[Federal Register Volume 67, Number 169 (Friday, August 30, 2002)]
[Notices]
[Pages 56092-56114]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-22018]
[[Page 56091]]
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Part IV
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 2003; Notice
Federal Register / Vol. 67, No. 169 / Friday, August 30, 2002 /
Notices
[[Page 56092]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1211-N]
RIN 0938-AL41
Medicare Program; Hospice Wage Index Fiscal Year 2003
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, 2002
through September 30, 2003. 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, 2002.
FOR FURTHER INFORMATION CONTACT: Lynn Riley, (410) 786-1286.
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 through September 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 Medicare, Medicaid,
and SCHIP 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 SCHIP Benefits
Improvement and Protection Act of 2000 (BIPA) amended section
1814(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 the
BIPA further stipulated that the 5-percent increase in Medicare hospice
rates during the period beginning on April 1, 2001 through September
30, 2001 were to be treated as the payment rates in effect during 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 (PM) A-01-04 on January 16, 2001.
Also, section 321(d) of the 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.
Payment rates for FY 2003 will be updated according to section
1814(i) of the Act. The FY 2003 rates will be the full market basket
percentage increase for the FY. This rate update will be implemented
through a separate PM and is not part of this notice.
[[Page 56093]]
B. Update to the Hospice Wage Index
This annual update is effective October 1, 2002 through September
30, 2003. In accordance with the agreement we signed with other members
of the Hospice Wage Index Negotiated Rulemaking Committee, we are using
the most current hospital data available to us, including any changes
to the definitions of MSAs. The FY 2002 hospital wage index was the
most current hospital wage data available when the FY 2003 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
1.063422 and are subject to the wage index floor adjustment, if
applicable. We have completed all of the calculations described above
and have 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 by OMB based on
the decennial census. 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............ 0.8470
Taylor, TX.............
0060........................... Aguadilla, PR.......... 0.5385
Aguada, PR.............
Aguadilla, PR..........
Moca, PR...............
0080........................... Akron, OH.............. 1.0502
Portage, OH............
Summit, OH.............
0120........................... Albany, GA............. 1.1315
Dougherty, GA..........
Lee, GA................
0160........................... Albany-Schenectady- 0.9039
Troy, NY.
Albany, NY.............
Montgomery, NY.........
Rensselaer, NY.........
Saratoga, NY...........
Schenectady, NY........
Schoharie, NY..........
0200........................... Albuquerque, NM........ 1.0378
Bernalillo, NM.........
Sandoval, NM...........
Valencia, NM...........
0220........................... Alexandria, LA......... 0.8538
Rapides, LA............
0240........................... Allentown-Bethlehem- 1.0716
Easton, PA.
Carbon, PA.............
Lehigh, PA.............
Northampton, PA........
0280........................... Altoona, PA............ 0.9705
Blair, PA..............
0320........................... Amarillo, TX........... 0.9263
Potter, TX.............
Randall, TX............
0380........................... Anchorage, AK.......... 1.3367
Anchorage, AK..........
0440........................... Ann Arbor, MI.......... 1.1802
Lenawee, MI............
Livingston, MI.........
Washtenaw, MI..........
0450........................... Anniston, AL........... 0.8801
Calhoun, AL............
[[Page 56094]]
0460........................... Appleton-Oshkosh- 0.9827
Neenah, WI.
Calumet, WI............
Outagamie, WI..........
Winnebago, WI..........
0470........................... Arecibo, PR............ 0.8507
Arecibo, PR............
Camuy, PR..............
Hatillo, PR............
0480........................... Asheville, NC.......... 0.9783
Buncombe, NC...........
Madison, NC............
0500........................... Athens, GA............. 1.0466
Clarke, GA.............
Madison, GA............
Oconee, GA.............
0520........................... Atlanta, GA............ 1.0696
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.. 1.2009
Atlantic, NJ...........
Cape May, NJ...........
0580........................... Auburn-Opelika, AL..... 0.8752
Lee, AL................
0600........................... Augusta-Aiken, GA-SC... 1.0602
Columbia, GA...........
McDuffie, GA...........
Richmond, GA...........
Aiken, SC..............
Edgefield, SC..........
0640........................... Austin-San Marcos, TX.. 1.0241
Bastrop, TX............
Caldwell, TX...........
Hays, TX...............
Travis, TX.............
Williamson, TX.........
0680........................... Bakersfield, CA........ 1.0123
Kern, CA...............
0720........................... Baltimore, MD.......... 1.0481
Anne Arundel, MD.......
Baltimore, MD..........
Baltimore City, MD.....
Carroll, MD............
Harford, MD............
Howard, MD.............
Queen Anne's, MD.......
0733........................... Bangor, ME............. 1.0201
Penobscot, ME..........
0743........................... Barnstable-Yarmouth, MA 1.4490
Barnstable, MA.........
[[Page 56095]]
0760........................... Baton Rouge, LA........ 0.8666
Ascension, LA..........
East Baton Rouge, LA...
Livingston, LA.........
West Baton Rouge, LA...
0840........................... Beaumont-Port Arthur, 0.8977
TX.
Hardin, TX.............
Jefferson, TX..........
Orange, TX.............
0860........................... Bellingham, WA......... 1.2576
Whatcom, WA............
0870........................... Benton Harbor, MI...... 0.9451
Berrien, MI............
0875........................... Bergen-Passaic, NJ..... 1.2430
Bergen, NJ.............
Passaic, NJ............
0880........................... Billings, MT........... 0.9945
Yellowstone, MT........
0920........................... Biloxi-Gulfport- 0.8975
Pascagoula, MS.
Hancock, MS............
Harrison, MS...........
Jackson, MS............
0960........................... Binghamton, NY......... 0.8982
Broome, NY.............
Tioga, NY..............
1000........................... Birmingham, AL......... 0.9367
Blount, AL.............
Jefferson, AL..........
St. Clair, AL..........
Shelby, AL.............
1010........................... Bismarck, ND........... 0.8490
Burleigh, ND...........
Morton, ND.............
1020........................... Bloomington, IN........ 0.9403
Monroe, IN.............
1040........................... Bloomington-Normal, IL. 0.9611
McLean, IL.............
1080........................... Boise City, ID......... 0.9624
Ada, ID................
Canyon, ID.............
1123........................... Boston-Worcester- 1.2105
Lawrence-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... 1.0420
Boulder, CO............
