[Federal Register Volume 62, Number 190 (Wednesday, October 1, 1997)]
[Notices]
[Pages 51536-51550]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-25983]
[[Page 51535]]
_______________________________________________________________________
Part VI
Department of Health and Human Services
_______________________________________________________________________
Health Care Financing Administration
_______________________________________________________________________
Medicare Program; Adjustments to Cost Limits for Skilled Nursing
Facility Inpatient Routine Service Costs; Notice
Medicare Program; Schedules of Limits and Prospectively Determined
Payment Rates for Skilled Nursing Facility Inpatient Routine Service
Costs; Notice
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 /
Notices
[[Page 51536]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[BPD-895-FNC]
RIN 0938-AL15
Medicare Program; Schedules of Limits and Prospectively
Determined Payment Rates for Skilled Nursing Facility Inpatient Routine
Service Costs
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final notice with comment period.
-----------------------------------------------------------------------
SUMMARY: This final notice with comment period sets forth an updated
schedule of limits on skilled nursing facility (SNF) routine service
costs for which payment may be made under the Medicare program and sets
forth an updated schedule of payment rates for low Medicare volume SNFs
that elect to receive prospectively determined payment rates for
routine service costs. Section 1888(a) of the Social Security Act (the
Act) requires that the Secretary update the per diem cost limits for
SNF routine service costs for cost reporting periods beginning on or
after October 1, 1995, and every 2 years thereafter. In addition,
section 1888(d)(4) of the Act requires the Secretary to establish and
publish prospectively determined payment rates at least 90 days prior
to the beginning of the Federal fiscal year (FY) to which such rates
are to be applied.
DATES: Effective date: The schedule of cost limits and the schedule of
prospectively determined payment rates are effective for cost reporting
periods beginning on or after October 1, 1997.
Comment date: Written comments will be considered if we receive
them at the appropriate address, as provided below, no later than 5:00
p.m. on December 1, 1997.
ADDRESSES: Mail written comments (an original and three copies) to the
following address: Health Care Financing Administration, Department of
Health and Human Services, Attention: BPD-895-NC, P.O. Box 7517,
Baltimore, MD 21244-0517.
If you prefer, you may deliver your written comments (one original
and three copies) to one of the following addresses: Room 309-G, Hubert
H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC
20201, or Room C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-
1850.
Comments may also be submitted electronically to the following E-
mail address: [email protected]. E-mail comments must include the
full name and address of the sender and must be submitted to the
referenced address in order to be considered. All comments must be
incorporated in the E-mail message because we may not be able to access
attachments. Electronically submitted comments will be available for
public inspection at the Independence Avenue address, below.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code BPD-895-NC. Comments received timely will be available for
public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document, in Room 309-G of
the Department's offices at 200 Independence Avenue, SW, Washington,
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.
(phone: (202) 690-7890).
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
the Superintendent of Documents, or enclose your Visa or Master Card
number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $8.00. As an alternative, you can view
and photocopy the Federal Register document at most libraries
designated as Federal Depository Libraries and at many other public and
academic libraries throughout the country that receive the Federal
Register.
FOR FURTHER INFORMATION CONTACT: Robert Kuhl, (410) 786-4597.
SUPPLEMENTARY INFORMATION:
I. Background
A. Authority for Establishing Cost Limits and Prospectively Determined
Payment Rates
1. Cost Limits
Sections 1861(v)(1)(A) and 1888 of the Act authorize the Secretary
to set limits on allowable costs incurred by a provider of services for
which payment may be made under Medicare. These limits are based on
estimates of the costs necessary for the efficient delivery of needed
health services. Section 1888(a) of the Act directs the Secretary to
set limits on per diem inpatient routine service costs for hospital-
based and freestanding SNFs by urban or rural area. Implementing
regulations appear at 42 CFR 413.30.
2. Prospectively Determined Payment Rates
Most SNFs are paid on a reasonable cost basis up to the routine
service per diem cost limits described in the previous paragraph.
However, under section 1888(d) of the Act, for cost reporting periods
beginning on or after October 1, 1986, a SNF with fewer than 1,500
Medicare covered days in a given cost reporting period may choose to
receive payment based on a prospectively determined payment rate in the
subsequent cost reporting period. Implementing regulations appear at 42
CFR Part 413, Subpart I.
The rates for the low Medicare volume SNFs are established on a per
diem basis and include payment for the cost of furnishing general
inpatient routine services and capital-related costs associated with
routine services. We are required to publish annual revisions to the
rates at least 90 days before the beginning of the Federal FY to which
the revised rates apply. In addition, under Sec. 413.312(a)(1)(i), we
are required to base the revised rates on the same cost data used to
develop the cost limits that are in effect for that Federal FY.
B. Previously Published Schedules of and Updates to Cost Limits and
Rates
1. Effective for FY 1993
We published a final notice with comment period on October 7, 1992
(57 FR 46177) announcing a schedule of limits for freestanding and
hospital-based SNFs effective for cost reporting periods beginning in
FY 1993. In December 1992, we published section 2828 of the Medicare
Provider Reimbursement Manual (HCFA Pub. 15-1), Transmittal Number 370,
establishing rates effective for cost reporting periods beginning in FY
1993. The same cost report, wage, and inflation data were used to
develop these cost limits and rates. The cost reports used to develop
the FY 1993 cost limits and rates covered cost reporting periods ending
on or after June 30, 1989, through May 31, 1990, for freestanding SNFs
and on or after October 31, 1988, through September 30, 1989, for
hospital-based SNFs. The 1988 hospital wage data and Metropolitan
Statistical Area (MSA) designations, based on pre-1990 census data as
described in the April 1, 1991, notice (56 FR 13319), were used to
develop the wage index that was applicable to the FY 1993 cost limits
and rates. It has been our longstanding
[[Page 51537]]
policy not to make changes in the cost report data or recognize changes
in the wage and MSA data until we publish a Federal Register notice
announcing an update to the SNF cost limits.
2. Effective for FY 1994 and FY 1995
Sections 13503(a)(1) and 13503(b) of the Omnibus Budget
Reconciliation Act of 1993 (OBRA `93) (Public Law 103-66) required that
there be no changes in the FY 1993 SNF routine cost limits and rates
(including adjustments for changes in the wage index or applicable
MSAs) established under section 1888 of the Act for cost reporting
periods beginning during Federal FY 1994 and FY 1995. This 2-year
freeze on the cost limits and rates resulted in a savings to the
Medicare program. These provisions of OBRA `93 were implemented, for
cost limits, in a final notice with comment period on January 6, 1994
(59 FR 762) and, for rates, in section 2828 L of the Provider
Reimbursement Manual (Transmittal 374, December 1993).
3. Effective for FY 1996
Section 13503(a)(2) of OBRA '93 amended section 1888(a) of the Act
and required that an update to the cost limits be provided for cost
reporting periods beginning on or after October 1, 1995 (FY 1996), and
every 2 years thereafter. However, during the FY 1996 legislative
period, reconciliation legislation contained a provision to preserve
the savings from the 2-year freeze by inflating the FY 1993 cost limits
and rates to cost reporting periods beginning in FY 1996, except that
inflation for FY 1994 and FY 1995 would not have been recognized. We
did not believe that it would be appropriate to issue the required
update to the cost limits and rates for cost reporting periods
beginning in FY 1996 until the prospect of this provision becoming law
was known. We determined in April 1996 (7 months into FY 1996) that the
FY 1996 legislative period would not produce a law that included this
provision.
On May 3, 1996, we expedited the issuance of the required update to
the FY 1996 cost limits and rates through a memorandum to all Associate
Regional Administrators (ARAs) for Medicare. We instructed the ARAs to
notify the intermediaries to implement this update. (This memorandum
also included corrections to erroneous projected rates of inflation
used to develop the FY 1990 and FY 1993 cost limits.) This memorandum
contained the monthly inflation factors that were needed to extend the
FY 1993 cost limits and rates to cost reporting periods beginning in FY
1996.
Our policy regarding the methodology used to provide the required
update to the limits and rates for FY 1996 conformed with the update
methodology described below Table IV of the October 7, 1992 notice,
which extends the cost reporting periods affected by the FY 1993 limits
by computing monthly inflation factors beyond those shown in Table IV.
Intermediaries were using this methodology to compute limits and rates
between October 1, 1995, and the issuance of the aforementioned
memorandum. We explained that this update methodology would be used
until a new schedule of limits or other provision is issued.
4. Effective for FY 1997
Section 1888(a) of the Act did not require us to provide an update
to the cost limits for FY 1997. Therefore, we trended the FY 1996 cost
limits and rates to cost reporting periods beginning in FY 1997 using
the latest available rates of inflation.
On August 22, 1996, we issued a memorandum to all ARAs for Medicare
to notify the intermediaries of the cost limits and monthly inflation
factors for cost reporting periods beginning in FY 1997.
