock, AR.
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420..................... Longview-Marshall, TX....... 0.9499
Gregg, TX
Harrison, TX
Upshur, TX
4480..................... Los Angeles-Long Beach, CA... 1.2772
Los Angeles, CA
4520..................... Louisville, KY-IN............ 0.9955
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600..................... Lubbock, TX.................. 0.9410
Lubbock, TX
4640..................... Lynchburg, VA................ 0.9441
Amherst, VA
Bedford, VA
Bedford City, VA
Campbell, VA
Lynchburg City, VA
4680..................... Macon, GA.................... 0.9555
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720..................... Madison, WI.................. 1.0936
Dane, WI
4800..................... Mansfield, OH................ 0.9252
Crawford, OH
Richland, OH
4840..................... Mayaguez, PR................. 0.5277
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880..................... McAllen-Edinburg-Mission, TX. 0.9120
Hidalgo, TX
4890..................... Medford-Ashland, OR.......... 1.1014
Jackson, OR
4900..................... Melbourne-Titusville-Palm 1.0315
Bay, FL.
Brevard, FL
[[Page 49465]]
4920..................... Memphis, TN-AR-MS............ 0.9288
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940..................... Merced, CA................... 1.0270
Merced, CA
5000..................... Miami, FL.................... 1.0710
Dade, FL
5015..................... Middlesex-Somerset-Hunterdon, 1.1792
NJ.
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080..................... Milwaukee-Waukesha, WI....... 1.0399
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120..................... Minneapolis-St. Paul, MN-WI.. 1.1730
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherbune, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5140..................... Missoula, MT................. 0.9874
Missoula, MT
5160..................... Mobile, AL................... 0.8691
Baldwin, AL
Mobile, AL
5170..................... Modesto, CA.................. 1.1069
Stanislaus, CA
5190..................... Monmouth-Ocean, NJ........... 1.2008
Monmouth, NJ
Ocean, NJ
5200..................... Monroe, LA................... 0.8939
Ouachita, LA
5240..................... Montgomery, AL............... 0.8148
Autauga, AL
Elmore, AL
Montgomery, AL
5280..................... Muncie, IN................... 1.1679
Delaware, IN
5330..................... Myrtle Beach, SC............. 0.8986
Horry, SC
5345..................... Naples, FL................... 1.0286
Collier, FL
5360..................... Nashville, TN................ 1.0104
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380..................... Nassau-Suffolk, NY........... 1.4834
Nassau, NY
Suffolk, NY
5483..................... New Haven-Bridgeport-Stamford- 1.3093
Waterbury-Danbury, CT.
Fairfield, CT
New Haven, CT
5523..................... New London-Norwich, CT....... 1.2844
[[Page 49466]]
New London, CT
5560..................... New Orleans, LA.............. 0.9897
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600..................... New York, NY................. 1.5599
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640..................... Newark, NJ................... 1.2603
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660..................... Newburgh, NY-PA.............. 1.1549
Orange, NY
Pike, PA
5720..................... Norfolk-Virginia Beach- 0.8956
Newport News, VA-NC.
