[Federal Register Volume 66, Number 87 (Friday, May 4, 2001)]
[Proposed Rules]
[Pages 22646-22891]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-11062]



[[Page 22645]]

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Part II





Department of Health and Human Services





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Health Care Financing Administration



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42 CFR Parts 405, 412, 413, etc.



Medicare Program; Changes to the Hospital Inpatient Prospective Payment 
Systems and Fiscal Year 2002 Rates; Proposed Rule

  Federal Register / Vol. 66 , No. 87 / Friday, May 4, 2001 / Proposed 
Rules  

[[Page 22646]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 405, 412, 413, 485, and 486

[HCFA-1158-P]
RIN 0938-AK73


Medicare Program; Changes to the Hospital Inpatient Prospective 
Payment Systems and Fiscal Year 2002 Rates

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Proposed rule.

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SUMMARY: We are proposing to revise the Medicare hospital inpatient 
prospective payment systems for operating and capital costs to: 
Implement applicable statutory requirements, including a number of 
provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement 
and Protection Act of 2000 (Public Law 106-554); and implement changes 
arising from our continuing experience with these systems. In addition, 
in the Addendum to this proposed rule, we are describing proposed 
changes to the amounts and factors used to determine the rates for 
Medicare hospital inpatient services for operating costs and capital-
related costs. These changes would be applicable to discharges 
occurring on or after October 1, 2001. We also are setting forth 
proposed rate-of-increase limits as well as proposed policy changes for 
hospitals and hospital units excluded from the prospective payment 
systems.
    We also are proposing changes to the policies governing payments to 
hospitals for the direct costs of graduate medical education and 
critical access hospitals.

DATES: Comments will be considered if received at the appropriate 
address, as provided below, no later than 5 p.m. on July 3, 2001.

ADDRESSES: Mail written comments (an original and three copies) to the 
following address ONLY: Health Care Financing Administration, 
Department of Health and Human Services, Attention: HCFA-1158-P, P.O. 
Box 8010, Baltimore, MD 21244-1850.
    If you prefer, you may deliver by courier your written comments (an 
original and three copies) to one of the following addresses:

Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or

Room C5-14-03, Central Building, 7500 Security Boulevard, Baltimore, MD 
21244-1850.

    Comments mailed to those addresses specified as appropriate for 
courier delivery may be delayed and could be considered late.
    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-1158-P.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.
    For comments that relate to information collection requirements, 
mail a copy of comments to the following addresses:

Health Care Financing Administration, Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards, 
Room N2-14-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. 
Attn: John Burke, HCFA-1158-P; and

Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 3001, New Executive Office Building, Washington, DC 20503, 
Attn: Allison Herron Eydt, HCFA Desk Officer.

FOR FURTHER INFORMATION CONTACT:
Steve Phillips, (410) 786-4548, Operating Prospective Payment, 
Diagnosis-Related Groups (DRGs), Wage Index, Hospital Geographic 
Reclassifications, and Sole Community Hospital Issues

Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded 
Hospitals, Graduate Medical Education and Critical Access Hospital 
Issues

SUPPLEMENTARY INFORMATION:

Inspection of Public Comments

    Comments received timely will be available for public inspection as 
they are received, generally beginning approximately 3 weeks after 
publication of a document, in Room C5-12-08 of the Health Care 
Financing Administration, 7500 Security Blvd., Baltimore, MD, on Monday 
through Friday of each week from 8:30 a.m. to 5 p.m. Please call (410) 
786-7197 to arrange to view these comments.

Availability of Copies and Electronic Access

    Copies: To order copies of the Federal Register containing this 
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password required).

I. Background

A. Summary

    Section 1886(d) of the Social Security Act (the Act) sets forth a 
system of payment for the operating costs of acute care hospital 
inpatient stays under Medicare Part A (Hospital Insurance) based on 
prospectively set rates. Section 1886(g) of the Act requires the 
Secretary to pay for the capital-related costs of hospital inpatient 
stays under a prospective payment system. Under these prospective 
payment systems, Medicare payment for hospital inpatient operating and 
capital-related costs is made at predetermined, specific rates for each 
hospital discharge. Discharges are classified according to a list of 
diagnosis-related groups (DRGs).
    Under section 1886(d)(1)(B) of the Act in effect without 
consideration of the amendments made by the Balanced Budget Act of 1997 
(Public Law 105-33), the Balanced Budget Refinement Act of 1999 (Public 
Law 106-113, and the recent Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (Public Law 106-554, enacted on 
December 21, 2000), certain specialty hospitals are excluded from the 
hospital inpatient prospective payment system: Psychiatric hospitals 
and units, rehabilitation hospitals and

[[Page 22647]]

units, children's hospitals, long-term care hospitals, and cancer 
hospitals. For these hospitals and units, Medicare payment for 
operating costs is based on reasonable costs subject to a hospital-
specific annual limit, until the payment provisions of Public Laws 105-
33, 106-113, and 106-554 that are applicable to three classes of these 
hospitals are implemented, as discussed below.
    Various sections of Public Laws 105-33, 106-113, and 106-554 
provide for the transition of rehabilitation hospitals and units, 
psychiatric hospitals and units, and long-term care hospitals from 
being paid on an excluded hospital basis to being paid on an individual 
prospective payment system basis. These provisions are as follows:
     Rehabilitation Hospitals and Units. Section 1886(j) of the 
Act, as added by section 4421 of Public Law 105-33 and amended by 
section 125 of Public Law 106-113 and section 305 of Public Law 106-
554, authorizes the implementation of a prospective payment system for 
inpatient hospital services furnished by rehabilitation hospitals and 
units. Section 4421 of Public Law 105-33 amended the Act by adding 
section 1886(j). Section 1886(j) of the Act provides for a fully 
implemented prospective payment system for inpatient rehabilitation 
hospitals and rehabilitation units, effective for cost reporting 
periods beginning on or after October 2002, with payment provisions 
during a transitional period of October 1, 2000 to October 1, 2002 
based on target amounts specified in section 1886(b) of the Act. 
Section 125 of Public Law 106-113 amended section 1886(j) of the Act to 
require the Secretary to use a discharge as the payment unit for 
inpatient rehabilitation services under the prospective payment system 
and to establish classes of patient discharges by functional-related 
groups. Section 305 of Public Law 106-554 further amended section 
1886(j) of the Act to allow hospitals to elect to be paid the full 
Federal prospective payment rather than the transitional period 
payments specified in the Act. A brief discussion of the November 3, 
2000 proposed rule (65 FR 66304) that we issued to propose 
implementation of the prospective payment system for inpatient 
rehabilitation hospitals and rehabilitation units is included under 
section VI.A.4. of this preamble.
     Psychiatric Hospitals and Units. Sections 124(a) and (c) 
of Public Law 106-113 provide for the development of a per diem 
prospective payment system for payment for inpatient hospital services 
of psychiatric hospitals and units under the Medicare program, 
effective for cost reporting periods beginning on or after October 1, 
2002. This system must include an adequate patient classification 
system that reflects the differences in patient resource use and costs 
among these hospitals and must maintain budget neutrality. We are in 
the process of developing a proposed rule, to be followed by a final 
rule, to implement the prospective payment system for psychiatric 
hospitals and units, effective for October 1, 2002.
     Long-Term Care Hospitals. Sections 123(a) and (c) of 
Public Law 106-113 provide for the development of a per discharge 
prospective payment system for payment for inpatient hospital services 
furnished by long-term care hospitals under the Medicare program, 
effective for cost reporting periods beginning on or after October 1, 
2002. Section 307(b)(1) of Public Law 106-554 provides that payments 
under the long-term care prospective payment system will be made on a 
prospective payment basis rather than a cost basis. The long-term care 
hospital prospective payment system must include a patient 
classification system that reflects the differences in patient resource 
use and costs, and must maintain budget neutrality. We are planning to 
develop a proposed rule, to be followed by a final rule, to implement 
the prospective payment system for long-term care hospitals, effective 
for October 1, 2002. Section 307 of Public Law 106-554 provides that if 
the Secretary is unable to develop a prospective payment system for 
long-term care hospitals that can be implemented by October 1, 2002, 
the Secretary must implement a prospective payment system that bases 
payment under the system using the existing acute hospital DRGs, 
modified where feasible to account for resource use of long-term care 
hospital patients using the most recently available hospital discharge 
data for long-term care services.
    Under sections 1820 and 1834(g) of the Act, payments are made to 
critical access hospitals (CAHs) (that is, rural hospitals or 
facilities that meet certain statutory requirements) for inpatient and 
outpatient services on a reasonable cost basis. Reasonable cost is 
determined under the provisions of section 1861(v)(1)(A) of the Act and 
existing regulations under Parts 413 and 415.
    Under section 1886(a)(4) of the Act, costs of approved educational 
activities are excluded from the operating costs of inpatient hospital 
services. Hospitals with approved graduate medical education (GME) 
programs are paid for the direct costs of GME in accordance with 
section 1886(h) of the Act; the amount of payment for direct GME costs 
for a cost reporting period is based on the hospital's number of 
residents in that period and the hospital's costs per resident in a 
base year.
    The regulations governing the hospital inpatient prospective 
payment system are located in 42 CFR Part 412. The regulations 
governing excluded hospitals and hospital units are located in Parts 
412 and 413. The regulations governing GME payments and payments to 
CAHs are located in Part 413.
    On August 1, 2000, we published a final rule in the Federal 
Register (65 FR 47054) that implemented both statutory requirements and 
other changes to the Medicare hospital inpatient prospective payment 
systems for both operating costs and capital-related costs, as well as 
changes addressing payment for excluded hospitals and payments for GME 
costs. Generally, these changes were effective for discharges occurring 
on or after October 1, 2000. On March 2, 2001, we published correction 
notices in the Federal Register (66 FR 13020) relating to the 
calculation of certain wage indexes and the labeling of certain DRGs.
    Public Law 106-554 made a number of changes to the Act relating to 
prospective payments to hospitals for inpatient services and payments 
to excluded hospitals. This proposed rule would implement amendments 
enacted by Public Law 106-554 relating to FY 2002 payments for hospital 
inpatient services, new medical services and technology, GME costs, the 
payment adjustment for disproportionate share hospitals (DSHs), the 
indirect medical education (IME) adjustment for teaching hospitals, 
sole community hospitals (SCHs), and CAHs. It would also implement 
changes affecting hospitals' geographic reclassifications and wage 
index. These changes are addressed in sections II., III., IV., and VI. 
of this preamble.
    Other provisions of Public Law 106-554 that relate to Medicare 
payments to hospitals effective prior to October 1, 2001 (that is, for 
FY 2001 or for the period between April 1, 2001 and September 30, 
2001), are addressed in a separate interim final rule with comment 
period (HCFA-1178-IFC).

B. Major Contents of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the 
Medicare hospital inpatient prospective payment systems for operating 
costs and for capital-related costs in FY 2002. We also are proposing 
changes relating to payments for GME costs and payments to excluded 
hospitals and units and CAHs. The proposed changes would be

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effective for discharges occurring on or after October 1, 2001.
    The following is a summary of the major changes that we are 
proposing to make:
1. Proposed Changes to the DRG Reclassifications and Recalibrations of 
Relative Weights
    As required by section 1886(d)(4)(C) of the Act, we adjust the DRG 
classifications and relative weights annually. Based on analyses of 
Medicare claims data, we are proposing to establish a number of new 
DRGs and make changes to the designation of diagnosis and procedure 
codes under other existing DRGs. Our proposed changes for FY 2002 are 
set forth in section II. of this preamble.
    We also address the provisions of section 533 of Public Law 106-544 
regarding development of a mechanism for adequate payment for new 
medical services and technologies and the required report to Congress 
on expeditiously introducing new medical services and technology into 
the DRGs.
2. Proposed Changes to the Hospital Wage Index
    In section III. of this preamble, we discuss proposed revisions to 
the wage index and the annual update of the wage data. Specific issues 
addressed in this section include the following:
     The FY 2002 wage index update, using FY 1998 wage data.
     The transition to excluding from the wage index Part A 
physician wage costs that are teaching-related, as well as resident and 
Part A certified registered nurse anesthetist (CRNA) costs.
     The costs of contracted pharmacy and laboratory services.
     The collection of occupational mix data, as required by 
section 304(c) of Public Law 106-554.
     Revisions to the wage index based on hospital 
redesignations and reclassifications, including changes to reflect the 
provisions of sections 304(a) and (b) of Public Law 106-554 relating to 
3-year wage index reclassifications by the MGCRB, the use of 3 years of 
wage data for evaluating reclassification requests for FYs 2003 and 
later, and the application of a statewide wage index for 
reclassifications beginning in FY 2003.
     Requests for wage data corrections and modification of the 
process and timetable for updating the wage index, and a proposed 
revision of that timetable.
3. Other Decisions and Proposed Changes to the Prospective Payment 
System for Inpatient Operating and Graduate Medical Education Costs
    In section IV. of this preamble, we discuss several provisions of 
the regulations in 42 CFR Parts 412 and 413 and set forth certain 
proposed changes concerning the following:
     Sole community hospitals.
     Rural referral centers.
     Changes relating to the IME adjustment as a result of 
section 302 of Public Law 106-554.
     Changes relating to the DSH adjustment as a result of 
section 303 of Public Law 106-554.
     The establishment of policies relating to the 3-year 
application of wage index reclassifications by the MGCRB, the use of 3 
years of wage data in evaluating reclassification requests to the MGCRB 
for FYs 2003 and later, and the use of a statewide wage index for 
reclassifications beginning in FY 2003, as required by sections 304(a) 
and (b) of Public Law 106-554.
     Proposed requirements for additional payments for new 
medical services and technology, as required by section 533(b) of 
Public Law 106-554.
     Changes relating to payment for the direct costs of GME, 
including changes as a result of section 511 of Public Law 106-554.
4. Prospective Payment System for Capital-Related Costs
    In section V. of this preamble, we specify the proposed payment 
requirements for capital-related costs, including the special 
exceptions payment, beginning October 1, 2002.
5. Proposed Changes for Hospitals and Hospital Units Excluded from the 
Prospective Payment Systems
    In section VI. of this preamble, we discuss the following proposals 
concerning excluded hospital and hospital units and CAHs:
     Limits on and adjustments to the proposed target amounts 
for FY 2002.
     Revision of the methodology for wage neutralizing the 
hospital-specific target amounts using preclassified wage data.
     Updated caps for new excluded hospitals and units as well 
as changes in the effective date of classifications of excluded 
hospitals and units.
     The prospective payment system for inpatient 
rehabilitation hospitals and units.
     Payments to CAHs, including exclusion from the payment 
window requirements; the availability of CRNA pass-through payments; 
payment for emergency room on-call physicians; treatment of ambulance 
services; the use of certain qualified practitioners for preanesthesia 
and postanesthesia evaluations; and clarification of location 
requirements for CAHs.
6. Determining Prospective Payment Operating and Capital Rates and 
Rate-of-Increase Limits
    In the Addendum to this proposed rule, we set forth proposed 
changes to the amounts and factors for determining the FY 2002 
prospective payment rates for operating costs and capital-related 
costs. We also establish the proposed threshold amounts for outlier 
cases. In addition, we address update factors for determining the rate-
of-increase limits for cost reporting periods beginning in FY 2002 for 
hospitals and hospital units excluded from the prospective payment 
system.
7. Impact Analysis
    In Appendix A, we set forth an analysis of the impact that the 
proposed changes described in this proposed rule would have on affected 
entities.
8. Capital Acquisition Model
    Appendix B contains the technical appendix on the proposed FY 2002 
capital cost model.
9. Report to Congress on the Update Factor for Hospitals Under the 
Prospective Payment System and Hospitals and Units Excluded From the 
Prospective Payment System
    Section 1886(e)(3) of the Act requires the Secretary to report to 
Congress on our initial estimate of a recommended update factor for FY 
2002 for payments to hospitals included in the prospective payment 
systems, and hospitals excluded from the prospective payment systems. 
This report is included as Appendix C to this proposed rule.
10. Proposed Recommendation of Update Factor for Hospital Inpatient 
Operating Costs
    As required by sections 1886(e)(4) and (e)(5) of the Act, Appendix 
D provides our recommendation of the appropriate percentage change for 
FY 2002 for the following:
     Large urban area and other area average standardized 
amounts (and hospital-specific rates applicable to sole community and 
Medicare-dependent, small rural hospitals) for hospital inpatient 
services paid for under the prospective payment system for operating 
costs.
     Target rate-of-increase limits to the allowable operating 
costs of hospital inpatient services furnished by hospitals

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and hospital units excluded from the prospective payment system.
11. Discussion of Medicare Payment Advisory Commission Recommendations
    Under section 1805(b) of the Act, the Medicare Payment Advisory 
Commission (MedPAC) is required to submit a report to Congress, not 
later than March 1 of each year, that reviews and makes recommendations 
on Medicare payment policies. This annual report makes recommendations 
concerning hospital inpatient payment policies. In section VII. of this 
preamble, we discuss the MedPAC recommendations and any actions we are 
proposing to take with regard to them (when an action is recommended). 
For further information relating specifically to the MedPAC March 1 
report or to obtain a copy of the report, contact MedPAC at (202) 653-
7220 or visit MedPAC's website at: www.medpac.gov.

II. Proposed Changes to DRG Classifications and Relative Weights

A. Background

    Under the prospective payment system, we pay for inpatient hospital 
services on a rate per discharge basis that varies according to the DRG 
to which a beneficiary's stay is assigned. The formula used to 
calculate payment for a specific case takes an individual hospital's 
payment rate per case and multiplies it by the weight of the DRG to 
which the case is assigned. Each DRG weight represents the average 
resources required to care for cases in that particular DRG relative to 
the average resources used to treat cases in all DRGS.
    Congress recognized that it would be necessary to recalculate the 
DRG relative weights periodically to account for changes in resource 
consumption. Accordingly, section 1886(d)(4)(C) of the Act requires 
that the Secretary adjust the DRG classifications and relative weights 
at least annually. These adjustments are made to reflect changes in 
treatment patterns, technology, and any other factors that may change 
the relative use of hospital resources. The proposed changes to the DRG 
classification system, and the proposed recalibration of the DRG 
weights for discharges occurring on or after October 1, 2001, are 
discussed below.

B. DRG Reclassification

1. General
    Cases are classified into DRGs for payment under the prospective 
payment system based on the principal diagnosis, up to eight additional 
diagnoses, and up to six procedures performed during the stay, as well 
as age, sex, and discharge status of the patient. The diagnosis and 
procedure information is reported by the hospital using codes from the 
International Classification of Diseases, Ninth Revision, Clinical 
Modification (ICD-9-CM). Medicare fiscal intermediaries enter the 
information into their claims processing systems and subject it to a 
series of automated screens called the Medicare Code Editor (MCE). 
These screens are designed to identify cases that require further 
review before classification into a DRG.
    After screening through the MCE and any further development of the 
claims, cases are classified into the appropriate DRG by the Medicare 
GROUPER software program. The GROUPER program was developed as a means 
of classifying each case into a DRG on the basis of the diagnosis and 
procedure codes and demographic information (that is, sex, age, and 
discharge status). It is used both to classify past cases in order to 
measure relative hospital resource consumption to establish the DRG 
weights and to classify current cases for purposes of determining 
payment. The records for all Medicare hospital inpatient discharges are 
maintained in the Medicare Provider Analysis and Review (MedPAR) file. 
The data in this file are used to evaluate possible DRG classification 
changes and to recalibrate the DRG weights.
    In the July 30, 1999 final rule (64 FR 41500), we discussed a 
process for considering non-MedPAR data in the recalibration process. 
In order for the use of particular data to be feasible, we must have 
sufficient time to evaluate and test the data. The time necessary to do 
so depends upon the nature and quality of the data submitted. 
Generally, however, a significant sample of the data should be 
submitted by August 1, approximately 8 months prior to the publication 
of the proposed rule, so that we can test the data and make a 
preliminary assessment as to the feasibility of using the data. 
Subsequently, a complete database should be submitted no later than 
December 1 for consideration in conjunction with the next year's 
proposed rule.
    Currently, cases are assigned to one of 503 DRGs (including one DRG 
for a diagnosis that is invalid as a discharge diagnosis and one DRG 
for ungroupable diagnoses) in 25 major diagnostic categories (MDCs). 
Most MDCs are based on a particular organ system of the body (for 
example, MDC 6 (Diseases and Disorders of the Digestive System)). 
However, some MDCs are not constructed on this basis because they 
involve multiple organ systems (for example, MDC 22 (Burns)).
    In general, cases are assigned to an MDC based on the principal 
diagnosis, before assignment to a DRG. However, there are five DRGs to 
which cases are directly assigned on the basis of procedure codes. 
These are the DRGs for liver, bone marrow, and lung transplants (DRGs 
480, 481, and 495, respectively) and the two DRGs for tracheostomies 
(DRGs 482 and 483). Cases are assigned to these DRGs before 
classification to an MDC.
    Within most MDCs, cases are then divided into surgical DRGs (based 
on a surgical hierarchy that orders individual procedures or groups of 
procedures by resource intensity) and medical DRGs. Medical DRGs 
generally are differentiated on the basis of diagnosis and age. Some 
surgical and medical DRGs are further differentiated based on the 
presence or absence of complications or comorbidities (CC).
    Generally, the GROUPER does not consider other procedures; that is, 
nonsurgical procedures or minor surgical procedures generally not 
performed in an operating room are not listed as operating room (OR) 
procedures in the GROUPER decision tables. However, there are a few 
non-OR procedures that do affect DRG assignment for certain principal 
diagnoses, such as extracorporeal shock wave lithotripsy for patients 
with a principal diagnosis of urinary stones.
    The major changes we are proposing to make to the DRG 
classification system for FY 2002 are summarized in Charts 1, 2, and 3 
below, followed by detailed discussions in individual sections 
according to MDC assignment. Other issues concerning DRGs are also set 
forth below. Unless otherwise noted, our DRG analysis is based on data 
from 100 percent of the FY 2000 MedPAR file containing hospital bills 
received through May 31, 2000 for discharges in FY 2000.

[[Page 22650]]



        Chart 1.--Summary of Proposed Changes in DRG Assignments
------------------------------------------------------------------------
                                                Added  as
       Diagnosis related groups (DRGs)             new         Removed
------------------------------------------------------------------------
Pre-MDC:
    DRG 512 (Simultaneous Pancreas/Kidney               X
     Transplant)............................
    DRG 513 (Pancreas Transplants)..........            X
MDC 5 (Diseases and Disorders of the
 Circulatory System):
    DRG 112 (Percutaneous Cardiovascular                              X
     Procedures)............................
    DRG 514 (Cardiac Defibrillator Implant              X
     with Cardiac Catheterization)..........
    DRG 515 (Cardiac Defibrillator Implant              X
     without Cardiac Catheterization).......
    DRG 516 (Percutaneous Cardiovascular                X
     Procedures with Acute Myocardial
     Infarction (AMI))......................
    DRG 517 (Percutaneous Cardiovascular                X
     Procedures without AMI, with Coronary
     Artery Stent Implant...................
    DRG 518 (Percutaneous Cardiovascular                X
     Procedures without AMI, without
     Coronary Artery Stent Implant..........
MDC 8 (Diseases and Disorders of the
 Musculoskeletal System and Connective
 Tissue):
    DRG 519 (Cervical Spinal Fusion with CC)            X
    DRG 520 (Cervical Spinal Fusion without             X
     CC)....................................
MDC 20 (Alcohol/Drug Use and Alcohol/Drug-
 Induced Organic Mental Disorders):
    DRG 434 Alcohol/Drug Abuse or                                     X
     Dependency, Detoxification or Other
     Symptomatic Treatment with CC).........
    DRG 435 (Alcohol/Drug Abuse or                                    X
     Dependency, Detoxification or Other
     Symptomatic Treatment without CC)......
    DRG 436 (Alcohol/Drug Dependence with                             X
     Rehabilitation Therapy)................
    DRG 437 (Alcohol/Drug Dependence,                                 X
     Combined Rehabilitation and
     Detoxification Therapy)................
    DRG 521 (Alcohol/Drug Abuse or                      X
     Dependence with CC)....................
    DRG 522 (Alcohol/Drug Abuse or                      X
     Dependence without CC, with
     Rehabilitation Therapy)................
    DRG 523 (Alcohol/Drug Abuse or                      X
     Dependence without CC, without
     Rehabilitation Therapy)................
------------------------------------------------------------------------


    Chart 2.--Summary of Proposed Assignment or Reassignment of Diagnosis or Procedure Codes in Existing DRGs
----------------------------------------------------------------------------------------------------------------
    Diagnosis/procedure codes                 Removed from DRG                       Reassigned to DRG
----------------------------------------------------------------------------------------------------------------
MDC 5 (Diseases and Disorders of
 the Circulatory System):
    Principal Diagnosis Code:
      410.01  Acute myocardial     116...................................  516
       infarction of
       anterolateral wall,
       initial episode of care.
      410.11  Acute myocardial     116...................................  516
       infarction of other
       anterior wall, initial
       episode of care.
      410.21  Acute myocardial     116...................................  516
       infarction of
       inferolateral wall,
       initial episode of care.
      410.31  Acute myocardial     116...................................  516
       infarction of
       inferoposterior wall,
       initial episode of care.
      410.41  Acute myocardial     116...................................  516
       infarction of other
       inferior wall, initial
       episode of care.
      410.51  Acute myocardial     116...................................  516
       infarction of other
       lateral wall, initial
       episode of care.
      410.61  True posterior wall  116...................................  516
       infarction, initial
       episode of care.
      410.71  Subendocardial       116...................................  516
       infarction, initial
       episode of care.
      410.81  Acute myocardial     116...................................  516
       infarction of other
       specified sites, initial
       episode of care.
      410.91  Acute myocardial     116...................................  516
       infarction of unspecified
       site, initial episode of
       care.
    Procedure Codes:
      37.94  Implantation or       104, 105..............................  514, 515
       replacement of automatic
       cardioverter/
       defibrillation, total
       system (AICD).
      37.95  Implantation of       104, 105..............................  514, 515
       automatic cardioverter/
       defibrillator lead(s) only.
      37.96  Implantation of       104, 105..............................  514, 515
       automatic cardioverter/
       defibrillator pulse
       generator only.
      37.97  Replacement of        104, 105..............................  514, 515
       automatic cardioverter/
       defibrillator lead(s) only.
      37.98  Replacement of        104, 105..............................  514, 515
       automatic cardioverter/
       defibrillator pulse
       generator only.
    Operating Room Procedures:
      35.96  Percutaneous          116...................................  516, 517, 518
       valvuloplasty.
      36.01  Single vessel         116...................................  516, 517, 518
       percutaneous transluminal
       coronary angioplasty
       (PTCA) or coronary
       atherectomy without
       mention of thrombolytic
       agent.
      36.02  Single vessel         116...................................  516, 517, 518
       percutaneous transluminal
       coronary angioplasty
       (PTCA) or coronary
       atherectomy with mention
       of thrombolytic agent.
      36.05  Multiple vessel       116...................................  516, 517, 518
       percutaneous transluminal
       coronary angioplasty
       (PTCA) or coronary
       atherectomy performed
       during the same operation,
       with or without mention of
       thrombolytic agent.
      36.09  Other removal of      116...................................  516, 517, 518
       coronary artery
       obstruction.
      37.34  Catheter ablation of  116...................................  516, 517, 518
       lesion or tissues of heart.
      92.27  Implantation or       Non-OR in MDC-5.......................  517
       insertion of radioactive
       elements.
    Nonoperating Room Procedures:
      36.06  Insertion of          116...................................  517
       coronary artery stent(s).
      37.21  Right heart cardiac   104...................................  514
       catheterization.

[[Page 22651]]

 
      37.22  Left heart cardiac    104...................................  514
       catheterization.
      37.23  Right and left heart  104...................................  514
       cardiac catheterization.
      37.26  Cardiac               104, 112..............................  514, 516, 517, 518
       electrophysiologic
       stimulation and recording
       studies.
      37.27  Cardiac mapping.....  112...................................  516, 517, 518
      88.52  Angiocardiography of  104...................................  514
       right heart structures.
      88.53  Angiocardiography of  104...................................  514
       left heart structures.
      88.54  Combined right and    104...................................  514
       left heart
       angiocardiography.
      88.55  Coronary              104...................................  514
       arteriography using a
       single catheter.
      88.56  Coronary              104...................................  514
       arteriography using two
       catheters.
      88.57  Other and             104...................................  514
       unspecified coronary
       arteriography.
      88.58  Negative-contrast     104...................................  514
       cardiac roentgenography.
MDC 8 (Diseases and Disorders of
 the Musculoskeletal System and
 Connective Tissue):
    Procedure Codes:
      81.02  Other cervical        497, 498..............................  519, 520
       fusion, anterior technique.
      81.03  Other cervical        497, 498..............................  519, 520
       fusion, posterior
       technique.
MDC 15 (Newborns and Other
 Neonates with Conditions
 Originating in the Perinatal
 Period)
    Diagnosis Codes:
      773.0  Hemolytic disease     389...................................  390
       due to RH isoimmunization.
      773.1  Hemolytic disease     389...................................  390
       due to ABO isoimmunization.
    Secondary Diagnosis Codes:
      478.1  Other diseases of     390...................................  391
       nasal cavity and sinuses.
      520.6  Disturbances in       390...................................  391
       tooth eruption.
      623.8  Other specified       390...................................  391
       noninflammatory disorders
       of vagina.
      709.00  Dyschroma,           390...................................  391
       unspecified.
      709.01  Vitiglio...........  390...................................  391
      709.09  Dyschromia, Other..  390...................................  391
      744.1  Accessory Auricle...  390...................................  391
      754.61  Congenital pes       390...................................  391
       planus.
      757.33  Congenital           390...................................  391
       pigmentary anomalies of
       skin.
      757.39  Other specified      390...................................  391
       anomaly of skin.
      764.08  ``Light for dates''  390...................................  391
       without mention of fetal
       malnutrition, 2,000-2,499
       grams.
      764.98  Fetal growth         390...................................  391
       retardation, unspecified,
       2,000-2,499 grams.
      772.6  Cutaneous hemorrhage  390...................................  391
      794.15  Abnormal and         390...................................  391
       auditory function studies.
      796.4  Other abnormal        390...................................  391
       clinical findings.
      V20.2  Routine infant or     390...................................  391
       child health check.
      V72.1  Examination of ears   390...................................  391
       and hearing.
----------------------------------------------------------------------------------------------------------------


               Chart 3.--Summary of Proposed Retitled DRGs
------------------------------------------------------------------------
       MDC            DRG  No.         Current name      Proposed name
------------------------------------------------------------------------
MDC 5...........  DRG 116           Other Permanent    Other Cardiac
                                     Cardiac            Pacemaker
                                     Pacemaker          Implantation.
                                     Implantation, or
                                     PTCA, with
                                     Coronary Artery
                                     Stent Implant.
MDC 8...........  DRG 497           Spinal Fusion      Spinal Fusion
                                     with CC.           except Cervical
                                                        with CC.
MDC 8...........  DRG 498           Spinal Fusion      Spinal Fusion
                                     without CC.        except Cervical
                                                        without CC.
------------------------------------------------------------------------

2. MDC 5 (Diseases and Disorders of the Circulatory System)
a. Removal of Defibrillator Cases From DRGs 104 and 105
    DRGs 104 (Cardiac Valve & Other Major Cardiothoracic Procedures 
with Cardiac Catheterization) and 105 (Cardiac Valve & Other Major 
Cardiothoracic Procedures without Cardiac Catheterization) include the 
replacement or open repair of one or more of the four heart valves. 
These valves may be diseased or damaged, resulting in either leakage or 
restriction of blood flow to the heart, compromising the ability of the 
heart to pump blood. This procedure requires the use of a heart-lung 
bypass machine, as the heart must be stilled and opened to repair or 
replace the valve.
    Cardiac defibrillators are implanted to correct episodes of 
fibrillation (very fast heart rate) caused by malfunction of the 
conduction mechanism of the heart. Through implanted cardiac leads, the 
defibrillator mechanism senses changes in heart rhythm. When very fast 
heart rates occur, the defibrillator produces a burst of electric 
current through the leads to restore the normal heart rate. An 
implanted defibrillator constantly monitors heart rhythm. The 
implantation of this device does not require the use of a heart-lung 
bypass machine, and would be expected to be very different in terms of 
resource usage, although both procedures currently group to DRGs 104 
and 105.
    As part of our ongoing review of DRGs, we examined Medicare claims 
data on DRG 104 and DRG 105. We reviewed 100 percent of the FY 2000 
MedPAR file containing hospital bills received through May 31, 2000, 
for

[[Page 22652]]

discharges in FY 2000, and found that the average charges across all 
cases in DRG 104 were $84,060, while the average charges across all 
cases in DRG 105 were $66,348. Carving out code 37.94 (Implantation or 
replacement of automatic cardioverter/defibrillator, total system 
[AICD]) from DRGs 104 and 105 increased those average charges to 
$91,366 for DRG 104 and $67,323 for DRG 105. We identified 11,021 
defibrillator cases in DRG 104 (out of 25,112 total cases), with 
average charges of $74,719, and 2,434 defibrillator cases in DRG 105 
(out of 20,094 total cases), with average charges of $59,267.
    We performed additional review on cases containing code 37.95 
(Implantation of automatic cardioverter/ defibrillator lead(s) only) 
with code 37.96 (Implantation of automatic cardioverter/defibrillator 
pulse generator only) and on cases containing code 37.97 (Replacement 
of automatic cardioverter/defibrillator lead(s) only) with code 37.98 
(Replacement of automatic cardioverter/defibrillator pulse generator 
only). This subgrouping contained only 56 patients. The average charges 
for the 18 patients in DRG 104 were $58,847. The average charges for 
the 38 patients in DRG 105 were $54,891.
    Because we believe the defibrillator cases are significantly 
different from other cases in DRGs 104 and 105, we are proposing to 
create two new DRGs: DRG 514 (Cardiac Defibrillator Implant with 
Cardiac Catheterization) and DRG 515 (Cardiac Defibrillator Implant 
without Cardiac Catheterization).
    We are proposing to remove procedure codes 37.94, 37.95 and 37.96, 
and 37.97 and 37.98 from DRGs 104 and 105 to form the new DRGs 514 and 
515. The proposed new DRGs 514 and 515 would include principal 
diagnosis codes and procedure codes as reflected in Chart 4 below:

     Chart 4.--Composition of Proposed New DRGs 514 and 515 in MDC 5
------------------------------------------------------------------------
                                               Included in   Included in
        Diagnosis and procedure codes         proposed DRG  proposed DRG
                                                   514           515
------------------------------------------------------------------------
Principal Diagnosis Codes:
    All of the principal diagnosis codes                X             X
     assigned to MDC-5......................
Principal or Secondary Procedure Code:
    37.94  Implantation or replacement of               X             X
     automatic cardioverter/defibrillation,
     total system (AICD)....................
Combination Operating Procedure Codes:
    37.95  Implantation of automatic
     cardioverter/defibrillator lead(s)
     only; plus
    37.96  Implantation of automatic                    X             X
     cardioverter/defibrillator pulse
     generator only;........................
Or
    37.97  Replacement of automatic
     cardioverter/defibrillator lead(s)
     only; plus
    37.98  Replacement of automatic                     X             X
     cardioverter/defibrillator pulse
     generator only.........................
Plus: One of the Following Nonoperating Room
 Procedure Codes:
    37.21  Right heart cardiac                          X
     catheterization........................
    37.22  Left heart cardiac                           X
     catheterization........................
    37.23  Combined right and left heart                X
     cardiac catheterization................
    37.26  Cardiac electrophysiologic                   X
     stimulation and recording studies......
    88.52  Angiocardiography of right heart             X
     structures.............................
    88.53  Angiocardiography of left heart              X
     structures.............................
    88.54  Combined right and left heart                X
     angiocardiography......................
    88.55  Coronary arteriography using a               X
     single catheter........................
    88.56  Coronary arteriography using two             X
     catheters..............................
    88.57  Other and unspecified coronary               X
     arteriography..........................
    88.58  Negative-contrast cardiac                    X
     roentgenography........................
------------------------------------------------------------------------

b. Percutaneous Cardiovascular Procedures
    We reviewed other DRGs within MDC 5 in order to determine if there 
were also logic changes that could be made to these DRGs. The data was 
arrayed in a variety of ways displaying myriad permutations, resulting 
in the following proposed changes. A percutaneous transluminal coronary 
angioplasty (PTCA) is an acute intervention intended to minimize 
cardiac damage by restarting circulation to the heart. Some patients 
with an acute myocardial infarction (AMI) are now treated by performing 
a PTCA during the hospitalization for the AMI. Currently, PTCAs with a 
coronary stent implant are assigned to DRG 116 (Other Permanent Cardiac 
Pacemaker Implantation, or PTCA with Coronary Artery Stent Implant), 
along with pacemaker implants. The remaining percutaneous 
cardiovascular procedures are assigned to DRG 112 (Percutaneous 
Cardiovascular Procedures).
    The volume of percutaneous cardiovascular procedures has grown 
dramatically, with 186,669 cases identified in the FY 2000 MedPAR file 
containing hospital bills submitted through May 31, 2000. Because of 
the high volume, we decided to review the DRG for percutaneous 
cardiovascular procedures. As a first step in the evaluation, we 
combined the percutaneous cardiovascular procedures from DRGs 112 and 
116. We then subdivided the combined percutaneous cardiovascular 
procedure group into two groups based on the principal diagnosis (Pdx) 
of AMI.

------------------------------------------------------------------------
                                                               Average
                     Group                         Count        charge
------------------------------------------------------------------------
With Pdx of AMI...............................       50,442      $31,722
Without Pdx of AMI............................      136,227       23,989
------------------------------------------------------------------------

    Each of these groups was further evaluated by subdividing them 
based on whether a coronary stent was implanted. The vast majority of 
patients with an AMI had a coronary stent implanted. Patients without 
an AMI were subdivided into two groups based on whether a coronary 
stent was implanted.

------------------------------------------------------------------------
                                                               Average
                     Group                         Count        charge
------------------------------------------------------------------------
Without Pdx of AMI with stent.................      111,441      $24,745

[[Page 22653]]

 
Without Pdx of AMI without stent..............       24,786       20,589
------------------------------------------------------------------------

    Based on this analysis, we are proposing to remove the PTCAs with 
coronary artery stent from DRG 116, thus limiting DRG 116 to permanent 
cardiac pacemaker implantation. This removal will leave approximately 
68,000 non-PTCA cases in DRG 116.
    In conjunction with this evaluation, we considered a new 
technology, intravascular brachytherapy, that is being used to treat 
coronary in-stent stenosis. A gamma-radiation-impregnated tape is 
threaded through the affected vessel for a specified amount of dwell 
time, and then the tape is removed. Intravascular brachytherapy was 
approved by the Food and Drug Administration in November 2000.
    Intravascular brachytherapy is assigned to procedure code 92.27 
(Implantation or insert of radioactive elements). With the use of 
angioplasty, these cases are currently assigned to DRG 112 
(Percutaneous Cardiovascular Procedures). Therefore, cases involving 
this new technology will be implicated by these proposed changes.
    We are proposing to retitle DRG 116 ``Other Cardiac Pacemaker 
Implantation,'' remove DRG 112, and create three new DRGs: DRG 516 
(Percutaneous Cardiovascular Procedures with Acute Myocardial 
Infarction (AMI)); DRG 517 (Percutaneous Cardiovascular Procedures 
without AMI, with Coronary Artery Stent Implant; and DRG 518 
(Percutaneous Cardiovascular Procedures without AMI, without Coronary 
Artery Stent Implant). The principal diagnosis codes and operating room 
and nonoperating room procedure codes that are proposed to be included 
in the new DRGs 516, 517, and 518 are reflected in Chart 5.
    In order to be assigned to new DRG 516, cases must contain one of 
the principal diagnoses plus the operating room procedures listed in 
Chart 5. Because DRG 516 contains acute myocardial infarction, which is 
hierarchically ordered before DRGs 517 and 518, any AMI cases also 
containing codes 92.27 or 36.06 would automatically be assigned to DRG 
516. We are proposing to assign patients with a percutaneous 
cardiovascular procedure and intravascular radiation treatment to new 
DRG 517. As more data become available, we will reassess the assignment 
of intravascular radiation treatment to DRG 517. Proposed new DRG 518 
would contain the same operating room and nonoperating room procedures 
as new proposed DRG 517, with the exception of codes 92.27 and 36.06.

   Chart 5.--Composition of Proposed New DRGs 516, 517, and 518 in MDC 5
------------------------------------------------------------------------
                                 Included in   Included in   Included in
 Diagnosis and procedure codes  Proposed DRG  Proposed DRG  Proposed DRG
                                     516           517           518
------------------------------------------------------------------------
Principal Diagnosis Codes:
    410.01  Acute myocardial              X
     infarction of
     anterolateral wall,
     initial episode of care..
    410.11  Acute myocardial              X
     infarction of other
     anterior wall, initial
     episode of care..........
    410.21  Acute myocardial              X
     infarction of
     inferolateral wall,
     initial episode of care..
    410.31  Acute myocardial              X
     infarction of
     inferoposterior wall,
     initial episode of care..
    410.41  Acute myocardial              X
     infarction of other
     inferior wall, initial
     episode of care..........
    410.51  Acute myocardial              X
     infarction of other
     lateral wall, initial
     episode of care..........
    410.61  True posterior                X
     wall infarction, initial
     episode of care..........
    410.71  Subendocardial                X
     infarction, initial
     episode of care..........
    410.81  Acute myocardial              X
     infarction of other
     specified sites, initial
     episode of care..........
    410.91  Acute myocardial              X
     infarction of unspecified
     site, initial episode of
     care.....................
plus: Operating Room
 Procedures:
    35.96  Percutaneous                   X             X             X
     valvuloplasty............
      and
    36.01  Single vessel                  X             X             X
     percutaneous transluminal
     coronary angioplasty
     (PTCA) or coronary
     atherectomy without
     mention of thromolytic
     agent....................
      or
    36.02  Single vessel                  X             X             X
     percutaneous transluminal
     coronary angioplasty
     (PTCA) or coronary
     atherectomy with mention
     of thrombolytic agent....
      or
    36.05  Multiple vessel                X             X             X
     percutaneous transluminal
     coronary angioplasty
     (PTCA) or coronary
     atherectomy performed
     during the same
     operation, with or
     without mention of
     thrombolytic agent.......
      and
    36.09  Other removal of               X             X             X
     coronary artery
     obstruction..............
      and
    37.34  Catheter ablation              X             X             X
     of lesion or tissues of
     heart....................
    92.27  Implantation or                              X
     insertion of radioactive
     elements.................
OR: Nonoperating Room
 Procedures:
    36.06  Insertion of                                 X
     coronary artery stent(s).
    37.26  Cardiac                        X             X             X
     electrophysiologic
     stimulation and recording
     studies..................
    37.27  Cardiac mapping....            X             X             X
------------------------------------------------------------------------

    DRG 121 (Circulatory Disorders with AMI and Major Complication, 
Discharged Alive), DRG 122 (Circulatory Disorders with AMI without 
Major Complication, Discharged Alive), and DRG 123 (Circulatory 
Disorders with AMI, Expired) are not affected by these changes.
c. Removal of Heart Assist Systems
    The ICD-9-CM Coordination and Maintenance Committee considered the 
nonoperative removal of heart assist systems at its November 17, 2000 
meeting. A device called the intra-aortic balloon pump (IABP) is one of 
the most common types of ventricular assist systems. A balloon catheter 
is placed

[[Page 22654]]

into the patient's descending thoracic aorta, and inflates and deflates 
with each heartbeat. This device is timed with the patient's own heart 
rhythm, and inflates and circulates blood to the heart and other 
organs. This allows the heart to rest and recover. The IABP may be used 
preoperatively, intraoperatively, or postoperatively. It supports the 
patient from a few hours to several days.
    Code 37.64 (Removal of heart assist system) already exists, and it 
is considered by the GROUPER to be an operative procedure. However, the 
nonoperative removal of a heart assist system can be done at the 
patient's bedside, is noninvasive, and requires no anesthesia. 
Therefore, the Committee created code 97.44 (Nonoperative removal of 
heart assist system) for use with discharges beginning on or after 
October 1, 2001.
    In the past, we have assigned new ICD-9-CM codes to the same DRG to 
which the predecessor code was assigned. If this practice were to be 
followed, we would have proposed that code 97.44 be assigned to MDC 5, 
DRGs 478 (Other Vascular Procedures with CC) and 479 (Other Vascular 
Procedures without CC). After hospital charge data became available, we 
would have considered moving it to other DRGs. However, in accordance 
with section 533(a) of Public Law 106-554, which requires a more 
expeditious technique of recognizing new medical services or technology 
for the hospital inpatient prospective payment system, we will 
reconsider this longstanding practice when possible. Therefore, as code 
97.44 was designed to capture heart assist system removal that is 
clearly nonoperative, we are not proposing to designate 97.44 as a code 
which the GROUPER recognizes as a procedure. This assignment can be 
found in Table 6B, New Procedure Codes in the addendum to this proposed 
rule. Therefore, these cases will be assigned by the GROUPER to a 
medical DRG based on the principal diagnosis, or to a surgical DRG if a 
surgical procedure recognized by the GROUPER is performed.
3. MDC 8 (Diseases and Disorders of the Musculoskeletal System and 
Connective Tissue)
a. Refusions
    We have received questions from correspondents regarding the 
appropriateness of the spinal fusion DRGs: DRG 496 (Combined Anterior/
Posterior Spinal Fusion); DRG 497 (Spinal Fusion with CC); and DRG 498 
(Spinal Fusion without CC). Several correspondents expressed concern 
about the inclusion of all refusions of the spine into one procedure 
code, 81.09 (Refusion of spine, any level or technique). The 
correspondents pointed out that because all refusions using any 
technique or level are in this one code, all of these cases are 
assigned to DRG 497 and DRG 498. They also pointed out that fusion 
cases involving both an anterior and posterior technique are assigned 
to DRG 496. Although cases with the refusion code that involve anterior 
and posterior techniques would appear to be more appropriately assigned 
to DRG 496, this is not the case.
    We recognized this limitation in the refusion codes and further 
acknowledged that this limitation in the ICD-9-CM coding system creates 
DRG problems by preventing the assignment to DRG 496 even when both 
anterior and posterior techniques are used for refusion cases. 
Therefore, we referred the issue to the ICD-9-CM Coordination and 
Maintenance Committee and requested the Committee to consider code 
revisions for the refusions of the spine during its year 2000 public 
meetings.
    After its deliberations, the Committee approved a series of new 
procedure codes for refusion of the spine that could lead to 
improvements within DRGs 497 and 498. These new codes, listed below, go 
into effect on October 1, 2001.

81.30  Refusion of spine, not otherwise specified
81.31  Refusion of atlas-axis spine
81.32  Refusion of other cervical spine, anterior technique
81.33  Refusion of other cervical spine, posterior technique
81.34  Refusion of dorsal and dorsolumbar spine, anterior technique
81.35  Refusion of dorsal and dorsolumbar spine, posterior technique
81.36  Refusion of lumbar and lumbosacral spine, anterior technique
81.37  Refusion of lumbar and lumbosacral spine, lateral transverse 
process technique
81.38  Refusion of lumbar and lumbosacral spine, posterior technique
81.39  Refusion of spine, not elsewhere classified

    As previously stated, all refusions of the spine and corrections of 
the pseudarthrosis of the spine are assigned to code 81.09. Code 81.09, 
which is always assigned to DRG 497 or DRG 498, includes refusions at 
any level of the spine using any technique. With the creation of the 
new procedure codes listed above, it will be possible to determine the 
level of the spine at which the refusion is performed, as well as the 
technique used, and assign the case to a more appropriate DRG.
    These new procedure codes should greatly improve our ability to 
determine the level and technique used in the refusion.
    In the past, we have assigned new ICD-9-CM codes to the same DRG to 
which the predecessor code was assigned. If this practice were 
followed, these new codes would have been assigned to DRG 497 and 498 
as they are currently. After data became available, we would have 
considered moving them to other DRGs. However, in accordance with 
section 533(a) of Public Law 106-554, which requires more expeditious 
methods of recognizing new medical services or technology under the 
inpatient hospital prospective payment system, we will reconsider this 
longstanding practice when possible. Since the new codes clearly allow 
us to identify cases where the technique was either anterior or 
posterior and these cases are clinically similar and, therefore, should 
be handled in the same fashion, we are proposing to immediately assign 
these cases on the same basis as the fusion codes (81.00 through 
81.09). We would not wait for actual claims data before making this 
change. These proposed assignments are reflected in Chart 6 and also 
can be found in Table 6B, in section V. of the Addendum to this 
proposed rule.
b. Fusion of Cervical Spine
    We have received an additional inquiry concerning the spinal DRGs 
that focused on fusions of the cervical spine. The inquirer stated that 
there was a significant difference between inpatients who undergo 
anterior cervical spinal fusion and other types of spinal fusion in 
regard to treatment, recovery time, costs, and risk of complications. 
Anterior cervical spinal fusions are assigned to procedure code 81.02, 
Other cervical fusion, anterior technique. The inquirer pointed out 
that anterior cervical fusions differ significantly from anterior 
techniques at other levels since the anatomic approach is far less 
invasive. Thoracic anterior techniques require working around the 
cardiac and respiratory systems in the chest cavity, while lumbar 
anterior working around bowel and digestive system and the abdominal 
muscles. The inquirer recommended that code 81.02 be removed from DRGs 
497 and 498 and grouped separately.
    We analyzed claims data from 100 percent of the FY 2000 MedPAR file 
containing hospital bills received through May 31, 2000, and confirmed

[[Page 22655]]

that charges are lower for fusions of the cervical spine than fusions 
of the thoracic and lumbar spine. This was true for both anterior and 
posterior cervical fusions of the spine. Our medical consultants agree 
that the data and their clinical analysis support the creation of new 
DRGs for cervical fusions of the spine. Therefore, we are proposing to 
remove procedure codes 81.02 and 81.03 from the spinal fusion DRGs 
(currently, DRGs 497 and 498) and assign them to new DRGs for cervical 
spinal fusion with and without CC. We are proposing to make four 
groupings for fusion DRGs. We believe that the net effect of this 
proposal would be an increase in the weights for DRGs 497 and 498, 
since the lower charges for the cervical fusions would be removed. The 
average standardized charge for all spinal fusions with CCs was 
$26,957. For all spinal fusions without CCs, the average charge was 
$16,492. The table below also shows average standardized charges for 
these types of cases before and after the proposed revisions.

------------------------------------------------------------------------
                                                  Average
                                                   charge      Average
      Proposed revised spinal fusion DRGs          before       charge
                                                  proposed      after
                                                 revisions    revisions
------------------------------------------------------------------------
DRG 497 Spinal Fusion Except Cervical with CC.      $26,957      $36,821
DRG 498 Spinal Fusion Except Cervical without        17,492       26,297
 CC...........................................
DRG 519 Cervical Spinal Fusion with CC........  ...........       26,957
DRG 520 Cervical Spinal Fusion without CC.....  ...........       16,492
------------------------------------------------------------------------

    Based on the proposed groupings, we would create two new DRGs: DRG 
519 (Cervical Spinal Fusion with CC); and DRG 520 (Cervical Spinal 
Fusion without CC). The procedure codes that would be included in the 
proposed DRGs 519 and 520 are reflected in Chart 6 below.
    We are also proposing to add the new ICD-9-CM procedure codes for 
refusion of the cervical spine (81.32 and 81.33) to the new cervical 
spine fusion DRGs because they are clinically similar.
    We are proposing to retitle DRG 497 ``Spinal Fusion Except Cervical 
with CC'' and DRG 498 ``Spinal Fusion Except Cervical without CC.'' The 
retitled DRGs 497 and 498 would retain fusion codes 81.00, 81.01, and 
81.04 through 81.08 and include the proposed new refusion codes 81.30, 
81.31, and 81.34 through 81.39, as reflected in Chart 6 below.
c. Posterior Spinal Fusion
    We received other correspondence regarding the current DRG 
assignment for code 81.07, Lumbar and lumbosacral fusion, lateral 
transverse process technique. The correspondent stated that physicians 
consider code 81.07 to be a posterior procedure. The patient is placed 
prone on the operating table and the spine is exposed through a 
vertical midline incision. The correspondent pointed out that code 
81.07 is not classified as a posterior procedure within DRG 496 
(Combined Anterior/Posterior Spinal Fusion). Therefore, when 81.07 is 
reported with one of the anterior techniques fusion codes, it is not 
assigned to DRG 496. The correspondent recommended that code 81.07 be 
added to the list of posterior spinal fusion codes for use in 
determining assignment to DRG 496.
    We have consulted with our clinical advisors and they agree that 
this addition should be made. Since we are proposing to handle the new 
refusion codes in the same manner as the fusion codes, we also are 
proposing to assign DRG 496 when 81.37 is used with one of the anterior 
technique fusion or refusion codes. This would be similar to the manner 
in which code 81.07 is classified. For assignment to DRG 496, we would 
consider codes 81.01, 81.04, 81.06, 81.32, 81.34, and 81.36 to be 
anterior techniques and codes 81.03, 81.05, 81.07, 81.08, 81.33, 81.35, 
and 81.38 to be posterior techniques.

  Chart 6.--Proposed Revised Composition of DRGS 496, 497, and 498 and Proposed Composition of Proposed DRG 519
                                                and 520 in MDC 8
----------------------------------------------------------------------------------------------------------------
                                   Existing DRG 496
                             ----------------------------  Proposed to   Proposed to
   Diagnosis and procedure     Proposed to   Proposed to   be retained   be retained   Included in   Included in
            codes              be assigned   be assigned   in or added   in or added  proposed DRG  proposed DRG
                               as anterior  as posterior   to existing   to existing       519           520
                               techniques    techniques      DRG 497       DRG 498
----------------------------------------------------------------------------------------------------------------
Principal or Secondary
 Procedure Codes:
    81.00  Spinal fusion,                                           X             X
     not otherwise specified
    81.01  Atlas-axis fusion                                        X             X
    81.02  Other cervical               X                                                       X             X
     fusion, anterior
     technique..............
    81.03  Other cervical                             X                                         X             X
     fusion, posterior
     technique..............
    81.04  Lumbar and                   X                           X             X
     lumbosacral fusion,
     anterior technique.....
    81.05  Lumbar and                                 X             X             X
     lumbosacral fusion,
     posterior technique....
    81.06  Lumbar and                   X                           X             X
     lumbosacral fusion,
     anterior technique.....
    81.07  Lumbar and                                 X             X             X
     lumbosacral fusion,
     lateral transverse
     process technique......
    81.08  Lumbar and                                 X             X             X
     lumbosacral fusion,
     posterior technique....
    81.30  Refusion of                                              X             X
     spine, not otherwise
     specified..............
    81.31  Refusion of atlas-                                       X             X
     axis spine.............
    81.32  Refusion of other            X                                                       X             X
     cervical spine,
     anterior technique.....

[[Page 22656]]

 
    81.33  Refusion of other                          X                                         X             X
     cervical spine,
     posterior technique....
    81.34  Refusion of                  X                           X             X
     dorsal and dorsolumbar
     spine, anterior
     technique..............
    81.35  Refusion of                                X             X             X
     dorsal and dorsolumbar
     spine, posterior
     technique..............
    81.36  Refusion of                  X                           X             X
     lumbar and lumbosacral
     spine, anterior
     technique..............
    81.37  Refusion of                                X             X             X
     lumbar and lumbosacral
     spine, posterior
     technique..............
    81.38  Refusion of                                X             X             X
     lumbar and lumbosacral
     spine, posterior
     technique..............
    81.39  Refusion of                                              X             X
     spine, not elsewhere
     classified.............
----------------------------------------------------------------------------------------------------------------

d. Spinal Surgery
    The California Division of Workers' Compensation notified us of a 
possible problem with the following spinal DRGs:

DRG 496  (Combined Anterior/Posterior Spinal Fusion)
DRG 497  (Spinal Fusion with CC)
DRG 498  (Spinal Fusion without CC)
DRG 499  (Back & Neck Procedures except Spinal Fusion with CC)
DRG 500  (Back & Neck Procedures except Spinal Fusion without CC)

    The Division of Workers' Compensation uses the DRG categories 
developed by HCFA to classify types of hospital care. However, instead 
of using HCFA's weights for determining reimbursement for inpatient 
services, the Division sets a global fee for all inpatient medical 
services not otherwise exempted. This fee is established by multiplying 
the product of the DRG weight (or revised DRG weight for a small number 
of categories) and the health facility's composite factor by 1.20 to 
get the maximum amount for worker compensation admissions.
    The Division of Workers' Compensation has received reports that the 
formula it uses for reimbursing cases may be providing inadequate 
reimbursement. California hospitals and orthopedists have reported that 
certain spinal surgery DRGs (DRGs 496 through 500) may involve 
different types of care and/or technologies than those in use at the 
time these groups were formulated. Health care providers in California 
report ``recent increased use of the new implantation devices, 
hardware, and instrumentation, coupled with requirements for intensive 
hospital services accompanying use of new procedures, has led to 
inadequate reimbursement in these DRGs.'' As a short-term response to 
these concerns, the California Division of Workers' Compensation is 
exempting the costs of hardware and instrumentation from the global fee 
of the fee schedule for DRGS 496 through 500. The Division also 
requested that HCFA examine these DRGs for any potential problem under 
the Medicare reimbursement system.
    The ICD-9-CM coding system does not capture specific types of 
implantation devices, hardware, and instrumentation. Therefore, we were 
not able to verify the claim that these new devices have led to 
increased costs in specific cases. As discussed in section II.D. of 
this preamble, we believe that the adoption of a more detailed coding 
system, such as ICD-10-PCS, would supply greater amounts of detail on 
these items. However, in the short term, it is not possible to identify 
a specific problem that involves implantation devices, hardware, and 
instrumentation.
4. MDC 12 (Diseases and Disorders of the Male Reproductive System)
    At its May 11, 2000 public meeting, the ICD-9-CM Coordination and 
Maintenance Committee considered a request from a manufacturer to 
create a unique code for the procedure, Penile plethysmography with 
nerve stimulation, in DRG 334 (Major Male Pelvic Procedures with CC). 
The penile plethysmography is a test that can be performed during a 
radical prostatectomy procedure. During the course of the procedure, 
the physician places a probe within an area where the prostatic nerves 
are thought to be located and is able to detect minor changes in penile 
tumescence or detumescence. This reaction tells the physician that the 
nerve bundles have been located, which may aid the physician in 
performing a nerve-sparing radical prostatectomy procedure with 
precision. The nerve bundles can also be restimulated at the conclusion 
of the procedure, providing immediate feedback as to whether erectile 
function will be restored after surgery.
    After a presentation on the nerve identifying procedure and review 
of existing ICD-9-CM codes, the ICD-9-CM Coordination and Maintenance 
Committee determined that the existing code 89.58 (Plethysmogram) 
adequately describes this test.
    Radical prostatectomies for patients with cancer of the prostate 
are grouped in either DRG 334 (Major Male Pelvic Procedures with CC) or 
DRG 335 (Major Male Pelvic Procedures without CC). We have received a 
request from a manufacturer of a nerve-identifying device to assign 
cases containing code 89.58 into DRG 334 only, not into DRG 335, 
resulting in higher payments to hospitals. During FY 2001, DRG 334 had 
a relative weight of 1.5591, and DRG 335 had a relative weight of 
1.1697. The manufacturer requested that we designate code 89.58 as an 
operating room procedure code that would be recognized by the GROUPER 
software, and make that code applicable only to DRG 334. The 
manufacturer believed that this would serve to take any cases of nerve 
sparing out of the lower paying DRG 335, and would make the technology 
more attractive to hospitals. As paired DRGs 334 and 335 are currently 
structured, they differ only in whether or not a secondary diagnosis 
identified as a CC is recorded.
    Using 100 percent of the FY 2000 MedPAR file which contains 
hospital

[[Page 22657]]

bills for FY 2000 through May 31, 2000, we examined those cases in DRG 
334 to which the procedure code for prostatectomy was assigned. Of the 
total 7,241 cases in DRG 334 identified, 5,611 of these cases contained 
procedure code 60.5 (Radical prostatectomy). Only three of the 
prostatectomy cases included code 89.58. There is not a sufficient 
number of cases on which to base an assessment of the payment for this 
procedure. Therefore, we are not proposing to modify the assignment of 
code 89.58.
5. MDC 15 (Newborns and Other Neonates With Conditions Originating in 
the Perinatal Period)
    DRG 390 (Neonate with Other Significant Problems) contains newborn 
or neonate cases with other significant problems, not assigned to DRGs 
385 through 389, DRG 391, or DRG 469. To be assigned to DRG 389 (Full 
Term Neonate with Major Problems), the neonate must have one of the 
principal or secondary diagnosis listed under this DRG. A neonate is 
assigned to DRG 390 when the neonate has a principal or secondary 
diagnosis of newborn or neonate with other significant problems that 
are not assigned to DRG 385 through 389, 391, or 469.
    We have received correspondence suggesting a number of changes to 
be made to DRGs 398 and 391. These changes involve removing two codes 
from DRG 389 and adding 17 codes to DRG 391, as described below.
a. DRG 389 (Full Term Neonate With Major Problems)
    The correspondent suggested removing the following codes from DRG 
389 and assigning them to DRG 390:

773.0  Hemolytic disease due to RH isoimmunization
773.1  Hemolytic disease due to ABO isoimmunization

    The correspondent stated that hemolytic disease due to RH 
isoimmunization or due to ABO isoimmunization should not be considered 
a major problem. The correspondent recommended that these two 
conditions be classified as significant problems instead and thus 
assigned to DRG 390.
    Our medical consultants sought additional advice from the National 
Association of Children's Hospitals and Related Institutions (NACHRI). 
(HCFA contracts with the 3M Health Information Systems to maintain the 
DRG system. The medical experts at 3M evaluate proposed DRG changes 
from a clinical perspective. These medical consultants assist HCFA in 
evaluating alternative proposals.) NACHRI and our medical consultants 
agree that it is appropriate to remove codes 773.0 and 773.1 from DRG 
389. Therefore, we are proposing to remove 773.0 and 773.1 from DRG 389 
so that neonates with these conditions are assigned to DRG 390.
b. DRG 391 (Normal Newborn)
    We also have received correspondence with recommendations for 
changes to DRG 391. The correspondent pointed out that the following 
secondary codes currently lead to the assignment of the neonate to DRG 
390 (Neonate with Other Significant Problems). The correspondent 
believed that the conditions described by these codes should not cause 
the neonate to be classified under DRG 390 when reported as a secondary 
diagnosis. The correspondent recommended that these conditions be 
listed under DRG 391 (Normal Newborn).

478.1  Other diseases of nasal cavity and sinuses
520.6  Disturbances in tooth eruption
623.8  Other specified noninflammatory disorders of vagina
709.00  Dyschroma, unspecified
709.01  Vitiglio
709.09  Dyschromia, Other
744.1  Accesory auricle
754.61  Congenital pes planus
757.33  Congenital pigmentary anomalies of skin
757.39  Other specified anomaly of skin, Other
764.08  ``Light for dates'' without mention of fetal malnutrition, 
2,000-2,499 grams
764.98  Fetal growth retardation, unspecified, 2,000-2,499 grams
772.6  Cutaneous hemorrhage
794.15  Abnormal and auditory function studies
796.4  Other abnormal clinical findings
V20.2  Routine infant or child health check
V72.1  Examination of ears and hearing

    Our medical consultants also sought the advice of NACHRI on this 
recommendation. NACHRI reviewed the list of codes and agreed that none 
of these conditions should be considered to be a significant problem 
for a neonate. NACHRI concurred that neonates with these secondary 
diagnoses should be classified as normal newborns. Therefore, we are 
proposing to add the codes listed above to DRG 391 and not classify 
them to DRG 390 when reported as a secondary diagnosis.
c. Medicare Code Editor Changes
    The Medicare Code Editor (MCE) is a front-end software program that 
detects and reports errors in the coding of claims data. The age 
conflict edit detects inconsistencies between a patient's age and any 
diagnosis on the patient's record. A subset of diagnoses is considered 
valid only for patients over the age of 14 years. These diagnoses are 
identified as ``adult'' diagnoses and range in age from 15 through 124 
years. Therefore, any codes included on the Newborn Diagnoses edit are 
valid only for patients under age 14.
    It has come to our attention that cases including the ICD-9-CM code 
770.7, Chronic respiratory disease arising in the perinatal period, are 
being rejected. However, a condition such as bronchopulmonary dysplasia 
always originates in the perinatal period, so regardless of the 
patient's age, this condition is always coded as 770.7. The age at 
which the diagnosis was established or the age at continuing treatment 
does not affect the assignment of code 770.7.
    Because correct coding is causing these claims to be rejected, we 
are proposing to remove code 770.7 from the Newborn Diagnoses edit in 
the MCE, as well as remove it from DRG 387 (Prematurity with Major 
Problems) and DRG 389 (Full Term Neonate with Major Problems). Clinical 
conditions in code 770.7, such as pulmonary fibrosis, would group to 
DRG 92 (Interstitial Lung Disease with CC) and DRG 93 (Interstitial 
Lung Disease without CC). Therefore, we are proposing the addition of 
code 770.7 to DRGs 92 and 93, as they are most similar clinically. We 
will monitor these cases in upcoming MedPAR data to ascertain that the 
cases consume similar resources.
6. MDC 20 (Alcohol/Drug Use and Alcohol/Drug-Induced Organic Mental 
Disorders)
    DRG 434 (Alcohol/Drug Abuse or Dependency, Detoxification or Other 
Symptomatic Treatment with CC is assigned when the patient has a 
principal diagnosis of alcohol or drug abuse or dependence along with a 
secondary diagnosis classified as a CC. If these patients do not have a 
CC, they are assigned to DRG 435 (Alcohol/Drug Abuse or Dependency, 
detoxification or Other Symptomatic Treatment without CC). When the 
patients receive rehabilitation and detoxification therapy during the 
stay, they are assigned to DRG 437 (Alcohol/Drug Dependence, Combined 
Rehabilitation and Detoxification Therapy). If the patients receive 
only rehabilitation therapy, they are assigned to DRG 436 (Alcohol/Drug 
Dependence with Rehabilitation Therapy).

[[Page 22658]]

    We have received inquiries as to why the relative weight for DRG 
437, which includes both rehabilitation and detoxification (for FY 
2001, the relative weight is .6606, with a geometric mean length of 
stay of 7.5) is lower than the FY 2001 relative weight for DRG 434, 
which includes only detoxification (.7256, with a geometric mean length 
of stay of 3.9). Likewise, the FY 2001 relative weight for DRG 436, 
which includes only rehabilitation (.7433), is higher than the FY 2001 
relative weight for DRG 437, which includes combined rehabilitation and 
detoxification therapy (.6606). The inquirers indicated that those 
patients receiving the combination therapy would be expected to have a 
longer length of stay, require more services, and, therefore, be more 
costly to treat.
    We analyzed data from 100 percent of the FY 2000 MedPAR file which 
contains hospital bills received through May 31, 2000, and did not find 
support for the inquirers' assertion that combination therapy is more 
costly to treat. The relative weights indicate that the presence of a 
CC in DRG 434 leads to a significantly higher weight than is found in 
DRG 435, which does not have a CC. Therefore, we analyzed the alcohol/
drug DRGs and focused on eliminating the distinction between 
rehabilitation and rehabilitation with detoxification and assessing the 
impact of CCs. We combined data on DRGs 436 and 437 and then subdivided 
the data based on the presence or absence of a CC. The following table 
contains the results of the analysis.

                                  Average Charges for Cases--With and Without CCs
----------------------------------------------------------------------------------------------------------------
                                                   With CC                               Without CC
                                   -----------------------------------------------------------------------------
               DRGs                                            Length of                              Length of
                                       Count        Charge        stay        Count        Charge        stay
----------------------------------------------------------------------------------------------------------------
Detoxification Cases--DRG 434 and         3,298       $8,548          5.0        9,689       $5,111          4.1
 DRG 435..........................
All Rehabilitation Cases--DRG 436         3,298        8,117         10.1        4,473        7,407          9.6
 and DRG 437......................
----------------------------------------------------------------------------------------------------------------

    We found that, for both the detoxification and rehabilitation DRGs, 
the with-CC group has higher charges than the without-CC group. 
However, the with-CC groups still contain the anomaly that the 
detoxification DRG 434 has a slightly higher average charge than the 
combined rehabilitation DRGs 436 and 437. It appears that any 
significant medical problems as indicated by the presence of a CC 
dominate the cost incurred by hospitals for treating alcohol and drug 
abuse patients. For the without-CC groups, the detoxification DRG 435 
has substantially lower average charges than the combined 
rehabilitation DRGs 436 and 437. Because the average charges of the 
with-CC for both the detoxification DRG 434 and combined rehabilitation 
DRGs 436 and 437 have similar average charges, we are proposing to 
combine these two groups.
    Based on the results of our analysis, we are proposing to 
restructure MDC 20 as follows. We first identified those cases with a 
principal diagnosis within MDC 20 where the patient left against 
medical advice. These cases are found in DRG 433 (Alcohol/Drug Abuse or 
Dependence, Left Against Medical Advice (AMA)). We next identified all 
remaining cases with a principal diagnosis within MDC 20 where there 
was a CC. We assigned these cases to a proposed new DRG, Alcohol/Drug 
Abuse or Dependence with CC). The remaining cases (without CC and did 
not leave against medical advice) were then divided into two proposed 
new DRGs based on whether or not the patient received rehabilitation 
(Alcohol/Drug Abuse or Dependence without CC, with Rehabilitation 
Therapy; and Alcohol/Drug Abuse or Dependence without CC, without 
Rehabilitation Therapy).
    The following table illustrates the number of patients and average 
charges for each of the four proposed DRGs.

               Frequencies and Average Charges for New DRGs
------------------------------------------------------------------------
                                                 Number of     Average
          DRG                 Group title          cases       charges
------------------------------------------------------------------------
433....................  Alcohol/Drug Abuse or        3,509       $3,855
                          Dependence, Left
                          Against Medical
                          Advice.
521....................  Alcohol/Drug Abuse or       18,235        8,470
                          Dependence with CC.
522....................  Alcohol/Drug Abuse or        4,473        7,407
                          Dependence without
                          CC, with
                          Rehabilitation
                          Therapy.
523....................  Alcohol/Drug Abuse or        9,689        5,111
                          Dependence without
                          CC, without
                          Rehabilitation
                          Therapy.
------------------------------------------------------------------------

    This table illustrates that groups based first on the presence of 
CC and then on whether or not the patient receives rehabilitation 
therapy provide a much better explanation of differences in charges. 
Therefore, we are proposing to retain DRG 433, make DRGs 434 through 
437 invalid, and create new DRGs 521, 522, and 523 to include the 
diagnosis and procedure codes reflected in Chart 7 below.

                                     Chart 7.--Proposed Restructure of MDC 20
                      [Alcohol/drug use and alcohol/drug-induced organic mental disorders]
----------------------------------------------------------------------------------------------------------------
                                                           Included in   Included in   Included in   Included in
              Diagnosis and procedure code                existing DRG  proposed DRG  proposed DRG  proposed DRG
                                                               433           521           522           523
----------------------------------------------------------------------------------------------------------------
Principal diagnosis:
    All principal diagnosis within existing MDC 20                  X
     involving cases in which patients left against
     medical advice (AMA)...............................

[[Page 22659]]

 
    All principal diagnoses within existing MDC 20 where                          X
     there is a CC and where patient did not leave
     against medical advice (AMA).......................
    All principal diagnoses within existing MDC 20                                              X
     without CC and where patient did not leave against
     medical advice (AMA)...............................
    All principal diagnoses in existing MDC 20 involving                                                      X
     cases where patients did not leave against medical
     advice (AMA).......................................
Procedure Codes:
    94.61  Alcohol rehabilitation.......................                                        X
    94.63  Alcohol rehabilitation and detoxification....                                        X
    94.64  Drug rehabilitation..........................                                        X
    94.66  Drug rehabilitation and detoxification.......                                        X
    94.67  Combined alcohol and drug rehabilitation.....                                        X
    94.69  Combined alcohol and drug rehabilitation and                                         X
     detoxification.....................................
----------------------------------------------------------------------------------------------------------------

7. MDC 25 (Human Immunodeficiency Virus Infections)
    Effective October 1, 2000, ICD-9-CM diagnosis codes 783.2 (Abnormal 
loss of weight) and 783.4 (Lack of expected normal physiological 
development) were made invalid (65 FR 47171). These two old diagnosis 
codes were expanded to five digits and the following new diagnosis 
codes were created:

783.21  Loss of weight
783.22  Underweight
783.40  Unspecified lack of normal physiological development
783.41  Failure to thrive
783.42  Delayed milestones
783.43  Short stature

    These six revised codes were created in response to an industry 
request. Specifically, code 783.2 did not differentiate between whether 
the patient had lost weight recently or whether the patient was 
underweight. Code 783.4 was expanded to capture concepts such as 
failure to thrive, delayed milestones, and short stature. None of these 
concepts were captured in the old codes.
    We listed these new codes in the August 1, 2000 final rule on the 
hospital inpatient prospective payment system in Table 6A--New 
Diagnosis Codes (65 FR 47169). At the time the final rule was 
published, all of these codes were assigned to DRGs 296 through 298. 
After the final rule was published, we received an inquiry as to why 
these new diagnosis codes were not included in MDC 25 as human 
immunodeficiency virus (HIV)-related conditions. The inquirer pointed 
out that the predecessor codes (783.2 and 783.4) were included in MDC 
25 as HIV-related conditions and suggested that the new codes be added 
to MDC 25. These cases will be assigned to other MDCs if the patient 
does not have HIV.
    We agree that the expanded codes should have been placed in the MDC 
25 as HIV-related conditions. The omission was an oversight. Therefore, 
we are proposing to add diagnosis codes 783.21, 783.22, 783.40, 783.41, 
783.42, and 783.43 as HIV-related conditions within MDC 25. When these 
six revised codes are reported with code 042 HIV, the patient will be 
classified within MDC 25.
8. Surgical Hierarchies
    Some inpatient stays entail multiple surgical procedures, each one 
of which, occurring by itself, could result in assignment of the case 
to a different DRG within the MDC to which the principal diagnosis is 
assigned. Therefore, it is necessary to have a decision rule by which 
these cases are assigned to a single DRG. The surgical hierarchy, an 
ordering of surgical classes from resource intensive most least, 
performs that function. Its application ensures that cases involving 
multiple surgical procedures are assigned to the DRG associated with 
the most resource-intensive surgical class.
    Because the relative resource intensity of surgical classes can 
shift as a function of DRG reclassification and recalibration, we 
reviewed the surgical hierarchy of each MDC, as we have for previous 
reclassifications, to determine if the ordering of classes coincided 
with the intensity of resource utilization, as measured by the same 
billing data used to compute the DRG relative weights.
    A surgical class can be composed of one or more DRGs. For example, 
in MDC 11, the surgical class ``kidney transplant'' consists of a 
single DRG (DRG 302) and the class ``kidney, ureter and major bladder 
procedures'' consists of three DRGs (DRGs 303, 304, and 305). 
Consequently, in many cases, the surgical hierarchy has an impact on 
more than one DRG. The methodology for determining the most resource-
intensive surgical class involves weighting each DRG for frequency to 
determine the average resources for each surgical class. For example, 
assume surgical class A includes DRGs 1 and 2 and surgical class B 
includes DRGs 3, 4, and 5. Assume also that the average charge of DRG 1 
is higher than that of DRG 3, but the average charges of DRGs 4 and 5 
are higher than the average charge of DRG 2. To determine whether 
surgical class A should be higher or lower than surgical class B in the 
surgical hierarchy, we would weight the average charge of each DRG by 
frequency (that is, by the number of cases in the DRG) to determine 
average resource consumption for the surgical class. The surgical 
classes would then be ordered from the class with the highest average 
resource utilization to that with the lowest, with the exception of 
``other OR procedures'' as discussed below.
    This methodology may occasionally result in a case involving 
multiple procedures being assigned to the lower-weighted DRG (in the 
highest, most resource-intensive surgical class) of the available 
alternatives. However, given that the logic underlying the surgical 
hierarchy provides that the GROUPER searches for the procedure in the 
most resource-intensive surgical class, this result is unavoidable.
    We note that, notwithstanding the foregoing discussion, there are a 
few instances when a surgical class with a lower average relative 
weight is ordered above a surgical class with a higher average relative 
weight. For example, the ``other OR procedures'' surgical class is 
uniformly ordered last in the surgical hierarchy of each MDC in which 
it occurs, regardless of the fact that the relative weight for the DRG 
or

[[Page 22660]]

DRGs in that surgical class may be higher than that for other surgical 
classes in the MDC. The ``other OR procedures'' class is a group of 
procedures that are least likely to be related to the diagnoses in the 
MDC but are occasionally performed on patients with these diagnoses. 
Therefore, these procedures should only be considered if no other 
procedure more closely related to the diagnoses in the MDC has been 
performed.
    A second example occurs when the difference between the average 
weights for two surgical classes is very small. We have found that 
small differences generally do not warrant reordering of the hierarchy 
since, by virtue of the hierarchy change, the relative weights are 
likely to shift such that the higher-ordered surgical class has a lower 
average weight than the class ordered below it.
    Based on the preliminary recalibration of the DRGs, we are 
proposing to modify the surgical hierarchy as set forth below. As we 
stated in the September 1, 1989 final rule (54 FR 36457), we are unable 
to test the effects of proposed revisions to the surgical hierarchy and 
to reflect these changes in the proposed relative weights due to the 
unavailability of the revised GROUPER software at the time the proposed 
rule is prepared. Rather, we simulate most major classification changes 
to approximate the placement of cases under the proposed 
reclassification and then determine the average charge for each DRG. 
These average charges then serve as our best estimate of relative 
resource use for each surgical class. We test the proposed surgical 
hierarchy changes after the revised GROUPER is received and reflect the 
final changes in the DRG relative weights in the final rule. Further, 
as discussed in section II.C. of this preamble, we anticipate that the 
final recalibrated weights will be somewhat different from those 
proposed, because they will be based on more complete data. 
Consequently, further revision of the hierarchy, using the above 
principles, may be necessary in the final rule.
    At this time, we are proposing to revise the surgical hierarchy for 
the pre-MDC DRGs, MDC 5 (Diseases and Disorders of the Circulatory 
System), MDC 8 (Diseases and Disorders of the Musculoskeletal System & 
Connective Tissue) and MDC 20 (Alcohol/Drug Use & Alcohol/Drug Induced 
Organic Mental Disorders), as these are proposed to be revised under 
sections II.B.2., II.B.3., and II.B.6. of this preamble, as follows:
     In the pre-MDC DRGs, we are proposing to reorder Lung 
Transplant (DRG 495) above Bone Marrow Transplant (DRG 481). We are 
also proposing to reorder Simultaneous Pancreas/Kidney Transplant (DRG 
512) and Pancreas Transplant (DRG 513) above Lung Transplant (DRG 495).
     In MDC 5, we are proposing to reorder Cardiac 
Defibrillator Implants (DRGs 514 and 515) above Other Cardiothoracic 
Procedures (DRG 108). We are also proposing to reorder Percutaneous 
Cardiovascular Procedures (DRGs 516, 517, and 518) above Other Vascular 
Procedures (DRGs 478 and 479).
     In MDC 8, we are proposing to reorder Cervical Spinal 
Fusion (DRGs 519 and 520) above Back & Neck Procedures Except Spinal 
Fusion (DRGs 499 and 500).
     In MDC 20, we are proposing to order as follows: Alcohol/
Drug Abuse or Dependence, Left AMA (DRG 433) above Alcohol/Drug Abuse 
or Dependence With CC (DRG 521); Alcohol/Drug Abuse or Dependence With 
CC (DRG 521) above Alcohol/Drug Abuse or Dependence With Rehabilitation 
Therapy Without CC (DRG 522); and Alcohol/Drug Abuse or Dependence With 
Rehabilitation Therapy Without CC (DRG 522) above Alcohol/Drug Abuse or 
Dependence Without Rehabilitation Therapy Without CC (DRG 523).
9. Refinement of Complications and Comorbidities (CC) List
    In the September 1, 1987 final notice (52 FR 33143) concerning 
changes to the DRG classification system, we modified the GROUPER logic 
so that certain diagnoses included on the standard list of CCs would 
not be considered a valid CC in combination with a particular principal 
diagnosis. Thus, we created the CC Exclusions List. We made these 
changes for the following reasons: (1) To preclude coding of CCs for 
closely related conditions; (2) to preclude duplicative coding or 
inconsistent coding from being treated as CCs; and (3) to ensure that 
cases are appropriately classified between the complicated and 
uncomplicated DRGs in a pair. We developed this standard list of 
diagnoses using physician panels to include those diagnoses that, when 
present as a secondary condition, would be considered a substantial 
complication or comorbidity. In previous years, we have made changes to 
the standard list of CCs, either by adding new CCs or deleting CCs 
already on the list. At this time, we do not propose to delete any of 
the diagnosis codes on the CC list.
    In the May 19, 1987 proposed notice (52 FR 18877) concerning 
changes to the DRG classification system, we explained that the 
excluded secondary diagnoses were established using the following five 
principles:
      Chronic and acute manifestations of the same condition 
should not be considered CCs for one another (as subsequently corrected 
in the September 1, 1987 final notice (52 FR 33154)).
     Specific and nonspecific (that is, not otherwise specified 
(NOS)) diagnosis codes for a condition should not be considered CCs for 
one another.
     Conditions that may not coexist, such as partial/total, 
unilateral/bilateral, obstructed/unobstructed, and benign/malignant, 
should not be considered CCs for one another.
     The same condition in anatomically proximal sites should 
not be considered CCs for one another.
     Closely related conditions should not be considered CCs 
for one another.
    The creation of the CC Exclusions List was a major project 
involving hundreds of codes. The FY 1988 revisions were intended only 
as a first step toward refinement of the CC list in that the criteria 
used for eliminating certain diagnoses from consideration as CCs were 
intended to identify only the most obvious diagnoses that should not be 
considered complications or comorbidities of another diagnosis. For 
that reason, and in light of comments and questions on the CC list, we 
have continued to review the remaining CCs to identify additional 
exclusions and to remove diagnoses from the master list that have been 
shown not to meet the definition of a CC. (See the September 30, 1988 
final rule (53 FR 38485) for the revision made for the discharges 
occurring in FY 1989; the September 1, 1989 final rule (54 FR 36552) 
for the FY 1990 revision; the September 4, 1990 final rule (55 FR 
36126) for the FY 1991 revision; the August 30, 1991 final rule (56 FR 
43209) for the FY 1992 revision; the September 1, 1992 final rule (57 
FR 39753) for the FY 1993 revision; the September 1, 1993 final rule 
(58 FR 46278) for the FY 1994 revisions; the September 1, 1994 final 
rule (59 FR 45334) for the FY 1995 revisions; the September 1, 1995 
final rule (60 FR 45782) for the FY 1996 revisions; the August 30, 1996 
final rule (61 FR 46171) for the FY 1997 revisions; the August 29, 1997 
final rule (62 FR 45966) for the FY 1998 revisions; the July 31, 1998 
final rule (63 FR 40954) for the FY 1999 revisions, and the August 1, 
2000 final rule (65 FR 47064) for the FY 2001 revisions. In the July 
30, 1999 final rule (64 FR 41490) we did not modify the CC Exclusions 
List for FY 2000 because we

[[Page 22661]]

did not make any changes to the ICD-9-CM codes for FY 2000.
    We are proposing a limited revision of the CC Exclusions List to 
take into account the changes that will be made in the ICD-9-CM 
diagnosis coding system effective October 1, 2001. (See section 
II.B.11. below, for a discussion of ICD-9-CM changes.) These proposed 
changes are being made in accordance with the principles established 
when we created the CC Exclusions List in 1987.
    Tables 6F and 6G in section V. of the Addendum to this proposed 
rule contain the proposed revisions to the CC Exclusions List that 
would be effective for discharges occurring on or after October 1, 
2001. Each table shows the principal diagnoses with proposed changes to 
the excluded CCs. Each of these principal diagnoses is shown with an 
asterisk, and the additions or deletions to the CC Exclusions List are 
provided in an indented column immediately following the affected 
principal diagnosis.
    CCs that are added to the list are in Table 6G--Additions to the CC 
Exclusions List. Beginning with discharges on or after October 1, 2001, 
the indented diagnoses will not be recognized by the GROUPER as valid 
CCs for the asterisked principal diagnosis.
    CCs that are deleted from the list are in Table 6H--Deletions from 
the CC Exclusions List. Beginning with discharges on or after October 
1, 2001, the indented diagnoses will be recognized by the GROUPER as 
valid CCs for the asterisked principal diagnosis.
    Copies of the original CC Exclusions List applicable to FY 1988 can 
be obtained from the National Technical Information Service (NTIS) of 
the Department of Commerce. It is available in hard copy for $133.00 
plus shipping and handling. A request for the FY 1988 CC Exclusions 
List (which should include the identification accession number (PB) 88-
133970) should be made to the following address: National Technical 
Information Service, United States Department of Commerce, 5285 Port 
Royal Road, Springfield, VA 22161; or by calling (800) 553-6847.
    Users should be aware of the fact that all revisions to the CC 
Exclusions List (FYs 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 
1997, 1998, and 1999) and those in Tables 6F and 6G of this document 
must be incorporated into the list purchased from NTIS in order to 
obtain the CC Exclusions List applicable for discharges occurring on or 
after October 1, 2001. (Note: There was no CC Exclusions List in FY 
2000 because we did not make changes to the ICD-9-CM codes for FY 
2000.)
    Alternatively, the complete documentation of the GROUPER logic, 
including the current CC Exclusions List, is available from 3M/Health 
Information Systems (HIS), which, under contract with HCFA, is 
responsible for updating and maintaining the GROUPER program. The 
current DRG Definitions Manual, Version 18.0, is available for $225.00, 
which includes $15.00 for shipping and handling. Version 19.0 of this 
manual, which includes the final FY 2002 DRG changes, will be available 
in October 2001 for $225.00. These manuals may be obtained by writing 
3M/HIS at the following address: 100 Barnes Road, Wallingford, CT 
06492; or by calling (203) 949-0303. Please specify the revision or 
revisions requested.
10. Review of Procedure Codes in DRGs 468, 476, and 477
    Each year, we review cases assigned to DRG 468 (Extensive OR 
Procedure Unrelated to Principal Diagnosis), DRG 476 (Prostatic OR 
Procedure Unrelated to Principal Diagnosis), and DRG 477 (Nonextensive 
OR Procedure Unrelated to Principal Diagnosis) to determine whether it 
would be appropriate to change the procedures assigned among these 
DRGs.
    DRGs 468, 476, and 477 are reserved for those cases in which none 
of the OR procedures performed is related to the principal diagnosis. 
These DRGs are intended to capture atypical cases, that is, those cases 
not occurring with sufficient frequency to represent a distinct, 
recognizable clinical group. DRG 476 is assigned to those discharges in 
which one or more of the following prostatic procedures are performed 
and are unrelated to the principal diagnosis:

60.0  Incision of prostate
60.12  Open biopsy of prostate
60.15  Biopsy of periprostatic tissue
60.18  Other diagnostic procedures on prostate and periprostatic tissue
60.21  Transurethral prostatectomy
60.29  Other transurethral prostatectomy
60.61  Local excision of lesion of prostate
60.69  Prostatectomy NEC
60.81  Incision of periprostatic tissue
60.82  Excision of periprostatic tissue
60.93  Repair of prostate
60.94  Control of (postoperative) hemorrhage of prostate
60.95  Transurethral balloon dilation of the prostatic urethra
60.99  Other operations on prostate

    All remaining OR procedures are assigned to DRGs 468 and 477, with 
DRG 477 assigned to those discharges in which the only procedures 
performed are nonextensive procedures that are unrelated to the 
principal diagnosis. The original list of the ICD-9-CM procedure codes 
for the procedures we consider nonextensive procedures, if performed 
with an unrelated principal diagnosis, was published in Table 6C in 
section IV. of the Addendum to the September 30, 1988 final rule (53 FR 
38591). As part of the final rules published on September 4, 1990 (55 
FR 36135), August 30, 1991 (56 FR 43212), September 1, 1992 (57 FR 
23625), September 1, 1993 (58 FR 46279), September 1, 1994 (59 FR 
45336), September 1, 1995 (60 FR 45783), August 30, 1996 (61 FR 46173), 
and August 29, 1997 (62 FR 45981), we moved several other procedures 
from DRG 468 to 477, and some procedures from DRG 477 to 468. No 
procedures were moved in FY 1999, as noted in the July 31, 1998 final 
rule (63 FR 40962); in FY 2000, as noted in the July 30, 1999 final 
rule (64 FR 41496); or in FY 2001, as noted in the August 1, 2000 final 
rule (65 FR 47064).
a. Moving Procedure Codes From DRGs 468 or 477 to MDCs
    We annually conduct a review of procedures producing assignment to 
DRG 468 or DRG 477 on the basis of volume, by procedure, to see if it 
would be appropriate to move procedure codes out of these DRGs into one 
of the surgical DRGs for the MDC into which the principal diagnosis 
falls. The data are arrayed two ways for comparison purposes. We look 
at a frequency count of each major operative procedure code. We also 
compare procedures across MDCs by volume of procedure codes within each 
MDC.
    Using 100 percent of the FY 2000 MedPAR file containing bills 
submitted through May 31, 2000 for discharges in FY 2000, we determined 
that the quantity of cases in DRG 477 totaled 17,153. There were 106 
instances where the major operative procedure appeared only once (6.4 
percent of the time), resulting in assignment to DRG 477.
    Using the same 100 percent sample of the FY 2000 MedPAR file, we 
reviewed DRG 468. There were a total of 40,429 cases, with one major 
operative code causing the DRG assignment 311 times (or 8 percent) and 
230 instances where the major operative procedure appeared only once 
(or 6 percent of the time).
    Our medical consultants then identified those procedures occurring 
in conjunction with certain principal diagnoses with sufficient 
frequency to justify adding them to one of the surgical DRGs for the 
MDC in which the

[[Page 22662]]

diagnosis falls. Based on this year's review, we did not identify any 
necessary changes in procedures under DRG 477 and, therefore, are not 
proposing to move any procedures from DRG 477 to one of the surgical 
DRGs. However, our medical consultants have identified a number of 
procedure codes that should be removed from DRG 468 and put into more 
clinically coherent DRGs. The movement of these codes are specified in 
the charts below:

                 Movement of Procedure Codes From DRG 468
------------------------------------------------------------------------
                                       Included in
   Procedure code       Description        DRG           Description
------------------------------------------------------------------------
           MDC 1--Diseases and Disorders of the Nervous System
------------------------------------------------------------------------
5495................  Peritoneal                 7  Peripheral and
                       Incision.                     Cranial Nerve and
                                                     Other Nervous
                                                     System Procedures
                                                     with CC
5495................  Peritoneal                 8  Peripheral and
                       Incision.                     Cranial Nerve and
                                                     Other Incision
                                                     Nervous System
                                                     Procedures without
                                                     CC
------------------------------------------------------------------------
                MDC 3--Diseases and Disorders of the Ear
------------------------------------------------------------------------
3821................  Blood Vessel              63  Other Ear, Nose,
                       Biopsy.                       Mouth and Throat OR
                                                     Procedure
------------------------------------------------------------------------
         MDC 4--Diseases and Disorders of the Respiratory System
------------------------------------------------------------------------
3821................  Blood Vessel              76  Other Respiratory
                       Biopsy.                       System OR
                                                     Procedures with CC
3821................  Blood Vessel              77  Other Respiratory
                       Biopsy.                       System OR
                                                     Procedures without
                                                     CC
3929................  Vascular Shunt            76  Other Respiratory
                       & Bypass NEC.                 System OR
                                                     Procedures with CC
3929................  Vascular Shunt            77  Other Respiratory
                       & Bypass NEC.                 System OR
                                                     Procedures without
                                                     CC
3931................  Suture of                 76  Other Respiratory
                       Artery.                       System OR
                                                     Procedures with CC
3931................  Suture of                 77  Other Respiratory
                       Artery.                       System OR
                                                     Procedures without
                                                     CC
5411................  Exploratory               76  Other Respiratory
                       Laparotomy.                   System OR
                                                     Procedures with CC
5411................  Exploratory               77  Other Respiratory
                       Laparotomy.                   System OR
                                                     Procedures without
                                                     CC
7749................  Bone Biopsy NEC           76  Other Respiratory
                                                     System OR
                                                     Procedures with CC
7749................  Bone Biopsy NEC           77  Other Respiratory
                                                     System OR
                                                     Procedures without
                                                     CC
8669................  Free Skin Graft           76  Other Respiratory
                       NEC.                          System OR
                                                     Procedures with CC
8669................  Free Skin Graft           77  Other Respiratory
                       NEC.                          System OR
                                                     Procedures without
                                                     CC
------------------------------------------------------------------------
         MDC 5--Diseases and Disorders of the Circulatory System
------------------------------------------------------------------------
3402................  Exploratory              120  Other Circulatory
                       Thoracotomy.                  System OR
                                                     Procedures
3403................  Reopen                   120  Other Circulatory
                       Thoracotomy                   System OR
                       Site.                         Procedures
3421................  Transpleura              120  Other Circulatory
                       Thoracoscopy.                 System OR
                                                     Procedures
3422................  Mediastinoscoy           120  Other Circulatory
                       Circulatory.                  System OR
                                                     Procedures
3426................  Open                     120  Other Circulatory
                       Mediastinal                   System OR
                       Biopsy.                       Procedures
436.................  Distal                   120  Other Circulatory
                       Gastrectomy.                  System OR
                                                     Procedures
437.................  Partial                  120  Other Circulatory
                       Gastrectomy                   System OR
                       with Jejunal                  Procedures
                       Anastamosis.
4389................  Partial                  120  Other Circulatory
                       Gastrectomy.                  System OR
                                                     Procedures
4399................  Total                    120  Other Circulatory
                       Gastrectomy.                  System OR
                                                     Procedures
14561...............  Multiple                 120  Other Circulatory
                       Segment Small                 System OR
                       Bowel Excision.               Procedures
4562................  Partial Small            120  Other Circulatory
                       Bowel                         System OR
                       Resectomy NEC.                Procedures
4572................  Cecectomy......          120  Other Circulatory
                                                     System OR
                                                     Procedures
4573................  Right                    120  Other Circulatory
                       Hemicolectomy.                System OR
                                                     Procedures
4574................  Transverse               120  Other Circulatory
                       Colon                         System OR
                       Resectomy.                    Procedures
4575................  Left                     120  Other Circulatory
                       Hemicolectomy.                System OR
                                                     Procedures
4579................  Partial Large            120  Other Circulatory
                       Bowel Excision                System OR
                       NEC.                          Procedures
458.................  Total Intra-             120  Other Circulatory
                       Abdominal                     System OR
                       Colectomy.                    Procedures
4593................  Small-to-Large           120  Other Circulatory
                       Bowel NEC.                    System OR
                                                     Procedures
4603................  Large Bowel              120  Other Circulatory
                       Exteriorizatio                System OR
                       n.                            Procedures
4613................  Permanent                120  Other Circulatory
                       Colostomy.                    System OR
                                                     Procedures
4709................  Other                    120  Other Circulatory
                       Appendectomy.                 System OR
                                                     Procedures
4862................  Anterior Rectal          120  Other Circulatory
                       Resction With                 System OR
                       Colostomy.                    Procedures
4863................  Anterior Rectal          120  Other Circulatory
                       Resection NEC.                System OR
                                                     Procedures
4869................  Rectal                   120  Other Circulatory
                       Resection.                    System OR
                                                     Procedures
5012................  Open Liver               120  Other Circulatory
                       Biopsy.                       System OR
                                                     Procedures
540.................  Abdominal Wall           120  Other Circulatory
                       Incision.                     System OR
                                                     Procedures
------------------------------------------------------------------------
          MDC 6--Diseases and Disorders of the Digestive System
------------------------------------------------------------------------
5122................  Cholecystectomy          170  Other Digestive
                                                     System OR
                                                     Procedures with CC
5122................  Cholecystectomy          171  Other Digestive
                                                     System OR
                                                     Procedures without
                                                     CC
5123................  Laparoscopic             170  Other Digestive
                       Cholecystectom                System OR
                       y.                            Procedures with CC
5132................  GB-To-Intestine          170  Other Digestive
                       Anastomy.                     System OR
                                                     Procedures with CC
5136................  Choledochoenter          170  Other Digestive
                       ostomy.                       System OR
                                                     Procedures with CC

[[Page 22663]]

 
5136................  Choledochoenter          171  Other Digestive
                       ostomy.                       System OR
                                                     Procedures without
                                                     CC
5137................  Hepatic Duct-GI          170  Other Digestive
                       Anastomy.                     System OR
                                                     Procedures with
                                                     Anastomy CC
5137................  Hepatic Duct-GI          171  Other Digestive
                       Anastomy.                     System OR
                                                     Procedures without
                                                     CC
5159................  Bile Duct                170  Other Digestive
                       Incision NEC.                 System OR
                                                     Procedures with CC
5159................  Bile Duct                171  Other Digestive
                       Incision NEC.                 System OR
                                                     Procedures without
                                                     CC
------------------------------------------------------------------------
 MDC 7--Diseases and Disorders of the Hepatobiliary System and Pancreas
------------------------------------------------------------------------
540.................  Abdominal Wall           201  Other Hepatobiliary
                       Incision.                     and Pancreas
                                                     Procedure
------------------------------------------------------------------------
     MDC 8--Diseases and Disorders of the Musculoskeletal System and
                            Connective Tissue
------------------------------------------------------------------------
3479................  Other Chest              233  Other
                       Wall Repair.                  Musculoskeletal
                                                     System & Connective
                                                     Tissue OR Procedure
                                                     with CC
3479................  Other Chest              234  Other
                       Wall Repair.                  Musculoskeletal
                                                     System & Connective
                                                     Tissue OR Procedure
                                                     without CC
------------------------------------------------------------------------
     MDC 11--Diseases and Disorders of the Kidney and Urinary Tract
------------------------------------------------------------------------
540.................  Abdominal Wall           315  Other Kidney &
                       Incision.                     Urinary Tract OR
                                                     Procedure
5451................  Laparoscopic             315  Other Kidney &
                       Periton                       Urinary Tract OR
                       Adhesiolysis.                 Procedure
5459................  Other Periton            315  Other Kidney &
                       Adhesiolysis.                 Urinary Tract OR
                                                     Procedure
------------------------------------------------------------------------

b. Reassignment of Procedures Among DRGs 468, 476, and 477
    We also annually review the list of ICD-9-CM procedures that, when 
in combination with their principal diagnosis code, result in 
assignment to DRGs 468, 476, and 477, to ascertain if any of those 
procedures should be moved from one of these DRGs to another of these 
DRGs based on average charges and length of stay. We look at the data 
for trends such as shifts in treatment practice or reporting practice 
that would make the resulting DRG assignment illogical. If our medical 
consultants were to find these shifts, we would propose moving cases to 
keep the DRGs clinically similar or to provide payment for the cases in 
a similar manner. Generally, we move only those procedures for which we 
have an adequate number of discharges to analyze the data. Based on our 
review this year, we are not proposing to move any procedures from DRG 
468 to DRGs 476 or 477, from DRG 476 to DRGs 468 or 477, or from DRG 
477 to DRGs 468 or 476.
c. Adding Diagnosis Codes to MDCs
    Based on our review this year, we are not proposing to add any 
diagnosis codes to MDCs.
11. Changes to the ICD-9-CM Coding System
    As described in section II.B.1. of this preamble, the ICD-9-CM is a 
coding system that is used for the reporting of diagnoses and 
procedures performed on a patient. In September 1985, the ICD-9-CM 
Coordination and Maintenance Committee was formed. This is a Federal 
interdepartmental committee, co-chaired by the National Center for 
Health Statistics (NCHS) and HCFA, charged with maintaining and 
updating the ICD-9-CM system. The Committee is jointly responsible for 
approving coding changes, and developing errata, addenda, and other 
modifications to the ICD-9-CM to reflect newly developed procedures and 
technologies and newly identified diseases. The Committee is also 
responsible for promoting the use of Federal and non-Federal 
educational programs and other communication techniques with a view 
toward standardizing coding applications and upgrading the quality of 
the classification system.
    The NCHS has lead responsibility for the ICD-9-CM diagnosis codes 
included in the Tabular List and Alphabetic Index for Diseases, while 
HCFA has lead responsibility for the ICD-9-CM procedure codes included 
in the Tabular List and Alphabetic Index for Procedures.
    The Committee encourages participation in the above process by 
health-related organizations. In this regard, the Committee holds 
public meetings for discussion of educational issues and proposed 
coding changes. These meetings provide an opportunity for 
representatives of recognized organizations in the coding field, such 
as the American Health Information Management Association (AHIMA) 
(formerly American Medical Record Association (AMRA)), the American 
Hospital Association (AHA), and various physician specialty groups as 
well as physicians, medical record administrators, health information 
management professionals, and other members of the public to contribute 
ideas on coding matters. After considering the opinions expressed at 
the public meetings and in writing, the Committee formulates 
recommendations, which then must be approved by the agencies.
    The Committee presented proposals for coding changes for 
implementation in FY 2002 at public meetings held on May 11, 2000 and 
November 17, 2000, and finalized the coding changes after consideration 
of comments received at the meetings and in writing by January 8, 2001.
    Copies of the Coordination and Maintenance Committee minutes of the 
2000 meetings can be obtained from the HCFA home page at: http://www.hcfa.gov/medicare/icd9cm.htm. Paper copies of these minutes are no 
longer available and the mailing list has been discontinued. We 
encourage commenters to address suggestions on coding issues involving 
diagnosis codes to: Donna Pickett, Co-Chairperson; ICD-9-CM 
Coordination and Maintenance Committee; NCHS; Room 1100; 6525 Belcrest 
Road; Hyattsville, MD 20782. Comments may be sent by E-mail to: 
[email protected].
    Questions and comments concerning the procedure codes should be 
addressed to: Patricia E. Brooks, Co-Chairperson; ICD-9-CM Coordination 
and Maintenance Committee; HCFA, Center for Health Plans and Providers, 
Purchasing Policy Group, Division of Acute Care; C4-07-07; 7500 
Security

[[Page 22664]]

Boulevard; Baltimore, MD 21244-1850. Comments may be sent by E-mail to: 
[email protected].
    The ICD-9-CM code changes that have been approved will become 
effective October 1, 2001. The new ICD-9-CM codes are listed, along 
with their proposed DRG classifications, in Tables 6A and 6B (New 
Diagnosis Codes and New Procedure Codes, respectively) in section V. of 
the Addendum to this proposed rule. As we stated above, the code 
numbers and their titles were presented for public comment at the ICD-
9-CM Coordination and Maintenance Committee meetings. Both oral and 
written comments were considered before the codes were approved. 
Therefore, we are soliciting comments only on the proposed DRG 
classification of these new codes.
    Further, the Committee has approved the expansion of certain ICD-9-
CM codes to require an additional digit for valid code assignment. 
Diagnosis codes that have been replaced by expanded codes or other 
codes or have been deleted are in Table 6C (Invalid Diagnosis Codes). 
These invalid diagnosis codes will not be recognized by the GROUPER 
beginning with discharges occurring on or after October 1, 2001. For 
codes that have been replaced by new or expanded codes, the 
corresponding new or expanded diagnosis codes are included in Table 6A 
(New Diagnosis Codes). There were no procedure codes that were replaced 
by expanded codes or other codes, or were deleted. Revisions to 
diagnosis code titles are in Table 6E (Revised Diagnosis Code Titles), 
which also include the proposed DRG assignments for these revised 
codes. Revisions to procedure code titles are in Table 6F (Revised 
Procedure Codes Titles).
    In September 2000, the Department implemented a policy of paying 
for inpatient hospital stays for Medicare beneficiaries participating 
in clinical trials (HCFA Program Memorandum AB 00-89, September 19, 
2000). Hospitals were encouraged to identify the patients involved by 
reporting an ICD-9-CM code. This would allow the examination of data on 
the patients involved in clinical trials. However, there was no clear 
ICD-9-CM diagnosis code for patients who took part in a clinical trial. 
There was a code for patients receiving an examination as part of the 
control group for clinical trials. This control group code was V70.7 
(Examination for normal comparison or control in clinical research). 
Hospitals were instructed to use V70.5 (Health examination of defined 
subpopulations), for patients participating in a clinical trial.
    This coding directive has created some confusion because of the 
title and description of the two codes. Hospitals also have requested 
that all clinical patients be captured under one code. They indicated 
that the use of one code would be especially useful because patients 
frequently do not know if they are part of the control group or are 
receiving new therapy.
    To help alleviate the confusion, the ICD-9-CM Coordination and 
Maintenance Committee revised code V70.7. Effective October 1, 2001, 
the new title of code V70.7 is ``Examination of patient in clinical 
trial.'' This revision will make it easier to capture data on Medicare 
beneficiaries who are participating in a clinical trial.
12. Other Issues
a. Pancreas Transplant
    Effective July 1, 1999, Medicare covers whole organ pancreas 
transplantation if the transplantation is performed simultaneously with 
or after a kidney transplant (procedure codes 55.69 (Other kidney 
transplantation), or diagnosis code V42.0 (Organ or tissue replaced by 
transplant, Kidney), along with 52.80 (Pancreatic transplant, not 
otherwise specified), or 52.82 (Homotransplant of pancreas)). A 
discussion of the history of these coverage decisions and codes can be 
found in the August 1, 2000 final rule on the prospective payment 
system for FY 2001 (65 FR 47067).
    We discussed the appropriate DRG classification for these cases in 
both the July 30, 1999 final rule (64 FR 41497) and the August 1, 2000 
final rule (65 FR 47067). Currently, cases can be assigned to one of 
two major DRGs depending on principal diagnosis. If a kidney transplant 
and a pancreas transplant are performed simultaneously on a patient 
with chronic renal failure secondary to diabetes with renal 
manifestations (diagnosis codes 250.40 through 250.43), the cases will 
be assigned to DRG 302 (Kidney Transplant). If a pancreas transplant is 
performed following a kidney transplant (during a different hospital 
admission) on a patient with chronic renal failure secondary to 
diabetes with renal manifestations, the case is assigned to DRG 468 
(Extensive OR Procedure Unrelated to Principal Diagnosis). This is 
because pancreas transplant is not assigned to MDC 11 (Diseases and 
Disorders of the Kidney and Urinary Tract), the MDC to which a 
principal diagnosis of chronic renal failure secondary to diabetes is 
assigned.
    In the August 1, 2000 final rule, we noted that we would continue 
to monitor these transplant cases to determine the appropriateness of 
establishing a new DRG. For this proposed rule, using 100 percent of 
the data in the FY 2000 MedPAR file (which contains hospital bills 
received for FY 2000 through May 31, 2000), we analyzed the cases for 
which procedure codes 52.80 and 52.82 were reported. (Our data showed 
that 15 of the cases were coded using 52.83 (Heterotransplant of 
pancreas), which is not a covered procedure under any circumstances.) 
We identified a total of 221 cases for this time period. The United 
Network for Organ Sharing (UNOS) reported it had identified 270 cases 
through September 2000.
    These 221 MedPAR cases were distributed over 6 DRGs, with the 
majority (158 cases or 72 percent) assigned to DRG 302, and 23 cases 
(10 percent) assigned to DRG 468. The remaining 40 cases were 
distributed between 4 other DRGs, with the majority (25 cases) being 
assigned to DRG 292 (Other Endocrine, Nutritional and Metabolic OR 
Procedures with CC). Four cases were assigned to DRG 483 (Tracheostomy 
with Principal Diagnosis except Face, Mouth and Neck Diagnoses) in the 
Pre-MDC grouping, which took precedence over any other DRG assignment.
    We arrayed the data based on the presence or absence of kidney 
transplant; that is, pancreas transplant codes with or without 55.69. 
The majority of cases (166 or 75 percent) had the combined kidney-
pancreas transplant in one operative episode, with 55 (25 percent) of 
the cases having pancreas transplant subsequent to the kidney 
transplant. Differences in hospital charges were significantly higher 
for a pancreas transplant plus a kidney transplant ($138,809) than a 
pancreas transplant alone ($85,972), and both were higher than average 
standardized charges in DRG 302 ($64,760) or DRG 468 ($39,707), 
although it must be noted that these figures do reflect the resource 
intensive patients assigned to DRG 483. Those patients in DRG 483 had 
average standardized charges of $377,934.
    Because these categories of patients do not fit into existing DRGs 
from either a clinical or resource perspective, we are proposing to 
create two new DRGs that would reflect these patients' unique clinical 
profiles: DRG 512 (Simultaneous Pancreas/Kidney Transplant) and DRG 513 
(Pancreas Transplants). Cases grouped to either proposed DRGs 512 or 
513 must have a principal or secondary diagnosis code and procedure 
code or combination of

[[Page 22665]]

procedure codes as indicated in the chart below:

                 Composition of Proposed DRGs 512 and 513
------------------------------------------------------------------------
                                               Included in   Included in
        Diagnosis and procedure codes         proposed DRG  proposed DRG
                                                   512           513
------------------------------------------------------------------------
Principal or Secondary ICD-9-CM Diabetes
 Mellitus Code:
    250.00  Diabetes mellitus without                   X             X
     mention of complication, Type II or
     unspecified type, not stated as
     uncontrolled...........................
    250.01  Diabetes mellitus without                   X             X
     mention of complication, Type I, not
     stated as uncontrolled.................
    250.02  Diabetes mellitus without                   X             X
     mention of complication, Type I,.......
    250.03  Diabetes mellitus without                   X             X
     mention of complication, Type I,
     uncontrolled...........................
    250.10  Diabetes with ketoacidosis, Type            X             X
     II or Unspecified type, not stated as
     uncontrolled...........................
    250.11  Diabetes with ketoacidosis, Type            X             X
     I, not stated as uncontrolled..........
    250.12  Diabetes with ketoacidosis, Type            X             X
     II or unspecified type, uncontrolled...
    250.13  Diabetes with ketoacidosis, Type            X             X
     I, controlled..........................
    250.20  Diabetes with hyperosmolarity,              X             X
     Type II or unspecified type, not stated
     as uncontrolled........................
    250.21  Diabetes with hyperosmolarity,              X             X
     Type I, not stated as uncontrolled.....
    250.22  Diabetes with hyperosmolarity,              X             X
     Type II or unspecified type,
     uncontrolled...........................
    250.23  Diabetes with hyperosmolarity,              X             X
     Type I, uncontrolled...................
    250.30  Diabetes with other coma, Type
     II or unspecified type, not stated as
     uncontrolled...........................
    250.31  Diabetes with other coma, Type              X             X
     I, not stated as uncontrolled..........
    250.32  Diabetes with other coma, Type              X             X
     II or unspecified type, uncontrolled...
    250.33  Diabetes with other coma, Type              X             X
     I, uncontrolled........................
    250.40  Diabetes with renal                         X             X
     manifestations, Type II or unspecified
     type, not stated as uncontrolled.......
    250.41  Diabetes with renal                         X             X
     manifestations, Type I, not stated as
     uncontrolled...........................
    250.42  Diabetes with renal                         X             X
     manifestations, Type II unspecified
     type, uncontrolled.....................
    250.43  Diabetes with renal                         X             X
     manifestations, Type I, uncontrolled...
    250.50  Diabetes with ophthalmic                    X             X
     manifestations, Type II or unspecified
     type, not stated as uncontrolled.......
    250.51  Diabetes with ophthalmic                    X             X
     manifestations, Type I, not stated as
     uncontrolled...........................
    250.52  Diabetes with ophthalmic                    X             X
     manifestations, Type II or unspecified
     type, uncontrolled.....................
    250.53  Diabetes with ophthalmic                    X             X
     manifestations, Type I, uncontrolled...
    250.60  Diabetes with neurological                  X             X
     manifestations, Type II or unspecified
     type, not stated as uncontrolled.......
    250.61  Diabetes with neurological                  X             X
     manifestations, Type I, not stated as
     uncontrolled...........................
    250.62  Diabetes with neurological                  X             X
     manifestations, Type II or unspecified
     type, uncontrolled.....................
    250.63  Diabetes with neurological                  X             X
     manifestations, Type I uncontrolled....
    250.70  Diabetes with peripheral                    X             X
     circulatory disorders, Type II or
     unspecified type, not stated as
     uncontrolled...........................
    250.71  Diabetes with peripheral                    X             X
     circulatory disorders, Type I, not
     stated as uncontrolled.................
    250.72  Diabetes with peripheral                    X             X
     circulatory disorders, Type II or
     unspecified type, uncontrolled.........
    250.73  Diabetes with peripheral                    X             X
     circulatory disorders, Type I,
     uncontrolled...........................
    250.80  Diabetes with other specified               X             X
     manifestations, Type II or unspecified
     type, not stated as uncontrolled.......
    250.81  Diabetes with other specified               X             X
     manifestations, Type I, not stated as
     uncontrolled...........................
    250.82  Diabetes with other specified               X             X
     manifestations, Type II or unspecified
     type, uncontrolled.....................
    250.83  Diabetes with other specified               X             X
     manifestations, Type I, uncontrolled...
    250.90  Diabetes with unspecified                   X             X
     complication, Type II or unspecified
     type, not stated as uncontrolled.......
    250.91  Diabetes with unspecified                   X             X
     complication, Type I, not stated as
     uncontrolled...........................
    250.92  Diabetes with unspecified                   X             X
     complication, Type II or unspecified
     type, uncontrolled.....................
    250.93  Diabetes with unspecified                   X             X
     complication, Type I, uncontrolled.....
Principal or Secondary Diagnosis Code:
    585  Chronic renal failure..............            X             X
    403.01  Hypertensive renal disease,                 X             X
     malignant, with renal failure..........
    403.11  Hypertensive renal disease,                 X             X
     benign, with renal failure.............
    403.91  Hypertensive renal disease,                 X             X
     unspecified, with renal failure........
    404.02  Hypertensive heart & renal                  X             X
     disease, malignant, with renal failure.
    404.03  Hypertensive heart & renal                  X             X
     disease, malignant, with congestive
     heart failure and renal disease........
    404.12  Hypertensive heart & renal                  X             X
     disease, benign, with renal failure....
    404.13  Hypertensive heart & renal                  X             X
     disease, benign, with congestive heart
     failure and renal disease..............
    404.92  Hypertensive heart & renal                  X             X
     disease, unspecified, with renal
     failure................................
    404.93  Hypertensive heart & renal                  X             X
     disease, unspecified, with congestive
     heart failure and renal failure........
    V42.0  Organ or tissue replaced by                  X             X
     transplant, kidney.....................
    V43.89  Organ or tissue replaced by                 X             X
     other means, other (Kidney)............
Procedure Code:
    52.80  Pancreatic transplant, not                                 X
     otherwise specified....................
    52.82  Homotransplant of pancreas.......                          X
Combination Procedure Codes:
    52.80  Pancreatic transplant, not
     otherwise specified, plus
    55.69  Other kidney transplantation.....            X
    or
    52.82  Homotransplant of pancreas plus
    55.69  Other kidney transplantation.....            X
------------------------------------------------------------------------


[[Page 22666]]

    The logic for the proposed DRG 512 accepts the pair of diagnosis 
codes in any position (principal/secondary or secondary/secondary). The 
pair of procedure codes must be present along with the two diagnosis 
codes. This DRG would be placed in the Pre-MDC GROUPER logic 
immediately following DRG 480 (Liver Transplant).
    The logic for DRG 513 accepts the pair of diagnosis codes in any 
position (principal/secondary or secondary/secondary). Only one 
procedure code must be used along with the two diagnosis codes. This 
DRG would be placed in the Pre-MDC GROUPER logic immediately following 
proposed new DRG 512 (Simultaneous Pancreas/Kidney Transplant).
b. Intestinal Transplantation
    Effective April 1, 2001, Medicare covers intestinal transplantation 
for the purpose of restoring intestinal function in patients with 
irreversible intestinal failure (Medicare Program Memorandum 
Transmittal No. AB-00-130, December 22, 2000). This procedure is 
covered only when performed for patients who have failed total 
parenteral nutrition (TPN) and only when performed in centers that meet 
approval criteria.
    Intestinal failure is defined as the loss of absorptive capacity of 
the small bowel secondary to severe primary gastrointestinal disease or 
surgically induced short bowel syndrome. Intestinal failure prevents 
oral nutrition and may be associated with both mortality and profound 
morbidity.
    If an intestinal transplantation alone is performed on a patient 
with an intestinal principal diagnosis, the case would be assigned to 
either DRG 148 (Major Small & Large Bowel Procedures With CC) or DRG 
149 (Major Small & Large Bowel Procedures Without CC). If an intestinal 
transplantation and a liver transplantation are performed 
simultaneously, the case would be assigned to DRG 480 (Liver 
Transplant).
    If an intestinal transplantation and a pancreas transplantation are 
performed simultaneously, currently the case would be assigned to 
either DRG 148 or DRG 149. As we have proposed in section II.B.12.A. of 
this proposed rule, effective October 1, 2001, the case would be 
assigned to DRG 513 (Pancreas Transplant). We are proposing to make a 
conforming change to the regulations at Sec. 412.2(e)(4) and 
Sec. 486.302 to include intestines (and multivisceral organs) in the 
list of organs for which Medicare pays for the acquisition costs on a 
reasonable cost basis.
    Effective October 1, 2000, procedure code 46.97 (Transplant of 
intestine) was created. We have examined our Medicare claims data to 
determine whether it is appropriate to propose a new intestinal 
transplant DRG. We examined 100 percent of the data in the FY 2000 
MedPAR file containing bills submitted through May 31, 2000. Therefore, 
we focused our examination on the previous code assignment for 
intestinal transplant, code 46.99 (Other operations on intestines), and 
facilities that are currently performing intestinal transplantation. We 
were able to identify only one case, with an average charge of 
approximately $10,738 as compared to the average standardized charges 
for DRGs 148 and 149, which are approximately $37,961, and $16,965, 
respectively. We will continue to monitor these cases to determine 
whether it may be appropriate in the future to establish a new DRG.

C. Recalibration of DRG Weights

    We are proposing to use the same basic methodology for the FY 2002 
recalibration as we did for FY 2001 (August 1, 2000 final rule (65 FR 
47069)). That is, we would recalibrate the weights based on charge data 
for Medicare discharges. However, we propose to use the most current 
charge information available, the FY 2000 MedPAR file. (For the FY 2001 
recalibration, we used the FY 1999 MedPAR file.) The MedPAR file is 
based on fully coded diagnostic and procedure data for all Medicare 
inpatient hospital bills.
    The proposed recalibrate DRG relative weights are constructed from 
FY 2000 MedPAR data (discharges occurring between October 1, 1999 and 
September 30, 2000), based on bills received by HCFA through December 
31, 2000, from all hospitals subject to the prospective payment system 
and short-term acute care hospitals in waiver States. The FY 2000 
MedPAR file includes data for approximately 11,008,302 Medicare 
discharges.
    The methodology used to calculate the proposed DRG relative weights 
from the FY 2000 MedPAR file is as follows:
     To the extent possible, all the claims were regrouped 
using the proposed DRG classification revisions discussed in section 
II.B. of this preamble. As noted in section II.B.8., due to the 
unavailability of the revised GROUPER software, we simulated most major 
classification changes to approximate the placement of cases under the 
proposed reclassification. However, there are some changes that cannot 
be modeled.
     Charges were standardized to remove the effects of 
differences in area wage levels, indirect medical education and 
disproportionate share payments, and, for hospitals in Alaska and 
Hawaii, the applicable cost-of-living adjustment.
     The average standardized charge per DRG was calculated by 
summing the standardized charges for all cases in the DRG and dividing 
that amount by the number of cases classified in the DRG.
     We then eliminated statistical outliers, using the same 
criteria used in computing the current weights. That is, all cases that 
are outside of 3.0 standard deviations from the mean of the log 
distribution of both the charges per case and the charges per day for 
each DRG are eliminated.
     The average charge for each DRG was then recomputed 
(excluding the statistical outliers) and divided by the national 
average standardized charge per case to determine the relative weight. 
A transfer case is counted as a fraction of a case based on the ratio 
of its transfer payment under the per diem payment methodology to the 
full DRG payment for nontransfer cases. That is, transfer cases paid 
under the transfer methodology equal to half of what the case would 
receive as a nontransfer would be counted as 0.5 of a total case.
     We established the relative weight for heart and heart-
lung, liver, and lung transplants (DRGs 103, 480, and 495) in a manner 
consistent with the methodology for all other DRGs except that the 
transplant cases that were used to establish the weights were limited 
to those Medicare-approved heart, heart-lung, liver, and lung 
transplant centers that have cases in the FY 1999 MedPAR file. 
(Medicare coverage for heart, heart-lung, liver, and lung transplants 
is limited to those facilities that have received approval from HCFA as 
transplant centers.)
     Acquisition costs for kidney, heart, heart-lung, liver, 
lung, and pancreas transplants continue to be paid on a reasonable cost 
basis. Unlike other excluded costs, the acquisition costs are 
concentrated in specific DRGs (DRG 302 (Kidney Transplant); DRG 103 
(Heart Transplant); DRG 480 (Liver Transplant); DRG 495 (Lung 
Transplant); and proposed new DRGs 512 (Simultaneous Pancreas/Kidney 
Transplant) and 513 (Pancreas Transplant). Because these costs are paid 
separately from the prospective payment rate, it is necessary to make 
an adjustment to prevent the relative weights for these DRGs from 
including the acquisition costs. Therefore, we subtracted the 
acquisition charges from the total charges on each transplant bill that 
showed acquisition charges before computing the average charge for the 
DRG and before eliminating statistical outliers.

[[Page 22667]]

    When we recalibrated the DRG weights for previous years, we set a 
threshold of 10 cases as the minimum number of cases required to 
compute a reasonable weight. We propose to use that same case threshold 
in recalibrating the DRG weights for FY 2002. Using the FY 2000 MedPAR 
data set, there are 39 DRGs that contain fewer than 10 cases. We 
computed the weights for these 39 low-volume DRGs by adjusting the FY 
2001 weights of these DRGs by the percentage change in the average 
weight of the cases in the other DRGs.
    The new weights are normalized by an adjustment factor (1.44813) so 
that the average case weight after recalibration is equal to the 
average case weight before recalibration. This adjustment is intended 
to ensure that recalibration by itself neither increases nor decreases 
total payments under the prospective payment system, and accounts for 
the gradual shift in cases toward higher-weighted DRGs over time.
    Section 1886(d)(4)(C)(iii) of the Act requires that, beginning with 
FY 1991, reclassification and recalibration changes be made in a manner 
that assures that the aggregate payments are neither greater than nor 
less than the aggregate payments that would have been made without the 
changes. Although normalization is intended to achieve this effect, 
equating the average case weight after recalibration to the average 
case weight before recalibration does not necessarily achieve budget 
neutrality with respect to aggregate payments to hospitals because 
payment to hospitals is affected by factors other than average case 
weight. Therefore, as we have done in past years and as discussed in 
section II.A.4.b. of the Addendum to this proposed rule, we are 
proposing to make a budget neutrality adjustment to ensure that the 
requirement of section 1886(d)(4)(C)(iii) of the Act is met.

D. Incorporating New Medical Services and Technologies in the Inpatient 
Hospital Prospective Payment System

    Much attention recently has focused on how well Medicare 
incorporates the cost of new medical services and technologies into its 
payment systems. Of particular concern is the adequacy of Medicare's 
payment systems in facilitating access to new technologies for Medicare 
beneficiaries. Section 533 of Public Law 106-554 directs the Secretary 
to develop a mechanism for ensuring adequate payment under the hospital 
inpatient prospective payment system for new medical services and 
technologies, and to report to Congress on ways to more expeditiously 
incorporate new services and technologies into that system. This 
discussion addresses the requirements of section 533 of Public Law 106-
554.
1. Overview
    Medicare payment for an inpatient hospital discharge under the 
inpatient prospective payment system is determined by multiplying the 
relative weight associated with a particular DRG by the national 
average standardized amount (adjusted for other hospital 
characteristics such as a geographic wage index, teaching status, and 
treating a high percentage of low-income patients). Cases are 
classified into DRGs for payment under the prospective payment system 
based on the principal diagnosis, up to eight additional diagnoses, and 
up to six procedures performed during the stay, as well as age, sex, 
and discharge status of the patient. The diagnosis and procedure 
information is reported by the hospital using codes from the 
International Classification of Diseases, Ninth Revision, Clinical 
Modification (ICD-9-CM). The DRG relative weights are recalculated each 
year to reflect the average resources expended across all hospitals to 
treat patients within a particular DRG.
    In general, the inpatient prospective payment system makes payments 
for new medical services and technologies as soon as these items are 
payable. New items or services generally fit within existing DRGs, and 
hospitals using these items and services will be paid at established 
payment rates for the applicable DRGs. Payment rates may subsequently 
be adjusted through the annual process of evaluating the assignment of 
cases within DRGs and recalculating the relative weights associated 
with each DRG based on average charges. These annual changes are made 
to reflect changes in treatment patterns, technology, and any other 
factors that may change the relative use of hospital resources.
    Since the prospective payment system was first implemented in 
October 1983, the pace of innovation in medical technology has been 
rapid. Generally speaking, the system appears to have accommodated 
these innovations without occasioning significant concerns regarding 
access to new technologies. In its March 2001 report to the Congress, 
the Medicare Payment Advisory Commission stated ``the design of the 
inpatient PPS (prospective payment system) makes it easier to ensure an 
appropriate distribution of payments while accommodating technological 
advances'' (page 44).
2. Current Practice--Coding and Payment
    A number of issues arise relating to present methods of 
incorporation of new technologies in the inpatient hospital prospective 
payment system. One issue is the appropriate ICD-9-CM code to be 
assigned to the new technology. This issue is discussed in detail 
below. Assuming the new technology is or can be covered by Medicare, a 
determination must be made concerning to which DRG should the new 
technology be assigned. The DRG (and the value of the relative weight 
associated with that DRG) to which the new technology is assigned 
determines the payment rate for the new technology. Under the DRG 
system, the condition of the patient is the primary consideration in 
the decision to assign a new technology to a DRG. Therefore, a new 
technology generally will be assigned to the same DRG as the DRG's 
predecessor technologies and treatment modalities. In this way, 
hospitals can receive payment for new technology under the inpatient 
hospital prospective payment system quickly. As use of the new 
technology diffuses among hospitals, HCFA will gradually and largely 
automatically recalibrate DRG payment rates based on hospital claims 
data to reflect increasing or decreasing costs of cases assigned to the 
DRG. Generally, it takes 2 years for claims data to be reflected in 
recalibrated DRG weights. Considering the actual costs as reflected in 
the claims data, HCFA may also reassign new technologies to different 
DRGs. However, because a new technology is often more costly initially 
than the predecessor technologies, the adequacy of the initial payment 
rate occasionally becomes an issue.
    At present, if payment is to be made other than by routine 
assignment of the new technology to an existing DRG, it is necessary to 
establish a new ICD-9-CM code. The lag between application for a new 
code and its being made effective for payment is at least a year. 
Because we use actual charge data from hospitals, additional costs or 
savings from the new technology are not reflected in the DRG weight for 
2 years after a new code is effective. For example, the costs or 
savings attributable to any new technologies that were assigned new 
ICD-9-CM codes effective October 1, 1999, will be reflected in the DRG 
relative weights effective for discharges on or after October 1, 2001.
    The lag before new technology affected payment has been viewed by 
some observers as a useful check on payment changes, helping to ensure 
that

[[Page 22668]]

these changes reflect the benefit of a new technology. Hospitals would 
adopt and utilize the new technology, it was reasoned, with a speed and 
to a degree commensurate with its medical advantages. Any differences 
in the resource requirements between the new and existing technologies 
would then be reflected over time in claims data and in changes in the 
DRG weights. To the extent particular new technologies may have been 
initially given relatively low payment, the design of the system 
provided incentives to compensate by achieving efficiencies elsewhere. 
Conversely, if a particular new technology reduced costs compared to 
existing technologies, hospitals would reap the payment benefits until 
such time as the DRG weights began to reflect the lower costs.
3. Current Practice--Data
    Recently, HCFA provided an explicit avenue to permit more rapid 
payment adjustment through use of additional data. The Conference 
Report that accompanied the Balanced Budget Act of 1997 (Public Law 
105-33) stated that ``in order to ensure that Medicare beneficiaries 
have access to innovative new drug therapies, the conferees believe 
that HCFA should consider, to the extent feasible, reliable, validated 
data other than Medicare Provider Analysis and Review (MedPAR) data in 
annually recalibrating and reclassifying the DRGs'' (H.R. Conf. Rep. 
No. 105-217, 105th Cong., 1st Sess., at 734 (1997)). The MedPAR 
contains records for all Medicare hospital discharges and is the source 
data used for DRG recalibration. Although we had never precluded the 
use of non-MedPAR data, we established an explicit process for the 
submission of such data in a manner consistent with the annual 
recalibration of the DRG weights. We stated in the July 30, 1999 
Federal Register that, in the case of external data, a significant 
sample of the data should be submitted by August 1, approximately 8 
months prior to the publication of the proposed rule. This would allow 
us to verify and test the data and make a preliminary assessment as to 
the feasibility of the data's use (64 FR 41499). Subsequently, a 
complete database must be submitted no later than December 1, 
approximately 4 months prior to the publication of the proposed rule. 
On the issue of the use of sample data, we stated in the Federal 
Register that we were not establishing specific criteria regarding 
sample sizes or data collection methodologies prior to gaining 
experience that would enable us to realistically reflect the 
availability of external data based on actual experience. We also 
encouraged anyone interested in submitting such data in the future to 
contact us to discuss the specific data they wish to submit and whether 
the data may be adequate.
4. New Legislation
    Section 533 of Public Law 106-554 addresses the issue of how new 
technologies are introduced into the DRGs, and how DRG payment rates 
must be adapted to accommodate them. Specifically, the provision 
requires that the Secretary:
     Not later than April 1, 2001, submit a report to Congress 
on methods of expeditiously incorporating new medical services and 
technologies into the clinical coding system.
     Not later than October 1, 2001, implement the preferred 
methods described in the report.
     Effective October 1, 2001, establish a mechanism to 
recognize the costs of new medical services and technologies after 
notice and opportunity for public comment.
     Establish criteria to identify new medical services or 
technologies after notice and an opportunity for public comment.
5. DRG Assignment Issues
    As background for discussion of how the DRGs should be changed to 
better accommodate new technology, this section will discuss the 
rationale for basing the initial DRG assignment on patient condition. 
The underlying assumption of the prospective payment system is that 
because hospitals are responsible for the delivery of care they can 
respond to the incentives to control costs inherent in the system. The 
success of any payment system that is predicated on providing 
incentives for cost control is almost totally dependent on the 
effectiveness with which the incentives are communicated. The DRGs were 
designed to be a management tool that is used also as the basis for 
prospective payments. The key distinction between a management tool and 
payment method is the ability of the hospital to use the information to 
take action in response to the incentives in the system. Thus, a 
management tool communicates information in a form and at a level of 
detail that can lead to specific actions. The effectiveness of any 
incentive-based payment system is enhanced if the payment method is 
simultaneously a management tool.
    Because the DRGs were developed to group clinically similar 
patients, an extremely important means of communication between the 
clinical and financial aspects of care was created. DRGs provided 
administrators and physicians with a meaningful basis for evaluating 
both the process of providing care and the associated financial 
impacts. Development of care pathways by DRG and profit-and-loss 
reports by DRG product lines became commonplace. With the adoption of 
these new management methods, length of stay and the use of ancillary 
services dropped dramatically.
    The DRGs not only provided a communications tool for hospital 
management, but they also provided an effective means for hospitals and 
Medicare to communicate. Instead of accountants and lawyers arguing the 
fine points of cost accounting, the focus of payment deliberations 
became the determination of a fair payment rate for patients with 
specific clinical problems. The vast majority of modifications to the 
DRGs since the inception of the Medicare inpatient hospital prospective 
payment system have resulted from recommendations from hospitals. The 
recommendations have almost always been the result of clinicians 
identifying specific types of patients with unique needs. A recent 
example of such a clinical dialogue relates to the DRGs for burns. The 
FY 1999 update to the DRGs included a major restructuring of the burn 
DRGs. This restructuring was the direct result of detailed and specific 
clinical recommendations provided to HCFA by burn specialists.
    Central to the success of the Medicare inpatient hospital 
prospective payment system is that DRGs have remained a clinical 
description of why the patient required hospitalization. We believe it 
would be undesirable to transform DRGs into detailed descriptions of 
the technology and processes used by the hospital to treat the patient. 
If such a transformation were to happen, the DRGs would become largely 
a repackaging of fee-for-service without the management and 
communication benefits. A fundamental assumption underlying DRGs is 
that the hospital has the responsibility for deciding what technology 
and process to employ in treating a particular type of patient. As 
hospitals in the aggregate make treatment decisions, these decisions 
are reflected in the DRG payment weights. The separation of the 
clinical and payment weight methodologies allows a stable clinical 
methodology to be maintained while the payment weights evolve in 
response to changing practice patterns. The packaging of all services 
associated with the care of a particular type of patient into a single 
payment amount provides the incentive for efficiency inherent in a DRG-
based prospective payment system. Substantial disaggregation of the 
DRGs

[[Page 22669]]

into smaller units of payment, or a substantial number of cases 
receiving extra payments, would undermine the incentives and 
communication value in the DRG system.
6. Coding Issues
    To permit us to identify use of a new technology on hospital claims 
and hence to make different payments than would otherwise be 
applicable, we would require a code that can be used to specify when 
that technology is used.
a. Process for Establishing New Codes
    The ICD-9-CM Coordination and Maintenance Committee is responsible 
for discussing potential changes to ICD-9-CM. This is a Federal 
interdepartmental committee, co-chaired by the National Center for 
Health Statistics (NCHS) and HCFA. The NCHS has lead responsibility for 
the ICD-9-CM diagnosis codes, while HCFA has lead responsibility for 
the ICD-9-CM procedure codes. The committee holds meetings twice a 
year, usually in May and November. Agendas for the discussions about 
procedure codes are published on HCFA's Internet website a month before 
the meeting. A Federal Register notice is also published listing topics 
to be discussed. The meetings are open to the public and are held 
usually in Baltimore, Maryland. Shortly afterwards, an extensive 
summary of the meeting is published on HCFA's website and the public is 
given an additional opportunity to comment. Final comments are due by 
early January. A complete, current timeline is included in the Summary 
Report of the Committee at: www.hcfa.gov/medicare/icd9cm.htm.
    For a topic to be discussed at one of the two yearly meetings of 
the committee, the committee must receive a request 2 months prior to 
the meeting. This timeframe allows HCFA to publish the agendas in the 
Federal Register notices and allows individuals and organizations to 
review the agenda and to determine if they wish to attend the public 
meetings. The timeframe is also necessary to allow the committee to 
research the topic and prepare a draft solution in time for the 
meeting. During the meetings, the committee provides a brief 
description of the topic (such as a new technology that may not be 
adequately identified by the current code) and then describes the 
technology or procedure through a formal presentation. Frequently, 
medical experts who perform the procedure make a presentation to 
describe the procedure and how it might be different from other 
procedures in the current code. Proposals are made to either continue 
capturing the procedure in the existing code, revise existing codes, or 
create a new code. The public then discusses the merits of the 
proposals and offers any alternate suggestions.
    The ICD-9-CM is updated once a year, effective October 1. This date 
coincides with the annual updates to the DRGs within the inpatient 
hospital prospective payment system. Each spring HCFA publishes a 
proposed rule that includes proposed changes to the inpatient hospital 
prospective payment system. This notice also includes final decisions 
on changes to ICD-9-CM codes. By August 1, HCFA publishes the new codes 
in the Addendum to the final rule, which is a technical presentation of 
actual changes to be made in both the index and tabular sections of the 
ICD-9-CM coding books. The Addendum is available on HCFA's website and 
is also sent to organizations such as the American Hospital Association 
(AHA) and the American Health Information Management Association 
(AHIMA) to distribute to their members. By October 1 of each year, the 
Department of Health and Human Services also produces a CD-ROM version 
of the ICD-9-CM, which may be purchased at the Government Printing 
Office. Since the ICD-9-CM is not a copyrighted system, many publishers 
and organizations distribute and sell books or other publications that 
include the changes to ICD-9-CM.
    Although the committee's process for discussing proposed changes to 
the ICD-9-CM fully involves and informs the public, the deliberative 
nature of the process does require some time. Topics discussed at the 
May and November 2000 meetings of the Committee are for changes to ICD-
9-CM in October 2001. Therefore, depending on whether a request is 
considered at the May or November meeting, resulting changes may not be 
effective for approximately a year to a year-and-a-half later.
b. Options To Expedite the Implementation of Coding Changes
    Several constraints upon the system would complicate implementing 
extensive changes. One significant complication is the interaction 
between the DRG system and the ICD-9-CM diagnosis and procedure codes 
(in the case of new services and technologies, the discussion focuses 
on procedure rather than diagnosis codes). When a new procedure code is 
created, a decision must be made as to whether the new code affects DRG 
assignment (for example, resulting in a case being assigned to a 
surgical rather than a medical DRG). Currently, new technology is 
generally assigned to the same DRG as its predecessor codes. Even if 
new codes do not affect DRG assignment, the GROUPER software (used to 
assign cases to DRGs) must be reprogrammed to recognize and classify 
all the new codes. This is necessary to allow Medicare's claims 
processing systems to process the claim.
    In addition to the changes to the GROUPER software, implementing 
changes to ICD-9-CM codes is a detailed and far-reaching process 
involving modifications to code books and software coding systems, as 
well as changes to hospitals' claims processing systems. As described 
above, the current process is organized around the annual publication 
of coding changes in the Federal Register as part of the updates and 
changes to the inpatient hospital prospective payment system. The 
changes are made available during the summer, and communicated via 
multiple channels to hospitals. This process allows for the necessary 
processing changes to be thoroughly tested prior to implementation, 
both by HCFA and by the hospitals. This testing procedure is essential 
given the volume (generally 11 million claims annually) and dollar 
impact (approximately $75 billion during FY 2001) of Medicare inpatient 
discharges.
    Another important issue when considering expediting the process of 
making coding changes is that the annual DRG reclassification and 
recalibration of the relative weights must be made in a manner that 
ensures that aggregate payments to hospitals are not affected (section 
1886(d)(4)(C)(iii) of the Act). If ICD-9-CM changes were made at 
multiple times during the year, the budget neutrality requirement would 
mean the standardized amounts, and potentially the cost outlier 
thresholds, would change as well. These changes would compromise the 
prospective nature of the payment system, whereby hospitals are able to 
project their revenues for the year and plan accordingly. Because we do 
not believe the requirement in section 533 of Public Law 106-554 to 
explore ways to expedite coding changes was intended to disrupt the 
prospective nature of the payment system, we did not consider options 
that would require revising the DRG weights and the standardized 
amounts more than once a year.
    With these considerations in mind, we explored the potential for 
shortening the current process.
    First, we are proposing to move the November meeting of the 
Coordination and Maintenance Committee to December without significant 
disruption. To move it further would

[[Page 22670]]

disrupt the process for production of the annual inpatient prospective 
payment system regulation. This step would shorten the code assignment 
process by a month and permit coding changes resulting in payment 
changes to be implemented in a year.
    Second, we are proposing to expedite the process by issuing new 
coding decisions resulting from the spring meeting of the Committee 
(currently in May) that would be effective the following October 1. It 
may be necessary to move the May meeting to April to accommodate this 
procedure. Because the timing of this process would not allow the 
coding changes to be incorporated into the proposed rule published in 
the spring, cases with the new codes would have to be assigned to the 
same DRG to which they would have been assigned without the new code 
and no other payment adjustments would be possible. These coding 
changes would thus not affect the DRG weights or the budget neutrality 
calculations. However, more rapid introduction of new codes would 
permit reflection of the codes in claims data more quickly, and thus 
would permit eventual adjustment of payment rates sooner than otherwise 
possible. This capability could be of particular use where otherwise 
available data were not sufficient to support an immediate payment 
change, because hospital claims data permitting identification of use 
of the new technology would be available more quickly.
    This change would reduce the time between discussion of a proposed 
code and its implementation from a minimum of 11 months to 6 months. It 
would allow for the collection of MedPAR data a full year earlier than 
under the current process, providing the possibility that DRG revisions 
based on new codes could be expedited by up to 1 year.
    There would be significant challenges to making this proposed 
process work. Because the changes would not be published in the 
proposed rule, the public would be given less opportunity to consider 
the merits of the proposals, and it would have to either attend the 
spring meeting of the Committee or respond to the summary report within 
a few weeks. The decisions from the spring meeting must be finalized by 
the middle of June in order for us to include the changes in the 
Addendum of the final rule and in order to make changes in the GROUPER 
software to be effective October 1; it may be necessary to schedule the 
spring meeting earlier to meet this deadline. The opportunity to 
solicit additional input from industry groups and experts would be 
curtailed because of the short time lines. There would be an increased 
risk of errors related to revisions in the procedure code index (a 
manual process performed by HCFA), as there would be less time 
available to review and revise the procedure index to ensure that all 
changes are accurately reflected.
    For example, we are creating a new procedure code to capture 
percutaneous gastrojejunostomy (code 44.32). All coding instructions 
(indexing, inclusion terms, and exclusion terms) must be verified so 
that the procedure is appropriately indexed. If one of the many index 
entries for gastrojejunostomy is not correctly updated, percutaneous 
gastrojejunostomy would be assigned to another gastroenterostomy (code 
44.39), which is an operating room procedure. This can have a 
significant impact on national health care data. Coders at different 
hospitals may follow different entries and arrive at different codes. 
To limit the potential for confusion in the hospital and coding 
communities resulting from two separate schedules for implementing code 
changes, we would limit these changes to those that meet our definition 
of new technology eligible for special treatment as proposed below. It 
would not be necessary, however, to demonstrate that the cases 
involving the new technology would be inadequately paid, since there 
would be no payment impacts of these changes.
    The changes would be included in the Addendum of the proposed rule 
for the inpatient hospital prospective payment system, and placed on 
the website for use by the industry in updating books and software 
systems. They also would be published in the final rule, and included 
in the CD-ROM version of ICD-9-CM that is distributed by the Government 
Printing Office. We are requesting public comments on this proposal.
c. Limitations of ICD-9-CM
    While the updating process currently in use may not lend itself to 
expeditiously incorporating new medical services and technologies into 
the ICD-9-CM coding system, another important factor is the dated and 
limited structure of the ICD-9-CM system. The ICD-9-CM system was 
developed in the 1970s and implemented in 1979. Dramatic advances have 
occurred in medicine since that time. Although the ICD-9-CM 
Coordination and Maintenance Committee has attempted to make coding 
modifications to capture new technology, it has sometimes been 
difficult to achieve a reasonable result.
    The ICD-9-CM procedure codes are made up of four digits: two 
numerical characters followed by a decimal, and then two additional 
numerical characters. The first two digits indicate a category, such as 
36--Operations on the vessels of the heart. The third digit provides 
additional breakdown, such as 36.0--Removal of coronary artery 
obstruction and insertion of stents. When the fourth digit is added, 
the code is fully described. There are only 10 codes available within 
each category (fourth digits 0-9). Once a category is full, we must 
either combine types of similar procedures under one code, or find a 
place in another section of the codebook for a new code. The benefit of 
such a system is that we can collapse the codes into categories when 
analyzing claims data to capture a wide range of similar procedures. 
However, if similar codes are placed in separate sections of the code 
book, coders may not easily find them. Errors may occur when trying to 
identify particular types of cases when codes are not carefully placed 
within a system such as the current ICD-9-CM.
    ICD-9-CM is 22 years old and the premises on which the coding 
system was established are dated. A number of approaches and techniques 
used for procedures such as lasers and the use of scopes were not 
anticipated when the structure of ICD-9-CM was developed. Consequently, 
the basic categories were established on technology that is now 
outdated. Making needed coding changes each year has been quite 
difficult and involves making compromises that effect the precision of 
the coding.
 d. Short-Term Solutions Within the ICD-9-CM Structure
    To consider how we might better respond to requests for new codes 
in the short term, we examined ICD-9-CM to attempt to identify an open 
series of codes that could be used for new procedures and technologies. 
There are currently 16 chapters of procedure codes. However, codes 
17.00 through 17.99 are not in use. These codes are found between 
Chapter 3, ``Operations on the Eye,'' and Chapter 4, ``Operations on 
the Ear.'' This series of 100 codes could be used to provide codes for 
new procedures and technology. To fully utilize this new series of 
codes, we would assign new procedures to the next available code.
    A limitation of this approach would be that this new chapter would 
capture a diverse group of procedures potentially affecting all body 
systems. Assigning procedure codes to this new chapter would 
undoubtedly create

[[Page 22671]]

considerable confusion for coders. Currently, procedures are grouped by 
body system, and similar procedures are placed in categories. This 
arrangement assists the coder in choosing the most appropriate code 
because he or she can quickly review closely related codes that are 
together. Using Chapter 17 for new technology codes, on the other hand, 
would mean that closely related codes would be widely separated.
    Use of Chapter 17 would also require a major revision of coding 
rules since coders are taught to identify codes within a group of 
similar procedures. They are not accustomed to looking for a list of 
unrelated procedures in a separate section of the coding book.
    To supplement the Chapter 17 codes, the Coordination and 
Maintenance Committee may be able to assign vacant codes in other 
chapters. However, large numbers of sequences are already fully or 
nearly fully occupied, and this strategy would only provide limited 
availability of new codes.
e. Alternative Short-Term Approaches
    Some observers have expressed concern that the additional codes 
available within the ICD-9-CM code set may not be adequate to 
accommodate both routine changes in coding and the new technologies 
under consideration here, particularly if a long-term change, such as 
adoption of ICD-10-PCS, is significantly delayed. We have examined 
several alternative short-term options in the event the additional 
available codes are used before a long-term solution is reached. In 
evaluating these alternatives, one must consider the changes each 
entails to hospitals' and HCFA's coding and claims processing systems, 
and the time necessary to implement such changes (balanced against the 
timeframe for adopting a long-term coding solution).
    Expanding ICD-9-CM procedure codes by making them alphanumeric or 
adding a fifth digit would make available a substantial number of new 
codes for new technology but would require substantial system changes 
and create standards issues. This approach was extensively discussed in 
meetings of the ICD-9-CM Coordination and Maintenance Committee prior 
to the development of ICD-10-PCS. Input from the public indicated that 
such a significant modification to a limited and dated system would 
only make the system worse. The time it would take to make this system 
work well would be longer than that required to build a new system and 
the resources needed for system changes would be significant. Such a 
modification of the ICD-9-CM standard code set would require the formal 
standards setting process prescribed by the regulations implementing 
the Health Insurance Portability and Accountability Act of 1996 (Public 
Law 104-191). We solicit comments from the public about the 
desirability of pursuing expansion and modification of the ICD-9-CM 
standards for this purpose.
    Using the V-code section of ICD-9-CM diagnosis codes to report new 
technology would not require any systems changes or create any 
standards issues and would create a moderate number of codes for new 
technology. We have discussed this recommendation with NCHS. NCHS 
opposed this option as an inappropriate use of diagnosis codes. While 
``V'' codes are used for the classification of factors influencing 
health status and contact with health services, they are not a 
substitute for procedure coding. By adding procedure coding concepts to 
the diagnosis coding system, confusion could easily lead to increased 
errors. Furthermore, the V-code section has only a limited number of 
available spots.
    We also considered using HCFA Common Procedure Coding System 
(HCPCS) codes to report use of new technology for inpatient cases. 
However, using HCPCS would require a moderate amount of systems change 
and may require the formal standards setting process prescribed by 
Public Law 104-191, since the HCPCS code set is not the standard for 
inpatient services. However, it would make a substantial number of 
codes available for new technology. Alphanumeric HCPCS codes are 
currently used in outpatient departments and physician offices for 
reporting services, and they are used on a limited basis by hospitals 
in reporting specific inpatient services. For instance, alphanumeric 
HCPCS codes are used for reporting the use of hemophilia clotting 
factors used during an inpatient stay.
    Use of HCPCS codes would require that a new service or technology 
either be assigned a code through otherwise applicable processes for 
HCPCS coding or that HCFA assign a specific, temporary code for use in 
connection with new technology payments for inpatient hospital 
services. Specifically assigned codes could be assigned relatively 
quickly. However, use of such codes would run the risk of confusion if 
other codes were assigned to the same service or items when used in 
other settings. More generally, HCPCS coding would duplicate 
information found in the ICD-9-CM procedure codes. Careful attention to 
integration of coding across the two systems would be necessary, and 
dissemination of information about correct coding to hospital coders 
would present challenges. Even with excellent integration and 
dissemination, the risk of confusion by hospital coders would be high.
    The use of HCPCS codes would also raise questions on how the 
accuracy of claims data will be assessed. HCFA contracts with Peer 
Review Organizations (PROs) to validate the accuracy of coded data. 
Consideration would need to be given to how the accuracy of these data 
could be verified. If two separate coding systems with overlapping 
information are used, considerable variations in reporting practices 
might arise.
    Similar to the option of using alphanumeric ICD-9-CM procedure 
codes, changes in systems and in hospital coding procedures that would 
be associated with this approach would take time and resources to 
implement for hospitals, HCFA, and potentially other payers such as 
Medicare secondary insurers.
    In recognition of these considerations, we do not propose to 
proceed with use of HCPCS codes for this purpose at the present. We 
believe this possibility should be revisited later if the ICD-9-CM 
codes in fact prove inadequate and if a longer term solution is not yet 
available. However, we are encouraging public comments on the concept 
of using HCPCS codes to identify specific new technologies on inpatient 
hospital claims.
f. Development of ICD-10-PCS; A Possible Long-Term Solution
    While acknowledging the limitations of the ICD-9-CM system, the 
Secretary designated the ICD-9-CM system as the national standard in a 
final rule in the Federal Register on August 17, 2000 (65 FR 50311) 
following notice and comment rulemaking in accordance with Public Law 
104-191. In that same final rule, the public was advised that there 
would be a need in the near future to replace this dated coding system 
with a system that could better capture today's health care 
information. At that time, work was proceeding on an updated variant of 
the ICD system, ICD-10, that could replace ICD-9-CM, but this system 
was not yet completed. The World Health Organization developed ICD-10 
as an international diagnosis coding system. NCHS has been modifying 
ICD-10 to replace the diagnosis section of ICD-9-CM. This system is 
being referred to as ICD-10-CM. At the same time, HCFA has been 
developing the ICD-10-Procedure Coding System (ICD-10-PCS) as a 
possible replacement for the ICD-9-CM procedure codes.

[[Page 22672]]

    Criteria for the development of a new procedure coding system were 
established by the National Committee on Vital and Health Statistics 
(NCVHS). The criteria included the following:
     Completeness--all substantially different procedures have 
a unique code.
     Expandability--the structure of the system allows 
incorporation of new procedures and technologies as unique codes.
     Standardized terminology--the coding system includes 
definitions of the terminology used. While the meaning of the specific 
words can vary in common usage, the coding scheme does not include 
multiple meanings for the same term. Each term is assigned a specific 
meaning.
     Multiaxial--the system has a multiaxial structure with 
each code character having the same meaning within the specific 
procedure section and across procedure sections to the extent possible.
     Diagnostic information is not included in the procedure 
description.
    The ICD-10-PCS was developed using these criteria by HCFA through a 
contract with 3M Health Information Systems. The ICD-10-PCS system 
provides much greater code capacity because all substantially different 
procedures have a unique code. While the ICD-9-CM procedure coding 
system is limited to a maximum of 10,000 codes, the current draft of 
ICD-10-PCS contains 197,769 codes and the number could be expanded 
further.
g. Public Meeting on Implementing ICD-10-PCS
    The Department of Health and Human Services is starting the process 
of soliciting public comments on whether it should proceed to adopt 
ICD-10-PCS as the national standard for coding inpatient hospital 
services to replace ICD-9-CM procedures. A public meeting on this issue 
has been scheduled for May 17, 2001, in the HCFA Auditorium in 
Baltimore, Maryland. Information on this meeting can be found in the 
Summary Report of the November 2000 meeting of the ICD-9-CM 
Coordination and Maintenance Committee at: www.hcfa.gov/medicare/icd9cm.htm. The public is encouraged to attend and participate in the 
discussion on whether ICD-10-PCS should become a national standard. 
Organizations and groups will be given the opportunity to make a brief 
presentation on their members' behalf. Groups wishing to be scheduled 
to present should contact Pat Brooks, HCFA, at (410) 786-5318. This 
meeting will begin the process of evaluating ICD-10-PCS as a future 
national standard.
h. Proposed Methods of Expeditiously Incorporating New Medical Services 
and Technologies Into the Coding System
    In summary, we are proposing a two-part strategy for expeditiously 
incorporating new medical services and technologies into the clinical 
coding system used with respect to payment for inpatient hospital 
services. First, we are proposing to shorten the timeframe for 
implementing new codes by processing changes that do not have payment 
implications without first publishing them in the proposed rule in the 
spring. This means new codes approved at the spring meeting of the ICD-
9-CM Coordination and Maintenance Committee could be implemented by 
October of the same year. We also are proposing to move the November 
meeting to December. These proposed changes would reduce the time it 
currently takes to implement new codes, as well as reduce the time 
required to collect data through the MedPAR by up to a year in many 
cases.
    Second, to make more codes available to identify new technology, we 
will immediately begin to work with the public to use Chapter 17 of 
ICD-9-CM procedures. This will provide room for 100 additional 
procedure codes. We also will continue the current process of adding 
and revising codes within the current chapters as room and structure 
allow. Our long-range strategy is to consider the implementation of 
ICD-10-PCS as a replacement system for ICD-9-CM. However, because of 
the need to address any such change through notice and public 
rulemaking procedures (a proposed and final rule), in addition to the 
need to revise both our payment systems and those of hospitals, this 
could occur no earlier than October 2003.
7. New Requirements Relative to New Services and Technologies
    Section 533 of Public Law 106-554 addresses the process by which 
new technologies and services are introduced into the DRGs and how DRG 
payment rates are to be adapted to accommodate them. Section 533(b) 
added new section 1886(d)(5)(K) to the Act, which specifies that the 
Secretary must establish criteria to use to identify a new technology 
after notice and an opportunity for public comment. Under new section 
1886(d)(5)(K)(ii)(I) of the Act, effective for discharges occurring on 
or after October 1, 2001, the Secretary is required to apply a 
mechanism to recognize the costs of new technologies if, ``based on the 
estimated costs incurred with respect to discharges involving such 
service or technology, the DRG prospective payment rate otherwise 
applicable to such discharges under this subsection is inadequate.'' 
Further, new section 1886(d)(5)(K)(v) stipulates that the requirement 
for an additional payment for a new medical service or technology may 
be satisfied by means of ``an add-on payment, a payment adjustment, or 
any other similar mechanism for increasing the amount otherwise payable 
with respect to a discharge under this subsection.'' Section 533(b) 
also added a new section 1886(d)(5)(L) to the Act which states that the 
requirement for an additional payment for a new medical service or 
technology may also be met through establishing ``new-technology groups 
into which a new medical service or technology will be classified.''
    In section IV.F. of this preamble, we are setting forth, for public 
comment, our policy proposals to implement section 1886(d)(5)(K) of the 
Act, as added by section 533(b) of Public Law 106-554. In summary, the 
proposed policies include--
     Proposed criteria for identifying new medical services and 
technologies for additional payments beyond the DRG prospective payment 
system payment.
     The proposed methodology for determining the adequacy of 
current payments for new services and technology.
     The proposed methodology for determining the amount of the 
additional payment and for payment mechanism for new medical services 
and technologies.

III. Proposed Changes to the Hospital Wage Index

A. Background

    Section 1886(d)(3)(E) of the Act requires that, as part of the 
methodology for determining prospective payments to hospitals, the 
Secretary must adjust the 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 
accordance with the broad discretion conferred under the Act, we 
currently define hospital labor market areas based on the definitions 
of Metropolitan Statistical Areas (MSAs), Primary MSAs (PMSAs), and New 
England County Metropolitan Areas (NECMAs) issued by the Office of 
Management and Budget

[[Page 22673]]

(OMB). The OMB also designates Consolidated MSAs (CMSAs). A CMSA is a 
metropolitan area with a population of one million or more, comprising 
two or more PMSAs (identified by their separate economic and social 
character). For purposes of the hospital wage index, we use the PMSAs 
rather than CMSAs since they allow a more precise breakdown of labor 
costs. If a metropolitan area is not designated as part of a PMSA, we 
use the applicable MSA. Rural areas are areas outside a designated MSA, 
PMSA, or NECMA. For purposes of the wage index, we combine all of the 
rural counties in a State to calculate a rural wage index for that 
State.
    We note that, effective April 1, 1990, the term Metropolitan Area 
(MA) replaced the term MSA (which had been used since June 30, 1983) to 
describe the set of metropolitan areas consisting of MSAs, PMSAs, and 
CMSAs. The terminology was changed by OMB in the March 30, 1990 Federal 
Register to distinguish between the individual metropolitan areas known 
as MSAs and the set of all metropolitan areas (MSAs, PMSAs, and CMSAs) 
(55 FR 12154). For purposes of the prospective payment system, we will 
continue to refer to these areas as MSAs.
    Beginning October 1, 1993, section 1886(d)(3)(E) of the Act 
requires that we update the wage index annually. Furthermore, this 
section provides that the Secretary base the update on a survey of 
wages and wage-related costs of short-term, acute care hospitals. The 
survey should measure, to the extent feasible, the earnings and paid 
hours of employment by occupational category, and must exclude the 
wages and wage-related costs incurred in furnishing skilled nursing 
services. As discussed below in section III.F. of this preamble, we 
also take into account the geographic reclassification of hospitals in 
accordance with sections 1886(d)(8)(B) and 1886(d)(10) of the Act when 
calculating the wage index.

