[Federal Register Volume 66, Number 188 (Thursday, September 27, 2001)]
[Notices]
[Pages 49454-49475]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-23820]



[[Page 49453]]

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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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Medicare Program; Hospice Wage Index Fiscal Year 2002; Notice

  Federal Register / Vol. 66, No. 188 / Thursday, September 27, 2001 / 
Notices  

[[Page 49454]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1175-N]
RIN 0938-ZA08


Medicare Program; Hospice Wage Index Fiscal Year 2002

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the annual update to the hospice wage 
index as required by statute. This update is effective October 1, 2001 
through September 30, 2002. The wage index is used to reflect local 
differences in wage levels. The hospice wage index methodology and 
values are based on recommendations of a negotiated rulemaking advisory 
committee and were originally published in the Federal Register on 
August 8, 1997.

EFFECTIVE DATE: October 1, 2001.

FOR FURTHER INFORMATION CONTACT:

Lynn Riley, (410) 786-1286
Carol Blackford, (410) 786-5909

SUPPLEMENTARY INFORMATION

I. Background

A. Statute and Regulations

    Hospice Care is an approach to treatment that recognizes that the 
impending death of an individual warrants a change in the focus from 
curative care to palliative care (relief of pain and other 
uncomfortable symptoms). The goal of hospice care is to help terminally 
ill individuals continue life with minimal disruption to normal 
activities while remaining primarily in the home environment. A hospice 
uses an interdisciplinary approach to deliver medical, social, 
psychological, emotional, and spiritual services through use of a broad 
spectrum of professional and other caregivers, with the goal of making 
the individual as physically and emotionally comfortable as possible. 
Counseling and inpatient respite services are available to the family 
of the hospice patient. Hospice programs consider both the patient and 
the family as a unit of care.
    Section 1861(dd) of the Social Security Act (the Act) provides for 
coverage of hospice care for terminally ill Medicare beneficiaries who 
elect to receive care from a participating hospice. The statutory 
authority for payment to hospices participating in the Medicare program 
is contained in section 1814(i) of the Act.
    Our existing regulations under 42 CFR Part 418 establish 
eligibility requirements and payment standards and procedures, define 
covered services, and delineate the conditions a hospice must meet to 
be approved for participation in the Medicare program. Subpart G of 
Part 418 provides for payment to hospices based on one of four 
prospectively determined rates for each day in which a qualified 
Medicare beneficiary is under the care of a hospice. The four rate 
categories are routine home care, continuous home care, inpatient 
respite care, and general inpatient care. Payment rates are established 
for each category.
    The regulations at Sec. 418.306(c), which require the rates to be 
adjusted by a wage index, were revised in the August 8, 1997 final rule 
published in the Federal Register (62 FR 42860). This rule implemented 
a new methodology for calculating the hospice wage index based on the 
recommendations of a negotiated rulemaking committee. The committee 
reached consensus on the methodology. We included the resulting 
committee statement, describing that consensus, as an appendix to the 
August 8, 1997 final rule (62 FR 42883). The provisions of the final 
hospice wage index rule are as follows:
     The revised hospice wage index will be calculated using 
the most current available hospital wage data.
     The revised hospice wage index was phased in over a 3-year 
transition period. For the first year of the transition period, October 
1, 1997 through September 30, 1998, a blended index was calculated by 
adding two-thirds of the 1983 index value for an area to one-third of 
the revised wage index value for that area. During the second year of 
the transition period, October 1, 1998 through September 30, 1999, the 
calculation was similar, except that the blend was one-third of the 
1983 index value and two-thirds of the revised wage index value for 
that area. We fully implemented the revised wage index during the third 
transition period, October 1, 1999 throughSeptember 30, 2000.
     All hospice wage index values of 0.8 or greater are 
subject to a budget-neutrality adjustment to ensure that we do not pay 
more in the aggregate than we would have paid under the original 1983 
wage index. The budget-neutrality adjustment is calculated by 
multiplying the hospice wage index for a given area by the budget-
neutrality adjustment factor. The budget-neutrality adjustment is to be 
applied annually, both during and after the transition period.
     All hospice wage index values below 0.8 receive the 
greater of the following adjustments: the wage index floor, a 15 
percent increase, subject to a maximum wage index value of 0.8; or, the 
budget-neutrality adjustment.
     The wage index is to be updated annually, in the Federal 
Register, based on the most current available hospital wage data. These 
data will include any changes to the definitions of Metropolitan 
Statistical Areas (MSA).
    Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended 
section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice 
rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to 
be updated by a factor equal to the market basket index, minus 1 
percentage point. However, section 131(a) of the Balanced Budget 
Refinement Act of 1999 (BBRA) changed the payment rates for FYs 2001 
and 2002 by increasing the FY 2001 rate by 0.5 percent and the FY 2002 
rate by 0.75 percent. Section 131(b) of the BBRA states that any 
additional payments made under section 131(a) of the BBRA shall not be 
included in updating the hospice rates after those 2 years.
    Section 321(a) of the Medicare, Medicaid and State Child Health 
Insurance Program (SCHIP) Benefits Improvement and Protection Act 
(BIPA) amended section 814(i)(1)(C)(ii)(VI) of the Act by increasing 
Medicare hospice rates for FY 2001 by 5 percentage points. This 
amendment was applicable to hospice care furnished on or after April 1, 
2001. Section 321(b) of BIPA further stipulated that the 5 percent 
increase in Medicare hospice rates during the period beginning on April 
1, 2001 through September 30, 2001 will be treated as the payment rates 
in effect during the FY 2001. This means that the 5 percent increase 
was made to the base that is updated annually according to a 
statutorily dictated percentage of the market basket update, as 
provided in section 1814(i) of the Act. The new Medicare rates for this 
time period were announced through HCFA Program Memorandum A-01-04 on 
January 16, 2001.
    Also, section 321(d) of BIPA specified that the Secretary of Health 
and Human Services use 1.0043 as the hospice wage index value for the 
Wichita, Kansas MSA in calculating payments for a hospice program 
providing hospice care in this MSA during FY 2000. CMS's Regional Home 
Health Intermediaries were instructed, through HCFA Program Memorandum 
A-01-07, to re-calculate the payment for Medicare hospice services 
provided during FY 2000 by Medicare hospice providers in the Wichita, 
Kansas MSA using the new wage index value of 1.0043, and to disburse a 
lump sum payment reflecting

[[Page 49455]]

the difference in the two values that fiscal year.

B. Update to the Hospice Wage Index

    This annual update is effective October 1, 2001 through September 
30, 2002. In accordance with the agreement signed by the Centers for 
Medicaid & Medicare Services (CMS) and all other members of the Hospice 
Wage Index Negotiated Rulemaking Committee, we are using the most 
current CMS hospital data available, including any changes to the 
definitions of MSAs. The FY 2001 hospital wage index was the most 
current hospital wage data available when the FY 2002 wage index values 
were calculated. We used the pre-reclassified and pre-floor hospital 
area wage index data.
    All wage index values are adjusted by a budget-neutrality factor of 
1.064726 and are subject to the wage index floor adjustment, if 
applicable. We have completed all of the calculations described above 
and included them in the wage index values reflected in both Tables A 
and B below. A detailed description of the method used to compute the 
hospice wage index is contained in both the September 4, 1996 proposed 
rule published in the Federal Register (61 FR 46579) and the August 8, 
1997 final rule published in the Federal Register (62 FR 42860).
1. Metropolitan Statistical Areas
    As explained in the September 4, 1996 hospice wage index proposed 
rule, each hospice's labor market area would be established by the MSA 
definitions issued by the Office of Management and Budget (OMB) on 
December 28, 1992 based on the 1990 census, and updated periodically by 
OMB. Any changes to the MSA definitions would be effective annually and 
announced in the final rule updating the hospice wage index.
2. MSA Wage Index Values Lower than Rural Values
    As explained above, any area not included in an MSA is considered 
to be nonurban and receives the statewide rural rate. We are aware that 
in the past, a number of MSAs have had wage index values that were 
lower than their rural statewide value. This difference is due to 
variations in local wage data as compared to national wage data. The 
hospice wage index is computed by dividing the hourly wage rate for an 
MSA or nonurban area by a national hourly wage rate. Nonurban areas 
could receive a higher wage index value than urban areas in the same 
State if the hourly wage rate in the nonurban area increased at a 
greater rate.