Currituck, NC
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
James City, VA
Isle of Wight, VA
Mathews, VA
Newport News City, VA
Norfolk City, VA
Poquoson City, VA
Portsmouth City, VA
Suffolk City, VA
Virginia Beach City, VA
Williamsburg City, VA
York, VA
5775..................... Oakland, CA.................. 1.5953
Alameda, CA
Contra Costa, CA
5790..................... Ocala, FL.................... 0.9841
Marion, FL
5800..................... Odessa-Midland, TX........... 0.9801
Ector, TX
Midland, TX
5880..................... Oklahoma City, OK............ 0.9393
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910..................... Olympia, WA.................. 1.1368
Thurston, WA
5920..................... Omaha, NE-IA................. 1.0192
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945..................... Orange County, CA............ 1.2209
Orange, CA
5960..................... Orlando, FL.................. 1.0232
Lake, FL
[[Page 49467]]
Orange, FL
Osceola, FL
Seminole, FL
5990..................... Owensboro, KY................ 0.8687
Daviess, KY
6015..................... Panama City, FL.............. 0.9593
Bay, FL
6020..................... Parkersburg-Marietta, WV-OH.. 0.8810
Washington, OH
Wood, WV
6080..................... Pensacola, FL................ 0.8705
Escambia, FL
Santa Rosa, FL
6120..................... Peoria-Pekin, IL............. 0.9205
Peoria, IL
Tazewell, IL
Woodford, IL
6160..................... Philadelphia, PA-NJ.......... 1.1645
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200..................... Phoenix-Mesa, AZ............. 1.0295
Maricopa, AZ
Pinal, AZ
6240..................... Pine Bluff, AR............... 0.8295
Jefferson, AR
6280..................... Pittsburgh, PA............... 1.0371
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323..................... Pittsfield, MA............... 1.0954
Berkshire, MA
6340..................... Pocatello, ID................ 0.9663
Bannock, ID
6360..................... Ponce, PR.................... 0.5757
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403..................... Portland, ME................. 1.0379
Cumberland, ME
Sagadahoc, ME
York, ME
6440..................... Portland-Vancouver, OR-WA.... 1.1616
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483..................... Providence-Warwick-Pawtucket, 1.1567
RI.
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520..................... Provo-Orem, UT............... 1.0678
Utah, UT
6560..................... Pueblo, CO................... 0.9386
Pueblo, CO
[[Page 49468]]
6580..................... Punta Gorda, FL.............. 1.0235
Charlotte, FL
6600..................... Racine, WI................... 0.9845
6640..................... Raleigh-Durham-Chapel Hill, 1.0270
NC.
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660..................... Rapid City, SD............... 0.9439
Pennington, SD
6680..................... Reading, PA.................. 0.9744
Berks, PA
6690..................... Redding, CA.................. 1.2419
Shasta, CA
6720..................... Reno, NV..................... 1.1233
Washoe, NV
6740..................... Richland-Kennewick-Pasco, WA. 1.2202
Benton, WA
Franklin, WA
6760..................... Richmond-Petersburg, VA...... 1.0239
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780..................... Riverside-San Bernardino, CA. 1.1966
Riverside, CA
San Bernardino, CA
6800..................... Roanoke, VA.................. 0.9316
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820..................... Rochester, MN................ 1.2047
Olmsted, MN
6840..................... Rochester, NY................ 0.9776
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
6880..................... Rockford, IL................. 0.9390
Boone, IL
Ogle, IL
Winnebago, IL
6895..................... Rocky Mount, NC.............. 0.9422
Edgecombe, NC
Nash, NC
6920..................... Sacramento, CA............... 1.2723
El Dorado, CA
Placer, CA
Sacramento, CA
6960..................... Saginaw-Bay City-Midland, MI. 1.0195
Bay, MI
Midland, MI
Saginaw, MI
6980..................... St. Cloud, MN................ 1.0664
Benton, MN
Stearns, MN
7000..................... St. Joseph, MO............... 0.9658
[[Page 49469]]
Andrew, MO
Buchanan, MO
7040..................... St. Louis, MO-IL............. 0.9635
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
Clinton, IL
Jersey, IL
Madison, IL
Monroe, IL
St. Clair, IL
7080..................... Salem, OR.................... 1.0848
Marion, OR
Polk, OR
7120..................... Salinas, CA.................. 1.5441
Monterey, CA
7160..................... Salt Lake City-Ogden, UT..... 1.0442
Davis, UT
Salt Lake, UT
Weber, UT
7200..................... San Angelo, TX............... 0.8606
Tom Green, TX
7240..................... San Antonio, TX.............. 0.9135
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320..................... San Diego, CA................ 1.2547
San Diego, CA
7360..................... San Francisco, CA............ 1.5072
Marin, CA
San Francisco, CA
San Mateo, CA
7400..................... San Jose, CA................. 1.4536
Santa Clara, CA
7440..................... San Juan-Bayamon, PR......... 0.5394
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR..................