B. FY 2002 Wage Index Update

    The proposed FY 2002 wage index values in section V of the Addendum 
to this proposed rule (effective for hospital discharges occurring on 
or after October 1, 2001 and before October 1, 2002) are based on the 
data collected from the Medicare cost reports submitted by hospitals 
for cost reporting periods beginning in FY 1998 (the FY 2001 wage index 
was based on FY 1997 wage data).
    The proposed FY 2002 wage index includes the following categories 
of data associated with costs paid under the hospital inpatient 
prospective payment system (as well as outpatient costs), which were 
also included in the FY 2001 wage index:
     Salaries and hours from short-term, acute care hospitals.
     Home office costs and hours.
     Certain contract labor costs and hours.
     Wage-related costs.
    Consistent with the wage index methodology for FY 2001, the 
proposed wage index for FY 2002 also continues to exclude the direct 
and overhead salaries and hours for services not paid through the 
inpatient prospective payment system such as skilled nursing facility 
(SNF) services, home health services, or other subprovider components 
that are not subject to the prospective payment system.
    We calculate a separate Puerto Rico-specific wage index and apply 
it to the Puerto Rico standardized amount. (See 62 FR 45984 and 46041.) 
This wage index is based solely on Puerto Rico's data. Finally, section 
4410 of Public Law 105-33 provides that, for discharges on or after 
October 1, 1997, the area wage index applicable to any hospital that is 
not located in a rural area may not be less than the area wage index 
applicable to hospitals located in rural areas in that State.

C. FY 2002 Wage Index Proposal

    Because it is used to adjust payments to hospitals under the 
prospective payment system, the hospital wage index should, to the 
extent possible, reflect the wage costs associated with the areas of 
the hospital included under the hospital inpatient prospective payment 
system. In response to concerns within the hospital community related 
to the removal, from the wage index calculation, of costs related to 
graduate medical education (GME) (teaching physicians and residents) 
and certified registered nurse anesthetists (CRNAs), which are paid by 
Medicare separately from the prospective payment system, the American 
Hospital Association (AHA) convened a workgroup to develop a consensus 
recommendation on this issue. The workgroup recommended that costs 
related to GME and CRNAs be phased out of the wage index calculation 
over a 5-year period. Based upon our analysis of hospitals' FY 1996 
wage data, and consistent with the AHA workgroup's recommendation, we 
specified in the July 30, 1999 final rule (64 FR 41505) that we would 
phase-out these costs from the calculation of the wage index over a 5-
year period, beginning in FY 2000. In keeping with the decision to 
phase-out costs related to GME and CRNAs, the proposed FY 2002 wage 
index is based on a blend of 40 percent of an average hourly wage 
including these costs, and 60 percent of an average hourly wage 
excluding these costs.
    Beginning with the FY 1998 cost reports, we revised the Worksheet 
S-3, Part II so that hospitals can separately report teaching physician 
Part A costs on lines 4.01, 10.01, 12.01, and 18.01. Therefore, it is 
no longer necessary for us to conduct the special survey we used for 
the FY 2000 and FY 2001 wage indexes (64 FR 41505 and 65 FR 47071).
1. Health Insurance and Health-Related Costs
    In the August 1, 2000 final rule, we clarified our definition of 
``purchased health insurance costs'' and ``self-insurance'' for 
hospitals that provide health insurance to employees (65 FR 47073). For 
purposes of the wage index, purchased or self-funded health insurance 
plan costs include the hospitals' insurance premium costs, external 
administration costs, and the share of costs for services delivered to 
employees.
    In response to a comment received concerning this issue, we stated 
that, for self-funded health insurance costs, personnel costs 
associated with hospital staff that deliver the services to the 
employees must continue to be excluded from wage-related costs if the 
costs are already included in the wage data as salaries on Worksheet S-
3, Part II, Line 1. However, after further consideration of this 
policy, particularly with respect to concerns expressed by our fiscal 
intermediaries about the level of effort required during the wage index 
desk review process to ensure hospitals are appropriately identifying 
and excluding these costs, we are proposing a revision. Effective with 
the calculation of the FY 2003 wage index, for either purchased or 
self-funded health insurance, we would allow health insurance personnel 
costs, associated with hospital staff that deliver services to 
employees, to be included as part of the wage-related costs. We believe 
this proposed revised policy will ensure that health insurance costs 
are consistently reported by hospitals. Health insurance costs would 
continue to be developed using generally accepted accounting 
principles.
    In the August 1, 2000 final rule (65 FR 47073), we further 
clarified that health-related costs (including employee physical 
examinations, flu shots, and clinic visits, and other services that are 
not covered by employees' health insurance plans but are provided at no 
cost or at discounted rates to employees of the hospital) may be 
included as ``other'' wage-related costs if, among

[[Page 22674]]

other criteria, the combined cost of all such health-related costs is 
greater than one percent of the hospital's total salaries (less 
excluded area salaries).
    For purposes of calculating the FY 2003 wage index (which will be 
based on data for cost reporting periods beginning in FY 1999), we are 
proposing to revise this policy to allow hospitals to include health-
related costs as allowable core wage-related costs.
2. Costs of Contracted Pharmacy and Laboratory Services
    Our policy concerning inclusion of contract labor costs for 
purposes of calculating the wage index has evolved over the years. We 
recognize the role of contract labor in meeting special personnel needs 
of many hospitals. In addition, improvements in the wage data have 
allowed us to more accurately identify contract labor costs and hours. 
As a result, effective with the FY 1994 wage index, we included the 
costs of direct patient care contract services in the wage index 
calculation. The FY 1999 wage index included the costs and hours of 
certain management contract services, and the FY 2000 wage index 
included the costs for contract physician Part A services. (The 1996 
proposed rule (61 FR 27456) provided an in-depth background to the 
issues related to the inclusion of contract labor costs in the wage 
index calculation.)
    We revised the 1998 cost report to collect the data associated with 
contract pharmacy, Worksheet S-3, Part II, Line 9.01, and contract 
laboratory, Worksheet S-3, Part II, Line 9.02. The cost reporting 
instructions for these line numbers followed that for all contract 
labor lines; that is, to include the amount paid for services furnished 
under contract for direct patient care, and not include cost for 
equipment, supplies, travel expenses, and other miscellaneous or 
overhead items (Medicare Provider Reimbursement Manual, Part 2, Cost 
Reporting Forms and Instructions, Chapter 36, Transmittal 6, page 36-
32). Effective with the FY 2002 wage index, which uses FY 1998 wage 
data, we are proposing to include the costs and hours of contract 
pharmacy and laboratory.
3. Collection of Occupational Mix Data
    Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) 
of the Act to require that the Secretary must provide for the 
collection of data every 3 years on the occupational mix of employees 
for each short-term, acute care hospital participating in the Medicare 
program, in order to construct an occupational mix adjustment to the 
wage index. The initial collection of these data must be completed by 
September 30, 2003, for application beginning October 1, 2004.
    Currently, the wage data collected by HCFA on the cost report 
reflect the sum of wages, hours, and wage-related costs for all 
hospital employees. There is no separate collection by occupational 
categories of employees, such as registered nurses or physical 
therapists. Total salaries and hours reflect management decisions made 
by hospitals in terms of how many employees within a certain occupation 
to employ to treat different types of patients. For example, a large 
academic medical center may tend to hire more high-cost specialized 
employees to treat its more acutely ill patient population. The 
argument is that the higher labor costs incurred to treat this patient 
population are reflected in the higher case mix of these hospitals, and 
therefore, reflecting these costs in the wage index is essentially 
counting them twice.
    An occupational mix adjustment can be used to account for hospital 
management decisions about how many employees to hire in each 
occupational category. Occupational mix data measure the price the 
hospital must pay for employees within each category. A wage index that 
reflected only these market prices would remove the impact of 
management decisions about the mix of employees needed and, therefore, 
better capture geographic variations in the labor market.
    We have examined this issue previously. In the May 27, 1994 Federal 
Register (59 FR 27724), we discussed the outcome of consideration of 
this issue by a hospital workgroup. At that time, the workgroup's 
consensus was that the data required to implement an occupational mix 
adjustment were not available and the likelihood of obtaining such data 
would be minimal. There seemed to be little support among hospital 
industry representatives for developing a system that would create 
additional reporting burdens with an unproven or minimal impact on the 
distribution of payments. Also, in the August 30, 1991 Federal Register 
(56 FR 43219), we stated our belief that the collection of these data 
would be costly and difficult.
    In considering the format to collect occupational mix data, we 
looked to data currently being collected by the Bureau of Labor 
Statistics (BLS), which conducts an annual mail survey to produce 
estimates of employment and wages for specific occupations. This 
program, Occupational Employment Statistics (OES), collects data on 
wage and salary workers in nonfarm establishments in order to produce 
employment and wage estimates for over 700 occupations.
    The OES survey collects wage data in 12 hourly rate intervals. 
Employers report the number of employees in an occupation per each wage 
range. To illustrate, the wage intervals used for the 1999 survey are 
as follows:

----------------------------------------------------------------------------------------------------------------
              Interval                            Hourly wages                          Annual wages
----------------------------------------------------------------------------------------------------------------
Range A.............................  Under $6.75.........................  Under $14,040
Range B.............................  6.75 to 8.49........................  14,040 to 17,659
Range C.............................  8.50 to 10.74.......................  17,660 to 22,359
Range D.............................  10.75 to 13.49......................  22,360 to 28,079
Range E.............................  13.50 to 16.99......................  28,080 to 35,359
Range F.............................  17.00 to 21.49......................  35,360 to 44,719
Range G.............................  21.50 to 27.24......................  44,720 to 56,679
Range H.............................  27.25 to 34.49......................  56,680 to 71,759
Range I.............................  34.50 to 43.74......................  71,760 to 90,999
Range J.............................  43.75 to 55.49......................  91,000 to 115,439
Range K.............................  55.50 to 69.99......................  115,440 to 145,599
Range L.............................  70,000 and over.....................  145,600 and over
----------------------------------------------------------------------------------------------------------------

    It should be noted that this table is for illustrative purposes, 
and we may update the data ranges in our actual collection instrument.
    Although we initially considered using the OES data, section 304(c) 
of Public Law 106-554 requires us to

[[Page 22675]]

collect data from every short-term, acute care hospital. The OES data 
are a sample survey and, therefore, as currently conducted, are not 
consistent with the statutory requirement to include data from every 
hospital. Another issue with using OES data is that, for purposes of 
the Medicare wage index, the hospitals' data must be reviewed and 
verified by the fiscal intermediaries. The OES survey is a voluntary 
survey.
    Although we decided to pursue a separate data collection effort 
than OES, we propose to model our format after the one used by OES. In 
this way, hospitals participating in the OES survey, should have no 
additional recordkeeping and reporting requirements beyond those of the 
OES survey.
    The OES survey of the hospital industry is designed to capture all 
occupational categories within the industry. For purposes of adjusting 
the wage index for occupational mix, we do not believe it is necessary 
to collect data from such a comprehensive scope of categories. 
Furthermore, because the data must be audited, a comprehensive list of 
categories would be excessively burdensome.
    In deciding which job categories to include, we reviewed the 
occupational categories collected by OES and identified those with at 
least 35,000 hospital employees. Our goal is to collect data from a 
sample of job categories that provides a valid measure of wage rates 
within a geographical area. Using this threshold of at least 35,000 
employees within a category nationally, we are proposing to collect the 
number of employees by wage range as illustrated in the above table, 
for the occupational categories listed below. The following data are 
based on the 1999 OES survey:

----------------------------------------------------------------------------------------------------------------
                                                                                    Percent of
               OES code                         Category             Employees    total hospital    Mean hourly
                                                                                     employees         wage
----------------------------------------------------------------------------------------------------------------
15008.................................  Medicine and Health               93,680            1.9           $27.38
                                         Services Managers.
27302.................................  Social Workers, Medial            53,360            1.1            16.33
                                         and Psychiatric.
32102.................................  Physicians and Surgeons.         125,640            2.6            43.76
32308.................................  Physical Therapists.....          39,840            0.8            26.14
32502.................................  Registered Nurses.......       1,231,980           25.0            21.12
32505.................................  Licensed Practical               206,360            4.2            13.39
                                         Nurses.
32517.................................  Pharmacists.............          46,860            1.0            28.62
32911, 32928, 32931...................  Clinical Technologists           122,380            2.50           11.69
                                         and Technicians.
51002, 55105, 55108, 55305............  First-Line Supervisors           445,730            9.5            11.39
                                         and Clerical Workers.
55332, 55347
65038, 67002, 67005...................  Food Preparation Workers         218,440            4.5             8.17
                                         and Housekeeping.
66008.................................  Nursing Aides,                   301,240            6.2             8.67
                                         Orderlies, and
                                         Attendants.
----------------------------------------------------------------------------------------------------------------

    We believe this list of occupational categories provides a good 
representation of the employee mix at most hospitals. Definitions for 
each occupational category are available on the BLS website at http://stats.bls.gov/oes/1999/oes_alph.htm.
    We have yet to settle on the methodology on how to use the 
occupational mix index. One option would be to weight each hospital's 
wage index by its occupational mix index. This requires calculating a 
national occupational mix index and then breaking it down by MSA and by 
hospital, similar to how the wage index is broken down. In this way, 
the wage index would capture geographic differences in wage rates. The 
decision about how to apply the occupational mix index to the wage 
index depends on the quality of the data collected, since this effort 
will be the first time wage and hour data by occupation are collected 
in this audited manner.
    Section 304(c) directs the Secretary to provide for the collection 
of these data by September 30, 2003, and to apply them in the wage 
index by October 1, 2004. Therefore, the data are to be incorporated in 
the FY 2005 wage index. Under our current timetable, the FY 2005 wage 
index will be based on wage data collected from hospitals' cost 
reporting periods beginning during FY 2001. In order to facilitate the 
fiscal intermediaries' review of these data, we believe the 
occupational mix data should coincide with the data otherwise used to 
calculate the cost report. Therefore, we will conduct a special survey 
of all short-term acute-care hospitals that are required to report wage 
data to collect these data coinciding with hospitals' FY 2001 cost 
reports. More specific procedural information regarding this survey 
will be included in the FY 2002 final rule scheduled to be published by 
August 1, 2001.

D. Verification of Wage Data From the Medicare Cost Report

    The data for the proposed FY 2002 wage index were obtained from 
Worksheet S-3, Parts II and III of the FY 1998 Medicare cost reports. 
The data file used to construct the proposed wage index includes FY 
1998 data submitted to HCFA as of mid-February 2001. As in past years, 
we performed an intensive review of the wage data, mostly through the 
use of edits designed to identify aberrant data.
    We asked our fiscal intermediaries to revise or verify data 
elements that resulted in specific edit failures. Some unresolved data 
elements are included in the calculation of the proposed FY 2002 wage 
index pending their resolution before calculation of the final FY 2002 
wage index. We have instructed the intermediaries to complete their 
verification of questionable data elements and to transmit any changes 
to the wage data no later than April 9, 2001. We expect that all 
unresolved data elements will be resolved by that date. The revised 
data will be reflected in the final rule.
    Also, as part of our editing process, we removed data for 47 
hospitals that failed edits. For 23 of these hospitals, we were unable 
to obtain sufficient documentation to verify or revise the data because 
the hospitals are no longer participating in the Medicare program or 
are in bankruptcy status. Twenty-four hospitals had incomplete or 
inaccurate data resulting in zero or negative average hourly wages. 
Therefore, they were removed from the calculation. The data for these 
hospitals will be included in the final wage index if we receive 
corrected data that pass our edits. As a result, the proposed FY 2002 
wage index is calculated based on FY 1998 wage data for 4,868 
hospitals.

[[Page 22676]]

E. Computation of the Proposed FY 2002 Wage Index

    We note a proposed technical change to the FY 2002 calculation. For 
the FY 2001 wage index calculation, we initially proposed to subtract 
Line 13 of Worksheet S-3, Part III from total hours when determining 
the excluded hours ratio used to estimate the amount of overhead 
attributed to excluded areas (65 FR 26299). However, the formula 
resulted in large and inappropriate increases in the average hourly 
wages for some hospitals (65 FR 47074), particularly hospitals that 
have large overhead and excluded area costs. Therefore, for the final 
FY 2001 wage index calculation, we reverted to the FY 2000 excluded 
hours ratio formula, which did not subtract Line 13.
    We, and others in the hospital community, continued to believe that 
subtracting Part III, Line 13 from total hours is the correct formula 
for determining the excluded hours ratio. We analyzed how the 
application of this formula resulted in overstated average hourly wages 
for some hospitals and how we could improve the overall accuracy of the 
overhead allocation methodology. We became aware that the problem was 
not in the excluded hours ratio formula. Rather, our wage index 
calculation did not also remove the overhead wage-related costs 
associated with excluded areas, an amount that must be estimated before 
it can be subtracted from the calculation. The combined effect of 
applying the excluded hours ratio formula, which appropriately removes 
salaries of lower-wage, overhead employees, and not subtracting 
overhead wage-related costs associated with excluded areas, resulted in 
overstated salary costs and average hourly wages.
    For the FY 2002 wage index calculation, we are proposing to apply 
the excluded hours ratio formula that subtracts Part III, Line 13 from 
total hours. Additionally, for the first time in the wage index 
calculation, we estimated and subtracted overhead wage-related costs 
allocated to excluded areas.
    After we applied this new calculation, there were still a few 
hospitals that experienced large increases in their average hourly 
wages. The intermediaries verified that the hospitals' wage data were 
accurate, so we kept the data in the wage index calculation. These 
hospitals primarily function as SNFs, psychiatric hospitals, or 
rehabilitation hospitals that have few acute care beds. The hospitals' 
higher average hourly wages reflect the costs of the higher salaried 
employees that remain in the wage index calculation after we subtract 
the costs of excluded area and associated overhead employees.
    The method used to compute the proposed FY 2002 wage index follows.
    Step 1--As noted above, we are proposing to base the FY 2002 wage 
index on wage data reported on the FY 1998 Medicare cost reports. We 
gathered data from each of the non-Federal, short-term, acute care 
hospitals for which data were reported on the Worksheet S-3, Parts II 
and III of the Medicare cost report for the hospital's cost reporting 
period beginning on or after October 1, 1997 and before October 1, 
1998. In addition, we included data from any hospital that had cost 
reporting periods beginning before October 1997 and reported a cost 
reporting period covering all of FY 1998. These data were included 
because no other data from these hospitals would be available for the 
cost reporting period described above, and because particular labor 
market areas might be affected due to the omission of these hospitals. 
However, we generally describe these wage data as FY 1998 data. We note 
that, if a hospital had more than one cost reporting period beginning 
during FY 1998 (for example, a hospital had two short cost reporting 
periods beginning on or after October 1, 1997 and before October 1, 
1998), we included wage data from only one of the cost reporting 
periods, the longest, in the wage index calculation. If there was more 
than one cost reporting period and the periods were equal in length, we 
included the wage data from the latest period in the wage index 
calculation.
    Step 2--Salaries--The method used to compute a hospital's average 
hourly wage is a blend of 40 percent of the hospital's average hourly 
wage including all GME and CRNA costs, and 60 percent of the hospital's 
average hourly wage after eliminating all GME and CRNA costs.
    In calculating a hospital's average salaries plus wage-related 
costs, including all GME and CRNA costs, we subtracted from Line 1 
(total salaries) the Part B salaries reported on Lines 3 and 5, home 
office salaries reported on Line 7, and excluded salaries reported on 
Lines 8 and 8.01 (that is, direct salaries attributable to skilled 
nursing facility services, home health services, and other subprovider 
components not subject to the prospective payment system). We also 
subtracted from Line 1 the salaries for which no hours were reported on 
Lines 2, 4, and 6. To determine total salaries plus wage-related costs, 
we added to the net hospital salaries the costs of contract labor for 
direct patient care, certain top management, pharmacy, laboratory, and 
physician Part A services (Lines 9, 9.01, 9.02, 10, and 10.01), home 
office salaries and wage-related costs reported by the hospital on 
Lines 11, 12, and 12.01, and nonexcluded area wage-related costs (Lines 
13, 14, 16, 18, 18.01, and 20).
    We note that contract labor and home office salaries for which no 
corresponding hours are reported were not included. In addition, wage-
related costs for specific categories of employees (Lines 16, 18, 
18.01, and 20) are excluded if no corresponding salaries are reported 
for those employees (Lines 2, 4, 4.01, and 6, respectively).
    We then calculated a hospital's salaries plus wage-related costs by 
subtracting from total salaries the salaries plus wage-related costs 
for teaching physicians, Lines (4.01, 10.01, 12.01, and 18.01), Part A 
CRNAs (Lines 2 and 16), and residents (Lines 6 and 20).
    Step 3--Hours--With the exception of wage-related costs, for which 
there are no associated hours, we computed total hours using the same 
methods as described for salaries in Step 2.
    Step 4--For each hospital reporting both total overhead salaries 
and total overhead hours greater than zero, we then allocated overhead 
costs to areas of the hospital excluded from the wage index 
calculation. First, we determined the ratio of excluded area hours (sum 
of Lines 8 and 8.01 of Worksheet S-3, Part II) to revised total hours 
(Line 1 minus the sum of Part II, Lines 3, 5, 7, and Part III, Line 13 
of Worksheet S-3). We then computed the amounts of overhead salaries 
and hours to be allocated to excluded areas by multiplying the above 
ratio by the total overhead salaries and hours reported on Line 13 of 
Worksheet S-3, Part III. Next, we computed the amounts of overhead 
wage-related costs to be allocated to excluded areas using three steps: 
(1) We determined the ratio of overhead hours (Part III, Line 13) to 
revised hours (Line 1 minus the sum of Lines 3, 5, and 7); (2) we 
computed overhead wage-related costs by multiplying the overhead hours 
ratio by wage-related costs reported on Part II, Lines 13, 14, 16, 18, 
18.01, and 20; and (3) we multiplied the computed overhead wage-related 
costs by the above excluded area hours ratio. Finally, we subtracted 
the computed overhead salaries, wage-related costs, and hours 
associated with excluded areas from the total salaries (plus wage-
related costs) and hours derived in Steps 2 and 3. Using the above 
method for computing overhead salaries, wage-related costs, and hours 
to allocate to

[[Page 22677]]

excluded areas, we also computed these costs excluding all costs 
associated with GME and CRNAs (Lines 2, 4.01, 6, 10.01, 12.01, and 
18.01).
    Step 5--For each hospital, we adjusted the total salaries plus 
wage-related costs to a common period to determine total adjusted 
salaries plus wage-related costs. To make the wage adjustment, we 
estimated the percentage change in the employment cost index (ECI) for 
compensation for each 30-day increment from October 14, 1997 through 
April 15, 1999 for private industry hospital workers from the Bureau of 
Labor Statistics' Compensation and Working Conditions. We use the ECI 
because it reflects the price increase associated with total 
compensation (salaries plus fringes) rather than just the increase in 
salaries. In addition, the ECI includes managers as well as other 
hospital workers. This methodology to compute the monthly update 
factors uses actual quarterly ECI data and assures that the update 
factors match the actual quarterly and annual percent changes. The 
factors used to adjust the hospital's data were based on the midpoint 
of the cost reporting period, as indicated below.

                    Midpoint of Cost Reporting Period
------------------------------------------------------------------------
                                                              Adjustment
                     After                         Before       factor
------------------------------------------------------------------------
12/14/97......................................     01/15/98      1.03292
01/14/98......................................     02/15/98      1.03048
02/14/98......................................     03/15/98      1.02828
03/14/98......................................     04/15/98      1.02621
04/14/98......................................     05/15/98      1.02411
05/14/98......................................     06/15/98      1.02200
06/14/98......................................     07/15/98      1.01973
07/14/98......................................     08/15/98      1.01714
08/14/98......................................     09/15/98      1.01424
09/14/98......................................     10/15/98      1.01137
10/14/98......................................     11/15/98      1.00885
11/14/98......................................     12/15/98      1.00669
12/14/98......................................     01/15/99      1.00462
01/14/99......................................     02/15/99      1.00239
02/14/99......................................     03/15/99      1.00000
03/14/99......................................     04/15/99      0.99746
------------------------------------------------------------------------

    For example, the midpoint of a cost reporting period beginning 
January 1, 1998 and ending December 31, 1998 is June 30, 1998. An 
adjustment factor of 1.01973 would be applied to the wages of a 
hospital with such a cost reporting period. In addition, for the data 
for any cost reporting period that began in FY 1998 and covered a 
period of less than 360 days or more than 370 days, we annualized the 
data to reflect a 1-year cost report. Annualization is accomplished by 
dividing the data by the number of days in the cost report and then 
multiplying the results by 365.
    Step 6--Each hospital was assigned to its appropriate urban or 
rural labor market area before any reclassifications under section 
1886(d)(8)(B) or section 1886(d)(10) of the Act. Within each urban or 
rural labor market area, we added the total adjusted salaries plus 
wage-related costs obtained in Step 5 (with and without GME and CRNA 
costs) for all hospitals in that area to determine the total adjusted 
salaries plus wage-related costs for the labor market area.
    Step 7--We divided the total adjusted salaries plus wage-related 
costs obtained under both methods in Step 6 by the sum of the 
corresponding total hours (from Step 4) for all hospitals in each labor 
market area to determine an average hourly wage for the area.
    Because the proposed FY 2002 wage index is based on a blend of 
average hourly wages, we then added 40 percent of the average hourly 
wage calculated without removing GME and CRNA costs, and 60 percent of 
the average hourly wage calculated with these costs excluded.
    Step 8--We added the total adjusted salaries plus wage-related 
costs obtained in Step 5 for all hospitals in the nation and then 
divided the sum by the national sum of total hours from Step 4 to 
arrive at a national average hourly wage (using the same blending 
methodology described in Step 7). Using the data as described above, 
the national average hourly wage is $22.0545.
    Step 9--For each urban or rural labor market area, we calculated 
the hospital wage index value by dividing the area average hourly wage 
obtained in Step 7 by the national average hourly wage computed in Step 
8.
    Step 10--Following the process set forth above, we developed a 
separate Puerto Rico-specific wage index for purposes of adjusting the 
Puerto Rico standardized amounts. (The national Puerto Rico 
standardized amount is adjusted by a wage index calculated for all 
Puerto Rico labor market areas based on the national average hourly 
wage as described above.) We added the total adjusted salaries plus 
wage-related costs (as calculated in Step 5) for all hospitals in 
Puerto Rico and divided the sum by the total hours for Puerto Rico (as 
calculated in Step 4) to arrive at an overall average hourly wage of 
$10.8100 for Puerto Rico. For each labor market area in Puerto Rico, we 
calculated the Puerto Rico-specific wage index value by dividing the 
area average hourly wage (as calculated in Step 7) by the overall 
Puerto Rico average hourly wage.
    Step 11--Section 4410 of Public Law 105-33 provides that, for 
discharges on or after October 1, 1997, the area wage index applicable 
to any hospital that is located in an urban area may not be less than 
the area wage index applicable to hospitals located in rural areas in 
that State. Furthermore, this wage index floor is to be implemented in 
such a manner as to ensure that aggregate prospective payment system 
payments are not greater or less than those that would have been made 
in the year if this section did not apply. For FY 2002, this change 
affects 240 hospitals in 41 MSAs. The MSAs affected by this provision 
are identified in Table 4A by a footnote.

F. Revisions to the Wage Index Based on Hospital Redesignation

    Under section 1886(d)(8)(B) of the Act, hospitals in certain rural 
counties adjacent to one or more MSAs are considered to be located in 
one of the adjacent MSAs if certain standards are met. Under section 
1886(d)(10) of the Act, the MGCRB considers applications by hospitals 
for geographic reclassification for purposes of payment under the 
prospective payment system.
1. Provisions of Public Law 106-554
    Section 304 of Public Law 106-554 made changes to several 
provisions of section 1886(d)(10) of the Act relating to hospital 
reclassifications and the wage index:
     Section 304(a) amended section 1886(d)(10)(D) of the Act 
by adding a clause (v) to provide that, beginning with FY 2001, an 
MGCRB decision on a hospital reclassification for purposes of the wage 
index is effective for 3 years, unless the hospital elects to terminate 
the reclassification. Section 304(a) also provides that the MGCRB must 
use the 3 most recent years' average hourly wage data in evaluating a 
hospital's reclassification application for FY 2003 and any succeeding 
fiscal year (section 1886(d)(10)(D)(vi) of the Act).
     Section 304(b) provides that, by October 1, 2001, the 
Secretary must establish a mechanism under which a statewide entity may 
apply to have all of the geographic areas in the State treated as a 
single geographic area for purposes of computing and applying a single 
wage index, for reclassifications beginning in FY 2003. Section 304(b) 
further requires that, if the Secretary applies a statewide wage index 
to an area, an application by an individual hospital in that area would 
not be considered.
    We address our policy proposals relating to implementation of these 
three provisions of sections 304(a) and (b) of Public Law 106-554 in 
section IV. of this proposed rule. The following

[[Page 22678]]

discussion of the proposed revisions to the wage index based on 
hospital redesignations reflects these proposed policies.
2. Effects of Reclassification
    The methodology for determining the wage index values for 
redesignated hospitals is applied jointly to the hospitals located in 
those rural counties that were deemed urban under section 1886(d)(8)(B) 
of the Act and those hospitals that were reclassified as a result of 
the MGCRB decisions under section 1886(d)(10) of the Act. Section 
1886(d)(8)(C) of the Act provides that the application of the wage 
index to redesignated hospitals is dependent on the hypothetical impact 
that the wage data from these hospitals would have on the wage index 
value for the area to which they have been redesignated. Therefore, as 
provided in section 1886(d)(8)(C) of the Act, the wage index values 
were determined by considering the following:
     If including the wage data for the redesignated hospitals 
would reduce the wage index value for the area to which the hospitals 
are redesignated by 1 percentage point or less, the area wage index 
value determined exclusive of the wage data for the redesignated 
hospitals applies to the redesignated hospitals.
     If including the wage data for the redesignated hospitals 
reduces the wage index value for the area to which the hospitals are 
redesignated by more than 1 percentage point, the area wage index 
determined inclusive of the wage data for the redesignated hospitals 
(the combined wage index value) applies to the redesignated hospitals.
     If including the wage data for the redesignated hospitals 
increases the wage index value for the area to which the hospitals are 
redesignated, both the area and the redesignated hospitals receive the 
combined wage index value.
     The wage index value for a redesignated urban or rural 
hospital cannot be reduced below the wage index value for the rural 
areas of the State in which the hospital is located.
     Rural areas whose wage index values would be reduced by 
excluding the wage data for hospitals that have been redesignated to 
another area continue to have their wage index values calculated as if 
no redesignation had occurred.
     Rural areas whose wage index values increase as a result 
of excluding the wage data for the hospitals that have been 
redesignated to another area have their wage index values calculated 
exclusive of the wage data of the redesignated hospitals.
     Currently, the wage index value for an urban area is 
calculated exclusive of the wage data for hospitals that have been 
reclassified to another area.
    For the FY 2002 wage index, we are proposing to include the wage 
data for a reclassified urban hospital in both the area to which it is 
reclassified and the MSA where the hospital is physically located. We 
believe this will improve consistency and predictability in hospital 
reclassification and wage indices, as well as alleviate the 
fluctuations in the wage indexes due to reclassifications. For example, 
hospitals applying to reclassify into another area will know which 
hospitals' data will be included in calculating the wage index, because 
even if some hospitals in the area are reclassified, their data will be 
included in the calculation of the wage index of the area where they 
are geographically located. Also, in some cases, excluding the data of 
hospitals reclassified to another MSA could have a large downward 
impact on the wage index of the MSA in which the hospital is physically 
located. The negative impact of removing the data of the reclassified 
hospitals from the wage index calculation could lead to large wage 
disparities between the reclassified hospitals and other hospitals in 
the MSA, as the remaining hospitals would receive reduced payments due 
to a lower wage index. Our proposed approach would promote consistency, 
and simplify our rules, with respect to how we construct the wage 
indexes of rural and urban areas. As noted above, in the case of rural 
hospitals redesignated to another area, the wage index of the rural 
area where the hospitals are geographically located is calculated by 
including the wage data of the redesignated hospitals (unless doing so 
would result in a lower wage index).
    Finally, we note that the Medicare Payment Advisory Commission 
(MedPAC), in its March 2001 ``Report to the Congress: Medicare Payment 
Policy,'' recommended this policy (p. 82). (Section VII. of this 
preamble includes a discussion of MedPAC's recommendations and our 
responses.) To illustrate the potential negative impact on hospitals in 
an area where reclassifications of some hospitals to another area 
results in a decline in the wage index after the reclassified hospitals 
are excluded from the wage index calculation, MedPAC points out that 
hospitals in several MSAs have organized to pay qualifying hospitals 
not to reclassify. Our proposed policy change would remove this 
distorted incentive.
    The proposed wage index values for FY 2002 are shown in Tables 4A, 
4B, 4C, and 4F in the Addendum to this proposed rule. Hospitals that 
are redesignated should use the wage index values shown in Table 4C. 
Areas in Table 4C may have more than one wage index value because the 
wage index value for a redesignated urban or rural hospital cannot be 
reduced below the wage index value for the rural areas of the State in 
which the hospital is located. When the wage index value of the area to 
which a hospital is redesignated is lower than the wage index value for 
the rural areas of the State in which the hospital is located, the 
redesignated hospital receives the higher wage index value; that is, 
the wage index value for the rural areas of the State in which it is 
located, rather than the wage index value otherwise applicable to the 
redesignated hospitals.
    As mentioned earlier, section 304(a) of Public Law 106-554 amended 
section 1886(d)(10)(D) of the Act by adding a new clause (v) to provide 
that a reclassification of a hospital by the MGCRB for purposes of the 
wage index is effective for 3 years (instead of 1 year) unless, under 
procedures established by the Secretary, the hospital elects to 
terminate the reclassification before the end of the 3-year period. 
Section 304(a) of Public Law 106-554 also amended section 
1886(d)(10)(D) of the Act to specify that, for applications for 
reclassification for the wage index for FYs 2003 and later, the MGCRB 
must base any comparison of the average hourly wage of the hospital 
with the average hourly wage for hospitals in the area in which it is 
located and the area to which it seeks reclassification, using data 
from the most recently published hospital wage survey (as of the date 
of the hospital's application), as well as data from each of the two 
immediately preceding surveys. (Our policy proposals to incorporate the 
provisions of section 304(a) of Public Law 106-554 in the regulations 
are addressed in section IV.E. of this proposed rule).
    Consistent with the section 304(a) amendment, Tables 3A and 3B list 
the 3-year average hourly wage for each labor market area before the 
redesignation of hospitals, based on FY 1996, 1997, and 1998 wage data. 
In addition, Table 2 in the Addendum to this proposed rule includes the 
adjusted average hourly wage for each hospital from the FY 1996 and FY 
1997 cost reporting periods, as well as the FY 1998 period. Table 2 
also shows the 3-year average (as well as hospitals' average hourly 
wages for each of the 3 years) that the MGCRB will use (as published in 
the final rule following

[[Page 22679]]

this proposed rule) to evaluate a hospital's application for 
reclassification for FY 2003 (unless that average hourly wage is later 
revised in accordance with Sec. 412.63(w)(2)). The 3-year averages are 
calculated by dividing the sum of the dollars (adjusted to a common 
reporting period using the method described previously in this section) 
across all 3 years, by the sum of the hours. If a hospital is missing 
data for any of the previous years, its average hourly wage for the 3-
year period is calculated based on the data available during that 
period.
    Applications for FY 2003 reclassifications are due to the MGCRB by 
September 1, 2001. (We note that the new location and mailing address 
of the MGCRB and the Provider Reimbursement Review Board (PRRB) is: 
2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670. The MGCRB 
and PRRB will be functioning at this new location as of May 21, 2001. 
Also, please specify whether the mail is intended for the MGCRB or the 
PRRB.)
    At the time this proposed wage index was constructed, the MGCRB had 
completed its review of FY 2002 reclassification requests. The proposed 
FY 2002 wage index values incorporate all 643 hospitals redesignated 
for purposes of the wage index (hospitals redesignated under section 
1886(d)(8)(B) or section 1886(d)(10) of the Act for FY 2002. The final 
number of reclassifications may vary because some MGCRB decisions are 
still under review by the Administrator and because some hospitals may 
withdraw their requests for reclassification.
    Any changes to the wage index that result from withdrawals of 
requests for reclassification, wage index corrections, appeals, and the 
Administrator's review process will be incorporated into the wage index 
values published in the final rule following this proposed rule. The 
changes may affect not only the wage index value for specific 
geographic areas, but also the wage index value redesignated hospitals 
receive; that is, whether they receive the wage index value for the 
area to which they are redesignated, or a wage index value that 
includes the data for both the hospitals already in the area and the 
redesignated hospitals. Further, the wage index value for the area from 
which the hospitals are redesignated may be affected.
    Under Sec. 412.273, hospitals that have been reclassified by the 
MGCRB are permitted to withdraw their applications within 45 days of 
the publication of this proposed rule in the Federal Register. The 
request for withdrawal of an application for reclassification that 
would be effective in FY 2002 must be received by the MGCRB by June 18, 
2001. A hospital that requests to withdraw its application may not 
later request that the MGCRB decision be reinstated.
    In addition, because the 3-year effect of the amendment made by 
section 304(a) of Public Law 106-554 is applicable to reclassifications 
for FY 2001 (which had already taken place prior to the date of 
enactment of Public Law 106-554) and because the application process 
for reclassification for FY 2002 had already been completed by the date 
of enactment, we are deeming hospitals that are reclassified for 
purposes of the wage index to one area for FY 2001 and are reclassified 
for purposes of the wage index or the standardized amount to another 
area for FY 2002 to be reclassified to the area for which they applied 
for FY 2002, unless they elect to receive the wage index 
reclassification they were granted for FY 2001. Consistent with our 
application withdrawal procedures under Sec. 412.273, we are allowing 
hospitals that wish to receive, for FY 2002, the reclassification they 
were granted for FY 2001, to withdraw their applications within 45 days 
of the publication of this proposed rule (that is, by June 18, 2001. 
(These procedures are discussed in detail under section IV.E.1. of this 
preamble.)
3. Statewide Wage Index
    As stated earlier, section 304(b) of Public Law 106-554 requires 
the Secretary to establish, by October 1, 2001, a process (based on the 
voluntary process utilized by the Secretary under section 1848 of the 
Act) under which an appropriate statewide entity may apply to have all 
the geographic areas in the State treated as a single geographic area 
for purposes of computing and applying a single wage index, for 
reclassification beginning in FY 2003. Section 304(b) further requires 
that, if the Secretary applies a statewide wage index to an area, an 
application by an individual hospital in that area would not be 
considered. We believe the reference to the voluntary process utilized 
by the Secretary under section 1848 of the Act refers to the process 
whereby we allow a State containing multiple physician fee schedule 
payment areas (and thus multiple geographic adjustment factors) to 
voluntarily convert to a single statewide payment area with a single 
geographic adjustment factor (see Sec. 414.4(b), as discussed in the 
June 24, 1994 Federal Register (59 FR 32759).
    Section IV.E. of this proposed rule contains our policy proposal 
for implementing the provisions of section 304(b) in regulations. We 
are proposing that hospitals that seek a statewide geographic 
reclassification under the amendments made by section 304(b) of Public 
Law 106-554 apply to the MGCRB with the same deadlines as other 
hospitals. An approved application by the MGCRB would mean that the 
data of all the hospitals in the State would be used in computing and 
applying the wage index for that State. We are proposing that the 
statewide wage index would be applicable for 3 years from the date of 
approval or until all of the participating hospitals terminate their 
approved statewide wage index reclassification (effective with the next 
full fiscal year after their termination request), whichever occurs 
first.
4. Section 402 of Public Law 106-113
    Beginning October 1, 1988, section 1886(d)(8)(B) of the Act 
required us to treat a hospital located in a rural county adjacent to 
one or more urban areas as being located in the MSA to which the 
greatest number of workers in the county commute, if the rural county 
would otherwise be considered part of an urban area under the standards 
published in the Federal Register on January 3, 1980 (45 FR 956) for 
designating MSAs (and for designating NECMAs), and if the commuting 
rates used in determining outlying counties (or, for New England, 
similar recognized areas) were determined on the basis of the aggregate 
number of resident workers who commute to (and, if applicable under the 
standards, from) the central county or counties of all contiguous MSAs 
(or NECMAs). Hospitals that met the criteria using the January 3, 1980 
version of these OMB standards were deemed urban for purposes of the 
standardized amounts and for purposes of assigning the wage data index.
    During FY 1994, we incorporated the revised MSA definitions based 
on 1990 census population data. As a result, some counties that 
previously were treated as an adjacent county under section 
1886(d)(8)(B) of the Act officially became part of certain MSAs. 
However, as specified in the Act, we continued to utilize the January 
3, 1980 standards. For FY 2000, there were 27 hospitals in 22 counties 
affected by this provision.
    On March 30, 1990, OMB issued revised 1990 standards (55 FR 12154). 
There has been an increasing amount of interest by the hospital 
industry in using the 1990 standards as opposed to the 1980 standards 
to determine which hospitals qualify under the provisions set forth in 
section 1886(d)(8)(B) of the Act. Section 402 of Public Law 106-113 
provides that, with respect to FYs 2001

[[Page 22680]]

and 2002, a hospital may elect to have the 1990 standards applied to it 
for purposes of section 1886(d)(8)(B) and that, beginning with FY 2003, 
hospitals will be required to use the standards published in the 
Federal Register by the Director of OMB based on the most recent 
decennial census.
    We worked with staff of the Population Distribution Branch within 
the Population Division of the United States Census Bureau to compile a 
list of hospitals that meet the March 30, 1990 standards using 1990 
census population data and information prepared for the Metropolitan 
Area Standards Review Project. The conditions that must be met for a 
hospital located in a rural county adjacent to one or more urban areas 
to be treated as being located in the urban area to which the greatest 
number of workers in the rural county commute are as follows:
     The rural county would otherwise be considered part of an 
MSA but for the fact that the rural county does not meet the standard 
established by OMB relating to the commuting rate of workers between 
the county and the central county or counties of any adjacent MSA.
     The county would meet the commuting standard if commuting 
to (and where applicable, from) the central county or central counties 
of all adjacent MSAs or NECMAs (rather than to just one) were 
considered.
    A county meeting the above commuting standards must also meet the 
other standards established by OMB for inclusion in an MSA as an 
outlying county. In order to meet these requirements, the rural county 
must have a degree of ``metropolitan character.'' ``Metropolitan 
character'' is established by meeting one of the following OMB 
standards, which were published in the Federal Register on March 30, 
1990:
    a. At least 50 percent of the employed workers residing in the 
county commute to the central county/counties, and either--
     The population density of the county is at least 25 
persons per square mile; or
     At least 10 percent of the population, or at least 5,000 
persons, lives in the qualifier urbanized area(s).
    b. From 40 to 50 percent of the employed workers commute to the 
central county/counties, and either--
     The population density is at least 35 persons per square 
mile; or
     At least 10 percent of the population, or at least 5,000 
persons, lives in the qualifier urbanized area(s).
    c. From 25 to 40 percent of the employed workers commute to the 
central county/counties and either the population density of the county 
is at least 50 persons per square mile, or any two of the following 
conditions exist:
     Population density is at least 35 persons per square mile.
     At least 35 percent of the population is urban.
     At least 10 percent of the population, or at least 5,000 
persons, lives in the qualifier urbanized area(s).
    d. From 15 to 25 percent of the employed workers commute to the 
central county/counties, the population density of the county is at 
least 50 persons per square mile, and any two of the following 
conditions also exist:
     Population density is at least 60 persons per square mile.
     At least 35 percent of the population is urban.
     Population growth between the last two decennial censuses 
is at least 20 percent.
     At least 10 percent of the population, or at least 5,000 
persons, lives in the qualifier urbanized area(s).
    Also accepted as meeting this commuting requirement under item d. 
are:
     The number of persons working in the county who live in 
the central county/counties is equal to at least 15 percent of the 
number of employed workers living in the county; or
     The sum of the number of workers commuting to and from the 
central county/counties is equal to at least 20 percent of the number 
of employed workers living in the county.
    e. From 15 to 25 percent of the employed workers commute to the 
central county/counties, the population density of the county is less 
than 50 persons per square mile, and any two of the following 
conditions also exist:
     At least 35 percent of the population is urban.
     Population growth between the last two decennial censuses 
is at least 20 percent.
     At least 10 percent of the population, or at least 5,000 
persons, lives in the qualifier urbanized area(s).
    f. At least 2,500 of the population lives in a central city of the 
MSA located in the qualifier urbanized area(s).
    When we apply the 1990 standards as opposed to 1980 standards, the 
number of qualifying counties increases from 22 to 31. On the basis of 
the evaluation of these data, effective for discharges occurring on or 
after October 1, 2001, hospitals located in the first column of the 
following table are proposed to be considered, for purposes of 
assigning the inpatient standardized amount and the wage index, to be 
located in the corresponding urban area in the second column:

------------------------------------------------------------------------
               Rural County                              MSA
------------------------------------------------------------------------
Chilton, AL...............................  Birmingham, AL.
Marshall, AL..............................  Huntsville, AL.
Talladega, AL.............................  Anniston, AL.
Bradford, FL..............................  Jacksonville, FL.
Hendry, FL................................  West Palm Beach-Boca Raton,
                                             FL.
Putnam, FL................................  Gainesville, FL.
Jackson, GA...............................  Athens, GA.
Christian, IL.............................  Springfield, IL.
Macoupin, IL..............................  St. Louis, MO-IL.
Piatt, IL.................................  Champaign-Urbana, IL.
Brown, IN.................................  Indianapolis, IN.
Carroll, IN...............................  Lafayette, IN.
Henry, IN.................................  Indianapolis, IN.
Jefferson, KS.............................  Topeka, KS.
Barry, MI.................................  Kalamazoo-Battle Creek, MI.
Cass, MI..................................  Benton Harbor, MI.
Ionia, MI.................................  Grand Rapids-Muskegon-
                                             Holland, MI.
Shiawassee, MI............................  Flint, MI.
Tuscola, MI...............................  Saginaw-Bay City-Midland, MI
Caswell, NC...............................  Greensboro-Winston Salem-
                                             High Point, NC.
Greene, NC................................  Greenville, NC.
Harnett, NC...............................  Raleigh-Durham-Chapel Hill,
                                             NC.
Wilson, NC................................  Rocky Mount, NC.
Preble, OH................................  Dayton-Springfield, OH.
Van Wert, OH..............................  Lima, OH.
Adams, PA.................................  York, PA.
Lawrence, PA..............................  Pittsburgh, PA.
Monroe, PA................................  Newark, NJ.
Schuylkill, PA............................  Reading, PA.
Jefferson, WI.............................  Milwaukee-Waukesha, WI.
Walworth, WI..............................  Milwaukee-Waukesha, WI.
------------------------------------------------------------------------

    There are 14 counties that meet the qualifying criteria using 1990 
standards that did not meet the criteria using the 1980 standards. 
These 14 counties are:

Chilton, AL
Talladega, AL
Bradford, FL
Hendry, FL
Putnam, FL
Jackson, GA
Piatt, IL
Brown, IN
Carroll, IN
Greene, NC
Wilson, NC
Adams, PA
Monroe, PA
Schuylkill, PA

    In addition, when we apply the 1980 standards for three of the 
counties, the MSA assigned is different from the MSA that would be 
assigned using the 1990 standards. These counties are as follows:

[[Page 22681]]



------------------------------------------------------------------------
                                     1980 MSA
         Rural county              designation      1990 MSA designation
------------------------------------------------------------------------
Ionia, MI.....................  Lansing-East       Grand Rapids-Muskegon-
                                 Lansing, MI.       Hollan, MI.
Caswell, NC...................  Danville, VA.....  Greensboro-Winston
                                                    Salem-High Point,
                                                    NC.
Harnett, NC...................  Fayetteville, NC.  Raleigh-Durham-Chapel
                                                    Hill, NC.
------------------------------------------------------------------------

    Section 402 of Public Law 106-113 states that hospitals may elect 
to use either the January 3, 1980 standards or the March 30, 1990 
standards for payments during FY 2001 and FY 2002. We are assuming 
hospitals will elect to go to the MSA resulting in the highest payment 
amount accounting for the applicable wage indexes and standardized 
amounts. Based on our analysis, we believe all hospitals in the 
designated rural counties would benefit by being included in the 
respective MSAs shown above. Therefore, we are proposing to assign the 
FY 2002 standardized amount and wage index of each respective MSA to 
the affected hospitals. Hospitals electing not to use the 1990 
standards would be required to notify their fiscal intermediary in 
writing of such election prior to September 1, 2001, in order to allow 
sufficient time to reflect this change in our payment systems. (For FY 
2001, we are providing further information related to this election, 
including recalculated wage indexes, through separate instruction.)
    We note that five rural counties no longer meet the qualifying 
criteria when we apply the revised OMB standards. These rural counties 
are as follows: Indian River, FL; Mason, IL; Owen, IN; Morrow, OH; and 
Lincoln, WV. For FY 2002, we propose to continue to treat these 
hospitals as attached to an MSA on the basis of the 1980 standards. 
Beginning FY 2003, they must meet the 1990 standards to continue to be 
treated as such.
    We stated in the August 1, 2000 final rule that implemented changes 
to the prospective payment system for FY 2001 that we were in the 
process of working with OMB to identify the hospitals that would be 
affected by section 402 of Public Law 106-113 (65 FR 47076). We further 
indicated we would revise payments to hospitals in the affected 
counties as soon as data were available. Now that the affected counties 
have been identified, hospitals in the 14 counties identified above 
will be offered the opportunity to elect this designation, as 
previously described. (For FY 2001, we are providing further 
information related to this election, including recalculated wage 
indexes, through separate instructions.)
    Finally, three hospitals located in counties affected by the 
revised OMB standards also have been reclassified by the MGCRB. The 
affected hospitals are listed below. If the hospitals do not wish to be 
reclassified for FY 2002 based on their new designation as described 
above, they must follow the procedures described above for requesting 
that their reclassification be withdrawn.

------------------------------------------------------------------------
                                                           FY 2002
       Provider Number        1990 MSA designation    reclassification,
                                                             MSA
------------------------------------------------------------------------
34-0071.....................  Raleigh-Durham-       Fayetteville, NC.
                               Chapel Hill, NC.
34-0124.....................  Raleigh-Durham-       Fayetteville, NC.
                               Chapel Hill, NC.
34-0126.....................  Rocky Mount, NC.....  Raleigh-Durham-
                                                     Chapel Hill, NC
                                                     (wage index only.)
------------------------------------------------------------------------

G. Requests for Wage Data Corrections

    As stated in section II.D. of this preamble, the data file used to 
construct the proposed wage index includes FY 1998 data submitted to 
HCFA as of mid-February 2001. In a memorandum dated February 5, 2001, 
we instructed all Medicare intermediaries to inform the prospective 
payment hospitals they service of the availability of the wage data 
file and the process and timeframe for requesting revisions. The wage 
data file was made available on February 13, 2001 through the Internet 
at HCFA's home page (http://www.hcfa.gov). We also instructed the 
intermediaries to advise hospitals of the availability of these data 
either through their representative hospital organizations or directly 
from HCFA. Additional details on ordering this data file are discussed 
in section IX.A of this preamble, ``Requests for Data from the 
Public.''
    In addition, Table 2 in the Addendum to this proposed rule contains 
each hospital's adjusted average hourly wage used to construct the 
proposed wage index values for the past 3 years, including the FY 1998 
data used to construct the proposed FY 2002 wage index. It should be 
noted that the hospital average hourly wages shown in Table 2 do not 
reflect any changes made to a hospital's data after mid-February 2001. 
Changes approved by a hospital's fiscal intermediary and forwarded to 
HCFA by April 9, 2001, will be reflected on the final public use wage 
data file scheduled to be made available on or about May 4, 2001.
    We believe hospitals have sufficient time to ensure the accuracy of 
their FY 1998 wage data. Moreover, the ultimate responsibility for 
accurately completing the cost report rests with the hospital, which 
must attest to the accuracy of the data at the time the cost report is 
filed. Hospitals should know what wage data were submitted on their 
cost reports. Additionally, they are notified of any changes to their 
data as a result of their intermediary's review. However, if a hospital 
believed that its FY 1998 wage data were incorrectly reported, the 
hospital was to submit corrections along with complete, detailed 
supporting documentation to its intermediary by March 9, 2001. 
Hospitals were notified of this deadline, and of all other possible 
deadlines and requirements, through written communications from their 
fiscal intermediaries in early February 2001.
    After reviewing requested changes submitted by hospitals, 
intermediaries transmitted any revised cost reports to HCFA and 
forwarded a copy of the revised Worksheet S-3, Parts II and III to the 
hospitals. In addition, fiscal intermediaries were to notify hospitals 
of the changes or the reasons that changes were not accepted. This 
procedure ensures that hospitals have every opportunity to verify the 
data that will be used to construct their wage index values. We believe 
that fiscal intermediaries are generally in the best position to make 
evaluations regarding the appropriateness of a particular cost and 
whether it should be included in the wage index data. However, if a 
hospital disagrees with the intermediary's resolution of a requested 
change, the hospital may contact HCFA in an effort to resolve policy 
disputes. We note that the April 9, 2001 deadline also applies to these 
requested changes. We will not consider factual determinations at this 
time, as these

[[Page 22682]]

should have been resolved earlier in the process.
    Any wage data corrections to be reflected in the final wage index 
must have been reviewed and verified by the intermediary and 
transmitted to HCFA on or before April 9, 2001. (The deadline for 
hospitals to request changes from their fiscal intermediaries was March 
9, 2001.) These deadlines are necessary to allow sufficient time to 
review and process the data so that the final wage index calculation 
can be completed for development of the final prospective payment rates 
to be published by August 1, 2001.
    We have created the process described above to resolve all 
substantive wage data correction disputes before we finalize the wage 
data for the FY 2002 payment rates. Accordingly, hospitals that do not 
meet the procedural deadlines set forth above will not be afforded a 
later opportunity to submit wage data corrections or to dispute the 
intermediary's decision with respect to requested changes. 
Specifically, our policy is that hospitals that do not meet the 
procedural deadlines set forth above will not be permitted to later 
challenge, before the Provider Reimbursement Review Board, HCFA's 
failure to make a requested data revision (See W. A. Foote Memorial 
Hospital v. Shalala, No. 99-CV-75202-DT (E.D. Mich. 2001)).
    The final wage data public use file will be released by May 4, 
2001. Hospitals should examine both Table 2 of this proposed rule and 
the May 4 final public use wage data file (which reflects revisions to 
the data used to calculate the values in Table 2) to verify the data 
HCFA is using to calculate the wage index. Hospitals will have until 
June 4, 2001, to submit requests to correct errors in the final wage 
data due to data entry or tabulation errors by the intermediary or 
HCFA. The correction requests that will be considered at that time will 
be limited to errors in the entry or tabulation of the final wage data 
that the hospital could not have known about before the release of the 
final wage data public use file.
    As with the file made available in February 2001, HCFA will make 
the final wage data file released in May 2001 available to hospital 
associations and the public on the Internet. However, the May 2001 file 
will be made available solely for the limited purpose of identifying 
any potential errors made by HCFA or the intermediary in the entry of 
the final wage data that result from the correction process described 
above (with the March 9 deadline). Hospitals are encouraged to review 
their hospital wage data promptly after the release of the final file. 
Data presented at this time cannot be used by hospitals to initiate new 
wage data correction requests.
    If, after reviewing the final file, a hospital believes that its 
wage data are incorrect due to a fiscal intermediary or HCFA error in 
the entry or tabulation of the final wage data, it should send a letter 
to both its fiscal intermediary and HCFA. The letters should outline 
why the hospital believes an error exists and provide all supporting 
information, including dates. These requests must be received by HCFA 
and the intermediaries no later than June 4, 2001. Requests mailed to 
HCFA should be sent to: Health Care Financing Administration; Center 
for Health Plans and Providers; Attention: Wage Index Team, Division of 
Acute Care; C4-07-07; 7500 Security Boulevard; Baltimore, MD 21244-
1850. Each request must also be sent to the hospital's fiscal 
intermediary. The intermediary will review requests upon receipt and 
contact HCFA immediately to discuss its findings.
    At this point in the process, that is, between release of the May 
2001 wage index file and June 4, 2001, changes to the hospital wage 
data will only be made in those very limited situations involving an 
error by the intermediary or HCFA that the hospital could not have 
known about before its review of the final wage data file. 
Specifically, neither the intermediary nor HCFA will accept the 
following types of requests at this stage of the process:
     Requests for wage data corrections that were submitted too 
late to be included in the data transmitted to HCFA on or before April 
9, 2001.
     Requests for correction of errors that were not, but could 
have been, identified during the hospital's review of the February 2001 
wage data file.
     Requests to revisit factual determinations or policy 
interpretations made by the intermediary or HCFA during the wage data 
correction process.
    Verified corrections to the wage index received timely (that is, by 
June 4, 2001) will be incorporated into the final wage index to be 
published by August 1, 2001 and effective October 1, 2001.
    Again, we believe the wage data correction process described above 
provides hospitals with sufficient opportunity to bring errors in their 
wage data to the intermediary's attention. Moreover, because hospitals 
will have access to the final wage data by early May 2001, they will 
have the opportunity to detect any data entry or tabulation errors made 
by the intermediary or HCFA before the development and publication of 
the FY 2002 wage index by August 1, 2001 and the implementation of the 
FY 2002 wage index on October 1, 2001. If hospitals avail themselves of 
this opportunity, the wage index implemented on October 1 should be 
accurate. Nevertheless, in the event that errors are identified after 
that date, we retain the right to make midyear changes to the wage 
index under very limited circumstances.
    Specifically, in accordance with Sec. 412.63(w)(2), we may make 
midyear corrections to the wage index only in those limited 
circumstances in which a hospital can show (1) That the intermediary or 
HCFA made an error in tabulating its data; and (2) that the hospital 
could not have known about the error, or did not have an opportunity to 
correct the error, before the beginning of FY 2002 (that is, by the 
June 4, 2001 deadline). As indicated earlier, since a hospital will 
have the opportunity to verify its data, and the intermediary will 
notify the hospital of any changes, we do not foresee any specific 
circumstances under which midyear corrections would be necessary. 
However, should a midyear correction be necessary, the wage index-
change for the affected area will be effective prospectively from the 
date the correction is made.

H. Modification of the Process and Timetable for Updating the Wage 
Index

    Although the wage data correction process described above has 
proven successful in the past for ensuring that the wage data used each 
year to calculate the wage indexes are generally reliable and accurate, 
we are concerned about the growing volume of wage data revisions 
initiated by hospitals during February and the first week of March. We 
first discussed this issue in the FY 1998 proposed rule (62 FR 29918). 
At that time, we noted that, in developing the FY 1997 wage index, the 
wage data were revised between the proposed and final rules for more 
than 13 percent of the hospitals (approximately 700 of 5,200). Last 
year, in developing the FY 2001 wage index, the wage data were revised 
between the proposed and final rules for more than 32 percent of the 
hospitals (1,605 of 4,950).
    Since hospitals are expected to submit complete and accurate cost 
report data, and intermediaries review and request hospitals to correct 
problematic wage data before the data are submitted to HCFA in mid-
November, we believe there should be limited revisions at this stage of 
the process. We remind the hospital community that the primary purpose 
of this file is to allow hospitals to verify that we have their correct 
data on file. However, according to information received from the

[[Page 22683]]

intermediaries, these late revisions are frequently due to hospitals' 
lack of responsiveness in providing sufficient information to the 
intermediaries during the desk reviews (that is, during the 
intermediary's review of the hospital's cost report).
    We are proposing two changes to the wage index development process 
and timetable beginning with the FY 2003 wage index. We believe these 
changes will encourage earlier submissions of wage data revisions by 
hospitals and will allow intermediaries more time to address the heavy 
volume of revisions requested after the intermediaries have completed 
their desk reviews of these data. First, we are proposing to release 
the preliminary wage data file by early January rather than early 
February. As with the current preliminary file, the January file would 
include desk reviewed wage data that intermediaries submitted to HCFA 
by November of the previous year and any timely revisions HCFA received 
from intermediaries prior to release of the January file. Hospitals 
would be allowed until early February to submit requests for wage data 
revisions to their intermediaries. Second, intermediaries would be 
allowed approximately 8 weeks from the hospitals' deadline for 
submitting revision requests (that is, until early March) to review and 
transmit revised wage data to HCFA.
    We believe this proposed revised schedule will improve the quality 
of the wage index by allowing intermediaries more time to sufficiently 
review wage data revisions before the data are submitted to HCFA. 
Further, we believe the proposed revised process will encourage 
hospitals to submit revisions earlier, so the proposed wage index, from 
which hospitals base geographic reclassification decisions, is more 
accurate.

IV. Other Decisions and Proposed Changes to the Prospective Payment 
System for Inpatient Operating Costs and Graduate Medical Education 
Costs

A. Sole Community Hospitals (SCHs) (Secs. 412.63, 412.71, 412.72, 
412.73, 412.75, 412.77, and 412.92)

    For the benefit of the reader, in this proposed rule, we are 
discussing and seeking to clarify many of the rules and policies 
governing SCHs because of the legislative changes that have occurred in 
recent years. It has been several years since the SCH criteria have 
been published in one location. Rather than continue to refer to 
various Federal Register documents and sections of the Code of Federal 
Regulations, we are publishing a detailed discussion of these policies, 
proposing to make further changes to incorporate the provisions of 
sections 213, 302, 303, 304, and 311 of Public Law 106-554, and 
proposing to clarify other related policies.
    Under the hospital inpatient prospective payment system, special 
payment protections are provided to an SCH. Section 1886(d)(5)(D)(iii) 
of the Act defines an SCH as a hospital that, by reason of factors such 
as isolated location, weather conditions, travel conditions, absence of 
other like hospitals (as determined by the Secretary), or historical 
designation by the Secretary as an Essential Access Community Hospital 
(EACH), is the sole source of inpatient hospital services reasonably 
available to Medicare beneficiaries. The regulations that set forth the 
criteria that a hospital must meet to be classified as an SCH are at 
Sec. 412.92. To be classified as an SCH, a hospital must either have 
been designated as an SCH prior to the beginning of the prospective 
payment system on October 1, 1983, and must be located more than 35 
miles from other like hospitals, or the hospital must be located in a 
rural area and meet one of the following requirements:
     It is located more than 35 miles from other like 
hospitals.
     It is located between 25 and 35 miles from other like 
hospitals, and it--
--Serves at least 75 percent of all inpatients, or 75 percent of 
Medicare beneficiary inpatients, within a 35-mile radius or, if larger, 
within its service area; or
--Has fewer than 50 beds and would qualify on the basis of serving 75 
percent of its area's inpatients except that some patients seek 
specialized care unavailable at the hospital.

     It is located between 15 and 25 miles from other like 
hospitals, and because of local topography or extreme weather 
conditions, the other like hospitals are inaccessible for at least 30 
days in each of 2 out of 3 years.
     The travel time between the hospital and the nearest like 
hospital is at least 45 minutes because of distance, posted speed 
limits, and predictable weather conditions.
     Effective with hospital cost reporting periods beginning 
on or after April 1, 1990, section 1886(d)(5)(D)(i) of the Act, as 
amended by section 6003(e) of Public Law 101-239, provides that SCHs 
are paid based on whichever of the following rates yields the greatest 
aggregate payment:
     The Federal rate applicable to the hospital.
     The updated hospital-specific rate based on FY 1982 costs 
per discharge.
     The updated hospital-specific rate based on FY 1987 costs 
per discharge.
    Effective with hospital cost reporting periods beginning on or 
after October 1, 2000, section 1886(b)(3)(I)(i) of the Act, as added by 
section 405 of Public Law 106-113 and amended by section 213 of Public 
Law 106-554, provides for other options, in addition to the three 
bulleted options in the above paragraph, for determining which rate 
would yield the greatest aggregate payment. For discharges for FY 2001 
through FY 2003, these additional optional rates are--
     A phase-in blended rate of the updated hospital-specific 
rate based on FY 1982 costs per discharge and an FY 1996 hospital-
specific rate; or
     A phase-in blended rate of the updated hospital-specific 
rate based on FY 1987 costs per discharge and an FY 1996 hospital-
specific rate.
    For discharges beginning in FY 2004, the additional optional rate 
would be 100 percent of the FY 1996 hospital-specific rate.
    For each cost reporting period, the fiscal intermediary determines 
which of the payment options will yield the highest rate of payment. 
Payments are automatically made at the highest rate using the best data 
available at the time the fiscal intermediary makes the determination. 
However, it may not be possible for the fiscal intermediary to 
determine in advance precisely which of the rates will yield the 
highest payment by year's end. In many instances, it is not possible to 
forecast the update factor for the Federal rates, outlier payments, the 
amount of the DSH adjustment, or the IME adjustment, all of which are 
applicable only to payments based on the Federal rate. The fiscal 
intermediary makes a final adjustment at the close of the cost 
reporting period to determine precisely which of the payment rates 
would yield the highest payment to the hospital.
    If a hospital disagrees with the fiscal intermediary's 
determination regarding the final amount of program payment to which it 
is entitled, it has the right to appeal the fiscal intermediary's 
decision in accordance with the procedures set forth in Subpart R of 
Part 405, which concern provider payment determinations and appeals.
    In calculating a hospital-specific rate for an SCH based on its FY 
1996 cost reporting period, we will, to the extent possible, use the 
same methodology that we used to calculate the hospital-specific rate 
based on either the FY 1982 or FY 1987 cost reporting period. That

[[Page 22684]]

methodology is set forth in Secs. 412.71, 412.72, 412.73, 412.75 and 
412.77.
     If a hospital has a cost reporting period ending in FY 
1982, it will be paid a hospital-specific rate based on its FY 1982 
costs; or a hospital-specific rate based on its FY 1987 costs; or a 
hospital-specific rate based on its FY 1996 costs (which, until FY 
2004, would be a blend of the greater of the FY 1982 or FY 1987 costs 
and the FY 1996 costs); or it will be paid based on the Federal rate.
     If a hospital has no cost reporting period ending in FY 
1982, it will be paid a hospital-specific rate based on its FY 1987 
costs; or a hospital-specific rate based on its FY 1996 costs (which, 
until FY 2004, would be a blend of its FY 1987 costs and FY 1996 
costs); or it will be paid based on the Federal rate.
     If a hospital has no cost reporting period ending in 
either FY 1982 or FY 1987, it will be paid based on its FY 1996 costs; 
or it will be paid based on the Federal rate.
     If a hospital has no cost reporting period ending in FY 
1982, FY 1987, or FY 1996, it cannot be paid based on a hospital-
specific rate; it will be paid based on the Federal rate.
     If a hospital was operating during any or all of FY 1982, 
FY 1987, or FY 1996, but, for some reason, the cost report records are 
no longer available, the hospital will be treated as if it had no cost 
report for the applicable period. The hospital will not be allowed to 
substitute any other base period for the FY 1982, FY 1987, or FY 1996 
base period.
    For each SCH, the fiscal intermediary will calculate a hospital-
specific rate based on the hospital's FY 1982, FY 1987, or FY 1996 cost 
report as follows:
     Determine the hospital's total allowable Medicare 
inpatient operating cost, as stated on the cost report.
     Divide the total Medicare operating cost by the number of 
Medicare discharges (without adjusting for transfers) in the cost 
reporting period to determine the base period cost per case.
     In order to take into consideration the hospital's 
individual case-mix, the base year cost per case is divided by the 
hospital's case-mix index applicable to the cost reporting period. This 
step is necessary to adjust the hospital's base period cost for case 
mix. This is done to remove the effects of case mix from the base 
period costs per case. Payments using these base period costs are then 
adjusted to reflect the actual case mix during the payment year. A 
hospital's case mix is computed based on its Medicare patient 
discharges subject to DRG-based payment.
    The fiscal intermediary will inform each SCH of its hospital-
specific rate based on its applicable cost reporting period within 180 
days after the start of its cost reporting period.
    An SCH is also eligible for a payment adjustment if, for reasons 
beyond its control, it experiences a decline in volume of greater than 
5 percent compared to its preceding cost reporting period. This 
adjustment is also available to hospitals that could qualify as SCHs 
but choose not to be paid as SCHs; that is, hospitals that qualify and 
successfully apply to be designated as SCHs but continue to receive 
payments based on the Federal rate. In addition, section 6003(c)(1) of 
Public Law 101-239 deleted the sunset date on the 5-percent volume 
decline adjustment, thus allowing SCHs to receive the adjustment 
indefinitely. The sunset provision was included under section 
1886(d)(5)(C)(ii) of the Act. (Section 6003(c)(1) of Public Law 101-239 
amended that provision and redesignated it as section 1886(d)(5)(D) of 
the Act.)
    In the September 1, 1983, issue of the Federal Register (48 FR 
39781), we stated that any hospital designated as an SCH would retain 
that status until it experienced a change in circumstances. Section 
6003(e)(3) of Public Law 101-239 specifically stated that any hospital 
classified as an SCH as of the date of enactment of Public Law 101-239 
(December 19, 1989), will retain its SCH status even if the hospital 
did not meet the criteria established under section 6003(e)(1) of that 
law. These hospitals are the ``grandfathered'' SCH hospitals. 
Therefore, we have continued to allow hospitals designated as SCHs 
prior to December 19, 1989, to be ``grandfathered'' under current 
criteria.
    In the June 4, 1991, Federal Register, we stated that a hospital's 
special status as an SCH would not be retained in light of the 
hospital's geographic reclassification for purposes of the standardized 
amount. In the event the hospital's reclassification ceases, it must 
reapply for special status and must meet all of the applicable 
qualifying criteria in effect at the time it seeks requalification (56 
FR 25482). However, in the event a ``grandfathered'' SCH was 
successfully reclassified, it would be reinstated as an SCH if its 
reclassification ceased.
    Section 401(a) of Public Law 106-113 established that any 
subsection (d) hospital (section 1886(d) of the Act) located in an 
urban area may be redesignated as being located in a rural area if the 
hospital meets one of several criteria established by the legislation. 
One of these criteria is that the hospital could qualify as an SCH if 
the hospital were located in a rural area. Under this provision, an 
urban hospital that may have been ``grandfathered'' as an SCH could now 
qualify and receive payment as an SCH if it met the criteria of a rural 
SCH. Given this extension of SCH eligibility, we no longer believe it 
is necessary to extend special protection to ``grandfathered'' SCHs 
that successfully apply for geographic reclassification through the 
MGCRB for the standardized amount after their MGCRB reclassification 
ends. This circumstance falls under the provisions of 
Secs. 412.92(b)(3) and (b)(5), which state that an approved 
classification as an SCH remains in effect without need for reapproval 
unless there is a change in the circumstances under which the 
classification was approved. We believe that a successful 
reclassification by the MGCRB fits the definition of a change in 
circumstances.
    Because some hospitals may not have understood the effect 
reclassification would have on their special status, under existing 
Sec. 412.273(a) we are permitting affected hospitals the option to 
withdraw their applications for reclassification for FY 2002, even if 
the MGCRB has issued a decision, by submitting a withdrawal request to 
the MGCRB within 45 days of publication of this proposed rule. Finally, 
just as a competing hospital that closes leaves an opportunity for an 
existing hospital to qualify as an SCH, a new hospital that opens in an 
area with an existing hospital designated as an SCH endangers the SCH 
status of the existing hospital.
    As of October 1, 1997, no designations of hospitals as EACHs can be 
made. The EACHs designated by HCFA before October 1, 1997, will 
continue to be paid as SCHs for as long as they comply with the terms, 
conditions, and limitations under which they were designated as EACHs.
    Under Sec. 412.92(b)(2), we define the effective dates for several 
situations in which a hospital gains or gives up SCH status. First, SCH 
status and the associated payment adjustment is effective 30 days after 
HCFA's written notification to the SCH. Thus, 30 days after the 
issuance of HCFA's notice of approval, the hospital is considered to be 
an SCH and the payment adjustment is applied to discharges occurring on 
or after that date.
    Second, Sec. 412.92(b)(4)(ii) defines the effective date when a 
hospital chooses to give up its SCH status. Our policy has always been 
that an SCH can elect to give up its SCH status at any time by 
submitting a written request to the appropriate HCFA regional office

[[Page 22685]]

through its fiscal intermediary. The change to fully national rates 
becomes effective no later than 30 days after the hospital submits its 
request. We believe that the ``no later than 30 days'' policy for the 
effective date for cancelling SCH status is in keeping with the 
prospective nature of the prospective payment system. In addition, the 
30-day timeframe to give up SCH status provides the fiscal 
intermediaries with enough time to alter their automated payment 
systems prospectively, thus avoiding expensive and time-consuming 
reprocessing of claims. The variable timeframe of ``no later than 30 
days from the date of the hospital's request'' also permits the 
regional office, the fiscal intermediary, and the hospital to select a 
mutually agreeable date, for example, at the end of a month, to 
facilitate the change in SCH status. We expect that hospitals will 
anticipate when they wish to give up SCH status and to submit their 
requests in sufficient time to permit the 30-day period for making the 
change.
    In addition, Sec. 412.92(b)(2)(ii) defines the effective date of 
SCH status in the situation where a final and nonappealable 
administrative or judicial decision reverses HCFA's denial of SCH 
status to a hospital. In this situation, if the hospital's application 
was submitted on or after October 1, 1983, the effective date will be 
30 days after the date of HCFA's original written notification of 
denial.
    Under Sec. 412.92(b)(2)(iii), we define retroactive approval of SCH 
status. If a hospital is granted retroactive approval of SCH status by 
a final and nonappealable court order or an administrative decision 
under subpart R of Part 405 of the regulations, and it wishes its SCH 
status terminated prior to the current date (that is, it wishes to be 
paid as an SCH for a time-limited period, all of which is in the past), 
it must submit written notice to the HCFA regional office through its 
fiscal intermediary within 90 days of the court order or the 
administrative decision. This written notice must clearly state that, 
although SCH status was granted retroactively by the court order or by 
the administrative decision, the hospital wants this status terminated 
as of a specific date. If written notice is not received within 90 days 
of the court order or the administrative decision, SCH status will 
continue. Written requests to terminate SCH status that are received 
subsequent to the 90-day period will be effective no later than 30 days 
after the request is submitted, as discussed above.
    Under Sec. 412.92(c)(1), we define mileage. We believe that mileage 
should continue to be measured by the shortest route over improved 
roads maintained by any local, State, or Federal Government entity for 
public use. We consider improved roads to include the paved surface up 
to the front entrance of the hospital because this portion of the 
distance is utilized by the public to access the hospital. This 
definition provides consistency with the interpretation of the MGCRB 
when considering hospital reclassification applications. The MGCRB 
measures the distance between the hospital and the county line of the 
area to which it seeks reclassification beginning with the paved area 
outside the front entrance of the hospital. This provides a consistent, 
national definition that is easily recognizable for each hospital. 
Finally, rounding of mileage is not permissible. this is also 
consistent with the MGCRB definition of mileage (56 FR 25483). We are 
proposing to revise the definition of ``miles'' under Sec. 412.92(c)(1) 
to state that an improved road includes the paved surface up to the 
front entrance of the hospital.
    Under Sec. 412.92(c)(2), we define ``like'' hospital. We consider 
like hospitals to be those hospitals furnishing short-term acute care. 
That is, a hospital may not qualify for an SCH classification on the 
grounds that neighboring hospitals offer specialty services, thereby 
seeking to exclude close-by competitors as like hospitals, in order to 
meet the mileage criteria by measuring to a like hospital that is 
located further away. For example, we believe that competing hospitals 
within a given area may each have their own specialty services, while 
all the facilities continue to be considered short-term acute care 
hospitals. We note that under Sec. 412.92(a)(1)(ii), a hospital with 
fewer than 50 beds may qualify for SCH status under a special provision 
if patients that it would normally serve are seeking care elsewhere due 
to the unavailability of specialty services. This means that, if a 
hospital can prove that the patients from its service area are seeking 
specialty services elsewhere (such as, among others, heart surgery, 
transplants, and burn care), rather than routine care, and, because of 
that fact, that it otherwise would have met the criteria of section 
Sec. 412.92(a)(1)(i), it can qualify as an SCH.
    We note that Sec. 412.92(b)(1)(iii)(A) retains an outdated 
reference to ``hospitals located within a 50 mile radius of the 
hospital.'' With the issuance of the September 1, 1989 Federal Register 
(54 FR 36481, 36482), the 50 mile radius was determined to be 
unreasonable and all references should have been changed to 35 miles in 
accordance with Sec. 412.92(a)(1)(i). We are proposing to revise the 
reference to ``a 50 mile radius'' in Sec. 412.92(b)(1)(iii)(A) to read 
``a 35 mile radius''.
    We note that the travel time and weather conditions criteria set 
forth in Sec. 412.92(a)(3) were discussed in detail in the September 4, 
1990 Federal Register (55 FR 36050 through 36055 and 36162 through 
36163).
    Under Sec. 412.92(a)(1)(i) and (b)(1)(ii), we define the market 
area analysis criteria used to determine SCH status. There are several 
points concerning these requests for SCH status that we would like to 
clarify in this proposed rule. First, a hospital seeking an SCH 
designation based on these criteria must make its initial request to 
the fiscal intermediary with all the appropriate documents as will be 
discussed below (Sec. 412.92(b)(1)(i)). The fiscal intermediary will 
make a recommendation on the request, based on receipt of all the 
appropriate documentation and its own investigation and analysis, and 
that recommendation will be forwarded to the HCFA regional office for 
another level of review and final approval or disapproval. The fiscal 
intermediary would forward its recommendation to the HCFA regional 
office located in the hospital's area as opposed to the fiscal 
intermediary's area, if there is a difference in these areas. As 
discussed above, an approval of the request for SCH status will be 
effective 30 days after HCFA issues the approval letter. If a 
determination on the request requires the use of data that are 
available at HCFA central office only, upon receipt of the fiscal 
intermediary's recommendation, the HCFA regional office will forward 
the request and the fiscal intermediary's recommendation to the 
appropriate contact at HCFA central office where the determination will 
be made.
    Second, a hospital must provide patient origin data (the number of 
patients from each zip code from which the hospital draws inpatients) 
for all inpatient discharges to document the boundaries of its service 
area (Sec. 412.92(b)(1)(ii)(A)). Or, the hospital can request that HCFA 
develop patient origin data to define its service area based on the 
number of patients from each zip code from which the hospital draws 
Medicare Part A inpatients (Sec. 412.92(b)(1)(iii)). Then, the lowest 
number of zip codes in descending percentage order of Medicare 
inpatients that meets the 75-percent threshold will be used to 
represent the hospital's service area. We note that hospitals cannot 
substitute zip codes elsewhere

[[Page 22686]]

on the list in order to manipulate the service area. See (Howard Young 
Medical Center, Inc. v. Shalala, 207 F.3d 437 (7th Cir. 2000).)
    Third, the hospital must provide patient origin data from all other 
hospitals located within a 35-mile radius of it or, if larger, within 
its service area, to document that no more than 25 percent of either 
all of the population or the Medicare beneficiaries residing in the 
hospital's service area and hospitalized for inpatient care were 
admitted to other like hospitals for care (Sec. 412.92(b)(1)(ii)(B)). 
Again, HCFA central office can develop patient origin data for other 
hospitals within the requesting hospital's service area if the hospital 
is requesting SCH status based on an examination of Medicare Part A 
inpatient utilization. In either case, the requesting hospital is 
required to submit a comprehensive list of hospitals located within a 
35-mile radius or, if larger, within its service area. This list will 
be checked by both the fiscal intermediary and HCFA. Again, a 
requesting hospital cannot argue that a competing hospital should be 
excluded from the service area based on the existence of specialty 
services at that hospital if both hospitals are short-term acute care 
facilities. Distances between all reported hospitals will be checked by 
both the fiscal intermediary and HCFA, through electronic geographic 
mapping services (such as Yahoo or Mapquest) or by physically driving 
the distance involved.
    In addition, data will be analyzed based on the year for which the 
hospital requests SCH status. Subsequent hospital mergers or 
terminations will not be taken into consideration in processing the 
request. For example, if a hospital requests SCH status using data for 
FY 1999, and that data show that there is a competing hospital in 
existence that subsequently closed its doors in FY 2000, the data will 
be analyzed with the terminated hospital in existence, unless the 
hospital seeking SCH status applies using later data, such as FY 2001. 
This principle is consistent with how we analyze wage index data. If a 
terminated hospital has a viable cost report for the year of wage data 
that is being analyzed to produce the wage index, its data are included 
as part of the computation.

B. Rural Referral Centers (Sec. 412.96)

    Under the authority of section 1886(d)(5)(C)(i) of the Act, the 
regulations at Sec. 412.96 set forth the criteria a hospital must meet 
in order to receive special treatment under the prospective payment 
system as a rural referral center. For discharges occurring before 
October 1, 1994, rural referral centers received the benefit of payment 
based on the other urban amount rather than the rural standardized 
amount. Although the other urban and rural standardized amounts were 
the same for discharges beginning with that date, rural referral 
centers would continue to receive special treatment under both the 
disproportionate share hospital (DSH) payment adjustment and the 
criteria for geographic reclassification.
    Section 401 of Public Law 106-113 amended section 1886(d)(8) of the 
Act by adding subparagraph (E), which creates a mechanism, separate and 
apart from the MGCRB, permitting an urban hospital to apply to the 
Secretary to be treated as being located in the rural area of the State 
in which the hospital is located. The statute directs the Secretary to 
treat a qualifying hospital as being located in the rural area for 
purposes of provisions under section 1886(d) of the Act. Congress 
clearly intended hospitals that become rural under section 
1886(d)(8)(E) of the Act to receive some benefit as a result. In 
addition, one of the criteria under section 1886(d)(8)(E) of the Act is 
that the hospital would qualify as an SCH or a rural referral center if 
it were located in a rural area. An SCH would be eligible to be paid on 
the basis of the higher of its hospital-specific rate or the Federal 
rate. On the other hand, the only benefit under section 1886(d) of the 
Act for an urban hospital to become a rural referral center would be 
waiver of the proximity requirements that are otherwise applicable 
under the MGCRB process, as set forth in Sec. 412.230(a)(3)(i).
    When we implemented section 401 of Public Law 106-113 in the August 
1, 2000 final rule (65 FR 47089), we stated that we believed Congress 
contemplated that hospitals might seek to be reclassified as rural 
under section 1886(d)(8)(E) of the Act in order to become rural 
referral centers so that the hospitals would be exempt from the MGCRB 
proximity requirement and could be reclassified by the MGCRB to another 
urban area. Therefore, in that final rule we sought a policy approach 
that would appropriately address our concern that these urban to rural 
redesignations not be utilized inappropriately, and that would benefit 
hospitals seeking to reclassify under the MGCRB process by achieving 
rural referral center status. (We became aware of several specific 
hospitals that were rural referral centers for FY 1991, but 
subsequently lost their status when the county in which they were 
located became urban, and had expressed their wish to be redesignated 
as a rural referral center in order to be eligible to reclassify.) 
Accordingly, in light of section 1886(d)(8)(E) of the Act and the 
language in the accompanying Conference Report, effective as of October 
1, 2000, hospitals located in what is now an urban area, if they were 
ever a rural referral center, were reinstated to rural referral center 
status.
    In addition, as discussed in 62 FR 45999 and 63 FR 26317, under 
section 4202 of Public Law 105-33, a hospital that was classified as a 
rural referral center for FY 1991 is to be classified as a rural 
referral center for FY 1998 and later years so long as that hospital 
continued to be located in a rural area and did not voluntarily 
terminate its rural referral center status. Otherwise, a hospital 
seeking rural referral center status must satisfy applicable criteria. 
One of the criteria under which a hospital may qualify as a rural 
referral center is to have 275 or more beds available for use. A rural 
hospital that does not meet the bed size requirement can qualify as a 
rural referral center if the hospital meets two mandatory prerequisites 
(specifying a minimum case-mix index and a minimum number of 
discharges) and at least one of three optional criteria (relating to 
specialty composition of medical staff, source of inpatients, or 
referral volume). With respect to the two mandatory prerequisites, a 
hospital may be classified as a rural referral center if its--
     Case-mix index is at least equal to the lower of the 
median case-mix index for urban hospitals in its census region, 
excluding hospitals with approved teaching programs, or the median 
case-mix index for all urban hospitals nationally; and
     Number of discharges is at least 5,000 per year, or if 
fewer, the median number of discharges for urban hospitals in the 
census region in which the hospital is located. (The number of 
discharges criterion for an osteopathic hospital is at least 3,000 
discharges per year.)
1. Case-Mix Index
    Section 412.96(c)(1) provides that HCFA will establish updated 
national and regional case-mix index values in each year's annual 
notice of prospective payment rates for purposes of determining rural 
referral center status. The methodology we use to determine the 
proposed national and regional case-mix index values is set forth in 
regulations at Sec. 412.96(c)(1)(ii). The proposed national case-mix 
index value includes all urban hospitals nationwide, and the proposed 
regional values are the median values of urban hospitals within each 
census region, excluding those

[[Page 22687]]

with approved teaching programs (that is, those hospitals receiving 
indirect medical education payments as provided in Sec. 412.105). These 
values are based on discharges occurring during FY 1999 (October 1, 
1998 through September 30, 1999) and include bills posted to HCFA's 
records through December 1999.
    We are proposing that, in addition to meeting other criteria, 
hospitals with fewer than 275 beds, if they are to qualify for initial 
rural referral center status for cost reporting periods beginning on or 
after October 1, 2001, must have a case-mix index value for FY 2000 
that is at least--
     1.3286; or
     The median case-mix index value for urban hospitals 
(excluding hospitals with approved teaching programs as identified in 
Sec. 412.105) calculated by HCFA for the census region in which the 
hospital is located.
    The median case-mix values by region are set forth in the following 
table:

------------------------------------------------------------------------
                                                          Case-mix index
                         Region                                value
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT).................          1.2377
2. Middle Atlantic (PA, NJ, NY).........................          1.2305
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV)..          1.3055
4. East North Central (IL, IN, MI, OH, WI)..............          1.2613
5. East South Central (AL, KY, MS, TN)..................          1.2537
6. West North Central (IA, KS, MN, MO, NE, ND, SD)......          1.1653
7. West South Central (AR, LA, OK, TX)..................          1.2484
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)............          1.3286
9. Pacific (AK, CA, HI, OR, WA).........................          1.2693
------------------------------------------------------------------------

    The preceding numbers will be revised in the final rule to the 
extent required to reflect the updated FY 2000 MedPAR file, which will 
contain data from additional bills received through March 31, 2001.
    Hospitals seeking to qualify as rural referral centers or those 
wishing to know how their case-mix index value compares to the criteria 
should obtain hospital-specific case-mix values from their fiscal 
intermediaries. Data are available on the Provider Statistical and 
Reimbursement (PS&R) System. In keeping with our policy on discharges, 
these case-mix index values are computed based on all Medicare patient 
discharges subject to DRG-based payment.
2. Discharges
    Section 412.96(c)(2)(i) provides that HCFA will set forth the 
national and regional numbers of discharges in each year's annual 
notice of prospective payment rates for purposes of determining rural 
referral center status. As specified in section 1886(d)(5)(C)(ii) of 
the Act, the national standard is set at 5,000 discharges. We are 
proposing to update the regional standards based on discharges for 
urban hospitals' cost reporting periods that began during FY 1999 (that 
is, October 1, 1998 through September 30, 1999). That is the latest 
year for which we have complete discharge data available.
    Therefore, we are proposing that, in addition to meeting other 
criteria, a hospital, if it is to qualify for initial rural referral 
center status for cost reporting periods beginning on or after October 
1, 2001, must have as the number of discharges for its cost reporting 
period that began during FY 1999 a figure that is at least--
     5,000; or
     The median number of discharges for urban hospitals in the 
census region in which the hospital is located, as indicated in the 
following table:

------------------------------------------------------------------------
                                                             Number of
                         Region                             discharges
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT).................            7083
2. Middle Atlantic (PA, NJ, NY).........................            8371
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV)..            8202
4. East North Central (IL, IN, MI, OH, WI)..............            7430
5. East South Central (AL, KY, MS, TN)..................            6505
6. West North Central (IA, KS, MN, MO, NE, ND, SD)......            4708
7. West South Central (AR, LA, OK, TX)..................            4911
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)............            8287
9. Pacific (AK, CA, HI, OR, WA).........................            7001
------------------------------------------------------------------------

    These numbers will be revised in the final rule based on the latest 
FY 1999 cost report data.
    We reiterate that an osteopathic hospital, if it is to qualify for 
rural referral center status for cost reporting periods beginning on or 
after October 1, 2001, must have at least 3,000 discharges for its cost 
reporting period that began during FY 2000.

C. Indirect Medical Education (IME) Adjustment (Sec. 412.105)

1. IME Adjustment Factor Formula Multiplier (Section 302 of Public Law 
106-554 and Sec. 412.105(d)(3))
    Section 1886(d)(5)(B) of the Act provides that prospective payment 
hospitals that have residents in an approved graduate medical education 
(GME) program receive an additional payment to reflect the higher 
indirect operating costs associated with GME. The regulations regarding 
the calculation of this additional payment, known as the indirect 
medical education (IME) adjustment, are located at Sec. 412.105. The 
additional payment is based in part on the applicable IME adjustment 
factor. The IME adjustment factor is calculated using a hospital's 
ratio of residents to beds, which is represented as r, and a 
multiplier, which is represented as c, in the following equation: c  x  
[(1 + r)\.405\ - 1]. The formula is traditionally described in terms of 
a certain percentage increase in

[[Page 22688]]

payment for every 10-percent increase in the resident-to-bed ratio.
    Section 302 of Public Law 106-554 amended section 1886(d)(5)(B) of 
the Act to modify the transition for the IME formula multiplier, or c, 
that was first established by Public Law 105-33 and revised by Public 
Law 106-113.
    Section 302(a) of Public Law 106-554 provides that, for discharges 
occurring during FY 2002, the formula multiplier is 1.6. For discharges 
occurring during FY 2003 and thereafter, the formula multiplier is 
1.35. (Section 302(b) of Public Law 106-554 provides for a special 
payment rule which states that, for discharges occurring on or after 
April 1, 2001 and before October 1, 2001, IME payments are to be made 
if ``c'' equalled 1.66 rather than 1.54. We are issuing a separate 
interim final rule with comment period (HCFA-1178-IFC) to include this 
change for payments in FY 2001.) The multiplier of 1.6 for FY 2002 
represents a 6.5-percent increase for every 10-percent increase in the 
resident-to-bed ratio. The multiplier for FY 2003 and thereafter (1.35) 
represents a 5.5-percent increase for every 10-percent increase in the 
resident-to-bed ratio.
    We are proposing to revise Sec. 412.105(d)(3)(vi) to reflect the 
change in the formula multiplier for FY 2002 to 1.6 as made by section 
302(a) of Public Law 106-554 for discharges occurring during FY 2002. 
We also are proposing to add Sec. 412.105(d)(3)(vii) to incorporate the 
formula multiplier of 1.35 for discharges occurring on or after October 
1, 2002.
2. Resident-to-Bed Ratio Cap (Sec. 412.105(a)(1))
    It has come to our attention that there is some misunderstanding 
about Sec. 412.105(a)(1) regarding the determination of the resident-
to-bed ratio that is used in calculating the IME adjustment. Section 
4621(b)(1) of Public Law 105-33 amended section 1886(d)(5)(B) of the 
Act by adding a new clause (vi) to provide that, effective for cost 
reporting periods beginning on or after October 1, 1997, the resident-
to-bed ratio may not exceed the ratio calculated during the prior cost 
reporting period (after accounting for the cap on the hospital's number 
of full-time equivalent (FTE) residents). We implemented this policy in 
the August 29, 1997 final rule (62 FR 46003) and the May 12, 1998 final 
rule (63 FR 26323) under regulations at Sec. 412.105(a)(1). Existing 
Sec. 412.105(a)(1) specifies that ``[e]xcept for the special 
circumstances for affiliated groups and new programs described in 
paragraphs (f)(1)(vi) and (f)(1)(vii) of this section, for a hospital's 
cost reporting periods beginning on or after October 1, 1997, this 
ratio may not exceed the ratio for the hospital's most recent prior 
cost reporting period.'' We are proposing to clarify Sec. 412.105(a)(1) 
to add a provision that this ratio may not exceed the ratio for the 
hospital's most recent prior cost reporting period after accounting for 
the cap on the number of FTE residents.
    In general, the resident-to-bed ratio from the prior cost reporting 
period, which is to be used as the cap on the resident-to-bed ratio for 
the current payment cost reporting period, should only include an FTE 
count that is subject to the FTE cap on the number of allopathic and 
osteopathic residents, but is not subject to the rolling average. (An 
explanation of rolling average appears in section IV.G.3. of this 
preamble.)
    The following illustrates the steps for determining the resident-
to-bed ratio for the current payment year cost reporting period and the 
cap on the resident-to-bed ratio:
    Current payment year cost reporting period resident-to-bed ratio:
    Step 1. Determine the hospital's number of FTE residents in the 
current payment year cost reporting period.
    Step 2. Compare the number of FTEs from step 1 to the hospital's 
FTE cap (Sec. 412.105(f)(1)(iv)). If the number of FTEs from step 1 
exceeds the FTE cap, replace it with the number of FTEs in the FTE cap.
    Step 3. Determine the 3-year rolling average of the FTE residents 
using the FTEs from the current payment year cost reporting period and 
the prior two cost reporting periods (subject to the FTE cap in each 
cost reporting period). (Include podiatry and dental residents, and 
exclude residents in new programs in accordance with 
Sec. 412.105(f)(1)(iv) and proposed revised (f)(1)(v). Residents in new 
programs are added to the quotient of the rolling average.)
    Step 4. Determine the hospital's number of beds (see 
Sec. 412.105(b)) in the current payment year cost reporting period.
    Step 5. Determine the ratio of the number of FTEs from step 3 to 
the number of beds from step 4. The lower of this resident-to-bed ratio 
or the resident-to-bed ratio cap (calculated below) from the 
immediately preceding cost reporting period is used to calculate the 
hospital's IME adjustment factor for the current payment year cost 
reporting period.
    Resident-to-bed ratio cap:
    Step 1. Determine the hospital's number of FTE residents in its 
cost reporting period that immediately precedes the current payment 
year cost reporting period.
    Step 2. Compare the number of FTEs from step 1 to the hospital's 
FTE cap. If the number of FTEs from step 1 exceeds the FTE cap, replace 
it with the number of FTEs in the FTE cap. (If there is an increase in 
the number of FTEs in the current payment year cost reporting period 
due to a new program or an affiliation agreement, these FTEs are added 
to FTEs in the preceding cost reporting period after comparison to the 
FTE cap.)
    Step 3. Determine the hospital's number of beds (Sec. 412.105(b)) 
in its cost reporting period that immediately precedes the current 
payment year cost reporting period.
    Step 4. Determine the ratio of the number of FTEs in step 2 to the 
number of beds in step 3. This ratio is the resident-to-bed ratio cap 
for the current payment year cost reporting period.
    Step 5. Compare the resident-to-bed ratio cap in step 4 to the 
resident-to-bed ratio in the current payment year cost reporting 
period. The lower of the resident-to-bed ratio from the current payment 
year cost reporting period or the resident-to-bed ratio cap from the 
immediately preceding cost reporting period is used to calculate the 
hospital's IME adjustment factor for the current payment year cost 
reporting period.
    We note that the resident-to-bed ratio cap is a cap on the 
resident-to-bed ratio calculated for all residents, including 
allopathic, osteopathic, dental, and podiatry residents (63 FR 26324, 
May 12, 1998). However, as described in existing Sec. 412.105(a)(1), 
the resident-to-bed ratio cap may be adjusted to reflect an increase in 
the current cost reporting period's resident-to-bed ratio due to 
residents in a new GME program or an affiliation agreement. While this 
exception does not apply if the resident-to-bed ratio increases because 
of an increase in the number of podiatry or dentistry residents or 
because of a change in the number of beds, the ratio could increase 
after a one-year delay. An increase in the current cost reporting 
period's ratio (while subject to the cap on the overall number of 
allopathic and osteopathic residents) thereby establishes a higher cap 
for the following cost reporting period.
    The following is an example of the application of the cap on the 
resident-to-bed ratio:
    Example--Part 1:
     Assume Hospital A has 50 FTEs in its cost reporting period 
ending September 30, 1996, thereby establishing an IME FTE resident cap 
of 50 FTEs.

[[Page 22689]]

     In its cost reporting period of October 1, 1996 to 
September 30, 1997 (the prior year), it has 50 FTEs and 200 beds, so 
that its resident-to-bed ratio for this period is 50/200 = .25.
     In the (current year) cost reporting period of October 1, 
1997 to September 30, 1998 (the first cost reporting period in which 
the FTE resident cap, the resident-to-bed ratio cap, and the rolling 
average apply), Hospital A has 50 FTEs and 200 beds.
     Hospital A s FTEs do not exceed its FTE cap, so its 
current number of FTEs (50) is used to calculate the 2-year rolling 
average: (50 + 50)/2 = 50.
     The result of the rolling average is used as the numerator 
of the resident-to-bed ratio. Thus, the resident-to-bed ratio is 50/200 
= .25.
     .25 is compared to the resident-to-bed ratio from the 
prior period of October 1, 1996 to September 30, 1997. Because the FTE 
resident cap and the rolling average were not yet effective in the 
period of October 1, 1996 to September 30, 1997, that period's 
resident-to-bed ratio does not have to be recalculated to account for 
the FTE resident cap. Accordingly, the resident-to-bed ratio cap for 
October 1, 1997 to September 30, 1998 is .25.
     Because the resident-to-bed ratio does not exceed the 
prior year ratio, Hospital A would use the resident-to-bed ratio of .25 
to determine the IME adjustment in its cost reporting period of October 
1, 1997 to September 30, 1998.
    Example--Part 2:
     In the (current year) cost reporting period of October 1, 
1998 to September 30, 1999, Hospital A adds 1 podiatric and 1 dental 
resident, so that it has a total of 52 FTEs and 200 beds. Since the FTE 
resident cap only includes allopathic and osteopathic residents, 
Hospital A has not exceeded its FTE resident cap with the addition of a 
podiatric and a dental resident.
     Accordingly, the (now) 3-year rolling average would be (52 
+ 50 + 50)/3 = 50.67.
     50.67 is used in the numerator of the current payment 
year's resident-to-bed ratio, so that the resident-to-bed ratio is 
50.67/200 = .253.
     .253 is compared to the resident-to-bed ratio from the 
prior year's cost reporting period of October 1, 1997 to September 30, 
1998 that is recalculated to account for the FTE resident cap. Because 
Hospital A did not exceed its FTE resident cap of 50 FTEs in this 
period of October 1, 1997 to September 30, 1998, the recalculated 
resident-to-bed ratio would be 50/200 = .25.
     Compare the current year resident-to-bed ratio (.253) to 
the resident-to-bed ratio cap (.25); .253 does exceed .25.
     Therefore, the resident-to-bed ratio in the period of 
October 1, 1998 to September 30, 1999 is capped at .25, which is to be 
used in calculating Hospital A's IME adjustment for October 1, 1998 to 
September 30, 1999.
    Example--Part 3:
     In the cost reporting period of October 1, 1999 to 
September 30, 2000, Hospital A adds 2 internal medicine residents so 
that it has a total of 54 FTEs and 200 beds. While podiatric and dental 
residents are not included in the FTE resident cap, internal medicine 
residents are included. Hospital A has exceeded its IME FTE resident 
cap of 50 by 2 FTEs. Thus, 2 FTEs are excluded from the FTE count.
     Accordingly, the rolling average would be (52 + 52 + 50)/3 
= 51.33.
     51.33 is used in the numerator of the resident-to-bed 
ratio, so that the resident-to-bed ratio is 51.33/200 = .257.
     .257 is compared to the resident-to-bed ratio from October 
1, 1998 to September 30, 1999 that is recalculated to only account for 
the FTE resident cap. The recalculated resident-to-bed ratio would be 
50 allopathic or osteopathic FTEs plus 1 podiatric and 1 dental 
resident, which is 52/200 = .26.
     .26 is the resident-to-bed ratio cap for October 1, 1999 
to September 30, 2000. .257 does not exceed .26.
     Therefore, the resident-to-bed ratio in the period of 
October 1, 1998 to September 30, 1999 is .257, which is to be used in 
calculating this period s IME adjustment.
    If a hospital starts a new GME program, the adjustment to the 
resident-to-bed ratio cap applies for the period of years equal to the 
minimum accredited length for that type of program. (For example, for a 
new internal medicine program, the period of years equals 3; for a new 
surgery program, the period of years equals 5.) Within these program 
years, the number of new FTE residents in the current cost reporting 
period is added to the FTE resident count used in the numerator of the 
resident-to-bed ratio from the previous cost reporting period. The 
lower of the resident-to-bed ratio from the current cost reporting 
period or the adjusted resident-to-bed ratio from the preceding cost 
reporting period is used to calculate the hospital's IME adjustment for 
the current cost reporting period. If a hospital continues to expand 
its program after the period of years, the numerator of the resident-
to-bed ratio from the preceding cost reporting period would not be 
adjusted to reflect these additional residents. However, an increase in 
the ratio of the current cost reporting period would establish a higher 
cap for the following cost reporting period. We also are proposing to 
add a provision that the exception for new programs described in 
Sec. 412.105(f)(1)(vii) applies for the period of years equal to the 
minimum accredited length for that type of program.
    Similarly, if a hospital increases the number of FTE residents in 
the current cost reporting period because of an affiliation agreement, 
the number of additional FTEs is added to the FTE resident count used 
in the numerator of the resident-to-bed ratio from the previous cost 
reporting period. The lower of the resident-to-bed ratio from the 
current cost reporting period or the adjusted resident-to-bed ratio 
from the preceding cost reporting period is used to calculate the 
hospital's IME adjustment for the current cost reporting period.
3. Conforming Changes (Sec. 412.105(f)(1)(ii)(C) and (f)(1)(v))
    In the August 29, 1997 final rule with comment period (62 FR 
46003), the May 12, 1998 final rule (63 FR 26323), and the July 31, 
1998 final rule (63 FR 40986), to implement the provisions of Public 
Law 105-33, we set forth certain policies that affected payment for 
both direct and indirect GME. Some of these policies related to the FTE 
cap on allopathic and osteopathic residents, the rolling average, and 
payment for residents training in nonhospital settings. When we amended 
the regulations under Sec. 413.86 for direct GME, we inadvertently did 
not make certain conforming changes in Sec. 412.105 for IME. We are 
proposing to make the following conforming changes:
     To revise Sec. 412.105(f)(1)(ii)(C) to specify that, 
effective for discharges occurring on or after October 1, 1997, the 
time residents spend training in a nonhospital setting in patient care 
activities under an approved medical residency training program may be 
counted towards the determination of full-time equivalency if the 
criteria set forth at Sec. 413.86(f)(3) or Sec. 413.86(f)(4), as 
applicable, are met.
     To revise Sec. 412.105(f)(1)(v) to specify that residents 
in new residency programs are not included in the rolling average for a 
period of years equal to the minimum accredited length for the type of 
program.
    In addition, we are proposing to revise Sec. 412.105(f)(1)(ix) to 
specify, for IME purposes, a temporary adjustment to a hospital's FTE 
cap to reflect residents added because of another hospital's closure of 
its medical residency program (to conform to the

[[Page 22690]]

proposed change for GME discussed in section IV.G.5. of this preamble).

D. Payments to Disproportionate Share Hospitals (Sec. 412.106)

    Effective for discharges beginning on or after May 1, 1986, 
hospitals that serve a significantly disproportionate number of low-
income patients (as defined in section 1886(d)(5)(F) of the Act) 
receive additional payments through the DSH adjustment.
    Section 1886(d)(5)(F)(ix) of the Act, as amended by section 112 of 
Public Law 106-113, specifies a percentage reduction in the payments a 
hospital would otherwise receive under the disproportionate share 
formula. Prior to enactment of section 303 of Public Law 106-554, the 
reduction percentages were as follows: 3 percent for FY 2001, 4 percent 
for FY 2002, and 0 percent for FY 2003 and each subsequent fiscal year.
    Section 303 of Public Law 106-554 revised the amount of the percent 
reductions to 2 percent for discharges occurring in FY 2001, and to 3 
percent for discharges occurring in FY 2002. The reduction continues to 
be 0 percent for FY 2003 and each subsequent fiscal year. Section 303 
of Public Law 106-554 contains a special rule for FY 2001: For 
discharges occurring on or after October 1, 2000 and before April 1, 
2001, the reduction is to be 3 percent, and for discharges occurring on 
or after April 1, 2001 and before October 1, 2001, the reduction is to 
be 1 percent. Changes made by section 303 with respect to FY 2001 
discharges are being implemented in a separate interim final rule with 
comment period (HCFA-1178-IFC).
    We are proposing to revise Sec. 412.106(e) to reflect the change in 
the percentage for FY 2002 made by section 303 of Public Law 106-554. 
We also are proposing to make a technical change in the heading of 
paragraph (e).

E. Medicare Geographic Classification Review Board (Proposed New 
Sec. 412.235 and Existing Secs. 412.256, 412.273, 412.274(b), and 
412.276)

    With the creation of the Medicare Geographic Classification Review 
Board (MGCRB), beginning in FY 1991, under section 1886(d)(10) of the 
Act, hospitals could request reclassification from one geographic 
location to another for the purpose of using the other area's 
standardized amount for inpatient operating costs or the wage index 
value, or both (September 6, 1990 interim final rule with comment 
period (55 FR 36754), June 4, 1991 final rule with comment period (56 
FR 25458), and June 4, 1992 proposed rule (57 FR 23631)). Implementing 
regulations in Subpart L of Part 412 (Secs. 412.230 et seq.) set forth 
criteria and conditions for redesignations from rural to urban, rural 
to rural, or from an urban area to another urban area with special 
rules for SCHs and RRCs.
    Section 304 of Public Law 106-554 contained several provisions 
related to the wage index and reclassification decisions made by the 
MGCRB. In summary, section 304 first establishes that hospital 
reclassification decisions by the MGCRB for wage index purposes are 
effective for 3 years, beginning with reclassifications for FY 2001. 
Second, it provides that the MGCRB must use the 3 most recent years of 
average hourly wage data in evaluating a hospital's reclassification 
application for FY 2003 and subsequent years. Third, it provides that 
an appropriate statewide entity may apply to have all of the geographic 
areas in a State treated as a single geographic area for purposes of 
computing and applying the wage index, for reclassifications beginning 
in FY 2003. A discussion of how we are proposing to implement these 
three provisions follows. (Section III.F. of this preamble discusses 
the application of these proposed policy changes to the development of 
the proposed FY 2002 and later wage indexes based on hospital 
reclassification under the provisions of section 304 of Public Law 106-
554.)
1. Three-Year Reclassifications for Wage Index Purposes
    Section 304(a) of Public Law 106-554 amended section 1886(d)(10)(D) 
of the Act by adding clause (v), which provides that, if a hospital is 
approved for reclassification by the MGCRB for purposes of the wage 
index, the reclassification is effective for 3 years. The amendment 
made by section 304(a) is effective for reclassifications for FY 2001 
and subsequent years. In addition, the legislation specifies that the 
Secretary must establish a mechanism under which a hospital may elect 
to terminate such reclassification during the 3-year period.
    Consistent with new section 1886(d)(10)(D)(v) of the Act, we are 
proposing to revise Sec. 412.274(b) to provide under new paragraph 
(b)(2) that any hospital that is reclassified for a particular fiscal 
year for purposes of receiving the wage index value of another area 
would receive that reclassification for 3 years beginning with 
discharges occurring on the first day (October 1) of the second Federal 
fiscal year in which a hospital files a complete application. This 3-
year reclassification would remain in effect unless the hospital 
terminates the reclassification under proposed revised procedures that 
we are establishing under new proposed Sec. 412.273(b). The proposed 
provision would apply to hospitals that are reclassified for purposes 
of the wage index only, as well as those that are reclassified for both 
the wage index and the standardized amount. However, in the latter 
case, only the wage index reclassification would be extended for 2 
additional years beyond the 1 year provided for in the existing 
regulations (3 years total). Hospitals seeking reclassification for 
purposes of the standardized amount must continue to reapply to the 
MGCRB on an annual basis.
a. Special Rule for a Hospital That Was Reclassified for FY 2001 and FY 
2002 to Different Areas
    Because the 3-year effect of the amendment made by section 304(a) 
of Public Law 106-554 is applicable to reclassifications for FY 2001 
(which had already taken place prior to the date of enactment of 
section 304(a) (December 21, 2000), and because the application process 
for reclassifications for FY 2002 had already been completed by the 
date of enactment, we are establishing special procedures for hospitals 
that are reclassified for purposes of the wage index to one area for FY 
2001, and are reclassified for purposes of the wage index or the 
standardized amount to another area for FY 2002. We are deeming such a 
hospital to be reclassified to the area for which it applied for FY 
2002, unless the hospital elects to receive the wage index 
reclassification it was granted for FY 2001. Consistent with our 
procedures for withdrawing an application for reclassification 
(Sec. 412.273), we are allowing a hospital that wishes to receive the 
reclassification it was granted for FY 2001 to withdraw its FY 2002 
application by making a written request to the MGCRB within 45 days of 
the publication date of this proposed rule (that is, by June 18, 2001). 
Again, only the wage index reclassification is extended for 2 
additional years (3 years total). Hospitals seeking reclassification 
for purposes of the standardized amount must continue to reapply to the 
MGCRB on an annual basis.

    (We note that the new location and mailing address of the MGCRB and 
the Provider Reimbursement Review Board (PRRB) is: 2520 Lord Baltimore 
Drive, Suite L, Baltimore, MD 21244-2670. The MGCRB and PRRB will be 
functioning at this new location as of May 21, 2001. Also, please 
specify whether the mail is intended for the MGCRB or the PRRB.)

[[Page 22691]]

b. Overlapping Reclassifications Are Not Permitted
    Under the broad authority delegated to the Secretary by section 
1886(d)(10) of the Act, we are proposing that a hospital that is 
reclassified to an area for purposes of the wage index may not extend 
the 3-year effect of the reclassification under section 304(a) of 
Public Law 106-554 by subsequently applying for reclassification to the 
same area for purposes of the wage index for a fiscal year that would 
be within the 3-year period. For example, if a hospital is reclassified 
for purposes of the wage index to Area A for FY 2002, is approved to 
receive Area A's wage index for 3 years (FYs 2002, 2003, and 2004), and 
reapplies to be reclassified to Area A for FYs 2003, 2004, and 2005 (3 
years) for purposes of the wage index, the hospital would not be 
permitted to receive Area A's wage index for FY 2005 as a result of the 
reapplication. Instead, we are proposing that if the hospital wishes to 
extend the FY 2002 3-year reclassification for fiscal years beyond FY 
2004, it would have to apply for reclassification for FY 2005.
    We believe new section 1886(d)(10)(D)(v) of the Act replaces the 
current annual reclassification cycle with a 3-year reclassification 
cycle. We believe this policy was intended to provide consistency and 
predictability in hospital reclassification and wage index data, as 
well as to alleviate the year-to-year fluctuations in the ability of 
some hospitals to qualify for reclassification. We do not believe it 
was intended to be used to extend reclassifications for which hospitals 
otherwise would not be eligible (by reapplying during the second year 
of a 3-year reclassification because a hospital fears it may not be 
eligible for reclassification after its current 3-year reclassification 
expires).
c. Withdrawals of Applications and Terminations of Approved 
Reclassifications
(1) General
    Under Sec. 412.273(a), a hospital, or group of hospitals, may 
withdraw its application for reclassification at any time before the 
MGCRB issues its decision or, if after the MGCRB issues its decision, 
within 45 days of publication of our annual notice of proposed 
rulemaking concerning changes to the inpatient hospital prospective 
payment system and proposed payment rates for the fiscal year for which 
the application was filed. We are proposing that the withdrawal 
procedures and the applicable timeframes in the existing regulations 
would apply to hospitals that would receive 3-year reclassification for 
wage index purposes. For example, if a hospital applied for 
reclassification to Area A for purposes of the wage index for FY 2002, 
but wished or wishes to withdraw its application, it must have done so 
prior to the MGCRB issuing a decision on its application or, if the 
MGCRB issued such a decision, within 45 days of the publication date of 
this proposed rule. Such a withdrawal, if effective, means that the 
hospital would not be reclassified to Area A for purposes of the wage 
index for FY 2002 (and would not receive continued reclassification for 
FYs 2003 and 2004). In other words, a withdrawal, if accepted, prevents 
a reclassification from ever becoming effective.
    On the other hand, a reclassification decision that is terminated 
upon the request of the hospital has partial effect. Section 
1886(d)(10)(D)(v) of the Act, as added by section 304(a) of Public Law 
106-554, provides that a reclassification for purposes of the wage 
index is effective for 3 years ``except that the Secretary shall 
establish procedures under which a * * * hospital may elect to 
terminate such reclassification before the end of such period.'' 
Consistent with section 1886(d)(10)(D)(v) of the Act, we are proposing 
to allow a hospital to terminate its approved 3-year reclassification 
for 1 or 2 years of the 3-year effective period (proposed 
Sec. 412.273(b)). For example, a hospital that has been reclassified 
for purposes of the wage index for FY 2001 is also reclassified for FYs 
2002 and 2003 (3 years). Such a hospital could terminate its approved 
reclassification so that the reclassification is effective only for FY 
2001, or only for FYs 2001 and 2002. Consistent with the prospective 
nature of reclassifications, we would not permit a hospital to 
terminate its approved 3-year reclassification for part of a fiscal 
year. A termination would be effective for the next fiscal year. In 
order to terminate an approved 3-year reclassification, we would 
require the hospital to notify the MGCRB in writing within 45 days of 
the publication date of the annual proposed rule for changes to the 
inpatient hospital prospective payment system. A termination request, 
once accepted, is effective for the balance of the 3-year period (as 
discussed below under reapplying within original 3-year period, 
following a termination).
    We are establishing a special procedural rule for handling FY 2001 
reclassifications. As noted above, the amendments made by section 
304(a) of Public Law 106-554 are effective for reclassifications for 
FYs 2001 and beyond, and reclassification applications for FY 2001 had 
already been submitted prior to the date of enactment of section 
304(a). We are deeming those hospitals that were reclassified for FY 
2001 to be reclassified for FYs 2002 and 2003. Therefore, if a deemed 
hospital that was reclassified for purposes of the wage index for FY 
2001 does not wish to continue its reclassification for FY 2002 and FY 
2003, the hospital must notify the MGCRB in writing within 45 days 
after the publication of this proposed rule (that is, by June 18, 
2001).
(2) Reinstatement After a Withdrawal of Application or a Termination of 
an Approved Reclassification
    We are proposing that if a hospital elects to withdraw its 3-year 
reclassification application after the MGCRB has issued its decision, 
it may cancel its withdrawal in a subsequent fiscal year and request 
the MGCRB to reinstate its reclassification for the remaining fiscal 
years of the 3-year reclassification period. (This proposal is 
consistent with our proposal that 3-year reclassification periods may 
not overlap, as discussed in section IV.E.1.b. of this preamble.) 
Alternatively, a hospital may apply for reclassification to a different 
area (that is, an area different from the one to which it was 
originally reclassified), and if successful, the reclassification 
effect would be for 3 years.

    Example 1: Hospital A files an application and the MGCRB issues 
a decision to reclassify it to Area A for purposes of wage index for 
FY 2002 through FY 2004 (3 years). Within 45 days after the 
publication of this proposed rule, Hospital A withdraws its 
application. Within the time for applying for a FY 2003 
reclassification, Hospital A cancels its withdrawal for 
classification to Area A. Its reclassification to Area A is 
reinstated, but only for FYs 2003 and 2004.
    Example 2: Hospital B files an application for reclassification 
for wage index purposes for FY 2002 through FY 2004 and the MGCRB 
issues a decision for reclassification to Area B. Within 45 days 
after publication of this proposed rule, Hospital B withdraws its 
application. Hospital B does not cancel its withdrawal of the 
application. Hospital B timely applies and is reclassified to Area B 
for 3 years, beginning with FY 2003. In this case, the 
reclassification to Area B would be for FYs 2003 through 2005.
    Similarly, and for the same reasons, we are proposing that if a 
hospital elects to terminate its accepted 3-year reclassification, 
it may cancel that termination and have its original 
reclassification reinstated for the duration of the original 3-year 
period. Alternatively, a hospital could apply for reclassification 
to a different area and receive a new 3-year period of 
reclassification.
    Example 3: Hospital C is reclassified to Area A for purposes of 
the wage index for FY

[[Page 22692]]

2002, and terminates its 3-year reclassification effective for FYs 
2003 and 2004. Within the timeframe for applying for FY 2004 
reclassification, Hospital C cancels its termination. Its 
reclassification to Area A would be reinstated for FY 2004 only.
    Example 4: Hospital D has the same circumstances as Hospital C 
in Example 3, except that instead of canceling its termination, 
Hospital D applies and is reclassified to Area B for FY 2004. In 
this case, the reclassification would be for FYs 2004 through 2006.
d. Special Rules for Group Reclassifications
    Section 412.232 discusses situations where all hospitals in a rural 
county are seeking urban redesignation, and Sec. 412.234 discusses 
criteria where all hospitals in an urban county are seeking 
redesignation to another urban county. In these cases, hospitals submit 
an application as a group, and all hospitals in the county must be a 
party to the application. The reclassification is effective both for 
purposes of the wage index and the standardized amount of the area to 
which the hospitals are reclassified.
    Section 304(a) of Public Law 106-554 does not specifically address 
the group reclassification situations under Secs. 412.232 and 412.234. 
However, we believe that, in the case of hospitals reclassified under 
these group reclassification procedures, it would be appropriate to 
extend the 3-year reclassification provision to these situations for 
the wage index only. In order to be reclassified for the standardized 
amount during the second and third years of a 3-year reclassification 
for the wage index, the hospitals located in these counties would have 
to reapply on an annual basis to the MGCRB either as a group or as 
individual hospitals and meet the criteria outlined in Secs. 412.232(a) 
and 412.234(a).
    Hospitals that are part of a group reclassification would be able 
to withdraw or terminate their 3-year wage index reclassifications in 
the same manner as described above. If one hospital within the group 
elects to withdraw or terminate its reclassification, the 
reclassification of other hospitals in the group would be unaffected.
    Under section 152(b) of Public Law 106-113, hospitals in certain 
counties were deemed to be located in specified areas for purposes of 
payment under the hospital inpatient prospective payment system, for 
discharges occurring on or after October 1, 2000. For payment purposes, 
these hospitals are to be treated as though they were reclassified for 
purposes of both the standardized amount and the wage index. Section 
152(b) also requires that these reclassifications be treated for FY 
2001 as though they are reclassification decisions by the MGCRB. For 
purposes of applying the 3-year extension of wage index 
reclassifications, we are proposing to extend section 1886(d)(10)(D)(v) 
to hospitals reclassified under section 152(b) of Public Law 106-113. 
These hospitals also would have to apply for the standardized amount on 
an annual basis to the MGCRB.
e. Administrator Authority To Cancel Inappropriate Reclassification 
Decisions
    Under the provisions of Sec. 412.278(g), the Administrator has the 
authority to review an inappropriate reclassification decision made by 
the MGCRB, as discovered by either the hospital or HCFA, including 3-
year reclassifications in the second and third year, and to determine 
whether or not to cancel that decision as a result of the review of the 
facts. Hospitals that are concerned that they have been inappropriately 
reclassified should follow the procedures outlined in Sec. 412.278.
2. Three-Year Average Hourly Wages
    Section 304(a) of Public Law 106-554 amended section 1886(d)(10)(D) 
of the Act by adding clause (vi) which provides that the MGCRB must use 
the average of the 3 most recent years of hourly wage data for the 
hospital when evaluating a hospital's request for reclassification. 
Specifically, the MGCRB must base its evaluation on an average of the 
average hourly wage for the most recent years for the hospital seeking 
reclassification and the area to which the hospital seeks to 
reclassify. This provision is effective for reclassifications for FY 
2003 and subsequent years. (Section III.F. of this preamble discusses 
the development and application of the proposed 3-year average hourly 
wage data (Table 2 in the Addendum to this proposed rule) that the 
MGCRB would use to evaluate hospitals' applications for 
reclassifications for FY 2003; and the 3-year average hourly wage data 
(Tables 3A and 3B in the Addendum to this proposed rule) for hospital 
reclassification applications for FY 2001.)
    We are proposing to revise Secs. 412.230(e)(2) and 412.232(d)(2) to 
incorporate the provisions of section 1886(d)(10)(D)(vi) of the Act as 
added by section 304(a) of Public Law 106-554. Specifically, we are 
providing that, for redesignations effective beginning FY 2003, for 
hospital-specific data, the hospital must provide a 3-year average of 
its average hourly wages using data from the HCFA hospital wage survey 
used to construct the wage index in effect for prospective payment 
purposes. For data for other hospitals, we are proposing to require 
hospitals to provide a 3-year average of the average hourly wage in the 
area in which the hospital is located and a 3-year average of the 
average hourly wage in the area to which the hospital seeks 
reclassification. The wage data would be taken from the HCFA hospital 
wage survey used to construct the wage index for prospective payment 
purposes. The 3-year averages are calculated by dividing the sum of the 
dollars (adjusted to a common reporting period using the method 
described in section III. of the proposed rule) across all 3 years, by 
the sum of the hours.
3. Statewide Wage Index
    As stated earlier, section 304(b) of Public Law 106-554 provides 
for a process under which an appropriate statewide entity may apply to 
have all the geographic areas in the State treated as a single 
geographic area for purposes of computing and applying the area wage 
index for reclassifications beginning in FY 2003.
    Section 304 does not indicate the duration of the application of 
these statewide wage indexes. However, it should be noted that the 
statutory language does refer to these applications as 
reclassifications. We are proposing that these statewide wage index 
applications be processed similar to MGCRB applications, with the same 
effective dates of the decisions and the withdrawal process. Therefore, 
similar to wage index reclassification decisions under section 
1886(d)(10)(D)(v) of the Act as added by section 304(a) of Public Law 
106-554, the statewide wage index reclassification would be effective 
for a total of 3 years. The same deadlines and timetable applicable to 
MGCRB reclassification applications would apply for statewide wage 
index applications.
    We are proposing to establish a new Sec. 412.235 to include the 
requirements for statewide wage indexes. We are proposing to apply the 
following criteria to determine whether hospitals would be approved for 
a statewide geographic wage index reclassification (proposed 
Sec. 412.235(a)):
     There must be unanimous support for a statewide wage index 
among hospitals in the State in which the statewide wage index would be 
applied. We would require a signed affidavit on behalf of all the 
hospitals in the State of this support as part of the application for 
reclassification.

[[Page 22693]]

     All hospitals in the State must apply through a signed 
single application for the statewide wage index in order for the 
application to be considered by the MGCRB. We believe this is necessary 
to ensure that every hospital in the State is included in the 
application, since the payment of every hospital would be affected by 
the statewide wage index.
     There must be unanimous support for the termination or 
withdrawal of a statewide wage index among hospitals in the State in 
which the statewide index would be applied. We would require a signed 
affidavit for this agreement.
     All hospitals in the State waive their rights to any wage 
index that they would otherwise receive absent the statewide wage 
index, including a wage index that any of the hospitals might have 
received through individual or group geographic reclassification under 
Sec. 412.273(a).
    An individual hospital within the State may receive a wage index 
that could be higher or lower under the statewide wage index 
reclassification in comparison to its wage index otherwise (proposed 
Sec. 412.235(b)). Specifically, hospitals must be aware that there may 
be a reduction in the wage index as a result of participation on a 
statewide basis.
    We are proposing to consider statewide wage index applications 
under the same process we use for hospital reclassification 
applications, including the effective dates of the MGCRB decision and 
the withdrawal process (proposed Sec. 412.235(c)). We are proposing 
that applications for the statewide wage index would be effective for 3 
years beginning with discharges occurring on the first day (October 1) 
of the second Federal fiscal year following the Federal fiscal year in 
which the hospitals file a complete application unless all of the 
participating hospitals terminate their approved statewide wage index 
classification earlier, as discussed below. Once approved by the MGCRB, 
an application for a statewide wage index can only be withdrawn or 
terminated as a result of a signed affidavit on behalf of all the 
hospitals in the State indicating their request that the statewide 
reclassification be withdrawn or terminated. A request for withdrawal 
or termination must be submitted within 45 days of the publication of 
the annual proposed rule for the inpatient hospital prospective payment 
system announcing the reclassification. New hospitals that open prior 
to the deadline for submitting an application for a statewide wage 
index, but after a group application has been submitted, would be 
required to agree to the statewide wage index in order for the group 
application to remain viable. New hospitals that open after the 
deadline for submitting an application would receive the statewide wage 
index. The agreement of new hospitals would also be required in order 
to withdraw or terminate a statewide wage index reclassification. The 
proposed rules discussed under section IV.E.1.c. of this preamble for 
withdrawals of applications and terminations of approved 3-year wage 
index reclassification decisions would apply to decisions regarding 
statewide wage index reclassifications.
    We also are proposing to allow hospitals outside a State in which 
hospitals have received approval of a statewide wage index 
classification to seek reclassification for the statewide wage index 
into that State. In that case, an outside hospital(s) that is 
reclassified into the statewide wage index area would receive a wage 
index calculated based on the statewide wage index reclassification. 
However, the support of such an outside hospital(s) would not be needed 
in the case of withdrawal or termination of a statewide wage index 
reclassification.

F. New Medical Services and Technology: Additional Payments Under the 
Inpatient Hospital Prospective Payment System (Proposed New 
Secs. 412.87 and 412.88)

    Section 533(b) of Public Law 106-554 amended section 1886(d)(5) of 
the Act to add new subparagraphs (K) and (L) to address a process of 
identifying and ensuring adequate payment for new medical services and 
technologies under Medicare. Under new section 1886(d)(5)(K)(i) of the 
Act, effective for discharges beginning on or after October 1, 2001, 
the Secretary is required to establish (after notice and opportunity 
for public comment) a mechanism to recognize the costs of new services 
and technologies under the inpatient hospital prospective payment 
system. New section 1886(d)(5)(K)(ii)(I) of the Act specifies that the 
mechanism must apply to a new medical service or technology if, ``based 
on the estimated costs incurred with respect to discharges involving 
such service or technology, the DRG prospective payment rate otherwise 
applicable to such discharges * * * is inadequate.'' New section 
1886(d)(5)(K)(vi) of the Act specifies that a medical service or 
technology will be considered ``new'' if it meets criteria established 
by the Secretary (after notice and opportunity for public comment).
    New sections 1886(d)(5)(K)(ii) through (vi) of the Act further 
provide--
     For an additional payment for new medical services and 
technology in an amount beyond the DRG prospective payment system 
payment rate that adequately reflects the estimated average cost of the 
service or technology.
     That the requirement for an additional payment for a new 
service or technology may be satisfied by means of a new-technology 
group (described in new section 1886(d)(5)(L) of the Act), an add-on 
payment, a payment adjustment, or any other similar mechanism for 
increasing the amount otherwise payable with respect to a discharge.
     For the collection of data relating to the cost of new 
medical service, or technology for not less than 2 years and no more 
than 3 years after an appropriate inpatient hospital services code is 
issued. The statute further provides that discharges involving new 
services or technology that occur after the collection of these data 
will be classified within a new or existing DRG group with a weighting 
factor derived from cost data collected for discharges occurring during 
such period.
    A discussion of how we are proposing to implement the provisions of 
section 533(b) of Public Law 106-554 follows. Section II.D. of this 
preamble discusses the Report to Congress required by section 533(a) of 
Public Law 106-553 relating to methods of expeditiously incorporating 
new medical services and technologies into the clinical coding system 
used for payments for inpatient hospital services and our preferred 
method of achieving this purpose.
1. Criteria for Identifying New Medical Services and Technology
    New section 1886(d)(5)(K)(vi) of the Act specifies that a medical 
service or technology will be considered ``new'' if it meets criteria 
established by the Secretary (after notice and opportunity for public 
comment). (For convenience, hereafter we refer to ``new medical 
services and technology'' as ``new technology.'') We are proposing that 
a new technology would be an appropriate candidate for an additional 
payment when, in the judgment of the Secretary, it represents an 
advance in medical technology that substantially improves, relative to 
technologies previously available, the diagnosis or treatment of 
Medicare beneficiaries (proposed Sec. 412.87(b)(1)). This criterion is 
to ensure that new technology can be demonstrated to provide a 
substantial clinical improvement based on verifiable evidence. Because 
any additional payments made under this

[[Page 22694]]

provision will be financed by reducing the payments made for all other 
services (in order to maintain budget neutrality as discussed under 
section IV.F.4. of this preamble), we believe that these payments 
should be focused on those technologies that afford clear improvements 
over use of previously available technologies. As explained below, we 
are proposing that new technologies meeting this clinical definition 
also must be demonstrated to be inadequately paid otherwise under the 
DRG system to receive special payment treatment (proposed 
Sec. 412.87(b)(3)). Hospitals adopting other new technologies that do 
not meet these standards would be paid for these technologies through 
other applicable DRG payments. These payments would be recalibrated 
over time to reflect actual use of the new technology.
    We expect to implement this criterion by considering the clinical 
benefits for beneficiaries. We are aware that some technologies may 
offer substantial clinical improvements for small subsets of 
beneficiaries, such as those who have not responded to other 
treatments, and we expect to recognize such substantial advantages in 
these instances.
    In addition to the clinical and cost criteria, we are proposing 
that, in order to qualify for the special payment treatment provided 
under new section 1886(d)(5)(K)(ii)(I) of the Act, a specific 
technology must be new (proposed Sec. 412.87(b)(2)). We believe the new 
provision contemplates the special payment treatment for new 
technologies until such time as data are available to reflect the cost 
of the technology in the DRG weights through recalibration (generally 2 
years). Specifically, new section 1886(d)(5)(K)(ii)(II) of the Act 
states that the Secretary must ``provide for the collection of data 
with respect to the costs of a new medical service or technology * * * 
for a period of not less than two years and not more than three years 
beginning on the date on which an inpatient hospital code is issued 
with respect to the service or technology.'' In addition, new section 
1886(d)(5)(K)(ii)(III) states that the Secretary must ``provide for 
additional payment to be made * * * with respect to discharges 
involving a new medical service or technology described in subclause 
(I) that occur during the period described in subclause (II) in an 
amount that adequately reflects the estimated average costs of such 
service or technology.''
    We are proposing to make determinations regarding which 
technologies meet this criterion using a panel of Federal clinical and 
other experts, supplemented as appropriate with outside expertise. The 
results of all such determinations would be announced in the Federal 
Register as part of the annual updates and changes to the inpatient 
hospital prospective payment system (proposed Sec. 412.87(b)(1)). We 
note that this determination is separate and distinct from the coverage 
decision process. In the case of new technologies that have gone 
through the national coverage determination process, we would expect 
that the evidence reviewed in that process would, in general, be 
sufficient for making these determinations as well.
    Requests to recognize new technology for special payment treatment 
under new section 1886(d)(5)(K)(ii)(I) of the Act would be evaluated 
against this proposed criterion based on evidence submitted by the 
requestor. These requests should be submitted in conjunction with the 
initial submission of data on the costs of the new technology. In 
general, we encourage interested parties to initiate this process by 
August of the year preceding the year in which a new code identifying 
the new technology would become effective. This will allow maximum time 
to review the requestor's data and clinical material. In particular, it 
affords an opportunity to work with the requestor to resolve any 
problems or questions that may arise. At a minimum, requests should be 
submitted by early October of that year. It should be noted that 
submitting requests as late as October may not afford the opportunity 
for HCFA to work with the requestor to resolve problems or questions. 
Requests must be submitted by early October to allow adequate time to 
consider all aspects of a request prior to making a determination to be 
included in the proposed rule. Work begins on preparing the DRG changes 
for the following fiscal year by the middle of December, and any 
decisions to recognize particular new technologies should be taken into 
account at that time.
    We are soliciting comments on these proposals. In particular, given 
that this process is the result of new legislation with possibly major 
implications for the hospital inpatient prospective payment system, we 
invite public comment on: our definition of new medical services and 
technologies; the use of Federal clinical and other experts to make 
determinations regarding which criteria meet our definition of a new 
service or technology; the information necessary to determine whether 
payment would be inadequate; and our payment mechanism (see following 
discussions for these latter two issues).
2. Determining Adequacy of Current Payments for New Services and 
Technology
    Because the inpatient hospital prospective payment system includes 
costs associated with all aspects of a patient's stay in the hospital, 
it is not enough to simply identify a technology as ``new'' and pay an 
additional amount. A single DRG may encompass many different treatment 
approaches for a particular illness, with an array of costs associated 
with those approaches. Clinicians are expected to select the 
appropriate approach based on the needs of the patient, with the 
payments averaging out over time to approximate the level of resources 
needed to treat the average patient in the DRG.
    Section 1886(d)(b)(K)(ii) of the Act, as added by section 533(b) of 
Public Law 106-554, requires that the Secretary make a determination 
whether the payment otherwise applicable under the existing DRG is 
inadequate compared to the estimated costs incurred with respect to new 
technology (as defined previously). We believe that, in order to 
evaluate whether the DRG payment inadequately reflects the costs of new 
technology, we must be able to assess the costs of cases involving the 
new technology against other cases in the DRG. In other words, the 
criteria for identifying new technology that will receive special 
payment treatment should reflect whether the new technology is so 
expensive that hospitals are unlikely to offset the higher costs with 
other less costly cases within the DRG. We are proposing that this 
threshold be set at one standard deviation beyond the mean standardized 
charge for all cases in the DRG to which the new technology is assigned 
(or the case-weighted average of all relevant DRGs, if the new 
technology occurs in many different DRGs) (proposed Sec. 412.87(b)(3)). 
(Standardization adjusts the actual charges of a case by the payment 
factors such as the wage index, the indirect medical education 
adjustment factor, and the disproportionate share adjustment factor.)
    This comparison would preferably be done using Medicare cases 
identifiable in our MedPAR database, although data from a clinical 
trial (including Food and Drug Administration clinical trials) where no 
bills were submitted for payment may be considered. To the extent 
possible, HCFA intends to rely on existing information in making these 
determinations. In most instances, the information would include the 
Medicare provider number of the hospital where each case was treated,

[[Page 22695]]

the beneficiary identification numbers of the Medicare patients, the 
dates of admission and discharge, the charges associated with each 
case, and all relevant ICD-9-CM codes associated with each case. We 
would then assess the charges of identified cases involving the new 
technology, accounting for the additional costs of the new technology 
that might not be included in the charges if the new technology is 
being provided by the manufacturer as part of the clinical trial. If 
the costs of the new technology are not included in the total charges, 
the requestor must submit adequate documentation upon which to 
formulate an estimate of the likely costs to hospitals of the new 
technology.
    A significant sample of the data should be submitted no later than 
early October, approximately 6 months prior to the publication of the 
proposed rule. Subsequently, a complete database must be submitted no 
later than mid-December. This timetable is necessary to allow adequate 
time to assess and verify the data, as well as to work with the 
submitters to deal with any unique situations with respect to data 
availability. It is also necessary to allow us to accurately 
incorporate the data into the proposed rule, which we begin preparing 
in January. We are soliciting public comments on this process.
    To illustrate the proposed use of the standard deviation 
thresholds, consider DRG 8 (Peripheral and Cranial Nerve and Other 
Nervous System Procedures Without CC). The average standardized charge 
of cases assigned to this DRG based on discharges during FY 2000 was 
$13,212, and the standard deviation was $8,978. Therefore, if a 
requestor were to seek assignment of a new technology that would 
otherwise be assigned to DRG 8 to a different DRG, the requestor would 
be expected to provide data indicating that the average standardized 
charge of cases receiving this new technology will exceed $22,190. 
These data must be of a sufficient sample size to demonstrate a 
significant likelihood that the true mean across all cases likely to 
receive the new technology will exceed the mean for the cases in DRG 8 
by one standard deviation.
    Using standard deviation as the threshold takes into account the 
distribution of charges associated with different treatment modalities 
around the mean charge for a particular DRG, and the extent to which 
lower cost cases in the DRG should be expected to offset higher cost 
cases. Using this method, new technology in a DRG with very little 
variation in charges would be more likely to meet the criteria. This 
would be appropriate because there are fewer opportunities within such 
a DRG to recover the costs of very high cost cases from excess payments 
for very low cost cases.
    We note that, although we anticipate a limited number of new 
technologies will qualify under this proposed threshold, we will 
continue to evaluate the appropriateness of all DRG assignments. This 
applies not only to new technology but existing technologies as well.
3. Developing a Payment Mechanism
    Section 1886(d)(5)(K)(v) of the Act, as added by section 533(b) of 
Public Law 106-554, provides flexibility to the Secretary in terms of 
deciding exactly how the requirement for an additional payment will be 
satisfied: a new-technology group, an add-on payment, a payment 
adjustment, or any other similar mechanism for increasing the amount 
otherwise payable. We believe the approach most consistent with the 
design and incentives of the inpatient hospital prospective payment 
system would be to assign new technology to the most appropriate DRG 
based on the condition of the patient as described above, and adjust 
payments for individual cases that involve the new technology when the 
costs of those cases exceed a threshold amount. That is, we would not 
pay an additional amount for every case involving the new technology, 
but only where the costs of the entire case exceed the DRG payment 
amount. We are concerned that the establishment of new DRGs 
specifically for the purpose of recognizing costly new technology could 
potentially severely disrupt the DRG classification structure. In 
particular, we are concerned that some new technologies may involve 
large numbers of cases across multiple DRGs. Creating new DRGs 
specifically for new technology would pull cases out of existing DRGs, 
possibly leading to severe distortions in the relative weights and 
inadequate payments for cases remaining in the existing DRGs.
    We are proposing that Medicare provide higher payments for cases 
with higher costs involving identified new technologies, while 
preserving some of the incentives under the average-based payments for 
all treatment modalities for a particular patient category. The payment 
mechanism we are proposing would be based on the cost to hospitals for 
the new technology. We are proposing under Sec. 412.88 that Medicare 
would pay a marginal cost factor of 50 percent for the costs of the new 
technology in excess of the full DRG payment. This would be calculated 
before any outlier payments under section 1886(d)(5)(A) of the Act, if 
applicable. Similarly, cases involving new technology would be eligible 
for outlier payments, with the additional amounts paid for the new 
technology included in the base payment amount. Costs would be 
determined by applying the cost-to-charge ratio in a manner identical 
to that currently used for outlier payments. If the costs of a new 
technology case exceed the DRG payment by more than the estimated costs 
of the new technology, Medicare payment would be limited to the DRG 
payment plus 50 percent of the estimated costs of the new technology, 
except if the case qualified for outlier payments. (We are proposing a 
conforming change to Sec. 412.80 by adding a new paragraph (a)(3) to 
provide that outlier qualifying thresholds and payments would be in 
addition to standard DRG payments and additional payments for new 
medical services and technology (effective October 1, 2001).)
    For example, consider a new technology estimated to cost $3,000, in 
a DRG that pays $20,000. A hospital submits three claims for cases 
involving this new technology. After applying the hospital's cost-to-
charge ratio, it is determined the costs of these three cases are 
$19,000, $22,000, and $25,000. Under our proposal, Medicare would pay 
$20,000 (the DRG payment) for the first claim. For the second claim, 
Medicare would pay one half of the amount by which the costs of the 
case exceed the DRG payment, up to the estimated cost of the new 
technology, or $21,000 ($20,000 plus one half of $2,000). For the third 
claim, Medicare would pay $21,500 ($20,000 plus one half of the total 
estimated costs of the new technology).
    We believe it is appropriate to limit the additional payment to 50 
percent of the additional cost to appropriately balance the incentives. 
This limit would provide hospitals an incentive for continued cost-
effective behavior in relation to the overall costs of the case. In 
addition, hospitals would face an incentive to balance the desirability 
of using the new technology versus the old; otherwise, there would be a 
large and perhaps inappropriate incentive to use the new technology. 
For example, in the late 1980s, we considered whether to establish a 
special payment adjustment for tissue plasminogen activator (TPA), a 
thrombolytic agent used in treating blockages of coronary arteries, 
reflecting the high costs of the drug. We did not establish such an 
adjustment because we believed that the updates to the standardized 
amounts, combined with the potential for continuing improvements in 
hospital

[[Page 22696]]

productivity, would be adequate to finance appropriate care of Medicare 
patients. In fact, the costs of the drug were offset by shorter 
hospital stays and an overall reduction in costs per case. As clinical 
experience with TPA accumulated, furthermore, it appeared that the drug 
was not as widely beneficial as its original proponents expected. 
Establishing an add-on payment for this drug might have actually led to 
more extensive use of this drug for patients who would not have 
benefited, and might have even been harmed, by its blood-thinning 
characteristics.
4. Budget Neutrality
    The report language accompanying section 533 of Public Law 106-554 
directs that the Secretary implement the new mechanism on a budget 
neutral basis (H.R. Conf. Rep. No. 106-1033, 106th Cong., 2d Sess. at 
897 (2000)). Section 1886(d)(4)(C)(iii) of the Act requires that the 
adjustments to annual DRG classifications and relative weights must be 
made in a manner that ensures that aggregate payments to hospitals are 
not affected. Therefore, we would simulate projected payments under 
this provision for new technology during the upcoming fiscal year at 
the same time we estimate the payment effect of changes to the DRG 
classifications and recalibration. The impact of those additional 
payments would then be factored into the budget neutrality factor, 
which is applied to the standardized amounts.
    Because any additional payments directed toward new technology 
under this provision would be offset to ensure budget neutrality, it is 
important to carefully consider the extent of this provision and ensure 
that only technologies representing substantial advances are recognized 
for additional payments. In that regard, we would discuss in the annual 
proposed and final regulations implementing changes to the inpatient 
hospital prospective payment system those technologies that were 
considered under this provision; our determination as to whether a 
particular new technology meets our criteria for a new technology; 
whether it is determined further that cases involving the new 
technology would be inadequately paid under the existing DRG payment; 
and any assumptions that went into the budget neutrality calculations 
related to additional payments for that new technology, including the 
expected number, distribution, and costs of these cases.
    The payments made under this provision would be redistributed from 
all other payments made under the inpatient prospective payment system; 
DRG payments would be reduced by amounts we estimate to be necessary to 
pay for the estimated aggregate new technology payments. Our 
projections of the aggregate payments for new technology would involve 
not only estimates of the effect of the new technology on the entire 
cost per case but also estimates of the volume of cases expected to 
involve the new technology during the upcoming year. Given the 
uncertainty in both of these aspects of the projections, we believe it 
is important to expose our estimates to public comment before 
implementing them.

G. Payment for Direct Costs of Graduate Medical Education (Sec. 413.86)

1. Background
    Under section 1886(h) of the Act, Medicare pays hospitals for the 
direct costs of graduate medical education (GME). The payments are 
based in part on the number of residents trained by the hospital. 
Section 1886(h) of the Act, as amended by section 4623 of Public Law 
105-33, caps the number of residents that hospitals may count for 
direct GME.
    Section 1886(h)(2) of the Act, as amended by section 9202 of the 
Consolidated Omnibus Reconciliation Act (COBRA) of 1985 (Public Law 99-
272), and implemented in regulations at Sec. 413.86(e), establishes a 
methodology for determining payments to hospitals for the costs of 
approved GME programs. Section 1886(h)(2) of the Act, as amended by 
COBRA, sets forth a payment methodology for the determination of a 
hospital-specific, base-period per resident amount (PRA) that is 
calculated by dividing a hospital's allowable costs of GME for a base 
period by its number of residents in the base period. The base period 
is, for most hospitals, the hospital's cost reporting period beginning 
in FY 1984 (that is, the period of October 1, 1983 through September 
30, 1984). The PRA is multiplied by the number of FTE residents working 
in all areas of the hospital complex (or nonhospital sites, when 
applicable), and the hospital's Medicare share of total inpatient days 
to determine Medicare's direct GME payments. In addition, as specified 
in section 1886(h)(2)(D)(ii) of the Act, for cost reporting periods 
beginning on or after October 1, 1993, through September 30, 1995, each 
hospital's PRA for the previous cost reporting period is not updated 
for inflation for any FTE residents who are not either a primary care 
or an obstetrics and gynecology resident. As a result, hospitals with 
both primary care and obstetrics and gynecology residents and 
nonprimary care residents have two separate PRAs beginning in FY 1994: 
one for primary care and one for nonprimary care.
    Section 1886(h)(2) of the Act was further amended by section 311 of 
Public Law 106-113 to establish a methodology for the use of a national 
average PRA in computing direct GME payments for cost reporting periods 
beginning on or after October 1, 2000, and on or before September 30, 
2005. Generally, section 1886(h)(2) of the Act establishes a ``floor'' 
and a ``ceiling'' based on a locality-adjusted, updated, weighted 
average PRA. Each hospital's PRA is compared to the floor and ceiling 
to determine whether its PRA should be revised. PRAs that are below the 
floor, that is, 70 percent of the locality-adjusted, updated, weighted 
average PRA, would be revised to equal 70 percent of the locality-
adjusted, updated, weighted average PRA. PRAs that exceed the ceiling, 
that is, 140 percent of the locality-adjusted, updated, weighted 
average PRA, would, depending on the fiscal year, either be frozen and 
not increased for inflation, or increased by a reduced inflation 
factor. We implemented section 311 of Public Law 106-113 in the 
hospital inpatient prospective payment system final rule published on 
August 1, 2000 (65 FR 47090). In that final rule, we set forth the 
methodology for calculating the weighted average PRA and outlined the 
steps for determining whether a hospital's PRA would be revised.
2. Amendments Made by Section 511 of Public Law 106-554 
(Sec. 413.86(e)(4)(ii)(C) and (e)(5)(iv))
    Section 511 of Public Law 106-554 amended section 
1886(h)(2)(D)(iii) of the Act by increasing the floor to 85 percent of 
the locality-adjusted national average PRA. In general, section 511 
provides that, effective for cost reporting periods beginning on or 
after October 1, 2001, and before October 1, 2002, PRAs that are below 
85 percent of the respective locality-adjusted national average PRA 
would be increased to equal 85 percent of that locality-adjusted 
national average PRA. Accordingly, we are proposing to implement 
section 511 by revising Sec. 413.86(e)(4)(ii)(C)(1) to incorporate this 
change and by outlining the methodology for determining whether a 
hospital's PRA(s) will be adjusted in FY 2002 relative to the increased 
floor of the locality-adjusted national average PRA.
    In the August 1, 2000 final rule (65 FR 47091 and 47092), as 
implemented at

[[Page 22697]]

Sec. 413.86(e)(4), we determined, in accordance with section 311 of 
Public Law 106-113, that the weighted average PRA for cost reporting 
periods ending during FY 1997 is $68,464. We described the procedures 
for updating the weighted average PRA of $68,464 for inflation to FY 
2001 and for adjusting this average for the locality of each individual 
hospital. We then outlined the steps for comparing each hospital's 
PRA(s) to the locality-adjusted national average PRA to determine if, 
for cost reporting periods beginning on or after October 1, 2000, and 
before October 1, 2001, the PRAs should be revised to equal the 70-
percent floor.
    In accordance with section 511 of Public Law 106-554, in this 
proposed rule, we are proposing that, for cost reporting periods 
beginning during FY 2002, the FY 2002 PRAs of hospitals that are below 
85 percent of the respective locality-adjusted national average PRA for 
FY 2002 be increased to equal 85 percent of that locality-adjusted 
national average PRA. Specifically, to determine which PRAs (primary 
care and nonprimary care separately) for each hospital are below the 
85-percent floor, each hospital's locality-adjusted national average 
PRA for FY 2002 is multiplied by 85 percent. This resulting number is 
then compared to each hospital's PRA that is updated for inflation to 
FY 2002. If the hospital's PRA would be less than 85 percent of the 
locality-adjusted national average PRA, the individual PRA is replaced 
with 85 percent of the locality-adjusted national average PRA for that 
cost reporting period, and in future years the new PRA would be updated 
for inflation by the Consumer Price Index for All Urban Consumers (CPI-
U) as compiled by the Bureau of Labor Statistics.
    There may be some hospitals with both primary care and nonprimary 
care PRAs that are below the floor, and both PRAs are, therefore, 
replaced with 85 percent of the locality-adjusted national average PRA. 
In these situations, the hospitals would receive a single PRA; a 
distinction between PRAs would no longer be made for differences in 
inflation (under Sec. 413.86(e)(3)(ii)). On the other hand, hospitals 
may have primary care PRAs that are above the floor, and nonprimary 
care PRAs that are below the floor. In these situations, only the 
nonprimary care PRAs would be revised to equal 85 percent of the 
locality adjusted national average PRA, and the prior year primary care 
PRAs would be updated for inflation by the CPI-U.
    For example, if the FY 2002 locality-adjusted national average PRA 
for Area X is $100,000, then 85 percent of that amount is $85,000. If, 
in Area X, Hospital A has a primary care FY 2002 PRA of $84,000 and a 
nonprimary care FY 2002 PRA of $82,000, both of Hospital A's FY 2002 
PRAs are replaced by the $85,000 floor. Thus, $85,000 is the amount 
that would be used to determine Hospital A's direct GME payments for 
both primary care and nonprimary care FTEs in its cost reporting period 
beginning in FY 2002, and the $85,000 PRA would be updated for 
inflation by the CPI-U in subsequent years. However, Hospital B, also 
located in Area X, has a primary care FY 2002 PRA of $86,000 and a 
nonprimary care FY 2002 PRA of $84,000. Thus, for Hospital B, only the 
nonprimary care PRA of $84,000 is replaced by the $85,000 floor. This 
new PRA of $85,000 would be updated for inflation by the CPI-U in 
subsequent years. Hospital B's primary care PRA of $86,000 and its 
nonprimary care PRA of $85,000 would be used to determine its direct 
GME payments in its cost reporting period beginning in FY 2002.
    We note that section 511 of Public Law 106-554 only affects 
hospitals with PRAs below the 85-percent floor, and does not affect 
hospitals with PRAs that are either between the floor and ceiling or 
exceed the ceiling. Thus, with the exception of the change in the floor 
as provided by section 511, the policy regarding the use of a national 
average PRA for making direct GME payments remains as implemented in 
the regulations at Sec. 413.86(e)(4).
    We are proposing to amend Sec. 413.86(e)(4)(ii)(C)(1) to add the 
rules implementing section 1886(h)(2)(D)(iii) of the Act as amended by 
section 511 of Public Law 106-554.
    We also are proposing to amend Sec. 413.86(e)(5) regarding the 
determination of base year PRAs for new teaching hospitals for cost 
reporting periods beginning during FYs 2001 through 2005. In the August 
1, 2000 final rule, we made a conforming change to Sec. 413.86(e)(5) to 
account for situations in which hospitals do not have a 1984 base year 
PRA and establish a PRA in a cost reporting period beginning on or 
after October 1, 2000. Existing Sec. 413.86(e)(5)(iv) specifies that 
the new base year PRAs of such hospitals are subject to the regulations 
regarding the floor and the ceiling of the locality-adjusted national 
average PRA. Although the determination of new base year PRAs is 
subject to the national average methodology, it is not necessary to 
include this provision in the regulations. Therefore, we are proposing 
to remove Sec. 413.86(e)(5)(iv).
    We would like to clarify that, for purposes of calculating a base 
year PRA for a new teaching hospital, when calculating the weighted 
mean value of PRAs of hospitals located in the same geographic area or 
the weighted mean value of the PRAs in the hospital's census region (as 
defined in Sec. 412.62(f)(1)(i)), the PRAs used in the weighted average 
calculation must not be less than the floors for cost reporting periods 
beginning during FY 2001 or FY 2002, or if they exceed the ceiling, 
they must either be frozen for FYs 2001 and 2002 or updated with the 
CPI-U minus 2 percent for FYs 2003 through 2005. In addition, existing 
Sec. 413.86(e)(5) provides that the PRA for a new teaching hospital is 
based on the lower of the hospital's actual costs incurred in 
connection with the GME program or the weighted mean value of PRAs. For 
cost reporting periods beginning during FYs 2001 and 2005, the PRA for 
a new teaching hospital also would be subject to the floor and the 
ceiling of the national average PRA methodology. If a hospital's actual 
costs of the GME program during its cost reporting period beginning 
during FY 2001 or FY 2002 are less than the floors, the hospital's PRA 
would not be based on the actual costs. Instead, it would be equal to 
70 percent in FY 2001, or 85 percent during FY 2002, of the locality-
adjusted national average PRA. The floor applies to hospitals with 
existing PRAs in FYs 2001 and 2002, or to hospitals that are 
establishing new base year PRAs in FYs 2001 and 2002. We are proposing 
to clarify that if a hospital establishes a new base year PRA in a cost 
reporting period beginning after FY 2002, its PRA would not be 
increased to equal the floor if it is less than the floor. Similarly, 
the ceiling applies to hospitals with existing PRAS in FYs 2001 through 
2005, or to hospitals that are establishing new base year PRAs in FYs 
2001 through 2005.
3. Determining the 3-Year Rolling Average for Direct GME Payments 
(Sec. 413.86(g)(4) and (g)(5))
    Section 1886(h)(4)(G)(iii) of the Act, as added by section 4623 of 
Public Law 106-33, provides that for the hospital's first cost 
reporting period beginning on or after October 1, 1997, the hospital's 
weighted FTE count for direct GME payment purposes equals the average 
of the weighted FTE count for that cost reporting period and the 
preceding cost reporting period. For cost reporting periods beginning 
on or after October 1, 1998, section 1886(h)(4)(G) of the Act requires 
that hospitals' direct medical education weighted FTE count for payment 
purposes equal the average of the actual weighted FTE count for the 
payment year cost reporting period and

[[Page 22698]]

the preceding two cost reporting periods (rolling average). This 
provision phases in the associated reduction in payment over a 3-year 
period for hospitals that are reducing their number of residents.
    In the August 29, 1997 final rule with comment period (62 FR 
46004), we revised Sec. 413.86(g)(5) accordingly, and outlined the 
methodology for determining a hospital's direct GME payment. Based on 
what we explained in the 1997 final rule, for cost reporting periods 
beginning on or after October 1, 1997, we would determine a hospital's 
direct GME payment as follows:
    Step 1. Determine the average of the weighted FTE counts for the 
payment year cost reporting period and the prior two immediately 
preceding cost reporting periods (with exception of the hospital's 
first cost reporting period beginning on or after October 1, 1997, 
which will be based on the average of the weighted average for that 
cost reporting period and the immediately preceding cost reporting 
period).
    Step 2. Determine the hospital's direct GME amount without regard 
to the FTE cap (before determining Medicare's share). That is, take the 
sum of (a) the product of the primary care PRA and the primary care 
weighted FTE count in the current payment year, and (b) the product of 
the nonprimary care PRA and the nonprimary care weighted FTE count in 
the current payment year.
    Step 3. Divide the hospital's direct GME amount by the total number 
of FTE residents (including the effect of weighting factors) for the 
cost reporting period to determine the weighted average PRA (this 
amount reflects the FTE weighted average of the primary and nonprimary 
care PRAs) for the cost reporting period.
    Step 4. Multiply the weighted average PRA for the cost reporting 
period by the 3-year average weighted count to determine the hospital's 
allowable direct GME costs. This product is then multiplied by the 
hospital's Medicare patient load for the cost reporting period to 
determine Medicare's direct GME payment to the hospital.
    Steps 2 and 3 above describe the methodology for combining a 
hospital's primary care PRA and nonprimary care PRA to determine the 
hospital's single weighted average PRA for the payment year cost 
reporting period. (This step accounts for hospitals that were training 
residents in both primary care and nonprimary care residency programs 
in FYs 1994 and 1995, when, as described in Sec. 413.86(e)(3)(ii), each 
hospital's PRA for the previous cost reporting period was not adjusted 
for any resident FTEs who were not either a primary care resident or an 
obstetrics or a gynecology resident. As a result, such hospitals have 
two PRAs for direct GME payment; one for primary care and obstetrics 
and gynecology residents, and one for all other, or nonprimary care, 
residents. Hospitals that train either only primary care (including 
obstetrics and gynecology) residents or only nonprimary care residents 
follow the methodology described above, with the exception of combining 
two PRAs). Step 4 then dictates that the resulting average PRA is 
multiplied by the 3-year rolling average, which, in turn, is multiplied 
by the hospital's Medicare patient load in the current year to 
determine Medicare's direct GME payment to the hospital for that cost 
reporting period.
    In implementing this provision in the August 29, 1997 final rule 
with comment period, we believed that the methodology described above 
was appropriate because it was consistent with the methodology 
described under section 1886(h)(3)(B) of the Act. This section 
specifies that, in order to arrive at the average PRA, or ``aggregate 
approved amount,'' HCFA must multiply a hospital's PRA by the 
``weighted average number of [FTE] residents * * * in the hospital's 
approved medical residency training programs in that period'' (emphasis 
added).
    We also believed the methodology outlined above and in the August 
29, 1997 rule was appropriate because it was consistent with the intent 
of the statute that, after October 1, 1997, direct GME payments should 
be based on a rolling average. Specifically, section 4623 of Public Law 
106-33 provides that, ``For cost reporting periods beginning on or 
after October 1, 1997 * * * the total number of full-time equivalent 
residents for determining a hospital's graduate medical education 
payment shall equal the average of the actual full-time equivalent 
resident counts for the cost reporting period and the preceding two 
cost reporting periods'' (emphasis added). Thus, while the statute does 
not include a specific methodology for computing the direct GME 
payments, it clearly indicates that the payment should be based on a 3-
year average of the weighted number of residents, not the weighted 
number of residents in the current payment year cost reporting period.
    As stated above, Congress provided that the direct GME payments 
should be made based on a 3-year average of the weighted number of 
residents in order to phase in the associated reduction in payment over 
a 3-year period for hospitals that are reducing the number of residents 
they are training. However, in steps 2 and 3 above, when combining a 
hospital's primary care PRA and nonprimary care PRA, we weight the 
respective PRAs by current year residents. This introduces the number 
of residents that a hospital is training in the current cost reporting 
period into the payment formula. A payment formula that incorporates 
the number of current year residents ``dilutes'' the effect of the 
rolling average as related to direct GME payments. After further 
consideration, we believe that, consistent with the statute, the 
formula should be based on rolling average counts of residents. We are 
proposing an alternative methodology in which the direct GME payment 
would be the sum of (a) the product of the primary care PRA and the 
primary care and obstetrics and gynecology rolling average, and (b) the 
product of the nonprimary care PRA and the nonprimary care rolling 
average. (This sum would then be multiplied by the Medicare patient 
load.) We note that IME payments would not be affected because, 
although they also are based on a 3-year rolling average, there is no 
distinction between primary care and nonprimary care residents.
    The new methodology would be effective for cost reporting periods 
beginning on or after October 1, 2001. The proposed methodology for 
determining a hospital's direct GME payment is as follows:
    Step 1. Determine that the hospital's total unweighted FTE counts 
in the payment year cost reporting period and the prior two immediately 
preceding cost reporting periods for all residents in allopathic and 
osteopathic medicine do not exceed the hospital's FTE cap for these 
residents in accordance with Sec. 413.86(g)(4). If the hospital's total 
unweighted FTE count in a cost reporting period exceeds its cap, the 
hospital's weighted FTE count, for primary care and obstetrics and 
gynecology residents and nonprimary care residents, respectively, will 
be reduced in the same proportion that the number of these FTE 
residents for that cost reporting period exceeds the unweighted FTE 
count in the cap. The proportional reduction is calculated for primary 
care and obstetrics and gynecology residents and nonprimary care 
residents separately in the following manner:

(FTE cap/unweighted total FTEs in the cost reporting period)  x  
(weighted primary care and obstetrics and gynecology FTEs in the cost 
reporting period)
      plus
(FTE cap/unweighted total FTEs in the cost reporting period)  x  
(weighted nonprimary care FTEs in the cost reporting period).