C. Tables

              Table A.--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
                              Urban area (constituent
       MSA Code No.              counties or county       Wage index \2\
                                  equivalents) \1\
------------------------------------------------------------------------
0040.....................  Abilene, TX..................          0.8773
                             Taylor, TX
0060.....................  Aguadilla, PR................          0.5050
                             Aguada, PR
                             Aguadilla, PR
                             Moca, PR
0080.....................  Akron, OH....................          1.0366
                             Portage, OH
                             Summit, OH
0120.....................  Albany, GA...................          1.0576
                             Dougherty, GA
                             Lee, GA
0160.....................  Albany-Schenectady-Troy, NY..          0.9102
                             Albany, NY
                             Montgomery, NY
                             Rensselaer, NY
                             Saratoga, NY
                             Schenectady, NY
                             Schoharie, NY
0200.....................  Albuquerque, NM..............          0.9727
                             Bernalillo, NM
                             Sandoval, NM
                             Valencia, NM
0220.....................  Alexandria, LA...............          0.8649
                             Rapides, LA
0240.....................  Allentown-Bethlehem-Easton,            1.0567
                            PA.
                             Carbon, PA
                             Lehigh, PA
                             Northampton, PA
0280.....................  Altoona, PA..................          0.9951
                             Blair, PA
0320.....................  Amarillo, TX.................          0.9279
                             Potter, TX
                             Randall, TX
0380.....................  Anchorage, AK................          1.3621
                             Anchorage, AK
0440.....................  Ann Arbor, MI................          1.1982
                             Lenawee, MI
                             Livingston, MI
                             Washtenaw, MI
0450.....................  Anniston, AL.................          0.8820
                             Calhoun, AL
0460.....................  Appleton-Oshkosh-Neenah, WI..          0.9638
                             Calumet, WI

[[Page 49456]]

 
                             Outagamie, WI
                             Winnebago, WI
0470.....................  Arecibo, PR..................          0.8518
                             Arecibo, PR
                             Camuy, PR
                             Hatillo, PR
0480.....................  Asheville, NC................          1.0132
                             Buncombe, NC
                             Madison, NC
0500.....................  Athens, GA...................          1.0369
                             Clarke, GA
                             Madison, GA
                             Oconee, GA
0520.....................  Atlanta, GA..................          1.0749
                             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........          1.1906
                             Atlantic, NJ
                             Cape May, NJ
0580.....................  Aubrn-Opelika, AL............          0.8631
                             Lee, AL
0600.....................  Augusta-Aiken, GA-SC.........          0.9753
                             Columbia, GA
                             McDuffie, GA
                             Richmond, GA
                             Aiken, SC
                             Edgefield, SC
0640.....................  Austin-San Marcos, TX........          1.0197
                             Bastrop, TX
                             Caldwell, TX
                             Hays, TX
                             Travis, TX
                             Williamson, TX
0680.....................  Bakersfield, CA..............          1.0304
                             Kern, CA
0720.....................  Baltimore, MD................          0.9971
                             Anne Arundel, MD
                             Baltimore, MD
                             Baltimore City, MD
                             Carroll, MD
                             Harford, MD
                             Howard, MD
                             Queen Anne's, MD
0733.....................  Bangor, ME...................          1.0180
                             Penobscot, ME
0743.....................  Barnstable-Yarmouth, MA......          1.4735
                             Barnstable, MA
0760.....................  Baton Rouge, LA..............          0.9414
                             Ascension, LA
                             East Baton Rouge, LA
                             Livingston, LA
                             West Baton Rouge, LA
0840.....................  Beaumont-Port Arthur, TX.....          0.9310

[[Page 49457]]

 
                             Hardin, TX
                             Jefferson, TX
                             Orange, TX
0860.....................  Bellingham, WA...............          1.2179
                             Whatcom, WA
0870.....................  Benton Harbor, MI............          0.9232
                             Berrien, MI
0875.....................  Bergen-Passaic, NJ...........          1.2615
                             Bergen, NJ
                             Passaic, NJ
0880.....................  Billings, MT.................          1.0205
                             Yellowstone, MT
0920.....................  Biloxi-Gulfport-Pascagoula,            0.8769
                            MS.
                             Hancock, MS
                             Harrison, MS
                             Jackson, MS
0960.....................  Binghamton, NY...............          0.9252
                             Broome, NY
                             Tioga, NY
1000.....................  Birmingham, AL...............          0.8999
                             Blount, AL
                             Jefferson, AL
                             St. Clair, AL
                             Shelby, AL
1010.....................  Bismarck, ND.................          0.8204
                             Burleigh, ND
                             Morton, ND
1020.....................  Bloomington, IN..............          0.9298
                             Monroe, IN
1040.....................  Bloomington-Normal, IL.......          0.9684
                             McLean, IL
1080.....................  Boise City, ID...............          0.9589
                             Ada, ID
                             Canyon, ID
1123.....................  Boston-Worcester-Lawrence-             1.1882
                            Lowell-Brockton, MA-NH.
                             Bristol, MA
                             Essex, MA
                             Middlesex, MA
                             Norfolk, MA
                             Plymouth, MA
                             Suffolk, MA
                             Worcester, MA
                             Hillsborough, NH
                             Merrimack, NH
                             Rockingham, NH
                             Strafford, NH
1125.....................  Boulder-Longmont, CO.........          1.0361
                             Boulder, CO
1145.....................  Brazoria, TX.................          0.9218
                             Brazoria, TX
1150.....................  Bremerton, WA................          1.1685
                             Kitsap, WA
1240.....................  Brownsville-Harlingen-San              0.9287
                            Benito, TX.
                             Cameron, TX
1260.....................  Bryan-College Station, TX....          0.8770
                             Brazos, TX
1280.....................  Buffalo-Niagara Falls, NY....          1.0200
                             Erie, NY
                             Niagara, NY
1303.....................  Burlington, VT...............          1.1430
                             Chittenden, VT
                             Franklin, VT
                             Grand Isle, VT
1310.....................  Caguas, PR...................          0.5246
                             Caguas, PR
                             Cayey, PR
                             Cidra, PR
                             Gurabo, PR
                             San Lorenzo, PR
1320.....................  Canton-Massillon, OH.........          0.9140
                             Carroll, OH

[[Page 49458]]