7460..................... San Luis Obispo-Atascadero- 1.1364
Paso Robles, CA.
[[Page 49470]]
San Luis Obispo, CA
7480..................... Santa Barbara-Santa Maria- 1.1283
Lompoc, CA.
Santa Barbara, CA
7485..................... Santa Cruz-Watsonville, CA... 1.4949
Santa Cruz, CA
7490..................... Santa Fe, NM................. 1.1219
Los Alamos, NM
Santa Fe, NM
7500..................... Santa Rosa, CA............... 1.3465
Sonoma, CA
7510..................... Sarasota-Bradenton, FL....... 1.0444
Manatee, FL
Sarasota, FL
7520..................... Savannah, GA................. 1.0325
Bryan, GA
Chatham, GA
Effingham, GA
7560..................... Scranton-Wilkes-Barre- 0.8966
Hazleton, PA.
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600..................... Seattle-Bellevue-Everett, WA. 1.1708
Island, WA
King, WA
Snohomish, WA
7610..................... Sharon, PA................... 0.8441
Mercer, PA
7620..................... Sheboygan, WI................ 0.8921
Sheboygan, WI
7640..................... Sherman-Denison, TX.......... 0.9257
Grayson, TX
7680..................... Shreveport-Bossier City, LA.. 0.9316
Bossier, LA
Caddo, LA
Webster, LA
7720..................... Sioux City, IA-NE............ 0.9021
Woodbury, IA
Dakota, NE
7760..................... Sioux Falls, SD.............. 0.9359
Lincoln, SD
Minnehaha, SD
7800..................... South Bend, IN............... 1.0647
St. Joseph, IN
7840..................... Spokane, WA.................. 1.1193
Spokane, WA
7880..................... Springfield, IL.............. 0.9247
Menard, IL
Sangamon, IL
7920..................... Springfield, MO.............. 0.9037
Christian, MO
Greene, MO
Webster, MO
8003..................... Springfield, MA.............. 1.1325
Hampden, MA
Hampshire, MA
8050..................... State College, PA............ 0.9623
Centre, PA
8080..................... Steubenville-Weirton, OH-WV.. 0.9101
Jefferson, OH
Brooke, WV
Hancock, WV
8120..................... Stockton-Lodi, CA............ 1.1317
San Joaquin, CA
8140..................... Sumter, SC................... 0.8806
Sumter, SC
8160..................... Syracuse, NY................. 1.0167
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
[[Page 49471]]
8200..................... Tacoma, WA................... 1.2312
Pierce, WA
8240..................... Tallahassee, FL.............. 0.9098
Gadsden, FL
Leon, FL
8280..................... Tampa-St. Petersburg- 0.9563
Clearwater, FL.
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320..................... Terre Haute, IN.............. 0.8841
Clay, IN
Vermillion, IN
Vigo, IN
8360..................... Texarkana, AR-Texarkana, TX.. 0.8904
Miller, AR
Bowie, TX
8400..................... Toledo, OH................... 1.0468
Fulton, OH
Lucas, OH
Wood, OH
8440..................... Topeka, KS................... 0.9707
Shawnee, KS
8480..................... Trenton, NJ.................. 1.0793
Mercer, NJ
8520..................... Tucson, AZ................... 0.9363
Pima, AZ
8560..................... Tulsa, OK.................... 0.9001
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600..................... Tuscaloosa, AL............... 0.8586
Tuscaloosa, AL
8640..................... Tyler, TX.................... 1.0013
Smith, TX
8680..................... Utica-Rome, NY............... 0.9114
Herkimer, NY
Oneida, NY
8720..................... Vallejo-Fairfield-Napa, CA... 1.3679
Napa, CA
Solano, CA
8735..................... Ventura, CA.................. 1.1744
Ventura, CA
8750..................... Victoria, TX................. 0.8682
Victoria, TX
8760..................... Vineland-Millville-Bridgeton, 1.1181
NJ.