[[Page 22699]]


    Add the two products to determine the hospital's reduced cap.
    Step 2. Determine the 3-year average of the weighted FTE count for 
primary care and obstetrics and gynecology residents in the payment 
year cost reporting period and the two immediately preceding cost 
reporting periods. Determine the 3-year average of the weighted FTE 
count for nonprimary care residents in the payment year cost reporting 
period and the two immediately preceding cost reporting periods.
    Step 3. Determine the product of the primary care PRA and the 
primary care and obstetrics and gynecology 3-year average from step 2. 
Determine the product of the nonprimary care PRA and the nonprimary 
care 3-year average from step 2.
    Step 4. Sum the products of step 3.
    Step 5. Multiply the sum from step 4 by the hospital's Medicare 
patient load for the cost reporting period to determine Medicare's 
direct GME payment to the hospital.
    Existing Sec. 413.86(g)(5) specifies that residents in new programs 
are excluded from the rolling average calculation for a period of years 
equal to the minimum accredited length for the type of program, and are 
added to the payment formula after applying the averaging rules. 
Accordingly, for hospitals that qualify for an adjustment to their FTE 
caps for residents training in new programs under Sec. 413.86(g)(6), 
primary care and obstetrics and gynecology residents in new programs 
would be added to the quotient of the primary care and obstetrics and 
gynecology 3-year average, and nonprimary care residents in new 
programs would be added to the quotient of the nonprimary care 3-year 
average. The sums of the respective 3-year averages and new residents 
would then be multiplied by the respective PRAs.
    The following example illustrates the determination of direct GME 
payment under the proposed rolling average methodology for an existing 
teaching hospital with no new programs:
    Example: Assume a hospital with a cost reporting period ending 
September 30, 1996 (beginning October 1, 1995) had 100 unweighted FTE 
residents and 90 weighted FTE residents. The hospital's FTE cap is 100 
unweighted residents.
    Step 1. In its cost reporting period beginning in FY 2000, it had 
100 unweighted residents and 90 weighted residents (50 primary care and 
40 nonprimary care).
     The hospital had 90 unweighted residents and 85 weighted 
residents (50 primary care and 35 nonprimary care) for its cost 
reporting period beginning in FY 2001.
     In its cost reporting period beginning in FY 2002, the 
hospital had 80 unweighted residents and 80 weighted residents (50 
primary care and 30 nonprimary care).
    Step 2. The 3-year average of weighted primary care and obstetrics 
and gynecology residents is (50 + 50 + 50)/3 = 50. The 3-year average 
of weighted nonprimary care residents is (40 + 35 + 30)/3 = 35.
    Step 3. Primary care: $80,000 PRA  x  50 weighted primary care and 
obstetrics and gynecology FTEs = $4,000,000. Nonprimary care: $78,000 
x  35 weighted nonprimary care FTEs = $2,730,000.
    Step 4. $4,000,000 + $2,730,000 = $6,730,000.
    Step 5. If the hospital's Medicare patient load for the payment 
cost reporting period is .20, Medicare's direct GME payment would be 
$6,730,000  x  .20 = $1,346,000.
    Whether the proposed methodology results in a payment difference 
for a hospital is dependent upon whether or not the number and mix 
(primary care and nonprimary care) of FTEs changes in a 3-year period. 
If the number and mix of FTEs does not change in a 3-year period, there 
would be no difference in a direct GME payment amount derived using the 
proposed methodology versus the existing methodology. For example, if a 
hospital has 90 weighted FTEs (50 primary care and 40 nonprimary care) 
in the current year and the 2 previous years (using the PRAs and the 
Medicare patient load from the example above), the payment amounts 
derived from the existing methodology and the proposed methodology 
would be equal.
    If the number and mix of FTEs varies from year to year, there will 
be a difference in the results of the two methodologies. In some 
instances the existing methodology would result in a higher payment, 
and in other instances the proposed methodology would result in a 
higher payment. In the example above, the hospital has reduced its 
number of weighted residents by 5 FTEs in FYs 2001 and 2002. 
Calculating this hospital's direct GME payment amount using the 
existing methodology (using the PRAs and the Medicare patient load from 
the example) would result in a payment of $1,347,250, which is $1,250 
more than $1,346,000, the amount calculated in the example using the 
proposed methodology.
    In a scenario where a hospital makes larger reductions to the 
number of FTEs, the proposed methodology may be more beneficial. For 
example, using the PRAs and the Medicare patient load from the example 
above, assume a hospital has 90 weighted FTEs (50 primary care and 40 
nonprimary care) in FY 2000, 85 weighted FTEs (50 primary care and 35 
nonprimary care) in FY 2001, and 70 weighted FTEs (35 primary care and 
35 nonprimary care) in FY 2002. If the proposed methodology is used, 
the payment amount of $1,292,050 would be calculated, which is $1,666 
more than $1,290,386, the amount calculated if the existing methodology 
is used.
    We are proposing to revise Sec. 413.86(g)(4) to specify that, 
effective for cost reporting periods beginning on or after October 1, 
2001, if the hospital's total unweighted FTE count in a cost reporting 
period exceeds its cap, the hospital's weighted FTE count, for primary 
care and obstetrics and gynecology residents and nonprimary care 
residents, respectively, will be reduced in the same proportion that 
the number of these FTE residents for that cost reporting period 
exceeds the unweighted FTE count in the cap. We also are proposing to 
revise Sec. 413.86(g)(5) to specify that, effective for cost reporting 
periods beginning on or after October 1, 2001, the direct GME payment 
will be calculated using two separate rolling averages, one for primary 
care and obstetrics and gynecology residents and one for nonprimary 
care residents.
4. Counting Research Time as Direct and Indirect GME Costs 
(Secs. 412.105 and 413.86)
    It has come to our attention that there appears to be some 
confusion in the provider community as to whether the time that 
residents spend performing research is countable for the purposes of 
direct and indirect GME reimbursement. Although we are not proposing to 
make any policy changes in this proposed rule, we would like to 
reiterate our longstanding policy regarding time that residents spend 
in research and propose to incorporate this policy in the IME 
regulations.
    Section 413.86(f) specifies that, for the purposes of determining 
the total number of FTE residents for the direct GME payment, residents 
in an approved program working in all areas of the hospital complex may 
be counted. Accordingly, the time the residents spend performing 
research as part of an approved program anywhere in the hospital 
complex may be counted for direct GME payment purposes. If the 
requirements listed at Secs. 413.86(f)(3) and (f)(4) are met, a 
hospital may also count the time residents spend doing research in non-
hospital settings for direct GME payment.
    For purposes of determining the IME payment, Sec. 412.105(f)(ii) 
specifies that

[[Page 22700]]

the time residents spend training in parts of the hospital that are 
subject to the inpatient prospective payment system, in the outpatient 
departments, or (effective on or after October 1, 1997, in accordance 
with Secs. 413.86(f)(3) and (f)(4)) in nonhospital settings, may be 
counted. Section 2405.3.F.2. of the Provider Reimbursement Manual (PRM) 
further states that a resident must not be counted for the IME 
adjustment if the resident is engaged exclusively in research. Resident 
time spent ``exclusively'' in research means that the research is not 
associated with the treatment or diagnosis of a particular patient of 
the hospital. Therefore, although the research component may be part of 
an approved program, the time that residents devote specifically to 
performing research that is not related to delivering patient care, 
whether it occurs in the hospital complex or in non-hospital settings, 
may not be counted for IME payment purposes. ``Exclusively research'' 
time is not allowable for IME purposes irrespective of whether the 
resident is engaged only in research or spends only part of his or her 
time on research. Accordingly, time spent exclusively in research over 
the course of a program year should be subtracted from the total FTE 
for that year. For example, if a resident is required to spend 3 months 
in a particular program year engaged in research activities unrelated 
to delivering patient care, that amount of time should be subtracted 
from the total FTE, whether or not the research time is fulfilled in 
one block of time, or is distributed throughout the training year.
    We note that in order to count residents for both direct GME and 
IME payment purposes, the residents' training must be part of an 
approved program. This applies whether or not the residents are doing 
work that is clinical in nature. There are situations where residents 
have completed their residency program requirements but remain for an 
additional period of time to continue their training (that is, to 
conduct research or other activities) outside the context of a formally 
organized approved program. As we explained in the September 29, 1989 
final rule (54 FR 40306), these residents are not countable for direct 
GME or IME reimbursement. Rather, patient care services provided by 
these residents should be paid as Part B services.
    We are proposing to amend Sec. 412.105(f)(1)(iii) to add a 
paragraph (B) to incorporate language that reflects this policy.
5. Temporary Adjustments to FTE Cap To Reflect Residents Affected by 
Residency Program Closure
    In the July 30, 1999 hospital inpatient prospective payment system 
final rule (64 FR 41522), we indicated that we would allow a temporary 
adjustment to a hospital's FTE resident cap under limited circumstances 
and if certain criteria are met when a hospital assumes the training of 
additional residents because of another hospital's closure. We made 
this change because hospitals had indicated a reluctance to accept 
additional residents from a closed hospital without a temporary 
adjustment to their caps. When we proposed this change 2 years ago, we 
received several comments suggesting that we include lost accreditation 
of a program (that is, a program's closure) in the temporary adjustment 
policy. We explained in our response to these comments (64 FR 41522) 
that we did not believe it was appropriate to expand our policy to 
cover any acts other than a hospital's closure. We made this decision 
because, unless the hospital terminates its Medicare agreement, the 
hospital would retain its statutory FTE cap and could affiliate with 
other hospitals to enable the residents to finish their training.
    It has come to our attention that, despite a hospital's ability to 
affiliate with other hospitals when it shuts down a residency program, 
some hospitals for various reasons do not affiliate before their 
programs close, particularly when the program closes abruptly towards 
the end of the program year (the deadline to submit Medicare 
affiliation agreements is July 1 of the upcoming program year). 
Therefore, we are proposing that if a hospital that closes its 
residency training program agrees to temporarily reduce its FTE cap, 
another hospital(s) may receive a temporary adjustment to its FTE cap 
to reflect residents added because of the closure of the former 
hospital's residency training program. For purposes of this proposed 
policy on closed programs, we are proposing to define ``closure of a 
hospital residency training program'' as when the hospital ceases to 
offer training for residents in a particular approved medical residency 
training program (proposed Sec. 413.86(g)(8)(i)(B)). The methodology 
for adjusting the caps for the ``receiving hospital'' and the 
``hospital that closed its program'' is described below.
    a. Receiving hospital. We are proposing that a hospital(s) may 
receive a temporary adjustment to its (or their) FTE cap to reflect 
residents added because of the closure of another hospital's residency 
training program if--
     The hospital is training additional residents from the 
residency training program of a hospital that closed its program; and
     No later that 60 days after the hospital begins to train 
the residents, the hospital submits to its fiscal intermediary a 
request for a temporary adjustment to its FTE cap, documents that the 
hospital is eligible for this temporary adjustment by identifying the 
residents who have come from another hospital's closed program and have 
caused the hospital to exceed its cap, specifies the length of time the 
adjustment is needed, and submits to its fiscal intermediary a copy of 
the FTE cap reduction statement by the hospital closing the program, as 
specified in paragraph (g)(8)(iii)(B)(2).
    In general, the above criteria we are proposing for the temporary 
adjustment are reflective of the criteria for the temporary adjustment 
for taking on the training of displaced residents from closed 
hospitals. We note that we are proposing that more than one hospital 
would be eligible to apply for the temporary adjustment, because 
residents from one closed program may go to different hospitals, or 
they may finish their training at more than one hospital. We also note 
that only to the extent a hospital would exceed its FTE cap by training 
displaced residents would it be eligible for the temporary adjustment.
    Finally, we note that we are proposing that hospitals that meet the 
above proposed criteria would be eligible to receive temporary 
adjustments (for cost reporting periods beginning on or after October 
1, 2001, for direct GME and with discharges beginning on or after 
October 1, 2001 for IME) for training the displaced residents from 
programs that closed even before the effective date of this policy. We 
mention this because hospitals may have closed programs in the recent 
past and the residents from the closed programs may not have completed 
their training as of the effective date of this policy. For instance, 
if a 5-year residency program, such as surgery, closed on July 1, 1997, 
the 5th program year residents may still be training during this 
residency year (2001). We are proposing that if both the receiving 
hospital(s) and the hospital that closed the program in this example 
follow the criteria described in this preamble, the receiving hospital 
may receive a temporary adjustment to its FTE cap for 9 months (October 
1, 2001 through June 30, 2002) to accommodate the 5th year surgery 
residents. However, we note that hospitals would not be

[[Page 22701]]

eligible to receive a temporary adjustment for training the residents 
until the effective date of this rule.
    b. Hospital that closed its program(s). We are proposing that a 
hospital that agrees to train residents who have been displaced by the 
closure of another hospital's program may receive a temporary FTE cap 
adjustment only if the hospital with the closed program(s)--
     Temporarily reduces its FTE cap by the number of FTE 
residents in each program year training in the program at the time of 
the program's closure. The yearly reduction would be determined by 
deducting the number of those residents who would have been training in 
the program year during each year had the program not closed; and
     No later than 60 days after the residents who were in the 
closed program begin training at another hospital, submits to its 
fiscal intermediary a statement signed and dated by its representative 
that specifies that it agrees to the temporary reduction in its FTE cap 
to allow the hospital training the displaced residents to obtain a 
temporary adjustment to its cap; identifies the residents who were 
training at the time of the program's closure; identifies the hospitals 
to which the residents are transferring once the program closes; and 
specifies the reduction for the applicable program years.
    Unlike the closed hospital policy at Sec. 413.86(g)(8), we are 
proposing under this closed program policy (which we are proposing to 
amend Sec. 413.86(g)(8) to include), that in order for the receiving 
hospital(s) to qualify for a temporary adjustment to its FTE cap, the 
hospitals that are closing their programs would need to reduce their 
FTE cap for the duration of time the displaced residents would need to 
finish their training. We are proposing this change because, as 
explained below, the hospital that closes the program still has the FTE 
slots in its cap, even if the hospital chooses not to fill the slots 
with residents. We believe it is inappropriate to allow an increase to 
the receiving hospital's cap without an attendant decrease to the cap 
of the hospital with the closed program, even if the increase is only 
temporary. We note that even under this proposed closed program policy, 
the hospital that closes its program may choose instead to affiliate 
with another hospital by July 1 of the next residency year so that the 
residents can more easily finish their training.
    We are proposing that the cap reduction for the hospital with the 
closed program would be based on the number of FTE residents in each 
program year who were in the program at the program's closure, and who 
began training at another hospital, rather than the count of residents 
each year at the hospital(s) receiving the temporary adjustment(s). We 
believe it would be too burdensome administratively to require the 
hospital closing the program to keep track of the status of the 
residents when they are training at other hospitals. For instance, Joe 
Smith, a resident who is a PGY 1 when Hospital X closes its pathology 
residency program, may then finish his training at Hospital Y. The 
resident trains for one year at Hospital Y as a PGY 2, but decides to 
drop out of the program before finishing. It would be burdensome to 
require Hospital X to keep track of Joe Smith's status while he is 
training at Hospital Y for purposes of the reduction in Hospital X's 
cap. Therefore, we are proposing to ``freeze'' the basis for the 
reduction of the FTE cap of the hospital that closed the program based 
on the count and status of the residents when the hospital closes the 
program.
    Example: Hospital A, which has a direct GME FTE cap of 20 FTEs and 
an IME FTE cap of 18 FTEs, is experiencing financial difficulties and 
decides to close down its internal medicine residency training program 
effective June 30, 2002. As of June 30, 2002, Hospital A is training 2 
PGY 1s, 4 PGY 2s, and 6 PGY 3s in its internal medicine program. 
Hospitals B, C, and D take on the training of the displaced residents. 
These hospitals are eligible to receive temporary adjustments to their 
FTE caps if they follow the proposed criteria stated above. In order 
for Hospitals B, C, and D to receive the temporary adjustments, 
however, Hospital A must agree to reduce its FTE cap. According to the 
proposed criteria stated above, Hospital A's reduction would be:

July 1, 2002 through June 30, 2003

Direct GME FTE cap: 14 FTEs, (20 FTEs cap--2 PGY 2s--4 PGY 3s)
IME FTE cap: 12 FTEs (18 FTEs--2 PGY 2s--4 PGY 3s)
    We note that no downward adjustment for the 6 PGY 3s for either cap 
is necessary since these residents will have completed their training 
in that program by the July 1, 2000 through June 30, 2003 program year.

July 1, 2003 through June 30, 2004

Direct GME FTE cap: 18 FTEs (20 FTEs cap--2 PGY 3s)
IME FTE cap: 16 FTEs (18 FTEs cap--2 PGY 3s)

July 1, 2004 through June 30, 2005

Direct GME FTE cap: 20 FTEs
IME FTE cap: 18 FTEs
    We also are proposing to revise Sec. 412.105(f)(1)(ix) to make the 
provision relating to the adjustment to FTE caps to reflect residents 
affected by closure of hospitals' medical residency training programs 
applicable to determining the IME payment.
6. Conforming Change to Regulations Governing Payment to Federally 
Qualified Health Centers (Sec. 405.2468(f))
    We have discovered a technical error in the regulations at 
Sec. 405.2468(f) regarding payment to federally qualified health 
centers (FQHCs) and rural health centers (RHCs) for the costs of 
graduate medical education. Specifically, Sec. 405.2468(f)(6)(ii)(D) 
provides that ``The costs associated with activities described in 
Sec. 413.85(d) of this chapter'' are not allowable graduate medical 
education costs. We recently amended Sec. 413.85 in a final rule (66 FR 
3358, January 12, 2001) regarding Medicare pass-through payment for 
approved nursing and allied health education programs. However, we 
inadvertently did not make a conforming change to 
Sec. 405.2468(f)(6)(ii)(D). Section 405.2468(f)(6)(ii)(D) should read 
``The costs associated with activities described in Sec. 413.85(h) of 
this chapter.'' We are proposing to revise Sec. 405.2468(f)(6)(ii)(D) 
to reflect this change.

V. Proposed Changes to the Prospective Payment System for Capital-
Related Costs

A. End of the Transition Period

    Federal fiscal year (FY) 2001 is the last year of the 10-year 
transition period established to phase in the prospective payment 
system for hospital capital-related costs. For the readers' benefit in 
this proposed rule, we are providing a summary of the statutory basis 
for the system, the development and evolution of the system, the 
methodology used to determine capital-related payments to hospitals, 
and the policy for providing exceptions payments during the transition 
period.
    Section 1886(g) of the Act requires the Secretary to pay for the 
capital-related costs of inpatient hospital services ``in accordance 
with a prospective payment system established by the Secretary.'' Under 
the statute, the Secretary has broad authority in establishing and 
implementing the capital prospective payment system. We initially 
implemented the capital prospective payment system in the August 30, 
1991 final rule (56 FR 43409), in which we

[[Page 22702]]

established a 10-year transition period to change the payment 
methodology for Medicare inpatient capital-related costs from a 
reasonable cost-based methodology to a prospective methodology (based 
fully on the Federal rate).
    The 10-year transition period established to phase in the 
prospective payment system for capital-related costs is effective for 
cost reporting periods beginning on or after October 1, 1991 (FY 1992) 
and before October 1, 2001 (FY 2002). Beginning in FY 2001, the last 
year of the 10-year transition period for the prospective payment 
system for hospital capital-related costs, capital prospective payment 
system payments are based solely on the Federal rate for the vast 
majority of hospitals. Since FY 2001 is the final year of the capital 
transition period, we will no longer determine a hospital-specific rate 
for FY 2002 in section IV. of the Addendum of this proposed rule. For 
cost reporting periods beginning on or after October 1, 2001, payment 
for capital-related costs for all hospitals, except those defined as 
new hospitals under Sec. 412.30(b), will be determined based solely on 
the capital standard Federal rate.
    Generally, during the transition period, inpatient capital-related 
costs are paid on a per discharge basis, and the amount of payment 
depended on the relationship between the hospital-specific rate and the 
Federal rate during the hospital's base year. A hospital with a base 
year hospital-specific rate lower than the Federal rate is paid under 
the fully prospective payment methodology during the transition period. 
This method is based on a dynamic blend percentage of the hospital's 
hospital-specific rate and the applicable Federal rate for each year 
during the transition period. A hospital with a base period hospital-
specific rate greater than the Federal rate is paid under the hold-
harmless payment methodology during the transition period.
    During the transition period, a hospital paid under the hold-
harmless payment methodology receives the higher of (1) a blended 
payment of 85 percent of reasonable cost for old capital plus an amount 
for new capital based on a portion of the Federal rate; or (2) a 
payment based on 100 percent of the adjusted Federal rate. The amount 
recognized as old capital is generally limited to the allowable 
Medicare capital-related costs that were in use for patient care as of 
December 31, 1990. Under limited circumstances, capital-related costs 
for assets obligated as of December 31, 1990, but put in use for 
patient care after December 31, 1990, also may be recognized as old 
capital if certain conditions were met. These costs are known as 
obligated capital costs. New capital costs are generally defined as 
allowable Medicare capital-related costs for assets put in use for 
patient care after December 31, 1990.
    Hospitals that are defined as ``new'' for the purposes of capital 
payments during the transition period (see Sec. 412.300(b)) will 
continue to be paid according to the applicable payment methodology 
outlined in Sec. 412.324. During the transition period, new hospitals 
are exempt from the prospective payment system for capital-related 
costs for their first 2 years of operation and are paid 85 percent of 
their reasonable capital-related costs during that period. The 
hospital's first 12-month cost reporting period (or combination of cost 
reporting periods covering at least 12 months), beginning at least 1 
year after the hospital accepts its first patient, serves as the 
hospital's base period. Those base year costs qualify as old capital 
and are used to establish its hospital-specific rate used to determine 
its payment methodology under the capital prospective payment system. 
Effective with the third year of operation, the hospital will be paid 
under either the fully prospective methodology or the hold-harmless 
methodology. If the fully prospective methodology is applicable, the 
hospital is paid using the appropriate transition blend of its 
hospital-specific rate and the Federal rate for that fiscal year until 
the conclusion of the transition period, at which time the hospital 
will be paid based on 100 percent of the Federal rate. If the hold-
harmless methodology is applicable, the hospital will receive hold-
harmless payment for assets in use during the base period for 8 years, 
which may extend beyond the transition period.
    The basic methodology for determining capital prospective payments 
based on the Federal rate is set forth in Sec. 412.312. For the purpose 
of calculating payments for each discharge, the standard Federal rate 
is adjusted as follows:

(Standard Federal Rate)  x  (DRG Weight)  x  (GAF)  x  (Large Urban 
Add-on, if applicable)  x  (COLA Adjustment for Hospitals Located in 
Alaska and Hawaii)  x  (1 + DSH Adjustment Factor + IME Adjustment 
Factor)

    Hospitals may also receive outlier payments for those cases that 
qualify under the thresholds established for each fiscal year. Section 
412.312(c) provides for a single set of thresholds to identify outlier 
cases for both inpatient operating and inpatient capital-related 
payments.
    In accordance with section 1886(d)(9)(A) of the Act, under the 
prospective payment system for inpatient operating costs, hospitals 
located in Puerto Rico are paid for operating costs under a special 
payment formula. Prior to FY 1998, hospitals in Puerto Rico were paid a 
blended rate that consisted of 75 percent of the applicable 
standardized amount specific to Puerto Rico hospitals and 25 percent of 
the applicable national average standardized amount. However, effective 
October 1, 1997, under amendments to the Act enacted by section 4406 of 
Public Law 105-33, operating payments to hospitals in Puerto Rico are 
based on a blend of 50 percent of the applicable standardized amount 
specific to Puerto Rico hospitals and 50 percent of the applicable 
national average standardized amount. In conjunction with this change 
to the operating blend percentage, effective with discharges on or 
after October 1, 1997, we compute capital payments to hospitals in 
Puerto Rico based on a blend of 50 percent of the Puerto Rico rate and 
50 percent of the Federal rate as specified in the regulations at 
Sec. 412.374. For capital-related costs, we compute a separate payment 
rate specific to Puerto Rico hospitals using the same methodology used 
to compute the national Federal rate for capital-related costs.
    In the August 30, 1991 final rule (56 FR 43409), we established a 
capital exceptions policy, which provided for exceptions payments 
during the transition period (Sec. 412.348). Section 412.348 provides 
that, during the transition period, a hospital may receive additional 
payment under the exceptions process when its regular payments are less 
than a minimum percentage, established by class of hospital, of the 
hospital's reasonable capital-related costs. The amount of the 
exceptions payment is the difference between the hospital's minimum 
payment level and the payments the hospital would have received under 
the capital prospective payment system in the absence of an exceptions 
payment. The comparison is made on a cumulative basis for all cost 
reporting periods during which the hospital has been subject to the 
capital prospective payment transition rules. The minimum payment 
percentages throughout the transition period for regular capital 
exceptions payments by class of hospitals are:
     For sole community hospitals, 90 percent;
     For urban hospitals with at least 100 beds that have a 
disproportionate share patient percentage of at least 20.2

[[Page 22703]]

percent or that received more than 30 percent of their net inpatient 
care revenues from State or local governments for indigent care, 80 
percent;
     For all other hospitals, 70 percent of the hospital's 
reasonable inpatient capital-related costs.
    The provision for regular exceptions payments expires at the end of 
the transition period, that is, on September 30, 2001. Capital 
prospective payment system payments are no longer adjusted to reflect 
regular exceptions payments at Sec. 412.348 after that date. 
Accordingly, for cost reporting periods beginning on or after October 
1, 2001, all hospitals other than those defined as ``new'' under 
Sec. 412.300(b) will receive only the per discharge payment based on 
the Federal rate for capital costs (plus any applicable DSH or IME and 
outlier adjustments) unless a hospital qualifies for a special 
exceptions payment under Sec. 412.348(g).

B. Special Exceptions Process

    In the August 30, 1991 final rule (56 FR 43409), we established a 
capital exceptions policy at Sec. 412.348, which provided for regular 
exception payments during the transition period. In the September 1, 
1994 final rule (59 FR 45385), we added the special exceptions process, 
describing it as ``* * * narrowly defined, focusing on a small group of 
hospitals who found themselves in a disadvantaged position. The target 
hospitals were those who had an immediate and imperative need to begin 
major renovations or replacements just after the beginning of the 
capital prospective payment system. These hospitals would not be 
eligible for protection under the old capital and obligated capital 
provisions, and would not have been allowed any time to accrue excess 
capital prospective payments to fund these projects.''
    Under the special exceptions provisions at Sec. 412.348(g), an 
additional payment may be made through the 10th year beyond the end of 
the capital prospective payment system transition period for eligible 
hospitals that meet (1) a project need requirement as described at 
Sec. 412.348(g)(2), which, in the case of certain urban hospitals, 
includes an excess capacity test; and (2) a project size requirement as 
described at Sec. 412.348(g)(5). Eligible hospitals include sole 
community hospitals, urban hospitals with at least 100 beds that have a 
disproportionate share percentage of at least 20.2 percent, and 
hospitals with a combined Medicare and Medicaid inpatient utilization 
of at least 70 percent.
    When we established the special exceptions process, we selected the 
hospital's cost reporting period beginning before October 1, 2001, as 
the project completion date in order to limit cost-based exceptions 
payments to a period of not more than 10 years beyond the end of the 
transition to the fully Federal capital prospective payment system. 
Therefore, hospitals are eligible to receive special exceptions 
payments for the 10 years after the cost reporting year in which they 
complete their project. Generally, if a project is completed in the 
hospital cost reporting period ending September 29, 2002, exceptions 
payments would continue through September 29, 2012. In addition, we 
believe that, for projects completed after the deadline, hospitals 
would have had the opportunity to reserve their prior years' capital 
prospective payment system payments for financing projects. We note 
that the August 1, 2000 final rule (65 FR 47095) incorrectly stated 
that special exceptions payments could extend through September 30, 
2011; the date should have been September 29, 2012.
    For each cost reporting period, the amount of the special 
exceptions payment is determined by comparing the cumulative payments 
made to the hospital under the capital payment system to the cumulative 
minimum payment levels applicable to the hospital for each cost 
reporting period subject to the prospective payment system. This 
comparison is offset or reduced by (1) any amount by which the 
hospital's cumulative payments exceed its cumulative minimum payments 
under the regular exceptions process for all cost reporting periods 
during which the hospital has been subject to the capital prospective 
payment system; and (2) any amount by which the hospital's current year 
Medicare inpatient operating and capital prospective payment system 
payments (excluding 75 percent of its operating DSH payments) exceed 
its Medicare inpatient operating and capital costs (or its Medicare 
inpatient margin). During the capital prospective payment system 
transition period, the minimum payment level under the regular 
exceptions process varied by class of hospital as set forth in 
Sec. 412.348(c) and described in section V.A. of this preamble. After 
the transition period and for the duration of the special exceptions 
provision, the minimum payment level is 70 percent as set forth in 
Sec. 412.348(g)(6).
    In the July 31, 1998 final rule (63 FR 40999), we stated that a few 
hospitals had expressed concern with the required completion date of 
October 1, 2001, and other qualifying criteria for the special 
exceptions payment. Therefore, we solicited certain information from 
hospitals on major capital construction projects that might qualify for 
the capital special exceptions payments so we could determine if any 
changes in the special exceptions criteria or process were necessary. 
In the May 7, 1999 proposed rule (64 FR 24736), we reported that four 
hospitals had responded timely to our solicitation with information on 
their major capital construction projects. The hospitals submitted 
information about their location, the cost of the project, the date 
that the certificate of need approval was received, the start date of 
the project, and the anticipated completion date. Some hospitals also 
suggested changing a number of the requirements of the special 
exception provision.
    When we issued the May 7, 1999 proposed rule, we had no specific 
proposal to revise the special exceptions process. However, we invited 
comments and suggestions from hospitals and other interested parties on 
the revision to the special exceptions process (64 FR 24738). We noted 
that, because the capital special exceptions process is budget neutral, 
any liberalization of the policy would require a commensurate reduction 
in the capital rate paid to all hospitals. That is, we will continue to 
make an adjustment to the capital Federal rate in a budget neutral 
manner to pay for exceptions as long as an exceptions policy is in 
force, just as we have for regular exceptions during the transition 
period. We also stated that, based on the comments we received, we may 
make changes to the special exceptions criteria in the final regulation 
or propose changes in the FY 2001 proposed rule.
    In the July 30, 1999 final rule (64 FR 41526), we responded to the 
six comments we received on potential changes to the special exceptions 
process. In that same final rule, we also described our attempt to 
obtain information on hospital projects that might qualify for special 
exceptions payments in order to assess the impact of the recommended 
changes to the existing policy. In conjunction with the most recent 
cost report data readily available at that time (FY 1996), we attempted 
to estimate which of the hospital construction projects might qualify 
for special exception payments under the existing policy and how that 
universe of hospitals might change as a result of the recommended 
revisions to the special exceptions criteria.
    Because exception payments to a hospital for a given cost reporting 
period are based on a percentage of the

[[Page 22704]]

capital costs incurred during the cost reporting period, we were unable 
to determine a precise estimate of the amount of payments to hospitals 
that might be eligible for special exceptions. In addition, hospitals 
are not eligible for special exception payments until the assets are 
put into use for patient care. Once eligibility for special exceptions 
payment has been demonstrated, it is some time before completed and 
settled cost reports are available to determine these payments.
    Based on our research, we determined that it is difficult to 
predict whether particular hospitals will be able to meet all of the 
special exceptions eligibility criteria (DSH percentage, completion 
date, project size, and project need requirements) as well as qualify 
to receive special exception payments after taking into account the 
appropriate offsets, such as inpatient operating and capital margins. 
However, we believe that any changes to the special exceptions policy 
may affect a significant number of hospitals.
    Based on our belief that these changes may have an impact on a 
significant number of hospitals, our evaluation of the comments, and 
careful consideration of all the issues, we stated in the July 30, 1999 
final rule that the more appropriate forum for addressing changes to 
the capital special exceptions policy is the legislative process in 
Congress rather than the regulation process (64 FR 41528).
    As we also indicated in the July 30, 1999 final rule (64 FR 41526), 
we have little information about the number of hospitals that may 
qualify for special exceptions payments or the projected dollar amount 
of special exception payments, because no hospitals are currently being 
paid under the special exceptions process. Until FY 2002, the special 
exceptions provision pays either the same as the regular exceptions 
process or less for high DSH and sole community hospitals. In 
accordance with Sec. 412.348(g)(7), a qualifying hospital may receive 
additional payments for up to 10 years from the year in which it 
completes a project that meets the project need and project size 
requirements of the special exception provision in Secs. 412.348(g)(2) 
through (g)(5). Because a qualifying project under the special 
exceptions provision at Sec. 412.348(g) must be completed (put into use 
for patient care) by the end of the hospital's last cost reporting 
period beginning before the end of the transition period (September 30, 
2001), a hospital may receive special exception payments for 10 years 
through September 30, 2012. For example, an eligible hospital that 
completes a qualifying project in October 1993 (FY 1994) will be 
eligible to receive special exception payments up through FY 2003 
(September 30, 2003).
    In order to assist our fiscal intermediaries in determining the end 
of the 10-year period in which an eligible hospital will no longer be 
entitled to receive special exception payments, we are proposing to add 
a new Sec. 412.348(g)(9) to require that hospitals eligible for special 
exception payments under Sec. 412.348(g) submit documentation to the 
intermediary indicating the completion date of their project (the date 
the project was put in use for patient care) that meets the project 
need and project size requirements outlined in Secs. 412.348(g)(2) 
through (g)(5). We are proposing that, in order for an eligible 
hospital to receive special exception payments, this documentation 
would have to be submitted in writing to the intermediary by the later 
of October 1, 2001, or within 3 months of the end of the hospital's 
last cost reporting period beginning before October 1, 2001, during 
which a qualifying project was completed. For example, if a hospital 
completed a qualifying project in March 1995, it would be required to 
submit documentation to the intermediary by October 1, 2001. If a 
hospital with a 12-month cost reporting period beginning on July 1 
completed a qualifying project in November 2001, it would be required 
to submit documentation to the intermediary no later than September 30, 
2002, which is 3 months after the end of its 12-month cost reporting 
period that began on July 1, 2001.

C. Exceptions Minimum Payment Level

    Section 412.348(h) limits the estimated aggregate amount of 
exceptions payments under both the regular exceptions and special 
exceptions process to no more than 10 percent of the total estimated 
capital prospective payment system payments in a given fiscal year. 
Consistent with the requirements for regular exceptions at 
Sec. 412.348(c), we are proposing that if we estimate that special 
exception payments would exceed 10 percent of total capital prospective 
payment system payments for a given fiscal year, we will adjust the 
minimum payment level of 70 percent by one percentage point increments 
until the estimated payments are within the 10-percent limit. For 
example, we could set the minimum payment level at 69 percent to ensure 
that estimated aggregate special exceptions payments do not exceed 10 
percent of estimated total capital prospective payment system payments. 
If the estimate of aggregate special exceptions payments were still 
projected to exceed 10 percent of total capital prospective payment 
system payments, we would continue reducing the minimum payment level 
by one percentage point increments until the requirements in 
Sec. 412.348(h) were satisfied. We are proposing to revise 
Sec. 412.348(g)(6) accordingly to reflect this policy.

D. Exceptions Adjustment Factor

    Section 412.308(c)(3) requires that the standard capital Federal 
rate be reduced by an adjustment factor equal to the estimated 
proportion of additional payments for both regular exceptions and 
special exceptions under Sec. 412.348 relative to total capital 
prospective payment system payments. In estimating the proportion of 
regular exceptions payments to total capital prospective payment system 
payments during the transition period, we used the model originally 
developed for determining budget neutrality (described in Appendix B of 
this proposed rule) to determine the exception adjustment factor, which 
was applied to both the Federal and hospital-specific rates. Below we 
describe our proposed methodology for determining the special 
exceptions adjustment used in establishing the Federal capital rate.
    Under the special exceptions provision specified at 
Sec. 412.348(g)(1), eligible hospitals include SCHs, urban hospitals 
with at least 100 beds that have a disproportionate share percentage of 
at least 20.2 percent or qualify for DSH payments under 
Sec. 412.106(c)(2), and hospitals with a combined Medicare and Medicaid 
inpatient utilization of at least 70 percent. An eligible hospital may 
receive special exception payments if it meets (1) a project need 
requirement as described at Sec. 412.348(g)(2), which, in the case of 
certain urban hospitals, includes an excess capacity test; (2) an age 
of assets test as described at Sec. 412.348(g)(3); and (3) a project 
size requirement as described at Sec. 412.348(g)(5).
    In order to determine the estimated proportion of special 
exceptions payments to total capital payments, we attempted to identify 
the universe of eligible hospitals that may potentially qualify for 
special exception payments. First, we identified hospitals that met the 
eligibility requirements at Sec. 412.348(g)(1). Then we determined each 
hospital's average fixed asset age in the earliest available cost 
report starting in FY 1992 and later. For each of those hospitals, we 
calculated the average fixed asset age by dividing the

[[Page 22705]]

accumulated depreciation by the current year's depreciation. In 
accordance with Sec. 412.348(g)(3), a hospital must have an average age 
of buildings and fixed assets above the 75th percentile of all 
hospitals in the first year of capital prospective payment system. In 
the September 1, 1994 final rule (59 FR 45385), we stated that, based 
on the June 1994 update of the cost report files in HCRIS, the 75th 
percentile for buildings and fixed assets for FY 1992 was 16.4 years. 
However, we noted that we would make a final determination of that 
value on the basis of more complete cost report information at a later 
date. In the August 29, 1997 final rule (62 FR 46012), based on the 
December 1996 update of HCRIS and the removal of outliers, we finalized 
the 75th percentile for buildings and fixed assets for FY 1992 as 15.4 
years. Thus, we eliminated any hospitals from the potential universe of 
hospitals that may qualify for special exception payments if its 
average age of fixed assets did not exceed 15.4 years.
    For the hospitals remaining in the potential universe, we estimated 
project-size by using the fixed capital acquisitions shown on Worksheet 
A7 from the following HCRIS cost reports updated through December 2000.

------------------------------------------------------------------------
                                                 Cost reports periods
                  PPS year                           beginning in
------------------------------------------------------------------------
IX.........................................  FY 1992
X..........................................  FY 1993
XI.........................................  FY 1994
XII........................................  FY 1995
XIII.......................................  FY 1996
XIV........................................  FY 1997
XV.........................................  FY 1998
XVI........................................  FY 1999
------------------------------------------------------------------------

    Because the project phase-in may overlap 2 cost reporting years, we 
added together the fixed acquisitions from sequential pairs of cost 
reports to determine project size. Under Sec. 412.348(g)(5), the 
project-size must meet the following requirements: (1) $200 million; or 
(2) 100 percent of its operating cost during the first 12-month cost 
reporting period beginning on or after October 1, 1991. We calculated 
the operating costs from the earliest available cost report starting in 
FY 1992 and later by subtracting inpatient capital costs from inpatient 
costs (for all payers). We did not subtract the direct medical 
education costs as those costs are not available on every update of the 
HCRIS minimum data set. If the hospital met the project size 
requirement, we assumed that it also met the project need requirements 
at Sec. 412.348(g)(2) and the excess capacity test for urban hospitals 
at Sec. 412.348(g)(4).
    Because we estimate that so few hospitals will qualify for special 
exceptions, projecting costs, payments, and margins would result in 
high statistical variance. Consequently, we decided to model the 
effects of special exceptions using historical data based on hospitals' 
actual cost experiences. If we determined that a hospital may qualify 
for special exceptions, we modeled special exceptions payments from the 
project start date through the last available cost report (FY 1999). 
For purposes of modeling we used the cost and payment data on the cost 
reports from HCRIS assuming that special exceptions would begin at the 
start of the qualifying project. In other words, when modeling costs 
and payment data, we ignored any regular exception payments that these 
hospitals may otherwise have received as if there had not been regular 
exceptions during the transition period. In projecting an eligible 
hospital's special exception payments, we applied the 70-percent 
minimum payment level, the cumulative comparison of current year 
capital prospective payment system payments and costs, and the 
cumulative operating margin offset (excluding 75 percent of operating 
DSH payments).
    Because hospitals may receive regular exception payments up through 
the end of their last cost reporting period beginning before October 1, 
2001, hospitals with cost reporting periods beginning on a day other 
than October 1 will continue to receive regular exception payments 
until the end of their FY 2002 cost reporting period. Therefore, these 
hospitals will only receive special exception payments for the 
remainder of Federal FY year 2002. Consequently, the special exceptions 
payments made in FY 2002 will be less than for subsequent years since 
they are only being paid a special exception payment for a portion of 
FY 2002.
    Our modeling of special exception payments produced the following 
results:

----------------------------------------------------------------------------------------------------------------
                                                                                                      Special
                                                                                                   exceptions as
                                                                                                   a fraction of
                                                                                      Special         capital
                                                                     Number of     exceptions as    payments to
                                                                     hospitals     a fraction of   all hospitals
                           Cost report                             eligible for       capital       weighted by
                                                                      special       payments to    portion of FY
                                                                    exceptions     all hospitals  2002 for which
                                                                                                      special
                                                                                                  exceptions are
                                                                                                       paid
----------------------------------------------------------------------------------------------------------------
PPS IX..........................................................  ..............  ..............  ..............
PPS X...........................................................  ..............  ..............  ..............
PPS XI..........................................................               3  ..............  ..............
PPS XII.........................................................               6          0.0002          0.0001
PPS XIII........................................................               8          0.0001          0.0000
PPS XIV.........................................................              14          0.0002          0.0001
PPS XV..........................................................              18          0.0016          0.0002
PPS XVI.........................................................              22          0.0011          0.0008
----------------------------------------------------------------------------------------------------------------

    Currently, the PPS XVI cost reports in HCRIS are incomplete because 
there is a 2-year lag time between the end of a hospital's cost 
reporting period and the submission and processing of the cost reports 
for HCRIS. In particular, hospitals whose cost reporting periods begin 
July 1 are missing. We expect more hospitals to qualify for special 
exceptions once data from later HCRIS updates are available. In 
addition, hospitals still have two more cost reporting periods (PPS 
XVII and PPS XVIII) to complete their projects in order to be eligible 
for special exceptions. We estimate that about 30 additional hospitals 
could qualify for special exceptions. Thus, we project

[[Page 22706]]

that special exception payments as a fraction of capital payments to 
all hospitals could be approximately 0.0025. However, after weighting 
this amount to account for the FY 2002 phase-in of special exception 
payments, we project that this factor would be approximately 0.0012. 
Because special exceptions are budget neutral, we propose to offset the 
Federal capital rate by 0.12 percent for special exceptions for FY 
2002. Therefore, the proposed exceptions adjustment factor would equal 
0.9988 (1 minus 0.0012) to account for special exception payments in FY 
2002. We will revise this projection of the special exception 
adjustment factor in the final rule based on the latest available data.

VI. Proposed Changes for Hospitals and Hospital Units Excluded From 
the Prospective Payment System

A. Limits on and Adjustments to the Target Amounts for Excluded 
Hospitals and Units (Secs. 413.40(b)(4) and (g))

1. Updated Caps for Existing Hospitals and Units
    Section 1886(b)(3) of the Act (as amended by section 4414 of Public 
Law 105-33) established caps on the target amounts for certain existing 
hospitals and units excluded from the prospective payment system for 
cost reporting periods beginning on or after October 1, 1997 through 
September 30, 2002. The caps on the target amounts apply to the 
following three classes of excluded hospitals: psychiatric hospitals 
and units, rehabilitation hospitals and units, and long-term care 
hospitals.
    In addition, section 4416 of Public Law 105-33 limited payments for 
psychiatric hospitals and units, rehabilitation hospitals and units, 
and long-term care hospitals that first received payments on or after 
October 1, 1997. Payment for these hospitals and units is limited to 
the lesser of the hospital's operating costs per case or 110 percent of 
the national median of target amounts for the same class of hospitals 
for cost reporting periods ending during FY 1996, updated and adjusted 
for differences in area wage levels.
    A discussion of how the caps on the target amounts and the payment 
limitation were calculated can be found in the August 29, 1997 final 
rule with comment period (62 FR 46018); the May 12, 1998 final rule (63 
FR 26344); the July 31, 1998 final rule (63 FR 41000), and the July 30, 
1999 final rule (64 FR 41529). For purposes of calculating the caps for 
existing facilities, the statute required the Secretary to estimate the 
national 75th percentile of the target amounts for each class of 
hospital (psychiatric, rehabilitation, or long-term care) for cost 
reporting periods ending during FY 1996 without adjusting for 
differences in area wage levels. Under section 1886(b)(3)(H)(iii) of 
the Act, the resulting amounts are updated by the market basket 
percentage to the applicable fiscal year.
    Section 121 of Public Law 106-113 amended section 1886(b)(3)(H) of 
the Act to also provide for an appropriate wage adjustment to the caps 
on the target amounts for existing psychiatric hospitals and units, 
rehabilitation hospitals and units, and long-term care hospitals, 
effective for cost reporting periods beginning on or after October 1, 
1999, through September 30, 2002. On August 1, 2000, we published an 
interim final rule with comment period that implemented this provision 
for cost reporting periods beginning on or after October 1, 1999 and 
before October 1, 2000 (65 FR 47026) and a final rule that implemented 
this provision for cost reporting periods beginning on or after October 
1, 2000 (65 FR 47054). This proposed rule addresses the wage adjustment 
to the caps and payment limitations for cost reporting periods 
beginning on or after October 1, 2001.
    For purposes of calculating the caps, section 1886(b)(3)(H)(ii) of 
the Act requires the Secretary to first ``estimate the 75th percentile 
of the target amounts for such hospitals within such class for cost 
reporting periods ending during fiscal year 1996.'' Furthermore, 
section 1886(b)(3)(H)(iii), as added by Public Law 106-113, requires 
the Secretary to also provide for existing hospitals ``an appropriate 
adjustment to the labor-related portion of the amount determined under 
such subparagraph to take into account the differences between average 
wage-related costs in the area of the hospital and the national average 
of such costs within the same class of hospital.''
    Consistent with the broad authority conferred on the Secretary by 
section 1886(b)(3)(H)(iii) of the Act to determine the appropriate wage 
adjustment, we account for differences in wage-related costs by 
adjusting the caps to account for the following:
    First, we adjust each hospital's target amount to account for area 
differences in wage-related costs. For each class of hospitals 
(psychiatric, rehabilitation, and long-term care), we determine the 
labor-related portion of each hospital's FY 1996 target amount by 
multiplying its target amount by the actuarial estimate of the labor-
related portion of costs (or 0.71553). Similarly, we determine the 
nonlabor-related portion of each hospital's FY 1996 target amount by 
multiplying its target amount by the actuarial estimate of the 
nonlabor-related portion of costs (or 0.28447).
    Next, we account for wage differences among hospitals within each 
class by dividing the labor-related portion of each hospital's target 
amount by the hospital's wage index under the hospital inpatient 
prospective payment system. Within each class, each hospital's wage-
neutralized target amount was calculated by adding the wage-neutralized 
labor-related portion of its target amount and the nonlabor-related 
portion of its target amount. Then, the wage-neutralized target amounts 
for hospitals within each class were arrayed in order to determine the 
national 75th percentile caps on the target amounts for each class.
    Taking into account the national 75th percentile of the target 
amounts for cost reporting periods ending during FY 1996 (wage-
neutralized using the FY 2000 acute care wage index), the wage 
adjustment provided for under Public Law 106-113, and the applicable 
update factor based on the market basket percentage increase for FY 
2001, in the August 1, 2000 final rule (65 FR 47096), we established 
the FY 2001 caps on the target amounts as follows:

------------------------------------------------------------------------
                                                  FY 2001      FY 2001
                                                   labor-     nonlabor-
      Class of excluded hospital or unit          related      related
                                                   share        share
------------------------------------------------------------------------
Psychiatric...................................       $8,131       $3,233
Rehabilitation................................       15,164        6,029
Long Term Care................................       29,284       11,642
------------------------------------------------------------------------

    In reviewing our methodology for wage neutralizing the hospital 
specific target amounts, it appears that we incorrectly used the FY 
2000 hospital inpatient prospective payment system wage index published 
in Tables 4A and 4B of the July 30, 1999 final rule (64 FR 41585 
through 41593), which is based on wage data after taking into account 
geographic reclassification under section 1886(d)(8) of the Act. We are 
proposing to revise the methodology of wage neutralizing the hospital-
specific target amounts using pre-reclassified wage data. We propose to 
recalculate the limit for new excluded hospitals and units, as well as 
calculate the cap for existing excluded hospitals and units, using the 
pre-reclassification wage index. The pre-reclassification wage index is 
the same wage index used under the prospective payment system for 
skilled nursing facilities (SNFs) and was included in Table 7 of the 
July 30, 1999 SNF final rule (64 FR 41690). (We note that both SNFs and 
ambulatory surgical centers use the prospective payment system 
inpatient wage index

[[Page 22707]]

without regard to the prospective payment system reclassification as a 
proxy for variations in local costs.)
    As we stated in the August 1, 2000 final rule, long-term care 
hospitals, rehabilitation hospitals and units, and psychiatric 
hospitals and units that are exempt from the prospective payment system 
are not subject to the prospective payment system hospital 
reclassification system under section 1886(d)(10)(A) of the Act. This 
section establishes the MGCRB for the purpose of evaluating 
applications from short-term, acute care providers. There is no 
equivalent statutory mandate for HCFA to develop an alternative board 
for long-term care hospitals, psychiatric hospitals and units, and 
rehabilitation hospitals and units. In addition, while it would be 
feasible to allow units physically located in prospective payment 
system hospitals that have been reclassified by the MGCRB to use the 
wage index for the area to which that hospital has been reclassified, 
at the present time there is no process in place to make 
reclassification determinations for freestanding excluded providers. 
There are approximately 1,000 freestanding excluded providers. 
Therefore, in the interest of equity, we believe that, in determining a 
hospital's wage-adjusted cap on its target amount, it is appropriate 
for excluded hospitals and units to use the wage index associated with 
the area in which they are physically located (MSA or rural area) and 
the prospective payment system reclassification under section 
1886(d)(10) of the Act is not applicable. This policy is also 
consistent with the policy for SNFs and ambulatory surgical centers 
that use the acute care, inpatient hospital prospective payment system 
wage index and that does not allow for reclassifications since there is 
no analogous determinations process to the MGCRB. The MGCRB only has 
authority over the prospective payment system for acute care hospitals.
    Therefore, based on the broad authority conferred on the Secretary 
by section 1886(b)(3)(H)(iii) of the Act to determine the appropriate 
wage adjustment to the caps, we have determined the labor-related and 
nonlabor-related portions of the proposed caps on the target amounts 
for FY 2002 using the methodology outlined above.

------------------------------------------------------------------------
                                                  FY 2002      FY 2002
                                                  proposed     proposed
      Class of excluded hospital or unit           labor-     nonlabor-
                                                  related      related
                                                   share        share
------------------------------------------------------------------------
Psychiatric...................................       $8,404       $3,341
Rehabilitation................................       15,689        6,237
Long-Term Care................................       31,399       12,483
------------------------------------------------------------------------

    These labor-related and nonlabor-related portions of the proposed 
caps on the target amounts for FY 2002 are based on the current 
estimate of the market basket increase for excluded hospitals and units 
for FY 2002 of 3.0 percent and reflect the change in applying the pre-
reclassified hospital inpatient prospective payment system wage index 
as discussed above. Furthermore, in accordance with section 307(a) of 
Public Law 106-554, which amended section 1886(b)(3) of the Act, the 
labor-related and nonlabor-related portions of the proposed cap for 
long-term care hospitals for FY 2002 are increased by 2 percent. We are 
providing a further discussion of this provision in an interim final 
rule with comment period that will implement provisions of Public Law 
106-554 for FY 2001 and for periods in FY 2001 from April 1, 2001 
through September 30, 2001 (HCFA-1178-IFC).
    Finally, to determine payments described in Sec. 413.40(c), the cap 
on the hospital's target amount per discharge is determined by adding 
the hospital's nonlabor-related portion of the national 75th percentile 
cap to its wage-adjusted, labor-related portion of the national 75th 
percentile cap. A hospital's wage-adjusted, labor-related portion of 
the target amount is calculated by multiplying the labor-related 
portion of the national 75th percentile cap for the hospital's class by 
the hospital's applicable wage index. For FY 2002, a hospital's 
applicable wage index is the pre-reclassified wage index under the 
hospital inpatient prospective payment system (see Sec. 412.63). The 
proposed wage index values are computed based on the same data used to 
compute the proposed FY 2002 wage index values for the hospital 
inpatient prospective payment system without taking into account 
changes in geographic reclassification under section 1886(d)(8)(B) of 
the Act for certain rural hospitals or reclassifications based on MGCRB 
decisions or the Secretary's decisions under sections 1886(d)(8) 
through (d)(10) of the Act. For cost reporting periods beginning on or 
after October 1, 2001 and before October 1, 2002, the pre-reclassified 
wage index is in Tables 4G and 4H of this proposed rule. A hospital's 
applicable wage index corresponds to the area in which the hospital or 
unit is physically located (MSA or rural area).
2. New Excluded Hospitals and Units
a. Updated Caps (Sec. 413.40(f))
    Section 1886(b)(7) of the Act establishes a payment methodology for 
new psychiatric hospitals and units, new rehabilitation hospitals and 
units, and new long-term care hospitals. Under the statutory 
methodology, for a hospital that is within a class of hospitals 
specified in the statute and first receives payments as a hospital or 
unit excluded from the prospective payment system on or after October 
1, 1997, the amount of payment will be determined as follows: For the 
first two 12-month cost reporting periods, the amount of payment is the 
lesser of (1) the operating costs per case; or (2) 110 percent of the 
national median of target amounts for the same class of hospitals for 
cost reporting periods ending during FY 1996, updated to the first cost 
reporting period in which the hospital receives payments as adjusted 
for differences in area wage levels.
    As discussed earlier, in reviewing our methodology for wage 
neutralizing the hospital-specific target amounts, it appears we 
incorrectly used the FY 2000 hospital inpatient prospective payment 
system wage index published in Tables 4A and 4B of the July 30, 1999 
final rule, which is based on wage data after taking into account 
geographic reclassifications under section 1886(d)(8) of the Act. 
Therefore, we also are proposing to revise the methodology of wage 
neutralizing the hospital-specific target amounts using pre-
reclassified wage data in our calculation of the limit for new excluded 
hospitals and units.
    The proposed amounts included in the following table reflect the 
updated and recalculated 110 percent of the wage neutralized national 
median target amounts for each class of excluded hospitals and units 
for cost reporting periods beginning during FY 2002. These figures are 
updated to reflect the projected market basket increase of 3.0 percent. 
For a new provider, the labor-related share of the target amount is 
multiplied by the appropriate geographic area wage index, without 
regard to prospective payment system reclassifications, and added to 
the nonlabor-related share in order to determine the per case limit on 
payment under the statutory payment methodology for new providers.

------------------------------------------------------------------------
                                                  FY 2002      FY 2002
                                                  proposed     proposed
      Class of excluded hospital or unit           labor-     nonlabor-
                                                  related      related
                                                   share        share
------------------------------------------------------------------------
Psychiatric...................................       $6,795       $2,701
Rehabilitation................................       13,425        5,337

[[Page 22708]]

 
Long-Term Care................................       16,651        6,620
------------------------------------------------------------------------

b. Changes in Type of Hospital Classification (Secs. 412.23 and 412.25)
    Section 1886(b)(3) of the Act (as amended by section 4414 of Public 
Law 105-33) establishes caps on the target amounts for existing 
psychiatric hospitals and units, rehabilitation hospitals and units, 
and long-term care hospitals for cost reporting periods beginning on or 
after October 1, 1997 through September 30, 2002. Section 4416 of 
Public Law 105-33 amended section 1886(b)(7) of the Act to provide for 
a limitation on payment for new excluded psychiatric hospitals and 
units, new rehabilitation hospitals and units, and new long-term care 
hospitals. Since the establishment of the caps on target amounts and 
the payment limitations, there has been an increase in the number of 
hospitals requesting a change from one classification type to another 
(for example, from rehabilitation to long-term care). Regulations at 
Sec. 412.22(d) state that ``For purposes of exclusion from the 
prospective payment systems under this subpart, the status of each 
currently participating hospital (excluded or not excluded) is 
determined at the beginning of each cost reporting period and is 
effective for the entire cost reporting period. Any changes in the 
status of the hospital are made only at the start of a cost reporting 
period.'' Even though the existing regulations directly address only a 
hospital that changes from a prospective payment system hospital to an 
excluded hospital, our longstanding policy has been that a change of 
any classification type can be effective only at the beginning of the 
provider's cost reporting period. Although the existing regulations do 
not directly address changes in a classification type of excluded 
hospital, we believe that a change from one classification type of 
excluded hospital to another type of excluded hospital is analogous to 
a change from a prospective payment system hospital to an excluded 
hospital. Therefore, we believe it would be consistent with our 
longstanding policy to amend our regulations to specify that a change 
from one excluded hospital classification type to another type is 
allowed only at the beginning of the hospital's cost reporting period.
    The rationale underlying our present policy of requiring that these 
types of changes should only be effective at the beginning of the cost 
reporting period is the need to avoid any undue (and possibly 
significant) administrative burden that could result from doing 
otherwise (for example, cost allocation, cost reporting requirements, 
certification issues). If we were to accept changes in an excluded 
hospital's classification type from one type of classification to 
another, other than at the beginning of the cost reporting period, the 
hospital would need to file a terminating cost report with respect to 
its original classification as well as file a separate cost report for 
the remainder of the cost reporting period with respect to its new 
classification. Filing these cost reports would involve gathering the 
appropriate cost data, allocating the data, and apportioning the data 
between the two hospital classes. Additionally, we would have to 
validate the cost reports. To allow these types of changes in the 
middle of a cost reporting period would result in a significant 
administrative burden. We would point out that this burden is 
applicable equally for either a change from a prospective payment 
system hospital to an excluded hospital, or a change from one excluded 
hospital classification type to another classification type. Therefore, 
we are proposing to amend the regulations to provide that the effective 
date of any of these classification changes is only at the beginning of 
a provider's cost reporting period (proposed Sec. 412.23(i), for 
excluded hospitals, and proposed Sec. 412.25(f), for excluded units).
3. Effective Date of Exclusion of Long-Term Care Hospitals
    Existing regulations at Sec. 412.23(e) require a newly established 
long-term care hospital to operate for at least 6 months with an 
average length of stay in excess of 25 days in order to qualify for 
exclusion from the inpatient hospital prospective payment system as a 
long-term care hospital. Other regulations at Sec. 412.22(d) allow 
changes in a hospital's status from not excluded to excluded to occur 
only at the start of a cost reporting period. These two regulations, 
taken together, typically require a hospital to operate for at least 6 
months under the prospective payment system before becoming eligible 
for payment at the more favorable rate under section 1886(b)(3) of the 
Act.
    These regulations were challenged in litigation by a chain 
organization that operates a large number of long-term care hospitals 
(Transitional Hospital Corporation of Louisiana, Inc. v. Shalala, 222 
F.3d 1019 (D.C. Cir. 2000) (THC)). Although the court of appeals in 
this case found that the Secretary has ample authority to adopt current 
regulatory provisions, it also concluded that the Secretary has not 
adequately considered other policy options. Consequently, it remanded 
the case to the agency for the agency to consider whether it wanted to 
continue its existing policy or adopt a policy of either ``self-
certification'' or ``retroactive adjustment.'' Generally, under a self-
certification approach, hospitals that have not yet demonstrated the 
required average length of stay would be excluded from the prospective 
payment system based on a commitment to maintain such a length of stay. 
Under a retroactive adjustment approach, a hospital's long-term care 
classification would be made effective with the beginning of the 6-
month period in which it demonstrated the required average length of 
stay. Payments for that period initially would be made under the 
prospective payment system and then adjusted retroactively to amounts 
payable for an excluded long-term care hospital once length of stay was 
successfully established.
    As directed by the court of appeals, we are reviewing the issues 
raised in this case in light of the court's decision, and are 
specifically considering the options of self-certification and 
retroactive adjustment. Our current proposals and the alternatives we 
considered before arriving at them are set forth below. To assist us in 
completing the review process, we are requesting public comment on our 
proposals, taking into account the following considerations.
a. Demonstrating Required Average Length of Stay
    Although we understand that we have discretion to select other 
policy options, we are proposing to continue our policy of requiring 
hospitals seeking long-term care hospital classification to demonstrate 
the required average length of stay based on 6 months of data, instead 
of permitting these hospitals to ``self-certify'' the required average 
length of stay.
    We note that the statute provides the agency with broad authority 
to determine the methodology by which facilities can qualify for 
exclusion as long-term care hospitals (section 1886(d)(1)(B)(iv)(I) of 
the Act specifies that ``a hospital which has an average inpatient 
length of stay (as determined by the Secretary) of greater than 25 
days'' qualifies for exclusion as a long-term care hospital). As the 
court of appeals decided, the parenthetical phrase as determined by the 
Secretary ``gives the Secretary considerable leeway to determine 
whether to require

[[Page 22709]]

prospective, contemporaneous, or retrospective evaluation and 
payment.'' (THC at 1026.)
    Although we have considered the self-certification option, we do 
not believe that it is appropriate to permit long-term care hospitals 
to self-certify. Long-term care hospitals ``are licensed as acute care 
hospitals in the States in which they operate [and] their only 
distinguishing characteristic is their long average length of stay'' 
(ProPAC March 1, 1997 Report and Recommendations to the Congress, 
Recommendation 30). For this reason, and because average length of stay 
can be difficult, if not impossible, to forecast when a new hospital 
first opens its doors for service, it would not be appropriate to allow 
new hospitals to self-certify that they will have an average length of 
stay exceeding 25 days.
    Requiring newly participating hospitals to collect at least 6 
months of length of stay data before permitting them to qualify as 
long-term care hospitals is consistent with treatment of other types of 
excluded hospitals in the regulations. Like long-term care hospitals, 
children's hospitals, which by statute are also excluded from the 
prospective payment system, also have just one distinguishing 
characteristic from acute care hospitals; namely, having inpatients who 
are predominantly individuals under 18 years of age (section 
1886(d)(1)(B)(iii) of the Act). As with long-term care hospitals, we do 
not permit children's hospitals to self-certify that they will meet 
this requirement as to a future cost reporting period (Sec. 412.23(d)).
    Although we permit rehabilitation hospitals to self-certify that 
they meet certain elements of the definition for such a hospital, 
important differences between rehabilitation hospitals and long-term 
care hospitals render such a scheme inappropriate for the latter. The 
differences in the two types of excluded hospitals begin with the 
statute, which excludes from the prospective payment system ``a 
rehabilitation hospital (as defined by the Secretary)'' and ``a 
hospital which has an average inpatient length of stay (as defined by 
the Secretary) of greater than 25 days''; that is, a long-term care 
hospital (sections 1886(d)(1)(B)(ii) and 1886(d)(1)(B)(iv)(I) of the 
Act). Thus, Congress delegated broad authority to the Secretary to 
define rehabilitation hospitals, but provided the definition of long-
term care hospitals in the statute itself (and then, as discussed 
above, gave the agency broad authority to determine how to apply that 
definition).
    In exercising our authority to define a rehabilitation hospital, we 
promulgated regulations that contain several defining features that a 
facility must possess to be considered such a hospital, as opposed to 
the one statutorily mandated feature (average length of stay) that 
defines long-term care hospitals (Sec. 412.23(b)). The requirements 
that a rehabilitation hospital must meet include a showing that 75 
percent of its patients are of a certain type, the existence of a 
preadmission screening process, assurance that patients will receive 
close medical supervision and that the hospital will furnish certain 
types of therapy through the use of qualified personnel, the presence 
of a director of rehabilitation with certain qualifications, evidence 
of a plan of treatment for each inpatient that is established and 
monitored by a physician, and the use of a coordinated 
interdisciplinary team approach in the rehabilitation of each patient 
(Sec. 412.23(b)(1) through (b)(7)). With the exception of the ``75 
percent rule,'' all of these requirements are ``characteristics of the 
patients and types of services that the facility furnishes'' that ``can 
be assessed at a given point in time'' (ProPAC March 1, 1997 Report and 
Recommendations to the Congress, Recommendation 30).
    Thus, rehabilitation hospitals are defined primarily by static and 
observable features, most of which can be accurately assessed when a 
new rehabilitation hospital is first certified under the Medicare 
program. As a result, the regulations permit a new rehabilitation 
hospital to provide written certification that it will meet the 75 
percent rule, provided we find that it also meets the six other 
elements of the definition of a rehabilitation facility 
(Sec. 412.23(b)(8)). The hospital's demonstrated ability to meet the 
six remaining requirements provides an adequate level of assurance that 
the hospital will also meet the 75-percent requirement if it so 
certifies. No such assurance is available, however, regarding whether a 
hospital might, during a future period, meet the sole requirement for 
qualification as a long-term care hospital--the average length of stay 
of its patients.
b. Effective Date of Exclusion From the Prospective Payment System
    Because we propose to continue our policy of not allowing a 
hospital to self-certify the required average length of stay in order 
to be paid as an excluded long-term care hospital, it is necessary to 
consider the effective date of excluded status for a hospital that has 
demonstrated the required average length of stay. We considered making 
long-term care classification effective retroactively with the 
beginning of the 6-month period in which the hospital demonstrated the 
required average length of stay. Doing so would mean, for example, that 
a hospital that admitted its first patient on January 1, 2001, and 
demonstrated that its average length of stay exceeded 25 days for the 
period January 1 through June 30, and that was approved for long-term 
care classification on July 15, would be paid for its discharges from 
January 1, 2001 forward as an excluded long-term care hospital rather 
than under the prospective payment system, as long as it continued to 
demonstrate the requisite average length of stay. However, we believe 
that such retroactive application of excluded status is inappropriate.
    For the reasons below, we are proposing to continue our policy that 
a hospital's payment as a long-term care hospital would be effective 
with the beginning of the hospital's cost reporting period that follows 
the determination to classify the hospital as a long-term care 
hospital. From the first rulemaking implementing the inpatient acute 
hospital prospective payment system payment methodology, the agency has 
generally applied decisions regarding various elements of the 
prospective payment system payment methodology prospectively only, and 
the courts have upheld that action. (THC at 1022 (``status'' decisions 
regarding whether a hospital is subject to or excluded from the 
prospective payment system); County of Los Angeles v. Shalala 192 F.3d 
1005 (D.C. Cir. 1999) (decisions regarding criteria for receipt of 
``outlier'' payments); Methodist Hospital of Sacramento v. Shalala, 38 
F.3d 1225 (D.C. Cir. 1994) (decisions to revise ``wage index'' 
component of the prospective payment system payment rate); Hennepin 
County v. Sullivan, 883 F.2d 85, 91 (D.C. Cir. 1989) (``there is 
nothing inherently arbitrary or capricious about an agency's decision 
to apply new data prospectively only''); 57 FR 39746 and 39798 (1992).)
    For the same reasons that existed in the cases cited above, we 
believe that prospective implementation of the statutory exclusion for 
long-term care hospitals is fully consistent with Congress' goals in 
enacting the prospective payment system. It allows both the hospital 
and us to know with certainty at the beginning of each cost reporting 
period of the hospital whether the hospital is subject to or excluded 
from the prospective payment system for that cost reporting period and 
thus

[[Page 22710]]

promotes certainty and predictability of payment for both providers and 
the agency. County of Los Angeles at 1019; Methodist Hospital of 
Sacramento at 1232 (``because the Secretary's prospectivity policy 
permits hospitals to rely with certainty on one additional element in 
the PPS calculation rate * * * the Secretary could reasonably conclude 
that it will promote efficient and realistic cost saving targets'').
    Moreover, retroactive application of a prospective payment system 
excluded status decision would entail a significant administrative 
burden as it would require reprocessing of large numbers of a 
hospital's claims for hospital inpatient services. See 49 FR 234 and 
271 (1984) (making retroactive changes in decisions regarding 
providers' status as ``sole community hospitals'' would require us ``to 
reprocess every inpatient hospital claim submitted for the hospital and 
make adjustment payments at the new rate). It is reasonable to conclude 
that such a burden outweighs any ``increase in accuracy that would 
result'' from retroactive application of decisions regarding long-term 
care hospital exclusions (Methodist Hospital of Sacramento at 1233).
    Finally, we apply our prospective-only policy evenhandedly, 
regardless of whether it results in a hospital's being subject to, or 
excluded from, the prospective payment system. Thus, retroactive 
adjustments in hospitals' status are as likely to hurt providers that 
slip below the required average length of stay during a cost reporting 
period as they are to help them by furnishing reimbursement for a past 
period in which they met that requirement (Methodist Hospital of 
Sacramento at 1232, 1233). Any adverse effect of the prospective only 
policy that might be perceived by new long-term care facilities is also 
lessened by the availability of a short initial cost reporting period 
and outlier payments for extraordinarily lengthy cases during the 
initial period when the hospital is subject to the prospective payment 
system.
    In addition to believing that it is appropriate to make payment as 
a long-term care hospital effective prospectively rather than 
retroactively, we believe it is also appropriate to continue our policy 
of making payment effective with the beginning of the hospital's next 
cost reporting period rather than as of the date of approval of long-
term care status. This policy is consistent with how we treat changes 
in status (that is, from excluded to nonexcluded or from nonexcluded to 
excluded) for all types of hospitals. As we explain in more detail in 
section VI.A.2.b of this proposed rule, the rationale for requiring 
changes in a hospital's status, or changes in a hospital's 
classification (that is, from one type of excluded hospital to 
another), only at the start of the hospital's cost reporting period is 
to alleviate the administrative burden and potential confusion that 
would result from doing otherwise.
    As noted earlier, we request public comments on the proposals 
described above.
4. Development of Prospective Payment System for Inpatient 
Rehabilitation Hospitals and Units
    Section 1886(j) of the Act, as added by section 4421 of Public Law 
105-33, provided the phase-in of a case-mix adjusted prospective 
payment system for inpatient rehabilitation services (freestanding 
hospitals and units) for cost reporting periods beginning on or after 
October 1, 2000 and before October 1, 2002, with a fully implemented 
system for cost reporting periods beginning on or after October 1, 
2002. Section 1886(j) of the Act was amended by section 125 of Public 
Law 106-113 to require the Secretary to use the discharge as the 
payment unit under the prospective payment system for inpatient 
rehabilitation services and to establish classes of patient discharges 
by functional-related groups. Section 305 of Public Law 106-554 further 
amended section 1886(j) of the Act to allow hospitals to elect to be 
paid the full Federal prospective payment rather than the transitional 
period payments specified in the Act.
    On November 3, 2000, we issued a notice of proposed rulemaking in 
the Federal Register (65 FR 66303) on the proposed establishment of the 
prospective payment system for inpatient rehabilitation facilities, to 
be effective on April 1, 2001. Due to the scope and complexity of the 
proposed system and requests from the public for more time to comment 
on the proposed rule, we extended the public comment period for an 
additional 30 days, from January 3, 2001 to February 1, 2001. As a 
result of the extension of the comment period, it would have been 
technically impossible to publish a final rule 60 days prior to 
implementing the prospective payment system for rehabilitation 
facilities by April l. We anticipate publication of a final rule in May 
2001 and intend to announce our plans for implementation at that time.

B. Critical Access Hospitals (CAHs)

1. Exclusion of CAHs From Payment Window Requirements
    Section 1886 of the Act specifies the requirements governing 
payment to full-service hospitals for the operating costs of inpatient 
hospital services under both the inpatient hospital prospective payment 
system and the limits on the target amounts for hospitals excluded from 
the prospective payment system. ``Operating costs of inpatient hospital 
services'' are defined in section 1886(a)(3) of the Act, which provides 
in part that costs of certain services provided to a beneficiary during 
the 3 days (or in the case of an excluded hospital or unit, during the 
1 day) immediately preceding the patient's admission are to be included 
in the payments for costs under the inpatient hospital prospective 
payment system, or the target amount for excluded hospitals and units. 
This part of the definition is sometimes referred to as the ``payment 
window'' requirement. Regulations implementing the payment window 
requirement are found at Sec. 412.2(c)(5) for hospitals subject to the 
prospective payment system, and Sec. 413.40(c)(2) for hospitals 
excluded from the prospective payment system.
    Payment to CAHs for inpatient services is not made under section 
1886 of the Act, nor are CAHs considered to be hospitals excluded from 
the inpatient hospital Prospective Payment System. Instead, payment is 
made on a reasonable cost basis, as mandated by section 1814(l) of the 
Act. Neither section 1814(l) nor section 1861(v) of the Act (which 
defines ``reasonable cost'') requires application of the payment window 
to services furnished on an outpatient basis immediately before 
admission to a CAH. Therefore, we have determined that the payment 
window provision does not apply to CAHs. To clarify this point and 
avoid possible misapplication of the payment window, we are proposing 
to amend Sec. 413.70(a)(l) to provide that the requirements of 
Secs. 412.2(c)(5) and 413.40(c)(2) do not apply to CAHs.
2. Availability of CRNA Pass-Through for CAHs
    Generally, anesthesia services furnished to a hospital patient by a 
certified registered nurse anesthetist (CRNA) must be billed to the 
Part B carrier and payment is made under the applicable fee schedule 
provisions of Sec. 414.60. However, certain rural hospitals that 
furnish no more than 500 surgical procedures requiring anesthesia per 
year and meet other specified requirements are exempted from the fee

[[Page 22711]]

schedule. These hospitals are paid on a reasonable cost basis for their 
costs of anesthesia services furnished by qualified nonphysician 
anesthetists. The exemption is provided in accordance with section 
9320(k) of the Omnibus Budget Reconciliation Act of 1986 (Public Law 
99-509) (as added by section 608(c)(2) of the Family Support Act of 
1988 (Public Law 100-185), as amended by section 6132 of the Omnibus 
Budget Reconciliation Act of 1989 (Public Law 101-239)). HCFA has 
codified this exemption at Sec. 412.113(c).
    Although Sec. 412.113(c) does not specifically extend eligibility 
for the pass-through payment for CRNAs to CAHs, some CAHs have pointed 
out that they are similar to the rural hospitals that are eligible for 
this payment, in that they also furnish low volumes of surgical 
procedures requiring anesthesia and could face the same problem of 
potentially inadequate payment for CRNA services if they are not 
allowed to qualify for the pass-through payment. We share this concern.
    We recognize that the legislation cited above, which provides the 
legal basis for the pass-through payments, refers only to 
``hospitals,'' not to CAHs. Moreover, section 1861(e) of the Act states 
that ``the term ``hospital'' does not include, unless the context 
otherwise requires, a critical access hospital * * *.'' It is clear 
from section 1861(e) of the Act that CAHs are not to be considered 
hospitals under the Medicare law for most purposes. However, the 
reference to ``context'' in the provision indicates that CAHs may be 
classified as hospitals where, in specific contexts, it would be 
consistent with the purpose of the legislation to do so.
    We believe this is the case with the statutory provisions 
authorizing pass-through payments for CRNA costs. The purpose of the 
pass-through legislation is to provide small rural hospitals with low 
surgical volumes with relief from the difficulties they might otherwise 
have in furnishing CRNA services for their patients. CAHs are by 
definition limited'service facilities located in rural areas and, as 
such, they serve a population much like those served by hospitals 
eligible for the pass-through payments. In some cases, an institution 
that now participates as a CAH may even have been eligible for the 
pass-through payments when it participated as a hospital. Such an 
institution would clearly be disadvantaged if it were to lose this 
status. Thus, in accordance with section 1861(e) of the Act and in 
light of the context of the pass-through legislation cited above, we 
consider CAHs to be ``hospitals'' for purposes of extending eligibility 
for the CRNA pass-through payments to them.
    Therefore, we are proposing to add a new Sec. 413.70(a)(3) and 
revise Secs. 413.70(a)(2), (b)(1), and (b)(6) to permit CAHs that meet 
the criteria for the pass-through payments in Sec. 412.113(c) to 
qualify for pass-through payments for the costs of anesthesia services 
for both inpatient and outpatient surgeries, on the same basis as full 
service rural hospitals. As an unrelated technical correction, we are 
proposing to revise Sec. 413.70(b)(2)(i)(C) to delete the incorrect 
reference to Sec. 413.130(j)(2) and replace it with a reference to 
reduction in capital costs under Sec. 413.130(j). We also are proposing 
to revise Sec. 412.113(c) by changing the term ``hospital'' to 
``hospital or CAH''.
3. Payment to CAHs for Emergency Room On-Call Physicians (Proposed 
Sec. 413.70(b)(4))
    Under section 1834(g) of the Act, Medicare payment to a CAH for 
facility services to Medicare outpatients is the reasonable costs of 
the CAH in providing such services. The term ``reasonable cost'' is 
defined in section 1861(v) of the Act and in regulations at 42 CFR Part 
413, including, with specific reference to CAHs, Sec. 413.70. 
Consistent with the general policies stated in section 2109 of the 
Medicare Provider Reimbursement Manual (PRM), Part I (HCFA Publication 
15-1), the reasonable cost of CAH services to outpatients may include 
reasonable costs of compensating physicians who are on standby status 
in the emergency room (that is, physicians who are present and ready to 
treat patients if necessary). However, under existing policy, the 
reasonable cost of CAH services to outpatients may not include any 
costs of compensating physicians who are not present in the facility 
but are on call.
    Section 204 of Public Law 106-554 further amended section 1834(g) 
of the Act (as amended by section 201 of Public Law 106-554) by adding 
a new paragraph (5). New section 1834(g)(5) of the Act provides that, 
in determining the reasonable costs of outpatient CAH services under 
sections 1834(g)(1) and 1834(g)(2)(A) of the Act, the Secretary shall 
recognize as allowable costs amounts (as defined by the Secretary) for 
reasonable compensation and related costs for emergency room physicians 
who are on call (as defined by the Secretary) but who are not present 
on the premises of the CAH involved, are not otherwise furnishing 
physicians' services, and are not on call at any other provider or 
facility. The provisions of section 204 of Public Law 106-554 are 
effective for cost reporting periods beginning on or after October 1, 
2001.
    To implement the provisions of section 1834(g)(5) of the Act, we 
are proposing to add a new paragraph (4) to Sec. 413.70(b). The 
proposed Sec. 413.70(b)(4) would permit the reasonable costs of CAH 
outpatient services to include the reasonable compensation and related 
costs of emergency room on-call physicians under the terms and 
conditions specified in the statute. As directed in the statute, under 
Sec. 413.70(b)(4)(ii)(A) of this proposed rule, we are defining 
``amounts for reasonable compensation and related costs'' as those 
allowable costs of compensating emergency room physicians for being on 
call, to the extent these costs are found to be reasonable under the 
rules in Sec. 413.70(b)(2).
    In addition, as specified under Sec. 413.70(b)(4)(ii)(A) of this 
proposed rule, we are defining an ``emergency room physician who is on 
call'' as a doctor of medicine or osteopathy with training or 
experience in emergency care who is immediately available by telephone 
or radio contact, and who is available on site within the timeframes 
specified in our existing regulations under Sec. 485.618(d). Existing 
Sec. 485.618(d) specifies that the physician must be available on site 
(1) within 30 minutes, on a 24-hour a day basis, if the CAH is located 
in an area other than an area described in item (2); or (2) within 60 
minutes, on a 24-hour a day basis, if all of the following requirements 
are met:
     The CAH is located in an area designated as a frontier 
area (that is, an area with fewer than six residents per square mile 
based on the latest population data published by the Bureau of the 
Census) or in an area that meets criteria for a remote location adopted 
by the State in its rural health care plan, and approved by HCFA, under 
section 1820(b) of the Act.
     The State has determined under criteria in its rural 
health care plan that allowing an emergency response time longer than 
30 minutes is the only feasible method of providing emergency care to 
residents of the area served by the CAH.
     The State maintains documentation showing that the 
response time of up to 60 minutes at a particular CAH it designates is 
justified because other available alternatives would increase the time 
needed to stabilize a patient in an emergency.
    We also believe that it is essential that physicians who are paid 
to be in on-call status in fact come to the facility when

[[Page 22712]]

summoned. Therefore, we are proposing to specify that costs of on-call 
emergency room physicians are allowable only if the costs are incurred 
under written contracts that require them to come to the CAH when their 
presence is medically required.
4. Treatment of Ambulance Services Furnished by Certain Critical Access 
Hospitals (Proposed Sec. 413.70(b)(5))
    Under section 1861(s)(7) of the Act, Medicare Part B covers and 
pays for ambulance services, to the extent prescribed in regulations, 
when the use of other methods of transportation would be 
contraindicated. Various Congressional reports indicate that Congress 
intended that (1) the ambulance benefit cover transportation services 
only if other means of transportation are contraindicated by the 
beneficiary's medical condition; and (2) only ambulance services to 
local facilities be covered unless necessary services are not available 
locally, in which case, transportation to the nearest facility 
furnishing those services is covered. (H.R. Rept. No. 89-213, 89th 
Cong., 1st Sess. at 37 (1995) and S. Rept. No. 89-404, 89th Cong., 1st 
Sess., Pt. I, at 43 (1995).)
    The Medicare program currently pays for ambulance services on a 
reasonable cost basis when furnished by a provider and on a reasonable 
charge basis when furnished by a supplier. (The term ``provider'' 
includes all Medicare-participating institutional providers that submit 
claims for Medicare ambulance services (hospitals, CAHs, SNFs, and home 
health agencies). The term ``supplier'' means an entity that is 
independent of any provider. The reasonable charge methodology that is 
the basis of payment for ambulance services is determined by the lowest 
of the customary, prevailing, actual, or inflation indexed charge.
    Section 4531(a)(1) of Public Law 105-33 amended section 1861(v)(1) 
of the Act and imposed an additional per trip limitation on reasonable 
cost payment to hospitals and CAHs for ambulance service. As amended, 
the statute provides that, in determining the reasonable cost of 
ambulance services furnished by a provider of services, the Secretary 
shall not recognize the cost per trip in excess of the prior year's 
reasonable cost per trip updated by an inflation factor. This trip 
limit provision was first effective for services furnished during 
Federal fiscal year 1998 (October 1, 1997 through September 30, 1998).
    Section 205 of Public Law 106-554 amended section 1834(l) of the 
Act by adding a new paragraph (8) to that section. New section 
1834(l)(8) provides that the Secretary is to pay the reasonable costs 
incurred in furnishing ambulance services if such services are 
furnished by a CAH (as defined in section 1861(mm)(1) of the Act), or 
by an entity owned or operated by the CAH. This provision in effect 
eliminates any trip limit that CAHs had been subject to as a result of 
section 1861(v)(1) of the Act, as amended by Public Law 105-33. 
However, section 205 further states that in order to receive reasonable 
cost reimbursement for the furnishing of ambulance services, the CAH or 
entity must be the only provider or supplier of ambulance services 
located within a 35-mile drive of the CAH. Section 205 is effective for 
services furnished on or after December 21, 2000, the date of enactment 
of Public Law 106-554.
    To implement the provisions of section 1834(l)(8) of the Act, we 
are proposing to add a new paragraph (5) to Sec. 413.70(b). Proposed 
Sec. 413.70(b)(5) would permit a CAH, or an entity owned or operated by 
a CAH, to be paid for furnishing ambulance services on a reasonable 
cost basis if the CAH or entity is the only provider or supplier of 
ambulance services within a 35-mile drive of the CAH. In determining 
whether there is any other provider or supplier of ambulance services 
within a 35-mile drive of a CAH or entity, we would first identify the 
site where the nearest other ambulance provider or supplier garages its 
vehicles, and then determine whether that site is within 35 miles, 
calculated as the shortest distance in miles measured over improved 
roads. An improved road for this purpose would be defined as any road 
that is maintained by a local, State, or Federal government entity, and 
is available for use by the general public. Consistent with the change 
we are proposing in Sec. 412.92(c)(1) relating to SCH determinations 
(as explained in section IV. of this preamble), we would consider 
improved roads to include the paved surface up to the front entrance of 
the hospital and, for purposes of Sec. 413.70(b)(5), the front entrance 
of the garage.
5. Qualified Practitioners for Preanesthesia and Postanesthesia 
Evaluation in CAHs
    Section 1820 of the Act sets forth the conditions for designating 
certain hospitals as CAHs. Implementing regulations for section 1820 of 
the Act are located in 42 CFR part 485, Subpart F. Among the conditions 
of participation regulations for CAHs in subpart F is the condition for 
surgical services (Sec. 485.639). Existing Sec. 485.639 specifies that 
preanesthesia and postanesthesia services in a CAH can only be 
performed by a doctor of medicine or an osteopathic practitioner; a 
doctor of dental surgery or dental medicine; or a doctor of podiatric 
medicine. This Medicare condition of participation requirement 
regarding preanesthesia and postanesthesia evaluations for CAHs differs 
from, and is more restrictive than, the current requirement for acute 
care hospitals in general. In an acute care hospital, the CRNA is 
listed among the practitioners who may perform the preanesthesia and 
postanesthesia evaluations.
    Our principal consideration in regulating providers is to ensure 
patient safety and high quality patient outcomes. As circumstances and 
health care environments change, we reassess regulations and propose 
changes accordingly.
    When the regulations for the initial Rural Primary Care Hospital 
(RPCH) program (which later became the CAH program) were adopted, RPCHs 
were limited to patient stays of no more than 72 hours and to bed 
counts of no more than 6 acute care beds. We initially viewed RPCHs as 
very limited-service facilities that would be unlikely to perform any 
surgery beyond what might be done in a physician's office; therefore, 
we did not have a condition of participation for surgery. Section 
102(a)(1) of the Social Security Amendments of 1994, Public Law 103-
432, specifically authorized surgical care in RPCHs. In June 1995, we 
proposed a surgical condition of participation that incorporated the 
ambulatory surgery center (ASC) standards. We expected that the types 
of procedures done in a RPCH would most likely be those that could be 
done in ASCs. At the time, we received no comments in response to the 
proposed standards and therefore adopted them in the final RPCH 
conditions of participation that were published on September 1, 1995 
(60 FR 45851).
    In 1997, the RPCH (now CAH) program was expanded through a 
statutory change to include all States and to allow for an increase in 
bed size and length of stay (August 29, 1997 final rule, 62 FR 46035). 
Since that time, the program's original conditions of participation 
have been revised to remove possible barriers to access to care. One 
example of this effort is the final rule to eliminate the Federal 
requirement for physician supervision of CRNAs in CAHs as well as acute 
care hospitals and ASCs that was published in the Federal Register on 
January 18, 2001 (66 FR 96570).
    Recently, provider and medical groups have suggested that CAHs may

[[Page 22713]]

be at risk of losing the ability to provide access to appropriate 
surgical services without the full support of available CRNAs. They 
indicated that the existing regulations place the responsibility of the 
preanesthesia and postanesthesia evaluations on the operating 
practitioner, thereby creating a higher standard for CAHs than for 
other hospitals.
    In an effort to eliminate or minimize potential access issues in 
rural areas and to recognize the CAH's program expansion, we are 
proposing to revise Sec. 485.639(b) to allow CRNAs to perform 
preanesthesia and postanesthesia evaluations in a CAH. As with any 
licensed independent health care provider, the proposed change would 
not permit CRNAs to practice beyond his or her licensed scope of 
practice or the approved policies and procedures of the CAH.
6. Clarification of Location Requirements for CAHs
    Under section 1820(c)(2)(B)(i) of the Act, a facility seeking 
designation by the State as a CAH must meet two distinct types of 
location requirements. First, the facility must either be actually 
located in a county or equivalent unit of local government in a rural 
area, as defined in section 1886(d)(2)(D) of the Act, or it must be 
located in an urban area as defined in section 1886(d)(2)(D) of the 
Act, but be treated as being located in a rural area under section 
1886(d)(8)(E) of the Act. Second, the facility must also be located 
more than a 35-mile drive (or, in the case of mountainous terrain or in 
areas with only secondary roads available, a 15-mile drive) from a 
hospital or similar facility described in section 1820(c) of the Act, 
or it must be certified by the State as being a necessary provider of 
health care services to residents in the area. Implementing regulations 
for these provisions were published in an interim final rule with 
comment period in the Federal Register on August 1, 2000 (65 FR 47026) 
and are set forth at Sec. 485.610(b).
    Recently, concern has been expressed that Sec. 485.610(b) does not 
accurately reflect the fact that a facility may satisfy the ``rural 
location'' requirement either by actually being located in a rural area 
or by being located in an urban area but qualifying for treatment as 
rural under section 1886(d)(8)(E) of the Act. In addition, we have 
received questions as to whether a potential CAH must meet both the 
rural location requirement and the requirement for location relative to 
other facilities (or certification by the State as a ``necessary 
provider'').
    To avoid any further confusion, and ensure that our regulations 
reflect the provisions of the law accurately, we are proposing to 
revise Sec. 485.610(b) to clarify that a potential CAH must either be 
actually located in a rural area, or be treated as being rural under 
section 1886(d)(8)(E) of the Act. In addition, we are proposing to 
place the provisions of the existing Sec. 485.610(b)(5) in a newly 
created paragraph (c) entitled, ``Location relative to other facilities 
or necessary provider certification''. We are proposing to relocate 
this provision in order to clarify that these criteria are separate 
from the rural location criteria. These proposed changes do not reflect 
any change in policy; they are merely an attempt to improve the clarity 
of the regulations.

VII. MedPAC Recommendations

    We have reviewed the March 1, 2001 report submitted by MedPAC to 
Congress and have given it careful consideration in conjunction with 
the proposals set forth in this document. Recommendation 5A concerning 
the update factor for inpatient hospital operating costs and for 
hospitals and hospital distinct-part units excluded from the 
prospective payment system are discussed in Appendix D to this proposed 
rule. Other MedPAC recommendations and our responses are set forth 
below.

A. Accounting for New Technology in Hospital Prospective Payment 
Systems (Recommendations 3D and 3E)

    Recommendation 3D: For the inpatient payment system, the Secretary 
should develop formalized procedures for expeditiously assigning codes, 
updating relative weights, and investigating the need for patient 
classification changes to recognize the costs of new and substantially 
improved technologies.
    Response: Section 533 of Public Law 106-554 directs the Secretary 
to develop a mechanism for ensuring adequate payment under the hospital 
inpatient prospective payment system for new medical services and 
technologies, and to report to Congress on ways to more expeditiously 
incorporate new services and technologies into that system. The 
discussion relating to new medical services and technologies is found 
in section II.D. of this proposed rule and addresses MedPAC's concern 
regarding the process of assigning new codes. In addition, MedPAC 
acknowledges, and we agree, that the process of updating the relative 
weights has an established track record.
    MedPAC states that a more formal system for assigning codes and 
investigating the need for DRG changes would have enabled the current 
system to more adequately respond to new technology. Although we 
believe the current process for assigning new codes has the advantage 
of being well-understood, the proposed new process we described in 
section II. of this proposed rule should improve the ability of the 
system to respond to the introduction of new technology.
    Recommendation 3E: Additional payments in the inpatient payment 
system should be limited to new or substantially improved technologies 
that add significantly to the cost of care in a diagnosis related group 
and should be made on a budget-neutral basis.
    Response: Section 533 of Public Law 106-554 directed the Secretary 
to establish a mechanism to make these payments beginning with 
discharges on or after October 1, 2001, and we are proposing 
implementation of this provision under section IV.F. of this proposed 
rule.

B. Occupational-Mix Adjusted Wage Index for FY 2005 (Recommendation 4)

    Recommendation: To implement an occupation-mix adjusted wage index 
in FY 2005, the Secretary should collect data on wage rates by 
occupation in the fiscal year 2002 Medicare cost reports. Hospital-
specific wage rates for each occupation should be supplemented by data 
on the mix of occupations for each provider type. The Secretary also 
should continue to improve the accuracy of the wage index by 
investigating differences in wages across areas for each type of 
provider and in the substitution of one occupation for another.
    Response: We are proposing to collect occupational mix data from 
hospitals through a supplemental survey to the cost report for cost 
reporting periods beginning during FY 2001. A more complete discussion 
of our proposed methodology can be found in section III. of this 
proposed rule.

C. Financial Performance and Inpatient Payment Issues (Recommendations 
5B, 5C, and 5D)

    Recommendation 5B: In collecting sample patient-level data, HCFA 
should seek to balance the goals of minimizing payment errors and 
furthering understanding of the effects of coding on case-mix change.
    Response: The sample data referred to by MedPAC is the Payment 
Error Prevention Program (PEPP) Surveillance Sample. These data are 
collected to monitor the payment error rate for Medicare inpatient 
prospective payment system services and provide outcome data to measure 
PROs' performance in

[[Page 22714]]

reducing payment errors in their respective States. This information 
can be appropriately weighted to reflect the true distribution of DRGs 
nationally. The sample data supplant the DRG validation sample that 
MedPAC used in its original 1996 through 1998 estimates. The current 
PEPP Surveillance Sample doubles the size of the earlier DRG validation 
sample. It is comprised of approximately 60,000 cases per year. We 
believe this is a sufficient number of cases to both monitor case-mix 
index changes and PRO performance on payment error reduction.
    Recommendation 5C: Although the Benefits Improvement and Protection 
Act of 2000 improved the equity of the hospital disproportionate share 
adjustment, Congress still needs to reform this adjustment by:
     Including the costs of all poor patients in calculating 
low-income shares used to distribute disproportionate share payments; 
and
     Using the same formula to distribute payments to all 
hospitals covered by prospective payment.
    Response: HCFA is participating a Medicare Technical Advisory Group 
workgroup concerning technical issues related to the collection of 
uncompensated care data relative to the Medicare disproportionate share 
formula. A worksheet and instructions to collect these data will be 
sent out for prior consultation this summer for revisions to the cost 
reports applicable for cost reporting periods beginning on or after 
October 1, 2001.
    Recommendation 5E: The Congress should protect urban hospitals from 
the adverse effect of nearby hospitals being reclassified to areas with 
higher wage indexes by computing each area's wage index as if none of 
the hospitals located in the area had been reassigned.
    Response: With this rule, HCFA has proposed to include the wage 
data for a reclassified hospital in both the area to which it is 
reclassified and the area where the hospital is physically located. We 
agree with MedPAC and believe that this will provide consistency and 
predictability in hospital reclassification and wage indices.

D. Specialties With Training Beyond the Initial Residency Period 
(Recommendation 10)

    Recommendation: The Congress should eliminate the weighting factors 
that currently determine Medicare's direct graduate medical education 
payments and count all residencies equally through completion of 
residents' first specialty or combined program and subspecialty if one 
is pursued. Residents training longer than the minimum number of years 
required for board eligibility in a specialty, combined program, or 
subspecialty should not be included in hospitals' direct graduate 
medical education resident counts. These policy changes should be 
implemented in a budget-neutral manner through adjustments to the per 
resident payment amounts.
    Response: Currently, Medicare payments to hospitals for direct GME 
is dependent, in part, on the initial residency period of the 
residents. Generally, the initial residency period is defined at 
Sec. 413.86(g)(1) as the minimum number of years required for board 
eligibility, not to exceed 5 years. For purposes of determining the 
direct GME payment, residents are weighted at 1.0 FTE within the 
initial residency period, and at .5 FTE beyond the initial residency 
period. The limitation on the initial residency period was designed by 
Congress to limit full Medicare direct GME payment to the time required 
to train in a single specialty.
    MedPAC states that Medicare's current direct GME payment policy of 
limiting full funding to the first specialty in which a resident trains 
provides a disincentive for hospitals to offer training in 
subspecialties or combined programs, and therefore, may influence 
hospitals' decisions on the types of residents that they train. MedPAC 
believes that Medicare should not influence workforce policy and 
recommends that the disincentive be removed to make Medicare payments 
policies neutral with regard to programs with prerequisites, 
subspecialties, and combined programs. Accordingly, MedPAC recommends 
that Congress eliminate the weighting factors associated with direct 
GME payment so that all residents would be counted for full direct GME 
payment through the completion of their first specialty, combined 
program, or subspecialty. Residents training beyond the minimum number 
of years required for board eligibility in a specialty, combined 
program, or subspecialty should not be counted for purposes of the 
direct GME payment.
    MedPAC also believes that eliminating the weighting factors could 
potentially increase Medicare's direct GME payments by approximately 5 
to 8 percent. Therefore, MedPAC recommends that hospitals' per resident 
amounts (PRAs), which are used to calculate the direct GME payment, be 
reduced so that this change can be implemented, to the extent possible, 
in a budget-neutral manner. MedPAC explains that, although further 
research is needed, it appears that hospitals with substantial 
subspecialty training (that is, at least 15 percent of the resident 
mix) would likely see a small net increase in payments, despite the 
reduction to the PRAs, while hospitals that do not have subspecialty 
training would likely see a small decrease in payments.
    In response to MedPAC's recommendation, we question MedPAC's 
estimate that eliminating the weighting factors could increase Medicare 
direct GME payments by only 5 to 8 percent. We believe that 
subspecialty training constitutes a significant portion of all GME 
programs, and, consequently, the elimination of the weighting factors 
could potentially increase payments by far more than 8 percent. If 
budget neutrality is to be maintained, this could mean that the 
attendant reductions to the PRAs could be much greater than MedPAC 
might assume. For those teaching hospitals that have substantial 
subspecialty training, there is no guarantee that the decreases in the 
PRAs will be offset by the increases in the direct GME payments due to 
the elimination of the weighting factors.
    While the recommendation would remove the existing disincentive for 
training in subspecialties, we believe the reductions to the PRAs, 
whether they are minimal or more significant, will be far more 
detrimental to the smaller teaching hospitals that have little or no 
subspecialty training. Many of these hospitals provide care to 
beneficiaries in rural, underserved areas and in nonhospital settings. 
We believe these conditions may discourage the expansion of residency 
training in these areas. It may be inappropriate to limit the direct 
GME funding to such hospitals, considering Congress' initiatives to 
encourage residency training in rural, underserved areas and in 
nonhospital settings. We also are unclear as to how MedPAC would 
implement the proposed reduction to the PRAs. MedPAC did not explain in 
its recommendation how it would propose to do this.

VIII. Other Required Information

A. Requests for Data From the Public

    In order to respond promptly to public requests for data related to 
the prospective payment system, we have established a process under 
which commenters can gain access to raw data on an expedited basis. 
Generally, the data are available in computer tape or cartridge format; 
however, some files are available on diskette as well as on the 
Internet at http://www.hcfa.gov/stats/pubfiles.html. Data files, and 
the cost for each, are listed below. Anyone wishing to purchase data 
tapes, cartridges, or

[[Page 22715]]

diskettes should submit a written request along with a company check or 
money order (payable to HCFA-PUF) to cover the cost to the following 
address: Health Care Financing Administration, Public Use Files, 
Accounting Division, P.O. Box 7520, Baltimore, Maryland 21207-0520, 
(410) 786-3691. Files on the Internet may be downloaded without charge.
1. Expanded Modified MedPAR-Hospital (National)
    The Medicare Provider Analysis and Review (MedPAR) file contains 
records for 100 percent of Medicare beneficiaries using hospital 
inpatient services in the United States. (The file is a Federal fiscal 
year file, that is, discharges occurring October 1 through September 30 
of the requested year.) The records are stripped of most data elements 
that would permit identification of beneficiaries. The hospital is 
identified by the 6-position Medicare billing number. The file is 
available to persons qualifying under the terms of the Notice of 
Proposed New Routine Uses for an Existing System of Records published 
in the Federal Register on December 24, 1984 (49 FR 49941), and amended 
by the July 2, 1985 notice (50 FR 27361). The national file consists of 
approximately 11 million records. Under the requirements of these 
notices, an agreement for use of HCFA Beneficiary Encrypted Files must 
be signed by the purchaser before release of these data. For all files 
requiring a signed agreement, please write or call to obtain a blank 
agreement form before placing an order. Two versions of this file are 
created each year. They support the following:
     Notice of Proposed Rulemaking (NPRM) published in the 
Federal Register. This file, scheduled to be available by the end of 
April, is derived from the MedPAR file with a cutoff of 3 months after 
the end of the fiscal year (December file).
     Final Rule published in the Federal Register. The FY 2000 
MedPAR file used for the FY 2002 final rule will be cut off 6 months 
after the end of the fiscal year (March file) and is scheduled to be 
available by the end of April.

Media: Tape/Cartridge
File Cost: $3,655.00 per fiscal year
Periods Available: FY 1988 through FY 2000
2. Expanded Modified MedPAR-Hospital (State)
    The State MedPAR file contains records for 100 percent of Medicare 
beneficiaries using hospital inpatient services in a particular State. 
The records are stripped of most data elements that will permit 
identification of beneficiaries. The hospital is identified by the 6-
position Medicare billing number. The file is available to persons 
qualifying under the terms of the Notice of Proposed New Routine Uses 
for an Existing System of Records published in the December 24, 1984 
Federal Register notice, and amended by the July 2, 1985 notice. This 
file is a subset of the Expanded Modified MedPAR-Hospital (National) as 
described above. Under the requirements of these notices, an agreement 
for use of HCFA Beneficiary Encrypted Files must be signed by the 
purchaser before release of these data. Two versions of this file are 
created each year. They support the following:
     NPRM published in the Federal Register. This file, 
scheduled to be available by the end of April, is derived from the 
MedPAR file with a cutoff of 3 months after the end of the fiscal year 
(December file).
     Final Rule published in the Federal Register. The FY 2000 
MedPAR file used for the FY 2002 final rule will be cut off 6 months 
after the end of the fiscal year (March file) and is scheduled to be 
available by the end of April.

Media: Tape/Cartridge
File Cost: $1,130.00 per State per year
Periods Available: FY 1988 through FY 2000
3. HCFA Wage Data
    This file contains the hospital hours and salaries for FY 1998 used 
to create the proposed FY 2002 prospective payment system wage index. 
The file will be available by the beginning of February for the NPRM 
and the beginning of May for the final rule.

------------------------------------------------------------------------
                                                 Wage data    PPS fiscal
                Processing year                     year         year
------------------------------------------------------------------------
2001..........................................         1998         2002
2000..........................................         1997         2001
1999..........................................         1996         2000
1998..........................................         1995         1999
1997..........................................         1994         1998
1996..........................................         1993         1997
1995..........................................         1992         1996
1994..........................................         1991         1995
1993..........................................         1990         1994
1992..........................................         1989         1993
1991..........................................         1988         1992
------------------------------------------------------------------------

    These files support the following:
     NPRM published in the Federal Register.
     Final Rule published in the Federal Register.

Media: Diskette/most recent year on the Internet
File Cost: $165.00 per year
Periods Available: FY 2002 PPS Update
4. HCFA Hospital Wages Indices (Formerly: Urban and Rural Wage Index 
Values Only)
    This file contains a history of all wage indices since October 1, 
1983.

Media: Diskette/most recent year on the Internet
File Cost: $165.00 per year
Periods Available: FY 2002 PPS Update
5. PPS SSA/FIPS MSA State and County Crosswalk
    This file contains a crosswalk of State and county codes used by 
the Social Security Administration (SSA) and the Federal Information 
Processing Standards (FIPS), county name, and a historical list of 
Metropolitan Statistical Area (MSA).

Media: Diskette/Internet
File Cost: $165.00 per year
Periods Available: FY 2002 PPS Update
6. Reclassified Hospitals New Wage Index (Formerly: Reclassified 
Hospitals by Provider Only)
    This file contains a list of hospitals that were reclassified for 
the purpose of assigning a new wage index. Two versions of these files 
are created each year. They support the following:
     NPRM published in the Federal Register.
     Final Rule published in the Federal Register.

Media: Diskette/Internet
File Cost: $165.00 per year
Periods Available: FY 2002 PPS Update
7. PPS-IV to PPS-XII Minimum Data Set
    The Minimum Data Set contains cost, statistical, financial, and 
other information from Medicare hospital cost reports. The data set 
includes only the most current cost report (as submitted, final 
settled, or reopened) submitted for a Medicare participating hospital 
by the Medicare fiscal intermediary to HCFA. This data set is updated 
at the end of each calendar quarter and is available on the last day of 
the following month.

Media: Tape/Cartridge
File Cost: $770.00 per year

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    And before
                                                on or after
------------------------------------------------------------------------
PPS-IV........................................     10/01/86     10/01/87
PPS-V.........................................     10/01/87     10/01/88
PPS-VI........................................     10/01/88     10/01/89
PPS-VII.......................................     10/01/89     10/01/90
PPS-VIII......................................     10/01/90     10/01/91
PPS-IX........................................     10/01/91     10/01/92
PPS-X.........................................     10/01/92     10/01/93
PPS-XI........................................     10/01/93     10/01/94
PPS-XII.......................................     10/01/94     10/01/95
------------------------------------------------------------------------



[[Page 22716]]

    Note: The PPS-XIII, PPS-XIV, PPS-XV, and PPS-XVI Minimum Data 
Sets are part of the PPS-XIII, PPS-XIV, PPS-XV, and PPS XVI Hospital 
Data Set Files.

8. PPS-IX to PPS-XII Capital Data Set
    The Capital Data Set contains selected data for capital-related 
costs, interest expense and related information and complete balance 
sheet data from the Medicare hospital cost report. The data set 
includes only the most current cost report (as submitted, final settled 
or reopened) submitted for a Medicare certified hospital by the 
Medicare fiscal intermediary to HCFA. This data set is updated at the 
end of each calendar quarter and is available on the last day of the 
following month.

Media: Tape/Cartridge
File Cost: $770.00 per year

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    And before
                                                on or after
------------------------------------------------------------------------
PPS-IX........................................     10/01/91     10/01/92
PPS-X.........................................     10/01/92     10/01/93
PPS-XI........................................     10/01/93     10/01/94
PPS-XII.......................................     10/01/94     10/01/95
------------------------------------------------------------------------


    Note: The PPS-XIII, PPS-XIV, PPS-XV, and PPS-XVI Capital Data 
Sets are part of the PPS-XIII, PPS-XIV, PPS-XV, and PPS-XVI Hospital 
Data Set Files.

9. PPS-XIII to PPS-XVI Hospital Data Set
    The file contains cost, statistical, financial, and other data from 
the Medicare Hospital Cost Report. The data set includes only the most 
current cost report (as submitted, final settled, or reopened) 
submitted for a Medicare-certified hospital by the Medicare fiscal 
intermediary to HCFA. The data set are updated at the end of each 
calendar quarter and is available on the last day of the following 
month.

Media: Diskette/Internet
File Cost: $2,500.00

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    And before
                                                on or after
------------------------------------------------------------------------
PPS-XIII......................................     10/01/95     10/01/96
PPS-XIV.......................................     10/01/96     10/01/97
PPS-XV........................................     10/01/97     10/01/98
PPS-XVI.......................................     10/01/98     10/01/99
------------------------------------------------------------------------

10. Provider-Specific File
    This file is a component of the PRICER program used in the fiscal 
intermediary's system to compute DRG payments for individual bills. The 
file contains records for all prospective payment system eligible 
hospitals, including hospitals in waiver States, and data elements used 
in the prospective payment system recalibration processes and related 
activities. Beginning with December 1988, the individual records were 
enlarged to include pass-through per diems and other elements.

Media: Diskette/Internet
File Cost: $265.00
Periods Available: FY 2002 PPS Update
11. HCFA Medicare Case-Mix Index File
    This file contains the Medicare case-mix index by provider number 
as published in each year's update of the Medicare hospital inpatient 
prospective payment system. The case-mix index is a measure of the 
costliness of cases treated by a hospital relative to the cost of the 
national average of all Medicare hospital cases, using DRG weights as a 
measure of relative costliness of cases. Two versions of this file are 
created each year. They support the following:
     NPRM published in the Federal Register.
     Final rule published in the Federal Register.

Media: Diskette/most recent year on Internet
Price: $165.00 per year/per file
Periods Available: FY 1985 through FY 2000
12. DRG Relative Weights (Formerly Table 5 DRG)
    This file contains a listing of DRGs, DRG narrative description, 
relative weights, and geometric and arithmetic mean lengths of stay as 
published in the Federal Register. The hard copy image has been copied 
to diskette. There are two versions of this file as published in the 
Federal Register:
     NPRM.
     Final rule.

Media: Diskette/Internet
File Cost: $165.00
Periods Available: FY 2002 PPS Update
13. PPS Payment Impact File
    This file contains data used to estimate payments under Medicare's 
hospital inpatient prospective payment systems for operating and 
capital-related costs. The data are taken from various sources, 
including the Provider-Specific File, Minimum Data Sets, and prior 
impact files. The data set is abstracted from an internal file used for 
the impact analysis of the changes to the prospective payment systems 
published in the Federal Register. This file is available for release 1 
month after the proposed and final rules are published in the Federal 
Register.

Media: Diskette/Internet
File Cost: $165.00
Periods Available: FY 2002 PPS Update
14. AOR/BOR Tables
    This file contains data used to develop the DRG relative weights. 
It contains mean, maximum, minimum, standard deviation, and coefficient 
of variation statistics by DRG for length of stay and standardized 
charges. The BOR tables are ``Before Outliers Removed'' and the AOR is 
``After Outliers Removed.'' (Outliers refers to statistical outliers, 
not payment outliers.) Two versions of this file are created each year. 
They support the following:
     NPRM published in the Federal Register.
     Final rule published in the Federal Register.

Media: Diskette/Internet
File Cost: $165.00
Periods Available: FY 2002 PPS Update

    For further information concerning these data tapes, contact the 
HCFA Public Use Files Hotline at (410) 786-3691.
    Commenters interested in obtaining or discussing any other data 
used in constructing this rule should contact Stephen Phillips at (410) 
786-4531.

B. Information Collection Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 requires that we solicit comment on the following issues:
     The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
     The accuracy of our estimate of the information collection 
burden.
     The quality, utility, and clarity of the information to be 
collected.
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    We are soliciting public comments on each of these issues for the 
sections that contain information collection requirements.

[[Page 22717]]

Proposed New Sec. 412.230(e)(2)(ii)  Criteria for an Individual 
Hospital Seeking Redesignation to Another Rural Area or an Urban Area; 
Proposed New Sec. 412.232(d)(2)(ii)  Criteria for All Hospitals in a 
Rural County Seeking Urban Redesignation; Proposed New Sec. 412.235  
Criteria for All Hospitals in a State Seeking a Statewide Wage Index; 
and Proposed Revised Sec. 412.273  Withdrawing an Application or 
Terminating an Approved 3-Year Reclassification

    Proposed Secs. 412.230(e)(2)(ii) and 412.232(d)(2)(ii) specify 
that, for hospital-specific data for wage index changes for 
redesignations effective beginning FY 2003, the hospital must provide a 
3-year average of its average hourly wages using data from the HCFA 
hospital wage survey used to construct the wage index in effect for 
prospective payment purposes. For other data, the hospital must provide 
a weighted 3-year average of the average hourly wage in the area in 
which the hospital is located and a weighted 3-year average of the 
average hourly wage in the area to which the hospital seeks 
reclassification. Proposed new Sec. 412.235 specifies that in order for 
all prospective payment system hospitals in a State to use a statewide 
wage index, the hospitals as a group must submit an application to the 
MGCRB for a decision for reclassifications for wage index purposes. The 
proposed changes to Sec. 412.273 would incorporate proposed revised 
procedures for hospitals that request withdraw of their wage index 
application or termination of their wage index reclassification. These 
proposed changes, discussed in detail in section IV.E. of this proposed 
rule, implement sections 304(a) and (b) of Public Law 106-554.
    The information collection requirements associated with a 
hospital's application to the MGCRB for geographic reclassifications, 
including reclassifications for wage index purposes and the required 
submittal of wage data, that are codified in Part 412 are currently 
approved by OMB under OMB Approval Number 0938-0573, with an expiration 
date of September 30, 2002.

Proposed Sec. 412.348(g)(9)  Exception Payments

    As discussed in section V. of this proposed rule, Medicare makes 
special exceptions payments for capital-related costs through the 10th 
year beyond the end of the capital prospective payment system 
transition period for eligible hospitals that complete a project that 
meets certain requirements specified in Sec. 412.348. In order to 
assist our fiscal intermediaries in determining the end of the 10-year 
period in which an eligible hospital will no longer be entitled to 
receive special exception payments, we are proposing to add a new 
Sec. 412.348(g)(9) to require that hospitals eligible for special 
exception payments under Sec. 412.348(g) submit documentation to the 
intermediary indicating the completion date of their project (the date 
the project was put in use for patient care) that meets the project 
need and project size requirements outlined in Secs. 412.348(g)(2) 
through (g)(5). We are proposing that, in order for an eligible 
hospital to receive special exception payments, this documentation 
would have to be submitted in writing to the intermediary by the later 
of October 1, 2001, or within 3 months of the end of the hospital's 
last cost reporting period beginning before October 1, 2001, during 
which a qualifying project was completed.
    We estimate that the information collection requirement of 
preparing and submitting the documentation on a hospital's capital 
project would impose a burden of approximately 1 hour for approximately 
30 hospitals.
    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following addresses:

Health Care Financing Administration, Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards 
Room N2-14-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850, 
Attn: John Burke HCFA-1158-P; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 3001, New Executive Office Building, Washington, DC 20503, 
Attn: Allison Herron Eydt, HCFA Desk Officer.

    These new information collection and recordkeeping requirements 
have been submitted to the Office of Management and Budget (OMB) for 
review under the authority of PRA. We have submitted a copy of the 
proposed rule to OMB for its review of the information collection 
requirements. These requirements will not be effective until they have 
been approved by OMB.

C. Public Comments

    Because of the large number of items of correspondence we normally 
receive on a proposed rule, we are not able to acknowledge or respond 
to them individually. However, in preparing the final rule, we will 
consider all comments concerning the provisions of this proposed rule 
that we receive by the date and time specified in the DATES section of 
this preamble and respond to those comments in the preamble to that 
rule. We emphasize that section 1886(e)(5) of the Act requires the 
final rule for FY 2002 to be published by August 1, 2001, and we will 
consider only those comments that deal specifically with the matters 
discussed in this proposed rule.

List of Subjects

42 CFR Part 405

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements, Rural areas, X-rays.

42 CFR Part 412

    Administrative practice and procedure, Health facilities, Medicare, 
Puerto Rico, Reporting and recordkeeping requirements.

42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Puerto Rico, 
Reporting and recordkeeping requirements.

42 CFR Part 485

    Grant programs-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

42 CFR Part 486

    Health professions, Medicare, Organ procurement, X-rays.

    42 CFR Chapter IV is proposed to be amended as set forth below:

PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

    A. Part 405 is amended as set forth below:
    1. The authority citation for Part 405 continues to read as 
follows:

    Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 
1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 
1395hh, 1395kk, 1395rr, and 1395ww(k), and sec. 353 of the Public 
Health Service Act (42 U.S.C. 263a).

    2. In Sec. 405.2468, paragraph (f)(6)(ii) is republished and 
paragraph (f)(6)(ii)(D) is revised to read as follows.


Sec. 405.2468  Allowable costs.

* * * * *
    (f) Graduate medical education. * * *
    (6) * * *

[[Page 22718]]

    (ii) The following costs are not allowable graduate medical 
education costs:
* * * * *
    (D) The costs associated with activities described in 
Sec. 413.85(h) of this chapter.
* * * * *

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL 
SERVICES

    B. Part 412 is amended as follows:
    1. The authority citation for Part 412 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. Section 412.2 is amended as follows:
    a. The introductory text of paragraph (e) is republished.
    b. Paragraph (e)(4) is revised.
    c. The introductory text of paragraph (f) is republished.
    d. A new paragraph (f)(9) is added.


Sec. 412.2  Basis of payment.

* * * * *
    (e) Excluded costs. The following inpatient hospital costs are 
excluded from the prospective payment amounts and are paid on a 
reasonable cost basis:
* * * * *
    (4) The acquisition costs of hearts, kidneys, livers, lungs, 
pancreas, and intestines (or multivisceral organs) incurred by approved 
transplantation centers.
* * * * *
    (f) Additional payments to hospitals. In addition to payments based 
on the prospective payment system rates for inpatient operating and 
inpatient capital-related costs, hospitals receive payments for the 
following:
* * * * *
    (9) Special additional payment for certain new technology as 
specified in Sec. 412.87 and 412.88 of Subpart F.
    3. Section 412.23 is amended by adding a new paragraph (i) to read 
as follows:


Sec. 412.23  Excluded hospitals: Classifications.

* * * * *
    (i) Changes in classification of hospitals. For purposes of 
exclusions from the prospective payment system, the classification of a 
hospital is effective for the hospital's entire cost reporting period. 
Any changes in the classification of a hospital are made only at the 
start of a cost reporting period.
    4. Section 412.25 is amended by adding a new paragraph (f) to read 
as follows:


Sec. 412.25  Excluded hospital units: Common requirements.

* * * * *
    (f) Changes in classification of hospital units. For purposes of 
exclusions from the prospective payment system under this section, the 
classification of a hospital unit is effective for the unit's entire 
cost reporting period. Any changes in the classification of a hospital 
unit is made only at the start of a cost reporting period.
    5. Section 412.63 is amended by revising paragraphs (t) and (u) to 
read as follows:


Sec. 412.63  Federal rates for inpatient operating costs for fiscal 
years after Federal fiscal year 1984.

* * * * *
    (t) Applicable percentage change for fiscal years 2002 and 2003. 
The applicable percentage change for fiscal years 2002 and 2003 is the 
percentage increase in the market basket index for prospective payment 
hospitals (as defined in Sec. 413.40(a) of this subchapter) minus 0.55 
percentage points for hospitals in all areas.
    (u) Applicable percentage change for fiscal year 2004 and for 
subsequent fiscal years. The applicable percentage change for fiscal 
year 2004 and for subsequent years is the percentage increase in the 
market basket index for prospective payment hospitals (as defined in 
Sec. 413.40(a) of this subchapter) for hospitals in all areas.
* * * * *
    6. The title of Subpart F is revised to read as follows:

Subpart F--Payment for Outlier Cases and Special Treatment Payment 
for New Technology

    7. A new undesignated center heading is added after the Subpart F 
heading and before Sec. 412.80; the section heading of Sec. 412.80 is 
revised; and a new paragraph (a)(3) is added to read as follows:

Payment for Outlier Cases


Sec. 412.80  Outlier cases: General provisions.

    (a) Basic rule.
* * * * *
    (3) Discharges occurring on or after October 1, 2001. For 
discharges occurring on or after October 1, 2001, except as provided in 
paragraph (b) of this section concerning transfers, HCFA provides for 
additional payment, beyond standard DRG payments and beyond additional 
payments for new medical services or technology specified in 
Secs. 412.87 and 412.88, to a hospital for covered inpatient hospital 
services furnished to a Medicare beneficiary if the hospital's charges 
for covered services, adjusted to operating costs and capital costs by 
applying cost-to-charge ratios as described in Sec. 412.84(h), exceed 
the DRG payment for the case (plus payments for indirect costs of 
graduate medical education (Sec. 412.105), payments for serving a 
disproportionate share of low-income patients (Sec. 412.106), and 
additional payments for new medical services or technologies) plus a 
fixed dollar amount (adjusted for geographic variation in costs) as 
specified by HCFA.
* * * * *
    8. A new undesignated center heading and Secs. 412.87 and 412.88 
are added immediately following Sec. 412.86, to read as follows:

Additional Special Payment for Certain New Technology


Sec. 412.87  Additional payment for new medical services and 
technologies: General provisions.

    (a) Basis. Sections 412.87 and 412.88 implement sections 
1886(d)(5)(K) and 1886(d)(5)(L) of the Act, which authorizes the 
Secretary to establish a mechanism to recognize the costs of new 
medical services and technologies under the hospital inpatient 
prospective payment system.
    (b) Eligibility criteria. For discharges occurring on or after 
October 1, 2001, HCFA provides for additional payments (as specified in 
Sec. 412.88) beyond the standard DRG payments and outlier payments to a 
hospital for discharges involving covered inpatient hospital services 
that are new medical services and technologies, if the following 
conditions are met:
    (1) A new medical service or technology represents an advance that 
substantially improves, relative to technologies previously available, 
the diagnosis or treatment of Medicare beneficiaries. HCFA will 
determine whether a new medical service or technology meets this 
criterion and announce the results of its determinations in the Federal 
Register as a part of its annual updates and changes to the hospital 
inpatient prospective payment system.
    (2) A medical service or technology may be considered new within 2 
or 3 years after it becomes available on the market (depending on when 
a new code is assigned and data on the new service or technology become 
available for DRG recalibration). After HCFA has recalibrated the DRGs, 
based on

[[Page 22719]]

available data, to reflect the costs of an otherwise new medical 
service or technology, the medical service or technology will no longer 
be considered ``new'' under the criterion of this section.
    (3) The DRG prospective payment rate otherwise applicable to 
discharges involving the medical service or technology is determined to 
be inadequate, based on application of a threshold amount to estimated 
costs incurred with respect to such discharges. To determine whether 
the payment would be adequate, HCFA will determine whether the costs of 
the cases involving a new medical service or technology will exceed a 
threshold amount set at one standard deviation beyond the mean 
standardized charge for all cases in the DRG to which the new medical 
service or technology is assigned (or the case-weighted average of all 
relevant DRGs if the new medical service or technology occurs in many 
different DRGs). Standardized charges reflect the actual charges of a 
case adjusted by the prospective payment system payment factors 
applicable to an individual hospital, such as the wage index, the 
indirect medical education adjustment factor, and the disproportionate 
share adjustment factor.


Sec. 412.88  Additional payment for new medical service or technology.

    (a) For discharges involving new medical services or technologies 
that meet the criteria specified in Sec. 412.87, Medicare payment will 
be:
    (1) The standard DRG payment; plus
    (2) If the costs of the discharge (determined by applying cost-to-
charge ratios as described in Sec. 412.84(h)) exceed the standard DRG 
payment, an additional amount equal to the lesser of--
    (i) 50 percent of the costs of the new medical service or 
technology; or
    (ii) 50 percent of the amount by which the costs of the case exceed 
the standard DRG payment.
    (b) Unless a discharge case qualifies for outlier payment under 
Sec. 412.84, Medicare will not pay any additional amount beyond the DRG 
payment plus 50 percent of the estimated costs of the new medical 
service or technology.
    9. Section 412.92 is amended as follows:
    a. Paragraph (b)(1)(iii)(A) is amended by revising the phrase ``50 
mile radius'' to read ``35 mile radius.''
    b. Paragraph (c)(1) is revised.


Sec. 412.92  Special treatment: Sole community hospitals.

* * * * *
    (c) Terminology. * * *
    (1) The term miles means the shortest distance in miles measured 
over improved roads. An improved road for this purpose is any road that 
is maintained by a local, State, or Federal government entity and is 
available for use by the general public. An improved road includes the 
paved surface up to the front entrance of the hospital.
* * * * *
    10. Section 412.105 is amended as follows:
    a. The introductory text of paragraph (a) is republished.
    b. Paragraph (a)(1) is revised.
    c. Paragraph (d)(3)(vi) is revised.
    d. A new paragraph (d)(3)(vii) is added.
    e. Paragraph (f)(1)(ii)(C) is revised.
    f. Paragraph (f)(1)(iii) is revised.
    g. Paragraph (f)(1)(v) is amended by adding four sentences at the 
end.
    h. Paragraph (f)(1)(ix) is revised.


Sec. 412.105  Special treatment: Hospitals that incur indirect costs 
for graduate medical education programs.

* * * * *
    (a) Basic data. HCFA determines the following for each hospital:
    (1) The hospital's ratio of full-time equivalent residents, except 
as limited under paragraph (f) of this section, to the number of beds 
(as determined under paragraph (b) of this section). Except for the 
special circumstances for affiliated groups and new programs described 
in paragraphs (f)(1)(vi) and (f)(1)(vii) of this section, for a 
hospital's cost reporting periods beginning on or after October 1, 
1997, this ratio may not exceed the ratio for the hospital's most 
recent prior cost reporting period after accounting for the cap on the 
number of full-time equivalent residents as described in paragraph 
(f)(1)(iv) of this section. The exception for new programs described in 
paragraph (f)(1)(vii) of this section applies for the period of years 
equal to the minimum accredited length for that type of program.
* * * * *
    (d) Determination of education adjustment factor.
* * * * *
    (3) * * *
    (vi) For discharges occurring during fiscal year 2002, 1.6.
    (vii) For discharges occurring on or after October 1, 2002, 1.35.
* * * * *
    (f) Determining the total number of full-time equivalent residents 
for cost reporting periods beginning on or after July 1, 1991.
    (1) * * *
    (ii) * * *
    (C) Effective for discharges occurring on or after October 1, 1997, 
the time spent by a resident in a non-hospital setting in patient care 
activities under an approved medical residency training program is 
counted towards the determination of full-time equivalency if the 
criteria set forth in Sec. 413.86(f)(3) or Sec. 413.86 (f)(4), as 
applicable, are met.
    (iii) (A) Full-time equivalent status is based on the total time 
necessary to fill a residency slot. No individual may be counted as 
more than one full-time equivalent. If a resident is assigned to more 
than one hospital, the resident counts as a partial full-time 
equivalent based on the proportion of time worked in any of the areas 
of the hospital listed in paragraph (f)(1)(ii) of this section, to the 
total time worked by the resident. A part-time resident or one working 
in an area of the hospital other than those listed under paragraph 
(f)(1)(ii) of this section (such as a freestanding family practice 
center or an excluded hospital unit) would be counted as a partial 
full-time equivalent based on the proportion of time assigned to an 
area of the hospital listed in paragraph (f)(1)(ii) of this section, 
compared to the total time necessary to fill a full-time residency 
slot.
    (B) The time spent by a resident in research that is not associated 
with the treatment or diagnosis of a particular patient of the hospital 
is not countable.
* * * * *
    (v) * * * If a hospital qualified for an adjustment to the limit 
established under paragraph (f)(1)(iv) of this section for new medical 
residency programs created under paragraph (f)(1)(vii) of this section, 
the count of residents participating in new medical residency training 
programs above the number included in the hospital's FTE count for the 
cost reporting period ending during calendar year 1996 is added after 
applying the averaging rules in this paragraph for a period of years. 
Residents participating in new medical residency training programs are 
included in the hospital's FTE count before applying the averaging 
rules after the period of years has expired. For purposes of this 
paragraph, the period of years equals the minimum accredited length for 
the type of program. The period of years begins when the first resident 
begins training.
* * * * *
    (ix) A hospital may receive a temporary adjustment to its full-time 
equivalent cap to reflect residents added because of another hospital's 
closure if the hospital meets the criteria specified in 
Secs. 413.86(g)(8)(i) and (g)(8)(ii) of this

[[Page 22720]]

subchapter. If a hospital that closes its residency training program 
agrees to temporarily reduce its FTE cap according to the criteria 
specified in Secs. 413.86(g)(8)(i) and (g)(8)(iii)(B) of this 
subchapter, another hospital(s) may receive a temporary adjustment to 
its FTE cap to reflect residents added because of the closure of the 
residency training program if the criteria specified in 
Secs. 413.86(g)(8)(i) and (g)(8)(iii)(A) of this subchapter are met.
* * * * *
    11. Section 412.106 is amended by revising the heading of paragraph 
(e) and paragraph (e)(5) to read as follows:


Sec. 412.106  Special treatment: Hospitals that serve a 
disproportionate share of low-income patients.

* * * * *
    (e) Reduction in payments beginning FY 1998. * * *
    (5) For FY 2002, 3 percent.
* * * * *


Sec. 412.113  [Amended]

    12. In Sec. 412.113(c), including the heading for paragraph (c), 
the term ``hospital'', wherever it appears, is revised to read 
``hospital or CAH'' (16 times).
    13. Section 412.230 is amended by revising paragraph (e)(2) to read 
as follows:


Sec. 412.230  Criteria for an individual hospital seeking redesignation 
to another rural area or an urban area.

* * * * *
    (e) Use of urban or other rural area's wage index.
* * * * *
    (2) Appropriate wage data. For a wage index change, the hospital 
must submit appropriate wage data as follows:
    (i) For redesignations effective through FY 2002:
    (A) For hospital-specific data, the hospital must provide data from 
the HCFA hospital wage survey used to construct the wage index in 
effect for prospective payment purposes during the fiscal year prior to 
the fiscal year for which the hospital requests reclassification.
    (B) For data for other hospitals, the hospital must provide data 
concerning the average hourly wage in the area in which the hospital is 
located and the average hourly wage in the area to which the hospital 
seeks reclassification. The wage data are taken from the HCFA hospital 
wage survey used to construct the wage index in effect for prospective 
payment purposes during the fiscal year prior to the fiscal year for 
which the hospital requests reclassification.
    (C) If the hospital is requesting reclassification under paragraph 
(e)(1)(iv)(B) of this section, the hospital must provide occupational-
mix data to demonstrate the average occupational mix for each 
employment category in the area to which it seeks reclassification. 
Occupational-mix data can be obtained from surveys conducted by the 
American Hospital Association.
    (ii) For redesignations effective beginning FY 2003:
    (A) For hospital-specific data, the hospital must provide a 
weighted 3-year average of its average hourly wages using data from the 
HCFA hospital wage survey used to construct the wage index in effect 
for prospective payment purposes.
    (B) For data for other hospitals, the hospital must provide a 
weighted 3-year average of the average hourly wage in the area in which 
the hospital is located and a weighted 3-year average of the average 
hourly wage in the area to which the hospital seeks reclassification. 
The wage data are taken from the HCFA hospital wage survey used to 
construct the wage index in effect for prospective payment purposes.
* * * * *
    14. Section 412.232 is amended by revising paragraph (d)(2) to read 
as follows:


Sec. 412.232  Criteria for all hospitals in a rural county seeking 
urban redesignation.

* * * * *
    (d) Appropriate data.
* * * * *
    (2) Appropriate wage data. The hospitals must submit appropriate 
data as follows:
    (i) For redesignations effective through FY 2002:
    (A) For hospital-specific data, the hospitals must provide data 
from the HCFA wage survey used to construct the wage index in effect 
for prospective payment purposes during the fiscal year prior to the 
fiscal year for which the hospitals request reclassification.
    (B) For data for other hospitals, the hospitals must provide the 
following:
    (1) The average hourly wage in the adjacent area, which is taken 
from the HCFA hospital wage survey used to construct the wage index in 
effect for prospective payment purposes during the fiscal year prior to 
the fiscal year for which the hospitals request reclassification.
    (2) Occupational-mix data to demonstrate the average occupational 
mix for each employment category in the adjacent area. Occupational-mix 
data can be obtained from surveys conducted by the American Hospital 
Association.
    (ii) For redesignations effective beginning FY 2003:
    (A) For hospital-specific data, the hospital must provide a 
weighted 3-year average of its average hourly wages using data from the 
HCFA hospital wage survey used to construct the wage index in effect 
for prospective payment purposes.
    (B) For data for other hospitals, the hospital must provide a 
weighted 3-year average of the average hourly wage in the area in which 
the hospital is located and a weighted 3-year average of the average 
hourly wage in the area to which the hospital seeks reclassification. 
The wage data are taken from the HCFA hospital wage survey used to 
construct the wage index in effect for prospective payment purposes.
    15. Section 412.235 is added to read as follows:


Sec. 412.235  Criteria for all hospitals in a State seeking a statewide 
wage index redesignation.

    (a) General criteria. For all prospective payment system hospitals 
in a State to be redesignated to a statewide wage index, the following 
conditions must be met:
    (1) All prospective payment system hospitals in the State must 
apply as a group for reclassification to a statewide wage index through 
a signed single application.
    (2) All prospective payment system hospitals in the State must 
agree to the reclassification to a statewide wage index through a 
signed affidavit on the application.
    (3) All prospective payment system hospitals in the State must 
agree, through an affidavit, to withdrawal of an application or to 
termination of an approved statewide wage index reclassification.
    (4) All hospitals in the State must waive their rights to any wage 
index classification that they would otherwise receive absent the 
statewide wage index classification, including a wage index that any of 
the hospitals might have received through individual geographic 
reclassification.
    (5) New hospitals that open within the State prior to the deadline 
for submitting an application for a statewide wage index 
reclassification (September 1), regardless of whether a group 
application has already been filed, must agree to the use of the 
statewide wage index as part of the group application. New hospitals 
that open within the State after the deadline for submitting a 
statewide wage index reclassification application or during the 
approved reclassification period will be considered a party to the 
statewide

[[Page 22721]]

wage index application and reclassification.
    (b) Effect on payments. (1) An individual hospital within the State 
may receive a wage index that could be higher or lower under the 
statewide wage index reclassification in comparison to its otherwise 
redesignated wage index.
    (2) Any new prospective payment system hospital that opens in the 
State during the effective period of an approved statewide wage index 
reclassification will be designated to receive the statewide wage index 
for the duration of that period.
    (3) A hospital located in an area outside a State in which all 
participating hospitals have received an approved statewide wage index 
reclassification may apply to be reclassified into the statewide wage 
index area. In that case, such a hospital that is reclassified into a 
statewide wage index area will receive a wage index calculated based on 
the statewide wage index reclassification.
    (c) Terms of the decision. (1) A decision by the MGCRB on an 
application for a statewide wage index reclassification will be 
effective for 3 years beginning with discharges occurring on the first 
day (October 1) of the second Federal fiscal year following the Federal 
fiscal year in which the hospitals filed a complete application.
    (2) The procedures and timeframes specified in Sec. 412.273 apply 
to withdrawals of applications for redesignation to a statewide wage 
index and terminations of approved statewide wage index 
reclassifications, including the requirement that, to withdraw an 
application or terminate an approved reclassification, the request must 
be made in writing by all hospitals that are party to the application, 
except hospitals reclassified into the State for purposes of receiving 
the statewide wage index.
    16. Section 412.273 is amended as follows:
    a. The title of the section is revised.
    b. Paragraphs (b) and (c) are redesignated as paragraphs (c) and 
(d), respectively.
    c. A new paragraph (b) is added.
    d. Redesignated paragraph (c) is revised.


Sec. 412.273  Withdrawing an application or terminating an approved 3-
year reclassification.

* * * * *
    (b) Request for termination of approved 3-year wage index 
reclassifications.
    (1) A hospital, or a group of hospitals, that has been issued a 
decision on its application for a 3-year reclassification for wage 
index purposes only or for redesignation to a statewide wage index and 
has not withdrawn that application under the procedures specified in 
paragraph (a) of this section may request termination of its approved 
3-year wage index reclassification under the following conditions:
    (i) The request to terminate must be received by the MGCRB within 
45 days of the publication of the annual notice of proposed rulemaking 
concerning changes to the inpatient hospital prospective payment system 
and proposed payment rates for the fiscal year for which the 
termination is to apply.
    (ii) A request to terminate a 3-year reclassification will be 
effective only for the full fiscal year(s) remaining in the 3-year 
period at the time the request is received. Requests for terminations 
for part of a fiscal year will not be considered.
    (2) Reapplication within the approved 3-year period.
    (i) If a hospital elects to withdraw its wage index application 
after the MGCRB has issued its decision, it may terminate its 
withdrawal in a subsequent fiscal year and request the MGCRB to 
reinstate its wage index reclassification for the remaining fiscal 
year(s) of the 3-year period.
    (ii) A hospital may apply for reclassification for purposes of the 
wage index to a different area (that is, an area different from the one 
to which it was originally reclassified for the 3-year period). If the 
application is approved, the reclassification will be effective for 3 
years.
    (c) Written request only. A request to withdraw an application or 
terminate an approved reclassification must be made in writing to the 
MGCRB by all hospitals that are party to the application or 
reclassification.
* * * * *
    17. Section 412.274 is amended by revising paragraph (b) to read as 
follows:


Sec. 412.274  Scope and effect of an MGCRB decision.

* * * * *
    (b) Effective date and term of the decision. (1) A standardized 
amount classification change is effective for one year beginning with 
discharges occurring on the first day (October 1) of the second Federal 
fiscal year following the Federal fiscal year in which the complete 
application is filed and ending effective at the end of that Federal 
fiscal year (the end of the next September 30).
    (2) A wage index classification change is effective for 3 years 
beginning with discharges occurring on the first day (October 1) of the 
second Federal fiscal year in which the complete application is filed.
* * * * *
    18. Section 412.348 is amended by revising paragraph (g)(6) and 
adding a new paragraph (g)(9) to read as follows:


Sec. 412.348  Exception payments.

* * * * *
    (g) Special exceptions process. * * *
    (6) Minimum payment level.
    (i) The minimum payment level for qualifying hospitals will be 70 
percent.
    (ii) HCFA will adjust the minimum payment level in one percentage 
point increments as necessary to satisfy the requirement specified in 
paragraph (h) of this section that total estimated payments under the 
exceptions process not exceed 10 percent of the total estimated capital 
prospective payment system payments for the same fiscal year.
* * * * *
    (9) Notification requirement. Eligible hospitals must submit 
documentation to the intermediary indicating the completion date of a 
project that meets the project need requirement under paragraph (g)(2) 
of this section, the project size requirement under paragraph (g)(5) of 
this section, and, in the case of certain urban hospitals, an excess 
capacity test under paragraph (g)(4) of this section, by the later of 
October 1, 2001 or within 3 months of the end of the hospital's last 
cost reporting period beginning before October 1, 2001, during which a 
qualifying project was completed.
* * * * *

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED 
PAYMENT RATES FOR SKILLED NURSING FACILITIES

    C. Part 413 is amended as follows:
    1. The authority citation for Part 413 is revised to read as 
follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 
U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395hh, 1395rr, 1395tt, and 1395ww).

    2. Section 413.70 is amended as follows:
    a. Paragraph (a)(1) introductory text is republished.
    b. A new paragraph (a)(1)(iv) is added.
    c. Paragraph (a)(2) is revised.
    d. A new paragraph (a)(3) is added.
    e. Paragraph (b)(1) is revised.

[[Page 22722]]

    f. Paragraph (b)(2)(i)(C) is revised.
    g. New paragraphs (b)(4), (b)(5) and (b)(6) are added.


Sec. 413.70  Payment for services of a CAH.

    (a) Payment for inpatient services furnished by a CAH.
    (1) Payment for inpatient services of a CAH is the reasonable costs 
of the CAH in providing CAH services to its inpatients, as determined 
in accordance with section 1861(v)(1)(A) of the Act and the applicable 
principles of cost reimbursement in this part and in Part 415 of this 
chapter, except that the following payment principles are excluded when 
determining payment for CAH inpatient services:
* * * * *
    (iv) The payment window provisions for preadmission services, 
specified in Sec. 412.2(c)(5) of this subchapter and Sec. 413.40(c)(2).
    (2) Except as specified in paragraph (a)(3) of this section, 
payment to a CAH for inpatient services does not include any costs of 
physician services or other professional services to CAH inpatients, 
and is subject to the Part A hospital deductible and coinsurance, as 
determined under subpart G of part 409 of this chapter.
    (3) If a CAH meets the criteria in Sec. 412.113(c) of this 
subchapter for pass-through of costs of anesthesia services furnished 
by qualified nonphysician anesthetists employed by the CAH or obtained 
under arrangements, payment to the CAH for the costs of those services 
is made in accordance with Sec. 412.113(c).
    (b) Payment for outpatient services furnished by CAH.--(1) General. 
(i) Unless the CAH elects to be paid for services to its outpatients 
under the method specified in paragraph (b)(3) of this section, the 
amount of payment for outpatient services of a CAH is the amount 
determined under paragraph (b)(2) of this section.
    (ii) Except as specified in paragraph (b)(6) of this section, 
payment to a CAH for outpatient services does not include any costs of 
physician services or other professional services to CAH outpatients.
* * * * *
    (2) Reasonable costs for facility services.
    (i) * * *
    (C) Any type of reduction to operating or capital costs under 
Sec. 413.124 or Sec. 413.130(j).
* * * * *
    (4) Costs of emergency room on-call physicians. (i) Effective for 
cost reporting periods beginning on or after October 1, 2001, the 
reasonable costs of outpatient CAH services under paragraph (b) of this 
section may include amounts for reasonable compensation and related 
costs for an emergency room physician who is on call but who is not 
present on the premises of the CAH involved, is not otherwise 
furnishing physicians' services, and is not on call at any other 
provider or facility.
    (ii) For purposes of this paragraph (b)(4)--
    (A) ``Amounts for reasonable compensation and related costs'' means 
all allowable costs of compensating emergency room physicians who are 
on call to the extent the costs are found to be reasonable under the 
rules specified in paragraph (b)(2) of this section and the applicable 
sections of Part 413. Costs of compensating emergency room physicians 
are allowable only if the costs are incurred under written contracts 
that require the physician to come to the CAH when the physician's 
presence is medically required.
    (B) An ``emergency room physician who is on call' means a doctor of 
medicine or osteopathy with training or experience in emergency care 
who is immediately available by telephone or radio contact, and is 
available on site within the timeframes specified in Sec. 485.618(d) of 
this chapter.
    (5) Costs of ambulance services. (i) Effective for services 
furnished on or after December 21, 2000, payment for ambulance services 
furnished by a CAH or an entity that is owned and operated by a CAH is 
the reasonable costs of the CAH or the entity in furnishing those 
services, but only if the CAH or the entity is the only provider or 
supplier of ambulance services located within a 35-mile drive of the 
CAH or the entity.
    (ii) For purposes of paragraph (b)(5) of this section, the distance 
between the CAH or the entity and the other provider or supplier of 
ambulance services will be determined as the shortest distance in miles 
measured over improved roads between the CAH or the entity and the site 
at which the vehicles of the closest provider or supplier of ambulance 
services are garaged. An improved road for this purpose is any road 
that is maintained by a local, State, or Federal government entity and 
is available for use by the general public. An improved road will be 
considered to include the paved surface up to the front entrance of the 
hospital and the front entrance of the garage.
    (6) If a CAH meets the criteria in Sec. 412.113(c) of this 
subchapter for pass-through of costs of anesthesia services furnished 
by nonphysician anesthetists employed by the CAH or obtained under 
arrangement, payment to the CAH for the costs of those services is made 
in accordance with Sec. 412.113(c).
* * * * *
    3. Section 413.86 is amended as follows:
    a. Paragraph (e)(4)(ii)(C)(1) is revised.
    b. Paragraph (e)(5)(iv) is removed.
    c. Paragraph (g)(4) is revised.
    d. Paragraph (g)(5) is revised.
    e. Paragraph (g)(8) is revised.


Sec. 413.86  Direct graduate medical education payments.

* * * * *
    (e) Determining per residents amounts for the base period. * * *
    (4) * * *
    (ii) * * *
    (C) Determining necessary revisions to the per resident amount. * * 
*
    (1) Floor. (i) For cost reporting periods beginning on or after 
October 1, 2000, and before October 1, 2001, if the hospital's per 
resident amount would otherwise be less than 70 percent of the 
locality-adjusted national average per resident amount for FY 2001 (as 
determined under paragraph (e)(4)(ii)(B) of this section), the per 
resident amount is equal to 70 percent of the locality-adjusted 
national average per resident amount for FY 2001.
    (ii) For cost reporting periods beginning on or after October 1, 
2001, and before October 1, 2002, if the hospital's per resident amount 
would otherwise be less than 85 percent of the locality-adjusted 
national average per resident amount for FY 2002 (as determined under 
paragraph (e)(4)(ii)(B) of this section), the per resident amount is 
equal to 85 percent of the locality-adjusted national average per 
resident amount for FY 2002.
    (iii) For subsequent cost reporting periods beginning on or after 
October 1, 2002, the hospital's per resident amount is updated using 
the methodology specified under paragraph (e)(3)(i) of this section.
* * * * *
    (g) Determining the weighted number of FTE residents.  * * *
    (4) For purposes of determining direct graduate medical education 
payments--
    (i) For cost reporting periods beginning on or after October 1, 
1997, a hospital's unweighted FTE count for residents in allopathic and 
osteopathic medicine may not exceed the hospital's unweighted FTE count 
(or, effective for cost reporting periods beginning on or after April 
1, 2000, 130 percent of the unweighted FTE count for a hospital located 
in a rural area) for these residents for the most recent cost reporting 
period ending on or before December 31, 1996.

[[Page 22723]]

    (ii) If a hospital's number of FTE residents in a cost reporting 
period beginning on or after October 1, 1997, and before October 1, 
2001, exceeds the limit described in this paragraph (g), the hospital's 
total weighted FTE count (before application of the limit) will be 
reduced in the same proportion that the number of FTE residents for 
that cost reporting period exceeds the number of FTE residents for the 
most recent cost reporting period ending on or before December 31, 
1996.
    (iii) If the hospital's number of FTE residents in a cost reporting 
period beginning on or after October 1, 2001 exceeds the limit 
described in this paragraph (g), the hospital's weighted FTE count 
(before application of the limit), for primary care and obstetrics and 
gynecology residents and nonprimary care residents, respectively, will 
be reduced in the same proportion that the number of FTE residents for 
that cost reporting period exceeds the number of FTE residents for the 
most recent cost reporting period ending on or before December 31, 
1996.
    (iv) Hospitals that are part of the same affiliated group may elect 
to apply the limit on an aggregate basis.
    (v) The fiscal intermediary may make appropriate modifications to 
apply the provisions of this paragraph (g)(4) based on the equivalent 
of a 12-month cost reporting period.
    (5) For purposes of determining direct graduate medical education 
payment--
    (i) For the hospital's first cost reporting period beginning on or 
after October 1, 1997, the hospital's weighted FTE count is equal to 
the average of the weighted FTE count for the payment year cost 
reporting period and the preceding cost reporting period.
    (ii) For cost reporting periods beginning on or after October 1, 
1998, and before October 1, 2001, the hospital's weighted FTE count is 
equal to the average of the weighted FTE count for the payment year 
cost reporting period and the preceding two cost reporting periods.
    (iii) For cost reporting periods beginning on or after October 1, 
2001, the hospital's weighted FTE count for primary care and obstetrics 
and gynecology residents is equal to the average of the weighted 
primary care and obstetrics and gynecology counts for the payment year 
cost reporting period and the preceding two cost reporting periods, and 
the hospital's weighted FTE count for nonprimary care residents is 
equal to the average of the weighted nonprimary care FTE counts for the 
payment year cost reporting period and the preceding two cost reporting 
periods.
    (iv) The fiscal intermediary may make appropriate modifications to 
apply the provisions of this paragraph (g)(5) based on the equivalent 
of 12-month cost reporting periods.
    (v) If a hospital qualifies for an adjustment to the limit 
established under paragraph (g)(4) of this section for new medical 
residency programs created under paragraph (g)(6) of this section, the 
count of the residents participating in new medical residency training 
programs above the number included in the hospital's FTE count for the 
cost reporting period ending during calendar year 1996 is added after 
applying the averaging rules in this paragraph (g)(5) for a period of 
years. Residents participating in new medical residency training 
programs are included in the hospital's FTE count before applying the 
averaging rules after the period of years has expired. For purposes of 
this paragraph (g)(5), the period of years equals the minimum 
accredited length for the type of program. The period of years begins 
when the first resident begins training.
* * * * *
    (8) Closure of hospital or hospital residency program. 
    (i) Definitions. For purposes of this paragraph (g)(8)--
    (A) ``Closure of a hospital'' means the hospital terminates its 
Medicare agreement under the provisions of Sec. 489.52 of this chapter.
    (B) ``Closure of a hospital residency training program'' means the 
hospital ceases to offer training for residents in a particular 
approved medical residency training program.
    (ii) Closure of a hospital. A hospital may receive a temporary 
adjustment to its FTE cap to reflect residents added because of another 
hospital's closure if the hospital meets the following criteria:
    (A) The hospital is training additional residents from a hospital 
that closed on or after July 1, 1996.
    (B) No later than 60 days after the hospital begins to train the 
residents, the hospital submits a request to its fiscal intermediary 
for a temporary adjustment to its FTE cap, documents that the hospital 
is eligible for this temporary adjustment by identifying the residents 
who have come from the closed hospital and have caused the hospital to 
exceed its cap, and specifies the length of time the adjustment is 
needed.
    (iii) Closure of a hospital's residency training program. If a 
hospital that closes its residency training program voluntarily agrees 
to temporarily reduce its FTE cap according to the criteria specified 
in paragraph (g)(8)(iii)(B) of this section, another hospital(s) may 
receive a temporary adjustment to its FTE cap to reflect residents 
added because of the closure of the residency training program if the 
criteria specified in paragraph (g)(8)(iii)(A) of this section are met.
    (A) Receiving hospital(s). A hospital may receive a temporary 
adjustment to its FTE cap to reflect residents added because of the 
closure of another hospital's residency training program if--
    (1) The hospital is training additional residents from the 
residency training program of a hospital that closed a program; and
    (2) No later than 60 days after the hospital begins to train the 
residents, the hospital submits to its fiscal intermediary a request 
for a temporary adjustment to its FTE cap, documents that it is 
eligible for this temporary adjustment by identifying the residents who 
have come from another hospital's closed program and have caused the 
hospital to exceed its cap, specifies the length of time the adjustment 
is needed, and submits to its fiscal intermediary a copy of the FTE 
reduction statement by the hospital that closed its program, as 
specified in paragraph (g)(8)(iii)(B)(2) of this section.
    (B) Hospital that closed its program(s). A hospital that agrees to 
train residents who have been displaced by the closure of another 
hospital's program may receive a temporary FTE cap adjustment only if 
the hospital with the closed program--
    (1) Temporarily reduces its FTE cap based on the FTE residents in 
each program year training in the program at the time of the program's 
closure. This yearly reduction in the FTE cap will be determined based 
on the number of those residents who would have been training in the 
program during that year had the program not closed; and
    (2) No later than 60 days after the residents who were in the 
closed program begin training at another hospital, submit to its fiscal 
intermediary a statement signed and dated by its representative that 
specifies that it agrees to the temporary reduction in its FTE cap to 
allow the hospital training the displaced residents to obtain a 
temporary adjustment to its cap; identifies the residents who were in 
training at the time of the program's closure; identifies the hospitals 
to which the residents are transferring once the program closes; and 
specifies the reduction for the applicable program years.
* * * * *

[[Page 22724]]

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    D. Part 485 is amended as follows:
    1. The authority citation for part 485 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Act (42 U.S.C. 1302 and 
1395hh).

    2. Section 485.610 is amended by revising paragraph (b) and adding 
a new paragraph (c) to read as follows:


Sec. 485.610  Condition of participation: Status and location.

* * * * *
    (b) Standard: Location in a rural area or treatment as rural. The 
CAH meets the requirements of either paragraph (b)(1) or (b)(2) of this 
section.
    (1) The CAH meets the following requirements:
    (i) The CAH is located outside any area that is a Metropolitan 
Statistical Area, as defined by the Office of Management and Budget, or 
that has been recognized as urban under Sec. 412.62(f) of this chapter;
    (ii) The CAH is not deemed to be located in an urban area under 
Sec. 412.63(b) of this chapter; and
    (iii) The CAH has not been classified as an urban hospital for 
purposes of the standardized payment amount by HCFA or the Medicare 
Geographic Classification Review Board under Sec. 412.230(e) of this 
chapter, and is not among a group of hospitals that have been 
redesignated to an adjacent urban area under Sec. 412.232 of this 
chapter.
    (2) The CAH is located within a Metropolitan Statistical Area, as 
defined by the Office of Management and Budget, but is being treated as 
being located in a rural area in accordance with Sec. 412.103 of this 
chapter.
    (c) Standard: Location relative to other facilities or necessary 
provider certification. The CAH is located more than a 35-mile drive 
(or, in the case of mountainous terrain or in areas with only secondary 
roads available, a 15-mile drive) from a hospital or another CAH, or 
the CAH is certified by the State as being a necessary provider of 
health care services to residents in the area.
    3. Section 485.639 is amended by revising paragraph (b) to read as 
follows:


Sec. 485.639  Condition of participation: Surgical services.

* * * * *
    (b) Anesthetic risk and evaluation. (1) A qualified practitioner, 
as specified in paragraph (a) of this section, must examine the patient 
immediately before surgery to evaluate the risk of the procedure to be 
performed.
    (2) A qualified practitioner, as specified in paragraph (c) of this 
section, must examine each patient before surgery to evaluate the risk 
of anesthesia.
    (3) Before discharge from the CAH, each patient must be evaluated 
for proper anesthesia recovery by a qualified practitioner, as 
specified in paragraph (c) of this section.
* * * * *
    4. Section 485.643 is amended by revising paragraph (f) to read as 
follows:


Sec. 485.643  Condition of participation: Organ, tissue, and eye 
procurement.

* * * * *
    (f) For purposes of these standards, the term ``organ'' means a 
human kidney, liver, heart, lung, pancreas, or intestines (or 
multivisceral organs).

PART 486--CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED 
BY SUPPLIERS

    F. Part 486 is amended as follows:
    1. The authority citation for Part 486 continues to read as 
follows:

    Authority: Sections 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. Section 486.302 is amended by revising the definition of 
``organ'' to read as follows:


Sec. 486.302  Definitions.

* * * * *
    ``Organ'' means a human kidney, liver, heart, lung, pancreas, or 
intestines (or multivisceral organs).
* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: March 15, 2001.
Michael McMullan,
Acting Deputy Administrator, Health Care Financing Administration.
    Dated: April 3, 2001.
Tommy G. Thompson,
Secretary.

    Editorial Note: The following Addendum and appendixes will not 
appear in the Code of Federal Regulations.