1145........................... Brazoria, TX........... 0.8730
Brazoria, TX...........
1150........................... Bremerton, WA.......... 1.1440
Kitsap, WA.............
1240........................... Brownsville-Harlingen- 0.9584
San Benito, TX.
Cameron, TX............
1260........................... Bryan-College Station, 0.9920
TX.
Brazos, TX.............
1280........................... Buffalo-Niagara Falls, 1.0059
NY.
Erie, NY...............
Niagara, NY............
1303........................... Burlington, VT......... 1.0510
Chittenden, VT.........
Franklin, VT...........
Grand Isle, VT.........
[[Page 56096]]
1310........................... Caguas, PR............. 0.5404
Caguas, PR.............
Cayey, PR..............
Cidra, PR..............
Gurabo, PR.............
San Lorenzo, PR........
1320........................... Canton-Massillon, OH... 0.9524
Carroll, OH............
Stark, OH..............
1350........................... Casper, WY............. 1.0098
Natrona, WY............
1360........................... Cedar Rapids, IA....... 0.9251
Linn, IA...............
1400........................... Champaign-Urbana, IL... 0.9896
Champaign, IL..........
1440........................... Charleston-North 0.9790
Charleston, SC.
Berkeley, SC...........
Charleston, SC.........
Dorchester, SC.........
1480........................... Charleston, WV......... 0.9852
Kanawha, WV............
Putnam, WV.............
1520........................... Charlotte-Gastonia-Rock 0.9928
Hill, NC-SC.
Cabarrus, NC...........
Gaston, NC.............
Lincoln, NC............
Mecklenburg, NC........
Rowan, NC..............
Stanly, NC.............
Union, NC..............
York, SC...............
1540........................... Charlottesville, VA.... 1.1236
Albermale, VA..........
Charlottesville City,
VA.
Fluvanna, VA...........
Greene, VA.............
1560........................... Chattanooga, TN-GA..... 0.9963
Catoosa, GA............
Dade, GA...............
Walker, GA.............
Hamilton, TN...........
Marion, TN.............
1580........................... Cheyenne, WY........... 0.8814
Laramie, WY............
1600........................... Chicago, IL............ 1.1747
Cook, IL...............
DeKalb, IL.............
Du Page, IL............
Grundy, IL.............
Kane, IL...............
Kendall, IL............
Lake, IL...............
McHenry, IL............
Will, IL...............
1620........................... Chico-Paradise, CA..... 1.0481
Butte, CA..............
1640........................... Cincinnati, OH-KY-IN... 1.0074
Brown, OH..............
Clermont, OH...........
Hamilton, OH...........
Warren, OH.............
Boone, KY..............
Campbell, KY...........
Gallatin, KY...........
Grant, KY..............
Kenton, KY.............
Pendleton, KY..........
Dearborn, IN...........
Ohio, IN...............
[[Page 56097]]
1660........................... Clarksville- 0.8866
Hopkinsville, TN-KY.
Christian, KY..........
Montgomery, TN.........
1680........................... Cleveland-Lorain- 1.0057
Elyria, OH.
Ashtabula, OH..........
Cuyahoga, OH...........
Geauga, OH.............
Lake, OH...............
Lorain, OH.............
Medina, OH.............
1720........................... Colorado Springs, CO... 1.0362
El Paso, CO............
1740........................... Columbia, MO........... 0.9237
Boone, MO..............
1760........................... Columbia, SC........... 1.0094
Lexington, SC..........
Richland, SC...........
1800........................... Columbus, GA-AL........ 0.8975
Chattahoochee, GA......
Harris, GA.............
Muscogee, GA...........
Russell, AL............
1840........................... Columbus, OH........... 1.0172
Delaware, OH...........
Fairfield, OH..........
Franklin, OH...........
Licking, OH............
Madison, OH............
Pickaway, OH...........
1880........................... Corpus Christi, TX..... 0.8870
Nueces, TX.............
San Patricio, TX.......
1890........................... Corvallis, Oregon...... 1.2385
Benton, OR.............
1900........................... Cumberland, MD-WV...... 0.8833
Allegany, MD...........
Mineral, WV............
1920........................... Dallas, TX............. 1.0566
Collin, TX.............
Dallas, TX.............
Denton, TX.............
Ellis, TX..............
Henderson, TX..........
Hunt, TX...............
Kaufman, TX............
Rockwall, TX...........
1950........................... Danville, VA........... 0.9159
Danville City, VA......
Pittsylvania, VA.......
1960........................... Davenport-Moline-Rock 0.9186
Island, IA-IL.
Scott, IA..............
Henry, IL..............
Rock Island, IL........
2000........................... Dayton-Springfield, OH. 0.9810
Clark, OH..............
Greene, OH.............
Miami, OH..............
Montgomery, OH.........
2020........................... Daytona Beach, FL...... 0.9541
Flagler, FL............
Volusia, FL............
2030........................... Decatur, AL............ 0.9332
Lawrence, AL...........
Morgan, AL.............
2040........................... Decatur, IL............ 0.8494
Macon, IL..............
[[Page 56098]]
2080........................... Denver, CO............. 1.0983
Adams, CO..............
Arapahoe, CO...........
Denver, CO.............
Douglas, CO............
Jefferson, CO..........
2120........................... Des Moines, IA......... 0.9336
Dallas, IA.............
Polk, IA...............
Warren, IA.............
2160........................... Detroit, MI............ 1.1152
Lapeer, MI.............
Macomb, MI.............
Monroe, MI.............
Oakland, MI............
St. Clair, MI..........
Wayne, MI..............
2180........................... Dothan, AL............. 0.8452
Dale, AL...............
Houston, AL............
2190........................... Dover, DE.............. 1.0949
Kent, DE...............
2200........................... Dubuque, IA............ 0.9059
Dubuque, IA............
2240........................... Duluth-Superior, MN-WI. 1.0936
St. Louis, MN..........
Douglas, WI............
2281........................... Dutchess County, NY.... 1.1200
Dutchess, NY...........
2290........................... Eau Claire, WI......... 0.9463
Chippewa, WI...........
Eau Claire, WI.........
2320........................... El Paso, TX............ 0.9799
El Paso, TX............
2330........................... Elkhart-Goshen, IN..... 1.0249
Elkhart, IN............
2335........................... Elmira, NY............. 0.8949
Chemung, NY............
2340........................... Enid, OK............... 0.8887
Garfield, OK...........