On September 3, 1996, we published a final notice with comment
period (61 FR 46466) announcing the schedule of rates effective for
cost reporting periods beginning in FY 1997. That notice represented
the first schedule of rates published in the Federal Register after the
regulations implementing section 1888(d) were issued on July 21, 1995
(60 FR 37590).
C. Cost Limits and Rates Effective for FY 1998
This notice with comment period announces the schedule of cost
limits and rates effective for cost reporting periods beginning in FY
1998, as required under section 1888(a) of the Act. To meet the update
requirement under section 1888(a), we trended the FY 1997 cost limits
and rates to cost reporting periods beginning in FY 1998 using the
latest rates of inflation.
There is, however, increasing concern that post-1990 census data
have not been used in determining MSA designations and wage index
values since our last Federal Register notice was published on October
7, 1992. We believe that the numerous changes to the MSA designations
since we published the FY 1993 cost limits and rates should be
recognized in determining the appropriate wage index values used in
this notice. This notice presents the opportunity to implement these
changes to the wage data and to the MSA designations and conforms with
our longstanding policy to make such changes only in a Federal Register
notice.
This is the first time we have published a combined schedule of
cost limits and rates. Combining the cost limits and rates in one
notice is more economical in that they both utilize the same cost
report data, wage index values, and rates of inflation. In addition,
under section 1888(d) of the Act, an individual provider's
prospectively determined rate may not exceed its applicable cost limit
(see Section III.D. of this notice). This notice, containing cost
limits and rates for cost reporting periods beginning in FY 1998,
allows a provider to more conveniently determine its individual rate
than in previous years.
II. Update of the SNF Schedule of Limits and the Schedule of
Prospectively Determined Rates
Under the authority cited in section I. of this notice, this final
notice with comment period sets forth for cost reporting periods
beginning in FY 1998: (1) an updated schedule of limits on SNF routine
service costs for which payment may be made under the Medicare program;
and (2) an updated schedule of prospectively determined payment rates
for low Medicare volume SNFs that have elected to receive prospective
payments for routine service costs.
The cost limits set forth in Table I and the rates set forth in
Tables II and III of this notice are based on the FY 1997 cost limits
and rates, respectively, trended to cost reporting periods beginning in
FY 1998, using the most recent projections of the rates of inflation or
increase in the costs included in the SNF market basket.
We are continuing to use the HCFA hospital wage data to account for
area wage differences. This is necessary because industry-specific data
needed to calculate a wage index for SNFs are not available. Under
section 106 of the Social Security Act Amendments of 1994 (Public Law
103-432), the Secretary was required to begin collecting data no later
than October 31, 1995, on employee compensation and paid hours of
employment in SNFs for the purpose of constructing a SNF wage index
adjustment to the routine service cost limits. Until this data
collection effort is completed and the data are analyzed, we believe
that hospital wage data provide the best measure of comparable wages
that would also be paid by SNFs, since hospitals and SNFs generally
compete in the same labor
[[Page 51538]]
market for employees. We believe that the use of the hospital wage data
results in an appropriate adjustment to the labor-portion of the costs
based on an appropriate wage index as required under section 1888(a) of
the Act.
For the schedule of cost limits and rates effective with this
notice, we are using wage index values that are based on hospital wage
data from cost reporting periods beginning in FY 1993--the most recent
hospital wage data in effect before the effective date of this notice
and the most recent MSA designations. Accordingly, with the exception
of those wage index values that may be affected by recent corrections
to the 1993 wage data, the wage index values used in this notice are
based on the same wage data as are used to compute the wage index
values for the hospital prospective payment system for discharges
occurring on or after October 1, 1996. (A detailed description of the
methodology used to compute the hospital prospective payment wage index
is set forth in the final rule published in the Federal Register on
August 30, 1996 (61 FR 46166).) While these wage index values are based
on the MSA designations in effect prior to the effective date of this
notice, they do not, however, reflect changes in geographic
classification for certain rural hospitals required under section
1886(d)(8)(B) of the Act or geographic reclassifications based on
decisions of the Medicare Geographic Classification Review Board or the
Secretary under section 1886(d)(10) of the Act. Section 1886 of the Act
applies to hospitals only. Accordingly, as in the past, it would not be
appropriate to recognize changes in the geographic classification of
hospitals for purposes of computing the SNF cost limits even though an
SNF may be part of a medical complex that includes a reclassified
hospital.
III. Provisions of the SNF Schedule of Cost Limits and Prospectively
Determined Payment Rates
The schedule of cost limits set forth below applies to all SNFs,
including those low Medicare volume SNFs that are eligible to receive
the optional prospectively determined payment rate for routine
services. Under Sec. 413.314(d), the operational portion of an SNF's
prospectively determined payment rate, excluding capital-related costs,
cannot exceed its actual routine service cost limit (without regard to
exceptions, exemptions, or retroactive adjustments) in effect at the
time of the election to be paid a prospectively determined payment
rate. The eligibility requirements for receiving prospectively
determined payment rates are specified in subpart I of part 413.
These schedules of cost limits and rates provide for the following:
A. Separate Groupings for Labor-Related and Nonlabor-Related Components
of Per Diem Routine Service Costs
We are retaining the same groupings for the labor-related and
nonlabor-related components of per diem routine service costs as
follows:
1. As described in the October 7, 1992 notice for the FY 1993 cost
limits, separate group means were computed for the labor-related and
nonlabor-related components for hospital-based and freestanding SNFs in
accordance with the MSA or non-MSA designation in effect with that
notice. Each group mean was then multiplied by 112 percent.
2. As described in the September 3, 1996 notice for the FY 1997
rates, separate group means were computed for labor-related, nonlabor-
related, and capital-related components in accordance with the SNF's
census region and MSA or non-MSA designation in effect with that
notice. Each group mean was then multiplied by 105 percent.
B. Adjustment of SNF Labor-Related Data by the Wage Index
We are using a wage index based on 1993 hospital wage data and
post-1990 MSA designations, as discussed in section II of this notice,
to adjust the labor-related portion of the cost limits and rates
contained in this notice for area wage differences.
C. Use of SNF Market Basket
We are trending the FY 1997 cost limits and rates to FY 1998 using
projected cost increases by applying the SNF market basket index. This
market basket index is used to adjust the SNF cost data to reflect cost
increases occurring between the cost reporting periods represented in
the data collection and the midpoints of the cost reporting periods to
which the cost limits and rates apply.
The market basket index is comprised of the most commonly used
categories of SNF routine service expenses. The categories are based
primarily on those used by the National Center for Health Statistics in
its National Nursing Home Surveys.
The categories of expenses are weighted according to the estimated
proportion of SNF routine service costs attributable to each category.
A detailed description of the market basket index is described in the
October 7, 1992 notice for cost limits and the September 3, 1996 notice
for the rates.
In developing the market basket index, we obtained historical and
projected (estimated) rates of change in the price of goods and
services in each category. For cost limit purposes only, estimated
rates of change may be revised, retroactively, based on actual (final)
rates of change. As described in all previous schedules of cost limits,
if the final rate of change in the market basket index for a calendar
year differs from the estimated rate of change by at least 0.3
percentage points, we will adjust the limits. Elsewhere in this issue
of the Federal Register, we are proposing in a separate notice to
eliminate this provision to adjust the limits.
D. Application of the Adjusted Hospital Wage Index to the Labor-Related
Costs
In developing the FY 1997 cost limits and rates, we applied the
wage index to five categories of labor-related costs: wages, employee
benefits, health service costs, business service costs, and
miscellaneous costs. We continue to use this methodology in computing
the FY 1998 cost limits and rates.
For purposes of applying the wage index, employee benefits include
such items as FICA tax, health insurance, life insurance, facility
contributions to employee retirement funds, and all other compensation
that the SNF records in the ``employee health and welfare'' cost center
on its Medicare cost report. Health service costs include the costs of
physician services that are purchased under arrangement from outside
sources. Business service costs include costs of banking, contract
laundry, telephone, and other services that SNFs purchase at retail
from outside suppliers. Miscellaneous costs include various types of
routine operating costs not allocated to any other category of the
market basket.
E. Per Diem Add-On to the Cost Limits and Prospective Rates Effective
for Cost Reporting Periods Beginning in FY 1998
In the October 7, 1992 notice and the September 3, 1996 notice, we
described a per diem add-on to the limits and rates, respectively. This
per diem add-on was developed to take into account the costs associated
with the additional requirements placed on SNFs by the nursing home
reform provisions in section 1819 of the Act, including conducting
nurse aide training and competency evaluation programs, and to
recognize the additional costs due to the universal precaution
requirements of the Occupational Safety and Health Administration
(OSHA).
[[Page 51539]]
The per diem add-on effective for FY 1997 will be trended to cost
reporting periods beginning in FY 1998, using the latest market basket
index. For cost limit purposes, the per diem add-on is $2.27 for cost
reporting periods beginning on or after October 1, 1997. For rate
purposes, the per diem add-on is $2.13 for cost reporting periods
beginning on or after October 1, 1997.