 
                             Stark, OH
1350.....................  Casper, WY...................          0.9289
                             Natrona, WY
1360.....................  Cedar Rapids, IA.............          0.9301
                             Linn, IA
1400.....................  Champaign-Urbana, IL.........          0.9793
                             Champaign, IL
1440.....................  Charleston-North Charleston,           0.9623
                            SC.
                             Berkeley, SC
                             Charleston, SC
                             Dorchester, SC
1480.....................  Charleston, WV...............          0.9838
                             Kanawha, WV
                             Putnam, WV
1520.....................  Charlotte-Gastonia-Rock Hill,          0.9999
                            NC-SC.
                             Cabarrus, NC
                             Gaston, NC
                             Lincoln, NC
                             Mecklenburg, NC
                             Rowan, NC
                             Stanly, NC
                             Union, NC
                             York, SC
1540.....................  Charlottesville, VA..........          1.1487
                             Albemarle, VA
                             Charlottesville City, VA
                             Fluvanna, VA
                             Greene, VA
1560.....................  Chattanooga, TN-GA...........          1.0469
                             Catoosa, GA
                             Dade, GA
                             Walker, GA
                             Hamilton, TN
                             Marion, TN
1580.....................  Cheyenne, WY.................          0.8846
                             Laramie, WY
1600.....................  Chicago, IL..................          1.1867
                             Cook, IL
                             DeKalb, IL
                             Du Page, IL
                             Grundy, IL
                             Kane, IL
                             Kendall, IL
                             Lake, IL
                             McHenry, IL
                             Will, IL
1620.....................  Chico-Paradise, CA...........          1.0560
                             Butte, CA
1640.....................  Cincinnati, OH-KY-IN.........          1.0024
                             Brown, OH
                             Clermont, OH
                             Hamilton, OH
                             Warren, OH
                             Boone, KY
                             Campbell, KY
                             Gallatin, KY
                             Grant, KY
                             Kenton, KY
                             Pendleton, KY
                             Dearborn, IN
                             Ohio, IN
1660.....................  Clarksville-Hopkinsville, TN-          0.8735
                            KY.
                             Christian, KY
                             Montgomery, TN
1680.....................  Cleveland-Lorain-Elyria, OH..          1.0218
                             Ashtabula, OH
                             Cuyahoga, OH
                             Geauga, OH
                             Lake, OH
                             Lorain, OH
                             Medina, OH

[[Page 49459]]

 
1720.....................  Colorado Springs, CO.........          1.0325
                             El Paso, CO
1740.....................  Columbia, MO.................          0.9541
                             Boone, MO
1760.....................  Columbia, SC.................          1.0172
                             Lexington, SC
                             Richland, SC
1800.....................  Columbus, GA-AL..............          0.9123
                             Chattahochee, GA
                             Harris, GA
                             Muscogee, GA
                             Russell, AL
1840.....................  Columbus, OH.................          1.0242
                             Delaware, OH
                             Fairfield, OH
                             Franklin, OH
                             Licking, OH
                             Madison, OH
                             Pickaway, OH
1880.....................  Corpus Christi, TX...........          0.9291
                             Nueces, TX
                             San Patricio, TX
1890.....................  Corvallis, Oregon............          1.2059
                             Benton, OR
1900.....................  Cumberland, MD-WV............          0.8911
                             Allegany, MD
                             Mineral, WV
1920.....................  Dallas, TX...................          1.0555
                             Collin, TX
                             Dallas, TX
                             Denton, TX
                             Ellis, TX
                             Henderson, TX
                             Hunt, TX
                             Kaufman, TX
                             Rockwall, TX
1950.....................  Danville, VA.................          0.9145
                             Danville City, VA
                             Pittsylvania, VA
1960.....................  Davenport-Moline-Rock Island,          0.9474
                            IA-IL.
                             Scott, IA
                             Henry, IL
                             Rock Island, IL
2000.....................  Dayton-Springfield, OH.......          1.0053
                             Clark, OH
                             Greene, OH
                             Miami, OH
                             Montgomery, OH
2020.....................  Daytona Beach, FL............          0.9795
                             Flagler, FL
                             Volusia, FL
2030.....................  Decatur, AL..................          0.9086
                             Lawrence, AL
                             Morgan, AL
2040.....................  Decatur, IL..................          0.8651
                             Macon, IL
2080.....................  Denver, CO...................          1.0840
                             Adams, CO
                             Arapahoe, CO
                             Denver, CO
                             Douglas, CO
                             Jefferson, CO
2120.....................  Des Moines, IA...............          0.9708
                             Dallas, IA
                             Polk, IA
                             Warren, IA
2160.....................  Detroit, MI..................          1.1190
                             Lapeer, MI
                             Macomb, MI
                             Monroe, MI
                             Oakland, MI

[[Page 49460]]

 
                             St. Clair, MI
                             Wayne, MI
2180.....................  Dothan, AL...................          0.8457
                             Dale, AL
                             Houston, AL
2190.....................  Dover, DE....................          1.0730
                             Kent, DE
2200.....................  Dubuque, IA..................          0.9312
                             Dubuque, IA
2240.....................  Duluth-Superior, MN-WI.......          1.0681
                             St. Louis, MN
                             Douglas, WI
2281.....................  Dutchess County, NY..........          1.0912
                             Dutchess, NY
2290.....................  Eau Claire, WI...............          0.9359
                             Chippewa, WI
                             Eau Claire, WI
2320.....................  El Paso, TX..................          0.9951
                             El Paso, TX
2330.....................  Elkhart-Goshen, IN...........          0.9737
                             Elkhart, IN
2335.....................  Elmira, NY...................          0.9099
                             Chemung, NY
2340.....................  Enid, OK.....................          0.9167
                             Garfield, OK
2360.....................  Erie, PA.....................          0.9567
                             Erie, PA
2400.....................  Eugene-Springfield, OR.......          1.1675
                             Lane, OR
2440.....................  Evansville-Henderson, IN-KY..          0.8702
                             Posey, IN
                             Vanderburgh, IN
                             Warrick, IN
                             Henderson, KY
2520.....................  Fargo-Moorhead, ND-MN........          0.9315
                             Clay, MN
                             Cass, ND
2560.....................  Fayetteville, NC.............          0.9215
                             Cumberland, NC
2580.....................  Fayetteville-Springdale-               0.8422
                            Rogers, AR.
                             Benton, AR
                             Washington, AR
2620.....................  Flagstaff, AZ-UT.............          1.1378
                             Coconino, AZ
                             Kane, UT
2640.....................  Flint, MI....................          1.1930
                             Genesee, MI
2650.....................  Florence, AL.................          0.8109
                             Colbert, AL
                             Lauderdale, AL
2655.....................  Florence, SC.................          0.9345
                             Florence, SC
2670.....................  Fort Collins-Loveland, CO....          1.1336
                             Larimer, CO
2680.....................  Ft. Lauderdale, FL...........          1.0776
                             Broward, FL
2700.....................  Fort Myers-Cape Coral, FL....          0.9846
                             Lee, FL
2710.....................  Fort Pierce-Port St. Lucie,            1.0155
                            FL.
                             Martin, FL
                             St. Lucie, FL
2720.....................  Fort Smith, AR-OK............          0.8573
                             Crawford, AR
                             Sebastian, AR
                             Sequoyah, OK
2750.....................  Fort Walton Beach, FL........          1.0229
                             Okaloosa, FL
2760.....................  Fort Wayne, IN...............          0.9226
                             Adams, IN
                             Allen, IN
                             De Kalb, IN

[[Page 49461]]

 
                             Huntington, IN
                             Wells, IN
                             Whitley, IN
2800.....................  Forth Worth-Arlington, TX....          1.0144
                             Hood, TX
                             Johnson, TX
                             Parker, TX
                             Tarrant, TX
2840.....................  Fresno, CA...................          1.0758
                             Fresno, CA
                             Madera, CA
2880.....................  Gadsden, AL..................          0.8968
                             Etowah, AL
2900.....................  Gainesville, FL..............          1.0726
                             Alachua, FL
2920.....................  Galveston-Texas City, TX.....          1.0560
                             Galveston, TX
2960.....................  Gary, IN.....................          1.0066
                             Lake, IN
                             Porter, IN
2975.....................  Glens Falls, NY..............          0.8902
                             Warren, NY
                             Washington, NY
2980.....................  Goldsboro, NC................          0.8968
                             Wayne, NC
2985.....................  Grand Forks, ND-MN...........          0.9387
                             Grand Forks, ND
                             Polk, MN
2995.....................  Grand Junction, CO...........          0.9699
                             Mesa, CO
3000.....................  Grand Rapids-Muskegon-                 1.0911
                            Holland, MI.
                             Allegan, MI
                             Kent, MI
                             Muskegon, MI
                             Ottawa, MI
3040.....................  Great Falls, MT..............          0.9652
                             Cascade, MT
3060.....................  Greeley, CO..................          1.0449
                             Weld, CO
3080.....................  Green Bay, WI................          0.9822
                             Brown, WI
3120.....................  Greensboro-Winston-Salem-High          0.9722
                            Point, NC.
                             Alamance, NC
                             Davidson, NC
                             Davie, NC
                             Forsyth, NC
                             Guilford, NC
                             Randolph, NC
                             Stokes, NC
                             Yadkin, NC
3150.....................  Greenville, NC...............          0.9991
                             Pitt, NC
3160.....................  Greenville-Spartanburg-                0.9586
                            Anderson, SC.
                             Anderson, SC
                             Cherokee, SC
                             Greenville, SC
                             Pickens, SC
                             Spartanburg, SC
3180.....................  Hagerstown, MD...............          1.0018
                             Washington, MD
3200.....................  Hamilton-Middletown, OH......          0.9648
                             Butler, OH
3240.....................  Harrisburg-Lebanon-Carlisle,           0.9994
                            PA.
                             Cumberland, PA
                             Dauphin, PA
                             Lebanon, PA
                             Perry, PA
3283.....................  Hartford, CT.................          1.2109
                             Hartford, CT
                             Litchfield, CT
                             Middlesex, CT

