[Federal Register Volume 67, Number 148 (Thursday, August 1, 2002)]
[Notices]
[Pages 49928-49944]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-19468]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1205-N]
RIN 0938-AL22


Medicare Program; Inpatient Rehabilitation Facility Prospective 
Payment System for FY 2003

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

ACTION: Notice.

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SUMMARY: This notice updates prospective payment rates for inpatient 
rehabilitation facilities for Federal fiscal year (FY) 2003 as 
authorized under section 1886(j)(3)(C) of the Social Security Act (the 
Act). Section 1886(j)(5) of the Act requires the Secretary to publish 
in the Federal Register on or before August 1 before each fiscal year, 
the classifications and weighting factors for the inpatient 
rehabilitation facility (IRF) case-mix groups and a description of the 
methodology and data used in computing the prospective payment rates 
for that fiscal year.

DATES: Effective Date: The updated IRF prospective payment rates are 
effective for discharges occurring on or after October 1, 2002 and on 
or before September 30, 2003 (FY 2003).

FOR FURTHER INFORMATION CONTACT: Robert Kuhl, (410) 786-4597, Nora 
Hoban, (410) 786-0675.

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Table of Contents

I. Background
    A. Requirements of the Statute for Updating the Prospective 
Payment System (PPS) for Inpatient Rehabilitation Facilities (IRFs)
    B. IRF Prospective Payment--General Overview
    C. Classification System for the IRF PPS
    D. IRF Market Basket Index
    E. Update of Payment Rates Under the PPS for IRFs for FY 2003
    F. Area Wage Adjustment
    G. Examples of Computing the Total Adjusted IRF Prospective 
Payments
II. Future Updates
III. Collection of Information Requirements
IV. Waiver of Proposed Rulemaking
V. Regulatory Impact Analysis
    A. Introduction
    1. Executive Order 12866
    2. Regulatory Flexibility Act (RFA) and Impact on Small 
Hospitals
    3. Unfunded Mandates Reform Act
    4. Executive Order 13132
    5. Overall Impact
    B. Anticipated Effects of the Notice
    1. Budgetary Impact
    2. Impact on Providers
    3. Calculation of the Estimated FY 2002 IRF Prospective Payments
    4. Calculation of the Estimated FY 2003 IRF Prospective Payments

I. Background

A. Requirements of the Statute for Updating the Prospective Payment 
System (PPS) for Inpatient Rehabilitation Facilities (IRFs)

    On August 7, 2001, we published a final rule entitled ``Medicare 
Program; Prospective Payment System for Inpatient Rehabilitation 
Facilities (CMS-1069-F)'' in the Federal Register (66 FR 41316), that 
established a prospective payment system (PPS) for inpatient 
rehabilitation facilities (IRFs) as authorized under section 1886(j) of 
the Social Security Act (the Act) and codified at subpart P of part 412 
of the Medicare regulations. In the August 7, 2001 final rule, we set 
forth per discharge Federal rates for FY 2002 that provided payment for 
inpatient operating and capital costs of furnishing covered 
rehabilitation services (that is, routine, ancillary, and capital 
costs) but not costs of approved educational activities, bad debts, and 
other services or items that are outside the scope of the IRF PPS.
    Covered rehabilitation services include services for which benefits 
are provided under the fee-for-service Part A (Hospital Insurance 
Program) of the Medicare program. Annual updates to the IRF PPS rates 
are required by section 1886(j)(3)(C) of the Act.
    In this notice, we set forth the prospective payment rates 
applicable for IRFs for discharges occurring during FY 2003 as mandated 
by the Act. In establishing these payment rates, we update the IRF per 
discharge payment rates that were published in the August 7, 2001 final 
rule.
    Section 1886(j)(5) of the Act requires the Secretary to publish in 
the Federal Register, on or before August 1 of the preceding fiscal 
year, the classifications and weighting factors for the IRF case-mix 
groups (CMGs) and a description of the methodology and data used in 
computing the prospective payment rates for the upcoming fiscal year. 
In this notice, we are using the same classifications and weighting 
factors for the IRF CMGs that were set forth in the August 7, 2001 
final rule. Although the statute permits the Secretary to adjust the 
classification and weighting factors for IRF CMGs from time to time, we 
are not making any adjustments at this time because the data are not 
available as discussed in section I.C of this notice. Further, the case 
and facility level adjustments described in the August 7,