When HCFA updates the SNF cost limits and prospective rates using a
later data base that includes the costs of complying with these
additional requirements, a per diem add-on will no longer be needed
because those updated limits and rates would include these costs.
The following applies to the schedule of cost limits only:
F. Setting of Freestanding SNF Limits
The FY 1997 cost limits for freestanding SNFs were set at 112
percent of the average labor-related and average nonlabor-related costs
of each group, as described in the October 7, 1992 notice. This
methodology is prescribed by section 1888(a) of the Act. We continue to
use this methodology to set the freestanding SNF cost limits contained
in this notice.
G. Setting of Hospital-Based SNF Limits
The FY 1997 cost limits for hospital-based SNFs were set at the
freestanding SNF limit plus 50 percent of the difference between the
freestanding SNF limit and 112 percent of the mean per diem routine
service costs of hospital-based SNFs. This methodology for setting
hospital-based SNF cost limits was described in the October 7, 1992
notice and the January 6, 1994 notice. This methodology is prescribed
by sections 1888(a) and (b) of the Act. We continue to use this
methodology to set the hospital-based SNF cost limits contained in this
notice.
H. Cost-of-Living Adjustments to the Limits for Alaska, Hawaii, Puerto
Rico, and the Virgin Islands
To avoid disadvantaging SNFs located in Alaska, Hawaii, Puerto
Rico, and the Virgin Islands, we will continue to provide a cost-of-
living adjustment to the limits for these areas. This is an adjustment
of the nonlabor-related component of the limit that applies to these
areas, based on the amount of the most recently determined cost-of-
living differentials developed by the Office of Personnel Management.
Since we adjust the labor-related component by the applicable wage
index as discussed in section III.D. of this notice, this cost-of-
living adjustment will apply only to the nonlabor-related component.
I. Exception to Cost Limits
A SNF may request an exception to the cost limits under the
provisions of Sec. 413.30(f). The SNF must make the request to the
appropriate Medicare fiscal intermediary in accordance with section
2530 of the Provider Reimbursement Manual (HCFA Pub. 15-1). An
adjustment may be granted if the costs in excess of the limit are
reasonable, attributable to the circumstances specified in
Sec. 413.30(f)(1) through (f)(8), separately identified by the SNF, and
verified by the intermediary.
J. Use of Classification System for the Limits
The classification system we use is based on whether a SNF is
located within a MSA or in a New England County Metropolitan Area
(NECMA) based on standards published in the Federal Register on March
30, 1990 (55 FR 12154), using Bureau of the Census data or Bureau of
Census estimates made after 1990. The latest standards for developing
MSAs are the ones contained in the March 30, 1990 Federal Register.
The following applies to the schedule of rates only:
K. Use of Classification System for the Rates
We will retain the classification system based on grouping SNFs by
census regions and by urban or rural area designation within the
region. As required by sections 1883(d)(3) and 1886(d)(2)(D) of the
Act, the term ``region'' means one of the 9 census divisions,
comprising the 50 States and the District of Columbus, established by
the Bureau of Census for Statistical and reporting purposes. The term
``urban rate'' means an area within a MSA (as defined by the Office of
Management and Budget (OMB), with exceptions for certain NECMAs, as
described in a notice published in the Federal Register on April 1,
1991 (56 FR 13319)). The term ``rural area'' means an area outside such
an area (MSA).
IV. Methodology for Determining Per Diem Routine Service Cost Limits
and Low Volume Prospective Payment Rates
A. Development of Base Cost Limits and Rates
As discussed in section I of this notice, we trended the FY 1997
cost limits and rates using the latest market basket index, as
discussed in section III.C. of this notice. The annual percentage
increases in the market basket over the previous year that we used for
this projection in this notice are:
1993................................................................3.7
1994................................................................3.4
1995................................................................2.9
1996
...........................................................1
2.7
1997
...........................................................1
3.2
1998
...........................................................1
3.4
1999
...........................................................1
3.6
1 Forecasted increase.
B. Calculation of SNF Limit
1. Components of Limit
For each freestanding group, the freestanding limits for FY 1998
are shown in Table I of this notice. We used the computation below to
determine the hospital-based cost limits shown in Table I.
Cost Limit Data--Hospital-Based SNFs for Cost Reporting Periods
Beginning on or After October 1, 1997
------------------------------------------------------------------------
Rural (non-
112 percent of hospital-based mean cost Urban (MSA) MSA)
------------------------------------------------------------------------
Labor......................................... $166.13 $143.18
Nonlabor...................................... 34.97 23.58
-------------------------
Total..................................... 201.10 166.76
------------------------------------------------------------------------
[[Page 51540]]
Calculation of 50 Percent of Difference Between 112 Percent of Hospital-
Based Mean Cost and Freestanding Limit
------------------------------------------------------------------------
Labor Nonlabor
------------------------------------------------------------------------
Urban (MSA)
------------------------------------------------------------------------
112 Percent of Hospital-Based Mean Cost....... $166.13 $34.97
Freestanding Limit (Table I).................. -91.23 -19.59
Difference................................ 74.90 15.38
50 Percent of Difference.................. 37.45 7.69
Plus Freestanding Limit................... +91.23 +19.59
Hospital-Based Limit (MSA).................... 128.68 27.28
------------------------------------------------------------------------
Rural (Non-MSA)
------------------------------------------------------------------------
112 Percent of Hospital-Based Mean Cost....... $143.18 $23.58
Freestanding Limit (Table I).................. -92.64 -15.64
Difference................................ 50.54 7.94
50 Percent of Difference.................. 25.27 3.97
Plus Freestanding Limit................... +92.64 +15.64
Hospital-Based Limit (Non-MSA)................ 117.91 19.61
------------------------------------------------------------------------
2. Adjustment of Labor-Related Component by Wage Index
To arrive at a labor-adjusted limit for each SNF, we multiply the
labor-related component of the limit for the SNF's group by the wage
index developed from wage levels for hospital workers in the area in
which the SNF is located (see Tables IV and V of this notice). The
adjusted limit that applies to a SNF is the sum of the nonlabor-related
component, plus the adjusted labor-related component, plus the OBRA/
OSHA per diem add-on discussed in section III.E. of this notice.
Example--Calculation of Adjusted Limit for a Freestanding SNF
Located in Dallas, Texas:
Labor-Related Component..................................... $ 91.23 (Table I).
Wage Index.................................................. x 0.9729 (Table IV).
-----------
Adjusted Labor Component.................................... 88.76
Nonlabor-Related Component.................................. +19.59 (Table I).
OBRA/OSHA Per Diem Add-On................................... +2.27 (Sec. III.E.).
-----------
Adjusted Limit.............................................. 110.62
3. Adjustment for Cost Reporting Period
If a facility has a cost reporting period beginning in a month
after October 1, 1997, the intermediary increases the limit that
otherwise would apply to the SNF by the factor from Table VI of this
notice that corresponds to the month and year in which the cost
reporting period begins. Each factor represents the compounded monthly
increase derived from the projected annual increase in the market
basket index and is used to account for inflation in costs that occur
after the date on which the limits are effective.
Example: The following is a computation of a revised limit for the
previously cited SNF that has a cost reporting period that begins
January 1, 1998. The base adjusted limit for the SNF is $110.62. The
revised limit applicable to its cost reporting period $111.56, is
computed as follows:
Individual SNF Adjusted Base Limit........................... $110.62
Adjustment Factor from Table V............................... x 1.0084
6
----------
Revised Limit................................................ 111.56
If a facility uses a cost reporting period that is not 12 months in
duration, a special adjustment factor will be calculated. This is
necessary because projections are computed to the midpoint of a cost
reporting period and the adjustment factors in Table VI of this notice
are based on an assumed 12-month reporting period. For cost reporting
periods of other than 12 months, the calculation is done for the
midpoint of the specific cost reporting period. The SNF's intermediary
will obtain this adjustment factor from HCFA Central Office.
C. Calculation of the Routine Operating Portion of the Rates.
1. Adjustment of Labor-Related Component by Wage Index
a. Urban SNFs. To arrive at a labor adjusted component for the
rates, we multiply the labor-related component of the rate for the
SNF's region (Table II of this notice) by the wage index developed from
wage levels for hospital workers in the area in which the SNF is
located (Table IV of this notice).
b. Rural SNFs. To arrive at a labor adjusted component for the
rates, we multiply the labor-related rate for the SNF's region (Table
III of this notice) by the wage index developed from wage levels for
hospital workers in the state in which the SNF is located (Table V of
this notice).
2. Non-Labor-Related and OBRA/OSHA Per Diem Add-on
The adjusted routine operating portion of the rate that applies to
a SNF is the sum of the nonlabor-related component, plus the labor
adjusted component, plus the OBRA/OSHA per diem add-on discussed in
section III.E. of this notice.
[[Page 51541]]
3. Adjustment for Cost Reporting Period
If a facility has a cost reporting period beginning in a month
after October 1, 1997, the intermediary increases the adjusted routine
operating portion of the rate that otherwise apply to the SNF by the
factor from Table VI of this notice that corresponds to the month and
year in which the cost reporting period begins. Each factor represents
the compounded monthly increase derived from the annual increase in the
market basket index and is used to account for inflation in costs that
occur after the date on which the prospective payment rates are
effective.