[[Page 49462]]

 
                             Tolland, CT
3285.....................  Hattiesburg, MS..............          0.8000
                             Forrest, MS
                             Lamar, MS
3290.....................  Hickory-Morganton-Lenoir, NC.          0.9591
                             Alexander, NC
                             Burke, NC
                             Caldwell, NC
                             Catawba, NC
3320.....................  Honolulu, HI.................          1.2631
                             Honolulu, HI
3350.....................  Houma, LA....................          0.8609
                             Lafourche, LA
                             Terrebonne, LA
3360.....................  Houston, TX..................          1.0362
                             Chambers, TX
                             Fort Bend, TX
                             Harris, TX
                             Liberty, TX
                             Montgomery, TX
                             Waller, TX
3400.....................  Huntington-Ashland, WV-KY-OH.          1.0515
                             Boyd, KY
                             Carter, KY
                             Greenup, KY
                             Lawrence, OH
                             Cabell, WV
                             Wayne, WV
3440.....................  Huntsville, AL...............          0.9510
                             Limestone, AL
                             Madison, AL
3480.....................  Indianapolis, IN.............          1.0420
                             Boone, IN
                             Hamilton, IN
                             Hancock, IN
                             Hendricks, IN
                             Johnson, IN
                             Madison, IN
                             Marion, IN
                             Morgan, IN
                             Shelby, IN
3500.....................  Iowa City, IA................          1.0282
                             Johnson, IA
3520.....................  Jackson, MI..................          0.9725
                             Jackson, MI
3560.....................  Jackson, MS..................          0.9382
                             Hinds, MS
                             Madison, MS
                             Rankin, MS
3580.....................  Jackson, TN..................          0.9365
                             Madison, TN
                             Chester, TN
3600.....................  Jacksonville, FL.............          0.9804
                             Clay, FL
                             Duval, FL
                             Nassau, FL
                             St. Johns, FL
3605.....................  Jacksonville, NC.............          0.8280
                             Onslow, NC
3610.....................  Jamestown, NY................          0.8324
                             Chautauqua, NY
3620.....................  Janesville-Beloit, WI........          1.0205
                             Rock, WI
3640.....................  Jersey City, NJ..............          1.2246
                             Hudson, NJ
3660.....................  Johnson City-Kingsport-                0.8807
                            Bristol, TN-VA.
                             Carter, TN
                             Hawkins, TN
                             Sullivan, TN
                             Unicoi, TN
                             Washington, TN

[[Page 49463]]

 
                             Bristol City, VA
                             Scott, VA
                             Washington, VA
3680.....................  Johnstown, PA................          0.9419
                             Cambria, PA
                             Somerset, PA
3700.....................  Jonesboro, AR................          0.8339
                             Craighead, AR
3710.....................  Joplin, MO...................          0.8675
                             Jasper, MO
                             Newton, MO
3720.....................  Kalamazoo-Battlecreek, MI....          1.1130
                             Calhoun, MI
                             Kalamazoo, MI
                             Van Buren, MI
3740.....................  Kankakee, IL.................         1.05423
                             Kankakee, IL
3760.....................  Kansas City, KS-MO...........          1.0144
                             Johnson, KS
                             Leavenworth, KS
                             Miami, KS
                             Wyandotte, KS
                             Cass, MO
                             Clay, MO
                             Clinton, MO
                             Jackson, MO
                             LaFayette, MO
                             Platte, MO
                             Ray, MO
3800.....................  Kenosha, WI..................          1.0233
                             Kenosha, WI
3810.....................  Kileen-Temple, TX............          1.0774
                             Bell, TX
                             Coryell, TX
3840.....................  Knoxville, TN................          0.8880
                             Anderson, TN
                             Blount, TN
                             Loudon, TN
                             Sevier, TN
                             Union, TN
3850.....................  Kokomo, IN...................          1.0134
                             Howard, IN
                             Tipton, IN
3870.....................  La Crosse, WI-MN.............          0.9807
                             Houston, MN
                             La Crosse, WI
3880.....................  Lafayette, LA................          0.9040
                             Acadia, LA
                             Lafayette, LA
                             St. Landry, LA
                             St. Martin, LA
3920.....................  Lafayette, IN................          0.9406
                             Clinton, IN
                             Tippecanoe, IN
3960.....................  Lake Charles, LA.............          0.8000
                             Calcasieu, LA
3980.....................  Lakeland-Winter Haven, FL....          0.9837
                             Polk, FL
4000.....................  Lancater, PA.................          0.9858
                             Lancaster, PA
4040.....................  Lansing-East Lansing, MI.....          1.0577
                             Clinton, MI
                             Eaton, MI
                             Ingham, MI
4080.....................  Laredo, TX...................          0.8697
                             Webb, TX
4100.....................  Las Cruces, NM...............          0.9218
                             Dona Ana, NM
4120.....................  Las Vegas, NV-AZ.............          1.1495
                             Mohave, AZ
                             Clarke, NV

[[Page 49464]]

 
                             Nye, NV
4150.....................  Lawrence, KS.................          0.8720
                             Douglas, KS
4200.....................    Lawton, OK                           0.9578
                             Comanche, OK
4243.....................  Lewiston-Auburn, ME..........          0.9621
                             Androscoggin, ME
4280.....................  Lexington, KY................          0.9440
                             Bourbon, KY
                             Clark, KY
                             Fayette, KY
                             Jessamine, KY
                             Madison, KY
                             Scott, KY
                             Woodford, KY
4320.....................  Lima, OH.....................          0.9923
                             Allen, OH
                             Auglaize, OH
4360.....................  Lincoln, NE..................          1.0249
                             Lancaster, NE
4400.....................  Little Rock-North Little               0.9482
                            Rock, AR.
                             Faulkner, AR
                             Lonoke, AR
                             Pulaski, AR
                             Saline, AR
4420.....................   Longview-Marshall, TX.......          0.9499
                             Gregg, TX
                             Harrison, TX
                             Upshur, TX
4480.....................  Los Angeles-Long Beach, CA...          1.2772
                             Los Angeles, CA
4520.....................  Louisville, KY-IN............          0.9955
                             Clark, IN
                             Floyd, IN
                             Harrison, IN
                             Scott, IN
                             Bullitt, KY
                             Jefferson, KY
                             Oldham, KY
4600.....................  Lubbock, TX..................          0.9410
                             Lubbock, TX
4640.....................  Lynchburg, VA................          0.9441
                             Amherst, VA
                             Bedford, VA
                             Bedford City, VA
                             Campbell, VA
                             Lynchburg City, VA
4680.....................  Macon, GA....................          0.9555
                             Bibb, GA
                             Houston, GA
                             Jones, GA
                             Peach, GA
                             Twiggs, GA
4720.....................  Madison, WI..................          1.0936
                             Dane, WI
4800.....................  Mansfield, OH................          0.9252
                             Crawford, OH
                             Richland, OH
4840.....................  Mayaguez, PR.................          0.5277
                             Anasco, PR
                             Cabo Rojo, PR
                             Hormigueros, PR
                             Mayaguez, PR
                             Sabana Grande, PR
                             San German, PR
4880.....................  McAllen-Edinburg-Mission, TX.          0.9120
                             Hidalgo, TX
4890.....................  Medford-Ashland, OR..........          1.1014
                             Jackson, OR
4900.....................  Melbourne-Titusville-Palm              1.0315
                            Bay, FL.
                             Brevard, FL