2360........................... Erie, PA............... 0.9269
Erie, PA...............
2400........................... Eugene-Springfield, OR. 1.2199
Lane, OR...............
2440........................... Evansville-Henderson, 0.9054
IN-KY.
Posey, IN..............
Vanderburgh, IN........
Warrick, IN............
Henderson, KY..........
2520........................... Fargo-Moorhead, ND-MN.. 0.9855
Clay, MN...............
Cass, ND...............
2560........................... Fayetteville, NC....... 0.9600
Cumberland, NC.........
2580........................... Fayetteville-Springdale- 0.8981
Rogers, AR.
Benton, AR.............
Washington, AR.........
2620........................... Flagstaff, AZ-UT....... 1.1225
Coconino, AZ...........
Kane, UT...............
2640........................... Flint, MI.............. 1.1605
Genesee, MI............
2650........................... Florence, AL........... 0.8343
Colbert, AL............
Lauderdale, AL.........
2655........................... Florence, SC........... 0.9275
Florence, SC...........
2670........................... Fort Collins-Loveland, 1.0682
CO.
Larimer, CO............
2680........................... Ft. Lauderdale, FL..... 1.0946
Broward, FL............
[[Page 56099]]
2700........................... Fort Myers-Cape Coral, 0.9969
FL.
Lee, FL................
2710........................... Fort Pierce-Port St. 1.0862
Lucie, FL.
Martin, FL.............
St. Lucie, FL..........
2720........................... Fort Smith, AR-OK...... 0.8564
Crawford, AR...........
Sebastian, AR..........
Sequoyah, OK...........
2750........................... Fort Walton Beach, FL.. 0.9573
Okaloosa, FL...........
2760........................... Fort Wayne, IN......... 0.9787
Adams, IN..............
Allen, IN..............
De Kalb, IN............
Huntington, IN.........
Wells, IN..............
Whitley, IN............
2800........................... Fort Worth-Arlington, 0.9990
TX.
Hood, TX...............
Johnson, TX............
Parker, TX.............
Tarrant, TX............
2840........................... Fresno, CA............. 1.0617
Fresno, CA.............
Madera, CA.............
2880........................... Gadsden, AL............ 0.9350
Etowah, AL............
2900........................... Gainesville, FL........ 1.0082
Alachua, FL............
2920........................... Galveston-Texas City, 1.0967
TX.
Galveston, TX..........
2960........................... Gary, IN............... 1.0134
Lake, IN...............
Porter, IN.............
2975........................... Glens Falls, NY........ 0.8865
Warren, NY.............
Washington, NY.........
2980........................... Goldsboro, NC.......... 0.9261
Wayne, NC..............
2985........................... Grand Forks, ND-MN..... 0.9644
Grand Forks, ND........
Polk, MN...............
2995........................... Grand Junction, CO..... 1.0176
Mesa, CO...............
3000........................... Grand Rapids-Muskegon- 1.0685
Holland, MI.
Allegan, MI............
Kent, MI...............
Muskegon, MI...........
Ottawa, MI.............
3040........................... Great Falls, MT........ 0.9433
Cascade, MT............
3060........................... Greeley, CO............ 1.0097
Weld, CO...............
3080........................... Green Bay, WI.......... 0.9792
Brown, WI..............
3120........................... Greensboro-Winston- 1.0144
Salem-High Point, NC.
Alamance, NC...........
Davidson, NC...........
Davie, NC..............
Forsyth, NC............
Guilford, NC...........
Randolph, NC...........
Stokes, NC.............
Yadkin, NC.............
3150........................... Greenville, NC......... 0.9878
Pitt, NC...............
[[Page 56100]]
3160........................... Greenville-Spartanburg- 0.9802
Anderson, SC.
Anderson, SC...........
Cherokee, SC...........
Greenville, SC.........
Pickens, SC............
Spartanburg, SC........
3180........................... Hagerstown, MD......... 0.8896
Washington, MD.........
3200........................... Hamilton-Middletown, OH 0.9876
Butler, OH.............
3240........................... Harrisburg-Lebanon- 1.0023
Carlisle, PA.
Cumberland, PA.........
Dauphin, PA............
Lebanon, PA............
Perry, PA..............
3283........................... Hartford, CT........... 1.2264
Hartford, CT...........
Litchfield, CT.........
Middlesex, CT..........
Tolland, CT............
3285........................... Hattiesburg, MS........ 0.8000
Forrest, MS............
Lamar, MS..............
3290........................... Hickory-Morganton- 0.9961
Lenoir, NC.
Alexander, NC..........
Burke, NC..............
Caldwell, NC...........
Catawba, NC............
3320........................... Honolulu, HI........... 1.2271
Honolulu, HI...........
3350........................... Houma, LA.............. 0.8481
Lafourche, LA..........
Terrebonne, LA.........
3360........................... Houston, TX............ 1.0242
Chambers, TX...........
Fort Bend, TX..........
Harris, TX.............
Liberty, TX............
Montgomery, TX.........
Waller, TX.............
3400........................... Huntington-Ashland, WV- 1.0226
KY-OH.
Boyd, KY...............
Carter, KY.............
Greenup, KY............
Lawrence, OH...........
Cabell, WV.............
Wayne, WV..............
3440........................... Huntsville, AL......... 0.9446
Limestone, AL..........
Madison, AL............
3480........................... Indianapolis, IN....... 1.0313
Boone, IN..............
Hamilton, IN...........
Hancock, IN............
Hendricks, IN..........
Johnson, IN............
Madison, IN............
Marion, IN.............
Morgan, IN.............
Shelby, IN.............
3500........................... Iowa City, IA.......... 1.0484
Johnson, IA............
3520........................... Jackson, MI............ 0.9844
Jackson, MI............
3560........................... Jackson, MS............ 0.9030
Hinds, MS..............
Madison, MS............
Rankin, MS.............
3580........................... Jackson, TN............ 0.9585
Madison, TN............
Chester, TN............
[[Page 56101]]
3600........................... Jacksonville, FL....... 0.9808
Clay, FL...............
Duval, FL..............
Nassau, FL.............
St. Johns, FL..........
3605........................... Jacksonville, NC....... 0.8105
Onslow, NC.............
3610........................... Jamestown, NY.......... 0.8561
Chautauqua, NY.........
3620........................... Janesville-Beloit, WI.. 1.0357
Rock, WI...............
3640........................... Jersey City, NJ........ 1.1887
Hudson, NJ.............
