[Federal Register Volume 64, Number 37 (Thursday, February 25, 1999)]
[Rules and Regulations]
[Pages 9378-9399]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-4506]
[[Page 9377]]
_______________________________________________________________________
Part II
Department of Health and Human Services
_______________________________________________________________________
Health Care Financing Administration
_______________________________________________________________________
42 CFR Part 412
Medicare Program; Changes to the FY 1999 Hospital Inpatient Prospective
Payment Wage Index and Standardized Amounts Resulting From Approved
Requests for Wage Data Revisions; Final Rule
Federal Register / Vol. 64, No. 37 / Thursday, February 25, 1999 /
Rules and Regulations
[[Page 9378]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 412
[HCFA-1049-F]
RIN 0938-AJ26
Medicare Program; Changes to the FY 1999 Hospital Inpatient
Prospective Payment Wage Index and Standardized Amounts Resulting From
Approved Requests for Wage Data Revisions
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule implements revised wage index values,
geographic adjustment factors, operating standardized amounts, and
capital Federal rates for hospitals subject to the inpatient
prospective payment system. These changes result from requests made by
hospitals in response to a final rule with comment period published in
the Federal Register on November 19, 1998. These revisions will be
implemented on a prospective basis.
DATES: Effective date: The provisions of this final rule are effective
March 1, 1999.
FOR FURTHER INFORMATION CONTACT: Stephen Phillips, (410) 786-4531.
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I. Background
Section 1886(d)(3)(E) of the Social Security Act (the Act) requires
that, as part of the methodology for determining prospective payments
to hospitals for inpatient operating costs, the Secretary must adjust
standardized amounts ``for area differences in hospital wage levels by
a factor (established by the Secretary) reflecting the relative
hospital wage level in the geographic area of the hospital compared to
the national average hospital wage level.'' In addition, section
1886(d)(3)(E) of the Act requires that the hospital wage index be
updated annually and that updates or adjustments to the hospital wage
index be budget neutral.
In the July 31, 1998 Federal Register (63 FR 40966), we published
hospital inpatient prospective payment rates and policies for Federal
fiscal year (FY) 1999, including the hospital wage index. The FY 1999
wage index is based on data from Medicare cost reports for cost
reporting periods beginning in FY 1995. These cost report data are
submitted by hospitals and certified by hospitals. Before the
calculation of the FY 1999 hospital wage index was published on July
31, 1998, we provided opportunities to hospitals to request wage data
revisions and to verify wage data in HCFA's files. We established
deadlines for requesting wage data revisions.
Notwithstanding these deadlines, numerous hospitals contacted us to
request revisions to the data reflected in the FY 1999 hospital wage
index. Many of these requests related to issues arising from hospitals'
failure to properly report costs in the first place and failure to
request revisions, or from hospitals' failure to verify the final wage
data. However, it came to our attention that certain aspects of the
development of the FY 1999 wage index may have led to some confusion
among the hospital community.
In light of the totality of the circumstances, in the November 19,
1998 Federal Register (63 FR 64191), we provided hospitals with an
additional opportunity to request limited types of revisions to the
wage data used to calculate the FY 1999 hospital wage index.
II. Provisions of the November 19, 1998 Final Rule With Comment
Period
A. Criteria for Requesting Revisions and Explanation of the Types of
Revisions
We provided a window of opportunity, from November 19, 1998 until
December 3, 1998, for hospitals to request revisions to their FY 1995
wage data, if they met one of the following criteria:
The hospital's data on the May 1998 public use file is
recorded as zero on Line 28 of Worksheet S-3, Part III (wage-related
costs).
The hospital's data on the May 1998 public use file is
recorded as zero in either column 3 or 4 (but not both), with nonzero
data in the other column, for Lines 2, 4, 6, or 33 of Worksheet S-3,
Part III.
The hospital properly requested a wage data revision by
March 9, 1998, the fiscal intermediary approved a revision (as
reflected in a revised Worksheet S-3), but the fiscal intermediary or
HCFA made a data entry or tabulation error.
B. Rationale for Accepting Limited Types of Revisions
As we stated in the November 19, 1998 final rule with comment
period (63 FR 64193), we provided for these limited revisions because
of the totality of the circumstances, including--
The number of hospitals contacting us about the same types
of problems;
The hardship that might result for a number of hospitals
if we did not revise the wage data;
The changes to the Medicare cost report, reflected for the
first time in the FY 1999 wage index;
The revised statutory timetable for publishing the
proposed and final hospital inpatient prospective payment system rules,
effective for the first time for FY 1999 (see section 4644 of the
Balanced Budget Act of 1997); and
The revised timetable for finalizing wage data (including
the revised timetable for releasing the final public use wage data file
and the revised timetable for requesting corrections of data entry and
tabulation errors), applied for the first time in developing the FY
1999 wage index.
[[Page 9379]]
None of these factors, by itself, would be sufficient grounds for
making a mid-year revision. For example, we believe we should not make
a wage index revision merely because a single individual hospital might
receive significantly lower payments as a result of its failure to
properly report costs or its failure to properly request revisions and
verify data. In deciding which types of revisions we would allow, we
considered the factors above not only in combination with each other,
but also in light of the previous opportunities we provided to
hospitals to verify data and request revisions.
We evaluated the totality of the circumstances and decided it was
appropriate to make limited types of revisions. As indicated above, we
believe most problems with wage data arise because hospitals fail to
properly report costs on the cost report, fail to properly request
revisions, or fail to verify the data that the intermediary and HCFA
are using to calculate the wage index. We believed that it was only
necessary or appropriate to consider requests for revisions to the FY
1995 wage data from hospitals who met certain criteria. We noted in the
November 19, 1998 final rule with comment period that, if we permitted
hospitals to request any and all revisions, it would take longer for
hospitals to receive revised wage index values for FY 1999.
Also, we emphasize that this final rule should not be construed as
an acknowledgment that the development of the FY 1999 wage index, as
reflected in the July 31, 1998 Federal Register, was in any way unfair
or unreasonable. Moreover, it should not be construed as an
acknowledgment that mid-year corrections may be appropriate in other
contexts or in other years. Many of our policies reflect balancing the
competing considerations of finality, accuracy, and certainty, and many
aspects of developing payment rates and policies require the use of the
best data available at the time. As stated above, we provided for
limited wage data revisions for FY 1999 because of the totality of the
circumstances in this context.
In addition to the requests for wage data revisions, the November
19, 1998 document provided a 30-day period for public comment, which
ended on December 21, 1998. We received 150 requests from hospitals for
wage data revisions. We also received 12 comments. The actions we took
with regard to these requests and a discussion of the comments we
received follow.
III. Provisions of the Final Rule
A. Implementation of Wage Index Revisions
We reviewed each of the wage data revision requests and the
supporting documentation. If necessary, we contacted the hospital's
fiscal intermediary for additional verification.
Of the 150 requests, we approved full wage data revisions for 101
hospitals. An additional seven hospitals were granted a partial
revision. Requests from 35 hospitals did not meet the criteria for
revision as stated in the November 19 final rule with comment period
and, therefore, were denied. Of the remaining seven requests, we found
that five of the requested wage data revisions were already reflected
in the wage index published in the July 31, 1998 final rule. Two
hospitals withdrew their requests; one determined there was no error in
its data, and the other determined that it would not benefit from the
requested revision.
For each hospital whose wage data were revised, we calculated a
revised average hourly wage following the same methodology described in
the July 31, 1998 final rule (63 FR 40972). We also calculated a
revised national average hourly wage of $20.7771. (The national average
hourly wage in the July 31, 1998 final rule was $20.7325.) As we noted
in the November 19, 1998 final rule with comment period (63 FR 64193),
revising the wage data for some hospitals affects the wage index for
all hospitals, including hospitals that did not request revisions. This
is because the hospital wage index measures relative wage levels across
geographic areas, and reflects the average hourly wage in each labor
market area as well as the national average hourly wage. Thus, since
the revised national average hourly wage is different from that
published in the July 31, 1998 final rule, we must calculate revised
wage index values for all labor market areas. The wage index values for
each labor market area were recalculated by dividing the area's average
hourly wage by the revised national average hourly wage of $20.7771.
Payments to hospitals under the capital prospective payment system
are adjusted for local cost variation based on the hospital wage index
value that is applicable to the hospital (42 FR 413.316). The
adjustment factor equals the hospital wage index applicable to the
hospital raised to the .6848 power, and is applied to 100 percent of
the Federal rate. Therefore, because hospitals' wage index values are
revised as a result of this final rule, the capital geographic
adjustment factor (GAF) is also revised.
For hospitals that have received an adjustment to their wage data
under this window of opportunity, the revised average hourly wages are
set forth in Table 3C of this document. Tables 4A through 4C show the
new wage index values and GAFs applicable for all hospitals effective
for discharges occurring on or after March 1, 1999. Table 4D and 4E
show the revised Metropolitan Statistical Area (MSA) average hourly
wages. Table 4F shows the revised Puerto Rico specific wage index
values and GAFs.
B. Comments and Responses
We received 12 comments in response to our November 19, 1998 final
rule with comment period. Several comments we received concerned the
treatment of the wage data for specific hospitals. These comments were
submitted on behalf of hospitals located in the same labor market area
as a hospital that filed a revision request and supported that
hospital's request for a wage data revision. Other commenters were
critical of the policy set forth in the November 19, 1998 final rule
with comment.
Comment: Several commenters wrote to oppose our policy to apply the
revisions to the wage indexes prospectively. These commenters believe
that we are unfairly penalizing hospitals who qualified for a revision
by not making the changes effective retroactively. The commenters
referred to the negative financial impact upon affected hospitals from
this prospective only policy.
Response: It has been our longstanding policy to make revisions to
the wage index only on a prospective basis. (See, for example, 60 FR
45795 (September 1, 1995), 54 FR 36478 (September 1, 1989), 53 FR 38496
(September 30, 1988), and 49 FR 258 (January 1, 1984).) We believe it
is consistent with the principles of the prospective payment system to
implement these changes in such a way that they do not affect payments
already made to hospitals. Applying changes to the wage index
retroactively would violate the prospective nature of the system. We
note that we could have decided not to permit mid-year revisions at
all.
Comment: We received two comments requesting that we remove from
the wage data file the wage data for two hospitals that are now closed.
The commenters are concerned that because the hospitals are closed,
they could not have requested wage data revisions during the usual wage
index process.
[[Page 9380]]
Response: This comment does not address the provisions of the
November 19, 1998 final rule with comment period. Nevertheless, we note
that we responded to a similar comment in the September 1, 1994 Federal
Register (59 FR 45353). As we explained in that document, we believe it
is appropriate to include the data of a hospital that has closed but
was in operation during the data collection period, because the
hospital's data reflects conditions occurring in the labor market area
during the period. However, we do remove wage data for a closed
hospital if the data appear to be aberrant based on our edits and we
are not able to verify the accuracy of those data because the
documentation is unavailable due to the hospital's closure. Regarding
the two hospitals specifically addressed by the commenters, we did not
remove their data from the FY 1999 wage index because the data did not
appear to be aberrant.
Comment: One commenter, writing on behalf of a hospital, believes
that we should add another category of revisions to the limited types
of revisions permitted under the November 19, 1998 final rule with
comment period. Specifically, the commenter believes that we should
allow its hospital and ``all other similarly situated hospitals'' to
revise wage data ``to include compensation costs for physicians under
contract.'' The commenter argues that, because we previously excluded
contract physician costs as well as physician compensation costs
incurred by related medical schools, it was ``futile for hospitals to
report those costs on the S-3.'' The commenter also suggests that we
failed to give hospitals ``timely notice'' that the cost data at issue
were ``relevant.'' The commenter further argues that there is ``no
rational basis'' for distinguishing the commenter's situation from
those addressed in the November 19 final rule with comment period, and
that it would be arbitrary and capricious for us not to permit the
revision it seeks. To support these conclusions, the commenter asserts
that two of the reasons for providing mid-year revisions apply equally
to this situation.
Response: We do not agree that we should expand our criteria to
permit mid-year revisions to address situations in which hospitals
failed to report contract physician part A costs or the costs of
physicians employed by the home office or a related organization. The
commenter's analysis reflects a fundamental misunderstanding about the
wage data reporting process and about the considerations underlying our
decision to permit certain types of mid-year revisions.
The commenter argues that, because we did not include contract
physician costs or physician compensation costs incurred by related
medical schools in the wage index calculation for previous fiscal
years, ``it was futile for hospitals to report those costs on the S-
3.'' Citing statements in the September 1, 1994 final rule concerning
the wage index calculation, the commenter also states it would have
been ``fruitless'' to report the costs at issue.
Contrary to the reasoning of the commenter, a hospital's obligation
to properly report wage costs is not limited to those costs that the
hospital believes will be included in the wage index for a given fiscal
year. It is inappropriate for a hospital to engage in selective
reporting; that is, it is inappropriate for a hospital to report some
costs properly and other costs improperly depending on whether the
hospital believes that a particular cost will or will not be included
in the wage index. Hospitals are always required to properly report all
costs.
It is important to distinguish between wage data reporting issues
and wage index methodology issues. The Medicare statute requires annual
updates to the hospital wage index. Hospitals know or should know that
each year we might propose and implement changes to the categories of
wage costs that we include in the wage index. Thus, proper reporting of
all categories of wage data is always ``relevant.''
Significantly, the commenter acknowledged that the inclusion of
contract physician part A costs reflects ``good policy reasons.'' Thus,
the commenter does not object to our policy of including the costs at
issue in the wage index calculation; instead, the commenter complains
because the hospital believed we would not implement this ``better
policy'' and thus the hospital did not properly report the costs. To
the extent the commenter had questions about how to report the costs at
issue, we note (as we did in the July 31, 1998 final rule) that the
cost report instructions at section 2806.3 of the Provider
Reimbursement Manual, Part II, instruct hospitals to include the costs
of physician part A services from related organizations or the home
office on Line 33 of Worksheet S-3.
Thus, we believe that the commenter is wrong to the extent it
argues that it is reasonable for a hospital not to properly report wage
costs because we had previously excluded the costs from the wage index
calculation or because the hospital believed that we would not include
the costs in the future. Similarly, the hospital is wrong to the extent
it suggests that it did not have ``timely notice'' that the cost at
issues would be ``relevant.'' As the discussion above reflects, proper
reporting of costs is always relevant and important, and hospitals are
on notice that each year we might propose and implement changes to the
wage index methodology. In fact, we have addressed the issue of
contract physician costs in particular in several previous Federal
Register documents, so hospitals were on notice that we might revise
the wage index methodology to address these costs. Thus, we believe it
was not reasonable for the hospital to improperly report the costs at
issue.