Addendum--Proposed Schedule of Standardized Amounts Effective With 
Discharges Occurring On or After October 1, 2001 and Update Factors 
and Rate-of-Increase Percentages Effective With Cost Reporting 
Periods Beginning On or After October 1, 2001

I. Summary and Background

    In this Addendum, we are setting forth the proposed amounts and 
factors for determining prospective payment rates for Medicare 
inpatient operating costs and Medicare inpatient capital-related costs. 
We are also setting forth proposed rate-of-increase percentages for 
updating the target amounts for hospitals and hospital units excluded 
from the prospective payment system.
    For discharges occurring on or after October 1, 2001, except for 
SCHs, MDHs, and hospitals located in Puerto Rico, each hospital's 
payment per discharge under the prospective payment system will be 
based on 100 percent of the Federal national rate.
    SCHs are paid based on whichever of the following rates yields the 
greatest aggregate payment: the Federal national rate, the updated 
hospital-specific rate based on FY 1982 cost per discharge, the updated 
hospital-specific rate based on FY 1987 cost per discharge, or, if 
qualified, 50 percent of the updated hospital-specific rate based on FY 
1996 cost per discharge, plus the greater of 50 percent of the updated 
FY 1982 or FY 1987 hospital-specific rate or 50 percent of the Federal 
DRG payment rate. Section 213 of Public Law 106-554 amended section 
1886(b)(3) of the Act to allow all SCHs to rebase their hospital-
specific rate based on their FY 1996 cost per discharge.
    Under section 1886(d)(5)(G) of the Act, MDHs are paid based on the 
Federal national rate or, if higher, the Federal national rate plus 50 
percent of the difference between the Federal national rate and the 
updated hospital-specific rate based on FY 1982 or FY 1987 cost per 
discharge, whichever is higher.
    For hospitals in Puerto Rico, the payment per discharge is based on 
the sum of 50 percent of a Puerto Rico rate and 50 percent of a Federal 
national rate. (See section II.D.3. of this Addendum for a complete 
description.)
    As discussed below in section II. of this Addendum, we are 
proposing to make changes in the determination of the prospective 
payment rates for Medicare inpatient operating costs for FY 2002. The 
changes, to be applied prospectively, would affect the calculation of 
the Federal rates. In section III. of this Addendum, we discuss our 
proposed changes for

[[Page 22725]]

determining the prospective payment rates for Medicare inpatient 
capital-related costs for FY 2002. Section IV. of this Addendum sets 
forth our proposed changes for determining the rate-of-increase limits 
for hospitals excluded from the prospective payment system for FY 2002. 
The tables to which we refer in the preamble to this proposed rule are 
presented at the end of this Addendum in section V.

II. Proposed Changes to Prospective Payment Rates for Inpatient 
Operating Costs for FY 2002

    The basic methodology for determining prospective payment rates for 
inpatient operating costs is set forth at Sec. 412.63. The basic 
methodology for determining the prospective payment rates for inpatient 
operating costs for hospitals located in Puerto Rico is set forth at 
Secs. 412.210 and 412.212. Below, we discuss the proposed factors used 
for determining the prospective payment rates. The Federal and Puerto 
Rico rate changes, once issued as final, will be effective with 
discharges occurring on or after October 1, 2001.
    In summary, the proposed standardized amounts set forth in Tables 
1A and 1C of section V. of this Addendum reflect--
     Updates of 2.55 percent for all areas (that is, the market 
basket percentage increase of 3.1 percent minus 0.55 percentage 
points);
     An adjustment to ensure budget neutrality of hospital 
geographic reclassification, as provided for under sections 
1886(d)(4)(C)(iii) and (d)(3)(E) of the Act, by applying new budget 
neutrality adjustment factors to the large urban and other standardized 
amounts;
     An adjustment to ensure budget neutrality as provided for 
in section 1886(d)(8)(D) of the Act by removing the FY 2001 budget 
neutrality factor and applying a revised factor;
     An adjustment to apply the revised outlier offset by 
removing the FY 2001 outlier offsets and applying a new offset; and
     An adjustment in the Puerto Rico standardized amounts to 
reflect the application of a Puerto Rico-specific wage index.

A. Calculation of Adjusted Standardized Amounts

1. Standardization of Base-Year Costs or Target Amounts
    Section 1886(d)(2)(A) of the Act required the establishment of 
base-year cost data containing allowable operating costs per discharge 
of inpatient hospital services for each hospital. The preamble to the 
September 1, 1983 interim final rule (48 FR 39763) contains a detailed 
explanation of how base-year cost data were established in the initial 
development of standardized amounts for the prospective payment system 
and how they are used in computing the Federal rates.
    Section 1886(d)(9)(B)(i) of the Act required us to determine the 
Medicare target amounts for each hospital located in Puerto Rico for 
its cost reporting period beginning in FY 1987. The September 1, 1987 
final rule (52 FR 33043, 33066) contains a detailed explanation of how 
the target amounts were determined and how they are used in computing 
the Puerto Rico rates.
    The standardized amounts are based on per discharge averages of 
adjusted hospital costs from a base period or, for Puerto Rico, 
adjusted target amounts from a base period, updated and otherwise 
adjusted in accordance with the provisions of section 1886(d) of the 
Act. Sections 1886(d)(2)(B) and (d)(2)(C) of the Act required us to 
update base-year per discharge costs for FY 1984 and then standardize 
the cost data in order to remove the effects of certain sources of cost 
variations among hospitals. These effects include case-mix, differences 
in area wage levels, cost-of-living adjustments for Alaska and Hawaii, 
indirect medical education costs, and payments to hospitals serving a 
disproportionate share of low-income patients.
    Under sections 1886(d)(2)(H) and (d)(3)(E) of the Act, in making 
payments under the prospective payment system, the Secretary estimates 
from time to time the proportion of costs that are wages and wage-
related costs. Since October 1, 1997, when the market basket was last 
revised, we have considered 71.1 percent of costs to be labor-related 
for purposes of the prospective payment system. The average labor share 
in Puerto Rico is 71.3 percent. We are proposing to revise the 
discharge-weighted national standardized amount for Puerto Rico to 
reflect the proportion of discharges in large urban and other areas 
from the FY 2000 MedPAR file.
2. Computing Large Urban and Other Area Averages
    Sections 1886(d)(2)(D) and (d)(3) of the Act require the Secretary 
to compute two average standardized amounts for discharges occurring in 
a fiscal year: one for hospitals located in large urban areas and one 
for hospitals located in other areas. In addition, under sections 
1886(d)(9)(B)(iii) and (d)(9)(C)(i) of the Act, the average 
standardized amount per discharge must be determined for hospitals 
located in large urban and other areas in Puerto Rico. Hospitals in 
Puerto Rico are paid a blend of 50 percent of the applicable Puerto 
Rico standardized amount and 50 percent of a national standardized 
payment amount.
    Section 1886(d)(2)(D) of the Act defines ``urban area'' as those 
areas within a Metropolitan Statistical Area (MSA). A ``large urban 
area'' is defined as an urban area with a population of more than 1 
million. In addition, section 4009(i) of Public Law 100-203 provides 
that a New England County Metropolitan Area (NECMA) with a population 
of more than 970,000 is classified as a large urban area. As required 
by section 1886(d)(2)(D) of the Act, population size is determined by 
the Secretary based on the latest population data published by the 
Bureau of the Census. Urban areas that do not meet the definition of a 
``large urban area'' are referred to as ``other urban areas.'' Areas 
that are not included in MSAs are considered ``rural areas'' under 
section 1886(d)(2)(D) of the Act. Payment for discharges from hospitals 
located in large urban areas will be based on the large urban 
standardized amount. Payment for discharges from hospitals located in 
other urban and rural areas will be based on the other standardized 
amount.
    Based on 1999 population estimates published by the Bureau of the 
Census, 63 areas meet the criteria to be defined as large urban areas 
for FY 2002. These areas are identified in Table 4A.
3. Updating the Average Standardized Amounts
    Under section 1886(d)(3)(A) of the Act, we update the average 
standardized amounts each year. In accordance with section 
1886(d)(3)(A)(iv) of the Act, we are proposing to update the large 
urban areas' and the other areas' average standardized amounts for FY 
2002 using the applicable percentage increases specified in section 
1886(b)(3)(B)(i) of the Act. Section 1886(b)(3)(B)(i)(XVII) of the Act 
as amended by section 301 of Public Law 106-554 specifies that the 
update factor for the standardized amounts for FY 2002 is equal to the 
market basket percentage increase minus 0.55 percentage points for 
hospitals in all areas. Section 301 also established that the update 
factor for FY 2003 is equal to the market basket percentage increase 
minus 0.55 percentage points. We are proposing to revise Sec. 412.63 to 
reflect these changes.
    The percentage change in the market basket reflects the average 
change in the price of goods and services purchased by hospitals to 
furnish inpatient care. The most recent forecast of the hospital

[[Page 22726]]

market basket increase for FY 2002 is 3.1 percent. Thus, for FY 2002, 
the proposed update to the average standardized amounts equals 2.55 
percent for hospitals in all areas.
    As in the past, we are adjusting the FY 2001 standardized amounts 
to remove the effects of the FY 2001 geographic reclassifications and 
outlier payments before applying the FY 2002 updates. That is, we are 
increasing the standardized amounts to restore the reductions that were 
made for the effects of geographic reclassification and outliers. We 
then apply the new offsets to the standardized amounts for outliers and 
geographic reclassifications for FY 2002.
    Although the update factors for FY 2002 are set by law, we are 
required by section 1886(e)(3) of the Act to report to the Congress our 
initial recommendation of update factors for FY 2002 for both 
prospective payment hospitals and hospitals excluded from the 
prospective payment system. For general information purposes, we have 
included the report to Congress as Appendix C to this proposed rule. 
Our proposed recommendation on the update factors (which is required by 
sections 1886(e)(4)(A) and (e)(5)(A) of the Act) is set forth as 
Appendix D to this proposed rule.
4. Other Adjustments to the Average Standardized Amounts
    a. Recalibration of DRG Weights and Updated Wage Index--Budget 
Neutrality Adjustment. Section 1886(d)(4)(C)(iii) of the Act specifies 
that, beginning in FY 1991, the annual DRG reclassification and 
recalibration of the relative weights must be made in a manner that 
ensures that aggregate payments to hospitals are not affected. As 
discussed in section II. of the preamble, we normalized the 
recalibrated DRG weights by an adjustment factor, so that the average 
case weight after recalibration is equal to the average case weight 
prior to recalibration.
    Section 1886(d)(3)(E) of the Act requires us to update the hospital 
wage index on an annual basis beginning October 1, 1993. This provision 
also requires us to make any updates or adjustments to the wage index 
in a manner that ensures that aggregate payments to hospitals are not 
affected by the change in the wage index.
    To comply with the requirement of section 1886(d)(4)(C)(iii) of the 
Act that DRG reclassification and recalibration of the relative weights 
be budget neutral, and the requirement in section 1886(d)(3)(E) of the 
Act that the updated wage index be budget neutral, we used FY 2000 
discharge data to simulate payments and compared aggregate payments 
using the FY 2001 relative weights and wage index to aggregate payments 
using the proposed FY 2002 relative weights and wage index. The same 
methodology was used for the FY 2001 budget neutrality adjustment. (See 
the discussion in the September 1, 1992 final rule (57 FR 39832).) 
Based on this comparison, we computed a budget neutrality adjustment 
factor equal to 0.992493. We also adjust the Puerto Rico-specific 
standardized amounts for the effect of DRG reclassification and 
recalibration. We computed a budget neutrality adjustment factor for 
Puerto Rico-specific standardized amounts equal to 0.994677. These 
budget neutrality adjustment factors are applied to the standardized 
amounts without removing the effects of the FY 2001 budget neutrality 
adjustments. We do not remove the prior budget neutrality adjustment 
because estimated aggregate payments after the changes in the DRG 
relative weights and wage index should equal estimated aggregate 
payments prior to the changes. If we removed the prior year adjustment, 
we would not satisfy this condition.
    In addition, we are proposing to apply these same adjustment 
factors to the hospital-specific rates that are effective for cost 
reporting periods beginning on or after October 1, 2001. (See the 
discussion in the September 4, 1990 final rule (55 FR 36073).)
    b. Reclassified Hospitals--Budget Neutrality Adjustment. Section 
1886(d)(8)(B) of the Act provides that, effective with discharges 
occurring on or after October 1, 1988, certain rural hospitals are 
deemed urban. In addition, section 1886(d)(10) of the Act provides for 
the reclassification of hospitals based on determinations by the 
Medicare Geographic Classification Review Board (MGCRB). Under section 
1886(d)(10) of the Act, a hospital may be reclassified for purposes of 
the standardized amount or the wage index, or both.
    Under section 1886(d)(8)(D) of the Act, the Secretary is required 
to adjust the standardized amounts so as to ensure that aggregate 
payments under the prospective payment system after implementation of 
the provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the 
Act are equal to the aggregate prospective payments that would have 
been made absent these provisions. To calculate this budget neutrality 
factor, we used FY 2000 discharge data to simulate payments, and 
compared total prospective payments (including indirect medical 
education and disproportionate share hospital payments) prior to any 
reclassifications to total prospective payments after 
reclassifications. Based on these simulations, we are applying an 
adjustment factor of 0.991054 to ensure that the effects of 
reclassification are budget neutral.
    The adjustment factor is applied to the standardized amounts after 
removing the effects of the FY 2001 budget neutrality adjustment 
factor. We note that the proposed FY 2002 adjustment reflects wage 
index and standardized amount reclassifications approved by the MGCRB 
or the Administrator as of February 28, 2001, and the effects of 
section 304 of Public Law 106-554 to extend wage index 
reclassifications for 3 years. The effects of any additional 
reclassification changes resulting from appeals and reviews of the 
MGCRB decisions for FY 2002 or from a hospital's request for the 
withdrawal of a reclassification request will be reflected in the final 
budget neutrality adjustment published in the final rule for FY 2002.
    c. Outliers. Section 1886(d)(5)(A) of the Act provides for payments 
in addition to the basic prospective payments for ``outlier'' cases, 
cases involving extraordinarily high costs (cost outliers). Section 
1886(d)(3)(B) of the Act requires the Secretary to adjust both the 
large urban and other area national standardized amounts by the same 
factor to account for the estimated proportion of total DRG payments 
made to outlier cases. Similarly, section 1886(d)(9)(B)(iv) of the Act 
requires the Secretary to adjust the large urban and other standardized 
amounts applicable to hospitals in Puerto Rico to account for the 
estimated proportion of total DRG payments made to outlier cases. 
Furthermore, under section 1886(d)(5)(A)(iv) of the Act, outlier 
payments for any year must be projected to be not less than 5 percent 
nor more than 6 percent of total payments based on DRG prospective 
payment rates.
    i. FY 2002 outlier thresholds. For FY 2001, the fixed loss cost 
outlier threshold was equal to the prospective payment rate for the DRG 
plus the IME and DSH payments plus $17,550 (16,036 for hospitals that 
have not yet entered the prospective payment system for capital-related 
costs). The marginal cost factor for cost outliers (the percent of 
costs paid after costs for the case exceed the threshold) was 80 
percent. We applied an outlier adjustment to the FY 2001 standardized 
amounts of 0.948908 for the large urban and other areas rates and 
0.9409 for the capital Federal rate.
    For FY 2002, we propose to establish a fixed loss cost outlier 
threshold equal to the prospective payment rate for the

[[Page 22727]]

DRG plus the IME and DSH payments plus $21,000. The capital prospective 
payment system is fully phased in, effective FY 2002. Therefore, we no 
longer are establishing a separate threshold for hospitals that have 
not yet entered the prospective payment system for capital-related 
costs. We propose to maintain the marginal cost factor for cost 
outliers at 80 percent.
    To calculate FY 2002 outlier thresholds, we simulated payments by 
applying FY 2002 rates and policies to the December 2000 update of the 
FY 2000 MedPAR file and the December 2000 update of the provider-
specific file. As we have explained in the past, to calculate outlier 
thresholds, we apply a cost inflation factor to update costs for the 
cases used to simulate payments. For FY 2000, we used a cost inflation 
factor of zero percent. For FY 2001, we used a cost inflation factor 
(or cost adjustment factor) of 1.8 percent. To set the proposed FY 2002 
outlier thresholds, we are using a 2-year cost inflation factor of 5.5 
percent (to inflate FY 2000 charges to FY 2002). This factor reflects 
our analysis of the best available cost report data as well as 
calculations (using the best available data) indicating that the 
percentage of actual outlier payments for FY 2000 is higher than we 
projected before the beginning of FY 2000, and that the percentage of 
actual outlier payments for FY 2001 will likely be higher than we 
projected before the beginning of FY 2001. The calculations of 
``actual'' outlier payments are discussed further below.
    ii. Other changes concerning outliers. In accordance with section 
1886(d)(5)(A)(iv) of the Act, we calculated proposed outlier thresholds 
so that outlier payments are projected to equal 5.1 percent of total 
payments based on DRG prospective payment rates. In accordance with 
section 1886(d)(3)(E), we reduced the proposed FY 2002 standardized 
amounts by the same percentage to account for the projected proportion 
of payments paid to outliers.
    As stated in the September 1, 1993 final rule (58 FR 46348), we 
establish outlier thresholds that are applicable to both inpatient 
operating costs and inpatient capital-related costs. When we modeled 
the combined operating and capital outlier payments, we found that 
using a common set of thresholds resulted in a higher percentage of 
outlier payments for capital-related costs than for operating costs. We 
project that the proposed thresholds for FY 2002 will result in outlier 
payments equal to 5.1 percent of operating DRG payments and 5.7 percent 
of capital payments based on the Federal rate.
    The proposed outlier adjustment factors to be applied to the 
standardized amounts for FY 2002 are as follows:

------------------------------------------------------------------------
                                                 Operating     Capital
                                               standardized    federal
                                                  amounts        rate
------------------------------------------------------------------------
National.....................................      0.948910     0.974711
Puerto Rico..................................      0.942593     0.970336
------------------------------------------------------------------------

    We apply the proposed outlier adjustment factors after removing the 
effects of the FY 2001 outlier adjustment factors on the standardized 
amounts.
    Table 8A in section V. of this Addendum contains the updated 
Statewide average operating cost-to-charge ratios for urban hospitals 
and for rural hospitals to be used in calculating cost outlier payments 
for those hospitals for which the fiscal intermediary is unable to 
compute a reasonable hospital-specific cost-to-charge ratio. These 
Statewide average ratios would replace the ratios published in the 
August 1, 2000 final rule (65 FR 47054). Table 8B contains comparable 
statewide average capital cost-to-charge ratios. These average ratios 
would be used to calculate cost outlier payments for those hospitals 
for which the fiscal intermediary computes operating cost-to-charge 
ratios lower than 0.1908357 or greater than 1.3133937 and capital cost-
to-charge ratios lower than 0.0120498 or greater than 0.1668928. This 
range represents 3.0 standard deviations (plus or minus) from the mean 
of the log distribution of cost-to-charge ratios for all hospitals. We 
note that the cost-to-charge ratios in Tables 8A and 8B would be used 
during FY 2002 when hospital-specific cost-to-charge ratios based on 
the latest settled cost report are either not available or outside the 
three standard deviations range.
    iii. FY 2000 and FY 2001 outlier payments. In the August 1, 2000 
final rule (65 FR 47054), we stated that, based on available data, we 
estimated that actual FY 2000 outlier payments would be approximately 
6.2 percent of actual total DRG payments. This was computed by 
simulating payments using the March 2000 update of the FY 1999 bill 
data available at the time. That is, the estimate of actual outlier 
payments did not reflect actual FY 2000 bills but instead reflected the 
application of FY 2000 rates and policies to available FY 1999 bills. 
Our current estimate, using available FY 2000 bills, is that actual 
outlier payments for FY 2000 were approximately 7.4 percent of actual 
total DRG payments. We note that the MedPAR file for FY 2000 discharges 
continues to be updated. Thus, the data indicate that, for FY 2000, the 
percentage of actual outlier payments relative to actual total payments 
is higher than we projected before FY 2000 (and thus exceeds the 
percentage by which we reduced the standardized amounts for FY 2000). 
In fact, the data indicate that the proportion of actual outlier 
payments for FY 2000 exceeds 6.0 percent. Nevertheless, consistent with 
the policy and statutory interpretation we have maintained since the 
inception of the prospective payment system, we do not plan to recoup 
money and make retroactive adjustments to outlier payments for FY 2000.
    We currently estimate that actual outlier payments for FY 2001 will 
be approximately 5.9 percent of actual total DRG payments, 0.8 percent 
higher than the 5.1 percent we projected in setting outlier policies 
for FY 2001. This estimate is based on simulations using the December 
2000 update of the provider-specific file and the December 2000 update 
of the FY 2000 MedPAR file (discharge data for FY 2000 bills). We used 
these data to calculate an estimate of the actual outlier percentage 
for FY 2001 by applying FY 2001 rates and policies to available FY 2000 
bills.
5. FY 2002 Standardized Amounts
    The adjusted standardized amounts are divided into labor and 
nonlabor portions. Table 1A contains the two national standardized 
amounts that we are proposing to be applicable to all hospitals, except 
hospitals in Puerto Rico. Under section 1886(d)(9)(A)(ii) of the Act, 
the Federal portion of the Puerto Rico payment rate is based on the 
discharge-weighted average of the national large urban standardized 
amount and the national other standardized amount (as set forth in 
Table 1A). The labor and nonlabor portions of the national average 
standardized amounts for Puerto Rico hospitals are set forth in Table 
1C. This table also includes the Puerto Rico standardized amounts.

B. Adjustments for Area Wage Levels and Cost of Living

    Tables 1A and 1C, as set forth in this Addendum, contain the 
proposed labor-related and nonlabor-related shares that would be used 
to calculate the prospective payment rates for hospitals located in the 
50 States, the District of Columbia, and Puerto Rico. This section 
addresses two types of adjustments to the standardized amounts that are 
made in determining the prospective payment rates as described in this 
Addendum.

[[Page 22728]]

1. Adjustment for Area Wage Levels
    Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require 
that we make an adjustment to the labor-related portion of the 
prospective payment rates to account for area differences in hospital 
wage levels. This adjustment is made by multiplying the labor-related 
portion of the adjusted standardized amounts by the appropriate wage 
index for the area in which the hospital is located. In section III. of 
this preamble, we discuss the data and methodology for the proposed FY 
2002 wage index. The proposed wage index is set forth in Tables 4A, 4B, 
4C, and 4F of this Addendum.
2. Adjustment for Cost-of-Living in Alaska and Hawaii
    Section 1886(d)(5)(H) of the Act authorizes an adjustment to take 
into account the unique circumstances of hospitals in Alaska and 
Hawaii. Higher labor-related costs for these two States are taken into 
account in the adjustment for area wages described above. For FY 2002, 
we propose to adjust the payments for hospitals in Alaska and Hawaii by 
multiplying the nonlabor portion of the standardized amounts by the 
appropriate adjustment factor contained in the table below. If the 
Office of Personnel Management releases revised cost-of-living 
adjustment factors before July 1, 2001, we will publish them in the 
final rule and use them in determining FY 2002 payments.

 Table of Cost-of-Living Adjustment Factors, Alaska and Hawaii Hospitals
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Alaska--All areas..........................................         1.25
Hawaii:
  County of Honolulu.......................................       1.1650
  County of Hawaii.........................................       1.2325
  County of Kauai..........................................       1.2325
  County of Maui...........................................       1.2375
  County of Kalawao........................................      1.2375
------------------------------------------------------------------------
(The above factors are based on data obtained from the U.S. Office of
  Personnel Management.)

C. DRG Relative Weights

    As discussed in section II. of the preamble, we have developed a 
classification system for all hospital discharges, assigning them into 
DRGs, and have developed relative weights for each DRG that reflect the 
resource utilization of cases in each DRG relative to Medicare cases in 
other DRGs. Table 5 of section V. of this Addendum contains the 
relative weights that we are proposing to use for discharges occurring 
in FY 2002. These factors have been recalibrated as explained in 
section II. of the preamble.

D. Calculation of Prospective Payment Rates for FY 2002

General Formula for Calculation of Prospective Payment Rates for FY 
2002

    The prospective payment rate for all hospitals located outside of 
Puerto Rico, except SCHs and MDHs, equals the Federal rate.
    The prospective payment rate for SCHs equals whichever of the 
following rates yields the greatest aggregate payment: the Federal 
national rate, the updated hospital-specific rate based on FY 1982 cost 
per discharge, the updated hospital-specific rate based on FY 1987 cost 
per discharge, or, if qualified, 50 percent of the updated hospital-
specific rate based on FY 1996 cost per discharge, plus the greater of 
50 percent of the updated FY 1982 or FY 1987 hospital-specific rate or 
50 percent of the Federal DRG payment rate. Section 213 of Public Law 
106-554 amended section 1886(b)(3) of the Act to allow all SCHs to 
rebase their hospital-specific rate based on their FY 1996 cost per 
discharge.
    The prospective payment rate for MDHs equals 100 percent of the 
Federal rate, or, if the greater of the updated FY 1982 hospital-
specific rate or the updated FY 1987 hospital-specific rate is higher 
than the Federal rate, 100 percent of the Federal rate plus 50 percent 
of the difference between the applicable hospital-specific rate and the 
Federal rate.
    The prospective payment rate for Puerto Rico equals 50 percent of 
the Puerto Rico rate plus 50 percent of a discharge-weighted average of 
the national large urban standardized amount and the Federal national 
other standardized amount.
1. Federal Rate
    For discharges occurring on or after October 1, 2001 and before 
October 1, 2002, except for SCHs, MDHs, and hospitals in Puerto Rico, 
the hospital's payment is based exclusively on the Federal national 
rate.
    The payment amount is determined as follows:
    Step 1--Select the appropriate national standardized amount 
considering the type of hospital and designation of the hospital as 
large urban or other (see Table 1A in section V. of this Addendum).
    Step 2--Multiply the labor-related portion of the standardized 
amount by the applicable wage index for the geographic area in which 
the hospital is located (see Tables 4A, 4B, and 4C of section V. of 
this Addendum).
    Step 3--For hospitals in Alaska and Hawaii, multiply the nonlabor-
related portion of the standardized amount by the appropriate cost-of-
living adjustment factor.
    Step 4--Add the amount from Step 2 and the nonlabor-related portion 
of the standardized amount (adjusted, if appropriate, under Step 3).
    Step 5--Multiply the final amount from Step 4 by the relative 
weight corresponding to the appropriate DRG (see Table 5 of section V. 
of this Addendum).
2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)
    Section 1886(b)(3)(C) of the Act provides that SCHs are paid based 
on whichever of the following rates yields the greatest aggregate 
payment: the Federal national rate, the updated hospital-specific rate 
based on FY 1982 cost per discharge, the updated hospital-specific rate 
based on FY 1987 cost per discharge, or, if qualified, 50 percent of 
the updated hospital-specific rate based on FY 1996 cost per discharge, 
plus the greater of 50 percent of the updated FY 1982 or FY 1987 
hospital-specific rate or 50 percent of the Federal DRG payment rate.
    Section 1886(d)(5)(G) of the Act provides that MDHs are paid based 
on whichever of the following rates yields the greatest aggregate 
payment: the Federal rate or the Federal rate plus 50 percent of the 
difference between the Federal rate and the greater of the updated 
hospital-specific rate based on FY 1982 and FY 1987 cost per discharge.
    Hospital-specific rates have been determined for each of these 
hospitals based on either the FY 1982 cost per discharge, the FY 1987 
cost per discharge or, for qualifying SCHs, the FY 1996 cost per 
discharge. For a more detailed discussion of the calculation of the 
hospital-specific rates, we refer the reader to the September 1, 1983 
interim final rule (48 FR 39772); the April 20, 1990 final rule with 
comment (55 FR 15150); the September 4, 1990 final rule (55 FR 35994); 
and the August 1, 2000 final rule (65 FR 47082).
    a. Updating the FY 1982, FY 1987, and FY 1996 Hospital-Specific 
Rates for FY 2002. We are proposing to increase the hospital-specific 
rates by 2.55 percent (the hospital market basket percentage increase 
minus 0.55 percentage points) for SCHs and MDHs for FY 2002. Section 
1886(b)(3)(C)(iv) of the Act provides that the update factor applicable 
to the hospital-specific rates for SCHs equal the update factor 
provided under section 1886(b)(3)(B)(iv) of the Act, which, for SCHs in 
FY 2002,

[[Page 22729]]

is the market basket rate of increase minus 0.55 percentage points. 
Section 1886(b)(3)(D) of the Act provides that the update factor 
applicable to the hospital-specific rates for MDHs equals the update 
factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for 
FY 2002, is the market basket rate of increase minus 0.55 percentage 
points.
    b. Calculation of Hospital-Specific Rate. For SCHs, the applicable 
FY 2002 hospital-specific rate would be based on the following: the 
hospital-specific rate calculated using the greater of the FY 1982 or 
FY 1987 costs, increased by the applicable update factor of 2.55 
percent; or, if the hospital-specific rate based on cost per case in FY 
1996 is greater than the hospital-specific rate using either the FY 
1982 or the FY 1987 costs, the greater of 50 percent of the hospital-
specific rate based on the FY 1982 or FY 1987 costs, increased by the 
applicable update factor, or 50 percent of the Federal rate plus 50 
percent of its rebased FY 1996 hospital-specific rate updated through 
FY 2002. For MDHs, the applicable FY 2002 hospital-specific rate would 
be calculated by increasing the hospital's hospital-specific rate for 
the preceding fiscal year by the applicable update factor of 2.55 
percent, which is the same as the update for all prospective payment 
hospitals. In addition, for both SCHs and MDHs, the hospital-specific 
rate would be adjusted by the budget neutrality adjustment factor (that 
is, by 0.992493) as discussed in section II.A.4.a. of this Addendum. 
The resulting rate is used in determining the payment under which rate 
an SCH or a MDH is paid for its discharges beginning on or after 
October 1, 2001.
3. General Formula for Calculation of Prospective Payment Rates for 
Hospitals Located in Puerto Rico Beginning On or After October 1, 2001 
and Before October 1, 2002
    a. Puerto Rico Rate. The Puerto Rico prospective payment rate is 
determined as follows:
    Step 1--Select the appropriate adjusted average standardized amount 
considering the large urban or other designation of the hospital (see 
Table 1C of section V. of the Addendum).
    Step 2--Multiply the labor-related portion of the standardized 
amount by the appropriate Puerto Rico-specific wage index (see Table 4F 
of section V. of the Addendum).
    Step 3--Add the amount from Step 2 and the nonlabor-related portion 
of the standardized amount.
    Step 4--Multiply the result in Step 3 by 50 percent.
    Step 5--Multiply the amount from Step 4 by the appropriate DRG 
relative weight (see Table 5 of section V. of the Addendum).
    b. National Rate. The national prospective payment rate is 
determined as follows:
    Step 1--Multiply the labor-related portion of the national average 
standardized amount (see Table 1C of section V. of the Addendum) by the 
appropriate national wage index (see Tables 4A and 4B of section V. of 
the Addendum).
    Step 2--Add the amount from Step 1 and the nonlabor-related portion 
of the national average standardized amount.
    Step 3--Multiply the result in Step 2 by 50 percent.
    Step 4--Multiply the amount from Step 3 by the appropriate DRG 
relative weight (see Table 5 of section V. of the Addendum).
    The sum of the Puerto Rico rate and the national rate computed 
above equals the prospective payment for a given discharge for a 
hospital located in Puerto Rico.

III. Proposed Changes to Payment Rates for Inpatient Capital-
Related Costs for FY 2002

    The prospective payment system for hospital inpatient capital-
related costs was implemented for cost reporting periods beginning on 
or after October 1, 1991. Effective with that cost reporting period and 
during a 10-year transition period extending through FY 2001, hospital 
inpatient capital-related costs are paid on the basis of an increasing 
proportion of the capital prospective payment system Federal rate and a 
decreasing proportion of a hospital's historical costs for capital.
    The basic methodology for determining Federal capital prospective 
rates is set forth at Secs. 412.308 through 412.352. Below we discuss 
the factors that we used to determine the proposed Federal for FY 2002. 
The rates, which will be effective for discharges occurring on or after 
October 1, 2001. As we stated in section V of the preamble of this 
proposed rule, we are no longer determining an update to the capital 
hospital-specific rate, since FY 2001 is the last year of the 10-year 
transition period, and beginning in FY 2002 all hospitals (except those 
defined as ``new'' under Sec. 412.300) will be paid based on 100 
percent of the capital Federal rate.
    For FY 1992, we computed the standard Federal payment rate for 
capital-related costs under the prospective payment system by updating 
the FY 1989 Medicare inpatient capital cost per case by an actuarial 
estimate of the increase in Medicare inpatient capital costs per case. 
Each year after FY 1992, we update the standard Federal rate, as 
provided in Sec. 412.308(c)(1), to account for capital input price 
increases and other factors. Also, Sec. 412.308(c)(2) provides that the 
Federal rate is adjusted annually by a factor equal to the estimated 
proportion of outlier payments under the Federal rate to total capital 
payments under the Federal rate. In addition, Sec. 412.308(c)(3) 
requires that the Federal rate be reduced by an adjustment factor equal 
to the estimated proportion of payments for (regular and special) 
exceptions under Sec. 412.348. Furthermore, Sec. 412.308(c)(4)(ii) 
requires that the Federal rate be adjusted so that the annual DRG 
reclassification and the recalibration of DRG weights and changes in 
the geographic adjustment factor are budget neutral. For FYs 1992 
through 1995, Sec. 412.352 required that the Federal rate also be 
adjusted by a budget neutrality factor so that aggregate payments for 
inpatient hospital capital costs were projected to equal 90 percent of 
the payments that would have been made for capital-related costs on a 
reasonable cost basis during the fiscal year. That provision expired in 
FY 1996. Section 412.308(b)(2) describes the 7.4 percent reduction to 
the rate that was made in FY 1994, and Sec. 412.308(b)(3) describes the 
0.28 percent reduction to the rate made in FY 1996 as a result of the 
revised policy of paying for transfers. In the FY 1998 final rule with 
comment period (62 FR 45966), we implemented section 4402 of Public Law 
105-33, which requires that for discharges occurring on or after 
October 1, 1997, and before October 1, 2002, the unadjusted standard 
Federal rate is reduced by 17.78 percent. A small part of that 
reduction will be restored effective October 1, 2002.
    To determine the appropriate budget neutrality adjustment factor 
and the regular exceptions payment adjustment, we developed a dynamic 
model of Medicare inpatient capital-related costs, that is, a model 
that projects changes in Medicare inpatient capital-related costs over 
time. With the expiration of the budget neutrality provision, the model 
is still used to estimate the regular exceptions payment adjustment and 
other factors. The model and its application are described in greater 
detail in Appendix B of this proposed rule.
    In accordance with section 1886(d)(9)(A) of the Act, under the 
prospective payment system for inpatient operating costs, hospitals 
located in Puerto Rico are paid for operating costs under a special 
payment

[[Page 22730]]

formula. Prior to FY 1998, hospitals in Puerto Rico were paid a blended 
rate that consisted of 75 percent of the applicable standardized amount 
specific to Puerto Rico hospitals and 25 percent of the applicable 
national average standardized amount. However, effective October 1, 
1997, as a result of section 4406 of Public Law 105-33, operating 
payments to hospitals in Puerto Rico are based on a blend of 50 percent 
of the applicable standardized amount specific to Puerto Rico hospitals 
and 50 percent of the applicable national average standardized amount. 
In conjunction with this change to the operating blend percentage, 
effective with discharges on or after October 1, 1997, we compute 
capital payments to hospitals in Puerto Rico based on a blend of 50 
percent of the Puerto Rico rate and 50 percent of the Federal rate.
    Section 412.374 provides for the use of this blended payment system 
for payments to Puerto Rico hospitals under the prospective payment 
system for inpatient capital-related costs. Accordingly, for capital-
related costs, we compute a separate payment rate specific to Puerto 
Rico hospitals using the same methodology used to compute the national 
Federal rate for capital.

A. Determination of Federal Inpatient Capital-Related Prospective 
Payment Rate Update

    In the August 1, 2000 final rule (65 FR 47122), we established a 
Federal rate of $382.03 for FY 2001. In a separate interim final rule 
with comment, as a result of implementing section 301(a) of Public Law 
106-554 we are establishing a Federal rate of $380.85 for discharges 
occurring on or after April 1, 2001 and before October 1, 2001. In 
accordance with section 547 of Public Law 106-554, the special 
increases and adjustments provided by Public Law 106-554 effective 
between April and October 2001 do not apply for discharges occurring 
after FY 2001 and should not be included in determining the payment 
rates in subsequent years. Thus, the adjustments and rates published in 
the August 1, 2000 final rule were used in determining the proposed FY 
2002 rates. As a result of the changes we are proposing to the factors 
used to establish the Federal rate in this addendum, the proposed FY 
20021 Federal rate is $389.09.
    In the discussion that follows, we explain the factors that were 
used to determine the proposed FY 2002 Federal rate. In particular, we 
explain why the proposed FY 2002 Federal rate has increased 1.85 
percent compared to the FY 2001 Federal rate (published in the August 
1, 2000 final rule (65 FR 47122)). We also estimate aggregate capital 
payments will increase by 3.80 percent during this same period. This 
increase is primarily due to the increase in the number of hospital 
admissions and the increase in case-mix. This increase in capital 
payments is less than last year (5.48 percent) because with the end of 
the transition period the remaining hold harmless hospitals receiving 
``cost-based'' payments will begin being paid based on 100 percent of 
the Federal rate.
    Total payments to hospitals under the prospective payment system 
are relatively unaffected by changes in the capital prospective 
payments. Since capital payments constitute about 10 percent of 
hospital payments, a 1 percent change in the capital Federal rate 
yields only about 0.1 percent change in actual payments to hospitals. 
Aggregate payments under the capital prospective payment transition 
system are estimated to increase in FY 2002 compared to FY 2001.
1. Standard Federal Rate Update
    a. Description of the Update Framework. Under Sec. 412.308(c)(1), 
the standard Federal rate is updated on the basis of an analytical 
framework that takes into account changes in a capital input price 
index and other factors. The update framework consists of a capital 
input price index (CIPI) and several policy adjustment factors. 
Specifically, we have adjusted the projected CIPI rate of increase as 
appropriate each year for case-mix index-related changes, for 
intensity, and for errors in previous CIPI forecasts. The proposed 
update factor for FY 2002 under that framework is 1.1 percent. This 
proposal is based on a projected 0.5 percent increase in the CIPI, a 
0.3 percent adjustment for intensity, a 0.0 percent adjustment for 
case-mix, a 0.0 percent adjustment for the FY 2000 DRG reclassification 
and recalibration, and a forecast error correction of 0.3 percent. We 
explain the basis for the FY 2002 CIPI projection in section II.D. of 
this Addendum. Below we describe the policy adjustments that have been 
applied.
    The case-mix index is the measure of the average DRG weight for 
cases paid under the prospective payment system. Because the DRG weight 
determines the prospective payment for each case, any percentage 
increase in the case-mix index corresponds to an equal percentage 
increase in hospital payments.
    The case-mix index can change for any of several reasons:
     The average resource use of Medicare patients changes 
(``real'' case-mix change);
     Changes in hospital coding of patient records result in 
higher weight DRG assignments (``coding effects''); and
     The annual DRG reclassification and recalibration changes 
may not be budget neutral (``reclassification effect'').
    We define real case-mix change as actual changes in the mix (and 
resource requirements) of Medicare patients as opposed to changes in 
coding behavior that result in assignment of cases to higher weighted 
DRGs but do not reflect higher resource requirements. In the update 
framework for the prospective payment system for operating costs, we 
adjust the update upwards to allow for real case-mix change, but remove 
the effects of coding changes on the case-mix index. We also remove the 
effect on total payments of prior changes to the DRG classifications 
and relative weights, in order to retain budget neutrality for all 
case-mix index-related changes other than patient severity. (For 
example, we are adjustinged for the effects of the FY 2000 DRG 
reclassification and recalibration as part of our FY 2002 update 
recommendation.) We have adopted this case-mix index adjustment in the 
capital update framework as well.
    For FY 2002, we are projecting a 1.0 percent increase in the case-
mix index. We estimate that real case-mix increase will equal 1.0 
percent in FY 2002. Therefore, the proposed net adjustment for case-mix 
change in FY 2002 is 0.0 percentage points.
    We estimate that FY 2000 DRG reclassification and recalibration 
will result in a 0.0 percent change in the case-mix when compared with 
the case-mix index that would have resulted if we had not made the 
reclassification and recalibration changes to the DRGs. Therefore, we 
are making a 0.0 percent adjustment for DRG reclassification and 
recalibration in the update recommendation for FY 2002.
    The capital update framework contains an adjustment for forecast 
error. The input price index forecast is based on historical trends and 
relationships ascertainable at the time the update factor is 
established for the upcoming year. In any given year there may be 
unanticipated price fluctuations that may result in differences between 
the actual increase in prices and the forecast used in calculating the 
update factors. In setting a prospective payment rate under the 
framework, we make an adjustment for forecast error only if our 
estimate of the change in the capital input price index for any year is 
off by 0.25 percentage points or more. There is a 2-year lag between 
the forecast and the measurement of the forecast error. A

[[Page 22731]]

forecast error of 0.3 percentage points was calculated for the FY 2000 
update. That is, current historical data indicate that the FY 2000 CIPI 
used in calculating the forecasted FY 2000 update factor (0.6 percent) 
understated the actual realized price increases (0.9 percent) by 0.3 
percent. This under-prediction was due to prices from municipal bond 
yields declining slower than expected. Therefore, we are making a 0.3 
percent adjustment for forecast error in the update for FY 2002.
    Under the capital prospective payment system framework, we also 
make an adjustment for changes in intensity. We calculate this 
adjustment using the same methodology and data as in the framework for 
the operating prospective payment system. The intensity factor for the 
operating update framework reflects how hospital services are utilized 
to produce the final product, that is, the discharge. This component 
accounts for changes in the use of quality-enhancing services, changes 
in within-DRG severity, and expected modification of practice patterns 
to remove cost-ineffective services.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services), and changes in real case-mix. The use 
of total charges in the calculation of the proposed intensity factor 
makes it a total intensity factor, that is, charges for capital 
services are already built into the calculation of the factor. 
Therefore, we have incorporated the intensity adjustment from the 
operating update framework into the capital update framework. Without 
reliable estimates of the proportions of the overall annual intensity 
increases that are due, respectively, to ineffective practice patterns 
and to the combination of quality-enhancing new technologies and 
within-DRG complexity, we assume, as in the revised operating update 
framework, that one-half of the annual increase is due to each of these 
factors. The capital update framework thus provides an add-on to the 
input price index rate of increase of one-half of the estimated annual 
increase in intensity to allow for within-DRG severity increases and 
the adoption of quality-enhancing technology.
    For FY 2002, we have developed a Medicare-specific intensity 
measure based on a 5-year average using FY 1996 through 2000 data. In 
determining case-mix constant intensity, we found that observed case-
mix increase was 1.6 percent in FY 1996, 0.3 percent in FY 1997, -0.4 
percent in FY 1998, and -0.3 in FY 1999, and -0.7 percent in FY 2000. 
Since we found an increase in case-mix of 1.6 for FY 1996, which was 
outside of the range of 1.0 to 1.4 percent, we estimate that real case-
mix increase was 1.0 to 1.4 percent for that year. The estimate of 1.0 
to 1.4 percent is supported by past studies of case-mix change by the 
RAND Corporation. The most recent study was ``Has DRG Creep Crept Up? 
Decomposing the Case Mix Index Change Between 1987 and 1988'' by G. M. 
Carter, J. P. Newhouse, and D. A. Relles, R-4098-HCFA/ProPAC (1991). 
The study suggested that real case-mix change was not dependent on 
total change, but was usually a fairly steady 1.0 to 1.4 percent per 
year. We use 1.4 percent as the upper bound because the RAND study did 
not take into account that hospitals may have induced doctors to 
document medical records more completely in order to improve payment. 
Following that study, we consider up to 1.4 percent of observed case-
mix change as real for FY 1996 through FY 2000. Based on this analysis, 
we believe that all of the observed case-mix increase for FY 1997, FY 
1998, and FY 1999, and FY 2000 is real. The increases for FY 1996 was 
in excess of our estimate of real case-mix increase.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services), and changes in real case-mix. Based 
upon an upper limit of 1.0 percent real case-mix increase, we estimate 
that case-mix constant intensity increased by an average 0.3 percent 
during FYs 1996 through 2000, for a cumulative increase of 1.4 percent 
given estimates of real case-mix of 1.0 percent for FY 1996, 0.3 
percent for FY 1997, -0.4 for FY 1998, and -0.3 for FY 1999, and -0.7 
percent for FY 2000. Based upon an upper limit of 1.4 percent real 
case-mix increase, we estimate that case-mix constant intensity 
increase by an average 0.2 percent during FYs 1996 through 2000, for a 
cumulative increase of 1.2 percent, given that real case-mix increase 
was 1.4 percent for FY 1996, 0.3 percent for FY 1997, -0.4 for FY 1998, 
-0.3 for FY 1999, and -0.7 percent for FY 2000. Since we estimate that 
intensity has increased during that period, we are recommending a 0.3 
percent intensity adjustment for FY 2002.
    b. Comparison of HCFA and MedPAC Update Recommendations. In its 
March 2001 Report to Congress, MedPAC presented a combined operating 
and capital update for hospital inpatient prospective payment system 
payments for FY 2002. Currently, section 1886(b)(3)(B)(i)(XVII) of the 
Act sets forth the FY 2002 percentage increase in the prospective 
payment system operating cost standardized amounts. The prospective 
payment system capital update is set at the discretion of the Secretary 
under the framework outlined in Sec. 412.308(c)(1).
    For FY 2002, MedPAC's update framework supports a combined 
operating and capital update for hospital inpatient prospective payment 
system payments of 1.5 percent to 3.0 percent (or between the increase 
in the combined operating and capital market basket minus 1.3 
percentage points and the increase in the combined operating and 
capital market basket plus 0.2 percentage points). MedPAC also notes 
that while the number of hospitals with negative inpatient hospital 
margins have increased in FY 1999 (from 33.7 percent in FY 1998 to 36.7 
percent in FY 1999 (page 71)), overall high inpatient Medicare margins 
generally offset hospital losses on other lines of Medicare services. 
MedPAC continues to project substantially improved hospital total 
margins for FY 2000 based on performance in the first half of the 
fiscal year (page 72).
    MedPAC's FY 2002 combined operating and capital update framework 
uses a weighted average of HCFA's forecasts of the operating (PPS Input 
Price Index) and capital (CIPI) market baskets. This combined market 
basket is used to develop an estimate of the change in overall 
operating and capital prices. MedPAC calculated a combined market 
basket forecast by weighting the operating market basket forecast by 
0.92 and the capital market basket forecast by 0.08, since operating 
costs are estimated to represent 92 percent of total hospital costs 
(capital costs are estimated to represent the remaining 8 percent of 
total hospital costs). MedPAC's combined market basket for FY 2002 is 
estimated to increase by 2.8 percent, based on HCFA's December 2000 
forecasted operating market basket increase of 3.0 percent and HCFA's 
December 2000 forecasted capital market basket increase of 0.8 percent.
    Response: As we stated in the August 1, 2000 final rule (65 FR 
47119), our long-term goal is to develop a single update framework for 
operating and capital prospective payments and that we would begin 
development of a unified framework. However, we have not yet developed 
such a single framework as the actual operating system update has been 
determined by Congress through FY 2003 (as amended by Public Law 106-
554). In the meantime, we intend to maintain as much consistency as 
possible with the current operating framework in order to

[[Page 22732]]

facilitate the eventual development of a unified framework.
    Our recommendation for updating the prospective payment system 
capital Federal rate is supported by the following analyses that 
measure changes in scientific and technological advances, practice 
pattern changes, changes in case-mix, the effect of reclassification 
and recalibration, and forecast error correction. MedPAC recommends a 
1.5 to 3.0 percent combined operating and capital update for hospital 
inpatient prospective payments. Under our existing capital update 
framework, we are recommending a 1.1 percent update to the capital 
Federal rate. For purposes of comparing HCFA's capital update 
recommendation and MedPAC's update recommendation for FY 2002, we have 
isolated the capital component of MedPAC's combined market basket 
forecast, which was based on HCFA's December 2000 CIPI forecast of 0.8 
percent. As a result, MedPAC's update recommendation for FY 2002 for 
capital payments is between -0.9 percent and 0.6 percent (see Table 1).
    There are some differences between HCFA's and MedPAC's update 
frameworks, which account for the difference in the respective update 
recommendations. In its combined FY 2002 update recommendation, MedPAC 
uses HCFA's capital input price index (the CIPI) as the starting point 
for estimating the change in prices since the previous year. HCFA's 
CIPI includes price measures for interest expense, which are an 
indicator of the interest rates facing hospitals during their capital 
purchasing decisions. Previously, MedPAC's capital market basket did 
not include interest expense; instead it included a financing policy 
adjustment when necessary to account for the prolonged changes in 
interest rates. HCFA's CIPI is vintage-weighted, meaning that it takes 
into account price changes from past purchases of capital when 
determining the current period update. In the past, MedPAC's capital 
market basket was not vintage-weighted, and only accounted for the 
current year price changes. Beginning last year, both HCFA's and 
MedPAC's FY 2002 update frameworks use HCFA's CIPI. MedPAC used HCFA's 
December 2000 CIPI in preparing its FY 2002 recommendation, which was 
forecast at 0.8 percent. Currently, the CIPI is forecast at 0.5 percent 
(March 2001).
    MedPAC and HCFA also differ in the adjustments they make to their 
price indices. (See Table 1 for a comparison of HCFA and MedPAC's 
update recommendations.) MedPAC makes an adjustment for scientific and 
technological advances, which is offset by a fixed standard for 
productivity growth and one-time factors. HCFA has not adopted a 
separate adjustment for capital science and technology or productivity 
and efficiency.
    In addition, MedPAC includes, when appropriate, an adjustment for 
one-time factors expected to affect costs in FY 2002 and the removal of 
the adjustment for FY 2002 one-time factors in its science and 
technology adjustment. MedPAC concluded that a one-time adjustment of 
0.5 percent for the Health Insurance Portability and Accountability Act 
of 1996 (HIPAA) regulatory requirements be reflected in its FY 2002 
payment update. Additionally, since MedPAC believes that the costs 
associated with one-time factors should not be built permanently into 
the rates, it recommended that the FY 2002 payment rates be reduced by 
0.5 percent to offset the increase it recommended in the FY 2000 update 
for the costs associated with year 2000 (Y2K) computer improvements. 
Thus, MedPAC's combined FY 2002 adjustment for science and 
technological advances is 0.0 percent to 0.5 percent.
    Instead, we have identified a total intensity factor, which 
reflects scientific and technological advances, but we have not 
identified an adequate total productivity measure. MedPAC also includes 
a site-of-care substitution adjustment (unbundling of the payment unit) 
to account for the decline in the average length of Medicare acute 
inpatient stays. This adjustment is designed to shift funding along 
with associated costs when Medicare patients are discharged to 
postacute settings that replace acute impatient days. Other factors, 
such as technological advances that allow for a decreased need in 
follow-up care and BBA mandated policy on payment for transfer cases 
that limits payments within certain DRGs, are reflected in the site-of-
care substitution adjustment as well. We agree with MedPAC that the 
site-of-care substitution effect is real and believe that it is 
factored into our intensity recommendation.
    For FY 2002, MedPAC recommends a -2.0 to -1.0 percent combined 
adjustment for site-of-care substitutions. MedPAC recommends a 0.0 to a 
0.5 percent combined adjustment for scientific and technological 
advances, which was offset by a fixed productivity standard of 0.5 
percent and a 0.0 percent adjustment for one-time factors for FY 2002. 
We recommend a 0.3 intensity adjustment.
    Additionally, MedPAC includes an adjustment for Medicare policy 
changes affecting financial status in its section of factors affecting 
current level of payments in its FY 2002 update recommendation. While 
MedPAC's update framework has not considered such costs in the past, 
MedPAC believes that it is appropriate to account for significant costs 
incurred as a result of new Medicare policy. For FY 2002, MedPAC 
believes that legislated updates will match cost growth and that the 
overall net affects of legislative changes (from Public Law 105-33, 
Public Law 106-113, and Public Law 106-554) will be small. Thus, it did 
not recommend any additional allowance for these costs for FY 2002. 
Accordingly, MedPAC recommended a 0.0 percent adjustment for Medicare 
policy changes.
    MedPAC makes a two-part adjustment for case-mix changes, which 
takes into account changes in case-mix in the past year. It recommends 
a 0.0 percent combined adjustment for DRG coding change and a 0.0 
percent combined adjustment for within-DRG complexity change. This 
results in a combined total case-mix adjustment of 0.0 percent. We 
recommend a 0.0 adjustment for case-mix, since we are projecting a 1.0 
percent increase in case-mix index and we estimate that real case-mix 
increase will equal 1.0 percent in FY 2002.
    We recommend a 0.3 percent adjustment for forecast error 
correction. MedPAC's combined FY 2002 update recommendation includes a 
0.7 percent adjustment for forecast error correction. However, it noted 
that this forecast error adjustment is a result of the difference 
between the forecasted FY 2000 operating market basket of 2.9 percent 
and the actual FY 2000 operating market basket increase of 3.6 percent. 
The FY 2000 capital market basket was forecast at 0.6 percent, while 
the actual observed increase equaled 0.9 percent for capital costs. 
Therefore, we have included 0.3 percent adjustment for FY 2000 forecast 
error correction in the comparison of MedPAC's and HCFA's update 
recommendations for FY 2002 shown below in Table 1.
    We applied MedPAC's ratio of hospital capital costs to total 
hospital costs (8 percent) to the adjustment factors in its update 
framework for comparison with HCFA's capital update framework. The net 
result of these adjustments is that MedPAC has recommended a -0.9 to 
0.6 percent update to the capital Federal rate for FY 2002. MedPAC 
believes that the annual updates to the capital and operating payments 
under the prospective payment system should not differ substantially, 
even though they are determined separately, since they correspond to 
costs generated by providing the same inpatient hospital

[[Page 22733]]

services to the same Medicare patients. We describe the basis for our 
1.1 percent total capital update for FY 2002 in the preceding section. 
Our recommendation of 1.1 percent is 0.5 percent higher than the upper 
limit of the range recommended by MedPAC due to MedPAC's -2.0 to -1.0 
percent combined (operating and capital) adjustment for unbundling of 
the payment unit for FY 2002. If we had applied only the portion of 
that adjustment attributable to capital-related services, our proposed 
update recommendation would most likely have fallen with in the range 
of MedPAC's update recommendation for capital for FY 2002. While in 
previous years, our update recommendation has fallen within the range 
recommended by MedPAC, since MedPAC has developed its combined 
operating and capital update recommendation beginning in FY 2001, we 
have only been outside of that range by 0.5 percent. For FY 2001, our 
update recommendation of 0.9 percent was only 0.5 percentage points 
below MedPAC's lower limit of its FY 2002 recommendation.

   Table 1.--HCFA's FY 2002 Update Factor and MedPAC's Recommendation
------------------------------------------------------------------------
                                  HCFA's update
                                     factor      MedPAC's recommendation
------------------------------------------------------------------------
Capital Input Price Index......             0.5  0.8\1\
Policy Adjustment Factors:
    Intensity..................             0.3  (\2\)
        Science and Technology.  ..............  0.0 to 0.5.
        Real within DRG Change.  ..............  (\3\)
        Site-of-Care             ..............  -2.0 to -1.0.
         Substitution.
        One-Time Factors.......           (\4\)  0.0
                                ----------------------------------------
        Subtotal...............             0.3  -2.0 to -0.5.
                                ----------------------------------------
    Medicare Policy Change;....  ..............  0.0
Case-Mix Adjustment Factors:
    Projected Case-Mix Change..            -1.0  .......................
    Real Across DRG Change.....             1.0  .......................
    Coding Change..............  ..............  0.0
    Real within DRG Change.....           (\4\)  0.0
                                ----------------------------------------
        Subtotal...............             0.0  0.0
Effect of FY 2000                           0.0  .......................
 Reclassification and
 Recalibration.
Forecast Error Correction......             0.3  0.3
                                ========================================
        Total Update...........             1.1  -0.9 to 0.6.
------------------------------------------------------------------------
\1\ Used HCFA's December 2000 capital marker basket forecast in its
  combined update recommendation.
\2\ Included in MedPAC's productivity offset in its science and
  technology adjustment.
\3\ Included in MedPAC's case-mix adjustment.
\4\ Included in HCFA's intensity factor.

2. Outlier Payment Adjustment Factor
    Section 412.312(c) establishes a unified outlier methodology for 
inpatient operating and inpatient capital-related costs. A single set 
of thresholds is used to identify outlier cases for both inpatient 
operating and inpatient capital-related payments. Section 412.308(c)(2) 
provides that the standard Federal rate for inpatient capital-related 
costs be reduced by an adjustment factor equal to the estimated 
proportion of capital-related outlier payments to total inpatient 
capital-related PPS payments. The outlier thresholds are set so that 
operating outlier payments are projected to be 5.1 percent of total 
operating DRG payments.
    In the August 1, 2000 final rule, we estimated that outlier 
payments for capital in FY 2001 would equal 5.91 percent of inpatient 
capital-related payments based on the Federal rate (65 FR 47121). 
Accordingly, we applied an outlier adjustment factor of 0.9409 to the 
Federal rate. Based on the thresholds as set forth in section II.A.4.d. 
of this Addendum, we estimate that outlier payments for capital will 
equal 5.74 percent of inpatient capital-related payments based on the 
Federal rate in FY 2002. Therefore, we are proposing an outlier 
adjustment factor of 0.9426 to the Federal rate. Thus, the projected 
percentage of capital outlier payments to total capital standard 
payments for FY 2002 is lower than the percentage for FY 2001.
    The outlier reduction factors are not built permanently into the 
rates; that is, they are not applied cumulatively in determining the 
Federal rate. As explained previously, in accordance with section 547 
of Public Law 106-554, the proposed FY 2002 rates are based on the FY 
2001 adjustments and rates published in the August 1, 2000 final rule 
(65 FR 47122). Therefore, the proposed net change in the outlier 
adjustment to the Federal rate for FY 2002 is 1.0018 (0.9426/0.9409). 
The outlier adjustment increases the FY 2002 Federal rate by 0.18 
percent compared with the FY 2001 outlier adjustment.
3. Budget Neutrality Adjustment Factor for Changes in DRG 
Classifications and Weights and the Geographic Adjustment Factor
    Section 412.308(c)(4)(ii) requires that the Federal rate be 
adjusted so that aggregate payments for the fiscal year based on the 
Federal rate after any changes resulting from the annual DRG 
reclassification and recalibration and changes in the geographic 
adjustment factor (GAF) are projected to equal aggregate payments that 
would have been made on the basis of the Federal rate without such 
changes. We use the actuarial model, described in Appendix B of this 
proposed rule, to estimate the aggregate payments that would have been 
made on the basis of the Federal rate without changes in the DRG 
classifications and weights and in the GAF. We also use the model to 
estimate aggregate payments that would be made on the basis of the 
Federal rate as a result of those changes. We then use

[[Page 22734]]

these figures to compute the adjustment required to maintain budget 
neutrality for changes in DRG weights and in the GAF.
    For FY 2001, we calculated a GAF/DRG budget neutrality factor of 
0.9979. For FY 2002, we are proposing a GAF/DRG budget neutrality 
factor of 0.9913. The GAF/DRG budget neutrality factors are built 
permanently into the rates; that is, they are applied cumulatively in 
determining the Federal rate. This follows from the requirement that 
estimated aggregate payments each year be no more than they would have 
been in the absence of the annual DRG reclassification and 
recalibration and changes in the GAF. As explained previously, in 
accordance with section 547 of Public Law 106-554, the proposed FY 2002 
adjustments and rates are based on the FY 2001 adjustment and rates 
published in the August 1, 2000 final rule (65 FR 47122). The proposed 
incremental change in the adjustment from FY 2001 to FY 2002 is 0.9913. 
The proposed cumulative change in the rate due to this adjustment is 
0.9906 (the product of the incremental factors for FY 1993, FY 1994, FY 
1995, FY 1996, FY 1997, FY 1998, FY 1999, FY 2000, FY 2001 and the 
proposed incremental factor for FY 2002: 0.9980  x  1.0053  x  0.9998 
x  0.9994  x  0.9987  x  0.9989  x  1.0028  x  0.9985  x  0.9979  x  
0.9913 = 0.9906).
    This proposed factor accounts for DRG reclassifications and 
recalibration and for changes in the GAF. It also incorporates the 
effects on the GAF of FY 2002 geographic reclassification decisions 
made by the MGCRB compared to FY 2001 decisions. However, it does not 
account for changes in payments due to changes in the DSH and IME 
adjustment factors or in the large urban add-on.
4. Exceptions Payment Adjustment Factor
    Section 412.308(c)(3) requires that the standard Federal rate for 
inpatient capital-related costs be reduced by an adjustment factor 
equal to the estimated proportion of additional payments for exceptions 
under Sec. 412.348 relative to total capital payments payments under 
the hospital-specific rate and Federal rate. We use the model 
originally developed for determining the budget neutrality adjustment 
factor to determine the regular exceptions payment adjustment factor. 
We describe that model in Appendix B to this proposed rule. An 
adjustment for regular exceptions is necessary for determining the FY 
2002 rates because we will continue to pay regular exceptions for cost 
reporting periods beginning before October 1, 2001 but ending in FY 
2002 in accordance with Sec. 412.312(c)(3). In FY 2003 and later, no 
payments will be made under the regular exceptions provision, hence we 
will only compute a budget neutrality adjustment under Sec. 412.348(d) 
for special exceptions. We describe the proposed methodology to 
determine to special exceptions adjustment in section V.D. of this 
proposed rule. For FY 2002, the exceptions adjustment is a combination 
of the adjustment that would be made under the regular exceptions 
provision and under the special exceptions provision under 
Sec. 412.348(g).
    For FY 2001, we estimated that exceptions payments would equal 2.15 
percent of aggregate payments based on the Federal rate and the 
hospital-specific rate. Therefore, we applied an exceptions reduction 
factor of 0.9785 (1-0.0215) in determining the Federal rate. For this 
proposed rule, we estimate that regular exceptions payments for FY 2002 
will equal 0.63 percent of aggregate payments based on the Federal rate 
we estimate that special exceptions payments for FY 2002 will equal 
0.12 percent of aggregate payments based on the Federal rate. 
Therefore, we estimate that total exceptions payments for FY 2002 will 
equal 0.75 percent (0.63 + 0.12 = 0.75) of aggregate payments based on 
the Federal rate and we are proposing an exceptions payment reduction 
factor of 0.9925 (1 - 0.0075) to the Federal rate for FY 2002. The 
proposed exceptions reduction factor for FY 2002 is 1.43 percent higher 
than the factor for FY 2001 published in the August 1, 2000 final rule. 
This increase is primarily due to the expiration of the regular 
exceptions provision and the narrowly defined nature of the special 
exceptions policy.
    The exceptions reduction factors are not built permanently into the 
rates; that is, the factors are not applied cumulatively in determining 
the Federal rate. As explained previously, in accordance with section 
547 of Public Law 106-554, the proposed FY 2002 adjustments and rates 
are based on the FY 2001 adjustments and rates published in the August 
1, 2000 final rule (65 FR 47122). Therefore, the proposed net 
adjustment to the FY 2002 Federal rate is 0.9925/0.9785, or 1.0143.
5. Standard Capital Federal Rate for FY 2002
    For FY 2001, the capital Federal rate was $383.06 for discharges 
occurring between October 1, 2000 and April 1, 2001. As a result of 
implementing section 301(a) of Public Law 106-554, for discharges 
occurring from April to October 2001, the capital Federal rate was 
$380.85. However, as explained previously, in accordance with section 
547 of Public Law 106-554, the proposed FY 2002 adjustments and rates 
are based on the FY 2001 adjustments and rates published in the August 
1, 2000 final rule (65 FR 47122). As a result of changes we are 
proposing to the factors used to establish the Federal rate, the 
proposed FY 2002 Federal rate is $389.09. The proposed Federal rate for 
FY 2002 was calculated as follows:
     The proposed FY 2002 update factor is 1.0110; that is, the 
proposed update is 1.10 percent.
     The proposed FY 2002 budget neutrality adjustment factor 
that is applied to the standard Federal payment rate for changes in the 
DRG relative weights and in the GAF is 0.9913.
     The proposed FY 2002 outlier adjustment factor is 0.9426.
     The proposed FY 2002 (regular and special) exceptions 
payments adjustment factor is 0.9925.
    Since the Federal rate has already been adjusted for differences in 
case-mix, wages, cost-of-living, indirect medical education costs, and 
payments to hospitals serving a disproportionate share of low-income 
patients, we propose to make no additional adjustments in the standard 
Federal rate for these factors other than the budget neutrality factor 
for changes in the DRG relative weights and the GAF.
    We are providing a chart that shows how each of the factors and 
adjustments for FY 2002 affected the computation of the proposed FY 
2002 Federal rate in comparison to the FY 2001 Federal rate. The 
proposed FY 2002 update factor has the effect of increasing the Federal 
rate by 1.10 percent compared to the FY 2001 rate published in the 
August 1, 2000 final rule, while the proposed geographic and DRG budget 
neutrality factor has the effect of decreasing the Federal rate by 0.87 
percent. The proposed FY 2002 outlier adjustment factor has the effect 
of increasing the Federal rate by 0.18 percent compared to the FY 2001 
rate published in the August 1, 2000 final rule. The proposed FY 2002 
(regular and special) exceptions reduction factor has the effect of 
increasing the Federal rate by 1.43 percent compared to the exceptions 
reduction for FY 2001. The combined effect of all the proposed changes 
is to increase the proposed Federal rate by 1.85 percent compared to 
the Federal rate for FY 2001.

[[Page 22735]]



          Comparison of Factors and Adjustments: FY 2001 Federal Rate and Proposed FY 2002 Federal Rate
----------------------------------------------------------------------------------------------------------------
                                                                    Proposed FY
                                                      FY 2001          2002           Change      Percent change
----------------------------------------------------------------------------------------------------------------
Update factor \1\...............................          1.0090          1.0110          1.0110            1.10
GAF/DRG Adjustment Factor \1\...................          0.9979          0.9913          0.9913           -0.87
Outlier Adjustment Factor \2\...................          0.9409          0.9426          1.0018            0.18
Exceptions Adjustment Factor \2\................          0.9785          0.9925          1.0143            1.43
Federal Rate....................................       $382.03          $38.09             1.018           1.85
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality factors are built permanently into the rates. Thus, for
  example, the incremental change from FY 2000 to FY 2001 resulting from the application of the 0.9913 GAF/DRG
  budget neutrality factor for FY 2001 is 0.9913.
\2\ The outlier reduction factor and the exceptions reduction factor are not built permanently into the rates;
  that is, these factors are not applied cumulatively in determining the rates. Thus, for example, the net
  change resulting from the application of the FY 2001 outlier reduction factor is 0.9426/0.9409, or 1.0018.

6. Special Rate for Puerto Rico Hospitals
    As explained at the beginning of section IV of this Addendum, 
hospitals in Puerto Rico are paid based on 50 percent of the Puerto 
Rico rate and 50 percent of the Federal rate. The Puerto Rico rate is 
derived from the costs of Puerto Rico hospitals only, while the Federal 
rate is derived from the costs of all acute care hospitals 
participating in the prospective payment system (including Puerto 
Rico). To adjust hospitals' capital payments for geographic variations 
in capital costs, we apply a GAF to both portions of the blended rate. 
The GAF is calculated using the operating prospective payment system 
wage index and varies depending on the MSA or rural area in which the 
hospital is located. We use the Puerto Rico wage index to determine the 
GAF for the Puerto Rico part of the capital-blended rate and the 
national wage index to determine the GAF for the national part of the 
blended rate.
    Because we implemented a separate GAF for Puerto Rico in FY 1998, 
we also apply separate budget neutrality adjustments for the national 
GAF and for the Puerto Rico GAF. However, we apply the same budget 
neutrality factor for DRG reclassifications and recalibration 
nationally and for Puerto Rico. The Puerto Rico GAF budget neutrality 
factor is 0.99941, while the DRG adjustment is 0.9943, for a combined 
cumulative adjustment of 0.9937.
    In computing the payment for a particular Puerto Rico hospital, the 
Puerto Rico portion of the rate (50 percent) is multiplied by the 
Puerto Rico-specific GAF for the MSA in which the hospital is located, 
and the national portion of the rate (50 percent) is multiplied by the 
national GAF for the MSA in which the hospital is located (which is 
computed from national data for all hospitals in the United States and 
Puerto Rico). In FY 1998, we implemented a 17.78 percent reduction to 
the Puerto Rico rate as a result of Public Law 105-33.
    For FY 2001, before application of the GAF, the special rate for 
Puerto Rico hospitals was $185.06. As explained previously, in 
accordance with section 547 of Public Law 106-554, the proposed FY 2002 
adjustments and rates are based on the FY 2001 rates published in the 
August 1, 2000 final rule. With the changes we are proposing to the 
factors used to determine the rate, the proposed FY 2002 special rate 
for Puerto Rico is $188.67.

B. Calculation of Inpatient Capital-Related Prospective Payments for FY 
2002

    With the end of the capital prospective payment system transition 
period, all hospitals (except those defined as ``new'' under 
Sec. 412.300(b)) will be paid based on 100 percent of the Federal rate 
in FY 2002. The applicable Federal rate was determined by making 
adjustments as follows:
     For outliers, by dividing the standard Federal rate by the 
outlier reduction factor for that fiscal year; and
      For the payment adjustments applicable to the hospital, 
by multiplying the hospital's GAF, disproportionate share adjustment 
factor, and IME adjustment factor, when appropriate.
    For purposes of calculating payments for each discharge during FY 
2002, the standard Federal rate is adjusted as follows:

(Standard Federal Rate)  x  (DRG weight)  x  (GAF)  x  (Large Urban 
Add-on, if applicable)  x  (COLA adjustment for hospitals located in 
Alaska and Hawaii)  x  (1 + Disproportionate Share Adjustment Factor 
+ IME Adjustment Factor, if applicable).

    The result is the adjusted Federal rate.
    Hospitals also may receive outlier payments for those cases that 
qualify under the thresholds established for each fiscal year. Section 
412.312(c) provides for a single set of thresholds to identify outlier 
cases for both inpatient operating and inpatient capital-related 
payments. The proposed outlier thresholds for FY 2002 are in section 
II.A.4.c. of this Addendum. For FY 2002, a case qualifies as a cost 
outlier if the cost for the case (after standardization for the 
indirect teaching adjustment and disproportionate share adjustment) is 
greater than the prospective payment rate for the DRG plus $20,900.
    During the capital prospective payment system transition period, a 
hospital also may receive an additional payment under the regular an 
exceptions process through its cost reporting period beginning before 
October 1, 2001 but ending in FY 2002 if its total inpatient capital-
related payments are less than a minimum percentage of its allowable 
Medicare inpatient capital-related costs. The minimum payment level is 
established by class of hospital under Sec. 412.348(c). Under 
Sec. 412.348(d), the amount of a regular exceptions payment is 
determined by comparing the cumulative payments made to the hospital 
under the capital prospective payment system to the cumulative minimum 
payment levels applicable to the hospital for each cost reporting 
period subject to that system. Any amount by which the hospital's 
cumulative payments exceed its cumulative minimum payment is deducted 
from the additional payment that would otherwise be payable for a cost 
reporting period.
    An eligible hospital may qualify for a special exception payment 
under Sec. 412.348(g) through the 10th year beyond the end of the 
capital transition period if meets (1) a project need requirement 
described at Sec. 412.348(g)(2), which in the case of certain urban 
hospitals includes an excess capacity test; and (2) a project size 
requirement as described at Sec. 412.348(g)(5). Eligible hospitals 
include sole community hospitals, urban hospitals with at lest 100 beds 
that have a DSH percentage of at least

[[Page 22736]]

20.2 percent, and hospitals that have a combined Medicare and Medicaid 
inpatient utilization of at least 70 percent. Under Sec. 412.348(g)(8), 
the amount of a special exceptions payment is determined by comparing 
the cumulative payments made to the hospital under the capital 
prospective payment system to the cumulative minimum payment level. 
This amount is offset by (1) any amount by which a hospital's 
cumulative capital payments exceed its cumulative minimum payment 
levels applicable under the regular exceptions process for cost 
reporting periods beginning during which the hospital has been subject 
to capital PPS; and (2) any amount by which a hospital's current year 
operating and capital payments (excluding 75 percent of operating DSH 
payments) exceed its operating and capital costs. The minimum payment 
level is 70 percent for all eligible hospitals under Sec. 412.348(g).
    New hospitals as defined under Sec. 412.300 are exempted from the 
capital prospective payment system for their first 2 years of operation 
and are paid 85 percent of their reasonable costs during that period. A 
new hospital's old capital costs are its allowable costs for capital 
assets that were put in use for patient care on or before the later of 
December 31, 1990, or the last day of the hospital's base year cost 
reporting period, and are subject to the rules pertaining to old 
capital and obligated capital as of the applicable date. Effective with 
the third year of operation, we will pay the hospital under either the 
fully prospective methodology, using the appropriate transition blend 
in that Federal fiscal year, or the hold-harmless methodology. If the 
hold-harmless methodology is applicable, the hold-harmless payment for 
assets in use during the base period would extend for 8 years, even if 
the hold-harmless payments extend beyond the normal transition period.

C. Capital Input Price Index

1. Background
    Like the operating input price index, the capital input price index 
(CIPI) is a fixed-weight price index that measures the price changes 
associated with costs during a given year. The CIPI differs from the 
operating input price index in one important aspect--the CIPI reflects 
the vintage nature of capital, which is the acquisition and use of 
capital over time. Capital expenses in any given year are determined by 
the stock of capital in that year (that is, capital that remains on 
hand from all current and prior capital acquisitions). An index 
measuring capital price changes needs to reflect this vintage nature of 
capital. Therefore, the CIPI was developed to capture the vintage 
nature of capital by using a weighted-average of past capital purchase 
prices up to and including the current year.
    Using Medicare cost reports, American Hospital Association (AHA) 
data, and Securities Data Company data, a vintage-weighted price index 
was developed to measure price increases associated with capital 
expenses. We periodically update the base year for the operating and 
capital input prices to reflect the changing composition of inputs for 
operating and capital expenses. Currently, the CIPI is based to FY 1992 
and was last rebased in 1997. The most recent discussion of the cost 
category weights in the CIPI was in the final rule with comment period 
for FY 1998 published on August 29, 1997 (62 FR 46050).
2. Forecast of the CIPI for Federal Fiscal Year 2001
    We are forecasting the CIPI to increase 0.9 percent for FY 2002. 
This reflects a projected 1.5 percent increase in vintage-weighted 
depreciation prices (building and fixed equipment, and movable 
equipment) and a 3.5 percent increase in other capital expense prices 
in FY 2002, partially offset by a 1.3 percent decline in vintage-
weighted interest rates in FY 2002. The weighted average of these three 
factors produces the 0.9 percent increase for the CIPI as a whole.

IV. Proposed Changes to Payment Rates for Excluded Hospitals and 
Hospital Units: Rate-of-Increase Percentages

    The inpatient operating costs of hospitals and hospital units 
excluded from the prospective payment system are subject to rate-of-
increase limits established under the authority of section 1886(b) of 
the Act, which is implemented in regulations at Sec. 413.40. Under 
these limits, a hospital-specific target amount (expressed in terms of 
the inpatient operating cost per discharge) is set for each hospital, 
based on the hospital's own historical cost experience trended forward 
by the applicable rate-of-increase percentages (update factors). In the 
case of a psychiatric hospital or hospital unit, a rehabilitation 
hospital or hospital unit, or a long-term care hospital, the target 
amount may not exceed the updated figure for the 75th percentile of 
target amounts adjusted to take into account differences between 
average wage-related costs in the area of the hospital and the national 
average of such costs within the same class of hospital for hospitals 
and units in the same class (psychiatric, rehabilitation, and long-term 
care) for cost reporting periods ending during FY 1996. The target 
amount is multiplied by the number of Medicare discharges in a 
hospital's cost reporting period, yielding the ceiling on aggregate 
Medicare inpatient operating costs for the cost reporting period.
    Each hospital-specific target amount is adjusted annually, at the 
beginning of each hospital's cost reporting period, by an applicable 
update factor.
    Section 1886(b)(3)(B) of the Act, which is implemented in 
regulations at Sec. 413.40(c)(3)(vii), provides that for cost reporting 
periods beginning on or after October 1, 1998 and before October 1, 
2002, the update factor for a hospital or unit depends on the 
hospital's or hospital unit's costs in relation to the ceiling for the 
most recent cost reporting period for which information is available. 
For hospitals with costs exceeding the ceiling by 10 percent or more, 
the update factor is the market basket increase. For hospitals with 
costs exceeding the ceiling by less than 10 percent, the update factor 
is the market basket minus .25 percent for each percentage point by 
which costs are less than 10 percent over the ceiling. For hospitals 
with costs equal to or less than the ceiling but greater than 66.7 
percent of the ceiling, the update factor is the greater of 0 percent 
or the market basket minus 2.5 percent. For hospitals with costs that 
do not exceed 66.7 percent of the ceiling, the update factor is 0.
    The most recent forecast of the market basket increase for FY 2002 
for hospitals and hospital units excluded from the prospective payment 
system is 3.0 percent. Therefore, the update to a hospital's target 
amount for its cost reporting period beginning in FY 2002 would be 
between 0.5 and 3.0 percent, or 0 percent, depending on the hospital's 
or unit's costs in relation to its rate-of-increase limit.
    In addition, Sec. 413.40(c)(4)(iii) requires that for cost 
reporting periods beginning on or after October 1, 1998 and before 
October 1, 2002, the target amount for each psychiatric hospital or 
hospital unit, rehabilitation hospital or hospital unit, and long-term 
care hospital cannot exceed a cap on the target amounts for hospitals 
in the same class.
    Section 1886(b)(3)(H) of the Act, as amended by section 121 of 
Public Law 106-113, provides for an appropriate wage adjustment to the 
caps on the target amounts for psychiatric hospitals and units, 
rehabilitation hospitals and units, and long-term care hospitals, 
effective for cost reporting periods beginning on or after October 1, 
1999, through September 30, 2002. On August

[[Page 22737]]

1, 2000, we published an interim final rule with comment period that 
implemented this provision for cost reporting periods beginning on or 
after October 1, 1999 and before October 1, 2000 (65 FR 47026) and a 
final rule that implemented the provision for cost reporting periods 
beginning on or after October 1, 2000 and before October 1, 2001 (65 FR 
47054). This proposed rule addresses the wage adjustment to the caps 
for cost reporting periods beginning on or after October 1, 2001.
    As discussed in section VI. of the preamble of this proposed rule, 
the cap on the target amount per discharge is determined by adding the 
hospital's nonlabor-related portion of the national 75th percentile cap 
to its wage-adjusted, labor-related portion of the national 75th 
percentile cap (the labor-related portion of costs equals 0.71553 and 
the nonlabor-related portion of costs equals 0.28447). A hospital's 
wage-adjusted, labor-related portion of the target amount is calculated 
by multiplying the labor-related portion of the national 75th 
percentile cap for the hospital's class by the wage index under the 
hospital inpatient prospective payment system (see Sec. 412.63), 
without taking into account reclassifications under sections 
1886(d)(8)(B) and (d)(10) of the Act.
    As discussed in section VI. of the preamble of this proposed rule, 
we are proposing to make an adjustment to the caps on target amounts 
for new and existing excluded hospitals and units. In calculating the 
wage-adjusted caps on target amounts for new and existing excluded and 
units for FY 2001, we inadvertently made an error. In wage neutralizing 
FY 1996 target amounts, we used the FY 2000 hospital inpatient 
prospective payment system wage index published in Tables 4A and 4B of 
the July 30, 1999 final rule (64 FR 41585 through 41593), which is 
based on wage data after taking into account geographic 
reclassifications under section 1886(d)(8) of the Act. We are proposing 
to use pre-reclassified wage data in our recalculation of the caps for 
FY 2002. We propose to recalculate the limits for new excluded 
hospitals and units, as well as calculate the cap for existing excluded 
hospitals and units using the same wage index used under the 
prospective payment system for skilled nursing facilities (SNF) as 
shown in Table 7 of the July 30, 1999 SNF final rule (64 FR 41690). We 
do not anticipate a significant impact on overall payments to these 
hospitals and units.
    Section 307(a) of Public Law 106-554 amended section 1886(b)(3) of 
the Act to provide for a 2-percent increase to the wage-adjusted 75th 
percentile cap on the target amount for long-term care hospitals, 
effective for cost reporting periods beginning during FY 2001. This 
provision is applicable to long-term care hospitals that were subject 
to the cap for existing excluded hospitals and units, as specified in 
Sec. 413.40(c).
    In addition to the increase to the cap on target amounts for long-
term care hospitals, section 307(a) of Public Law 106-554 amended 
section 1886(b)(3)(A) of the Act to make the section applicable to all 
long-term care hospitals, effective for cost reporting periods 
beginning during FY 2001. This provision requires a revision to the 
determination of each long-term care hospital's FY 2001 target amount 
as specified in Sec. 413.40(c)(4). For cost reporting periods beginning 
during FY 2001, the hospital-specific target amount otherwise 
determined for a long-term care hospital as specified under 
Sec. 413.40(c)(4)(ii) is multiplied by 1.25 (that is, increased by 25 
percent). However, the revised FY 2001 target amount for a long-term 
care hospital cannot exceed its wage-adjusted national cap as required 
by section 1886(b)(3) of the Act, as amended by section 307(a) of 
Public Law 106-554.
    For cost reporting periods beginning in FY 2002, the proposed caps 
are as follows:

------------------------------------------------------------------------
                                                   Labor-     Nonlabor-
      Class of excluded hospital or unit          related      related
                                                   share        share
------------------------------------------------------------------------
Psychiatric...................................       $8,404       $3,341
Rehabilitation................................       15,689        6,237
Long-Term Care................................       31,399       12,483
------------------------------------------------------------------------

    Regulations at Sec. 413.40(d) specify the formulas for determining 
bonus and relief payments for excluded hospitals and specify 
established criteria for an additional bonus payment for continuous 
improvement. Regulations at Sec. 413.40(f)(2)(ii) specify the payment 
methodology for new hospitals and hospital units (psychiatric, 
rehabilitation, and long-term care) effective October 1, 1997.

V. Tables

    This section contains the tables referred to throughout the 
preamble to this proposed rule and in this Addendum. For purposes of 
this proposed rule, and to avoid confusion, we have retained the 
designations of Tables 1 through 5 that were first used in the 
September 1, 1983 initial prospective payment final rule (48 FR 39844). 
Tables 1A, 1C, 1D, 2, 3A, 3B, 4A, 4B, 4C, 4F, 4G, 4H, 5, 6A, 6B, 6C, 
6D, 6E, 6F, 6G, 6H, 7A, 7B, 8A, and 8B are presented below. The tables 
presented below are as follows:

Table 1A--National Adjusted Operating Standardized Amounts, Labor/
Nonlabor
Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico, 
Labor/Nonlabor
Table 1D--Capital Standard Federal Payment Rate
Table 2--Hospital Average Hourly Wage for Federal Fiscal Years 2000 
(1996 Wage Data), 2001 (1997 Wage Data) and 2002 (1998 Wage Data) Wage 
Indexes and 3-Year Average of Hospital Average Hourly Wages
Table 3A--3-Year Average Hourly Wage for Urban Areas
Table 3B--3-Year Average Hourly Wage for Rural Areas
Table 4A--Wage Index and Capital Geographic Adjustment Factor (GAF) for 
Urban Areas
Table 4B--Wage Index and Capital Geographic Adjustment Factor (GAF) for 
Rural Areas
Table 4C--Wage Index and Capital Geographic Adjustment Factor (GAF) for 
Hospitals That Are Reclassified
Table 4F--Puerto Rico Wage Index and Capital Geographic Adjustment 
Factor (GAF)
Table 4G--Pre-Reclassified Wage Index for Urban Areas
Table 4H--Pre-Reclassified Wage Index for Rural Areas
Table 5--List of Diagnosis Related Groups (DRGs), Relative Weighting 
Factors, Geometric and Arithmetic Mean Length of Stay
Table 6A--New Diagnosis Codes
Table 6B--New Procedure Codes
Table 6C--Invalid Diagnosis Codes
Table 6D--Invalid Procedure Codes
Table 6E--Revised Diagnosis Code Titles
Table 6F--Revised Procedure Code Titles
Table 6G--Additions to the CC Exclusions List
Table 6H--Deletions to the CC Exclusions List
Table 7A--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay FY 2000 MedPAR Update 12/00 GROUPER V18.0
Table 7B--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay FY 2000 MedPAR Update 12/00 GROUPER V20.0
Table 8A--Statewide Average Operating Cost-to-Charge Ratios for Urban 
and Rural Hospitals (Case Weighted) March 2001
Table 8B--Statewide Average Capital Cost-to-Charge Ratios (Case 
Weighted) March 2001

[[Page 22738]]



   Table 1A.--National Adjusted Operating Standardized Amounts, Labor/
                                Nonlabor
------------------------------------------------------------------------
          Large urban areas                       Other areas
------------------------------------------------------------------------
  Labor-related     Nonlabor-related    Labor-related   Nonlabor-related
------------------------------------------------------------------------
      $2,940.89          $1,195.38          $2,894.33         $1,176.46
------------------------------------------------------------------------


               Table 1C.--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
                                                         Large urban areas                  Other areas
                                                 ---------------------------------------------------------------
                                                       Labor         Nonlabor          Labor         Nonlabor
----------------------------------------------------------------------------------------------------------------
National........................................       $2,915.45       $1,185.04       $2,915.45       $1,185.04
Puerto Rico.....................................        1,414.18          569.25        1,391.79          560.23
----------------------------------------------------------------------------------------------------------------


            Table 1D.--Capital Standard Federal Payment Rate
------------------------------------------------------------------------
                                                               Rate
------------------------------------------------------------------------
National................................................         $389.09
Puerto Rico.............................................          188.67
------------------------------------------------------------------------

    --------------------
* Wage data not available for the provider that year.

** For Federal Fiscal Year 2002 only, the average hourly wage is based 
upon data on file as of February 15, 2001. It does not reflect changes 
processed after that date.

*** The 3-year average hourly wage is weighted by salaries and hours.

[[Page 22738]]



Table 2.--Hospital Average Hourly Wage for Federal Fiscal Years 2000 (1996 Wage Data), 2001 (1997 Wage Data) and
             2002 (1998 Wage Data) Wage Indexes and 3-Year Average of Hospital Average Hourly Wages
----------------------------------------------------------------------------------------------------------------
                                                      Average         Average        Average**      Average***
                  Provider No.                      hourly wage     hourly wage     hourly wage     hourly wage
                                                     FFY 2000        FFY 2001        FFY 2002        (3 years)
----------------------------------------------------------------------------------------------------------------
010001..........................................         15.8484         16.4088         17.1352         16.4665
010004..........................................         15.0194         17.9732         19.0010         17.1863
010005..........................................         16.2615         17.5985         18.6554         17.4986
010006..........................................         17.3081         16.7480         17.3537         17.1306
010007..........................................         14.8048         15.4798         15.6788         15.3288
010008..........................................         17.6549         14.7443         17.4728         16.6080
010009..........................................         17.5328         18.7731         18.4390         18.2439
010010..........................................         15.9090         16.4468         16.4664         16.2848
010011..........................................         20.6261         20.7972         21.9311         21.1001
010012..........................................         19.2992         17.7171         15.8686         17.5430
010015..........................................         18.3461         15.4510         18.7062         17.3913
010016..........................................         16.1311         17.2473         18.6772         17.4112
010018..........................................         18.9617         17.6449         18.9388         18.5180
010019..........................................         15.4910         16.3493         17.0672         16.3245
010021..........................................         14.6297         16.2919         15.1241         15.3000
010022..........................................         20.5050         18.5879         17.6435         18.8422
010023..........................................         16.2581         16.1025         16.3209         16.2283
010024..........................................         16.0263         16.2900         16.2974         16.2091
010025..........................................         14.5311         15.1356         15.1548         14.9441
010027..........................................         14.9278         11.7900         16.8595         14.1053
010029..........................................         16.4103         17.6461         18.3605         17.4403
010031..........................................         18.0194         18.7835         18.5180         18.4445
010032..........................................         12.6540         12.5995         15.3590         13.6017
010033..........................................         19.6797         20.3923         21.1818         20.4188
010034..........................................         14.7342         15.0959         15.3639         15.0606
010035..........................................         17.4788         20.1853         16.0377         17.7343
010036..........................................         17.2880         17.8140         17.0366         17.3872
010038..........................................         18.3309         18.2671         19.6098         18.7632
010039..........................................         18.8080         20.1045         20.3406         19.7778
010040..........................................         19.1030         18.9376         19.9152         19.2851
010043..........................................         16.2022         30.7489         18.6640         19.9982
010044..........................................         17.0229         22.0091         24.0265         20.8906
010045..........................................         15.0065         15.2200         17.0417         15.7248
010046..........................................         17.1822         17.3970         18.9737         17.8750
010047..........................................         16.3803         13.3521         15.4332         15.2044
010049..........................................         14.4823         14.7590         15.5246         14.9487
010050..........................................         15.4159         18.5163         17.3895         17.0820

[[Page 22739]]

 
010051..........................................          9.9390         11.9275         11.8108         11.1940
010052..........................................         13.8649         16.5486         18.0653         16.1248
010053..........................................         13.1778         14.6267         15.5649         14.5406
010054..........................................         17.1246         18.5103         19.5148         18.4901
010055..........................................         18.1930         18.9526         18.8590         18.6711
010058..........................................         12.7809         16.1702         16.9715         15.1274
010059..........................................         18.1886         19.1286         18.8020         18.7124
010061..........................................         15.9215         14.9547         14.5003         15.1112
010062..........................................         13.5690         14.7732         12.3259         13.5151
010064..........................................         20.8966         20.4139         19.5256         20.2712
010065..........................................         15.6357         16.4049         16.8752         16.3279
010066..........................................         12.0681         15.4317         13.1559         13.4757
010068..........................................         18.7367         12.0525         12.9616         14.2644
010069..........................................         13.5684         13.8636         14.7211         14.0429
010072..........................................         14.3481         14.9526         16.2339         15.1957
010073..........................................         12.8328         13.8601         14.1273         13.6015
010078..........................................         17.7110         17.9202         18.1028         17.9134
010079..........................................         16.8701         16.4421         14.5611         15.8427
010080..........................................         13.8473               *               *         13.8473
010081..........................................         16.9823         18.9474         17.2996         17.7081
010083..........................................         16.2146         16.8933         18.0312         17.0916
010084..........................................         18.7794         18.4965         18.7769         18.6812
010085..........................................         18.8696         18.4744         19.6888         19.0044
010086..........................................         14.9255         16.6694         16.5711         16.0968
010087..........................................         18.3889         19.0033         17.3321         18.3237
010089..........................................         16.6090         16.8042         17.7800         17.0521
010090..........................................         18.1121         18.3866         18.9445         18.4882
010091..........................................         16.3620         13.9405         17.0799         15.6820
010092..........................................         16.4980         16.9900         17.8144         17.1322
010094..........................................         18.5603               *               *         18.5603
010095..........................................         11.8993         12.4525         12.2597         12.2090
010097..........................................         12.8955         13.0413         12.7286         12.8889
010098..........................................         14.2787         15.9165         14.0300         14.6833
010099..........................................         15.9309         15.9874         15.5619         15.8073
010100..........................................         15.4826         17.2011         17.7237         16.8503
010101..........................................         15.4173         15.3859         14.4460         15.0721
010102..........................................         12.7251         13.7933         13.8136         13.4259
010103..........................................         19.3115         17.9358         16.6514         17.9628
010104..........................................         18.0997         17.7126         15.9964         17.2534
010108..........................................         20.7914         17.9017         19.4617         19.3047
010109..........................................         14.0870         15.3107         14.6834         14.6934
010110..........................................         15.9066         15.6317         15.8283         15.7917
010112..........................................         15.1056         15.1401         16.8271         15.6716
010113..........................................         17.2440         16.9683         13.9413         15.9844
010114..........................................         17.2612         15.2454         17.0136         16.4485
010115..........................................         13.7524         14.6268         14.9632         14.4787
010118..........................................         16.6889         18.8477         17.0834         17.5145
010119..........................................         18.1707         18.8024         20.7741         19.7059
010120..........................................         17.0332         17.2336         18.2567         17.5146
010121..........................................         15.1806         14.6444         14.5262         14.8160
010123..........................................         18.1604         16.7344         19.2140         17.9949
010124..........................................         16.2666         16.2846         16.7465         16.4273
010125..........................................         14.4153         15.5304         16.0136         15.3557
010126..........................................         17.6405         19.5710         19.1065         18.7347
010127..........................................         19.6095         19.5190         18.2786         19.1726
010128..........................................         12.5747         14.5056         14.4322         13.6385
010129..........................................         14.4267         14.7286         16.1733         15.1385
010130..........................................         16.3465         16.6809         18.1314         16.9797
010131..........................................         17.9076         17.8260         20.1883         18.6602
010134..........................................         10.7817         18.8835         19.9856         15.8677
010137..........................................         15.9348         12.1217         20.4561         15.8609
010138..........................................         12.1295         12.8675         14.5254         13.1763
010139..........................................         19.9487         19.0001         20.6815         19.8355

[[Page 22740]]

 
010143..........................................         15.7144         16.7911         17.6212         16.7651
010144..........................................         17.1211         17.1320         17.7580         17.3377
010145..........................................         20.7460         20.8434         20.5895         20.7209
010146..........................................         18.8561         18.5198         19.1415         18.8309
010148..........................................         14.6443         12.2214         15.8349         13.9784
010149..........................................         17.0836         18.6333         18.0156         17.9216
010150..........................................         16.9749         17.8951         18.8977         17.9203
010152..........................................         17.3835         17.8306         18.2173         17.8172
010155..........................................         16.7028          9.0300         15.0689         12.5183
010158..........................................               *         17.3227         18.3957         17.8637
020001..........................................         27.9690         28.1747         27.4110         27.8426
020002..........................................         26.9145         24.5815         25.1987         25.5092
020004..........................................         26.3979         30.5667         25.4679         27.5927
020005..........................................         29.0068         30.2920         29.2378         29.5337
020006..........................................         26.7706         31.2404         28.1417         28.8630
020007..........................................         24.9555         27.8319         32.3852         28.0097
020008..........................................         30.4712         29.4146         30.8691         30.2487
020009..........................................         23.1801         20.1930         18.4660         20.3801
020010..........................................         18.6417         23.6727         22.7559         21.4818
020011..........................................         29.4697         30.4727         28.0658         29.3006
020012..........................................         23.9259         24.8543         25.5320         24.7635
020013..........................................         26.8172         23.8847         28.1557         26.0576
020014..........................................         24.0932         27.3823         24.9201         25.4246
020017..........................................         24.9714         26.8319         27.6501         26.5037
020024..........................................         22.7263         24.0872         25.3205         24.0621
020025..........................................         27.1529         21.7557         20.2583         22.6334
030001..........................................         19.8695         20.3673         21.7869         20.6506
030002..........................................         21.6263         21.5977         21.8375         21.6886
030003..........................................         23.6722         23.4833         22.6804         23.3063
030004..........................................         17.7333         14.0711         15.5478         15.4308
030006..........................................         17.6409         18.2668         19.7289         18.5307
030007..........................................         18.5602         19.6708         21.5169         19.9379
030008..........................................               *         22.2758         22.2190         22.2524
030009..........................................         17.9343         18.1794         18.7557         18.2786
030010..........................................         18.7997         19.0907         19.5123         19.1422
030011..........................................         20.0784         19.2973         19.4310         19.5785
030012..........................................         19.4245         18.9918         20.6585         19.6997
030013..........................................         21.0182         20.7458         19.6369         20.4298
030014..........................................         19.4697         19.9315         19.7966         19.7342
030016..........................................         20.5606         19.3967         19.4785         19.8559
030017..........................................         20.4185         22.8765         21.7938         21.6805
030018..........................................         18.9115         20.2032         20.8980         20.0193
030019..........................................         19.9211         21.7005         21.2540         20.9846
030022..........................................         15.7886         19.2966         17.3485         17.0947
030023..........................................         22.4365         23.6697         24.1678         23.4686
030024..........................................         21.6692         22.2541         22.6199         22.1974
030025..........................................         17.6759         12.7254         11.9894         13.7385
030027..........................................         17.5796         15.7554         17.6555         16.9563
030030..........................................         21.6249         20.8303         21.6932         21.3795
030033..........................................         16.8396         20.0044         20.2820         18.9069
030034..........................................         19.0868         16.8241         20.8689         18.8279
030035..........................................         19.7153         19.2781         20.0226         19.6580
030036..........................................         18.9449         20.7567         21.6371         20.4743
030037..........................................         21.4376         22.8266         23.7615         22.6712
030038..........................................         22.0777         22.6776         22.9822         22.5885
030040..........................................         17.9722         18.5456         19.7636         18.7537
030041..........................................         17.4389         15.8921         18.8717         17.2718
030043..........................................         20.7721         20.9341         20.5598         20.7468
030044..........................................         16.4654         16.8649         17.6575         17.0214
030047..........................................         19.6916         22.6401         21.4412         21.2271
030049..........................................         19.0896         19.0881         19.3580         19.1639
030054..........................................         14.4861         15.3338         15.0657         14.9801
030055..........................................         18.2751         16.3613         20.2991         18.2684

[[Page 22741]]

 
030059..........................................         21.7100         24.0465         22.6279         22.7570
030060..........................................         16.7661         19.2461         18.6313         18.2043
030061..........................................         17.3470         18.9063         19.9047         18.7238
030062..........................................         17.4825         17.6738         18.0603         17.7568
030064..........................................         18.5391         19.5673         19.9437         19.3687
030065..........................................         19.9277         20.5130         20.7838         20.4254
030067..........................................         15.6207         14.4446         17.2778         15.7364
030068..........................................         17.3482         17.3614         17.7208         17.4823
030069..........................................         19.0013         19.0961         21.0936         19.7255
030080..........................................         19.9865         20.5144         20.6581         20.3684
030083..........................................         23.6433         23.3355         23.5229         23.4991
030085..........................................         17.8402         21.0954         20.8611         19.9420
030086..........................................         18.5030         19.5436               *         19.0352
030087..........................................         20.0469         21.4084         21.9465         21.1838
030088..........................................         19.5772         19.8682         20.4978         20.0029
030089..........................................         19.9018         20.4019         20.9516         20.4404
030092..........................................         21.5628         20.6986         21.8308         21.3646
030093..........................................         19.4688         19.7262         20.4314         19.9052
030094..........................................         19.4773         21.6218         22.8123         21.4086
030095..........................................         14.2499         13.7293         13.7664         13.9087
030099..........................................         18.0747         16.1541         18.2263         17.4781
030100..........................................               *               *         23.7609         23.7609
030101..........................................               *               *         19.2547         19.2547
030102..........................................               *               *         18.2413         18.2413
040001..........................................         15.5735         15.1624         16.9178         15.8741
040002..........................................         14.0865         13.0592         15.1107         14.0333
040003..........................................         14.0027         14.2089         15.5740         14.5731
040004..........................................         17.2926         17.8476         17.9034         17.6718
040005..........................................         12.8825         13.2597         11.1318         12.3937
040007..........................................         19.5299         21.9583         18.6998         19.9568
040008..........................................         12.6974         15.3040         14.7985         14.3087
040010..........................................         17.6231         18.6023         19.4913         18.6031
040011..........................................         12.2654         14.5319         16.0995         14.1756
040014..........................................         15.3853         17.6340         18.1434         17.0051
040015..........................................         14.6045         16.5891         15.5207         15.5649
040016..........................................         17.5431         19.0295         20.2321         18.9152
040017..........................................         14.9533         13.5098         15.4686         14.6576
040018..........................................         17.5602         17.6027         18.7463         17.9749
040019..........................................         25.7080         22.6769         23.4163         23.8479
040020..........................................         14.8059         16.4827         18.9844         16.6335
040021..........................................         16.4628         17.6398         19.6835         17.8176
040022..........................................         16.0006         17.0397         14.8398         15.8797
040024..........................................         15.7282         14.4541         17.6523         15.9585
040025..........................................         10.9496         11.5079         13.4705         11.8847
040026..........................................         18.2398         19.5563         19.7924         19.1863
040027..........................................         14.5406         16.0975         17.4431         16.0716
040028..........................................         12.8409         14.6584         13.9946         13.7921
040029..........................................         17.7777         17.8787         21.1370         18.9480
040030..........................................         14.1541         13.5428         11.2402         12.7784
040032..........................................         13.3280         13.7030         13.2872         13.4471
040035..........................................         11.2123         12.8300         10.9569         11.6408
040036..........................................         17.9080         18.9757         20.0835         18.9954
040037..........................................         13.4815         14.6559         14.0941         14.0704
040039..........................................         13.8386         14.3576         14.7177         14.3115
040040..........................................         17.4283         18.0895         19.1984         18.2668
040041..........................................         13.3613         15.9896         16.4624         15.2103
040042..........................................         14.6641         15.2142         15.2057         15.0333
040044..........................................         11.4422         12.6275         13.3501         12.5381
040045..........................................         18.7724         14.9429         16.2469         16.4870
040047..........................................         16.3948         16.8654         17.5336         16.9538
040048..........................................         15.8203               *               *         15.8203
040050..........................................         11.7934         13.3818         14.0036         13.0341
040051..........................................         16.2803         15.8627         16.6039         16.2390

[[Page 22742]]

 
040053..........................................         15.8193         16.3610         15.0219         15.7502
040054..........................................         15.0412         15.3219         14.2577         14.8844
040055..........................................         16.1029         17.1269         17.7214         16.9813
040058..........................................         15.6706         17.6766         16.4278         16.6344
040060..........................................         11.4686         12.8148         17.9805         13.6105
040062..........................................         17.2757         18.2048         17.8902         17.8204
040064..........................................         12.4007         10.7255         11.5029         11.4801
040066..........................................         17.6429         18.3377         17.8338         17.9377
040067..........................................         13.4930         14.6014         14.4741         14.1956
040069..........................................         16.1147         17.5052         17.0026         16.8681
040070..........................................         15.4757         16.9027         16.9700         16.4358
040071..........................................         16.3022         16.9610         17.2834         16.8497
040072..........................................         15.8425         16.0895         17.4822         16.4893
040074..........................................         17.3819         18.3224         18.7542         18.1968
040075..........................................         12.7496         13.3623         14.0975         13.3977
040076..........................................         18.5512         19.0732         20.5840         19.3801
040077..........................................         12.4625         12.9211         13.9114         13.0965
040078..........................................         17.8573         18.7600         18.5821         18.4100
040080..........................................         15.7397         19.2461         19.3707         18.0636
040081..........................................         10.6791         11.3169         11.1332         11.0311
040082..........................................         16.5127         16.2152         15.1331         15.9302
040084..........................................         17.2469         17.2613         17.7295         17.4070
040085..........................................         15.7765         16.8957         16.5216         16.3838
040088..........................................         15.6710         17.9636         17.1624         16.9372
040090..........................................         17.5503         17.8282         19.0824         18.0989
040091..........................................         17.0444         19.8700         20.1378         18.8893
040093..........................................         12.9010         12.3537         13.9741         13.0114
040100..........................................         14.9688         14.7587         15.6833         15.1704
040105..........................................         14.2409         15.3319         14.3896         14.6616
040106..........................................         15.4000         15.6545         18.1341         16.4515
040107..........................................         19.6184         18.8120         17.8628         18.6841
040109..........................................         13.9807         14.6266         16.6278         15.0815
040114..........................................         18.3133         18.8743         21.1110         19.3778
040116..........................................         19.5695         20.2716               *         19.9151
040118..........................................         17.4300         19.3720         18.2123         18.3407
040119..........................................         15.3847         15.5338         16.7730         15.9002
040124..........................................         17.2547         19.1349         19.2889         18.5723
040126..........................................         11.6845         12.5368         11.6517         11.9404
040132..........................................         13.1760         17.5179         10.3875         13.4483
040134..........................................               *         18.0787         19.0185         18.5701
040135..........................................               *         22.6761         23.0084         22.8797
050002..........................................         27.6006         37.8295         36.9630         33.5586
050006..........................................         19.5272         19.5594         18.2061         19.0382
050007..........................................         29.5398         30.7126         30.8676         30.4910
050008..........................................         25.8570         26.2458         26.3682         26.1654
050009..........................................         26.2506         26.8159         28.0701         27.0878
050013..........................................         24.8541         23.2201         28.0569         25.1985
050014..........................................         24.5302         22.8478         23.6745         23.6450
050015..........................................         25.3838         26.2481         27.7731         26.4938
050016..........................................         20.1542         20.5566         21.2045         20.6377
050017..........................................         23.6639         23.9625         24.4598         24.0349
050018..........................................         14.6622         15.4721         15.2903         15.1444
050021..........................................         28.5003         25.8966               *         27.2682
050022..........................................         22.9583         24.0318         24.5254         23.8802
050024..........................................         20.3427         21.3989         22.4274         21.4070
050025..........................................         21.9952         23.3896         23.9879         23.0936
050026..........................................         28.6850         27.8736         27.0130         27.8531
050028..........................................         16.4531         16.4671         17.6138         16.8496
050029..........................................         23.2911         25.1259         24.6839         24.3441
050030..........................................         21.0096         20.9812         21.5621         21.1955
050032..........................................         22.5868         25.2010         24.3598         24.0616
050033..........................................         24.5609         24.9328         31.7747         27.1293
050036..........................................         20.4703         21.2420         20.1678         20.6131

[[Page 22743]]

 
050038..........................................         27.8274         28.6528         29.9698         28.8293
050039..........................................         22.2524         22.7117         22.5974         22.5195
050040..........................................         30.6664         32.1287         30.4110         31.0613
050042..........................................         22.2343         24.8067         24.5260         23.8317
050043..........................................         33.2286         32.9958         33.8255         33.3456
050045..........................................         20.7307         19.8831         21.1474         20.5973
050046..........................................         31.3831         25.3185         25.2005         27.4555
050047..........................................         29.4412         29.9255         29.9580         29.7840
050051..........................................         17.8401         17.8945         18.7809         18.1179
050054..........................................         19.3686         20.7212         22.0982         20.7075
050055..........................................         29.0872         29.3984         29.2730         29.2593
050056..........................................         23.8507         27.4321         23.8058         24.9609
050057..........................................         21.7581         21.1554         20.7050         21.1842
050058..........................................         25.7261         23.1641         23.3009         23.9601
050060..........................................         20.9219         20.7747         20.5450         20.7207
050061..........................................         23.7443         23.5454         24.5488         23.9503
050063..........................................         23.0724         24.8851         25.7593         24.5061
050065..........................................         21.1848         24.0420         24.3835         23.0762
050066..........................................         21.4187         16.5725         16.1649         17.6784
050067..........................................         21.3029         23.1966         25.8857         23.3989
050068..........................................         28.4804         20.6851         19.3615         22.4409
050069..........................................         29.2980         25.9420         24.6153         26.4351
050070..........................................         32.5964         32.5166         33.0195         32.7172
050071..........................................         33.1379         33.1850         33.3740         33.2367
050072..........................................         32.9660         33.2858         38.5136         34.8941
050073..........................................         34.6111         33.3922         31.4874         33.0669
050075..........................................         33.5246         33.9095         32.6142         33.3899
050076..........................................         33.8835         27.7797         32.7847         31.3195
050077..........................................         23.2986         24.1019         24.2083         23.8775
050078..........................................         22.8023         23.0736         24.3150         23.3638
050079..........................................         34.4253         33.2432         30.0167         32.3461
050082..........................................         21.7004         22.1009         23.7617         22.5498
050084..........................................         23.0966         23.5866         25.4517         24.0054
050088..........................................         24.0634         20.8406         24.9641         23.1779
050089..........................................         20.0194         20.9117         21.9331         20.9434
050090..........................................         23.8969         23.4097         23.9183         23.7390
050091..........................................         22.2220         25.2792         23.7713         23.6457
050092..........................................         15.3841         16.7969         17.1211         16.4241
050093..........................................         24.0837         25.2130         25.6647         24.9860
050095..........................................         33.3761         33.6718         32.5552         33.2492
050096..........................................         21.6752         20.0487         22.7394         21.3870
050097..........................................         22.6147         16.7054         22.5991         20.1968
050099..........................................         24.2921         24.8091         23.5693         24.1958
050100..........................................         30.0552         29.8758         25.0335         28.0584
050101..........................................         30.0132         31.0264         31.8957         30.9871
050102..........................................         21.2947         22.2937         24.0014         22.4745
050103..........................................         25.3384         24.7932         25.4133         25.1832
050104..........................................         25.4407         25.5797         26.8367         25.9399
050107..........................................         21.7649         21.2690         22.2019         21.7497
050108..........................................         25.2116         23.5564         25.1307         24.5504
050109..........................................         26.4768               *               *         26.4768
050110..........................................         20.1769         20.1870         19.9589         20.1175
050111..........................................         21.7397         21.5487         20.7897         21.3840
050112..........................................         26.2922         25.3015         26.8182         26.1335
050113..........................................         27.7805         28.8420         28.5224         28.4025
050114..........................................         25.9073         24.7286         26.6757         25.7599
050115..........................................         21.0499         21.3291         23.0182         21.8124
050116..........................................         25.5919         25.2130         24.9196         25.2412
050117..........................................         20.4379         23.3612         22.2123         21.9903
050118..........................................         23.9976         23.7698         23.7129         23.8243
050121..........................................         18.8818         19.5252         18.4827         18.9563
050122..........................................               *         26.3172         26.9546         26.6358
050124..........................................         23.0193         22.7736         24.5069         23.3667

[[Page 22744]]

 
050125..........................................         24.0434         29.6147         32.0230         28.3742
050126..........................................         23.8424         23.9247         24.6752         24.1448
050127..........................................         19.7654         22.1937         20.9157         20.9577
050128..........................................         24.1801         25.7240         26.6132         25.5185
050129..........................................         27.1586         26.5030         23.0719         25.3795
050131..........................................         29.0570         31.0732         32.5462         30.8106
050132..........................................         22.9139         24.0834         24.0173         23.6527
050133..........................................         24.4011         24.9746         23.2093         24.1354
050135..........................................         27.0341         23.2361         24.7157         24.9796
050136..........................................         24.4336         24.7921         24.4162         24.5396
050137..........................................         30.0725         32.6507         31.5620         31.4326
050138..........................................         37.4088         37.3286         40.3920         38.3945
050139..........................................         31.3785         32.9351         30.3774         31.5037
050140..........................................         33.6644         34.1499         31.6524         33.0748
050144..........................................         25.7483         27.8751         27.4069         26.9409
050145..........................................         33.0620         32.3857         34.5185         33.3152
050148..........................................         21.0584         21.9211         20.0971         20.9748
050149..........................................         23.3754         24.6078         26.8674         24.8666
050150..........................................         23.4777         24.9073         24.6596         24.3771
050152..........................................         27.7504         34.0766         33.3305         31.5833
050153..........................................         29.5915         30.5714         32.3389         30.8441
050155..........................................         22.9420         21.0257         25.3354         22.9852
050158..........................................         27.9789         27.5623         28.6071         28.0313
050159..........................................         25.2105         23.2912         22.5313         23.6099
050167..........................................         21.6778         21.9128         21.8796         21.8226
050168..........................................         25.2504         23.3511         25.1937         24.5830
050169..........................................         24.6361         22.3888         24.8407         23.8796
050170..........................................         22.1989         23.9574         24.3654         23.4164
050172..........................................         17.6976         20.1841         19.6120         19.1630
050173..........................................         23.3255         24.5545         24.8694         24.1923
050174..........................................         31.2136         30.2140         30.1320         30.4943
050175..........................................         27.7875         27.2806         24.7548         26.2477
050177..........................................         20.2485         21.7943         21.1396         21.0728
050179..........................................         19.2861         21.7175         23.8868         21.4573
050180..........................................         32.1883         31.8947         33.3257         32.5107
050183..........................................         19.9765         20.3638               *         20.1665
050186..........................................         21.9062         22.4155         23.6288         22.6119
050188..........................................         27.4364         28.0918         28.2364         27.9460
050189..........................................         23.2415         22.8687         27.4071         24.6245
050191..........................................         26.7297         20.8321         25.2399         24.1511
050192..........................................         17.8095         18.6701         14.0828         16.5416
050193..........................................         23.7260         22.6316         24.9444         23.7567
050194..........................................         28.2701         29.7371         29.3310         29.0932
050195..........................................         34.7789         35.5621         36.9068         35.7823
050196..........................................         16.6866         18.5180         18.2411         17.8430
050197..........................................         31.4513         35.7449         32.0779         32.9661
050204..........................................         24.3944         23.6105         22.7099         23.5849
050205..........................................         21.1545         23.6831         24.1691         23.0778
050207..........................................         20.8576         21.6214         22.9941         21.8243
050211..........................................         31.2175         31.6084         31.7280         31.5153
050213..........................................         20.7338         21.4806         21.4438         21.1694
050214..........................................         20.8704         21.7335         24.0276         22.1888
050215..........................................         28.4058         29.8563         32.4402         30.1364
050217..........................................         19.8913         19.6010         20.2042         19.9076
050219..........................................         25.4730         21.7444         21.2458         22.6404
050222..........................................         27.0713         27.4809         26.9958         27.1794
050224..........................................         23.7942         23.5316         23.5101         23.6043
050225..........................................         20.7978         23.3480         21.6206         21.8948
050226..........................................         26.9297         27.7315         24.4443         26.2380
050228..........................................         30.3772         34.0711         34.2596         32.7722
050230..........................................         25.3640         27.7357         26.6291         26.5638
050231..........................................         25.5798         26.1508         26.7319         26.1758
050232..........................................         23.3849         24.3072         24.5245         24.0793

[[Page 22745]]

 
050233..........................................         31.3954               *               *         31.3954
050234..........................................               *               *         28.5188         25.7035
050235..........................................         25.8595         25.2527         27.0922         26.0726
050236..........................................         26.2723         26.9803         25.9458         26.4027
050238..........................................         24.0043         24.2922         24.5823         24.2994
050239..........................................         20.4071         22.6625         21.9889         21.6674
050240..........................................         25.2540         26.3657         26.7736         26.0561
050241..........................................         27.2198         26.3740         29.8345         27.7426
050242..........................................         30.1432         31.1576         31.9079         31.0590
050243..........................................         22.9123         28.9635         26.4627         26.1049
050245..........................................         24.3969         23.8124         23.2716         23.7873
050248..........................................         27.4214         26.2015         27.6457         27.0910
050251..........................................         18.4990         21.6574         23.6360         21.1907
050253..........................................         20.0658         16.0701         16.7540         17.4281
050254..........................................         19.6899         19.3126         20.1176         19.7146
050256..........................................         23.5302         23.6887         23.4835         23.5723
050257..........................................         19.5923         15.2306         15.0481         16.3402
050260..........................................         23.5201         23.2421         27.4234         24.5032
050261..........................................         20.4496         20.0552         20.1040         20.2029
050262..........................................         29.0054         28.8785         29.5550         29.1532
050264..........................................         29.4542         32.1312         36.0219         32.4654
050267..........................................         24.7464         26.2264         26.0401         25.6690
050270..........................................         23.7260         24.0439         25.3757         24.3521
050272..........................................         21.4374         22.4247         23.1111         22.3118
050274..........................................         21.1943         20.0422               *         20.6204
050276..........................................         28.5051         29.8624         33.3302         30.5715
050277..........................................         22.3125         20.0520         26.0822         22.5131
050278..........................................         23.8434         24.7787         23.9289         24.1853
050279..........................................         21.0570         20.8444         21.8949         21.2309
050280..........................................         24.4267         25.2149         25.4011         25.0356
050281..........................................         18.5907         19.6888         24.2251         20.7934
050282..........................................         24.4593         28.8261         25.4428         26.2214
050283..........................................         27.8763         29.7734         31.7669         30.1598
050286..........................................         17.8045         16.5708         18.5915         17.4822
050289..........................................         26.7185         34.1393         30.4750         30.2632
050290..........................................         26.3745         28.6231         29.6796         28.2631
050291..........................................         26.4908         30.2748         28.3483         28.3026
050292..........................................         22.4878         21.6243         20.8410         21.6183
050293..........................................         19.1761         22.2963         24.1875         21.4642
050295..........................................         20.7393         21.2892         21.5335         21.1814
050296..........................................         25.3166         27.2948         28.3906         27.0098
050298..........................................         20.5181         24.4477         23.2006         22.6781
050299..........................................         25.7697         26.4543         25.5035         25.9187
050300..........................................         22.7423         23.5116         25.9228         24.1102
050301..........................................         26.0355         22.5201         21.1403         23.0323
050302..........................................         29.2007               *               *         29.2007
050305..........................................         32.7082         34.5185         36.7908         34.7340
050307..........................................         27.9830         17.2147               *         21.7503
050308..........................................         28.4019         29.3803         28.9284         28.9113
050309..........................................         24.4034         23.7884         25.3515         24.5133
050310..........................................         20.6181               *               *         20.6181
050312..........................................         23.7936         26.7617         26.0015         25.5439
050313..........................................         23.1009         21.7577         25.6827         23.5594
050315..........................................         21.9227         24.7086         22.7359         23.0264
050317..........................................         19.4479         21.6937               *         20.5789
050320..........................................         30.6054         30.4101         32.4809         31.1252
050324..........................................         26.2735         26.6049         25.3694         26.0738
050325..........................................         23.2355         24.4862         23.6327         23.7872
050327..........................................         22.8511         23.9484         25.6450         24.1469
050328..........................................         23.1889               *               *         23.1889
050329..........................................         21.4125         19.7455         15.1669         18.2146
050331..........................................         25.5252         22.2536         25.0230         24.1261
050333..........................................         20.1468         19.4589         19.1449         19.5671

[[Page 22746]]

 
050334..........................................         32.0169         34.2330         34.2557         33.5307
050335..........................................         20.2013         23.0258         22.9926         22.0827
050336..........................................         20.0980         20.7979         21.3402         20.7523
050342..........................................         19.3524         20.1841         20.8255         20.1210
050343..........................................         17.3394         17.2085               *         17.2799
050348..........................................         20.7505         23.8779         25.1085         23.3219
050349..........................................         15.0515         14.9754         15.0667         15.0310
050350..........................................         25.0676         24.8340         26.4161         25.4163
050351..........................................         24.6936         25.4791         24.8121         24.9948
050352..........................................         23.5927         26.1380         26.0974         25.3078
050353..........................................         23.2468         23.0564         23.2699         23.1944
050355..........................................         17.1597         17.2778         21.0969         18.0157
050357..........................................         23.6411         22.6545         24.5345         23.6386
050359..........................................         20.4005         17.7907         21.7548         19.8316
050360..........................................         31.7608         31.3526         31.7583         31.6236
050366..........................................         21.3442         23.7528         19.6823         21.4770
050367..........................................         29.4763         28.2805         30.7328         29.5063
050369..........................................         24.2604         27.0548         26.2234         25.8174
050373..........................................         26.6548         26.9776         28.0655         27.2088
050376..........................................         25.3036         26.5840         28.5679         26.7332
050377..........................................         25.6401         17.1764         17.0012         20.1035
050378..........................................         22.2363         25.9810         26.9101         24.8709
050379..........................................         15.4994         15.2022         17.8958         16.1098
050380..........................................         30.5790         31.4343         31.9578         31.3600
050382..........................................         26.1465         26.1398         25.9244         26.0725
050385..........................................         25.9188         24.6083         20.1687         23.1378
050388..........................................         13.7863         19.1512         22.0122         17.5709
050390..........................................         22.5668         25.0426         24.2700         23.9349
050391..........................................         22.4881         18.9266         20.0615         20.3952
050392..........................................         21.9324         21.6729         22.9430         22.1487
050393..........................................         23.1387         25.6964         24.1981         24.3082
050394..........................................         22.2424         23.0604         23.1526         22.8333
050396..........................................         23.6322         24.0636         25.3729         24.3512
050397..........................................         20.7698         20.2601         20.6397         20.5453
050401..........................................         17.7807         20.7473         18.4593         18.9557
050404..........................................         19.2754         17.3396         15.9839         17.4356
050406..........................................         16.8931         17.3016         17.8596         17.3407
050407..........................................         30.1222         29.9642         30.8346         30.2996
050410..........................................         16.4735         17.6769         19.8508         17.8663
050411..........................................         32.2364         34.8899         32.2157         33.0639
050414..........................................         24.4243         24.2060         23.9069         24.1441
050417..........................................         21.8884         21.5739         23.3005         22.2456
050419..........................................         23.1162         23.7584         23.4936         23.4646
050420..........................................         22.6819         22.3166         23.1651         22.7188
050423..........................................         23.3296         17.3771         21.3552         20.6272
050424..........................................         23.7788         22.8350         24.0727         23.5641
050425..........................................         33.6911         32.8364         33.8624         33.4842
050426..........................................         23.7082         25.2453         29.2475         25.9886
050427..........................................         20.0698         20.1674         16.4330         18.6499
050430..........................................         21.3428         23.8788         21.2275         22.2136
050432..........................................         21.4984         24.4133         24.5630         23.4427
050433..........................................         16.8035         17.4643         18.9021         17.7004
050434..........................................         15.6348         19.7591               *         17.6624
050435..........................................         32.9865         25.6676         23.3426         26.8858
050436..........................................         16.3594         14.8121               *         15.5729
050438..........................................         24.0828         25.0138         22.5006         23.8790
050440..........................................         21.1100         23.5167         22.6946         22.4056
050441..........................................         28.7067         28.9804         31.8774         29.8169
050443..........................................         16.4308         19.9020         17.2875         17.7906
050444..........................................         24.6741         21.4533         22.4530         22.8550
050446..........................................         20.5383         20.4908         22.3422         21.1378
050447..........................................         18.4183         17.9751         18.9851         18.4558
050448..........................................         20.0757         19.7046         21.7718         20.5035

[[Page 22747]]

 
050449..........................................         22.1784         23.8001         23.4614         23.1469
050454..........................................         28.6857         28.7432         30.9487         29.5840
050455..........................................         19.9209         20.1643         20.2611         20.1204
050456..........................................         17.6229         20.1254         18.1585         18.5890
050457..........................................         31.2489         34.4949         32.1910         32.6376
050459..........................................         37.0914               *               *         37.0914
050464..........................................         22.3142         25.3292         25.7710         24.4665
050468..........................................         23.1701         23.3050         22.2926         22.8998
050469..........................................         23.4404         23.8759         24.5205         23.8915
050470..........................................         17.0353         16.0292         15.7832         16.2133
050471..........................................         24.2887         25.6172         26.2221         25.3560
050476..........................................         23.1428         22.4754         24.0253         23.2552
050477..........................................         27.7855         27.9595         27.5819         27.7866
050478..........................................         23.0530         24.5401         26.3306         24.6133
050481..........................................         26.8293         28.9722         27.7973         27.8692
050482..........................................         16.9268         18.1217         16.0114         17.0134
050483..........................................         21.6038         22.7182               *         22.1632
050485..........................................         23.1933         24.1983         24.6906         24.0174
050486..........................................         24.4967               *               *         24.4967
050488..........................................         32.8620         34.6939         31.7481         33.0979
050491..........................................         25.1011         26.8703         27.4600         26.4606
050492..........................................         21.4156         19.5457         20.5030         20.4277
050494..........................................         25.4078         29.2621         29.1296         27.9125
050496..........................................         33.0168         32.5168         34.9704         33.4862
050497..........................................               *         13.8110         15.4115         14.5264
050498..........................................         24.8445         24.9677         26.1716         25.3085
050502..........................................         22.6253         22.3788         24.3517         23.0821
050503..........................................         23.5911         24.4069         23.3745         23.7879
050506..........................................         21.2165         25.0845         25.0333         23.8164
050510..........................................         33.4617         33.3774         32.6940         33.1728
050512..........................................         34.3138         35.3581         33.4465         34.3098
050515..........................................         35.0412         35.3419         32.6021         34.2147
050516..........................................         25.1850         24.7992         26.1969         25.4171
050517..........................................         20.3733         20.9550         22.0985         21.1081
050522..........................................         31.7326         35.3784         35.2780         33.9529
050523..........................................         28.4235         27.0544         31.2522         28.8864
050526..........................................         26.9206         23.8099         26.4014         25.6096
050528..........................................         18.6898         19.0611         18.9155         18.8867
050531..........................................         20.7332         22.7308         21.3948         21.6689
050534..........................................         23.3026         24.0700         24.0001         23.7954
050535..........................................         24.2257         25.4215         26.8511         25.4120
050537..........................................         22.2073         22.2256         23.8790         22.8084
050539..........................................         23.2501         20.7129         21.2318         21.6610
050541..........................................         34.6195         34.4573         35.5912         34.9089
050542..........................................         17.8537         16.0892         17.7737         17.2018
050543..........................................         23.0437         22.3994         21.6795         22.3610
050545..........................................         27.5713         26.3304         31.7280         27.9472
050546..........................................         27.7557         26.1949         38.8087         28.7303
050547..........................................         27.0845         26.8305         37.7681         28.7499
050548..........................................         26.5922         28.8083         29.8516         28.2370
050549..........................................         27.9098         27.2765         28.5457         27.9239
050550..........................................         25.7546         24.8048         25.6588         25.4034
050551..........................................         24.0488         25.4652         24.8084         24.7966
050552..........................................         22.8731         21.5216         20.3239         21.6775
050557..........................................         22.1385         21.1243         22.2562         21.8314
050559..........................................         24.6689         23.5759         24.7866         24.3485
050561..........................................         33.9268         34.5791         32.3907         33.5772
050564..........................................         24.5099         23.5922         24.2091         24.0891
050565..........................................         22.8785         23.7829         20.8349         22.3644
050566..........................................         18.3297         17.4423         22.3448         19.2949
050567..........................................         24.2349         24.6454         25.0787         24.6746
050568..........................................         20.5205         19.5816         20.5376         20.2025
050569..........................................         24.9453         26.5479         27.3429         26.2484

[[Page 22748]]

 
050570..........................................         24.4961         25.2294         26.1015         25.2629
050571..........................................         24.3741         26.2039         23.6702         24.7124
050573..........................................         25.1398         24.9644         25.6589         25.2612
050575..........................................               *         19.5611         20.7090         20.0979
050577..........................................         20.5177         25.1549         23.5487         22.9797
050578..........................................         28.9073         28.5379         28.3177         28.5843
050579..........................................         30.0694         30.4952         29.9348         30.1803
050580..........................................         23.9183         25.9004         24.6962         24.8350
050581..........................................         23.5660         23.8584         24.1233         23.8604
050583..........................................         23.3609         24.3987         25.8800         24.5448
050584..........................................         23.1610         21.2366         19.5805         21.2667
050585..........................................         26.4985         25.9426         24.2824         25.5872
050586..........................................         23.8402         23.4079         23.1850         23.4570
050588..........................................         30.3873         25.3094         24.5472         26.4705
050589..........................................         24.3453         24.8698         23.8109         24.3084
050590..........................................               *         22.4480         23.9599         23.1967
050591..........................................         22.3224         23.9412         24.8356         23.6641
050592..........................................         26.0528         21.1745         22.1174         23.0414
050594..........................................         22.7826         27.1584         27.7002         25.6455
050597..........................................         23.1789         22.8523         23.3280         23.1176
050598..........................................         28.1062         24.3597         23.9202         25.2869
050599..........................................         26.3191         29.1221         26.0892         27.1846
050601..........................................         32.8704         31.8670         29.7417         31.4201
050603..........................................         22.7500         23.3390         21.7031         22.5608
050604..........................................         33.3239         34.0461         34.3923         33.9347
050607..........................................         24.1052               *               *         24.1052
050608..........................................         16.1529         18.0947         17.6170         17.2527
050609..........................................         31.9340         34.9935         32.3640         33.0668
050613..........................................         23.4779         23.3835         30.2413         25.4419
050615..........................................         23.7015         23.8815         27.5682         24.9089
050616..........................................         22.7960         22.7437         24.9843         23.5101
050618..........................................         21.7032         21.6509         21.4895         21.6219
050623..........................................         30.3208         29.1806         33.3458         30.6877
050624..........................................         22.3419         22.7148         26.4659         23.7251
050625..........................................         24.3503         26.4849         27.5816         26.1377
050630..........................................         24.0961         23.9159         23.9834         23.9961
050633..........................................         21.9790         23.1918         25.4283         23.5401
050635..........................................         37.8481               *               *         37.8481
050636..........................................         20.8349         21.2618         23.5257         21.8335
050638..........................................         23.6341         18.2859         18.2159         19.5807
050641..........................................         21.3605         21.8315         17.1258         19.7042
050644..........................................         23.1229         22.3456         22.1489         22.5048
050661..........................................         20.4769         19.6780               *         20.1699
050662..........................................         28.2910         26.9606         35.0989         28.9225
050663..........................................         23.7097         30.6591         24.9110         25.8492
050667..........................................         24.1064         24.9979         27.5045         25.1663
050668..........................................         39.9001         42.0974         61.7751         44.9671
050670..........................................         21.8750         20.0152         24.6101         21.9523
050674..........................................         36.2361         34.7380         31.4935         33.9505
050675..........................................         15.8423         15.6794               *         15.7602
050676..........................................         17.5302         18.6672         52.8683         22.3243
050677..........................................         33.7056         35.6503         32.6045         33.9333
050678..........................................         22.6591         26.8741         22.7756         23.9129
050680..........................................         27.3188         28.0584         31.4839         28.9200
050682..........................................         17.9715         26.2882         17.3566         19.6443
050684..........................................         21.8067         22.3398         23.3697         22.4849
050685..........................................         32.1330         31.1725         35.1307         32.7762
050686..........................................         33.2515         35.2631         32.3401         33.5425
050688..........................................         29.9990         30.6635         31.0648         30.5922
050689..........................................         34.1851         30.7295         30.9399         31.8127
050690..........................................         33.8277         32.8204         33.7648         33.4827
050693..........................................         33.2977         26.8265         25.5662         28.3155
050694..........................................         22.5719         23.2293         23.5572         23.1120

[[Page 22749]]

 
050695..........................................         23.5215         21.1377         24.3451         23.0440
050696..........................................         26.4103         28.0015         28.3291         27.6235
050697..........................................         21.4716         21.1566         18.2338         20.1433
050699..........................................         28.4754         25.7843         17.5296         23.1610
050700..........................................         28.4522               *               *         28.4522
050701..........................................         27.6190         22.6959         24.3055         24.7548
050702..........................................         12.2518               *               *         12.2518
050704..........................................         20.7568         22.8716         22.7618         22.3025
050707..........................................         27.5065         26.2732         27.8958         27.2979
050708..........................................         21.9149         22.7821         24.8647         23.2324
050709..........................................         19.4255         21.9598         19.4977         20.2535
050710..........................................         26.8095         26.9060         26.7221         26.8057
050713..........................................         15.3027         17.7259         16.8538         16.6077
050714..........................................               *         28.9314         30.1925         29.4900
050715..........................................         19.1151               *               *         19.1151
050717..........................................               *         25.9534         29.6608         27.7154
050718..........................................               *         17.6062         18.0940         17.8064
050719..........................................               *         25.5508         23.0833         23.8495
050720..........................................               *               *         25.8677         25.8677
060001..........................................         20.5908         21.3659         21.1819         21.0411
060003..........................................         19.3243         19.8023         20.4682         19.8685
060004..........................................         21.7899         22.8750         21.4496         22.0469
060006..........................................         17.8613         19.3651         20.0213         19.0568
060007..........................................         16.3833         17.4682         18.2977         17.3945
060008..........................................         17.0944         18.0333         18.4590         17.8646
060009..........................................         21.1795         21.4312         22.6084         21.7644
060010..........................................         22.7241         24.0872         23.6827         23.5135
060011..........................................         21.9727         23.4366         22.6254         22.6752
060012..........................................         19.7746         20.1442         19.4932         19.7974
060013..........................................         19.1369         22.7346         18.4230         20.1121
060014..........................................         20.5353         24.2459         23.8228         22.8253
060015..........................................         23.5675         20.9773         23.0206         22.5102
060016..........................................         15.9627         16.4707         20.2408         17.3661
060018..........................................         21.8607         20.3183         21.5083         21.2146
060020..........................................         17.7250         18.3099         18.8985         18.3187
060022..........................................         19.6488         21.0558         21.0830         20.6200
060023..........................................         19.6534         19.2373         21.2785         20.0409
060024..........................................         22.8347         21.9955         22.5663         22.4704
060027..........................................         21.6731         20.9846         21.7448         21.4691
060028..........................................         22.2461         23.2065         23.1792         22.8860
060029..........................................         21.4111         20.8585         18.2938         20.0752
060030..........................................         20.0345         20.5002         20.3452         20.2923
060031..........................................         19.3998         21.1649         22.0161         20.8402
060032..........................................         22.3702         23.4162         21.7060         22.5248
060033..........................................         13.8165         15.9085         16.0760         15.2591
060034..........................................         21.4110         22.4791         22.1375         22.0321
060036..........................................         19.2386         15.0698         18.5988         17.4095
060037..........................................         14.0458         15.5611         15.4513         15.0213
060038..........................................         14.3084         14.0791         14.3249         14.2429
060041..........................................         14.8299         14.8934         19.1263         15.9980
060042..........................................         20.0815         19.1892         20.8597         19.9134
060043..........................................         13.0544         13.6717         13.4443         13.3963
060044..........................................         22.5286         19.7039         20.8673         21.1240
060046..........................................         20.4359         19.4567         22.2699         20.7384
060047..........................................         15.1181         15.8770         17.1534         15.9786
060049..........................................         20.6427         21.7797         25.5038         22.5344
060050..........................................         16.8012         18.2238         19.0832         18.0606
060052..........................................         12.5517         13.4210         14.6309         13.5896
060053..........................................         14.9399         15.9806         18.0232         16.2596
060054..........................................         19.3943         22.8985         20.4160         20.8278
060056..........................................         17.0509         18.2831         18.1263         17.9597
060057..........................................         23.3804         26.4046         25.4185         25.1123
060058..........................................         16.9064         15.4856         13.8539         15.6088

[[Page 22750]]

 
060060..........................................         14.8894         15.6469         15.6018         15.4330
060062..........................................         14.9354         17.2991         16.8640         16.3901
060063..........................................         15.0896               *               *         15.0896
060064..........................................         20.9349         21.2207         22.6830         21.6302
060065..........................................         24.3032         21.6305         23.7162         23.1229
060066..........................................         14.0672         16.3485         17.2537         15.7129
060068..........................................         19.6355               *               *         19.6355
060070..........................................         16.5821         17.3184         18.8960         17.6173
060071..........................................         16.9545         17.5987         17.4068         17.3254
060073..........................................         15.8385         15.7860         17.0846         16.2338
060075..........................................         22.8498         24.1550         23.8724         23.6295
060076..........................................         19.2861         24.8732         20.3265         21.3796
060085..........................................         13.4761         13.6277         14.3409         13.7955
060087..........................................         21.0277               *               *         21.0277
060088..........................................         16.6753         25.2786         13.7174         17.2655
060090..........................................         14.5096         22.2974         16.3760         17.6196
060096..........................................         23.1232         21.9623         20.8937         21.9261
060100..........................................         21.9983         23.5986         22.9395         23.0367
060103..........................................         22.3414         24.8151         23.5320         23.5039
060104..........................................         22.3008         22.2295         21.0656         21.8025
060107..........................................         13.6449         14.2698         21.9221         15.1674
070001..........................................         26.5150         26.0878         26.1878         26.2690
070002..........................................         25.4570         26.2801         26.2089         25.9775
070003..........................................         26.0894         25.6949         27.3062         26.3527
070004..........................................         23.2664         22.4871         24.2567         23.3158
070005..........................................         25.5739         26.6483         26.7916         26.3250
070006..........................................         28.7139         27.5674         28.4368         28.2423
070007..........................................         27.1867         26.9505         26.0179         26.7076
070008..........................................         26.0269         23.0227         24.2971         24.3585
070009..........................................         23.4686         24.6201         24.1871         24.0886
070010..........................................         25.9375         26.2354         28.0116         26.6816
070011..........................................         23.9603         23.3638         23.0883         23.4486
070012..........................................         25.1022         23.0321         28.8067         25.3536
070015..........................................         25.3317         23.8240         25.4250         24.8350
070016..........................................         26.3005         24.9148         24.4633         25.2035
070017..........................................         24.8038         26.2923         26.0424         25.7039
070018..........................................         28.8776         28.0689         30.6864         29.1923
070019..........................................         24.7025         25.7283         24.9249         25.1145
070020..........................................         23.7227         23.9987         25.0719         24.2498
070021..........................................         26.5173         25.2978         27.1879         26.2849
070022..........................................         25.0845         26.5691         26.5225         26.0295
070024..........................................         25.1491         25.2983         24.8948         25.1081
070025..........................................         25.4055         25.1315         25.0631         25.2037
070026..........................................         18.7892               *               *         18.7892
070027..........................................         23.6381         23.6412         26.8450         24.6648
070028..........................................         24.6913         24.6788         25.6145         24.9846
070029..........................................         22.7507         22.0080         23.9682         22.8885
070030..........................................         24.9676         28.9117         22.1578         25.5338
070031..........................................         21.6565         23.4419         24.1198         23.0342
070033..........................................         28.8099         30.4214         31.4671         30.2045
070034..........................................         29.1220         28.9200         29.1514         29.0628
070035..........................................         23.0574         23.0869         23.7003         23.2881
070036..........................................         28.9463         28.8400         29.9470         29.2263
070039..........................................         21.7791         22.9032         22.3356         22.3067
080001..........................................         25.2849         25.4836         24.2845         25.0307
080002..........................................         15.5984         19.6011         20.1965         18.4286
080003..........................................         22.3957         22.1856         22.6814         22.4058
080004..........................................         19.7725         21.9391         23.0537         21.6106
080005..........................................         14.4289               *               *         14.4289
080006..........................................         22.2632         20.0792         21.1059         21.1131
080007..........................................         20.3833         19.6213         21.2441         20.4479
090001..........................................         25.8921         21.7526         19.4884         22.5234
090002..........................................         19.6997         19.4191         21.5726         20.1912

[[Page 22751]]

 
090003..........................................         28.6092         22.1090         23.1268         24.5792
090004..........................................         24.4267         24.3367         25.4836         24.6979
090005..........................................         24.8766         23.8620         26.1199         24.9264
090006..........................................         20.0816         20.8675         22.0789         21.0107
090007..........................................         21.6551         22.1973         29.2840         24.7855
090008..........................................         21.5972         20.2166         25.2708         22.3042
090010..........................................         15.8676         24.1287         23.6616         20.2595
090011..........................................         27.3741         27.4781         25.5395         26.7683
100001..........................................         17.6948         19.5796         19.4948         18.9110
100002..........................................         21.3243         20.7136         20.8100         20.9384
100004..........................................         15.2465         14.6283         15.4149         15.0845
100006..........................................         20.6302         20.1133         21.0230         20.6052
100007..........................................         21.7217         21.7242         21.8476         21.7676
100008..........................................         20.7232         20.4980         20.8381         20.6876
100009..........................................         24.2947         22.6419         20.1263         22.1819
100010..........................................         21.9101         21.9078         23.0637         22.2904
100012..........................................         18.5169         19.6177         20.4659         19.5030
100014..........................................         19.8352         19.8023         19.5770         19.7276
100015..........................................         18.2394         18.4779         18.0654         18.2696
100017..........................................         17.7739         19.0608         19.8655         18.9086
100018..........................................         20.8392         21.0332         21.0971         20.9923
100019..........................................         19.8134         22.6152         22.9645         21.7772
100020..........................................         26.1783         21.3848         20.7816         22.5004
100022..........................................         25.8853         26.4094         26.5695         26.2778
100023..........................................         21.1068         19.9739         19.1787         20.0604
100024..........................................         20.7760         21.8791         22.1332         21.6047
100025..........................................         19.1219         18.7774         19.4159         19.1009
100026..........................................         20.7591         20.5641         20.9461         20.7639
100027..........................................         12.9410         19.1481         14.7916         15.3484
100028..........................................         19.7491         19.3757         19.3371         19.4791
100029..........................................         19.1768         20.8745         20.8950         20.2753
100030..........................................         18.8229         22.8204         20.6176         20.6840
100032..........................................         19.3165         19.8127         19.7451         19.6185
100034..........................................         18.2314         17.8743         19.5282         18.5138
100035..........................................         19.5842         20.1540         23.7366         21.2058
100038..........................................         24.7851         23.3578         24.5864         24.2183
100039..........................................         20.2529         21.5297         21.7861         21.1854
100040..........................................         18.6417         19.0449         18.4371         18.7010
100043..........................................         17.5215         18.7993         18.8206         18.3605
100044..........................................         21.1370         21.4764         22.3808         21.6907
100045..........................................         20.7688         20.9216         20.5433         20.7423
100046..........................................         21.2094         21.6207         22.0001         21.5991
100047..........................................         18.8677         20.0114         20.6068         19.8263
100048..........................................         13.5021         15.0584         15.7790         14.8232
100049..........................................         18.5598         18.8535         19.1025         18.8421
100050..........................................         16.6058         17.2377         17.9039         17.2452
100051..........................................         18.8377         23.1273         17.9453         19.6449
100052..........................................         16.1855         17.9537         18.1780         17.4312
100053..........................................         18.7103         20.1724         19.6800         19.5213
100054..........................................         18.1853         23.5491         21.1710         20.9429
100055..........................................         17.6226         18.0547         18.8760         18.1971
100056..........................................         23.6545         25.7863         21.8506         23.8349
100057..........................................         18.7489         19.9712         19.5319         19.4242
100060..........................................         22.3904         23.2561         23.5983         23.0794
100061..........................................         21.7923         22.1133         22.9176         22.2483
100062..........................................         17.9575         19.4370         21.4424         19.6570
100063..........................................         16.2324         19.2629         18.4642         17.9066
100067..........................................         17.3950         18.0877         18.4851         17.9682
100068..........................................         18.6480         19.9305         19.8148         19.4667
100069..........................................         16.1393         16.8271         17.3666         16.7757
100070..........................................         20.3358         18.7408         19.5034         19.4826
100071..........................................         16.4756         17.5451         17.7234         17.2640
100072..........................................         19.2223         21.0225         20.1930         20.2012

[[Page 22752]]

 
100073..........................................         18.1554         21.1898         22.2812         20.4948
100075..........................................         18.0548         18.3688         19.4480         18.6211
100076..........................................         16.2469         17.8733         17.8612         17.3644
100077..........................................         19.6214         22.3438         18.0424         19.9689
100078..........................................         18.2791         18.4499         19.2891         18.6609
100080..........................................         21.1603         22.1966         21.4042         21.5955
100081..........................................         13.9564         14.8313         15.4253         14.7661
100082..........................................         19.8033         18.8998               *         19.3432
100084..........................................         20.4002         22.3674         22.0600         21.6577
100085..........................................         21.0802         22.1231               *         21.5986
100086..........................................         21.1625         21.6997         23.3718         22.0734
100087..........................................         23.1162         23.6090         23.3607         23.3648
100088..........................................         20.0571         20.3693         20.5566         20.3435
100090..........................................         17.8768         19.1479         19.7695         18.9939
100092..........................................         18.1953         17.9216         20.1760         18.7907
100093..........................................         16.6310         16.5128         16.8422         16.6633
100098..........................................         19.0319         19.2427         20.8315         19.7124
100099..........................................         15.2983         15.7823         15.7591         15.6112
100102..........................................         19.3330         18.9701         19.7673         19.3542
100103..........................................         18.1019         17.2364         18.7844         18.0201
100105..........................................         21.5028         21.6604         21.8268         21.6611
100106..........................................         19.3113         17.2527         17.4958         17.9164
100107..........................................         18.0142         20.1281         20.0396         19.3936
100108..........................................         11.4692         19.9593         20.1125         16.4375
100109..........................................         22.1715         20.8440         19.8488         20.8649
100110..........................................         19.6439         20.8995         20.1853         20.2509
100112..........................................          9.7706         25.2570         15.2128         15.6728
100113..........................................         22.2584         23.2020         28.8892         24.7828
100114..........................................         23.4501         21.6262         22.8178         22.5825
100117..........................................         18.8619         20.7624         20.6962         20.1889
100118..........................................         19.7608         22.8702         20.7323         21.1427
100121..........................................         19.3435               *         18.2789         18.7785
100122..........................................         18.0551         19.8783         19.2567         19.0659
100124..........................................         19.0527         17.0713         20.4022         18.8192
100125..........................................         17.3358         18.9535         19.6097         18.6719
100126..........................................         18.0943         19.5413         19.3103         18.9490
100127..........................................         19.8727         19.9860         19.2122         19.6859
100128..........................................         21.3653         20.1536         22.8826         21.4045
100129..........................................         18.5723         19.1936               *         18.8646
100130..........................................         19.1052         18.6751         20.0947         19.3019
100131..........................................         22.1680         23.4373         21.1195         22.2597
100132..........................................         16.8978         18.1167         18.7863         17.9218
100134..........................................         13.4711         15.1764         15.9733         14.8260
100135..........................................         17.4785         18.8253         19.0430         18.4539
100137..........................................         19.0464         18.6955         19.5562         19.1372
100138..........................................         11.0135         17.1373         14.9539         13.7935
100139..........................................         15.6444         15.6514         15.2532         15.5227
100140..........................................         17.3518         17.1389         19.0584         17.8826
100142..........................................         18.6812         19.6815         13.0623         16.5381
100144..........................................         15.0197         12.2877               *         13.4059
100145..........................................         19.1143               *               *         19.1143
100146..........................................         17.8692         18.1267         21.3359         19.1001
100147..........................................         14.6751         14.6616         15.2348         14.8665
100150..........................................         21.0224         21.2807         21.5057         21.2659
100151..........................................         19.3990         21.6087         23.8489         21.6478
100154..........................................         19.8485         20.0015         20.4068         20.1020
100156..........................................         17.1335         19.4980         18.4779         18.3856
100157..........................................         21.0324         22.6744         22.6195         22.1032
100159..........................................         16.3778         10.2793          6.3232          9.8839
100160..........................................         21.6339         20.5581         23.3121         21.8278
100161..........................................         21.5025         22.2994         22.4181         22.0895
100162..........................................         19.8748         20.1411         14.1842         17.5642
100165..........................................         18.5739         19.0388         22.6622         20.3299

[[Page 22753]]

 
100166..........................................         20.4228         20.0250         21.2309         20.5491
100167..........................................         21.8138         23.4075         23.2969         22.8605
100168..........................................         20.1260         20.1994         20.2632         20.1979
100169..........................................         20.7778         20.9506         20.6223         20.7811
100170..........................................         15.1167         18.5088         19.3005         17.5325
100172..........................................         15.1848         14.3446         14.8826         14.8099
100173..........................................         17.3416         18.5662         17.1337         17.6572
100174..........................................         20.5125         26.1826         21.9807         22.2819
100175..........................................         17.8237         18.1692         20.5477         19.0035
100176..........................................         24.6978         22.8604         24.3089         23.9493
100177..........................................         22.0034         24.4296         23.5394         23.2665
100179..........................................         20.9053         22.3015         18.4114         20.3782
100180..........................................         18.4754         20.2130         21.5180         19.9976
100181..........................................         24.5704         23.0800         18.9510         21.8206
100183..........................................         20.8579         24.6121         23.0654         22.6623
100187..........................................         20.6938         20.2533         18.7750         19.8300
100189..........................................         21.0102         21.3147         26.5962         23.0255
100191..........................................         18.4692         19.9879         18.8676         19.1050
100199..........................................         23.3713         21.7193               *         22.5030
100200..........................................         22.2575         22.4579         23.8729         22.8861
100203..........................................         18.8628               *               *         18.8628
100204..........................................         20.2049         20.8995         19.6128         20.2366
100206..........................................         20.3511         19.5710         20.1171         20.0138
100207..........................................         15.9173               *               *         15.9173
100208..........................................         20.8337         21.2117         20.7029         20.9220
100209..........................................         19.7329         22.4577         22.7340         21.6408
100210..........................................         19.1799         21.3575         21.8545         20.7662
100211..........................................         25.5277         20.6427         20.7516         21.9172
100212..........................................         25.3441         21.1187         20.6343         22.0357
100213..........................................         19.1238         20.6558         21.1818         20.2975
100217..........................................         19.8700         20.5909         22.7335         21.0211
100220..........................................         19.9121         21.2796         21.1605         20.7655
100221..........................................         22.2517         17.3965         21.2672         20.0933
100222..........................................         22.1958               *               *         22.1958
100223..........................................         18.7580         20.6302         18.6039         19.2991
100224..........................................         24.7023         20.0251         21.8799         21.8886
100225..........................................         20.6404         20.6802         21.1013         20.8046
100226..........................................         24.8641         20.6858         22.0308         22.2904
100228..........................................         23.6986         21.3168         20.9039         21.8386
100229..........................................         18.2070         19.6908         18.2350         18.7682
100230..........................................         20.6018         20.5051         22.5650         21.2357
100231..........................................         17.4002         17.9226         18.3597         17.8974
100232..........................................         17.3171         19.3491         19.8002         18.8267
100234..........................................         21.5763         20.9104         21.6362         21.3290
100235..........................................         17.6648         17.1622               *         17.4262
100236..........................................         21.8111         20.3766         19.9007         20.6153
100237..........................................         22.9344         22.0865         23.2408         22.7368
100238..........................................         17.6310         19.6367         20.8252         19.4032
100239..........................................         19.7605         21.3193         19.4481         20.1474
100240..........................................         17.9339         20.4340         21.0606         19.8014
100241..........................................         13.8344         14.7224         17.1063         15.0865
100242..........................................         17.1154         17.9260         18.6938         17.9097
100243..........................................         20.3838         21.2644         20.8041         20.8228
100244..........................................         17.4124         18.6227         20.5352         18.9148
100246..........................................         21.2160         19.6376         20.8989         20.5473
100248..........................................         21.5399         20.7007         21.3017         21.1691
100249..........................................         19.0243         19.2808         18.1397         18.8067
100252..........................................         17.8726         17.7778         19.8032         18.4710
100253..........................................         20.6014         21.3232         21.8890         21.2952
100254..........................................         20.9080         19.6598         19.5489         19.9883
100255..........................................         21.0224         25.2119         21.0284         22.2338
100256..........................................         23.5640         20.9356         20.8947         21.6340
100258..........................................         21.8764         21.3501         20.0300         21.0257

[[Page 22754]]

 
100259..........................................         19.8600         20.3815         21.1160         20.4723
100260..........................................         21.2224         21.0506         24.6599         22.2640
100262..........................................         19.5874         20.0433         21.0927         20.2558
100263..........................................         16.9012               *               *         16.9012
100264..........................................         17.6085         19.1556         19.9394         18.8935
100265..........................................         19.8571         18.8301         18.2291         18.8491
100266..........................................         17.7319         18.2993         19.3623         18.4763
100267..........................................         17.0986         20.1141         21.7430         19.6266
100268..........................................         23.5863         23.9249         24.0538         23.8633
100269..........................................         21.2047         21.6724         22.5114         21.8200
100270..........................................         19.8576         15.1462         16.7148         17.2012
100271..........................................         19.9208         20.4824         20.8695         20.4494
100275..........................................         21.3273         20.9188         21.2396         21.1563
100276..........................................         21.9797         22.3646         24.1022         22.8308
100277..........................................         16.1410         16.6255         19.7241         17.0041
100279..........................................         23.0213         22.9095         21.5291         22.5018
100280..........................................         16.5851         17.3676         18.1972         17.4129
100281..........................................         22.0202         22.4392         23.0142         22.5262
100282..........................................         19.7717         19.1978         17.7837         18.9361
100284..........................................               *               *         18.9448         18.9448
110001..........................................         18.0571         19.1971         20.1150         19.1086
110002..........................................         17.3674         17.1406         19.5113         18.0107
110003..........................................         16.9099         18.1168         17.1450         17.3940
110004..........................................         18.9468         19.5591         19.7733         19.4194
110005..........................................         19.2639         17.7348         21.4023         19.6576
110006..........................................         20.1273         20.7820         21.0601         20.6571
110007..........................................         23.4976         21.9505         25.0143         23.4851
110008..........................................         18.2642         22.0081         18.5265         19.5622
110009..........................................         14.8218         16.3069         17.4306         16.2843
110010..........................................         24.5493         23.3213         23.8794         23.9073
110011..........................................         18.2846         18.6144         18.9823         18.6368
110013..........................................         16.0264         16.2811         18.9160         17.1183
110014..........................................         16.1168         16.0658         18.1787         16.7192
110015..........................................         19.4769         21.2146         20.9926         20.5614
110016..........................................         15.2967         22.5321         14.2398         16.6540
110017..........................................         10.5399         13.1960         21.4010         15.0953
110018..........................................         21.0415         19.6064         22.1480         20.9298
110020..........................................         18.5251         18.3147         19.4457         18.7684
110023..........................................         18.6460         21.1994         21.8081         20.5099
110024..........................................         19.7923         20.7297         20.7345         20.4144
110025..........................................         18.6463         19.5749         20.4232         19.5033
110026..........................................         16.1414         17.2977         16.2484         16.5517
110027..........................................         14.6834         16.0642         14.8266         15.2090
110028..........................................         19.8894         20.1547         29.1670         22.3800
110029..........................................         20.0507         20.2906         19.6048         19.9639
110030..........................................         17.6785         18.8105         19.6354         18.7183
110031..........................................         21.5794         19.9482         20.0553         20.4598
110032..........................................         16.1859         15.7349         18.2014         16.6413
110033..........................................         21.4143         22.1879         25.1743         22.8060
110034..........................................         18.1882         19.6055         19.5554         19.0987
110035..........................................         21.1670         19.3795         22.7950         21.1658
110036..........................................         24.4181         22.2498         20.7284         22.3301
110038..........................................         16.3750         17.7060         17.5767         17.2140
110039..........................................         20.7710         20.6011         20.4998         20.6248
110040..........................................         16.4043         17.0743         16.8083         16.7529
110041..........................................         16.6927         18.8035         20.2755         18.6583
110042..........................................         20.6503         24.0153         25.2331         23.2575
110043..........................................         17.2175         20.1016         20.6150         19.2219
110044..........................................         19.5983         16.3624         17.2087         17.5794
110045..........................................         19.9445         20.2498         21.3049         20.4714
110046..........................................         19.2327         19.7377         21.4905         20.1167
110048..........................................         15.6463         16.3148         15.6113         15.8483
110049..........................................         14.2135         16.1817         16.8639         15.7669

[[Page 22755]]

 
110050..........................................         18.7516         20.7619         19.2291         19.5578
110051..........................................         15.7475         17.0070         17.2292         16.6496
110052..........................................         15.0562               *               *         15.0562
110054..........................................         19.2712               *         20.2638         19.7639
110056..........................................         16.4960         15.6202         15.8122         15.9689
110059..........................................         17.6984         16.6678         16.7990         17.0253
110061..........................................         13.7196         15.0367         16.3557         15.0889
110062..........................................         12.2107         18.8019         17.0053         16.1264
110063..........................................         17.9743         16.9612         18.5071         17.7965
110064..........................................         18.3368         18.9515         19.1203         18.8163
110065..........................................         13.3245         15.6771         16.3546         15.1604
110066..........................................         20.6502         21.0207         22.4189         21.3274
110069..........................................         18.3519         19.3109         20.9575         19.5384
110070..........................................         18.2264         21.0227         17.3438         18.7743
110071..........................................         14.8902         14.5984         18.8321         15.8863
110072..........................................         12.4303         12.7877         12.7625         12.6652
110073..........................................         15.1377         15.4261         16.4658         15.6663
110074..........................................         20.7572         21.3945         22.3769         21.5169
110075..........................................         17.0067         18.5199         20.1757         18.5793
110076..........................................         20.4430         21.2867         21.9798         21.2384
110078..........................................         24.7069         22.3718         24.0893         23.6954
110079..........................................         20.1385         21.0593         22.1070         21.0913
110080..........................................         23.4336         18.4768         19.1839         20.1449
110082..........................................         22.0078         23.8768         24.2358         23.3923
110083..........................................         21.3578         23.1219         23.1463         22.5746
110086..........................................         14.9756         18.2815         16.6374         16.5417
110087..........................................         20.5420         21.7773         22.7069         21.7189
110089..........................................         18.5761         18.5587         19.0889         18.7374
110091..........................................         21.3789         19.5114         21.5328         20.7784
110092..........................................         15.0890         17.3479         16.9725         16.4433
110093..........................................         14.8049               *         16.9827         15.7486
110094..........................................         13.8658         14.5641         16.9503         15.0650
110095..........................................         15.9478         16.4670         17.2273         16.5433
110096..........................................         16.3202         16.8541         17.4157         16.8647
110097..........................................         15.6164         15.5811         17.4558         16.1121
110098..........................................         14.0067         16.3532         16.0597         15.3226
110100..........................................         20.3764         18.6978         19.0764         19.3213
110101..........................................         11.7278         10.8187         18.8491         12.7872
110103..........................................         11.9352         13.6842         21.1837         14.0859
110104..........................................         15.3184         15.7781         15.8542         15.6538
110105..........................................         16.5196         16.8909         16.7775         16.7306
110107..........................................         17.3921         19.3609         19.3897         18.7335
110108..........................................         15.1401         19.7938         25.2161         19.3940
110109..........................................         16.3703         15.9359         16.4031         16.2270
110111..........................................         17.3215         18.5108         18.3951         18.0800
110112..........................................         19.1288         19.0619         19.8617         19.3018
110113..........................................         15.1896         16.8179         15.9532         15.9721
110114..........................................         15.1303         14.6888         16.4812         15.4358
110115..........................................         24.8332         43.9427         22.9566         28.0177
110118..........................................         15.3992         20.5368         19.7509         18.5122
110120..........................................         15.1878         15.2589         17.7429         15.9886
110121..........................................         15.5792         16.2711         19.1640         17.0021
110122..........................................         18.8497         21.1385         21.1469         20.3688
110124..........................................         17.1306         17.5732         18.3366         17.6460
110125..........................................         17.3254         19.1311         18.0692         18.1623
110127..........................................         13.7612         14.6143         20.3765         16.2641
110128..........................................         18.9705         18.1845         18.0835         18.4293
110129..........................................         18.1208         18.9388         19.0001         18.6851
110130..........................................         13.0779         16.0580         14.6011         14.6559
110132..........................................         15.0231         16.0419         16.3943         15.8158
110134..........................................         11.5583         12.5723         18.6076         14.6296
110135..........................................         17.0834         17.4380         17.3504         17.2967
110136..........................................         16.1680         18.0639         16.9629         16.8702