3660........................... Johnson City-Kingsport- 0.9164
Bristol, TN-VA.
Carter, TN.............
Hawkins, TN............
Sullivan, TN...........
Unicoi, TN.............
Washington, TN.........
Bristol City, VA.......
Scott, VA..............
Washington, VA.........
3680........................... Johnstown, PA.......... 0.9276
Cambria, PA............
Somerset, PA...........
3700........................... Jonesboro, AR.......... 0.8959
Craighead, AR..........
3710........................... Joplin, MO............. 0.9280
Jasper, MO.............
Newton, MO.............
3720........................... Kalamazoo-Battlecreek, 1.1314
MI.
Calhoun, MI............
Kalamazoo, MI..........
Van Buren, MI..........
3740........................... Kankakee, IL........... 1.0516
Kankakee, IL...........
3760........................... Kansas City, KS-MO..... 1.0141
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............ 1.0175
Kenosha, WI............
3810........................... Killeen-Temple, TX..... 0.9008
Bell, TX...............
Coryell, TX............
3840........................... Knoxville, TN.......... 0.9454
Anderson, TN...........
Blount, TN.............
Knox, TN...............
Loudon, TN.............
Sevier, TN.............
Union, TN..............
3850........................... Kokomo, IN............. 0.9705
Howard, IN.............
Tipton, IN.............
3870........................... La Crosse, WI-MN....... 0.9837
Houston, MN............
La Crosse, WI..........
3880........................... Lafayette, LA.......... 0.9086
Acadia, LA.............
Lafayette, LA..........
St. Landry, LA.........
St. Martin, LA.........
[[Page 56102]]
3920........................... Lafayette, IN.......... 0.9700
Clinton, IN............
Tippecanoe, IN.........
3960........................... Lake Charles, LA....... 0.8257
Calcasieu, LA..........
3980........................... Lakeland-Winter Haven, 0.9642
FL.
Polk, FL...............
4000........................... Lancaster, PA.......... 0.9886
Lancaster, PA..........
4040........................... Lansing-East Lansing, 1.0265
MI.
Clinton, MI............
Eaton, MI..............
Ingham, MI.............
4080........................... Laredo, TX............. 0.8347
Webb, TX...............
4100........................... Las Cruces, NM......... 0.9168
Dona Ana, NM...........
4120........................... Las Vegas, NV-AZ....... 1.1891
Mohave, AZ.............
Clarke, NV.............
Nye, NV................
4150........................... Lawrence, KS........... 0.8307
Douglas, KS............
4200........................... Lawton, OK............. 0.9233
Comanche, OK...........
4243........................... Lewiston-Auburn, ME.... 0.9876
Androscoggin, ME.......
4280........................... Lexington, KY.......... 0.9349
Bourbon, KY............
Clark, KY..............
Fayette, KY............
Jessamine, KY..........
Madison, KY............
Scott, KY..............
Woodford, KY...........
4320........................... Lima, OH............... 1.0071
Allen, OH..............
Auglaize, OH...........
4360........................... Lincoln, NE............ 1.0818
Lancaster, NE..........
4400........................... Little Rock-North 0.9523
Little Rock, AR.
Faulkner, AR...........
Lonoke, AR.............
Pulaski, AR............
Saline, AR.............
4420........................... Longview-Marshall, TX.. 0.9115
Gregg, TX..............
Harrison, TX...........
Upshur, TX.............
4480........................... Los Angeles-Long Beach, 1.2706
CA.
Los Angeles, CA........
4520........................... Louisville, KY-IN...... 1.0133
Clark, IN..............
Floyd, IN..............
Harrison, IN...........
Scott, IN..............
Bullitt, KY............
Jefferson, KY..........
Oldham, KY.............
4600........................... Lubbock, TX............ 0.8985
Lubbock, TX............
4640........................... Lynchburg, VA.......... 0.9680
Amherst, VA............
Bedford, VA............
Bedford City, VA.......
Campbell, VA...........
Lynchburg City, VA.....
[[Page 56103]]
4680........................... Macon, GA.............. 0.9525
Bibb, GA...............
Houston, GA............
Jones, GA..............
Peach, GA..............
Twiggs, GA.............
4720........................... Madison, WI............ 1.0993
Dane, WI...............
4800........................... Mansfield, OH.......... 0.9260
Crawford, OH...........
Richland, OH...........
4840........................... Mayaguez, PR........... 0.5589
Anasco, PR.............
Cabo Rojo, PR..........
Hormigueros, PR........
Mayaguez, PR...........
Sabana Grande, PR......
San German, PR.........
4880........................... McAllen-Edinburg- 0.8909
Mission, TX.
Hidalgo, TX............
4890........................... Medford-Ashland, OR.... 1.0968
Jackson, OR............
4900........................... Melbourne-Titusville- 1.0542
Palm Bay, FL.
Brevard, Fl............
4920........................... Memphis, TN-AR-MS...... 0.9547
Crittenden, AR.........
DeSoto, MS.............
Fayette, TN............
Shelby, TN.............
Tipton, TN.............
4940........................... Merced, CA............. 1.0578
Merced, CA.............
5000........................... Miami, FL.............. 1.0581
Dade, FL...............
5015........................... Middlesex-Somerset- 1.2196
Hunterdon, NJ.
Hunterdon, NJ..........
Middlesex, NJ..........
Somerset, NJ...........
5080........................... Milwaukee-Waukesha, WI. 1.0603
Milwaukee, WI..........
Ozaukee, WI............
Washington, WI.........
Waukesha, WI...........
5120........................... Minneapolis-St. Paul, 1.1623
MN-WI.
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........... 0.9958
Missoula, MT...........
5160........................... Mobile, AL............. 0.8595
Baldwin, AL............
Mobile, AL.............
5170........................... Modesto, CA............ 1.1506
Stanislaus, CA.........
5190........................... Monmouth-Ocean, NJ..... 1.1539
Monmouth, NJ...........
Ocean, NJ..............
5200........................... Monroe, LA............. 0.8721
Ouachita, LA...........
[[Page 56104]]
5240........................... Montgomery, AL......... 0.8000
Autauga, AL............
Elmore, AL.............
Montgomery, AL.........
5280........................... Muncie, IN............. 1.0569
Delaware, IN...........
5330........................... Myrtle Beach, SC....... 0.9327
Horry, SC..............
5345........................... Naples, FL............. 1.0314
Collier, FL............