Moreover, in the November 19, 1998 final rule with comment period,
we emphasized that our decision to permit limited types of mid-year
revisions reflected the ``totality of the circumstances,'' and
reflected a number of factors in combination with each other. With
respect to the situation presented by the commenter, we believe that
the totality of the circumstances and consideration of all the factors
does not dictate adding another category of revisions.
The commenter argues, among other things, that adding this
criterion is consistent with two of the factors underlying the final
rule with comment period: the hardship that a number of hospitals will
incur if data is not corrected and the changes to the Medicare cost
report that were reflected for the first time in the FY 1999 wage
index. The commenter does not mention another important factor that we
cited: the number of hospitals contacting us about the same type of
problem. At the time we developed the November 19, 1998 final rule with
comment period, we had no reason to believe that there might be
widespread problems in the reporting of the costs at issue; even as of
today, we have received very few complaints about this issue. The
commenter asserts that omission of physician compensation data should
have been ``apparent'' to both intermediaries and HCFA. However,
something that might be ``apparent'' on close examination might not be
apparent in the context of developing a wage index that takes place
under extremely tight timelines and involves data for thousands of
hospitals. Moreover, the absence of contract physician costs on a
hospital's cost report, by itself, does not on its face necessarily
indicate a problem with the data.
We decided to permit mid-year revisions because certain issues came
to
[[Page 9381]]
our attention shortly after publication of the July 31 final rule. We
considered the totality of the circumstances, and decided to permit
certain types of mid-year revisions based on the information available
at the time we developed the November 19, 1998 final rule with comment
period. We believe it would be inappropriate and impractical to add
another category of revisions at this point. If we added another
category now, we would have to provide another window of opportunity
for all other similarly situated hospitals to submit requests and
supporting documentation; we would then have to evaluate the requests,
calculate revised wage indexes and, if necessary, calculate revised
standardized amounts (which would affect payments to all hospitals). In
light of all the factors, we believe that at this point in the fiscal
year the interests of finality take precedence over any increased
accuracy that might result from providing another window of opportunity
for revisions. Therefore, we are not adopting the commenter's
suggestion to add another category of revisions.
IV. Other Related Issues
A. Budget Neutrality and Adjustment to Standardized Amounts
Under section 1886(d)(3)(E) of the Act, ``adjustments or updates''
to the hospital wage index for a fiscal year ``shall be made in a
manner that assures that aggregate payments * * * in the fiscal year
are not greater than or less than those that would have been made in
the year without such adjustment.'' Accordingly, to the extent that
changes to the hospital wage index affect aggregate payments, we are
revising the budget neutrality adjustments to the standardized amounts
so that aggregate payments ``are not greater than or less than those
that would have been made in the year without adjustment.'' The budget
neutrality factors and the adjustments to the standardized amounts
described here are effective for discharges occurring on or after March
1, 1999.
The budget neutrality factor for changes to the wage index and DRG
reclassification and recalibration is revised from 0.999006 in the July
31, 1998 final rule (63 FR 41007) to 0.998978. Because of the payment
interaction between wage index changes and the diagnosis-related groups
(DRGs), the budget neutrality factor applied to the Puerto Rico
standardized amounts changes slightly, from 0.998912 to 0.998915.
Also, Sec. 412.308(c)(4)(ii) requires that the Federal capital rate
be adjusted so that any changes resulting from the annual DRG
reclassification and recalibration and changes in the GAF are budget
neutral. As stated in the July 31, 1998 final rule (63 FR 41014), the
incremental change in the national GAF/DRG budget neutrality factor
from FY 1998 to FY 1999 applied to the standard Federal capital payment
rate was 1.0027. The cumulative change in the rate due to this
adjustment was 1.0028. These factors are applicable for all discharges
occurring on or after October 1, 1998 and before March 1, 1999. For
discharges occurring on or after March 1, 1999, the incremental change
applicable to the national GAF/DRG budget neutrality factor is 1.0028,
and the cumulative factor is 1.0029. The factors for Puerto Rico
(incremental and cumulative) are unchanged, thus the Puerto Rico rate
will remain unchanged. The hospital-specific rates will also not be
affected by these changes since it is not based on the GAF/DRG budget
neutrality adjustment.
The revised operating standardized amounts and capital rates are
set forth in Tables 1A and 1C through 1F.
B. The Relationship Between Wage Revisions and the MGCRB Process
Under section 1886(d)(10) of the Act, the Medicare Geographic
Classification Review Board (MGCRB) considers applications by hospitals
to be reclassified to another geographic area for purposes of the wage
index. We stated in the November 19, 1998 final rule with comment
period that, for purposes of evaluating a hospital's application for
reclassification for FY 2000, the MGCRB will use hospitals' average
hourly wages incorporating all of the revisions made at the time the
MGCRB rules on the hospital's application.
V. Waiver of 30-Day Delay in the Effective Date
We ordinarily provide a delay of 30 days in the effective date of a
final rule. However, if adherence to this procedure would be
impracticable, unnecessary, or contrary to the public interest, we may
waive the delay in the effective date. As discussed above, we provided
this process for mid-year revisions because of the totality of the
circumstances arising this year. These circumstances include the number
of hospitals contacting us about the same types of wage data problems
(reflecting apparent confusion about certain aspects of the development
of the FY 1999 wage index) and the hardship that might result if we did
not revise the wage data for these hospitals. If we delayed the
implementation of the revised wage index in order to comply with the
30-day delay requirement, we would diminish the extent to which we
address the potential hardship that might result for certain hospitals.
Therefore, we find good cause to waive the 30-day delay in the
effective date. Thus, the changes set forth in this final rule will be
effective for discharges occurring on or after March 1, 1999. This is
the earliest possible effective date given our need to revise and
distribute the PRICER software reflecting these changes.
VI. Regulatory Impact Statement
We have examined the impacts of this final rule as required by
Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Public
Law 96-354). Executive Order 12866 directs agencies to assess all costs
and benefits of available regulatory alternatives and, when regulation
is necessary, to select regulatory approaches that maximize net
benefits (including potential economic, environmental, public health
and safety effects, distributive impacts, and equity). The RFA requires
agencies to analyze options for regulatory relief of small businesses.
For purposes of the RFA, small entities include small businesses,
nonprofit organizations, and government agencies. Most hospitals and
most other providers and suppliers are small entities, either by
nonprofit status or by having revenues of $5 million or less annually.
For purposes of the RFA, all hospitals are considered to be small
entities.
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. 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 MSA and has fewer
than 50 beds.
In the November 19, 1998 Federal Register, we indicated that the
final rule with comment period rule was major rule as defined in Title
5, United States Code, section 804(2). However, we stated that the
actual impact of that rule could not be determined prior to reviewing
the revision requests. Based upon our analysis of the redistributive
impacts of the revision to the wage index values and GAFs described
below, we have now determined this is not a major rule under that
section. That is, the total impact of payments redistributed from
hospitals whose payments increased to those whose payments decreased
does not exceed $100 million.
[[Page 9382]]
A. Impact of This Final Rule
As we noted above, we received a total of 150 requests for wage
data revisions, of which 108 were approved. Table A displays the
impacts of these changes on the MSAs for the hospitals receiving
revisions. The first column displays the MSA number, the second the MSA
name (or State name in the case of rural areas). The third column is
the area wage index value published in the July 31, 1998 final rule (63
FR 41052), that is effective for discharges occurring on or after
October 1, 1998 and before March 1, 1999. The fourth column is the wage
index value from Table 4A of this final rule that is effective for
discharges occurring on or after March 1, 1999. The fifth column is the
percentage change in the area wage index value.
Despite the fact that these changes generally increased both the
hospital's and its area's average hourly wage, several areas in which
hospitals had data revisions will experience a decrease in their wage
index value from that published in the July 31, 1998 final rule. This
occurs because the resulting change in the area average hourly wage was
less (in percentage terms) than the change in the national average
hourly wage (which increased by 0.2 percent). In addition, one MSA,
Beaumont-Port Arthur, Texas, has a decrease in its wage index value
because its average hourly wage decreased as a result of the revision
to its wage data.
Nonetheless, most labor market areas in Table A have increases in
their wage index values as a result of the wage data revisions. The
largest increases are in Yolo, California (5.6 percent increase), and
Mayaguez, Puerto Rico (5.1 percent increase). The actual increase in
payments for hospitals in these areas will be slightly less because
only the labor-related portion of the standardized amount is adjusted
by the wage index (just over 71 percent of the standardized amount).
Table A.--Wage Index for MSAS With Revised Area Average Hourly Wages
----------------------------------------------------------------------------------------------------------------
Wage index
--------------------------------
MSA No. MSA name October 1, Percent change
1998 March 1, 1999
----------------------------------------------------------------------------------------------------------------
01........................... RURAL ALABAMA.................... 0.7338 0.7326 -0.16
05........................... RURAL CALIFORNIA................. 0.9959 0.9979 0.20
17........................... RURAL KANSAS..................... 0.7330 0.7319 -0.15
32........................... RURAL NEW MEXICO................. 0.8136 0.8269 1.64
45........................... RURAL TEXAS...................... 0.7441 0.7565 1.67
49........................... RURAL VIRGINIA................... 0.7863 0.7857 -0.08
0320......................... AMARILLO, TX..................... 0.8509 0.8517 0.09
0640......................... AUSTIN-SAN MARCOS, TX............ 0.8442 0.8782 4.03
0680......................... BAKERSFIELD, CA.................. 0.9959 0.9979 0.20
0840......................... BEAUMONT-PORT ARTHUR, TX......... 0.9071 0.8659 -4.54
1123......................... BOSTON-WORCESTER-LAWRENCE-LOWELL- 1.1307 1.1288 -0.17
BROCKTON, MA-NH.
1145......................... BRAZORIA, TX..................... 0.8925 0.8928 0.03
1320......................... CANTON-MASSILLON, OH............. 0.8827 0.8813 -0.16
1520......................... CHARLOTTE-GASTONIA-ROCK HILL, NC- 0.9562 0.9686 1.30
SC.
1600......................... CHICAGO, IL...................... 1.0469 1.0461 -0.08
1920......................... DALLAS, TX....................... 0.9364 0.9348 -0.17
2000......................... DAYTON-SPRINGFIELD, OH........... 0.9584 0.9605 0.22
2080......................... DENVER, CO....................... 1.0059 1.0334 2.73
2340......................... ENID, OK......................... 0.7969 0.7983 0.18
2520......................... FARGO-MOORHEAD, ND-MN............ 0.9537 0.9520 -0.18
2670......................... FORT COLLINS-LOVELAND, CO........ 1.0319 1.0770 4.37
2700......................... FORT MYERS-CAPE CORAL, FL........ 0.8936 0.8942 0.07
2800......................... FORT WORTH-ARLINGTON, TX......... 0.9729 0.9727 -0.02
2840......................... FRESNO, CA....................... 1.0409 1.0700 2.80
2920......................... GALVESTON-TEXAS CITY, TX......... 1.0848 1.0894 0.42
2995......................... GRAND JUNCTION, CO............... 0.9099 0.9116 0.19
3360......................... HOUSTON, TX...................... 0.9904 0.9889 -0.15
4080......................... LAREDO, TX....................... 0.7441 0.7565 1.67
4480......................... LOS ANGELES-LONG BEACH, CA....... 1.2070 1.2116 0.38
4680......................... MACON, GA........................ 0.8629 0.8980 4.07
4840......................... MAYAGUEZ, PR..................... 0.4188 0.4401 5.09
4880......................... MCALLEN-EDINBURG-MISSION, TX..... 0.8506 0.8893 4.55
4920......................... MEMPHIS, TN-AR-MS................ 0.8371 0.8361 -0.12
5080......................... MILWAUKEE-WAUKESHA, WI........... 0.9135 0.9356 2.42
5380......................... NASSAU-SUFFOLK, NY............... 1.3579 1.3593 0.10
5600......................... NEW YORK-NEWARK, NY-NJ-PA........ 1.4431 1.4461 0.21
5640......................... NEWARK, NJ....................... 1.0895 1.0914 0.17
5720......................... NORFOLK-VIRGINIA BEACH-NEWPORT 0.8214 0.8275 0.74
NEWS, VA-NC.
5945......................... ORANGE COUNTY, CA................ 1.1472 1.1468 -0.04
6160......................... PHILADELPHIA, PA-NJ.............. 1.1382 1.1370 -0.11
6780......................... RIVERSIDE-SAN BERNADINO, CA...... 1.0141 1.0585 4.38
6920......................... SACRAMENTO, CA................... 1.1864 1.1962 0.83
7160......................... SALT LAKE CITY-OGDEN, UT......... 0.9400 0.9420 0.21
7360......................... SAN FRANCISCO, CA................ 1.3507 1.3563 0.42
7460......................... SAN LUIS OBISPO-ATASCADERO-PASO 1.0739 1.1264 4.89
ROBLES, CA.
7490......................... SANTA FE, NM..................... 0.9623 0.9652 0.30
7680......................... SHREVEPORT-BOSSIER CITY, LA...... 0.9400 0.9386 -0.15
8720......................... VALLEJO-FARIFIELD-NAPA, CA....... 1.2845 1.3311 3.63
8735......................... VENTURA, CA...................... 1.0715 1.0764 0.46
[[Page 9383]]
8840......................... WASHINGTON, DC-MD-VA-WV.......... 1.0812 1.0807 -0.05
9270......................... YOLO, CA......................... 1.0636 1.1233 5.61
----------------------------------------------------------------------------------------------------------------
All other labor market areas' wage index values decrease slightly.
This is because, as noted above, the changes slightly increase the
national average hourly wage from $20.7325 to $20.7771. Therefore, for
areas in which no hospital's average hourly wage was revised, the
area's wage index value decreases slightly because the area's unchanged
average hourly wage is compared to the higher national average hourly
wage. The revision to the wage index is applied only to the labor-
related portion of the standardized amount.
Table B displays the payment impacts for all hospitals.
Specifically, this table compares simulated payments for hospitals
using the wage index and standardized amounts effective with discharges
occurring on or after October 1, 1998 (see the July 31, 1998 final
rule) to simulated payments using the wage index and standardized
amounts published in this final rule. The hospital categories in the
table are identical to those published in the July 31, 1998 final rule
(63 FR 41106). Also, the simulation methodology here is identical to
the methodology described in that final rule. The overall impact is a
0.0 percent change in payments across all hospitals, even though the
average payment per case changes slightly ($1 per case decrease).
Because a $1 per case change in payments is less than 0.1 percent of
total payments, this rounds to 0.0.
The percentage changes across hospital groups are minimal. For the
most part, hospitals receiving revisions are not concentrated in any
particular category; therefore, the impacts are not predictable.