[[Page 49465]]

 
4920.....................  Memphis, TN-AR-MS............          0.9288
                             Crittenden, AR
                             DeSoto, MS
                             Fayette, TN
                             Shelby, TN
                             Tipton, TN
4940.....................  Merced, CA...................          1.0270
                             Merced, CA
5000.....................  Miami, FL....................          1.0710
                             Dade, FL
5015.....................  Middlesex-Somerset-Hunterdon,          1.1792
                            NJ.
                             Hunterdon, NJ
                             Middlesex, NJ
                             Somerset, NJ
5080.....................  Milwaukee-Waukesha, WI.......          1.0399
                             Milwaukee, WI
                             Ozaukee, WI
                             Washington, WI
                             Waukesha, WI
5120.....................  Minneapolis-St. Paul, MN-WI..          1.1730
                             Anoka, MN
                             Carver, MN
                             Chisago, MN
                             Dakota, MN
                             Hennepin, MN
                             Isanti, MN
                             Ramsey, MN
                             Scott, MN
                             Sherbune, MN
                             Washington, MN
                             Wright, MN
                             Pierce, WI
                             St. Croix, WI
5140.....................  Missoula, MT.................          0.9874
                             Missoula, MT
5160.....................  Mobile, AL...................          0.8691
                             Baldwin, AL
                             Mobile, AL
5170.....................  Modesto, CA..................          1.1069
                             Stanislaus, CA
5190.....................  Monmouth-Ocean, NJ...........          1.2008
                             Monmouth, NJ
                             Ocean, NJ
5200.....................  Monroe, LA...................          0.8939
                             Ouachita, LA
5240.....................  Montgomery, AL...............          0.8148
                             Autauga, AL
                             Elmore, AL
                             Montgomery, AL
5280.....................  Muncie, IN...................          1.1679
                             Delaware, IN
5330.....................  Myrtle Beach, SC.............          0.8986
                             Horry, SC
5345.....................  Naples, FL...................          1.0286
                             Collier, FL
5360.....................  Nashville, TN................          1.0104
                             Cheatham, TN
                             Davidson, TN
                             Dickson, TN
                             Robertson, TN
                             Rutherford, TN
                             Sumner, TN
                             Williamson, TN
                             Wilson, TN
5380.....................  Nassau-Suffolk, NY...........          1.4834
                             Nassau, NY
                             Suffolk, NY
5483.....................  New Haven-Bridgeport-Stamford-         1.3093
                            Waterbury-Danbury, CT.
                             Fairfield, CT
                             New Haven, CT
5523.....................  New London-Norwich, CT.......          1.2844

[[Page 49466]]

 
                             New London, CT
5560.....................  New Orleans, LA..............          0.9897
                             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.................          1.5599
                             Bronx, NY
                             Kings, NY
                             New York, NY
                             Putnam, NY
                             Queens, NY
                             Richmond, NY
                             Rockland, NY
                             Westchester, NY
5640.....................  Newark, NJ...................          1.2603
                             Essex, NJ
                             Morris, NJ
                             Sussex, NJ
                             Union, NJ
                             Warren, NJ
5660.....................  Newburgh, NY-PA..............          1.1549
                             Orange, NY
                             Pike, PA
5720.....................  Norfolk-Virginia Beach-                0.8956
                            Newport News, VA-NC.
                             Currituck, NC
                             Chesapeake City, VA
                             Gloucester, VA
                             Hampton City, VA
                             James City, VA
                             Isle of Wight, 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..................          1.5953
                             Alameda, CA
                             Contra Costa, CA
5790.....................  Ocala, FL....................          0.9841
                             Marion, FL
5800.....................  Odessa-Midland, TX...........          0.9801
                             Ector, TX
                             Midland, TX
5880.....................  Oklahoma City, OK............          0.9393
                             Canadian, OK
                             Cleveland, OK
                             Logan, OK
                             McClain, OK
                             Oklahoma, OK
                             Pottawatomie, OK
5910.....................  Olympia, WA..................          1.1368
                             Thurston, WA
5920.....................  Omaha, NE-IA.................          1.0192
                             Pottawattamie, IA
                             Cass, NE
                             Douglas, NE
                             Sarpy, NE
                             Washington, NE
5945.....................  Orange County, CA............          1.2209
                             Orange, CA
5960.....................  Orlando, FL..................          1.0232
                             Lake, FL

[[Page 49467]]

 
                             Orange, FL
                             Osceola, FL
                             Seminole, FL
5990.....................  Owensboro, KY................          0.8687
                             Daviess, KY
6015.....................  Panama City, FL..............          0.9593
                             Bay, FL
6020.....................  Parkersburg-Marietta, WV-OH..          0.8810
                             Washington, OH
                             Wood, WV
6080.....................  Pensacola, FL................          0.8705
                             Escambia, FL
                             Santa Rosa, FL
6120.....................  Peoria-Pekin, IL.............          0.9205
                             Peoria, IL
                             Tazewell, IL
                             Woodford, IL
6160.....................  Philadelphia, PA-NJ..........          1.1645
                             Burlington, NJ
                             Camden, NJ
                             Gloucester, NJ
                             Salem, NJ
                             Bucks, PA
                             Chester, PA
                             Delaware, PA
                             Montgomery, PA
                             Philadelphia, PA
6200.....................  Phoenix-Mesa, AZ.............          1.0295
                             Maricopa, AZ
                             Pinal, AZ
6240.....................  Pine Bluff, AR...............          0.8295
                             Jefferson, AR
6280.....................  Pittsburgh, PA...............          1.0371
                             Allegheny, PA
                             Beaver, PA
                             Butler, PA
                             Fayette, PA
                             Washington, PA
                             Westmoreland, PA
6323.....................  Pittsfield, MA...............          1.0954
                             Berkshire, MA
6340.....................  Pocatello, ID................          0.9663
                             Bannock, ID
6360.....................  Ponce, PR....................          0.5757
                             Guayanilla, PR
                             Juana Diaz, PR
                             Penuelas, PR
                             Ponce, PR
                             Villalba, PR
                             Yauco, PR
6403.....................  Portland, ME.................          1.0379
                             Cumberland, ME
                             Sagadahoc, ME
                             York, ME
6440.....................  Portland-Vancouver, OR-WA....          1.1616
                             Clackamas, OR
                             Columbia, OR
                             Multnomah, OR
                             Washington, OR
                             Yamhill, OR
                             Clark, WA
6483.....................  Providence-Warwick-Pawtucket,          1.1567
                            RI.
                             Bristol, RI
                             Kent, RI
                             Newport, RI
                             Providence, RI
                             Washington, RI
6520.....................  Provo-Orem, UT...............          1.0678
                             Utah, UT
6560.....................  Pueblo, CO...................          0.9386
                             Pueblo, CO

[[Page 49468]]