5360........................... Nashville, TN.......... 1.0373
Cheatham, TN...........
Davidson, TN...........
Dickson, TN............
Robertson, TN..........
Rutherford TN..........
Sumner, TN.............
Williamson, TN.........
Wilson, TN.............
5380........................... Nassau-Suffolk, NY..... 1.4508
Nassau, NY.............
Suffolk, NY............
5483........................... New Haven-Bridgeport- 1.3014
Stamford-Waterbury-
Danbury, CT.
Fairfield, CT..........
New Haven, CT..........
5523........................... New London-Norwich, CT. 1.2257
New London, CT.........
5560........................... New Orleans, LA........ 0.9609
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........... 1.5342
Bronx, NY..............
Kings, NY..............
New York, NY...........
Putnam, NY.............
Queens, NY.............
Richmond, NY...........
Rockland, NY...........
Westchester, NY........
5640........................... Newark, NJ............. 1.2359
Essex, NJ..............
Morris, NJ.............
Sussex, NJ.............
Union, NJ..............
Warren, NJ.............
5660........................... Newburgh, NY-PA........ 1.1818
Orange, NY.............
Pike, PA...............
5720........................... Norfolk-Virginia Beach- 0.9123
Newport News, VA-NC.
Currituck, NC..........
Chesapeake City, VA....
Gloucester, VA.........
Hampton City, VA.......
Isle of Wight, VA......
James City, 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...............
[[Page 56105]]
5775........................... Oakland, CA............ 1.6291
Alameda, CA............
Contra Costa, CA.......
5790........................... Ocala, FL.............. 1.0162
Marion, FL.............
5800........................... Odessa-Midland, TX..... 1.0745
Ector, TX..............
Midland, TX............
5880........................... Oklahoma City, OK...... 0.9245
Canadian, OK...........
Cleveland, OK..........
Logan, OK..............
McClain, OK............
Oklahoma, OK...........
Pottawatomie, OK.......
5910........................... Olympia, WA............ 1.2070
Thurston, WA...........
5920........................... Omaha, NE-IA........... 1.0328
Pottawattamie, IA......
Cass, NE...............
Douglas, NE............
Sarpy, NE..............
Washington, NE.........
5945........................... Orange County, CA...... 1.1828
Orange, CA.............
5960........................... Orlando, FL............ 1.0254
Lake, FL...............
Orange, FL.............
Osceola, FL............
Seminole, FL...........
5990........................... Owensboro, KY.......... 0.8863
Daviess, KY............
6015........................... Panama City, FL........ 0.9636
Bay, FL................
6020........................... Parkersburg-Marietta, 0.8649
WV-OH.
Washington, OH.........
Wood, WV...............
6080........................... Pensacola, FL.......... 0.8891
Escambia, FL...........
Santa Rosa, FL.........
6120........................... Peoria-Pekin, IL....... 0.9329
Peoria, IL.............
Tazewell, IL...........
Woodford, IL...........
6160........................... Philadelphia, PA-NJ.... 1.1641
Burlington, NJ.........
Camden, NJ.............
Gloucester, NJ.........
Salem, NJ..............
Bucks, PA..............
Chester, PA............
Delaware, PA...........
Montgomery, PA.........
Philadelphia, PA.......
6200........................... Phoenix-Mesa, AZ....... 1.0249
Maricopa, AZ...........
Pinal, AZ..............
6240........................... Pine Bluff, AR......... 0.8396
Jefferson, AR..........
6280........................... Pittsburgh, PA......... 1.0166
Allegheny, PA..........
Beaver, PA.............
Butler, PA.............
Fayette, PA............
Washington, PA.........
Westmoreland, PA.......
6323........................... Pittsfield, MA......... 1.0930
Berkshire, MA..........
6340........................... Pocatello, ID.......... 1.0047
Bannock, ID............
[[Page 56106]]
6360........................... Ponce, PR.............. 0.6001
Guayanilla, PR.........
Juana Diaz, PR.........
Penuelas, PR...........
Ponce, PR..............
Villalba, PR...........
Yauco, PR..............
6403........................... Portland, ME........... 1.0025
Cumberland, ME.........
Sagadahoc, ME..........
York, ME...............
6440........................... Portland-Vancouver, OR- 1.1816
WA.
Clackamas, OR..........
Columbia, OR...........
Multnomah, OR..........
Washington, OR.........
Yamhill, OR............
Clark, WA..............
6483........................... Providence-Warwick- 1.1490
Pawtucket, RI.
Bristol, RI............
Kent, RI...............
Newport, RI............
Providence, RI.........
Washington, RI.........
6520........................... Provo-Orem, UT......... 1.0467
Utah, UT...............
6560........................... Pueblo, CO............. 0.9150
Pueblo, CO.............
6580........................... Punta Gorda, FL........ 0.9587
Charlotte, FL..........
6600........................... Racine, WI............. 0.9925
Racine, WI.............
6640........................... Raleigh-Durham-Chapel 1.0441
Hill, NC.
Chatham, NC............
Durham, NC.............
Franklin, NC...........
Johnston, NC...........
Orange, NC.............
Wake, NC...............
6660........................... Rapid City, SD......... 0.9431
Pennington, SD.........
6680........................... Reading, PA............ 1.0191
Berks, PA..............
6690........................... Redding, CA............ 1.1862
Shasta, CA.............
6720........................... Reno, NV............... 1.1082
Washoe, NV.............
6740........................... Richland-Kennewick- 1.1655
Pasco, WA.
Benton, WA.............
Franklin, WA...........
6760........................... Richmond-Petersburg, VA 1.0292
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 1.1817
Bernardino, CA.
Riverside, CA..........
San Bernardino, CA.....
[[Page 56107]]
6800........................... Roanoke, VA............ 0.8902
Botetourt, VA..........
Roanoke, VA............
Roanoke City, VA.......
Salem City, VA.........
6820........................... Rochester, MN.......... 1.2189
Olmsted, MN............
6840........................... Rochester, NY.......... 0.9940
Genesee, NY............
Livingston, NY.........
Monroe, NY.............
Ontario, NY............
Orleans, NY............
Wayne, NY..............
6880........................... Rockford, IL........... 0.9788
Boone, IL..............
Ogle, IL...............
Winnebago, IL..........
6895........................... Rocky Mount, NC........ 0.9687
Edgecombe, NC..........
Nash, NC...............
6920........................... Sacramento, CA......... 1.2581
El Dorado, CA..........