Approximately two-thirds of the wage data revisions approved were for
urban hospitals. This is reflected in the fact that urban hospitals
experience no payment change overall, while rural hospitals experience
a 0.1 percent decrease. Examining urban and rural census divisions,
most categories experience either no change or a 0.1 percent decrease
in payments. For urban hospitals in the Pacific and Mountain census
divisions, payments rise by 0.3 percent and 0.2 percent, respectively.
The largest increase among all categories is for urban hospitals with
fewer than 100 beds that also receive the disproportionate share
adjustment. Payments for this group increase by 0.4 percent.
Because the capital geographic adjustment factors are based upon
the wage indexes, similar impacts will be experienced in capital
payments. In addition, to the extent the Medicare payment methodologies
for other provider types (for example, skilled nursing facilities, home
health agencies, and ambulatory surgical centers) use the hospital wage
index, their payments will likewise be affected. Impacts to these
providers will not be experienced as soon as inpatient hospitals
because these providers' payment rates are updated on different
schedules than inpatient hospital prospective payment rates. Skilled
nursing facilities' payments will be updated using the revised FY 1999
hospital wage index beginning July 1, 1999. Other provider types' will
employ the revised FY 1999 hospital wage index wage index after the end
of the current fiscal year.
Table B.--Impact Analysis of Wage Data Revisions for FY 1999 Operating Prospective Payment System (Payments per
Case)
----------------------------------------------------------------------------------------------------------------
Average
payment per Average
case (for FY payment per
Number of 1999 case (for FY
hospitals discharges 1999 All changes
occuring discharges
before March occuring after
1,1999) March 1, 1999)
(1) (2)\1\ (3)\1\ (4)
----------------------------------------------------------------------------------------------------------------
(BY GEOGRAPHIC LOCATION):
ALL HOSPITALS............................... 4,975 6,707 6,706 0.0
URBAN HOSPITALS............................. 2,810 7,246 7,246 0.0
LARGE URBAN AREAS........................... 1,611 7,758 7,761 0.0
OTHER URBAN AREAS........................... 1,199 6,544 6,540 -0.1
RURAL AREAS................................. 2,165 4,517 4,514 -0.1
BED SIZE (URBAN):
0-99 BEDS................................... 704 4,889 4,894 0.1
100-199 BEDS................................ 937 6,056 6,057 0.0
200-299 BEDS................................ 568 6,851 6,851 0.0
300-499 BEDS................................ 449 7,738 7,737 0.0
500 OR MORE BEDS............................ 152 9,592 9,592 0.0
BED SIZE (RURAL):
0-49 BEDS................................... 1,137 3,701 3,700 0.0
50-99 BEDS.................................. 634 4,207 4,205 -0.1
100-149 BEDS................................ 229 4,662 4,658 -0.1
150-199 BEDS................................ 91 4,894 4,890 -0.1
200 OR MORE BEDS............................ 74 5,704 5,698 -0.1
URBAN BY CENSUS DIVISION:
[[Page 9384]]
NEW ENGLAND................................. 152 7,682 7,673 -0.1
MIDDLE ATLANTIC............................. 425 8,107 8,106 0.0
SOUTH ATLANTIC.............................. 414 6,948 6,946 0.0
EAST NORTH CENTRAL.......................... 476 6,873 6,871 0.0
EAST SOUTH CENTRAL.......................... 162 6,524 6,516 -0.1
WEST NORTH CENTRAL.......................... 189 6,996 6,986 -0.1
WEST SOUTH CENTRAL.......................... 354 6,720 6,719 0.0
MOUNTAIN.................................... 129 6,971 6,982 0.2
PACIFIC..................................... 461 8,245 8,267 0.3
PUERTO RICO................................. 48 3,056 3,058 0.1
RURAL BY CENSUS DIVISION:
NEW ENGLAND................................. 53 5,287 5,282 -0.1
MIDDLE ATLANTIC............................. 80 4,881 4,876 -0.1
SOUTH ATLANTIC.............................. 286 4,694 4,690 -0.1
EAST NORTH CENTRAL.......................... 285 4,553 4,548 -0.1
EAST SOUTH CENTRAL.......................... 269 4,235 4,230 -0.1
WEST NORTH CENTRAL.......................... 500 4,236 4,232 -0.1
WEST SOUTH CENTRAL.......................... 342 4,017 4,021 0.1
MOUNTAIN.................................... 204 4,779 4,778 0.0
PACIFIC..................................... 141 5,643 5,640 -0.1
PUERTO RICO................................. 5 2,370 2,366 -0.2
(BY PAYMENT CATEGORIES):
URBAN HOSPITALS............................. 2,894 7,207 7,207 0.0
LARGE URBAN AREAS........................... 1,698 7,670 7,673 0.0
OTHER URBAN AREAS........................... 1,196 6,530 6,526 -0.1
RURAL AREAS................................. 2,081 4,494 4,491 -0.1
TEACHING STATUS:
NON-TEACHING................................ 3,880 5,450 5,450 0.0
FEWER THAN 100 RESIDENTS.................... 854 7,145 7,144 0.0
100 OR MORE RESIDENTS....................... 241 10,755 10,753 0.0
DISPROPORTIONATE SHARE HOSPITALS (DSH):
NON-DSH..................................... 3,089 5,799 5,798 0.0
URBAN DSH:
100 BEDS OR MORE........................ 1,404 7,843 7,844 0.0
FEWER THAN 100 BEDS..................... 88 5,007 5,028 0.4
RURAL DSH:
SOLE COMMUNITY (SCH).................... 162 4,249 4,247 0.0
REFERRAL CENTERS (RRC).................. 53 5,428 5,422 -0.1
OTHER RURAL DSH HOSP:
100 BEDS OR MORE........................ 60 4,162 4,157 -0.1
FEWER THAN 100 BEDS..................... 119 3,600 3,596 -0.1
URBAN TEACHING AND DSH:
BOTH TEACHING AND DSH....................... 709 8,828 8,827 0.0
TEACHING AND NO DSH......................... 331 7,291 7,289 0.0
NO TEACHING AND DSH......................... 783 6,271 6,275 0.1
NO TEACHING AND NO DSH...................... 1,071 5,612 5,611 0.0
SPECIAL UPDATE HOSPITALS (UNDER SEC. 4401(b) 344 5,236 5,232 -0.1
OF PUBLIC LAW 105-33.......................
RURAL HOSPITAL TYPES:
NONSPECIAL STATUS HOSPITALS................. 888 3,947 3,944 -0.1
RRC......................................... 145 5,286 5,279 -0.1
SCH......................................... 637 4,501 4,501 0.0
MDH......................................... 352 3,753 3,751 0.0
SCH AND RRC................................. 59 5,402 5,399 -0.1
TYPE OF OWNERSHIP:
VOLUNTARY................................... 2,858 6,884 6,883 0.0
PROPRIETARY................................. 671 6,096 6,097 0.0
GOVERNMENT.................................. 1,331 6,209 6,209 0.0
UNKNOWN..................................... 115 7,811 7,819 0.1
MEDICARE UTILIZATION AS A PERCENT OF INPATIENT
DAYS:
0-25........................................ 247 8,754 8,772 0.2
25-50....................................... 1,264 8,127 8,130 0.0
50-65....................................... 1,978 6,134 6,130 -0.1
[[Page 9385]]
OVER 65..................................... 1,371 5,241 5,238 -0.1
UNKNOWN..................................... 115 7,811 7,819 0.1
HOSPITALS RECLASSIFIED BY THE MEDICARE
GEOGRAPHIC REVIEW BOARD:
RECLASSIFICATION STATUS DURING FY98 AND FY99:
RECLASSIFIED DURING:
BOTH FY98 AND FY99...................... 315 5,944 5,942 0.0
URBAN............................... 72 7,302 7,306 0.0
RURAL............................... 243 5,254 5,250 -0.1
RECLASSIFIED DURING:
FY99 ONLY............................... 170 5,427 5,422 -0.1
URBAN............................... 15 8,207 8,203 0.0
RURAL............................... 155 4,960 4,955 -0.1
RECLASSIFIED DURING:
FY98 ONLY............................... 126 6,084 6,079 -0.1
URBAN............................... 53 7,011 7,005 -0.1
RURAL............................... 73 4,188 4,186 -0.1
FY 99 RECLASSIFICATIONS:
ALL RECLASSIFIED HOSP....................... 485 5,763 5,760 -0.1
STAND. AMT. ONLY........................ 94 5,899 5,893 -0.1
WAGE INDEX ONLY......................... 281 5,935 5,935 0.0
BOTH.................................... 47 6,264 6,259 -0.1
NONRECLASS.............................. 4,526 6,786 6,786 0.0
ALL URBAN RECLASSIFIED...................... 87 7,472 7,474 0.0
STAND. AMT. ONLY........................ 26 5,635 5,628 -0.1
WAGE INDEX ONLY......................... 40 8,872 8,884 0.1
BOTH.................................... 21 6,725 6,718 -0.1
NONRECLASSIFIED......................... 2,696 7,249 7,249 0.0
ALL RURAL RECLASSIFIED...................... 398 5,134 5,129 -0.1
STAND. AMT. ONLY........................ 55 4,494 4,491 -0.1
WAGE INDEX ONLY......................... 314 5,194 5,188 -0.1
BOTH.................................... 29 5,231 5,230 0.0
NONRECLASSIFIED......................... 1,767 4,127 4,124 -0.1
OTHER RECLASSIFIED HOSPITALS (SECTION 27 4,714 4,716 0.0
1886(d)(8)(B)).................................
----------------------------------------------------------------------------------------------------------------
\1\ These payment amounts per case do not reflect any estimates of annual case-mix increase.
VII. Tables
This section contains the tables referred to in the preamble to
this final rule. These tables, which apply to discharges occurring on
or after March 1, 1999 replace or update those published in the July
31, 1998 final rule that are effective for discharges occurring on or
after October 1, 1998 and before March 1, 1999.
Table 1A.--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
Large urban areas other areas
----------------------------------------------------------------------------------------------------------------
Labor-related Nonlabor-related Labor-related Nonlabor-related
----------------------------------------------------------------------------------------------------------------
2,783.34................... 1,131.34 2,739.28 1,113.44
----------------------------------------------------------------------------------------------------------------
Table 1C.--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
Large urban areas Other areas
----------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
National........................................ 2,759.94 1,121.83 2,759.94 1,121.83
Puerto Rico..................................... 1,327.81 534.48 1,306.79 526.02
----------------------------------------------------------------------------------------------------------------
[[Page 9386]]
Table 1D.--Capital Standard Federal Payment Rate
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National................................................ 378.10
Puerto Rico............................................. 181.10
------------------------------------------------------------------------
Table 1E.--National Adjusted Operating Standardized Amounts for ``Temporary Relief'' Hospitals, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
Large urban areas Other areas
----------------------------------------------------------------------------------------------------------------
Labor-related Nonlabor-related Labor-related Nonlabor-related
----------------------------------------------------------------------------------------------------------------
2,791.65................... 1,134.72 2,747.46 1,116.76
----------------------------------------------------------------------------------------------------------------
Table 1F.--Adjusted Operating Standardized Amounts for ``Temporary Relief'' Hospitals, in Puerto Rico, Labor/
Nonlabor
----------------------------------------------------------------------------------------------------------------
Large urban areas Other areas
----------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
National........................................ 2,768.18 1,125.18 2,768.18 1,125.18
Puerto Rico..................................... 1,331.77 536.08 1,310.69 527.59
----------------------------------------------------------------------------------------------------------------
Table 3C.--Hospital Average Hourly Wage for Federal Fiscal Year 1999:
Wage Index for Hospitals With Wage Data Revisions
------------------------------------------------------------------------
Average
Provider hourly wage
------------------------------------------------------------------------
010120.................................................. 16.27
050060.................................................. 21.10
050088.................................................. 25.57
050129.................................................. 15.62
050152.................................................. 28.62
050177.................................................. 20.30
050299.................................................. 23.85
050327.................................................. 22.33
050352.................................................. 23.58
050382.................................................. 28.37
050390.................................................. 19.91
050410.................................................. 15.01
050419.................................................. 19.93
050421.................................................. 25.00
050438.................................................. 21.35
050455.................................................. 20.80
050485.................................................. 23.81
050537.................................................. 22.00
050578.................................................. 30.66
050590.................................................. 24.48
050592.................................................. 21.53
050667.................................................. 28.01
050684.................................................. 20.34
050694.................................................. 20.81
060011.................................................. 22.10
060030.................................................. 22.48
060063.................................................. 14.88
100012.................................................. 16.74
100124.................................................. 18.02
110107.................................................. 18.54
140103.................................................. 15.98
140208.................................................. 24.68
170019.................................................. 16.42
170045.................................................. 16.16
170049.................................................. 18.45
190041.................................................. 20.28
220049.................................................. 21.15
250044.................................................. 15.41
310063.................................................. 21.57
320002.................................................. 19.62
320003.................................................. 15.94
[[Page 9387]]
320004.................................................. 17.43
320035.................................................. 27.42
330043.................................................. 26.81
330121.................................................. 15.35
330158.................................................. 26.25
330162.................................................. 27.00
330221.................................................. 29.07
330259.................................................. 23.47
330270.................................................. 31.95
330309.................................................. 24.40
330316.................................................. 28.86
330338.................................................. 20.97
330395.................................................. 33.45
340001.................................................. 21.44
340068.................................................. 16.62
350004.................................................. 18.34
360051.................................................. 23.40
360100.................................................. 17.85
370026.................................................. 16.66
390083.................................................. 21.74
390136.................................................. 15.10
400014.................................................. 9.30
410009.................................................. 23.51
440147.................................................. 17.64
440183.................................................. 20.71
440208.................................................. 17.90
450055.................................................. 14.45
450078.................................................. 12.49
450085.................................................. 16.22
450092.................................................. 14.96
450096.................................................. 16.91
450124.................................................. 21.71
450128.................................................. 15.63
450144.................................................. 16.52
450148.................................................. 22.61
450151.................................................. 15.21
450155.................................................. 17.86
450157.................................................. 15.26
450176.................................................. 16.13
450181.................................................. 14.80
450190.................................................. 27.69
450200.................................................. 18.00
450236.................................................. 14.92
450243.................................................. 12.16
450246.................................................. 20.36
450264.................................................. 17.74
450369.................................................. 14.48
450370.................................................. 11.23
450399.................................................. 13.77
450424.................................................. 16.39
450475.................................................. 16.42
450534.................................................. 18.86
450654.................................................. 12.84
450723.................................................. 18.89
450807.................................................. 12.89
460042.................................................. 17.45
460047.................................................. 19.91
490017.................................................. 16.47
490019.................................................. 16.46
490043.................................................. 23.23
490079.................................................. 16.03
500001.................................................. 21.87
520102.................................................. 20.07
520138.................................................. 19.07
520140.................................................. 19.69
------------------------------------------------------------------------
[[Page 9388]]
Table 4A.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Urban Areas
------------------------------------------------------------------------
Urban area (constituent Wage
counties) index GAF
------------------------------------------------------------------------
0040................ Abilene, TX, Taylor, TX......... 0.8066 0.8631
0060................ Aguadilla, PR, Aguada, PR, 0.4727 0.5986
Aguadilla, PR Moca, PR.