If a facility uses a cost reporting period that is not 12 months in
duration, a special adjustment factor is calculated. This is necessary
because market basket increases are computed to the midpoint of a cost
reporting period and the adjustment factors in Table VI of this notice
are based on an assumed 12-month cost reporting period. For cost
reporting periods of other than 12 months, the calculation is done for
the midpoint of the specific cost reporting period. The SNF's
intermediary obtains this adjustment factor from the HCFA Central
Office.
D. Comparison of Provider's Prospective Payment Rate With Provider's
Cost Limit
Below is an example of the calculation of the prospectively
determined payment rate for a provider, including a comparison of the
adjusted routine operating portion of the rate with the applicable
routine operating cost limit applicable to the specific provider. The
capital-related component of the rate is added to the lower of the
SNF's specific cost limit or its adjusted routine operating portion of
the rate to arrive at the provider's actual prospectively determined
payment rate.
Example: In this case, the adjusted cost limit is less than the
adjusted rate for a freestanding SNF located in Providence, Rhode
Island (MSA Region 1), with a cost reporting period beginning January
1, 1998. Therefore, the prospectively determined payment rate for this
SNF is the adjusted limit plus the capital-related component of the
rate ($134.93).
------------------------------------------------------------------------
Labor- Non-labor Capital-
related related related
component component component
------------------------------------------------------------------------
Limit (Table I).................. $91.23 $19.59 ...........
Rate (Table II).................. 120.13 22.91 $10.00
------------------------------------------------------------------------
Calculation of Prospective Payment rate
----------------------------------------------------------------------------------------------------------------
Limit Rate Rate source
----------------------------------------------------------------------------------------------------------------
Labor-Related Component...................... $91.23 $120.13 (Chart above).
Wage Index................................... x 1.1092 x 1.1092 (Table IV).
----------------------------
Adjusted Labor Component..................... 101.19 133.25 .....................................
Non-Labor Component.......................... 19.59 22.91 (Chart above).
OBRA/OSHA Add-on............................. +2.27 +2.13 (Sec III.E.).
----------------------------
Adjusted Limit/Rate.......................... 123.05 $158.29 .....................................
Cost Reporting Year Adjustment Factor........ x 1.00846 x 1.00846 (Table VI).
----------------------------
Revised Limit/Rate........................... 124.09 159.63 .....................................
Capital-Related Component.................... +10.00 (Chart above).
--------------
Prospectively Determined Payment Rate........ 134.09 .....................................
----------------------------------------------------------------------------------------------------------------
V. Schedule of Limits
Under the authority of sections 1861(v)(1)(A) and 1888 of the Act,
the following group per diem limits will apply to the adjusted SNF
inpatient routine service costs paid for under Medicare for cost
reporting periods beginning on or after October 1, 1997. Medicare
fiscal intermediaries will compute the adjusted limits for SNFs using
the methodology set forth in this notice and will notify each SNF of
its applicable limit. These limits, as adjusted by the applicable wage
indexes, cost reporting year adjustments, and adjusted by the OBRA/OSHA
per diem add-on, will remain in effect for cost reporting periods
beginning on or after October 1, 1997, until a new schedule of cost
limits or other provision is issued.
Table I.--SNF Group Limits
[Cost Reporting Periods Beginning On or After 10/1/97]
------------------------------------------------------------------------
Labor- Non-labor *
Location related related
component component
------------------------------------------------------------------------
Freestanding:
MSA Limit................................. $91.23 $19.59
Non-MSA Limit............................. 92.64 15.64
Hospital-Based:
MSA Limit................................. 128.68 27.28
Non-MSA Limit............................. 117.91 19.61
------------------------------------------------------------------------
* The nonlabor portion of the limits for SNFs located in the States of
Alaska and Hawaii, the Commonwealth of Puerto Rico, and the Virgin
Islands will be increased by the following cost-of-living adjustments:
[[Page 51542]]
Adjustment
Area factor
Alaska..................................................... 1.250
Hawaii:
Oahu................................................... 1.225
Kauai.................................................. 1.175
Maui, Lanai and Molokai................................ 1.200
Hawaii (island)........................................ 1.150
Puerto Rico................................................ 1.100
Virgin Islands............................................. 1.125
Table II.--Prospective Rates--MSA Locations Effective October 1, 1997
------------------------------------------------------------------------
Labor- Nonlabor- Capital-
Region \1\ related related related
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH,
RI, VT)......................... $120.13 $22.91 $10.00
2. Middle Atlantic (PA, NJ, NY).. 115.86 20.94 9.79
3. South Atlantic (DE, DC, FL,
GA, MD, NC, SC, VA, WV)......... 103.86 16.70 9.81
4. East North Central (IL, IN,
MI, OH, WI)..................... 98.70 16.40 9.18
5. East South Central (AL, KY,
MS, TN)......................... 99.28 14.61 7.32
6. West North Central (IA, KS,
MN, MO, NE, ND, SD)............. 105.87 17.59 10.23
7. West South Central (AR, LA,
OK, TX)......................... 92.64 14.47 10.06
8. Mountain (AZ, CO, ID, MT, NV,
NM, UT, WY)..................... 110.22 18.83 13.04
9. Pacific (AK, CA, HI, OR, WA).. 100.30 20.56 8.40
------------------------------------------------------------------------
\1\ There are 17 MSAs that have counties in two or more regions. For
each of these MSAs, the region in which a majority of the SNFs are
located determines the regional rate that is paid as shown below. This
is the same methodology as that used to implement the requirements of
section 1886(d)(2)(D) of the Act as they apply to the hospital
prospective payment system.
The MSAs are as follows:
------------------------------------------------------------------------
MSA Region
------------------------------------------------------------------------
Chattanooga, TN-GA......................................... 5
Cincinnati, OH-KY-IN....................................... 4
Columbus, GA-AL............................................ 3
Davenport-Rock Island-Moline, IA-IL........................ 4
Duluth-Superior, MN-WI..................................... 6
Evansville-Henderson, IN-KY................................ 4
Huntington-Ashland, WV-KY-OH............................... 3
Johnson City-Kingsport-Bristol, TN-VA...................... 5
La Crosse, WI-MN........................................... 4
Louisville, KY-IN.......................................... 5
Memphis, TN-AR-MS.......................................... 5
Minneapolis-St. Paul, MN-WI................................ 6
Parkersburg-Marietta, WV-OH................................ 3
St. Louis, MO-IL........................................... 6
Steubenville-Weirton, OH-WV................................ 4
Wheeling, WV-OH............................................ 3
Wilmington-Newark, DE-NJ-MD................................ 3
------------------------------------------------------------------------
Table III.--Prospective Rates--Non-MSA Locations Effective October 1,
1997
------------------------------------------------------------------------
Labor- Nonlabor- Capital-
Region related related related
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH,
RI, VT)......................... $129.68 $21.62 $10.58
2. Middle Atlantic (PA, NJ, NY).. 121.14 17.40 7.94
3. South Atlantic (DE, DC, FL,
GA, MD, NC, SC, VA, WV)......... 114.52 15.56 9.19
4. East North Central (IL, IN,
MI, OH, WI)..................... 108.02 15.08 8.28
5. East South Central (AL, KY,
MS, TN)......................... 108.81 13.70 6.77
6. West North Central (IA, KS,
MN, MO, NE, ND, SD)............. 111.41 14.83 6.66
7. West South Central (AR, LA,
OK, TX)......................... 105.74 13.44 9.22
8. Mountain (AZ, CO, ID, MT, NV,
NM, UT, WY)..................... 110.40 16.18 8.36
9. Pacific (AK, CA, HI, OR, WA).. 123.54 20.74 10.16
------------------------------------------------------------------------
[[Page 51543]]
Table IV.--Wage Index for Urban Areas
------------------------------------------------------------------------
Wage
Urban area (constituent counties or county equivalents) index
------------------------------------------------------------------------
0040 Abilene, TX............................................ 0.8048
Taylor, TX
0060 Aguadilla, PR.......................................... 0.4237
Aguada, PR
Aguadilla, PR
Moca, PR
0080 Akron, OH.............................................. 0.9853
Portage, OH
Summit, OH
0120 Albany, GA............................................. 0.8597
Dougherty, GA
Lee, GA
0160 Albany-Schenectady-Troy, NY............................ 0.8624
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200 Albuquerque, NM........................................ 0.9344
Bernalillo, NM
Sandoval, NM
Valencia, NM
0220 Alexandria, LA......................................... 0.8119
Rapides, LA
0240 Allentown-Bethlehem-Easton, PA......................... 0.9992
Carbon, PA
Lehigh, PA
Northampton, PA
0280 Altoona, PA............................................ 0.9510
Blair, PA
0320 Amarillo, TX........................................... 0.8730
Potter, TX
Randall, TX
0380 AK Anchorage, AK....................................... 1.3224
Anchorage,
0440 Ann Arbor, MI........................................... 1.1662
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450 Anniston, AL........................................... 0.8023
Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI............................ 0.8890
Calumet, WI
Outagamie, WI
Winnebago, WI
0470 Arecibo, PR............................................ 0.4397
Arecibo, PR
Camuy, PR
Hatillo, PR