 
6580.....................  Punta Gorda, FL..............          1.0235
                             Charlotte, FL
6600.....................  Racine, WI...................          0.9845
6640.....................  Raleigh-Durham-Chapel Hill,            1.0270
                            NC.
                             Chatham, NC
                             Durham, NC
                             Franklin, NC
                             Johnston, NC
                             Orange, NC
                             Wake, NC
6660.....................  Rapid City, SD...............          0.9439
                             Pennington, SD
6680.....................  Reading, PA..................          0.9744
                             Berks, PA
6690.....................  Redding, CA..................          1.2419
                             Shasta, CA
6720.....................  Reno, NV.....................          1.1233
                             Washoe, NV
6740.....................  Richland-Kennewick-Pasco, WA.          1.2202
                             Benton, WA
                             Franklin, WA
6760.....................  Richmond-Petersburg, VA......          1.0239
                             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.          1.1966
                             Riverside, CA
                             San Bernardino, CA
6800.....................  Roanoke, VA..................          0.9316
                             Botetourt, VA
                             Roanoke, VA
                             Roanoke City, VA
                             Salem City, VA
6820.....................  Rochester, MN................          1.2047
                             Olmsted, MN
6840.....................  Rochester, NY................          0.9776
                             Genesee, NY
                             Livingston, NY
                             Monroe, NY
                             Ontario, NY
                             Orleans, NY
                             Wayne, NY
6880.....................  Rockford, IL.................          0.9390
                             Boone, IL
                             Ogle, IL
                             Winnebago, IL
6895.....................  Rocky Mount, NC..............          0.9422
                             Edgecombe, NC
                             Nash, NC
6920.....................  Sacramento, CA...............          1.2723
                             El Dorado, CA
                             Placer, CA
                             Sacramento, CA
6960.....................  Saginaw-Bay City-Midland, MI.          1.0195
                             Bay, MI
                             Midland, MI
                             Saginaw, MI
6980.....................  St. Cloud, MN................          1.0664
                             Benton, MN
                             Stearns, MN
7000.....................  St. Joseph, MO...............          0.9658

[[Page 49469]]

 
                             Andrew, MO
                             Buchanan, MO
7040.....................  St. Louis, MO-IL.............          0.9635
                             Franklin, MO
                             Jefferson, MO
                             Lincoln, MO
                             St. Charles, MO
                             St. Louis, MO
                             St. Louis City, MO
                             Warren, MO
                             Clinton, IL
                             Jersey, IL
                             Madison, IL
                             Monroe, IL
                             St. Clair, IL
7080.....................  Salem, OR....................          1.0848
                             Marion, OR
                             Polk, OR
7120.....................  Salinas, CA..................          1.5441
                             Monterey, CA
7160.....................  Salt Lake City-Ogden, UT.....          1.0442
                             Davis, UT
                             Salt Lake, UT
                             Weber, UT
7200.....................  San Angelo, TX...............          0.8606
                             Tom Green, TX
7240.....................  San Antonio, TX..............          0.9135
                             Bexar, TX
                             Comal, TX
                             Guadalupe, TX
                             Wilson, TX
7320.....................  San Diego, CA................          1.2547
                             San Diego, CA
7360.....................  San Francisco, CA............          1.5072
                             Marin, CA
                             San Francisco, CA
                             San Mateo, CA
7400.....................  San Jose, CA.................          1.4536
                             Santa Clara, CA
7440.....................  San Juan-Bayamon, PR.........          0.5394
                             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-            1.1364
                            Paso Robles, CA.

[[Page 49470]]

 
                             San Luis Obispo, CA
7480.....................  Santa Barbara-Santa Maria-             1.1283
                            Lompoc, CA.
                             Santa Barbara, CA
7485.....................  Santa Cruz-Watsonville, CA...          1.4949
                             Santa Cruz, CA
7490.....................  Santa Fe, NM.................          1.1219
                             Los Alamos, NM
                             Santa Fe, NM
7500.....................  Santa Rosa, CA...............          1.3465
                             Sonoma, CA
7510.....................  Sarasota-Bradenton, FL.......          1.0444
                             Manatee, FL
                             Sarasota, FL
7520.....................  Savannah, GA.................          1.0325
                             Bryan, GA
                             Chatham, GA
                             Effingham, GA
7560.....................  Scranton-Wilkes-Barre-                 0.8966
                            Hazleton, PA.
                             Columbia, PA
                             Lackawanna, PA
                             Luzerne, PA
                             Wyoming, PA
7600.....................  Seattle-Bellevue-Everett, WA.          1.1708
                             Island, WA
                             King, WA
                             Snohomish, WA
7610.....................  Sharon, PA...................          0.8441
                             Mercer, PA
7620.....................  Sheboygan, WI................          0.8921
                             Sheboygan, WI
7640.....................  Sherman-Denison, TX..........          0.9257
                             Grayson, TX
7680.....................  Shreveport-Bossier City, LA..          0.9316
                             Bossier, LA
                             Caddo, LA
                             Webster, LA
7720.....................  Sioux City, IA-NE............          0.9021
                             Woodbury, IA
                             Dakota, NE
7760.....................  Sioux Falls, SD..............          0.9359
                             Lincoln, SD
                             Minnehaha, SD
7800.....................  South Bend, IN...............          1.0647
                             St. Joseph, IN
7840.....................  Spokane, WA..................          1.1193
                             Spokane, WA
7880.....................  Springfield, IL..............          0.9247
                             Menard, IL
                             Sangamon, IL
7920.....................  Springfield, MO..............          0.9037
                             Christian, MO
                             Greene, MO
                             Webster, MO
8003.....................  Springfield, MA..............          1.1325
                             Hampden, MA
                             Hampshire, MA
8050.....................  State College, PA............          0.9623
                             Centre, PA
8080.....................  Steubenville-Weirton, OH-WV..          0.9101
                             Jefferson, OH
                             Brooke, WV
                             Hancock, WV
8120.....................  Stockton-Lodi, CA............          1.1317
                             San Joaquin, CA
8140.....................  Sumter, SC...................          0.8806
                             Sumter, SC
8160.....................  Syracuse, NY.................          1.0167
                             Cayuga, NY
                             Madison, NY
                             Onondaga, NY
                             Oswego, NY

[[Page 49471]]

 
8200.....................  Tacoma, WA...................          1.2312
                             Pierce, WA
8240.....................  Tallahassee, FL..............          0.9098
                             Gadsden, FL
                             Leon, FL
8280.....................  Tampa-St. Petersburg-                  0.9563
                            Clearwater, FL.
                             Hernando, FL
                             Hillsborough, FL
                             Pasco, FL
                             Pinellas, FL
8320.....................  Terre Haute, IN..............          0.8841
                             Clay, IN
                             Vermillion, IN
                             Vigo, IN
8360.....................  Texarkana, AR-Texarkana, TX..          0.8904
                             Miller, AR
                             Bowie, TX
8400.....................  Toledo, OH...................          1.0468
                             Fulton, OH
                             Lucas, OH
                             Wood, OH
8440.....................  Topeka, KS...................          0.9707
                             Shawnee, KS
8480.....................  Trenton, NJ..................          1.0793
                             Mercer, NJ
8520.....................  Tucson, AZ...................          0.9363
                             Pima, AZ
8560.....................  Tulsa, OK....................          0.9001
                             Creek, OK
                             Osage, OK
                             Rogers, OK
                             Tulsa, OK
                             Wagoner, OK
8600.....................  Tuscaloosa, AL...............          0.8586
                             Tuscaloosa, AL
8640.....................  Tyler, TX....................          1.0013
                             Smith, TX
8680.....................  Utica-Rome, NY...............          0.9114
                             Herkimer, NY
                             Oneida, NY
8720.....................  Vallejo-Fairfield-Napa, CA...          1.3679
                             Napa, CA
                             Solano, CA
8735.....................  Ventura, CA..................          1.1744
                             Ventura, CA
8750.....................  Victoria, TX.................          0.8682
                             Victoria, TX
8760.....................  Vineland-Millville-Bridgeton,          1.1181
                            NJ.
                             Cumberland, NJ
8780.....................  Visalia-Tulare-Porterville,            1.0169
                            CA.
                             Tulare, CA
8800.....................  Waco, TX.....................          0.8852
                             McLennan, TX
8840.....................  Washington, DC-MD-VA-WV......          1.1451
                             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