[[Page 22756]]

 
110140..........................................         17.8806         17.8870         17.7915         17.8571
110141..........................................         12.5051         13.2501         14.4935         13.4024
110142..........................................         12.3029         14.6144         13.9525         13.5947
110143..........................................         21.6898         20.1603         22.5926         21.5352
110144..........................................         17.9766         16.8685         17.5112         17.4397
110146..........................................         17.6068         16.1316         17.1835         16.9320
110149..........................................         22.2256         17.7535         32.1975         23.0615
110150..........................................         18.7724         20.2644         21.2909         20.0962
110152..........................................         14.7674         15.3996         15.1324         15.1011
110153..........................................         18.6862         19.2744         20.5068         19.4781
110154..........................................         14.8067         14.9636         17.3761         15.6408
110155..........................................         17.1370         15.5306         16.5146         16.3434
110156..........................................         15.3422         14.7477         16.3876         15.4698
110161..........................................         20.8657         21.7153         22.2861         21.6563
110163..........................................         18.2016         20.4202         18.6088         18.9884
110164..........................................         19.4946         20.2074         21.2301         20.2993
110165..........................................         18.9974         21.2577         20.8030         20.3401
110166..........................................         19.8510         20.5882         20.5637         20.3331
110168..........................................         19.8178         20.6646         21.8508         20.8181
110169..........................................         18.7189         20.6385         22.6648         20.4216
110171..........................................         20.0874         23.7893         25.5187         22.6232
110172..........................................         25.4390         23.3730         23.6761         24.1702
110174..........................................         14.2978         13.7339         14.6199         14.1905
110176..........................................         22.3971               *               *         22.3971
110177..........................................         19.5888         20.7187         21.2661         20.5227
110178..........................................         16.8555         18.8306               *         17.8083
110179..........................................         20.5161         22.7841         22.8884         21.9497
110181..........................................         13.7195         14.0941         12.9798         13.6399
110183..........................................         21.1797         23.3826         22.5148         22.3473
110184..........................................         20.9465         22.1970         22.1920         21.7791
110185..........................................         16.2487         16.7246         17.7925         16.9013
110186..........................................         17.3398         17.4287         18.3013         17.6927
110187..........................................         21.4462         20.1154         19.8419         20.4516
110188..........................................         20.0548         24.8376         23.7089         22.6478
110189..........................................         18.8627         22.2715         20.8786         20.7023
110190..........................................         19.4318         18.5728         18.3649         18.7761
110191..........................................         19.1065         20.2033         21.4033         20.2583
110192..........................................         20.7660         21.4951         21.0390         21.1032
110193..........................................         18.7807         20.6380         20.7867         20.0518
110194..........................................         15.0937         15.1480         14.8115         15.0165
110195..........................................         10.5227         13.9135         12.7261         12.3146
110198..........................................         26.1898         24.1999         24.4684         24.9086
110200..........................................         17.2129         18.1862         16.0807         17.1358
110201..........................................         19.2438         20.4699         21.0011         20.2421
110203..........................................         20.2958         26.8148         22.7453         23.1944
110204..........................................         20.5728         19.7317         30.7342         21.7754
110205..........................................         26.1154         21.1435         21.3617         22.7145
110207..........................................         12.8710         12.9727         14.7154         13.5335
110208..........................................         14.8907         15.1742         15.6161         15.1789
110209..........................................         20.4640         17.9190         18.6404         18.9942
110211..........................................         21.8226         20.9372         26.9151         23.1427
110212..........................................         12.6583         11.8545         14.3790         12.8830
110213..........................................         13.1976         14.3651               *         13.7453
110215..........................................               *         20.1928         18.1539         19.0047
110216..........................................               *               *         27.1878         27.1878
110217..........................................               *               *         34.0758         34.0758
120001..........................................         26.7134         27.9213         29.0427         27.8237
120002..........................................         24.3780         25.0744         25.2021         24.8896
120003..........................................         23.8452         25.9059         23.9115         24.5394
120004..........................................         24.0456         23.9208         24.8632         24.2413
120005..........................................         20.5380         23.3975         24.1662         22.6197
120006..........................................         23.7151         25.0895         25.8943         24.8700
120007..........................................         23.2684         22.7200         22.8772         22.9509

[[Page 22757]]

 
120009..........................................         19.0216         17.4693         16.4621         17.5649
120010..........................................         25.3976         25.1480         24.1923         24.8868
120011..........................................         33.5459         35.0582         37.2759         35.3313
120012..........................................         22.5219         23.1144         21.8507         22.5391
120014..........................................         24.0467         22.8866         24.0359         23.6453
120015..........................................         29.0747         32.9906         42.6465         33.1800
120016..........................................         29.4104         27.9127         45.6878         31.2151
120018..........................................         25.6088         24.5031         31.1879         26.2841
120019..........................................         21.9199         22.9341         25.5659         23.4285
120021..........................................         19.4236         23.4508         23.1839         21.8865
120022..........................................         17.9306         21.7868         19.0792         19.4460
120024..........................................         22.2846         29.4808         32.2514         26.8486
120025..........................................         19.0197         20.1065         50.6376         21.3455
120026..........................................         23.2237         26.0787         25.1314         24.7719
120027..........................................         24.5549         24.7255         24.4535         24.5737
120028..........................................         23.4873         27.5023         27.0897         25.8902
130001..........................................         24.9511         18.8471         17.6306         20.1752
130002..........................................         16.1853         16.6620         16.9867         16.6200
130003..........................................         19.9499         21.7313         22.3600         21.3642
130005..........................................         20.1678         20.7169         21.2386         20.7149
130006..........................................         18.8705         19.3392         20.4614         19.5797
130007..........................................         19.8442         20.8338         21.8107         20.8426
130008..........................................         12.9177         12.5506         13.6018         12.9892
130009..........................................         18.2958         19.1837         15.9701         17.7296
130010..........................................         21.4325         17.6795         17.5119         18.7875
130011..........................................         19.0816         20.5031         20.1147         19.9190
130012..........................................         22.6153         22.9813         24.9976         23.5891
130013..........................................         19.2170         17.4038         15.1129         17.1523
130014..........................................         17.9836         18.9769         19.1105         18.6941
130015..........................................         15.2662         15.7233         18.5913         16.3849
130016..........................................         16.9987         17.3942         19.0516         17.7864
130017..........................................         16.8822         17.1710         19.6875         17.7220
130018..........................................         17.9651         19.7368         19.8425         19.2288
130019..........................................         17.2317         18.6648         19.1711         18.3322
130021..........................................         12.2562         12.8588         15.6155         13.6528
130022..........................................         19.5040         16.5270         18.9127         18.2241
130024..........................................         18.3789         19.3634         19.0703         18.9600
130025..........................................         15.2691         17.5213         16.4627         16.4881
130026..........................................         20.5535         21.5934         21.8106         21.3093
130027..........................................         20.7044         21.4279         20.5344         20.8883
130028..........................................         18.2074         19.1093         20.9674         19.4388
130029..........................................         20.3153         18.4263         18.7694         19.1364
130030..........................................         18.3981         17.8440         17.5759         17.9347
130031..........................................         17.6458         16.2397         16.7766         16.8967
130034..........................................         18.8164         16.9873         18.9483         18.2785
130035..........................................         20.4708         19.3478         20.7770         20.1943
130036..........................................         13.7942         13.7933         13.6362         13.7373
130037..........................................         17.7374         18.8071         18.6856         18.3986
130043..........................................         16.0686         16.5102         16.7904         16.4511
130044..........................................         13.1816         17.8160         13.4513         14.6424
130045..........................................         16.4655         16.0990         19.0208         17.0869
130048..........................................         15.0924         16.0899         16.7900         15.9311
130049..........................................         20.3928         20.3129         22.4440         21.0760
130054..........................................         17.7802         17.2729         17.7085         17.5766
130056..........................................         15.6551         14.6862         20.9476         16.5492
130058..........................................         17.7462               *               *         17.7462
130060..........................................         20.8508         21.8662         22.7399         21.8288
130061..........................................         16.7839         15.4006         14.7394         15.6929
130062..........................................         15.1086         16.5672         19.8157         17.1915
130063..........................................               *         15.9441         18.8024         17.8420
140001..........................................         15.4448         16.3372         17.7990         16.4814
140002..........................................         19.2575         19.0248         19.9284         19.3999
140003..........................................         18.0001         21.2886         17.8595         18.9466

[[Page 22758]]

 
140004..........................................         17.5200         15.7042         17.4574         16.8965
140005..........................................         10.8718         11.6127         12.3002         11.5858
140007..........................................         22.4015         22.9799         23.0743         22.8202
140008..........................................         21.2844         21.6548         22.0157         21.6522
140010..........................................         25.2227         31.8207         28.4268         28.3237
140011..........................................         17.2856         17.8676         18.6164         17.9499
140012..........................................         19.4406         23.0653         21.0475         21.1353
140013..........................................         17.3488         18.3060         19.6722         18.4213
140014..........................................         20.7563         22.4737         23.0372         21.9976
140015..........................................         15.0232         16.6735         17.6805         16.4314
140016..........................................         12.5363         13.1278         14.4938         13.3972
140018..........................................         21.4147         22.3070         24.6202         22.7573
140019..........................................         15.3435         16.6548         16.4254         16.1654
140024..........................................         14.6674         16.8271         15.3782         15.5912
140025..........................................         16.9489         16.9462         18.5135         17.4713
140026..........................................         15.9557         16.6612         18.3220         16.9446
140027..........................................         17.5023         18.7553         19.2149         18.5013
140029..........................................         21.0358         22.8322         26.0833         23.2140
140030..........................................         22.4414         21.9475         22.1760         22.1946
140031..........................................         15.9442         19.5731         17.6067         17.6942
140032..........................................         17.3363         18.1058         19.0383         18.1645
140033..........................................         22.5583         24.1722         25.1639         23.9291
140034..........................................         19.1482         19.5278         19.7903         19.4886
140035..........................................         12.9963         15.2649         15.5040         14.5633
140036..........................................         17.0419         18.5771         19.1076         18.2935
140037..........................................         12.5012         13.0764         14.1083         13.2105
140038..........................................         17.6094         18.3035         18.4624         18.1246
140040..........................................         16.2462         19.9267         16.7450         17.5895
140041..........................................         17.2829         17.6582         23.7556         19.4569
140042..........................................         15.6092         15.4095         15.8892         15.6354
140043..........................................         18.9464         19.4683         20.1176         19.5022
140045..........................................         20.6541         15.5807         17.7799         17.9528
140046..........................................         16.4621         18.9763         18.6371         18.0097
140047..........................................         16.3298         17.1539         13.3610         15.4382
140048..........................................         20.5773         24.0913         22.7155         22.4684
140049..........................................         21.5937         28.4958         26.9483         25.7338
140051..........................................         20.8455         23.8264         23.0662         22.5696
140052..........................................         19.6045         19.6409         17.5433         18.8875
140053..........................................         17.8218         19.1892         19.5761         18.8494
140054..........................................         26.1497         22.1921         23.2565         23.8024
140055..........................................         14.8031         16.3404         14.3603         15.1391
140058..........................................         17.2716         17.4927         18.6861         17.8100
140059..........................................         15.3934         15.0195               *         15.1978
140061..........................................         15.9612         17.3012         18.2039         17.1185
140062..........................................         27.0912         28.0877         28.6768         27.9630
140063..........................................         22.3882         25.3641         24.0303         23.8508
140064..........................................         19.2549         19.1023         18.9379         19.0960
140065..........................................         23.1610         24.1128         25.3336         24.1516
140066..........................................         16.1759         17.3902         13.6491         15.5770
140067..........................................         18.4031         19.3267         19.5292         19.0846
140068..........................................         18.8739         19.9691         21.6188         20.0995
140069..........................................         16.1453         16.7544         17.3879         16.7949
140070..........................................         19.2995         22.9678         22.7153         21.2244
140074..........................................         19.0077         19.3504         21.6052         19.9120
140075..........................................         22.5083         21.6313         21.0600         21.7539
140077..........................................         16.6447         17.5305         17.3647         17.1709
140079..........................................         21.9205         23.3020         23.6928         22.9153
140080..........................................         20.9999         21.0739         22.0345         21.3383
140081..........................................         15.5103         16.2247         16.9808         16.1897
140082..........................................         22.6227         23.8960         29.6534         24.8396
140083..........................................         18.1349         19.3145         21.0096         19.4873
140084..........................................         20.0133         20.9709         22.3467         21.0939
140086..........................................         17.3717         18.3803         19.1613         18.3356

[[Page 22759]]

 
140087..........................................         18.3639         16.1009         17.1147         17.1839
140088..........................................         24.2568         25.2369         22.0679         23.8109
140089..........................................         17.2086         17.6366         18.3157         17.7164
140090..........................................         23.5888         26.4325         27.0060         25.4162
140091..........................................         20.7039         20.9018         21.9322         21.1441
140093..........................................         19.1469         18.2899         20.1528         19.1437
140094..........................................         20.6129         21.4709         21.9383         21.3227
140095..........................................         21.5376         24.0549         23.3001         22.8780
140097..........................................         16.8997         17.5081         21.1719         18.4160
140100..........................................         19.0588         21.3581         23.1399         21.1571
140101..........................................         26.0894         21.5473         21.7186         22.8766
140102..........................................         15.0777         17.1500         17.5729         16.5644
140103..........................................         17.8586         19.2783         18.1303         18.4145
140105..........................................         20.9068         22.6573         22.6913         22.0594
140107..........................................         12.7573         13.7533         11.8383         12.6800
140108..........................................         28.6028         25.4742         26.9971         26.9964
140109..........................................         15.4724         15.7465         14.5498         15.2467
140110..........................................         18.8112         19.1822         19.2888         19.0728
140112..........................................         16.2399         17.6856         17.6974         17.1885
140113..........................................         17.9151         19.0592         18.8593         18.5977
140114..........................................         20.4808         21.1639         21.8154         21.1561
140115..........................................         20.0939         21.1926         21.0433         20.7564
140116..........................................         21.8290         23.1177         23.7281         22.8966
140117..........................................         19.6445         21.5671         20.4740         20.5537
140118..........................................         23.0797         23.5952         24.2708         23.6385
140119..........................................         26.5042         29.1419         27.2387         27.6111
140120..........................................         14.8375         18.0743         17.9716         16.8874
140121..........................................          9.5268         16.0397         16.6993         13.2257
140122..........................................         23.7473         24.6470         25.8773         24.7639
140124..........................................         26.9706         27.1906         27.9517         27.3458
140125..........................................         17.0974         17.6759         16.9735         17.2524
140127..........................................         19.4259         19.8973         17.5075         18.9895
140128..........................................         17.6751         19.4955         23.1327         20.0664
140129..........................................         15.2494         18.2639         20.2868         17.8627
140130..........................................         23.7682         22.2285         23.1873         23.0442
140132..........................................         23.0443         23.5475         23.3054         23.2992
140133..........................................         19.9083         21.4090         21.1453         20.7897
140135..........................................         17.6927         17.8100         17.3985         17.6268
140137..........................................         16.5141         16.8969         18.6330         17.3470
140138..........................................         14.5877         16.7420         17.1968         16.2121
140139..........................................         16.5794         14.0619         11.0397         13.5138
140140..........................................         15.2985         17.8243         17.6845         16.9747
140141..........................................         15.1782         17.5204         19.1097         17.2133
140143..........................................         18.7616         19.1862         18.9984         18.9893
140144..........................................         19.7913         21.3245         22.2864         21.1022
140145..........................................         16.6111         17.5471         18.1788         17.4556
140146..........................................         23.7400         21.9573         19.9704         21.7285
140147..........................................         24.8191         16.1336         18.8049         19.2135
140148..........................................         19.5026         18.6598         17.9816         18.6917
140150..........................................         27.8485         27.3378         26.7896         27.3222
140151..........................................         19.3016         21.3896         20.0310         20.2086
140152..........................................         22.4270         24.6333         24.9613         23.9173
140155..........................................         17.3131         19.9738         19.5083         18.8605
140158..........................................         22.2666         22.7639         22.7988         22.5990
140160..........................................         17.8822         17.7691         17.7921         17.8132
140161..........................................         19.0448         20.0948         20.3799         19.8258
140162..........................................         18.4167         19.6464         20.3452         19.4479
140164..........................................         18.6120         18.7806         18.6589         18.6860
140165..........................................         15.4186         14.9156         14.7223         15.0080
140166..........................................         17.5434         17.5496         18.2503         17.7751
140167..........................................         16.5671         17.1479         17.6525         17.1325
140168..........................................         16.4638         16.6770         17.7453         16.9752
140170..........................................         14.1360         16.1621         16.4107         15.5211

[[Page 22760]]

 
140171..........................................         14.7316         14.1637         15.0237         14.6354
140172..........................................         20.7982         23.8431         21.0186         21.8883
140173..........................................         18.4788         15.1487         16.3924         16.7054
140174..........................................         19.9216         20.5339         40.5916         23.4138
140176..........................................         21.4129         23.2866         24.0512         22.8950
140177..........................................         18.1692         18.2648         15.0827         17.1204
140179..........................................         22.6989         21.1948         21.9258         21.9422
140180..........................................         23.2536         22.4548         22.5661         22.7489
140181..........................................         20.5461         20.8709         21.9155         21.0777
140182..........................................         20.7013         22.0170         22.5552         21.7590
140184..........................................         14.9763         17.8155         17.2401         16.6194
140185..........................................         17.3616         17.6514         18.2867         17.7696
140186..........................................         18.9878         22.7890         21.0934         20.9521
140187..........................................         17.6910         17.9201         18.3331         17.9863
140188..........................................         14.8373         15.2479         16.1907         15.4001
140189..........................................         19.0791         21.0616         20.6627         20.2758
140190..........................................         15.8770         16.3366         17.5263         16.5534
140191..........................................         24.7368         25.8835         25.2628         25.2833
140193..........................................         15.5196         15.8022         17.4057         16.2409
140197..........................................         17.9828         18.6394         19.3774         18.6752
140199..........................................         18.8333         18.3507         18.0450         18.4044
140200..........................................         21.6508         21.5220         20.0559         21.0333
140202..........................................         22.1800         22.1939         22.2334         22.2042
140203..........................................         20.7854         19.9194         21.0848         20.5915
140205..........................................         17.2369         17.4751         20.0784         18.0505
140206..........................................         20.5096         21.3295         22.5109         21.4570
140207..........................................         20.2048         21.9779         22.3905         21.3996
140208..........................................         23.9441         25.9900         26.2527         25.3856
140209..........................................         17.7889         18.1206         20.1557         18.6405
140210..........................................         12.6648         15.6899         14.8248         14.4319
140211..........................................         20.9615         21.8891         22.6265         21.8594
140213..........................................         26.2041         27.0645         23.9146         25.7381
140215..........................................         14.4544         15.9949         15.2893         15.2456
140217..........................................         23.3192         24.8229         25.4896         24.5129
140218..........................................         15.0750         14.9459         14.9851         15.0038
140220..........................................         16.7341         17.6370         17.8450         17.4280
140223..........................................         21.4725         24.9249         24.8504         23.6225
140224..........................................         22.9945         25.8668         32.8061         26.7812
140228..........................................         18.6731         19.6988         19.7113         19.3775
140230..........................................         16.5979         18.0918         18.2983         17.6740
140231..........................................         21.6062         23.9176         24.5019         23.4404
140233..........................................         18.3703         19.4542         21.8857         19.8854
140234..........................................         18.7156         18.9945               *         18.8552
140236..........................................         13.1341               *         12.9253         13.0112
140239..........................................         18.8785         18.8127         19.6792         19.1309
140240..........................................         24.2141         23.6860         24.4498         24.1185
140242..........................................         22.6679         24.5428         25.1416         24.1471
140245..........................................         15.5554         13.4839         14.2481         14.3597
140246..........................................         12.8238         13.4639         11.6267         12.5798
140250..........................................         23.4127         25.0876         23.6449         24.0578
140251..........................................         20.5813         21.4385         21.8059         21.2700
140252..........................................         24.4856         25.2246         24.9718         24.8965
140253..........................................         16.7356         18.5511         19.5858         18.2440
140258..........................................         21.1321         23.2973         25.0755         23.1842
140271..........................................         15.3606         15.5079         12.0079         14.1590
140275..........................................         17.9597         20.1699         23.8171         20.5857
140276..........................................         23.7163         26.6777         25.3078         25.2303
140280..........................................         18.8420         20.2360         18.8300         19.2649
140281..........................................         23.3433         24.0192         25.2719         24.2302
140285..........................................         14.7087         18.1181         17.3787         16.8092
140286..........................................         19.9500         20.3735         22.1015         20.8673
140288..........................................         21.8213         25.2327         24.4331         23.7989
140289..........................................         16.4542         17.1388         18.1747         17.3055

[[Page 22761]]

 
140290..........................................         21.2384         21.1784         22.8465         21.7717
140291..........................................         22.4352         25.0911         24.9537         24.1790
140292..........................................         22.7136         20.8560         21.4533         21.6516
140294..........................................         17.5226         17.7226         17.7301         17.6645
140297..........................................         21.4692               *               *         21.4692
140300..........................................         23.2560         25.3662         27.8436         25.5898
150001..........................................         21.6990         22.8109         24.0620         22.8643
150002..........................................         18.7568         19.3401         19.7035         19.2828
150003..........................................         19.3117         19.7661         20.8636         19.9824
150004..........................................         19.7020         20.3685         21.2449         20.4349
150005..........................................         18.9964         20.6260         21.1610         20.2631
150006..........................................         20.0433         20.8158         20.6523         20.5130
150007..........................................         19.5255         20.1826         20.6635         20.1487
150008..........................................         20.9684         21.4545         21.8457         21.4285
150009..........................................         18.2168         18.7073         18.5540         18.4858
150010..........................................         18.4776         21.7125         20.5570         20.1836
150011..........................................         19.1957         18.3742         18.3041         18.6202
150012..........................................         20.5193         22.4751         22.1402         21.6785
150013..........................................         16.0043         17.0352         16.9327         16.6522
150014..........................................         21.2812         22.0143         21.5168         21.6212
150015..........................................         22.0452         22.5409         21.9037         22.1546
150017..........................................         18.8898         18.7664         19.5361         19.0702
150018..........................................         19.5612         20.4947         20.7080         20.2547
150019..........................................         15.2892         16.6327         17.8585         16.5672
150020..........................................         14.4592         15.1120         16.6600         15.3745
150021..........................................         19.0162         19.5096         21.5636         20.0344
150022..........................................         17.9206         19.1555         17.9222         18.3309
150023..........................................         18.6641         18.3598         19.0270         18.6729
150024..........................................         17.8311         18.4140         19.0380         18.3973
150025..........................................         18.1490         17.7007         12.7222         15.7084
150026..........................................         20.5085         18.8417         22.4284         20.5038
150027..........................................         16.4846         17.3284         18.0335         17.2600
150029..........................................         21.7414         23.0546         23.2454         22.7440
150030..........................................         17.3296         17.9992         18.6947         18.0196
150031..........................................         18.0060         17.2429         18.3463         17.8675
150032..........................................         20.6391               *               *         20.6391
150033..........................................         21.6854         21.8768         22.7658         22.1130
150034..........................................         21.2868         22.1317         23.1533         22.1845
150035..........................................         19.8177         20.4477         21.2374         20.5107
150036..........................................         20.3848         20.8692         21.4567         20.9448
150037..........................................         17.7868         21.7109         24.0213         21.0127
150038..........................................         20.2503         21.2193         22.0572         21.2025
150039..........................................         17.4919         18.4729         19.6215         18.5025
150042..........................................         17.1241         18.1632         20.0557         18.3464
150043..........................................         17.9834         19.0120         20.1741         18.9948
150044..........................................         17.6432         18.4381         19.1309         18.4093
150045..........................................         17.0395         16.8121         18.1670         17.3563
150046..........................................         17.3210         17.6342         18.2543         17.7460
150047..........................................         24.8819         19.7441         22.0305         22.1067
150048..........................................         16.9573         19.3329         19.1648         18.5048
150049..........................................         16.8529         17.0141         18.5099         17.4307
150050..........................................         17.1442         16.8354         17.7354         17.2410
150051..........................................         18.1990         19.0130         19.1637         18.7924
150052..........................................         15.3618         15.8590         17.3750         16.2411
150053..........................................         18.7463         19.1421         18.8632         18.9165
150054..........................................         17.3296         17.3825         18.3916         17.7528
150056..........................................         23.2991         22.4087         21.5774         22.2457
150057..........................................         16.8630         16.5882         16.9736         16.8076
150058..........................................         20.9537         20.8178         23.0807         21.5904
150059..........................................         20.8004         21.2535         22.7360         21.5830
150060..........................................         16.0098         17.0743         18.0032         17.0216
150061..........................................         17.2141         17.3887         19.7968         18.0770
150062..........................................         18.4110         20.5415         20.8274         20.0239

[[Page 22762]]

 
150063..........................................         21.0899         22.0925         22.6525         21.9213
150064..........................................         17.0309         18.1400         20.3865         18.5718
150065..........................................         19.0051         19.8913         21.2153         20.0425
150066..........................................         14.5977         15.3373         19.5313         16.4634
150067..........................................         17.0829         18.2926         18.8862         18.0821
150069..........................................         17.3918         21.5310         23.3969         20.9447
150070..........................................         17.1992         17.9260         18.0827         17.7417
150071..........................................         14.7306         13.4760         13.5111         13.9122
150072..........................................         16.1091         16.2054         15.0765         15.7702
150073..........................................         19.0292         22.2968               *         20.5664
150074..........................................         18.8597         20.4175         20.1054         19.7802
150075..........................................         14.9786         15.5603         16.7532         15.7414
150076..........................................         22.3407         22.9382         22.6424         22.6387
150077..........................................         17.5750               *               *         17.5750
150078..........................................         19.0096         19.2718         19.9668         19.4018
150079..........................................         15.4545         17.2436         18.0265         16.8569
150082..........................................         17.8796         17.5265         17.8162         17.7421
150084..........................................         22.9159         23.2506         23.9940         23.3857
150086..........................................         17.3442         18.9735         18.2185         18.1968
150088..........................................         19.4475         18.9869         20.3366         19.5726
150089..........................................         22.9458         23.8791         21.3690         22.6571
150090..........................................         19.0595         20.7726         21.0945         20.2459
150091..........................................         19.8912         20.4053         22.4640         20.9087
150092..........................................         15.9174         16.7434         16.9179         16.5364
150094..........................................         18.3410         16.5788         17.5244         17.5067
150095..........................................         17.1187         17.1324         19.2749         17.7838
150096..........................................         20.0281         23.2764         20.2897         21.1086
150097..........................................         18.3103         19.3802         19.7751         19.1545
150098..........................................         14.2953         15.0943         13.8800         14.4383
150099..........................................         18.9718         22.4229               *         20.3545
150100..........................................         17.4776         18.4148         19.8066         18.6620
150101..........................................         17.5554         16.4604         15.9718         16.6097
150102..........................................         11.5034         19.7426         23.7180         17.1422
150103..........................................         17.3064         18.4781         18.7036         18.2137
150104..........................................         17.2642         17.6981         20.0765         18.3399
150105..........................................         19.1709         20.0431         22.4412         20.4692
150106..........................................         18.9097         16.1510         15.7497         16.7986
150109..........................................         18.2289         18.8077         19.6344         18.8790
150110..........................................         18.5752         18.6627         21.9336         19.5289
150111..........................................         16.1707         18.4556         19.2355         17.8619
150112..........................................         19.8155         20.4109         20.5253         20.2569
150113..........................................         19.1988         20.3780         19.6603         19.7455
150114..........................................         16.9638         19.5183         17.9877         18.1743
150115..........................................         17.0627         17.4315         18.2882         17.5968
150122..........................................         19.3545         18.7139         17.7867         18.6097
150123..........................................         15.1552         14.1105         15.1583         14.8238
150124..........................................         15.0706         14.6245         15.6449         15.1149
150125..........................................         20.3198         20.6735         21.3115         20.7738
150126..........................................         20.2958         21.3697         20.6857         20.7640
150127..........................................         22.8129         17.1994         17.0052         18.8048
150128..........................................         19.9205         18.5100         19.5158         19.3219
150129..........................................         23.4718         24.7711         28.6211         25.2796
150130..........................................         16.4144         18.1971         18.4846         17.6635
150132..........................................         19.4805         20.1684         20.9443         20.1836
150133..........................................         16.4910         17.3966         16.0923         16.6709
150134..........................................         17.0612         19.2526         19.3632         18.5912
150136..........................................         19.2819         20.1245         21.8097         20.3987
150145..........................................               *         16.6851               *         16.6851
150146..........................................               *               *         19.0204         19.0204
160001..........................................         19.0279         18.6035         19.0085         18.8767
160002..........................................         15.3724         15.9534         16.6003         15.9668
160003..........................................         15.7747         16.0862         16.2208         16.0221
160005..........................................         15.2320         17.6153         17.9405         16.9144

[[Page 22763]]

 
160007..........................................         15.6638         13.2101         15.1738         14.6237
160008..........................................         14.9698         15.9742         16.6410         15.8545
160009..........................................         16.0919         16.8391         17.9886         16.9591
160012..........................................         16.5409         16.4827         16.7112         16.5761
160013..........................................         17.0602         18.3996         18.6304         18.0298
160014..........................................         15.0861         15.9086         16.7146         15.8981
160016..........................................         18.3710         19.6322         19.9747         19.3376
160018..........................................         14.1634         14.5946         15.6141         14.7975
160020..........................................         14.4135         15.4712         15.5384         15.1417
160021..........................................         15.4860         16.5049         16.7617         16.2368
160023..........................................         14.2015         15.0665         15.0099         14.7723
160024..........................................         18.9548         19.7050         19.4764         19.3806
160026..........................................         18.6624         18.8379         19.5260         19.0040
160027..........................................         15.7403         16.3477         16.9417         16.3376
160028..........................................         20.5416         19.9595         21.0000         20.4893
160029..........................................         20.4003         20.4678         21.3457         20.7382
160030..........................................         17.9860         19.9508         19.6182         19.1837
160031..........................................         15.2831         15.2448         16.1267         15.5484
160032..........................................         16.1820         17.3202         18.3168         17.2888
160033..........................................         18.3736         18.8673         18.8205         18.6982
160034..........................................         14.5053         15.0019         16.5957         15.3739
160035..........................................         15.9199         15.2211         16.3991         15.8029
160036..........................................         19.1984         17.8849         17.4558         18.1820
160037..........................................         18.3968         19.0532         19.5211         18.9895
160039..........................................         17.6272         17.4758         17.8647         17.6551
160040..........................................         16.8295         18.1949         18.0667         17.6917
160041..........................................         15.4700         16.7850         17.4435         16.5782
160043..........................................         15.6261         15.6909         14.8564         15.3356
160044..........................................         16.0385         16.7439         17.8323         16.9072
160045..........................................         20.1154         20.1236         19.4334         19.7761
160046..........................................         14.7672         14.5655         16.2737         15.1831
160047..........................................         16.6926         18.3593         19.0787         18.0537
160048..........................................         13.1417         14.6144         15.6856         14.5140
160049..........................................         13.3614         14.5457         15.5673         14.5017
160050..........................................         16.4161         17.4912         17.7878         17.2198
160051..........................................         14.2660         14.6400         16.4261         15.1036
160052..........................................         17.5509         18.0941         21.7647         19.2313
160054..........................................         15.7093         16.1753         16.1981         16.0321
160055..........................................         14.0647         14.7600         15.1674         14.6539
160056..........................................         15.3758         16.1575         17.0172         16.1537
160057..........................................         17.4101         18.1776         19.1378         18.2553
160058..........................................         20.3402         21.1159         22.1061         21.1598
160060..........................................         15.9527         16.0436         17.2825         16.3968
160061..........................................         17.5707         17.3215         16.6061         17.1891
160062..........................................         14.4433         17.8086         17.4388         16.4393
160063..........................................         16.2960         16.8834         16.3583         16.5061
160064..........................................         19.9135         20.5496         21.0458         20.5185
160065..........................................         16.5087         16.9373         17.1043         16.8758
160066..........................................         16.2651         17.1875         17.9971         17.1716
160067..........................................         17.8551         17.8514         16.7833         17.4322
160068..........................................         15.8526         17.9892         19.0572         17.5565
160069..........................................         18.4857         19.7280         19.1640         19.1095
160070..........................................         15.6647         16.7017         18.4588         16.9299
160072..........................................         14.1920         14.9536         14.4141         14.5422
160073..........................................         15.0526         11.8261         11.4997         12.6736
160074..........................................         16.4772         19.5092         17.9513         18.0038
160075..........................................         17.8870         19.4948         18.4613         18.6342
160076..........................................         17.3086         17.9381         17.8824         17.7060
160077..........................................         11.4028         12.8826         13.6658         12.6451
160079..........................................         17.7050         17.6187         18.6333         17.9899
160080..........................................         17.8143         18.6687         19.4925         18.6704
160081..........................................         16.5150         17.0052         17.4466         17.0164
160082..........................................         18.7630         19.6499         19.5322         19.3143

[[Page 22764]]

 
160083..........................................         18.4078         20.6189         19.7542         19.5937
160085..........................................         18.5510         18.0063         21.2557         19.2281
160086..........................................         16.4558         17.3271         17.5308         17.0998
160088..........................................         17.5331         20.2331         22.3655         19.9346
160089..........................................         16.7419         16.9538         17.3449         17.0079
160090..........................................         16.6002         17.1090         17.9614         17.2461
160091..........................................         12.1893         12.8516         14.2573         13.0755
160092..........................................         15.7979         15.5011         17.0633         16.0971
160093..........................................         15.9525         17.7457         18.5675         17.5141
160094..........................................         16.5609         18.7653         17.6094         17.6731
160095..........................................         14.2649         15.1895         15.2722         14.9322
160097..........................................         15.2079         15.9263         16.6790         15.9380
160098..........................................         15.5385         16.3135         16.8670         16.2509
160099..........................................         13.7864         13.9053         15.0880         14.2533
160101..........................................         17.8654         18.3705         18.9788         18.3824
160102..........................................         18.3631         18.8765         20.1161         19.0875
160103..........................................         17.1519         17.0973         18.2741         17.4869
160104..........................................         19.7387         18.8301         17.4829         18.7797
160106..........................................         16.6624         16.9639         17.3474         16.9910
160107..........................................         16.5622         18.0634         18.0097         17.5762
160108..........................................         15.4183         16.0529         16.7779         16.0861
160109..........................................         16.4885         16.5593         17.9873         16.9740
160110..........................................         18.8056         19.1420         20.6215         19.5351
160111..........................................         13.1689         14.1644         14.9965         14.0808
160112..........................................         16.2829         16.8332         17.2450         16.7911
160113..........................................         14.5838         14.7097         15.4834         14.9308
160114..........................................         15.5812         16.1423         16.5006         16.0651
160115..........................................         15.7566         15.8995         16.5654         16.0764
160116..........................................         16.6927         16.9534         16.6993         16.7818
160117..........................................         17.2914         17.9410         18.7615         17.9848
160118..........................................         15.8351         17.2523         19.4472         17.5046
160120..........................................         12.5642         10.5992         15.6789         12.4454
160122..........................................         18.5214         18.9252         18.1469         18.5357
160124..........................................         17.1642         18.0908         19.1600         18.1198
160126..........................................         17.7397         17.8142         19.4903         18.3068
160129..........................................         15.8914         16.7131         17.2112         16.5953
160130..........................................         15.4477         16.0528         15.6666         15.7242
160131..........................................         14.6874         15.4898         16.0424         15.4292
160134..........................................         13.3246         13.4743         15.3012         14.0359
160135..........................................         16.3294         18.2682         18.7711         17.7744
160138..........................................         15.7076         16.8699         17.1491         16.5906
160140..........................................         18.7962         18.4007         18.5630         18.5823
160142..........................................         16.1372         16.2875         18.1467         16.8318
160143..........................................         15.9240         16.6154         17.4497         16.6799
160145..........................................         15.1745         13.9152         16.9092         15.2763
160146..........................................         16.3532         16.6024         17.7010         16.8728
160147..........................................         18.3917         17.4880         19.4041         18.3938
160151..........................................         15.7384         16.8257         17.2177         16.5833
160152..........................................         15.2179         15.6170         15.9500         15.5914
160153..........................................         19.6927         20.2316         21.2085         20.3741
170001..........................................         17.4383         17.9304         17.9218         17.7616
170004..........................................         13.0635         15.0636         16.1442         14.7434
170006..........................................         19.3075         17.2192         17.5982         17.9438
170008..........................................         13.9009         14.9124         16.8412         15.1327
170009..........................................         19.5867         20.7795         23.1349         21.2143
170010..........................................         17.8995         18.7384         19.4584         18.6890
170012..........................................         16.7886         17.8719         18.3965         17.6979
170013..........................................         17.8949         18.6454         19.4667         18.6963
170014..........................................         17.3379         17.9349         18.4616         17.9223
170015..........................................         15.8887         16.5750         17.1302         16.5216
170016..........................................         19.6393         19.2130         20.0675         19.6307
170017..........................................         17.8690         17.7958         19.5994         18.4143
170018..........................................         14.2759         15.2984         15.3237         14.9817

[[Page 22765]]

 
170019..........................................         16.6611         15.2094         16.9362         16.2597
170020..........................................         16.1460         17.3400         18.1325         17.2351
170022..........................................         17.9383         18.5309         19.1888         18.5543
170023..........................................         19.3585         19.1351         19.2441         19.2444
170024..........................................         13.0566         13.6803         14.3604         13.6835
170025..........................................         16.3716         17.8667         18.7182         17.6087
170026..........................................         13.3122         15.0470         14.8974         14.3412
170027..........................................         16.3859         17.3604         17.8690         17.2095
170030..........................................         15.2397         14.6530         15.9282         15.2488
170031..........................................         13.4670         13.9601         14.2151         13.8715
170032..........................................         14.4835         15.6093         16.3449         15.4817
170033..........................................         16.0529         16.4059         19.1952         17.1087
170034..........................................         14.6349         15.8202         16.9586         15.7633
170035..........................................         15.6240         18.5885         17.0945         17.0832
170036..........................................         14.1732               *               *         14.1732
170038..........................................         14.2092         14.7776         13.8582         14.2922
170039..........................................         14.2952         15.8635         17.0774         15.7642
170040..........................................         20.1419         21.6440         19.4713         20.4318
170041..........................................         11.4691         11.7566         12.4488         11.8690
170044..........................................         14.7801         15.3011         17.3254         15.8168
170045..........................................         12.1066         14.0875         24.6556         16.5680
170049..........................................         18.5821         19.9415         20.7921         19.8083
170051..........................................         14.1572         15.0889         16.4851         15.2703
170052..........................................         14.6176         15.0108         15.2283         14.9500
170053..........................................          9.0407         16.5102         14.6133         11.9759
170054..........................................         12.7655         14.4353         14.6354         13.9214
170055..........................................         14.9875         16.9800         18.2607         16.7698
170056..........................................         14.8656         17.0442         18.2840         16.8012
170057..........................................         15.0892         13.0007               *         13.9776
170058..........................................         18.3389         18.6983         19.5415         18.8159
170060..........................................         17.2271         17.3482         18.9853         17.7512
170061..........................................         14.1380         15.6527         15.0258         14.9459
170063..........................................         11.3284         12.8082         14.1185         12.6216
170064..........................................         12.4183               *               *         12.4183
170066..........................................         14.4790         15.5322         16.2891         15.4168
170067..........................................         12.7846         14.7492         14.9921         14.1535
170068..........................................         15.8175         15.1790         17.0022         15.9795
170070..........................................         12.8158         14.2445         14.0627         13.7083
170072..........................................         13.3379         12.6329         12.7709         12.9159
170073..........................................         16.4690         17.5368         17.7056         17.2186
170074..........................................         14.4009         17.5537         17.3699         16.4326
170075..........................................         11.2598         12.4212         13.6816         12.5950
170076..........................................         13.5820         14.5866         14.6109         14.2394
170077..........................................         12.7244         13.5235         13.9104         13.3651
170079..........................................         14.2859         13.5261         11.5902         13.1470
170080..........................................         12.2012         12.6014         14.8293         13.1562
170081..........................................         12.5122         13.8077         14.6823         13.7421
170082..........................................         12.3902         12.8563         13.7464         12.9855
170084..........................................         12.1611         12.5410         13.0519         12.5742
170085..........................................         14.5069         15.4518         17.5422         15.9150
170086..........................................         19.8496         20.4068         19.7182         19.9991
170088..........................................         11.7505         13.4542         13.4860         12.9031
170089..........................................         18.0823         18.8136         15.4860         17.4574
170090..........................................         11.2747         11.9147         10.9444         11.3947
170092..........................................         12.8507               *               *         12.8507
170093..........................................         12.7780         13.5490         14.0276         13.4193
170094..........................................         17.7091         20.1985         21.2035         19.6936
170095..........................................         15.7469         15.5463         15.3532         15.5482
170097..........................................         15.8504         16.4608         17.6255         16.6758
170098..........................................         14.1026         15.5259         16.6210         15.4425
170099..........................................         13.5509         13.6033         14.3370         13.8072
170100..........................................         14.4700               *               *         14.4700
170101..........................................         12.8847         14.5629         18.0143         14.7718

[[Page 22766]]

 
170102..........................................         13.2434         13.6321         14.2048         13.6933
170103..........................................         16.6578         17.2844         17.9530         17.2887
170104..........................................         19.7645         20.6182         20.9336         20.4421
170105..........................................         15.9290         16.5408         16.7403         16.4083
170106..........................................         14.6773         18.5479         17.7467         16.9030
170109..........................................         16.9421         17.2629         16.9782         17.0622
170110..........................................         15.5549         16.9823         18.5731         17.1658
170112..........................................         13.3908         14.3855         15.4049         14.4270
170113..........................................         13.3935         13.9038         14.6486         13.9920
170114..........................................         14.5116         14.4545         16.0283         14.9432
170115..........................................         12.6815         12.6997         12.9216         12.7709
170116..........................................         15.7566         16.8714         18.0591         16.9087
170117..........................................         15.2818         15.7875         16.8237         15.8968
170119..........................................         13.9673         15.1990         15.2708         14.7822
170120..........................................         16.2122         17.6748         17.4917         17.1241
170122..........................................         20.1266         20.0615         20.5347         20.2343
170123..........................................         21.4168         23.1697         23.5468         22.6616
170124..........................................         10.2089         11.1249         15.0596         11.8247
170126..........................................         12.1268         12.8096         13.5736         12.8129
170128..........................................         14.9919         14.8891         14.1676         14.6301
170131..........................................         13.0978         10.1000               *         11.3849
170133..........................................         17.1103         18.0243         15.7918         16.8958
170134..........................................         14.2252         14.1085         14.6799         14.3402
170137..........................................         17.4151         17.8290         19.3118         18.1884
170139..........................................         13.3896         14.1967         14.3001         13.9545
170142..........................................         17.3234               *         17.7134         17.5177
170143..........................................         15.8802         15.6509         16.0415         15.8575
170144..........................................         16.0860         19.0929         20.4392         18.4073
170145..........................................         16.7499         17.1837         19.0142         17.6442
170146..........................................         19.9725         20.9075         21.7919         20.9132
170147..........................................         16.2829         22.3017         17.8070         18.7377
170148..........................................         17.2497         16.9183         19.9697         17.9186
170150..........................................         15.4283         15.5651         15.9072         15.6422
170151..........................................         13.3674         13.8934         14.3668         13.8637
170152..........................................         13.6846         14.9139         15.6423         14.7323
170160..........................................         13.3087         13.7108         14.4732         13.8369
170164..........................................         15.5597         16.6542         17.4072         16.5279
170166..........................................         17.5681         27.5567         12.7507         18.3396
170171..........................................         13.8059         12.5200         13.1792         13.1761
170175..........................................         17.8802         19.0232         19.9694         18.9232
170176..........................................         20.3194         21.3400         23.0743         21.5773
170180..........................................               *         16.6921          8.6352         11.8552
170182..........................................         14.1971         22.2164         21.0546         19.7649
170183..........................................         19.0919         20.3505         19.5182         19.7036
170184..........................................         27.0152               *               *         27.0152
180001..........................................         19.5188         17.9906         20.4885         19.3882
180002..........................................         18.1348         17.9669         17.5798         17.8819
180004..........................................         15.9921         17.2581         17.7149         16.9654
180005..........................................         20.6280         21.1390         22.4634         21.3796
180006..........................................         11.2254         11.4398         10.3400         11.0123
180007..........................................         17.1997         17.6776         17.9491         17.6005
180009..........................................         20.8103         21.4730         21.0608         21.1163
180010..........................................         17.5452         19.1100         19.6311         18.7406
180011..........................................         16.9311         17.1050         19.0526         17.8588
180012..........................................         18.7350         18.7223         18.9481         18.8031
180013..........................................         17.4487         18.2354         19.6031         18.4802
180014..........................................         20.8033         21.4856         21.3242         21.1722
180016..........................................         18.8422         19.8892         21.1458         20.0187
180017..........................................         15.1699         15.4140         15.6583         15.4240
180018..........................................         18.9020         17.1692         15.4575         17.0460
180019..........................................         16.7648         17.3970         17.2177         17.1400
180020..........................................         17.7782         17.7288         18.0111         17.8397
180021..........................................         15.1627         15.4580         17.0618         15.8957

[[Page 22767]]

 
180023..........................................         15.2219         15.8803         17.4717         16.1885
180024..........................................         15.3299         16.1731         16.5040         15.9951
180025..........................................         17.1688         14.1841         15.4180         15.4826
180026..........................................         14.1571         14.6804         15.0118         14.6082
180027..........................................         14.8869         16.4116         17.5286         16.2087
180028..........................................         19.3519         19.5276         15.7005         18.0068
180029..........................................         18.0191         17.7729         17.7248         17.8352
180030..........................................         17.0234         17.3430         17.9543         17.4342
180031..........................................         13.7862         13.9844         13.1848         13.6178
180032..........................................         16.0941         16.8318         17.2784         16.7976
180033..........................................         13.7667         17.7344         15.4131         15.5472
180034..........................................         17.3158         15.3369         16.3991         16.3000
180035..........................................         19.4485         20.1305         21.3666         20.2870
180036..........................................         19.1922         19.8398         19.8830         19.6408
180037..........................................         18.8053         19.9737         21.2184         19.9797
180038..........................................         17.1643         17.7626         18.4077         17.7880
180040..........................................         19.4450         19.5337         20.6296         19.8636
180041..........................................         15.1703         15.0785         16.3699         15.5655
180042..........................................         16.2924         16.7691         17.1519         16.7450
180043..........................................         16.6077         16.8027         13.8503         15.6793
180044..........................................         17.8196         18.5571         19.4984         18.6534
180045..........................................         17.7272         17.7130         20.8455         18.9499
180046..........................................         17.9096         19.2523         21.2465         19.4702
180047..........................................         15.0354         16.2304         18.6938         16.6027
180048..........................................         19.5681         18.3442         17.7816         18.5208
180049..........................................         16.0799         16.4319         16.5459         16.3594
180050..........................................         18.4753         17.8540         17.1493         17.7884
180051..........................................         15.6796         16.3960         17.5441         16.5170
180053..........................................         14.6299         15.9284         15.8994         15.5002
180054..........................................         16.3875         19.4858         20.0946         18.5771
180055..........................................         14.6446         15.2663         15.8422         15.2446
180056..........................................         16.6240         17.0056         17.5728         17.0694
180058..........................................         14.3562         15.9685         14.5355         14.9226
180059..........................................         14.2605         13.3955         14.7032         14.1102
180060..........................................          7.2139               *               *          7.2139
180063..........................................         11.9120         13.1036         12.4448         12.4785
180064..........................................         14.4872         15.2424         15.5066         15.0871
180065..........................................         20.0286         12.0629         11.1934         13.8815
180066..........................................         18.5635         19.2981         19.7883         19.2237
180067..........................................         18.5288         20.6322         19.8756         19.6602
180069..........................................         17.2956         17.7911         16.2916         17.1149
180070..........................................         13.8370         13.1923         15.9362         14.2840
180072..........................................         17.8554         16.9021         17.2347         17.3229
180075..........................................         15.0701               *               *         15.0701
180078..........................................         19.1615         21.1170         21.7116         20.6787
180079..........................................         13.4072         15.1636         15.9048         14.8197
180080..........................................         15.8327         16.4989         16.6428         16.3363
180087..........................................         14.9660         14.9167         15.6089         15.1555
180088..........................................         22.5349         22.0374         22.4148         22.3261
180092..........................................         16.3099         18.2405         18.3597         17.6633
180093..........................................         16.8286         17.0132         17.9623         17.2606
180094..........................................         12.5074         13.5490         13.6233         13.2263
180095..........................................         13.3991         13.8021         13.9050         13.6989
180099..........................................         13.6988         13.3631         13.2991         13.4593
180101..........................................         19.5644         18.4883               *         18.9778
180102..........................................         17.8751         17.9618         18.5018         18.0941
180103..........................................         19.2182         19.8965         20.3774         19.8456
180104..........................................         18.8730         18.9281         19.4139         19.0718
180105..........................................         14.0811         15.2394         16.6997         15.2994
180106..........................................         13.6062         14.3505         15.2895         14.3903
180108..........................................         14.6222         14.8187         13.9862         14.4793
180115..........................................         17.1079         16.7003         16.9096         16.9026
180116..........................................         16.9389         18.0392         18.2848         17.7647

[[Page 22768]]

 
180117..........................................         18.3821         17.7857         23.0192         19.6584
180118..........................................         12.1533         15.8597         16.9250         14.8270
180120..........................................         17.8145         16.1591         15.3115         16.3371
180121..........................................         14.5134         15.0983         20.0494         16.3330
180122..........................................         16.9678         18.5094         18.1930         17.8754
180123..........................................         18.9995         21.0613         21.1067         20.4023
180124..........................................         18.4064         17.4994         18.7682         18.2003
180125..........................................         19.7341         19.6416         14.9314         17.5744
180126..........................................         12.3959         12.9228         14.3551         13.2733
180127..........................................         17.3452         19.2581         17.5540         18.0362
180128..........................................         17.0508         17.6385         18.2817         17.6802
180129..........................................         17.8600         16.8378         22.3536         18.8696
180130..........................................         19.0110         19.8192         20.6684         19.8450
180132..........................................         17.2657         17.7744         19.1884         18.0615
180133..........................................         22.2325         21.6794         21.7800         21.8995
180134..........................................         13.6287         13.1935         12.5041         13.1008
180136..........................................         17.7146         17.3542               *         17.5359
180138..........................................         18.6149         19.3692         19.9343         19.3216
180139..........................................         18.7679         18.7198         18.0041         18.4600
180140..........................................         20.3953         16.8152         15.2719         17.3915
180141..........................................         20.0075         20.9820         23.8930         21.4590
180142..........................................               *               *         20.7510         20.7510
190001..........................................         17.0159         17.6832         18.1514         17.6263
190002..........................................         18.8381         19.1924         19.8834         19.2931
190003..........................................         22.1543         19.7749         19.9121         20.4811
190004..........................................         17.5385         17.7710         18.3620         17.8959
190005..........................................         16.7149         17.2422         17.3078         17.0856
190006..........................................         17.7335         17.8036         17.5911         17.7112
190007..........................................         13.6014         13.8189         14.4720         13.9833
190008..........................................         16.8916         18.6664         19.2456         18.2327
190009..........................................         14.2085         15.3555         15.9731         15.1819
190010..........................................         17.0192         16.2805         16.5020         16.6088
190011..........................................         15.1715         15.9534         15.6351         15.5881
190013..........................................         16.5706         16.8181         15.5019         16.2739
190014..........................................         17.0170         17.0959         17.7761         17.3018
190015..........................................         18.1943         18.6266         18.9896         18.6153
190017..........................................         15.7894         16.2393         17.5381         16.5250
190018..........................................         16.9761         15.0668         11.1898         14.5841
190019..........................................         17.4006         18.5257         18.3788         18.1281
190020..........................................         17.3084         17.5256         17.6840         17.5059
190025..........................................         16.0738         18.6369         15.8910         16.9047
190026..........................................         17.2166         18.1622         18.5015         17.9532
190027..........................................         16.1856         17.0827         17.4761         16.9034
190029..........................................         17.1103         16.5239         19.1967         17.5497
190033..........................................         10.7448               *               *         10.7448
190034..........................................         16.5066         16.8503         18.0754         17.1513
190036..........................................         19.9456         20.1780         19.1695         19.7802
190037..........................................         12.0237         17.6945         19.9878         16.0686
190039..........................................         17.1687         19.4713         19.0376         18.5119
190040..........................................         20.3180         21.4634         21.7075         21.1804
190041..........................................         17.8975         17.6646         18.0991         17.8870
190043..........................................         12.5660         15.5580         15.5618         14.5094
190044..........................................         17.1984         17.2892         17.4471         17.3108
190045..........................................         21.6948         21.6107         21.2853         21.5139
190046..........................................         19.3538         19.7964         20.4273         19.8671
190048..........................................         16.3404         16.6683         16.8136         16.6153
190049..........................................         16.4250         17.2280         17.7417         17.1570
190050..........................................         15.3771         16.1980         16.2854         15.9545
190053..........................................         12.4980         13.2159         13.0080         12.9160
190054..........................................         16.4683         19.1738         18.9059         18.1924
190059..........................................         15.8443         15.6942         15.8373         15.7915
190060..........................................         18.3689         14.7186         17.5317         16.6606
190064..........................................         19.9047         20.4482         18.2466         19.4909

[[Page 22769]]

 
190065..........................................         19.3856         20.9927         18.4695         19.5739
190071..........................................         13.5908         14.4827         16.4138         14.8320
190077..........................................         12.8290         15.7805         16.5536         15.0793
190078..........................................         13.4990         14.8826         16.9383         14.8793
190079..........................................         17.2909         17.7120         17.9403         17.6368
190081..........................................         12.0190         15.3198         14.9707         14.2301
190083..........................................         16.1374         18.8895         18.4951         17.8399
190086..........................................         14.9295         15.8694         16.5074         15.7738
190088..........................................         19.6328         20.5531         19.9362         20.0391
190089..........................................         12.7879         13.0503         15.0395         13.5823
190090..........................................         16.5580         16.6664               *         16.6122
190092..........................................         18.0655               *               *         18.0655
190095..........................................         15.7316         16.2287         17.3258         16.3915
190098..........................................         19.2175         20.4897         21.0847         20.2301
190099..........................................         18.9255         19.9018               *         19.4679
190102..........................................         19.0477         20.0300         20.5106         19.8707
190103..........................................         15.5698         12.1389         14.4158         13.8580
190106..........................................         17.7468         18.5813               *         18.1836
190109..........................................         14.5288         15.5767         15.8187         15.3068
190110..........................................         12.9925         15.8052         15.7313         14.8387
190111..........................................         20.0376         19.7514         20.6508         20.1574
190112..........................................         19.2067         21.0232         22.0741         20.6951
190113..........................................         18.9922         12.5777               *         15.7380
190114..........................................         12.9083         12.6366         13.9209         13.1568
190115..........................................         20.4914         20.2473         22.3441         21.0026
190116..........................................         12.5881         15.5481         17.3757         15.1678
190118..........................................         12.9537         14.7876         16.3776         14.7222
190120..........................................         13.6938         13.9591         17.2309         14.9846
190122..........................................         14.8255         15.4793         15.3742         15.2287
190124..........................................         22.3825         20.6222         20.1206         20.9375
190125..........................................         18.6287         20.4517         19.8298         19.6458
190128..........................................         19.7127         20.4688         20.8770         20.3583
190130..........................................         12.4307         15.1467         14.0379         13.8956
190131..........................................         19.5984         20.7565         18.8958         19.7536
190133..........................................         13.4750         13.5383         15.1393         13.9917
190134..........................................         12.6774         12.1749         12.4507         12.4351
190135..........................................         21.3511         21.6875         21.1206         21.3903
190136..........................................         11.3250         12.4091         15.1662         13.0730
190138..........................................         22.7088               *               *         22.7088
190140..........................................         12.0285         14.2256         14.6829         13.6611
190142..........................................         14.9820         15.4861         16.2280         15.5517
190144..........................................         16.8360         16.2068         18.4405         17.1561
190145..........................................         13.9893         15.2345         16.2505         15.1638
190146..........................................         20.0941         21.2825         22.0000         21.1693
190147..........................................         14.3219         14.4345         14.7202         14.4910
190148..........................................         14.0180         16.6337         15.5338         15.4604
190149..........................................         15.1862         17.5997         16.4722         16.4169
190151..........................................         11.9190         14.7333         15.5210         14.0028
190152..........................................         20.3951         22.2070         22.0319         21.4716
190155..........................................         11.0800               *               *         11.0800
190156..........................................         12.4786         15.7478         16.0442         14.6766
190158..........................................         19.6164         20.4637         20.4078         20.1474
190160..........................................         18.4746         17.1003         18.4662         18.0078
190161..........................................         14.6295         15.5737         15.9280         15.3544
190162..........................................         19.5027         20.6143         20.1962         20.0440
190164..........................................         16.3328         15.1783         18.2379         16.4778
190167..........................................         16.2880         16.6681         17.7611         16.9143
190170..........................................         13.5772         14.1750         14.5222         14.0895
190173..........................................         19.6362         23.6398         22.5148         21.9224
190175..........................................         20.6908         19.3625         20.1330         20.0312
190176..........................................         18.8205         24.0574         22.0869         21.4121
190177..........................................         20.3177         18.6715         19.7794         19.5846
190178..........................................         10.4941         11.0657         12.0372         11.1714

[[Page 22770]]

 
190182..........................................         20.0267         20.2855         20.7102         20.3281
190183..........................................         16.1064         16.7671         16.0752         16.3134
190184..........................................         14.8645         17.2044         19.8436         17.2547
190185..........................................         19.3707         20.1444         20.3479         19.9607
190186..........................................         16.3586         18.7568         17.4078         17.5306
190189..........................................         26.5419               *               *         26.5419
190190..........................................         18.6656         17.4642         15.8985         17.1134
190191..........................................         18.1353         20.4975         19.6911         19.4475
190196..........................................         14.8699         17.9225         18.6138         17.2784
190197..........................................         17.9166         19.5569         20.2082         19.2721
190199..........................................         13.4222         16.0637         15.3522         14.6078
190200..........................................         19.4148         22.0391         21.6852         21.0397
190201..........................................         19.1432         18.7079         19.7539         19.2099
190202..........................................         17.8959               *               *         17.8959
190203..........................................         21.3096         21.7350         21.7931         21.5975
190204..........................................         21.2119         21.4624         20.7215         21.1251
190205..........................................         18.1007         19.6587         19.3737         19.0483
190206..........................................         20.0648         21.7012         21.3307         21.0222
190207..........................................         17.6712         20.5082         19.0961         19.1272
190208..........................................         14.6096         20.0065         16.9641         17.1855
190218..........................................         18.1627         19.7518         19.2992         19.0335
190223..........................................         19.2550               *               *         19.2550
190227..........................................         12.1086               *               *         12.1086
190231..........................................         16.8850         15.8287         17.7247         16.7665
190235..........................................         18.2702               *               *         18.2702
190236..........................................         22.1837         19.3395         21.1982         20.9440
190238..........................................               *               *         20.6799         20.6799
190239..........................................               *               *         19.7601         19.7601
190240..........................................               *               *         14.3579         14.3579
200001..........................................         17.4890         18.0527         18.1207         17.8991
200002..........................................         18.7745         19.3629         22.9761         20.4367
200003..........................................         16.7389         16.9566         18.1540         17.2860
200006..........................................         19.7984         17.6586         21.0922         19.4856
200007..........................................         17.8859         18.7992         18.0655         18.2525
200008..........................................         20.5020         21.7489         21.2206         21.1621
200009..........................................         20.6433         22.2280         21.3591         21.4199
200012..........................................         17.0130         18.3484         20.0235         18.4600
200013..........................................         16.4933         18.0566         18.2737         17.6653
200015..........................................         20.1117               *               *         20.1117
200016..........................................         17.6623         18.0866         17.4335         17.7276
200017..........................................         19.6462         17.2930               *         18.7598
200018..........................................         17.2422         18.5397         18.2644         17.9737
200019..........................................         18.6399         19.2348         20.1070         19.3592
200020..........................................         20.5967         22.4526         22.5506         21.8845
200021..........................................         19.4052         19.9133         20.7565         20.0011
200023..........................................         14.9164         16.1707         18.8427         16.3595
200024..........................................         18.6518         19.4329         21.0233         19.7086
200025..........................................         19.0659         20.2259         20.4823         19.9499
200026..........................................         17.2842         18.1194         17.8759         17.7682
200027..........................................         18.2775         18.5659         19.6658         18.8842
200028..........................................         16.9306         19.5708         19.9218         18.7752
200031..........................................         15.9043         16.2217         16.3382         16.1598
200032..........................................         17.9160         18.9315         19.6907         18.8137
200033..........................................         21.4031         21.8634         22.0783         21.7858
200034..........................................         19.2407         20.1519         20.4939         19.9679
200037..........................................         18.2419         18.6713         19.2304         18.7348
200038..........................................         19.2147         23.3851         21.9205         21.5084
200039..........................................         20.2901         19.8589         20.2311         20.1007
200040..........................................         19.2970         19.5503         19.0188         19.2835
200041..........................................         17.6559         19.3563         18.4593         18.4719
200043..........................................         16.5368         16.7224         18.3804         17.1882
200050..........................................         18.0805         20.1214         13.1684         16.5253
200051..........................................         19.5925         22.1525         22.0712         21.5149

[[Page 22771]]

 
200052..........................................         15.1216         17.2099         17.8551         16.7641
200055..........................................         17.1729         18.8422         18.6877         18.2119
200062..........................................         16.5139         17.2273         18.2221         17.3074
200063..........................................         19.6658         19.9331         25.6527         21.3771
200066..........................................         16.3431         17.0289         17.1538         16.8395
210001..........................................         18.7266         20.4841         18.6617         19.2372
210002..........................................         22.8448         19.9219         20.4315         21.0189
210003..........................................         25.3730         20.3446         26.0447         23.6583
210004..........................................         23.5884         24.2909         24.9760         24.2880
210005..........................................         19.6162         21.4929         21.3829         20.7876
210006..........................................         17.7721         18.9436         19.3682         18.7016
210007..........................................         21.5415         23.1007         23.8840         22.8043
210008..........................................         19.5006         21.1768         21.2895         20.6531
210009..........................................         21.8111         20.5447         20.7479         21.0282
210010..........................................         14.3783         18.7197         19.5908         17.3758
210011..........................................         21.2422         21.4862         21.4043         21.3727
210012..........................................         23.4317         20.7203         21.3977         21.7764
210013..........................................         18.8455         19.7288         19.4505         19.3405
210015..........................................         16.6898         16.1912         18.6087         17.1516
210016..........................................         22.1469         23.8739         26.5193         24.0991
210017..........................................         17.1747         18.8928         18.5079         18.1448
210018..........................................         21.4055         22.2135         22.8553         22.1574
210019..........................................         19.0899         19.3046         20.6025         19.6453
210022..........................................         21.8160         22.6389         24.3016         22.9230
210023..........................................         21.7988         23.1950         22.9989         22.6719
210024..........................................         19.5645         20.6011         21.1669         20.3654
210025..........................................         19.5704         19.5876         21.2769         20.0208
210026..........................................         11.6440         12.1348         13.3494         12.4124
210027..........................................         18.4862         17.6855         17.1060         17.7943
210028..........................................         18.8623         19.6408         19.4157         19.3091
210029..........................................         22.3876         21.2167         22.7191         22.0801
210030..........................................         21.0169         21.7403         20.9574         21.2261
210031..........................................         15.5873         16.2299               *         15.9014
210032..........................................         18.4983         17.7228         20.1955         18.7972
210033..........................................         19.9144         20.8053         23.7588         21.3886
210034..........................................         16.1216         15.7322         25.0849         18.5047
210035..........................................         20.6092         20.2731         20.8317         20.5720
210037..........................................         18.7361         18.3072         20.5528         19.2053
210038..........................................         23.2616         23.4971         24.9762         23.8679
210039..........................................         20.7291         19.9901         21.3559         20.7067
210040..........................................         25.0770         21.5014         23.4252         23.3184
210043..........................................         18.5891         19.6474         22.4000         20.0973
210044..........................................         22.2438         22.5781         23.0917         22.6329
210045..........................................          9.6862         11.6086         12.1467         11.1781
210048..........................................         22.3923         23.0537         24.6921         23.3434
210049..........................................         17.6697         19.0821         19.3022         18.6991
210051..........................................         20.7633         22.4335         23.6476         22.3235
210054..........................................         23.5122         22.3559         23.2730         23.0396
210055..........................................         20.1012         29.2539         26.5272         25.0062
210056..........................................         20.9445         19.2662         22.9654         21.0453
210057..........................................         22.5717         23.8289         26.0076         24.0668
210058..........................................         21.4976         22.0753         16.3191         20.0884
210059..........................................         23.1274         22.6766         25.6052         23.5899
210060..........................................               *               *         26.5846         26.5846
210061..........................................         20.0203         17.2240         16.1931         17.8181
220001..........................................         26.3207         21.9369         22.9064         22.9526
220002..........................................         22.5808         24.1285         24.7920         23.8005
220003..........................................         19.1383         16.9246         17.9319         17.9948
220004..........................................         20.0058               *               *         20.0058
220006..........................................         22.1228         22.3085         22.6469         22.3611
220008..........................................         21.8873         24.4691         22.0796         22.7689
220010..........................................         21.9226         21.8582         22.0067         21.9297
220011..........................................         28.5673         26.1827         29.5290         28.2047

[[Page 22772]]

 
220012..........................................         29.5051         32.0829         31.2303         30.9286
220015..........................................         21.7813         22.5773         23.1893         22.4843
220016..........................................         23.1440         23.3750         23.0951         23.2050
220017..........................................         25.2630         22.4605         24.9576         24.2129
220019..........................................         19.1264         19.5613         19.8551         19.5190
220020..........................................         19.9925         21.4152         22.2245         21.2040
220021..........................................         23.6313               *               *         23.6313
220023..........................................         18.7625         16.1885               *         18.0910
220024..........................................         21.5871         21.5363         21.9316         21.6947
220025..........................................         19.9398         20.7882         22.8593         21.1235
220028..........................................         22.0721         22.8036         21.0630         21.9530
220029..........................................         21.8711         23.1509         25.6560         23.4858
220030..........................................         14.5383         18.5441         18.7429         17.2580
220031..........................................         28.1584         30.2430         29.3091         29.1415
220033..........................................         20.4120         20.0695         20.2601         20.2365
220035..........................................         21.9974         21.6396         23.1892         22.2365
220036..........................................         24.1570         24.6470         24.4091         24.3977
220038..........................................         22.3494         22.6518         22.3162         22.4382
220041..........................................         23.1483         23.4720         27.5034         24.5999
220042..........................................         25.2852         25.0779         26.0473         25.4181
220046..........................................         22.4677         22.7068         23.3149         22.8459
220049..........................................         23.0283         26.0025         26.3191         25.1679
220050..........................................         20.8345         22.0144         22.5265         21.7871
220051..........................................         20.4765         21.1033         21.7357         21.0973
220052..........................................         23.1376         23.7650         23.5225         23.4708
220053..........................................         21.2679         19.1280               *         20.2813
220055..........................................         21.5706         21.3743               *         21.4727
220057..........................................         23.0010         25.3902         25.8064         24.6606
220058..........................................         20.1888         19.9369         26.8345         22.1915
220060..........................................         26.1753         28.0843         28.0794         27.4392
220062..........................................         20.0560         20.4685         20.2254         20.2505
220063..........................................         20.9547         20.3951         20.8079         20.7132
220064..........................................         22.1785         22.3260         22.7497         22.4060
220065..........................................         20.1974         20.1364         20.1424         20.1584
220066..........................................         20.4586         20.7826         21.7186         21.0071
220067..........................................         25.7414         26.4443         27.5405         26.5452
220068..........................................          6.4548               *               *          6.4548
220070..........................................         19.7678         19.7528         19.0333         19.5401
220071..........................................         24.6508         25.6184         26.8257         25.6808
220073..........................................         25.8680         25.6025         26.1328         25.8683
220074..........................................         24.0523         25.6390         24.8429         25.0647
220075..........................................         21.5418         22.8057         22.5329         22.2794
220076..........................................         24.7783         22.6668         23.2795         23.6106
220077..........................................         24.8019         25.2646         25.5336         25.1941
220079..........................................         21.0090         22.6256         17.9964         20.4339
220080..........................................         20.5007         21.5238         22.1971         21.3825
220081..........................................         25.3370         29.1726         29.6682         28.0686
220082..........................................         20.0175         21.6726         22.1453         21.2140
220083..........................................         23.0759         23.9156         22.5815         23.1732
220084..........................................         24.6624         23.6641         21.3072         23.1862
220086..........................................         30.4649         23.8705         27.6595         26.7829
220088..........................................         23.3783         22.9067         23.4258         23.2384
220089..........................................         21.7884         23.0965         25.4106         23.3099
220090..........................................         21.6353         22.0041         23.2456         22.2523
220092..........................................         17.0409         18.5239         24.2591         19.3548
220094..........................................         21.9853               *               *         21.9853
220095..........................................         21.4468         21.4831         21.7851         21.5735
220098..........................................         20.8596         21.5906         23.1547         21.8533
220100..........................................         25.3484         25.7077         27.5841         26.2007
220101..........................................         24.3260         25.9204         27.0711         25.7662
220104..........................................         27.5297         28.0021         28.7258         28.0695
220105..........................................         21.6873         21.4129         21.9185         21.6684
220106..........................................         24.5518         25.6577         25.9277         25.3659

[[Page 22773]]

 
220107..........................................         20.2719               *               *         20.2719
220108..........................................         22.6372         21.9115         23.4975         22.6709
220110..........................................         29.1927         28.7071         28.8697         28.9201
220111..........................................         23.0475         23.8066         24.7510         23.8707
220116..........................................         24.9744         26.1662         32.0049         27.4579
220118..........................................         30.5213               *               *         30.5213
220119..........................................         22.8586         23.3216         23.8785         23.3181
220123..........................................         27.3063         25.8994         32.4678         28.6276
220126..........................................         20.9557         22.5218         22.9620         22.1062
220128..........................................         20.5636               *               *         20.5636
220133..........................................         35.2747         25.4596         29.3911         30.0324
220135..........................................         25.0798         25.6522         26.6636         25.7967
220153..........................................         23.8981         22.9592               *         23.4152
220154..........................................         22.1261         22.4770         21.1563         22.0118
220163..........................................         27.3527         29.1143         29.6933         28.6971
220171..........................................         23.4340         24.5553         25.2585         24.4462
230001..........................................         19.2015         19.8020         20.0438         19.6841
230002..........................................         21.9058         22.7991         23.3790         22.7047
230003..........................................         19.6118         19.8420         21.2215         20.2501
230004..........................................         22.0310         23.1036         20.5005         21.8004
230005..........................................         19.4040         18.5644         17.0943         18.3438
230006..........................................         18.4681         19.1041         20.4978         19.3271
230007..........................................         19.4339         15.5538               *         18.1334
230012..........................................         18.6663         15.0803               *         16.5807
230013..........................................         20.6322         20.8018         22.2211         21.1847
230015..........................................         20.4264         20.1104         20.6464         20.3967
230017..........................................         20.3975         22.2822         22.4824         21.6902
230019..........................................         21.3222         22.2622         22.1491         21.9247
230020..........................................         21.3206         22.1280         22.1198         21.8771
230021..........................................         18.5670         18.9636         19.8256         19.1973
230022..........................................         19.7598         18.8006         21.9129         20.1618
230024..........................................         27.9551         23.7326         24.9664         25.4314
230027..........................................         18.0285         14.6950         19.6393         17.2624
230029..........................................         21.0636         19.4911         22.1092         20.9014
230030..........................................         17.7040         18.3916         18.6230         18.2489
230031..........................................         17.5352         19.3162         19.9465         18.8845
230032..........................................         20.6821         21.8845         24.8930         22.4347
230034..........................................         17.2302         19.0473         19.4366         18.6363
230035..........................................         17.5607         17.5109         17.7490         17.6051
230036..........................................         21.7565         23.2119         23.8398         22.9390
230037..........................................         19.0688         20.4747         23.2751         20.8659
230038..........................................         23.3876         23.5251         21.9692         22.9521
230040..........................................         20.3897         21.4393         20.7841         20.8605
230041..........................................         19.0278         20.3131         21.7364         20.3273
230042..........................................         19.4937         22.1043         21.0266         20.8816
230046..........................................         25.9482         25.5696         25.3206         25.6107
230047..........................................         20.6379         21.5381         22.4279         21.5449
230053..........................................         22.1781         25.4968         25.5139         24.3278
230054..........................................         19.5427         20.6963         20.8014         20.3482
230055..........................................         19.8381         20.7932         20.8908         20.4862
230056..........................................         16.4101         16.0766         18.9203         17.0117
230058..........................................         18.2349         20.4165         21.0303         19.9623
230059..........................................         19.5098         19.9240         20.7092         20.0517
230060..........................................         17.8716         19.8021         19.4211         19.0237
230062..........................................         16.2952         17.1540         18.8039         17.3634
230063..........................................         20.2211         20.4171               *         20.3143
230065..........................................         21.1507         22.3459         22.3216         22.0094
230066..........................................         21.5116         22.1768         23.0475         22.2618
230069..........................................         21.7909         23.2076         24.1210         23.0181
230070..........................................         20.0645         20.2505         21.5666         20.8098
230071..........................................         22.1556         22.9052         23.1337         22.7304
230072..........................................         20.4308         20.6944         20.4456         20.5245
230075..........................................         19.4316         20.0545         22.5866         20.6203

[[Page 22774]]

 
230076..........................................         23.8201         24.4547         24.7010         24.2886
230077..........................................         20.3937         21.0178         19.7982         20.3917
230078..........................................         16.2486         17.5577         17.9868         17.2435
230080..........................................         18.9084         19.7687         20.2104         19.6745
230081..........................................         17.9510         19.0345         19.0199         18.6644
230082..........................................         17.7417         18.2992         19.0419         18.3501
230085..........................................         17.5447         20.2096         23.4996         20.3924
230086..........................................         16.9754         18.9420         20.1857         18.6805
230087..........................................         15.7694         18.9034         19.9700         18.0112
230089..........................................         21.3914         23.9100         22.6994         22.6194
230092..........................................         18.9567         20.0145         20.8313         19.9501
230093..........................................         20.1928         20.4655         20.6425         20.4363
230095..........................................         16.7830         17.3313         17.6444         17.2565
230096..........................................         22.5613         22.8410         22.7785         22.7256
230097..........................................         20.0960         21.2854         21.1254         20.8481
230099..........................................         20.2529         21.1933         21.7513         21.0709
230100..........................................         13.1107         17.1336         17.3842         16.0282
230101..........................................         18.6098         20.0932         20.5315         19.7445
230103..........................................         19.6014         22.7696         11.3429         17.7532
230104..........................................         23.4703         23.1457         24.1238         23.5809
230105..........................................         20.8765         21.5210         22.6098         21.6727
230106..........................................         18.3508         20.7997         21.6825         20.2936
230107..........................................         14.6673         16.5966         17.1386         15.9949
230108..........................................         17.4231         18.8631         20.3437         18.8600
230110..........................................         17.8017         18.9825         19.7262         18.8384
230113..........................................         11.1676         14.9411               *         12.8926
230115..........................................         16.4728         18.4050         19.2636         18.0559
230116..........................................         16.3563         16.5419         14.5692         15.7763
230117..........................................         23.9389         25.9318         25.6797         25.1927
230118..........................................         21.7089         21.3028         20.6797         21.2068
230119..........................................         23.9568         21.1918         22.5415         22.5507
230120..........................................         19.6400         18.5264         20.3306         19.4421
230121..........................................         20.0786         20.3158         21.3342         20.5789
230122..........................................         18.0903         20.9078               *         19.5648
230124..........................................         18.8938         20.3608         18.6352         19.2618
230125..........................................         15.3497               *               *         15.3497
230128..........................................         23.5787         24.9081         24.0724         24.1436
230130..........................................         22.5204         23.5170         22.1775         22.7280
230132..........................................         26.1727         26.6386         26.2269         26.3491
230133..........................................         17.5688         17.6894         17.1058         17.4473
230134..........................................         15.3248               *               *         15.3248
230135..........................................         22.7401         22.5258         20.5637         22.0738
230137..........................................         18.3431         19.1813               *         18.7522
230141..........................................         23.0496         22.1299         22.4570         22.5592
230142..........................................         20.1242         22.2940         23.3483         21.7608
230143..........................................         16.4468         16.3043         16.7948         16.5112
230144..........................................         20.9906         22.1108         23.3502         22.1007
230145..........................................         16.5986         20.2542         19.2638         18.8354
230146..........................................         18.6293         20.5044         21.1818         20.1337
230147..........................................         20.5144         21.8496         23.2755         21.8616
230149..........................................         14.1740         20.7691         18.8005         17.7545
230151..........................................         20.8884         22.1713         23.1152         21.9998
230153..........................................         17.3280         19.5633         18.7403         18.5291
230154..........................................         14.5846         15.4456         15.4362         15.1635
230155..........................................         16.9857         17.2076         20.5409         18.1875
230156..........................................         23.6126         24.7587         25.5835         24.6629
230157..........................................         19.7197         20.3667         17.3571         19.2380
230159..........................................         18.8426         20.0749               *         19.3914
230162..........................................         17.7689         21.4636         21.7148         20.3064
230165..........................................         23.3147         23.0106         23.2019         23.1727
230167..........................................         20.3210         21.5048         22.1550         21.3066
230169..........................................         22.8606         23.0652         24.3780         23.4313
230171..........................................         14.9595         13.3863         17.1282         15.0778

[[Page 22775]]

 
230172..........................................         20.2191         20.6417         21.4675         20.7898
230174..........................................         20.8542         23.0272         22.7304         22.1820
230175..........................................         21.8097         16.8909               *         19.0428
230176..........................................         21.8618         22.7772         23.8883         22.8410
230178..........................................         16.0818         16.9156         17.3030         16.7485
230180..........................................         15.4837         15.8769         18.5744         16.6297
230184..........................................         17.2928         19.0604         19.7717         18.6605
230186..........................................               *         19.5337         16.4977         18.0186
230188..........................................         15.5563         15.7112         16.2975         15.8821
230189..........................................         15.9089         16.6838         17.9218         16.8493
230190..........................................         23.7134         26.8196         26.4687         25.7543
230191..........................................         17.1221         19.0013         18.4861         18.1647
230193..........................................         20.1805         19.7066         19.2961         19.7939
230195..........................................         22.3745         21.7775         22.5842         22.2594
230197..........................................         21.6184         24.0184         23.3951         22.9141
230199..........................................         18.4012         19.4451         20.6580         19.5586
230201..........................................         15.3206         17.2141         18.0787         16.9556
230204..........................................         22.9506         25.4181         23.4966         23.9387
230205..........................................         13.8861         14.3788         15.9314         14.6555
230207..........................................         20.3538         20.6375         21.2483         20.7256
230208..........................................         17.1501         16.0733         15.8925         16.3949
230211..........................................         17.5087         18.6744         21.8581         19.0214
230212..........................................         22.1370         23.3021         24.2611         23.2193
230213..........................................         15.3159         15.1908         15.5469         15.3407
230216..........................................         19.5921         20.3359         21.0710         20.3422
230217..........................................         20.9510         21.2707         22.2698         21.4978
230219..........................................         20.7018         19.1549         20.0442         19.9745
230221..........................................         21.5000               *               *         21.5000
230222..........................................         20.8430         22.1785         22.0823         21.7090
230223..........................................         21.4990         21.1528         22.2627         21.6325
230227..........................................         21.3801         23.7259         22.7599         22.5824
230230..........................................         22.5346         22.2385         22.3092         22.3585
230232..........................................         12.6373               *               *         12.6373
230235..........................................         15.9466         16.8684         17.7197         16.8275
230236..........................................         23.2178         24.3835         25.9676         24.5556
230239..........................................         19.2349         18.0942         17.8168         18.3625
230241..........................................         18.8451         19.1000         20.0497         19.3344
230244..........................................         21.0758         21.7413         22.2697         21.6892
230253..........................................         21.9497         20.5945         21.0433         21.1989
230254..........................................         21.2786         21.9402         22.6335         21.9383
230257..........................................         20.4721         19.6982         21.3695         20.4944
230259..........................................         21.1519         22.2393         22.3969         21.9147
230264..........................................         15.1818         17.1319         17.4864         16.5360
230269..........................................         22.8138         23.3105         24.0992         23.4229
230270..........................................         20.0803         22.6187         21.5711         21.3628
230273..........................................         23.4000         22.9199         22.8715         23.0744
230275..........................................         17.5975         17.7487         20.8985         18.2554
230276..........................................         18.5750         21.3722         25.8709         21.5415
230277..........................................         22.5012         23.1456         23.9771         23.2364
230278..........................................         16.6645         18.2110               *         17.3814
230279..........................................         16.0437         17.6973         17.8074         17.2147
230280..........................................         14.2249         15.6654         18.3497         15.8025
230283..........................................               *         27.9480         22.5082         24.9202
240001..........................................         22.8480         24.6207         25.6936         24.3586
240002..........................................         23.0240         22.7981         23.2225         23.0151
240004..........................................         23.9195         25.1908         23.8151         24.2981
240005..........................................         16.9775         17.9563         20.3193         18.3770
240006..........................................         27.1133         25.1602         23.0715         24.9568
240007..........................................         16.9802         17.7625         19.0850         17.9138
240008..........................................         21.8068         20.2158         23.3783         21.6628
240009..........................................         16.6910         16.8965         17.1187         16.9211
240010..........................................         23.6323         23.6477         25.4752         24.2587
240011..........................................         18.9559         20.5192         21.5875         20.3298

[[Page 22776]]

 
240013..........................................         18.9705         20.3282         21.7544         20.2656
240014..........................................         21.8560         23.0025         24.3446         23.0734
240016..........................................         19.8624         20.4017         22.2011         20.8274
240017..........................................         17.2325         18.3585         18.9272         18.1627
240018..........................................         19.0671         20.8501         18.4268         19.4219
240019..........................................         20.9869         22.1501         23.1477         22.1062
240020..........................................         19.5727         21.1937         20.8849         20.5389
240021..........................................         17.3968         18.7515         20.1457         18.6569
240022..........................................         19.1554         21.7889         21.3234         20.7594
240023..........................................         20.3923         21.5087         22.8224         21.4999
240025..........................................         17.2464         18.8345         20.0308         18.7384
240027..........................................         16.2531         19.1017         16.7758         17.3367
240028..........................................         19.3781         19.7918         25.1934         21.5071
240029..........................................         17.9880         21.1329         20.0164         19.6781
240030..........................................         18.4358         18.8547         20.1653         19.1669
240031..........................................         18.0652         18.1566         19.3983         18.5009
240036..........................................         20.3270         22.2460         22.1721         21.6421
240037..........................................         18.4564         19.2345         20.1195         19.3188
240038..........................................         26.3539         25.3061         24.3957         25.3169
240040..........................................         19.9022         20.4813         23.1352         21.0482
240041..........................................         19.2127         19.2864         21.8655         20.0389
240043..........................................         17.3064         17.7335         16.9859         17.3013
240044..........................................         18.9217         18.8411         20.3339         19.3394
240045..........................................         20.9873         21.1396         24.1557         22.0716
240047..........................................         21.8576         22.6152         23.8098         22.7467
240048..........................................         23.3110               *               *         23.3110
240049..........................................         22.1345               *               *         22.1345
240050..........................................         24.5027         25.2983         21.6499         22.6550
240051..........................................         18.2287         19.9195         22.5855         20.1307
240052..........................................         19.2190         20.7749               *         19.9948
240053..........................................         21.1987         22.9611         23.8858         22.7864
240056..........................................         22.2927         23.4226         23.7139         23.1375
240057..........................................         23.2377         24.2159         24.3404         23.9501
240058..........................................         14.9141         14.9697         18.1695         15.9021
240059..........................................         21.9575         23.6215         23.7808         23.1092
240061..........................................         25.5581         27.2603         25.9951         26.2655
240063..........................................         23.5426         23.7866         24.4031         23.9101
240064..........................................         20.7602         23.2860         22.6742         22.2043
240065..........................................         12.5547         12.7867         14.8734         13.4307
240066..........................................         22.0542         23.0698         24.1143         23.1023
240069..........................................         19.1834         19.8282         21.7991         20.2573
240071..........................................         19.1913         20.2101         21.1721         20.2070
240072..........................................         18.0015         21.1824         20.9529         20.0007
240073..........................................         15.6318         16.0840         17.3559         16.3592
240075..........................................         21.1934         21.2654         21.4157         21.2934
240076..........................................         21.0702         21.8795         22.3280         21.7859
240077..........................................         14.9493         15.3794         20.3445         16.8827
240078..........................................         22.7122         23.9150         25.1082         23.9382
240079..........................................         17.8206         18.4338         18.8345         18.3648
240080..........................................         23.7286         24.3399         25.5619         24.7160
240082..........................................         18.0272         18.3555         18.7995         18.3952
240083..........................................         19.2922         19.7637         21.0317         20.0094
240084..........................................         19.6078         19.4739         21.7421         20.2965
240085..........................................         18.0214         22.5736         20.9778         20.5540
240086..........................................         15.3302         16.9392         18.1401         16.9654
240087..........................................         17.0624         18.8352         21.3323         19.0315
240088..........................................         21.0202         21.6858         23.1056         21.8928
240089..........................................         18.4171         20.7239         21.1989         20.0227
240090..........................................         18.0490         19.2968         19.2166         18.8331
240093..........................................         18.6788         18.7092         20.2400         19.2268
240094..........................................         20.5705         20.9446         22.0247         21.2053
240096..........................................         18.3365         20.1644         21.0417         19.7961
240097..........................................         23.6230         24.2662         27.7781         25.0667

[[Page 22777]]

 
240098..........................................         20.6036         21.3467         24.2296         22.0643
240099..........................................         14.3759         14.4649         15.4964         14.7485
240100..........................................         19.1921         20.8302         18.9953         19.6501
240101..........................................         17.7478         19.2120         20.0872         18.9539
240102..........................................         15.5644         14.6067         16.3659         15.5008
240103..........................................         16.8805         19.1540         18.7510         18.2532
240104..........................................         24.0175         23.2178         23.5351         23.5902
240105..........................................         14.7904         14.3965               *         14.6094
240106..........................................         23.7818         23.5148         23.5005         23.6022
240107..........................................         19.0299         20.3983         20.9004         20.0558
240108..........................................         16.4605         15.3547         18.2427         16.5529
240109..........................................         13.1537         13.5537         16.3216         14.2359
240110..........................................         17.2834         19.4828         21.0675         19.2326
240111..........................................         17.0408         17.2100         17.8617         17.3567
240112..........................................         15.3246         15.8350         16.6242         15.9307
240114..........................................         15.4919         16.2505         17.3682         16.3794
240115..........................................         22.1575         23.7765         23.8675         23.3187
240116..........................................         15.1757         16.6731         18.3520         16.6014
240117..........................................         17.5676         18.0636         17.9941         17.8845
240119..........................................         22.4981         20.6126         21.8289         21.5894
240121..........................................         21.3747         23.4018         22.2266         22.3266
240122..........................................         18.0396         19.1811         21.2876         19.5090
240123..........................................         15.5968         16.5098         18.3941         16.7420
240124..........................................         19.0505         19.4400         20.4728         19.6473
240125..........................................         13.1505         12.3627         14.9708         13.5694
240127..........................................         14.7670         15.8966         17.9724         16.1476
240128..........................................         16.0759         17.2513         16.3608         16.5520
240129..........................................         15.4226         14.4212         16.5209         15.4258
240130..........................................         15.6477         14.9399         16.4271         15.6650
240132..........................................         24.4998         23.0669         23.1452         23.5239
240133..........................................         18.5216         19.2126         19.5294         19.1081
240135..........................................         13.6014         14.3069         15.7015         14.4270
240137..........................................         19.1770         20.3750         21.5073         20.3195
240138..........................................         13.7359         15.2062         16.7332         15.1922
240139..........................................         17.0163         20.8053         20.5496         19.6213
240141..........................................         21.9909         23.8066         23.1009         22.9648
240142..........................................         20.6139         25.2770         29.2238         24.5024
240143..........................................         14.2790         16.6172               *         15.4691
240144..........................................         15.8710         18.2604         21.4469         18.2664
240145..........................................         14.9997         17.2778         19.0689         17.4197
240146..........................................         16.7496         16.0652         16.5412         16.4544
240148..........................................         11.3388         18.8779         19.5204         16.6060
240150..........................................         12.8255         13.8786         20.8331         15.4453
240152..........................................         20.2020         21.1678         22.4744         21.2973
240153..........................................         15.6079         16.5412         19.3336         17.0363
240154..........................................         17.0625         17.5769         21.5052         18.6158
240155..........................................         20.4189         19.8762         20.9385         20.4180
240157..........................................         14.6914         17.4168         15.2821         15.8915
240160..........................................         16.6034         15.9492         15.9014         16.1454
240161..........................................         15.4160         15.7996         16.8809         15.9681
240162..........................................         19.0404         16.6292         19.1542         18.1964
240163..........................................         17.8714         18.8320         20.4760         18.9698
240166..........................................         16.3907         17.3233         19.4131         17.7688
240169..........................................         18.6155         16.6725         16.3958         17.2174
240170..........................................         17.6501         18.8762         20.3779         18.9004
240171..........................................         16.7237         17.2886         18.5172         17.5402
240172..........................................         16.0711         18.2852         20.8606         18.2323
240173..........................................         16.7411         17.2655         18.5190         17.5028
240179..........................................         16.6464         17.5116         20.4007         18.1225
240184..........................................         14.3996         15.3793         16.8917         15.4746
240187..........................................         17.5154         19.9230         21.2736         19.5789
240193..........................................         16.3004         17.8226         18.4664         17.4827
240196..........................................         23.2666         24.3472         25.3479         24.3358

[[Page 22778]]

 
240200..........................................         14.7295         14.3415         14.9076         14.6539
240207..........................................         23.3339         24.1127         25.2814         24.2879
240210..........................................         23.8391         24.2218         24.5664         24.2274
240211..........................................         20.5548         19.7399         30.6260         22.1746
250001..........................................         18.1407         18.4233         19.2756         18.6319
250002..........................................         15.6036         17.2501         18.6938         17.1218
250003..........................................         15.6560         17.6539         16.7570         16.6622
250004..........................................         17.1177         17.8868         18.3860         17.7913
250005..........................................         12.0032         12.5993         12.5834         12.3909
250006..........................................         15.7036         16.9048         17.5192         16.6995
250007..........................................         19.1555         19.2913         19.7562         19.3984
250008..........................................         13.3179         14.1760         15.8506         14.4224
250009..........................................         16.1847         18.5610         17.7283         17.5396
250010..........................................         13.3372         13.3905         14.6101         13.7324
250012..........................................         18.4756         14.1623         16.7579         16.4800
250015..........................................         11.0747         13.5274         11.7249         11.9737
250017..........................................         17.3006         17.9410         20.5976         18.5334
250018..........................................         13.4707         11.9311         13.1687         12.7895
250019..........................................         17.1501         16.7425         18.0956         17.3536
250020..........................................         14.0618         13.4476         16.2698         14.4562
250021..........................................          9.0772          9.4318         10.5844          9.6552
250023..........................................         13.5440         13.9116         12.3434         13.2963
250024..........................................         11.5940         12.7127         12.9899         12.4525
250025..........................................         17.8890         19.0390         20.3625         19.2022
250027..........................................         12.4241         14.9519         14.5445         13.9032
250029..........................................         14.8456         16.4834         16.0682         15.8412
250030..........................................         13.6277         17.3636         26.6173         19.2750
250031..........................................         18.7663         17.9715         18.3825         18.3676
250032..........................................         17.2983         17.1339         17.5957         17.3467
250033..........................................         15.7646         17.8257         15.0941         16.2509
250034..........................................         18.1269         16.6988         17.0399         17.2230
250035..........................................         17.4148         15.2353         16.8349         16.3942
250036..........................................         13.7928         15.8445         16.1913         15.3676
250037..........................................         10.3212         15.4325         12.7156         12.4979
250038..........................................         13.6207         16.8454         17.7019         16.0182
250039..........................................         16.5105         14.1556         15.1409         15.2552
250040..........................................         15.6367         17.3430         18.3364         17.1495
250042..........................................         16.4728         16.3867         17.6050         16.8239
250043..........................................         13.6492         16.0729         16.6500         15.4718
250044..........................................         16.7462         16.1218         16.7321         16.5323
250045..........................................         19.4788         22.0839         21.8988         21.2480
250047..........................................         12.0953         13.3706         14.7461         13.3242
250048..........................................         15.7073         16.8932         17.6649         16.7793
250049..........................................         10.7578         11.6715         12.1635         11.5642
250050..........................................         13.9220         14.3949         15.1159         14.4819
250051..........................................          9.6017          9.3464         10.4900          9.8032
250057..........................................         14.2863         15.9237         16.1838         15.4582
250058..........................................         15.4206         15.5327         15.7197         15.5555
250059..........................................         14.2997         16.2845         16.6494         15.7755
250060..........................................          7.9882         13.0301         16.1804         11.2768
250061..........................................         13.9655         11.0308         11.5108         11.9846
250063..........................................         14.9743         13.2540         13.3092         13.7869
250065..........................................         12.6803         12.8853         13.6904         13.0682
250066..........................................         14.3274         15.6760         16.1742         15.4025
250067..........................................         15.2871         16.4120         16.8522         16.2039
250068..........................................         11.4272         13.6768         13.4127         12.8087
250069..........................................         15.7653         17.8960         16.8980         16.8834
250071..........................................         11.2079         14.3781         12.3488         12.5425
250072..........................................         16.9263         18.2218         18.9487         18.0776
250076..........................................               *         10.5098               *         10.5098
250077..........................................         11.4135         12.2564         13.7404         12.5026
250078..........................................         15.4571         15.6336         15.9627         15.6858
250079..........................................         19.0587         16.2712         16.5835         17.1998

[[Page 22779]]

 
250081..........................................         16.1412         17.3325         19.0358         17.4600
250082..........................................         14.0249         16.0975         17.1427         15.7611
250083..........................................          9.2019         14.2634         16.6065         13.1746
250084..........................................         19.7390         17.0189         20.6429         19.0165
250085..........................................         13.8487         14.3797         15.4477         14.5716
250088..........................................         16.7514         17.8674         18.2736         17.6409
250089..........................................         13.0481         13.4238         14.3027         13.5884
250093..........................................         15.0918         15.2044         16.1506         15.4926
250094..........................................         17.8539         18.0852         18.5063         18.1422
250095..........................................         16.3574         17.0039         17.4217         16.9079
250096..........................................         17.0713         19.0688         19.0584         18.3546
250097..........................................         18.4099         16.9905         15.5741         16.9320
250098..........................................         14.3017         13.1341               *         13.6607
250099..........................................         14.4142         14.8528         15.1265         14.8018
250100..........................................         16.6033         17.1682         17.8688         17.2128
250101..........................................         16.3083         18.4685         17.7194         17.5079
250102..........................................         20.0190         23.9329         18.9348         20.8793
250104..........................................         17.5421         18.2502         18.7651         18.1832
250105..........................................         14.5986         14.5401         15.5133         14.8921
250107..........................................         13.6296         15.1496         15.0737         14.6455
250109..........................................         14.5496         22.1551         21.3867         18.8951
250112..........................................         14.2023         15.5610         16.3640         15.3179
250117..........................................         14.5171         16.1225         16.9787         15.9014
250119..........................................         12.7379         15.2199         16.1218         14.6728
250120..........................................         14.4126         15.3433         16.7182         15.4420
250122..........................................         17.7079         18.9417         19.2990         18.6619
250123..........................................         17.4068         18.8690         18.7863         18.3698
250124..........................................         12.6677         13.1823         13.2490         13.0310
250125..........................................         14.4867         20.8895         21.2660         18.4338
250126..........................................         14.7083         18.2355         21.9101         17.8900
250128..........................................         12.9968         14.0048         16.1418         14.4375
250131..........................................         10.2765         12.6056         12.4557         11.6657
250134..........................................         17.9755         17.0671         18.5142         17.8554
250136..........................................         18.0538         18.9689         21.3497         19.3579
250138..........................................         17.5999         18.4028         20.4550         18.6918
250141..........................................         17.1247         19.0113         19.6692         18.6505
250145..........................................         11.4047         10.2507         11.2120         10.9506
250146..........................................         13.2763         14.4924         14.7781         14.1955
250148..........................................         14.8234         18.0980         19.4233         17.4956
250149..........................................         12.9840         12.9569         15.2318         13.7102
250150..........................................               *               *         21.8599         21.8599
260001..........................................         17.5520         18.0971         19.7805         18.4701
260002..........................................         20.5878         22.1183         21.6400         21.4524
260003..........................................         14.3537         14.6553         15.4482         14.8108
260004..........................................         13.7528         13.0133         13.7035         13.4793
260005..........................................         19.7058         19.5554         23.9681         21.0036
260006..........................................         18.9408         19.7467         20.0994         19.6144
260008..........................................         16.2451         13.8495         16.8893         15.5719
260009..........................................         17.9364         18.5080         18.2863         18.2469
260011..........................................         18.3378         19.1027         19.5059         18.9819
260012..........................................         14.4594         14.3645         17.1662         15.3316
260013..........................................         15.5388         15.9884         16.1825         15.8932
260015..........................................         21.3327         16.5822         17.8817         18.4578
260017..........................................         15.8013         16.7916         14.7406         15.7355
260018..........................................         12.2293         12.0060         12.5301         12.2688
260019..........................................         23.6727         18.6113               *         20.6992
260020..........................................         21.8585         20.5142         20.2241         20.8205
260021..........................................         17.5694         22.1017         21.6237         20.1803
260022..........................................         19.3454         17.2462         17.7772         17.8898
260023..........................................         15.8235         16.4705         17.8649         16.6827
260024..........................................         13.4737         15.2356         15.7815         14.8371
260025..........................................         14.9377         15.4935         17.0965         15.8836
260027..........................................         21.0084         21.2977         21.3033         21.2013

[[Page 22780]]

 
260029..........................................         17.4744         19.7484         21.1858         19.3784
260030..........................................         11.2434         12.5118         11.9215         11.8847
260031..........................................         18.3039         19.4921         19.6943         19.1343
260032..........................................         20.8097         20.1988         19.6728         20.2222
260034..........................................         17.8986         17.4233         20.4902         18.5746
260035..........................................         12.5886         13.1065         13.0071         12.9052
260036..........................................         18.3128         16.7430         18.8104         17.9282
260039..........................................         14.1980         14.1866         14.6644         14.3527
260040..........................................         15.3853         17.3099         18.0140         16.9033
260042..........................................         17.4459         18.7567         18.7514         18.2697
260044..........................................         17.1177         15.9927         15.9206         16.3491
260047..........................................         17.2768         19.0112         19.2247         18.5386
260048..........................................         21.4309         20.0885         21.0602         20.8622
260050..........................................         18.7366         15.6908         16.8520         17.0991
260052..........................................         17.7502         18.0553         18.0914         17.9657
260053..........................................         12.0098         15.2236         16.5166         14.4005
260054..........................................         17.3708         20.0199         19.9510         19.1024
260055..........................................         13.7961         12.0118         15.4214         13.6790
260057..........................................         15.3276         17.4636         19.7144         17.7259
260059..........................................         15.7887         16.1000         17.0546         16.3478
260061..........................................         15.0099         14.7175         15.7112         15.1405
260062..........................................         20.2655         20.1477         21.3138         20.5946
260063..........................................         16.8474         18.2309         18.6551         17.9110
260064..........................................         16.5033         16.5934         17.8033         16.9429
260065..........................................         18.4654         19.4382         20.0975         19.3238
260066..........................................         14.4163         14.9640         15.3460         14.8934
260067..........................................         12.1588         14.2249         15.1837         13.8617
260068..........................................         19.8261         20.2418         19.4240         19.8242
260070..........................................         21.6873               *         13.9510         17.3672
260073..........................................         13.0075         14.2550         15.9182         14.4333
260074..........................................         15.4480         19.0350         19.8915         18.1123
260077..........................................         18.2594         18.6473         19.4482         18.8035
260078..........................................         15.4754         15.6381         14.9463         15.3700
260079..........................................         14.8281         14.2985         16.1453         15.0169
260080..........................................         12.5631         13.5384         14.6832         13.5392
260081..........................................         18.9629         21.0151         20.3053         20.0653
260082..........................................         15.7880         15.9407         15.9858         15.9090
260085..........................................         19.5153         20.4669         20.5247         20.1531
260086..........................................         14.8730         14.3164         15.2927         14.8291
260091..........................................         19.6081         19.9987         21.4056         20.5321
260094..........................................         15.8705         18.0085         18.5395         17.5281
260095..........................................         19.7672         19.6944         20.3468         19.9375
260096..........................................         21.7176         23.0282         22.5972         22.4661
260097..........................................         15.7899         16.5582         19.0632         17.1704
260100..........................................         15.7324         15.7047         16.6523         16.0345
260102..........................................         16.3653         20.1264         20.6361         18.8983
260103..........................................         17.3541         18.5957         19.7146         18.4987
260104..........................................         19.1158         21.0138         20.3176         20.0928
260105..........................................         20.8006         24.7223         24.8181         23.3052
260107..........................................         18.4618         19.8422         19.6490         19.2823
260108..........................................         19.2422         19.4609         20.0034         19.5906
260109..........................................         13.4400         13.9129         14.8181         14.0725
260110..........................................         16.9952         17.8375         18.3227         17.7209
260113..........................................         14.8968         14.6756         16.2223         15.2316
260115..........................................         17.8971         19.2259         17.4698         18.2033
260116..........................................         14.5715         16.2774         14.9812         15.2548
260119..........................................         16.2000         16.8836         17.2942         16.7641
260120..........................................         17.1269         16.3755         16.4904         16.6414
260122..........................................         14.5390         14.9697         16.0931         15.2238
260123..........................................         13.9960         14.6444         14.6822         14.4496
260127..........................................         15.9481         18.3572         18.4026         17.5109
260128..........................................         11.2705         13.0481         12.6414         12.2813
260129..........................................         14.6353               *               *         14.6353

[[Page 22781]]

 
260131..........................................         19.7491         17.7686         18.4154         18.5978
260134..........................................         16.5834         16.2832         17.5127         16.7877
260137..........................................         15.2169         17.9531         19.4697         17.5188
260138..........................................         21.3885         22.6491         22.1044         22.0654
260141..........................................         17.9598         19.1580         19.1893         18.7555
260142..........................................         16.0299         17.1248         17.3084         16.7937
260143..........................................         11.9389         12.7867         13.9040         12.7859
260147..........................................         13.6568         14.0778         14.7769         14.1672
260148..........................................         10.3383         11.8674         11.3524         11.2072
260158..........................................         12.4020         12.3005         12.7699         12.4966
260159..........................................         18.2232         20.3177         19.7951         19.3893
260160..........................................         16.1922         15.8394         16.5792         16.2009
260162..........................................         20.7103         19.5655         21.4099         20.5728
260163..........................................         14.8051         16.4245         15.8593         15.6940
260164..........................................         14.3089         14.9372         15.1211         14.8191
260166..........................................         19.5343         20.1025         20.3449         20.0093
260172..........................................         12.4851         15.4163         16.0772         14.6285
260173..........................................         11.9777         12.8523         14.2090         13.1471
260175..........................................         16.2940         16.9023         17.5625         16.9246
260176..........................................         19.5449         26.8712         21.6044         22.7500
260177..........................................         20.7457         21.2578         21.9014         21.3180
260178..........................................         21.4080         19.6638         20.2796         20.4480
260179..........................................         20.7397         21.4906         22.7185         21.6624
260180..........................................         18.5398         19.5819         18.9881         19.0361
260183..........................................         20.1940         20.0712         21.3175         20.5306
260186..........................................         18.0588         19.3238         19.6026         19.0698
260188..........................................         18.5772         20.6388         21.6920         20.2650
260189..........................................         10.7518         11.3004         16.4233         12.7425
260190..........................................         18.1639         18.5168         19.4910         18.7481
260191..........................................         19.3386         17.9812         18.1604         18.4767
260193..........................................         20.5055         21.1588         20.2577         20.6284
260195..........................................         15.9518         17.7237         19.7068         17.8042
260197..........................................         16.4605         19.2840         20.5453         18.3884
260198..........................................         17.6381         11.9751         19.7552         15.6949
260200..........................................         18.8755         20.5339         20.6888         20.0233
260205..........................................               *         17.6210               *         17.6210
270002..........................................         17.1866         28.9959         19.2387         20.5385
270003..........................................         22.1299         22.0995         22.5019         22.2424
270004..........................................         21.3442         19.6292         19.4834         20.1660
270006..........................................         16.1872         16.0238         17.0715         16.3653
270007..........................................         13.1679         11.3143         13.8824         12.6774
270009..........................................         17.7016         17.2292         20.4393         18.3783
270011..........................................         19.8229         20.2669         21.1653         20.3748
270012..........................................         22.8770         19.7346         19.7878         20.8557
270013..........................................         20.4012               *               *         20.4012
270014..........................................         18.5595         19.0872         19.9219         19.1986
270016..........................................         19.7675         19.6717         18.6149         19.4350
270017..........................................         19.5798         21.0800         20.0152         20.2382
270019..........................................         12.7812         18.1099         15.4128         15.4635
270021..........................................         16.6541         17.1787         16.9457         16.9258
270023..........................................         20.3641         22.2639         22.7181         21.7139
270026..........................................         15.6381         17.5102         18.0568         17.0775
270027..........................................          9.7758         13.1392         17.2091         12.8885
270028..........................................         17.2132         21.1492         19.1177         19.1160
270029..........................................         17.8852         16.5666         17.3710         17.2639
270032..........................................         17.0285         17.7393         16.0946         16.9320
270033..........................................         16.4554         16.9602         15.3447         16.2871
270035..........................................         17.6482         16.8295         16.4302         16.9974
270036..........................................         14.0815         14.2537         16.8552         14.8821
270039..........................................         15.3501         15.9368         19.6796         16.7774
270040..........................................         19.1901         18.8145         20.1242         19.3585
270041..........................................         16.7791         19.0327         25.8153         19.7981
270044..........................................         13.4559         16.7710         17.6489         15.9061

[[Page 22782]]

 
270046..........................................         17.1048               *               *         17.1048
270048..........................................         15.8403         17.0154         18.0666         16.8972
270049..........................................         21.1670         22.2444         22.9547         22.1282
270050..........................................         18.0448         16.7110         19.9356         18.1546
270051..........................................         18.9468         20.2735         20.1950         19.8100
270052..........................................         14.8042         14.4773         11.6737         13.7344
270057..........................................         20.0080         21.1317         20.6714         20.6119
270058..........................................         14.0669         14.7481         16.1412         14.9510
270059..........................................         15.5957         14.7530         19.1808         16.3576
270060..........................................         14.0212         15.2727         20.4148         16.5316
270063..........................................         14.2287         12.6108         15.1049         13.8837
270073..........................................         15.5281         14.4569         16.1937         15.3359
270079..........................................         15.0277         15.6873         16.7048         15.7603
270080..........................................         14.0437         16.3171         15.0705         15.0926
270081..........................................         15.5207         15.6262         16.7389         15.9424
270082..........................................         16.1280         17.3443         23.1245         18.7794
270083..........................................         20.8231         18.4432         17.8554         18.9597
270084..........................................         16.2075         16.6243         16.2958         16.3734
280001..........................................         17.8928         17.3541         18.1831         17.7825
280003..........................................         21.9957         22.3179         23.0213         22.4564
280005..........................................         18.7477         19.2405         23.6949         20.6104
280009..........................................         18.7541         19.8145         20.9643         19.8453
280010..........................................         16.5417         17.4859         20.0462         17.5272
280011..........................................         13.9627         15.8573         15.9614         15.3328
280012..........................................         16.4079               *               *         16.4079
280013..........................................         22.1767         22.8063         22.3488         22.4214
280014..........................................         15.2414         15.9596         16.8368         15.9667
280015..........................................         14.6353         17.0281         16.6939         16.1405
280017..........................................         14.1897         14.2059         13.9939         14.1278
280018..........................................         14.8492         15.1328         15.4496         15.1512
280020..........................................         19.3963         19.9667         21.0924         20.2072
280021..........................................         16.6949         17.1048         17.6345         17.1389
280022..........................................         15.7059         16.7179         16.8184         16.3693
280023..........................................         21.2387         25.8494         22.3433         23.0540
280024..........................................         13.9115         14.2186         15.3050         14.4398
280025..........................................         14.2701         15.5850         21.4764         16.6875
280026..........................................         16.0599         16.6861         16.5851         16.4520
280028..........................................         15.8871         17.3176         18.0793         17.1201
280029..........................................         19.0519         23.1292         24.4359         21.9196
280030..........................................         28.7091         24.5366         24.1113         25.6720
280031..........................................         13.2242         13.5654          9.6321         12.1542
280032..........................................         19.3884         18.8964         19.1191         19.1301
280033..........................................         14.9334         15.7583         17.4745         16.1329
280034..........................................         15.2821               *               *         15.2821
280035..........................................         15.3304         15.9170         16.6872         15.8969
280037..........................................         16.1684         16.7952         17.1064         16.6926
280038..........................................         16.4685         17.0878         18.2503         17.2635
280039..........................................         15.1916         16.0442         16.1587         15.8239
280040..........................................         18.9717         19.5333         20.7630         19.8033
280041..........................................         13.3901         16.4083         16.5503         15.4920
280042..........................................         15.3029         16.1191         16.6239         16.0122
280043..........................................         15.7858         16.6570         17.5937         16.7160
280045..........................................         14.2741         16.9048         15.7630         15.6286
280046..........................................         13.7155         17.9221         17.3214         16.1724
280047..........................................         18.3743         18.3407         16.6409         17.7457
280048..........................................         14.0702         15.8723         15.8100         15.1939
280049..........................................         15.6343         18.3605         18.4365         17.4677
280050..........................................         15.3413         16.6432         19.9901         17.5838
280051..........................................         15.8504         15.6336         17.1942         16.1502
280052..........................................         13.6489         14.0819         14.1201         13.9629
280054..........................................         17.5819         18.7992         18.7575         18.3765
280055..........................................         12.9933         13.5667         13.8129         13.4587
280056..........................................         14.0151         12.6475         15.6135         14.0018

[[Page 22783]]

 
280057..........................................         15.7623         18.0454         20.0686         17.7576
280058..........................................         17.8798         19.6752         21.4868         19.6876
280060..........................................         28.6047         19.7527         20.7022         22.2434
280061..........................................         17.9511         17.1629         18.6370         17.9240
280062..........................................         13.6738         14.4896         15.6018         14.6170
280064..........................................         15.5092         16.2977         16.8330         16.2046
280065..........................................         18.5327         19.2932         20.6502         19.5213
280066..........................................         11.6416         11.6621         11.7207         11.6766
280068..........................................         10.1327          9.4943         10.5987         10.0463
280070..........................................         13.7353         17.7400         22.6201         17.5276
280073..........................................         17.0583         17.4244         17.7698         17.4266
280074..........................................         15.2182         16.4310         16.7879         16.0977
280075..........................................         13.7875         15.5327         13.2230         14.1041
280076..........................................         13.9203         14.8469         16.7488         15.0947
280077..........................................         19.0145         19.2068         20.0148         19.4096
280079..........................................          9.9132         10.4540         16.6117         11.4307
280080..........................................         14.3528         15.3308         16.9487         15.6285
280081..........................................         20.9196         21.0771         20.1127         20.6778
280082..........................................         13.1250         14.3399         14.6173         14.0723
280083..........................................         17.5544         18.2992         21.5336         19.2134
280084..........................................         11.6868         12.5836         13.6536         12.6157
280085..........................................         21.5793         20.4302         20.4825         20.9817
280088..........................................         22.1147         20.2961               *         21.2560
280089..........................................         17.4696         18.1668         18.9567         18.1923
280090..........................................         14.7191         14.1362         15.1274         14.6962
280091..........................................         15.2184         15.8436         16.1866         15.7538
280092..........................................         14.1998         14.1945         14.7912         14.4303
280094..........................................         15.8843         17.6873         16.3474         16.6450
280097..........................................         14.2990         14.1734         13.8223         14.0824
280098..........................................         10.1686         13.0029         12.5875         12.0141
280101..........................................         17.4168         13.5261         16.9973         15.7528
280102..........................................         12.9367         14.0102               *         13.4735
280104..........................................         13.3842         13.2819         16.1207         14.1161
280105..........................................         18.7851         18.6575         21.0735         19.5325
280106..........................................         15.5396         16.1247         16.0679         15.9189
280107..........................................         13.4553         13.3311         14.4679         13.7065
280108..........................................         17.2185         17.5625         17.1961         17.3277
280109..........................................         11.0622         12.6803         12.4408         12.0678
280110..........................................         12.2950         12.7546         14.2136         13.0914
280111..........................................         23.0856         21.8773         19.6283         21.4131
280114..........................................         13.5580         15.7160         17.3076         15.4628
280115..........................................         16.4282         16.7041         18.1480         17.1049
280117..........................................         16.8216         17.7276         18.8279         17.8057
280118..........................................         16.9228         16.8687         18.6524         17.4822
280123..........................................         20.7732         14.0637         11.8582         15.0281
280125..........................................               *         16.1332         16.3944         16.2644
290001..........................................         22.4188         22.8226         22.4085         22.5500
290002..........................................         20.9442         17.2554         16.5419         18.3712
290003..........................................         25.0066         22.8840         23.7504         23.8240
290005..........................................         17.8609         19.4888         21.9814         19.6686
290006..........................................         19.8815         21.8070         22.4063         21.4371
290007..........................................         29.6864         29.7706         30.9075         30.1389
290008..........................................         20.2506         20.6190         24.1255         21.5150
290009..........................................         22.7399         23.3620         23.8871         23.3177
290010..........................................         14.4800         15.6423         16.4476         15.5219
290011..........................................         16.4419         20.1564         21.1234         19.0261
290012..........................................         21.5139         21.8275         25.0430         22.8581
290013..........................................         17.0883         18.2713         15.7932         17.0224
290014..........................................         18.3755         18.9743         18.7829         18.7144
290015..........................................         17.8303         22.3487         19.4504         19.7229
290016..........................................         12.7869         14.3542         23.8656         16.2244
290019..........................................         20.9336         21.2509         22.2045         21.4895
290020..........................................         26.1502         20.8733         21.2380         22.7207

[[Page 22784]]

 
290021..........................................         21.1250         21.5806         22.8732         21.8512
290022..........................................         24.0856         24.5468         25.4709         24.7290
290027..........................................         16.4289         16.7786         13.4076         15.4211
290032..........................................         22.7882         22.8447         23.4661         23.0210
290036..........................................         18.6112               *         12.9074         15.9259
290038..........................................         23.1402         20.6753         27.7030         22.6435
290039..........................................         25.8004         25.3864         24.6317         25.1994
290041..........................................               *               *         26.1003         26.1003
290042..........................................               *               *         18.7527         18.7527
290043..........................................               *               *         27.9053         27.9053
300001..........................................         21.4192         22.0909         23.8567         22.4761
300003..........................................         23.3777         22.9111         24.1297         23.4634
300005..........................................         19.9876         20.7545         22.2858         20.9804
300006..........................................         18.9331         23.7793         18.9745         20.5179
300007..........................................         19.3447         20.2372         20.2433         19.9403
300008..........................................         16.4649         20.7702         19.6149         18.9666
300009..........................................         20.0057         18.0602         20.0938         19.3221
300010..........................................         19.3833         19.3940         20.2130         19.6671
300011..........................................         21.2429         22.4325         23.0279         22.1850
300012..........................................         23.8859         24.5673         24.5672         24.3274
300013..........................................         18.9664         19.1247         20.1669         19.4250
300014..........................................         19.7969         20.3292         20.1774         20.0987
300015..........................................         19.9308         20.4916         19.6627         20.0406
300016..........................................         18.5037         21.8659         17.8148         19.4173
300017..........................................         22.3408         21.6563         22.7231         22.2428
300018..........................................         20.8947         21.2381         21.6385         21.2565
300019..........................................         20.6090         20.9753         19.6728         20.4155
300020..........................................         21.9725         21.9165         22.6627         22.2032
300021..........................................         17.3477         18.6211         19.3101         18.4253
300022..........................................         17.1864         18.3507         19.1875         18.2148
300023..........................................         20.3909         22.1210         22.1608         21.5715
300024..........................................         17.9460         19.9116         21.5842         19.6334
300028..........................................         18.0515         17.4075         19.9359         18.5255
300029..........................................         20.8961         22.5748         22.5952         22.0043
300033..........................................         19.8506         17.1869         17.1632         17.9333
300034..........................................         23.5215         25.5182         24.3286         24.4526
310001..........................................         27.5967         28.1329         25.3674         26.9474
310002..........................................         27.8735         28.3434         28.9800         28.3940
310003..........................................         27.4152         29.1096         27.2582         27.9096
310005..........................................         23.0493         22.1146         21.7223         22.2720
310006..........................................         21.5557         21.5957         22.0894         21.7417
310008..........................................         24.9483         23.5084         23.6523         24.0400
310009..........................................         23.1906         23.6371         21.1082         22.6736
310010..........................................         21.1064         22.5682         21.7892         21.7942
310011..........................................         23.4038         23.1977         24.2885         23.6223
310012..........................................         26.3249         26.5242         26.5603         26.4724
310013..........................................         22.1062         21.2251         22.0056         21.7900
310014..........................................         28.6964         27.4614         23.1544         26.3494
310015..........................................         26.7584         27.4331         27.5468         27.2399
310016..........................................         26.0518         24.3838         23.8492         24.7461
310017..........................................         26.0703         25.7902         24.5976         25.5018
310018..........................................         24.5312         22.8428         22.4779         23.3087
310019..........................................         23.0888         24.0542         24.9914         24.0619
310020..........................................         19.2663         24.1848         24.4152         22.3484
310021..........................................         22.6456         23.9369         24.5562         23.6719
310022..........................................         20.7276         21.2706         20.8258         20.9386
310024..........................................         22.7831         24.2353         24.9521         23.9428
310025..........................................         22.8129         24.3513         24.1812         23.7695
310026..........................................         23.8726         23.5491         22.1997         23.2228
310027..........................................         21.7666         21.8846         22.5696         22.0722
310028..........................................         23.5188         23.4577         23.9428         23.6444
310029..........................................         23.3801         22.6629         23.5968         23.2088
310031..........................................         25.1780         26.1567         26.8214         26.0435

[[Page 22785]]

 
310032..........................................         23.3017         24.3528         24.4098         24.0274
310034..........................................         21.6851         23.2729         23.9672         22.9482
310036..........................................         19.8178         20.1905         24.0906         21.3182
310037..........................................         27.4447         27.7823         29.3440         28.1550
310038..........................................         25.3832         26.7209         30.4319         27.5814
310039..........................................         22.0259         22.1754         22.7317         22.2988
310040..........................................         23.9864         26.1492         24.5150         24.8208
310041..........................................         23.7829         24.8960         23.5559         24.0709
310042..........................................         24.3292         23.2472               *         23.7901
310043..........................................         22.0887         21.9022         21.6128         21.8925
310044..........................................         20.4309         21.6677         23.1076         21.6842
310045..........................................         28.1570         28.4854         28.2393         28.2925
310047..........................................         24.5225         25.1101         26.1921         25.2615
310048..........................................         23.3295         23.6118         25.2088         24.0558
310049..........................................         24.7617         24.8299         26.1668         25.1997
310050..........................................         22.5877         25.1752         24.7988         24.2032
310051..........................................         25.2762         27.1265         26.9716         26.4268
310052..........................................         22.5753         22.9326         23.0520         22.8616
310054..........................................         24.7413         26.1726         27.2074         25.9539
310057..........................................         20.4484         21.1686         22.2572         21.2802
310058..........................................         26.2243         26.5308         26.3765         26.3747
310060..........................................         19.1119         19.1992         20.3713         19.5633
310061..........................................         20.8023         23.2646         33.9582         25.0082
310062..........................................         19.2729         22.9073               *         21.3672
310063..........................................         21.8540         21.9045         21.9181         21.8914
310064..........................................         24.2115         24.8567         25.1096         24.7198
310067..........................................         22.2740         25.0888         23.9278         23.7333
310069..........................................         24.1662         23.7531         24.2916         24.0734
310070..........................................         25.0448         26.0903         28.4556         26.4357
310072..........................................         22.2231         21.7605         22.5611         22.1704
310073..........................................         25.6299         28.5149         26.6390         26.9057
310074..........................................         24.4638         23.8340         23.6327         23.9943
310075..........................................         26.4606         23.3266         23.5841         24.4497
310076..........................................         28.8981         30.0797         33.7139         30.9519
310077..........................................         25.0569         25.2500         26.0801         25.4318
310078..........................................         23.4788         23.8841         24.0587         23.7967
310081..........................................         23.8898         22.0762         22.4086         22.8084
310083..........................................         23.6761         23.8852         24.8204         24.1353
310084..........................................         24.0915         26.6753         24.6049         25.1157
310086..........................................         21.4350         22.1674         22.7566         22.1186
310087..........................................         20.8875         20.7243         21.1297         20.9153
310088..........................................         22.3419         22.3160         23.1722         22.6064
310090..........................................         24.2426         23.8284         24.7947         24.2732
310091..........................................         22.0103         22.7978         23.2969         22.6743
310092..........................................         22.3446         20.5165         20.1062         20.9829
310093..........................................         21.2302         22.4291         23.7251         22.4166
310096..........................................         26.3041         25.1572         24.5759         25.3591
310105..........................................         24.4851         25.5891         26.9400         25.6544
310108..........................................         22.8801         22.4756         25.2476         23.5055
310110..........................................         20.1400         21.8341         23.2594         21.7903
310111..........................................         21.7218         21.1066         22.1022         21.6426
310112..........................................         22.5213         23.6701         24.7914         23.6656
310113..........................................         22.9536         23.6841         23.1961         23.2803
310115..........................................         20.0667         21.7320         21.3837         21.0468
310116..........................................         25.2429         22.9812         23.4566         23.8506
310118..........................................         24.5443         26.4625         26.5492         25.7555
310119..........................................         29.4809         33.6686         32.7858         31.9394
310120..........................................         21.6852         23.9681         23.3200         22.9127
310121..........................................         18.7365               *               *         18.7365
320001..........................................         17.8522         19.1150         20.6225         19.1818
320002..........................................         22.4623         22.6175         23.0983         22.7062
320003..........................................         15.3484         15.9504         13.9079         15.0840
320004..........................................         17.2353         18.5824         19.6642         18.5890

[[Page 22786]]

 
320005..........................................         19.8698         21.6103         21.0411         20.8577
320006..........................................         18.6472         18.9019         20.3863         19.2674
320009..........................................         17.6400         18.2883         19.3500         18.4218
320011..........................................         16.5481         20.0601         18.4503         18.4082
320012..........................................         15.9972         16.4355         16.7110         16.3828
320013..........................................         23.8390         22.9573         27.8924         25.0936
320014..........................................         15.9666         16.3598         16.8412         16.4003
320016..........................................         18.9296         20.5398         18.7247         19.3888
320017..........................................         18.1545         18.6388         19.4498         18.7392
320018..........................................         18.1944         18.8479         19.2336         18.7690
320019..........................................         19.2600         24.4707         26.9637         23.5577
320021..........................................         17.1647         17.8705         18.6167         17.8360
320022..........................................         15.8391         16.1777         17.1375         16.3840
320023..........................................         16.4170         18.0548         22.5706         18.5691
320030..........................................         16.5266         16.5495         18.6943         17.2018
320031..........................................         13.9914         19.6768         25.1715         19.2605
320032..........................................         18.7536         18.8097         21.1505         19.5091
320033..........................................         20.3137         25.0777         21.0621         21.9427
320035..........................................         25.7392         21.5186         15.0612         19.2882
320037..........................................         17.0846         17.0305         19.8700         17.9947
320038..........................................         16.2896         16.8117         22.2664         18.6619
320046..........................................         19.0033         18.3190         25.1691         21.0078
320048..........................................         19.1705         19.9642         16.8769         18.5918
320063..........................................         19.8320         18.3237         17.3297         18.4052
320065..........................................         16.1046         16.7933         18.6525         17.1721
320067..........................................         57.4818         33.8654         15.3228         25.9798
320068..........................................         18.1809         17.4785         18.4868         18.1081
320069..........................................         11.3058         13.0094         14.4212         12.8497
320074..........................................         18.6545         19.3406         20.2290         19.3600
320079..........................................         17.0696         18.2828         19.5946         18.2729
330001..........................................         25.2067         26.5533         27.3996         26.4208
330002..........................................         26.3926         26.5370         26.9827         26.6287
330003..........................................         18.0549         19.4102         18.8260         18.7489
330004..........................................         19.9573         22.5298         20.9501         21.1368
330005..........................................         24.2795         24.8338         20.9401         22.5763
330006..........................................         25.9186         25.0576         25.8006         25.5856
330007..........................................         18.7956         18.9024         19.3974         18.8931
330008..........................................         18.0684         19.0045         18.5531         18.5296
330009..........................................         30.4220         30.6918         31.3435         30.8056
330010..........................................         14.7382         17.4512         16.5924         16.1266
330011..........................................         18.0419         18.2986         18.6748         18.3483
330012..........................................         31.5135         32.7624               *         32.1317
330013..........................................         19.9929         19.0856         19.7303         19.6038
330014..........................................         27.5704         32.3370         36.6670         32.2107
330016..........................................         17.4069         16.9717         16.8016         17.0572
330019..........................................         32.4515         35.9822         32.8743         33.7601
330020..........................................         14.5488         15.5527         15.1142         15.0641
330023..........................................         24.2708         24.4006         25.6145         24.7662
330024..........................................         33.6175         34.1682         37.3316         34.9189
330025..........................................         16.0290         16.2033         16.8687         16.3599
330027..........................................         32.4959         33.4738         35.5255         33.7629
330028..........................................         27.0752         28.2089         29.5294         28.2349
330029..........................................         16.5552         18.1567         17.0016         17.2536
330030..........................................         15.0551         17.4977         19.1085         16.8779
330033..........................................         16.7497         18.5353         17.0721         17.4766
330034..........................................         30.7840         31.3997         27.7738         30.5701
330036..........................................         24.3239         23.9874         25.2820         24.5370
330037..........................................         16.0026         16.1140         16.4866         16.2081
330038..........................................         16.0153         16.2549         17.3429         16.5336
330039..........................................         12.4666               *               *         12.4666
330041..........................................         30.4192         24.5215         31.4871         28.4761
330043..........................................         27.6286         28.7467         27.4661         27.9537
330044..........................................         18.6969         20.0238         19.5219         19.4106

[[Page 22787]]

 
330045..........................................         27.1759         28.0758         27.9919         27.7401
330046..........................................         31.9802         32.4189         35.2703         33.1562
330047..........................................         17.6895         18.1815         18.5536         18.1416
330048..........................................         17.6239         17.8787         19.1093         18.1878
330049..........................................         19.3136         19.4993         20.5731         19.7930
330053..........................................         15.6659         17.4430         17.8082         16.9823
330055..........................................         30.7330         36.1109         28.8026         31.5674
330056..........................................         30.2206         30.4525         30.0945         30.2540
330057..........................................         18.6891         18.7478         19.0732         18.8421
330058..........................................         16.9805         17.0014         17.7672         17.2379
330059..........................................         32.2285         34.1705         34.2426         33.4744
330061..........................................         25.0674         25.7331         25.4082         25.4024
330062..........................................         15.2819         17.6067         18.1318         16.9856
330064..........................................         32.8724         33.1269         33.6447         33.2084
330065..........................................         18.3686         19.8940         19.9327         19.3474
330066..........................................         19.9455         19.5611         19.9424         19.8214
330067..........................................         21.2872         20.9443         22.1065         21.4528
330072..........................................         29.3096         30.8019         30.4171         30.1659
330073..........................................         15.8849         16.2898         16.4518         16.2013
330074..........................................         18.1636         18.0005         17.7308         17.9678
330075..........................................         17.4266         17.2298         17.6385         17.4324
330078..........................................         17.4863         16.7949         19.0779         17.7511
330079..........................................         16.7608         17.4555         18.7622         17.6535
330080..........................................         26.8766         29.2686         21.2449         25.8366
330084..........................................         23.0327         18.0435         19.2211         19.8357
330085..........................................         18.7835         20.2926         20.4054         19.8243
330086..........................................         30.6954         31.2980         23.6496         28.6407
330088..........................................         25.6160         25.6626         25.7940         25.6905
330090..........................................         18.6833         19.3954         19.4896         19.1855
330091..........................................         18.5334         19.0953         19.7776         19.1249
330092..........................................         12.6540         14.0671         13.3723         13.3059
330094..........................................         17.7196         17.5585         17.8413         17.7095
330095..........................................         18.5502         20.1073         21.1096         19.8197
330096..........................................         16.5963         17.9641         18.5149         17.6975
330097..........................................         16.9626         16.2169         16.4433         16.5145
330100..........................................         28.1060         27.0661         29.0916         28.0415
330101..........................................         31.3075         32.4105         30.3486         31.0539
330102..........................................         17.5230         17.5755         19.0058         18.0012
330103..........................................         16.5212         15.7197         16.8110         16.3435
330104..........................................         28.7669         31.6471         31.2074         30.5068
330106..........................................         35.8740         40.2686         35.0511         36.9438
330107..........................................         28.0780         28.5580         27.7797         28.1411
330108..........................................         17.0846         17.3605         17.7326         17.3908
330111..........................................         15.2047         19.5314         15.9321         16.7001
330114..........................................         18.2390         17.3522         17.0581         17.5626
330115..........................................         16.5581         17.4430         17.1354         17.0407
330116..........................................         24.2266         24.4622         14.9610         20.6732
330118..........................................         20.7550         20.6936         21.8568         21.0906
330119..........................................         34.7478         34.8385         33.3533         34.3131
330121..........................................         15.8468         16.1052         16.3385         16.0964
330122..........................................         21.2021         20.8204         20.2417         20.7389
330125..........................................         19.7456         19.8494         18.7943         19.4752
330126..........................................         22.6990         23.7938         23.8190         23.4522
330127..........................................         29.3317         31.9046         29.0166         30.1127
330128..........................................         27.8693         29.0222         26.1374         27.7856
330132..........................................         14.7006         15.7633         14.3673         14.9673
330133..........................................         32.3812         37.2494         35.3576         34.8196
330135..........................................         18.3346         18.7120         22.2670         19.6717
330136..........................................         17.6041         18.2422         18.7546         18.1908
330140..........................................         19.5016         19.1438         18.5579         19.0661
330141..........................................         25.1371         26.4956         26.7096         26.0966
330144..........................................         15.5068         14.0566         14.5344         14.7317
330148..........................................         15.0400         16.8151         16.2552         16.0122

[[Page 22788]]

 
330151..........................................         13.9700         16.0714         15.8490         15.2603
330152..........................................         29.4818         30.5409         31.2106         30.3169
330153..........................................         17.4996         18.9689         17.7451         18.0540
330157..........................................         20.8239         22.0792         22.3804         21.7687
330158..........................................         26.0476         25.7569         27.1228         26.3184
330159..........................................         18.0211         19.1536         19.6027         18.8964
330160..........................................         30.5678         32.7840         28.8043         30.6325
330162..........................................         27.7162         27.1166         27.6010         27.4784
330163..........................................         20.4555         18.7816         20.7456         19.9795
330164..........................................         19.4831         19.8647         20.8018         20.0537
330166..........................................         14.1815         15.0954         15.4420         14.8722
330167..........................................         31.1834         29.3634         30.2346         30.2561
330169..........................................         33.4462         37.2655         35.4794         35.3665
330171..........................................         25.4314         25.5307         24.8035         25.2597
330175..........................................         16.6851         17.3290         18.3116         17.4443
330177..........................................         14.5378         17.2907         16.3704         16.0830
330179..........................................         12.6857         13.4999         13.8953         13.3684
330180..........................................         15.5304         16.8787         17.7604         16.6634
330181..........................................         32.4718         32.5192         33.0908         32.6900
330182..........................................         30.9260         32.9371         33.5756         32.5197
330183..........................................         19.9964         19.9207         20.1294         20.0163
330184..........................................         27.4859         30.0400         31.3706         29.6316
330185..........................................         26.9496         25.6112         26.8344         26.4445
330188..........................................         18.7208         20.9587         18.8000         19.4696
330189..........................................         17.6585         15.1253         18.4498         16.9610
330191..........................................         18.8586         18.6206         19.0348         18.8384
330193..........................................         29.8042         36.5481         30.2260         31.8162
330194..........................................         35.5748         34.6785         35.2036         35.1664
330195..........................................         31.3915         33.3254         34.8966         33.0747
330196..........................................         28.4465         30.8165         23.7924         27.8886
330197..........................................         16.9990         17.6646         18.3527         17.6922
330198..........................................         23.8113         24.6038         24.8590         24.4203
330199..........................................         27.6605         28.7609         24.3024         26.9772
330201..........................................         30.3293         32.1149         27.8738         30.0899
330202..........................................         30.7869         31.4435         25.5880         29.1884
330203..........................................         19.2353         20.7575               *         19.9954
330204..........................................         29.3662         29.4418         23.6548         27.7204
330205..........................................         19.4642         20.5793         22.3490         20.7832
330208..........................................         25.8201         26.1822         26.6682         26.2220
330209..........................................         24.8834         23.9924         25.1281         24.6749
330211..........................................         19.0968         19.5064         19.5405         19.3836
330212..........................................         21.1777         21.7705         24.7681         22.5597
330213..........................................         18.5066         18.7722         19.6796         18.9552
330214..........................................         32.1966         36.4447         31.4165         33.0084
330215..........................................         17.5818         19.6926         17.9863         18.3902
330218..........................................         21.7072         21.4796         21.1890         21.4557
330219..........................................         22.1476         23.9908         23.4310         23.1411
330221..........................................         32.2081         27.8485         33.4064         31.2763
330222..........................................         17.8140         18.3666         18.8006         18.3281
330223..........................................         17.2754         17.6199         17.8306         17.5845
330224..........................................         21.9728         19.6410         19.2734         20.3025
330225..........................................         25.8043         25.5823         27.0379         26.0910
330226..........................................         17.6708         16.6711         23.2189         18.8201
330229..........................................         16.2509         16.8026         17.5326         16.8453
330230..........................................         28.8625         29.7626         29.6283         29.3810
330231..........................................         29.0917         30.0923         21.4675         27.3980
330232..........................................         19.5042         17.9083         19.1787         18.8569
330233..........................................         33.3008         30.9241         44.1265         35.0751
330234..........................................         33.3286         35.1777         35.0720         34.4830
330235..........................................         19.4532         21.0842         19.5880         20.0417
330236..........................................         30.7017         29.5913         31.3463         30.5397
330238..........................................         14.7951         15.6245         17.3976         15.9047
330239..........................................         17.2808         17.4462         18.5079         17.7328

[[Page 22789]]

 
330240..........................................         30.4765         29.7082         23.8099         28.5234
330241..........................................         22.6046         24.6076         23.8638         23.6409
330242..........................................         24.7401         28.2612         27.6384         26.8305
330245..........................................         17.2803         17.6767         18.5221         17.8508
330246..........................................         26.6587         28.1090         28.1205         27.6612
330247..........................................         27.6203         28.5310         27.7465         27.9483
330249..........................................         16.4818         16.2687         17.1320         16.6304
330250..........................................         19.5553         19.5823         19.9619         19.7058
330252..........................................         17.0379               *               *         17.0379
330254..........................................         16.7252         18.4057         15.9123         17.0146
330258..........................................         30.4656         29.7426         31.8910         30.6921
330259..........................................         25.2526         26.2661         25.9994         25.8364
330261..........................................         26.1654         25.7244         29.1996         27.0324
330263..........................................         19.6388         20.4149         18.7378         19.6517
330264..........................................         23.1359         22.8672         22.8099         22.9301
330265..........................................         15.6249         18.0193         17.7470         17.0706
330267..........................................         23.5561         24.5183         24.5939         24.2287
330268..........................................         14.6249         13.0595         15.9060         14.5364
330270..........................................         28.2392         34.4254         33.6294         31.8926
330273..........................................         25.8910         23.1511         26.0565         24.9430
330275..........................................         17.4223         19.0548         18.5826         18.2987
330276..........................................         17.7452         18.2870         19.0228         18.3342
330277..........................................         17.1570         18.3169         19.1761         18.2131
330279..........................................         19.9079         19.5983         20.7107         20.0436
330285..........................................         22.4717         23.5264         23.3068         23.0987
330286..........................................         25.0948         26.7633         27.6508         26.5469
330290..........................................         32.5792         33.5056         30.4706         32.2470
330293..........................................         15.3782         16.2158         16.9238         16.1248
330304..........................................         29.3687         26.7683         27.3562         27.8227
330306..........................................         27.6214         27.3798         29.5186         28.1311
330307..........................................         20.7362         21.0673         21.7142         21.1685
330308..........................................         36.8361               *               *         36.8361
330314..........................................         24.7399         24.5444         25.9937         25.0514
330316..........................................         28.7872         27.6102         27.9543         28.1177
330327..........................................         16.9724         16.4611         20.3874         17.9258
330331..........................................         31.0405         31.6216         33.1276         32.0298
330332..........................................         27.1554         27.6914         25.3689         26.7855
330333..........................................               *         29.1931         39.5812         33.8163
330336..........................................         30.1708         29.7689         29.8294         29.9290
330338..........................................         23.0077         22.4581         21.2670         22.2755
330339..........................................         19.6730         20.0111         20.1028         19.9220
330340..........................................         26.9201         28.8419         28.4129         28.0687
330350..........................................         30.3754         30.8889         30.9763         30.7427
330353..........................................         33.5519         32.1984         34.2431         33.3163
330357..........................................         34.7492         36.5928         33.5805         35.0171
330359..........................................         29.2920               *               *         29.2920
330372..........................................         22.5027         28.8482         33.3771         27.5982
330381..........................................         29.2438         31.0091         31.8602         30.6612
330385..........................................         28.8373         35.6722         26.5687         30.6041
330386..........................................         24.6713         17.6383         20.4231         20.5236
330389..........................................         32.4234         30.2505         37.3749         32.9392
330390..........................................         29.7936         31.1577         30.8744         30.5843
330393..........................................         27.9901         26.4958         28.7973         27.7348
330394..........................................         18.7724         19.2392         19.1086         19.0396
330395..........................................         37.6805         32.8749         32.7494         34.3792
330396..........................................         30.7228         34.8648         24.4840         30.2958
330397..........................................         31.0043         33.9061         32.6068         32.3768
330398..........................................         30.3217         28.7707         29.2872         29.6846
330399..........................................         35.5212         32.9100         27.1103         31.5503
330400..........................................               *               *         16.2707         16.2707
340001..........................................         19.0159         18.1814         19.7093         18.9605
340002..........................................         18.7790         20.8858         20.5253         20.0921
340003..........................................         21.9674         20.2540         19.5145         20.4958

[[Page 22790]]

 
340004..........................................         17.8923         19.0695         20.8540         19.2829
340005..........................................         14.0941         15.8205         16.7176         15.5039
340006..........................................         17.8145         16.9818         16.5709         17.0955
340007..........................................         17.1708         17.2356         18.3399         17.5929
340008..........................................         18.3769         21.2889         20.3756         20.0138
340009..........................................         20.5011         20.5023         20.9178         20.6132
340010..........................................         17.6500         18.3380         19.4302         18.4900
340011..........................................         14.9215         13.6554         14.4798         14.3110
340012..........................................         16.6574         18.8701         17.5112         17.6905
340013..........................................         17.4302         20.1747         19.4613         19.0754
340014..........................................         19.9203         20.5748         27.5775         22.0875
340015..........................................         19.0056         20.1562         19.4256         19.5364
340016..........................................         16.3977         17.5404         18.8958         17.5664
340017..........................................         19.2203         19.4192         20.2775         19.6581
340018..........................................         15.1579         14.0930         18.1751         15.6569
340019..........................................         13.5919         14.8980         15.2887         14.5682
340020..........................................         16.7515         18.6334         18.0897         17.8512
340021..........................................         19.6658         19.8020         20.5813         20.0277
340022..........................................         16.7211         17.8178         18.7714         17.7886
340023..........................................         17.2054         18.5414         19.3146         18.3540
340024..........................................         16.6389         17.3824         17.9130         17.3104
340025..........................................         16.8198         17.2648         18.4628         17.5179
340027..........................................         17.2971         18.0816         19.4548         18.2602
340028..........................................         17.7196         18.4787         19.9403         18.7490
340030..........................................         20.0530         21.1420         22.4709         21.2046
340031..........................................         12.3895         14.6951         14.6370         13.8761
340032..........................................         20.4735         20.0049         20.7444         20.4083
340035..........................................         18.0988         20.2312         18.9930         19.1067
340036..........................................         16.9674         18.2190         17.7619         17.6323
340037..........................................         15.5347         16.6576         17.5829         16.5842
340038..........................................         17.0154         17.3762         18.1493         17.5050
340039..........................................         20.1470         20.5876         21.3711         20.7125
340040..........................................         20.1214         20.4282         21.9720         20.8376
340041..........................................         17.7626         15.1419         15.5873         16.0395
340042..........................................         16.6300         16.9298         17.0034         16.8680
340044..........................................         16.3657         18.8687         18.0863         17.7757
340045..........................................         12.4152         13.0538         13.6182         12.9769
340047..........................................         19.6050         20.0602         20.0744         19.9132
340049..........................................         16.4988         19.2050         19.5127         18.2917
340050..........................................         18.5570         20.0090         19.6726         19.4142
340051..........................................         18.5953         16.5617         19.3627         18.0980
340052..........................................         21.3746         22.8173         23.2134         22.4161
340053..........................................         19.4881         20.9495         19.9915         20.1403
340054..........................................         14.4722         15.5993         15.5090         15.2167
340055..........................................         18.1786         19.6056         19.0861         18.9634
340060..........................................         17.9167         18.7137         19.3410         18.6670
340061..........................................         20.8474         21.5385         21.9695         21.4360
340063..........................................         16.9232         17.0249         16.7377         16.9005
340064..........................................         17.2584         20.7125         18.5069         18.8299
340065..........................................         18.3212         17.5414         17.5818         17.8131
340067..........................................         18.6132         19.3785         19.7187         19.2365
340068..........................................         16.7015         16.6305         17.8065         17.0483
340069..........................................         19.9948         21.0840         21.6728         20.9166
340070..........................................         18.6270         19.7796         20.5881         19.6815
340071..........................................         16.3701         17.1424         18.0767         17.2043
340072..........................................         15.6014         16.7400         17.7129         16.7307
340073..........................................         20.6905         21.9761         23.5832         22.0016
340075..........................................         18.2060         18.7090         20.8934         19.2370
340080..........................................         16.8453         22.2533         18.2061         19.0642
340084..........................................         21.7813         17.1532         19.0103         19.0182
340085..........................................         16.2355         17.3462         18.3179         17.3020
340087..........................................         16.6987         17.3884         18.2255         17.4652
340088..........................................         19.8314         21.0226         22.2322         21.0156

[[Page 22791]]

 
340089..........................................         13.8633         13.8535         15.4760         14.4308
340090..........................................         17.8457         17.0584         18.6263         17.8484
340091..........................................         19.3955         20.5923         20.2909         20.1016
340093..........................................         15.1615         16.3276         16.8903         16.0870
340094..........................................         15.9568         19.0406               *         17.4328
340096..........................................         17.9764         17.8189         19.4696         18.4348
340097..........................................         21.3700         18.8412         18.2399         19.4192
340098..........................................         20.1671         21.4135         21.9578         21.2065
340099..........................................         15.0888         16.8305         15.3752         15.7269
340101..........................................         15.3610         13.9994         15.6509         14.9555
340104..........................................         15.8729         13.0462         11.5169         13.4465
340105..........................................         18.9007         20.2954               *         19.5963
340106..........................................         18.0769         17.7220         18.1211         17.9704
340107..........................................         16.9503         18.0205         19.3197         18.0904
340109..........................................         17.9576         18.7746         19.0532         18.6067
340111..........................................         14.9247         16.3344         16.5976         15.9665
340112..........................................         14.5966         14.7562         15.5142         14.9625
340113..........................................         20.8821         21.2906         21.7973         21.3226
340114..........................................         20.8195         21.2166         20.7261         20.9197
340115..........................................         18.6700         19.7578         21.7586         20.0594
340116..........................................         19.4786         20.4255         20.6800         20.2116
340119..........................................         16.8537         18.8507         19.3687         18.3855
340120..........................................         14.3822         15.0410         15.8240         15.1047
340121..........................................         15.9686         16.3295         17.8771         16.7251
340123..........................................         16.2227         16.9114         18.9078         17.3848
340124..........................................         14.0462         15.5779         17.4185         15.7171
340125..........................................         19.6252         19.7164         20.2270         19.8478
340126..........................................         17.7214         18.8100         19.2911         18.6445
340127..........................................         17.3849         19.3925         19.3842         18.7105
340129..........................................         19.7332         20.4605         20.5809         20.2641
340130..........................................         19.4430         19.7422         19.8707         19.6940
340131..........................................         18.9361         19.7908         21.3849         20.0481
340132..........................................         16.9369         17.3448         17.5711         17.3015
340133..........................................         14.3501         16.4766         17.2138         16.0568
340137..........................................               *         21.0249         31.7702         23.8273
340138..........................................         19.2807         20.7618               *         20.0092
340141..........................................         22.2234         21.3754         22.7090         22.1155
340142..........................................         16.0912         17.1525         18.0766         17.1107
340143..........................................         20.9509         21.3604         24.4098         22.2423
340144..........................................         19.1919         20.9113         22.9183         20.9333
340145..........................................         19.1964         20.1081         20.5002         19.9671
340146..........................................         13.0119         15.9203         17.3051         15.3284
340147..........................................         19.1087         19.6827         20.5069         19.7958
340148..........................................         18.4227         18.5875         18.9912         18.6555
340151..........................................         16.5671         16.7275         18.4733         17.2579
340153..........................................         20.6588         20.6420         20.7533         20.6847
340155..........................................         20.4236         20.5792         22.6127         21.1834
340158..........................................         17.2565         18.1439         19.0843         18.2232
340159..........................................         16.8048         17.3893         19.0255         17.7569
340160..........................................         15.5298         16.1778         16.7170         16.1477
340162..........................................         16.6362         14.3472               *         16.3541
340164..........................................         19.6820         21.2523         21.5769         20.8240
340166..........................................         19.1743         20.0434         20.8270         20.0663
340168..........................................         14.7508         15.2919         15.6071         15.2494
340171..........................................         20.0495         21.5973         22.4779         21.4041
340173..........................................         20.2132         19.3353         21.0898         20.2512
350001..........................................         11.7345         14.9080         16.6551         14.4005
350002..........................................         17.2834         17.5259         18.3459         17.7122
350003..........................................         17.4276         18.2470         19.0720         18.2341
350004..........................................         17.9049         20.6518         23.7016         20.6528
350005..........................................         16.0259         18.3792         19.8486         18.1602
350006..........................................         16.6241         18.4107         19.0343         17.9691
350007..........................................         13.2771         13.3292         14.7114         13.7285

[[Page 22792]]

 
350008..........................................         21.6983         20.4777         22.3784         21.4889
350009..........................................         18.2818         19.1611         18.3688         18.6099
350010..........................................         15.2762         16.2808         16.7899         16.1032
350011..........................................         18.4931         18.2008         19.1944         18.6474
350012..........................................         12.7287         15.7033         18.2524         15.6975
350013..........................................         16.6784         16.4579         17.2596         16.7923
350014..........................................         15.7906         16.8403         18.0997         16.8353
350015..........................................         15.8651         16.3397         16.4878         16.2122
350016..........................................         11.6255         11.6524               *         11.6395
350017..........................................         17.7835         17.6278         17.5124         17.6446
350018..........................................         13.6366         14.4928         16.4939         14.8276
350019..........................................         19.4037         19.3063         20.1608         19.6008
350021..........................................         12.6885         16.2898         16.8617         15.2799
350023..........................................         12.7952         17.9048         17.4983         16.4355
350024..........................................         14.3740         14.7529         15.7902         14.9309
350025..........................................         16.2400         17.1199         15.0469         16.0889
350027..........................................         17.1177         15.0835         15.5175         15.9198
350029..........................................         12.7950         13.5219         14.6177         13.6003
350030..........................................         17.3497         17.7209         18.1131         17.7195
350033..........................................         14.8953         14.9012         16.0870         15.2715
350034..........................................         18.3180         18.7245         19.6445         18.8742
350035..........................................         10.1561         10.4570         11.7675         10.7676
350038..........................................         18.7357         17.6666         19.6852         18.6647
350039..........................................         17.3128         17.0361         16.6280         17.0025
350041..........................................         14.6772         14.6680         19.1341         15.9095
350042..........................................         16.7544         16.7402         19.3309         17.4345
350043..........................................         17.1573         16.8876         16.7433         16.9224
350044..........................................         10.5296         10.2154         11.0178         10.5670
350047..........................................         17.9270         14.4628         18.0094         16.8202
350049..........................................         14.5330         14.8019         18.1993         15.6280
350050..........................................         10.5733         11.4921         11.2484         11.0842
350051..........................................         17.5323         17.7279         17.0183         17.4309
350053..........................................         13.9379         14.6398         15.9165         14.8076
350055..........................................         12.3722         14.5691         15.7916         14.3152
350056..........................................         14.7382         14.8293         15.0995         14.8885
350058..........................................         14.3484         15.9378         16.7034         15.7009
350060..........................................          9.5962         10.3666         10.3076         10.0926
350061..........................................         14.5894         15.7269         18.8790         16.4237
360001..........................................         17.3933         17.0791         18.9348         17.8110
360002..........................................         17.3955         18.0139         18.1923         17.9206
360003..........................................         22.0351         22.7471         22.9625         22.5524
360006..........................................         22.0906         21.8048         22.4436         22.1137
360007..........................................         17.0955         18.0941         14.8213         16.6387
360008..........................................         17.8185         18.5439         18.7961         18.3915
360009..........................................         17.5328         18.9322         18.8403         18.4150
360010..........................................         18.0886         19.2288         19.1852         18.8325
360011..........................................         18.9491         19.3835         21.3659         19.9105
360012..........................................         19.2221         19.9881         19.8772         19.7036
360013..........................................         20.8112         20.6021         21.3690         20.9190
360014..........................................         19.8844         20.2390         20.7419         20.2907
360016..........................................         18.7709         17.8065         21.2505         19.1632
360017..........................................         22.4972         21.7543         22.2740         22.1696
360018..........................................         21.3436         23.5219         24.6686         23.0168
360019..........................................         20.1726         18.7147         20.6480         19.8139
360020..........................................         22.9512         21.7806         22.1751         22.3268
360024..........................................         18.5412         19.8508         20.0395         19.4699
360025..........................................         19.2918         20.3638         20.2531         19.9763
360026..........................................         17.0378         18.2222         17.9523         17.7450
360027..........................................         20.3568         21.0406         21.7259         21.0412
360028..........................................         17.2681         17.0177         18.7174         17.5937
360029..........................................         18.2193         18.7622         19.2928         18.7626
360030..........................................         15.3535         17.5748         17.6058         16.8173
360031..........................................         19.8987         19.3858         21.0687         20.1028

[[Page 22793]]

 
360032..........................................         17.9274         18.6559         19.8020         18.7667
360034..........................................         15.5649         14.9534         17.9594         16.1258
360035..........................................         20.3358         20.5557         21.1368         20.6811
360036..........................................         19.1835         20.2107         20.9916         20.1250
360037..........................................         22.5240         23.5094         22.4361         22.8217
360038..........................................         19.8921         21.2467         22.7344         21.1378
360039..........................................         17.4033         18.7791         18.8648         18.5318
360040..........................................         18.1238         18.1618         18.7425         18.3503
360041..........................................         18.4244         19.5744         19.7968         19.2697
360042..........................................         16.1187         17.4306         17.1952         16.9328
360044..........................................         16.7925         17.0612         17.6882         17.1993
360045..........................................         21.1814         22.1471         22.4018         21.8209
360046..........................................         19.3198         20.4755         20.4607         20.0909
360047..........................................         15.3399         17.1871         15.2922         15.8884
360048..........................................         21.1719         22.5857         22.4890         22.0646
360049..........................................         18.8084         20.4564         20.8393         20.0008
360050..........................................         12.8888         12.9873         15.0568         13.6080
360051..........................................         20.9461         20.8338         20.8757         20.8844
360052..........................................         20.0182         19.6233         18.7143         19.4845
360054..........................................         16.1875         17.2574         17.4911         16.9860
360055..........................................         23.2671         21.5585         21.3101         22.0600
360056..........................................         18.7606         19.0474         19.9428         19.2810
360057..........................................         13.8094         15.0146         15.8569         14.8518
360058..........................................         17.9178         18.6992         19.3306         18.6392
360059..........................................         21.9689         20.5618         19.3576         20.6833
360062..........................................         20.3111         20.7588         22.2132         21.0473
360063..........................................         22.7866         18.4512         17.5108         19.4998
360064..........................................         20.6416         20.4846         19.6315         20.2734
360065..........................................         19.4531         20.0532         19.6199         19.7128
360066..........................................         20.0285         21.6015         22.8175         21.4937
360067..........................................         14.5687         15.3157         14.2745         14.7189
360068..........................................         21.2199         21.2789         22.5953         21.7071
360069..........................................         17.8329         16.6982         14.6597         16.2292
360070..........................................         17.5300         17.3758         18.8406         17.9171
360071..........................................         23.8013         17.9756         18.9990         20.2321
360072..........................................         17.9697         18.1467         19.0028         18.3949
360074..........................................         18.2614         20.8275         16.3870         18.3729
360075..........................................         18.4733         22.4523         26.0663         21.4074
360076..........................................         19.5864         20.0700         20.3028         19.9910
360077..........................................         20.8202         21.1053         21.5517         21.1550
360078..........................................         20.7940         21.4392         21.4033         21.2167
360079..........................................         22.0033         22.1096         21.6644         21.9274
360080..........................................         16.6414         17.3892         17.6369         17.2080
360081..........................................         19.6354         21.7342         20.4614         20.6451
360082..........................................         22.8585         22.9460         20.7610         22.1460
360083..........................................         18.4635               *               *         18.4635
360084..........................................         20.0914         20.4894         22.0492         20.8664
360085..........................................         21.6670         21.9051         22.0445         21.8712
360086..........................................         17.0389         19.5378         19.3701         18.5836
360087..........................................         20.0395         20.1684         20.7969         20.3249
360088..........................................         22.3121         24.0097         24.0822         23.4637
360089..........................................         20.5610         18.3881         18.1941         19.0415
360090..........................................         20.3955         21.0376         20.8971         20.7887
360091..........................................         21.0335         21.3126         21.8447         21.4132
360092..........................................         15.9095         20.4534         21.5073         18.9727
360093..........................................         18.5744         19.3292         19.0261         18.9905
360094..........................................         18.3105         18.8780         20.1227         19.0848
360095..........................................         18.7079         20.4149         19.8521         19.6643
360096..........................................         17.1617         18.2215         16.7129         17.3379
360098..........................................         18.3361         19.5314         19.7705         19.2208
360099..........................................         18.5523         18.5855         19.6241         18.9389
360100..........................................         17.6554         17.8989         18.0434         17.8622
360101..........................................         22.3121         21.3914         20.2635         21.3487