0080................ Akron, OH, Portage, OH, Summit, 0.9933 0.9954
OH.
0120................ Albany, GA, Dougherty, GA, Lee, 0.7975 0.8565
GA.
0160................ Albany-Schenectady-Troy, NY, 0.8610 0.9026
Albany, NY, Montgomery, NY,
Rensselaer, NY, Saratoga, NY,
Schenectady, NY Schoharie, NY.
0200................ Albuquerque, NM, Bernalillo, NM, 0.8613 0.9028
Sandoval, NM, Valencia, NM.
0220................ Alexandria, LA Rapides, LA...... 0.8526 0.8966
0240................ Allentown-Bethlehem-Easton, PA, 1.0204 1.0139
Carbon, PA, Lehigh, PA,
Northampton, PA.
0280................ Altoona, PA, Blair, PA.......... 0.9335 0.9540
0320................ Amarillo, TX, Potter, TX, 0.8517 0.8959
Randall, TX.
0380................ Anchorage, AK, Anchorage, AK.... 1.2979 1.1955
0440................ Ann Arbor, MI, Lenawee, MI, 1.1033 1.0696
Livingston, MI, Washtenaw, MI.
0450................ Anniston, AL, Calhoun, AL....... 0.8658 0.9060
0460................ Appleton-Oshkosh-Neenah, WI, 0.8825 0.9180
Calumet, WI, Outagamie, WI,
Winnebago, WI.
0470................ Arecibo, PR, Arecibo, PR, Camuy, 0.4867 0.6107
PR, Hatillo, PR.
0480................ Asheville, NC, Buncombe, NC, 0.8940 0.9261
Madison, NC.
0500................ Athens, GA, Clarke, GA, Madison, 0.8673 0.9071
GA, Oconee, GA.
0520................ Atlanta, GA,\1\ Barrow, GA, 0.9915 0.9942
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, Atlantic, 1.0355 1.0242
NJ, Cape May, NJ.
0600................ Augusta-Aiken, GA-SC, Columbia, 0.9233 0.9468
GA, McDuffie, GA, Richmond, GA,
Aiken, SC, Edgefield, SC.
0640................ Austin-San Marcos, TX,\1\ 0.8782 0.9149
Bastrop, TX, Caldwell, TX,
Hays, TX, Travis, TX,
Williamson, TX.
0680................ Bakersfield,\2\ CA, Kern, CA.... 0.9979 0.9986
0720................ Baltimore, MD,\1\ Anne Arundel, 0.9642 0.9753
MD, Baltimore, MD, Baltimore
City, MD, Carroll, MD, Harford,
MD, Howard, MD, Queen Anne's,
MD.
0733................ Bangor, ME, Penobscot, ME....... 0.9474 0.9637
0743................ Barnstable-Yarmouth, MA, 1.5382 1.3430
Barnstable, MA.
0760................ Baton Rouge, LA, Ascension, LA, 0.8872 0.9213
East Baton Rouge, LA,
Livingston, LA, West Baton
Rouge, LA.
0840................ Beaumont-Port Arthur, TX, 0.8659 0.9061
Hardin, TX, Jefferson, TX,
Orange, TX.
0860................ Bellingham, WA, Whatcom, WA..... 1.1434 1.0961
0870................ Benton Harbor, MI,\2\ Berrien, 0.8884 0.9222
MI.
0875................ Bergen-Passaic, NJ,\1\ Bergen, 1.1749 1.1167
NJ, Passaic, NJ.
0880................ Billings, MT, Yellowstone, MT... 0.9143 0.9405
0920................ Biloxi-Gulfport-Pascagoula, MS, 0.8276 0.8785
Hancock, MS, Harrison, MS,
Jackson, MS.
0960................ Binghamton, NY, Broome, NY, 0.9059 0.9346
Tioga, NY.
1000................ Birmingham, AL, Blount, AL, 0.9073 0.9356
Jefferson, AL, St. Clair, AL,
Shelby, AL.
1010................ Bismarck, ND, Burleigh, ND, 0.8025 0.8601
Morton, ND.
1020................ Bloomington, IN, Monroe, IN..... 0.8965 0.9279
1040................ Bloomington-Normal, IL, McLean, 0.8851 0.9198
IL.
1080................ Boise City, ID, Ada, ID, Canyon, 0.9190 0.9438
ID.
1123................ Boston-Worcester-Lawrence-Lowell- 1.1288 1.0865
Brockton, MA-NH,\1\ 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, Boulder, 1.0038 1.0026
CO.
1145................ Brazoria, TX, Brazoria, TX...... 0.8928 0.9253
1150................ Bremerton, WA, Kitsap, WA....... 1.1055 1.0711
1240................ Brownsville-Harlingen-San 0.8237 0.8756
Benito, TX, Cameron, TX.
1260................ Bryan-College Station, TX, 0.8066 0.8631
Brazos, TX.
1280................ Buffalo-Niagara Falls, NY, Erie, 0.9587 0.9715
NY,\1\ Niagara, NY.
1303................ Burlington, VT, Chittenden, VT, 0.9596 0.9722
Franklin, VT, Grand Isle, VT.
1310................ Caguas, PR, Caguas, PR, Cayey, 0.4410 0.5708
PR, Cidra, PR, Gurabo, PR, San
Lorenzo, PR.
1320................ Canton-Massillon, OH, Carroll, 0.8813 0.9171
OH, Stark, OH.
1350................ Casper, WY, Natrona, WY......... 0.9150 0.9410
1360................ Cedar Rapids, IA, Linn, IA...... 0.8814 0.9172
1400................ Champaign-Urbana, IL, Champaign, 0.8770 0.9140
IL.
1440................ Charleston-North Charleston, SC, 0.9114 0.9384
Berkeley, SC, Charleston, SC,
Dorchester, SC.
1480................ Charleston, WV, Kanawha, WV, 0.8990 0.9297
Putnam, WV.
1520................ Charlotte-Gastonia-Rock Hill, NC- 0.9686 0.9784
SC,\1\ Cabarrus, NC, Gaston,
NC, Lincoln, NC, Mecklenburg,
NC, Rowan, NC, Stanly, NC,
Union, NC, York, SC.
1540................ Charlottesville, VA, Albemarle, 1.0272 1.0185
VA, Charlottesville City, VA,
Fluvanna, VA, Greene, VA.
1560................ Chattanooga, TN-GA, Catoosa, GA, 0.9074 0.9356
Dade, GA, Walker, GA, Hamilton,
TN, Marion, TN.
1580................ Cheyenne, WY,\2\ Laramie, WY.... 0.8768 0.9139
1600................ Chicago, IL,\1\ Cook, IL, 1.0461 1.0313
DeKalb, IL, DuPage, IL, Grundy,
IL, Kane, IL, Kendall, IL,
Lake, IL, McHenry, IL, Will, IL.
1620................ Chico-Paradise, CA, Butte, CA... 1.0145 1.0099
1640................ Cincinnati, OH-KY-IN,\1\ 0.9595 0.9721
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, 0.8213 0.8739
Christian, KY, Montgomery, TN.
1680................ Cleveland-Lorain-Elyria, OH,\1\ 0.9886 0.9922
Ashtabula, OH, Cuyahoga, OH,
Geauga, OH, Lake, OH, Lorain,
OH, Medina, OH.
1720................ Colorado Springs, CO, El Paso, 0.9390 0.9578
CO.
1740................ Columbia, MO, Boone, MO......... 0.8942 0.9263
[[Page 9389]]
1760................ Columbia, SC, Lexington, SC, 0.9290 0.9508
Richland, SC.
1800................ Columbus, GA-AL Russell, AL, 0.8511 0.8955
Chattahoochee, GA, Harris, GA,
Muscogee, GA.
1840................ Columbus, OH,\1\ Delaware, OH, 0.9781 0.9850
Fairfield, OH, Franklin, OH,
Licking, OH, Madison, OH,
Pickaway, OH.
1880................ Corpus Christi, TX, Nueces, TX, 0.8531 0.8969
San Patricio, TX.
1900................ Cumberland, MD-WV (Maryland 0.8555 0.8986
Hospitals),\2\ Allegany, MD,
Mineral, WV.
1900................ Cumberland, MD-WV (West Virginia 0.8242 0.8760
Hospital), Allegany, MD,
Mineral, WV.
1920................ Dallas, TX,\1\ Collin, TX, 0.9348 0.9549
Dallas, TX, Denton, TX, Ellis,
TX, Henderson, TX, Hunt, TX,
Kaufman, TX, Rockwall, TX.
1950................ Danville, VA, Danville City, VA, 0.9045 0.9336
Pittsylvania, VA.
1960................ Davenport-Moline-Rock Island, IA- 0.8413 0.8884
IL, Scott, IA, Henry, IL, Rock
Island, IL.
2000................ Dayton-Springfield, OH, Clark, 0.9605 0.9728
OH, Greene, OH, Miami, OH,
Montgomery, OH.
2020................ Daytona Beach, FL, Flagler, FL, 0.9134 0.9399
Volusia, FL.
2030................ Decatur, AL, Lawrence, AL, 0.8233 0.8753
Morgan, AL.
2040................ Decatur, IL, Macon, IL.......... 0.8035 0.8609
2080................ Denver, CO,\1\ Adams, CO, 1.0334 1.0228
Arapahoe, CO, Denver, CO,
Douglas, CO, Jefferson, CO.
2120................ Des Moines, IA, Dallas, IA, 0.8475 0.8929
Polk, IA, Warren, IA.
2160................ Detroit, MI,\1\ Lapeer, MI, 1.0544 1.0369
Macomb, MI, Monroe, MI,
Oakland, MI, St. Clair, MI,
Wayne, MI.
2180................ Dothan, AL, Dale, AL, Houston, 0.7892 0.8503
AL.
2190................ Dover, DE, Kent, DE............. 0.9363 0.9559
2200................ Dubuque, IA, Dubuque, IA........ 0.8222 0.8745
2240................ Duluth-Superior, MN-WI, St. 1.0009 1.0006
Louis, MN, Douglas, WI.
2281................ Dutchess County, NY, Dutchess, 0.9883 0.9920
NY.
2290................ Eau Claire, WI,\2\ Chippewa, WI, 0.8711 0.9098
Eau Claire, WI.
2320................ El Paso, TX, El Paso, TX........ 0.9215 0.9456
2330................ Elkhart-Goshen, IN, Elkhart, IN. 0.9368 0.9563
2335................ Elmira, NY,\2\ Chemung, NY...... 0.8588 0.9010
2340................ Enid, OK, Garfield, OK.......... 0.7983 0.8570
2360................ Erie, PA, Erie, PA.............. 0.9271 0.9495
2400................ Eugene-Springfield, OR, Lane, OR 1.1193 1.0802
2440................ Evansville-Henderson, IN-KY, 0.8528 0.8967
Posey, IN, Vanderburgh, IN,
Warrick, IN, Henderson, KY.
2520................ Fargo-Moorhead, ND-MN, Clay, MN, 0.9520 0.9669
Cass, ND.
2560................ Fayetteville, NC, Cumberland, NC 0.8389 0.8867
2580................ Fayetteville-Springdale-Rogers, 0.8614 0.9029
AR, Benton, AR, Washington, AR.
2620................ Flagstaff, AZ-UT, Coconino, AZ, 0.9523 0.9671
Kane, UT.
2640................ Flint, MI, Genesee, MI.......... 1.1031 1.0695
2650................ Florence, AL, Colbert, AL, 0.7676 0.8343
Lauderdale, AL.
2655................ Florence, SC, Florence, SC...... 0.8501 0.8947
2670................ Fort Collins-Loveland, CO, 1.0770 1.0521
Larimer, CO.
2680................ Fort Lauderdale, FL,\1\ Broward, 0.9845 0.9894
FL.
2700................ Fort Myers-Cape Coral, FL, Lee, 0.8942 0.9263
FL.
2710................ Fort Pierce-Port St. Lucie, FL, 1.0241 1.0164
Martin, FL, St. Lucie, FL.
2720................ Fort Smith, AR-OK, Crawford, AR, 0.7623 0.8304
Sebastian, AR, Sequoyah, OK.
2750................ Fort Walton Beach, FL,\2\ 0.8877 0.9217
Okaloosa, FL.
2760................ Fort Wayne, IN, Adams, IN, 0.9047 0.9337
Allen, IN, De Kalb, IN,
Huntington, IN, Wells, IN,
Whitley, IN.
2800................ Fort Worth-Arlington, TX,\1\ 0.9727 0.9812
Hood, TX, Johnson, TX, Parker,
TX, Tarrant, TX.
2840................ Fresno, CA, Fresno, CA, Madera, 1.0700 1.0474
CA.
2880................ Gadsden, AL, Etowah, AL......... 0.8780 0.9148
2900................ Gainesville, FL, Alachua, FL.... 0.9462 0.9628
2920................ Galveston-Texas City, TX, 1.0894 1.0604
Galveston, TX.
2960................ Gary, IN, Lake, IN, Porter, IN.. 0.9462 0.9628
2975................ Glens Falls, NY,\2\ Warren, NY, 0.8588 0.9010
Washington, NY.
2980................ Goldsboro, NC, Wayne, NC........ 0.8530 0.8968
2985................ Grand Forks, ND-MN, Polk, MN, 0.8899 0.9232
Grand Forks, ND.
2995................ Grand Junction, CO, Mesa, CO.... 0.9116 0.9386
3000................ Grand Rapids-Muskegon-Holland, 0.9971 0.9980
MI,\1\ Allegan, MI, Kent, MI,
Muskegon, MI, Ottawa, MI.
3040................ Great Falls, MT, Cascade, MT.... 0.9284 0.9504
3060................ Greeley, CO, Weld, CO........... 0.9457 0.9625
3080................ Green Bay, WI, Brown, WI........ 0.9248 0.9479
3120................ Greensboro-Winston-Salem-High 0.9547 0.9688
Point, NC,\1\ Alamance, NC,
Davidson, NC, Davie, NC,
Forsyth, NC Guilford, NC,
Randolph, NC, Stokes, NC,
Yadkin, NC.