[[Page 49472]]

 
                             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.....          0.8948
                             Black Hawk, IA
8940.....................  Wausau, WI...................          1.0028
                             Marathon, WI
8960.....................  West Palm Beach-Boca Raton,            1.0309
                            FL.
                             Palm Beach, FL
9000.....................  Wheeling, WV-OH..............          0.8234
                             Belmont, OH
                             Marshall, WV
                             Ohio, WV
9040.....................  Wichita, KS..................          1.0162
                             Butler, KS
                             Harvey, KS
                             Sedgwick, KS
9080.....................  Wichita Falls, TX............          0.8164
                             Archer, TX
                             Wichita, TX
9140.....................  Williamsport, PA.............          0.8935
                             Lycoming, PA
9160.....................  Wilmington-Newark, DE-MD.....          1.1915
                             New Castle, DE
                             Cecil, MD
9200.....................  Wilmington, NC...............          1.0011
                             Brunswick, NC
                             New Hanover, NC
9260.....................  Yakima, WA...................          1.0548
                             Yakima, WA
9270.....................  Yolo, CA.....................          1.0859
                             Yolo, CA
9280.....................  York, PA.....................          0.9864
                             York, PA
9320.....................  Youngstown-Warren, OH........          1.0161
                             Columbiana, OH
                             Mahoning, OH
                             Trumbull, OH
9340.....................  Yuba City, CA................          1.1399
                             Sutter, CA
                             Yuba, CA
9360.....................  Yuma, AZ.....................          1.0146
                             Yuma, AZ
------------------------------------------------------------------------
\1\ This column lists each MSA area name and each county, or county
  equivalent, in the MSA area. Counties not listed in this Table are
  considered to be Rural Areas. Wage Index values for these areas are
  found in Table B.
\2\ Wage index values are based on FY 1997 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment of 1.064726. Wage index values below 0.8 are adjusted to be
  the greater of a 15-percent increase, subject to a maximum wage index
  value of 0.8, or an adjustment by multiplying the hospital wage index
  value for a given area by the budget-neutrality adjustment. We have
  completed all of these adjustments and included them in the wage index
  values reflected in this table.


                  Table B.--Wage Index for Rural Areas
------------------------------------------------------------------------
       MSA Code No.                Nonurban area          Wage index \3\
------------------------------------------------------------------------
9901.....................  Alabama......................          0.8000
9902.....................  Alaska.......................          1.3194
9903.....................  Arizona......................          0.8855
9904.....................  Arkansas.....................          0.8000
9905.....................  California...................          1.0499
9906.....................  Colorado.....................          0.9548
9907.....................  Connecticut..................          1.2473
9908.....................  Delaware.....................          0.9661
9910.....................  Florida......................          0.9496
9911.....................  Georgia......................          0.8868

[[Page 49473]]

 
9912.....................  Hawaii.......................          1.1775
9913.....................  Idaho........................          0.9240
9914.....................  Illinois.....................          0.8688
9915.....................  Indiana......................          0.9159
9916.....................  Iowa.........................          0.8550
9917.....................  Kansas.......................          0.8097
9918.....................  Kentucky.....................          0.8444
9919.....................  Louisiana....................          0.8178
9920.....................  Maine........................          0.9333
9921.....................  Maryland.....................          0.9211
9922.....................  Massachusetts................          1.1929
9923.....................  Michigan.....................          0.9569
9924.....................  Minnesota....................          0.9456
9925.....................  Mississippi..................          0.8000
9926.....................  Missouri.....................          0.8196
9927.....................  Montana......................          0.9250
9928.....................  Nebraska.....................          0.8634
9929.....................  Nevada.......................          0.9830
9930.....................  New Hampshire................          1.0482
9931.....................  New Jersey \4\...............  ..............
9932.....................  New Mexico...................          0.9047
9933.....................  New York.....................          0.9049
9934.....................  North Carolina...............          0.8987
9935.....................  North Dakota.................          0.8215
9936.....................  Ohio.........................          0.9231
9937.....................  Oklahoma.....................          0.8000
9938.....................  Oregon.......................          1.0788
9939.....................  Pennsylvania.................          0.9133
9940.....................  Puerto Rico..................          0.4904
9941.....................  Rhode Island \4\.............  ..............
9942.....................  South Carolina...............          0.8912
9943.....................  South Dakota.................          0.8060
9944.....................  Tennessee....................          0.8345
9945.....................  Texas........................          0.8000
9946.....................  Utah.........................          0.9622
9947.....................  Vermont......................          0.9874
9948.....................  Virgin Islands...............          0.7252
9949.....................  Virginia.....................          0.8719
9950.....................  Washington...................          1.1109
9951.....................  West Virginia................          0.8764
9952.....................  Wisconsin....................          0.9455
9953.....................  Wyoming......................          0.9388
9965.....................  Guam.........................          1.0233
------------------------------------------------------------------------
\3\ Wage index values are based on FY 1997 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment of 1.064726. Wage index values below 0.8 are adjusted to be
  the greater of a 15-percent increase, subject to a maximum wage index
  value of 0.8, or an adjustment by multiplying the hospital wage index
  value for a given area by the budget-neutrality adjustment. We have
  completed all of these adjustments and have included them in the wage
  index values reflected in this table.
\4\ All counties within the State are classified as urban.

II. Regulatory Impact Statement

A. Overall Impact

    We have examined the impacts of this notice as required by 
Executive Order 12866 (September 1993, Regulatory Planning & Review) 
and the Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 
96-354). In this notice, we identified an impact on hospices as a 
result of changes in the way we compute the hospice wage index. The 
change in the methodology for computing the wage index was determined 
through a negotiated rulemaking committee and implemented in the August 
8, 1997 final rule (62 FR 42860). We recognize that the BIPA adjusted 
hospice payments upward by 5 percent; however, we did not do a separate 
analysis of the impact of this payment adjustment. We used the new 
rates adjusted by the BIPA when estimating the payments to be made 
under the new wage index and when calculating the budget-neutrality 
adjustment factor. Overall, we believe the changes included in this 
notice to be insignificant.
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more in any 1 year). We have 
determined that this notice is not an economically significant rule 
under this Executive Order.
    The RFA requires agencies to determine whether a rule will have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations and government agencies.

[[Page 49474]]

Most hospital and most other providers and suppliers are small 
entities, either by nonprofit status or by having revenues of $5 
million or less annually. For purposes of the RFA, most hospices are 
small entities. Approximately 73 percent of Medicare certified hospices 
are identified as voluntary, government, or other agencies, and, 
therefore, are considered small entities. Because the National Hospice 
and Palliative Care Organization estimates that approximately 70 
percent of hospice patients are Medicare beneficiaries, we have not 
considered other sources of revenue in this analysis.
    As discussed below, the estimated decreases in payment to hospices 
overall are very slight. The effects of this notice indicate that on a 
regional basis, urban hospices in the New England, Middle Atlantic, 
South Atlantic, East South Central and Pacific regions will experience 
a slight decrease in payments. The payment decreases range from a 
minimum of 0.2 percent (East South Central region) to a maximum of 0.7 
percent (New England region). The mid-range of the decrease in 
estimated payments for urban hospices falls within the Middle Atlantic 
urban region with a 0.4 percent decrease. Rural hospices in the New 
England and Middle Atlantic regions will also experience a slight 
decrease in payments, 0.9 and 0.3 percent respectively. Therefore, 
based on an analysis of the wage index changes for FY 2002, hospices in 
the urban and rural areas of the New England and Middle Atlantic 
regions will be impacted the most. This payment decrease to these small 
entities indicates that this notice will have a significant impact on a 
substantial number of small entities. However, nationwide, hospices 
will receive an overall slight increase in estimated payments. We 
estimate that total hospice payments will increase by 0.5 percent, or 
$13,632,000. Urban hospices will receive an increase in estimated 
payments of 0.3 percent and rural hospices will receive an increase in 
estimated payments of 1.3 percent.
    We would like to emphasize that the methodology for the hospice 
wage index was previously determined by consensus through a negotiated 
rulemaking committee that included representatives of national hospice 
associations; rural, urban, large and small hospices; multi-site 
hospices; and consumer groups. Based on the options considered, the 
committee agreed on the methodology described in the committee 
statement, and adopted it into regulation in the August 8, 1997 final 
rule. The committee also agreed that this was favorable for the hospice 
community as well as for beneficiaries. Therefore, we believe that 
mitigating any negative effects on small entities has been taken into 
consideration.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside an MSA and has fewer 
than 100 beds.
    Section 202 of the Unfunded Mandate Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in an expenditure in any 1 year by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, in any 1 year of $110 million or more. This notice has 
no consequential effect on State, local, or tribal governments. We 
believe the private sector costs of this notice fall below the 
threshold as well.
    We have reviewed this notice under the threshold criteria of 
Executive Order 13132, Federalism, and have determined that this notice 
will not have any negative impact on the rights, roles, and 
responsibilities of State, local, or tribal governments.