0480 Asheville, NC.......................................... 0.9334
Buncombe, NC
Madison, NC
0500 Athens, GA............................................. 0.9408
Clarke, GA
Madison, GA
Oconee, GA
0520 Atlanta, GA............................................ 1.0033
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 City-Cape May, NJ............................. 1.1077
Atlantic City, NJ
Cape May, NJ
0600 Augusta-Aiken, GA-SC................................... 0.8836
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640 Austin-San Marcos, TX.................................. 0.9254
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX Williamson, TX
0680 Bakersfield, CA........................................ 1.0189
Kern, CA
0720 Baltimore, MD.......................................... 0.9798
Anne Arundel, MD
Baltimore, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Annes, MD
0733 Bangor, ME............................................. 0.9391
Penobscot, ME
0743 Barnstable-Yarmouth, MA................................ 1.3651
Barnstable, MA
0760 Baton Rouge, LA........................................ 0.8433
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX............................... 0.8576
Hardin, TX
Jefferson, TX
Orange, TX
0860 Bellingham, WA......................................... 1.1317
Whatcom, WA
0870 Benton Harbor, MI...................................... 0.8506
Berrien, MI
0875 Bergen-Passaic, NJ..................................... 1.1785
Bergen, NJ
Passaic, NJ
0880 Billings, MT........................................... 0.9086
Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS......................... 0.8554
Hancock, MS
Harrison, MS
Jackson, MS
0960 Binghamton, NY......................................... 0.8822
Broome, NY
Tioga, NY
1000 Birmingham, AL......................................... 0.9036
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010 Bismarck, ND........................................... 0.7923
Burleigh, ND
Morton, ND
1020 Bloomington, IN........................................ 0.8652
Monroe, IN
1040 Bloomington-Normal, IL................................. 0.8990
McLean, IL
1080 Boise City, ID......................................... 0.9383
Ada, ID
Canyon, ID
1123 Boston-Worcester Lawrence-Lowell-...................... 1.1613
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................................... 0.9522
Boulder, CO
1145 Brazoria, TX........................................... 0.9201
Brazoria, TX
1150 Bremerton, WA.......................................... 1.0901
Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX................... 0.8542
Cameron, TX
1260 Bryan-College Station, TX.............................. 0.8851
Brazos, TX
1280 Buffalo-Niagara Falls, NY.............................. 0.9107
Erie, NY
Niagara, NY
1303 Burlington, VT......................................... 1.0068
Chittenden, VT
Franklin, VT
Grand Isle, VT
1310 Caguas, PR............................................. 0.4573
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320 Canton-Massillon, OH................................... 0.8648
Carroll, OH
Stark, OH
1350 Casper, WY............................................. 0.8821
Natrona, WY
1360 Cedar Rapids, IA....................................... 0.8458
Linn, IA
1400 Champaign-Urbana, IL................................... 0.9391
Champaign, IL
1440 Charleston-North Charleston, SC........................ 0.8963
Berkeley, SC
Charleston, SC
Dorchester, SC
1480 Charleston, WV......................................... 0.9526
Kanawha, WV
Putnam, WV
1520 Charlotte-Gastonia-Rock Hill, NC-SC.................... 0.9620
Cabarrus, NC
Gaston, NC
Lincoln, NC
[[Page 51544]]
Mecklenburg, NC
Rowan, NC
Union, NC
York, SC
1540 Charlottesville, VA.................................... 0.9155
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560 Chattanooga, TN-GA..................................... 0.8847
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580 Cheyenne, WY........................................... 0.7678
Laramie, WY
1600 Chicago, IL............................................ 1.0760
Cook, IL
DeKalb, IL
DuPage, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620 Chico-Paradise, CA..................................... 1.0417
Butte, CA
1640 Cincinnati, OH-KY-IN................................... 0.9570
Dearborn, IN
Ohio, IN
Boone, KY
Campbell, KY
Gallatin, KY
Grant, KY
Kenton, KY
Pendleton, KY
Brown, OH
Clermont, OH
Hamilton, OH
Warren, OH
1660 Clarksville-Hopkinsville, TN-KY........................ 0.7716
Christian, KY
Montgomery, TN
1680 Cleveland-Lorain-Elyria, OH............................ 0.9886
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
Lake, OH
Lorain, OH
Medina, OH
1720 Colorado Springs, CO................................... 0.9341
El Paso, CO
1740 Columbia, MO........................................... 0.8899
Boone, MO
1760 Columbia, SC........................................... 0.9160
Lexington, SC
Richland, SC
1800 Columbus, GA-AL Russell, AL............................ 0.7779
Chattanoochee, GA
Harris, GA
Muscogee, GA
1840 Columbus, OH........................................... 0.9681
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880 Corpus Christi, TX..................................... 0.8881
Nueces, TX
San Patricio, TX
1900 Cumberland, MD-WV...................................... 0.8671
Allegany, MD
Mineral, WV
1920 Dallas, TX............................................. 0.9729
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950 Danville, VA........................................... 0.8497
Danville City, VA
Pittsylvania, VA
1960 Davenport-Rock Island-Moline, IA-IL.................... 0.8388
Scott, IA
Henry, IL
Rock Island, IL
2000 Dayton-Springfield, OH................................. 0.9559
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020 Daytona Beach, FL...................................... 0.8871
Flagler, FL
Volusia, FL
2030 Decatur, AL............................................ 0.8384
Lawrence, AL
Morgan, AL
2040 Decatur, IL............................................ 0.7848
Macon, IL
2080 Denver, CO............................................. 1.0166
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120 Des Moines, IA......................................... 0.8815
Dallas, IA
Polk, IA
Warren, IA
2160 Detroit, MI............................................ 1.0724
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180 Dothan, AL............................................. 0.7740
Dale, AL
Houston, AL
2190 Dover, DE.............................................. 0.8997
Kent, DE
2200 Dubuque, IA............................................ 0.8112
Dubuque, IA
2240 Duluth-Superior, MN-WI................................. 0.9416
St. Louis, MN
Douglas, WI
2281 Dutchess County, NY.................................... 1.0589
Dutchess, NY
2290 Eau Claire, WI......................................... 0.8678
Chippewa, WI
Eau Claire, WI
2320 El Paso, TX............................................ 0.9464
El Paso, TX
2330 Elkhart-Goshen, IN..................................... 0.8801
Elkhart, IN
2335 Elmira, NY............................................. 0.8417
Chemung, NY
2340 Enid, OK............................................... 0.7862
Garfield, OK
2360 Erie, PA............................................... 0.9159
Erie, PA
2400 Eugene-Springfield, OR................................. 1.1271
Lane, OR
2440 Evansville-Henderson, IN-KY............................ 0.8983
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520 Fargo-Moorhead, ND-MN.................................. 0.9045
Clay, MN
Cass, ND
2560 Fayetteville, NC....................................... 0.9007
Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR..................... 0.7220
Benton, AR
Washington, AR
2620 Flagstaff, AZ-UT....................................... 0.9019
Coconino, AZ
Kane, UT
2640 Flint, MI............................................... 1.1248
Genesee, MI
2650 Florence, AL........................................... 0.7938
Colbert, AL
Lauderdale, AL
2655 Florence, SC........................................... 0.8594
Florence, SC
2670 Fort Collins-Loveland, CO.............................. 1.0562
Larimer, CO
2680 Ft. Lauderdale, FL..................................... 1.0548
Broward, FL
2700 Fort Myers-Cape Coral, FL.............................. 0.9032
Lee, FL
2710 Fort Pierce-Port St. Lucie, FL......................... 1.0169
Martin, FL
St. Lucie, FL
2720 Fort Smith, AR-OK...................................... 0.7864
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750 Fort Walton Beach, FL.................................. 0.9192
Okaloosa, FL
2760 Fort Wayne, IN......................................... 0.8800
Adams, IN
Allen, IN
DeKalb, IN
Huntington, IN
Wells, IN
Whitley, IN
2800 Forth Worth-Arlington, TX.............................. 1.0153
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840 Fresno, CA............................................. 1.1183
Fresno, CA
Madera, CA
2880 Gadsden, AL............................................ 0.8881
[[Page 51545]]
Etowah, AL
2900 Gainesville, FL........................................ 0.9434
Alachua, FL
2920 Galveston-Texas City, TX............................... 1.0997
Galveston, TX
2960 Gary, IN............................................... 0.9641
Lake, IN
Porter, IN
2975 Glens Falls, NY........................................ 0.8562
Warren, NY
Washington, NY
2980 Goldsboro, NC.......................................... 0.8393
Wayne, NC
2985 Grand Forks, ND-MN..................................... 0.9011
Polk, MN
Grand Forks, ND
2995 Grand Junction, CO..................................... 0.8336
Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI...................... 1.0119
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040 Great Falls, MT........................................ 0.8681
Cascade, MT
3060 Greeley, CO............................................ 0.9690
Weld, CO
3080 Green Bay, WI.......................................... 0.9038
Brown, WI
3120 Greensboro-Winston-Salem-High Point, NC................ 0.9332
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
3150 Greenville, NC......................................... 0.9078
Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC.................... 0.8927
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180 Hagerstown, MD.......................................... 0.9175
Washington, MD
3200 Hamilton-Middletown, OH................................ 0.9490
Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA........................ 1.0158