[[Page 22794]]

 
360102..........................................         19.7700         19.4345         18.5367         19.2837
360103..........................................         22.6228               *               *         22.6228
360106..........................................         16.1843         18.9752         19.1778         18.1964
360107..........................................         18.6195         19.7599         22.1359         20.1794
360108..........................................         16.5076         17.5832         20.0681         18.0497
360109..........................................         19.5162         20.1032         19.9237         19.8530
360112..........................................         22.5676         22.5589         24.6335         23.2167
360113..........................................         22.4584         24.2654         21.4926         22.7777
360114..........................................         16.3288         17.8761         18.7509         17.6758
360115..........................................         18.1859         18.8059         20.5842         19.2284
360116..........................................         18.0835         18.8882         18.8319         18.6000
360118..........................................         18.6098         19.3732         19.9141         19.3196
360121..........................................         21.0979         22.1093         22.2175         21.8088
360123..........................................         19.1313         20.3236         20.9792         20.1480
360125..........................................         18.1756         19.0774         20.5508         19.2432
360126..........................................         20.4558         19.0036         24.5387         21.1181
360127..........................................         16.9228         17.5882         16.4582         16.9587
360128..........................................         15.5823         16.1243         17.0515         16.2361
360129..........................................         15.5241         15.5002         16.6114         15.8783
360130..........................................         15.3356         17.2009         18.4539         16.9275
360131..........................................         18.2897         19.2241         18.4688         18.6543
360132..........................................         18.2733         19.9171         21.3493         19.8413
360133..........................................         19.0349         19.4316         20.3421         19.5683
360134..........................................         20.2383         20.6876         20.8407         20.5767
360136..........................................         17.8473         17.7827         18.2194         17.9464
360137..........................................         20.2581         20.1756         21.6611         20.6928
360140..........................................         19.1263         20.2791         21.2881         20.2299
360141..........................................         22.8496         23.0016         23.4448         23.0886
360142..........................................         17.3154         17.0059         18.3188         17.5468
360143..........................................         20.4378         20.1989         21.0336         20.5552
360144..........................................         21.9159         23.2191         20.9033         21.9858
360145..........................................         19.3907         19.6413         20.0513         19.6956
360147..........................................         16.5898         16.6616         17.6779         16.9779
360148..........................................         18.8914         19.2816         19.1393         19.1100
360149..........................................         18.7891         19.9808               *         19.3785
360150..........................................         20.6253         21.1327         22.3752         21.3686
360151..........................................         17.4863         16.6019         19.2788         17.7101
360152..........................................         21.9978         20.8328         21.6005         21.4611
360153..........................................         14.8948         15.4132         16.7399         15.6460
360154..........................................         13.7761         14.3270         14.3593         14.1608
360155..........................................         20.8977         22.5347         22.4566         21.9588
360156..........................................         17.9155         17.8787         18.9095         18.2225
360159..........................................         20.7119         20.2841         21.5695         20.8609
360161..........................................         19.4122         19.1983         20.3933         19.6539
360162..........................................         18.6084               *               *         18.6084
360163..........................................         20.3821         20.7275         21.2689         20.8164
360164..........................................         16.1643               *               *         16.1643
360165..........................................         19.4831         18.2571         18.2417         18.6524
360166..........................................         16.9778         18.7321               *         17.8568
360170..........................................         17.1779         16.4653         20.4407         17.9153
360172..........................................         18.4690         18.6720         19.7088         19.0739
360174..........................................         19.0887         19.9725         20.2255         19.8619
360175..........................................         20.4133         21.1685         21.5450         21.0739
360176..........................................         15.4730         15.9430         16.6228         16.0305
360177..........................................         19.4122         18.7898         18.9576         19.0368
360178..........................................         17.3985         18.8704         16.7962         17.7254
360179..........................................         19.1417         21.1309         21.1234         20.4340
360180..........................................         22.0949         21.3826         21.0146         21.4888
360184..........................................         19.3502         19.1224               *         19.2391
360185..........................................         18.6697         18.7291         19.4858         18.9599
360186..........................................         20.8579         18.3246         20.7572         19.9570
360187..........................................         18.0209         18.5109         19.6535         18.7427
360188..........................................         17.5327         17.1044         18.3057         17.6838

[[Page 22795]]

 
360189..........................................         17.3713         17.8981         18.5940         17.9373
360192..........................................         20.9980         21.6365         22.7846         21.8042
360193..........................................         17.6874               *               *         17.6874
360194..........................................         17.6890         17.1884         17.6140         17.4968
360195..........................................         19.0173         19.9302         20.5828         19.8368
360197..........................................         19.4250         20.0603         20.5062         19.9981
360200..........................................         17.7583         16.2306         17.9623         17.3129
360203..........................................         15.6212         16.3181         15.9609         15.9716
360204..........................................         19.3543         22.2494               *         20.5754
360210..........................................         20.2809         20.9955         21.8629         21.0428
360211..........................................         19.5762         19.9895         20.6081         20.0860
360212..........................................         20.2288         21.1123         20.6987         20.6781
360213..........................................         18.3253         19.4765         19.0584         18.9547
360218..........................................         18.4140         18.9469         18.8204         18.7231
360230..........................................         21.4385         21.9763         20.8042         21.3850
360231..........................................         13.5586         12.9588         14.4168         13.6102
360234..........................................         22.4324         23.2588         19.5102         21.8679
360236..........................................         19.4881         17.8426         19.9971         19.0637
360239..........................................         19.8584         20.1854         19.5907         19.8872
360241..........................................         22.0795         23.5318         25.3741         23.5406
360243..........................................         13.5835         14.8694               *         14.2018
360244..........................................         10.5518               *               *         10.5518
360245..........................................         15.0579         16.4622         15.9782         15.8310
360247..........................................         18.1116         16.3092         17.0776         17.0967
360248..........................................         21.6499               *               *         21.6499
360249..........................................               *               *         25.4331         25.4331
370001..........................................         21.2714         22.5214         24.1929         22.6419
370002..........................................         14.0847         14.7315         15.4333         14.7194
370004..........................................         16.7671         19.3236         18.5233         18.1546
370005..........................................         17.3817         15.1654         15.3881         15.9167
370006..........................................         12.9493         16.6484         16.4995         15.3118
370007..........................................         17.1535         15.2905         15.8312         16.0498
370008..........................................         17.3048         16.6566         17.5553         17.1688
370011..........................................         14.6397         14.9701         14.9186         14.8316
370012..........................................         10.8003         11.7265         12.4942         11.6228
370013..........................................         18.0385         19.3398         18.9584         18.7911
370014..........................................         19.6543         20.6512         20.2858         20.2276
370015..........................................         17.8247         17.0319         20.8765         18.5256
370016..........................................         16.6401         19.1191         19.1613         18.3470
370017..........................................         12.9837         12.6400         13.6531         13.1239
370018..........................................         14.2438         18.5107         17.7054         16.6955
370019..........................................         16.8801         14.2277         14.6216         15.1546
370020..........................................         13.4787         14.3798         15.1035         14.3356
370021..........................................         11.2639         12.0474         12.9030         12.0738
370022..........................................         17.9015         17.2344         17.3302         17.4722
370023..........................................         16.8215         17.7630         17.5148         17.3665
370025..........................................         16.3970         17.4988         18.4375         17.4425
370026..........................................         16.8991         18.3371         18.0412         17.7563
370028..........................................         19.7118         18.4445         21.1086         19.7253
370029..........................................         13.8930         16.4924         18.2580         16.0663
370030..........................................         15.4736         16.3269         16.5803         16.1058
370032..........................................         16.6432         18.2821         18.1538         17.7030
370033..........................................         12.3910         13.5216         11.3210         12.4595
370034..........................................         14.5101         15.6386         15.6288         15.2811
370035..........................................         18.9629         25.5764               *         21.9610
370036..........................................         11.4593         12.4026         12.4070         12.0833
370037..........................................         17.7491         16.7012         18.8472         17.7402
370038..........................................         12.8135         13.3084         13.0210         13.0660
370039..........................................         16.2661         15.5206         19.4498         17.0406
370040..........................................         14.2582         14.4672         15.5109         14.7638
370041..........................................         17.4123         16.7356         16.2316         16.8488
370042..........................................         14.6146         14.9175         15.2764         14.9764
370043..........................................         16.0764         15.9534         17.0892         16.3549

[[Page 22796]]

 
370045..........................................         12.4352         10.1994         11.3560         11.2236
370046..........................................         18.1499         18.8334               *         18.4831
370047..........................................         15.6716         16.7554         17.8769         16.7444
370048..........................................         17.4356         18.2150         15.6803         17.1206
370049..........................................         19.8397         20.7176         19.4868         19.9892
370051..........................................         12.1816         11.6736         12.5171         12.1083
370054..........................................         16.5598         16.9049         18.0787         17.1343
370056..........................................         18.8774         18.4558         18.1432         18.4804
370057..........................................         14.6564         16.7261         15.1228         15.5054
370059..........................................         16.4578         18.1386         18.3314         17.6259
370060..........................................         15.1169         16.5403         19.3051         16.8157
370063..........................................         17.0645         14.4132         16.7342         16.0603
370064..........................................          8.7499         10.9676         11.9954         10.6741
370065..........................................         16.5638         16.6898         18.1349         17.1281
370071..........................................         14.9472         16.1439         16.4567         15.8354
370072..........................................         14.6497         14.4742         13.6519         14.2760
370076..........................................         12.8568         13.5694         14.3555         13.5818
370077..........................................         17.6236               *               *         17.6236
370078..........................................         17.2370         18.4086         19.2412         18.2505
370079..........................................         13.5976         16.6861         16.9201         15.7005
370080..........................................         14.3445         13.9239         14.7323         14.3058
370082..........................................         13.5434         13.9634         15.0669         14.1855
370083..........................................         11.4905         13.1519         13.1316         12.6096
370084..........................................         21.7484         22.0545         13.1197         17.8063
370085..........................................         11.8844         11.2842         48.1271         14.9179
370086..........................................         13.5646         15.4404         11.1900         13.1933
370089..........................................         14.4968         16.0966         17.2638         15.9758
370091..........................................         17.5839         19.1698         20.1860         18.9733
370092..........................................         14.6757         14.9802         15.7678         15.1529
370093..........................................         18.5747         18.4600         19.7008         19.0469
370094..........................................         18.3796         18.0002         19.5462         18.6588
370095..........................................         14.1319         12.6383         13.4202         13.3755
370097..........................................         23.3116         22.9714         23.2056         23.1716
370099..........................................         16.2649         15.4549         18.9823         16.7206
370100..........................................         17.1036         14.0168         18.8274         16.6764
370103..........................................         15.8967         19.2353         18.2685         17.7516
370105..........................................         17.6811         21.3352         20.7890         19.9853
370106..........................................         18.6238         18.5485         18.7413         18.6375
370108..........................................         12.2379         12.3279         12.7470         12.4421
370112..........................................         15.2488         14.8539         15.3039         15.1287
370113..........................................         16.2043         16.1046         17.6107         16.6143
370114..........................................         15.9801         16.5268         17.4009         16.6473
370121..........................................         19.5506         22.5611         21.3099         21.1472
370122..........................................         12.1514         15.0645         15.4375         13.9736
370123..........................................         16.3609         18.9159         19.4409         18.1517
370125..........................................         13.5453         15.6284         13.9436         14.3107
370126..........................................         18.2447         23.9654         15.8020         19.1824
370131..........................................         16.2403         17.5689         15.7261         16.4650
370133..........................................         10.0169         10.9575         12.9545         11.1921
370138..........................................         15.9372         16.4005         17.5551         16.6500
370139..........................................         13.3023         14.8612         14.9964         14.3624
370140..........................................         15.2265         16.0721         17.1393         16.1657
370141..........................................         12.1420         18.4101         20.7798         16.3574
370146..........................................         12.5581         12.6402         13.0399         12.7467
370148..........................................         16.4147         20.6458         20.6612         19.2220
370149..........................................         16.7218         16.1850         17.0929         16.6647
370153..........................................         15.3218         17.8352         16.4669         16.5507
370154..........................................         15.9128         15.5127         15.6093         15.6789
370156..........................................         13.6363         13.9255         14.5696         14.0273
370158..........................................         15.0865         15.6917         15.6994         15.4906
370159..........................................         17.8319         28.0536         21.1267         21.7006
370163..........................................         14.5609         17.6361         20.4217         17.2893
370165..........................................         13.2174         13.0910         13.0375         13.1156

[[Page 22797]]

 
370166..........................................         17.8154         17.2849         21.0944         18.6510
370169..........................................          9.4807         12.5243         12.7138         11.5273
370176..........................................         16.0355         15.9476         18.9951         16.9629
370177..........................................         11.8757         11.2536         14.6481         12.5743
370178..........................................         11.6384         10.5726         11.6200         11.2422
370179..........................................         19.2677         17.2829         21.3002         18.9651
370183..........................................          7.6164         10.2945         16.9318         11.0088
370186..........................................         13.3454         13.6192         15.4533         14.1321
370190..........................................         13.7032         14.1397         19.3570         15.3737
370192..........................................         16.7402         18.4614         19.6967         18.2866
370197..........................................         21.5718               *               *         21.5718
370198..........................................               *         21.3136               *         21.3136
370200..........................................               *               *         22.5299         22.5299
380001..........................................         22.0255         20.3127         26.4822         22.5494
380002..........................................         19.4764         24.0241         21.9185         21.9840
380003..........................................         24.7434         21.7826         20.9007         22.2865
380004..........................................         23.1432         23.1451         23.3609         23.2208
380005..........................................         23.2415         24.0838         25.0750         24.1485
380006..........................................         20.5375         21.2731         21.3520         21.0653
380007..........................................         24.2933         25.2995         32.2678         27.0282
380008..........................................         21.1888         20.7063         22.1442         21.3538
380009..........................................         25.1702         23.8104         24.3851         24.4234
380010..........................................         19.7477         23.7488         22.7276         21.8451
380011..........................................         21.1353         21.1151         20.3357         20.8683
380013..........................................         20.1038         18.6818         19.8180         19.5721
380014..........................................         23.4819         24.6574         25.9828         24.7413
380017..........................................         23.8231         26.0578         25.3954         25.0552
380018..........................................         22.0776         22.3525         22.9822         22.4971
380019..........................................         20.7700         22.1215         20.8176         21.2209
380020..........................................         21.3556         20.1464         22.9568         21.5448
380021..........................................         20.6358         21.1590         23.8499         21.8371
380022..........................................         21.6110         22.6408         24.5974         22.8841
380023..........................................         19.2357         20.5462         21.3831         20.3976
380025..........................................         24.6738         26.3652         26.9346         25.9824
380026..........................................         19.2663         20.4706         20.6972         20.1525
380027..........................................         20.1576         20.8647         21.5490         20.8958
380029..........................................         18.5699         19.4246         20.1471         19.4015
380031..........................................         22.8346         23.3181         23.1696         23.1091
380033..........................................         23.2881         25.2454         26.7146         25.0303
380035..........................................         21.6533         22.4099         23.9719         22.6232
380036..........................................         19.3269         27.1587         27.2157         23.8613
380037..........................................         21.2347         21.9158         22.1774         21.7911
380038..........................................         25.5750         26.0869         26.7759         26.1419
380039..........................................         22.1235         23.1746         22.8048         22.6937
380040..........................................         21.6378         26.2717         22.5477         23.4095
380042..........................................         19.8096         21.1176         24.4172         21.7244
380047..........................................         21.9511         23.0718         24.2524         23.1258
380048..........................................         18.3847         17.5885         18.3005         18.0671
380050..........................................         18.2486         20.3934         20.3205         19.6254
380051..........................................         21.2358         22.3568         22.3207         21.9927
380052..........................................         17.8741         19.4570         18.6299         18.6300
380055..........................................         21.2459               *               *         21.2459
380056..........................................         17.1600         19.5185         18.4961         18.3892
380060..........................................         23.2923         24.2670         25.2553         24.2520
380061..........................................         22.5983         22.3736         22.8781         22.6217
380062..........................................         18.5229         20.7716         18.2148         19.1910
380063..........................................         19.3566         20.4077               *         19.9113
380064..........................................         19.8719         19.9826         22.9160         20.8404
380065..........................................         22.1706         26.1404         22.9608         23.6770
380066..........................................         20.4189         22.0349         23.2794         21.9793
380068..........................................         22.7573         22.3178               *         22.5559
380069..........................................         19.5793         19.8300         20.4882         19.9809
380070..........................................         24.7116         27.2541         27.7790         26.6130

[[Page 22798]]

 
380071..........................................         20.4707         22.6386         25.1808         22.8743
380072..........................................         16.3169         19.1553         19.4346         18.3236
380075..........................................         22.1703         22.3625         22.4139         22.3203
380078..........................................         19.1035         20.2507         21.0903         20.1439
380081..........................................         20.5902         20.9882         20.4082         20.6790
380082..........................................         22.5856         22.2275         22.9606         22.5990
380083..........................................         21.8096         21.3859         21.7431         21.6440
380084..........................................         23.6412         24.2844         27.1689         24.9815
380087..........................................         14.0976         16.5309         17.0380         15.8783
380088..........................................         19.5204         21.5225         19.5346         20.1728
380089..........................................         23.7413         19.5255         25.2908         23.0572
380090..........................................         27.0867         29.2702         24.9351         26.9453
380091..........................................         22.8333         27.5560         25.3062         25.1774
390001..........................................         18.6384         19.2989         19.6732         19.2277
390002..........................................         18.0787         21.8353               *         19.8326
390003..........................................         17.2435         17.1371         18.1025         17.4798
390004..........................................         18.8899         19.2277         20.1410         19.4180
390005..........................................         16.4459         17.3506               *         16.9145
390006..........................................         19.6012         20.2959         21.1173         20.3037
390007..........................................         21.4093         21.7506         15.6739         19.2842
390008..........................................         16.7440         17.8297         18.1339         17.5605
390009..........................................         20.1181         20.6507         20.7869         20.5095
390010..........................................         17.2315         17.5127         17.3335         17.3583
390011..........................................         18.0683         18.1717         18.3257         18.1941
390012..........................................         20.0227         20.6523         21.0569         20.5659
390013..........................................         19.3300         19.2698         19.6562         19.4200
390015..........................................         12.9372         13.1337         13.7352         13.2647
390016..........................................         17.0679         16.9892         17.0438         17.0335
390017..........................................         16.2170         16.7493         18.6113         17.1752
390018..........................................         19.1241         21.3626         19.0279         19.8558
390019..........................................         16.3965         16.7848         17.9046         17.0403
390022..........................................         22.8967         21.5064         24.3824         22.9198
390023..........................................         19.5639         21.8270         21.0689         20.8880
390024..........................................         25.0359         24.9437         25.5672         25.1781
390025..........................................         15.7111         15.6155         15.6650         15.6645
390026..........................................         22.7645         22.3902         22.6877         22.6120
390027..........................................         27.6893         26.8878         31.2135         28.5811
390028..........................................         20.1087         22.7700         24.0895         22.1870
390029..........................................         19.6883         21.5729         21.2661         20.8012
390030..........................................         18.3978         17.9580         18.6645         18.3352
390031..........................................         19.5175         19.2755         18.3572         19.0574
390032..........................................         18.1492         17.8041         21.5105         19.0439
390035..........................................         18.5146         20.2029         18.5192         19.0782
390036..........................................         18.8657         19.9880         19.7671         19.5278
390037..........................................         22.2359         21.0616         20.4263         21.2243
390039..........................................         16.5438         17.1046         17.5268         17.0466
390040..........................................         15.1211         15.9612         16.6876         15.9078
390041..........................................         19.5760         19.8080         20.1482         19.8333
390042..........................................         21.1276         22.7693         22.6393         22.1864
390043..........................................         16.3561         17.2607         17.4764         17.0230
390044..........................................         19.5419         20.2813         13.2304         16.8712
390045..........................................         18.4591         18.5574         19.2907         18.7716
390046..........................................         20.4608         20.7303         16.6014         19.0179
390047..........................................         24.5824         27.6661         18.9455         23.5893
390048..........................................         18.3801         19.0920         19.7685         19.0433
390049..........................................         21.1318         21.1217         22.1009         21.4604
390050..........................................         20.9240         22.8808         22.2639         22.0253
390051..........................................         26.0485         25.7910         20.3683         23.9994
390052..........................................         17.0988         20.9306         19.2727         19.0857
390054..........................................         17.4382         17.8852         18.4975         17.9431
390055..........................................         25.8961         24.2211         23.5510         24.5324
390056..........................................         17.1692         17.7858         19.3901         18.0977
390057..........................................         19.7459         20.2059         16.4148         18.5380

[[Page 22799]]

 
390058..........................................         19.2543         19.7379         19.8418         19.6169
390060..........................................         13.6276               *               *         13.6276
390061..........................................         20.4819         21.2392         23.8722         21.8310
390062..........................................         16.4505         16.6721         17.3750         16.8291
390063..........................................         19.6373         20.0125         19.4965         19.7211
390065..........................................         20.0001         19.9361         15.3313         18.1038
390066..........................................         18.7064         19.8539         18.8152         19.1167
390067..........................................         20.6515         20.9688         21.2031         20.9451
390068..........................................         17.5524         18.3158         19.1109         18.3267
390069..........................................         19.2858         19.6466               *         19.4555
390070..........................................         20.1862         16.1988         21.8549         19.3957
390071..........................................         16.2298         15.7165         16.0100         15.9856
390072..........................................         15.5565         16.3133         16.2919         16.0432
390073..........................................         20.6859         20.5581         21.2623         20.8422
390074..........................................         16.5971         18.4806         18.3093         17.7465
390075..........................................         17.2676         17.9840         18.1131         17.7404
390076..........................................         21.4307         20.2475         21.3290         20.9889
390078..........................................         18.2328         19.2089         19.0156         18.8052
390079..........................................         18.1969         18.3312         18.9269         18.4731
390080..........................................         19.5180         18.8028         21.4768         19.8681
390081..........................................         23.9922         24.8351               *         24.4080
390083..........................................         20.5919               *               *         20.5919
390084..........................................         16.3463         16.4026         20.2529         17.4556
390086..........................................         17.2481         18.5265         18.6854         18.1599
390088..........................................         23.4941         23.6173         22.3275         23.2063
390090..........................................         20.6463         21.6437         21.3759         21.2068
390091..........................................         18.3746         18.1569         18.2060         18.2472
390093..........................................         16.6336         17.7171         18.4442         17.6019
390095..........................................         13.0459         16.3357         16.6933         15.2336
390096..........................................         19.3118         19.1171         22.4382         20.4516
390097..........................................         21.4115         23.5963         25.2738         23.2417
390100..........................................         20.3014         20.7859         20.9809         20.6913
390101..........................................         17.0534         17.9499         18.5039         17.8169
390102..........................................         19.4924         19.0461         21.5496         20.0293
390103..........................................         17.7054         18.4312         18.8667         18.3176
390104..........................................         15.9605         15.9008         16.3255         16.0548
390106..........................................         16.2783         16.6666         16.8439         16.6044
390107..........................................         19.1793         19.5178         21.0429         19.9329
390108..........................................         21.2872         21.0899         21.1820         21.1861
390109..........................................         14.6645         16.4597         16.5299         15.8639
390110..........................................         21.3191         21.5282         21.5388         21.4672
390111..........................................         28.7875         27.5193         32.0778         29.4304
390112..........................................         14.0439         14.9427               *         14.5099
390113..........................................         17.9377         19.1945         19.3634         18.8262
390114..........................................         22.9698         19.6295               *         21.2139
390115..........................................         24.7244         23.3461         21.3119         23.0378
390116..........................................         20.6016         21.4877         21.3671         21.1457
390117..........................................         16.9036         17.9393         18.0769         17.6425
390118..........................................         16.8962         18.3440         18.9507         18.0638
390119..........................................         18.5935         18.2951         18.8353         18.5714
390121..........................................         18.6422         20.8780         19.0503         19.5401
390122..........................................         17.4645         17.1902         17.7734         17.4764
390123..........................................         20.8412         20.8344         21.3974         21.0254
390125..........................................         15.9356         16.7983         17.5446         16.7393
390126..........................................         20.9383         20.6498               *         20.8020
390127..........................................         21.8849         21.7724         22.4555         22.0398
390128..........................................         19.4132         19.6792         19.3165         19.4699
390130..........................................         17.3253         17.7049         18.3695         17.7936
390131..........................................         16.8349         16.0986         19.2096         17.3202
390132..........................................         20.5528         21.1931         22.4903         21.3712
390133..........................................         24.6131         23.3489         19.9376         22.5639
390135..........................................         21.2497         21.5782         22.1905         21.6491
390136..........................................         17.6128         16.9737         20.6286         18.3801

[[Page 22800]]

 
390137..........................................         16.5598         17.5687         18.5397         17.5480
390138..........................................         18.8601         19.6212         20.6936         19.7394
390139..........................................         22.9351         24.4515         23.2945         23.5528
390142..........................................         26.7954         26.8086         27.9193         27.2106
390145..........................................         20.3393         20.3731         20.4228         20.3787
390146..........................................         17.7020         18.7922         18.6505         18.3503
390147..........................................         21.1085         20.9651         21.2492         21.1067
390150..........................................         19.6575         20.7294         20.3155         20.2474
390151..........................................         20.5084         21.6000         22.5206         21.5535
390152..........................................         19.1525         20.3353         19.4017         19.6203
390153..........................................         23.1183         23.7013         22.5900         23.1296
390154..........................................         15.8478         17.4036               *         16.6285
390156..........................................         21.1629         21.8498         22.5648         21.8420
390157..........................................         19.8268         19.6578         18.9868         19.5005
390158..........................................         21.6045               *               *         21.6045
390160..........................................         20.7676         21.4810         19.4463         20.4967
390161..........................................         12.3743         16.4799               *         14.3389
390162..........................................         21.0228         21.4095         21.9188         21.4386
390163..........................................         15.6227         16.8013         17.5312         16.6546
390164..........................................         21.5890         24.6765         24.9750         23.5327
390166..........................................         19.9612         19.0405               *         19.5017
390167..........................................         22.9136         19.8973               *         21.3982
390168..........................................         18.9936         18.7400         18.8863         18.8736
390169..........................................         18.9878         20.2382         22.0547         20.4487
390170..........................................         22.9877         26.5891               *         24.5773
390173..........................................         17.8568         18.5370         18.3816         18.2561
390174..........................................         25.2407         25.4189         25.4110         25.3577
390176..........................................         17.3577         17.8740         20.8368         18.6587
390178..........................................         17.7036         16.6993         17.0534         17.1490
390179..........................................         21.4093         21.6901         21.8593         21.6579
390180..........................................         25.1191         25.7074               *         25.4305
390181..........................................         17.0860         19.4654         23.1403         19.5445
390183..........................................         19.0834         17.8306         17.9848         18.2942
390184..........................................         20.7489         20.8060         20.9349         20.8256
390185..........................................         17.6516         18.8798         19.6989         18.7466
390189..........................................         18.6668         20.0889          5.6954         10.5640
390191..........................................         16.1993         16.3240         17.2270         16.5760
390192..........................................         16.3696         17.4537         17.2512         17.0206
390193..........................................         16.4663         16.7874         18.1209         17.0634
390194..........................................         20.1547         20.7953         21.2689         20.7092
390195..........................................         23.6920         24.6855         23.1069         23.8298
390197..........................................         18.9857         19.2690         19.7956         19.3317
390198..........................................         15.4508         15.9721         15.8833         15.7671
390199..........................................         16.6644         17.0515         17.9068         17.2031
390200..........................................         13.5898         15.1399         14.9496         14.6311
390201..........................................         20.5011         20.6296         20.3533         20.4916
390203..........................................         21.1895         20.9432         21.5141         21.2139
390204..........................................         20.8483         20.1779         22.5626         21.1871
390206..........................................         18.5746         18.4027               *         18.4910
390209..........................................         16.9558         17.4792         18.7059         17.7155
390211..........................................         17.9132         17.8638         18.4213         18.0846
390213..........................................         17.4453         18.8555         19.1553         18.5312
390215..........................................         21.4291         20.7084         21.1303         21.0799
390217..........................................         19.2926         19.1406         19.9837         19.4647
390219..........................................         21.6295         18.8292         19.6226         19.9600
390220..........................................         18.5178         18.7178               *         18.6191
390222..........................................         20.9080         21.5739         22.1548         21.5483
390223..........................................         22.6498         23.6482         21.4738         22.5019
390224..........................................         15.9058         15.3015               *         15.5965
390225..........................................         18.1752         18.6125         18.7290         18.5053
390226..........................................         23.1638         21.8268         21.7882         22.2642
390228..........................................         19.8129         19.4083         19.8180         19.6802
390231..........................................         24.4852         22.7544         19.7578         22.1186

[[Page 22801]]

 
390233..........................................         18.7707         19.4887         20.0152         19.4302
390235..........................................         24.6044         25.0857         21.4200         24.0078
390236..........................................         17.0339         16.2397         17.5043         16.9210
390237..........................................         21.7479         19.5230         22.2221         21.1193
390238..........................................               *         17.8211         17.1055         17.4821
390242..........................................         18.0943               *               *         18.0943
390244..........................................         14.4133         15.4611          8.2241         11.8858
390245..........................................         20.1544         26.0194               *         22.9968
390246..........................................         17.9214         18.9733         18.1348         18.3253
390247..........................................         20.6671         20.9526         21.2151         20.8919
390249..........................................         10.7336         12.7920         13.1657         12.2298
390256..........................................         23.7828         20.9469         20.5812         21.7018
390258..........................................         21.3629         21.9207         22.6852         21.9998
390260..........................................         21.1917         21.9509         15.1540         18.9540
390262..........................................         18.6684         18.2379               *         18.4504
390263..........................................         20.0939         20.6855         20.2304         20.3363
390265..........................................         19.5089         20.3580         20.4950         20.1207
390266..........................................         16.2372         17.1666         17.1290         16.8341
390267..........................................         20.5125         21.2974         19.2665         20.4773
390268..........................................         21.0161         21.3486         22.0909         21.4791
390270..........................................         17.8280         19.0925          9.3834         13.7053
390277..........................................         27.0983               *               *         27.0983
390278..........................................         19.2019         18.2865               *         18.7672
390279..........................................         13.6992         14.3241         14.8655         14.2998
390283..........................................               *               *         22.5490         22.5490
390284..........................................               *               *         34.3904         34.3904
400001..........................................          9.8615          9.9463         10.5757         10.1359
400002..........................................          9.3063         10.1417         13.0494         10.8249
400003..........................................          9.9865         10.8821         12.4078         11.0633
400004..........................................          8.4811          8.9864          8.5648          8.6695
400005..........................................          7.8494          9.5632          7.7432          8.3858
400006..........................................         10.5281         10.3444         10.1048         10.3288
400007..........................................          7.8637          6.4490          8.0174          7.3754
400009..........................................          8.3727          8.4207          8.8650          8.5497
400010..........................................         11.6642         10.6518         10.8011         10.9779
400011..........................................          5.6825          7.4979          8.5426          7.2512
400012..........................................          7.8134          8.2412          8.4728          8.1883
400013..........................................          8.2066          8.4579          9.2624          8.6839
400014..........................................          9.5354          9.5235          9.4798          9.5126
400015..........................................         10.3326         10.9505         14.4076         11.3577
400016..........................................         12.0743         13.2756         13.3922         12.9125
400017..........................................          8.5675          8.6421          9.2577          8.8024
400018..........................................          9.4534         10.4557          9.7049          9.8618
400019..........................................         10.1512         10.4332         10.8940         10.5307
400021..........................................          9.9121         10.6988         12.1434         10.9538
400022..........................................         11.1204         11.5861         12.2199         11.6336
400024..........................................          7.5594          7.8984          9.2409          8.1615
400026..........................................          7.1236          5.6454          5.8335          6.1312
400027..........................................          8.4862          9.5899               *          9.0120
400028..........................................          8.3991          8.8597          9.1794          8.7817
400031..........................................          9.7826          8.2660               *          8.9857
400032..........................................          9.7291         10.5498         10.0448         10.1074
400044..........................................         11.7484         11.9704         11.9486         11.8844
400048..........................................          8.9224          9.1701         15.1405         10.3604
400061..........................................         12.2770         12.4493         13.0988         12.5813
400079..........................................          7.0830               *          9.7203          8.1082
400087..........................................         10.3972          9.5097          9.8534          9.8687
400094..........................................          7.8208          8.9116          7.9187          8.1829
400098..........................................          7.2098          9.3308          9.7791          8.8630
400102..........................................          7.7288          9.8536          9.9903          9.1668
400103..........................................         10.7316         11.2069         11.5359         11.1167
400104..........................................          9.9416         11.0672         14.8764         11.3347
400105..........................................         10.1726          9.3049          9.0556          9.5335

[[Page 22802]]

 
400106..........................................          8.5143          9.3123          9.1611          8.9912
400109..........................................         10.1786         10.9826         11.8760         11.0486
400110..........................................         10.5250         10.3326         10.5277         10.4760
400111..........................................          9.5600          9.5583         10.9665         10.1021
400112..........................................         12.8478         10.1755               *         11.5026
400113..........................................          9.4835          9.2238          8.3168          9.0068
400114..........................................          6.4076          9.0496          7.0510          7.4630
400115..........................................          9.1311          9.8244          8.5487          9.1780
400117..........................................         10.0381         10.2295         10.8756         10.3823
400118..........................................          8.6964          9.4398         11.4051          9.9004
400120..........................................          9.7425          9.5274         10.6584          9.9956
400121..........................................          7.1061          7.8052          9.8322          8.2686
400122..........................................          8.4806          8.1911          7.6413          8.0571
400123..........................................          9.0217          7.8099         10.2367          9.0130
400124..........................................         11.4839         12.0999         12.2452         11.9729
400125..........................................               *               *         10.2056         10.2056
410001..........................................         22.5322         23.2808         22.0088         22.6048
410004..........................................         22.3212         22.4801         21.0638         22.0103
410005..........................................         21.2407         23.1444         22.7170         22.3365
410006..........................................         21.9798         23.3968         23.8700         23.0621
410007..........................................         20.9489         22.1452         23.1325         22.1106
410008..........................................         22.6133         23.0662         24.9726         23.5244
410009..........................................         24.0769         24.4899         23.9378         24.1687
410010..........................................         27.1426         26.9813         26.7847         26.9663
410011..........................................         24.3676         25.2926         26.0035         25.2143
410012..........................................         21.3337         24.5811         24.1695         23.4018
410013..........................................         25.0050         24.5122         24.8800         24.7951
420002..........................................         20.2049         19.4845         19.6477         19.7465
420004..........................................         19.4079         19.7968         20.8633         20.0389
420005..........................................         15.9906         17.3510         17.9694         17.1171
420006..........................................         18.2374         18.3439         19.1760         18.5687
420007..........................................         17.5783         18.2096         18.6456         18.1319
420009..........................................         17.2515         18.5456         19.8532         18.5742
420010..........................................         17.9141         17.1184         18.0252         17.6914
420011..........................................         14.9944         16.5664         18.0970         16.4913
420014..........................................         16.7219         16.6065         18.0519         17.0894
420015..........................................         17.1802         18.8411         20.1164         18.5841
420016..........................................         18.1451         15.6241         15.5485         16.2939
420018..........................................         19.7285         19.7367         21.8775         20.3791
420019..........................................         15.5521         16.9990         17.1726         16.5419
420020..........................................         17.9011         20.9449         20.2563         19.6716
420023..........................................         20.9663         19.4855         19.3278         19.8743
420026..........................................         21.8968         20.3476         21.8749         21.3678
420027..........................................         18.0774         18.8457         18.4837         18.4697
420029..........................................         18.3557               *               *         18.3557
420030..........................................         17.8215         19.1453         20.6448         19.3038
420031..........................................         13.0718         14.1855          8.2516         11.1227
420033..........................................         21.0863         21.7279         23.1303         21.9705
420036..........................................         19.7421         17.6136         21.3791         19.4718
420037..........................................         21.9603         21.7908         22.7099         22.1669
420038..........................................         16.1498         17.6726         18.6568         17.4393
420039..........................................         16.9646         15.8385         18.3017         17.0260
420042..........................................         14.6567               *               *         14.6567
420043..........................................         18.3607         19.4521         19.7570         19.1785
420048..........................................         18.0286         18.4367         18.8070         18.4223
420049..........................................         19.2340         17.5854         19.2946         18.6845
420051..........................................         18.2518         19.5001         19.2163         19.0146
420053..........................................         16.5452         16.9599         16.8300         16.7761
420054..........................................         16.5474         18.2702         20.2574         18.3229
420055..........................................         16.1823         19.2048         16.8717         17.3777
420056..........................................         15.5966         14.8695         15.1835         15.1636
420057..........................................         14.5006         15.9849         24.0765         18.1532
420059..........................................         19.1303         15.8160         17.1483         17.3325

[[Page 22803]]

 
420061..........................................         16.1310         16.5555         17.3543         16.6881
420062..........................................         18.9513         17.8205         21.3792         19.3650
420064..........................................         15.4531         16.7227         16.0794         16.0985
420065..........................................         19.0645         19.6902         19.9435         19.5673
420066..........................................         15.5001         15.1804         18.0042         16.2261
420067..........................................         18.3106         18.8610         19.7824         19.0239
420068..........................................         17.2144         18.5030         18.5481         18.0958
420069..........................................         16.3189         17.0788         18.1298         17.2134
420070..........................................         17.4486         18.0057         17.3876         17.6174
420071..........................................         18.2878         19.4482         20.3902         19.3836
420072..........................................         12.6013         13.8550         15.0158         13.8117
420073..........................................         19.2011         19.1604         19.8502         19.4076
420074..........................................         13.8038         16.9292         17.7050         16.1034
420075..........................................         16.2946         14.2931         12.8158         14.3372
420078..........................................         20.6818         20.7317         21.2688         20.9023
420079..........................................         18.7710         20.8639         21.0874         20.2636
420080..........................................         24.8321         22.3443         21.9968         22.9897
420081..........................................         20.4211               *               *         20.4211
420082..........................................         18.8848         20.4653         21.4326         20.2642
420083..........................................         23.3425         20.1472         22.6376         21.9902
420085..........................................         18.5502         19.9603         21.6791         20.1188
420086..........................................         19.3054         25.7179         20.2878         21.4636
420087..........................................         18.4016         19.1403         19.8388         19.1412
420088..........................................         17.9063         17.1938         19.9919         18.3046
420089..........................................         21.6608         20.2537         20.5360         20.7623
420091..........................................         18.5723         18.8687         20.3092         19.2195
420093..........................................         16.7734         17.4689         18.3902         17.5654
420094..........................................         32.6768               *               *         32.6768
430004..........................................         17.8435         18.5438         19.6344         18.6310
430005..........................................         15.8449         16.3059         16.4560         16.2068
430007..........................................         14.0586         14.1078         14.6331         14.2620
430008..........................................         16.7640         17.6640         18.1323         17.5240
430010..........................................         16.1093         17.1766         19.8191         17.5891
430011..........................................         16.4234         16.9848         17.4750         16.9703
430012..........................................         17.7809         17.2775         17.5713         17.5419
430013..........................................         17.2424         18.1338         18.4817         17.9391
430014..........................................         18.4417         16.8925         19.9484         18.3095
430015..........................................         16.4123         18.0019         18.2875         17.5236
430016..........................................         18.9715         19.4759         20.8850         19.7559
430018..........................................         14.9100         14.8854         16.2244         15.3323
430022..........................................         12.9532         13.4905         14.5118         13.6222
430023..........................................         11.6383         12.2331         16.2164         13.2302
430024..........................................         13.9942         15.4709         16.1801         15.3449
430026..........................................         10.8532               *               *         10.8532
430027..........................................         18.6367         19.1461         20.2591         19.2968
430028..........................................         16.7185         18.2312         17.1574         17.3521
430029..........................................         15.1010         16.6500         17.6986         16.5066
430031..........................................         12.4631         13.1258         12.4660         12.6792
430033..........................................         14.6423         15.3003         17.3652         15.6688
430034..........................................         12.8513         15.4064         14.2491         14.1740
430036..........................................         13.7807         13.6967         15.6258         14.3461
430037..........................................         15.9545         16.5368         18.1293         16.8632
430038..........................................         11.9419         13.7167         18.4078         14.2118
430040..........................................         13.3722         13.6745         14.4509         13.8057
430041..........................................         12.6235         13.1936         14.8816         13.4964
430043..........................................         13.4288         13.6908         14.9949         14.0204
430044..........................................         16.4488         18.4970         21.0823         18.5195
430047..........................................         15.6227         17.4956         17.9823         16.9377
430048..........................................         17.2589         18.3524         19.6010         18.3783
430049..........................................         14.4354         15.5381         15.2237         15.0640
430051..........................................         17.2139         17.0574         18.8070         17.6987
430054..........................................         13.5011         14.7251         14.8003         14.3524
430056..........................................         11.4117         11.7627          9.7578         10.9731

[[Page 22804]]

 
430057..........................................         15.1516         15.4390         17.2805         15.9601
430060..........................................          8.6409          9.0358         10.0176          9.2343
430062..........................................         10.8879               *               *         10.8879
430064..........................................         12.7394         14.4367         14.2184         13.7779
430065..........................................         12.7660               *               *         12.7660
430066..........................................         13.4380         14.3557         15.6660         14.4524
430073..........................................         14.9784         16.1133         15.3776         15.4839
430076..........................................         12.2452         12.7608         13.9883         12.9521
430077..........................................         17.7126         19.3012         19.8558         18.9586
430079..........................................         12.9780         13.6836         14.1815         13.5924
430087..........................................         10.4491               *               *         10.4491
430089..........................................         17.0065         17.8908         17.9790         17.6658
430090..........................................               *         21.5239         21.5974         21.5592
430091..........................................               *         19.2146         18.1567         18.5152
430092..........................................               *               *         21.3807         21.3807
430093..........................................               *               *         19.5013         19.5013
440001..........................................         15.3134         14.8713         15.5897         15.2550
440002..........................................         18.5411         19.1498         20.3740         19.3756
440003..........................................         17.4736         18.3658         19.3042         18.3967
440006..........................................         20.6559         19.6021         21.1072         20.4264
440007..........................................          7.7632         12.1230         14.8959         11.0241
440008..........................................         15.4701         17.2848         18.8994         17.1822
440009..........................................         15.4558         17.8424         17.4831         16.9676
440010..........................................         13.5118         19.9829         16.3283         16.4644
440011..........................................         17.1591         17.6948         18.3375         17.7161
440012..........................................         19.0606         15.9837         19.5537         18.2430
440014..........................................         14.6093         15.9195         16.1143         15.5705
440015..........................................         21.0884         18.2632         22.0659         20.4116
440016..........................................         14.9409         15.4097         16.2964         15.5583
440017..........................................         21.1258         19.6215         20.4426         20.3788
440018..........................................         18.2080         16.4115         17.4995         17.3550
440019..........................................         28.2242         20.0416         21.0768         22.6204
440020..........................................         15.5889         18.1154         17.4666         17.0702
440022..........................................         19.0214         15.8459               *         17.5909
440023..........................................         14.1410         15.4721         16.6111         15.3545
440024..........................................         18.1028         18.4432         18.4046         18.3183
440025..........................................         15.2826         15.8784         16.3140         15.8395
440026..........................................         22.9174         23.0550         23.2566         23.0549
440029..........................................         18.5183         19.4326         20.7050         19.5797
440030..........................................         15.5718         16.2941         16.9925         16.3267
440031..........................................         14.3023         15.5432         17.0211         15.6197
440032..........................................         13.5996         13.9775         13.8140         13.7931
440033..........................................         14.0409         14.5304         13.7328         14.1227
440034..........................................         17.9315         19.5470         19.5135         19.0190
440035..........................................         18.1578         18.9026         19.3034         18.7862
440039..........................................         19.3747         19.9439         21.6560         20.3432
440040..........................................         17.4965         16.3740         16.9275         16.9214
440041..........................................         13.6279         14.6621         14.9545         14.4249
440046..........................................         16.8798         18.1654         19.0756         18.0134
440047..........................................         17.0037         16.6646         17.8092         17.1528
440048..........................................         18.1449         19.4498         21.4993         19.5981
440049..........................................         16.7066         17.9292         20.8371         18.4663
440050..........................................         16.7627         19.1328         18.2511         18.0098
440051..........................................         14.9074         13.1901         16.0421         14.6532
440052..........................................         16.2693         16.6541               *         16.4546
440053..........................................         17.6873         18.5515         19.6494         18.6583
440054..........................................         12.3134         13.8716         13.3967         13.1942
440056..........................................         14.2534         15.9821         16.2742         15.4778
440057..........................................         12.7190         12.7925         13.7257         13.0446
440058..........................................         18.7381         18.8118         16.5104         18.0102
440059..........................................         17.5274         18.5418         19.6018         18.6049
440060..........................................         15.8599         18.0586         19.7916         17.7309
440061..........................................         16.8442         14.9708         24.0082         18.4685

[[Page 22805]]

 
440063..........................................         18.2923         19.3222         18.5737         18.7318
440064..........................................         17.6154         17.7652         18.8038         18.0538
440065..........................................         18.6943         18.5825         16.6540         17.9684
440067..........................................         22.0655         16.2811         17.1917         18.2178
440068..........................................         17.4513         19.4695         19.1569         18.6340
440070..........................................         15.0440         13.7035         14.0437         14.2715
440071..........................................         16.2691         17.0186         16.9416         16.7371
440072..........................................         16.7675         17.5995         19.1522         17.8026
440073..........................................         18.5576         19.1714         19.5554         19.1079
440078..........................................         13.0916         15.0849         16.0188         14.6728
440081..........................................         17.9702         18.3587         18.9886         18.4558
440082..........................................         23.0805         22.2857         20.3664         21.8599
440083..........................................         35.0978         14.8525         13.7423         17.4998
440084..........................................         13.3678         13.4378         13.7731         13.5305
440091..........................................         19.7250         19.6114         20.1065         19.8343
440100..........................................         13.9487         13.8437         14.7113         14.1637
440102..........................................         13.9575         14.3510         14.5500         14.2949
440103..........................................         19.2083         20.3052         18.6990         19.3857
440104..........................................         22.3883         22.4403         22.6754         22.4883
440105..........................................         16.0338         16.7131         17.1172         16.6050
440109..........................................         14.2491         16.0446         17.7443         15.8919
440110..........................................         15.9174         21.1716         17.4123         17.8783
440111..........................................         21.0682         23.2425         23.2254         22.5309
440114..........................................         13.6095         14.4997         15.0036         14.3318
440115..........................................         12.9668         17.4514         18.5457         16.2205
440120..........................................         18.2993         17.2384         16.3115         17.2831
440125..........................................         16.1067         15.6588         19.0514         16.9328
440130..........................................         16.6750         17.8223         17.4857         17.3264
440131..........................................         14.6752         15.5048         16.1214         15.4186
440132..........................................         15.9069         16.6553         16.8871         16.4950
440133..........................................         21.5116         21.5313         22.7184         21.8977
440135..........................................         20.9029         19.2010         22.2707         20.8388
440137..........................................         14.6966         14.5632         15.0070         14.7511
440141..........................................         12.4774         13.5308         15.9429         13.7977
440142..........................................         13.0059         15.7287         16.7797         15.0556
440143..........................................         17.8429         17.7821         18.2061         17.9416
440144..........................................         16.6666         17.6415         18.4330         17.5831
440145..........................................         13.6577         17.0608         18.3948         16.1716
440147..........................................         22.0069         21.4304         26.1464         23.0399
440148..........................................         17.6438         19.2435         19.4598         18.7842
440149..........................................         17.1496         16.6923         14.8350         16.2240
440150..........................................         13.0775         20.1411         20.0178         17.1910
440151..........................................         15.4250         17.4248         18.1216         16.9820
440152..........................................         17.8399         21.0287         22.7664         20.2196
440153..........................................         16.0954         16.7769         16.0572         16.3283
440156..........................................         19.6117         29.5557         21.0346         22.8749
440157..........................................         11.3982         16.9265         18.4249         15.5384
440159..........................................         17.6237         17.7158         20.9371         18.4872
440161..........................................         20.7643         21.8013         22.1611         21.5480
440162..........................................         14.4121         14.7637               *         14.5681
440166..........................................         18.1413         19.6684         19.2159         18.9985
440168..........................................         15.9513         18.6535         19.1509         17.9995
440173..........................................         18.4683         18.6402         19.1299         18.7524
440174..........................................         17.0080         17.3294         18.0865         17.4583
440175..........................................         17.6107         20.0802         15.5827         17.7347
440176..........................................         18.7529         18.0294         18.9159         18.5457
440180..........................................         17.3412         19.7773         20.4039         19.2011
440181..........................................         11.8471         16.4878         17.7709         15.0662
440182..........................................         20.3202         17.7487         19.7094         19.1341
440183..........................................         19.4374         22.7067         21.3465         21.1277
440184..........................................         18.0603         17.2037         16.8880         17.4646
440185..........................................         18.7286         19.3870               *         19.0562
440186..........................................         18.5312         19.3948         15.8016         17.9134

[[Page 22806]]

 
440187..........................................         16.2530         18.9713         15.3044         16.8551
440189..........................................         16.1906               *         18.5252         17.4309
440192..........................................         19.9669         19.0839         16.5173         18.5279
440193..........................................         18.3952         19.0811         18.2608         18.5816
440194..........................................         20.3343         19.8682         22.2384         20.8427
440197..........................................         23.1080         21.9618         21.3772         22.0839
440200..........................................         16.0619         17.9575         19.5226         17.9170
440203..........................................         16.6132         18.3400         16.2861         17.0710
440206..........................................         15.5462         16.4429               *         16.0270
440209..........................................         14.7466               *               *         14.7466
440210..........................................         12.3292         11.0218         11.0719         11.3670
440211..........................................               *         14.8972               *         14.8972
440212..........................................               *         17.0685               *         17.0685
440213..........................................               *         19.5760               *         19.5760
440214..........................................               *               *         28.0285         28.0285
440215..........................................               *               *         22.2928         22.2928
450002..........................................         19.9195         21.3749         21.4770         20.9126
450004..........................................         15.2751         16.6723         16.7850         16.2360
450005..........................................         15.5888         18.3600         16.6396         16.8103
450007..........................................         15.7536         16.9681         19.1910         17.3218
450008..........................................         15.7458         17.0832         17.6582         16.7901
450010..........................................         16.0790         16.5001         17.6677         17.0234
450011..........................................         18.0137         17.1942         20.5022         18.5856
450014..........................................         18.2173         17.9495         17.5550         17.8927
450015..........................................         18.4400         18.9895         20.0974         19.1233
450016..........................................         17.3054         18.4463         18.3456         18.0337
450018..........................................         20.4133         21.4788         22.8298         21.4884
450020..........................................         16.9661         17.8415         19.1153         18.0122
450021..........................................         22.6910         23.0843         21.7842         22.5219
450023..........................................         16.6408         16.0831         17.6360         16.7896
450024..........................................         16.5604         17.3518         18.5649         17.4769
450025..........................................         16.4396         17.0004               *         16.7280
450028..........................................         18.4287         18.8764         17.4971         18.2201
450029..........................................         17.6909         17.4716         17.5595         17.5741
450031..........................................         20.8992         22.2222         29.6945         23.8280
450032..........................................         15.2404         17.3317         13.9785         15.3652
450033..........................................         20.8634         19.7437         20.7772         20.4518
450034..........................................         18.9068         19.6721         18.7154         19.0969
450035..........................................         16.8132         20.0951         20.3500         19.0191
450037..........................................         18.6549         19.5411         19.8210         19.3526
450039..........................................         22.0811         19.8143         17.9888         20.0023
450040..........................................         17.5179         16.8534         19.6370         18.0669
450042..........................................         17.5906         19.8921         18.4417         18.6126
450044..........................................         21.0399         24.7961         20.1028         21.8870
450046..........................................         17.0917         18.6536         18.0851         17.8763
450047..........................................         13.9022         13.4486         16.9028         14.6102
450050..........................................         13.0037         14.7669         15.9701         14.4910
450051..........................................         20.0763         21.0236         20.2292         20.4528
450052..........................................         13.5278         13.8881         15.2911         14.2591
450053..........................................         17.3139         17.0467         14.3712         16.3666
450054..........................................         21.9835         22.8960         15.9388         20.5562
450055..........................................         14.8119         15.0433         15.8526         15.2415
450056..........................................         20.0008         21.8436         20.4781         20.7787
450058..........................................         16.9832         18.0967         17.4599         17.5079
450059..........................................         14.2072         15.2168         19.7037         16.2518
450063..........................................         13.8126         14.3815         12.7037         13.6024
450064..........................................         16.4165         17.4093         19.7682         17.8341
450065..........................................         19.6087         21.4934         23.3797         21.3723
450068..........................................         22.6924         22.8998         21.9406         22.5334
450072..........................................         17.3794         19.0111         18.0307         18.1442
450073..........................................         16.6168         17.1002         17.4642         17.0560
450078..........................................         13.4875         11.7265         13.2820         12.8188
450079..........................................         19.4899         21.0518         19.5823         20.0919

[[Page 22807]]

 
450080..........................................         16.3147         17.4553         19.5691         17.8032
450081..........................................         16.1653         16.3448         17.5737         16.7023
450082..........................................         13.2952         16.1585         18.1087         15.9363
450083..........................................         20.1830         21.5884         20.8111         20.8940
450085..........................................         14.2167         18.3602         20.0085         17.2728
450087..........................................         21.4764         22.0273         21.8971         21.7995
450090..........................................         13.9101         15.0939         15.7102         14.9065
450092..........................................         15.7316         16.8260         17.9520         16.8805
450094..........................................         19.4249         21.3158         23.0087         21.3016
450096..........................................         16.6300         17.8813         18.6802         17.7158
450097..........................................         18.2740         19.5723         19.7187         19.2252
450098..........................................         15.4796         20.5754         19.1707         18.3853
450099..........................................         22.8834         19.2258         20.4181         20.6312
450101..........................................         16.9628         17.1330         18.1155         17.3801
450102..........................................         18.8465         18.6707         18.5587         18.6892
450104..........................................         15.9781         16.6744         16.9800         16.5575
450107..........................................         20.7359         25.1986         23.0798         22.8910
450108..........................................         16.1451         15.6324         15.2394         15.6277
450109..........................................         12.7654         13.8127         10.7641         12.1774
450110..........................................         21.4421         19.5821               *         20.4354
450111..........................................         19.2749         19.6350               *         19.4562
450112..........................................         14.7610         16.0441         14.3254         14.9837
450113..........................................         18.5356         20.9777         20.8306         19.9901
450118..........................................         15.8317         17.9053               *         16.9195
450119..........................................         18.3166         20.2853         20.1852         19.6454
450121..........................................         18.2278         20.4641         21.6525         20.0695
450123..........................................         19.1912         15.7618         14.1755         16.0237
450124..........................................         21.0925         22.7480         21.9767         21.9459
450126..........................................         17.4512         21.7233         21.4686         19.9524
450128..........................................         15.8881         18.2184         18.1446         17.4552
450130..........................................         17.8722         20.4156         17.4027         18.5777
450131..........................................         17.6163         19.2589         17.4168         18.0711
450132..........................................         18.0745         18.1713         16.8847         17.6996
450133..........................................         19.9259         23.6366         26.0763         23.0339
450135..........................................         20.8065         21.0306         22.0320         21.2622
450137..........................................         23.9555         22.4590         23.1148         23.1794
450140..........................................         18.0743         20.2280         17.2060         18.5255
450143..........................................         14.4623         14.5270         14.8917         14.6528
450144..........................................         16.3037         18.1121         18.7521         17.8369
450145..........................................         14.8441         15.6078         15.8542         15.4241
450146..........................................         14.2041         17.8572         15.5030         15.8115
450147..........................................         18.0664         18.9363         18.5236         18.5193
450148..........................................         22.0269         18.6758         24.1780         21.4997
450149..........................................         24.0005         19.7521         21.7219         21.7182
450150..........................................         15.2061         16.3719         17.8612         16.4235
450151..........................................         14.8373         15.2906         16.4209         15.5098
450152..........................................         17.3780         18.0061         17.7265         17.7015
450153..........................................         19.9447         19.4419         17.3002         18.8465
450154..........................................         13.1810         13.8731         13.9119         13.6623
450155..........................................         23.7678         11.5841         13.3456         14.7760
450157..........................................         14.6623         15.6371         15.3083         15.2158
450160..........................................          8.7503         16.6533         10.6852         11.1452
450162..........................................         22.1981         20.9560         21.9218         21.6852
450163..........................................         16.9811         17.5403         18.1128         17.5693
450164..........................................         20.0368         16.9741         17.7723         18.1030
450165..........................................         15.1561         13.9218         14.3250         14.4625
450166..........................................         10.2801         11.4772         11.0097         10.9389
450169..........................................         15.8793         13.1990               *         14.1674
450170..........................................         14.8131         14.2997         14.3234         14.4821
450176..........................................         16.3031         16.9674         17.2576         16.8653
450177..........................................         14.7280         14.9241         15.2440         14.9810
450178..........................................         16.7550         17.8508         16.0280         16.8828
450181..........................................         14.0192         15.5622         16.9427         15.5485

[[Page 22808]]

 
450184..........................................         19.9674         21.1263         18.7419         19.9896
450185..........................................         13.0632         14.0714         11.1599         12.6084
450187..........................................         17.5702         16.6945         18.2036         17.4833
450188..........................................         13.7757         14.3938         15.1954         14.4624
450191..........................................         18.8023         20.1222         20.9512         19.9757
450192..........................................         19.3352         20.3795         21.2497         20.3207
450193..........................................         22.7325         23.1963         23.2623         23.0664
450194..........................................         19.1466         20.5187         20.4842         20.0547
450196..........................................         16.4929         17.1955         18.1011         17.2598
450200..........................................         17.3756         18.7387         19.2228         18.4203
450201..........................................         17.0548         16.9908         16.9500         16.9956
450203..........................................         18.6552         20.6712         19.0752         19.4944
450209..........................................         18.6566         19.0811         19.8943         19.1865
450210..........................................         14.2317         13.9758         16.5059         14.8500
450211..........................................         17.1433         17.9857         18.6419         17.9272
450213..........................................         18.4472         17.7631         18.3953         18.2239
450214..........................................         17.2465         19.0475         20.9959         19.0269
450217..........................................         11.6893         12.8457         12.7647         12.4509
450219..........................................         15.4207         15.3976         17.6884         16.1962
450221..........................................         16.9935         16.3700         15.0701         16.0556
450222..........................................         18.4542         20.3129         19.8967         19.5439
450224..........................................         22.8300         24.9046         16.2265         20.5869
450229..........................................         16.4116         16.4503         16.7853         16.5551
450231..........................................         17.7045         19.1564         18.8419         18.8309
450234..........................................         13.3012         16.1945         16.3955         15.4391
450235..........................................         13.4177         15.2332         16.1851         15.0198
450236..........................................         15.6774         16.6703         16.4957         16.3054
450237..........................................         17.3984         20.7930         18.0874         18.7189
450239..........................................         13.6376         17.1308         17.8401         16.0311
450241..........................................         14.8674         12.5675         16.4240         14.4148
450243..........................................         12.3626         11.9099         13.1754         12.4894
450246..........................................         17.9702         16.5478         16.7959         17.0548
450249..........................................         11.6279         12.0302         11.7658         11.8055
450250..........................................         14.9133         10.2844         13.6787         12.3052
450253..........................................         15.3542         12.2402         13.2177         13.4392
450258..........................................         13.2334         16.0466         16.7337         15.4196
450259..........................................         17.8488               *               *         17.8488
450264..........................................         13.8879         13.8929         14.5956         14.1447
450269..........................................         14.9334         12.3594         12.3957         13.0850
450270..........................................         12.7018         12.8381         14.1324         13.1772
450271..........................................         15.4998         16.6319         16.7831         16.3572
450272..........................................         17.9514         19.9331         18.4344         18.7713
450276..........................................         12.7053         13.1155         14.0745         13.3159
450278..........................................         13.7894         14.8291         15.2950         14.5985
450280..........................................         19.4926         22.2984         20.1523         20.6175
450283..........................................         13.8916         14.5664         15.1950         14.5306
450286..........................................         12.1212               *               *         12.1212
450288..........................................         15.9878         16.2502         18.3824         16.7799
450289..........................................         18.3478         20.3104         20.0002         19.5531
450292..........................................         19.5050         16.9693         16.1840         17.4483
450293..........................................         14.4281         16.0132         15.8531         15.4701
450296..........................................         20.6628         21.6000         22.3430         21.5410
450299..........................................         17.9678         21.5672               *         19.7778
450303..........................................         12.6720         12.4582         12.8996         12.6812
450306..........................................         13.3165         13.8216         14.3639         13.8801
450307..........................................         16.6779         16.4622         17.0691         16.7424
450309..........................................         16.2055         13.1480         11.4661         13.2592
450315..........................................         20.8043         22.8140         21.4684         21.6913
450320..........................................         19.6331         20.0946         20.6596         20.1159
450321..........................................         13.3932         13.1752         14.6055         13.7332
450322..........................................         12.4570         22.7667         29.1884         20.6852
450324..........................................         17.8697         17.7886         18.6228         18.0773
450327..........................................         16.0935         11.7511         13.3639         13.4001

[[Page 22809]]

 
450330..........................................         18.4163         18.9425         19.8066         19.0827
450334..........................................         12.2721         12.8051         13.7850         12.9653
450337..........................................         17.4208         17.1073         25.1355         18.7580
450340..........................................         15.8519         17.6914               *         16.7663
450341..........................................         19.1828         18.9429               *         19.0666
450346..........................................         17.1038         17.5367         18.9475         17.8083
450347..........................................         17.6908         17.1099         19.2848         18.0094
450348..........................................         12.9414         13.9535         13.2741         13.3967
450351..........................................         15.9772         18.4116         18.7311         17.7343
450352..........................................         17.8528         18.7480         20.1871         18.9532
450353..........................................         15.0020         17.7539         16.0003         16.2513
450355..........................................         14.3182         11.9473         11.7765         12.5557
450358..........................................         21.2812         22.3235         23.2886         22.3172
450362..........................................         15.3536         15.8847         18.1747         16.4652
450369..........................................         15.1854         15.2233         14.4262         14.9370
450370..........................................         15.4368         12.6061         14.6709         14.1203
450371..........................................         11.8996         24.6339         16.0236         16.3341
450372..........................................         19.8589         20.0924         19.9926         19.9822
450373..........................................         17.5998         17.4183         17.9531         17.6605
450374..........................................         12.8264         13.6099         15.1750         13.8338
450378..........................................         23.1598         23.5789         23.4599         23.4221
450379..........................................         20.2756         22.7632         22.8756         21.9542
450381..........................................         15.6215         16.4166         15.2513         15.8628
450388..........................................         17.5561         19.2499         18.9920         18.6062
450389..........................................         18.1478         18.1797         18.6769         18.3421
450393..........................................         18.7387         20.2784         22.4992         20.3300
450395..........................................         16.6754         18.3768         17.5097         17.5123
450399..........................................         16.3066         15.7845         15.3491         15.8113
450400..........................................         14.0761         19.5379         18.6668         17.2665
450403..........................................         21.3691         20.1989         22.7969         21.4798
450411..........................................         14.0463         14.4832         14.8054         14.4468
450417..........................................         13.8517         13.4983         15.3591         14.2291
450418..........................................         20.5847         21.9161         21.9690         21.5007
450419..........................................         21.8196         20.6325         22.8505         21.7461
450422..........................................         24.5309         26.4848         28.0257         26.2815
450423..........................................         19.4352         22.7132               *         20.9607
450424..........................................         17.5658         18.9741         18.7478         18.4717
450429..........................................         11.3811         13.8723               *         12.4654
450431..........................................         16.2696         19.6304         20.8421         18.7034
450438..........................................         16.5461         19.5028         14.5873         16.7445
450446..........................................         21.9685         13.0986         20.7592         18.0346
450447..........................................         16.6124         18.0376         18.1815         17.5795
450451..........................................         19.6424         18.8948         18.1921         18.8786
450457..........................................         19.7689         24.7880         19.6569         21.1382
450460..........................................         14.2156         15.1765         14.5364         14.6270
450462..........................................         20.1347         22.6212         17.9464         20.1419
450464..........................................         13.4714         13.2931         15.5908         14.0563
450465..........................................         15.2203         15.5650         15.4731         15.4326
450467..........................................         15.6034         10.6184         16.8658         13.7380
450469..........................................         22.1012         19.6269         21.1652         20.9069
450473..........................................         14.1895         19.9761         19.7148         17.9827
450475..........................................         16.2489         16.3404         16.4898         16.3610
450484..........................................         19.5869         16.8131         18.2663         18.1595
450488..........................................         18.6813         19.3457         19.2173         19.0899
450489..........................................         14.5747          9.9326         15.8517         12.9537
450497..........................................         11.9242         15.0886         15.1284         14.0029
450498..........................................         12.0249         13.8551         14.4713         13.5076
450508..........................................         19.8722         18.8069         18.7309         19.1164
450514..........................................         22.2791         21.3243         20.0144         21.2387
450517..........................................         12.8702         27.8815         14.3191         16.6822
450518..........................................         19.0112         19.8116         21.4888         20.0420
450523..........................................         20.2589         20.0792         20.8894         20.3958
450530..........................................         22.9101         22.8623         21.1634         22.2676

[[Page 22810]]

 
450534..........................................         24.0835         19.9376         20.1520         21.2600
450535..........................................         21.2659         19.6645         21.0513         20.6461
450537..........................................         21.7432         20.8438         20.1161         20.8690
450538..........................................         19.6864               *               *         19.6864
450539..........................................         14.2536         16.4921         17.7681         16.1703
450544..........................................         19.3848         23.9283         23.8271         21.9636
450545..........................................         16.9674         19.5558         20.2823         18.9428
450547..........................................         13.8074         14.8248         17.8756         15.6065
450551..........................................         13.9069         16.9439         16.6237         15.8128
450558..........................................         20.0164         22.2574         20.7404         21.0120
450559..........................................         13.4572               *               *         13.4572
450561..........................................         16.8162               *               *         16.8162
450563..........................................         30.3744         19.9218         21.3788         22.6596
450565..........................................         16.4545         16.2652         17.3803         16.7063
450570..........................................         17.7135         18.9532         19.0336         18.5591
450571..........................................         16.9705         17.5598         18.2784         17.6264
450573..........................................         15.6698         12.2502         17.0111         14.8796
450574..........................................         14.2411         14.5965         14.6128         14.4845
450575..........................................         19.0613         19.3925         22.5621         20.3955
450578..........................................         16.8731         15.4783         17.7906         16.6611
450580..........................................         15.3581         15.8321         16.5934         15.9704
450583..........................................         15.5040         15.6580         14.4411         15.1895
450584..........................................         13.3747         14.2321         14.7876         14.1390
450586..........................................         12.8439         14.3773         13.7155         13.6793
450587..........................................         17.1124         17.0230         18.5905         17.5554
450591..........................................         17.9151         17.8981         17.7442         17.8480
450596..........................................         14.8232         22.5420         21.6729         19.1117
450597..........................................         16.1797         17.0776         17.6667         16.9974
450603..........................................         12.7682         11.6442         23.5572         15.3844
450604..........................................         15.4790         16.4535         17.2702         16.4273
450605..........................................         20.1541         21.1400         19.4580         20.2362
450609..........................................         10.7323         15.9753         16.7508         14.5094
450610..........................................         16.7464         18.9924         19.2006         18.3347
450614..........................................         13.8304         17.9853         16.5754         15.9153
450615..........................................         14.7457         14.8562         15.1188         14.9156
450617..........................................         19.5381         20.3387         20.8919         20.3006
450620..........................................         13.7063         15.8380         16.0987         15.2421
450623..........................................         21.8275         22.1950         15.3964         19.4094
450626..........................................         19.7896         18.1673         18.4349         18.7617
450628..........................................         16.8345         20.5611         18.6078         18.6471
450630..........................................         19.1904         21.6876         20.9444         20.5676
450631..........................................         17.5555         20.0417         21.5359         19.4585
450632..........................................         12.7295         11.7587         13.9147         12.7814
450633..........................................         20.7209         19.5183         19.3340         19.8372
450634..........................................         20.2932         23.5333         22.9877         22.3295
450638..........................................         19.6968         23.1437         22.1704         21.6228
450639..........................................         20.3050         23.1936         20.9189         21.4283
450641..........................................         13.5049         16.5125         15.7019         15.1464
450643..........................................         17.4268         18.7054         16.8152         17.6481
450644..........................................         20.7904         23.6587         22.7721         22.2903
450646..........................................         19.9866         19.8274         18.0467         19.2248
450647..........................................         22.4196         24.7981         24.1058         23.8008
450648..........................................         14.7541         14.8488         14.8968         14.8343
450649..........................................         15.8156         16.4496         16.6577         16.3245
450651..........................................         20.7304         22.7664         22.6977         22.1014
450652..........................................         16.6461         13.4389         17.2445         15.4912
450653..........................................         19.2847         18.1834         19.2349         18.8580
450654..........................................         13.8833         14.5258         14.5423         14.3223
450656..........................................         18.7328         17.6723         18.2606         18.1968
450658..........................................         15.1477         16.2657         17.2630         16.2787
450659..........................................         20.5609         22.2550         23.0108         21.9106
450661..........................................         20.2196         19.7160         18.9071         19.5857
450662..........................................         18.6797         18.2284         18.5812         18.4954

[[Page 22811]]

 
450665..........................................         15.4395         15.2015         14.3068         14.9933
450666..........................................         19.3456         20.3248         20.2549         19.9584
450668..........................................         18.7218         20.6965         21.0972         20.1590
450669..........................................         22.2832         21.7632         21.4199         21.7939
450670..........................................         18.2030         16.8893         20.2632         18.5133
450672..........................................         21.2079         21.8559         21.4175         21.4876
450673..........................................         13.8444         13.9620         12.4735         13.3217
450674..........................................         20.6151         22.2796         22.2305         21.7310
450675..........................................         23.2587         22.4961         21.4164         22.2737
450677..........................................         18.7905         22.6839         20.6556         20.7200
450678..........................................         20.7453         23.2617         24.1301         22.6596
450683..........................................         21.1748         20.9143         26.4385         22.7231
450684..........................................         22.8552         19.7005         21.9962         21.3850
450686..........................................         15.0122         16.5661         16.4632         15.9861
450688..........................................         20.8988         19.6250         20.1831         20.2348
450690..........................................         22.4118         21.6578         22.4707         22.1725
450694..........................................         18.4917         17.4758         17.4643         17.7613
450696..........................................         17.5701         24.9636               *         21.1885
450697..........................................         15.9259         18.8405         19.4949         18.0008
450698..........................................         14.3983         14.6680         15.2170         14.7605
450700..........................................         15.1153         14.6421         15.9050         15.2506
450702..........................................         21.0157         20.8223               *         20.9141
450703..........................................         18.8029               *               *         18.8029
450704..........................................         21.6236         20.9821         20.7987         21.1724
450705..........................................         22.3175         30.0116         20.5505         24.0294
450706..........................................         21.3777         21.2072         22.0884         21.5769
450709..........................................         19.7741         20.8889         22.1490         21.0078
450711..........................................         18.2350         19.8126         19.3400         19.1455
450712..........................................         16.8942         13.6240         15.9298         15.4007
450713..........................................         23.6009         20.8065         21.5813         21.8464
450715..........................................         19.7719         22.0413         22.5711         21.5401
450716..........................................         19.9871         20.5544         20.9088         20.4817
450717..........................................         19.4546         20.7192         20.6551         20.2618
450718..........................................         19.0679         19.6886         22.1765         20.3069
450723..........................................         19.7044         19.7563         20.0191         19.8245
450724..........................................         20.0667         20.3235         20.3706         20.2569
450725..........................................         19.5572               *               *         19.5572
450727..........................................         17.7508         13.5458         17.0205         15.9095
450728..........................................         12.9277         17.5284         19.8308         16.6330
450730..........................................         20.9129         22.0819         23.0054         22.0459
450733..........................................         20.3718         20.7693         20.0619         20.4133
450735..........................................          8.0014         13.8767               *         10.0108
450742..........................................         20.7775         22.7655         21.8392         21.8145
450743..........................................         15.9493         18.8937         19.6015         18.1561
450746..........................................         20.7534         12.7904         30.2677         19.9077
450747..........................................         17.3842         19.2585         20.3914         18.9599
450749..........................................         12.9542         16.2130         19.1488         16.2577
450750..........................................         14.7207         14.6914         13.8098         14.4310
450751..........................................         22.2491         21.2198         18.8616         21.0697
450754..........................................         14.8896         16.0860         16.6057         15.9050
450755..........................................         14.7070         17.9904         18.0760         16.8948
450757..........................................         13.9636         13.8675         14.9434         14.2422
450758..........................................         18.6513         21.8669         19.0221         19.8347
450760..........................................         18.0690         17.4852         19.2225         18.2582
450761..........................................         11.1444         13.6152         15.7681         13.3382
450763..........................................         17.5603         18.2123         18.6092         18.1083
450766..........................................         21.8103         22.4348         23.3879         22.5926
450769..........................................         13.6183         14.5858         18.4163         15.2554
450770..........................................         16.8250         16.5458         19.0183         17.4436
450771..........................................         21.5814         22.4542         20.4326         21.4743
450774..........................................         16.5198         17.9964         16.2948         16.9482
450775..........................................         19.9651         19.8897         21.3504         20.4169
450776..........................................         10.1953         15.7750         13.8230         13.0171

[[Page 22812]]

 
450777..........................................         19.5923         21.0682         19.0380         19.9747
450779..........................................         22.9697         21.4546         20.8027         21.5263
450780..........................................         15.2800         19.1498         18.9543         17.5846
450785..........................................         18.5475         18.4976               *         18.5211
450788..........................................         20.9806         19.1463         19.0680         19.4275
450794..........................................         18.3981         18.2229               *         18.3485
450795..........................................         14.1682         16.6494         22.5753         17.9737
450796..........................................         17.4472         16.5362         19.2059         17.6627
450797..........................................         18.5901         15.9188         16.4923         16.8594
450798..........................................          9.2165          9.4634               *          9.3327
450801..........................................         16.6095         17.5669         17.9548         17.3668
450802..........................................         18.9018         19.9168         17.1435         18.5477
450803..........................................         16.2047         18.3767         21.6653         19.3492
450804..........................................         20.2223         19.4846         19.0893         19.5891
450807..........................................         13.2256         11.3192         10.7200         11.6398
450808..........................................         45.4728         16.9915         17.4917         21.1577
450809..........................................         19.0266         20.0202         19.5101         19.5395
450811..........................................         18.3847         19.0961         19.9168         19.1389
450812..........................................         20.7383               *               *         20.7383
450813..........................................               *         15.9166         11.2807         13.4305
450815..........................................               *               *         21.2741         21.2741
450819..........................................               *               *         16.5521         16.5521
450820..........................................               *               *         25.8653         25.8653
450822..........................................               *               *         24.2740         24.2740
460001..........................................         20.6336         21.7996         22.2735         21.5846
460003..........................................         20.5958         20.0452         22.6289         21.0329
460004..........................................         20.8196         21.3744         21.7234         21.3231
460005..........................................         17.5818         19.7069         22.5252         19.8732
460006..........................................         19.6485         20.6252         21.0700         20.4918
460007..........................................         20.5677         20.8026         21.1773         20.8773
460008..........................................         21.0338         18.8661         19.1153         19.6864
460009..........................................         21.1084         21.9016         22.5295         21.8515
460010..........................................         21.2473         21.9830         22.4948         21.9354
460011..........................................         16.7114         18.8660         19.7731         18.3715
460013..........................................         20.3331         20.7326         20.3976         20.4959
460014..........................................         19.5465         18.3865         18.5370         18.7488
460015..........................................         20.0987         20.6593         21.0470         20.6197
460016..........................................         18.0791         18.2408         21.9105         19.2998
460017..........................................         26.0310         17.7103         18.9929         19.9984
460018..........................................         16.8566         17.6235         17.0063         17.1606
460019..........................................         17.3683         16.2671         17.8690         17.1417
460020..........................................         17.0271         17.3467         17.2663         17.2239
460021..........................................         20.2613         21.0470         21.5174         20.9913
460022..........................................         18.2100         20.1534         21.3614         19.7210
460023..........................................         21.3321         22.3535         22.9265         22.2381
460024..........................................         13.0279               *               *         13.0279
460025..........................................         12.5083         19.4247         17.3494         16.5301
460026..........................................         17.3431         19.9241         20.2577         19.0203
460027..........................................         20.8331         21.8868         22.2955         21.6637
460029..........................................         17.2501         20.5154         20.8366         19.2190
460030..........................................         17.2196         17.6071         17.1705         17.3275
460032..........................................         19.5474         21.1006         21.4832         20.7171
460033..........................................         15.7233         19.5372         19.2664         18.1972
460035..........................................         14.2802         16.0021         16.1685         15.4874
460036..........................................         22.3788         23.5893         23.4573         23.1384
460037..........................................         18.7665         18.6850         17.7399         18.3920
460039..........................................         24.4781         24.9134         24.4808         24.6217
460041..........................................         21.6926         21.0623         20.2035         20.9715
460042..........................................         17.8455         18.8814         19.5662         18.7473
460043..........................................         23.8970         24.4779         23.2819         23.8380
460044..........................................         20.6897         21.4696         21.8485         21.3516
460046..........................................         17.1085         18.2224               *         17.6742
460047..........................................         21.3843         23.0433         22.7384         22.4725

[[Page 22813]]

 
460049..........................................         18.8206         19.6483         20.8283         19.8892
460050..........................................         26.2485               *               *         26.2485
460051..........................................         20.9797         19.4761         22.1758         20.8643
460052..........................................               *               *         19.8961         19.8961
470001..........................................         19.6108         20.2299         21.3817         20.4021
470003..........................................         22.5949         23.6949         21.6305         22.6336
470004..........................................         18.0952         16.8842         18.1879         17.7051
470005..........................................         21.5151         21.9191         23.1808         22.1962
470006..........................................         18.3898         17.8699         20.2829         18.8123
470008..........................................         19.4136         19.6069         20.1969         19.7378
470010..........................................         19.4652         20.2961         21.0616         20.2790
470011..........................................         21.2014         21.7675         22.2415         21.7386
470012..........................................         18.5162         18.5339         18.9444         18.6579
470015..........................................         19.2552         19.5366         20.2125         19.6399
470018..........................................         20.4161         21.5426         21.2406         21.0610
470020..........................................         18.9884         20.6643         21.5688         20.4558
470023..........................................         20.6391         20.4511         21.7139         20.9439
470024..........................................         20.4087         20.8510         21.9807         21.0777
490001..........................................         24.7604         21.9755         20.0570         22.0422
490002..........................................         12.9871         15.2287         15.7365         14.6222
490003..........................................         18.0034         19.1040         20.3237         19.1299
490004..........................................         18.7731         19.2126         19.7074         19.2382
490005..........................................         16.9087         20.5517         21.3318         19.6257
490006..........................................         15.2276         15.9537         12.3253         14.5928
490007..........................................         18.4330         18.7740         19.9391         19.0604
490009..........................................         22.9513         23.9344         23.7659         23.5499
490010..........................................         18.5780         21.7424               *         19.9381
490011..........................................         18.7508         18.6071         19.3983         18.9085
490012..........................................         13.7788         15.9973         15.2965         15.0022
490013..........................................         16.9324         17.3318         18.2396         17.5085
490014..........................................         24.5557         25.8315         23.5266         24.6242
490015..........................................         19.3608         19.6363         20.0667         19.6821
490017..........................................         17.3152         18.4361         19.4810         18.4236
490018..........................................         17.9433         18.3435         18.5508         18.2858
490019..........................................         17.5309         19.6178         21.0024         19.4180
490020..........................................         17.6655         18.5691         18.9621         18.4232
490021..........................................         19.4490         19.3945         20.0496         19.6794
490022..........................................         20.7223         21.2183         22.9170         21.6052
490023..........................................         18.9587         20.6694         21.5683         20.4224
490024..........................................         16.8904         17.7221         18.4314         17.8400
490027..........................................         14.4234         16.2761         16.7556         15.8360
490030..........................................         10.5029          9.1789          8.6446          9.5559
490031..........................................         15.8213         14.9539         16.0003         15.5875
490032..........................................         21.5592         22.4262         22.0162         21.9790
490033..........................................         18.3265         21.1723         19.2908         19.5511
490037..........................................         15.9704         16.3759         17.0113         16.4399
490038..........................................         15.7099         21.0218         17.6324         17.9048
490040..........................................         22.5237         22.7061         23.9490         23.0684
490041..........................................         16.5542         18.3589         20.8247         18.4498
490042..........................................         15.2717         16.4666         17.0972         16.2668
490043..........................................         20.6775         22.1574         21.5808         21.5222
490044..........................................         17.6282         18.3137         19.7842         18.6148
490045..........................................         19.6325         20.5468         20.6436         20.2902
490046..........................................         18.6112         18.4825         19.5729         18.9042
490047..........................................         17.1631         25.0438         17.5833         19.3625
490048..........................................         17.8907         18.4361         19.5417         18.6005
490050..........................................         22.7129         23.0729         23.3668         23.0530
490052..........................................         16.9363         16.8600         16.4787         16.7609
490053..........................................         15.6883         15.6996         16.8410         16.1062
490054..........................................         15.5516         15.4734         19.5780         16.7024
490057..........................................         19.0668         19.9210         20.3160         19.7770
490059..........................................         20.3744         20.8662         21.4801         20.8999
490060..........................................         19.2006         17.6308         18.5917         18.4363

[[Page 22814]]

 
490063..........................................         28.2527         28.6536         31.0113         29.3929
490066..........................................         16.5024         20.6972         15.9322         17.5889
490067..........................................         17.1922         17.0195         17.8487         17.3549
490069..........................................         15.6986         17.3297         19.9963         17.6603
490071..........................................         19.4701         21.8879         23.3511         21.4480
490073..........................................         26.1420         20.7960         26.0957         24.1488
490074..........................................         19.3417               *               *         19.3417
490075..........................................         19.1906         18.6983         19.0566         18.9744
490077..........................................         19.7866         21.3670         22.6504         21.2469
490079..........................................         16.4379         17.0815         17.7016         17.0749
490083..........................................         16.6406               *               *         16.6406
490084..........................................         16.3846         16.7834         18.0555         17.0646
490085..........................................         16.3979         17.4584         17.6158         17.1539
490088..........................................         15.5982         16.4362         17.9141         16.6068
490089..........................................         15.8618         17.7692         18.2290         17.2642
490090..........................................         16.2785         17.0199         17.4735         16.9381
490091..........................................         19.9949         20.8734         25.0272         21.8088
490092..........................................         15.6893         16.9533         16.7502         16.4464
490093..........................................         16.4767         17.3711         17.8275         17.2502
490094..........................................         16.7880         18.9204         22.3033         19.3562
490095..........................................         18.2495               *               *         18.2495
490097..........................................         15.8586         15.5780         16.9518         16.0789
490098..........................................         14.6971         15.1403         16.0488         15.2544
490099..........................................         16.8667         17.9665         18.3985         17.7293
490100..........................................         17.2189         22.5010               *         19.8823
490101..........................................         25.0907         24.7616         23.5502         24.4252
490104..........................................         28.4910         25.6889         27.6495         27.0461
490105..........................................         18.2461         18.5765         21.4428         19.2491
490106..........................................         16.9117         17.6596         22.1448         18.3912
490107..........................................         22.4054         23.5240         22.9283         22.9660
490108..........................................         19.7478         20.2112         24.1232         21.0559
490109..........................................         21.1589         23.6620         25.9475         23.4402
490110..........................................         15.8408         16.5131         18.1561         16.8181
490111..........................................         17.3453         17.1768         17.8510         17.4580
490112..........................................         20.5239         21.4532         22.0815         21.3493
490113..........................................         23.0840         23.2235         23.9043         23.4071
490114..........................................         16.9083         17.3047         18.0359         17.4375
490115..........................................         17.1023         16.5203         23.9711         20.3158
490116..........................................         16.4436         16.6170         17.2040         16.7676
490117..........................................         13.8429         14.0104         14.7944         14.2244
490118..........................................         20.8707         21.4674         21.5687         21.3058
490119..........................................         17.8686         17.9147         18.6046         18.1353
490120..........................................         19.9810         19.3707         20.5777         19.9742
490122..........................................         23.9695         23.8801         25.2027         24.3250
490123..........................................         16.8505         17.7461         19.3056         18.0001
490124..........................................         19.3616         22.0884         21.3818         20.8857
490126..........................................         18.2276         18.6844         20.4294         19.0254
490127..........................................         14.4815         16.0516         16.5993         15.6547
490129..........................................         27.4701         22.5885         28.6868         25.1130
490130..........................................         16.2779         16.4322         17.6943         16.7915
490132..........................................         17.0204         18.6570         18.4671         18.0649
500001..........................................         21.3476         22.1896         23.4901         22.3320
500002..........................................         21.0375         21.6332         19.8476         20.7811
500003..........................................         24.3055         24.2814         24.4333         24.3392
500005..........................................         23.4808         22.3955         21.7512         22.5379
500007..........................................         22.4269         26.0599         21.9911         23.4148
500008..........................................         24.1930         25.3064         25.9291         25.1336
500011..........................................         25.1836         24.0162         24.6554         24.5938
500012..........................................         22.2815         20.7032         24.2799         22.3541
500014..........................................         23.9276         24.3419         24.0990         24.1249
500015..........................................         23.2435         23.9297         24.9923         24.0554
500016..........................................         23.9034         24.3938         24.9439         24.4287
500019..........................................         22.3668         22.4213         23.2054         22.6470

[[Page 22815]]

 
500021..........................................         24.4622         25.9198         27.6490         25.9957
500023..........................................         27.1892         26.6535         27.1025         26.9568
500024..........................................         24.0453         23.7472         26.6452         24.7736
500025..........................................         23.9557         26.4810         24.4825         24.9695
500026..........................................         23.3491         23.8005         26.9884         24.7238
500027..........................................         25.0529         22.2158         20.9576         22.6384
500028..........................................         18.8588         19.2675         18.9556         19.0337
500029..........................................         16.8083         17.9237         18.5042         17.7373
500030..........................................         24.1321         24.9039         26.3828         25.1714
500031..........................................         23.3659         29.2707         23.6099         25.1784
500033..........................................         21.3906         22.3527         22.5462         22.1428
500036..........................................         21.8950         22.1096         23.6333         22.5254
500037..........................................         19.6803         20.7139         21.4059         20.6062
500039..........................................         23.3211         23.8918         24.0007         23.7403
500041..........................................         24.8556         23.9608         24.9237         24.5799
500042..........................................         22.1286         22.9125               *         22.5386
500043..........................................         20.2509         20.9459         22.0466         21.0230
500044..........................................         23.1128         23.3364         24.2212         23.5535
500045..........................................         22.0982         20.8881         24.0526         22.2906
500048..........................................         19.3029         22.1906         20.3207         20.5960
500049..........................................         22.9534         24.0489         24.5997         23.8657
500050..........................................         20.9445         22.0065         22.6563         21.9092
500051..........................................         24.4769         24.8203         25.9447         25.1087
500053..........................................         22.0515         23.9397         22.8399         22.9429
500054..........................................         22.9024         22.8829         23.8089         23.1889
500055..........................................         22.8769         23.7446         23.8622         23.5097
500057..........................................         18.0424         18.2737         19.0479         18.4516
500058..........................................         23.3984         24.7882         24.1106         24.0962
500059..........................................         22.5412         23.3506         26.6270         24.1016
500060..........................................         23.5360         25.0233         28.3655         25.4628
500061..........................................         20.3957         21.7013         20.8624         20.9851
500062..........................................         19.4607         18.6329         19.0557         19.0333
500064..........................................         24.5283         25.5748         26.7000         25.6273
500065..........................................         21.4254         21.9308         23.5671         22.3106
500068..........................................         18.6960         19.6574         19.2638         19.2003
500069..........................................         20.6262         21.3592         21.4542         21.1522
500071..........................................         19.3810         19.1906         19.1428         19.2439
500072..........................................         24.4599         25.3928         25.2001         25.0228
500073..........................................         21.4303         21.2469         21.7698         21.4835
500074..........................................         18.6506         18.9679         19.5981         19.0849
500077..........................................         23.2056         22.8536         23.9410         23.3357
500079..........................................         22.9809         24.2036         23.1041         23.4248
500080..........................................         13.8000         15.6630         18.3883         15.5897
500084..........................................         22.2169         23.4032         24.4044         23.3798
500085..........................................         28.6121         21.4403         20.4517         22.7948
500086..........................................         22.3132         23.3288         22.8829         22.8469
500088..........................................         23.6988         23.2701         24.7822         23.9172
500089..........................................         17.9399         18.7080         19.7166         18.7736
500090..........................................         16.3297         16.1576         20.4429         17.2562
500092..........................................         17.2881         16.7913         19.2028         17.7527
500094..........................................         18.1080         18.5835         15.7866         17.6577
500096..........................................         20.9580         21.0151         23.3564         21.7716
500097..........................................         20.8010         19.7706         20.8774         20.4568
500098..........................................         12.9935         16.3511         15.2040         14.9340
500101..........................................         19.4498         19.7337         15.8000         18.3994
500102..........................................         20.3321         20.9389         21.8963         21.0615
500104..........................................         22.5849         22.8154         24.9389         23.3843
500106..........................................         18.7087         18.6041         19.1465         18.7914
500107..........................................         17.2987         18.1201         17.9489         17.8064
500108..........................................         27.2126         26.2939         28.6229         27.3944
500110..........................................         21.4053         21.4553         22.9775         21.9505
500118..........................................         22.9245         23.8397         24.8034         23.8697
500119..........................................         21.5704         22.4373         22.1192         22.0436

[[Page 22816]]

 
500122..........................................         21.9135         22.4268         23.5264         22.6230
500123..........................................         19.5855         20.3181         19.6646         19.8819
500124..........................................         24.1473         23.2836         23.7742         23.7287
500125..........................................         16.6272         15.1112         14.7910         15.5165
500129..........................................         23.5952         26.1575         25.4685         25.1115
500132..........................................         19.3567         15.6717         23.1822         19.3937
500134..........................................         20.9570         17.7457         17.2430         18.5700
500139..........................................         20.8816         22.2297         22.3022         21.8369
500141..........................................         22.9358         23.8838         29.9695         25.5485
500143..........................................         17.6031         18.0343         18.2570         17.9797
500146..........................................         17.8558         21.6003               *         19.6218
510001..........................................         17.8282         19.1492         20.0429         18.9855
510002..........................................         17.3409         20.1527         17.0646         18.0884
510005..........................................         14.4330         14.2503         13.8621         14.1872
510006..........................................         17.8821         18.7313         19.9609         18.8717
510007..........................................         20.2483         21.2729         21.7064         21.0952
510008..........................................         17.3653         18.3296         19.0513         18.2388
510012..........................................         16.5037         15.8390         15.6089         15.9887
510013..........................................         16.6194         17.8527         19.5798         17.9628
510015..........................................         14.7904         14.9039         16.7310         15.5192
510016..........................................         12.0276               *               *         12.0276
510018..........................................         16.4757         18.5269         18.5358         17.8403
510020..........................................         12.6472         13.1837         14.1211         13.3435
510022..........................................         19.8375         20.1763         21.5770         20.5146
510023..........................................         15.9417         16.0129         16.7777         16.2444
510024..........................................         18.7982         19.0941         18.7461         18.8794
510026..........................................         13.4586         13.6888         13.7952         13.6491
510027..........................................         17.5759         17.2900         18.5945         17.8135
510028..........................................         20.7306         20.0628         19.9208         20.2198
510029..........................................         17.0519         17.7124         18.4668         17.7625
510030..........................................         18.3137         17.4198         17.7603         17.8189
510031..........................................         18.4887         28.6673         18.6341         21.0020
510033..........................................         18.8061         18.4082         18.4718         18.5670
510035..........................................         18.6471         16.5007         18.3164         17.7425
510036..........................................         13.1995         13.4559         13.8786         13.5021
510038..........................................         14.3433         15.8132         15.5576         15.2710
510039..........................................         16.0555         16.9398         17.1461         16.7060
510043..........................................         14.2872         14.0662         13.1308         13.8129
510046..........................................         17.7320         17.3821         18.5896         17.9120
510047..........................................         19.1202         19.8963         20.8101         19.9042
510048..........................................         20.3734         21.0407         17.1647         19.5052
510050..........................................         16.5681         16.9136         18.4036         17.3154
510053..........................................         15.5856         16.1036         17.5798         16.4010
510055..........................................         22.8376         23.7248         24.1069         23.5675
510058..........................................         17.9786         18.4156         18.2634         18.2213
510059..........................................         16.7732         16.5854         16.1044         16.5068
510060..........................................         15.6581         17.5594               *         16.5969
510061..........................................         14.2227         13.8204         14.1968         14.0767
510062..........................................         17.6276         19.3881         18.1588         18.4173
510065..........................................         14.5882               *               *         14.5882
510066..........................................         12.7164         12.2943               *         12.5091
510067..........................................         18.1079         16.7161         17.3067         17.3634
510068..........................................         16.2864         18.7938         14.3582         16.2743
510070..........................................         16.3616         18.5146         18.4252         17.8444
510071..........................................         16.2390         17.2148         18.0278         17.1797
510072..........................................         17.6579         15.6262         15.9257         16.4174
510077..........................................         16.4111         18.0668         18.2947         17.6316
510080..........................................         14.7966         17.4485         16.3453         16.1690
510081..........................................         13.0020         13.6359         11.9701         12.8648
510082..........................................         13.6905         17.4538         13.5946         14.7307
510084..........................................         12.4820         17.2395         13.5339         14.4076
510085..........................................         18.6367         17.5624         18.5207         18.2217
510086..........................................         13.7937         13.4763         14.2241         13.8304

[[Page 22817]]

 
510088..........................................               *               *         14.8854         14.8854
520002..........................................         18.3521         19.7447         19.6755         19.2773
520003..........................................         16.4334         17.1248         18.7956         17.5028
520004..........................................         18.1744         19.6512         20.4591         19.4206
520006..........................................         20.4446         21.5313         21.4884         21.1400
520007..........................................         13.1087         16.2001         18.4629         16.0134
520008..........................................         22.8024         22.8024         24.9395         23.5372
520009..........................................         18.5094         18.6002         21.3967         19.4603
520010..........................................         20.3447         22.7703         22.3311         21.8215
520011..........................................         20.3797         20.7410         21.5223         20.8830
520013..........................................         21.6289         20.3965         20.5944         20.8585
520014..........................................         16.3989         17.1646         18.0841         17.1764
520015..........................................         18.3185         18.6078         19.7672         18.9031
520016..........................................         13.2889         17.3018         18.4320         16.1862
520017..........................................         19.3179         19.6008         19.4780         19.4685
520018..........................................         18.6441         21.1941         20.5761         20.1814
520019..........................................         18.3143         19.5440         20.9164         19.5698
520021..........................................         20.0355         21.3471         21.9531         21.1390
520024..........................................         14.6107         14.0175         14.4750         14.3609
520025..........................................         18.1086         18.2430         20.3838         18.8661
520026..........................................         19.8131         21.5453         20.8546         20.7335
520027..........................................         18.9085         19.9324         19.3257         19.4032
520028..........................................         19.1370         21.2852         21.5674         20.6109
520029..........................................         16.7520         19.5750         21.4197         19.2161
520030..........................................         20.0043         20.5039         20.8529         20.4556
520031..........................................         18.7066         20.4814         20.9875         19.9520
520032..........................................         17.9007         19.5697         20.1439         19.2148
520033..........................................         18.8906         19.2954         20.2520         19.4725
520034..........................................         16.6858         17.1282         20.4307         18.0336
520035..........................................         17.0997         18.9452         18.7135         18.2608
520037..........................................         20.0516         20.6686         21.4693         20.7219
520038..........................................         17.7074         19.6294         20.6130         19.3169
520039..........................................         19.5990         20.7641         23.3687         21.1069
520040..........................................         20.7420         20.4677         20.4895         20.5693
520041..........................................         15.3666         17.1959         17.5718         16.7004
520042..........................................         17.6577         18.5843         18.9667         18.4230
520044..........................................         17.7932         18.4014         19.1877         18.4535
520045..........................................         19.6736         20.5917         20.7203         20.3442
520047..........................................         17.8702         18.3048         20.3487         18.7633
520048..........................................         19.1712         20.6583         19.5238         19.7870
520049..........................................         19.5727         20.3559         20.1667         20.0444
520051..........................................         19.7416         21.6497         23.1309         21.4330
520053..........................................         16.4887         17.3945         18.0851         17.3336
520054..........................................         15.9873         15.1747         16.6782         15.9073
520057..........................................         18.3186         19.0872         19.6305         19.0102
520058..........................................         18.1264         19.7283         21.2500         19.7133
520059..........................................         19.8530         20.9913         21.5796         20.8254
520060..........................................         17.1675         17.9258         18.7639         17.9403
520062..........................................         17.8000         19.1482         19.7038         18.8681
520063..........................................         20.7744         19.6136         20.5262         20.3055
520064..........................................         21.4586         22.7423         22.0878         22.0905
520066..........................................         22.4419         22.8837         23.9506         23.0411
520068..........................................         18.0798         18.9943         19.6855         18.9053
520069..........................................         17.9133         20.2934         20.1770         19.3716
520070..........................................         17.8192         18.5938         19.2094         18.5389
520071..........................................         18.7861         18.7304         19.1628         18.8949
520074..........................................         18.6923         20.4601         20.9007         20.0036
520075..........................................         19.0891         19.8457         20.5199         19.8188
520076..........................................         16.5072         17.6088         19.5360         17.8404
520077..........................................         15.5427         17.7830         18.7119         17.3266
520078..........................................         20.5559         21.3380         20.5439         20.8226
520082..........................................         16.7417         17.7405               *         17.1848
520083..........................................         22.5715         23.8849         23.5787         23.3411

[[Page 22818]]

 
520084..........................................         18.9475         20.8427         23.3327         20.9981
520087..........................................         19.3942         20.3624         20.6863         20.1537
520088..........................................         20.1529         20.6312         21.8931         20.8632
520089..........................................         20.6110         21.5456         22.1055         21.4053
520090..........................................         18.0026         18.9343         19.8314         18.9411
520091..........................................         20.0693         20.9927         20.9440         20.6686
520092..........................................         17.5577         17.6500         18.6248         17.9402
520094..........................................         19.7791         20.3611         20.6179         20.2438
520095..........................................         18.5066         20.3269         18.6425         19.1370
520096..........................................         19.2980         19.7757         20.6668         19.9365
520097..........................................         19.6470         20.2354         20.8016         20.2268
520098..........................................         20.0289         22.3348         23.4707         21.9054
520100..........................................         18.3788         18.3832         19.4788         18.7419
520101..........................................         17.8453         19.5186         19.9875         19.1542
520102..........................................         19.8354         20.1898         21.0138         20.3351
520103..........................................         21.2324         19.4809         20.0842         20.2050
520107..........................................         20.5441         20.3747         21.7907         20.8828
520109..........................................         18.6322         19.1303         19.7609         19.1753
520110..........................................         20.0319         20.4494         21.0055         20.5065
520111..........................................         17.2388         17.7834         17.7673         17.6163
520112..........................................         18.1827         19.1797         18.5706         18.6454
520113..........................................         20.5925         21.1485         21.8852         21.2341
520114..........................................         17.3799         16.6616         17.8476         17.2735
520115..........................................         17.3755         18.2980         19.2248         18.2555
520116..........................................         18.5698         19.8509         20.6922         19.7165
520117..........................................         17.4242         18.5414         18.3963         18.1365
520118..........................................         12.4422          4.2326         14.8626         13.8369
520120..........................................         15.6205         18.7437               *         17.3887
520121..........................................         17.5851         19.7305         20.8492         19.5992
520122..........................................         16.7552         16.2436         16.9335         16.6326
520123..........................................         17.4135         17.3980         17.7986         17.5610
520124..........................................         16.3902         17.2619         17.9205         17.1864
520130..........................................         15.1639         15.6845         17.1679         16.0030
520131..........................................         18.8043         18.7295         20.2591         19.2549
520132..........................................         17.2759         15.6379         18.1630         16.9564
520134..........................................         17.6094         18.0953         18.8150         18.1846
520135..........................................         14.4748         15.8246         17.3476         15.9083
520136..........................................         19.9935         19.8480         20.4404         20.0986
520138..........................................         20.8922         21.2260         22.5103         21.5421
520139..........................................         21.2797         20.9988         21.4042         21.2251
520140..........................................         21.4175         21.5207         22.0849         21.6757
520141..........................................         16.9543               *               *         16.9543
520142..........................................         17.7003         20.5858         21.9432         19.9586
520144..........................................         16.6231         18.5701         19.9120         18.4107
520145..........................................         17.2356         18.2654         18.7958         18.1015
520146..........................................         15.7318         17.9585         18.2370         17.3448
520148..........................................         16.9293         17.2421         19.1502         17.8057
520149..........................................         13.3032         14.1901         12.8928         13.4360
520151..........................................         18.0771         17.3267         18.7070         18.0230
520152..........................................         21.3333         19.5858         22.5980         21.0747
520153..........................................         15.4467         15.9753         17.0863         16.1441
520154..........................................         17.9229         18.5403         19.5994         18.6875
520156..........................................         19.8396         21.3377         20.9638         20.7243
520157..........................................         17.2784         17.1974         19.6008         18.0185
520159..........................................         18.7423         18.6760         17.7649         18.3871
520160..........................................         18.8444         19.4173         20.1406         19.4824
520161..........................................         18.5742         19.4905         18.7197         18.9334
520170..........................................         22.5033         21.5233         21.0637         21.6831
520171..........................................         15.7316         17.4560         18.0785         17.1053
520173..........................................         20.1410         21.3016         20.5744         20.6635
520177..........................................         21.7609         22.7221         22.9673         22.4954
520178..........................................         17.0411         18.6936         20.9010         18.7748
520188..........................................               *         13.9135               *         13.9135

[[Page 22819]]

 
530002..........................................         17.5888         19.3273         21.1066         19.4048
530003..........................................         15.7813         16.2139         15.9523         15.9820
530004..........................................         16.1862         15.0497         13.3788         14.7758
530005..........................................         15.1487         13.3529         15.3255         14.5529
530006..........................................         19.3403         18.5894         19.1305         19.0082
530007..........................................         18.0601         18.5161         17.7897         18.1450
530008..........................................         22.9625         18.8349         19.0113         20.0471
530009..........................................         19.4478         22.5009         21.7795         21.2113
530010..........................................         18.9317         21.6092         14.1699         17.7467
530011..........................................         17.4412         18.7354         19.4606         18.5542
530012..........................................         19.4829         18.9923         21.1854         19.8564
530014..........................................         17.3158         18.0869         18.5571         17.9899
530015..........................................         22.6465         22.4568         23.4040         22.8118
530016..........................................         17.7084         18.1562         19.3205         18.4153
530017..........................................         13.7131         16.3478         17.7736         15.9421
530018..........................................         17.8699         18.3783         19.5986         18.6254
530019..........................................         16.7630         18.5430         20.1097         18.3351
530022..........................................         17.8781         18.5002         19.6136         18.7082
530023..........................................         20.7527         20.1948         20.0677         20.3449
530025..........................................         20.3200         21.2598         22.0300         21.1974
530026..........................................         18.9175         17.0118         19.8969         18.4992
530027..........................................         29.7722         18.1664         25.5067         22.9705
530029..........................................         17.7993         16.5092         19.3361         17.7626
530031..........................................         13.3775         18.3322         20.1734         17.2600
530032..........................................         20.2143         21.0361         20.0132        20.4281
----------------------------------------------------------------------------------------------------------------
* Wage data not available for the provider that year.
** For Federal Fiscal Year 2002 only, the average hourly wage is based upon data on file as of February 15,
  2001. It does not reflect changes processed after that date.
*** The 3-year average hourly wage is weighted by salaries and hours.

      
  

  

  

  Federal Register / Vol. 66 , No. 87 / Friday, May 4, 2001 / Proposed 
Rules  

          Table 3A.--3-Year Average Hourly Wage for Urban Areas
  [Based on salaries and hours computed for Federal fiscal years 2000,
                             2001, and 2002]
------------------------------------------------------------------------
                                                                Average
                          Urban area                             hourly
                                                                  wage
------------------------------------------------------------------------
Abilene, TX..................................................    17.6806
Aguadilla, PR................................................     9.2769
Akron, OH....................................................    21.5297
Albany, GA...................................................    22.3923
Albany-Schenectady-Troy, NY..................................    18.7002
Albuquerque, NM..............................................    19.8373
Alexandria, LA...............................................    17.4211
Allentown-Bethlehem-Easton, PA...............................    21.3670
Altoona, PA..................................................    20.1636
Amarillo, TX.................................................    18.6302
Anchorage, AK................................................    27.5223
Ann Arbor, MI................................................    24.5218
Anniston, AL.................................................    18.1347
Appleton-Oshkosh-Neenah, WI..................................    19.6303
Arecibo, PR..................................................    10.1229
Asheville, NC................................................    19.9864
Athens, GA...................................................    21.2433
Atlanta, GA..................................................    21.9106
Atlantic-Cape May, NJ........................................    24.4342
Auburn-Opelika, AL...........................................    17.4403
Augusta-Aiken, GA-SC.........................................    20.3525
Austin-San Marcos, TX........................................    20.2151
Bakersfield, CA..............................................    20.7098
Baltimore, MD................................................    20.9279
Bangor, ME...................................................    20.7547
Barnstable-Yarmouth, MA......................................    29.3802
Baton Rouge, LA..............................................    18.6271
Beaumont-Port Arthur, TX.....................................    18.6898
Bellingham, WA...............................................    25.1714
Benton Harbor, MI............................................    18.7937
Bergen-Passaic, NJ...........................................    25.5796
Billings, MT.................................................    21.1153
Biloxi-Gulfport-Pascagoula, MS...............................    17.8351
Binghamton, NY...............................................    18.8043
Birmingham, AL...............................................    18.8368
Bismarck, ND.................................................    16.8910
Bloomington, IN..............................................    18.7924
Bloomington-Normal, IL.......................................    19.1663
Boise City, ID...............................................    19.6729
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.............    24.5501
Boulder-Longmont, CO.........................................    21.3227
Brazoria, TX.................................................    18.3793
Bremerton, WA................................................    23.7403
Brownsville-Harlingen-San Benito, TX.........................    19.2833
Bryan-College Station, TX....................................    18.7394
Buffalo-Niagara Falls, NY....................................    20.6480
Burlington, VT...............................................    22.4607
Caguas, PR...................................................    10.2778
Canton-Massillon, OH.........................................    19.0700
Casper, WY...................................................    19.8564
Cedar Rapids, IA.............................................    19.1268
Champaign-Urbana, IL.........................................    19.9316
Charleston-North Charleston, SC..............................    19.7508
Charleston, WV...............................................    20.0108
Charlotte-Gastonia-Rock Hill, NC-SC..........................    20.3826
Charlottesville, VA..........................................    23.1481
Chattanooga, TN-GA...........................................    20.9509
Cheyenne, WY.................................................    17.9899
Chicago, IL..................................................    23.8495
Chico-Paradise, CA...........................................    21.8173
Cincinnati, OH-KY-IN.........................................    20.5080
Clarksville-Hopkinsville, TN-KY..............................    17.8563
Cleveland-Lorain-Elyria, OH..................................    20.7803
Colorado Springs, CO.........................................    20.7284
Columbia, MO.................................................    19.2453
Columbia, SC.................................................    20.5806
Columbus, GA-AL..............................................    18.4599
Columbus, OH.................................................    21.1200
Corpus Christi, TX...........................................    18.5130
Corvallis, OR................................................    24.7413
Cumberland, MD-WV............................................    18.4566
Dallas, TX...................................................    20.9635
Danville, VA.................................................    18.9744
Davenport-Moline-Rock Island, IA-IL..........................    19.0733

[[Page 22820]]

 
Dayton-Springfield, OH.......................................    20.3789
Daytona Beach, FL............................................    19.7030
Decatur, AL..................................................    18.8129
Decatur, IL..................................................    17.6940
Denver, CO...................................................    22.1471
Des Moines, IA...............................................    19.3257
Detroit, MI..................................................    22.6805
Dothan, AL...................................................    17.1181
Dover, DE....................................................    21.6106
Dubuque, IA..................................................    18.6795
Duluth-Superior, MN-WI.......................................    22.1000
Dutchess County, NY..........................................    22.7121
Eau Claire, WI...............................................    19.2432
El Paso, TX..................................................    19.8290
Elkhart-Goshen, IN...........................................    20.3382
Elmira, NY...................................................    18.4943
Enid, OK.....................................................    18.0515
Erie, PA.....................................................    19.4310
Eugene-Springfield, OR.......................................    23.8559
Evansville, Henderson, IN-KY.................................    17.5189
Fargo-Moorhead, ND-MN........................................    19.3632
Fayetteville, NC.............................................    19.0183
Fayetteville-Springdale-Rogers, AR...........................    16.7888
Flagstaff, AZ-UT.............................................    22.9479
Flint, MI....................................................    23.9198
Florence, AL.................................................    16.9094
Florence, SC.................................................    18.9644
Fort Collins-Loveland, CO....................................    22.4773
Fort Lauderdale, FL..........................................    22.1771
Fort Myers-Cape Coral, FL....................................    19.9058
Fort Pierce-Port St. Lucie, FL...............................    21.3915
Fort Smith, AR-OK............................................    17.3369
Fort Walton Beach, FL........................................    19.5052
Fort Wayne, IN...............................................    19.4642
Fort Worth-Arlington, TX.....................................    20.8053
Fresno, CA...................................................    21.9101
Gadsden, AL..................................................    18.7282
Gainesville, FL..............................................    23.1249
Galveston-Texas City, TX.....................................    21.5574
Gary, IN.....................................................    20.5266
Glens Falls, NY..............................................    18.3428
Goldsboro, NC................................................    18.4900
Grand Forks, ND-MN...........................................    19.5346
Grand Junction, CO...........................................    20.1153
Grand Rapids-Muskegon-Holland, MI............................    22.0624
Great Falls, MT..............................................    20.7979
Greeley, CO..................................................    21.0411
Green Bay, WI................................................    19.9641
Greensboro-Winston-Salem-High Point, NC......................    20.0548
Greenville, NC...............................................    20.8376
Greenville-Spartanburg-Anderson, SC..........................    19.7086
Hagerstown, MD...............................................    19.2372
Hamilton-Middletown, OH......................................    19.7210
Harrisburg-Lebanon-Carlisle, PA..............................    20.6541
Hartford, CT.................................................    24.9991
Hattiesburg, MS..............................................    16.3812
Hickory-Morganton-Lenoir, NC.................................    19.9779
Honolulu, HI.................................................    25.2556
Houma, LA....................................................    17.3111
Houston, TX..................................................    20.7505
Huntington-Ashland, WV-KY-OH.................................    21.1928
Huntsville, AL...............................................    19.2325
Indianapolis, IN.............................................    21.1949
Iowa City, IA................................................    21.1012
Jackson, MI..................................................    19.7797
Jackson, MS..................................................    18.6455
Jackson, TN..................................................    19.1864
Jacksonville, FL.............................................    19.6584
Jacksonville, NC.............................................    16.8680
Jamestown, NY................................................    17.1876
Janesville-Beloit, WI........................................    20.9802
Jersey City, NJ..............................................    24.8343
Johnson City-Kingsport-Bristol, TN-VA........................    18.5293
Johnstown, PA................................................    19.0781
Jonesboro, AR................................................    16.9923
Joplin, MO...................................................    17.7354
Kalamazoo-Battlecreek, MI....................................    22.4822
Kankakee, IL.................................................    20.0356
Kansas City, KS-MO...........................................    20.4279
Kenosha, WI..................................................    20.4490
Killeen-Temple, TX...........................................    19.9750
Knoxville, TN................................................    19.0855
Kokomo, IN...................................................    19.9881
La Crosse, WI-MN.............................................    19.8516
Lafayette, LA................................................    18.3710
Lafayette, IN................................................    19.3581
Lake Charles, LA.............................................    16.7150
Lakeland-Winter Haven, FL....................................    19.6666
Lancaster, PA................................................    20.1757
Lansing-East Lansing, MI.....................................    21.3476
Laredo, TX...................................................    17.5925
Las Cruces, NM...............................................    18.7690
Las Vegas, NV-AZ.............................................    24.0639
Lawrence, KS.................................................    18.1884
Lawton, OK...................................................    19.7127
Lewiston-Auburn, ME..........................................    19.7957
Lexington, KY................................................    18.9597
Lima, OH.....................................................    20.0697
Lincoln, NE..................................................    21.3984
Little Rock-North Little Rock, AR............................    19.2004
Longview-Marshall, TX........................................    18.7809
Los Angeles-Long Beach, CA...................................    26.0786
Louisville, KY-IN............................................    20.4511
Lubbock, TX..................................................    18.6166
Lynchburg, VA................................................    19.4241
Macon, GA....................................................    19.2084
Madison, WI..................................................    21.9843
Mansfield, OH................................................    18.7455
Mayaguez, PR.................................................    10.2295
McAllen-Edinburg-Mission, TX.................................    18.1641
Medford-Ashland, OR..........................................    22.6022
Melbourne-Titusville-Palm Bay, FL............................    20.8444
Memphis, TN-AR-MS............................................    19.0229
Merced, CA...................................................    21.5061
Miami, FL....................................................    21.8283
Middlesex-Somerset-Hunterdon, NJ.............................    24.6509
Milwaukee-Waukesha, WI.......................................    21.3110
Minneapolis-St. Paul, MN-WI..................................    23.8021
Missoula, MT.................................................    20.0852
Mobile, AL...................................................    17.4552
Modesto, CA..................................................    22.6578
Monmouth-Ocean, NJ...........................................    24.1662
Monroe, LA...................................................    18.0030
Montgomery, AL...............................................    16.5093
Muncie, IN...................................................    22.6571
Myrtle Beach, SC.............................................    18.6825
Naples, FL...................................................    20.9923
Nashville, TN................................................    20.6183
Nassau-Suffolk, NY...........................................    30.2198
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT..........    26.6547
New London-Norwich, CT.......................................    26.0295
New Orleans, LA..............................................    19.8085
New York, NY.................................................    31.0941
Newark, NJ...................................................    25.6043
Newburgh, NY-PA..............................................    23.8506
Norfolk-Virginia Beach-Newport News, VA-NC...................    18.4034
Oakland, CA..................................................    32.8350
Ocala, FL....................................................    20.5545
Odessa-Midland, TX...........................................    19.5695
Oklahoma City, OK............................................    18.8746
Olympia, WA..................................................    23.8947
Omaha, NE-IA.................................................    21.4322
Orange County, CA............................................    24.7717
Orlando, FL..................................................    20.8479
Owensboro, KY................................................    17.7880
Panama City, FL..............................................    19.7652
Parkersburg-Marietta, WV-OH..................................    17.9669
Pensacola, FL................................................    18.0417
Peoria-Pekin, IL.............................................    18.6783
Philadelphia, PA-NJ..........................................    23.6329
Phoenix-Mesa, AZ.............................................    20.7971
Pine Bluff, AR...............................................    16.8497
Pittsburgh, PA...............................................    20.9887
Pittsfield, MA...............................................    22.3291
Pocatello, ID................................................    19.9570
Ponce, PR....................................................    11.0089
Portland, ME.................................................    20.7444
Portland-Vancouver, OR-WA....................................    23.9502
Providence-Warwick, RI.......................................    23.3619
Provo-Orem, UT...............................................    21.5657
Pueblo, CO...................................................    19.0481
Punta Gorda, FL..............................................    20.1726
Racine, WI...................................................    20.1696
Raleigh-Durham-Chapel Hill, NC...............................    21.0052
Rapid City, SD...............................................    18.9541
Reading, PA..................................................    17.8899
Redding, CA..................................................    24.6813
Reno, NV.....................................................    22.8615
Richland-Kennewick-Pasco, WA.................................    24.4034
Richmond-Petersburg, VA......................................    20.8459
Riverside-San Bernardino, CA.................................    24.1711
Roanoke, VA..................................................    18.3527
Rochester, MN................................................    24.8162
Rochester, NY................................................    19.9290
Rockford, IL.................................................    19.3616
Rocky Mount, NC..............................................    19.3552
Sacramento, CA...............................................    26.0254
Saginaw-Bay City-Midland, MI.................................    20.6078
St. Cloud, MN................................................    21.3050
St. Joseph, MO...............................................    19.6144
St. Louis, MO-IL.............................................    19.5920
Salem, OR....................................................    21.8859
Salinas, CA..................................................    31.8419
Salt Lake City-Ogden, UT.....................................    21.4139
San Angelo, TX...............................................    17.4362
San Antonio, TX..............................................    18.2088
San Diego, CA................................................    25.4124
San Francisco, CA............................................    30.6978
San Jose, CA.................................................    29.9903
San Juan-Bayamon, PR.........................................    10.2202

[[Page 22821]]

 
San Luis Obispo-Atascadero-Paso Robles, CA...................    23.3041
Santa Barbara-Santa Maria-Lompoc, CA.........................    23.3594
Santa Cruz-Watsonville, CA...................................    30.3548
Santa Fe, NM.................................................    22.5866
Santa Rosa, CA...............................................    27.7113
Sarasota-Bradenton, FL.......................................    21.5493
Savannah, GA.................................................    20.9278
Scranton-Wilkes Barre-Hazleton, PA...........................    17.9530
Seattle-Bellevue-Everett, WA.................................    24.0679
Sharon, PA...................................................    17.4923
Sheboygan, WI................................................    18.1442
Sherman-Denison, TX..........................................    19.5991
Shreveport-Bossier City, LA..................................    19.4652
Sioux City, IA-NE............................................    18.6963
Sioux Falls, SD..............................................    19.3356
South Bend, IN...............................................    21.7219
Spokane, WA..................................................    23.1813
Springfield, IL..............................................    18.6860
Springfield, MO..............................................    18.1563
Springfield, MA..............................................    23.1451
State College, PA............................................    19.7984
Steubenville-Weirton, OH-WV..................................    18.6797
Stockton-Lodi, CA............................................    23.2294
Sumter, SC...................................................    17.6174
Syracuse, NY.................................................    20.3619
Tacoma, WA...................................................    25.1530
Tallahassee, FL..............................................    18.3753
Tampa-St. Petersburg-Clearwater, FL..........................    19.5103
Terre Haute, IN..............................................    18.3195
Texarkana, AR-Texarkana, TX..................................    17.9743
Toledo, OH...................................................    21.2747
Topeka, KS...................................................    19.8271
Trenton, NJ..................................................    21.9528
Tucson, AZ...................................................    19.1755
Tulsa, OK....................................................    18.4006
Tuscaloosa, AL...............................................    17.6510
Tyler, TX....................................................    20.1434
Utica-Rome, NY...............................................    18.2674
Vallejo-Fairfield-Napa, CA...................................    28.6820
Ventura, CA..................................................    24.2443
Victoria, TX.................................................    17.9789
Vineland-Millville-Bridgeton, NJ.............................    22.7446
Visalia-Tulare-Porterville, CA...............................    21.3962
Waco, TX.....................................................    17.7862
Washington, DC-MD-VA-WV......................................    23.8268
Waterloo-Cedar Falls, IA.....................................    18.0820
Wausau, WI...................................................    20.4556
West Palm Beach-Boca Raton, FL...............................    21.2892
Wheeling, OH-WV..............................................    16.9419
Wichita, KS..................................................    20.5727
Wichita Falls, TX............................................    16.8194
Williamsport, PA.............................................    18.2904
Wilmington-Newark, DE-MD.....................................    23.9928
Wilmington, NC...............................................    20.9815
Yakima, WA...................................................    22.3174
Yolo, CA.....................................................    21.5151
York, PA.....................................................    18.9397
Youngstown-Warren, OH........................................    20.9566
Yuba City, CA................................................    23.0076
Yuma, AZ.....................................................    20.4298
------------------------------------------------------------------------


          Table 3B.--3-Year Average Hourly Wage for Rural Areas
  [Based on salaries and hours computed for Federal fiscal years 2000,
                             2001, and 2002]
------------------------------------------------------------------------
                                                                Average
                        Nonurban area                            hourly
                                                                  wage
------------------------------------------------------------------------
Alabama......................................................    16.1119
Alaska.......................................................    26.3477
Arizona......................................................    18.5108
Arkansas.....................................................    16.0724
California...................................................    21.4448
Colorado.....................................................    19.2806
Connecticut..................................................    26.3210
Delaware.....................................................    20.0732
Florida......................................................    19.2209
Georgia......................................................    17.8809
Hawaii.......................................................    23.8315
Idaho........................................................    18.9021
Illinois.....................................................    17.5886
Indiana......................................................    18.6071
Iowa.........................................................    17.4515
Kansas.......................................................    16.5492
Kentucky.....................................................    17.3334
Louisiana....................................................    16.4052
Maine........................................................    18.8730
Maryland.....................................................    18.9527
Massachusetts................................................    24.6681
Michigan.....................................................    19.4455
Minnesota....................................................    19.2586
Mississippi..................................................    16.1955
Missouri.....................................................    16.7949
Montana......................................................    18.5783
Nebraska.....................................................    17.6014
Nevada.......................................................    20.3129
New Hampshire................................................    21.4174
New Jersey \1\...............................................  .........
New Mexico...................................................    18.5917
New York.....................................................    18.5351
North Carolina...............................................    18.3321
North Dakota.................................................    16.8478
Ohio.........................................................    18.8435
Oklahoma.....................................................    16.1793
Oregon.......................................................    21.7904
Pennsylvania.................................................    18.4680
Puerto Rico..................................................     9.5092
Rhode Island \1\.............................................  .........
South Carolina...............................................    18.2462
South Dakota.................................................    16.6515
Tennessee....................................................    16.8980
Texas........................................................    16.3672
Utah.........................................................    19.5943
Vermont......................................................    20.4055
Virginia.....................................................    17.7547
Washington...................................................    22.5228
West Virginia................................................    17.6572
Wisconsin....................................................    19.3313
Wyoming......................................................   19.1675
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.


Table 4A.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
                               Urban Areas
------------------------------------------------------------------------
                                                        Wage
         Urban area  (Constituent counties)             index      GAF
------------------------------------------------------------------------
0040  Abilene, TX...................................    0.8118    0.8669
  Taylor, TX
0060  Aguadilla, PR.................................    0.4738    0.5996
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080  Akron, OH.....................................    0.9924    0.9948
  Portage, OH
  Summit, OH
0120  Albany, GA....................................    1.0675    1.0457
  Dougherty, GA
  Lee, GA
0160  Albany-Schenectady-Troy, NY...................    0.8597    0.9017
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200  Albuquerque, NM...............................    0.9855    0.9900
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220  Alexandria, LA................................    0.8137    0.8683
  Rapides, LA
0240  Allentown-Bethlehem-Easton, PA................    0.9443    0.9615
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280  Altoona, PA...................................    0.9225    0.9463
  Blair, PA
0320  Amarillo, TX..................................    0.8706    0.9095
  Potter, TX
  Randall, TX
0380  Anchorage, AK.................................    1.2605    1.1718
  Anchorage, AK
0440  Ann Arbor, MI.................................    1.1220    1.0820
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450  Anniston, AL..................................    0.8360    0.8846
  Calhoun, AL
0460  Appleton-Oshkosh-Neenah, WI...................    0.9203    0.9447
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470  Arecibo, PR...................................    0.4683    0.5948
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480  Asheville, NC.................................    0.9307    0.9520
  Buncombe, NC
  Madison, NC
0500  Athens, GA....................................    0.9956    0.9970
  Clarke, GA
  Madison, GA
  Oconee, GA
0520  \1\ Atlanta, GA...............................    1.0176    1.0120
  Barrow, GA
  Bartow, GA
  Carroll, GA
  Cherokee, GA
  Clayton, GA
  Cobb, GA
  Coweta, GA
  DeKalb, GA
  Douglas, GA
  Fayette, GA

[[Page 22822]]

 
  Forsyth, GA
  Fulton, GA
  Gwinnett, GA
  Henry, GA
  Newton, GA
  Paulding, GA
  Pickens, GA
  Rockdale, GA
  Spalding, GA
  Walton, GA
0560  Atlantic-Cape May, NJ.........................    1.1349    1.0905
  Atlantic, NJ
  Cape May, NJ
0580  Auburn-Opelika, AL............................    0.8325    0.8820
  Lee, AL
0600  Augusta-Aiken, GA-SC..........................    1.0090    1.0062
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640  \1\ Austin-San Marcos, TX.....................    0.9327    0.9534
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680  \2\ Bakersfield, CA...........................    0.9870    0.9911
  Kern, CA
0720  \1\ Baltimore, MD.............................    0.9723    0.9809
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733  Bangor, ME....................................    0.9559    0.9696
  Penobscot, ME
0743  Barnstable-Yarmouth, MA.......................    1.3539    1.2306
  Barnstable, MA
0760  Baton Rouge, LA...............................    0.8258    0.8772
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840  Beaumont-Port Arthur, TX......................    0.8508    0.8953
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860  Bellingham, WA................................    1.1963    1.1306
  Whatcom, WA
0870  \2\ Benton Harbor, MI.........................    0.9115    0.9385
  Berrien, MI
0875  \1\ Bergen-Passaic, NJ........................    1.1669    1.1115
  Bergen, NJ
  Passaic, NJ
0880  Billings, MT..................................    0.9623    0.9740
  Yellowstone, MT
0920  Biloxi-Gulfport-Pascagoula, MS................    0.8538    0.8974
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960  Binghamton, NY................................    0.8595    0.9015
  Broome, NY
  Tioga, NY
1000  Birmingham, AL................................    0.8648    0.9053
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010  \2\ Bismarck, ND..............................    0.7965    0.8557
  Burleigh, ND
  Morton, ND
1020  \2\ Bloomington, IN...........................    0.8757    0.9131
  Monroe, IN
1040  Bloomington-Normal, IL........................    0.8545    0.8979
  McLean, IL
1080  Boise City, ID................................    0.9190    0.9438
  Ada, ID
  Canyon, ID
1123  \1,\ \2\ Boston-Worcester-Lawrence-Lowell-        1.1586    1.1061
 Brockton, MA-NH (MA Hospitals).....................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1123  \1\ Boston-Worcester-Lawrence-Lowell-Brockton,    1.1483    1.0993
 MA-NH (NH Hospitals)...............................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125  Boulder-Longmont, CO..........................    0.9836    0.9887
  Boulder, CO
1145  Brazoria, TX..................................    0.8299    0.8801
  Brazoria, TX
1150  Bremerton, WA.................................    1.0882    1.0596
  Kitsap, WA
1240  Brownsville-Harlingen-San Benito, TX..........    0.8783    0.9150
  Cameron, TX
1260  Bryan-College Station, TX.....................    0.9296    0.9512
  Brazos, TX
1280  \1\ Buffalo-Niagara Falls, NY.................    0.9405    0.9589
  Erie, NY
  Niagara, NY
1303  Burlington, VT................................    0.9826    0.9881
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310  Caguas, PR....................................    0.5158    0.6355
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320  Canton-Massillon, OH..........................    0.9059    0.9346
  Carroll, OH
  Stark, OH
1350  Casper, WY....................................    0.9606    0.9728
  Natrona, WY
1360  Cedar Rapids, IA..............................    0.8711    0.9098
  Linn, IA
1400  Champaign-Urbana, IL..........................    0.9264    0.9490
  Champaign, IL
1440  Charleston-North Charleston, SC...............    0.9293    0.9510
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480  Charleston, WV................................    0.9369    0.9563
  Kanawha, WV
  Putnam, WV
1520  \1\ Charlotte-Gastonia-Rock Hill, NC-SC.......    0.9469    0.9633
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540  Charlottesville, VA...........................    1.0688    1.0466
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560  Chattanooga, TN-GA............................    0.9446    0.9617
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580  \2\ Cheyenne, WY..............................    0.8855    0.9201
  Laramie, WY
1600  \1\ Chicago, IL...............................    1.1011    1.0682
  Cook, IL
  DeKalb, IL
  DuPage, IL

[[Page 22823]]

 
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620  Chico-Paradise, CA............................    0.9909    0.9938
  Butte, CA
1640  \1\ Cincinnati, OH-KY-IN......................    0.9574    0.9706
  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...............    0.8481    0.8933
  Christian, KY
  Montgomery, TN
1680  \1\ Cleveland-Lorain-Elyria, OH...............    0.9496    0.9652
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720  Colorado Springs, CO..........................    0.9754    0.9831
  El Paso, CO
1740  Columbia, MO..................................    0.8787    0.9153
  Boone, MO
1760  Columbia, SC..................................    0.9589    0.9717
  Lexington, SC
  Richland, SC
1800  Columbus, GA-AL...............................    0.8471    0.8926
  Russell, AL
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840  \1\ Columbus, OH..............................    0.9724    0.9810
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880  Corpus Christi, TX............................    0.8203    0.8731
  Nueces, TX
  San Patricio, TX
1890  Corvallis, OR.................................    1.1781    1.1188
  Benton, OR
1900  \2\ Cumberland, MD-WV (MD Hospitals)..........    0.8962    0.9277
  Allegany, MD
  Mineral, WV
1900  Cumberland, MD-WV (WV Hospital)...............    0.8402    0.8876
  Allegany, MD
  Mineral, WV
1920  \1\ Dallas, TX................................    0.9506    0.9659
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950  Danville, VA..................................    0.8641    0.9048
  Danville City, VA
  Pittsylvania, VA
1960  Davenport-Moline-Rock Island, IA-IL...........    0.8790    0.9155
  Scott, IA
  Henry, IL
  Rock Island, IL
2000  Dayton-Springfield, OH........................    0.9323    0.9531
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020  Daytona Beach, FL.............................    0.9069    0.9353
  Flagler, FL
  Volusia, FL
2030  Decatur, AL...................................    0.8817    0.9174
  Lawrence, AL
  Morgan, AL
2040  \2\ Decatur, IL...............................    0.8140    0.8686
  Macon, IL
2080  \1\ Denver, CO................................    1.0289    1.0197
  Adams, CO
  Arapahoe, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120  Des Moines, IA................................    0.8881    0.9219
  Dallas, IA
  Polk, IA
  Warren, IA
2160  \1\ Detroit, MI...............................    1.0478    1.0325
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180  Dothan, AL....................................    0.8005    0.8587
  Dale, AL
  Houston, AL
2190  Dover, DE.....................................    1.0453    1.0308
  Kent, DE
2200  Dubuque, IA...................................    0.8617    0.9031
  Dubuque, IA
2240  Duluth-Superior, MN-WI........................    1.0401    1.0273
  St. Louis, MN
  Douglas, WI
2281  Dutchess County, NY...........................    1.0639    1.0433
  Dutchess, NY
2290  \2\ Eau Claire, WI............................    0.9121    0.9389
  Chippewa, WI
  Eau Claire, WI
2320  El Paso, TX...................................    0.9162    0.9418
  El Paso, TX
2330  Elkhart-Goshen, IN............................    0.9646    0.9756
  Elkhart, IN
2335  Elmira, NY....................................    0.8530    0.8968
  Chemung, NY
2340  Enid, OK......................................    0.8454    0.8914
  Garfield, OK
2360  Erie, PA......................................    0.8911    0.9241
  Erie, PA
2400  Eugene-Springfield, OR........................    1.1485    1.0995
  Lane, OR
2440  \2\ Evansville-Henderson, IN-KY (IN Hospitals)    0.8757    0.9131
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440  \2\ Evansville-Henderson, IN-KY (KY Hospitals)    0.8019    0.8597
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520  Fargo-Moorhead, ND-MN.........................    0.9374    0.9567
  Clay, MN
  Cass, ND
2560  Fayetteville, NC..............................    0.9132    0.9397
  Cumberland, NC
2580  Fayetteville-Springdale-Rogers, AR............    0.7587    0.8277
  Benton, AR
  Washington, AR
2620  Flagstaff, AZ-UT..............................    1.0678    1.0459
  Coconino, AZ
  Kane, UT
2640  Flint, MI.....................................    1.0920    1.0621
  Genesee, MI
2650  Florence, AL..................................    0.7927    0.8529
  Colbert, AL
  Lauderdale, AL
2655  Florence, SC..................................    0.8843    0.9192
  Florence, SC
2670  Fort Collins-Loveland, CO.....................    1.0161    1.0110
  Larimer, CO
2680  \1\ Ft. Lauderdale, FL........................    1.0906    1.0612
  Broward, FL
2700  Fort Myers-Cape Coral, FL.....................    0.9380    0.9571
  Lee, FL
2710  Fort Pierce-Port St. Lucie, FL................    1.0067    1.0046
  Martin, FL
  St. Lucie, FL
2720  Fort Smith, AR-OK.............................    0.8076    0.8639

[[Page 22824]]

 
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750  \2\ Fort Walton Beach, FL.....................    0.8733    0.9114
  Okaloosa, FL
2760  Fort Wayne, IN................................    0.9186    0.9435
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800  \1\ Forth Worth-Arlington, TX.................    0.9452    0.9621
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840  Fresno, CA....................................    0.9972    0.9981
  Fresno, CA
  Madera, CA
2880  Gadsden, AL...................................    0.8845    0.9194
  Etowah, AL
2900  Gainesville, FL...............................    1.2133    1.1416
  Alachua, FL
2920  Galveston-Texas City, TX......................    1.0271    1.0185
  Galveston, TX
2960  Gary, IN......................................    0.9571    0.9704
  Lake, IN
  Porter, IN
2975  \2\ Glens Falls, NY...........................    0.8530    0.8968
  Warren, NY
  Washington, NY
2980  Goldsboro, NC.................................    0.8810    0.9169
  Wayne, NC
2985  Grand Forks, ND-MN............................    0.9173    0.9426
  Polk, MN
  Grand Forks, ND
2995  Grand Junction, CO............................    0.9816    0.9874
  Mesa, CO
3000  \1\ Grand Rapids-Muskegon-Holland, MI.........    1.0161    1.0110
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040  Great Falls, MT...............................    0.9301    0.9516
  Cascade, MT
3060  Greeley, CO...................................    0.9604    0.9727
  Weld, CO
3080  Green Bay, WI.................................    0.9440    0.9613
  Brown, WI
3120  \1\ Greensboro-Winston-Salem-High Point, NC...    0.9616    0.9735
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150  Greenville, NC................................    0.9963    0.9975
  Pitt, NC
3160  Greenville-Spartanburg-Anderson, SC...........    0.9110    0.9382
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180  \2\ Hagerstown, MD............................    0.8962    0.9277
  Washington, MD
3200  Hamilton-Middletown, OH.......................    0.9269    0.9493
  Butler, OH
3240  Harrisburg-Lebanon-Carlisle, PA...............    0.9311    0.9523
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283  \1,\ \2\ Hartford, CT.........................    1.2357    1.1560
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285  \2\ Hattiesburg, MS...........................    0.7612    0.8296
  Forrest, MS
  Lamar, MS
3290  Hickory-Morganton-Lenoir, NC..................    0.9517    0.9667
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320  Honolulu, HI..................................    1.1658    1.1108
  Honolulu, HI
3350  Houma, LA.....................................    0.8043    0.8615
  Lafourche, LA
  Terrebonne, LA
3360  \1\ Houston, TX...............................    0.9604    0.9727
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400  Huntington-Ashland, WV-KY-OH..................    0.9700    0.9794
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440  Huntsville, AL................................    0.8854    0.9200
  Limestone, AL
  Madison, AL
3480  \1\ Indianapolis, IN..........................    0.9771    0.9843
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500  Iowa City, IA.................................    0.9973    0.9982
  Johnson, IA
3520  Jackson, MI...................................    0.9387    0.9576
  Jackson, MI
3560  Jackson, MS...................................    0.8589    0.9011
  Hinds, MS
  Madison, MS
  Rankin, MS
3580  Jackson, TN...................................    0.9117    0.9387
  Madison, TN
  Chester, TN
3600  \1\ Jacksonville, FL..........................    0.9040    0.9332
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605  \2\ Jacksonville, NC..........................    0.8632    0.9042
  Onslow, NC
3610  \2\ Jamestown, NY.............................    0.8530    0.8968
  Chautauqua, NY
3620  Janesville-Beloit, WI.........................    0.9840    0.9890
  Rock, WI
3640  Jersey City, NJ...............................    1.1216    1.0818
  Hudson, NJ
3660  Johnson City-Kingsport-Bristol, TN-VA.........    0.8540    0.8976
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680  Johnstown, PA.................................    0.8959    0.9275
  Cambria, PA
  Somerset, PA
3700  Jonesboro, AR.................................    0.8523    0.8963
  Craighead, AR
3710  Joplin, MO....................................    0.8736    0.9116
  Jasper, MO
  Newton, MO
3720  Kalamazoo-Battlecreek, MI.....................    1.0696    1.0472
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740  Kankakee, IL..................................    0.9268    0.9493
  Kankakee, IL
3760  \1\ Kansas City, KS-MO........................    0.9430    0.9606
  Johnson, KS
  Leavenworth, KS
  Miami, KS
  Wyandotte, KS
  Cass, MO
  Clay, MO
  Clinton, MO
  Jackson, MO

[[Page 22825]]

 
  Lafayette, MO
  Platte, MO
  Ray, MO
3800  Kenosha, WI...................................    0.9678    0.9778
  Kenosha, WI
3810  \2\ Killeen-Temple, TX........................    0.7673    0.8341
  Bell, TX
  Coryell, TX
3840  Knoxville, TN.................................    0.8904    0.9236
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850  Kokomo, IN....................................    0.9290    0.9508
  Howard, IN
  Tipton, IN
3870  La Crosse, WI-MN..............................    0.9328    0.9535
  Houston, MN
  La Crosse, WI
3880  Lafayette, LA.................................    0.8600    0.9019
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920  Lafayette, IN.................................    0.9165    0.9420
  Clinton, IN
  Tippecanoe, IN
3960  Lake Charles, LA..............................    0.7810    0.8443
  Calcasieu, LA
3980  Lakeland-Winter Haven, FL.....................    0.9167    0.9422
  Polk, FL
4000  Lancaster, PA.................................    0.9413    0.9594
  Lancaster, PA
4040  Lansing-East Lansing, MI......................    0.9653    0.9761
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080  Laredo, TX....................................    0.7877    0.8492
  Webb, TX
4100  \2\ Las Cruces, NM............................    0.8835    0.9187
  Dona Ana, NM
4120  \1\ Las Vegas, NV-AZ..........................    1.1238    1.0832
  Mohave, AZ
  Clark, NV
  Nye, NV
4150  Lawrence, KS..................................    0.8756    0.9130
  Douglas, KS
4200  Lawton, OK....................................    0.8783    0.9150
  Comanche, OK
4243  Lewiston-Auburn, ME...........................    0.9451    0.9621
  Androscoggin, ME
4280  Lexington, KY.................................    0.8850    0.9197
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320  Lima, OH......................................    0.9558    0.9695
  Allen, OH
  Auglaize, OH
4360  Lincoln, NE...................................    1.0272    1.0185
  Lancaster, NE
4400  Little Rock-North Little Rock, AR.............    0.9053    0.9341
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420  Longview-Marshall, TX.........................    0.8439    0.8903
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480  \1\ Los Angeles-Long Beach, CA................    1.2071    1.1376
  Los Angeles, CA
4520  \1\ Louisville, KY-IN.........................    0.9596    0.9722
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600  Lubbock, TX...................................    0.8547    0.8981
  Lubbock, TX
4640  Lynchburg, VA.................................    0.9208    0.9451
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680  Macon, GA.....................................    0.9077    0.9358
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720  Madison, WI...................................    1.0462    1.0314
  Dane, WI
4800  Mansfield, OH.................................    0.8827    0.9181
  Crawford, OH
  Richland, OH
4840  Mayaguez, PR..................................    0.4917    0.6150
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880  McAllen-Edinburg-Mission, TX..................    0.8433    0.8898
  Hidalgo, TX
4890  Medford-Ashland, OR...........................    1.0433    1.0295
  Jackson, OR
4900  Melbourne-Titusville-Palm Bay, FL.............    0.9883    0.9920
  Brevard, Fl
4920  \1\ Memphis, TN-AR-MS.........................    0.9435    0.9610
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940  Merced, CA....................................    0.9870    0.9911
  Merced, CA
5000  \1\ Miami, FL.................................    0.9934    0.9955
  Dade, FL
5015  \1\ Middlesex-Somerset-Hunterdon, NJ..........    1.1952    1.1299
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080  \1\ Milwaukee-Waukesha, WI....................    0.9898    0.9930
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120  \1\ Minneapolis-St. Paul, MN-WI...............    1.1000    1.0674
  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..................................    0.9453    0.9622
  Missoula, MT
5160  Mobile, AL....................................    0.7766    0.8410
  Baldwin, AL
  Mobile, AL
5170  Modesto, CA...................................    1.0945    1.0638
  Stanislaus, CA
5190  \1\ Monmouth-Ocean, NJ........................    1.1514    1.1014
  Monmouth, NJ
  Ocean, NJ
5200  Monroe, LA....................................    0.8296    0.8799
  Ouachita, LA
5240  Montgomery, AL................................    0.7502    0.8213
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280  Muncie, IN....................................    0.9689    0.9786
  Delaware, IN
5330  Myrtle Beach, SC..............................    0.8855    0.9201
  Horry, SC
5345  Naples, FL....................................    0.9566    0.9701
  Collier, FL
5360  \1\ Nashville, TN.............................    0.9602    0.9726
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN

[[Page 22826]]

 
  Williamson, TN
  Wilson, TN
5380  \1\ Nassau-Suffolk, NY........................    1.3841    1.2493
  Nassau, NY
  Suffolk, NY
5483  \1\ \2\ New Haven-Bridgeport-Stamford-            1.2357    1.1560
 Waterbury-Danbury, CT..............................
  Fairfield, CT
  New Haven, CT
5523  \12\ New London-Norwich, CT...................    1.2357    1.1560
  New London, CT
5560  \1\ New Orleans, LA...........................    0.9054    0.9342
  Jefferson, LA
  Orleans, LA
  Plaquemines, LA
  St. Bernard, LA
  St. Charles, LA
  St. James, LA
  St. John The Baptist, LA
  St. Tammany, LA
5600  \1\ New York, NY..............................    1.3923    1.2544
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640  \1\ Newark, NJ................................    1.2004    1.1332
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660  Newburgh, NY-PA...............................    1.1235    1.0830
  Orange, NY
  Pike, PA
5720  \1\ Norfolk-Virginia Beach-Newport News, VA-NC    0.8630    0.9040
  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  \1\ Oakland, CA...............................    1.5416    1.3450
  Alameda, CA
  Contra Costa, CA
5790  Ocala, FL.....................................    0.9579    0.9710
  Marion, FL
5800  Odessa-Midland, TX............................    0.9017    0.9316
  Ector, TX
  Midland, TX
5880  \1\ Oklahoma City, OK.........................    0.8728    0.9110
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910  Olympia, WA...................................    1.1481    1.0992
  Thurston, WA
5920  Omaha, NE-IA..................................    0.9696    0.9791
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945  \1\ Orange County, CA.........................    1.1354    1.0909
  Orange, CA
5960  \1\ Orlando, FL...............................    0.9464    0.9630
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990  Owensboro, KY.................................    0.8346    0.8835
  Daviess, KY
6015  Panama City, FL...............................    0.9166    0.9421
  Bay, FL
6020  Parkersburg-Marietta, WV-OH (WV Hospitals)....    0.8192    0.8723
  Washington, OH
  Wood, WV
6020  \2\ Parkersburg-Marietta, WV-OH (OH Hospitals)    0.8761    0.9134
  Washington, OH
  Wood, WV
6080  \2\ Pensacola, FL.............................    0.8733    0.9114
  Escambia, FL
  Santa Rosa, FL
6120  Peoria-Pekin, IL..............................    0.8883    0.9221
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160  \1\ Philadelphia, PA-NJ.......................    1.0626    1.0425
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200  \1\ Phoenix-Mesa, AZ..........................    0.9654    0.9762
  Maricopa, AZ
  Pinal, AZ
6240  Pine Bluff, AR................................    0.7837    0.8463
  Jefferson, AR
6280  \1\ Pittsburgh, PA............................    0.9714    0.9803
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323  \2\ Pittsfield, MA............................    1.1586    1.1061
  Berkshire, MA
6340  Pocatello, ID.................................    0.9557    0.9694
  Bannock, ID
6360  Ponce, PR.....................................    0.5278    0.6456
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403  Portland, ME..................................    0.9501    0.9656
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440  \1\ Portland-Vancouver, OR-WA.................    1.1291    1.0867
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483  \1\ Providence-Warwick-Pawtucket, RI..........    1.0781    1.0528
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520  Provo-Orem, UT................................    0.9967    0.9977
  Utah, UT
6560  \2\ Pueblo, CO................................    0.8909    0.9239
  Pueblo, CO
6580  Punta Gorda, FL...............................    0.8818    0.9175
  Charlotte, FL
6600  Racine, WI....................................    0.9441    0.9614
  Racine, WI
6640  \1\ Raleigh-Durham-Chapel Hill, NC............    0.9901    0.9932
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660  Rapid City, SD................................    0.8971    0.9283
  Pennington, SD
6680  \2\ Reading, PA...............................    0.8473    0.8927
  Berks, PA
6690  Redding, CA...................................    1.1222    1.0822
  Shasta, CA
6720  Reno, NV......................................    1.0456    1.0310
  Washoe, NV

[[Page 22827]]

 
6740  Richland-Kennewick-Pasco, WA..................    1.1086    1.0732
  Benton, WA
  Franklin, WA
6760  Richmond-Petersburg, VA.......................    0.9712    0.9802
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780  \1\ Riverside-San Bernardino, CA..............    1.1012    1.0682
  Riverside, CA
  San Bernardino, CA
6800  \2\ Roanoke, VA...............................    0.8473    0.8927
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820  Rochester, MN.................................    1.1595    1.1067
  Olmsted, MN
6840  \1\ Rochester, NY.............................    0.9238    0.9472
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880  Rockford, IL..................................    0.9194    0.9441
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895  Rocky Mount, NC...............................    0.9197    0.9443
  Edgecombe, NC
  Nash, NC
6920  \1\ Sacramento, CA............................    1.1809    1.1206
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960  Saginaw-Bay City-Midland, MI..................    0.9662    0.9767
  Bay, MI
  Midland, MI
  Saginaw, MI
6980  St. Cloud, MN.................................    1.0040    1.0027
  Benton, MN
  Stearns, MN
7000  St. Joseph, MO................................    0.9113    0.9384
  Andrew, MO
  Buchanan, MO
7040  \1\ St. Louis, MO-IL..........................    0.9024    0.9321
  Clinton, IL
  Jersey, IL
  Madison, IL
  Monroe, IL
  St. Clair, IL
  Franklin, MO
  Jefferson, MO
  Lincoln, MO
  St. Charles, MO
  St. Louis, MO
  St. Louis City, MO
  Warren, MO
7080  \2\ Salem, OR.................................    1.0156    1.0107
  Marion, OR
  Polk, OR
7120  Salinas, CA...................................    1.4854    1.3112
  Monterey, CA
7160  \1\ Salt Lake City-Ogden, UT..................    0.9976    0.9984
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200  San Angelo, TX................................    0.8288    0.8793
  Tom Green, TX
7240  \1\ San Antonio, TX...........................    0.8333    0.8826
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320  \1\ San Diego, CA.............................    1.1480    1.0991
  San Diego, CA
7360  \1\ San Francisco, CA.........................    1.4319    1.2787
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400  \1\ San Jose, CA..............................    1.4249    1.2744
  Santa Clara, CA
7440  \1\ San Juan-Bayamon, PR......................    0.4812    0.6060
  Aguas Buenas, PR
  Barceloneta, PR
  Bayamon, PR
  Canovanas, PR
  Carolina, PR
  Catano, PR
  Ceiba, PR
  Comerio, PR
  Corozal, PR
  Dorado, PR
  Fajardo, PR
  Florida, PR
  Guaynabo, PR
  Humacao, PR
  Juncos, PR
  Los Piedras, PR
  Loiza, PR
  Luguillo, PR
  Manati, PR
  Morovis, PR
  Naguabo, PR
  Naranjito, PR
  Rio Grande, PR
  San Juan, PR
  Toa Alta, PR
  Toa Baja, PR
  Trujillo Alto, PR
  Vega Alta, PR
  Vega Baja, PR
  Yabucoa, PR
7460  San Luis Obispo-Atascadero-Paso Robles, CA....    1.1117    1.0752
  San Luis Obispo, CA
7480  Santa Barbara-Santa Maria-Lompoc, CA..........    1.0927    1.0626
  Santa Barbara, CA
7485  Santa Cruz-Watsonville, CA....................    1.4049    1.2621
  Santa Cruz, CA
7490  Santa Fe, NM..................................    1.0312    1.0213
  Los Alamos, NM
  Santa Fe, NM
7500  Santa Rosa, CA................................    1.2727    1.1796
  Sonoma, CA
7510  Sarasota-Bradenton, FL........................    1.0118    1.0081
  Manatee, FL
  Sarasota, FL
7520  Savannah, GA..................................    0.9349    0.9549
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560  \2\ Scranton--Wilkes-Barre--Hazleton, PA......    0.8473    0.8927
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600  \1\ Seattle-Bellevue-Everett, WA..............    1.1056    1.0712
  Island, WA
  King, WA
  Snohomish, WA
7610  \2\ Sharon, PA................................    0.8473    0.8927
  Mercer, PA
7620  \2\ Sheboygan, WI.............................    0.9121    0.9389
  Sheboygan, WI
7640  Sherman-Denison, TX...........................    0.9163    0.9419
  Grayson, TX
7680  Shreveport-Bossier City, LA...................    0.9165    0.9420
  Bossier, LA
  Caddo, LA
  Webster, LA
7720  Sioux City, IA-NE.............................    0.8868    0.9210
  Woodbury, IA
  Dakota, NE
7760  Sioux Falls, SD...............................    0.9245    0.9477
  Lincoln, SD
  Minnehaha, SD
7800  South Bend, IN................................    1.0303    1.0207
  St. Joseph, IN
7840  Spokane, WA...................................    1.0791    1.0535
  Spokane, WA
7880  Springfield, IL...............................    0.8502    0.8948
  Menard, IL
  Sangamon, IL
7920  Springfield, MO...............................    0.8666    0.9066
  Christian, MO

[[Page 22828]]

 
  Greene, MO
  Webster, MO
8003  \2\ Springfield, MA...........................    1.1586    1.1061
  Hampden, MA
  Hampshire, MA
8050  State College, PA.............................    0.9239    0.9472
  Centre, PA
8080  \2\ Steubenville-Weirton, OH-WV (OH Hospitals)    0.8761    0.9134
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8080  Steubenville-Weirton, OH-WV (WV Hospitals)....    0.8737    0.9117
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120  Stockton-Lodi, CA.............................    1.1114    1.0750
  San Joaquin, CA
8140  \2\ Sumter, SC................................    0.8606    0.9023
  Sumter, SC
8160  Syracuse, NY..................................    0.9247    0.9478
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200  Tacoma, WA....................................    1.1751    1.1168
  Pierce, WA
8240  \2\ Tallahassee, FL...........................    0.8733    0.9114
  Gadsden, FL
  Leon, FL
8280  \1\ Tampa-St. Petersburg-Clearwater, FL.......    0.9095    0.9371
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320  \2\ Terre Haute, IN...........................    0.8757    0.9131
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360  Texarkana, AR-Texarkana, TX...................    0.8414    0.8885
  Miller, AR
  Bowie, TX
8400  Toledo, OH....................................    0.9815    0.9873
  Fulton, OH
  Lucas, OH
  Wood, OH
8440  Topeka, KS....................................    0.9015    0.9315
  Shawnee, KS
8480  Trenton, NJ...................................    1.0172    1.0117
  Mercer, NJ
8520  Tucson, AZ....................................    0.9002    0.9305
  Pima, AZ
8560  Tulsa, OK.....................................    0.8949    0.9268
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600  Tuscaloosa, AL................................    0.8265    0.8777
  Tuscaloosa, AL
8640  Tyler, TX.....................................    0.9109    0.9381
  Smith, TX
8680  \2\ Utica-Rome, NY............................    0.8530    0.8968
  Herkimer, NY
  Oneida, NY
8720  Vallejo-Fairfield-Napa, CA....................    1.3535    1.2303
  Napa, CA
  Solano, CA
8735  Ventura, CA...................................    1.1088    1.0733
  Ventura, CA
8750  Victoria, TX..................................    0.8354    0.8841
  Victoria, TX
8760  Vineland-Millville-Bridgeton, NJ..............    1.0473    1.0322
  Cumberland, NJ
8780  \2\ Visalia-Tulare-Porterville, CA............    0.9870    0.9911
  Tulare, CA
8800  Waco, TX......................................    0.8268    0.8779
  McLennan, TX
8840  \1\ Washington, DC-MD-VA-WV...................    1.1176    1.0791
  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......................    0.8608    0.9024
  Black Hawk, IA
8940  Wausau, WI....................................    0.9516    0.9666
  Marathon, WI
8960  \1\ West Palm Beach-Boca Raton, FL............    0.9785    0.9852
  Palm Beach, FL
9000  \2\ Wheeling, WV-OH (WV Hospitals)............    0.8145    0.8689
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000  \2\ Wheeling, WV-OH (OH Hospitals)............    0.8761    0.9134
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040  Wichita, KS...................................    0.9541    0.9683
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080  Wichita Falls, TX.............................    0.8015    0.8594
  Archer, TX
  Wichita, TX
9140  Williamsport, PA..............................    0.8503    0.8949
  Lycoming, PA
9160  Wilmington-Newark, DE-MD......................    1.0757    1.0512
  New Castle, DE
  Cecil, MD
9200  Wilmington, NC................................    0.9971    0.9980
  New Hanover, NC
  Brunswick, NC
9260  Yakima, WA....................................    1.0690    1.0468
  Yakima, WA
9270  \2\ Yolo, CA..................................    0.9870    0.9911
  Yolo, CA
9280  \2\ York, PA..................................    0.8473    0.8927
  York, PA
9320  Youngstown-Warren, OH.........................    0.9480    0.9641
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340  Yuba City, CA.................................    1.0479    1.0326
  Sutter, CA
  Yuba, CA
9360  Yuma, AZ......................................    0.8904    0.9236
  Yuma, AZ
------------------------------------------------------------------------
\1\ Large Urban Area
\2\ Hospitals geographically located in the area are assigned the
  statewide rural wage index for FY 2002.