[[Page 49929]]

2001 final rule will apply to the FY 2003 IRF PPS payment rates 
described in this notice.
    Accordingly, the CMGs, comorbidity tiers, and the corresponding 
relative weights presented in the August 7, 2001 final rule will be 
used as the basis for developing the FY 2003 IRF PPS rates set forth in 
this notice.
    Specifically, we multiply an increase factor, described in section 
I.D of this notice, by the FY 2002 IRF standardized payment amount 
(also referred to as the budget neutral conversion factor in the August 
7, 2001 final rule (66 FR 41364 through 41367) to develop the FY 2003 
standardized payment amount. Then we multiply the FY 2003 budget 
neutral conversion factor by the relative weights presented in the 
August 7, 2001 final rule and in Table 1 of this notice to develop the 
FY 2003 Federal unadjusted IRF PPS payment rates.

B. IRF Prospective Payment--General Overview

    Section 4421 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33), as amended by section 125 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), and by 
section 305 of the Medicare, Medicaid, and SCHIP Benefits Improvement 
and Protection Act of 2000 (BIPA) (Pub. L. 106-554), provides for the 
implementation of a per discharge PPS, through new section 1886(j) of 
the Act, for IRFs--inpatient rehabilitation hospitals and 
rehabilitation units. Although a complete discussion of the IRF PPS 
provisions appears in the August 7, 2001 final rule (66 FR 41316), we 
provide below a general description of the IRF PPS.
    The IRF PPS uses information from a patient assessment instrument, 
the Inpatient Rehabilitation--Patient Assessment Instrument (IRF-PAI), 
to classify patients into distinct case-mix groups (CMGs) based on 
clinical characteristics and expected resource needs. The CMGs were 
constructed using rehabilitation impairment categories, functional 
status (both motor and cognitive), age, comorbidities, and other 
factors that we deemed appropriate to improve the explanatory power of 
the groups.
    Payment for services furnished to a Medicare patient consists of a 
predetermined, per-discharge amount for each CMG with applicable case 
and facility level adjustments. Payments under the IRF PPS encompass 
inpatient operating and capital costs of furnishing covered 
rehabilitation services, (that is, routine, ancillary and capital 
costs) but not costs of approved educational activities, bad debts, and 
other services or items outside the scope of the IRF PPS.
    The IRF PPS uses Federal prospective payment rates across 100 
distinct CMGs. In addition, the existence of a specific comorbidity may 
affect the calculation of the Federal prospective payment rate. In 
general, however, the FY 2002 Federal prospective payment rates were 
established using a standardized payment amount. A set of relative 
payment weights (which account for the relative difference in resource 
use across CMGs) are applied to the budget neutral conversion factor, 
and finally, a number of facility level and case level adjustments may 
apply. The facility level adjustments include those that account for 
geographic variations in wages (wage index), the percentage of low-
income patients (LIPs), and location in a rural area. Case level 
adjustments include those that apply for transfers, short-stays, 
interrupted stays, outliers and cases in which the beneficiary expires.
    For cost reporting periods beginning on or after January 1, 2002 
and before October 1, 2002, section 1886(j)(1) of the Act and 
Sec. 412.626 of the regulations provide that IRFs transition into the 
PPS receiving a ``blended payment.'' For cost reporting periods 
beginning on or after January 1, 2002 and before October 1, 2002, these 
blended payments consist of 66\2/3\ percent of the Federal IRF PPS rate 
and 33\1/3\ percent of the payment the IRF would have been paid had the 
IRF PPS not been implemented. However, during the transition period, an 
IRF with a cost reporting period beginning on or after January 1, 2002 
and before October 1, 2002 may elect to bypass this blended payment and 
be paid 100 percent of the Federal IRF PPS rate. For cost reporting 
periods beginning on or after October 1, 2002 (FY 2003), however, 
payments for all IRFs will consist of 100 percent of the Federal IRF 
PPS rate.

