[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]]

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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