Cumberland, NJ
8780..................... Visalia-Tulare-Porterville, 1.0169
CA.
Tulare, CA
8800..................... Waco, TX..................... 0.8852
McLennan, TX
8840..................... Washington, DC-MD-VA-WV...... 1.1451
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpeper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
[[Page 49472]]
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA
Berkeley, WV
Jefferson, WV
8920..................... Waterloo-Cedar Falls, IA..... 0.8948
Black Hawk, IA
8940..................... Wausau, WI................... 1.0028
Marathon, WI
8960..................... West Palm Beach-Boca Raton, 1.0309
FL.
Palm Beach, FL
9000..................... Wheeling, WV-OH.............. 0.8234
Belmont, OH
Marshall, WV
Ohio, WV
9040..................... Wichita, KS.................. 1.0162
Butler, KS
Harvey, KS
Sedgwick, KS
9080..................... Wichita Falls, TX............ 0.8164
Archer, TX
Wichita, TX
9140..................... Williamsport, PA............. 0.8935
Lycoming, PA
9160..................... Wilmington-Newark, DE-MD..... 1.1915
New Castle, DE
Cecil, MD
9200..................... Wilmington, NC............... 1.0011
Brunswick, NC
New Hanover, NC
9260..................... Yakima, WA................... 1.0548
Yakima, WA
9270..................... Yolo, CA..................... 1.0859
Yolo, CA
9280..................... York, PA..................... 0.9864
York, PA
9320..................... Youngstown-Warren, OH........ 1.0161
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340..................... Yuba City, CA................ 1.1399
Sutter, CA
Yuba, CA
9360..................... Yuma, AZ..................... 1.0146
Yuma, AZ
------------------------------------------------------------------------
\1\ This column lists each MSA area name and each county, or county
equivalent, in the MSA area. Counties not listed in this Table are
considered to be Rural Areas. Wage Index values for these areas are
found in Table B.
\2\ Wage index values are based on FY 1997 hospital cost report data
before reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget-neutrality
adjustment of 1.064726. Wage index values below 0.8 are adjusted to be
the greater of a 15-percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget-neutrality adjustment. We have
completed all of these adjustments and included them in the wage index
values reflected in this table.
Table B.--Wage Index for Rural Areas
------------------------------------------------------------------------
MSA Code No. Nonurban area Wage index \3\
------------------------------------------------------------------------
9901..................... Alabama...................... 0.8000
9902..................... Alaska....................... 1.3194
9903..................... Arizona...................... 0.8855
9904..................... Arkansas..................... 0.8000
9905..................... California................... 1.0499
9906..................... Colorado..................... 0.9548
9907..................... Connecticut.................. 1.2473
9908..................... Delaware..................... 0.9661
9910..................... Florida...................... 0.9496
9911..................... Georgia...................... 0.8868
[[Page 49473]]
9912..................... Hawaii....................... 1.1775
9913..................... Idaho........................ 0.9240
9914..................... Illinois..................... 0.8688
9915..................... Indiana...................... 0.9159
9916..................... Iowa......................... 0.8550
9917..................... Kansas....................... 0.8097
9918..................... Kentucky..................... 0.8444
9919..................... Louisiana.................... 0.8178
9920..................... Maine........................ 0.9333
9921..................... Maryland..................... 0.9211
9922..................... Massachusetts................ 1.1929
9923..................... Michigan..................... 0.9569
9924..................... Minnesota.................... 0.9456
9925..................... Mississippi.................. 0.8000
9926..................... Missouri..................... 0.8196
9927..................... Montana...................... 0.9250
9928..................... Nebraska..................... 0.8634
9929..................... Nevada....................... 0.9830
9930..................... New Hampshire................ 1.0482
9931..................... New Jersey \4\............... ..............