3150................ Greenville, NC, Pitt, NC........ 0.9434 0.9609
3160................ Greenville-Spartanburg-Anderson, 0.9222 0.9460
SC, Anderson, SC, Cherokee, SC,
Greenville, SC, Pickens, SC,
Spartanburg, SC.
3180................ Hagerstown, MD, Washington, MD.. 1.0183 1.0125
3200................ Hamilton-Middletown, OH, Butler, 0.9233 0.9468
OH.
3240................ Harrisburg-Lebanon-Carlisle, PA, 1.0060 1.0041
Cumberland, PA, Dauphin, PA,
Lebanon, PA, Perry, PA.
3283................ Hartford, CT,\1\ \2\ Hartford, 1.2074 1.1378
CT, Litchfield, CT, Middlesex,
CT, Tolland, CT.
3285................ Hattiesburg, MS, Forrest,\2\ MS, 0.7312 0.8070
Lamar, MS.
3290................ Hickory-Morganton-Lenoir, NC, 0.8649 0.9054
Alexander, NC, Burke, NC,
Caldwell, NC, Catawba, NC.
3320................ Honolulu, HI, Honolulu, HI...... 1.1510 1.1011
3350................ Houma, LA, Lafourche, LA, 0.8197 0.8727
Terrebonne, LA.
3360................ Houston, TX,\1\ Chambers, TX, 0.9889 0.9924
Fort Bend, TX, Harris, TX,
Liberty, TX, Montgomery, TX,
Waller, TX.
[[Page 9390]]
3400................ Huntington-Ashland, WV-KY-OH, 0.9647 0.9757
Boyd, KY, Carter, KY, Greenup,
KY, Lawrence, OH, Cabell, WV,
Wayne, WV.
3440................ Huntsville, AL, Limestone, AL, 0.8385 0.8864
Madison, AL.
3480................ Indianapolis, IN,\1\ Boone, IN, 0.9831 0.9884
Hamilton, IN, Hancock, IN,
Hendricks, IN, Johnson, IN,
Madison, IN, Marion, IN,
Morgan, IN, Shelby, IN.
3500................ Iowa City, IA, Johnson, IA...... 0.9481 0.9642
3520................ Jackson, MI, Jackson, MI........ 0.9224 0.9462
3560................ Jackson, MS, Hinds, MS, Madison, 0.8292 0.8796
MS, Rankin, MS.
3580................ Jackson, TN, Madison, TN, 0.8560 0.8990
Chester, TN.
3600................ Jacksonville, FL,\1\ Clay, FL, 0.8900 0.9233
Duval, FL, Nassau, FL, St.
Johns, FL.
3605................ Jacksonville, NC,\2\ Onslow, NC. 0.8112 0.8665
3610................ Jamestown, NY,\2\ Chautauqua, NY 0.8588 0.9010
3620................ Janesville-Beloit, WI, Rock, WI. 0.9051 0.9340
3640................ Jersey City, NJ, Hudson, NJ..... 1.1598 1.1069
3660................ Johnson City-Kingsport-Bristol, 0.8773 0.9143
TN-VA, Carter, TN, Hawkins, TN,
Sullivan, TN, Unicoi, TN,
Washington, TN, Bristol City,
VA, Scott, VA, Washington, VA.
3680................ Johnstown, PA,\2\ Cambria, PA, 0.8664 0.9065
Somerset, PA.
3700................ Jonesboro, AR, Craighead, AR.... 0.7579 0.8271
3710................ Joplin, MO, Jasper, MO, Newton, 0.7873 0.8489
MO.
3720................ Kalamazoo-Battlecreek, MI, 1.1331 1.0893
Calhoun, MI, Kalamazoo, MI, Van
Buren, MI.
3740................ Kankakee, IL, Kankakee, IL...... 0.9418 0.9598
3760................ Kansas City, KS-MO,\1\ Johnson, 0.9645 0.9756
KS, Leavenworth, KS, Miami, KS,
Wyandotte, KS, Cass, MO, Clay,
MO, Clinton, MO, Jackson, MO,
Lafayette, MO, Platte, MO, Ray,
MO.
3800................ Kenosha, WI, Kenosha, WI........ 0.9129 0.9395
3810................ Killeen-Temple, TX, Bell, TX, 1.0109 1.0075
Coryell, TX.
3840................ Knoxville, TN, Anderson, TN, 0.8918 0.9246
Blount, TN, Knox, TN, Loudon,
TN, Sevier, TN, Union, TN.
3850................ Kokomo, IN, Howard, IN, Tipton, 0.9275 0.9498
IN.
3870................ La Crosse, WI-MN, Houston, MN, 0.8913 0.9242
La Crosse, WI.
3880................ Lafayette, LA, Acadia, LA, 0.8293 0.8797
Lafayette, LA, St. Landry, LA,
St. Martin, LA.
3920................ Lafayette, IN, Clinton, IN, 0.8909 0.9239
Tippecanoe, IN.
3960................ Lake Charles, LA, Calcasieu, LA. 0.7674 0.8342
3980................ Lakeland-Winter Haven, FL, Polk, 0.8877 0.9217
FL.
4000................ Lancaster, PA, Lancaster, PA.... 0.9561 0.9697
4040................ Lansing-East Lansing, MI, 1.0090 1.0062
Clinton, MI, Eaton, MI, Ingham,
MI.
4080................ Laredo, TX,\2\ Webb, TX......... 0.7565 0.8261
4100................ Las Cruces, NM, Dona Ana, NM.... 0.8970 0.9283
4120................ Las Vegas, NV-AZ,\1\ Mohave, AZ, 1.1413 1.0947
Clark, NV, Nye, NV.
4150................ Lawrence, KS, Douglas, KS....... 0.8655 0.9058
4200................ Lawton, OK, Comanche, OK........ 0.8697 0.9088
4243................ Lewiston-Auburn, ME, 0.9149 0.9409
Androscoggin, ME.
4280................ Lexington, KY, Bourbon, KY, 0.8506 0.8951
Clark, KY, Fayette, KY,
Jessamine, KY, Madison, KY,
Scott, KY, Woodford, KY.
4320................ Lima, OH, Allen, OH, Auglaize, 0.8949 0.9268
OH.
4360................ Lincoln, NE, Lancaster, NE...... 0.9303 0.9517
4400................ Little Rock-North Little Rock, 0.8534 0.8971
AR, Faulkner, AR, Lonoke, AR,
Pulaski, AR, Saline, AR.
4420................ Longview-Marshall, TX, Gregg, 0.8698 0.9089
TX, Harrison, TX, Upshur, TX.
4480................ Los Angeles-Long Beach, CA,\1\ 1.2116 1.1405
Los Angeles, CA.
4520................ Louisville, KY-IN, Clark, IN, 0.9093 0.9370
Floyd, IN, Harrison, IN, Scott,
IN, Bullitt, KY, Jefferson, KY,
Oldham, KY.
4600................ Lubbock, TX, Lubbock, TX........ 0.8496 0.8944
4640................ Lynchburg, VA, Amherst, VA, 0.8900 0.9233
Bedford, VA, Bedford City, VA,
Campbell, VA, Lynchburg City,
VA.
4680................ Macon, GA, Bibb, GA, Houston, 0.8980 0.9290
GA, Jones, GA, Peach, GA,
Twiggs, GA.
4720................ Madison, WI, Dane, WI........... 1.0018 1.0012
4800................ Mansfield, OH, Crawford, OH, 0.8534 0.8971
Richland, OH.
4840................ Mayaguez, PR, Anasco, PR, Cabo 0.4401 0.5700
Rojo, PR, Hormigueros, PR,
Mayaguez, PR, Sabana Grande,
PR, San German, PR.
4880................ McAllen-Edinburg-Mission, TX, 0.8893 0.9228
Hidalgo, TX.
4890................ Medford-Ashland, OR, Jackson, OR 1.0020 1.0014
4900................ Melbourne-Titusville-Palm Bay, 0.9216 0.9456
FL, Brevard, FL.
4920................ Memphis, TN-AR-MS,\1\ 0.8361 0.8846
Crittenden, AR, DeSoto, MS,
Fayette, TN, Shelby, TN,
Tipton, TN.
4940................ Merced, CA, Merced, CA.......... 1.0218 1.0149
5000................ Miami, FL,\1\ Dade, FL.......... 1.0017 1.0012
5015................ Middlesex-Somerset-Hunterdon, 1.0762 1.0516
NJ,\1\ Hunterdon, NJ,
Middlesex, NJ, Somerset, NJ.
5080................ Milwaukee-Waukesha, WI,\1\ 0.9356 0.9554
Milwaukee, WI, Ozaukee, WI,
Washington, WI, Waukesha, WI.
5120................ Minneapolis-St. Paul, MN-WI,\1\ 1.0854 1.0577
Anoka, MN, Carver, MN, Chisago,
MN, Dakota, MN, Hennepin, MN,
Isanti, MN, Ramsey, MN, Scott,
MN, Sherburne, MN, Washington,
MN, Wright, MN, Pierce, WI, St.
Croix, WI.
5140................ Missoula, MT, Missoula, MT...... 0.9189 0.9437
5160................ Mobile, AL, Baldwin, AL, Mobile, 0.8377 0.8858
AL.
5170................ Modesto, CA, Stanislaus, CA..... 1.0346 1.0236
5190................ Monmouth-Ocean, NJ,\1\ Monmouth, 1.1317 1.0884
NJ, Ocean, NJ.
5200................ Monroe, LA, Quachita, LA........ 0.8219 0.8743
5240................ Montgomery, AL, Autauga, AL, 0.7860 0.8480
Elmore, AL, Montgomery, AL.
5280................ Muncie, IN, Delaware, IN........ 0.9414 0.9595
5330................ Myrtle Beach, SC, Horry, SC..... 0.8179 0.8714
[[Page 9391]]
5345................ Naples, FL, Collier, FL......... 1.0177 1.0121
5360................ Nashville, TN,\1\ Cheatham, TN, 0.9480 0.9641
Davidson, TN, Dickson, TN,
Robertson, TN, Rutherford, TN,
Sumner, TN, Williamson, TN,
Wilson, TN.
5380................ Nassau-Suffolk, NY,\1\ Nassau, 1.3593 1.2339
NY, Suffolk, NY.
5483................ New Haven-Bridgeport-Stamford- 1.2245 1.1488
Waterbury-Danbury, CT,\1\
Fairfield, CT, New Haven, CT.
5523................ New London-Norwich, CT,\2\ New 1.2074 1.1378
London, CT.
5560................ New Orleans, LA,\1\ Jefferson, 0.9310 0.9522
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, Bronx, NY,\1\ 1.4461 1.2874
Kings, NY, New York, NY,
Putnam, NY, Queens, NY,
Richmond, NY, Rockland, NY,
Westchester, NY.
5640................ Newark, NJ,\1\ Essex, NJ, 1.0914 1.0617
Morris, NJ, Sussex, NJ, Union,
NJ, Warren, NJ.
5660................ Newburgh, NY-PA, Orange, NY, 1.1223 1.0822
Pike, PA.
5720................ Norfolk-Virginia Beach-Newport 0.8275 0.8784
News, VA-NC,\1\ 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\ Alameda, CA, 1.5162 1.3298
Contra Costa, CA.
5790................ Ocala, FL, Marion, FL........... 0.9152 0.9411
5800................ Odessa-Midland, TX, Ector, TX, 0.8664 0.9065
Midland, TX.
58801............... Oklahoma City, OK,\1\ Canadian, 0.8708 0.9096
OK, Cleveland, OK , Logan, OK,
McClain, OK, Oklahoma, OK,
Pottawatomie, OK.
5910................ Olympia, WA, Thurston, WA....... 1.1522 1.1019
59 Omaha, NE-IA, Pottawattamie, IA, 0.9972 0.9981
2 Cass, NE, Douglas, NE, Sarpy,
0. NE, Washington, NE.
5945................ Orange County, CA,\1\ Orange, CA 1.1468 1.0983
5960................ Orlando, FL,\1\ Lake, FL, 0.9813 0.9872
Orange, FL, Osceola, FL,
Seminole, FL.
5990................ Owensboro, KY,\2\ Daviess, KY... 0.7844 0.8468
6015................ Panama City, FL,\2\ Bay, FL..... 0.8877 0.9217
6020................ Parkersburg-Marietta, WV-OH 0.8016 0.8595
(West Virginia Hospitals),\2\
Washington, OH, Wood, WV.
6020................ Parkersburg-Marietta, WV-OH 0.8519 0.8960
(Ohio Hospitals),\2\
Washington, OH, Wood, WV.
6080................ Pensacola, FL,\2\ Escambia, FL, 0.8877 0.9217
Santa Rosa, FL.
6120................ Peoria-Pekin, IL, Peoria, IL, 0.8063 0.8629
Tazewell, IL, Woodford, IL.
6160................ Philadelphia, PA-NJ,\1\ 1.1370 1.0919
Burlington, NJ, Camden, NJ,
Gloucester, NJ, Salem, NJ,
Bucks, PA, Chester, PA,
Delaware, PA, Montgomery, PA,
Philadelphia, PA.
6200................ Phoenix-Mesa, AZ,\1\ Maricopa, 0.9591 0.9718
AZ, Pinal, AZ.
6240................ Pine Bluff, AR, Jefferson, AR... 0.7912 0.8518
6280................ Pittsburgh, PA,\1\ Allegheny, 0.9789 0.9855
PA, Beaver, PA, Butler, PA,
Fayette, PA, Washington, PA,
Westmoreland, PA.
6323................ Pittsfield, MA,\2\ Berkshire, MA 1.0834 1.0564
6340................ Pocatello, ID, Bannock, ID...... 0.8792 0.9156
6360................ Ponce, PR, Guayanilla, PR, Juana 0.4788 0.6039
Diaz, PR, Penuelas, PR, Ponce,
PR, Villalba, PR, Yauco, PR.
6403................ Portland, ME, Cumberland, ME, 0.9574 0.9706
Sagadahoc, ME, York, ME.
6440................ Portland-Vancouver, OR-WA,\1\ 1.1178 1.0792
Clackamas, OR, Columbia, OR,
Multnomah, OR, Washington, OR,
Yamhill, OR, Clark, WA.
6483................ Providence-Warwick-Pawtucket, 1.0801 1.0542
RI,\1\ Bristol, RI, Kent, RI,
Newport, RI, Providence, RI,
Washington, RI.