Table 4B.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
                               Rural Areas
------------------------------------------------------------------------
                                                        Wage
                    Nonurban area                       index      GAF
------------------------------------------------------------------------
Alabama.............................................    0.7483    0.8199
Alaska..............................................    1.2006    1.1334
Arizona.............................................    0.8747    0.9124
Arkansas............................................    0.7561    0.8258
California..........................................    0.9870    0.9911
Colorado............................................    0.8909    0.9239
Connecticut.........................................    1.2357    1.1560
Delaware............................................    0.9487    0.9646
Florida.............................................    0.8733    0.9114
Georgia.............................................    0.8341    0.8832
Hawaii..............................................    1.1235    1.0830
Idaho...............................................    0.8820    0.9176
Illinois............................................    0.8140    0.8686
Indiana.............................................    0.8757    0.9131
Iowa................................................    0.8194    0.8725

[[Page 22829]]

 
Kansas..............................................    0.7850    0.8472
Kentucky............................................    0.8019    0.8597
Louisiana...........................................    0.7755    0.8402
Maine...............................................    0.8714    0.9100
Maryland............................................    0.8962    0.9277
Massachusetts.......................................    1.1586    1.1061
Michigan............................................    0.9115    0.9385
Minnesota...........................................    0.9109    0.9381
Mississippi.........................................    0.7612    0.8296
Missouri............................................    0.7838    0.8464
Montana.............................................    0.8642    0.9049
Nebraska............................................    0.8233    0.8753
Nevada..............................................    0.9785    0.9852
New Hampshire.......................................    0.9914    0.9941
New Jersey \1\......................................  ........  ........
New Mexico..........................................    0.8835    0.9187
New York............................................    0.8530    0.8968
North Carolina......................................    0.8632    0.9042
North Dakota........................................    0.7965    0.8557
Ohio................................................    0.8761    0.9134
Oklahoma............................................    0.7646    0.8321
Oregon..............................................    1.0156    1.0107
Pennsylvania........................................    0.8473    0.8927
Puerto Rico.........................................    0.4654    0.5923
Rhode Island \1\....................................  ........  ........
South Carolina......................................    0.8606    0.9023
South Dakota........................................    0.7934    0.8534
Tennessee...........................................    0.7901    0.8510
Texas...............................................    0.7673    0.8341
Utah................................................    0.9156    0.9414
Vermont.............................................    0.9576    0.9708
Virginia............................................    0.8473    0.8927
Washington..........................................    1.0301    1.0205
West Virginia.......................................    0.8145    0.8689
Wisconsin...........................................    0.9121    0.9389
Wyoming.............................................    0.8855   0.9201
------------------------------------------------------------------------
\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
------------------------------------------------------------------------
                                                        Wage
                        Area                            index      GAF
------------------------------------------------------------------------
Abilene, TX.........................................    0.8118    0.8669
Akron, OH...........................................    0.9924    0.9948
Albany, GA..........................................    1.0675    1.0457
Albuquerque, NM.....................................    0.9748    0.9827
Alexandria, LA......................................    0.8137    0.8683
Allentown-Bethlehem-Easton, PA......................    0.9443    0.9615
Altoona, PA.........................................    0.9225    0.9463
Amarillo, TX........................................    0.8485    0.8936
Anchorage, AK.......................................    1.2605    1.1718
Ann Arbor, MI.......................................    1.1220    1.0820
Anniston, AL........................................    0.7922    0.8526
Asheville, NC.......................................    0.9307    0.9520
Athens, GA..........................................    0.9818    0.9875
Atlanta, GA.........................................    1.0066    1.0045
Augusta-Aiken, GA-SC................................    1.0090    1.0062
Austin-San Marcos, TX...............................    0.9327    0.9534
Barnstable-Yarmouth, MA.............................    1.3415    1.2229
Baton Rouge, LA.....................................    0.8258    0.8772
Bellingham, WA......................................    1.1427    1.0957
Benton Harbor, MI...................................    0.9115    0.9385
Bergen-Passaic, NJ..................................    1.1669    1.1115
Billings, MT........................................    0.9623    0.9740
Biloxi-Gulfport-Pascagoula, MS......................    0.8198    0.8728
Binghamton, NY......................................    0.8595    0.9015
Birmingham, AL......................................    0.8648    0.9053
Bismarck, ND........................................    0.7965    0.8557
Bloomington-Normal, IL..............................    0.8545    0.8979
Boise City, ID......................................    0.9190    0.9438
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH....    1.1483    1.0993
Burlington, VT......................................    0.9606    0.9728
Caguas, PR..........................................    0.4993    0.6215
Casper, WY..........................................    0.9454    0.9623
Champaign-Urbana, IL................................    0.9264    0.9490
Charleston-North Charleston, SC.....................    0.9293    0.9510
Charleston, WV......................................    0.8991    0.9298
Charlotte-Gastonia-Rock Hill, NC-SC.................    0.9469    0.9633
Chattanooga, TN-GA..................................    0.9207    0.9450
Chicago, IL.........................................    1.0887    1.0599
Cincinnati, OH-KY-IN................................    0.9574    0.9706
Clarksville-Hopkinsville, TN-KY.....................    0.8481    0.8933
Cleveland-Lorain-Elyria, OH.........................    0.9496    0.9652
Columbia, MO........................................    0.8787    0.9153
Columbia, SC........................................    0.9264    0.9490
Columbus, GA-AL.....................................    0.8471    0.8926
Columbus, OH........................................    0.9724    0.9810
Corpus Christi, TX..................................    0.8203    0.8731
Dallas, TX..........................................    0.9506    0.9659
Davenport-Moline-Rock Island, IA-IL.................    0.8790    0.9155
Dayton-Springfield, OH..............................    0.9323    0.9531
Denver, CO..........................................    1.0289    1.0197
Des Moines, IA......................................    0.8881    0.9219
Dothan, AL..........................................    0.8005    0.8587
Dover, DE...........................................    0.9957    0.9971
Duluth-Superior, MN-WI..............................    1.0299    1.0204
Eau Claire, WI......................................    0.9121    0.9389
Elkhart-Goshen, IN..................................    0.9516    0.9666
Erie, PA............................................    0.8780    0.9148
Eugene-Springfield, OR..............................    1.1073    1.0723
Fargo-Moorhead, ND-MN...............................    0.9247    0.9478
Fayetteville, NC....................................    0.8970    0.9283
Flagstaff, AZ-UT....................................    1.0222    1.0151
Flint, MI...........................................    1.0920    1.0621
Florence, AL........................................    0.7927    0.8529
Florence, SC........................................    0.8843    0.9192
Fort Collins-Loveland, CO...........................    1.0161    1.0110
Ft. Lauderdale, FL..................................    1.0906    1.0612
Fort Pierce-Port St. Lucie, FL......................    1.0067    1.0046
Fort Smith, AR-OK...................................    0.7889    0.8501
Fort Walton Beach, FL...............................    0.8547    0.8981
Fort Wayne, IN......................................    0.9059    0.9346
Forth Worth-Arlington, TX...........................    0.9452    0.9621
Gadsden, AL.........................................    0.8446    0.8908
Gainesville, FL.....................................    1.1855    1.1236
Grand Forks, ND-MN (ND Hospitals)...................    0.9022    0.9319
Grand Forks, ND-MN (MN Hospital)....................    0.9109    0.9381
Grand Junction, CO..................................    0.9816    0.9874
Grand Rapids-Muskegon-Holland, MI...................    1.0052    1.0036
Great Falls, MT.....................................    0.9301    0.9516
Greeley, CO.........................................    0.9604    0.9727
Green Bay, WI.......................................    0.9440    0.9613
Greensboro-Winston-Salem-High Point, NC.............    0.9474    0.9637
Greenville, NC......................................    0.9751    0.9829
Greenville-Spartanburg-Anderson, SC.................    0.9110    0.9382
Harrisburg-Lebanon-Carlisle, PA.....................    0.9068    0.9352
Hartford, CT........................................    1.1586    1.1061
Hattiesburg, MS.....................................    0.7612    0.8296
Hickory-Morganton-Lenoir, NC........................    0.9517    0.9667
Honolulu, HI........................................    1.1658    1.1108
Houston, TX.........................................    0.9604    0.9727
Huntington-Ashland, WV-KY-OH........................    0.9286    0.9505
Huntsville, AL......................................    0.8657    0.9060
Indianapolis, IN....................................    0.9666    0.9770
Iowa City, IA.......................................    0.9820    0.9876
Jackson, MS.........................................    0.8589    0.9011
Jackson, TN.........................................    0.8945    0.9265
Jacksonville, FL....................................    0.9040    0.9332
Johnson City-Kingsport-Bristol, TN-VA...............    0.8540    0.8976
Jonesboro, AR.......................................    0.8093    0.8651
Joplin, MO..........................................    0.8560    0.8990
Kalamazoo-Battlecreek, MI...........................    1.0537    1.0365
Kansas City, KS-MO..................................    0.9430    0.9606
Knoxville, TN.......................................    0.8904    0.9236
Kokomo, IN..........................................    0.9290    0.9508
Lafayette, LA.......................................    0.8430    0.8896
Lansing-East Lansing, MI............................    0.9653    0.9761
Las Vegas, NV-AZ....................................    1.1238    1.0832
Lawton, OK..........................................    0.8372    0.8854
Lexington, KY.......................................    0.8675    0.9072
Lima, OH............................................    0.9558    0.9695
Lincoln, NE.........................................    0.9945    0.9962
Little Rock-North Little Rock, AR...................    0.8938    0.9260
Longview-Marshall, TX...............................    0.8439    0.8903
Los Angeles-Long Beach, CA..........................    1.2071    1.1376
Louisville, KY-IN...................................    0.9481    0.9642
Lubbock, TX.........................................    0.8547    0.8981
Lynchburg, VA.......................................    0.8897    0.9231
Macon, GA...........................................    0.9077    0.9358
Madison, WI.........................................    1.0462    1.0314
Mansfield, OH.......................................    0.8827    0.9181
Medford-Ashland, OR.................................    1.0156    1.0107
Melbourne-Titusville-Palm Bay, FL...................    0.9883    0.9920
Memphis, TN-AR-MS...................................    0.9152    0.9411
Miami, FL...........................................    0.9934    0.9955

[[Page 22830]]

 
Milwaukee-Waukesha, WI..............................    0.9898    0.9930
Minneapolis-St. Paul, MN-WI.........................    1.1000    1.0674
Missoula, MT........................................    0.9273    0.9496
Mobile, AL..........................................    0.7766    0.8410
Modesto, CA.........................................    1.0945    1.0638
Monmouth-Ocean, NJ..................................    1.1514    1.1014
Monroe, LA..........................................    0.8191    0.8723
Montgomery, AL......................................    0.7502    0.8213
Myrtle Beach, SC....................................    0.8663    0.9064
Nashville, TN.......................................    0.9433    0.9608
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT.    1.2357    1.1560
New London-Norwich, CT..............................    1.1578    1.1055
New Orleans, LA.....................................    0.9054    0.9342
New York, NY........................................    1.3923    1.2544
Newark, NJ..........................................    1.2004    1.1332
Newburgh, NY-PA.....................................    1.0838    1.0567
Norfolk-Virginia Beach-Newport News, VA-NC..........    0.8632    0.9042
Oakland, CA.........................................    1.5313    1.3388
Odessa-Midland, TX (TX Hospitals)...................    0.8769    0.9140
Odessa-Midland, TX (NM Hospitals)...................    0.8835    0.9187
Oklahoma City, OK...................................    0.8728    0.9110
Omaha, NE-IA........................................    0.9696    0.9791
Orange County, CA...................................    1.1354    1.0909
Orlando, FL.........................................    0.9464    0.9630
Peoria-Pekin, IL....................................    0.8883    0.9221
Philadelphia, PA-NJ.................................    1.0626    1.0425
Pine Bluff, AR......................................    0.7837    0.8463
Pittsburgh, PA......................................    0.9550    0.9690
Pittsfield, MA......................................    1.0018    1.0012
Pocatello, ID.......................................    0.9264    0.9490
Portland, ME........................................    0.9501    0.9656
Portland-Vancouver, OR-WA...........................    1.1291    1.0867
Provo-Orem, UT......................................    0.9840    0.9890
Raleigh-Durham-Chapel Hill, NC......................    0.9901    0.9932
Rapid City, SD......................................    0.8849    0.9197
Reading, PA.........................................    0.8473    0.8927
Redding, CA.........................................    1.1222    1.0822
Reno, NV............................................    1.0456    1.0310
Richland-Kennewick-Pasco, WA........................    1.0478    1.0325
Richmond-Petersburg, VA.............................    0.9712    0.9802
Roanoke, VA.........................................    0.8468    0.8924
Rochester, MN.......................................    1.1595    1.1067
Rockford, IL........................................    0.9080    0.9360
Sacramento, CA......................................    1.1809    1.1206
Saginaw-Bay City-Midland, MI........................    0.9662    0.9767
St. Cloud, MN.......................................    1.0040    1.0027
St. Joseph, MO......................................    0.8953    0.9271
St. Louis, MO-IL....................................    0.8911    0.9241
Salinas, CA.........................................    1.4738    1.3042
Salt Lake City-Ogden, UT............................    0.9976    0.9984
San Diego, CA.......................................    1.1480    1.0991
Santa Fe, NM........................................    1.0013    1.0009
Santa Rosa, CA......................................    1.2408    1.1592
Sarasota-Bradenton, FL..............................    1.0118    1.0081
Savannah, GA........................................    0.9349    0.9549
Seattle-Bellevue-Everett, WA........................    1.1056    1.0712
Sherman-Denison, TX.................................    0.8899    0.9232
Shreveport-Bossier City, LA.........................    0.9165    0.9420
Sioux City, IA-NE...................................    0.8868    0.9210
Sioux Falls, SD.....................................    0.9037    0.9330
South Bend, IN......................................    1.0176    1.0120
Spokane, WA.........................................    1.0663    1.0449
Springfield, IL.....................................    0.8502    0.8948
Springfield, MO.....................................    0.8454    0.8914
Stockton-Lodi, CA...................................    1.1114    1.0750
Syracuse, NY........................................    0.9247    0.9478
Tampa-St. Petersburg-Clearwater, FL.................    0.9095    0.9371
Texarkana, AR-Texarkana, TX.........................    0.8414    0.8885
Toledo, OH..........................................    0.9815    0.9873
Topeka, KS..........................................    0.8850    0.9197
Tucson, AZ..........................................    0.9002    0.9305
Tulsa, OK...........................................    0.8815    0.9173
Tuscaloosa, AL......................................    0.8265    0.8777
Tyler, TX...........................................    0.8905    0.9237
Victoria, TX........................................    0.8212    0.8738
Waco, TX............................................    0.8268    0.8779
Washington, DC-MD-VA-WV.............................    1.1024    1.0690
Waterloo-Cedar Falls, IA............................    0.8608    0.9024
Wausau, WI..........................................    0.9516    0.9666
West Palm Beach-Boca Raton, FL......................    0.9785    0.9852
Wichita, KS.........................................    0.9218    0.9458
Wichita Falls, TX...................................    0.8015    0.8594
Wilmington-Newark, DE-MD............................    1.0757    1.0512
Rural Alabama.......................................    0.7483    0.8199
Rural Florida.......................................    0.8733    0.9114
Rural Illinois (IA Hospital)........................    0.8194    0.8725
Rural Illinois (MO Hospital)........................    0.8140    0.8686
Rural Kentucky......................................    0.8019    0.8597
Rural Louisiana.....................................    0.7755    0.8402
Rural Michigan......................................    0.9115    0.9385
Rural Minnesota.....................................    0.9109    0.9381
Rural Missouri (AK Hospital)........................    0.7838    0.8464
Rural Missouri (KS Hospital)........................    0.7850    0.8472
Rural Montana.......................................    0.8642    0.9049
Rural Nebraska......................................    0.8233    0.8753
Rural Nevada........................................    0.9219    0.9458
Rural Oregon........................................    1.0156    1.0107
Rural Texas.........................................    0.7673    0.8341
Rural Washington....................................    1.0301    1.0205
Rural Wisconsin.....................................    0.9121    0.9389
Rural Wyoming.......................................    0.8855    0.9201
------------------------------------------------------------------------


                Table 4F.--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF)
----------------------------------------------------------------------------------------------------------------
                                                                                        Wage index--
                                                                                          Reclass.      GAF--
                            Area                              Wage  index      GAF       hospitals     Reclass.
                                                                                                      hospitals
----------------------------------------------------------------------------------------------------------------
Aguadilla, PR...............................................       0.9666       0.9770  ...........  ...........
Arecibo, PR.................................................       0.9555       0.9693  ...........  ...........
Caguas, PR..................................................       1.0523       1.0355       1.0188       1.0128
Mayaguez, PR................................................       1.0031       1.0021  ...........  ...........
Ponce, PR...................................................       1.0768       1.0520  ...........  ...........
San Juan-Bayamon, PR........................................       0.9817       0.9874  ...........  ...........
Rural Puerto Rico...........................................       0.9495       0.9651  ...........  ...........
----------------------------------------------------------------------------------------------------------------


[[Page 22831]]


         Table 4G.--Pre-Reclassified Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
              Urban area  (Constituent counties)                  index
------------------------------------------------------------------------
0040  Abilene, TX.............................................    0.8057
  Taylor, TX
0060  Aguadilla, PR...........................................    0.4738
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080  Akron, OH...............................................    0.9924
  Portage, OH
  Summit, OH
0120  Albany, GA..............................................    1.0675
  Dougherty, GA
  Lee, GA
0160  Albany-Schenectady-Troy, NY.............................    0.8597
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200  Albuquerque, NM.........................................    0.9855
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220  Alexandria, LA..........................................    0.8121
  Rapides, LA
0240  Allentown-Bethlehem-Easton, PA..........................    0.9443
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280  Altoona, PA.............................................    0.9225
  Blair, PA
0320  Amarillo, TX............................................    0.8706
  Potter, TX
  Randall, TX
0380  Anchorage, AK...........................................    1.2454
  Anchorage, AK
0440  Ann Arbor, MI...........................................    1.1220
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450  Anniston, AL............................................    0.8360
  Calhoun, AL
0460  Appleton-Oshkosh-Neenah, WI.............................    0.9203
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470  Arecibo, PR.............................................    0.4683
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480  Asheville, NC...........................................    0.9307
  Buncombe, NC
  Madison, NC
0500  Athens, GA..............................................    0.9956
  Clarke, GA
  Madison, GA
  Oconee, GA
0520  Atlanta, GA.............................................    1.0176
  Barrow, GA
  Bartow, GA
  Carroll, GA
  Cherokee, GA
  Clayton, GA
  Cobb, GA
  Coweta, GA
  DeKalb, GA
  Douglas, GA
  Fayette, GA
  Forsyth, GA
  Fulton, GA
  Gwinnett, GA
  Henry, GA
  Newton, GA
  Paulding, GA
  Pickens, GA
  Rockdale, GA
  Spalding, GA
  Walton, GA
0560  Atlantic-Cape May, NJ...................................    1.1349
  Atlantic, NJ
  Cape May, NJ
0580  Auburn-Opelika, AL......................................    0.8325
  Lee, AL
0600  Augusta-Aiken, GA-SC....................................    1.0090
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640  Austin-San Marcos, TX...................................    0.9327
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680  Bakersfield, CA.........................................    0.9387
  Kern, CA
0720  Baltimore, MD...........................................    0.9723
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733  Bangor, ME..............................................    0.9559
  Penobscot, ME
0743  Barnstable-Yarmouth, MA.................................    1.3539
  Barnstable, MA
0760  Baton Rouge, LA.........................................    0.8258
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840  Beaumont-Port Arthur, TX................................    0.8508
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860  Bellingham, WA..........................................    1.1963
  Whatcom, WA
0870  Benton Harbor, MI.......................................    0.8912
  Berrien, MI
0875  Bergen-Passaic, NJ......................................    1.1549
  Bergen, NJ
  Passaic, NJ
0880  Billings, MT............................................    0.9623
  Yellowstone, MT
0920  Biloxi-Gulfport-Pascagoula, MS..........................    0.8538
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960  Binghamton, NY..........................................    0.8595
  Broome, NY
  Tioga, NY
1000  Birmingham, AL..........................................    0.8648
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010  Bismarck, ND............................................    0.7955
  Burleigh, ND
  Morton, ND
1020  Bloomington, IN.........................................    0.8689
  Monroe, IN
1040  Bloomington-Normal, IL..................................    0.8448
  McLean, IL
1080  Boise City, ID..........................................    0.9151
  Ada, ID
  Canyon, ID
1123  Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (NH        1.1483
 Hospitals)...................................................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125  Boulder-Longmont, CO....................................    0.9836
  Boulder, CO
1145  Brazoria, TX............................................    0.8299
  Brazoria, TX
1150  Bremerton, WA...........................................    1.0882
  Kitsap, WA
1240  Brownsville-Harlingen-San Benito, TX....................    0.8783
  Cameron, TX
1260  Bryan-College Station, TX...............................    0.9296
  Brazos, TX
1280  Buffalo-Niagara Falls, NY...............................    0.9405
  Erie, NY
  Niagara, NY
1303  Burlington, VT..........................................    0.9826
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310  Caguas, PR..............................................    0.5158
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320  Canton-Massillon, OH....................................    0.9059
  Carroll, OH
  Stark, OH
1350  Casper, WY..............................................    0.9606
  Natrona, WY
1360  Cedar Rapids, IA........................................    0.8711
  Linn, IA
1400  Champaign-Urbana, IL....................................    0.9264
  Champaign, IL
1440  Charleston-North Charleston, SC.........................    0.9293
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480  Charleston, WV..........................................    0.9369
  Kanawha, WV
  Putnam, WV
1520  Charlotte-Gastonia-Rock Hill, NC-SC.....................    0.9400

[[Page 22832]]

 
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540  Charlottesville, VA.....................................    1.0688
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560  Chattanooga, TN-GA......................................    0.9446
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580  Cheyenne, WY............................................    0.8414
  Laramie, WY
1600  Chicago, IL.............................................    1.1011
  Cook, IL
  DeKalb, IL
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620  Chico-Paradise, CA......................................    0.9909
  Butte, CA
1640  Cincinnati, OH-KY-IN....................................    0.9574
  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.........................    0.8433
  Christian, KY
  Montgomery, TN
1680  Cleveland-Lorain-Elyria, OH.............................    0.9496
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720  Colorado Springs, CO....................................    0.9754
  El Paso, CO
1740  Columbia, MO............................................    0.8787
  Boone, MO
1760  Columbia, SC............................................    0.9589
  Lexington, SC
  Richland, SC
1800  Columbus, GA-AL.........................................    0.8471
  Russell, AL
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840  Columbus, OH............................................    0.9724
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880  Corpus Christi, TX......................................    0.8203
  Nueces, TX
  San Patricio, TX
1890  Corvallis, OR...........................................    1.1781
  Benton, OR
1900  Cumberland, MD-WV (WV Hospital).........................    0.8402
  Allegany, MD
  Mineral, WV
1920  Dallas, TX..............................................    0.9506
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950  Danville, VA............................................    0.8641
  Danville City, VA
  Pittsylvania, VA
1960  Davenport-Moline-Rock Island, IA-IL.....................    0.8790
  Scott, IA
  Henry, IL
  Rock Island, IL
2000  Dayton-Springfield, OH..................................    0.9323
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020  Daytona Beach, FL.......................................    0.9069
  Flagler, FL
  Volusia, FL
2030  Decatur, AL.............................................    0.8817
  Lawrence, AL
  Morgan, AL
2040  Decatur, IL.............................................    0.8056
  Macon, IL
2080  Denver, CO..............................................    1.0289
  Adams, CO
  Arapahoe, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120  Des Moines, IA..........................................    0.8881
  Dallas, IA
  Polk, IA
  Warren, IA
2160  Detroit, MI.............................................    1.0478
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180  Dothan, AL..............................................    0.7959
  Dale, AL
  Houston, AL
2190  Dover, DE...............................................    1.0453
  Kent, DE
2200  Dubuque, IA.............................................    0.8617
  Dubuque, IA
2240  Duluth-Superior, MN-WI..................................    1.0401
  St. Louis, MN
  Douglas, WI
2281  Dutchess County, NY.....................................    1.0639
  Dutchess, NY
2290  Eau Claire, WI..........................................    0.8893
  Chippewa, WI
  Eau Claire, WI
2320  El Paso, TX.............................................    0.9162
  El Paso, TX
2330  Elkhart-Goshen, IN......................................    0.9646
  Elkhart, IN
2335  Elmira, NY..............................................    0.8530
  Chemung, NY
2340  Enid, OK................................................    0.8454
  Garfield, OK
2360  Erie, PA................................................    0.8911
  Erie, PA
2400  Eugene-Springfield, OR..................................    1.1485
  Lane, OR
2440  Evansville-Henderson, IN-KY (IN Hospitals)..............    0.7808
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520  Fargo-Moorhead, ND-MN...................................    0.9374
  Clay, MN
  Cass, ND
2560  Fayetteville, NC........................................    0.9132
  Cumberland, NC
2580  Fayetteville-Springdale-Rogers, AR......................    0.7587
  Benton, AR
  Washington, AR
2620  Flagstaff, AZ-UT........................................    1.0678
  Coconino, AZ
  Kane, UT
2640  Flint, MI...............................................    1.0920
  Genesee, MI
2650  Florence, AL............................................    0.7875
  Colbert, AL
  Lauderdale, AL
2655  Florence, SC............................................    0.8843
  Florence, SC
2670  Fort Collins-Loveland, CO...............................    1.0161
  Larimer, CO
2680  Ft. Lauderdale, FL......................................    1.0407
  Broward, FL
2700  Fort Myers-Cape Coral, FL...............................    0.9380
  Lee, FL
2710  Fort Pierce-Port St. Lucie, FL..........................    1.0067
  Martin, FL
  St. Lucie, FL
2720  Fort Smith, AR-OK.......................................    0.8076
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750  Fort Walton Beach, FL...................................    0.8695
  Okaloosa, FL
2760  Fort Wayne, IN..........................................    0.9186
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800  Forth Worth-Arlington, TX...............................    0.9452
  Hood, TX
  Johnson, TX

[[Page 22833]]

 
  Parker, TX
  Tarrant, TX
2840  Fresno, CA..............................................    0.9972
  Fresno, CA
  Madera, CA
2880  Gadsden, AL.............................................    0.8845
  Etowah, AL
2900  Gainesville, FL.........................................    1.2133
  Alachua, FL
2920  Galveston-Texas City, TX................................    1.0271
  Galveston, TX
2960  Gary, IN................................................    0.9571
  Lake, IN
  Porter, IN
2975  Glens Falls, NY.........................................    0.8432
  Warren, NY
  Washington, NY
2980  Goldsboro, NC...........................................    0.8810
  Wayne, NC
2985  Grand Forks, ND-MN......................................    0.9173
  Polk, MN
  Grand Forks, ND
2995  Grand Junction, CO......................................    0.9579
  Mesa, CO
3000  Grand Rapids-Muskegon-Holland, MI.......................    1.0161
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040  Great Falls, MT.........................................    0.8972
  Cascade, MT
3060  Greeley, CO.............................................    0.9604
  Weld, CO
3080  Green Bay, WI...........................................    0.9269
  Brown, WI
3120  Greensboro-Winston-Salem-High Point, NC.................    0.9616
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150  Greenville, NC..........................................    0.9963
  Pitt, NC
3160  Greenville-Spartanburg-Anderson, SC.....................    0.9096
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180  Hagerstown, MD..........................................    0.8462
  Washington, MD
3200  Hamilton-Middletown, OH.................................    0.9269
  Butler, OH
3240  Harrisburg-Lebanon-Carlisle, PA.........................    0.9311
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283  Hartford, CT............................................    1.1536
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285  \2\ Hattiesburg, MS.....................................    0.7559
  Forrest, MS
  Lamar, MS
3290  Hickory-Morganton-Lenoir, NC............................    0.9517
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320  Honolulu, HI............................................    1.1653
  Honolulu, HI
3350  Houma, LA...............................................    0.8043
  Lafourche, LA
  Terrebonne, LA
3360  Houston, TX.............................................    0.9604
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400  Huntington-Ashland, WV-KY-OH............................    0.9700
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440  Huntsville, AL..........................................    0.8854
  Limestone, AL
  Madison, AL
3480  Indianapolis, IN........................................    0.9771
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500  Iowa City, IA...........................................    0.9973
  Johnson, IA
3520  Jackson, MI.............................................    0.9387
  Jackson, MI
3560  Jackson, MS.............................................    0.8589
  Hinds, MS
  Madison, MS
  Rankin, MS
3580  Jackson, TN.............................................    0.9117
  Madison, TN
  Chester, TN
3600  Jacksonville, FL........................................    0.9040
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605  Jacksonville, NC........................................    0.7710
  Onslow, NC
3610  Jamestown, NY...........................................    0.8143
  Chautauqua, NY
3620  Janesville-Beloit, WI...................................    0.9840
  Rock, WI
3640  Jersey City, NJ.........................................    1.1216
  Hudson, NJ
3660  Johnson City-Kingsport-Bristol, TN-VA...................    0.8540
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680  Johnstown, PA...........................................    0.8959
  Cambria, PA
  Somerset, PA
3700  Jonesboro, AR...........................................    0.8523
  Craighead, AR
3710  Joplin, MO..............................................    0.8736
  Jasper, MO
  Newton, MO
3720  Kalamazoo-Battlecreek, MI...............................    1.0696
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740  Kankakee, IL............................................    0.9268
  Kankakee, IL
3760  Kansas City, KS-MO......................................    0.9430
  Johnson, KS
  Leavenworth, KS
  Miami, KS
  Wyandotte, KS
  Cass, MO
  Clay, MO
  Clinton, MO
  Jackson, MO
  Lafayette, MO
  Platte, MO
  Ray, MO
3800  Kenosha, WI.............................................    0.9678
  Kenosha, WI
3810  Killeen-Temple, TX......................................    0.7376
  Bell, TX
  Coryell, TX
3840  Knoxville, TN...........................................    0.8904
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850  Kokomo, IN..............................................    0.9232
  Howard, IN
  Tipton, IN
3870  La Crosse, WI-MN........................................    0.9328
  Houston, MN
  La Crosse, WI
3880  Lafayette, LA...........................................    0.8600
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920  Lafayette, IN...........................................    0.9165
  Clinton, IN
  Tippecanoe, IN
3960  Lake Charles, LA........................................    0.7810
  Calcasieu, LA
3980  Lakeland-Winter Haven, FL...............................    0.9167
  Polk, FL
4000  Lancaster, PA...........................................    0.9413
  Lancaster, PA
4040  Lansing-East Lansing, MI................................    0.9653
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080  Laredo, TX..............................................    0.7877
  Webb, TX

[[Page 22834]]

 
4100  Las Cruces, NM..........................................    0.8721
  Dona Ana, NM
4120  Las Vegas, NV-AZ........................................    1.1238
  Mohave, AZ
  Clark, NV
  Nye, NV
4150  Lawrence, KS............................................    0.8756
  Douglas, KS
4200  Lawton, OK..............................................    0.8783
  Comanche, OK
4243  Lewiston-Auburn, ME.....................................    0.9451
  Androscoggin, ME
4280  Lexington, KY...........................................    0.8850
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320  Lima, OH................................................    0.9558
  Allen, OH
  Auglaize, OH
4360  Lincoln, NE.............................................    1.0272
  Lancaster, NE
4400  Little Rock-North Little Rock, AR.......................    0.9053
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420  Longview-Marshall, TX...................................    0.8322
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480  Los Angeles-Long Beach, CA..............................    1.2062
  Los Angeles, CA
4520  \1\ Louisville, KY-IN...................................    0.9596
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600  Lubbock, TX.............................................    0.8547
  Lubbock, TX
4640  Lynchburg, VA...........................................    0.9208
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680  Macon, GA...............................................    0.9064
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720  Madison, WI.............................................    1.0456
  Dane, WI
4800  Mansfield, OH...........................................    0.8809
  Crawford, OH
  Richland, OH
4840  Mayaguez, PR............................................    0.4917
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880  McAllen-Edinburg-Mission, TX............................    0.8433
  Hidalgo, TX
4890  Medford-Ashland, OR.....................................    1.0433
  Jackson, OR
4900  Melbourne-Titusville-Palm Bay, FL.......................    0.9857
  Brevard, FL
4920  Memphis, TN-AR-MS.......................................    0.9435
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940  Merced, CA..............................................    0.9870
  Merced, CA
5000  Miami, FL...............................................    0.9934
  Dade, FL
5015  Middlesex-Somerset-Hunterdon, NJ........................    1.1952
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080  Milwaukee-Waukesha, WI..................................    0.9898
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120  Minneapolis-St. Paul, MN-WI.............................    1.1000
  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............................................    0.9453
  Missoula, MT
5160  Mobile, AL..............................................    0.7754
  Baldwin, AL
  Mobile, AL
5170  Modesto, CA.............................................    1.0945
  Stanislaus, CA
5190  Monmouth-Ocean, NJ......................................    1.0930
  Monmouth, NJ
  Ocean, NJ
5200  Monroe, LA..............................................    0.8296
  Ouachita, LA
5240  Montgomery, AL..........................................    0.7502
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280  Muncie, IN..............................................    0.9689
  Delaware, IN
5330  Myrtle Beach, SC........................................    0.8855
  Horry, SC
5345  Naples, FL..............................................    0.9566
  Collier, FL
5360  Nashville, TN...........................................    0.9602
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380  Nassau-Suffolk, NY......................................    1.3841
  Nassau, NY
  Suffolk, NY
5483  New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT.....    1.2267
  Fairfield, CT
  New Haven, CT
5523  New London-Norwich, CT..................................    1.1578
  New London, CT
5560  New Orleans, LA.........................................    0.9054
  Jefferson, LA
  Orleans, LA
  Plaquemines, LA
  St. Bernard, LA
  St. Charles, LA
  St. James, LA
  St. John The Baptist, LA
  St. Tammany, LA
5600  New York, NY............................................    1.3893
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640  Newark, NJ..............................................    1.2004
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660  Newburgh, NY-PA.........................................    1.1235
  Orange, NY
  Pike, PA
5720  Norfolk-Virginia Beach-Newport News, VA-NC..............    0.8629
  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.............................................    1.5416
  Alameda, CA
  Contra Costa, CA
5790  Ocala, FL...............................................    0.9579
  Marion, FL
5800  Odessa-Midland, TX......................................    0.9017
  Ector, TX
  Midland, TX
5880  Oklahoma City, OK.......................................    0.8728
  Canadian, OK

[[Page 22835]]

 
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910  Olympia, WA.............................................    1.1481
  Thurston, WA
5920  Omaha, NE-IA............................................    0.9696
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945  Orange County, CA.......................................    1.1242
  Orange, CA
5960  Orlando, FL.............................................    0.9464
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990  Owensboro, KY...........................................    0.8346
  Daviess, KY
6015  Panama City, FL.........................................    0.9166
  Bay, FL
6020  Parkersburg-Marietta, WV-OH.............................    0.8192
  Washington, OH
  Wood, WV
6080  Pensacola, FL...........................................    0.8367
  Escambia, FL
  Santa Rosa, FL
6120  Peoria-Pekin, IL........................................    0.8883
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160  Philadelphia, PA-NJ.....................................    1.0626
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200  Phoenix-Mesa, AZ........................................    0.9654
  Maricopa, AZ
  Pinal, AZ
6240  Pine Bluff, AR..........................................    0.7837
  Jefferson, AR
6280  Pittsburgh, PA..........................................    0.9714
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323  Pittsfield, MA..........................................    1.0396
  Berkshire, MA
6340  Pocatello, ID...........................................    0.9557
  Bannock, ID
6360  Ponce, PR...............................................    0.5278
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403  Portland, ME............................................    0.9501
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440  Portland-Vancouver, OR-WA...............................    1.1263
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483  Providence-Warwick-Pawtucket, RI........................    1.0781
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520  Provo-Orem, UT..........................................    0.9967
  Utah, UT
6560  Pueblo, CO..............................................    0.8704
  Pueblo, CO
6580  Punta Gorda, FL.........................................    0.8818
  Charlotte, FL
6600  Racine, WI..............................................    0.9441
  Racine, WI
6640  Raleigh-Durham-Chapel Hill, NC..........................    0.9901
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660  Rapid City, SD..........................................    0.8971
  Pennington, SD
6680  Reading, PA.............................................    0.6780
  Berks, PA
6690  Redding, CA.............................................    1.1222
  Shasta, CA
6720  Reno, NV................................................    1.0456
  Washoe, NV
6740  Richland-Kennewick-Pasco, WA............................    1.1086
  Benton, WA
  Franklin, WA
6760  Richmond-Petersburg, VA.................................    0.9712
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780  Riverside-San Bernardino, CA............................    1.1012
  Riverside, CA
  San Bernardino, CA
6800  Roanoke, VA.............................................    0.8468
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820  Rochester, MN...........................................    1.1595
  Olmsted, MN
6840  Rochester, NY...........................................    0.9238
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880  Rockford, IL............................................    0.9194
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895  Rocky Mount, NC.........................................    0.9197
  Edgecombe, NC
  Nash, NC
6920  Sacramento, CA..........................................    1.1809
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960  Saginaw-Bay City-Midland, MI............................    0.9662
  Bay, MI
  Midland, MI
  Saginaw, MI
6980  St. Cloud, MN...........................................    0.9966
  Benton, MN
  Stearns, MN
7000  St. Joseph, MO..........................................    0.9113
  Andrew, MO
  Buchanan, MO
7040  St. Louis, MO-IL........................................    0.9024
  Clinton, IL
  Jersey, IL
  Madison, IL
  Monroe, IL
  St. Clair, IL
  Franklin, MO
  Jefferson, MO
  Lincoln, MO
  St. Charles, MO
  St. Louis, MO
  St. Louis City, MO
  Warren, MO
7080  Salem, OR...............................................    1.0127
  Marion, OR
  Polk, OR
7120  Salinas, CA.............................................    1.4854
  Monterey, CA
7160  Salt Lake City-Ogden, UT................................    0.9976
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200  San Angelo, TX..........................................    0.8288
  Tom Green, TX
7240  San Antonio, TX.........................................    0.8333
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320  San Diego, CA...........................................    1.1480
  San Diego, CA
7360  San Francisco, CA.......................................    1.4319
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400  San Jose, CA............................................    1.4249
  Santa Clara, CA
7440  San Juan-Bayamon, PR....................................    0.4812
  Aguas Buenas, PR
  Barceloneta, PR
  Bayamon, PR

[[Page 22836]]

 
  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 Robles, CA..............    1.1117
  San Luis Obispo, CA
7480  Santa Barbara-Santa Maria-Lompoc, CA....................    1.0927
  Santa Barbara, CA
7485  Santa Cruz-Watsonville, CA..............................    1.4049
  Santa Cruz, CA
7490  Santa Fe, NM............................................    1.0312
  Los Alamos, NM
  Santa Fe, NM
7500  Santa Rosa, CA..........................................    1.2727
  Sonoma, CA
7510  Sarasota-Bradenton, FL..................................    1.0118
  Manatee, FL
  Sarasota, FL
7520  Savannah, GA............................................    0.9349
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560  Scranton--Wilkes-Barre--Hazleton, PA....................    0.8071
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600  Seattle-Bellevue-Everett, WA............................    1.1040
  Island, WA
  King, WA
  Snohomish, WA
7610  Sharon, PA..............................................    0.8013
  Mercer, PA
7620  Sheboygan, WI...........................................    0.8524
  Sheboygan, WI
7640  Sherman-Denison, TX.....................................    0.9163
  Grayson, TX
7680  Shreveport-Bossier City, LA.............................    0.9165
  Bossier, LA
  Caddo, LA
  Webster, LA
7720  Sioux City, IA-NE.......................................    0.8868
  Woodbury, IA
  Dakota, NE
7760  Sioux Falls, SD.........................................    0.9245
  Lincoln, SD
  Minnehaha, SD
7800  South Bend, IN..........................................    1.0303
  St. Joseph, IN
7840  Spokane, WA.............................................    1.0791
  Spokane, WA
7880  Springfield, IL.........................................    0.8502
  Menard, IL
  Sangamon, IL
7920  Springfield, MO.........................................    0.8666
  Christian, MO
  Greene, MO
  Webster, MO
8003  Springfield, MA.........................................    1.0747
  Hampden, MA
  Hampshire, MA
8050  State College, PA.......................................    0.9239
  Centre, PA
8080  Steubenville-Weirton, OH-WV (WV Hospitals)..............    0.8737
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120  Stockton-Lodi, CA.......................................    1.0939
  San Joaquin, CA
8140  Sumter, SC..............................................    0.7884
  Sumter, SC
8160  Syracuse, NY............................................    0.9243
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200  Tacoma, WA..............................................    1.1751
  Pierce, WA
8240  Tallahassee, FL.........................................    0.8402
  Gadsden, FL
  Leon, FL
8280  Tampa-St. Petersburg-Clearwater, FL.....................    0.8994
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320  Terre Haute, IN.........................................    0.8498
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360  Texarkana, AR-Texarkana, TX.............................    0.8414
  Miller, AR
  Bowie, TX
8400  Toledo, OH..............................................    0.9815
  Fulton, OH
  Lucas, OH
  Wood, OH
8440  Topeka, KS..............................................    0.9015
  Shawnee, KS
8480  Trenton, NJ.............................................    1.0172
  Mercer, NJ
8520  Tucson, AZ..............................................    0.8990
  Pima, AZ
8560  Tulsa, OK...............................................    0.8949
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600  Tuscaloosa, AL..........................................    0.8265
  Tuscaloosa, AL
8640  Tyler, TX...............................................    0.9109
  Smith, TX
8680  Utica-Rome, NY..........................................    0.8425
  Herkimer, NY
  Oneida, NY
8720  Vallejo-Fairfield-Napa, CA..............................    1.3535
  Napa, CA
  Solano, CA
8735  Ventura, CA.............................................    1.1088
  Ventura, CA
8750  Victoria, TX............................................    0.8354
  Victoria, TX
8760  Vineland-Millville-Bridgeton, NJ........................    1.0473
  Cumberland, NJ
8780  Visalia-Tulare-Porterville, CA..........................    0.9706
  Tulare, CA
8800  Waco, TX................................................    0.8249
  McLennan, TX
8840  Washington, DC-MD-VA-WV.................................    1.1176
  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................................    0.8134
  Black Hawk, IA
8940  Wausau, WI..............................................    0.9455
  Marathon, WI
8960  West Palm Beach-Boca Raton, FL..........................    0.9785
  Palm Beach, FL
9000  Wheeling, WV-OH.........................................    0.8077
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040  Wichita, KS.............................................    0.9541
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080  Wichita Falls, TX.......................................    0.7933
  Archer, TX
  Wichita, TX
9140  Williamsport, PA........................................    0.8503
  Lycoming, PA
9160  Wilmington-Newark, DE-MD................................    1.0757

[[Page 22837]]

 
  New Castle, DE
  Cecil, MD
9200  Wilmington, NC..........................................    0.9971
  New Hanover, NC
  Brunswick, NC
9260  Yakima, WA..............................................    1.0690
  Yakima, WA
9270  Yolo, CA................................................    0.9830
  Yolo, CA
9280  York, PA................................................    0.7840
  York, PA
9320  Youngstown-Warren, OH...................................    0.9480
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340  Yuba City, CA...........................................    1.0479
  Sutter, CA
  Yuba, CA
9360  Yuma, AZ................................................    0.8904
  Yuma, AZ
------------------------------------------------------------------------


         Table 4H.--Pre-Reclassified Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                         Nonurban area                            index
------------------------------------------------------------------------
Alabama.......................................................    0.7420
Alaska........................................................    1.2006
Arizona.......................................................    0.8747
Arkansas......................................................    0.7561
California....................................................    0.9870
Colorado......................................................    0.8909
Connecticut...................................................    1.2357
Delaware......................................................    0.9487
Florida.......................................................    0.8709
Georgia.......................................................    0.8341
Hawaii........................................................    1.1235
Idaho.........................................................    0.8820
Illinois......................................................    0.8140
Indiana.......................................................    0.8757
Iowa..........................................................    0.8194
Kansas........................................................    0.7850
Kentucky......................................................    0.8019
Louisiana.....................................................    0.7649
Maine.........................................................    0.8714
Maryland......................................................    0.8962
Massachusetts.................................................    1.1586
Michigan......................................................    0.9106
Minnesota.....................................................    0.9109
Mississippi...................................................    0.7612
Missouri......................................................    0.7826
Montana.......................................................    0.8642
Nebraska......................................................    0.8233
Nevada........................................................    0.9785
New Hampshire.................................................    0.9914
New Jersey \1\................................................  ........
New Mexico....................................................    0.8835
New York......................................................    0.8530
North Carolina................................................    0.8634
North Dakota..................................................    0.7965
Ohio..........................................................    0.8761
Oklahoma......................................................    0.7646
Oregon........................................................    1.0150
Pennsylvania..................................................    0.8473
Puerto Rico...................................................    0.4654
Rhode Island \1\..............................................  ........
South Carolina................................................    0.8606
South Dakota..................................................    0.7934
Tennessee.....................................................    0.7901
Texas.........................................................    0.7671
Utah..........................................................    0.9156
Vermont.......................................................    0.9576
Virginia......................................................    0.8473
Washington....................................................    1.0301
West Virginia.................................................    0.8145
Wisconsin.....................................................    0.9118
Wyoming.......................................................   0.8855
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.

                        
* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW 
VOLUME DRGS.

** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID 
DRGS.

NOTE: GEOMETRIC MEAN IS USED ONLY TO DETERMINE PAYMENT FOR TRANSFER 
CASES.

NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.

NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE 
APPROPRIATE FOR OTHER PATIENTS.

[[Page 22837]]



  Table 5.--List of Diagnosis Related Groups (DRGs), Relative Weighting Factors, Geometric and Arithmetic Mean
                                                 Length of Stay
----------------------------------------------------------------------------------------------------------------
                                                                              Relative    Geometric  Arithmetric
       DRG          MDC            Type                  DRG title             weights    mean LOS     mean LOS
----------------------------------------------------------------------------------------------------------------
1...............       01  SURG                 CRANIOTOMY AGE >17 EXCEPT        3.2546         7.6         10.2
                                                 FOR TRAUMA.
2...............       01  SURG                 CRANIOTOMY FOR TRAUMA AGE        3.3742         8.8         11.1
                                                 >17.
3...............       01  SURG                 * CRANIOTOMY AGE 0-17......      1.9527        12.7         12.7
4...............       01  SURG                 SPINAL PROCEDURES..........      2.4074         5.5          8.1
5...............       01  SURG                 EXTRACRANIAL VASCULAR            1.3612         2.3          3.2
                                                 PROCEDURES.
6...............       01  SURG                 CARPAL TUNNEL RELEASE......       .7238         2.1          3.0
7...............       01  SURG                 PERIPH & CRANIAL NERVE &         2.6736         8.5         11.3
                                                 OTHER NERV SYST PROC W CC.
8...............       01  SURG                 PERIPH & CRANIAL NERVE &         1.3727         2.3          3.4
                                                 OTHER NERV SYST PROC W/O
                                                 CC.
9...............       01  MED                  SPINAL DISORDERS & INJURIES      1.3411         5.3          7.0
10..............       01  MED                  NERVOUS SYSTEM NEOPLASMS W       1.2655         5.5          7.2
                                                 CC.
11..............       01  MED                  NERVOUS SYSTEM NEOPLASMS W/       .8455         3.3          4.3
                                                 O CC.
12..............       01  MED                  DEGENERATIVE NERVOUS SYSTEM       .8985         4.9          6.3
                                                 DISORDERS.
13..............       01  MED                  MULTIPLE SCLEROSIS &              .8107         4.5          5.5
                                                 CEREBELLAR ATAXIA.
14..............       01  MED                  SPECIFIC CEREBROVASCULAR         1.1667         4.8          6.1
                                                 DISORDERS EXCEPT TIA.
15..............       01  MED                  TRANSIENT ISCHEMIC ATTACK &       .7349         3.0          3.7
                                                 PRECEREBRAL OCCLUSIONS.
16..............       01  MED                  NONSPECIFIC CEREBROVASCULAR      1.1833         5.1          6.5
                                                 DISORDERS W CC.
17..............       01  MED                  NONSPECIFIC CEREBROVASCULAR       .6706         2.7          3.5
                                                 DISORDERS W/O CC.
18..............       01  MED                  CRANIAL & PERIPHERAL NERVE        .9762         4.6          5.8
                                                 DISORDERS W CC.
19..............       01  MED                  CRANIAL & PERIPHERAL NERVE        .6770         3.1          3.9
                                                 DISORDERS W/O CC.
20..............       01  MED                  NERVOUS SYSTEM INFECTION         2.7628         9.0         11.4
                                                 EXCEPT VIRAL MENINGITIS.
21..............       01  MED                  VIRAL MENINGITIS...........      1.4606         5.6          7.1
22..............       01  MED                  HYPERTENSIVE ENCEPHALOPATHY      1.0073         4.0          5.1
23..............       01  MED                  NONTRAUMATIC STUPOR & COMA.       .8101         3.4          4.4
24..............       01  MED                  SEIZURE & HEADACHE AGE >17       1.0182         4.0          5.3
                                                 W CC.
25..............       01  MED                  SEIZURE & HEADACHE AGE >17        .5945         2.7          3.3
                                                 W/O CC.
26..............       01  MED                  SEIZURE & HEADACHE AGE 0-17       .5846         2.3          2.8
27..............       01  MED                  TRAUMATIC STUPOR & COMA,         1.3456         3.7          5.6
                                                 COMA >1 HR.
28..............       01  MED                  TRAUMATIC STUPOR & COMA,         1.3526         5.2          6.8
                                                 COMA 1 HR AGE >17 W CC.
29..............       01  MED                  TRAUMATIC STUPOR & COMA,          .6903         3.0          3.8
                                                 COMA 1 HR AGE >17 W/O CC.
30..............       01  MED                  * TRAUMATIC STUPOR & COMA,        .3303         2.0          2.0
                                                 COMA 1 HR AGE 0-17.
31..............       01  MED                  CONCUSSION AGE >17 W CC....       .9098         3.5          4.8

[[Page 22838]]

 
32..............       01  MED                  CONCUSSION AGE >17 W/O CC..       .5191         2.0          2.6
33..............       01  MED                  * CONCUSSION AGE 0-17......       .2075         1.6          1.6
34..............       01  MED                  OTHER DISORDERS OF NERVOUS       1.0065         4.2          5.4
                                                 SYSTEM W CC.
35..............       01  MED                  OTHER DISORDERS OF NERVOUS        .5886         2.7          3.5
                                                 SYSTEM W/O CC.
36..............       02  SURG                 RETINAL PROCEDURES.........       .6586         1.2          1.5
37..............       02  SURG                 ORBITAL PROCEDURES.........      1.1220         2.9          4.3
38..............       02  SURG                 PRIMARY IRIS PROCEDURES....       .4730         2.0          2.6
39..............       02  SURG                 LENS PROCEDURES WITH OR           .5882         1.5          1.9
                                                 WITHOUT VITRECTOMY.
40..............       02  SURG                 EXTRAOCULAR PROCEDURES            .8274         2.4          3.6
                                                 EXCEPT ORBIT AGE >17.
41..............       02  SURG                 * EXTRAOCULAR PROCEDURES          .3362         1.6          1.6
                                                 EXCEPT ORBIT AGE 0-17.
42..............       02  SURG                 INTRAOCULAR PROCEDURES            .6273         1.6          2.3
                                                 EXCEPT RETINA, IRIS & LENS.
43..............       02  MED                  HYPHEMA....................       .4570         2.8          3.3
44..............       02  MED                  ACUTE MAJOR EYE INFECTIONS.       .6556         4.3          5.2
45..............       02  MED                  NEUROLOGICAL EYE DISORDERS.       .6765         2.7          3.3
46..............       02  MED                  OTHER DISORDERS OF THE EYE        .7983         3.9          5.0
                                                 AGE >17 W CC.
47..............       02  MED                  OTHER DISORDERS OF THE EYE        .5013         2.6          3.4
                                                 AGE >17 W/O CC.
48..............       02  MED                  * OTHER DISORDERS OF THE          .2962         2.9          2.9
                                                 EYE AGE 0-17.
49..............       03  SURG                 MAJOR HEAD & NECK                1.7590         3.8          5.2
                                                 PROCEDURES.
50..............       03  SURG                 SIALOADENECTOMY............       .8139         1.5          1.9
51..............       03  SURG                 SALIVARY GLAND PROCEDURES         .7928         1.8          2.7
                                                 EXCEPT SIALOADENECTOMY.
52..............       03  SURG                 CLEFT LIP & PALATE REPAIR..       .7608         1.5          1.9
53..............       03  SURG                 SINUS & MASTOID PROCEDURES       1.1741         2.3          3.7
                                                 AGE >17.
54..............       03  SURG                 * SINUS & MASTOID                 .4801         3.2          3.2
                                                 PROCEDURES AGE 0-17.
55..............       03  SURG                 MISCELLANEOUS EAR, NOSE,          .8500         1.8          2.7
                                                 MOUTH & THROAT PROCEDURES.
56..............       03  SURG                 RHINOPLASTY................       .8771         2.0          2.7
57..............       03  SURG                 T&A PROC, EXCEPT                 1.1547         2.8          4.2
                                                 TONSILLECTOMY &/OR
                                                 ADENOIDECTOMY ONLY, AGE
                                                 >17.
58..............       03  SURG                 * T&A PROC, EXCEPT                .2726         1.5          1.5
                                                 TONSILLECTOMY &/OR
                                                 ADENOIDECTOMY ONLY, AGE 0-
                                                 17.
59..............       03  SURG                 TONSILLECTOMY &/OR                .8324         1.9          2.8
                                                 ADENOIDECTOMY ONLY, AGE
                                                 >17.
60..............       03  SURG                 * TONSILLECTOMY &/OR              .2076         1.5          1.5
                                                 ADENOIDECTOMY ONLY, AGE 0-
                                                 17.
61..............       03  SURG                 MYRINGOTOMY W TUBE               1.3536         3.2          5.6
                                                 INSERTION AGE >17.
62..............       03  SURG                 * MYRINGOTOMY W TUBE              .2940         1.3          1.3
                                                 INSERTION AGE 0-17.
63..............       03  SURG                 OTHER EAR, NOSE, MOUTH &         1.3658         3.3          4.7
                                                 THROAT O.R. PROCEDURES.
64..............       03  MED                  EAR, NOSE, MOUTH & THROAT        1.2289         4.8          6.9
                                                 MALIGNANCY.
65..............       03  MED                  DYSEQUILIBRIUM.............       .5321         2.4          2.9
66..............       03  MED                  EPISTAXIS..................       .5538         2.6          3.3
67..............       03  MED                  EPIGLOTTITIS...............       .7556         3.0          3.7
68..............       03  MED                  OTITIS MEDIA & URI AGE >17        .6687         3.6          4.3
                                                 W CC.
69..............       03  MED                  OTITIS MEDIA & URI AGE >17        .4988         2.8          3.4
                                                 W/O CC.
70..............       03  MED                  OTITIS MEDIA & URI AGE 0-17       .4556         2.5          3.0
71..............       03  MED                  LARYNGOTRACHEITIS..........       .6714         3.1          4.0
72..............       03  MED                  NASAL TRAUMA & DEFORMITY...       .6722         2.9          3.7
73..............       03  MED                  OTHER EAR, NOSE, MOUTH &          .8016         3.6          4.7
                                                 THROAT DIAGNOSES AGE >17.
74..............       03  MED                  * OTHER EAR, NOSE, MOUTH &        .3341         2.1          2.1
                                                 THROAT DIAGNOSES AGE 0-17.
75..............       04  SURG                 MAJOR CHEST PROCEDURES.....      3.2016         8.8         10.8
76..............       04  SURG                 OTHER RESP SYSTEM O.R.           2.9628        10.0         12.6
                                                 PROCEDURES W CC.
77..............       04  SURG                 OTHER RESP SYSTEM O.R.           1.2254         4.1          5.4
                                                 PROCEDURES W/O CC.
78..............       04  MED                  PULMONARY EMBOLISM.........      1.3317         6.3          7.2
79..............       04  MED                  RESPIRATORY INFECTIONS &         1.7116         7.6          9.3
                                                 INFLAMMATIONS AGE >17 W CC.
80..............       04  MED                  RESPIRATORY INFECTIONS &          .9285         5.0          6.0
                                                 INFLAMMATIONS AGE >17 W/O
                                                 CC.
81..............       04  MED                  * RESPIRATORY INFECTIONS &       1.5125         6.1          6.1
                                                 INFLAMMATIONS AGE 0-17.
82..............       04  MED                  RESPIRATORY NEOPLASMS......      1.4325         6.0          7.6
83..............       04  MED                  MAJOR CHEST TRAUMA W CC....       .9783         4.8          5.9
84..............       04  MED                  MAJOR CHEST TRAUMA W/O CC..       .5455         2.9          3.5
85..............       04  MED                  PLEURAL EFFUSION W CC......      1.2505         5.5          6.9
86..............       04  MED                  PLEURAL EFFUSION W/O CC....       .6776         3.0          3.8
87..............       04  MED                  PULMONARY EDEMA &                1.4280         5.5          6.9
                                                 RESPIRATORY FAILURE.
88..............       04  MED                  CHRONIC OBSTRUCTIVE               .9137         4.5          5.4
                                                 PULMONARY DISEASE.
89..............       04  MED                  SIMPLE PNEUMONIA & PLEURISY      1.0636         5.3          6.3
                                                 AGE >17 W CC.
90..............       04  MED                  SIMPLE PNEUMONIA & PLEURISY       .6385         3.7          4.3
                                                 AGE >17 W/O CC.
91..............       04  MED                  SIMPLE PNEUMONIA & PLEURISY       .8141         3.9          4.8
                                                 AGE 0-17.
92..............       04  MED                  INTERSTITIAL LUNG DISEASE W      1.2313         5.6          6.8
                                                 CC.
93..............       04  MED                  INTERSTITIAL LUNG DISEASE W/      .7311         3.5          4.2
                                                 O CC.
94..............       04  MED                  PNEUMOTHORAX W CC..........      1.2011         5.4          6.9
95..............       04  MED                  PNEUMOTHORAX W/O CC........       .5833         3.2          3.9

[[Page 22839]]

 
96..............       04  MED                  BRONCHITIS & ASTHMA AGE >17       .7638         4.1          4.9
                                                 W CC.
97..............       04  MED                  BRONCHITIS & ASTHMA AGE >17       .5664         3.2          3.8
                                                 W/O CC.
98..............       04  MED                  BRONCHITIS & ASTHMA AGE 0-        .7073         3.1          4.4
                                                 17.
99..............       04  MED                  RESPIRATORY SIGNS &               .6971         2.6          3.3
                                                 SYMPTOMS W CC.
100.............       04  MED                  RESPIRATORY SIGNS &               .5206         1.8          2.2
                                                 SYMPTOMS W/O CC.
101.............       04  MED                  OTHER RESPIRATORY SYSTEM          .8605         3.6          4.7
                                                 DIAGNOSES W CC.
102.............       04  MED                  OTHER RESPIRATORY SYSTEM          .5226         2.1          2.7
                                                 DIAGNOSES W/O CC.
103.............      PRE  SURG                 HEART TRANSPLANT...........     19.8195        38.6         57.5
104.............       05  SURG                 CARDIAC VALVE & OTH MAJOR        7.7605        13.2         15.3
                                                 CARDIOTHORACIC PROC W CARD
                                                 CATH.
105.............       05  SURG                 CARDIAC VALVE & OTH MAJOR        5.6465         8.8         10.4
                                                 CARDIOTHORACIC PROC W/O
                                                 CARD CATH.
106.............       05  SURG                 CORONARY BYPASS W PTCA.....      7.4382        10.7         12.3
107.............       05  SURG                 CORONARY BYPASS W CARDIAC        5.3005         9.7         10.9
                                                 CATH.
108.............       05  SURG                 OTHER CARDIOTHORACIC             5.4994         9.2         11.2
                                                 PROCEDURES.
109.............       05  SURG                 CORONARY BYPASS W/O PTCA OR      3.8957         7.0          8.0
                                                 CARDIAC CATH.
110.............       05  SURG                 MAJOR CARDIOVASCULAR             4.1492         8.1         10.2
                                                 PROCEDURES W CC.
111.............       05  SURG                 MAJOR CARDIOVASCULAR             2.2835         4.3          5.1
                                                 PROCEDURES W/O CC.
112.............       05  SURG                 NO LONGER VALID............       .0000          .0           .0
113.............       05  SURG                 AMPUTATION FOR CIRC SYSTEM       2.6625         9.8         12.8
                                                 DISORDERS EXCEPT UPPER
                                                 LIMB & TOE.
114.............       05  SURG                 UPPER LIMB & TOE AMPUTATION      1.6689         7.2          9.3
                                                 FOR CIRC SYSTEM DISORDERS.
115.............       05  SURG                 PRM CARD PACEM IMPL W AMI,       3.3784         7.2          9.2
                                                 HRT FAIL OR SHK, OR AICD
                                                 LEAD OR GN.
116.............       05  SURG                 OTHER PERMANENT CARDIAC          2.2011         3.6          4.8
                                                 PACEMAKER IMPLANT.
117.............       05  SURG                 CARDIAC PACEMAKER REVISION       1.3197         2.8          4.4
                                                 EXCEPT DEVICE REPLACEMENT.
118.............       05  SURG                 CARDIAC PACEMAKER DEVICE         1.4322         1.8          2.7
                                                 REPLACEMENT.
119.............       05  SURG                 VEIN LIGATION & STRIPPING..      1.3557         3.3          5.3
120.............       05  SURG                 OTHER CIRCULATORY SYSTEM         2.3452         6.7          9.9
                                                 O.R. PROCEDURES.
121.............       05  MED                  CIRCULATORY DISORDERS W AMI      1.5799         5.6          6.9
                                                 & MAJOR COMP, DISCHARGED
                                                 ALIVE.
122.............       05  MED                  CIRCULATORY DISORDERS W AMI      1.0268         3.2          3.9
                                                 W/O MAJOR COMP, DISCHARGED
                                                 ALIVE.
123.............       05  MED                  CIRCULATORY DISORDERS W          1.5882         3.2          5.0
                                                 AMI, EXPIRED.
124.............       05  MED                  CIRCULATORY DISORDERS            1.4057         3.6          4.6
                                                 EXCEPT AMI, W CARD CATH &
                                                 COMPLEX DIAG.
125.............       05  MED                  CIRCULATORY DISORDERS            1.0395         2.2          2.8
                                                 EXCEPT AMI, W CARD CATH W/
                                                 O COMPLEX DIAG.
126.............       05  MED                  ACUTE & SUBACUTE                 2.6700        10.5         12.9
                                                 ENDOCARDITIS.
127.............       05  MED                  HEART FAILURE & SHOCK......      1.0110         4.5          5.6
128.............       05  MED                  DEEP VEIN THROMBOPHLEBITIS.       .7343         5.2          5.9
129.............       05  MED                  CARDIAC ARREST, UNEXPLAINED      1.0273         1.7          2.8
130.............       05  MED                  PERIPHERAL VASCULAR               .9401         5.0          6.1
                                                 DISORDERS W CC.
131.............       05  MED                  PERIPHERAL VASCULAR               .5775         3.8          4.5
                                                 DISORDERS W/O CC.
132.............       05  MED                  ATHEROSCLEROSIS W CC.......       .6490         2.5          3.1
133.............       05  MED                  ATHEROSCLEROSIS W/O CC.....       .5567         1.9          2.3
134.............       05  MED                  HYPERTENSION...............       .5829         2.7          3.4
135.............       05  MED                  CARDIAC CONGENITAL &              .9117         3.7          4.8
                                                 VALVULAR DISORDERS AGE >17
                                                 W CC.
136.............       05  MED                  CARDIAC CONGENITAL &              .5606         2.2          2.8
                                                 VALVULAR DISORDERS AGE >17
                                                 W/O CC.
137.............       05  MED                  * CARDIAC CONGENITAL &            .8150         3.3          3.3
                                                 VALVULAR DISORDERS AGE 0-
                                                 17.
138.............       05  MED                  CARDIAC ARRHYTHMIA &              .8231         3.3          4.2
                                                 CONDUCTION DISORDERS W CC.
139.............       05  MED                  CARDIAC ARRHYTHMIA &              .4973         2.1          2.5
                                                 CONDUCTION DISORDERS W/O
                                                 CC.
140.............       05  MED                  ANGINA PECTORIS............       .5367         2.2          2.7
141.............       05  MED                  SYNCOPE & COLLAPSE W CC....       .7231         3.0          3.8
142.............       05  MED                  SYNCOPE & COLLAPSE W/O CC..       .5392         2.2          2.7
143.............       05  MED                  CHEST PAIN.................       .5198         1.7          2.1
144.............       05  MED                  OTHER CIRCULATORY SYSTEM         1.1995         4.3          5.8
                                                 DIAGNOSES W CC.
145.............       05  MED                  OTHER CIRCULATORY SYSTEM          .5919         2.2          2.8
                                                 DIAGNOSES W/O CC.
146.............       06  SURG                 RECTAL RESECTION W CC......      2.7740         9.6         10.8
147.............       06  SURG                 RECTAL RESECTION W/O CC....      1.6036         6.2          6.7
148.............       06  SURG                 MAJOR SMALL & LARGE BOWEL        3.5315        11.1         13.1
                                                 PROCEDURES W CC.
149.............       06  SURG                 MAJOR SMALL & LARGE BOWEL        1.5103         6.2          6.7
                                                 PROCEDURES W/O CC.
150.............       06  SURG                 PERITONEAL ADHESIOLYSIS W        2.9493        10.5         12.2
                                                 CC.
151.............       06  SURG                 PERITONEAL ADHESIOLYSIS W/O      1.3502         5.3          6.3
                                                 CC.
152.............       06  SURG                 MINOR SMALL & LARGE BOWEL        1.9465         7.4          8.7
                                                 PROCEDURES W CC.

[[Page 22840]]

 
153.............       06  SURG                 MINOR SMALL & LARGE BOWEL        1.1614         5.1          5.6
                                                 PROCEDURES W/O CC.
154.............       06  SURG                 STOMACH, ESOPHAGEAL &            4.3487        11.9         14.7
                                                 DUODENAL PROCEDURES AGE
                                                 >17 W CC.
155.............       06  SURG                 STOMACH, ESOPHAGEAL &            1.3356         3.5          4.5
                                                 DUODENAL PROCEDURES AGE
                                                 >17 W/O CC.
156.............       06  SURG                 * STOMACH, ESOPHAGEAL &           .8392         6.0          6.0
                                                 DUODENAL PROCEDURES AGE 0-
                                                 17.
157.............       06  SURG                 ANAL & STOMAL PROCEDURES W       1.2606         4.4          5.9
                                                 CC.
158.............       06  SURG                 ANAL & STOMAL PROCEDURES W/       .6237         2.0          2.5
                                                 O CC.
159.............       06  SURG                 HERNIA PROCEDURES EXCEPT         1.3620         4.2          5.4
                                                 INGUINAL & FEMORAL AGE >17
                                                 W CC.
160.............       06  SURG                 HERNIA PROCEDURES EXCEPT          .7678         2.2          2.7
                                                 INGUINAL & FEMORAL AGE >17
                                                 W/O CC.
161.............       06  SURG                 INGUINAL & FEMORAL HERNIA        1.1388         3.2          4.5
                                                 PROCEDURES AGE >17 W CC.
162.............       06  SURG                 INGUINAL & FEMORAL HERNIA         .6145         1.6          1.9
                                                 PROCEDURES AGE >17 W/O CC.
163.............       06  SURG                 * HERNIA PROCEDURES AGE 0-        .6885         2.1          2.1
                                                 17.
164.............       06  SURG                 APPENDECTOMY W COMPLICATED       2.3980         7.8          9.0
                                                 PRINCIPAL DIAG W CC.
165.............       06  SURG                 APPENDECTOMY W COMPLICATED       1.3000         4.5          5.0
                                                 PRINCIPAL DIAG W/O CC.
166.............       06  SURG                 APPENDECTOMY W/O                 1.4919         4.2          5.4
                                                 COMPLICATED PRINCIPAL DIAG
                                                 W CC.
167.............       06  SURG                 APPENDECTOMY W/O                  .8778         2.2          2.6
                                                 COMPLICATED PRINCIPAL DIAG
                                                 W/O CC.
168.............       03  SURG                 MOUTH PROCEDURES W CC......      1.3056         3.6          5.2
169.............       03  SURG                 MOUTH PROCEDURES W/O CC....       .6981         1.8          2.3
170.............       06  SURG                 OTHER DIGESTIVE SYSTEM O.R.      3.0651         9.6         12.7
                                                 PROCEDURES W CC.
171.............       06  SURG                 OTHER DIGESTIVE SYSTEM O.R.      1.1773         3.9          5.0
                                                 PROCEDURES W/O CC.
172.............       06  MED                  DIGESTIVE MALIGNANCY W CC..      1.3972         5.9          7.6
173.............       06  MED                  DIGESTIVE MALIGNANCY W/O CC       .6929         2.9          3.9
174.............       06  MED                  G.I. HEMORRHAGE W CC.......       .9915         4.1          5.1
175.............       06  MED                  G.I. HEMORRHAGE W/O CC.....       .5435         2.6          3.0
176.............       06  MED                  COMPLICATED PEPTIC ULCER...      1.0908         4.4          5.6
177.............       06  MED                  UNCOMPLICATED PEPTIC ULCER        .8938         3.9          4.8
                                                 W CC.
178.............       06  MED                  UNCOMPLICATED PEPTIC ULCER        .6424         2.7          3.2
                                                 W/O CC.
179.............       06  MED                  INFLAMMATORY BOWEL DISEASE.      1.0861         5.1          6.4
180.............       06  MED                  G.I. OBSTRUCTION W CC......       .9581         4.6          5.7
181.............       06  MED                  G.I. OBSTRUCTION W/O CC....       .5245         3.0          3.5
182.............       06  MED                  ESOPHAGITIS, GASTROENT &          .7959         3.6          4.6
                                                 MISC DIGEST DISORDERS AGE
                                                 >17 W CC.
183.............       06  MED                  ESOPHAGITIS, GASTROENT &          .5586         2.4          3.0
                                                 MISC DIGEST DISORDERS AGE
                                                 >17 W/O CC.
184.............       06  MED                  ESOPHAGITIS, GASTROENT &          .4123         2.5          3.0
                                                 MISC DIGEST DISORDERS AGE
                                                 0-17.
185.............       03  MED                  DENTAL & ORAL DIS EXCEPT          .8675         3.6          4.8
                                                 EXTRACTIONS &
                                                 RESTORATIONS, AGE >17.
186.............       03  MED                  * DENTAL & ORAL DIS EXCEPT        .3199         2.9          2.9
                                                 EXTRACTIONS &
                                                 RESTORATIONS, AGE 0-17.
187.............       03  MED                  DENTAL EXTRACTIONS &              .7960         3.2          4.2
                                                 RESTORATIONS.
188.............       06  MED                  OTHER DIGESTIVE SYSTEM           1.1234         4.6          6.0
                                                 DIAGNOSES AGE >17 W CC.
189.............       06  MED                  OTHER DIGESTIVE SYSTEM            .5791         2.5          3.3
                                                 DIAGNOSES AGE >17 W/O CC.
190.............       06  MED                  OTHER DIGESTIVE SYSTEM           1.1905         4.5          7.5
                                                 DIAGNOSES AGE 0-17.
191.............       07  SURG                 PANCREAS, LIVER & SHUNT          4.6065        12.1         15.5
                                                 PROCEDURES W CC.
192.............       07  SURG                 PANCREAS, LIVER & SHUNT          1.8181         6.0          7.0
                                                 PROCEDURES W/O CC.
193.............       07  SURG                 BILIARY TRACT PROC EXCEPT        3.5045        11.6         13.6
                                                 ONLY CHOLECYST W OR W/O
                                                 C.D.E. W CC.
194.............       07  SURG                 BILIARY TRACT PROC EXCEPT        1.7226         6.3          7.3
                                                 ONLY CHOLECYST W OR W/O
                                                 C.D.E. W/O CC.
195.............       07  SURG                 CHOLECYSTECTOMY W C.D.E. W       3.0850         9.4         10.9
                                                 CC.
196.............       07  SURG                 CHOLECYSTECTOMY W C.D.E. W/      1.6183         5.3          6.1
                                                 O CC.
197.............       07  SURG                 CHOLECYSTECTOMY EXCEPT BY        2.5761         8.1          9.6
                                                 LAPAROSCOPE W/O C.D.E. W
                                                 CC.
198.............       07  SURG                 CHOLECYSTECTOMY EXCEPT BY        1.2114         4.2          4.7
                                                 LAPAROSCOPE W/O C.D.E. W/O
                                                 CC.
199.............       07  SURG                 HEPATOBILIARY DIAGNOSTIC         2.4813         8.3         10.8
                                                 PROCEDURE FOR MALIGNANCY.
200.............       07  SURG                 HEPATOBILIARY DIAGNOSTIC         3.1972         8.5         12.0
                                                 PROCEDURE FOR NON-
                                                 MALIGNANCY.
201.............       07  SURG                 OTHER HEPATOBILIARY OR           3.8125        12.4         15.6
                                                 PANCREAS O.R. PROCEDURES.
202.............       07  MED                  CIRRHOSIS & ALCOHOLIC            1.3280         5.5          7.0
                                                 HEPATITIS.
203.............       07  MED                  MALIGNANCY OF HEPATOBILIARY      1.3598         5.7          7.3
                                                 SYSTEM OR PANCREAS.
204.............       07  MED                  DISORDERS OF PANCREAS            1.2076         4.9          6.2
                                                 EXCEPT MALIGNANCY.

[[Page 22841]]

 
205.............       07  MED                  DISORDERS OF LIVER EXCEPT        1.2206         5.2          6.7
                                                 MALIG,CIRR,ALC HEPA W CC.
206.............       07  MED                  DISORDERS OF LIVER EXCEPT         .7345         3.3          4.1
                                                 MALIG,CIRR,ALC HEPA W/O CC.
207.............       07  MED                  DISORDERS OF THE BILIARY         1.1138         4.3          5.5
                                                 TRACT W CC.
208.............       07  MED                  DISORDERS OF THE BILIARY          .6397         2.4          3.0
                                                 TRACT W/O CC.
209.............       08  SURG                 MAJOR JOINT & LIMB               1.9943         4.6          5.1
                                                 REATTACHMENT PROCEDURES OF
                                                 LOWER EXTREMITY.
210.............       08  SURG                 HIP & FEMUR PROCEDURES           1.7528         6.1          6.9
                                                 EXCEPT MAJOR JOINT AGE >17
                                                 W CC.
211.............       08  SURG                 HIP & FEMUR PROCEDURES           1.2261         4.6          5.0
                                                 EXCEPT MAJOR JOINT AGE >17
                                                 W/O CC.
212.............       08  SURG                 * HIP & FEMUR PROCEDURES          .8428        11.1         11.1
                                                 EXCEPT MAJOR JOINT AGE 0-
                                                 17.
213.............       08  SURG                 AMPUTATION FOR                   1.9283         7.7         10.0
                                                 MUSCULOSKELETAL SYSTEM &
                                                 CONN TISSUE DISORDERS.
214.............       08  SURG                 NO LONGER VALID............       .0000          .0           .0
215.............       08  SURG                 NO LONGER VALID............       .0000          .0           .0
216.............       08  SURG                 BIOPSIES OF MUSCULOSKELETAL      2.3133         8.5         10.9
                                                 SYSTEM & CONNECTIVE TISSUE.
217.............       08  SURG                 WND DEBRID & SKN GRFT            3.1808        11.0         15.1
                                                 EXCEPT HAND, FOR
                                                 MUSCSKELET & CONN TISS DIS.
218.............       08  SURG                 LOWER EXTREM & HUMER PROC        1.5448         4.7          5.7
                                                 EXCEPT HIP, FOOT, FEMUR
                                                 AGE >17 W CC.
219.............       08  SURG                 LOWER EXTREM & HUMER PROC         .9972         2.8          3.3
                                                 EXCEPT HIP, FOOT, FEMUR
                                                 AGE >17 W/O CC.
220.............       08  SURG                 * LOWER EXTREM & HUMER PROC       .5814         5.3          5.3
                                                 EXCEPT HIP, FOOT, FEMUR
                                                 AGE 0-17.
221.............       08  SURG                 NO LONGER VALID............       .0000          .0           .0
222.............       08  SURG                 NO LONGER VALID............       .0000          .0           .0
223.............       08  SURG                 MAJOR SHOULDER/ELBOW PROC,        .9734         2.1          2.9
                                                 OR OTHER UPPER EXTREMITY
                                                 PROC W CC.
224.............       08  SURG                 SHOULDER, ELBOW OR FOREARM        .7724         1.6          1.9
                                                 PROC, EXC MAJOR JOINT
                                                 PROC, W/O CC.
225.............       08  SURG                 FOOT PROCEDURES............      1.1177         3.8          5.3
226.............       08  SURG                 SOFT TISSUE PROCEDURES W CC      1.5897         5.2          7.3
227.............       08  SURG                 SOFT TISSUE PROCEDURES W/O        .7937         2.1          2.8
                                                 CC.
228.............       08  SURG                 MAJOR THUMB OR JOINT PROC,       1.0885         2.7          4.0
                                                 OR OTH HAND OR WRIST PROC
                                                 W CC.
229.............       08  SURG                 HAND OR WRIST PROC, EXCEPT        .7168         1.9          2.5
                                                 MAJOR JOINT PROC, W/O CC.
230.............       08  SURG                 LOCAL EXCISION & REMOVAL OF      1.3559         3.9          5.8
                                                 INT FIX DEVICES OF HIP &
                                                 FEMUR.
231.............       08  SURG                 LOCAL EXCISION & REMOVAL OF      1.4317         3.6          5.4
                                                 INT FIX DEVICES EXCEPT HIP
                                                 & FEMUR.
232.............       08  SURG                 ARTHROSCOPY................       .9556         1.8          2.9
233.............       08  SURG                 OTHER MUSCULOSKELET SYS &        2.0909         6.2          8.4
                                                 CONN TISS O.R. PROC W CC.
234.............       08  SURG                 OTHER MUSCULOSKELET SYS &        1.2075         2.7          3.6
                                                 CONN TISS O.R. PROC W/O CC.
235.............       08  MED                  FRACTURES OF FEMUR.........       .7548         4.1          5.4
236.............       08  MED                  FRACTURES OF HIP & PELVIS..       .6882         3.9          4.9
237.............       08  MED                  SPRAINS, STRAINS, &               .5323         3.0          3.7
                                                 DISLOCATIONS OF HIP,
                                                 PELVIS & THIGH.
238.............       08  MED                  OSTEOMYELITIS..............      1.4035         7.3          9.3
239.............       08  MED                  PATHOLOGICAL FRACTURES &         1.0017         5.4          6.7
                                                 MUSCULOSKELETAL & CONN
                                                 TISS MALIGNANCY.
240.............       08  MED                  CONNECTIVE TISSUE DISORDERS      1.3701         5.6          7.2
                                                 W CC.
241.............       08  MED                  CONNECTIVE TISSUE DISORDERS       .6337         3.3          4.0
                                                 W/O CC.
242.............       08  MED                  SEPTIC ARTHRITIS...........      1.0920         5.7          7.2
243.............       08  MED                  MEDICAL BACK PROBLEMS......       .7299         4.0          4.9
244.............       08  MED                  BONE DISEASES & SPECIFIC          .7150         4.1          5.1
                                                 ARTHROPATHIES W CC.
245.............       08  MED                  BONE DISEASES & SPECIFIC          .4655         2.9          3.6
                                                 ARTHROPATHIES W/O CC.
246.............       08  MED                  NON-SPECIFIC ARTHROPATHIES.       .5711         3.2          4.0
247.............       08  MED                  SIGNS & SYMPTOMS OF               .5594         2.8          3.5
                                                 MUSCULOSKELETAL SYSTEM &
                                                 CONN TISSUE.
248.............       08  MED                  TENDONITIS, MYOSITIS &            .8148         4.1          5.1
                                                 BURSITIS.
249.............       08  MED                  AFTERCARE, MUSCULOSKELETAL        .6767         2.7          3.9
                                                 SYSTEM & CONNECTIVE TISSUE.
250.............       08  MED                  FX, SPRN, STRN & DISL OF          .6809         3.5          4.3
                                                 FOREARM, HAND, FOOT AGE
                                                 >17 W CC.
251.............       08  MED                  FX, SPRN, STRN & DISL OF          .4555         2.4          2.9
                                                 FOREARM, HAND, FOOT AGE
                                                 >17 W/O CC.

[[Page 22842]]

 
252.............       08  MED                  * FX, SPRN, STRN & DISL OF        .2525         1.8          1.8
                                                 FOREARM, HAND, FOOT AGE 0-
                                                 17.
253.............       08  MED                  FX, SPRN, STRN & DISL OF          .7398         4.0          5.0
                                                 UPARM, LOWLEG EX FOOT AGE
                                                 >17 W CC.
254.............       08  MED                  FX, SPRN, STRN & DISL OF          .4297         2.8          3.3
                                                 UPARM, LOWLEG EX FOOT AGE
                                                 >17 W/O CC.
255.............       08  MED                  * FX, SPRN, STRN & DISL OF        .2941         2.9          2.9
                                                 UPARM, LOWLEG EX FOOT AGE
                                                 0-17.
256.............       08  MED                  OTHER MUSCULOSKELETAL             .8170         4.2          5.5
                                                 SYSTEM & CONNECTIVE TISSUE
                                                 DIAGNOSES.
257.............       09  SURG                 TOTAL MASTECTOMY FOR              .8801         2.2          2.8
                                                 MALIGNANCY W CC.
258.............       09  SURG                 TOTAL MASTECTOMY FOR              .6970         1.7          1.9
                                                 MALIGNANCY W/O CC.
259.............       09  SURG                 SUBTOTAL MASTECTOMY FOR           .8736         1.8          2.7
                                                 MALIGNANCY W CC.
260.............       09  SURG                 SUBTOTAL MASTECTOMY FOR           .6431         1.3          1.4
                                                 MALIGNANCY W/O CC.
261.............       09  SURG                 BREAST PROC FOR NON-              .9218         1.7          2.3
                                                 MALIGNANCY EXCEPT BIOPSY &
                                                 LOCAL EXCISION.
262.............       09  SURG                 BREAST BIOPSY & LOCAL             .8377         3.0          4.2
                                                 EXCISION FOR NON-
                                                 MALIGNANCY.
263.............       09  SURG                 SKIN GRAFT &/OR DEBRID FOR       2.1570         9.4         12.7
                                                 SKN ULCER OR CELLULITIS W
                                                 CC.
264.............       09  SURG                 SKIN GRAFT &/OR DEBRID FOR       1.1826         6.0          7.7
                                                 SKN ULCER OR CELLULITIS W/
                                                 O CC.
265.............       09  SURG                 SKIN GRAFT &/OR DEBRID           1.6900         5.2          7.6
                                                 EXCEPT FOR SKIN ULCER OR
                                                 CELLULITIS W CC.
266.............       09  SURG                 SKIN GRAFT &/OR DEBRID            .8435         2.5          3.4
                                                 EXCEPT FOR SKIN ULCER OR
                                                 CELLULITIS W/O CC.
267.............       09  SURG                 PERIANAL & PILONIDAL              .9421         3.3          4.5
                                                 PROCEDURES.
268.............       09  SURG                 SKIN, SUBCUTANEOUS TISSUE &      1.2255         2.5          3.6
                                                 BREAST PLASTIC PROCEDURES.
269.............       09  SURG                 OTHER SKIN, SUBCUT TISS &        1.8049         6.9          9.3
                                                 BREAST PROC W CC.
270.............       09  SURG                 OTHER SKIN, SUBCUT TISS &         .8020         2.6          3.8
                                                 BREAST PROC W/O CC.
271.............       09  MED                  SKIN ULCERS................      1.1503         6.5          8.3
272.............       09  MED                  MAJOR SKIN DISORDERS W CC..      1.0243         5.2          6.7
273.............       09  MED                  MAJOR SKIN DISORDERS W/O CC       .5658         3.4          4.2
274.............       09  MED                  MALIGNANT BREAST DISORDERS       1.1892         5.5          7.2
                                                 W CC.
275.............       09  MED                  MALIGNANT BREAST DISORDERS        .6594         3.0          4.6
                                                 W/O CC.
276.............       09  MED                  NON-MALIGANT BREAST               .6954         4.0          5.0
                                                 DISORDERS.
277.............       09  MED                  CELLULITIS AGE >17 W CC....       .8585         5.1          6.1
278.............       09  MED                  CELLULITIS AGE >17 W/O CC..       .5638         3.9          4.6
279.............       09  MED                  * CELLULITIS AGE 0-17......       .6610         4.2          4.2
280.............       09  MED                  TRAUMA TO THE SKIN, SUBCUT        .6940         3.5          4.4
                                                 TISS & BREAST AGE >17 W CC.
281.............       09  MED                  TRAUMA TO THE SKIN, SUBCUT        .4591         2.5          3.1
                                                 TISS & BREAST AGE >17 W/O
                                                 CC.
282.............       09  MED                  * TRAUMA TO THE SKIN,             .2557         2.2          2.2
                                                 SUBCUT TISS & BREAST AGE 0-
                                                 17.
283.............       09  MED                  MINOR SKIN DISORDERS W CC..       .7154         3.8          4.9
284.............       09  MED                  MINOR SKIN DISORDERS W/O CC       .4216         2.5          3.2
285.............       10  SURG                 AMPUTAT OF LOWER LIMB FOR        2.1315         9.1         11.4
                                                 ENDOCRINE, NUTRIT, &
                                                 METABOL DISORDERS.
286.............       10  SURG                 ADRENAL & PITUITARY              2.2277         5.3          6.9
                                                 PROCEDURES.
287.............       10  SURG                 SKIN GRAFTS & WOUND DEBRID       1.9616         8.9         11.7
                                                 FOR ENDOC, NUTRIT & METAB
                                                 DISORDERS.
288.............       10  SURG                 O.R. PROCEDURES FOR OBESITY      2.1682         4.9          6.0
289.............       10  SURG                 PARATHYROID PROCEDURES.....       .9529         1.9          3.0
290.............       10  SURG                 THYROID PROCEDURES.........       .8853         1.7          2.3
291.............       10  SURG                 THYROGLOSSAL PROCEDURES....       .5910         1.5          1.8
292.............       10  SURG                 OTHER ENDOCRINE, NUTRIT &        2.7588         9.1         11.9
                                                 METAB O.R. PROC W CC.
293.............       10  SURG                 OTHER ENDOCRINE, NUTRIT &        1.2638         4.5          6.0
                                                 METAB O.R. PROC W/O CC.
294.............       10  MED                  DIABETES AGE >35...........       .7623         3.8          4.9
295.............       10  MED                  DIABETES AGE 0-35..........       .7468         3.1          3.9
296.............       10  MED                  NUTRITIONAL & MISC                .8632         4.3          5.5
                                                 METABOLIC DISORDERS AGE
                                                 >17 W CC.
297.............       10  MED                  NUTRITIONAL & MISC                .5070         2.9          3.5
                                                 METABOLIC DISORDERS AGE
                                                 >17 W/O CC.
298.............       10  MED                  NUTRITIONAL & MISC                .3944         2.2          2.9
                                                 METABOLIC DISORDERS AGE 0-
                                                 17.
299.............       10  MED                  INBORN ERRORS OF METABOLISM       .8939         4.3          5.6
300.............       10  MED                  ENDOCRINE DISORDERS W CC...      1.1234         5.3          6.6
301.............       10  MED                  ENDOCRINE DISORDERS W/O CC.       .6063         3.0          3.8
302.............       11  SURG                 KIDNEY TRANSPLANT..........      3.2881         7.9          9.3
303.............       11  SURG                 KIDNEY, URETER & MAJOR           2.4853         7.5          9.0
                                                 BLADDER PROCEDURES FOR
                                                 NEOPLASM.
304.............       11  SURG                 KIDNEY, URETER & MAJOR           2.4558         7.4          9.7
                                                 BLADDER PROC FOR NON-NEOPL
                                                 W CC.
305.............       11  SURG                 KIDNEY, URETER & MAJOR           1.1486         3.1          3.8
                                                 BLADDER PROC FOR NON-NEOPL
                                                 W/O CC.

[[Page 22843]]

 
306.............       11  SURG                 PROSTATECTOMY W CC.........      1.3006         4.3          6.2
307.............       11  SURG                 PROSTATECTOMY W/O CC.......       .6054         1.9          2.3
308.............       11  SURG                 MINOR BLADDER PROCEDURES W       1.6788         4.8          6.9
                                                 CC.
309.............       11  SURG                 MINOR BLADDER PROCEDURES W/       .8935         1.8          2.3
                                                 O CC.
310.............       11  SURG                 TRANSURETHRAL PROCEDURES W       1.1342         3.3          4.7
                                                 CC.
311.............       11  SURG                 TRANSURETHRAL PROCEDURES W/       .5952         1.5          1.8
                                                 O CC.
312.............       11  SURG                 URETHRAL PROCEDURES, AGE         1.0749         3.3          4.8
                                                 >17 W CC.
313.............       11  SURG                 URETHRAL PROCEDURES, AGE          .6598         1.8          2.3
                                                 >17 W/O CC.
314.............       11  SURG                 * URETHRAL PROCEDURES, AGE        .4927         2.3          2.3
                                                 0-17.
315.............       11  SURG                 OTHER KIDNEY & URINARY           2.1396         4.8          8.2
                                                 TRACT O.R. PROCEDURES.
316.............       11  MED                  RENAL FAILURE..............      1.3732         5.6          7.3
317.............       11  MED                  ADMIT FOR RENAL DIALYSIS...       .6157         2.0          2.9
318.............       11  MED                  KIDNEY & URINARY TRACT           1.1710         5.0          6.5
                                                 NEOPLASMS W CC.
319.............       11  MED                  KIDNEY & URINARY TRACT            .5918         2.1          2.8
                                                 NEOPLASMS W/O CC.
320.............       11  MED                  KIDNEY & URINARY TRACT            .8610         4.6          5.6
                                                 INFECTIONS AGE >17 W CC.
321.............       11  MED                  KIDNEY & URINARY TRACT            .5592         3.3          3.9
                                                 INFECTIONS AGE >17 W/O CC.
322.............       11  MED                  KIDNEY & URINARY TRACT            .5234         3.6          4.3
                                                 INFECTIONS AGE 0-17.
323.............       11  MED                  URINARY STONES W CC, &/OR         .7969         2.5          3.3
                                                 ESW LITHOTRIPSY.
324.............       11  MED                  URINARY STONES W/O CC......       .4447         1.6          1.9
325.............       11  MED                  KIDNEY & URINARY TRACT            .6332         3.1          4.0
                                                 SIGNS & SYMPTOMS AGE >17 W
                                                 CC.
326.............       11  MED                  KIDNEY & URINARY TRACT            .4118         2.1          2.7
                                                 SIGNS & SYMPTOMS AGE >17 W/
                                                 O CC.
327.............       11  MED                  KIDNEY & URINARY TRACT            .3741         2.8          3.2
                                                 SIGNS & SYMPTOMS AGE 0-17.
328.............       11  MED                  URETHRAL STRICTURE AGE >17        .7216         2.9          3.8
                                                 W CC.
329.............       11  MED                  URETHRAL STRICTURE AGE >17        .4388         1.6          2.0
                                                 W/O CC.
330.............       11  MED                  * URETHRAL STRICTURE AGE 0-       .3174         1.6          1.6
                                                 17.
331.............       11  MED                  OTHER KIDNEY & URINARY           1.0625         4.6          6.0
                                                 TRACT DIAGNOSES AGE >17 W
                                                 CC.
332.............       11  MED                  OTHER KIDNEY & URINARY            .6057         2.6          3.4
                                                 TRACT DIAGNOSES AGE >17 W/
                                                 O CC.
333.............       11  MED                  OTHER KIDNEY & URINARY            .8056         4.0          5.4
                                                 TRACT DIAGNOSES AGE 0-17.
334.............       12  SURG                 MAJOR MALE PELVIC                1.4761         4.0          4.5
                                                 PROCEDURES W CC.
335.............       12  SURG                 MAJOR MALE PELVIC                1.1081         3.0          3.2
                                                 PROCEDURES W/O CC.
336.............       12  SURG                 TRANSURETHRAL PROSTATECTOMY       .9149         2.9          3.9
                                                 W CC.
337.............       12  SURG                 TRANSURETHRAL PROSTATECTOMY       .5769         1.9          2.2
                                                 W/O CC.
338.............       12  SURG                 TESTES PROCEDURES, FOR           1.2150         3.7          5.6
                                                 MALIGNANCY.
339.............       12  SURG                 TESTES PROCEDURES, NON-          1.2384         3.5          5.5
                                                 MALIGNANCY AGE >17.
340.............       12  SURG                 * TESTES PROCEDURES, NON-         .2820         2.4          2.4
                                                 MALIGNANCY AGE 0-17.
341.............       12  SURG                 PENIS PROCEDURES...........      1.2740         1.9          3.1
342.............       12  SURG                 CIRCUMCISION AGE >17.......       .7866         2.6          3.6
343.............       12  SURG                 * CIRCUMCISION AGE 0-17....       .1533         1.7          1.7
344.............       12  SURG                 OTHER MALE REPRODUCTIVE          1.1746         1.6          2.4
                                                 SYSTEM O.R. PROCEDURES FOR
                                                 MALIGNANCY.
345.............       12  SURG                 OTHER MALE REPRODUCTIVE          1.2518         3.9          5.6
                                                 SYSTEM O.R. PROC EXCEPT
                                                 FOR MALIGNANCY.
346.............       12  MED                  MALIGNANCY, MALE                 1.0311         4.9          6.4
                                                 REPRODUCTIVE SYSTEM, W CC.
347.............       12  MED                  MALIGNANCY, MALE                  .5701         2.3          3.0
                                                 REPRODUCTIVE SYSTEM, W/O
                                                 CC.
348.............       12  MED                  * BENIGN PROSTATIC                .7105         6.2          6.2
                                                 HYPERTROPHY W CC.
349.............       12  MED                  * BENIGN PROSTATIC                .4357         4.9          4.9
                                                 HYPERTROPHY W/O CC.
350.............       12  MED                  INFLAMMATION OF THE MALE          .7173         3.8          4.6
                                                 REPRODUCTIVE SYSTEM.
351.............       12  MED                  * STERILIZATION, MALE......       .2352         1.3          1.3
352.............       12  MED                  OTHER MALE REPRODUCTIVE           .6878         3.0          4.2
                                                 SYSTEM DIAGNOSES.
353.............       13  SURG                 PELVIC EVISCERATION,             1.8386         5.4          6.8
                                                 RADICAL HYSTERECTOMY &
                                                 RADICAL VULVECTOMY.
354.............       13  SURG                 UTERINE,ADNEXA PROC FOR NON-     1.5275         5.1          6.1
                                                 OVARIAN/ADNEXAL MALIG W CC.
355.............       13  SURG                 UTERINE,ADNEXA PROC FOR NON-      .9039         3.1          3.3
                                                 OVARIAN/ADNEXAL MALIG W/O
                                                 CC.
356.............       13  SURG                 FEMALE REPRODUCTIVE SYSTEM        .7469         2.0          2.3
                                                 RECONSTRUCTIVE PROCEDURES.
357.............       13  SURG                 UTERINE & ADNEXA PROC FOR        2.4424         7.5          9.2
                                                 OVARIAN OR ADNEXAL
                                                 MALIGNANCY.
358.............       13  SURG                 UTERINE & ADNEXA PROC FOR        1.1910         3.7          4.4
                                                 NON-MALIGNANCY W CC.
359.............       13  SURG                 UTERINE & ADNEXA PROC FOR         .8191         2.6          2.8
                                                 NON-MALIGNANCY W/O CC.
360.............       13  SURG                 VAGINA, CERVIX & VULVA            .8530         2.4          2.9
                                                 PROCEDURES.
361.............       13  SURG                 LAPAROSCOPY & INCISIONAL         1.0927         2.2          3.0
                                                 TUBAL INTERRUPTION.
362.............       13  SURG                 * ENDOSCOPIC TUBAL                .3006         1.4          1.4
                                                 INTERRUPTION.
363.............       13  SURG                 D&C, CONIZATION & RADIO-          .8149         2.6          3.6
                                                 IMPLANT, FOR MALIGNANCY.
364.............       13  SURG                 D&C, CONIZATION EXCEPT FOR        .8190         2.9          4.1
                                                 MALIGNANCY.

[[Page 22844]]

 
365.............       13  SURG                 OTHER FEMALE REPRODUCTIVE        2.0115         5.8          8.1
                                                 SYSTEM O.R. PROCEDURES.
366.............       13  MED                  MALIGNANCY, FEMALE               1.2739         5.6          7.4
                                                 REPRODUCTIVE SYSTEM W CC.
367.............       13  MED                  MALIGNANCY, FEMALE                .5582         2.4          3.2
                                                 REPRODUCTIVE SYSTEM W/O CC.
368.............       13  MED                  INFECTIONS, FEMALE               1.1384         5.6          7.0
                                                 REPRODUCTIVE SYSTEM.
369.............       13  MED                  MENSTRUAL & OTHER FEMALE          .5584         2.5          3.4
                                                 REPRODUCTIVE SYSTEM
                                                 DISORDERS.
370.............       14  SURG                 CESAREAN SECTION W CC......      1.0417         4.6          6.1
371.............       14  SURG                 CESAREAN SECTION W/O CC....       .6848         3.3          3.7
372.............       14  MED                  VAGINAL DELIVERY W                .5578         2.6          3.3
                                                 COMPLICATING DIAGNOSES.
373.............       14  MED                  VAGINAL DELIVERY W/O              .3764         2.0          2.3
                                                 COMPLICATING DIAGNOSES.
374.............       14  SURG                 VAGINAL DELIVERY W                .7103         2.6          3.2
                                                 STERILIZATION &/OR D&C.
375.............       14  SURG                 VAGINAL DELIVERY W O.R.           .6081         2.1          2.3
                                                 PROC EXCEPT STERIL &/OR
                                                 D&C.
376.............       14  MED                  POSTPARTUM & POST ABORTION        .4954         2.5          3.2
                                                 DIAGNOSES W/O O.R.
                                                 PROCEDURE.
377.............       14  SURG                 POSTPARTUM & POST ABORTION       1.6465         3.7          5.6
                                                 DIAGNOSES W O.R. PROCEDURE.
378.............       14  MED                  ECTOPIC PREGNANCY..........       .7984         2.0          2.4
379.............       14  MED                  THREATENED ABORTION........       .4502         2.4          3.5
380.............       14  MED                  ABORTION W/O D&C...........       .4196         1.6          2.1
381.............       14  SURG                 ABORTION W D&C, ASPIRATION        .6654         1.8          2.5
                                                 CURETTAGE OR HYSTEROTOMY.
382.............       14  MED                  FALSE LABOR................       .1607         1.2          1.3
383.............       14  MED                  OTHER ANTEPARTUM DIAGNOSES        .4856         2.8          3.8
                                                 W MEDICAL COMPLICATIONS.
384.............       14  MED                  OTHER ANTEPARTUM DIAGNOSES        .3412         1.6          2.2
                                                 W/O MEDICAL COMPLICATIONS.
385.............       15  MED                  * NEONATES, DIED OR              1.3696         1.8          1.8
                                                 TRANSFERRED TO ANOTHER
                                                 ACUTE CARE FACILITY.
386.............       15  MED                  * EXTREME IMMATURITY OR          4.5165        17.9         17.9
                                                 RESPIRATORY DISTRESS
                                                 SYNDROME, NEONATE.
387.............       15  MED                  * PREMATURITY W MAJOR            3.0846        13.3         13.3
                                                 PROBLEMS.
388.............       15  MED                  * PREMATURITY W/O MAJOR          1.8612         8.6          8.6
                                                 PROBLEMS.
389.............       15  MED                  FULL TERM NEONATE W MAJOR        2.0857         7.9         13.7
                                                 PROBLEMS.
390.............       15  MED                  NEONATE W OTHER SIGNIFICANT      1.1337         3.5          4.3
                                                 PROBLEMS.
391.............       15  MED                  * NORMAL NEWBORN...........       .1519         3.1          3.1
392.............       16  SURG                 SPLENECTOMY AGE >17........      3.3890         8.3         10.8
393.............       16  SURG                 * SPLENECTOMY AGE 0-17.....      1.3416         9.1          9.1
394.............       16  SURG                 OTHER O.R. PROCEDURES OF         1.8266         5.1          8.1
                                                 THE BLOOD AND BLOOD
                                                 FORMING ORGANS.
395.............       16  MED                  RED BLOOD CELL DISORDERS          .8194         3.5          4.7
                                                 AGE >17.
396.............       16  MED                  RED BLOOD CELL DISORDERS         1.0480         3.9          5.0
                                                 AGE 0-17.
397.............       16  MED                  COAGULATION DISORDERS......      1.2664         4.2          5.6
398.............       16  MED                  RETICULOENDOTHELIAL &            1.3049         5.1          6.4
                                                 IMMUNITY DISORDERS W CC.
399.............       16  MED                  RETICULOENDOTHELIAL &             .6690         3.0          3.7
                                                 IMMUNITY DISORDERS W/O CC.
400.............       17  SURG                 LYMPHOMA & LEUKEMIA W MAJOR      2.9273         7.4         10.5
                                                 O.R. PROCEDURE.
401.............       17  SURG                 LYMPHOMA & NON-ACUTE             2.9814         9.9         12.8
                                                 LEUKEMIA W OTHER O.R. PROC
                                                 W CC.
402.............       17  SURG                 LYMPHOMA & NON-ACUTE             1.1619         3.1          4.4
                                                 LEUKEMIA W OTHER O.R. PROC
                                                 W/O CC.
403.............       17  MED                  LYMPHOMA & NON-ACUTE             1.8486         6.8          9.0
                                                 LEUKEMIA W CC.
404.............       17  MED                  LYMPHOMA & NON-ACUTE              .8711         3.4          4.6
                                                 LEUKEMIA W/O CC.
405.............       17  MED                  * ACUTE LEUKEMIA W/O MAJOR       1.9021         4.9          4.9
                                                 O.R. PROCEDURE AGE 0-17.
406.............       17  SURG                 MYELOPROLIF DISORD OR            2.9692         8.4         11.0
                                                 POORLY DIFF NEOPL W MAJ
                                                 O.R.PROC W CC.
407.............       17  SURG                 MYELOPROLIF DISORD OR            1.2484         3.8          4.7
                                                 POORLY DIFF NEOPL W MAJ
                                                 O.R.PROC W/O CC.
408.............       17  SURG                 MYELOPROLIF DISORD OR            2.2150         6.0          9.2
                                                 POORLY DIFF NEOPL W OTHER
                                                 O.R.PROC.
409.............       17  MED                  RADIOTHERAPY...............      1.1469         4.9          6.3
410.............       17  MED                  CHEMOTHERAPY W/O ACUTE            .9972         3.3          4.1
                                                 LEUKEMIA AS SECONDARY
                                                 DIAGNOSIS.
411.............       17  MED                  HISTORY OF MALIGNANCY W/O         .4401         1.8          2.3
                                                 ENDOSCOPY.
412.............       17  MED                  HISTORY OF MALIGNANCY W           .6073         1.9          2.4
                                                 ENDOSCOPY.
413.............       17  MED                  OTHER MYELOPROLIF DIS OR         1.3898         6.1          7.8
                                                 POORLY DIFF NEOPL DIAG W
                                                 CC.
414.............       17  MED                  OTHER MYELOPROLIF DIS OR          .7422         3.5          4.5
                                                 POORLY DIFF NEOPL DIAG W/O
                                                 CC.
415.............       18  SURG                 O.R. PROCEDURE FOR               3.8811        12.6         16.2
                                                 INFECTIOUS & PARASITIC
                                                 DISEASES.
416.............       18  MED                  SEPTICEMIA AGE >17.........      1.6209         6.4          8.1
417.............       18  MED                  SEPTICEMIA AGE 0-17........       .8498         4.5          5.3
418.............       18  MED                  POSTOPERATIVE & POST-            1.0452         5.3          6.6
                                                 TRAUMATIC INFECTIONS.

[[Page 22845]]

 
419.............       18  MED                  FEVER OF UNKNOWN ORIGIN AGE       .8617         4.0          5.0
                                                 >17 W CC.
420.............       18  MED                  FEVER OF UNKNOWN ORIGIN AGE       .6114         3.0          3.6
                                                 >17 W/O CC.
421.............       18  MED                  VIRAL ILLNESS AGE >17......       .6646         3.2          3.9
422.............       18  MED                  VIRAL ILLNESS & FEVER OF          .4800         2.6          3.2
                                                 UNKNOWN ORIGIN AGE 0-17.
423.............       18  MED                  OTHER INFECTIOUS &               1.8405         6.7          9.0
                                                 PARASITIC DISEASES
                                                 DIAGNOSES.
424.............       19  SURG                 O.R. PROCEDURE W PRINCIPAL       2.4350        10.7         15.6
                                                 DIAGNOSES OF MENTAL
                                                 ILLNESS.
425.............       19  MED                  ACUTE ADJUSTMENT REACTION &       .6799         3.2          4.2
                                                 PSYCHOSOCIAL DYSFUNCTION.
426.............       19  MED                  DEPRESSIVE NEUROSES........       .5276         3.5          4.7
427.............       19  MED                  NEUROSES EXCEPT DEPRESSIVE.       .5438         3.6          5.0
428.............       19  MED                  DISORDERS OF PERSONALITY &        .7200         5.0          7.6
                                                 IMPULSE CONTROL.
429.............       19  MED                  ORGANIC DISTURBANCES &            .8357         5.2          6.8
                                                 MENTAL RETARDATION.
430.............       19  MED                  PSYCHOSES..................       .7653         6.7          8.9
431.............       19  MED                  CHILDHOOD MENTAL DISORDERS.       .6309         5.0          6.8
432.............       19  MED                  OTHER MENTAL DISORDER             .7068         3.4          5.1
                                                 DIAGNOSES.
433.............       20  MED                  ALCOHOL/DRUG ABUSE OR             .2852         2.3          3.2
                                                 DEPENDENCE, LEFT AMA.
434.............       20  MED                  NO LONGER VALID............       .0000          .0           .0
435.............       20  MED                  NO LONGER VALID............       .0000          .0           .0
436.............       20  MED                  NO LONGER VALID............       .0000          .0           .0
437.............       20  MED                  NO LONGER VALID............       .0000          .0           .0
438.............       20  ...................  NO LONGER VALID............       .0000          .0           .0
439.............       21  SURG                 SKIN GRAFTS FOR INJURIES...      1.9350         6.7          9.5
440.............       21  SURG                 WOUND DEBRIDEMENTS FOR           2.0732         7.1         10.3
                                                 INJURIES.
441.............       21  SURG                 HAND PROCEDURES FOR               .9273         2.3          3.3
                                                 INJURIES.
442.............       21  SURG                 OTHER O.R. PROCEDURES FOR        2.5349         6.8          9.6
                                                 INJURIES W CC.
443.............       21  SURG                 OTHER O.R. PROCEDURES FOR         .9896         2.7          3.6
                                                 INJURIES W/O CC.
444.............       21  MED                  TRAUMATIC INJURY AGE >17 W        .7244         3.4          4.4
                                                 CC.
445.............       21  MED                  TRAUMATIC INJURY AGE >17 W/       .4713         2.4          3.0
                                                 O CC.
446.............       21  MED                  * TRAUMATIC INJURY AGE 0-17       .2949         2.4          2.4
447.............       21  MED                  ALLERGIC REACTIONS AGE >17.       .4851         1.9          2.5
448.............       21  MED                  * ALLERGIC REACTIONS AGE 0-       .0970         2.9          2.9
                                                 17.
449.............       21  MED                  POISONING & TOXIC EFFECTS         .8306         2.8          3.9
                                                 OF DRUGS AGE >17 W CC.
450.............       21  MED                  POISONING & TOXIC EFFECTS         .4161         1.6          2.0
                                                 OF DRUGS AGE >17 W/O CC.
451.............       21  MED                  * POISONING & TOXIC EFFECTS       .2618         2.1          2.1
                                                 OF DRUGS AGE 0-17.
452.............       21  MED                  COMPLICATIONS OF TREATMENT       1.0125         3.8          5.2
                                                 W CC.
453.............       21  MED                  COMPLICATIONS OF TREATMENT        .4997         2.2          2.8
                                                 W/O CC.
454.............       21  MED                  OTHER INJURY, POISONING &         .8713         3.4          4.9
                                                 TOXIC EFFECT DIAG W CC.
455.............       21  MED                  OTHER INJURY, POISONING &         .4617         1.9          2.6
                                                 TOXIC EFFECT DIAG W/O CC.
456.............       22  ...................  NO LONGER VALID............       .0000          .0           .0
457.............       22  MED                  NO LONGER VALID............       .0000          .0           .0
458.............       22  SURG                 NO LONGER VALID............       .0000          .0           .0
459.............       22  SURG                 NO LONGER VALID............       .0000          .0           .0
460.............       22  MED                  NO LONGER VALID............       .0000          .0           .0
461.............       23  SURG                 O.R. PROC W DIAGNOSES OF         1.1994         2.5          4.6
                                                 OTHER CONTACT W HEALTH
                                                 SERVICES.
462.............       23  MED                  REHABILITATION.............      1.2033        10.4         12.3
463.............       23  MED                  SIGNS & SYMPTOMS W CC......       .6818         3.4          4.3
464.............       23  MED                  SIGNS & SYMPTOMS W/O CC....       .4630         2.5          3.1
465.............       23  MED                  AFTERCARE W HISTORY OF            .6065         2.5          3.6
                                                 MALIGNANCY AS SECONDARY
                                                 DIAGNOSIS.
466.............       23  MED                  AFTERCARE W/O HISTORY OF          .6630         2.5          4.2
                                                 MALIGNANCY AS SECONDARY
                                                 DIAGNOSIS.
467.............       23  MED                  OTHER FACTORS INFLUENCING         .5762         2.7          4.1
                                                 HEALTH STATUS.
468.............  .......  ...................  EXTENSIVE O.R. PROCEDURE         3.8458        11.3         14.5
                                                 UNRELATED TO PRINCIPAL
                                                 DIAGNOSIS.
469.............  .......  ...................  ** PRINCIPAL DIAGNOSIS            .0000          .0           .0
                                                 INVALID AS DISCHARGE
                                                 DIAGNOSIS.
470.............  .......  ...................  ** UNGROUPABLE.............       .0000          .0           .0
471.............       08  SURG                 BILATERAL OR MULTIPLE MAJOR      2.9929         5.0          5.7
                                                 JOINT PROCS OF LOWER
                                                 EXTREMITY.
472.............       22  SURG                 NO LONGER VALID............       .0000          .0           .0
473.............       17  SURG                 ACUTE LEUKEMIA W/O MAJOR         3.9044         9.7         15.0
                                                 O.R. PROCEDURE AGE >17.
474.............       04  SURG                 NO LONGER VALID............       .0000          .0           .0
475.............       04  MED                  RESPIRATORY SYSTEM               3.9155        10.0         12.7
                                                 DIAGNOSIS WITH VENTILATOR
                                                 SUPPORT.
476.............  .......  SURG                 PROSTATIC O.R. PROCEDURE         2.2902        10.0         12.3
                                                 UNRELATED TO PRINCIPAL
                                                 DIAGNOSIS.

[[Page 22846]]

 
477.............  .......  SURG                 NON-EXTENSIVE O.R.               1.9571         6.7          9.3
                                                 PROCEDURE UNRELATED TO
                                                 PRINCIPAL DIAGNOSIS.
478.............       05  SURG                 OTHER VASCULAR PROCEDURES W      2.4276         5.9          8.2
                                                 CC.
479.............       05  SURG                 OTHER VASCULAR PROCEDURES W/     1.4024         2.8          3.7
                                                 O CC.
480.............      PRE  SURG                 LIVER TRANSPLANT...........     10.6132        17.7         22.8
481.............      PRE  SURG                 BONE MARROW TRANSPLANT.....      7.8889        23.4         25.6
482.............      PRE  SURG                 TRACHEOSTOMY FOR FACE,           3.8343        11.4         14.3
                                                 MOUTH & NECK DIAGNOSES.
483.............      PRE  SURG                 TRACHEOSTOMY EXCEPT FOR         15.2827        34.0         41.0
                                                 FACE, MOUTH & NECK
                                                 DIAGNOSES.
484.............       24  SURG                 CRANIOTOMY FOR MULTIPLE          5.1265        11.5         14.5
                                                 SIGNIFICANT TRAUMA.
485.............       24  SURG                 LIMB REATTACHMENT, HIP AND       3.1094         8.5         10.3
                                                 FEMUR PROC FOR MULTIPLE
                                                 SIGNIFICANT TRA.
486.............       24  SURG                 OTHER O.R. PROCEDURES FOR        5.2547        11.0         14.3
                                                 MULTIPLE SIGNIFICANT
                                                 TRAUMA.
487.............       24  MED                  OTHER MULTIPLE SIGNIFICANT       1.9199         6.3          8.2
                                                 TRAUMA.
488.............       25  SURG                 HIV W EXTENSIVE O.R.             5.1474        15.0         19.8
                                                 PROCEDURE.
489.............       25  MED                  HIV W MAJOR RELATED              1.8802         7.0          9.4
                                                 CONDITION.
490.............       25  MED                  HIV W OR W/O OTHER RELATED       1.0475         4.3          5.8
                                                 CONDITION.
491.............       08  SURG                 MAJOR JOINT & LIMB               1.6364         3.0          3.5
                                                 REATTACHMENT PROCEDURES OF
                                                 UPPER EXTREMITY.
492.............       17  MED                  CHEMOTHERAPY W ACUTE             4.8853        13.6         19.0
                                                 LEUKEMIA AS SECONDARY
                                                 DIAGNOSIS.
493.............       07  SURG                 LAPAROSCOPIC                     1.8468         4.9          6.3
                                                 CHOLECYSTECTOMY W/O C.D.E.
                                                 W CC.
494.............       07  SURG                 LAPAROSCOPIC                      .9800         1.9          2.5
                                                 CHOLECYSTECTOMY W/O C.D.E.
                                                 W/O CC.
495.............      PRE  SURG                 LUNG TRANSPLANT............      8.8879        13.8         16.2
496.............       08  SURG                 COMBINED ANTERIOR/POSTERIOR      5.6865         8.5         10.3
                                                 SPINAL FUSION.
497.............       08  SURG                 SPINAL FUSION EXCEPT             3.1996         5.8          6.8
                                                 CERVICAL W CC.
498.............       08  SURG                 SPINAL FUSION EXCEPT             2.2996         3.9          4.3
                                                 CERVICAL W/O CC.
499.............       08  SURG                 BACK & NECK PROCEDURES           1.4471         3.8          5.0
                                                 EXCEPT SPINAL FUSION W CC.
500.............       08  SURG                 BACK & NECK PROCEDURES            .9375         2.2          2.6
                                                 EXCEPT SPINAL FUSION W/O
                                                 CC.
501.............       08  SURG                 KNEE PROCEDURES W PDX OF         2.7466         9.8         12.0
                                                 INFECTION W CC.
502.............       08  SURG                 KNEE PROCEDURES W PDX OF         1.5591         5.9          6.9
                                                 INFECTION W/O CC.
503.............       08  SURG                 KNEE PROCEDURES W/O PDX OF       1.2336         3.3          4.2
                                                 INFECTION.
504.............       22  SURG                 EXTENSIVE 3RD DEGREE BURNS      13.8097        28.2         33.6
                                                 W SKIN GRAFT.
505.............       22  MED                  EXTENSIVE 3RD DEGREE BURNS       1.4893         2.0          3.4
                                                 W/O SKIN GRAFT.
506.............       22  SURG                 FULL THICKNESS BURN W SKIN       4.9149        15.7         19.9
                                                 GRAFT OR INHAL INJ W CC OR
                                                 SIG TRAUMA.
507.............       22  SURG                 FULL THICKNESS BURN W SKIN       1.8331         7.2          9.2
                                                 GRFT OR INHAL INJ W/O CC
                                                 OR SIG TRAUMA.
508.............       22  MED                  FULL THICKNESS BURN W/O          1.2966         6.0          8.3
                                                 SKIN GRFT OR INHAL INJ W
                                                 CC OR SIG TRAUMA.
509.............       22  MED                  FULL THICKNESS BURN W/O           .7323         3.7          4.9
                                                 SKIN GRFT OR INH INJ W/O
                                                 CC OR SIG TRAUMA.
510.............       22  MED                  NON-EXTENSIVE BURNS W CC OR      1.3509         5.8          8.0
                                                 SIGNIFICANT TRAUMA.
511.............       22  MED                  NON-EXTENSIVE BURNS W/O CC        .7558         3.6          5.1
                                                 OR SIGNIFICANT TRAUMA.
512.............      PRE  SURG                 SIMULTANEOUS PANCREAS/           6.6413        13.4         16.5
                                                 KIDNEY TRANSPLANT.
513.............      PRE  SURG                 PANCREAS TRANSPLANT........      6.6497        10.3         13.4
514.............       05  SURG                 CARDIAC DEFIBRILLATOR            6.4169         6.8          9.0
                                                 IMPLANT W CARDIAC CATH.
515.............       05  SURG                 CARDIAC DEFIBRILLATOR            5.0652         4.3          6.8
                                                 IMPLANT W/O CARDIAC CATH.
516.............       05  SURG                 PERCUTANEOUS CARDIOVASC          2.7250         4.1          5.0
                                                 PROC W AMI.
517.............       05  SURG                 PERC CARDIO PROC W CORONARY      2.1497         1.9          2.7
                                                 ARTERY STENT W/O AMI.
518.............       05  SURG                 PERC CARDIO PROC W/O             1.6673         2.5          3.6
                                                 CORONARY ARTERY STENT OR
                                                 AMI.
519.............       08  SURG                 CERVICAL SPINAL FUSION W CC      2.2654         3.4          5.1
520.............       08  SURG                 CERVICAL SPINAL FUSION W/O       1.5709         2.0          2.8
                                                 CC.
521.............       20  MED                  ALCOHOL/DRUG ABUSE OR             .7354         4.2          5.4
                                                 DEPENDENCE W CC.
522.............       20  MED                  ALC/DRUG ABUSE OR DEPEND W        .6631         9.0         10.7
                                                 REHABILITATION THERAPY W/O
                                                 CC.
523.............       20  MED                  ALC/DRUG ABUSE OR DEPEND W/       .3983         3.5         4.3
                                                 O REHABILITATION THERAPY W/
                                                 O CC.
----------------------------------------------------------------------------------------------------------------
* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.
** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.
NOTE: GEOMETRIC MEAN IS USED ONLY TO DETERMINE PAYMENT FOR TRANSFER CASES.
NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.
NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.

      
  

  

  

  

  Federal Register / Vol. 66 , No. 87 / Friday, May 4, 2001 / Proposed 
Rules  

[[Page 22847]]


      

                                         Table 6A.--New Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
 Diagnosis
    code              Description                    CC               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
     256.31  Premature menopause..........  N                             13  358, 359, 369
     256.39  Other ovarian failure........  N                             13  358, 359, 369
      277.7  Dysmetabolic Syndrome X......  N                             10  299
     464.00  Acute laryngitis, without      N                              3  68, 69, 70
              mention of obstruction.                                    pre  482
     464.01  Acute laryngitis, with         N                              3  68, 69, 70
              obstruction.                                               pre  482
     464.50  Unspecified supraglottis,      N                              3  68, 69, 70
              without mention of                                         pre  482
              obstruction.
     464.51  Unspecified supraglottis,      N                              3  68, 69, 70
              with obstruction.                                          pre  482
     521.00  Unspecified dental caries....  N                              3  185, 186, 187
                                                                         pre  482
     521.01  Dental caries limited to       N                              3  185, 186, 187
              enamel.                                                    pre  482
     521.02  Dental caries extending into   N                              3  185, 186, 187
              dentine.                                                   pre  482
     521.03  Dental caries extending into   N                              3  185, 186, 187
              pulp.                                                      pre  482
     521.04  Arrested dental caries.......  N                              3  185, 186, 187
                                                                         pre  482
     521.05  Odontoclasia.................  N                              3  185, 186, 187
                                                                         pre  482
     521.09  Other dental caries..........  N                              3  185, 186, 187
                                                                         pre  482
     525.10  Unspecified acquired absence   N                              3  185, 186, 187
              of teeth.                                                  pre  482
     525.11  Loss of teeth due to trauma..  N                              3  185, 186, 187
                                                                         pre  482
     525.12  Loss of teeth due to           N                              3  182, 183, 184
              periodontal disease.                                       pre  482
     525.13  Loss of teeth due to caries..  N                              3  185, 186, 187
                                                                         pre  482
     525.19  Other loss of teeth..........  N                              3  185, 186, 187
                                                                         pre  482
     530.12  Acute esophagitis............  N                              6  182, 183, 184
     564.00  Unspecified constipation.....  N                              6  182, 183, 184
     564.01  Slow transit constipation....  N                              6  182, 183, 184
     564.02  Outlet dysfunction             N                              6  182, 183, 184
              constipation.
     564.09  Other constipation...........  N                              6  182, 183, 184
      602.3  Dysplasia of prostate........  N                             12  352
     608.82  Hematospermia................  N                             12  352
     608.87  Retrograde ejaculation.......  N                             12  352
     692.76  Sunburn of second degree.....  N                              9  283, 284
     692.77  Sunburn of third degree......  N                              9  283, 284
     718.70  Developmental dislocation of   N                              8  256
              joint, site unspecified.
     718.71  Developmental dislocation of   N                              8  256
              joint, shoulder region.
     718.72  Developmental dislocation of   N                              8  256
              joint, upper arm.
     718.73  Developmental dislocation of   N                              8  256
              joint, forearm.
     718.74  Developmental dislocation of   N                              8  256
              joint, hand.
     718.75  Developmental dislocation of   N                              8  256
              joint, pelvic region and
              thigh.
     718.76  Developmental dislocation of   N                              8  256
              joint, lower leg.
     718.77  Developmental dislocation of   N                              8  256
              joint, ankle and foot.
     718.78  Developmental dislocation of   N                              8  256
              joint, other specified sites.
     718.79  Developmental dislocation of   N                              8  256
              joint, multiple sites.
     733.93  Stress fracture of tibia or    Y                              8  239
              fibula.
     733.94  Stress fracture of the         Y                              8  239
              metatarsals.
     733.95  Stress fracture of other bone  Y                              8  239
     772.10  Intraventricular hemorrhage,   Y                             15  387, 389
              unspecified grade.
     772.11  Intraventricular hemorrhage,   Y                             15  387, 389
              Grade I.
     772.12  Intraventricular hemorrhage,   Y                             15  387, 389
              Grade II.
     772.13  Intraventricular hemorrhage,   Y                             15  387, 389
              Grade III.
     772.14  Intraventricular hemorrhage,   Y                             15  387, 389
              Grade IV.
      779.7  Perventricular leukomalacia..  Y                             15  387, 389
     793.80  Unspecified abnormal           N                              9  276
              mammogram.
     793.81  Mammographic                   N                              9  276
              microcalcification.
     793.89  Other abnormal findings on     N                              9  276
              radiological examination
              breast.
      840.7  Superior glenoid labrum        N                              8  253, 254, 255
              lesions (SLAP).                                             24  487

[[Page 22848]]

 
     997.71  Vascular complications of      Y                              6  188, 189, 190
              mesenteric artery.                                          15  387,\1\ 389 \1\
     997.72  Vascular complications of      Y                             11  331, 332, 333
              renal artery.                                               15  387,\1\ 389 \1\
     997.79  Vascular complications of      Y                              5  130, 131
              other vessels.                                              15  387,\1\ 389 \1\
     V10.53  Personal history of malignant  N                             17  411, 412
              neoplasm, renal pelvis.
     V45.84  Dental restoration status....  N                             23  467
     V49.82  Dental sealant status........  N                             23  467
     V83.01  Asymptomatic hemophilia A      N                             23  467
              carrier.
     V83.02  Symptomatic hemophilia A       N                             23  467
              carrier.
----------------------------------------------------------------------------------------------------------------


                                         Table 6B.--New Procedure Codes
----------------------------------------------------------------------------------------------------------------
 Procedure
    code              Description                    OR               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
      37.28  Intracardiac echocardiography  N
      44.32  Percutaneous [endoscopic]      Y                              6  154-156
              gastrojejunostomy.                                           7  201
                                                                          10  288
                                                                          17  400, 406, 407
      67.51  Transabdominal cerclage of     Y                             13  360
              cervix.                                                     14  372, 373
                                                                          21  442, 443
                                                                          24  486
      67.59  Other repair of internal       Y                             13  360
              cervical os.                                                14  372, 373
                                                                          21  442, 443
                                                                          24  486
      75.38  Fetal pulse oximetry.........  N
      81.30  Refusion of spine, not         Y                              1  4
              otherwise specified.                                         8  497, 498
                                                                          21  442, 443
                                                                          24  486
      81.31  Refusion of Atlas-axis spine.  Y                              1  4
                                                                           8  497, 498
                                                                          21  442, 443
                                                                          24  486
      81.32  Refusion of other cervical     Y                              1  4
              spine, anterior technique.                                   8  496, 519, 520
                                                                          21  442, 443
                                                                          24  486
      81.33  Refusion of other cervical     Y                              1  4
              spine, posterior technique.                                  8  496, 519, 520
                                                                          21  442, 443
                                                                          24  486
      81.34  Refusion of dorsal and         Y                              1  4
              dorsolumbar spine, anterior                                  8  496, 497, 498
              technique.                                                  21  442, 443
                                                                          24  486
      81.35  Refusion of dorsal and         Y                              1  4
              dorsolumbar spine, posterior                                 8  496, 497, 498
              technique.                                                  21  442, 443
                                                                          24  486
      81.36  Refusion of lumbar and         Y                              1  4
              lumbosacral spine, anterior                                  8  496, 497, 498
              technique.                                                  21  442, 443
                                                                          24  486
      81.37  Refusion of lumbar and         Y                              1  4
              lumbosacral spine, lateral                                   8  496, 497, 498
              transverse process technique.                               21  442, 443
                                                                          24  486
      81.38  Refusion of lumbar and         Y                              1  4
              lumbosacral spine, posterior                                 8  496, 497, 498
              technique.                                                  21  442, 443
                                                                          24  486

[[Page 22849]]

 
      81.39  Refusion of spine, not         Y                              1  4
              elsewhere classified.                                        8  497, 498
                                                                          21  442, 443
                                                                          24  486
      97.44  Nonoperative removal of heart  N
              assist system.
----------------------------------------------------------------------------------------------------------------


                                       Table 6C.--Invalid Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
 Diagnosis
    code              Description                    CC               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
      256.3  Other ovarian failure........  N                             13  358, 359, 369
      464.0  Acute laryngitis.............  N                              3  68, 69, 70
                                                                         pre  482
      521.0  Dental caries................  N                              3  185, 186, 187
                                                                         pre  482
      525.1  Loss of teeth due to           N                              3  185, 186, 187
              accident, extraction, or                                   pre  482
              local periodontal disease.
      564.0  Constipation.................  N                              6  182, 183, 184
      772.1  Intraventricular hemorrhage..  Y                             15  387,389
      793.8  Nonspecific abnormal findings  N                              9  276
              on radiological and other
              examinations of body
              structure, breast.
----------------------------------------------------------------------------------------------------------------


                                       Table 6D.--Invalid Procedure Codes
----------------------------------------------------------------------------------------------------------------
 Procedure
    code              Description                    OR               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
       67.5  Repair of internal cervical    Y                             13  360
              os.                                                         14  372, 373
                                                                          21  442, 442
                                                                          24  486
      81.09  Refusion of spine, any level   Y                              1  4
              or technique.                                                8  497, 498
                                                                          21  442, 443
                                                                          24  486
----------------------------------------------------------------------------------------------------------------


                                    Table 6E.--Revised Diagnosis Code Titles
----------------------------------------------------------------------------------------------------------------
 Diagnosis
    code              Description                    CC               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
     411.81  Acute coronary occlusion       Y                              5  124, 140
              without myocardial
              infarction.
     493.00  Extrinsic asthma without       N                              4  96, 97, 98
              mention of status
              asthmaticus or acute
              exacerbation or unspecified.
     493.10  Intrinsic asthma without       N                              4  96, 97, 98
              mention of status
              asthmaticus or acute
              exacerbation or unspecified.
     493.20  Chronic obstructive asthma     Y                              4  88
              without mention of status
              asthmaticus or acute
              exacerbation or unspecified.
     493.90  Asthma, unspecified without    N                              4  96, 97, 98
              mention of status
              asthmaticus or acute
              exacerbation or unspecified.
      V70.7  Examination of participant in  N                             23  467
              clinical trial.
----------------------------------------------------------------------------------------------------------------


                                       Table 6F.--Revised Procedure Codes
----------------------------------------------------------------------------------------------------------------
 Procedure
    code              Description                    OR               MDC                     DRG
----------------------------------------------------------------------------------------------------------------
      75.34  Other fetal monitoring.......  N
----------------------------------------------------------------------------------------------------------------


[[Page 22850]]


             Table 6G.--Additions to the CC Exclusions List
   CCs that are added to the list are in Table 6F-Additions to the CC
    Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
 indented column immediately following the affected principal diagnosis.
------------------------------------------------------------------------
 
------------------------------------------------------------------------
*25631      80600     82010    80637    80606    82021    77212    77210
  2580      80601     82011    80638    80607    82022    77213    77211
  2581      80602     82012    80639    80608    82030    77214    77212
  2588      80603     82013    8064     80609    82031    7797     77213
  2589      80604     82019    8065     80610    82032  *7729      77214
*25639      80605     82020    80660    80611    8208     77210    7797
  2580      80606     82021    80661    80612    8209     77211  *7769
  2581      80607     82022    80662    80613    82100    77212    77210
  2588      80608     82030    80669    80614    82101    77213    77211
  2589      80609     82031    80670    80615    82110    77214    77212
*6023       80610     82032    80671    80616    82111    7797     77213
  5960      80611     8208     80672    80617  *7720    *7760      77214
  5996      80612     8209     80679    80618    77210    77210    7797
  6010      80613     82100    8068     80619    77211    77211  *7797
  6012      80614     82101    8069     80620    77212    77212    7722
  6013      80615     82110    8080     80621    77213    77213    7797
  6021      80616     82111    8082     80622    77214    77214  *7798
  78820     80617   *73394     8083     80623    7797     7797     77210
  78829     80618     73310    80843    80624  *77210   *7761      77211
*60887      80619     73311    80849    80625    77210    77210    77212
  5970      80620     73312    80851    80626    77211    77211    77213
  5994      80621     73313    80852    80627    77212    77212    77214
*73310      80622     73314    80853    80628    77213    77213    7797
  73393     80623     73315    80859    80629    77214    77214  *9972
  73394     80624     73316    8088     80630    7722     7797     99771
  73395     80625     73319    8089     80631    7797   *7762      99772
*73311      80626     73393    82000    80632  *77211     77210    99779
  73393     80627     73394    82001    80633    77210    77211  *99771
  73394     80628     73395    82002    80634    77211    77212    53640
  73395     80629     8058     82003    80635    77212    77213    53641
*73312      80630     8059     82009    80636    77213    77214    53642
  73393     80631     80600    82010    80637    77214    7797     53649
  73394     80632     80601    82011    80638    7722   *7763      56962
  73395     80633     80602    82012    80639    7797     77210    9974
*73313      80634     80603    82013    8064   *77212     77211    99771
  73393     80635     80604    82019    8065     77210    77212    99772
  73394     80636     80605    82020    80660    77211    77213    99779
  73395     80637     80606    82021    80661    77212    77214  *99772
*73314      80638     80607    82022    80662    77213    7797     9975
  73393     80639     80608    82030    80669    77214  *7764      99771
  73394     8064      80609    82031    80670    7722     77210    99772
  73395     8065      80610    82032    80671    7797     77211    99779
*73315      80660     80611    8208     80672  *77213     77212  *99779
  73393     80661     80612    8209     80679    77210    77213    9972
  73394     80662     80613    82100    8068     77211    77214    99771
  73395     80669     80614    82101    8069     77212    7797     99772
*73316      80670     80615    82110    8080     77213  *7765      99779
  73393     80671     80616    82111    8082     77214    77210  *99791
  73394     80672     80617  *73395     8083     7722     77211    99771
  73395     80679     80618    73310    80843    7797     77212    99772
*73319      8068      80619    73311    80849  *77214     77213    99779
  73393     8069      80620    73312    80851    77210    77214  *99799
  73394     8080      80621    73313    80852    77211    7797     99771
  73395     8082      80622    73314    80853    77212  *7766      99772
*73393      8083      80623    73315    80859    77213    77210    99779
  73310     80843     80624    73316    8088     77214    77211  *99881
  73311     80849     80625    73319    8089     7722     77212    99771
  73312     80851     80626    73393    82000    7797     77213    99772
  73313     80852     80627    73394    82001  *7722      77214    99779
  73314     80853     80628    73395    82002    77210    7797   *99883
  73315     80859     80629    8058     82003    77211  *7767      99771
  73316     8088      80630    8059     82009    77212    77210    99772
  73319     8089      80631    80600    82010    77213    77211    99779
  73393     82000     80632    80601    82011    77214    77212  *99889
  73394     82001     80633    80602    82012    7797     77213    99771
  73395     82002     80634    80603    82013  *7728      77214    99772
  8058      82003     80635    80604    82019    77210    7797     99779
  8059      82009     80636    80605    82020    77211  *7768    *9989
  99771
  99772
  99779
------------------------------------------------------------------------


[[Page 22851]]


             Table 6H.--Deletions to the CC Exclusions List
 CCs that are deleted from the list are in Table 6G--Deletions to the CC
    Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
 indented column immediately following the affected principal diagnosis.
------------------------------------------------------------------------
 
------------------------------------------------------------------------
*2563
  2580
  2581
  2588
  2589
*7720
  7721
*7721
  7721
  7722
*7722
  7721
*7728
  7721
*7729
  7721
*7760
  7721
*7761
  7721
*7762
  7721
*7763
  7721
*7764
  7721
*7765
  7721
*7766
  7721
*7767
  7721
*7768
  7721
*7769
  7721
*7798
  7721
------------------------------------------------------------------------


[[Page 22852]]


                                   Table 7A.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay
                                                       [FY2000 MEDPAR update 12/00 Grouper V18.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                              Number        Arithmetic         10th            25th            50th            75th            90th
                   DRG                      discharges       mean LOS       percentile      percentile      percentile      percentile      percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1.......................................           33822          8.9935               2               3               6              12              19
2.......................................            6772          9.9778               3               5               8              13              20
3.......................................               2         43.5000              35              35              52              52              52
4.......................................            6035          7.1639               1               2               5               9              15
5.......................................           93311          3.1649               1               1               2               3               7
6.......................................             366          2.9672               1               1               2               4               6
7.......................................           12470          9.9739               2               4               7              12              20
8.......................................            4164          3.2759               1               1               2               4               7
9.......................................            1610          6.3491               1               3               5               8              13
10......................................           17577          6.5503               2               3               5               8              13
11......................................            3128          4.0767               1               2               3               5               8
12......................................           46758          5.8962               2               3               4               7              11
13......................................            6415          5.2011               2               3               4               6               9
14......................................          319523          5.8762               2               3               5               7              11
15......................................          145366          3.5498               1               2               3               4               7
16......................................           11155          6.0293               2               3               5               7              12
17......................................            3519          3.3231               1               2               3               4               6
18......................................           25961          5.4162               2               3               4               7              10
19......................................            8638          3.6972               1               2               3               5               7
20......................................            5629         10.1482               3               5               8              13              20
21......................................            1309          6.5516               2               3               5               8              13
22......................................            2535          4.8174               1               2               4               6               9
23......................................            9464          4.1855               1               2               3               5               8
24......................................           52753          4.9830               1               2               4               6              10
25......................................           25370          3.2236               1               2               3               4               6
26......................................              31          2.7097               1               1               2               3               6
27......................................            3441          5.0584               1               1               3               6              11
28......................................           11316          6.2100               1               3               5               8              13
29......................................            4486          3.6097               1               2               3               5               7
30......................................               1          1.0000               1               1               1               1               1
31......................................            3488          4.4903               1               2               3               5               8
32......................................            1738          2.5621               1               1               2               3               5
33......................................               1          1.0000               1               1               1               1               1
34......................................           20249          5.0786               1               2               4               6              10
35......................................            5728          3.3959               1               2               3               4               6
36......................................            3190          1.4649               1               1               1               1               2
37......................................            1452          4.0296               1               1               2               5               9
38......................................             102          2.6569               1               1               2               3               5
39......................................             912          1.9079               1               1               1               2               4
40......................................            1545          3.4252               1               1               2               4               7
42......................................            2223          2.2852               1               1               1               3               5
43......................................              85          3.1882               1               2               3               4               6
44......................................            1238          4.9548               2               3               4               6               9
45......................................            2444          3.1678               1               2               3               4               6
46......................................            3051          4.6834               1               2               4               6               9
47......................................            1281          3.2560               1               1               3               4               6
49......................................            2241          4.8104               1               2               3               6               9
50......................................            2488          1.9425               1               1               1               2               3
51......................................             203          2.6995               1               1               1               2               6
52......................................             220          1.9318               1               1               1               2               3
53......................................            2478          3.5557               1               1               2               4               8
54......................................               2          1.5000               1               1               2               2               2
55......................................            1505          2.7442               1               1               1               3               6
56......................................             503          2.7256               1               1               2               3               5
57......................................             708          3.9492               1               1               2               5               9
59......................................             107          2.7850               1               1               2               3               5
60......................................               2          3.5000               2               2               5               5               5
61......................................             231          5.0996               1               1               2               6              12
62......................................               3          1.3333               1               1               1               2               2
63......................................            2934          4.3889               1               2               3               5               8
64......................................            3033          6.1800               1               2               4               8              13
65......................................           34466          2.8420               1               1               2               4               5
66......................................            6978          3.1635               1               1               2               4               6
67......................................             495          3.5960               1               2               3               4               7
68......................................           16724          4.1158               1               2               3               5               7
69......................................            5435          3.2736               1               2               3               4               6
70......................................              24          2.9167               1               2               2               4               5
71......................................              82          3.8049               1               2               3               4               7
72......................................             883          3.5663               1               2               3               4               6
73......................................            6630          4.4065               1               2               3               6               9

[[Page 22853]]

 
75......................................           39010          9.9124               3               5               7              12              19
76......................................           38998         11.2677               3               5               9              14              21
77......................................            2352          4.9184               1               2               4               7              10
78......................................           32087          6.7848               3               4               6               8              11
79......................................          169783          8.4892               3               4               7              11              16
80......................................            9018          5.6618               2               3               5               7              10
81......................................               4         18.2500               3               3               4               8              58
82......................................           61883          6.9447               2               3               5               9              14
83......................................            6446          5.5496               2               3               4               7              10
84......................................            1508          3.3455               1               2               3               4               6
85......................................           20572          6.3122               2               3               5               8              12
86......................................            2118          3.6643               1               2               3               5               7
87......................................           60110          6.2840               1               3               5               8              12
88......................................          389694          5.1207               2               3               4               6               9
89......................................          525838          5.9470               2               3               5               7              11
90......................................           53895          4.1549               2               3               4               5               7
91......................................              54          4.5185               2               2               3               5              10
92......................................           13774          6.3499               2               3               5               8              12
93......................................            1672          4.0353               1               2               3               5               7
94......................................           12030          6.2988               2               3               5               8              12
95......................................            1595          3.7179               1               2               3               5               7
96......................................           61986          4.6292               2               3               4               6               8
97......................................           31444          3.6560               1               2               3               5               7
98......................................              18          4.2222               1               2               2               4               6
99......................................           18996          3.1991               1               1               2               4               6
100.....................................            7619          2.1869               1               1               2               3               4
101.....................................           19997          4.3938               1               2               3               5               9
102.....................................            5146          2.6570               1               1               2               3               5
103.....................................             475         46.6021               9              13              25              60              98
104.....................................           36578         11.3165               7              11              28              60              98
105.....................................           29726          9.2831               5               6               8              15              98
106.....................................            3401         11.4963               5               7              10              14              20
107.....................................           87868         10.3783               5               7               9              12              17
108.....................................            6048         10.2116               3               5               8              13              19
109.....................................           60265          7.6926               4               5               6               9              12
110.....................................           52595          9.2013               2               5               7              11              18
111.....................................            8545          4.7604               1               2               5               6               8
113.....................................           42250         12.1885               3               6               9              15              24
114.....................................            8712          8.3768               2               4               7              10              16
115.....................................           14329          8.1687               1               4               7              11              16
116.....................................          330888          3.6061               2               9               7              11              16
117.....................................            3717          4.1512               1               1               2               5               9
118.....................................            7667          2.6849               1               1               1               3               6
119.....................................            1307          4.8829               1               1               3               6              12
120.....................................           35929          8.1178               1               2               5              10              16
121.....................................          162112          6.3821               2               3               5               8              12
122.....................................           78969          3.7027               1               2               3               5               7
123.....................................           40659          4.5833               1               1               3               6              11
124.....................................          132801          4.3427               1               2               3               5               8
125.....................................           80169          2.7657               1               1               2               4               5
126.....................................            5150         11.6882               3               6               9              14              22
127.....................................          678903          5.2745               2               3               4               7              10
128.....................................            9424          5.6175               2               4               5               7               9
129.....................................            4140          2.7621               1               1               1               3               6
130.....................................           86009          5.6760               2               3               5               7              10
131.....................................           28236          4.2426               1               2               4               6               7
132.....................................          147648          3.0002               1               1               2               4               6
133.....................................            8321          2.3367               1               1               2               3               4
134.....................................           36118          3.2406               1               2               3               4               6
135.....................................            7266          4.5531               1               2               3               6               9
136.....................................            1221          2.7158               1               1               2               3               5
138.....................................          194087          3.9932               1               2               3               5               8
139.....................................           82604          2.5072               1               1               2               3               5
140.....................................           69724          2.6533               1               1               2               3               5
141.....................................           90403          3.6691               1               2               3               5               7
142.....................................           45776          2.6508               1               1               2               3               5
143.....................................          203918          2.1253               1               1               2               3               4
144.....................................           81577          5.3196               1               2               4               7              11
145.....................................            7224          2.7460               1               1               2               3               5
146.....................................           10683         10.2826               5               7               9              12              17

[[Page 22854]]

 
147.....................................            2629          6.4196               3               5               6               8               9
148.....................................          129247         12.1904               5               7              10              15              22
149.....................................           18462          6.5184               4               5               6               8               9
150.....................................           19795         11.2770               4               7              10              14              20
151.....................................            4814          5.8286               2               3               5               8              10
152.....................................            4381          8.1438               3               5               7               9              14
153.....................................            2083          5.3711               3               4               5               7               8
154.....................................           28660         13.1491               4               7              10              16              25
155.....................................            6596          4.2179               1               2               3               6               8
156.....................................               4          7.5000               1               1               5               6              18
157.....................................            7903          5.3790               1               2               4               7              11
158.....................................            4630          2.5395               1               1               2               3               5
159.....................................           16309          4.9926               1               2               4               6              10
160.....................................           11655          2.6619               1               1               2               3               5
161.....................................           11119          4.2027               1               1               3               5               9
162.....................................            7199          1.9267               1               1               1               2               4
163.....................................               5          4.4000               1               1               3               4              13
164.....................................            4824          8.4279               4               5               7              10              15
165.....................................            2066          4.8049               2               3               5               6               8
166.....................................            3532          5.0337               2               2               4               6              10
167.....................................            3269          2.5990               1               2               2               3               5
168.....................................            1327          4.7641               1               2               3               6              10
169.....................................             834          2.3405               1               1               2               3               5
170.....................................           10975         11.1690               2               5               8              14              22
171.....................................            1284          4.6597               1               2               4               6               9
172.....................................           30412          6.9363               2               3               5               9              14
173.....................................            2685          3.6648               1               1               3               5               7
174.....................................          240400          4.7974               2               3               4               6               9
175.....................................           32375          2.9414               1               2               3               4               5
176.....................................           15101          5.2286               2               3               4               6              10
177.....................................            9190          4.5348               2               2               4               6               8
178.....................................            3597          3.0703               1               2               3               4               6
179.....................................           12291          5.9729               2               3               5               7              11
180.....................................           85599          5.3567               2               3               4               7              10
181.....................................           26315          3.4185               1               2               3               4               6
182.....................................          243506          4.3356               1               2               3               5               8
183.....................................           83969          2.9155               1               1               2               4               5
184.....................................              79          2.9620               1               2               2               4               6
185.....................................            4760          4.5210               1               2               3               6               9
186.....................................               3          9.3333               1               1               9              18              18
187.....................................             646          3.9164               1               1               3               5               8
188.....................................           75558          5.5580               1               2               4               7              11
189.....................................           11984          3.1542               1               1               2               4               6
190.....................................              49          7.0204               2               3               4               5               8
191.....................................            8889         13.7967               4               6              10              17              28
192.....................................            1105          6.5122               2               4               6               8              11
193.....................................            5258         12.5369               5               7              10              16              22
194.....................................             718          6.7869               2               4               6               8              12
195.....................................            4327         10.1470               4               6               9              12              17
196.....................................            1162          5.7212               2               4               5               7              10
197.....................................           18754          8.9335               3               5               7              11              16
198.....................................            5751          4.5416               2               3               4               6               8
199.....................................            1704          9.5827               2               4               7              13              20
200.....................................            1063         10.3518               1               3               7              13              22
201.....................................            1398         13.7790               3               6              11              17              25
202.....................................           25975          6.4045               2               3               5               8              13
203.....................................           29017          6.6364               2               3               5               9              13
204.....................................           57319          5.7964               2               3               4               7              11
205.....................................           22900          6.1735               2               3               5               8              12
206.....................................            1948          3.9168               1               2               3               5               7
207.....................................           30817          5.0832               1               2               4               6              10
208.....................................           10061          2.8946               1               1               2               4               6
209.....................................          343375          5.0786               3               3               4               6               8
210.....................................          120891          6.8189               3               4               6               8              11
211.....................................           31665          4.9325               3               4               4               6               7
212.....................................               6         13.5000               1               4               4              29              29
213.....................................            9144          8.9604               2               4               7              11              18
216.....................................            5956          9.6949               2               4               8              12              20
217.....................................           16333         13.1971               3               5               9              16              28
218.....................................           21296          5.4123               2               3               4               7              10

[[Page 22855]]

 
219.....................................           19530          3.2240               1               2               3               4               6
220.....................................               6          4.0000               1               1               3               7               7
223.....................................           13251          2.8497               1               1               2               3               6
224.....................................           11112          1.9343               1               1               2               2               3
225.....................................            5734          4.8575               1               2               3               6              11
226.....................................            5148          6.5874               1               2               4               8              14
227.....................................            4695          2.7242               1               1               2               3               5
228.....................................            2340          3.7970               1               1               2               5               8
229.....................................            1108          2.4838               1               1               2               3               5
230.....................................            2365          5.2592               1               2               3               6              11
231.....................................           11343          4.9395               1               2               3               6              11
232.....................................             807          2.8872               1               1               1               3               7
233.....................................            5059          7.5181               2               3               6              10              15
234.....................................            3168          3.4419               1               1               3               4               7
235.....................................            5036          5.0473               1               2               4               6               9
236.....................................           38265          4.8164               1               3               4               6               9
237.....................................            1687          3.5033               1               2               3               4               6
238.....................................            7930          8.5212               3               4               6              10              16
239.....................................           49088          6.2151               2               3               5               8              12
240.....................................           11318          6.6744               2               3               5               8              13
241.....................................            3168          3.8570               1               2               3               5               7
242.....................................            2434          6.6348               2               3               5               8              13
243.....................................           87407          4.6676               1               2               4               6               9
244.....................................           12162          4.8047               1               2               4               6               9
245.....................................            5130          3.4458               1               2               3               4               6
246.....................................            1386          3.8117               1               2               3               5               7
247.....................................           16832          3.3990               1               1               3               4               7
248.....................................           10529          4.8161               1               2               4               6               9
249.....................................           11336          3.6591               1               1               2               4               8
250.....................................            3456          4.1062               1               2               3               5               7
251.....................................            2406          2.8579               1               1               2               4               5
253.....................................           19677          4.7732               1               3               4               6               9
254.....................................           10449          3.1906               1               2               3               4               6
255.....................................               1          3.0000               3               3               3               3               3
256.....................................            6054          5.0766               1               2               4               6              10
257.....................................           16333          2.7359               1               1               2               3               5
258.....................................           15978          1.9342               1               1               2               2               3
259.....................................            3773          2.6801               1               1               1               2               6
260.....................................            4896          1.4167               1               1               1               2               2
261.....................................            1844          2.2749               1               1               1               3               5
262.....................................             612          3.9477               1               1               3               5               8
263.....................................           18146         12.0208               3               5               8              14              24
264.....................................            3608          7.4088               2               4               6               9              14
265.....................................            3681          6.8036               1               2               4               8              14
266.....................................            2698          3.3039               1               1               2               4               7
267.....................................             233          4.2060               1               1               3               6               9
268.....................................             878          3.4989               1               1               2               4               7
269.....................................            7390          8.2441               1               3               6              10              17
270.....................................            2623          3.5783               1               1               2               5               8
271.....................................            9621          7.6144               2               4               6               9              14
272.....................................            5459          6.1597               2               3               5               8              12
273.....................................            1286          4.0420               1               2               3               5               8
274.....................................            2334          6.5900               1               3               5               8              13
275.....................................             246          4.3130               1               1               3               5               9
276.....................................            1177          4.6669               1               2               4               6               8
277.....................................           85183          5.7309               2               3               5               7              10
278.....................................           33396          4.4205               2               3               4               6               8
279.....................................               3          2.3333               1               1               2               4               4
280.....................................           15577          4.1954               1               2               3               5               8
281.....................................            7128          3.0464               1               1               3               4               6
282.....................................               3          1.6667               1               1               2               2               2
283.....................................            5629          4.5756               1               2               4               6               9
284.....................................            1868          3.1124               1               1               2               4               6
285.....................................            6195         10.3080               3               5               8              13              20
286.....................................            2070          6.4396               2               3               5               7              13
287.....................................            5676         10.5374               3               5               7              12              21
288.....................................            2639          5.7704               2               3               4               6               9
289.....................................            4765          3.0002               1               1               2               3               7
290.....................................            8753          2.3103               1               1               2               2               4
291.....................................              65          1.8462               1               1               1               2               3

[[Page 22856]]

 
292.....................................            4702         10.4872               2               4               8              14              22
293.....................................             624          5.5096               1               2               4               7              12
294.....................................           87857          4.6066               1               2               4               6               9
295.....................................            3277          3.7376               1               2               3               5               7
296.....................................          235003          5.1556               2               2               4               6              10
297.....................................           43573          3.4124               1               2               3               4               6
298.....................................              86          2.8256               1               1               2               3               5
299.....................................            1178          5.2199               1               2               4               7              10
300.....................................           15999          6.1363               2               3               5               8              12
301.....................................            3208          3.6234               1               2               3               4               7
302.....................................            8018          9.0636               4               5               7              11              19
303.....................................           19452          8.4231               4               5               7              10              15
304.....................................           11767          8.7339               2               4               6              11              18
305.....................................            2984          3.6384               1               2               3               5               7
306.....................................            7320          5.6291               1               2               3               8              13
307.....................................            2082          2.2517               1               1               2               3               4
308.....................................            7463          6.1733               1               2               4               8              14
309.....................................            4096          2.2954               1               1               2               3               4
310.....................................           23873          4.4002               1               1               3               6              10
311.....................................            7963          1.8339               1               1               1               2               3
312.....................................            1487          4.4654               1               1               3               6              10
313.....................................             591          2.3316               1               1               1               3               5
315.....................................           29749          6.9546               1               1               4               9              15
316.....................................          104601          6.6228               2               3               5               8              13
317.....................................            1507          2.8779               1               1               2               3               6
318.....................................            5584          5.9979               1               3               5               8              12
319.....................................             422          2.7725               1               1               2               3               6
320.....................................          186678          5.3171               2               3               4               6              10
321.....................................           30428          3.7951               1               2               3               5               7
322.....................................              61          4.1475               2               2               3               5               8
323.....................................           17241          3.2172               1               1               2               4               7
324.....................................            7479          1.8826               1               1               1               2               3
325.....................................            8160          3.8241               1               2               3               5               7
326.....................................            2676          2.6648               1               1               2               3               5
327.....................................              11          3.0909               1               1               3               4               5
328.....................................             663          3.6305               1               1               3               5               8
329.....................................              77          2.0130               1               1               1               2               4
331.....................................           46045          5.5426               1               3               4               7              11
332.....................................            4930          3.2917               1               1               2               4               7
333.....................................             281          5.0569               1               2               4               6              10
334.....................................            8654          4.4386               2               3               4               5               7
335.....................................           10721          3.1791               2               2               3               4               5
336.....................................            9563          3.7848               1               2               3               4               8
337.....................................            3041          2.1500               1               1               2               3               3
338.....................................            1226          5.1117               1               2               3               7              11
339.....................................            1344          4.9821               1               1               3               7              12
340.....................................               1          1.0000               1               1               1               1               1
341.....................................            2738          3.1088               1               1               1               3               6
342.....................................             298          3.4094               1               1               2               4               7
344.....................................            3502          2.3829               1               1               1               2               5
345.....................................             410          5.1244               1               2               3               6              10
346.....................................            4441          5.8726               1               3               4               7              12
347.....................................             365          2.9479               1               1               2               4               6
350.....................................            6270          4.3933               1               2               4               5               8
352.....................................             756          3.9577               1               2               3               5               8
353.....................................            2533          6.4212               2               3               5               7              12
354.....................................            7562          5.8375               3               3               4               7              11
355.....................................            5504          3.2862               2               3               3               4               5
356.....................................           25128          2.2924               1               1               2               3               4
357.....................................            5548          8.4874               3               4               7              10              16
358.....................................           20294          4.3121               2               3               3               5               7
359.....................................           29890          2.7295               2               2               3               3               4
360.....................................           15941          2.8557               1               2               2               3               5
361.....................................             378          2.9233               1               1               2               3               5
363.....................................            2862          3.4693               1               2               2               3               7
364.....................................            1644          3.8534               1               1               3               5               8
365.....................................            1722          7.2410               1               3               5               9              16
366.....................................            4410          6.7329               1               3               5               8              14
367.....................................             583          3.0617               1               1               2               4               6
368.....................................            3110          6.4810               2               3               5               8              12

[[Page 22857]]

 
369.....................................            3133          3.2515               1               1               2               4               7
370.....................................            1095          5.8429               3               3               4               5              10
371.....................................            1307          3.6526               2               3               3               4               5
372.....................................             927          3.2891               1               2               2               3               5
373.....................................            3734          2.2499               1               2               2               3               3
374.....................................             120          3.1583               1               2               2               3               4
375.....................................              10          2.3000               1               2               2               3               4
376.....................................             247          3.0931               1               2               2               4               6
377.....................................              48          5.0000               1               1               3               6              12
378.....................................             157          2.4140               1               1               2               3               4
379.....................................             337          3.4303               1               1               2               4               6
380.....................................              58          2.1207               1               1               1               2               5
381.....................................             152          2.5132               1               1               1               3               5
382.....................................              45          1.2889               1               1               1               1               2
383.....................................            1707          3.5817               1               1               2               4               7
384.....................................             114          2.1842               1               1               1               3               5
385.....................................               1          1.0000               1               1               1               1               1
389.....................................              15         11.7333               1               3               6              10              24
390.....................................              14          4.0000               1               2               3               6               7
391.....................................               1          4.0000               4               4               4               4               4
392.....................................            2323          9.6750               3               4               7              12              20
394.....................................            1870          7.1428               1               2               4               8              16
395.....................................           86911          4.4001               1               2               3               6               9
396.....................................              15          4.6667               1               2               4               6               7
397.....................................           17554          5.1878               1               2               4               7              10
398.....................................           17526          5.9417               2               3               5               7              11
399.....................................            1721          3.5758               1               2               3               5               7
400.....................................            6444          9.1189               1               3               6              12              20
401.....................................            5581         11.2575               2               5               9              15              23
402.....................................            1498          4.1128               1               1               3               6               9
403.....................................           31732          8.0627               2               3               6              10              17
404.....................................            4639          4.2720               1               2               3               6               9
406.....................................            2513          9.8607               3               4               7              12              20
407.....................................             720          4.4417               1               2               4               5               8
408.....................................            2178          8.0317               1               2               5              10              18
409.....................................            2822          5.9072               2               3               4               6              12
410.....................................           33412          3.9069               1               2               4               5               6
411.....................................              13          2.3077               1               1               2               2               5
412.....................................              29          2.4483               1               1               2               3               4
413.....................................            6419          7.0662               2               3               5               9              14
414.....................................             767          4.2529               1               2               3               5               9
415.....................................           38683         14.2779               4               6              11              18              28
416.....................................          183557          7.3848               2               4               6               9              14
417.....................................              16          5.0000               2               2               4               6               9
418.....................................           22822          6.1160               2               3               5               7              11
419.....................................           15294          4.7204               2               2               4               6               9
420.....................................            3109          3.5002               1               2               3               4               6
421.....................................           11464          3.7872               1               2               3               5               7
422.....................................              80          3.0625               1               2               3               4               6
423.....................................            7452          8.1162               2               3               6              10              16
424.....................................            1275         13.4204               2               5               9              16              26
425.....................................           15710          3.9945               1               2               3               5               8
426.....................................            4443          4.4510               1               2               3               5               9
427.....................................            1633          4.6418               1               2               3               6               9
428.....................................             835          6.8192               1               2               4               8              14
429.....................................           25967          6.3055               2               3               5               7              12
430.....................................           58669          8.0151               2               3               6              10              16
431.....................................             313          6.2045               1               3               5               7              11
432.....................................             469          4.7271               1               2               3               5               9
433.....................................            5418          3.0945               1               1               2               4               6
439.....................................            1343          8.4080               1               3               5              10              19
440.....................................            5131          9.0209               2               3               6              11              20
441.....................................             601          3.2313               1               1               2               4               7
442.....................................           15366          8.4839               1               3               6              10              18
443.....................................            3730          3.4399               1               1               3               4               7
444.....................................            5185          4.1338               1               2               3               5               8
445.....................................            2427          2.9250               1               1               2               4               5
447.....................................            5451          2.4748               1               1               2               3               5
449.....................................           28048          3.7457               1               1               3               5               8
450.....................................            6867          2.0051               1               1               1               2               4

[[Page 22858]]