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283 Hartford, CT........................................... 1.2367
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285 Hattiesburg, MS........................................ 0.7252
Forrest, MS
Lamar, MS
3290 Hickory-Morganton-Lenoir, NC........................... 0.8626
Alexander, NC
Burke, NC
Caldwell, NC
Catawba, NC
3320 Honolulu, HI........................................... 1.1461
Honolulu, HI
3350 Houma, LA.............................................. 0.7853
Lafourche, LA
Terrebonne, LA
3360 Houston, TX............................................ 1.0000
Chambers, TX
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
3400 Huntington-Ashland, WV-KY-OH........................... 0.9174
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440 Huntsville, AL......................................... 0.8206
Limestone, AL
Madison, AL
3480 Indianapolis, IN....................................... 0.9903
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500 Iowa City, IA.......................................... 0.9361
Johnson, IA
3520 Jackson, MI............................................ 0.9045
Jackson, MI
3560 Jackson, MS............................................ 0.7884
Hinds, MS
Madison, MS
Rankin, MS
3580 Jackson, TN............................................ 0.8288
Chester, TN
Madison, TN
3600 Jacksonville, FL....................................... 0.9086
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605 Jacksonville, NC....................................... 0.7055
Onslow, NC
3610 Jamestown, NY.......................................... 0.7670
Chautaqua, NY
3620 Janesville-Beloit, WI.................................. 0.8645
Rock, WI
3640 Jersey City, NJ........................................ 1.1382
Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA.................. 0.8884
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
Bristol City, VA
Scott, VA
Washington, VA
3680 Johnstown, PA.......................................... 0.8398
Cambria, PA
Somerset, PA
3700 Jonesboro, AR.......................................... 0.7220
Craighead, AR
3710 Joplin, MO............................................. 0.7638
Jasper, MO
Newton, MO
3720 Kalamazoo-Battlecreek, MI.............................. 1.0542
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740 Kankakee, IL........................................... 0.9115
Kankakee, IL
3760 Kansas City, KS-MO..................................... 0.9478
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............................................ 0.9145
Kenosha, WI
3810 Killeen-Temple, TX..................................... 1.0392
Bell, TX
Coryell, TX
3840 Knoxville, TN.......................................... 0.8502
Anderson, TN
Blount, TN
Knox, TN
Loudon, TN
Sevier, TN
Union, TN
3850 Kokomo, IN............................................. 0.8590
Howard, IN
Tipton, IN
3870 La Crosse, WI-MN....................................... 0.8618
Houston, MN
La Crosse, WI
3880 Lafayette, LA.......................................... 0.8163
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920 Lafayette, IN.......................................... 0.8781
Clinton, IN
Tippecanoe, IN
3960 Lake Charles, LA....................................... 0.8034
Calcasieu, LA
3980 Lakeland-Winter Haven, FL.............................. 0.8774
Polk, FL
4000 Lancaster, PA.......................................... 0.9583
Lancaster, PA
4040 Lansing-East Lansing, MI............................... 1.0010
Clinton, MI
Eaton, MI
Ingham, MI
4080 Laredo, TX............................................. 0.7073
Webb, TX
4100 Las Cruces, NM......................................... 0.8497
Dona Ana, NM
4120 Las Vegas, NV-AZ....................................... 1.0870
Mohave, AZ
Clark, NV
[[Page 51546]]
Nye, NV
4150 Lawrence, KS........................................... 0.8597
Douglas, KS
4200 Lawton, OK............................................. 0.8365
Comanche, OK
4243 Lewiston-Auburn, ME.................................... 0.9410
Androscoggin, ME
4280 Lexington, KY.......................................... 0.8293
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320 Lima, OH............................................... 0.8732
Allen, OH
Auglaize, OH
4360 Lincoln, NE............................................ 0.9161
Lancaster, NE
4400 Little Rock-North Little Rock, AR...................... 0.8597
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420 Longview-Marshall, TX.................................. 0.8645
Gregg, TX
Harrison, TX
Upshur, TX
4480 Los Angeles-Long Beach, CA............................. 1.2343
Los Angeles, CA
4520 Louisville, KY-IN...................................... 0.9447
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600 Lubbock, TX............................................ 0.8510
Lubbock, TX
4640 Lynchburg, VA.......................................... 0.8052
Amherst, VA
Bedford City, VA
Bedford, VA
Campbell, VA
Lynchburg City, VA
4680 Macon, GA.............................................. 0.8824
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720 Madison, WI............................................ 1.0021
Dane, WI
4800 Mansfield, OH.......................................... 0.8524
Crawford, OH
Richland, OH
4840 Mayaguez, PR........................................... 0.4215
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880 McAllen-Edinburg-Mission, TX........................... 0.8485
Hidalgo, TX
4890 Medford-Ashland, OR.................................... 1.0068
Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL...................... 0.9068
Brevard, Fl
4920 Memphis, TN-AR-MS...................................... 0.8166
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940 Merced, CA............................................. 1.0660
Merced, CA
5000 Miami, FL.............................................. 0.9938
Dade, FL
5015 Middlesex-Somerset-Hunterdon, NJ....................... 1.0883
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080 Milwaukee-Waukesha, WI................................. 0.9645
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120 Minneapolis-St. Paul, MN-WI............................ 1.0777
Anoka, MN
Carver, MN
Chicago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherburne, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5160 Mobile, AL............................................. 0.7981
Baldwin, AL
Mobile, AL
5170 Modesto, CA............................................ 1.0600
Stanislaus, CA
5190 Monmouth-Ocean, NJ..................................... 1.0833
Monmouth, NJ
Ocean, NJ
5200 Monroe, LA............................................. 0.8211
Ouachita, LA
5240 Montgomery, AL......................................... 0.7876
Autauga, AL
Elmore, AL
Montgomery, AL
5280 Muncie, IN............................................. 0.9714
Delaware, IN
5330 Myrtle Beach, SC....................................... 0.7790
Horry, SC
5345 Naples, FL............................................. 1.0199
Collier, FL
5360 Nashville, TN.......................................... 0.9081
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380 Nassau-Suffolk, NY..................................... 1.3547
Nassau, NY
Suffolk, NY
5483 New Haven-Bridgeport-Stamford-Danbury-................. 1.2704
Waterbury,CT
Fairfield, CT
New Haven, CT
5523 New London-Norwich, CT................................. 1.2262
New London, CT
5560 New Orleans, LA........................................ 0.9294
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John Baptist, LA
St. Tammany, LA
5600 New York, NY........................................... 1.4154
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640 Newark, NJ............................................. 1.1762
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660 Newburgh, NY-PA........................................ 1.0803
Orange, NY
Pike, PA
5720 Norfolk-Virginia Beach-Newport News, VA-NC............. 0.8348
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
5775 Oakland, CA............................................ 1.4991
Alameda, CA
Contra Costa, CA
5790 Ocala, FL.............................................. 0.9105
Marion, FL
5800 Odessa-Midland, TX..................................... 0.8482
Ector, TX
Midland, TX
5880 Oklahoma City, OK...................................... 0.8371
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910 Olympia, WA............................................ 1.0689
Thurston, WA
[[Page 51547]]
5920 Omaha, NE-IA........................................... 0.9480
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945 Orange County, CA...................................... 1.1966
Orange, CA
5960 Orlando, FL............................................ 0.9470
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990 Owensboro, KY.......................................... 0.7575
Daviess, KY
6015 Panama City, FL........................................ 0.8061
Bay, FL
6020 Parkersburg-Marietta, WV-OH............................ 0.7877
Washington, OH
Wood, WV
6080 Pensacola, FL.......................................... 0.8202
Escambia, FL
Santa Rosa, FL
6120 Peoria-Pekin, IL....................................... 0.8905
Peoria, IL
Tazewell, IL
Woodford, IL
6160 Philadelphia, PA-NJ.................................... 1.1237
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200 Phoenix-Mesa, AZ....................................... 0.9810
Maricopa, AZ
Pinal, AZ
6240 Pine Bluff, AR......................................... 0.7886
Jefferson, AR
6280 Pittsburgh, PA......................................... 0.9701
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323 Pittsfield, MA......................................... 1.0552
Berkshire, MA
6340 Pocatelo, ID........................................... 0.8784
Bannock ID
6360 Ponce, PR.............................................. 0.4685
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403 Portland, ME........................................... 0.9619
Cumberland, ME
Sagadahoc, ME
York, ME
6440 Portland-Vancouver, OR-WA.............................. 1.1235
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483 Providence-Warwick-Pawtucket, RI....................... 1.1092
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520 Provo-Orem, UT......................................... 1.0116
Utah, UT
6560 Pueblo, CO............................................. 0.8284
Pueblo, CO
6580 Punta Gorda, FL........................................ 0.8999