6520................ Provo-Orem, UT, Utah, UT........ 0.9885 0.9921
6560................ Pueblo, CO, Pueblo, CO.......... 0.8712 0.9099
6580................ Punta Gorda, FL, Charlotte, FL.. 0.9031 0.9326
6600................ Racine, WI, Racine, WI.......... 0.9130 0.9396
6640................ Raleigh-Durham-Chapel Hill, 0.9812 0.9871
NC,\1\ Chatham, NC, Durham, NC,
Franklin, NC, Johnston, NC,
Orange, NC, Wake, NC.
6660................ Rapid City, SD, Pennington, SD.. 0.8208 0.8735
6680................ Reading, PA, Berks, PA.......... 0.9234 0.9469
6690................ Redding, CA, Shasta, CA......... 1.1858 1.1238
6720................ Reno, NV, Washoe, NV............ 1.1095 1.0738
6740................ Richland-Kennewick-Pasco,\2\ WA, 1.0489 1.0332
Benton, WA, Franklin, WA.
6760................ Richmond-Petersburg, VA, Charles 0.9211 0.9453
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,\1\ CA, 1.0585 1.0397
Riverside, CA, San Bernardino,
CA.
6800................ Roanoke, VA, Botetourt, VA, 0.8509 0.8953
Roanoke, VA, Roanoke City, VA,
Salem City, VA.
6820................ Rochester, MN, Olmsted, MN...... 1.1698 1.1134
6840................ Rochester, NY,\1\ Genesee, NY, 0.9657 0.9764
Livingston, NY, Monroe, NY,
Ontario, NY, Orleans, NY,
Wayne, NY.
6880................ Rockford, IL, Boone, IL, Ogle, 0.8615 0.9029
IL, Winnebago, IL.
6895................ Rocky Mount, NC, Edgecombe, NC, 0.9012 0.9312
Nash, NC.
6920................ Sacramento, CA,\1\ El Dorado, 1.1962 1.1305
CA, Placer, CA, Sacramento, CA.
6960................ Saginaw-Bay City-Midland, MI, 0.9487 0.9646
Bay, MI, Midland, MI, Saginaw,
MI.
6980................ St. Cloud, MN, Benton, MN, 0.9586 0.9715
Stearns, MN.
7000................ St. Joseph, MO, Andrew, MO, 0.9889 0.9924
Buchanan, MO.
7040................ St. Louis, MO-IL,\1\ Clinton, 0.9151 0.9411
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,\2\ Marion, OR, Polk, 0.9912 0.9940
OR.
7120................ Salinas, CA, Monterey, CA....... 1.5142 1.3286
7160................ Salt Lake City-Ogden, UT,\1\ 0.9420 0.9599
Davis, UT, Salt Lake, UT,
Weber, UT.
7200................ San Angelo, TX, Tom Green, TX... 0.7646 0.8321
[[Page 9392]]
7240................ San Antonio, TX,\1\ Bexar, TX, 0.8100 0.8656
Comal, TX, Guadalupe, TX,
Wilson, TX.
7320................ San Diego, CA,\1\ San Diego, CA. 1.2310 1.1529
7360................ San Francisco, CA,\1\ Marin, CA, 1.3563 1.2321
San Francisco, CA, San Mateo,
CA.
7400................ San Jose, CA,\1\ Santa Clara, CA 1.3695 1.2403
7440................ San Juan-Bayamon, PR,\1\ Aguas 0.4623 0.5896
Buenas, PR, Barceloneta, PR,
Bayamon, PR, Canovanas, PR,
Carolina, PR, Catano, PR,
Ceiba, PR, Comerio, PR,
Corozal, PR, Dorado, PR,
Fajardo, PR, Florida, PR,
Guaynabo, PR, Humacao, PR,
Juncos, PR, Los Piedras, PR,
Loiza, PR, Luguillo, PR,
Manati, PR, Morovis, PR,
Naguabo, PR, Naranjito, PR, Rio
Grande, PR, San Juan, PR, Toa
Alta, PR, Toa Baja, PR,
Trujillo Alto, PR, Vega Alta,
PR, Vega Baja, PR, Yabucoa, PR.
7460................ San Luis Obispo-Atascadero-Paso 1.1264 1.0849
Robles, CA, San Luis Obispo, CA.
7480................ Santa Barbara-Santa Maria- 1.1194 1.0803
Lompoc, CA, Santa Barbara, CA.
7485................ Santa Cruz-Watsonville, CA, 1.3981 1.2580
Santa Cruz, CA.
7490................ Santa Fe, NM, Los Alamos, NM, 0.9652 0.9760
Santa Fe, NM.
7500................ Santa Rosa, CA, Sonoma, CA...... 1.3071 1.2013
7510................ Sarasota-Bradenton, FL, Manatee, 0.9532 0.9677
FL, Sarasota, FL.
7520................ Savannah, GA, Bryan, GA, 1.0060 1.0041
Chatham, GA, Effingham, GA.
7560................ Scranton-Wilkes-Barre-Hazleton, 0.8664 0.9065
PA,\2\ Columbia, PA,
Lackawanna, PA, Luzerne, PA,
Wyoming, PA.
7600................ Seattle-Bellevue-Everett, WA,\1\ 1.1535 1.1027
Island, WA, King, WA, Sohomish,
WA.
7610................ Sharon, PA, Mercer, PA.......... 0.8847 0.9195
7620................ Sheboygan, WI,\2\ Sheboygan, WI. 0.8711 0.9098
7640................ Sherman-Denison, TX, Grayson, TX 0.8570 0.8997
7680................ Shreveport-Bossier City, LA, 0.9386 0.9575
Bossier, LA, Caddo, LA,
Webster, LA.
7720................ Sioux City, IA-NE, Woodbury, IA, 0.8481 0.8933
Dakota, NE.
7760................ Sioux Falls, SD, Lincoln, SD, 0.8912 0.9242
Minnehaha, SD.
7800................ South Bend, IN, St. Joseph, IN.. 0.9859 0.9903
7840................ Spokane, WA, Spokane, WA........ 1.0928 1.0627
7880................ Springfield, IL, Menard, IL, 0.8720 0.9105
Sangamon, IL.
7920................ Springfield, MO, Christian, MO, 0.8071 0.8635
Greene, MO, Webster, MO.
8003................ Springfield, MA, Hampden, MA, 1.0834 1.0564
Hampshire, MA.
8050................ State College, PA, Centre, PA... 0.9449 0.9619
8080................ Steubenville-Weirton, OH-WV 0.8519 0.8960
(Ohio Hospitals),\2\ Jefferson,
OH, Brooke, WV, Hancock, WV.
8080................ Steubenville-Weirton, OH-WV 0.8428 0.8895
(West Virginia Hospitals),
Jefferson, OH, Brooke, WV,
Hancock, WV.
8120................ Stockton-Lodi, CA, San Joaquin, 1.1075 1.0724
CA.
8140................ Sumter, SC, Sumter, SC.......... 0.8127 0.8676
8160................ Syracuse, NY, Cayuga, NY, 0.9400 0.9585
Madison, NY, Onondaga, NY,
Oswego, NY.
8200................ Tacoma, WA,\2\ Pierce, WA....... 1.0489 1.0332
8240................ Tallahassee, FL,\2\ Gadsden, FL, 0.8877 0.9217
Leon, FL.
8280................ Tampa-St. Petersburg-Clearwater, 0.9183 0.9433
FL,\1\ Hernando, FL,
Hillsborough, FL, Pasco, FL,
Pinellas, FL.
8320................ Terre Haute, IN, Clay, IN, 0.8991 0.9298
Vermillion, IN, Vigo, IN.
8360................ Texarkana, AR-Texarkana, TX, 0.8506 0.8951
Miller, AR, Bowie, TX.
8400................ Toledo, OH, Fulton, OH, Lucas, 0.9991 0.9994
OH, Wood, OH.
8440................ Topeka, KS, Shawnee, KS......... 0.9812 0.9871
8480................ Trenton, NJ, Mercer, NJ......... 1.0509 1.0346
8520................ Tucson, AZ, Pima, AZ............ 0.9028 0.9324
8560................ Tulsa, OK, Creek, OK, Osage, OK, 0.8463 0.8920
Rogers, OK, Tulsa, OK, Wagoner,
OK.
8600................ Tuscaloosa, AL, Tuscaloosa, AL.. 0.7641 0.8317
8640................ Tyler, TX, Smith, TX............ 0.8818 0.9175
8680................ Utica-Rome, NY,\2\ Herkimer, NY, 0.8588 0.9010
Oneida, NY.
8720................ Vallejo-Fairfield-Napa, CA, 1.3311 1.2164
Napa, CA, Solano, CA.
8735................ Ventura, CA, Ventura, CA........ 1.0764 1.0517
8750................ Victoria, TX, Victoria, TX...... 0.8382 0.8862
8760................ Vineland-Millville-Bridgeton, 1.0440 1.0299
NJ, Cumberland, NJ.
8780................ Visalia-Tulare-Porterville, CA, 1.0083 1.0057
Tulare, CA.
8800................ Waco, TX, McLennan, TX.......... 0.8371 0.8854
8840................ Washington, DC-MD-VA-WV,\1\ 1.0807 1.0546
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, IA, Black 0.8332 0.8825
Hawk, IA.
8940................ Wausau, WI, Marathon, WI........ 0.9733 0.9816
8960................ West Palm Beach-Boca Raton, 1.0181 1.0124
FL,\1\ Palm Beach, FL.
9000................ Wheeling, WV-OH (West Virginia 0.7875 0.8491
Hospitals),\2\ Belmont, OH,
Marshall, WV, Ohio, WV.
9000................ Wheeling, WV-OH (Ohio 0.8519 0.8960
Hospitals),\2\ Belmont, OH,
Marshall, WV, Ohio, WV.
9040................ Wichita, KS, Butler, KS, Harvey, 0.8898 0.9232
KS, Sedgwick, KS.
9080................ Wichita Falls, TX, Archer, TX, 0.7830 0.8458
Wichita, TX.
9140................ Williamsport, PA,\2\ Lycoming, 0.8664 0.9065
PA.
9160................ Wilmington-Newark, DE-MD, New 1.1868 1.1244
Castle, DE, Cecil, MD.
9200................ Wilmington, NC, New Hanover, NC, 0.9343 0.9545
Brunswick, NC.
9260................ Yakima, WA,\2\ Yakima, WA....... 1.0489 1.0332
9270................ Yolo, CA, Yolo, CA.............. 1.1233 1.0829
[[Page 9393]]
9280................ York, PA, York, PA.............. 0.9410 0.9592
9320................ Youngstown-Warren, OH, 0.9815 0.9873
Columbiana, OH, Mahoning, OH,
Trumbull, OH.
9340................ Yuba City, CA, Sutter, CA, Yuba, 1.0865 1.0585
CA.
9360................ Yuma, AZ, Yuma, AZ.............. 1.0058 1.0040
------------------------------------------------------------------------
\1\ Large Urban Area.
\2\ Hospitals geographically located in the area are assigned the
statewide rural wage index for FY 1999.
Table 4B.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Rural Areas
------------------------------------------------------------------------
Nonurban area Wage index GAF
------------------------------------------------------------------------
Alabama................................. 0.7326 0.8081
Alaska.................................. 1.2430 1.1606
Arizona................................. 0.7989 0.8575
Arkansas................................ 0.7250 0.8023
California.............................. 0.9979 0.9986
Colorado................................ 0.8436 0.8901
Connecticut............................. 1.2074 1.1378
Delaware................................ 0.8807 0.9167
Florida................................. 0.8877 0.9217
Georgia................................. 0.7888 0.8500
Hawaii.................................. 1.0910 1.0615
Idaho................................... 0.8477 0.8930
Illinois................................ 0.7925 0.8528
Indiana................................. 0.8380 0.8860
Iowa.................................... 0.7777 0.8418
Kansas.................................. 0.7319 0.8076
Kentucky................................ 0.7844 0.8468
Louisiana............................... 0.7465 0.8186
Maine................................... 0.8467 0.8923
Maryland................................ 0.8555 0.8986
Massachusetts........................... 1.0834 1.0564
Michigan................................ 0.8884 0.9222
Minnesota............................... 0.8595 0.9015
Mississippi............................. 0.7312 0.8070
Missouri................................ 0.7452 0.8176
Montana................................. 0.8578 0.9003
Nebraska................................ 0.7674 0.8342
Nevada.................................. 0.9256 0.9484
New Hampshire........................... 1.0240 1.0164
New Jersey \1\.......................... .............. ..............
New Mexico.............................. 0.8269 0.8780
New York................................ 0.8588 0.9010
North Carolina.......................... 0.8112 0.8665
North Dakota............................ 0.7497 0.8210
Ohio.................................... 0.8519 0.8960
Oklahoma................................ 0.7124 0.7928
Oregon.................................. 0.9912 0.9940
Pennsylvania............................ 0.8664 0.9065
Puerto Rico............................. 0.4080 0.5412
Rhode Island............................ .............. ..............
South Carolina.......................... 0.8046 0.8617
South Dakota............................ 0.7508 0.8218
Tennessee............................... 0.7492 0.8206
Texas................................... 0.7565 0.8261
Utah.................................... 0.8859 0.9204
Vermont................................. 0.9416 0.9596
Virginia................................ 0.7857 0.8478
Washington.............................. 1.0489 1.0332
West Virginia........................... 0.7875 0.8491
Wisconsin............................... 0.8711 0.9098
Wyoming................................. 0.8768 0.9139
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 4C.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Hospitals That Are Reclassified
------------------------------------------------------------------------
Area Wage index GAF
------------------------------------------------------------------------
Abilene, TX............................. 0.8066 0.8631
[[Page 9394]]
Albany, GA.............................. 0.7888 0.8500
Albuquerque, NM......................... 0.8613 0.9028
Alexandria, LA.......................... 0.8526 0.8966
Allentown-Bethlehem-Easton, PA.......... 1.0204 1.0139
Amarillo, TX............................ 0.8517 0.8959
Anchorage, AK........................... 1.2979 1.1955
Asheville, NC........................... 0.8940 0.9261
Atlanta, GA............................. 0.9915 0.9942
Augusta-Aiken, GA-SC.................... 0.9233 0.9468
Baltimore, MD........................... 0.9642 0.9753
Barnstable-Yarmouth, MA................. 1.4427 1.2853
Baton Rouge, LA......................... 0.8872 0.9213
Benton Harbor, MI....................... 0.8884 0.9222
Bergen-Passaic, NJ...................... 1.1749 1.1167
Billings, MT............................ 0.9143 0.9405
Binghamton, NY.......................... 0.9059 0.9346
Birmingham, AL.......................... 0.9073 0.9356
Bismarck, ND............................ 0.7846 0.8469
Boise City, ID.......................... 0.9190 0.9438
Boston-Worcester-Lawrence-Lowell- 1.1288 1.0865
Brockton, MA-NH........................