Placer, CA.............
Sacramento, CA.........
6960........................... Saginaw-Bay City- 1.0198
Midland, MI.
Bay, MI................
Midland, MI............
Saginaw, MI............
6980........................... St. Cloud, MN.......... 1.0476
Benton, MN.............
Stearns, MN............
7000........................... St. Joseph, MO......... 0.8391
Andrew, MO.............
Buchanan, MO...........
7040........................... St. Louis, MO-IL....... 0.9497
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.............. 1.0646
Marion, OR.............
Polk, OR...............
7120........................... Salinas, CA............ 1.5615
Monterey, CA...........
7160........................... Salt Lake City-Ogden, 1.0489
UT.
Davis, UT..............
Salt Lake, UT..........
Weber, UT..............
7200........................... San Angelo, TX......... 0.8713
Tom Green, TX..........
7240........................... San Antonio, TX........ 0.9128
Bexar, TX..............
Comal, TX..............
Guadalupe, TX..........
Wilson, TX.............
7320........................... San Diego, CA.......... 1.1979
San Diego, CA..........
7360........................... San Francisco, CA...... 1.5037
Marin, CA..............
San Francisco, CA......
San Mateo, CA..........
[[Page 56108]]
7400........................... San Jose, CA........... 1.5093
Santa Clara, CA........
7440........................... San Juan-Bayamon, PR... 0.5476
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- 1.1687
Atascadero-Paso
Robles, CA.
San Luis Obispo, CA....
7480........................... Santa Barbara-Santa 1.1487
Maria-Lompoc, CA.
Santa Barbara, CA......
7485........................... Santa Cruz-Watsonville, 1.4856
CA.
Santa Cruz, CA.........
7490........................... Santa Fe, NM........... 1.0841
Los Alamos, NM.........
Santa Fe, NM...........
7500........................... Santa Rosa, CA......... 1.3861
Sonoma, CA.............
7510........................... Sarasota-Bradenton, FL. 1.0730
Manatee, FL............
Sarasota, FL...........
7520........................... Savannah, GA........... 1.0653
Bryan, GA..............
Chatham, GA............
Effingham, GA..........
7560........................... Scranton-Wilkes-Barre- 0.9234
Hazleton, PA.
Columbia, PA...........
Lackawanna, PA.........
Luzerne, PA............
Wyoming, PA............
7600........................... Seattle-Bellevue- 1.2082
Everett, WA.
Island, WA.............
King, WA...............
Snohomish, WA..........
7610........................... Sharon, PA............. 0.8429
Mercer, PA.............
7620........................... Sheboygan, WI.......... 0.8961
Sheboygan, WI..........
7640........................... Sherman-Denison, TX.... 0.9967
Grayson, TX............
7680........................... Shreveport-Bossier 0.9624
City, LA.
Bossier, LA............
Caddo, LA..............
Webster, LA............
[[Page 56109]]
7720........................... Sioux City, IA-NE...... 0.9323
Woodbury, IA...........
Dakota, NE.............
7760........................... Sioux Falls, SD........ 0.9719
Lincoln, SD............
Minnehaha, SD..........
7800........................... South Bend, IN......... 1.0627
St. Joseph, IN.........
7840........................... Spokane, WA............ 1.1345
Spokane, WA............
7880........................... Springfield, IL........ 0.9226
Menard, IL.............
Sangamon, IL...........
7920........................... Springfield, MO........ 0.9110
Christian, MO..........
Greene, MO.............
Webster, MO............
8003........................... Springfield, MA........ 1.1571
Hampden, MA............
Hampshire, MA..........
8050........................... State College, PA...... 0.9712
Centre, PA.............
8080........................... Steubenville-Weirton, 0.9185
OH-WV.
Jefferson, OH..........
Brooke, WV.............
Hancock, WV............
8120........................... Stockton-Lodi, CA...... 1.1501
San Joaquin, CA........
8140........................... Sumter, SC............. 0.8288
Sumter, SC.............
8160........................... Syracuse, NY........... 1.0231
Cayuga, NY.............
Madison, NY............
Onondaga, NY...........
Oswego, NY.............
8200........................... Tacoma, WA............. 1.2353
Pierce, WA.............
8240........................... Tallahassee, FL........ 0.9068
Gadsden, FL............
Leon, FL...............
8280........................... Tampa-St. Petersburg- 0.9491
Clearwater, FL.
Hernando, FL...........
Hillsborough, FL.......
Pasco, FL..............
Pinellas, FL...........
8320........................... Terre Haute, IN........ 0.9073
Clay, IN...............
Vermillion, IN.........
Vigo, IN...............
8360........................... Texarkana, AR- 0.8855
Texarkana, TX.
Miller, AR.............
Bowie, TX..............
8400........................... Toledo, OH............. 1.0431
Fulton, OH.............
Lucas, OH..............
Wood, OH...............
8440........................... Topeka, KS............. 0.9477
Shawnee, KS............
8480........................... Trenton, NJ............ 1.1077
Mercer, NJ.............
8520........................... Tucson, AZ............. 0.9536
Pima, AZ...............
8560........................... Tulsa, OK.............. 0.9467
Creek, OK..............
Osage, OK..............
Rogers, OK.............
Tulsa, OK..............
Wagoner, OK............
8600........................... Tuscaloosa, AL......... 0.8689
Tuscaloosa, AL.........
8640........................... Tyler, TX.............. 1.0252
Smith, TX..............
[[Page 56110]]
8680........................... Utica-Rome, NY......... 0.8857
Herkimer, NY...........
Oneida, NY.............
8720........................... Vallejo-Fairfield-Napa, 1.4422
CA.
Napa, CA...............
Solano, CA.............
8735........................... Ventura, CA............ 1.1691
Ventura, CA............
8750........................... Victoria, TX........... 0.8856
Victoria, TX...........
8760........................... Vineland-Millville- 1.1103
Bridgeton, NJ.
Cumberland, NJ.........
8780........................... Visalia-Tulare- 1.0239
Porterville, CA.
Tulare, CA.............
8800........................... Waco, TX............... 0.8645
McLennan, TX...........
8840........................... Washington, DC-MD-VA-WV 1.1657
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............
Manassas City, VA......
Manassas Park City, VA.
Prince William, VA.....
Spotsylvania, VA.......
Stafford, VA...........
Warren, VA.............
Berkeley, WV...........
Jefferson, WV..........