9932..................... New Mexico................... 0.9047
9933..................... New York..................... 0.9049
9934..................... North Carolina............... 0.8987
9935..................... North Dakota................. 0.8215
9936..................... Ohio......................... 0.9231
9937..................... Oklahoma..................... 0.8000
9938..................... Oregon....................... 1.0788
9939..................... Pennsylvania................. 0.9133
9940..................... Puerto Rico.................. 0.4904
9941..................... Rhode Island \4\............. ..............
9942..................... South Carolina............... 0.8912
9943..................... South Dakota................. 0.8060
9944..................... Tennessee.................... 0.8345
9945..................... Texas........................ 0.8000
9946..................... Utah......................... 0.9622
9947..................... Vermont...................... 0.9874
9948..................... Virgin Islands............... 0.7252
9949..................... Virginia..................... 0.8719
9950..................... Washington................... 1.1109
9951..................... West Virginia................ 0.8764
9952..................... Wisconsin.................... 0.9455
9953..................... Wyoming...................... 0.9388
9965..................... Guam......................... 1.0233
------------------------------------------------------------------------
\3\ Wage index values are based on FY 1997 hospital cost report data
before reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget-neutrality
adjustment of 1.064726. Wage index values below 0.8 are adjusted to be
the greater of a 15-percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget-neutrality adjustment. We have
completed all of these adjustments and have included them in the wage
index values reflected in this table.
\4\ All counties within the State are classified as urban.
II. Regulatory Impact Statement
A. Overall Impact
We have examined the impacts of this notice as required by
Executive Order 12866 (September 1993, Regulatory Planning & Review)
and the Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L.
96-354). In this notice, we identified an impact on hospices as a
result of changes in the way we compute the hospice wage index. The
change in the methodology for computing the wage index was determined
through a negotiated rulemaking committee and implemented in the August
8, 1997 final rule (62 FR 42860). We recognize that the BIPA adjusted
hospice payments upward by 5 percent; however, we did not do a separate
analysis of the impact of this payment adjustment. We used the new
rates adjusted by the BIPA when estimating the payments to be made
under the new wage index and when calculating the budget-neutrality
adjustment factor. Overall, we believe the changes included in this
notice to be insignificant.
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any 1 year). We have
determined that this notice is not an economically significant rule
under this Executive Order.
The RFA requires agencies to determine whether a rule will have a
significant economic impact on a substantial number of small entities.
For purposes of the RFA, small entities include small businesses,
nonprofit organizations and government agencies.
[[Page 49474]]
Most hospital and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues of $5
million or less annually. For purposes of the RFA, most hospices are
small entities. Approximately 73 percent of Medicare certified hospices
are identified as voluntary, government, or other agencies, and,
therefore, are considered small entities. Because the National Hospice
and Palliative Care Organization estimates that approximately 70
percent of hospice patients are Medicare beneficiaries, we have not
considered other sources of revenue in this analysis.
As discussed below, the estimated decreases in payment to hospices
overall are very slight. The effects of this notice indicate that on a
regional basis, urban hospices in the New England, Middle Atlantic,
South Atlantic, East South Central and Pacific regions will experience
a slight decrease in payments. The payment decreases range from a
minimum of 0.2 percent (East South Central region) to a maximum of 0.7
percent (New England region). The mid-range of the decrease in
estimated payments for urban hospices falls within the Middle Atlantic
urban region with a 0.4 percent decrease. Rural hospices in the New
England and Middle Atlantic regions will also experience a slight
decrease in payments, 0.9 and 0.3 percent respectively. Therefore,
based on an analysis of the wage index changes for FY 2002, hospices in
the urban and rural areas of the New England and Middle Atlantic
regions will be impacted the most. This payment decrease to these small
entities indicates that this notice will have a significant impact on a
substantial number of small entities. However, nationwide, hospices
will receive an overall slight increase in estimated payments. We
estimate that total hospice payments will increase by 0.5 percent, or
$13,632,000. Urban hospices will receive an increase in estimated
payments of 0.3 percent and rural hospices will receive an increase in
estimated payments of 1.3 percent.