Brazoria, TX............................ 0.8928 0.9253
Bryan-College Station, TX............... 0.8066 0.8631
Buffalo-Niagara Falls, NY............... 0.9587 0.9715
Burlington, VT.......................... 0.9596 0.9722
Caguas, PR.............................. 0.4410 0.5708
Canton-Massillon, OH.................... 0.8813 0.9171
Casper, WY.............................. 0.9150 0.9410
Champaign-Urbana, IL.................... 0.8770 0.9140
Charleston-North Charleston, SC......... 0.9114 0.9384
Charleston, WV.......................... 0.8763 0.9135
Charlotte-Gastonia-Rock Hill, NC-SC..... 0.9686 0.9784
Charlottesville, VA..................... 0.9733 0.9816
Chattanooga, TN-GA...................... 0.8869 0.9211
Chicago, IL............................. 1.0461 1.0313
Cincinnati, OH-KY-IN.................... 0.9595 0.9721
Clarksville-Hopkinsville, TN-KY......... 0.8213 0.8739
Cleveland-Lorain-Elyria, OH............. 0.9886 0.9922
Columbia, MO............................ 0.8798 0.9160
Columbus, GA-AL......................... 0.8511 0.8955
Columbus, OH............................ 0.9781 0.9850
Corpus Christi, TX...................... 0.8531 0.8969
Dallas, TX.............................. 0.9348 0.9549
Danville, VA............................ 0.8716 0.9102
Davenport-Moline-Rock Island, IA-IL..... 0.8413 0.8884
Dayton-Springfield, OH.................. 0.9605 0.9728
Denver, CO.............................. 1.0334 1.0228
Des Moines, IA.......................... 0.8475 0.8929
Duluth-Superior, MN-WI.................. 1.0009 1.0006
Dutchess County, NY..................... 0.9883 0.9920
Elkhart-Goshen, IN...................... 0.9368 0.9563
Eugene-Springfield, OR.................. 1.1048 1.0706
Evansville-Henderson, IN-KY............. 0.8415 0.8885
Fargo-Moorhead, ND-MN................... 0.9246 0.9477
Fayetteville, NC........................ 0.8389 0.8867
Flagstaff, AZ-UT........................ 0.9523 0.9671
Flint, MI............................... 1.1031 1.0695
Fort Collins-Loveland, CO............... 1.0770 1.0521
Fort Lauderdale, FL..................... 0.9845 0.9894
Fort Pierce-Port St. Lucie, FL.......... 1.0241 1.0164
Fort Smith, AR-OK....................... 0.7519 0.8226
Fort Walton Beach, FL................... 0.8621 0.9034
Fort Worth-Arlington, TX................ 0.9727 0.9812
Gadsden, AL............................. 0.8780 0.9148
Gainesville, FL......................... 0.9462 0.9628
Goldsboro, NC........................... 0.8335 0.8827
Grand Forks, ND-MN...................... 0.8899 0.9232
Grand Junction, CO...................... 0.9116 0.9386
Grand Rapids-Muskegon-Holland, MI....... 0.9856 0.9901
Great Falls, MT......................... 0.9284 0.9504
Greeley, CO............................. 0.9356 0.9554
Green Bay, WI........................... 0.9248 0.9479
[[Page 9395]]
Greenville, NC.......................... 0.9098 0.9373
Greenville-Spartanburg-Anderson, SC..... 0.9222 0.9460
Harrisburg-Lebanon-Carlisle, PA......... 1.0060 1.0041
Hartford, CT............................ 1.1854 1.1235
Hattiesburg, MS......................... 0.7312 0.8070
Hickory-Morganton-Lenoir, NC............ 0.8649 0.9054
Honolulu, HI............................ 1.1510 1.1011
Houston, TX............................. 0.9889 0.9924
Huntington-Ashland, WV-KY-OH............ 0.9275 0.9498
Huntsville, AL.......................... 0.8223 0.8746
Indianapolis, IN........................ 0.9727 0.9812
Iowa City, IA........................... 0.9362 0.9559
Jackson, MS............................. 0.8292 0.8796
Jackson, TN............................. 0.8560 0.8990
Jacksonville, FL........................ 0.8900 0.9233
Johnson City-Kingsport-Bristol, TN-VA... 0.8773 0.9143
Jonesboro, AR........................... 0.7579 0.8271
Joplin, MO.............................. 0.7873 0.8489
Kalamazoo-Battlecreek, MI............... 1.1078 1.0726
Kansas City, KS-MO...................... 0.9645 0.9756
Knoxville, TN........................... 0.8918 0.9246
Lafayette, LA........................... 0.8293 0.8797
Lansing-East Lansing, MI................ 0.9974 0.9982
Las Cruces, NM.......................... 0.8970 0.9283
Las Vegas, NV-AZ........................ 1.1413 1.0947
Lexington, KY........................... 0.8506 0.8951
Lima, OH................................ 0.8768 0.9139
Lincoln, NE............................. 0.9032 0.9327
Little Rock-North Little Rock, AR....... 0.8534 0.8971
Los Angeles-Long Beach, CA.............. 1.2116 1.1405
Louisville, KY-IN....................... 0.9093 0.9370
Macon, GA............................... 0.8775 0.9144
Madison, WI............................. 1.0018 1.0012
Mansfield, OH........................... 0.8534 0.8971
Memphis, TN-AR-MS....................... 0.8361 0.8846
Merced, CA.............................. 1.0218 1.0149
Milwaukee-Waukesha, WI.................. 0.9356 0.9554
Minneapolis-St. Paul, MN-WI............. 1.0854 1.0577
Modesto, CA............................. 1.0346 1.0236
Monroe, LA.............................. 0.8080 0.8642
Montgomery, AL.......................... 0.7860 0.8480
Myrtle Beach, SC........................ 0.8179 0.8714
Nashville, TN........................... 0.9302 0.9517
New Haven-Bridgeport-Stamford-Waterbury- 1.2245 1.1488
Danbury, CT............................
New London-Norwich, CT.................. 1.1640 1.1096
New Orleans, LA......................... 0.9310 0.9522
New York, NY............................ 1.4461 1.2874
Newburgh, NY-PA......................... 1.1223 1.0822
Oakland, CA............................. 1.5162 1.3298
Odessa-Midland, TX...................... 0.8664 0.9065
Oklahoma City, OK....................... 0.8708 0.9096
Omaha, NE-IA............................ 0.9972 0.9981
Orange County, CA....................... 1.1468 1.0983
Orlando, FL............................. 0.9813 0.9872
Peoria-Pekin, IL........................ 0.8063 0.8629
Philadelphia, PA-NJ..................... 1.1370 1.0919
Pittsburgh, PA.......................... 0.9642 0.9753
Pocatello, ID (Idaho Hospital).......... 0.8654 0.9057
Pocatello, ID (Wyoming Hospitals)....... 0.8768 0.9139
Portland, ME............................ 0.9574 0.9706
Portland-Vancouver, OR-WA............... 1.1178 1.0792
Provo-Orem, UT.......................... 0.9885 0.9921
Raleigh-Durham-Chapel Hill, NC.......... 0.9812 0.9871
Rapid City, SD.......................... 0.8208 0.8735
Reno, NV................................ 1.1095 1.0738
Rochester, MN........................... 1.1698 1.1134
Rockford, IL............................ 0.8615 0.9029
Sacramento, CA.......................... 1.1962 1.1305
Saginaw-Bay City-Midland, MI............ 0.9487 0.9646
St. Cloud, MN........................... 0.9586 0.9715
St. Louis, MO-IL........................ 0.9151 0.9411
[[Page 9396]]
Salt Lake City-Ogden, UT................ 0.9420 0.9599
San Diego, CA........................... 1.2310 1.1529
Santa Fe, NM............................ 0.9516 0.9666
Santa Rosa, CA.......................... 1.2907 1.1909
Seattle-Bellevue-Everett, WA............ 1.1535 1.1027
Sharon, PA.............................. 0.8847 0.9195
Sherman-Denison, TX..................... 0.8249 0.8765
Sioux City, IA-NE....................... 0.8481 0.8933
Sioux Falls, SD......................... 0.8809 0.9168
South Bend, IN.......................... 0.9859 0.9903
Spokane, WA............................. 1.0729 1.0494
Springfield, IL......................... 0.8720 0.9105
Springfield, MO......................... 0.8071 0.8635
State College, PA....................... 0.8793 0.9157
Syracuse, NY............................ 0.9400 0.9585
Tallahassee, FL......................... 0.8500 0.8947
Tampa-St. Petersburg-Clearwater, FL..... 0.9183 0.9433
Texarkana, AR-Texarkana, TX............. 0.8506 0.8951
Toledo, OH.............................. 0.9991 0.9994
Topeka, KS.............................. 0.9588 0.9716
Tucson, AZ.............................. 0.9028 0.9324
Tulsa, OK............................... 0.8359 0.8845
Tuscaloosa, AL.......................... 0.7641 0.8317
Tyler, TX............................... 0.8818 0.9175
Vallejo-Fairfield-Napa, CA.............. 1.3311 1.2164
Victoria, TX............................ 0.8382 0.8862
Washington, DC-MD-VA-WV................. 1.0807 1.0546
Waterloo-Cedar Falls, IA................ 0.8332 0.8825
Wausau, WI.............................. 0.9422 0.9600
Wichita, KS............................. 0.8770 0.9140
Wichita Falls, TX....................... 0.7830 0.8458
Rural Alabama........................... 0.7326 0.8081
Rural Illinois.......................... 0.7925 0.8528
Rural Louisiana......................... 0.7465 0.8186
Rural Massachusetts..................... 1.0399 1.0272
Rural Michigan.......................... 0.8884 0.9222
Rural Minnesota......................... 0.8595 0.9015
Rural Missouri.......................... 0.7452 0.8176
Rural Nevada............................ 0.8832 0.9185
Rural New Mexico........................ 0.8269 0.8780
Rural Oregon............................ 0.9912 0.9940
Rural Washington........................ 1.0489 1.0332
Rural Wyoming........................... 0.8768 0.9139
------------------------------------------------------------------------
Table 4D.--Average Hourly Wage for Urban Areas
------------------------------------------------------------------------
Average
Urban area hourly wage
------------------------------------------------------------------------
Abilene, TX............................................. 16.5825
Aguadilla, PR........................................... 9.8222
Akron, OH............................................... 20.5687
Albany, GA.............................................. 16.5708
Albany-Schenectady-Troy, NY............................. 17.8900
Albuquerque, NM......................................... 17.8958
Alexandria, LA.......................................... 17.7146
Allentown-Bethlehem-Easton, PA.......................... 21.2002
Altoona, PA............................................. 19.3951
Amarillo, TX............................................ 17.6070
Anchorage, AK........................................... 26.6324
Ann Arbor, MI........................................... 22.9238
Anniston, AL............................................ 17.9884
Appleton-Oshkosh-Neenah, WI............................. 18.3354
Arecibo, PR............................................. 10.1129
Asheville, NC........................................... 18.5755
Athens, GA.............................................. 18.0203
Atlanta, GA............................................. 20.6008
Atlantic-Cape May, NJ................................... 23.9678
Augusta-Aiken, GA-SC.................................... 19.1829
Austin-San Marcos, TX................................... 18.2464
Bakersfield, CA......................................... 19.8019
Baltimore, MD........................................... 20.0332
Bangor, ME.............................................. 19.6846
Barnstable-Yarmouth, MA................................. 31.9593
Baton Rouge, LA......................................... 18.4325
Beaumont-Port Arthur, TX................................ 17.9913
Bellingham, WA.......................................... 23.7572
Benton Harbor, MI....................................... 17.7241
Bergen-Passaic, NJ...................................... 25.3184
Billings, MT............................................ 18.9960
Biloxi-Gulfport-Pascagoula, MS.......................... 17.1946
Binghamton, NY.......................................... 18.8217
Birmingham, AL.......................................... 18.8506
Bismarck, ND............................................ 16.6736
Bloomington,IN.......................................... 18.6271
Bloomington-Normal, IL.................................. 18.3900
Boise City, ID.......................................... 19.0323
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH........ 23.4143
Boulder-Longmont, CO.................................... 20.8550
Brazoria, TX............................................ 18.5041
Bremerton, WA........................................... 22.9686
Brownsville-Harlingen-San Benito, TX.................... 17.1138
Bryan-College Station, TX............................... 16.2473
Buffalo-Niagara Falls, NY............................... 19.9187
Burlington, VT.......................................... 19.8983
Caguas, PR.............................................. 9.1414
Canton-Massillon, OH.................................... 18.3114
Casper, WY.............................................. 18.0774
Cedar Rapids, IA........................................ 18.3134
Champaign-Urbana, IL.................................... 18.1242
[[Page 9397]]
Charleston-North Charleston, SC......................... 18.9373
Charleston, WV.......................................... 18.6776
Charlotte-Gastonia-Rock Hill, NC-SC..................... 20.1245
Charlottesville, VA..................................... 21.3425
Chattanooga, TN-GA...................................... 18.8525
Cheyenne, WY............................................ 16.9321
Chicago, IL............................................. 21.7349
Chico-Paradise, CA...................................... 21.0787
Cincinnati, OH-KY-IN.................................... 19.9348
Clarksville-Hopkinsville, TN-KY......................... 16.7045
Cleveland-Lorain-Elyria, OH............................. 20.5401
Colorado Springs, CO.................................... 19.5098
Columbia, MO............................................ 18.5780
Columbia, SC............................................ 19.3016
Columbus, GA-AL......................................... 17.6831
Columbus, OH............................................ 20.3213
Corpus Christi, TX...................................... 17.6885
Cumberland, MD-WV....................................... 17.1237
Dallas, TX.............................................. 19.4652
Danville, VA............................................ 18.7936
Davenport-Moline-Rock Island, IA-IL..................... 17.4790
Dayton-Springfield, OH.................................. 19.9557
Daytona Beach, FL....................................... 18.9775
Decatur, AL............................................. 17.1056
Decatur, IL............................................. 16.6936
Denver, CO.............................................. 21.4638
Des Moines, IA.......................................... 17.5526
Detroit, MI............................................. 21.9074
Dothan, AL.............................................. 16.3982
Dover, DE............................................... 19.4527
Dubuque, IA............................................. 17.0836
Duluth-Superior, MN-WI.................................. 20.6977
Dutchess County, NY..................................... 21.8781
Eau Claire, WI.......................................... 17.8112
El Paso, TX............................................. 19.1468
Elkhart-Goshen, IN...................................... 19.3331
Elmira, NY.............................................. 17.5367
Enid, OK................................................ 16.5863
Erie, PA................................................ 19.2614
Eugene-Springfield, OR.................................. 23.2566
Evansville, Henderson, IN-KY............................ 17.7198
Fargo-Moorhead, ND-MN................................... 19.7800
Fayetteville, NC........................................ 17.4302
Fayetteville-Springdale-Rogers, AR...................... 17.8965
Flagstaff, AZ-UT........................................ 19.7032
Flint, MI............................................... 22.9184
Florence, AL............................................ 15.9479
Florence, SC............................................ 17.6631
Fort Collins-Loveland, CO............................... 22.3767
Fort Lauderdale, FL..................................... 20.3766
Fort Myers-Cape Coral, FL............................... 18.5790
Fort Pierce-Port St. Lucie, FL.......................... 21.2784
Fort Smith, AR-OK....................................... 15.8375
Fort Walton Beach, FL................................... 17.8995
Fort Wayne, IN.......................................... 18.7962
Fort Worth-Arlington, TX................................ 20.1926
Fresno, CA.............................................. 22.2323
Gadsden, AL............................................. 18.2411
Gainesville, FL......................................... 19.6396
Galveston-Texas City, TX................................ 22.6345
Gary, IN................................................ 19.6025
Glens Falls, NY......................................... 17.6404
Goldsboro, NC........................................... 17.7222
Grand Forks, ND-MN...................................... 18.3589
Grand Junction, CO...................................... 17.2009
Grand Rapids-Muskegon-Holland, MI....................... 20.7161
Great Falls, MT......................................... 18.4336
Greeley, CO............................................. 19.6480
Green Bay, WI........................................... 19.0230
Greensboro-Winston-Salem-High Point, NC................. 19.8355
Greenville, NC.......................................... 19.6007
Greenville-Spartanburg-Anderson, SC..................... 19.1612
Hagerstown, MD.......................................... 21.1564
Hamilton-Middletown, OH................................. 19.1833
Harrisburg-Lebanon-Carlisle, PA......................... 20.9016
Hartford, CT............................................ 24.5817