8920........................... Waterloo-Cedar Falls, 0.8551
IA.
Black Hawk, IA.........
8940........................... Wausau, WI............. 1.0311
Marathon, WI...........
8960........................... West Palm Beach-Boca 1.0397
Raton, FL.
Palm Beach, FL.........
9000........................... Wheeling, WV-OH........ 0.8491
Belmont, OH............
Marshall, WV...........
Ohio, WV...............
9040........................... Wichita, KS............ 1.0215
Butler, KS.............
Harvey, KS.............
Sedgwick, KS...........
9080........................... Wichita Falls, TX...... 0.8366
Archer, TX.............
Wichita, TX............
9140........................... Williamsport, PA....... 0.9175
Lycoming, PA...........
9160........................... Wilmington-Newark, DE- 1.1567
MD.
New Castle, DE.........
Cecil, MD..............
9200........................... Wilmington, NC......... 1.0006
Brunswick, NC..........
New Hanover, NC........
9260........................... Yakima, WA............. 1.1237
Yakima, WA.............
9270........................... Yolo, CA............... 1.0316
Yolo, CA...............
[[Page 56111]]
9280........................... York, PA............... 1.0040
York, PA...............
9320........................... Youngstown-Warren, OH.. 1.0170
Columbiana, OH.........
Mahoning, OH...........
Trumbull, OH...........
9340........................... Yuba City, CA.......... 1.1016
Sutter, CA.............
Yuba, CA...............
9360........................... Yuma, AZ............... 0.9559
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 1998 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 1.063422. 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.............. 1.2614
9903.............................. Arizona............. 0.9232
9904.............................. Arkansas............ 0.8000
9905.............................. California.......... 1.0272
9906.............................. Colorado............ 0.9370
9907.............................. Connecticut......... 1.2843
9908.............................. Delaware............ 1.0197
9910.............................. Florida............. 0.9352
9911.............................. Georgia............. 0.8821
9912.............................. Hawaii.............. 1.1817
9913.............................. Idaho............... 0.9271
9914.............................. Illinois............ 0.8564
9915.............................. Indiana............. 0.9274
9916.............................. Iowa................ 0.8664
9917.............................. Kansas.............. 0.8307
9918.............................. Kentucky............ 0.8468
9919.............................. Louisiana........... 0.8078
9920.............................. Maine............... 0.9274
9921.............................. Maryland............ 0.9421
9922.............................. Massachusetts....... 1.2180
9923.............................. Michigan............ 0.9571
9924.............................. Minnesota........... 0.9608
9925.............................. Mississippi......... 0.8005
9926.............................. Missouri............ 0.8391
9927.............................. Montana............. 0.9204
9928.............................. Nebraska............ 0.8658
9929.............................. Nevada.............. 1.0344
9930.............................. New Hampshire....... 1.0399
9931.............................. New Jersey \4\...... ..............
9932.............................. New Mexico.......... 0.9226
9933.............................. New York............ 0.9089
9934.............................. North Carolina...... 0.9076
9935.............................. North Dakota........ 0.8379
9936.............................. Ohio................ 0.9218
9937.............................. Oklahoma............ 0.8046
9938.............................. Oregon.............. 1.0663
9939.............................. Pennsylvania........ 0.9153
9940.............................. Puerto Rico......... 0.5520
9941.............................. Rhode Island \4\.... ..............
9942.............................. South Carolina...... 0.9052
9943.............................. South Dakota........ 0.8360
9944.............................. Tennessee........... 0.8431
9945.............................. Texas............... 0.8201
9946.............................. Utah................ 0.9625
9947.............................. Vermont............. 1.0066
9948.............................. Virgin Islands...... 0.7759
9949.............................. Virginia............ 0.8764
9950.............................. Washington.......... 1.0856
[[Page 56112]]
9951.............................. West Virginia....... 0.8579
9952.............................. Wisconsin........... 0.9641
9953.............................. Wyoming............. 0.9302
9965.............................. Guam................ 1.0221
------------------------------------------------------------------------
\3\ Wage index values are based on FY 1998 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 1.063422. 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. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a notice such as this take effect. We can waive this
procedure, however, if we find good cause that a notice and comment
procedure is impracticable, unnecessary, or contrary to the public
interest and incorporate a statement of the finding and its reasons in
the notice issued.
We find it unnecessary to undertake notice and comment rulemaking
as the statute requires annual updates to the hospice payment rates.
The methodologies used to determine the wage index have been previously
subject to public comments, and this notice merely reflects the
application of those previously established methodologies. Therefore,
for good cause, we waive notice and comment procedures.
III. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this notice as required by
Executive Order 12866 (September 1993, Regulatory Planning and Review),
the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-
354), section 1102(b) of the Act, the Unfunded Mandates Reform Act of
1995 (Pub.L. 104-4), and Executive Order 13132. In this notice, we
identified the impact on hospices as a result of updating the hospice
wage index for FY 2003. 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). This notice
only updates the hospice wage index in accordance with that
methodology. We believe these changes to be insignificant. As Table C
below indicates, we estimate that total hospice payments will increase
from last year by 0.3 percent, or $12,731,000.
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. 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 details, see the Small Business Administration's regulation that
set forth size standards for health care industries (65 FR 69432)). 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 79 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 Middle Atlantic, East North
Central, West North Central, West South Central, and Pacific regions
will experience a slight decrease in payments. The payment decreases
range from a minimum of 0.1 percent (East North Central region) to a
maximum of 0.5 percent (Middle Atlantic region). The mid-range of the
decrease in estimated payments for urban hospices falls within the
Pacific urban region with a 0.3-percent decrease. Rural hospices in the
Pacific region will also experience a slight decrease in payment of 0.7
percent. Therefore, based on an analysis of the wage index changes for
FY 2003, hospices in the urban areas of the North Central (East and
West), South Central (West), and Middle Atlantic regions will be
impacted the most. This payment decrease to these small entities
indicates that this notice will have an 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 0.3 percent, or $12,731,000. Urban
hospices will receive an increase in estimated payments of 0.1 percent
and rural hospices will receive an increase in estimated payments of
2.1 percent. Rural hospices, with exception of the Pacific region,
received the largest increase in payments for FY 2003. We estimate that
rural hospice payments overall will increase by $9,860,000.
Specifically, rural hospices in Puerto Rico are estimated to receive a
13.6-percent increase in payments for FY 2003. This anomaly is due to
an increase in hospital wage data for FY 2002.