Charlotte, FL
6600 Racine, WI............................................. 0.8835
Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC......................... 0.9728
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660 Rapid City, SD......................................... 0.8455
Pennington, SD
6680 Reading, PA............................................ 0.9445
Berks, PA
6690 Redding, CA............................................ 1.1605
Shasta, CA
6720 Reno, NV............................................... 1.1018
Washoe, NV
6740 Richland-Kennewick-Pasco, WA........................... 0.9970
Benton, WA
Franklin, WA
6760 Richmond-Petersburg, VA................................ 0.9194
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........................... 1.1379
Riverside, CA
San Bernardino, CA
6800 Roanoke, VA............................................ 0.8702
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820 Rochester, MN.......................................... 1.0428
Olmsted, MN
6840 Rochester, NY.......................................... 0.9649
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
6880 Rockford, IL........................................... 0.8994
Boone, IL
Ogle, IL
Winnebago, IL
6895 Rocky Mount, NC........................................ 0.8955
Edgecombe, NC
Nash, NC
6920 Sacramento, CA......................................... 1.2351
El Dorado, CA
Placer, CA
Sacramento, CA
6960 Saginaw-Bay City-Midland, MI........................... 0.9612
Bay, MI
Midland, MI
Saginaw, MI
6980 St. Cloud, MN.......................................... 0.9457
Benton, MN
Stearns, MN
7000 St. Joseph, MO......................................... 0.8551
Andrews, MO
Buchanan, MO
7040 St. Louis, MO-IL....................................... 0.9022
Clinton, IL
Jersey, IL
Madison, IL
Monroe, IL
St. Clair, IL
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
7080 Salem, OR.............................................. 0.9728
Marion, OR
Polk, OR
7120 Salinas, CA............................................ 1.3803
Monterey, CA
7160 Salt Lake City-Ogden, UT............................... 0.9677
Davis, UT
Salt Lake, UT
Weber, UT
7200 San Angelo, TX......................................... 0.7577
Tom Green, TX
7240 San Antonio, TX........................................ 0.8390
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320 San Diego, CA.......................................... 1.2134
San Diego, CA
7360 San Francisco, CA...................................... 1.4260
Marin, CA
San Francisco, CA
San Mateo, CA
7400 San Jose, CA........................................... 1.4519
Santa Clara, CA
7440 San Juan-Bayamon, PR................................... 0.4506
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
[[Page 51548]]
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-Paso Robles, CA............. 1.1561
San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA................... 1.1242
Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA............................. 1.3520
Santa Cruz, CA
7490 Santa Fe, NM........................................... 1.0823
Los Alamos, NM
Santa Fe, NM
7500 Santa Rosa, CA......................................... 1.2526
Sonoma, CA
7510 Sarasota-Bradenton, FL................................. 0.9789
Manatee, FL
Sarasota, FL
7520 Savannah, GA........................................... 0.9649
Bryan, GA
Chatham, GA
Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA................... 0.8752
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600 Seattle-Bellevue-Everett, WA........................... 1.1384
Island, WA
King, WA
Snohomish, WA
7610 Sharon, PA............................................. 0.8885
Mercer, PA
7620 Sheboygan, WI.......................................... 0.7764
Sheboygan, WI
7640 Sherman-Denison, TX.................................... 0.8614
Grayson, TX
7680 Shreveport-Bossier City, LA............................ 0.9359
Bossier, LA
Caddo, LA
Webster, LA
7720 Sioux City, IA-NE...................................... 0.8313
Woodbury, IA
Dakota, NE
7760 Sioux Falls, SD........................................ 0.8620
Lincoln, SD
Minnehaha, SD
7800 South Bend, IN......................................... 0.9934
St. Joseph, IN
7840 Spokane, WA............................................ 1.0524
Spokane, WA
7880 Springfield, IL........................................ 0.8671
Menard, IL
Sangamon, IL
7920 Springfield, MO........................................ 0.7823
Christian, MO
Greene, MO
Webster, MO
8003 Springfield, MA........................................ 1.0586
Hampden, MA
Hampshire, MA
8050 State College, PA...................................... 0.9538
Centre, PA
8080 Steubenville-Weirton, OH-WV............................ 0.8266
Jefferson, OH
Brooke, WV
Hancock, WV
8120 Stockton-Lodi, CA...................................... 1.1330
San Joaquin, CA
8140 Sumter, SC............................................. 0.7699
Sumter, SC
8160 Syracuse, NY........................................... 0.9395
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200 Tacoma, WA............................................. 1.0860
Pierce, WA
8240 Tallahassee, FL........................................ 0.8313
Gadsden, FL
Leon, FL
8280 Tampa-St. Petersburg-Clearwater, FL.................... 0.9250
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320 Terre Haute, IN........................................ 0.8591
Clay, IN
Vermillion, IN
Vigo, IN
8360 Texarkana, AR-Texarkana, TX............................ 0.8503
Miller, AR
Bowie, TX
8400 Toledo, OH............................................. 1.0361
Fulton, OH
Lucas, OH
Wood, OH
8440 Topeka, KS............................................. 1.0086
Shawnee, KS
8480 Trenton, NJ............................................ 1.0549
Mercer, NJ
8520 Tucson, AZ............................................. 0.9068
Pima, AZ
8560 Tulsa, OK.............................................. 0.8095
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600 Tuscaloosa, AL......................................... 0.7784
Tuscaloosa, AL
8640 Tyler, TX.............................................. 0.9996
Smith, TX
8680 Utica-Rome, NY......................................... 0.8413
Herkimer, NY
Oneida, NY
8720 Vallejo-Fairfield-Napa, CA............................. 1.3947
Napa, CA
Solano, CA
8735 Ventura, CA............................................ 1.1454
Ventura, CA
8750 Victoria, TX........................................... 0.8393
Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ....................... 0.9993
Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA......................... 1.0151
Tulare, CA
8800 Waco, TX............................................... 0.7772
McLennan, TX
8840 Washington, DC-MD-VA-WV................................ 1.0823
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpepper, 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, IA............................... 0.8705
Black Hawk, IA
8940 Wausau, WI............................................. 1.0323
Marathon, WI
8960 West Palm Beach-Boca Raton, FL......................... 1.0202
Palm Beach, FL
9000 Wheeling, OH-WV........................................ 0.7563
Belmont, OH
Marshall, WV
Ohio, WV
9040 Wichita, KS............................................ 0.9369
Butler, KS
Harvey, KS
Sedgwick, KS
9080 Wichita Falls, TX...................................... 0.8041
Archer, TX
Wichita, TX
9140 Williamsport, PA....................................... 0.8467
Lycoming, PA
9160 Wilmington-Newark, DE-MD............................... 1.1315
New Castle, DE
Cecil, MD
9200 Wilmington, NC......................................... 0.9046
New Hanover, NC
Brunswick, NC
[[Page 51549]]
9260 Yakima, WA............................................. 1.0026
Yakima, WA
9270 Yolo, CA............................................... 1.1444
Yolo, CA
9280 York, PA............................................... 0.9104
York, PA
9320 Youngstown-Warren, OH.................................. 0.9742
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340 Yuba City, CA.......................................... 1.0414
Sutter, CA
Yuba, CA
9360 Yuma, AZ............................................... 0.9497
Yuma, AZ
------------------------------------------------------------------------
Table V.--Wage Index for Rural Areas
------------------------------------------------------------------------
Wage
Nonurban area index
------------------------------------------------------------------------
Alabama...................................................... 0.7122
Alaska....................................................... 1.2444
Arizona...................................................... 0.7928
Arkansas..................................................... 0.6954
California................................................... 1.0002
Colorado..................................................... 0.8092
Connecticut.................................................. 1.2759
Delaware..................................................... 0.9447
Florida...................................................... 0.8668
Georgia...................................................... 0.7653
Hawaii....................................................... 1.0245
Idaho........................................................ 0.8277
Illinois..................................................... 0.7553
Indiana...................................................... 0.8124
Iowa......................................................... 0.7373
Kansas....................................................... 0.7107
Kentucky..................................................... 0.7753
Louisiana.................................................... 0.7232
Maine........................................................ 0.8317
Maryland..................................................... 0.8427
Massachusetts................................................ 1.0070
Michigan..................................................... 0.8830
Minnesota.................................................... 0.8144
Mississippi.................................................. 0.6793
Missouri..................................................... 0.7261
Montana...................................................... 0.8128
Nebraska..................................................... 0.7214
Nevada....................................................... 0.8775
New Hampshire................................................ 0.9745
New Jersey 1................................................. .........