C. Classification System for the IRF PPS

    As previously stated, in this notice we are using the same case-mix 
classification system that was set forth in the August 7, 2001 final 
rule. It is our intention to pursue the development of refinements to 
the case-mix classification system that will improve the ability of the 
PPS to more accurately pay IRFs. We have awarded a contract to the Rand 
Corporation (RAND) to conduct additional research that will, in the 
initial(1), P. 9 of the signature package version, stages, provide us 
with the data necessary to address the feasibility of developing and 
implementing refinements. When the study has been completed, we plan to 
review various approaches so that we can propose an appropriate 
methodology to develop and apply refinements. Any specific refinement 
proposal resulting from this research will be published in the Federal 
Register for public review and comment.
    Table 1, Relative Weights for Case-Mix Groups (CMGs), presents the 
CMGs, comorbidity tiers, and the corresponding Federal relative 
weights. We also present the average length of stay for each CMG. As we 
discussed in the August 7, 2001 final rule, the average length of stay 
for each CMG is used to determine when an IRF discharge meets the 
definition of a transfer, which results in a per diem case level 
adjustment. Because these data elements are not changing as a result of 
this notice, Table 1 shown below is identical to Table 1 that was 
published in the August 7, 2001 final rule (66 FR 41394 through 41396). 
The relative weights reflect the inclusion of cases with an 
interruption of stay (patient returns on day of discharge or either of 
the next 2 days). The methodology we used to construct the data 
elements in Table 1 are described in detail in the August 7, 2001 final 
rule (66 FR 41350 through 41353).

                              Table 1.--Relative Weights for Case-Mix Groups (CMGs)
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            CMG description (M =             Relative weights                     Average length of stay
    CMG          motor, C =      -------------------------------------------------------------------------------
             cognitive, A = age)   Tier 1    Tier 2    Tier 3     None     Tier 1    Tier 2    Tier 3     None
----------------------------------------------------------------------------------------------------------------
0101......  Stroke M=69-84 and      0.4778    0.4279    0.4078    0.3859        10         9         6         8
             C=23-35.
0102......  Stroke M=59-68 and      0.6506    0.5827    0.5553    0.5255        11        12        10        10
             C=23-35.
0103......  Stroke M=59-84 and      0.8296    0.7430    0.7080    0.6700        14        12        12        12
             C=5-22.
0104......  Stroke M=53-58......    0.9007    0.8067    0.7687    0.7275        17        13        12        13
0105......  Stroke M=47-52......    1.1339    1.0155    0.9677    0.9158        16        17        15        15

[[Page 49930]]