We would like to emphasize that the methodology for the hospice
wage index was previously determined by consensus through a negotiated
rulemaking committee that included representatives of national hospice
associations; rural, urban, large and small hospices; multi-site
hospices; and consumer groups. Based on the options considered, the
committee agreed on the methodology described in the committee
statement, and adopted it into regulation in the August 8, 1997 final
rule. The committee also agreed that this was favorable for the hospice
community as well as for beneficiaries. Therefore, we believe that
mitigating any negative effects on small entities has been taken into
consideration.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside an MSA and has fewer
than 100 beds.
Section 202 of the Unfunded Mandate Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in an expenditure in any 1 year by
State, local, and tribal governments, in the aggregate, or by the
private sector, in any 1 year of $110 million or more. This notice has
no consequential effect on State, local, or tribal governments. We
believe the private sector costs of this notice fall below the
threshold as well.
We have reviewed this notice under the threshold criteria of
Executive Order 13132, Federalism, and have determined that this notice
will not have any negative impact on the rights, roles, and
responsibilities of State, local, or tribal governments.
B. Anticipated Effects
We have compared estimated payments using the FY 1983 hospice wage
index to estimated payments using the FY 2002 wage index and determined
the current hospice rates to be budget-neutral. This impact analysis
compares hospice payments using the FY 2001 hospice wage index to the
estimated payments using the FY 2002 wage index. The data used in
developing the quantitative analysis for this notice were obtained from
the March 2001 update of the national claims history file of all bills
submitted during FY 2000. We deleted bills from hospices that have
since closed.
Table C demonstrates the results of our analysis. In Column 2 of
Table C, we indicate the number of routine home care days that were
included in our analysis, although the analysis was performed on all
types of hospice care. Column 3 of Table C indicates payments that were
made using the FY 2001 wage index. Column 4 of Table C is based on FY
2000 claims and estimates payments to be made to hospices using the FY
2002 wage index. The final column, which compares Columns 3 and 4,
shows the percent change in estimated hospice payments made based on
the category of the hospice.
Table C categorizes hospices by various geographic and provider
characteristics. The first row displays the results of the impact
analysis for all Medicare certified hospices. The second and third rows
of the table categorize hospices according to their geographic location
(urban and rural). Our analysis indicated that there are 1,319 hospices
located in urban areas and 824 hospices located in rural areas. The
next two groupings in the table indicate the number of hospices by
census region, also broken down by urban and rural hospices. The sixth
grouping shows the impact on hospices based on the size of the
hospice's program. We determined that the majority of hospice payments
are made at the routine home care rate. Therefore, we based the size of
each individual hospice's program on the number of routine home care
days provided in 2000. The next grouping shows the impact on hospices
by type of ownership. The final grouping shows the impact on hospices
defined by whether they are provider-based or freestanding.
The results of our analysis shows that the greatest increases in
payment are for urban areas in the East North Central and West South
Central Regions, with a 1.8 percent and 1.9 percent increase,
respectively. The greatest decreases in payment are for urban and rural
areas in the New England and Middle Atlantic regions.
The breakdown by size, type of ownership, and facility base showed
an increase in payments to all hospice programs. Small hospice programs
showed significant increases of about 5 percent, while larger programs
experienced only a negligible increase. In terms of hospice base,
freestanding hospices showed the greatest estimated payment increase
while hospices affiliated with home health agencies and skilled nursing
facilities showed the smallest amount of payment increase.