New Mexico................................................... 0.8000
New York..................................................... 0.8558
North Carolina............................................... 0.7950
North Dakota................................................. 0.7358
Ohio......................................................... 0.8332
Oklahoma..................................................... 0.6942
Oregon....................................................... 0.9664
Pennsylvania................................................. 0.8453
Puerto Rico.................................................. 0.4026
Rhode Island1................................................ .........
South Carolina............................................... 0.7668
South Dakota................................................. 0.7063
Tennessee.................................................... 0.7341
Texas........................................................ 0.7462
Utah......................................................... 0.8848
Vermont...................................................... 0.8921
Virginia..................................................... 0.7713
Virgin Islands............................................... 0.5660
Washington................................................... 0.9933
West Virginia................................................ 0.7904
Wisconsin.................................................... 0.8430
Wyoming...................................................... 0.8177
------------------------------------------------------------------------
\1\ All counties within the State are classified urban.
Table VI.--Cost Reporting Year Adjustment Factors \1\
[Effective October 1, 1997]
------------------------------------------------------------------------
The
If a SNF cost reporting period begins: adjustment
factor is:
------------------------------------------------------------------------
Nov. 1, 1997................................................ 1.00285
Dec. 1, 1997................................................ 1.00560
Jan. 1, 1998................................................ 1.00846
Feb. 1, 1998................................................ 1.01149
Mar. 1, 1998................................................ 1.01424
Apr. 1, 1998................................................ 1.01729
May 1, 1998................................................. 1.02025
June 1, 1998................................................ 1.02332
July 1, 1998................................................ 1.02630
Aug. 1, 1998................................................ 1.02939
Sept. 1, 1998............................................... 1.03249
------------------------------------------------------------------------
\1\ Based on compounded projected market basket inflation rates of 3.4
percent for 1998 and 3.6 percent for 1999.
VI. Impact Statement
For notices such as this, we generally prepare a regulatory
flexibility analysis that is consistent with the Regulatory Flexibility
Act (RFA) (5 U.S.C. 601 through 612) unless we certify that a notice
will not have a significant economic impact on a substantial number of
small entities. For purposes of the RFA, all SNFs are considered to be
small entities. Individuals and States are not included in the
definition of a small entity.
This final notice with comment period sets forth an updated
schedule of limits on SNF routine service costs for which payment may
be made under the Medicare program and sets forth an updated schedule
of payment rates for low Medicare volume skilled nursing facilities
that elect to receive prospectively determined payment rates for
routine service costs. Section 1888(a) of the Act requires that the
Secretary update the per diem cost limits for SNF routine service costs
for cost reporting periods beginning on or after October 1, 1995, and
every 2 years thereafter. In addition, section 1888(d)(4) of the Act
requires the Secretary to establish and publish prospectively
determined payment rates at least 90 days prior to the beginning of the
Federal fiscal year to which such rates are to be applied.
This final notice with comment period is the first time we are
publishing a combined schedule of cost limits and rates. Combining the
cost limits and rates in one notice is more economical in that they
both utilize the same cost report data, wage index values, and rates of
inflation. In addition, under section 1888(d) of the Act, an individual
provider's prospectively determined rate may not exceed its applicable
cost limit (see Section III.D. of this notice). This final notice with
comment period, by containing both cost limits and rates for cost
reporting periods beginning FY 1998, allows a provider to more
conveniently determine its individual rate than in previous years.
As required under section 1888(a) and 1888(d) of the Act
respectively, this final notice with comment period sets forth a
revised schedule of SNF per diem cost limits and prospectively
determined payment rates for freestanding and hospital-based SNFs for
cost reporting periods beginning in FY 1998. As explained in this
notice, we have retained the same basic methodology used to compute the
limits and rates effective for cost reporting periods beginning in FY
1997, but we are revising the schedule of limits and rates to reflect
more recent wage data, MSA designations, and inflation data.
The estimated effects of this notice are that (1) the updated cost
limits will result in a loss of savings to the Medicare program of $20
million in FY 1998, and (2) the updated rates will have a negligible
effect. These estimates are the effect of the updating the cost limits
and rates to reflect more recent wage data, MSA designations, and
inflation data compared to just updating the previous (FY 1997) cost
limits or rates only for inflation.
The table below shows the effect of updating the cost limits
contained in this notice in comparison with updating the cost limits
effective for FY 1997 by inflation (the market basket). Specifically,
column (A) of the table shows the estimated total number of SNFs to
which the cost limits effective for FY 1998 will apply. Column (B)
shows the number of SNFs that would exceed the cost limits effective
for FY 1997 updated only for inflation. Column (C) shows the number of
SNFs that would exceed the cost limits contained in this notice.
Implementing the cost limits contained in this notice, as
[[Page 51550]]
compared with maintaining the FY 1997 cost limits updated for
inflation, will result in a small decrease in the number of SNFs with
costs in excess of the limits.
------------------------------------------------------------------------
Number of
Total SNFs Number of SNFs over
to which SNFs over FY 1998
limits FY 1997 limits
effective limits contained
for FY 1998 updated for in this
will apply inflation notice
(column A) (column B) (column C)
------------------------------------------------------------------------
Freestanding SNFs:
Urban (MSA).................. 4873 2353 2331
Rural (non-MSA).............. 1638 900 878
Hospital-Based SNFs: ........... ........... ...........
Urban (MSA).................. 367 301 283
Rural (non-MSA).............. 348 224 217
------------------------------------------------------------------------
We are unable to identify the effects of these provisions on
individual SNFs, but we expect that decreases in the number of SNFs
exceeding the limits generally would result in increases in payments to
those SNFs whose costs would previously have exceeded the limits but
now fall under the limits. The effects of the increase in the limits on
the total revenues of individual SNFs will depend on the SNF's ability
to operate within the cost limits and on the proportion of its revenues
that come from the Medicare program.
For purposes of the RFA, it is our practice not to consider an
economic impact to be significant unless the annual total costs or
revenues of a substantial number of entities will be increased or
decreased by at least 3 percent. Because Medicare payments generally do
not account for a high proportion of SNF revenue, we believe that the
updated SNF limits and rates will not result in a substantial number of
SNFs experiencing significant increases in their total revenues.
Therefore, we have determined, and we certify, that a regulatory
flexibility analysis under the RFA is not required.
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis if a notice such as this may have a significant impact
on the operations of a substantial number of small rural hospitals.
Such an 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 of a Metropolitan
Statistical Area and has fewer than 50 beds.
We have not prepared a rural impact statement since we have
determined that this final notice with comment period will not have a
significant economic impact on the operations of a substantial number
of small rural hospitals.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
VII. Waiver of Proposed Notice
In adopting notices such as this, we ordinarily publish a proposed
notice in the Federal Register with a 60-day period for public comment
as required under section 1871(b)(1) of the Act. However, we may waive
these procedures if we find good cause that prior notice and comment is
impractical, unnecessary, or contrary to the public interest.
As discussed in section II. of this notice, we have used the same
methodology to develop this schedule of limits that was used in setting
the limits published for public comment on October 7, 1992. As
discussed above, section 13503(a)(2) of OBRA' 93 delayed the update to
the schedule of limits until October 1, 1995 and then every 2 years. We
have also used the same methodology to develop this schedule of rates
that was used in setting the rates published for public comment on
September 3, 1996. Section 13503(b) of OBRA' 93 delayed the update to
the schedule of prospectively determined payment rates until October 1,
1995. Thus, in conformance with the clear direction provided in
sections 1861(v)(1) and 1888 of the Act and regulations at Secs. 413.30
and 413.320, this notice announces the update to the schedule of limits
for SNF routine service costs and the update to the schedule of
prospectively determined payment rates for SNF inpatient cost, for cost
reporting periods beginning on or after October 1, 1997. Because the
statute directs that this schedule of limits and this schedule of rates
are effective for cost reporting periods beginning October 1, 1997, and
given that we are making no changes in the methodology used to develop
these limits, we believe it is unnecessary to publish a proposed
notice. Therefore, we find good cause to waive publication of a
proposed notice. However, we are providing a 60-day period for public
comment, as indicated at the beginning of this notice.
VIII. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comments we receive by the date and time specified in the DATES
section of this notice, and, if we proceed with a subsequent document,
we will respond to the comments in that document.
Authority: (Secs. 1102, 1814(b), 1861(v)(1), 1866(a), 1871, and
1888 of the Social Security Act (42 U.S.C. 1302, 1395f(b),
1395x(v)(1), 1395cc(a), 1395hh, and 1395yy); section 13503 of Pub.
L. 103-66 (42 U.S.C. 1395x(v)(1)(B) and 1395yy (note)) and 42 CFR
413.1, 413.24, 413.300 through 413.321).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance)
Dated: September 25, 1997.
Nancy-Ann Min DeParle,
Deputy Administrator, Health Care Financing Administration.
Dated: September 25, 1997.
Donna E. Shalala,
Secretary.
[FR Doc. 97-25983 Filed 9-30-97; 8:45 am]
BILLING CODE 4120-01-P