B. Anticipated Effects

    We have compared estimated payments using the FY 1983 hospice wage 
index to estimated payments using the FY 2002 wage index and determined 
the current hospice rates to be budget-neutral. This impact analysis 
compares hospice payments using the FY 2001 hospice wage index to the 
estimated payments using the FY 2002 wage index. The data used in 
developing the quantitative analysis for this notice were obtained from 
the March 2001 update of the national claims history file of all bills 
submitted during FY 2000. We deleted bills from hospices that have 
since closed.
    Table C demonstrates the results of our analysis. In Column 2 of 
Table C, we indicate the number of routine home care days that were 
included in our analysis, although the analysis was performed on all 
types of hospice care. Column 3 of Table C indicates payments that were 
made using the FY 2001 wage index. Column 4 of Table C is based on FY 
2000 claims and estimates payments to be made to hospices using the FY 
2002 wage index. The final column, which compares Columns 3 and 4, 
shows the percent change in estimated hospice payments made based on 
the category of the hospice.
    Table C categorizes hospices by various geographic and provider 
characteristics. The first row displays the results of the impact 
analysis for all Medicare certified hospices. The second and third rows 
of the table categorize hospices according to their geographic location 
(urban and rural). Our analysis indicated that there are 1,319 hospices 
located in urban areas and 824 hospices located in rural areas. The 
next two groupings in the table indicate the number of hospices by 
census region, also broken down by urban and rural hospices. The sixth 
grouping shows the impact on hospices based on the size of the 
hospice's program. We determined that the majority of hospice payments 
are made at the routine home care rate. Therefore, we based the size of 
each individual hospice's program on the number of routine home care 
days provided in 2000. The next grouping shows the impact on hospices 
by type of ownership. The final grouping shows the impact on hospices 
defined by whether they are provider-based or freestanding.
    The results of our analysis shows that the greatest increases in 
payment are for urban areas in the East North Central and West South 
Central Regions, with a 1.8 percent and 1.9 percent increase, 
respectively. The greatest decreases in payment are for urban and rural 
areas in the New England and Middle Atlantic regions.
    The breakdown by size, type of ownership, and facility base showed 
an increase in payments to all hospice programs. Small hospice programs 
showed significant increases of about 5 percent, while larger programs 
experienced only a negligible increase. In terms of hospice base, 
freestanding hospices showed the greatest estimated payment increase 
while hospices affiliated with home health agencies and skilled nursing 
facilities showed the smallest amount of payment increase.

[[Page 49475]]



                                  Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                     Number of    Payments using  payments using  Percent change
                                     Number of     routine home    FY 2001 wage    FY 2002 wage     in hospice
                                   hospices  (1)   care days in      index in        index in      payments  (5)
                                                  thousands  (2)  thousands  (3)  thousands  (4)
----------------------------------------------------------------------------------------------------------------
    (By Geographic Location)
All Hospices....................           2,143          23,765       2,995,014       3,008,646             0.5
    Urban Hospices..............           1,319          20,078       2,616,198       2,624,874             0.3
    Rural Hospices..............             824           3,687         378,816         383,772             1.3
By Region--Urban:
    New England.................              89             662          98,780          98,045            -0.7
    Middle Atlantic.............             169           2,302         321,614         320,170            -0.4
    South Atlantic..............             184           4,402         618,316         616,008            -0.4
    East North Central..........             225           3,246         408,377         415,850             1.8
    East South Central..........              95           1,312         148,758         148,457            -0.2
    West North Central..........              94           1,220         139,067         139,550             0.3
    West South Central..........             178           2,752         324,985         331,103             1.9
    Mountain....................              87           1,358         186,025         187,093             0.6
    Pacific.....................             171           2,553         350,437         348,589            -0.5
    Puerto Rico.................              27             270          19,840          20,010             0.9
By Region--Rural:
    New England.................              26              67           7,825           7,752            -0.9
    Middle Atlantic.............              35             182          19,862          19,798            -0.3
    South Atlantic..............             122             763          78,343          80,149             2.3
    East North Central..........             138             595          61,827          62,535             1.1
    East South Central..........              82             649          63,742          64,465             1.1
    West North Central..........             178             439          45,187          45,577             0.9
    West South Central..........              98             479          45,051          45,793             1.6
    Mountain....................              86             240          25,762          26,223             1.8
    Pacific.....................              56             251          29,687          29,946             0.9
    Puerto Rico.................               3              22           1,530           1,533             0.2
            (Skilled)
Routine Home Care Days:
    0-1,754 Days................             386             347          37,277          39,056             4.8
    1,754-4,373 Days............             480           1,429         154,353         156,256             1.2
    4,373-9,681 Days............             540           3,600         412,953         414,477             0.4
    9,681 + Days................             736          18,044       2,348,755       2,357,398             0.4
Type of Ownership:
    Voluntary...................           1,336          15,108       1,904,983       1,913,143             0.4
    Proprietary.................             590           7,958       1,011,373       1,016,757             0.5
    Government..................             183             594          66,782          66,840             0.1
    Other.......................              34             105          11,877          11,906             0.2
Hospice Base:
    Freestanding................             910          14,401       1,826,242       1,840,289             0.8
    Home Health Agency..........             680           5,446         688,646         687,239            -0.2
    Hospital....................             536           3,789         460,963         461,980             0.2
    Skilled Nursing Facility....              17             129          19,163          19,138            -0.1
----------------------------------------------------------------------------------------------------------------

C. Conclusion

    We have determined, and we certify, that this rule will have a 
significant economic impact on a substantial number of small entities. 
However, we are not preparing analyses for either the RFA or Section 
1102(b) of the Act because the methodology for the hospice wage index 
was previously determined by consensus through a negotiated rulemaking 
committee. Based on the options considered, the committee agreed on the 
methodology described in the committee statement, and adopted it into 
regulation in the August 8, 1997 final rule. The committee, which 
included representatives of national hospice associates, rural, urban, 
large and small hospice, multi-site hospice, and consumer groups, 
agreed that this was favorable for the hospice community as well as for 
beneficiaries. Therefore, we believe that mitigating any negative 
effects on small entities has been taken into consideration.
OMB Review
    In accordance with the provisions of Executive Order 12866, the 
Office of Management and Budget reviewed this regulation.


    Authority: Section 1814(i) of the Social Security Act (42 U.S.C. 
1395f (i)(1))(Catalog of Federal Domestic Assistance Program No. 
93.773 Medicare--Hospital Insurance Program; and No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: July 10, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: August 31, 2001.
Tommy G. Thompson,
Secretary.
[FR Doc. 01-23820 Filed 9-20-01; 9:51 am]
BILLING CODE 4210-01-P