[[Page 49475]]
Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Payments using payments using Percent change
Number of routine home FY 2001 wage FY 2002 wage in hospice
hospices (1) care days in index in index in payments (5)
thousands (2) thousands (3) thousands (4)
----------------------------------------------------------------------------------------------------------------
(By Geographic Location)
All Hospices.................... 2,143 23,765 2,995,014 3,008,646 0.5
Urban Hospices.............. 1,319 20,078 2,616,198 2,624,874 0.3
Rural Hospices.............. 824 3,687 378,816 383,772 1.3
By Region--Urban:
New England................. 89 662 98,780 98,045 -0.7
Middle Atlantic............. 169 2,302 321,614 320,170 -0.4
South Atlantic.............. 184 4,402 618,316 616,008 -0.4
East North Central.......... 225 3,246 408,377 415,850 1.8
East South Central.......... 95 1,312 148,758 148,457 -0.2
West North Central.......... 94 1,220 139,067 139,550 0.3
West South Central.......... 178 2,752 324,985 331,103 1.9
Mountain.................... 87 1,358 186,025 187,093 0.6
Pacific..................... 171 2,553 350,437 348,589 -0.5
Puerto Rico................. 27 270 19,840 20,010 0.9
By Region--Rural:
New England................. 26 67 7,825 7,752 -0.9
Middle Atlantic............. 35 182 19,862 19,798 -0.3
South Atlantic.............. 122 763 78,343 80,149 2.3
East North Central.......... 138 595 61,827 62,535 1.1
East South Central.......... 82 649 63,742 64,465 1.1
West North Central.......... 178 439 45,187 45,577 0.9
West South Central.......... 98 479 45,051 45,793 1.6
Mountain.................... 86 240 25,762 26,223 1.8
Pacific..................... 56 251 29,687 29,946 0.9
Puerto Rico................. 3 22 1,530 1,533 0.2
(Skilled)
Routine Home Care Days:
0-1,754 Days................ 386 347 37,277 39,056 4.8
1,754-4,373 Days............ 480 1,429 154,353 156,256 1.2
4,373-9,681 Days............ 540 3,600 412,953 414,477 0.4
9,681 + Days................ 736 18,044 2,348,755 2,357,398 0.4
Type of Ownership:
Voluntary................... 1,336 15,108 1,904,983 1,913,143 0.4
Proprietary................. 590 7,958 1,011,373 1,016,757 0.5
Government.................. 183 594 66,782 66,840 0.1
Other....................... 34 105 11,877 11,906 0.2
Hospice Base:
Freestanding................ 910 14,401 1,826,242 1,840,289 0.8
Home Health Agency.......... 680 5,446 688,646 687,239 -0.2
Hospital.................... 536 3,789 460,963 461,980 0.2
Skilled Nursing Facility.... 17 129 19,163 19,138 -0.1
----------------------------------------------------------------------------------------------------------------
C. Conclusion
We have determined, and we certify, that this rule will have a
significant economic impact on a substantial number of small entities.
However, we are not preparing analyses for either the RFA or Section
1102(b) of the Act because the methodology for the hospice wage index
was previously determined by consensus through a negotiated rulemaking
committee. Based on the options considered, the committee agreed on the
methodology described in the committee statement, and adopted it into
regulation in the August 8, 1997 final rule. The committee, which
included representatives of national hospice associates, rural, urban,
large and small hospice, multi-site hospice, and consumer groups,
agreed that this was favorable for the hospice community as well as for
beneficiaries. Therefore, we believe that mitigating any negative
effects on small entities has been taken into consideration.
OMB Review
In accordance with the provisions of Executive Order 12866, the
Office of Management and Budget reviewed this regulation.
Authority: Section 1814(i) of the Social Security Act (42 U.S.C.
1395f (i)(1))(Catalog of Federal Domestic Assistance Program No.
93.773 Medicare--Hospital Insurance Program; and No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: July 10, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Dated: August 31, 2001.
Tommy G. Thompson,
Secretary.
[FR Doc. 01-23820 Filed 9-20-01; 9:51 am]
BILLING CODE 4210-01-P