 
451.....................................               3          1.3333               1               1               1               2               2
452.....................................           22666          4.8553               1               2               3               6              10
453.....................................            5068          2.8035               1               1               2               3               6
454.....................................            3940          4.5652               1               2               3               5               9
455.....................................             931          2.5994               1               1               2               3               5
461.....................................            3490          4.3739               1               1               2               5              11
462.....................................           12994         11.2271               4               6               9              14              21
463.....................................           21790          4.1239               1               2               3               5               8
464.....................................            6533          2.9963               1               1               2               4               6
465.....................................             154          3.4481               1               1               2               4               7
466.....................................            1470          3.9925               1               1               2               5               9
467.....................................             534          3.8390               1               1               2               4               8
468.....................................           58990         12.9159               3               6              10              17              30
471.....................................           11639          5.5322               3               4               4               6               9
473.....................................            7599         12.5038               1               3               7              18              32
475.....................................          107089         11.1800               2               5               9              15              22
476.....................................            4126         10.8924               2               5               9              14              21
477.....................................           24823          8.1004               1               3               6              11              17
478.....................................          106999          7.3166               1               3               5               9              15
479.....................................           24939          3.5376               1               1               3               5               7
480.....................................             541         20.4843               7               9              13              25              43
481.....................................             377         23.9310              10              18              22              27              38
482.....................................            5686         12.9474               4               7              10              15              25
483.....................................           42093         39.0315              14              22              33              49              70
484.....................................             313         12.6773               2               6              10              17              26
485.....................................            2880          9.5955               4               5               7              11              18
486.....................................            1856         12.4402               1               5              10              16              25
487.....................................            3339          7.3612               1               3               6              10              15
488.....................................             770         17.0078               3               7              13              22              36
489.....................................           14005          8.4383               2               3               6              10              17
490.....................................            5378          5.3405               1               2               4               6              10
491.....................................           12205          3.4483               2               2               3               4               6
492.....................................            2672         15.6662               3               5               8              25              34
493.....................................           54859          5.7621               1               3               5               7              11
494.....................................           29900          2.4482               1               1               2               3               5
495.....................................             153         15.0261               7               9              12              18              26
496.....................................            1444          9.5824               4               5               7              12              18
497.....................................           23721          6.1748               3               4               7              12              18
498.....................................           22152          3.3273               3               4               6              12              18
499.....................................           30284          4.6986               1               2               3               6               9
500.....................................           43962          2.6146               1               1               2               3               5
501.....................................            2180         10.9670               4               6               8              13              21
502.....................................             586          6.5648               3               4               5               8              11
503.....................................            5551          3.9996               1               2               3               5               7
504.....................................             114         29.5877               9              14              24              41              54
505.....................................             145          3.3517               1               1               1               3               7
506.....................................             915         17.4000               4               8              14              22              35
507.....................................             290          8.2621               2               4               7              11              18
508.....................................             657          7.4718               2               3               5               9              15
509.....................................             176          4.5455               1               2               4               6               9
510.....................................            1619          7.1779               2               3               5               9              15
511.....................................             602          4.7591               1               2               3               6              10
512.....................................  ..............  ..............               1               2               3               6              10
513.....................................  ..............  ..............               1               2               3               6              10
514.....................................  ..............  ..............               1               2               3               6              10
515.....................................  ..............  ..............               1               2               3               6              10
516.....................................  ..............  ..............               1               2               3               6              10
517.....................................  ..............  ..............               1               2               3               6              10
518.....................................  ..............  ..............               1               2               3               6              10
519.....................................  ..............  ..............               1               2               3               6              10
520.....................................  ..............  ..............               1               2               3               6              10
521.....................................  ..............  ..............               1               2               3               6              10
522.....................................  ..............  ..............               1               2               3               6              10
523.....................................  ..............  ..............               1               2               3               6              10
                                         ----------------
                                                10811358
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 22859]]


                                   Table 7B.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay
                                                       [FY2000 MEDPAR update 12/00 Grouper V19.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                              Number        Arithmetic         10th            25th            50th            75th            90th
                   DRG                      discharges       mean LOS       percentile      percentile      percentile      percentile      percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1.......................................           33822          8.9935               2               3               6              12              19
2.......................................            6772          9.9778               3               5               8              13              20
3.......................................               2         43.5000              35              35              52              52              52
4.......................................            6035          7.1639               1               2               5               9              15
5.......................................           93311          3.1649               1               1               2               3               7
6.......................................             366          2.9672               1               1               2               4               6
7.......................................           12470          9.9739               2               4               7              12              20
8.......................................            4164          3.2759               1               1               2               4               7
9.......................................            1610          6.3491               1               3               5               8              13
10......................................           17577          6.5503               2               3               5               8              13
11......................................            3128          4.0767               1               2               3               5               8
12......................................           46758          5.8962               2               3               4               7              11
13......................................            6415          5.2011               2               3               4               6               9
14......................................          319523          5.8762               2               3               5               7              11
15......................................          145366          3.5498               1               2               3               4               7
16......................................           11155          6.0293               2               3               5               7              12
17......................................            3519          3.3231               1               2               3               4               6
18......................................           25961          5.4162               2               3               4               7              10
19......................................            8638          3.6972               1               2               3               5               7
20......................................            5629         10.1482               3               5               8              13              20
21......................................            1309          6.5516               2               3               5               8              13
22......................................            2535          4.8174               1               2               4               6               9
23......................................            9464          4.1855               1               2               3               5               8
24......................................           52753          4.9830               1               2               4               6              10
25......................................           25370          3.2236               1               2               3               4               6
26......................................              31          2.7097               1               1               2               3               6
27......................................            3441          5.0584               1               1               3               6              11
28......................................           11316          6.2100               1               3               5               8              13
29......................................            4486          3.6097               1               2               3               5               7
30......................................               1          1.0000               1               1               1               1               1
31......................................            3488          4.4903               1               2               3               5               8
32......................................            1738          2.5621               1               1               2               3               5
33......................................               1          1.0000               1               1               1               1               1
34......................................           20249          5.0786               1               2               4               6              10
35......................................            5728          3.3959               1               2               3               4               6
36......................................            3190          1.4649               1               1               1               1               2
37......................................            1452          4.0296               1               1               2               5               9
38......................................             102          2.6569               1               1               2               3               5
39......................................             912          1.9079               1               1               1               2               4
40......................................            1545          3.4252               1               1               2               4               7
42......................................            2223          2.2852               1               1               1               3               5
43......................................              85          3.1882               1               2               3               4               6
44......................................            1238          4.9548               2               3               4               6               9
45......................................            2444          3.1678               1               2               3               4               6
46......................................            3051          4.6834               1               2               4               6               9
47......................................            1281          3.2560               1               1               3               4               6
49......................................            2241          4.8104               1               2               3               6               9
50......................................            2488          1.9425               1               1               1               2               3
51......................................             203          2.6995               1               1               1               2               6
52......................................             220          1.9318               1               1               1               2               3
53......................................            2478          3.5557               1               1               2               4               8
54......................................               2          1.5000               1               1               2               2               2
55......................................            1505          2.7442               1               1               1               3               6
56......................................             503          2.7256               1               1               2               3               5
57......................................             708          3.9492               1               1               2               5               9
59......................................             107          2.7850               1               1               2               3               5
60......................................               2          3.5000               2               2               5               5               5
61......................................             231          5.0996               1               1               2               6              12
62......................................               3          1.3333               1               1               1               2               2
63......................................            3003          4.4409               1               2               3               5               9
64......................................            3033          6.1800               1               2               4               8              13
65......................................           34466          2.8420               1               1               2               4               5
66......................................            6978          3.1635               1               1               2               4               6
67......................................             495          3.5960               1               2               3               4               7
68......................................           16724          4.1158               1               2               3               5               7
69......................................            5435          3.2736               1               2               3               4               6
70......................................              24          2.9167               1               2               2               4               5
71......................................              82          3.8049               1               2               3               4               7
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78......................................           32087          6.7848               3               4               6               8              11
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80......................................            9018          5.6618               2               3               5               7              10
81......................................               4         18.2500               3               3               4               8              58
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83......................................            6446          5.5496               2               3               4               7              10
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88......................................          389694          5.1207               2               3               4               6               9
89......................................          525838          5.9470               2               3               5               7              11
90......................................           53895          4.1549               2               3               4               5               7
91......................................              54          4.5185               2               2               3               5              10
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93......................................            1672          4.0353               1               2               3               5               7
94......................................           12030          6.2988               2               3               5               8              12
95......................................            1595          3.7179               1               2               3               5               7
96......................................           61986          4.6292               2               3               4               6               8
97......................................           31444          3.6560               1               2               3               5               7
98......................................              18          4.2222               1               2               2               4               6
99......................................           18996          3.1991               1               1               2               4               6
100.....................................            7619          2.1869               1               1               2               3               4
101.....................................           19997          4.3938               1               2               3               5               9
102.....................................            5146          2.6570               1               1               2               3               5
103.....................................             475         46.6021               9              13              25              60              98
104.....................................           19650         14.1922               6               8              12              17              25
105.....................................           25952          9.7562               4               6               8              11              17
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108.....................................            6047         10.2128               3               5               8              13              19
109.....................................           60265          7.6926               4               5               6               9              12
110.....................................           52587          9.2019               2               5               7              11              18
111.....................................            8545          4.7604               1               2               5               6               8
113.....................................           42250         12.1885               3               6               9              15              24
114.....................................            8712          8.3768               2               4               7              10              16
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116.....................................           91838          4.4683               1               2               3               6               9
117.....................................            3717          4.1512               1               1               2               5               9
118.....................................            7667          2.6849               1               1               1               3               6
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120.....................................           37500          8.5321               1               2               6              11              19
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125.....................................           80169          2.7657               1               1               2               4               5
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128.....................................            9424          5.6175               2               4               5               7               9
129.....................................            4140          2.7621               1               1               1               3               6
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131.....................................           28236          4.2426               1               2               4               6               7
132.....................................          147648          3.0002               1               1               2               4               6
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136.....................................            1221          2.7158               1               1               2               3               5
138.....................................          194087          3.9932               1               2               3               5               8
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140.....................................           69724          2.6533               1               1               2               3               5
141.....................................           90403          3.6691               1               2               3               5               7
142.....................................           45776          2.6508               1               1               2               3               5
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[[Page 22861]]

 
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151.....................................            4814          5.8286               2               3               5               8              10
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153.....................................            2083          5.3711               3               4               5               7               8
154.....................................           28660         13.1491               4               7              10              16              25
155.....................................            6596          4.2179               1               2               3               6               8
156.....................................               4          7.5000               1               1               5               6              18
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162.....................................            7199          1.9267               1               1               1               2               4
163.....................................               5          4.4000               1               1               3               4              13
164.....................................            4824          8.4279               4               5               7              10              15
165.....................................            2066          4.8049               2               3               5               6               8
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170.....................................           10975         11.1690               2               5               8              14              22
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172.....................................           30412          6.9363               2               3               5               9              14
173.....................................            2685          3.6648               1               1               3               5               7
174.....................................          240400          4.7974               2               3               4               6               9
175.....................................           32375          2.9414               1               2               3               4               5
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177.....................................            9190          4.5348               2               2               4               6               8
178.....................................            3597          3.0703               1               2               3               4               6
179.....................................           12291          5.9729               2               3               5               7              11
180.....................................           85599          5.3567               2               3               4               7              10
181.....................................           26315          3.4185               1               2               3               4               6
182.....................................          243506          4.3356               1               2               3               5               8
183.....................................           83969          2.9155               1               1               2               4               5
184.....................................              79          2.9620               1               2               2               4               6
185.....................................            4760          4.5210               1               2               3               6               9
186.....................................               3          9.3333               1               1               9              18              18
187.....................................             646          3.9164               1               1               3               5               8
188.....................................           75558          5.5580               1               2               4               7              11
189.....................................           11984          3.1542               1               1               2               4               6
190.....................................              49          7.0204               2               3               4               5               8
191.....................................            8867         13.7982               4               6              10              17              27
192.....................................            1105          6.5122               2               4               6               8              11
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199.....................................            1704          9.5827               2               4               7              13              20
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206.....................................            1948          3.9168               1               2               3               5               7
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209.....................................          343375          5.0786               3               3               4               6               8
210.....................................          120891          6.8189               3               4               6               8              11
211.....................................           31665          4.9325               3               4               4               6               7
212.....................................               6         13.5000               1               4               4              29              29
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248.....................................           10529          4.8161               1               2               4               6               9
249.....................................           11336          3.6591               1               1               2               4               8
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251.....................................            2406          2.8579               1               1               2               4               5
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254.....................................           10449          3.1906               1               2               3               4               6
255.....................................               1          3.0000               3               3               3               3               3
256.....................................            6054          5.0766               1               2               4               6              10
257.....................................           16333          2.7359               1               1               2               3               5
258.....................................           15978          1.9342               1               1               2               2               3
259.....................................            3773          2.6801               1               1               1               2               6
260.....................................            4896          1.4167               1               1               1               2               2
261.....................................            1844          2.2749               1               1               1               3               5
262.....................................             612          3.9477               1               1               3               5               8
263.....................................           18146         12.0208               3               5               8              14              24
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267.....................................             233          4.2060               1               1               3               6               9
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277.....................................           85183          5.7309               2               3               5               7              10
278.....................................           33396          4.4205               2               3               4               6               8
279.....................................               3          2.3333               1               1               2               4               4
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281.....................................            7128          3.0464               1               1               3               4               6
282.....................................               3          1.6667               1               1               2               2               2
283.....................................            5629          4.5756               1               2               4               6               9
284.....................................            1868          3.1124               1               1               2               4               6
285.....................................            6195         10.3080               3               5               8              13              20
286.....................................            2070          6.4396               2               3               5               7              13
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289.....................................            4765          3.0002               1               1               2               3               7
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297.....................................           43573          3.4124               1               2               3               4               6
298.....................................              86          2.8256               1               1               2               3               5
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302.....................................            7703          8.8384               4               5               7              10              15
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310.....................................           23873          4.4002               1               1               3               6              10
311.....................................            7963          1.8339               1               1               1               2               3
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315.....................................           30147          7.0663               1               1               4               9              16
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317.....................................            1507          2.8779               1               1               2               3               6
318.....................................            5584          5.9979               1               3               5               8              12
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320.....................................          186678          5.3171               2               3               4               6              10
321.....................................           30428          3.7951               1               2               3               5               7
322.....................................              61          4.1475               2               2               3               5               8
323.....................................           17241          3.2172               1               1               2               4               7
324.....................................            7479          1.8826               1               1               1               2               3
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326.....................................            2676          2.6648               1               1               2               3               5
327.....................................              11          3.0909               1               1               3               4               5
328.....................................             663          3.6305               1               1               3               5               8
329.....................................              77          2.0130               1               1               1               2               4
331.....................................           46045          5.5426               1               3               4               7              11
332.....................................            4930          3.2917               1               1               2               4               7
333.....................................             281          5.0569               1               2               4               6              10
334.....................................            8654          4.4386               2               3               4               5               7
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336.....................................            9563          3.7848               1               2               3               4               8
337.....................................            3041          2.1500               1               1               2               3               3
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340.....................................               1          1.0000               1               1               1               1               1
341.....................................            2738          3.1088               1               1               1               3               6
342.....................................             298          3.4094               1               1               2               4               7
344.....................................            3502          2.3829               1               1               1               2               5
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359.....................................           29890          2.7295               2               2               3               3               4
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361.....................................             378          2.9233               1               1               2               3               5
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373.....................................            3734          2.2499               1               2               2               3               3
374.....................................             120          3.1583               1               2               2               3               4
375.....................................              10          2.3000               1               2               2               3               4
376.....................................             247          3.0931               1               2               2               4               6
377.....................................              48          5.0000               1               1               3               6              12
378.....................................             157          2.4140               1               1               2               3               4
379.....................................             337          3.4303               1               1               2               4               6
380.....................................              58          2.1207               1               1               1               2               5
381.....................................             152          2.5132               1               1               1               3               5
382.....................................              45          1.2889               1               1               1               1               2
383.....................................            1707          3.5817               1               1               2               4               7
384.....................................             114          2.1842               1               1               1               3               5
385.....................................               1          1.0000               1               1               1               1               1
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390.....................................              14          4.0000               1               2               3               6               7
391.....................................               1          4.0000               4               4               4               4               4
392.....................................            2323          9.6750               3               4               7              12              20
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395.....................................           86911          4.4001               1               2               3               6               9
396.....................................              15          4.6667               1               2               4               6               7
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398.....................................           17526          5.9417               2               3               5               7              11
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400.....................................            6444          9.1189               1               3               6              12              20
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402.....................................            1498          4.1128               1               1               3               6               9
403.....................................           31732          8.0627               2               3               6              10              17
404.....................................            4639          4.2720               1               2               3               6               9
406.....................................            2513          9.8607               3               4               7              12              20
407.....................................             720          4.4417               1               2               4               5               8
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409.....................................            2822          5.9072               2               3               4               6              12
410.....................................           33412          3.9069               1               2               4               5               6
411.....................................              13          2.3077               1               1               2               2               5
412.....................................              29          2.4483               1               1               2               3               4
413.....................................            6419          7.0662               2               3               5               9              14
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415.....................................           38683         14.2779               4               6              11              18              28
416.....................................          183557          7.3848               2               4               6               9              14
417.....................................              16          5.0000               2               2               4               6               9
418.....................................           22822          6.1160               2               3               5               7              11
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452.....................................           22666          4.8553               1               2               3               6              10
453.....................................            5068          2.8035               1               1               2               3               6
454.....................................            3940          4.5652               1               2               3               5               9
455.....................................             931          2.5994               1               1               2               3               5
461.....................................            3490          4.3739               1               1               2               5              11
462.....................................           12994         11.2271               4               6               9              14              21
463.....................................           21790          4.1239               1               2               3               5               8
464.....................................            6533          2.9963               1               1               2               4               6
465.....................................             154          3.4481               1               1               2               4               7
466.....................................            1470          3.9925               1               1               2               5               9
467.....................................             534          3.8390               1               1               2               4               8
468.....................................           56874         12.7662               3               6              10              16              25
471.....................................           11639          5.5322               3               4               4               6               9
473.....................................            7599         12.5038               1               3               7              18              32
475.....................................          107089         11.1800               2               5               9              15              22
476.....................................            4126         10.8924               2               5               9              14              21
477.....................................           24823          8.1004               1               3               6              11              17
478.....................................          106997          7.3166               1               3               5               9              15
479.....................................           24939          3.5376               1               1               3               5               7
480.....................................             540         20.1370               7               9              13              25              43
481.....................................             377         23.9310              10              18              22              27              38
482.....................................            5686         12.9474               4               7              10              15              25
483.....................................           42087         39.0295              14              22              33              49              70
484.....................................             313         12.6773               2               6              10              17              26
485.....................................            2880          9.5955               4               5               7              11              18
486.....................................            1856         12.4402               1               5              10              16              25
487.....................................            3339          7.3612               1               3               6              10              15
488.....................................             770         17.0078               3               7              13              22              36
489.....................................           14005          8.4383               2               3               6              10              17
490.....................................            5378          5.3405               1               2               4               6              10
491.....................................           12205          3.4483               2               2               3               4               6
492.....................................            2672         15.6662               3               5               8              25              34
493.....................................           54859          5.7621               1               3               5               7              11
494.....................................           29900          2.4482               1               1               2               3               5
495.....................................             153         15.0261               7               9              12              18              26
496.....................................            1468          9.5320               4               5               7              12              19
497.....................................           17184          6.5116               3               4               5               7              11
498.....................................           12708          4.1701               2               3               4               5               6
499.....................................           30284          4.6986               1               2               3               6               9
500.....................................           43962          2.6146               1               1               2               3               5
501.....................................            2180         10.9670               4               6               8              13              21
502.....................................             586          6.5648               3               4               5               8              11
503.....................................            5551          3.9996               1               2               3               5               7
504.....................................             114         29.5877               9              14              24              41              54
505.....................................             145          3.3517               1               1               1               3               7
506.....................................             915         17.4000               4               8              14              22              35
507.....................................             290          8.2621               2               4               7              11              18
508.....................................             657          7.4718               2               3               5               9              15
509.....................................             176          4.5455               1               2               4               6               9
510.....................................            1619          7.1779               2               3               5               9              15
511.....................................             602          4.7591               1               2               3               6              10
512.....................................             328         15.2439               7               8              11              17              28
513.....................................             112         12.6161               6               7               8              12              20
514.....................................           16927          7.9786               2               3               6              10              16
515.....................................            3774          6.0297               1               1               4               8              14
516.....................................           75742          4.7497               2               2               4               6               9
517.....................................          171198          2.7066               1               1               2               3               6
518.....................................           47731          3.4397               1               1               2               4               8
519.....................................            5448          4.7412               1               2               3               6              11
520.....................................           10509          2.7887               1               1               2               3               6
521.....................................           22732          5.0204               1               2               4               6               9
522.....................................           11649          9.7928               3               5               8              12              20
523.....................................           14818          4.1079               1               2               3               5               7
                                         ----------------
                                                10916166
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 22866]]


 Table 8A.--Statewide Average Operating Cost-to-Charge Ratios for Urban
             and Rural Hospitals (Case Weighted) March 2001
------------------------------------------------------------------------
                        State                           Urban     Rural
------------------------------------------------------------------------
ALABAMA.............................................     0.344     0.410
ALASKA..............................................     0.417     0.696
ARIZONA.............................................     0.356     0.491
ARKANSAS............................................     0.466     0.446
CALIFORNIA..........................................     0.339     0.436
COLORADO............................................     0.422     0.577
CONNECTICUT.........................................     0.497     0.506
DELAWARE............................................     0.511     0.450
DISTRICT OF COLUMBIA................................     0.508  ........
FLORIDA.............................................     0.352     0.369
GEORGIA.............................................     0.459     0.470
HAWAII..............................................     0.413     0.554
IDAHO...............................................     0.545     0.561
ILLINOIS............................................     0.406     0.502
INDIANA.............................................     0.524     0.533
IOWA................................................     0.486     0.612
KANSAS..............................................     0.421     0.635
KENTUCKY............................................     0.479     0.492
LOUISIANA...........................................     0.410     0.488
MAINE...............................................     0.615     0.543
MARYLAND............................................     0.759     0.819
MASSACHUSETTS.......................................     0.512     0.571
MICHIGAN............................................     0.460     0.563
MINNESOTA...........................................     0.494     0.589
MISSISSIPPI.........................................     0.452     0.447
MISSOURI............................................     0.405     0.479
MONTANA.............................................     0.537     0.594
NEBRASKA............................................     0.449     0.610
NEVADA..............................................     0.306     0.498
NEW HAMPSHIRE.......................................     0.549     0.581
NEW JERSEY..........................................     0.394  ........
NEW MEXICO..........................................     0.466     0.491
NEW YORK............................................     0.528     0.609
NORTH CAROLINA......................................     0.516     0.464
NORTH DAKOTA........................................     0.620     0.654
OHIO................................................     0.501     0.570
OKLAHOMA............................................     0.409     0.494
OREGON..............................................     0.613     0.595
PENNSYLVANIA........................................     0.398     0.525
PUERTO RICO.........................................     0.486     0.583
RHODE ISLAND........................................     0.520  ........
SOUTH CAROLINA......................................     0.440     0.463
SOUTH DAKOTA........................................     0.529     0.638
TENNESSEE...........................................     0.438     0.453
TEXAS...............................................     0.402     0.494
UTAH................................................     0.497     0.586
VERMONT.............................................     0.572     0.599
VIRGINIA............................................     0.454     0.494
WASHINGTON..........................................     0.583     0.638
WEST VIRGINIA.......................................     0.568     0.527
WISCONSIN...........................................     0.525     0.611
WYOMING.............................................     0.522     0.717
------------------------------------------------------------------------


    Table 8B.--Statewide Average Capital Cost-to-Charge Ratios (Case
                          Weighted) March 2001
------------------------------------------------------------------------
                             State                                Ratio
------------------------------------------------------------------------
ALABAMA.......................................................     0.044
ALASKA........................................................     0.058
ARIZONA.......................................................     0.037
ARKANSAS......................................................     0.049
CALIFORNIA....................................................     0.034
COLORADO......................................................     0.045
CONNECTICUT...................................................     0.036
DELAWARE......................................................     0.051
DISTRICT OF COLUMBIA..........................................     0.040
FLORIDA.......................................................     0.043
GEORGIA.......................................................     0.051
HAWAII........................................................     0.038
IDAHO.........................................................     0.046
ILLINOIS......................................................     0.040
INDIANA.......................................................     0.056
IOWA..........................................................     0.050
KANSAS........................................................     0.050
KENTUCKY......................................................     0.046
LOUISIANA.....................................................     0.048
MAINE.........................................................     0.040
MARYLAND......................................................     0.013
MASSACHUSETTS.................................................     0.053
MICHIGAN......................................................     0.044
MINNESOTA.....................................................     0.047
MISSISSIPPI...................................................     0.044
MISSOURI......................................................     0.044
MONTANA.......................................................     0.058
NEBRASKA......................................................     0.054
NEVADA........................................................     0.030
NEW HAMPSHIRE.................................................     0.061
NEW JERSEY....................................................     0.036
NEW MEXICO....................................................     0.045
NEW YORK......................................................     0.051
NORTH CAROLINA................................................     0.046
NORTH DAKOTA..................................................     0.072
OHIO..........................................................     0.048
OKLAHOMA......................................................     0.046
OREGON........................................................     0.046
PENNSYLVANIA..................................................     0.039
PUERTO RICO...................................................     0.045
RHODE ISLAND..................................................     0.029
SOUTH CAROLINA................................................     0.046
SOUTH DAKOTA..................................................     0.059
TENNESSEE.....................................................     0.049
TEXAS.........................................................     0.046
UTAH..........................................................     0.047
VERMONT.......................................................     0.052
VIRGINIA......................................................     0.055
WASHINGTON....................................................     0.063
WEST VIRGINIA.................................................     0.045
WISCONSIN.....................................................     0.051
WYOMING.......................................................     0.065
------------------------------------------------------------------------

Appendix A--Regulatory Impact Analysis

I. Introduction

    We generally prepare a regulatory flexibility analysis that is 
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 
through 612), unless we certify that a proposed rule would not have 
a significant economic impact on a substantial number of small 
entities. For purposes of the RFA, we consider all hospitals to be 
small entities. We estimate the total impact of these changes for FY 
2002 payments compared to FY 2001 payments to be approximately a 
$1.7 billion increase. Therefore, we have prepared an impact 
analysis for this proposed rule.
    Also, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis for any proposed rule that 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 603 of the RFA. With the exception of 
hospitals located in certain New England counties, for purposes of 
section 1102(b) of the Act, we define a small rural hospital as a 
hospital with fewer than 100 beds that is located outside of a 
Metropolitan Statistical Area (MSA) or New England County 
Metropolitan Area (NECMA). Section 601(g) of the Social Security 
Amendments of 1983 (Public Law 98-21) designated hospitals in 
certain New England counties as belonging to the adjacent NECMA. 
Thus, for purposes of the hospital inpatient prospective payment 
systems, we classify these hospitals as urban hospitals.
    It is clear that the changes being proposed in this document 
would affect both a substantial number of small rural hospitals as 
well as other classes of hospitals, and the effects on some may be 
significant. Therefore, the discussion below, in combination with 
the rest of this proposed rule, constitutes a combined regulatory 
impact analysis and regulatory flexibility analysis.
    We have reviewed this proposed rule under the threshold criteria 
of Executive Order 13132, Federalism, and have determined that the 
proposed rule will not have any negative impact on the rights, 
roles, and responsibilities of State, local, or tribal governments.
    Section 202 of the Unfunded Mandate Reform Act of 1995 (Public 
Law 104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any proposed rule (or a final rule that has 
been preceded by a proposed rule) that may result in an expenditure 
in any one year by State, local, or tribal governments, in the 
aggregate, or by the private sector, of $110 million. This proposed 
rule would not mandate any requirements for State, local, or tribal 
governments.
    In accordance with the provisions of Executive Order 12866, this 
proposed rule was reviewed by the Office of Management and Budget.

II. Objectives

    The primary objective of the hospital inpatient prospective 
payment system is to create incentives for hospitals to operate 
efficiently and minimize unnecessary costs while at the same time 
ensuring that payments are sufficient to adequately compensate 
hospitals for their legitimate costs. In addition, we share national 
goals of preserving the Medicare Trust Fund.
    We believe the proposed changes would further each of these 
goals while maintaining the financial viability of the hospital 
industry and ensuring access to high quality health care for 
Medicare beneficiaries. We expect that these proposed changes would 
ensure that the outcomes of this payment system are reasonable and 
equitable while avoiding or minimizing unintended adverse 
consequences.

III. Limitations of Our Analysis

    As has been the case in our previously published regulatory 
impact analyses, the following quantitative analysis presents the 
projected effects of our proposed policy changes, as well as 
statutory changes

[[Page 22867]]

effective for FY 2002, on various hospital groups. We estimate the 
effects of individual policy changes by estimating payments per case 
while holding all other payment policies constant. We use the best 
data available, but we do not attempt to predict behavioral 
responses to our policy changes, and we do not make adjustments for 
future changes in such variables as admissions, lengths of stay, or 
case-mix. As we have done in previous proposed rules, we are 
soliciting comments and information about the anticipated effects of 
these changes on hospitals and our methodology for estimating them.

IV. Hospitals Included In and Excluded From the Prospective Payment 
System

    The prospective payment systems for hospital inpatient operating 
and capital-related costs encompass nearly all general, short-term, 
acute care hospitals that participate in the Medicare program. There 
were 44 Indian Health Service hospitals in our database, which we 
excluded from the analysis due to the special characteristics of the 
prospective payment method for these hospitals. Among other short-
term, acute care hospitals, only the 67 such hospitals in Maryland 
remain excluded from the prospective payment system under the waiver 
at section 1814(b)(3) of the Act. Thus, as of February 2001, we have 
included 4,583 hospitals in our analysis. This represents about 80 
percent of all Medicare-participating hospitals. The majority of 
this impact analysis focuses on this set of hospitals.
    The remaining 20 percent are specialty hospitals that are 
excluded from the prospective payment system and continue to be paid 
on the basis of their reasonable costs (subject to a rate-of-
increase ceiling on their inpatient operating costs per discharge). 
These hospitals include psychiatric, rehabilitation, long-term care, 
children's, and cancer hospitals. The impacts of our final policy 
changes on these hospitals are discussed below.

V. Impact on Excluded Hospitals and Units

    As of February 2001, there were 1,058 specialty hospitals 
excluded from the prospective payment system and instead paid on a 
reasonable cost basis subject to the rate-of-increase ceiling under 
Sec. 413.40. Broken down by specialty, there were 517 psychiatric, 
203 rehabilitation, 253 long-term care, 75 children's, and 10 cancer 
hospitals. In addition, there were 1,457 psychiatric units and 925 
rehabilitation units in hospitals otherwise subject to the 
prospective payment system. These excluded units are also paid in 
accordance with Sec. 413.40. Under Sec. 413.40(a)(2)(i)(A), the 
rate-of-increase ceiling is not applicable to the 67 specialty 
hospitals and units in Maryland that are paid in accordance with the 
waiver at section 1814(b)(3) of the Act.
    As required by section 1886(b)(3)(B) of the Act, the update 
factor applicable to the rate-of-increase limit for excluded 
hospitals and units for FY 2002 would be between 0.5 and 3.0 
percent, or 0 percent, depending on the hospital's or unit's costs 
in relation to its limit for the most recent cost reporting period 
for which information is available.
    The impact on excluded hospitals and units of the update in the 
rate-of-increase limit depends on the cumulative cost increases 
experienced by each excluded hospital or unit since its applicable 
base period. For excluded hospitals and units that have maintained 
their cost increases at a level below the percentage increases in 
the rate-of-increase limits since their base period, the major 
effect will be on the level of incentive payments these hospitals 
and units receive. Conversely, for excluded hospitals and units with 
per-case cost increases above the cumulative update in their rate-
of-increase limits, the major effect will be the amount of excess 
costs that would not be reimbursed.
    We note that, under Sec. 413.40(d)(3), an excluded hospital or 
unit whose costs exceed 110 percent of its rate-of-increase limit 
receives its rate-of-increase limit plus 50 percent of the 
difference between its reasonable costs and 110 percent of the 
limit, not to exceed 110 percent of its limit. In addition, under 
the various provisions set forth in Sec. 413.40, certain excluded 
hospitals and units can obtain payment adjustments for justifiable 
increases in operating costs that exceed the limit. At the same 
time, however, by generally limiting payment increases, we continue 
to provide an incentive for excluded hospitals and units to restrain 
the growth in their spending for patient services.

VI. Graduate Medical Education Impact

A. National Average Per Resident Amount (PRA)

    As discussed in detail in section IV.G.2. of this proposed rule, 
we are proposing to implement section 511 of Public Law 106-554, 
which increases the floor of the locality-adjusted national average 
(PRA for the purposes of computing direct GME payments for cost 
reporting periods beginning during FY 2002. The national average PRA 
payment methodology, as provided in section 311 of Public Law 106-
113, establishes a ``floor'' and ``ceiling'' based on a locality-
adjusted, updated national average PRA for cost reporting periods 
beginning on or after October 1, 2000 and before October 1, 2005. 
Section 511 of Public Law 106-554 increased the floor from 70 
percent to equal 85 percent of a locality-adjusted national average 
PRA for FY 2002.
    For this purpose rule, we have calculated an estimated impact of 
this proposed policy on teaching hospital's PRAs for FY 2002, making 
assumptions about update factors and geographic adjustment factors 
(GAF) for each hospital. Generally, using FY 1997 data, we 
calculated a floor based on 70 percent of the national average PRA 
and a floor based on 85 percent of the national average PRA. We then 
determined the amount of direct GME payments that would have been 
paid had the floor remained at 70 percent of the national average 
PRA. Next, we determined the amount of direct GME payments that 
would be paid with the floor increased to equal 85 percent of the 
national average PRA. We subtracted the difference between the two 
and inflated the difference to FY 2002 to determine the impact of 
this provision.
    The figures we use in this impact, except for the FY 1997 
weighted PRA of $68,464, are estimations and are for demonstrative 
purposes only. Hospitals must use the methodology stated in section 
IV.G. of this proposed rule to revise (if appropriate) their 
individual PRAs.
    In calculating this impact, we used Medicare cost report data 
for all cost reports ending in FY 1997. We excluded hospitals that 
file manual cost reports because we did not have access to their 
Medicare utilization data. We also excluded all teaching hospitals 
in Maryland, because these hospitals are paid on a Medicare waiver 
outside of the prospective payment system, and those hospitals' PRAs 
do not determine their level of direct GME payments. For hospitals 
that had two cost reporting periods ending in FY 1997, we used the 
later of the two periods. A total of 1,231 teaching hospitals were 
included in the analysis.
    Using the FY 1997 weighted average PRA of $68,464, we determined 
an 85 percent floor of $58,194 for FY 1997. We then determined that, 
for cost reporting periods ending in FY 1997, approximately 562 
hospitals had PRAs that were below $58,194 (336 hospitals of these 
hospitals had PRAs that were below the 70-percent floor, and 226 
hospitals had PRAs that were above the 70-percent floor but below 
the 85-percent floor). The estimated total cost to the Medicare 
program in FY 2002 of replacing the PRAs of the 562 hospitals with 
the 85-percent floor is $104.4 million.

B. Closed Training Programs or Hospitals That Close Their Training 
Programs

    As discussed in IV.G.5, of this proposed rule, we are proposing 
to allow a hospital to receive a temporary adjustment to its FTE cap 
to reflect residents added because of the closure of another 
hospital's GME program if the hospital that closed its program 
agrees to temporarily reduce its FTE cap. We have calculated an 
estimated impact on the Medicare program for FY 2002 as a result of 
this proposal. We used the best available cost report data from the 
FY 1997 HCRIS in our analysis.
    We estimate that approximately 5 to 10 programs, each with an 
average of 25 residents, close each year without advance warning, 
displacing the residents before they complete their training. 
Therefore, the number of residents displaced each year could be 
between 125 and 250. We estimated the impact of this proposed change 
based on direct GME and IME payment amounts in FY 1997 to determine 
a total GME amount and updated the total with the CPI-U for FY 2002. 
At most, the estimated impact for this proposed provision for FY 
2002 is moving payments of between $10 and $20 million among 
different hospitals. This would result from redirecting these 
payments from the hospital that closed its program to the 
hospital(s) that takes on the residents.

VII. Quantitative Impact Analysis of the Proposed Policy Changes Under 
the Prospective Payment System for Operating Costs

A. Basis and Methodology of Estimates

    In this proposed rule, we are announcing policy changes and 
payment rate updates for

[[Page 22868]]

the prospective payment systems for operating and capital-related 
costs. We have prepared separate impact analyses of the proposed 
changes to each system. This section deals with changes to the 
operating prospective payment system.
    The data used in developing the quantitative analyses presented 
below are taken from the FY 2000 MedPAR file and the most current 
provider-specific file that is used for payment purposes. Although 
the analyses of the changes to the operating prospective payment 
system do not incorporate cost data, the most recently available 
hospital cost report data were used to categorize hospitals. Our 
analysis has several qualifications. First, we do not make 
adjustments for behavioral changes that hospitals may adopt in 
response to these proposed policy changes. Second, due to the 
interdependent nature of the prospective payment system, it is very 
difficult to precisely quantify the impact associated with each 
proposed change. Third, we draw upon various sources for the data 
used to categorize hospitals in the tables. In some cases, 
particularly the number of beds, there is a fair degree of variation 
in the data from different sources. We have attempted to construct 
these variables with the best available source overall. For 
individual hospitals, however, some miscategorizations are possible.
    Using cases in the FY 2000 MedPAR file, we simulated payments 
under the operating prospective payment system given various 
combinations of payment parameters. Any short-term, acute care 
hospitals not paid under the general prospective payment systems 
(Indian Health Service hospitals and hospitals in Maryland) are 
excluded from the simulations. Payments under the capital 
prospective payment system, or payments for costs other than 
inpatient operating costs, are not analyzed here. Estimated payment 
impacts of proposed FY 2001 changes to the capital prospective 
payment system are discussed in section IX. of this Appendix.
    The proposed changes discussed separately below are the 
following:
     The effects of the annual reclassification of diagnoses 
and procedures and the recalibration of the diagnosis-related group 
(DRG) relative weights required by section 1886(d)(4)(C) of the Act.
     The effects of changes in hospitals' wage index values 
reflecting wage data from hospitals' cost reporting periods 
beginning during FY 1998, compared to the FY 1997 wage data.
     The effects of our proposal to increase the accuracy of 
the wage index calculation by changing the overhead allocation 
method used so that the salaries and hours of lower-range, overhead 
employees and the overhead wage-related costs associated with the 
excluded areas of the hospital are more accurately removed when 
calculating the overhead costs attributable to wages.
     The effects of our proposal to include the contract 
labor costs of laboratories and pharmacies from Worksheet S-3 Part 
II Lines 9.01 and 9.02 in the wage index calculation.
     The combined effects of our proposed changes to the 
wage index data and calculations and the changes in the DRG 
recalibration.
     The effects of geographic reclassifications by the 
Medicare Geographic Classification Review Board (MGCRB) that will be 
effective in FY 2002 not including the effects of our proposed 
policy to hold-harmless other hospitals in an urban area where 
certain hospitals are reclassified elsewhere by including the wage 
data of reclassified hospitals in their geographic area as well as 
the area to which they are reclassified.
     The effects of geographic reclassifications by the 
MGCRB that will be effective in FY 2002 including the effects of our 
proposed policy to hold-harmless other hospitals in an urban area 
where certain hospitals are reclassified elsewhere by including the 
wage data of reclassified hospitals in their geographic area as well 
as the area to which they are reclassified.
     The total change in payments based on FY 2002 policies 
relative to payments based on FY 2001 policies.
    To illustrate the impacts of the FY 2002 proposed changes, our 
analysis begins with a FY 2002 baseline simulation model using: the 
FY 2001 DRG GROUPER (version 18.0); the FY 2001 wage index; and no 
MGCRB reclassifications. Outlier payments are set at 5.1 percent of 
total DRG plus outlier payments.
    Each proposed and statutory policy change is then added 
incrementally to this baseline model, finally arriving at an FY 2002 
model incorporating all of the changes. This allows us to isolate 
the effects of each change.
    Our final comparison illustrates the percent change in payments 
per case from FY 2001 to FY 2002. Five factors have significant 
impacts here. The first is the update to the standardized amounts. 
In accordance with section 1886(d)(3)(A)(iv) of the Act, as amended 
by section 301 of Public Law 106-554, we are proposing to update the 
large urban and the other areas average standardized amounts for FY 
2002 using the most recently forecasted hospital market basket 
increase for FY 2002 of 3.1 percent minus 0.55 percentage points 
(for an update of 2.55 percent). Under section 1886(b)(3) of the 
Act, the updates to the hospital-specific amounts for sole community 
hospitals (SCHs) and for Medicare-dependent small rural hospitals 
(MDHs) is equal to the market basket increase of 3.1 percent minus 
0.55 percentage points (for an update of 2.55 percent).
    A second significant factor that impacts changes in hospitals' 
payments per case from FY 2001 to FY 2002 is the change in MGCRB 
status from one year to the next. That is, hospitals reclassified in 
FY 2001 that are no longer reclassified in FY 2002 may have a 
negative payment impact going from FY 2001 to FY 2002; conversely, 
hospitals not reclassified in FY 2001 that are reclassified in FY 
2002 may have a positive impact. In some cases, these impacts can be 
quite substantial, so if a relatively small number of hospitals in a 
particular category lose their reclassification status, the 
percentage change in payments for the category may be below the 
national mean. This effect may be alleviated somewhat by section 
304(a) of Public Law 106-554, which provided that reclassifications 
for purposes of the wage index are for a 3 year period.
    A third significant factor is that we currently estimate that 
actual outlier payments during FY 2001 will be 5.9 percent of actual 
total DRG payments. When the FY 2001 final rule was published, we 
projected FY 2001 outlier payments would be 5.1 percent of total DRG 
plus outlier payments; the standardized amounts were offset 
correspondingly. The effects of the higher than expected outlier 
payments during FY 2001 (as discussed in the Addendum to this 
proposed rule) are reflected in the analyses below comparing our 
current estimates of FY 2001 payments per case to estimated FY 2002 
payments per case.
    Fourth, section 213 of Public Law 106-554 provided that all SCHs 
may receive payment on the basis of their costs per case during 
their cost reporting period that began during 1996. For FY 2001, 
eligible SCHs that are rebased receive a hospital-specific rate 
comprised of the greater of 50-percent of the higher of their FY 
1982 or FY 1987 hospital-specific rate or 50-percent of the federal 
rate, and 50-percent of their FY 1996 hospital-specific rate.
    Fifth, sections 302 and 303 of Public Law 106-554 affect 
payments for indirect medical education (IME) and disproportionate 
share hospitals (DSH), respectively. These sections increased IME 
and DSH payments during FY 2001 (effective with discharges on or 
after April 1, 2001). For FY 2002, section 302 established IME 
payments at the same level as FY 2001 (6.5 percent), and section 303 
established DSH payments at the adjustment the hospital would 
otherwise receive minus 3 percent.
    Table I demonstrates the results of our analysis. The table 
categorizes hospitals by various geographic and special payment 
consideration groups to illustrate the varying impacts on different 
types of hospitals. The top row of the table shows the overall 
impact on the 4,795 hospitals included in the analysis. This number 
is 93 fewer hospitals than were included in the impact analysis in 
the FY 2001 final rule (65 FR 47191).
    The next four rows of Table I contain hospitals categorized 
according to their geographic location (all urban (which is further 
divided into large urban and other urban) and rural). There are 
2,721 hospitals located in urban areas (MSAs or NECMAs) included in 
our analysis. Among these, there are 1,563 hospitals located in 
large urban areas (populations over 1 million), and 1,158 hospitals 
in other urban areas (populations of 1 million or fewer). In 
addition, there are 2,074 hospitals in rural areas. The next two 
groupings are by bed-size categories, shown separately for urban and 
rural hospitals. The final groupings by geographic location are by 
census divisions, also shown separately for urban and rural 
hospitals.
    The second part of Table I shows hospital groups based on 
hospitals' FY 2002 payment classifications, including any 
reclassifications under section 1886(d)(10) of the Act. For example, 
the rows labeled urban, large urban, other urban, and rural show 
that the number of hospitals paid based on these categorizations 
(after consideration of geographic reclassifications) are 2,766, 
1,643, 1,123, and 2,029, respectively.
    The next three groupings examine the impacts of the proposed 
changes on hospitals

[[Page 22869]]

grouped by whether or not they have residency programs (teaching 
hospitals that receive an IME adjustment) or receive DSH payments, 
or some combination of these two adjustments. There are 3,674 non-
teaching hospitals in our analysis, 881 teaching hospitals with 
fewer than 100 residents, and 240 teaching hospitals with 100 or 
more residents.
    In the DSH categories, hospitals are grouped according to their 
DSH payment status, and whether they are considered urban or rural 
after MGCRB reclassifications. Hospitals in the rural DSH 
categories, therefore, represent hospitals that were not 
reclassified for purposes of the standardized amount or for purposes 
of the DSH adjustment. (They may, however, have been reclassified 
for purposes of the wage index.) We note that section 211 of Public 
Law 106-554 reduced the qualifying DSH threshold to 15 percent for 
all hospitals (this threshold previously applied to urban hospitals 
with 100 or more beds and rural hospitals with 500 or more beds). 
Consequently, many more hospitals qualify for DSH. In the FY 2001 
final rule, there were 3,070 hospitals that did not receive a DSH 
adjustment (65 FR 47192). In Table I, that number declines to 1,879. 
The number of urban hospitals with fewer than 100 beds receiving DSH 
increases from 72 prior to section 211 to 325 after its 
implementation. Among rural hospitals with fewer than 100 beds, 103 
received DSH prior to section 211; for FY 2002 that number increases 
to 443.
    The next category groups hospitals considered urban after 
geographic reclassification, in terms of whether they receive the 
IME adjustment, the DSH adjustment, both, or neither.
    The next five rows examine the impacts of the proposed changes 
on rural hospitals by special payment groups (SCHs, rural referral 
centers (RRCs), and MDHs), as well as rural hospitals not receiving 
a special payment designation. The RRCs (165), SCHs (667), MDHs 
(328), and SCH and RRCs that are not included in the SCH or the RRC 
categories (69) shown here were not reclassified for purposes of the 
standardized amount. There are 20 RRCs, 1 MDH, 5 SCHs and 2 SCH and 
RRCs that will be reclassified as urban for the standardized amount 
in FY 2002 and, therefore, are not included in these rows.
    The next two groupings are based on type of ownership and the 
hospital's Medicare utilization expressed as a percent of total 
patient days. These data are taken primarily from the FY 1999 
Medicare cost report files, if available (otherwise FY 1998 data are 
used). Data needed to determine ownership status or Medicare 
utilization percentages were unavailable for 46 and 78 hospitals, 
respectively. For the most part, these are new hospitals.
    The next series of groupings concern the geographic 
reclassification status of hospitals. The first grouping displays 
all hospitals that were reclassified by the MGCRB for FY 2002. The 
next two groupings separate the hospitals in the first group by 
urban and rural status. The final row in Table I contains hospitals 
located in rural counties but deemed to be urban under section 
1886(d)(8)(B) of the Act.

                                  Table I.--Impact Analysis of Changes for FY 2002 Operating Prospective Payment System
                                                         [Percent changes in payments per case]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       New       Include                                                        All FY
                                Number of    DRG re-    New wage    overhead    contract    DRG & WI          MCGRB         Reclassification     2001
                                hosps.\1\   calib.\2\   data \3\    alloc.\4\   labor \5\    changes     reclassification     hold-harmless     changes
                                   (0)         (1)         (2)         (3)         (4)      \6\  (5)         \7\  (6)        policy \8\  (7)   \9\  (8)
--------------------------------------------------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals............       4,795         0.5         0.2         0.0         0.0         0.0             -0.2                0.2            1.9
    Urban hospitals..........       2,721         0.6         0.2         0.0         0.0         0.0             -0.7                0.2            1.7
    Large urban areas               1,563         0.7        -0.1         0.0         0.0        -0.1             -0.8                0.3            1.5
     (populations over 1
     million)................
    Other urban areas               1,158         0.5         0.6         0.0         0.0         0.2             -0.5                0.1            2.0
     (populations of 1
     million of fewer).......
    Rural hospitals..........       2,074        -0.1         0.5         0.1         0.1        -0.2              2.7                0.1            3.2
Bed Size (Urban):
    0-99 beds................         712        -0.1         0.3         0.0         0.0        -0.4             -0.8                0.2            2.1
    100-199 beds.............         943         0.4         0.2         0.0         0.0        -0.2             -0.7                0.3            1.6
    200-299 beds.............         530         0.6         0.3         0.0         0.1         0.1             -0.7                0.3            1.8
    300-499 beds.............         391         0.7         0.1         0.0         0.0         0.0             -0.7                0.2            1.6
    500 or more beds.........         145         1.0         0.0         0.0         0.0         0.2             -0.6                0.1            1.5
Bed Size (Rural):
    0-49 beds................       1,209        -0.4         0.5         0.1         0.1        -0.5              0.4                0.0            3.0
    50-99 beds...............         520        -0.2         0.5         0.1         0.1        -0.4              1.1                0.0            3.3
    100-149 beds.............         204        -0.1         0.6         0.1         0.1        -0.1              3.2                0.2            3.0
    150-199 beds.............          75         0.1         0.4         0.1         0.1        -0.1              5.2                0.2            3.4
    200 or more beds.........          66         0.3         0.4         0.1         0.1         0.0              5.2                0.1            3.6
Urban by Region:
    New England..............         139         0.6         2.2        -0.1         0.0         1.3             -0.2                0.0            1.7
    Middle Atlantic..........         417         0.7        -1.2        -0.1         0.0        -1.4             -0.8                0.6            0.2
    South Atlantic...........         395         0.7         0.9         0.0         0.0         0.9             -0.8                0.3            2.8
    East North Central.......         462         0.5         0.1         0.0         0.1        -0.2             -0.6                0.1            1.6
    East South Central.......         160         0.6         1.1         0.1         0.0         1.1             -0.7                0.0            3.0
    West North Central.......         189         0.6         0.5         0.1         0.1         0.3             -0.7                0.0            2.0
    West South Central.......         342         0.7        -0.8         0.0         0.0        -0.9             -0.7                0.0            0.7
    Mountain.................         137         0.6         0.9         0.0         0.0         0.7             -0.7                0.0            2.4
    Pacific..................         434         0.7         0.4         0.1         0.0         0.4             -0.8                0.2            2.2
    Puerto Rico..............          46         0.4         1.3         0.1         0.0         1.0             -0.5               -0.3            2.6
Rural by Region:

[[Page 22870]]

 
    New England..............          49         0.0         0.6         0.1         0.0        -0.1              3.0                0.1            3.7
    Middle Atlantic..........          74         0.0        -0.2         0.0         0.0        -1.0              2.5                0.0            2.2
    South Atlantic...........         267         0.1         0.6         0.1         0.1         0.0              2.9                0.1            3.6
    East North Central.......         273        -0.2         0.6         0.0         0.1        -0.3              2.2                0.2            2.8
    East South Central.......         263         0.0         0.5         0.1         0.1        -0.2              3.3                0.0            3.6
    West North Central.......         479        -0.3         0.8         0.2         0.1        -0.1              2.1                0.1            2.5
    West South Central.......         331        -0.1         0.7         0.1         0.1         0.0              3.5                0.1            4.2
    Mountain.................         194        -0.1         0.4         0.2         0.0        -0.4              1.9                0.0            2.9
    Pacific..................         139         0.0        -0.2         0.1         0.1        -0.9              2.3                0.1            2.7
    Puerto Rico..............           5        -0.3         3.9         0.1         0.0         2.9              1.9               -0.8            8.4
By Payment Classification:
    Urban hospitals..........       2,766         0.6         0.2         0.0         0.0         0.0             -0.7                0.2            1.7
    Large urban areas               1,643         0.7        -0.1         0.0         0.0        -0.1             -0.7                0.3            1.5
     (populations over 1
     million)................
    Other urban areas               1,123         0.5         0.6         0.0         0.0         0.2             -0.6                0.1            2.0
     (populations of 1
     million of fewer).......
    Rural areas..............       2,029        -0.1         0.5         0.1         0.1        -0.2              2.5                0.0            3.2
Teaching Status:
    Non-teaching.............       3,674         0.3         0.4         0.0         0.0        -0.1              0.2                0.2            2.2
    Fewer than 100 Residents.         881         0.6         0.3         0.0         0.0         0.1             -0.6                0.2            1.9
    100 or more Residents....         240         1.0        -0.2         0.0         0.0         0.0             -0.5                0.1            1.3
Urban DSH:
    Non-DSH..................       1,879         0.4         0.2         0.0         0.0        -0.1             -0.2                0.3            1.7
    100 or more beds.........       1,378         0.7         0.2         0.0         0.0         0.1             -0.7                0.2            1.7
    Less than 100 beds.......         325         0.0         0.4         0.1         0.0        -0.3             -0.8                0.3            3.3
Rural DSH:
    Sole Community (SCH).....         540        -0.2         0.4         0.1         0.0        -0.5              0.4                0.0            3.1
    Referral Center (RRC)....         157         0.2         0.5         0.1         0.1         0.0              5.3                0.1            3.7
    Other Rural:
        100 or more beds.....          73        -0.1         0.7         0.1         0.1        -0.1              1.3                0.1            3.2
        Less than 100 beds...         443        -0.2         0.5         0.1         0.1        -0.4              0.6                0.0            4.3
Urban teaching and DSH:
    Both teaching and DSH....         754         0.8         0.1         0.0         0.0         0.0             -0.7                0.2            1.6
    Teaching and no DSH......         295         0.7         0.2         0.0         0.1         0.0             -0.6                0.3            1.6
    No teaching and DSH......         949         0.4         0.4         0.0         0.0         0.1             -0.6                0.3            2.0
    No teaching and no DSH...         768         0.3         0.2         0.0         0.0        -0.2             -0.6                0.3            1.5
    Rural Hospital Types:
        Non special status            800        -0.3         0.7         0.1         0.1        -0.2              0.9                0.0            3.6
         hospitals...........
        RRC..................         165         0.2         0.5         0.1         0.1         0.0              6.3                0.1            3.6
        SCH..................         667        -0.2         0.4         0.1         0.0        -0.5              0.4                0.0            2.5

[[Page 22871]]

 
        Medicare-dependent            328        -0.3         0.5         0.1         0.1        -0.5              0.5                0.0            3.2
         hospitals (MDH).....
        SCH and RRC..........          69         0.1         0.4         0.0         0.0        -0.3              2.5                0.0            2.7
Type of Ownership:
    Voluntary................       2,785         0.6         0.2         0.0         0.0        -0.1             -0.3                0.2            1.8
    Proprietary..............         777         0.6         0.2         0.1         0.0         0.1             -0.3                0.2            2.0
    Government...............       1,187         0.5         0.6         0.1         0.0         0.3              0.1                0.1            2.5
    Unknown..................          46         0.3         1.3         0.0         0.0         0.7             -1.7                1.0            2.6
    Medicare Utilization as a
     Percent of Inpatient
     Days:
        0-25.................         396         0.9         0.2         0.0         0.0         0.4             -0.5                0.1            2.2
        25-50................       1,886         0.7         0.1         0.0         0.0         0.0             -0.6                0.2            1.7
        50-65................       1,843         0.4         0.4         0.0         0.0         0.0              0.1                0.2            2.2
        Over 65..............         592         0.2         0.2         0.0         0.1        -0.2              0.2                0.3            1.9
        Unknown..............          78         0.5        -2.1        -0.1         0.0        -2.4             -0.7                0.1           -1.1
Hospitals Reclassified by the
 Medicare Geographic
 Classification Review Board:
 FY 2002
Reclassifications:
    All Reclassified                  636         0.3         0.6         0.0         0.1         0.2              4.5                0.3            2.9
     Hospitals...............
        Standardized Amount            74         0.1         0.7         0.0         0.0         0.0              1.9                1.0            4.0
         Only................
        Wage Index Only......         391         0.3         0.5         0.1         0.1         0.1              5.3                0.1            2.5
        Both.................          58         0.4         0.7         0.0         0.1         0.4              4.1                0.6            0.0
Nonreclassified Hospitals....       4,246         0.6         0.2         0.0         0.0         0.0             -0.8                0.2            1.9
All Reclassified Urban                119         0.7         0.8         0.0         0.1         0.6              2.8                0.4            2.0
 Hospitals...................
    Urban Nonreclassified              18         0.2         0.5         0.0         0.0        -0.2             -1.2                1.9           -0.6
     Hospitals...............
    Standardized Amount Only           81         0.8         0.7         0.0         0.1         0.6              3.3                0.1            2.2
    Wage Index Only..........          20         0.5         1.4         0.0         0.1         1.1              1.9                2.1            2.5
    Both.....................       2,564         0.6         0.2         0.0         0.0         0.0             -0.9                0.2            1.6
All Reclassified Rural                517         0.1         0.5         0.1         0.1        -0.1              5.6                0.2            3.6
 Hospitals...................
    Standardized Amount Only.          19        -0.2         0.5         0.1         0.0        -0.5              3.9                1.5            2.0
    Wage Index Only..........         475         0.1         0.5         0.1         0.1        -0.1              5.5                0.1            3.6
    Both.....................          23         0.1         0.8         0.1         0.1         0.2              7.7                1.5            4.2
Rural Nonreclassified               1,554        -0.3         0.5         0.1         0.1        -0.4             -0.6                0.0            2.8
 Hospitals...................
Other Reclassified Hospitals           41        -0.1        -6.1         0.1         0.1         0.4              0.3                0.1           3.9
 (Section 1886(D)(8)(B)).....
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the
  national total. Discharge data are from FY 2000, and hospital cost report data are from reporting periods beginning in FY 1999 and FY 1998.
\2\ This column displays the payment impact of the recalibration of the DRG weights based on FY 2000 MedPAR data and the DRG reclassification changes,
  in accordance with section 1886(d)(4)(C) of the Act.
\3\ This column shows the payment effects of updating the data used to calculate the wage index with data from the FY 1998 cost reports.
\4\ This column displays the impact of removing the salaries and hours of lower-range, overhead employees and the overhead wage-related costs associated
  with the excluded areas of the hospital from the wage index calculation.
\5\ This column displays the impact of including contract pharmacy and contract laboratory costs and hours in the wage index calculation.

[[Page 22872]]

 
\6\ This column displays the combined impact of the reclassification and recalibration of the DRGs, the updated and revised wage data used to calculate
  the wage index, the revised overhead allocation, the laboratory and pharmacy contract labor costs, and the budget neutrality adjustment factor for
  these two changes, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act. Thus, it represents the combined impacts shown in
  columns 1, 2 3, and 4, and the FY 2002 budget neutrality factor of .992394.
\7\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate
  the FY 2002 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2002. Reclassification for
  prior years has no bearing on the payment impacts shown here.
\8\ Shown here are the effects of geographic reclassifications by the MGCRB including the effects of our proposed policy to hold-harmless other
  hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic
  area as well as the area to which they are reclassified.
\9\ This column shows changes in payments from FY 2001 to FY 2002. It incorporates all of the changes displayed in columns 5, 6, and 7 (the changes
  displayed in columns 1, 2, 3, and 4 are included in column 5). It also displays the impact of the FY 2002 update, changes in hospitals'
  reclassification status in FY 2002 compared to FY 2001, and the difference in outlier payments from FY 2001 to FY 2002. It also reflects section 213
  of Public Law 106-554, which permitted all SCHs to rebase for a 1996 hospital-specific rate. The sum of these columns may be different from the
  percentage changes shown here due to rounding and interactive effects.

B. Impact of the Proposed Changes to the DRG Reclassifications and 
Recalibration of Relative Weights (Column 1)

    In column 1 of Table I, we present the combined effects of the 
DRG reclassifications and recalibration, as discussed in section II. 
of the preamble to this proposed rule. Section 1886(d)(4)(C)(i) of 
the Act requires us to annually make appropriate classification 
changes and to recalibrate the DRG weights in order to reflect 
changes in treatment patterns, technology, and any other factors 
that may change the relative use of hospital resources.
    We compared aggregate payments using the FY 2001 DRG relative 
weights (GROUPER version 18) to aggregate payments using the 
proposed FY 2002 DRG relative weights (GROUPER version 19). Overall 
payments increase 0.5 percent due to the DRG reclassification and 
recalibration. We note that, consistent with section 
1886(d)(4)(C)(iii) of the Act, we have applied a budget neutrality 
factor to ensure that the overall payment impact of the DRG changes 
is budget neutral. This budget neutrality factor of 0.992493 is 
applied to payments in Column 5.
    The DRG changes we are proposing in this proposed rule would 
result in higher payments to urban hospitals (0.6 percent) and 
somewhat lower payments to rural hospitals (-0.1). The changes also 
would result in higher payments to larger hospitals than to smaller 
hospitals. This impact is consistent for both urban and rural bed 
size groups.
    This distributional impact likely results from the changes we 
are proposing to major diagnostic category (MDC) 5 ``Diseases and 
Disorders of the Circulatory System.'' As described in section II., 
we are proposing to remove cardiac defribrillator cases from DRGs 
104 and 105, and create two new DRGs for these cases. In addition, 
we are proposing to revise the basis of the DRG assignment for cases 
involving percutaneous transluminal coronary angioplasty based on 
whether the patient experienced an acute myocardial infarction. 
Because MDC 5 is a high volume category, refining the 
categorizations of these cases has a noticeable impact.

C. Impact of Updating the Wage Data and the Proposed Changes to the 
Wage Index Calculation (Columns 2, 3 & 4)

    Section 1886(d)(3)(E) of the Act requires that, beginning 
October 1, 1993, we annually update the wage data used to calculate 
the wage index. In accordance with this requirement, the proposed 
wage index for FY 2002 is based on data submitted for hospital cost 
reporting periods beginning on or after October 1, 1997 and before 
October 1, 1998. As with column 1, the impact of the new data on 
hospital payments is isolated in column 2 by holding the other 
payment parameters constant in the two simulations. That is, column 
2 shows the percentage changes in payments when going from a model 
using the FY 2001 wage index (based on FY 1997 wage data before 
geographic reclassifications to a model using the FY 2002 pre-
reclassification wage index based on FY 1998 wage data).
    The wage data collected on the FY 1998 cost reports are similar 
to the data used in the calculation of the FY 2001 wage index. For a 
thorough discussion of the data used to calculate the wage index, 
see section III.B of this proposed rule.
    The results indicate that the new wage data are estimated to 
provide a 0.2 percent increase for hospital payments overall (prior 
to applying the budget neutrality factor, see column 5). Rural 
hospitals appear to experience the greatest benefit from the update 
to the 1998 wage data, with an increase of 0.5 percent. Rural 
hospitals in Nevada, Connecticut and Arizona experience wage index 
increases of more than 5 percent. Rural hospitals in Puerto Rico 
experience a 3.9 percent increase.
    Urban hospitals as a group are not significantly affected by the 
updated wage data. While large urban hospitals appear to experience 
a 0.1 percent decline, estimated payments to urban hospitals overall 
showed an increase of 0.2 percent. Payments in other urban areas 
increase by 0.6 percent. Among urban census divisions, the New 
England division experiences a 2.2 percent increase, Middle Atlantic 
a 1.2 percent decrease, East South Central a 1.1 percent increase, 
and Puerto Rico a 1.3 percent increase.
    Columns 3 and 4, respectively, show that the proposed change to 
the overhead calculation and the proposal to include contract labor 
costs in the wage index discussed in detail in Section III.C. of 
this proposed rule both appear to have negligible impacts on 
hospital payments overall. Urban hospitals as a group are not 
effected by these proposals as there is a 0.0 percent impact to 
their payments from each proposed change. Rural hospitals, however, 
do appear to benefit slightly from these changes, as evidenced by 
the estimated 0.1 percent increase in payments to this group.
    We note that the wage data used for the proposed wage index are 
based upon the data available as of February 22, 2001 and, 
therefore, do not reflect revision requests received and processed 
by the fiscal intermediaries after that date. To the extent these 
requests are granted by hospitals' fiscal intermediaries, these 
revisions will be reflected in the final rule. In addition, we 
continue to verify the accuracy of the data for hospitals with 
extraordinary changes in their data from the prior year.
    The following chart compares the shifts in wage index values for 
labor market areas for FY 2001 relative to FY 2002. This chart 
demonstrates the impact of the proposed changes for the FY 2002 wage 
index relative to the FY 2001 wage index. The majority of labor 
market areas (318) experience less than a 5-percent change. A total 
of 36 labor market areas experience an increase of more than 5 
percent with 4 having an increase greater than 10 percent. A total 
of 13 areas experience decreases of more than 5-percent. Of those, 4 
decline by 10 percent or more.

------------------------------------------------------------------------
                                                       Number of labor
                                                        market areas
   Percentage change in area wage index  values    ---------------------
                                                     FY 2001    FY 2002
------------------------------------------------------------------------
Increase more than 10 percent.....................          1          4
Increase more than 5 percent and less than 10              20         36
 percent..........................................
Increase or decrease less than 5 percent..........        339        318
Decrease more than 5 percent and less than 10              14         13
 percent..........................................
Decrease more than 10 percent.....................          1          4
------------------------------------------------------------------------

    Among urban hospitals, 163 would experience an increase of 
between 5 and 10 percent and 16 more than 10 percent. A total of 33 
rural hospitals have increases greater than 5 percent, but none 
greater than 10 percent. On the negative side, 121 urban hospitals 
have decreases in their wage index values of at least 5 percent but 
less than 10 percent. Five urban hospitals have decreases in their 
wage index values greater than 10 percent. There are no rural 
hospitals with decreases in their wage index values greater than 5 
percent or with increases of more than 10 percent. The following 
chart shows the projected impact for urban and rural hospitals.

[[Page 22873]]



------------------------------------------------------------------------
                                                     Number of hospitals
    Percentage change in area wage index values    ---------------------
                                                      Urban      Rural
------------------------------------------------------------------------
Increase more than 10 percent.....................         16          0
Increase more than 5 percent and less than 10             101         15
 percent..........................................
Increase or decrease less than 5 percent..........      2,395      2,135
Decrease more than 5 percent and less than 10             121          0
 percent..........................................
Decrease more than 10 percent.....................          5          0
------------------------------------------------------------------------

D. Combined Impact of DRG and Wage Index Changes--Including Budget 
Neutrality Adjustment (Column 5)

    The impact of DRG reclassifications and recalibration on 
aggregate payments is required by section 1886(d)(4)(C)(iii) of the 
Act to be budget neutral. In addition, section 1886(d)(3)(E) of the 
Act specifies that any updates or adjustments to the wage index are 
to be budget neutral. As noted in the Addendum to this proposed 
rule, we compared simulated aggregate payments using the FY 2001 DRG 
relative weights and wage index to simulated aggregate payments 
using the proposed FY 2002 DRG relative weights and blended wage 
index. Based on this comparison, we computed a wage and 
recalibration budget neutrality factor of 0.992493. In Table I, the 
combined overall impacts of the effects of both the DRG 
reclassifications and recalibration and the updated wage index are 
shown in column 5. The 0.0 percent impact for all hospitals 
demonstrates that these changes, in combination with the budget 
neutrality factor, are budget neutral.
    For the most part, the changes in this column are the sum of the 
changes in columns 1, 2, 3 and 4, minus approximately 0.7 percent 
attributable to the budget neutrality factor. There may be some 
variation of plus or minus 0.1 percent due to rounding.

E. Impact of MGCRB Reclassifications (Columns 6 & 7)

    Our impact analysis to this point has assumed hospitals are paid 
on the basis of their actual geographic location (with the exception 
of ongoing policies that provide that certain hospitals receive 
payments on bases other than where they are geographically located, 
such as hospitals in rural counties that are deemed urban under 
section 1886(d)(8)(B) of the Act). The changes in column 5 reflect 
the per case payment impact of moving from this baseline to a 
simulation incorporating the MGCRB decisions for FY 2002. The 
changes in column 6 add in the post-reclassified wage index values 
resulting from the proposed change to include the wage data for a 
reclassified hospital in both the area to which it is reclassified 
and the area where the hospital is physically located. As noted 
below, these decisions affect hospitals' standardized amount and 
wage index area assignments.
    By February 28 of each year, the MGCRB makes reclassification 
determinations that will be effective for the next fiscal year, 
which begins on October 1. The MGCRB may approve a hospital's 
reclassification request for the purpose of using the other area's 
standardized amount, wage index value, or both.
    The proposed FY 2002 wage index values incorporate all of the 
MGCRB's reclassification decisions for FY 2002. The wage index 
values also reflect any decisions made by the HCFA Administrator 
through the appeals and review process for MGCRB decisions as of 
February 28, 2001. Additional changes that result from the 
Administrator's review of MGCRB decisions or a request by a hospital 
to withdraw its application will be reflected in the final rule for 
FY 2002.
    The overall effect of geographic reclassification is required by 
section 1886(d)(8)(D) of the Act to be budget neutral. Therefore, we 
applied an adjustment of 0.991054 to ensure that the effects of 
reclassification are budget neutral. (See section II.A.4.b. of the 
Addendum to this proposed rule.) This results in a larger budget 
neutrality offset than the FY 2001 factor of 0.993187. This larger 
offset is accounted for by the extension of wage index 
reclassifications for 3 years as a result of section 304 of Public 
Law 106-554, and our proposed policy to hold-harmless the 
calculation of urban areas' wage indexes for reclassifications out 
of the area (see Column 7). We have identified 162 hospitals that 
were reclassified for FY 2001 but not FY 2002, that will nonetheless 
continue to be reclassified due to section 304 of Public Law 106-
554.
    As a group, rural hospitals benefit from geographic 
reclassification. Their payments rise 2.7 percent in Column 6. 
Payments to urban hospitals decline 0.7 percent. Hospitals in other 
urban areas see a decrease in payments of 0.5 percent, while large 
urban hospitals lose 0.8 percent. Among urban hospital groups (that 
is, bed size, census division, and special payment status), payments 
generally decline.
    A positive impact is evident among most of the rural hospital 
groups. The smallest increase among the rural census divisions is 
1.9 percent for Mountain and Puerto Rico regions. The largest 
increases are in rural West South Central and New England. These 
regions receive increases of 3.5 and 3.0 percent respectively.
    Among all the hospitals that were reclassified for FY 2002, the 
MGCRB changes are estimated to provide a 4.5 percent increase in 
payments. Urban hospitals reclassified for FY 2002 are anticipated 
to receive an increase of 2.8 percent, while rural reclassified 
hospitals are expected to benefit from the MGCRB changes with a 5.6 
percent increase in payments. Overall, among hospitals that were 
reclassified for purposes of the standardized amount only, a payment 
increase of 3.3 percent is expected, while those reclassified for 
purposes of the wage index only show a 1.9 percent increase in 
payments. Payments to urban and rural hospitals that did not 
reclassify are expected to decrease slightly due to the MGCRB 
changes, decreasing by 1.2 for urban hospitals and 0.6 for rural 
hospitals. Those hospitals located in rural counties but deemed to 
be urban under section 1886(d)(8)(B) of the Act are expected to 
receive an increase in payments of 0.3 percent.
    Column 7 shows the impacts of our proposed policy to include the 
wage data for a reclassified hospital in both the area to which it 
is reclassified and the area where the hospital is physically 
located. This change affects overall payments by 0.2 percent, 
partially accounting for the larger budget neutrality factor 
compared to FY 2001. The payment impacts are generally largest in 
urban hospital groups, with the largest impact, 0.6 percent, 
experienced by urban hospitals in the Middle Atlantic census 
division.
    The foregoing analysis was based on MGCRB and HCFA Administrator 
decisions made by February 28, 2001. As previously noted, there may 
be changes to some MGCRB decisions through the appeals, review, and 
applicant withdrawal process. The outcome of these cases will be 
reflected in the analysis presented in the final rule.

F. All Changes (Column 8)

    Column 8 compares our estimate of payments per case, 
incorporating all changes reflected in this proposed rule for FY 
2002 (including statutory changes), to our estimate of payments per 
case in FY 2001. It includes the effects of the 2.55 percent update 
to the standardized amounts and the hospital-specific rates for MDHs 
and SCHs. It also reflects the 0.8 percentage point difference 
between the projected outlier payments in FY 2001 (5.1 percent of 
total DRG payments) and the current estimate of the percentage of 
actual outlier payments in FY 2001 (5.9 percent), as described in 
the introduction to this Appendix and the Addendum to this proposed 
rule.
    We also note that section 211 of Public Law 106-554 changed the 
criteria for hospitals to qualify for DSH payment status. Since more 
hospitals are now eligible to receive DSH payments for the full FY 
2002, as opposed to for just the second 6 months of FY 2001, DSH 
payments to providers in FY 2002 would increase and this change is 
also captured in column 8.
    Section 213 of Public Law 106-554 provided that all SCHs may 
elect to receive payment on the basis of their costs per case during 
their cost reporting period that began during 1996. For FY 2002, 
eligible SCHs that rebase receive a hospital-specific rate comprised 
of 50 percent of the higher of their FY 1982 or FY 1987 hospital-
specific rate or their Federal rate, and 50 percent of their 1996 
hospital-specific rate. The impact of this provision is modeled in 
column 8 as well.
    There might also be interactive effects among the various 
factors comprising the payment system that we are not able to 
isolate. For these reasons, the values in column 7 may not equal the 
sum of the changes in columns 5 and 6, plus the other impacts that 
we are able to identify.
    Hospitals in urban areas experience a 1.7 percent increase in 
payments per case compared to FY 2001. The 0.7 percent

[[Page 22874]]

negative impact due to reclassification is offset by a similar 
negative impact for FY 2001 of 0.4 percent (65 FR 47196). Hospitals 
in rural areas, meanwhile, experience a 3.2 percent payment 
increase. This is primarily due to the change in the DSH threshold 
to 15 percent for all hospitals enacted by section 211 of Public Law 
106-554 and effective for discharges on or after April 1, 2001, and 
the positive effect of the reclassification changes (2.7 percent 
increase, plus an additional 0.1 percent increase from the proposal 
to include the wage data for a reclassified hospital in both the 
area to which it is reclassified and the area where the hospital is 
physically located).
    The impact of lowering the DSH threshold is demonstrated in 
Column 8, although we would note that the estimated FY 2001 payments 
do reflect 6 months of payments to hospitals affected by this 
change. The impacts are seen in the rows displaying urban hospitals 
with fewer than 100 beds receiving DSH (3.3 percent increase), and 
all rural DSH categories.
    Among urban census divisions, payments increased between 0.2 and 
3.0 percent between FY 2001 and FY 2002. The rural census division 
experiencing the smallest increase in payments was the Mid-Atlantic 
region (2.2 percent). The largest increases by rural hospitals is in 
Puerto Rico, where payments appear to increase by 8.4 percent and 
West South Central, where payments appear to increase by 4.2 
percent. Rural New England and South Atlantic regions also benefited 
with 3.7 and 3.6 percent respectively.
    Among special categories of rural hospitals, those hospitals 
receiving payment under the hospital-specific methodology (SCHs, 
MDHs, and SCH/RRCs) experience payment increases of 3.1 percent, 3.7 
percent, and 3.2 percent, respectively. This outcome is primarily 
related to the fact that, for hospitals receiving payments under the 
hospital-specific methodology, there are no outlier payments. 
Therefore, these hospitals do not experience negative payment 
impacts from the decline in outlier payments from FY 2001 to FY 2002 
(from 5.9 percent of total DRG plus outlier payments to 5.1 percent) 
as do hospitals paid based on the national standardized amounts.
    Among hospitals that were reclassified for FY 2002, hospitals 
overall are estimated to receive a 2.9 percent increase in payments. 
Urban hospitals reclassified for FY 2002 are anticipated to receive 
an increase of 2.0 percent, while rural reclassified hospitals are 
expected to benefit from reclassification with a 3.6 percent 
increase in payments. Overall, among hospitals reclassified for 
purposes of the standardized amount, only a payment increase of 4.0 
percent is expected, while those hospitals reclassified for purposes 
of the wage index only show an expected 2.5 percent increase in 
payments. Those hospitals located in rural counties but deemed to be 
urban under section 1886(d)(8)(B) of the Act are expected to receive 
an increase in payments of 3.9 percent.

             Table II.--Impact Analysis of Changes for FY 2001 Operating Prospective Payment System
                                               [Payments per case]
----------------------------------------------------------------------------------------------------------------
                                                                            Average FY   Average FY
                                                                               2001         2001     All FY 2001
                                                               Number  of  payment per  payment per     changes
                                                              hosps.  (1)    case \1\     case \1\       (4)
                                                                               (2)          (3)
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...........................................        4,795        6,969        7,100          1.9
    Urban hospitals.........................................        2,721        7,548        7,674          1.7
    Large urban areas (populations over 1 million)..........        1,563        8,087        8,207          1.5
    Other urban areas (populations of 1 million of fewer)...        1,158        6,854        6,989          2.0
    Rural hospitals.........................................        2,074        4,705        4,856          3.2
Bed Size (Urban):
    0-99 beds...............................................          712        5,114        5,220          2.1
    100-199 beds............................................          943        6,294        6,397          1.6
    200-299 beds............................................          530        7,192        7,320          1.8
    300-499 beds............................................          391        8,127        8,261          1.6
    500 or more beds........................................          145        9,946       10,099          1.5
Bed Size (Rural):
    0-49 beds...............................................        1,209        3,922        4,041          3.0
    50-99 beds..............................................          520        4,410        4,554          3.3
    100-149 beds............................................          204        4,780        4,922          3.0
    150-199 beds............................................           75        5,291        5,470          3.4
    200 or more beds........................................           66        5,961        6,173          3.6
Urban by Region:
    New England.............................................          139        8,077        8,214          1.7
    Middle Atlantic.........................................          417        8,561        8,579          0.2
    South Atlantic..........................................          395        7,183        7,386          2.8
    East North Central......................................          462        7,210        7,323          1.6
    East South Central......................................          160        6,771        6,973          3.0
    West North Central......................................          189        7,287        7,430          2.0
    West South Central......................................          342        7,039        7,087          0.7
    Mountain................................................          137        7,282        7,454          2.4
    Pacific.................................................          434        8,840        9,037          2.2
    Puerto Rico.............................................           46        3,235        3,319          2.6
Rural by Region:
    New England.............................................           49        5,615        5,821          3.7
    Middle Atlantic.........................................           74        5,052        5,165          2.2
    South Atlantic..........................................          267        4,871        5,046          3.6
    East North Central......................................          273        4,743        4,875          2.8
    East South Central......................................          263        4,398        4,556          3.6
    West North Central......................................          479        4,506        4,620          2.5
    West South Central......................................          331        4,177        4,351          4.2
    Mountain................................................          194        5,020        5,166          2.9
    Pacific.................................................          139        5,762        5,920          2.7
    Puerto Rico.............................................            5        2,529        2,742          8.4
By Payment Classification:
    Urban hospitals.........................................        2,766        7,526        7,652          1.7

[[Page 22875]]

 
    Large urban areas (populations over 1 million)..........        1,643        8,002        8,121          1.5
    Other urban areas (populations of 1 million of fewer)...        1,123        6,870        7,008          2.0
    Rural areas.............................................        2,029        4,687        4,838          3.2
Teaching Status:
    Non-teaching............................................        3,674        5,605        5,728          2.2
    Fewer than 100 Residents................................          881        7,309        7,445          1.9
    100 or more Residents...................................          240       11,258       11,410          1.3
Urban DSH:
    Non-DSH.................................................        1,879        6,354        6,461          1.7
    100 or more beds........................................        1,378        8,129        8,267          1.7
    Less than 100 beds......................................          325        4,925        5,089          3.3
Rural DSH:
    Sole Community (SCH)....................................          540        4,295        4,427          3.1
    Referral Center (RRC)...................................          157        5,521        5,723          3.7
    Other Rural:
        100 or more beds....................................           73        4,304        4,441          3.2
        Less than 100 beds..................................          443        3,928        4,095          4.3
Urban teaching and DSH:
    Both teaching and DSH...................................          754        9,091        9,238          1.6
    Teaching and no DSH.....................................          295        7,562        7,683          1.6
    No teaching and DSH.....................................          949        6,298        6,424          2.0
    No teaching and no DSH..................................          768        5,932        6,022          1.5
    Rural Hospital Types:
        Non special status hospitals........................          800        4,042        4,186          3.6
        RRC.................................................          165        5,434        5,630          3.6
        SCH.................................................          667        4,562        4,676          2.5
        Medicare-dependent hospitals (MDH)..................          328        3,844        3,966          3.2
        SCH and RRC.........................................           69        5,649        5,803          2.7
    Type of Ownership:
        Voluntary...........................................        2,785        7,136        7,261          1.8
        Proprietary.........................................          777        6,580        6,712          2.0
        Government..........................................        1,187        6,486        6,651          2.5
            Unknown.........................................           46        6,283        6,449          2.6
    Medicare Utilization as a Percent of Inpatient Days:
        0-25................................................          396        9,504        9,713          2.2
        25-50...............................................        1,886        8,030        8,164          1.7
        50-65...............................................        1,843        6,012        6,142          2.2
        Over 65.............................................          592        5,393        5,497          1.9
    Unknown.................................................           78       10,244       10,132         -1.1
Hospitals Reclassified by the Medicare Geographic
 Classification Review Board: FY 2002 Reclassifications:
    All Reclassified Hospitals..............................          636        6,153        6,334          2.9
    Standardized Amount Only................................           74        5,200        5,407          4.0
    Wage Index Only.........................................          391        6,004        6,152          2.5
    Both....................................................           58        6,818        6,816          0.0
All Nonreclassified Hospitals...............................        4,246        7,105        7,236          1.9
All Urban Reclassified Hospitals............................          119        8,253        8,415          2.0
Urban Nonreclassified Hospitals.............................           18        6,176        6,136         -0.6
    Standardized Amount Only................................           81        8,946        9,141          2.2
    Wage Index Only.........................................           20        6,193        6,346          2.5
    Both....................................................        2,564        7,531        7,654          1.6
All Reclassified Rural Hospitals............................          517        5,277        5,466          3.6
    Standardized Amount Only................................           19        4,658        4,750          2.0
    Wage Index Only.........................................          475        5,283        5,472          3.6
    Both....................................................           23        5,396        5,622          4.2
Rural Nonreclassified Hospitals.............................        1,554        4,153        4,268          2.8
Other Reclassified Hospitals (Section 1886(D)(8)(B))........           41        4,841        5,032         3.9
----------------------------------------------------------------------------------------------------------------
\1\ These payment amounts per case do not reflect any estimates of annual case-mix increase.

    Table II presents the projected impact of the proposed changes 
for FY 2002 for urban and rural hospitals and for the different 
categories of hospitals shown in Table I. It compares the estimated 
payments per case for FY 2001 with the average estimated per case 
payments for FY 2002, as calculated under our models. Thus, this 
table presents, in terms of the average dollar amounts paid per 
discharge, the combined effects of the changes presented in Table I. 
The percentage changes shown in the last column of Table II equal 
the percentage changes in average payments from column 8 of Table I.

[[Page 22876]]

VIII. Impact for Critical Access Hospitals (CAHs)

    There are approximately 365 facilities that qualify as CAHs. 
These CAHs are paid based on reasonable costs for their services to 
inpatients and outpatients. We examined several parts of the 
proposed rule, as discussed in detail in section VI.B. of the 
preamble, for their potential impact on CAHs.

A. Exclusion of CAHs From Payment Window Requirements

    In this proposed rule, we are proposing to clarify the policy 
that CAHs are not subject to the payment window provisions of 
section 1886(a)(3) of the Act. Existing regulations do not require 
that these provisions be applied to CAHs, and we are not aware of 
specific situations in which they are now being applied. 
Consequently, we do not expect any increase or decrease in Medicare 
spending based on this clarification.

B. Availability of CRNA Pass-Through for CAHs

    Under existing Sec. 412.113(c), CRNA pass-through payment is 
available only to hospitals that either qualified for the pass-
through of costs of anesthesia services furnished in calendar year 
1989, or employed or contracted with a qualified nonphysician 
anesthetist as of January 1, 1988, to perform anesthesia services. 
We are proposing that certain CAHs that meet the pass-through 
criteria would qualify for pass-through payments. Under the existing 
criterion, the only facilities that could qualify for the pass-
through as CAHs are those that would have qualified for the pass-
through if they had elected to continue participating in Medicare as 
hospitals rather than converting to CAH status. We do not expect any 
increase or decrease in Medicare spending based on the proposed 
change in the regulations.

C. Payment for Emergency Room On-Call Physicians

    In accordance with the amendments made by section 204 of Public 
Law 106-544, we are proposing to recognize as allowable costs, 
amounts for reasonable compensation and related costs for emergency 
room physicians who are on call but who are not present on the 
premises of a CAH. We expect that at least some CAHs will elect to 
compensate emergency room physicians for being on call, and that as 
a result, Medicare spending for CAH services will increase. However, 
we do not have information to develop a reliable estimate of how 
many CAHs will make this election, or how much physician 
compensation costs they will incur for on call time.

D. Treatment of Ambulance Services Furnished by Certain CAHs

    In accordance with the provisions of section 205 of Public Law 
106-554, we are proposing to amend the existing CAH regulations to 
provide for payment to CAHs for the reasonable costs of ambulance 
services furnished by a CAH or an entity owned or operated by the 
CAH if certain statutory requirements are met. We expect that at 
least some CAHs or entities owned or operated by CAHs will be able 
to qualify for payment for their ambulance services. To the extent 
that CAHs or CAH owned or operated entities furnish these services 
under the conditions specified in the law, ambulance services will 
be paid for at higher rates than would otherwise apply. As a result, 
Medicare spending for ambulance services will increase. However, we 
do not have sufficient information or data to develop a reliable 
estimate of how many CAHs or entities will qualify or the dollar 
amount of ambulance service costs they will incur.

E. Qualified Practitioners for Preanesthesia and Postanesthesia 
Evaluations in CAHs

    As discussed in section VI.B. of this proposed rule, in an 
effort to eliminate or minimize potential issues relating to 
beneficiary access to medical services in rural areas, we are 
proposing to allow CRNAs who administer the anesthesia to conduct 
the preanesthesia and postanesthesia evaluations in a CAH. As with 
any licensed independent health care provider, the proposed change 
would not permit CRNAs to practice beyond his or her licensed scope 
of practice.
    We believe that this proposal would increase flexibility of 
providers in furnishing medical services in rural areas. However, we 
do not have information or data to develop a reliable estimate of 
how many CRNAs would be used to conduct preanesthesia and 
postanesthesia evaluations in CAHs or what the associated costs 
would be.

IX. Impact of Proposed Changes in the Capital Prospective Payment 
System

A. General Considerations

    We now have cost report data for the 8th year of the capital 
prospective payment system (cost reports beginning in FY 1999) 
available through the December 2000 update of the HCRIS. We also 
have updated information on the projected aggregate amount of 
obligated capital approved by the fiscal intermediaries. However, 
our impact analysis of payment changes for capital-related costs is 
still limited by the lack of hospital-specific data on several 
items. These are the hospital's projected new capital costs for each 
year, its projected old capital costs for each year, and the actual 
amounts of obligated capital that will be put in use for patient 
care and recognized as Medicare old capital costs in each year. The 
lack of this information affects our impact analysis in the 
following ways:
     Major investment in hospital capital assets (for 
example, in building and major fixed equipment) occurs at irregular 
intervals. As a result, there can be significant variation in the 
growth rates of Medicare capital-related costs per case among 
hospitals. We do not have the necessary hospital-specific budget 
data to project the hospital capital growth rate for individual 
hospitals.
     Our policy of recognizing certain obligated capital as 
old capital makes it difficult to project future capital-related 
costs for individual hospitals. Under Sec. 412.302(c), a hospital is 
required to notify its intermediary that it has obligated capital by 
the later of October 1, 1992, or 90 days after the beginning of the 
hospital's first cost reporting period under the capital prospective 
payment system. The intermediary must then notify the hospital of 
its determination whether the criteria for recognition of obligated 
capital have been met by the later of the end of the hospital's 
first cost reporting period subject to the capital prospective 
payment system or 9 months after the receipt of the hospital's 
notification. The amount that is recognized as old capital is 
limited to the lesser of the actual allowable costs when the asset 
is put in use for patient care or the estimated costs of the capital 
expenditure at the time it was obligated. We have substantial 
information regarding fiscal intermediary determinations of 
projected aggregate obligated capital amounts. However, we still do 
not know when these projects will actually be put into use for 
patient care, the actual amount that will be recognized as obligated 
capital when the project is put into use, or the Medicare share of 
the recognized costs. Therefore, we do not know actual obligated 
capital commitments for purposes of the FY 2002 capital cost 
projections. In Appendix B of this proposed rule, we discuss the 
assumptions and computations that we employ to generate the amount 
of obligated capital commitments for use in the FY 2002 capital cost 
projections.
    In Table III of this section, we present the redistributive 
effects that are expected to occur between ``hold-harmless'' 
hospitals and ``fully prospective'' hospitals in FY 2002. In 
addition, we have integrated sufficient hospital-specific 
information into our actuarial model to project the impact of the 
proposed FY 2002 capital payment policies by the standard 
prospective payment system hospital groupings. While we now have 
actual information on the effects of the transition payment 
methodology and interim payments under the capital prospective 
payment system and cost report data for most hospitals, we still 
need to randomly generate numbers for the change in old capital 
costs, new capital costs for each year, and obligated amounts that 
will be put in use for patient care services and recognized as old 
capital each year. We continue to be unable to predict accurately FY 
2002 capital costs for individual hospitals, but with the most 
recent data on hospitals' experience under the capital prospective 
payment system, there is adequate information to estimate the 
aggregate impact on most hospital groupings.

B. Projected Impact Based on the Proposed FY 2002 Actuarial Model

1. Assumptions

    In this impact analysis, we model dynamically the impact of the 
capital prospective payment system from FY 2001 to FY 2002 using a 
capital cost model. The FY 2002 model, as described in Appendix B of 
this proposed rule, integrates actual data from individual hospitals 
with randomly generated capital cost amounts. We have capital cost 
data from cost reports beginning in FY 1989 through FY 1999 as 
reported on the December 2000 update of HCRIS, interim payment data 
for hospitals already receiving capital prospective payments through 
PRICER, and data reported by the intermediaries that include the 
hospital-

[[Page 22877]]

specific rate determinations that have been made through January 1, 
2001 in the provider-specific file. We used these data to determine 
the proposed FY 2002 capital rates. However, we do not have 
individual hospital data on old capital changes, new capital 
formation, and actual obligated capital costs. We have data on costs 
for capital in use in FY 1999, and we age that capital by a formula 
described in Appendix B. Therefore, we need to randomly generate 
only new capital acquisitions for any year after FY 1999. All 
Federal rate payment parameters are assigned to the applicable 
hospital. We will continue to pay regular exceptions during cost 
reporting periods beginning before October 1, 2001 but ending in FY 
2002. However, in FY 2003 and later, payments will no longer be made 
under the regular exceptions provision, hence, we will no longer 
require the actuarial model described in Appendix B of this proposed 
rule.
    For purposes of this impact analysis, the proposed FY 2002 
actuarial model includes the following assumptions:
     Medicare inpatient capital costs per discharge will 
change at the following rates during these periods:

        Average Percentage Change in Capital Costs Per Discharge
------------------------------------------------------------------------
                                                              Percentage
                        Fiscal year                             change
------------------------------------------------------------------------
2000.......................................................         1.39
2001.......................................................         1.37
2002.......................................................         2.58
------------------------------------------------------------------------

     We estimate that the Medicare case-mix index will 
increase by 0.0 percent in FY 2001 and will increase by 1.0 percent 
in FY 2002.
     The Federal capital rate and the hospital-specific rate 
were updated beginning in FY 1996 by an analytical framework that 
considers changes in the prices associated with capital-related 
costs and adjustments to account for forecast error, changes in the 
case-mix index, allowable changes in intensity, and other factors. 
The proposed FY 2002 update is 1.1 percent (see section IV. of the 
Addendum to this proposed rule).

2. Results

    We have used the actuarial model to estimate the change in 
payment for capital-related costs from FY 2001 to FY 2002. Table III 
shows the effect of the capital prospective payment system on low 
capital cost hospitals and high capital cost hospitals. We consider 
a hospital to be a low capital cost hospital if, based on a 
comparison of its initial hospital-specific rate and the applicable 
Federal rate, it will be paid under the fully prospective payment 
methodology. A high capital cost hospital is a hospital that, based 
on its initial hospital-specific rate and the applicable Federal 
rate, will be paid under the hold-harmless payment methodology. We 
are no longer displaying a column for the hospital-specific payments 
in Table III since the FY 2001 transition blend percentage for fully 
prospective hospitals is 100 percent of the Federal rate and zero 
percent of the hospital-specific rate, and all hospitals (except 
those defined as ``new'' under Sec. 412.300) are paid based on 100 
percent of the Federal rate for FY 2002. Based on our actuarial 
model, the breakdown of hospitals is as follows:

                               Capital Transition Payment Methodology for FY 2002
----------------------------------------------------------------------------------------------------------------
                                                                                         Percent of   Percent of
                      Type of hospital                         Percent of   Percent of    capital      capital
                                                               hospitals    discharges     costs       payments
----------------------------------------------------------------------------------------------------------------
Low Cost Hospital...........................................           66           62           57           61
High Cost Hospital..........................................           34           38           43           39
----------------------------------------------------------------------------------------------------------------

    A low capital cost hospital may request to have its hospital-
specific rate redetermined based on old capital costs in the current 
year, through the later of the hospital's cost reporting period 
beginning in FY 1994 or the first cost reporting period beginning 
after obligated capital comes into use (within the limits 
established in Sec. 412.302(c) for putting obligated capital into 
use for patient care). If the redetermined hospital-specific rate is 
greater than the adjusted Federal rate, these hospitals will be paid 
under the hold-harmless payment methodology. Regardless of whether 
the hospital became a hold-harmless payment hospital as a result of 
a redetermination, we continue to show these hospitals as low 
capital cost hospitals in Table III.
    Assuming no behavioral changes in capital expenditures, Table 
III displays the percentage change in payments from FY 2001 to FY 
2002 using the above described actuarial model. With the proposed 
Federal rate, we estimate aggregate Medicare capital payments will 
increase by 3.80 percent in FY 2002. This increase is somewhat lower 
than last year's (5.48 percent) due in part to the fact that because 
the transition period ends after FY 2001, there is no longer an 
increase in the Federal blend percentage, which increased from 90 to 
100 percent from FY 2000 to FY 2001, for fully prospective 
hospitals.

                                      Table III.--Impact of Proposed Changes for FY 2002 on Payments per Discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              Adjusted     Average        Hold                                 Percent
                                                Number of     Discharges      Federal      Federal      harmless    Exceptions     Total     change over
                                                hospitals                     payment      percent      payment      payment      payment       FY 2001
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2001 Payments per Discharge
    Low Cost Hospitals.......................        3,128       6,718,804      $626.20        99.70        $2.38        $5.69      $634.27  ...........
        Fully Prospective....................        2,945       6,231,764       627.54       100.00  ...........         5.09       632.63  ...........
        100% Federal Rate....................          163         451,843       627.89       100.00  ...........         7.75       635.64  ...........
        Hold Harmless........................           20          35,197       367.32        50.30       454.71        85.44       907.47  ...........
    High Cost Hospitals......................        1,577       4,110,246       636.96        97.69        19.34        10.64       666.93  ...........
        100% Federal Rate....................        1,386       3,744,619       648.86       100.00  ...........         8.82       657.68  ...........
        Hold Harmless........................          191         365,627       515.12        75.29       217.38        29.23       761.73  ...........
            Total Hospitals..................        4,705      10,829,050       630.28        98.92         8.82         7.57       646.67  ...........
FY 2002 Payments per Discharge
    Low Cost Hospitals.......................        3,128       6,826,288       647.17       100.00  ...........         3.19       650.36         2.54

[[Page 22878]]

 
        Fully Prospective....................        2,945       6,331,437       646.59       100.00  ...........         2.96       649.55         2.68
        100% Federal Rate....................          183         494,852       654.56       100.00  ...........         6.11       660.67         3.94
    High Cost Hospitals......................        1,577       4,176,324       671.77       100.00  ...........         5.72       677.49         1.58
        100% Federal Rate....................        1,577       4,176,324       671.77       100.00  ...........         5.72       677.49         3.01
            Total Hospitals..................        4,705      11,002,612       656.51       100.00  ...........         4.15       660.66         2.16
--------------------------------------------------------------------------------------------------------------------------------------------------------

    We project that low capital cost hospitals paid under the fully 
prospective payment methodology will experience an average increase 
in payments per case of 2.54 percent, and high capital cost 
hospitals will experience an average increase of 1.58 percent. These 
results are due to the fact that there is no longer an increase in 
the Federal blend percentage with the conclusion of the capital 
transition period in FY 2001 for fully prospective hospitals. 
Beginning FY 2002, all hospitals (except those defined as ``new'' 
under Sec. 412.300) are paid based on 100 percent of the Federal 
rate for FY 2002.
    For hospitals paid under the fully prospective payment 
methodology, the Federal rate payment percentage remains at 100 
percent from FY 2001 (last year of the transition period) since they 
no longer receive payments based on the hospital-specific rate. The 
Federal rate payment percentage in FY 2001 for hospitals paid under 
the hold-harmless payment methodology is based on the hospital's 
ratio of new capital costs to total capital costs. The average 
Federal rate payment percentage for high cost hospitals receiving a 
hold-harmless payment for old capital in FY 2001 will increase from 
75.29 percent to 100 percent since the transition period will have 
ended. All hold-harmless hospitals will be paid based on 100 percent 
of the Federal rate in FY 2002. We estimate that high cost hospitals 
(paid based on 100 percent of the Federal rate) will receive a 
decrease in exceptions payments from $8.82 per discharge in FY 2001 
to $5.72 per discharge in FY 2002. This is primarily due to the 
expiration of the regular exceptions provision in FY 2002.
    We are no longer presenting the average hospital-specific rate 
payment per discharge in Table III because the FY 2001 transition 
blend percentage for fully prospective hospitals is 100 percent of 
the Federal rate and zero percent of the hospital-specific rate, and 
all hospitals (except those defined as ``new'' under Sec. 412.300) 
will be paid based on 100 percent of the Federal rate for FY 2002.
    As stated previously, we will continue to pay regular exceptions 
for cost reporting periods beginning before October 1, 2001, but 
ending in FY 2002. However, in FY 2003 and later, regular exception 
payments will no longer be made under the regular exceptions 
provision, however, eligible hospitals could receive special 
exception payments under Sec. 412.348(g).
    We estimate that regular exceptions payments will decrease from 
1.17 percent of total capital payments in FY 2001 to 0.63 percent of 
payments in FY 2002. These results are primarily due to the 
expiration of the regular exceptions after FY 2001 and the limited 
nature of the special exceptions policy in FY 2002. The projected 
distribution of the exception payments is shown in the chart below:

                  Estimated FY 2002 Exceptions Payments
------------------------------------------------------------------------
                                                              Percent of
               Type of hospital                  Number of    exceptions
                                                 hospitals     payments
------------------------------------------------------------------------
Low Capital Cost..............................          122           48
High Capital Cost.............................          116           52
                                               -------------------------
      Total...................................          238          100
------------------------------------------------------------------------

    In the past we presented a cross-sectional summary of hospital 
groupings by the capital prospective payment transition period 
methodology generated by our actuarial model (Appendix B). We are no 
longer including such a comparison since all hospitals (except those 
defined as ``new'' under Sec. 412.300) will be paid based on 100 
percent of the Federal rate in FY 2002 with the conclusion of the 
10-year capital transition period.

C. Cross-Sectional Analysis of Changes in Aggregate Payments

    We used our FY 2002 actuarial model to estimate the potential 
impact of our proposed changes for FY 2002 on total capital payments 
per case, using a universe of 4,705 hospitals. The individual 
hospital payment parameters are taken from the best available data, 
including: The January 1, 2001 update to the provider-specific file, 
cost report data, and audit information supplied by intermediaries. 
In Table IV we present the results of the cross-sectional analysis 
using the results of our actuarial model and the aggregate impact of 
the proposed FY 2002 payment policies. As we explain in Appendix B 
of this proposed rule, we were not able to use 90 of the 4,795 
hospitals in our database due to insufficient (missing or unusable) 
data. Consequently, the payment methodology distribution is based on 
4,705 hospitals. These data should be fully representative of the 
payment methodologies that will be applicable to hospitals. Columns 
3 and 4 show estimates of payments per case under our model for FY 
2001 and FY 2002. Column 5 shows the total percentage change in 
payments from FY 2001 to FY 2002. Column 6 presents the percentage 
change in payments that can be attributed to Federal rate changes 
alone.
    Federal rate changes represented in Column 6 include the 1.85 
percent increase in the Federal rate, a 1.0 percent increase in case 
mix, changes in the adjustments to the Federal rate (for example, 
the effect of the new hospital wage index on the geographic 
adjustment factor), and reclassifications by the MGCRB. Column 5 
includes the effects of the Federal rate changes represented in 
Column 6. Column 5 also reflects the effects of all other changes, 
including the change for all hold-harmless hospitals being paid 
based on 100 percent of the Federal rate, and changes in exception 
payments. The comparisons are provided by: (1) Geographic location, 
(2) region, and (3) payment classification.
    The simulation results show that, on average, capital payments 
per case can be expected to increase 2.2 percent in FY 2002. The 
results show that the effect of the Federal rate change alone is to 
increase payments by 3.0 percent. In addition to the increase 
attributable to the Federal rate change, a 0.8 percent decrease is 
attributable to the effects of all other changes.
    Our comparison by geographic location shows an overall increase 
in payments to hospitals in all areas. This comparison also shows 
that urban and rural hospitals will experience slightly different 
rates of increase in capital payments per case (2.3 percent and 1.2 
percent, respectively). This difference is due to the lower rate of 
decrease for urban hospitals relative to rural hospitals (0.7 
percent and 1.7 percent, respectively) from the effect of all other 
changes. Urban hospitals will gain approximately the same as rural 
hospitals (3.0 percent versus 2.9 percent, respectively) from the 
effects of Federal rate changes alone.
    Most regions are estimated to receive increases in total capital 
payments per case, partly due to the fact that payments to all 
hospitals (except those defined as ``new'' under Sec. 412.300) will 
be based on 100 percent of the Federal rate in FY 2002. Changes by 
region vary from a minimum

[[Page 22879]]

maximum decrease of 0.6 percent (Mountain urban region) to a maximum 
increase of 3.0 percent (New England urban rural region).
    By type of ownership, voluntary hospitals are projected to have 
the largest rate of increase of total payment changes (2.5 percent, 
a 3.0 percent increase due to the Federal rate changes, and a 0.5 
percent decrease from the effects of all other changes). Similarly, 
payments to government hospitals will increase 2.2 percent (a 3.0 
percent increase due to Federal rate changes, and a 0.8 percent 
decrease from the effects of all other changes), while payments to 
proprietary hospitals will increase 0.5 percent (a 2.9 percent 
increase due to Federal rate changes, and a 2.4 percent decrease 
from the effects of all other changes). This 2.4 percent decrease 
from all other changes is primarily due to the estimated decrease in 
exceptions payments and the change for all hold-harmless hospitals 
being paid based on 100 percent of the Federal rate.
    Section 1886(d)(10) of the Act established the MGCRB. Hospitals 
may apply for reclassification for purposes of the standardized 
amount, wage index, or both and for purposes of DSH for FYs 1999 
through 2001. Although the Federal capital rate is not affected, a 
hospital's geographic classification for purposes of the operating 
standardized amount does affect a hospital's capital payments as a 
result of the large urban adjustment factor and the disproportionate 
share adjustment for urban hospitals with 100 or more beds. 
Reclassification for wage index purposes also affects the geographic 
adjustment factor, since that factor is constructed from the 
hospital wage index.
    To present the effects of the hospitals being reclassified for 
FY 2001 compared to the effects of reclassification for FY 2000, we 
show the average payment percentage increase for hospitals 
reclassified in each fiscal year and in total. For FY 2001 
reclassifications, we indicate those hospitals reclassified for 
standardized amount purposes only, for wage index purposes only, and 
for both purposes. The reclassified groups are compared to all other 
nonreclassified hospitals. These categories are further identified 
by urban and rural designation.
    Hospitals reclassified for FY 2001 as a whole are projected to 
experience a 2.0 percent increase in payments (a 3.0 percent 
increase attributable to Federal rate changes and a 1.0 percent 
decrease attributable to the effects of all other changes). Payments 
to nonreclassified hospitals will increase slightly more (2.2 
percent) than reclassified hospitals (2.0 percent) overall. Payments 
to nonreclassified hospitals will increase the same as reclassified 
hospitals from the Federal rate changes (3.0 percent), and they will 
lose less from the effects of all other changes (0.8 percent 
compared to 1.0 percent, respectively).

                                Table IV.--Comparison of Total Payments Per Case
                                 [FY 2001 Payments Compared to FY 2002 Payments]
----------------------------------------------------------------------------------------------------------------
                                                                                                      Portion
                                     Number of      Average FY      Average FY                     attributable
                                     hospitals    2001 payments/  2002  payments/  All  changes     to Federal
                                                       case            case                         rate change
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...............           4,705             647             661             2.2             3.0
    Large urban areas                      1,519             749             766             2.3             3.0
     (populations over 1
     million)...................
    Other urban areas                      1,125             635             650             2.4             3.0
     (populations of 1 million
     or fewer)..................
    Rural areas.................           2,061             439             444             1.2             2.9
    Urban hospitals.............           2,644             699             716             2.3             3.0
        0-99 beds...............             654             522             507            -2.8             2.8
        100-199 beds............             927             596             607             1.8             2.9
        200-299 beds............             528             667             684             2.6             3.0
        300-499 beds............             390             739             762             3.1             3.0
        500 or more beds........             145             902             925             2.6             2.9
    Rural hospitals.............           2,061             439             444             1.2             2.9
        0-49 beds...............           1,200             369             372             1.0             2.9
        50-99 beds..............             516             412             416             1.0             2.9
        100-149 beds............             204             452             457             1.1             2.9
        150-199 beds............              75             485             495             2.2             2.9
        200 or more beds........              66             548             553             1.0             3.0
By Region:
    Urban by Region.............           2,644             699             716             2.3             3.0
        New England.............             138             745             768             3.0             3.0
        Middle Atlantic.........             407             782             800             2.4             2.9
        South Atlantic..........             393             669             684             2.2             3.0
        East North Central......             448             672             690             2.7             3.0
        East South Central......             156             638             655             2.7             2.9
        West North Central......             181             688             708             2.9             3.0
        West South Central......             321             665             673             1.3             2.9
        Mountain................             127             702             698            -0.6             2.9
        Pacific.................             427             787             808             2.7             3.0
        Puerto Rico.............              46             295             304             3.1             3.1
    Rural by Region.............           2,061             439             444             1.2             2.9
        New England.............              49             522             534             2.3             3.0
        Middle Atlantic.........              73             463             469             1.5             2.9
        South Atlantic..........             267             457             458             0.1             2.9
        East North Central......             273             449             455             1.4             2.9
        East South Central......             260             410             415             1.2             2.9
        West North Central......             477             422             428             1.4             2.9
        West South Central......             325             390             398             2.1             2.9
        Mountain................             193             466             467             0.1             2.8
        Pacific.................             139             520             530             2.0             3.0
By Payment Classification:
    All hospitals...............           4,705             647             661             2.2             3.0
    Large urban areas                      1,599             742             759             2.3             3.0
     (populations over 1
     million)...................
    Other urban areas                      1,090             636             651             2.4             3.0
     (populations of 1 million
     or fewer)..................
    Rural areas.................           2,016             437             442             1.2             2.9

[[Page 22880]]

 
    Teaching Status:
        Non-teaching............           3,586             533             540             1.3             2.9
        Fewer than 100 Residents             879             675             695             2.9             3.0
        100 or more Residents...             240             999           1,026             2.7             2.9
    Urban DSH:
        100 or more beds........           1,374             734             752             2.4             3.0
        Less than 100 beds......             317             489             491             0.4             2.8
    Rural DSH:
        Sole Community (SCH/                 540             395             390            -1.3             2.8
         EACH)..................
        Referral Center (RRC/                157             504             511             1.4             2.9
         EACH)..................
        Other Rural:
            100 or more beds....              73             409             419             2.4             2.9
            Less than 100 beds..             439             369             380             2.8             3.0
    Urban teaching and DSH:
        Both teaching and DSH...             753             814             836             2.7             3.0
        Teaching and no DSH.....             294             717             740             3.3             3.0
        No teaching and DSH.....             938             585             595             1.7             2.9
        No teaching and no DSH..             704             590             595             0.9             2.9
    Rural Hospital Types:
        Non special status                   788             384             394             2.8             3.0
         hospitals..............
        RRC/EACH................             165             504             517             2.6             3.0
        SCH/EACH................             667             423             417            -1.5             2.8
        Medicare-dependent                   327             363             365             0.7             2.9
         hospitals (MDH)........
        SCH, RRC and EACH.......              69             510             508            -0.4             2.8
    Hospitals Reclassified by
     the Medicare Geographic
     Classification Review
     Board:
        Reclassification Status              482             564             576             2.1             3.0
         During FY01 and FY02:
        Reclassified During FY02             153             571             580             1.6             2.9
         Only...................
    FY02 Reclassifications:
        All Reclassified                     635             566             577             2.0             3.0
         Hospitals..............
        All Nonreclassified                4,157             659             674             2.2             3.0
         Hospitals..............
        All Urban Reclassified               119             741             763             2.9             3.0
         Hospitals..............
        Urban Nonreclassified              2,487             699             715             2.3             3.0
         Hospitals..............
        All Reclassified Rural               516             492             499             1.4             2.9
         Hospitals..............
        Rural Nonreclassified              1,542             388             392             0.9             2.9
         Hospitals..............
    Other Reclassified Hospitals              41             461             455            -1.3             2.9
     (Section 1886(D)(8)(B))....
    Type of Ownership:
        Voluntary...............           2,769             660             677             2.5             3.0
        Proprietary.............             755             639             642             0.5             2.9
        Government..............           1,179             581             594             2.2             3.0
    Medicare Utilization as a
     Percent of Inpatient Days:
        0-25....................             389             825             846             2.5             3.0
        25-50...................           1,872             736             755             2.5             3.0
        50-65...................           1,832             568             580             2.2             3.0
        Over 65.................             585             522             519            -0.7             2.9
----------------------------------------------------------------------------------------------------------------

Appendix B: Technical Appendix on the Capital Cost Model and Required 
Adjustments

    Under section 1886(g)(1)(A) of the Act, we set capital 
prospective payment rates for FY 1992 through FY 1995 so that 
aggregate prospective payments for capital costs were projected to 
be 10 percent lower than the amount that would have been payable on 
a reasonable cost basis for capital-related costs in that year. To 
implement this requirement, we developed the capital acquisition 
model to determine the budget neutrality adjustment factor. Even 
though the budget neutrality requirement expired effective with FY 
1996, we must continue to determine the recalibration and geographic 
reclassification budget neutrality adjustment factor and the 
reduction in the Federal and hospital-specific rates for exceptions 
payments. To determine these factors, we must continue to project 
capital costs and payments.
    We will continue to pay regular exceptions for cost reporting 
periods beginning before October 1, 2001 but ending in FY 2002. In 
FY 2003 and later, no payments will be made under the regular 
exceptions policy, hence we will not compute a budget neutrality 
factor for regular exceptions in FY 2003 and later. As described in 
section V.D. of the preamble of this proposed rule, the budget 
neutrality adjustment for special exceptions will be based on 
historical costs. Consequently, there will be no need to estimate 
capital costs with the capital acquisition model. We will not 
publish this appendix after the final rule for the FY 2002 capital 
rates.
    We used the capital acquisition model from the start of 
prospective payments for capital costs through FY 1997. We now have 
8 years of cost reports under the capital prospective payment 
system. For FY 1998, we developed a new capital cost model to 
replace the capital acquisition model. This revised model makes use 
of the data from these cost reports.
    The following cost reports are used in the capital cost model 
for this proposed rule: the December 31, 2000 update of the cost 
reports for PPS-IX (cost reporting periods beginning in FY 1992), 
PPS-X (cost reporting periods beginning in FY 1993), PPS-XI (cost 
reporting periods beginning in FY 1994), PPS-XII (cost reporting 
periods beginning in FY 1995), PPS-XIII (cost reporting periods 
beginning in FY 1996), PPS-XIV (cost reporting periods beginning in 
FY 1997),

[[Page 22881]]

PPS-XV (cost reporting periods beginning in FY 1998), and PPS-XVI 
(cost reporting periods beginning in FY 1999). In addition, to model 
payments, we use the January 1, 2001 update of the provider-specific 
file, and the March 1995 update of the intermediary audit file.
    Since hospitals under alternative payment system waivers (that 
is, hospitals in Maryland) are currently excluded from the capital 
prospective payment system, we excluded these hospitals from our 
model.
    We developed FY 1992 through FY 2001 hospital-specific rates 
using the provider-specific file and the intermediary audit file. 
(We used the cumulative provider-specific file, which includes all 
updates to each hospital's records, and chose the latest record for 
each fiscal year.) We checked the consistency between the provider-
specific file and the intermediary audit file. We ensured that 
increases in the hospital-specific rates were at least as large as 
the published updates (increases) for the hospital-specific rates 
each year. We were able to match hospitals to the files as shown in 
the following table:

------------------------------------------------------------------------
                                                              Number of
                           Source                             hospitals
------------------------------------------------------------------------
No match...................................................            4
Audit file only............................................           90
Provider-specific file only................................          185
Provider-specific and audit file...........................        4,516
                                                            ------------
      Total................................................        4,795
------------------------------------------------------------------------

    One hundred eighteen of the 4,795 hospitals had unusable or 
missing data, or had no cost reports available. For 52 of the 118 
hospitals, we were unable to determine a hospital-specific rate from 
the available cost reports. However, there was adequate cost 
information to determine that these hospitals were paid under the 
hold-harmless methodology. Since the hospital-specific rate is not 
used to determine payments for hospitals paid under the hold-
harmless methodology, there was sufficient cost report information 
available to include these 52 hospitals in the analysis. We were 
able to estimate hospital-specific amounts from the cost reports as 
shown in the following table.

------------------------------------------------------------------------
                                                              Number of
                        Cost report                           hospitals
------------------------------------------------------------------------
PPS-9......................................................            1
PPS-12.....................................................            1
PPS-13.....................................................            1
PPS-14.....................................................            1
PPS-15.....................................................            2
PPS-16.....................................................            8
                                                            ------------
      Total................................................           14
------------------------------------------------------------------------

    Hence we were able to use 66 (52 plus 14) of the 118 hospitals. 
The remaining 52 of the 118 hospitals could not be used in the 
analysis because we were not able to estimate their hospital-
specific amount. An additional 38 hospitals could not be used in the 
analysis because we could not determine their capital costs, either 
because we had no cost reports for them or because there was 
insufficient cost report data. Accordingly, we used 4,705 hospitals 
for the analysis. Ninety (52 plus 38) hospitals could not be used in 
the analysis because of insufficient (missing or unusable) 
information. These hospitals account for about 0.3 percent of 
admissions. Therefore, any effects from the elimination of their 
cost report data should be minimal.
    We analyzed changes in capital-related costs (depreciation, 
interest, rent, leases, insurance, and taxes) reported in the cost 
reports. We found a wide variance among hospitals in the growth of 
these costs. For hospitals with more than 100 beds, the distribution 
and mean of these cost increases were different for large changes in 
bed-size (greater than 20 percent). We also analyzed 
changes in the growth in old capital and new capital for cost 
reports that provided this information. For old capital, we limited 
the analysis to decreases in old capital. We did this since the 
opportunity for most hospitals to treat ``obligated'' capital put 
into service as old capital has expired. Old capital costs should 
decrease as assets become fully depreciated and as interest costs 
decrease as the loan is amortized.
    The new capital cost model separates the hospitals into three 
mutually exclusive groups. Hold-harmless hospitals with data on old 
capital were placed in the first group. Of the remaining hospitals, 
those hospitals with fewer than 100 beds comprise the second group. 
The third group consists of all hospitals that did not fit into 
either of the first two groups. Each of these groups displayed 
unique patterns of growth in capital costs. We found that the gamma 
distribution is useful in explaining and describing the patterns of 
increase in capital costs. A gamma distribution is a statistical 
distribution that can be used to describe patterns of growth rates, 
with the greatest proportion of rates being at the low end. We use 
the gamma distribution to estimate individual hospital rates of 
increase as follows:
    (1) For hold-harmless hospitals, old capital cost changes were 
fitted to a truncated gamma distribution, that is, a gamma 
distribution covering only the distribution of cost decreases. New 
capital costs changes were fitted to the entire gamma distribution, 
allowing for both decreases and increases.
    (2) For hospitals with fewer than 100 beds (small), total 
capital cost changes were fitted to the gamma distribution, allowing 
for both decreases and increases.
    (3) Other (large) hospitals were further separated into three 
groups:
     Bed-size decreases over 20 percent (decrease).
     Bed-size increases over 20 percent (increase).
     Other (no change).
    Capital cost changes for large hospitals were fitted to gamma 
distributions for each bed-size change group, allowing for both 
decreases and increases in capital costs. We analyzed the 
probability distribution of increases and decreases in bed size for 
large hospitals. We found the probability somewhat dependent on the 
prior year change in bed size and factored this dependence into the 
analysis. Probabilities of bed-size change were determined. Separate 
sets of probability factors were calculated to reflect the 
dependence on prior year change in bed size (increase, decrease, and 
no change).
    The gamma distributions were fitted to changes in aggregate 
capital costs for the entire hospital. We checked the relationship 
between aggregate costs and Medicare per discharge costs. For large 
hospitals, there was a small variance, but the variance was larger 
for small hospitals. Since costs are used only for the hold-harmless 
methodology and to determine exceptions, we decided to use the gamma 
distributions fitted to aggregate cost increases for estimating 
distributions of cost per discharge increases.
    Capital costs per discharge calculated from the cost reports 
were increased by random numbers drawn from the gamma distribution 
to project costs in future years. Old and new capital were projected 
separately for hold-harmless hospitals. Aggregate capital per 
discharge costs were projected for all other hospitals. Because the 
distribution of increases in capital costs varies with changes in 
bed size for large hospitals, we first projected changes in bed size 
for large hospitals before drawing random numbers from the gamma 
distribution. Bed-size changes were drawn from the uniform 
distribution with the probabilities dependent on the previous year 
bed-size change. The gamma distribution has a shape parameter and a 
scaling parameter. (We used different parameters for each hospital 
group, and for old and new capital.)
    We used discharge counts from the cost reports to calculate 
capital cost per discharge. To estimate total capital costs for FY 
2000 (the MedPAR data year) and later, we use the number of 
discharges from the MedPAR data. Some hospitals had considerably 
more discharges in FY 2000 than in the years for which we calculated 
cost per discharge from the cost report data. Consequently, a 
hospital with few cost report discharges would have a high capital 
cost per discharge, since fixed costs would be allocated over only a 
few discharges. If discharges increase substantially, the cost per 
discharge would decrease because fixed costs would be allocated over 
more discharges. If the projection of capital cost per discharge is 
not adjusted for increases in discharges, the projection of 
exceptions would be overstated. We address this situation by 
recalculating the cost per discharge with the MedPAR discharges if 
the MedPAR discharges exceed the cost report discharges by more than 
20 percent. We do not adjust for increases of less than 20 percent 
because we have not received all of the FY 2000 discharges, and we 
have removed some discharges from the analysis because they are 
statistical outliers. This adjustment reduces our estimate of 
exceptions payments, and consequently, the reduction to the Federal 
rate for exceptions is smaller. We will continue to monitor our 
modeling of exceptions payments and make adjustments as needed.
    The average national capital cost per discharge generated by 
this model is the combined average of many randomly generated 
increases. This average must equal the projected average national 
capital cost per discharge, which we projected separately

[[Page 22882]]

(outside this model). We adjusted the shape parameter of the gamma 
distributions so that the modeled average capital cost per discharge 
matches our projected capital cost per discharge. The shape 
parameter for old capital was not adjusted since we are modeling the 
aging of ``existing'' assets. This model provides a distribution of 
capital costs among hospitals that is consistent with our aggregate 
capital projections.
    Once each hospital's capital-related costs are generated, the 
model projects capital payments. We use the actual payment 
parameters (for example, the case-mix index and the geographic 
adjustment factor) that are applicable to the specific hospital.
    To project capital payments, the model first assigns the 
applicable payment methodology (fully prospective or hold-harmless) 
to the hospital as determined from the provider-specific file and 
the cost reports. The model simulates Federal rate payments using 
the assigned payment parameters and hospital-specific estimated 
outlier payments. The case-mix index for a hospital is derived from 
the FY 2000 MedPAR file using the FY 2002 DRG relative weights 
included in section VI. of the Addendum to this proposed rule. The 
case-mix index is increased each year after FY 2000 based on 
analysis of past experiences in case-mix increases. Based on 
analysis of recent case-mix increases, we estimate that case-mix 
will increase 0.0 percent in FY 2001. We project that case-mix will 
increase 1.0 percent in FY 2002. (Since we are using FY 2000 cases 
for our analysis, the FY 2000 increase in case-mix has no effect on 
projected capital payments.)
    Changes in geographic classification and revisions to the 
hospital wage data used to establish the hospital wage index affect 
the geographic adjustment factor. Changes in the DRG classification 
system and the relative weights affect the case-mix index.
    Section 412.308(c)(4)(ii) requires that the estimated aggregate 
payments for the fiscal year, based on the Federal rate after any 
changes resulting from DRG reclassifications and recalibration and 
the geographic adjustment factor, equal the estimated aggregate 
payments based on the Federal rate that would have been made without 
such changes. For FY 2001, the budget neutrality adjustment factors 
were 0.99933 for the national rate and 1.00508 for the Puerto Rico 
rate. In determining these factors, we used the factors from the 
first half of FY 2001 (October 2000 through March 2001) published in 
the August 1, 2000 final rule since section 547 of Public Law 106-
554 specifies that the special increases and adjustments in effect 
between April and October 2001 do not apply for discharges occurring 
after FY 2001 and should not be included in determining the payment 
rates in subsequent years.
    Since we implemented a separate geographic adjustment factor for 
Puerto Rico, we applied separate budget neutrality adjustments for 
the national geographic adjustment factor and the Puerto Rico 
geographic adjustment factor. We applied the same budget neutrality 
factor for DRG reclassifications and recalibration nationally and 
for Puerto Rico. Separate adjustments were unnecessary for FY 1998 
and earlier since the geographic adjustment factor for Puerto Rico 
was implemented in FY 1998.
    To determine the factors for FY 2002, we first determined the 
portions of the Federal national and Puerto Rico rates that would be 
paid for each hospital in FY 2002 based on its applicable payment 
methodology. Using our model, we then compared, separately for the 
national rate and the Puerto Rico rate, estimated aggregate Federal 
rate payments based on the FY 2001 DRG relative weights and the FY 
2001 geographic adjustment factor to estimated aggregate Federal 
rate payments based on the FY 2001 relative weights and the FY 2002 
geographic adjustment factor. In making the comparison, we held the 
FY 2002 Federal rate portion constant and set the other budget 
neutrality adjustment factor and the regular and special exceptions 
reduction factors to 1.00. To achieve budget neutrality for the 
changes in the national geographic adjustment factor, we applied an 
incremental budget neutrality adjustment of 0.99703 for FY 2002 to 
the previous cumulative FY 2001 adjustment of 0.99933, yielding a 
cumulative adjustment of 0.99637 through FY 2002. For the Puerto 
Rico geographic adjustment factor, we applied an incremental budget 
neutrality adjustment of 0.99943 for FY 2002 to the previous 
cumulative FY 2001 adjustment of 1.00508, yielding a cumulative 
adjustment of 1.00450 through FY 2002. We then compared estimated 
aggregate Federal rate payments based on the FY 2001 DRG relative 
weights and the FY 2002 geographic adjustment factors to estimated 
aggregate Federal rate payments based on the FY 2002 DRG relative 
weights and the FY 2002 geographic adjustment factors. The 
incremental adjustment for DRG classifications and changes in 
relative weights would be 0.99428 nationally and for Puerto Rico. 
The cumulative adjustments for DRG classifications and changes in 
relative weights and for changes in the geographic adjustment 
factors through FY 2002 would be 0.99067 nationally and 0.99876 for 
Puerto Rico. The following table summarizes the adjustment factors 
for each fiscal year:

[[Page 22883]]



                     Budget Neutrality Adjustment for DRG Reclassifications and Recalibration and the Geographic Adjustment Factors
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   National                                             Puerto Rico
                                           -------------------------------------------------------------------------------------------------------------
                                                            Incremental adjustment                                 Incremental adjustment
                Fiscal year                -------------------------------------------------------------------------------------------------------------
                                            Geographic         DRG                                 Geographic         DRG
                                            adjustment  reclassifications   Combined   Cumulative  adjustment  reclassifications   Combined   Cumulative
                                              factor    and recalibration                            factor    and recalibration
--------------------------------------------------------------------------------------------------------------------------------------------------------
1992......................................  ..........  .................  ..........     1.00000  ..........  .................  ..........  ..........
1993......................................  ..........  .................     0.99800     0.99800  ..........  .................  ..........  ..........
1994......................................  ..........  .................     1.00531     1.00330  ..........  .................  ..........  ..........
1995......................................  ..........  .................     0.99980     1.00310  ..........  .................  ..........  ..........
1996......................................  ..........  .................     0.99940     1.00250  ..........  .................  ..........  ..........
1997......................................  ..........  .................     0.99873     1.00123  ..........  .................  ..........  ..........
1998......................................  ..........  .................     0.99892     1.00015  ..........  .................  ..........     1.00000
1999......................................     0.99944         1.00335        1.00279     1.00294     0.99898         1.00335        1.00233     1.00233
2000......................................     0.99857         0.99991        0.99848     1.00142     0.99910         0.99991        0.99901     1.00134
2001 \1\..................................     0.99846         1.00019        0.99865     0.99933     1.00365         1.00009        1.00374     1.00508
2001 \2\..................................  \3\ 0.9977     \3\ 1.00009     \3\ 0.9978     0.99922  \3\ 1.0036     \3\ 1.00009     \3\ 1.0037     1.00508
                                                     1                              0                       5                              4
2002......................................  \4\ 0.9970     \4\ 0.99428     \4\ 0.9913     0.99067  \4\ 0.9994     \4\ 0.99428     \4\ 0.9937     0.99876
                                                     3                              3                       3                              1
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Factors effective for the first half of FY 2001 (October 2000 through March 2001).
\2\ Factors effective for the second half of FY 2001 (April 2001 through September 2001).
\3\ Incremental factors are applied to FY 2000 cumulative factors.
\4\ Incremental factors are applied to the cumulative factors for the first half of FY 2001.


[[Page 22884]]

    The methodology used to determine the recalibration and 
geographic (DRG/GAF) budget neutrality adjustment factor is similar 
to that used in establishing budget neutrality adjustments under the 
prospective payment system for operating costs. One difference is 
that, under the operating prospective payment system, the budget 
neutrality adjustments for the effect of geographic 
reclassifications are determined separately from the effects of 
other changes in the hospital wage index and the DRG relative 
weights. Under the capital prospective payment system, there is a 
single DRG/GAF budget neutrality adjustment factor (the national 
rate and the Puerto Rico rate are determined separately) for changes 
in the geographic adjustment factor (including geographic 
reclassification) and the DRG relative weights. In addition, there 
is no adjustment for the effects that geographic reclassification 
has on the other payment parameters, such as the payments for 
serving low-income patients or the large urban add-on payments.
    In addition to computing the DRG/GAF budget neutrality 
adjustment factor, we used the model to simulate total payments 
under the prospective payment system.
    Additional payments under the exceptions process are accounted 
for through a reduction in the Federal and hospital-specific rates. 
For FY 2002 additional payments for the ``regular'' exceptions are 
made only for cost reporting periods that begin before October 1, 
2001. The adjustment for ``special'' exceptions payments (see 
Sec. 412.348(g)) is described in section V.D. of the preamble of 
this proposed rule. Therefore, we used the model to calculate the 
exceptions reduction factor. This exceptions reduction factor 
ensures that aggregate payments under the capital prospective 
payment system, including exceptions payments, are projected to 
equal the aggregate payments that would have been made under the 
capital prospective payment system without an exceptions process. In 
modeling exceptions for FY 2002, we calculated exceptions only for 
qualifying cost reporting periods. Since changes in the level of the 
payment rates change the level of payments under the exceptions 
process, the exceptions reduction factor must be determined through 
iteration.
    In the August 30, 1991 final rule (56 FR 43517), we indicated 
that we would publish each year the estimated payment factors 
generated by the model to determine payments for the next 5 years. 
Since we will no longer use the model after the final notice for the 
FY 2002 rates, we propose to discontinue publishing this table after 
the final notice for the FY 2002 rates. The table below provides the 
actual factors for FYs 1992 through 2001, the proposed factors for 
FY 2002, and the estimated factors that would be applicable through 
FY 2006. We caution that these are estimates for FYs 2002 and later, 
and are subject to revisions resulting from continued methodological 
refinements, receipt of additional data, and changes in payment 
policy. We note that in making these projections, we have assumed 
that the cumulative national DRG/GAF budget neutrality adjustment 
factor will remain at 0.99067 (0.99876 for Puerto Rico) for FY 2002 
and later because we do not have sufficient information to estimate 
the change that will occur in the factor for years after FY 2002.
    The projections are as follows:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Exceptions        Budget          DRG/GAF         Outlier                      Federal rate
               Fiscal year                 Update factor     reduction      neutrality      adjustment      adjustment     Federal rate   (after outlier
                                                              factor          factor        factor \1\        factor        adjustment      reduction)
--------------------------------------------------------------------------------------------------------------------------------------------------------
1992....................................             N/A          0.9813          0.9602  ..............          0.9497  ..............          415.59
1993....................................            6.07           .9756           .9162           .9980           .9496  ..............          417.29
1994....................................            3.04           .9485           .8947          1.0053           .9454        \2\.9260          378.34
1995....................................            3.44           .9734           .8432           .9998           .9414  ..............          376.83
1996....................................            1.20           .9849             N/A           .9994           .9536        \3\.9972          461.96
1997....................................            0.70           .9358             N/A           .9987           .9481  ..............          438.92
1998....................................            0.90            9659             N/A           .9989           .9382        \4\.8222          371.51
1999....................................            0.10           .9783             N/A          1.0028           .9392  ..............          378.10
2000....................................            0.30           .9730             N/A           .9985           .9402  ..............          377.03
2001 \5\................................            0.90           .9785             N/A           .9979           .9409  ..............          382.03
2002....................................            1.10        \6\.9925             N/A          0.9913           .9426  ..............          389.09
2003....................................            0.60           .9975             N/A      \7\ 1.0000        \7\.9426      \4\ 1.0255          403.44
2004....................................            0.90           .9975             N/A          1.0000           .9426  ..............          407.07
2005....................................            1.10           .9975             N/A          1.0000           .9426  ..............          411.55
2006....................................            1.10           .9975             N/A          1.0000           .9426  ..............          416.07
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Note: The incremental change over the previous year.
\2\ Note: OBRA 1993 adjustment.
\3\ Note: Adjustment for change in the transfer policy.
\4\ Note: Balanced Budget Act of 1997 adjustment.
\5\ Note: Rates are for the first half of FY 2001 (October 1, 2000 through March 31, 2001).
\6\ Note: Product of general exceptions factor (0.9937) and special exceptions factor (0.9988).
\7\ Note: Future adjustments are, for purposes of this projection, assumed to remain at the same level.

BILLING CODE 4120-01-P

[[Page 22885]]

Appendix C--Report to Congress
[GRAPHIC] [TIFF OMITTED] TP04MY01.000


[[Page 22886]]


[GRAPHIC] [TIFF OMITTED] TP04MY01.001


[[Page 22887]]


[GRAPHIC] [TIFF OMITTED] TP04MY01.002


[[Page 22888]]


[GRAPHIC] [TIFF OMITTED] TP04MY01.003

Appendix D: Recommendation of Update Factors for Operating Cost Rates 
of Payment for Inpatient Hospital Services

I. Background

    Several provisions of the Act address the setting of update 
factors for inpatient services furnished in FY 2002 by hospitals 
subject to the prospective payment system and by hospitals or units 
excluded from the prospective payment system. Section 
1886(b)(3)(B)(i)(XVII) of the Act, as amended by Section 301 of 
Public Law 106-554, sets the FY 2002 percentage increase in the 
operating cost standardized amounts equal to the rate of increase in 
the hospital market basket minus 0.55 percent for prospective 
payment hospitals in all areas. Section 1886(b)(3)(B)(iv) of the Act 
sets the FY 2002 percentage increase in the hospital-specific rates 
applicable to SCHs and MDHs equal to the rate set forth in section 
1886(b)(3)(B)(i) of the Act, that is, the same update factor as all 
other hospitals subject to the prospective payment system, or the 
rate of increase in the market basket minus 0.55 percentage points.
    Under section 1886(b)(3)(B)(ii) of the Act, the FY 2002 
percentage increase in the rate-of-increase limits for hospitals and 
units excluded from the prospective payment system ranges from the 
percentage increase in the excluded hospital market basket less a 
percentage between 0 and 2.5 percentage points, depending on the 
hospital's or unit's costs in relation to its limit for the most 
recent cost reporting period for which information is available, or 
0 percentage point if costs do not exceed two-thirds of the limit.
    In accordance with section 1886(d)(3)(A) of the Act, we are 
proposing to update the standardized amounts, the hospital-specific 
rates, and the rate-of-increase limits for hospitals and units 
excluded from the prospective payment system as provided in section 
1886(b)(3)(B) of the Act. Based on the first quarter 2001 forecast 
of the FY 2002 market basket increase of 3.1 percent for hospitals 
and units subject to the prospective payment system, the proposed 
update to the standardized amounts is 2.55 percent (that is, the 
market basket rate of increase minus 0.55 percent percentage points) 
for hospitals in both large urban and other areas. The proposed 
update to the hospital-specific rate applicable to SCHs and MDHs is 
also 2.55 percent. The proposed update for hospitals and units 
excluded from the prospective payment system would range from the 
percentage increase in the excluded hospital market basket 
(currently estimated at 3.0 percent) minus a percentage between 0 
and 2.5 percentage points, or 0 percentage points, resulting in an 
increase in the rate-of-increase limit between 0.5 and 3.0 percent, 
or 0 percent.
    Section 1886(e)(4) of the Act requires that the Secretary, 
taking into consideration the recommendations of the Medicare 
Payment Advisory Commission (MedPAC), recommend update factors for 
each fiscal year that take into account the amounts necessary for 
the efficient and effective delivery of medically appropriate and 
necessary care of high quality. Under section 1886(e)(5) of the Act, 
we are required to publish the update factors recommended under 
section 1886(e)(4) of the Act. Accordingly, this Appendix provides 
the recommendations of appropriate update factors and the analysis 
underlying our recommendations and our response to MedPAC's 
recommendations concerning the update factors.
    In its March 1, 2001 report, MedPAC stated that the legislated 
update of market basket minus 0.55 percentage points would provide a 
reasonable level of payments to hospitals. MedPAC did not make a 
separate recommendation for the hospital-specific rate applicable to 
SCHs and MDHs. We discuss MedPAC's recommendations concerning the 
update factors and our responses to these recommendations in section 
III. below.

II. Secretary's Recommendations

    Under section 1886(e)(4) of the Act, we are recommending that an 
appropriate update factor for the standardized amounts is 2.55 
percentage points for hospitals located in large urban and other 
areas. We are also recommending an update of 2.55 percentage points 
to the hospital-specific rate for SCHs and MDHs. As MedPAC states in 
its March 2001 report, there are signs of substantial improvement in 
hospitals' financial performance in FY 2000 as a result of the 
enactment of Public Law 106-113 and Public Law 106-554. In 
conjunction with the various ``give-back'' provisions in Public Law 
106-113 and Public Law 106-554 and the continuation of positive 
(MedPAC estimates 12 percent for FY 1999 (page 64)) Medicare

[[Page 22889]]

hospital inpatient margins, we believe these recommended update 
factors for FY 2002 would ensure that Medicare acts as a prudent 
purchaser and provide incentives to hospitals for increased 
efficiency, thereby contributing to the solvency of the Medicare 
Part A Trust Fund.
    We recommend that hospitals excluded from the prospective 
payment system receive an update of between 0.5 and 3.0 percentage 
points, or 0 percentage points. The update for excluded hospitals 
and units is equal to the increase in the excluded hospital 
operating market basket less a percentage between 0 and 2.5 
percentage points, or 0 percentage points, depending on the 
hospital's or unit's costs in relation to its rate-of-increase limit 
for the most recent cost reporting period for which information is 
available. The market basket rate of increase for excluded hospitals 
and units is currently forecast at 3.0 percent.
    As required by section 1886(e)(4) of the Act, we have taken into 
consideration the recommendations of MedPAC in setting these 
recommended update factors. Our responses to the MedPAC 
recommendations concerning the update factors are discussed below.

III. MedPAC Recommendations for Updating the Prospective Payment System 
Operating Standardized Amounts

    In its March 2001 Report to Congress, MedPAC recommended a 
combined operating and capital update for hospital inpatient 
prospective payment system payments for FY 2002. With the end of the 
transition to fully prospective capital payments ending with FY 
2001, both operating and capital prospective system payments will be 
made using standard Federal rates adjusted by hospital specific 
payment variables. Currently, section 1886(b)(3)(B)(i)(XVII) of the 
Act sets forth the FY 2002 percentage increase in the prospective 
payment system operating cost standardized amounts. The prospective 
payment system capital update is set at the discretion of the 
Secretary under the framework outlined in Sec. 412.308(c)(1).
    MedPAC's FY 2001 combined operating and capital update framework 
uses a weighted average of HCFA's forecasts of the operating 
(prospective payment system input price index) and the capital input 
price index. This combined market basket was used to develop an 
estimate of the change in overall operating and capital prices. 
MedPAC calculated a combined market basket forecast by weighting the 
operating market basket forecast by 0.92 and the capital market 
basket forecast by 0.08, since operating costs are estimated to 
represent 92 percent of total hospital costs (capital costs are 
estimated to represent the remaining 8 percent of total hospital 
costs). MedPAC's combined market basket for FY 2002 is estimated to 
increase by 2.8 percent, based on HCFA's December 2000 forecasted 
operating market basket increase of 3.0 percent and HCFA's December 
2000 forecasted capital market basket increase of 0.8 percent.
    For FY 2002, MedPAC's update framework would support a combined 
operating and capital update for hospital inpatient prospective 
payment system payments of 1.5 percent to 3.0 percent (or between 
the increase in the combined operating and capital market basket 
minus 1.3 percentage points and the increase in the combined 
operating and capital market basket plus 0.2 percentage points). In 
its update recommendation, MedPAC studied factors affecting the 
adequacy of payments in FY 2001 and factors expected to affect 
hospital costs in FY 2002. MedPAC concluded, ``there is no 
compelling reason to change current law setting an operating update 
for fiscal year 2002 of 0.55 percent below the rate of increase in 
the operating market basket ``(page 73). MedPAC also notes that 
while the number of hospitals with negative inpatient hospital 
margins have increased in FY 1999 (from 33.7 percent in 1998 to 36.7 
percent in 1999) (page 71), overall high inpatient Medicare margins 
generally offset hospital losses on other lines of Medicare services 
(page 68). MedPAC continues to project substantially improved 
hospital total margins for FY 2000 based on performance in the first 
half of the fiscal year (page 72).
    Response: Our long-term goal is to develop a single update 
framework for operating and capital prospective payments. However, 
the operating system update has been determined by Congress through 
FY 2003 (as amended by section 301 of Public Law 106-554). In the 
meantime, we intend to maintain as much consistency as possible with 
the current operating framework in order to facilitate the eventual 
development of a unified framework.
    We agree with MedPAC's recommendation that the current law 
update for FY 2002 of the market basket minus 0.55 percentage points 
is appropriate for the operating system update. The following 
analyses measure changes in hospital productivity, scientific and 
technological advances, practice pattern changes, changes in case-
mix, the effect of reclassification on recalibration, and forecast 
error correction.

A. Productivity

    Service level labor productivity is defined as the ratio of 
total service output to full-time equivalent employees (FTEs). While 
we recognize that productivity is a function of many variables (for 
example, labor, nonlabor material, and capital inputs), we use the 
portion of productivity attributed to direct labor since this update 
framework applies to operating payment. To recognize that we are 
apportioning the short-run output changes to the labor input and not 
considering the nonlabor inputs, we weight our productivity measure 
by the share of direct labor services in the market basket to 
determine the expected effect on cost per case.
    Our recommendation for the service productivity component is 
based on historical trends in productivity and total output for both 
the hospital industry and the general economy, and projected levels 
of future hospital service output. MedPAC's predecessor, the 
Prospective Payment Assessment Commission (ProPAC), estimated 
cumulative service productivity growth to be 4.9 percent from 1985 
through 1989, or 1.2 percent annually. At the same time, ProPAC 
estimated total output growth at 3.4 percent annually, implying a 
ratio of service productivity growth to output growth of 0.35.
    Since it is not possible at this time to develop a productivity 
measure specific to Medicare patients, we examined productivity 
(output per hour) and output (gross domestic product) for the 
economy. Depending on the exact time period, annual changes in 
productivity range from 0.3 to 0.35 percent of the change in output 
(that is, a 1.0 percent increase in output would be correlated with 
a 0.3 to 0.35 percent change in output per hour).
    Under our framework, the recommended update is based in part on 
expected productivity--that is, projected service output during the 
year, multiplied by the historical ratio of service productivity to 
total service output, multiplied by the share of direct labor in 
total operating inputs, as calculated in the hospital market basket. 
This method estimates an expected productivity improvement in the 
same proportion to expected total service growth that has occurred 
in the past and assumes that, at a minimum, growth in FTEs changes 
proportionally to the growth in total service output. Thus, the 
recommendation allows for unit productivity to be smaller than the 
historical averages in years that output growth is relatively low 
and larger in years that output growth is higher than the historical 
averages. Based on the above estimates from both the hospital 
industry and the economy, we have chosen to employ the range of 
ratios of productivity change to output change of 0.30 to 0.35.
    The expected change in total hospital service output is the 
product of projected growth in total admissions (adjusted for 
outpatient usage), projected real case-mix growth, expected quality-
enhancing intensity growth, and net of expected decline in intensity 
due to reduction of cost-ineffective practice. Case-mix growth and 
intensity numbers for Medicare are used as proxies for those of the 
total hospital, since case-mix increases (used in the intensity 
measure as well) are unavailable for non-Medicare patients. Thus, 
expected FY 2002 hospital output growth is simply the sum of the 
expected change in intensity (0.3 percent), projected admissions 
change (1.6 percent for FY 2002), and projected real case-mix growth 
(1.0 percent), or 2.9 percent. The share of direct labor services in 
the market basket (consisting of wages, salaries, and employee 
benefits) is 61.4 percent.
    Multiplying the expected change in total hospital service output 
(2.9 percent) by the ratio of historical service productivity change 
to total service growth of 0.30 to 0.35 and by the direct labor 
share percentage 61.4, provides our productivity standard of -0.6 to 
-0.5 percent.
    In past years, MedPAC made an adjustment for productivity 
improvement to reflect the level of improvement in the production of 
health care services, without affecting the quality of those 
services. Typically, MedPAC made a downward adjustment in its 
framework to reflect expected improvements in hospital productivity. 
In its FY 2002 combined update framework, MedPAC did not make an 
adjustment for productivity. Instead, MedPAC believes that the costs 
associated with scientific and technological advances should be 
financed partially

[[Page 22890]]

through improvements in hospital productivity. As a result, MedPAC 
offset its adjustment for scientific and technological advances by a 
fixed standard of expected productivity growth of 0.5 percent for FY 
2002. Our productivity adjustment of -0.6 to -0.5 percent is 
consistent with the range of MedPAC's fixed standard of expected 
productivity growth of 0.5 percent for FY 2002.

B. Intensity

    We base our intensity standard on the combined effect of three 
separate factors: changes in the use of quality enhancing services, 
changes in the use of services due to shifts in within-DRG severity, 
and changes in the use of services due to reductions of cost-
ineffective practices. For FY 2002, we recommend an adjustment of 
0.2 to 0.3 percent. The basis of this recommendation is discussed 
below.
    We have no empirical evidence that accurately gauges the level 
of quality-enhancing technology changes. A study published in the 
Winter 1992 issue of the Health Care Financing Review, 
``Contributions of case mix and intensity change to hospital cost 
increases'' (pages 151-163), suggests that one-third of the 
intensity change is attributable to high-cost technology. The 
balance was unexplained but the authors speculated that it is 
attributable to fixed costs in service delivery.
    Typically, a specific new technology increases cost in some uses 
and decreases cost in other uses. Concurrently, health status is 
improved in some situations while in other situations it may be 
unaffected or even worsened using the same technology. It is 
difficult to separate out the relative significance of each of the 
cost-increasing effects for individual technologies.
    Other things being equal, per-discharge fixed costs tend to 
fluctuate in inverse proportion to changes in volume. Fixed costs 
exist whether patients are treated or not. If volume is declining, 
per-discharge fixed costs will rise, but the reverse is true if 
volume is increasing.
    Following methods developed by HCFA's Office of the Actuary for 
deriving hospital output estimates from total hospital charges, we 
have developed Medicare-specific intensity measures based on a 5-
year average using FYs 1996 through 2000 MedPAR billing data. Case-
mix constant intensity is calculated as the change in total Medicare 
charges per discharge adjusted for changes in the average charge per 
unit of service as measured by the Consumer Price Index (CPI) for 
hospital and related services and changes in real case-mix. Thus, in 
order to measure changes in intensity, one must measure changes in 
real case-mix.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services), and changes in real case-mix. 
Without reliable estimates of the proportions of the overall annual 
intensity increases due, respectively, to ineffective practice 
patterns and to the combination of quality-enhancing new 
technologies and within-DRG complexity, we assume that one-half of 
the annual increase is due to each of these factors.
    For FY 2002, we have developed a Medicare-specific intensity 
measure based on a 5-year average using FY 1996 through 2000 data. 
In determining case-mix constant intensity, we estimate that real 
case-mix increase was 1.0 to 1.4 percent each year. The estimate for 
those years is supported by past studies of case-mix change by the 
RAND Corporation. The most recent study was ``Has DRG Creep Crept 
Up? Decomposing the Case Mix Index Change Between 1987 and 1988'' by 
G. M. Carter, J. P. Newhouse, and D. A. Relles, R-4098-HCFA/ProPAC 
(1991). The study suggested that real case-mix change was not 
dependent on total change, but was usually a fairly steady 1.0 to 
1.4 percent per year. Following that study, we consider up to 1.4 
percent of observed case-mix change as real for FY 1996 through FY 
2000.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services), and changes in real case-mix. The 
average percentage change in charge per discharge was 4.7 percent 
and the average annual change in the CPI for hospital and related 
services was 4.2 percent. Dividing the change in charge per 
discharge by the quantity of the real case-mix index change and the 
CPI for hospital and related services yields an average annual 
change in intensity of -0.9 percent. Assuming the technology/fixed 
cost ratio still holds (.33), technology would account for a -0.3 
percent annual decline while fixed costs would account for a -0.6 
percent annual decline. The decline in fixed costs per discharge 
makes intuitive sense as volume, measured by total discharges, has 
increased during the period.
    For FYs 1995 through 1999, observed case-mix index change ranged 
from a low of -0.7 percent to a high of 1.6 percent, with a 5-year 
average change of 0.2 percent. If we assume that the upper bound of 
real case-mix was 1.0 percent, we estimate that case-mix constant 
intensity increased by an average 0.3 percent during FYs 1996 
through 2000, for a cumulative increase of 1.4 percent. If we assume 
that the upper bound of real case-mix increase was 1.4 percent, we 
estimate that case-mix constant intensity increased by an average 
0.2 percent during FYs 1996 through 2000, for a cumulative increase 
of 1.2 percent. Thus, we are recommending an intensity adjustment 
for FY 2002 between 0.2 and 0.3 percent.
    MedPAC does not make an adjustment for intensity per se, but its 
combined update recommendation for FY 2002 includes two categories 
that we consider to be comparable with our intensity recommendation. 
MedPAC is recommending a 0.0 to 0.5 update for scientific and 
technological advances to account for anticipated uses of emerging 
technologies that enhance the quality of hospital services, but 
increase costs of hospital care. MedPAC recognized an allowance for 
science and technological advances of 0.5 percent to 1.0 percent. It 
believes that the costs associated with scientific and technological 
advances should be financed at least in part through improvements in 
hospital productivity. Hence, MedPAC offsets its allowance for 
science and technology by 0.5 percent for productivity. In addition, 
MedPAC includes, when appropriate, an adjustment for one-time 
factors expected to affect costs in FY 2002 and the removal of the 
adjustment for FY 2002 one-time factors in its science and 
technology adjustment. MedPAC concluded that a one-time adjustment 
of 0.5 percent for the Health Insurance Portability and 
Accountability Act of 1996 (HIPAA) regulatory requirements should be 
reflected in the FY 2002 payment update. Additionally, since MedPAC 
believes that the costs associated with one-time factors should not 
be built permanently into the rates, it recommended that the FY 2002 
payment rates be reduced by 0.5 percent to offset the increase it 
recommended in the FY 2000 update for the costs associated with year 
2000 (Y2K) computer improvements. Thus, MedPAC's combined FY 2002 
adjustment for science and technological advances is 0.0 percent to 
0.5 percent.
    MedPAC's recommendation also takes into account the trend of 
some acute care providers to shift care to a postacute care 
facility. While this can occur for many reasons and the shifting of 
costs may maintain or improve quality of care for Medicare 
beneficiaries, it leads to an inappropriate distribution of payments 
and reduces the resources available for acute care providers to pay 
for services to other Medicare beneficiaries. We agree with MedPAC 
that the site-of-care substitution effect is real and believe that 
it is factored into our intensity recommendation.

C. Change in Case-Mix

    Our analysis takes into account projected changes in case-mix, 
adjusted for changes attributable to improved coding practices. For 
our FY 2002 update recommendation, we are projecting a 1.0 percent 
increase in the case-mix index. We define real case-mix change as 
actual changes in the mix (and resource requirements) of Medicare 
patients as opposed to changes in coding behavior that result in 
assignment of cases to higher-weighted DRGs, but do not reflect 
greater resource requirements. Unlike in past years, where we 
differentiated between ``real'' case-mix increase and increases 
attributable to changes in coding behavior, we do not believe 
changes in coding behavior will impact the overall case-mix in FY 
2002. As such, for FY 2002, we estimate that real case-mix is equal 
to projected change in case-mix. Thus, we are recommending a 0.0 
percent adjustment for case-mix.
    MedPAC's analysis indicates that coding change has reduced case-
mix index growth. In the past, MedPAC has recommended a negative 
adjustment when DRG coding changes has led to case-mix index growth 
(upcoding) and has recommended a positive adjustment when DRG coding 
changes have led to a decline in case-mix (downcoding). In light of 
evidence that coding had no significant effect on case-mix change, 
MedPAC recommended an adjustment of 0.0 percent for FY 2002.
    MedPAC also makes an adjustment for within-DRG severity. In past 
years, MedPAC has included an adjustment for increased case 
complexity not captured by the DRG classification system. MedPAC 
recognizes

[[Page 22891]]

that as the DRG system matures, it should account for more of the 
variation in costs by DRG assignment, leaving less within-DRG 
variation in case complexity and costliness (page 76). Therefore, 
MedPAC recommended an adjustment of 0.0 percent for FY 2002.

D. Effect of FY 2000 DRG Reclassification and Recalibration

    We estimate that DRG reclassification and recalibration for FY 
2000 resulted in a 0.0 percent change in the case-mix index when 
compared with the case-mix index that would have resulted if we had 
not made the reclassification and recalibration changes to the 
GROUPER.

E. Forecast Error Correction

    We make a forecast error correction if the actual market basket 
changes differ from the forecasted market basket by 0.25 percentage 
points or more. There is a 2-year lag between the forecast and the 
measurement of forecast error. The estimated market basket 
percentage increase used to update the FY 2000 payment rates was 2.9 
percent. Our most recent data indicates the actual FY 2000 increase 
was 3.6 percent. The resulting forecast error in the FY 2000 market 
basket rate of increase is 0.7 percentage points. This forecast 
error is a result of prices for wages, benefits, and chemicals 
increasing more rapidly than expected. Market conditions enabled 
hospitals to be less restrictive with pay increases than initially 
projected. Prices for chemicals were underestimated due to the 
unanticipated surge in oil prices in FY 2000.
    MedPAC also made a recommendation in its FY 2002 combined update 
framework to adjust for any error in the market basket forecasts 
used to set FY 2000 payment rates. It recommended a combined 
adjustment for FY 2000 forecast error correction of 0.7 percent. 
MedPAC determined this forecast error adjustment by weighting the 
difference between the actual and forecasted operating (92 percent) 
and capital (8 percent) market basket increases for FY 2000. The 
forecasted FY 2000 operating market basket was 2.9 percent and the 
actual FY 2000 operating market basket increase was 3.6 percent. The 
FY 2000 capital market basket was forecasted to increase by 0.6 
percent and the actual market basket increase was 0.9 percent. This 
implies that MedPAC's combined operating and capital market basket 
was forecasted at 2.7 percent and the combined actual operating and 
capital market basket was 3.4 percent. Accordingly, MedPAC 
recommended a 0.7 percent forecast error correction for its FY 2002 
combined update recommendation.

F. Medicare Policy Change

    In developing its update recommendation for FY 2002, MedPAC 
includes an adjustment for Medicare policy changes affecting 
financial status in its section of factors affecting current level 
of payments. While MedPAC's update framework has not considered such 
costs in the past, MedPAC believes that it is appropriate to account 
for significant costs incurred as a result of new Medicare policy. 
For FY 2002, MedPAC believes that legislated updates will match cost 
growth and that the overall the net affects of legislative changes 
(from Public Law 105-33, Public Law 106-113, and Public Law 106-554) 
will be small. Thus, it did not recommend any additional allowance 
for these costs for FY 2002. Accordingly, MedPAC recommended a 0.0 
percent adjustment for Medicare policy changes in its update 
framework for FY 2002.

                                  Comparison of FY 2002 Update Recommendations
----------------------------------------------------------------------------------------------------------------
                                                     HHS                                 MedPAC \1\
----------------------------------------------------------------------------------------------------------------
          Market basket                              MB                                    MB \1\
----------------------------------------------------------------------------------------------------------------
Policy Adjustment Factors:
    Productivity.................   -0.6 to -0.5.........................  (\2\)
    Site-of-Service Substitution.  (\3\).................................  -2.0 to - 1.0.
    Intensity....................  0.2 to 0.3............................  .....................................
    Science & Technology.........  ......................................  0.0 to 0.5.
    Real Within DRG Change.......  ......................................  (\4\)
    One-Time Factors.............  ......................................  0.0
    Medicare Policy Changes......  ......................................  0.0
                                  ------------------------------------------------------------------------------
        Subtotal.................  -0.4 to -0.2..........................  -2.0 to -0.5
Case-Mix Adjustment Factors:
    Projected Case-Mix Change....  1.0...................................  .....................................
    Real Across DRG Change.......  1.0...................................  0.0
        Subtotal.................  0.0...................................  0.0
    Effect of FY 2000 DRG Reclass/ 0.0...................................  .....................................
     Recalibration.
    Forecast Error Correction      0.7...................................  0.7
                                  ------------------------------------------------------------------------------
        Total Recommendation       MB + 0.3 to MB + 0.5..................  MB \1\ -1.3 to MB \1\ + 0.2.
         Update.
----------------------------------------------------------------------------------------------------------------
\1\ Used HCFA's December 2000 operating and capital market basket forecast in its combined update
  recommendation.
\2\ Included in MedPAC's Science and Technology Adjustment.
\3\ Included in HHS' Intensity Factor.
\4\ Included in MedPAC's Case-Mix Adjustment.

    While the above analysis would suggest an update between 
operating market basket plus 0.3 percentage points and the operating 
market basket plus 0.5 percentage points, consistent with current 
law, we are recommending an update of market basket increase minus 
0.55 percentage points (or 2.55 percent). Just as MedPAC believes 
that market basket minus 0.55 percentage points will provide a 
reasonable level of payments for FY 2002, we believe that a 2.55 
update factor for FY 2002 will appropriately reflect current trends 
in health care delivery, including the recent decreases in the use 
of hospital inpatient services and the corresponding increase in the 
use of hospital outpatient and postacute care services.
    Also consistent with current law, we are recommending that the 
hospital-specific rates applicable to SCHs and MDHs be increased by 
the same update, 2.55 percentage points. As MedPAC states in its 
March 2001 report, there are signs of substantial improvement in 
hospital financial performance in FY 2000. In conjunction with the 
various ``give-back'' provisions in Public Law 106-113 and Public 
Law 106-554 and the continuation of positive (12 percent for FY 
1999) Medicare hospital inpatient margins, we believe these 
recommended update factors for FY 2002 would ensure that Medicare 
acts as a prudent purchaser and provide incentives to hospitals for 
increased efficiency, thereby contributing to the solvency of the 
Medicare Part A Trust Fund.

[FR Doc. 01-11062 Filed 5-3-01; 8:45 am]
BILLING CODE 4120-01-P