Under the Medicare hospice benefit, hospices can provide four
different levels of care days. The majority of the days provided by a
hospice are routine home care days. Therefore, the number of routine
home care days can be used as a proxy for the size of the hospice, that
is, the more days of care provided, the larger the hospice. Using
routine home care days as a proxy for size, our analysis indicates
that, overall, the impact of the wage index update on small hospices
will be positive. For example, the smallest hospices (those that
provide only up to 1,754 days of routine home care) will experience an
approximately 4.2 percent increase in hospice payments as a result of
the wage
[[Page 56113]]
update. Overall, hospices will experience a positive increase in
payments. Therefore, we certify that this rule will not have a
significant impact on a substantial number of small entities, in
accordance with the RFA. Furthermore, the wage index methodology 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 all of the options considered,
the committee agreed on the methodology described in the committee
statement, and it was adopted 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. In developing the
process for updating the wage index in the 1997 final rule, we fully
considered the impact of this methodology on small entities and
attempted to mitigate any potential negative effects.
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. We have determined that this rule will not have a
significant impact on the operations of a substantial number of small
rural hospitals.
Section 202 of the Unfunded Mandates 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, 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 determined that this rule will not have a significant
impact on the operations of a substantial number of small rural
hospitals.
We have reviewed this notice under the threshold criteria of
Executive Order 13132, Federalism, and have determined that this notice
will not have a 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 2003 wage index and determined
the current hospice rates to be budget-neutral. This impact analysis
compares hospice payments using the FY 2002 hospice wage index to the
estimated payments using the FY 2003 wage index. The data used in
developing the quantitative analysis for this notice were obtained from
the March 2002 update of the national claims history file of all bills
submitted during FY 2001. We deleted bills from hospices that have
since closed.
Table C below 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 2002 wage index. Column 4 of Table C is based on FY
2001 claims (for hospices in business during that time period) and
estimates payments to be made to hospices using the FY 2003 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 1,327 hospices
located in urban areas and 854 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 2001. 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 rural areas in the West South Central, Mountain and
Puerto Rico regions, with a 7.2 percent, 2.5 percent, and 13.6 percent
increase, respectively. The greatest decreases in payment are for urban
areas in the Middle Atlantic and Pacific regions.
The breakdown by size, type of ownership, and facility base showed
an increase in payments to almost all hospice programs. Small hospice
programs showed significant increases of about 4 percent, while larger
programs experienced only a negligible increase. In terms of hospice
base, hospital-based hospices showed the greatest estimated payment
increase while hospices affiliated with skilled nursing facilities
showed the smallest amount of payment increase.
Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Payments using Payments using Percent Change
By Geographic Location Number of Routine Home FY 2002 Wage FY 2003 Wage in Hospice
Hospices Care Days in Index in Index in Payments
Thousands Thousands Thousands
(1) (2) (3) (4) (5)
----------------------------------------------------------------------------------------------------------------
All Hospices....................... 2,181 28,249 3,684,027 3,696,758 0.3
Urban Hospices................. 1,327 23,705 3,207,208 3,210,078 0.1
Rural Hospices................. 854 4,545 476,820 486,680 2.1
By Region--Urban:
New England.................... 87 755 116,018 116,611 0.5
Middle Atlantic................ 166 2,651 380,513 378,736 -0.5
South Atlantic................. 184 5,216 755,293 759,251 0.5
[[Page 56114]]
East North Central............. 224 3,861 515,761 515,007 -0.1
East South Central............. 98 1,639 191,446 192,498 0.5
West North Central............. 97 1,443 170,906 170,654 -0.1
West South Central............. 183 3,337 415,324 414,764 -0.1
Mountain....................... 89 1,635 230,315 231,781 0.6
Pacific........................ 171 2,885 410,028 408,742 -0.3
Puerto Rico.................... 28 283 21,604 22,035 2.0
By Region--Rural:
New England.................... 27 84 9,942 9,995 0.5
Middle Atlantic................ 34 200 22,721 22,770 0.2
South Atlantic................. 127 932 99,489 101,282 1.8
East North Central............. 139 675 72,904 73,109 0.3
East South Central............. 88 792 78,897 80,363 1.9
West North Central............. 180 499 53,251 53,931 1.3
West South Central............. 105 707 64,846 69,525 7.2
Mountain....................... 93 336 37,037 37,954 2.5
Pacific........................ 57 293 35,822 35,580 -0.7
Puerto Rico.................... 4 28 1,911 2,171 13.6
Routine Home Care Days:
0-1,754 Days................... 342 309 35,324 36,811 4.2
1,754-4,373 Days............... 445 1,337 149,372 151,600 1.5
4,373-9,681 Days............... 543 3,698 433,227 437,293 0.9
9,681+Days..................... 850 22,540 3,021,406 3,026,583 0.2
Type of Ownership:
Voluntary...................... 1,335 17,593 2,304,550 2,308,749 0.2
Proprietary.................... 626 9,872 1,286,655 1,294,446 0.6
Government..................... 185 646 76,624 77,398 1.0
Other.......................... 35 139 16,199 16,164 -0.2
Hospice Base:
Freestanding................... 960 17,736 2,336,621 2,344,044 0.3
Home Health Agency............. 661 6,184 808,876 810,740 0.2
Hospital....................... 543 4,172 514,913 518,370 0.7
Skilled Nursing Facility....... 17 158 23,617 23,604 -0.1
----------------------------------------------------------------------------------------------------------------
C. Conclusion
Our impact analysis compared hospice payments using the FY 2002
wage index to the estimated payments using the FY 2003 wage index.
Through the analysis, we estimate that total hospice payments will
increase from last year by 0.3 percent, or $12,731.000. Additionally,
we compared estimated payments using the FY 1983 hospice wage index to
estimated payments using the FY 2003 wage index and determined the
current hospice wage index to be budget neutral, as required by the
negotiated rulemaking committee. We have determined that this rule is
not an economically significant rule under Executive Order 12866. We do
believe that this rule will not have a significant economic impact on a
substantial number of small entities, but took any negative effects
into consideration during the negotiated rulemaking process. We have
determined that this rule will not have a significant impact on the
operations of a substantial number of small rural hospitals. Finally,
this rule will have no consequential effect on State, local, or tribal
governments.
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: June 20, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Dated: July 23, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-22018 Filed 8-29-02; 8:45 am]
BILLING CODE 4120-01-P