Hattiesburg, MS......................................... 15.0868
Hickory-Morganton-Lenoir, NC............................ 18.4995
Honolulu, HI............................................ 23.9148
Houma, LA............................................... 17.0314
Houston, TX............................................. 20.5460
Huntington-Ashland, WV-KY-OH............................ 20.0441
Huntsville, AL.......................................... 17.4211
Indianapolis, IN........................................ 20.4258
Iowa City, IA........................................... 19.6992
Jackson, MI............................................. 19.1645
Jackson, MS............................................. 17.2283
Jackson, TN............................................. 17.7852
Jacksonville, FL........................................ 18.4915
Jacksonville, NC........................................ 15.6996
Jamestown, NY........................................... 15.9148
Janesville-Beloit, WI................................... 18.8060
Jersey City, NJ......................................... 24.0964
Johnson City-Kingsport-Bristol, TN-VA................... 18.2276
Johnstown, PA........................................... 17.9084
Jonesboro, AR........................................... 15.3904
Joplin, MO.............................................. 16.3572
Kalamazoo-Battlecreek, MI............................... 23.5418
Kankakee, IL............................................ 19.5674
Kansas City, KS-MO...................................... 20.0387
Kenosha, WI............................................. 18.9676
Killeen-Temple, TX...................................... 21.0041
Knoxville, TN........................................... 18.5294
Kokomo, IN.............................................. 19.2700
La Crosse, WI-MN........................................ 18.5196
Lafayette, LA........................................... 17.1506
Lafayette, IN........................................... 18.3693
Lake Charles, LA........................................ 15.9437
Lakeland-Winter Haven, FL............................... 18.5726
Lancaster, PA........................................... 19.8644
Lansing-East Lansing, MI................................ 20.9650
Laredo, TX.............................................. 15.2556
Las Cruces, NM.......................................... 18.4298
Las Vegas, NV-AZ........................................ 23.7139
Lawrence, KS............................................ 17.9827
Lawton, OK.............................................. 18.0698
Lewiston-Auburn, ME..................................... 19.0090
Lexington, KY........................................... 17.6740
Lima, OH................................................ 18.5932
Lincoln, NE............................................. 19.3291
Little Rock-North Little Rock, AR....................... 17.6667
Longview-Marshall, TX................................... 18.0723
Los Angeles-Long Beach, CA.............................. 25.1088
Louisville, KY-IN....................................... 18.8926
Lubbock, TX............................................. 17.6523
Lynchburg, VA........................................... 18.4907
Macon, GA............................................... 18.6578
Madison, WI............................................. 20.8155
Mansfield, OH........................................... 17.7305
Mayaguez, PR............................................ 9.1443
McAllen-Edinburg-Mission, TX............................ 18.4765
Medford-Ashland, OR..................................... 20.8190
Melbourne-Titusville-Palm Bay, FL....................... 19.1487
Memphis, TN-AR-MS....................................... 17.3726
Merced, CA.............................................. 20.8449
Miami, FL............................................... 20.8119
Middlesex-Somerset-Hunterdon, NJ........................ 23.1702
Milwaukee-Waukesha, WI.................................. 19.4387
Minneapolis-St. Paul, MN-WI............................. 22.5517
Missoula, MT............................................ 19.0914
Mobile, AL.............................................. 17.4040
Modesto, CA............................................. 21.4951
Monmouth-Ocean, NJ...................................... 23.5125
Monroe, LA.............................................. 17.0762
Montgomery, AL.......................................... 16.2493
Muncie, IN.............................................. 19.5589
Myrtle Beach, SC........................................ 16.9930
Naples, FL.............................................. 21.1457
Nashville, TN........................................... 19.6966
Nassau-Suffolk, NY...................................... 28.2430
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT..... 25.6149
New London-Norwich, CT.................................. 24.1351
New Orleans, LA......................................... 19.3440
New York, NY............................................ 30.0458
Newark, NJ.............................................. 24.6548
Newburgh, NY-PA......................................... 23.1779
Norfolk-Virginia Beach-Newport News, VA-NC.............. 17.1926
Oakland, CA............................................. 31.1506
Ocala, FL............................................... 19.0159
Odessa-Midland, TX...................................... 17.9849
Oklahoma City, OK1...................................... 8.0923
Olympia, WA............................................. 23.9389
Omaha, NE-IA............................................ 20.7181
Orange County, CA....................................... 23.9400
Orlando, FL............................................. 20.3876
Owensboro, KY........................................... 16.1460
Panama City, FL......................................... 17.6753
Parkersburg-Marietta, WV-OH............................. 16.6559
Pensacola, FL........................................... 17.1334
Peoria-Pekin, IL........................................ 16.7415
Philadelphia, PA-NJ..................................... 23.6239
Phoenix-Mesa, AZ........................................ 19.9270
Pine Bluff, AR.......................................... 16.4382
Pittsburgh, PA.......................................... 20.3391
Pittsfield, MA.......................................... 22.4781
Pocatello, ID........................................... 18.2669
Ponce, PR............................................... 9.9487
Portland, ME............................................ 19.8655
Portland-Vancouver, OR-WA............................... 23.2244
Providence-Warwick, RI.................................. 22.4422
Provo-Orem, UT.......................................... 20.5384
Pueblo, CO.............................................. 18.1010
Punta Gorda, FL......................................... 18.7634
Racine, WI.............................................. 18.9687
Raleigh-Durham-Chapel Hill, NC.......................... 20.3867
Rapid City, SD.......................................... 17.0546
Reading, PA............................................. 19.1866
[[Page 9398]]
Redding, CA............................................. 24.6374
Reno, NV................................................ 23.0512
Richland-Kennewick-Pasco, WA............................ 21.3732
Richmond-Petersburg, VA................................. 19.1375
Riverside-San Bernardino, CA............................ 22.3498
Roanoke, VA............................................. 17.6802
Rochester, MN........................................... 24.3054
Rochester, NY........................................... 20.0636
Rockford, IL............................................ 17.8998
Rocky Mount, NC......................................... 18.7242
Sacramento, CA.......................................... 24.8541
Saginaw-Bay City-Midland, MI............................ 19.7109
St. Cloud, MN........................................... 19.9167
St. Joseph, MO.......................................... 20.5465
St. Louis, MO-IL........................................ 19.0136
Salem, OR............................................... 20.5776
Salinas, CA............................................. 31.4614
Salt Lake City-Ogden, UT................................ 19.5264
San Angelo, TX.......................................... 15.8857
San Antonio, TX......................................... 16.8290
San Diego, CA........................................... 25.4828
San Francisco, CA....................................... 28.9989
San Jose, CA............................................ 28.7281
San Juan-Bayamon, PR.................................... 9.6051
San Luis Obispo-Atascadero-Paso Robles, CA.............. 23.4029
Santa Barbara-Santa Maria-Lompoc, CA.................... 23.2580
Santa Cruz-Watsonville, CA.............................. 29.0487
Santa Fe, NM............................................ 20.0537
Santa Rosa, CA.......................................... 28.2508
Sarasota-Bradenton, FL.................................. 19.8054
Savannah, GA............................................ 20.9009
Scranton-Wilkes Barre-Hazleton, PA...................... 17.2431
Seattle-Bellevue-Everett, WA............................ 23.9482
Sharon, PA.............................................. 18.3824
Sheboygan, WI........................................... 17.0899
Sherman-Denison, TX..................................... 17.8053
Shreveport-Bossier City, LA............................. 19.5016
Sioux City, IA-NE....................................... 17.6215
Sioux Falls, SD......................................... 18.5158
South Bend, IN.......................................... 20.4831
Spokane, WA............................................. 22.7055
Springfield, IL......................................... 18.1176
Springfield, MO......................................... 16.7688
Springfield, MA......................................... 22.8337
State College, PA....................................... 19.6319
Steubenville-Weirton, OH-WV............................. 17.5119
Stockton-Lodi, CA....................................... 23.0115
Sumter, SC.............................................. 16.8850
Syracuse, NY............................................ 19.5305
Tacoma, WA.............................................. 21.5661
Tallahassee, FL......................................... 17.5545
Tampa-St. Petersburg-Clearwater, FL..................... 18.9348
Terre Haute, IN......................................... 18.6798
Texarkana, AR-Texarkana, TX............................. 17.6740
Toledo, OH.............................................. 20.7579
Topeka, KS.............................................. 20.3862
Trenton, NJ............................................. 21.8355
Tucson, AZ.............................................. 18.7576
Tulsa, OK............................................... 17.5841
Tuscaloosa, AL.......................................... 15.8762
Tyler, TX............................................... 18.3215
Utica-Rome, NY.......................................... 17.4892
Vallejo-Fairfield-Napa, CA.............................. 27.8686
Ventura, CA............................................. 22.8835
Victoria, TX............................................ 17.4131
Vineland-Millville-Bridgeton, NJ........................ 21.6923
Visalia-Tulare-Porterville, CA.......................... 20.9493
Waco, TX................................................ 17.3923
Washington, DC-MD-VA-WV................................. 22.4534
Waterloo-Cedar Falls, IA................................ 16.5347
Wausau, WI.............................................. 20.2214
West Palm Beach-Boca Raton, FL.......................... 21.2323
Wheeling, OH-WV......................................... 15.8460
Wichita, KS............................................. 18.4872
Wichita Falls, TX....................................... 16.2686
Williamsport, PA........................................ 17.7778
Wilmington-Newark, DE-MD................................ 24.6591
Wilmington, NC.......................................... 19.4129
Yakima, WA.............................................. 21.4371
Yolo, CA................................................ 23.3394
York, PA................................................ 19.5520
Youngstown-Warren, OH................................... 20.3921
Yuba City, CA........................................... 22.5751
Yuma, AZ................................................ 20.8977
------------------------------------------------------------------------
Table 4E.--Average Hourly Wage for Rural Areas
------------------------------------------------------------------------
Average
Nonurban area hourly wage
------------------------------------------------------------------------
Alabama................................................. 15.1554
Alaska.................................................. 25.8250
Arizona................................................. 16.5996
Arkansas................................................ 15.0624
California.............................................. 20.7330
Colorado................................................ 17.5278
Connecticut............................................. 25.0854
Delaware................................................ 18.2993
Florida................................................. 18.4445
Georgia................................................. 16.3888
Hawaii.................................................. 22.6670
Idaho................................................... 17.6129
Illinois................................................ 16.4463
Indiana................................................. 17.4120
Iowa.................................................... 16.1574
Kansas.................................................. 15.2062
Kentucky................................................ 16.2977
Louisiana............................................... 15.4880
Maine................................................... 17.5914
Maryland................................................ 17.7750
Massachusetts........................................... 22.5095
Michigan................................................ 18.4407
Minnesota............................................... 17.8572
Mississippi............................................. 15.1920
Missouri................................................ 15.4837
Montana................................................. 17.4489
Nebraska................................................ 15.9437
Nevada.................................................. 19.2311
New Hampshire........................................... 21.2761
New Jersey \1\.......................................... ..............
New Mexico.............................................. 17.1812
New York................................................ 17.8440
[[Page 9399]]
North Carolina.......................................... 16.8544
North Dakota............................................ 15.5776
Ohio.................................................... 17.6991
Oklahoma................................................ 14.8012
Oregon.................................................. 20.5901
Pennsylvania............................................ 18.0013
Puerto Rico............................................. 8.4766
Rhode Island \1\........................................ ..............
South Carolina.......................................... 16.7176
South Dakota............................................ 15.5989
Tennessee............................................... 15.5660
Texas................................................... 15.7178
Utah.................................................... 18.4060
Vermont................................................. 19.5637
Virginia................................................ 16.3242
Washington.............................................. 21.7934
West Virginia........................................... 16.3620
Wisconsin............................................... 18.0980
Wyoming................................................. 18.2168
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 4F.--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF)
----------------------------------------------------------------------------------------------------------------
Wage index--
Area Wage index GAF reclass. GAF--reclass.
hospitals hospitals
----------------------------------------------------------------------------------------------------------------
Aguadilla, PR.................................. 1.0295 1.0201 ............... ..............
Arecibo, PR.................................... 1.0599 1.0406 ............... ..............
Caguas, PR..................................... 0.9603 0.9726 0.9603 0.9726
Mayaguez, PR................................... 0.9584 0.9713 ............... ..............
Ponce, PR...................................... 1.0427 1.0290 ............... ..............
San Juan-Bayamon, PR........................... 1.0067 1.0046 ............... ..............
Rural Puerto Rico.............................. 0.8884 0.9222 ............... ..............
----------------------------------------------------------------------------------------------------------------
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: February 5, 1999.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Approved: February 10, 1999.
Donna E. Shalala,
Secretary.
[FR Doc. 99-4506 Filed 2-19-99; 11:15 am]
BILLING CODE 4120-01-P