 
0106......  Stroke M=42-46......    1.3951    1.2494    1.1905    1.1267        18        18        18        18
0107......  Stroke M=39-41......    1.6159    1.4472    1.3790    1.3050        17        20        21        21
0108......  Stroke M=34-38 and      1.7477    1.5653    1.4915    1.4115        25        27        22        23
             A>=83.
0109......  Stroke M=34-38 and      1.8901    1.6928    1.6130    1.5265        24        24        22        24
             A=82.
0110......  Stroke M=12-33 and      2.0275    1.8159    1.7303    1.6375        29        25        27        26
             A>=89.
0111......  Stroke M=27-33 and      2.0889    1.8709    1.7827    1.6871        29        26        24        27
             A=82-88.
0112......  Stroke M=12-26 and      2.4782    2.2195    2.1149    2.0015        40        33        30        31
             A=82-88.
0113......  Stroke M=27-33 and      2.2375    2.0040    1.9095    1.8071        30        27        27        28
             A=81.
0114......  Stroke M=12-26 and      2.7302    2.4452    2.3300    2.2050        37        34        32        33
             A=81.
0201......  Traumatic brain         0.7689    0.7276    0.6724    0.6170        13        14        14        11
             injury M=52-84 and
             C=24-35.
0202......  Traumatic brain         1.1181    1.0581    0.9778    0.8973        18        16        17        16
             injury M=40-51 and
             C=24-35.
0203......  Traumatic brain         1.3077    1.2375    1.1436    1.0495        19        20        19        18
             injury M=40-84 and
             C=5-23.
0204......  Traumatic brain         1.6534    1.5646    1.4459    1.3269        24        23        22        22
             injury M=30-39.
0205......  Traumatic brain         2.5100    2.3752    2.1949    2.0143        44        36        35        31
             injury M=12-29.
0301......  Non-traumatic brain     0.9655    0.8239    0.7895    0.7195        14        14        12        13
             injury M=51-84.
0302......  Non-traumatic brain     1.3678    1.1672    1.1184    1.0194        19        17        17        16
             injury M=41-50.
0303......  Non-traumatic brain     1.8752    1.6002    1.5334    1.3976        23        23        22        22
             injury M=25-40.
0304......  Non-traumatic brain     2.7911    2.3817    2.2824    2.0801        44        32        34        31
             injury M=12-24.
0401......  Traumatic spinal        0.9282    0.8716    0.8222    0.6908        15        15        16        14
             cord injury M=50-84.
0402......  Traumatic spinal        1.4211    1.3344    1.2588    1.0576        21        18        22        19
             cord injury M=36-49.
0403......  Traumatic spinal        2.3485    2.2052    2.0802    1.7478        32        32        31        30
             cord injury M=19-35.
0404......  Traumatic spinal        3.5227    3.3078    3.1203    2.6216        46        43        62        40
             cord injury M=12-18.
0501......  Non-traumatic spinal    0.7590    0.6975    0.6230    0.5363        12        13        10        10
             cord injury M=51-84
             and C=30-35.
0502......  Non-traumatic spinal    0.9458    0.8691    0.7763    0.6683        15        17        10        12
             cord injury M=51-84
             and C=5-29.
0503......  Non-traumatic spinal    1.1613    1.0672    0.9533    0.8206        17        17        15        14
             cord injury M=41-50.
0504......  Non-traumatic spinal    1.6759    1.5400    1.3757    1.1842        23        21        21        19
             cord injury M=34-40.
0505......  Non-traumatic spinal    2.5314    2.3261    2.0778    1.7887        31        31        29        28
             cord injury M=12-33.
0601......  Neurological M=56-84    0.8794    0.6750    0.6609    0.5949        14        13        12        12
0602......  Neurological M=47-55    1.1979    0.9195    0.9003    0.8105        15        15        14        15
0603......  Neurological M=36-46    1.5368    1.1796    1.1550    1.0397        21        18        18        18
0604......  Neurological M=12-35    2.0045    1.5386    1.5065    1.3561        31        24        25        23
0701......  Fracture of lower       0.7015    0.7006    0.6710    0.5960        13        13        12        11
             extremity M=52-84.
0702......  Fracture of lower       0.9264    0.9251    0.8861    0.7870        15        15        16        14
             extremity M=46-51.
0703......  Fracture of lower       1.0977    1.0962    1.0500    0.9326        18        17        17        16
             extremity M=42-45.
0704......  Fracture of lower       1.2488    1.2471    1.1945    1.0609        14        20        19        18
             extremity M=38-41.
0705......  Fracture of lower       1.4760    1.4740    1.4119    1.2540        20        22        22        21
             extremity M=12-37.
0801......  Replacement of lower    0.4909    0.4696    0.4518    0.3890         9         9         8         8
             extremity joint
             M=58-84.
0802......  Replacement of lower    0.5667    0.5421    0.5216    0.4490        10        10         9         9
             extremity joint
             M=55-57.
0803......  Replacement of lower    0.6956    0.6654    0.6402    0.5511         9        11        11        10
             extremity joint
             M=47-54.
0804......  Replacement of lower    0.9284    0.8881    0.8545    0.7356        15        14        14        12
             extremity joint
             M=12-46 and C=32-35.
0805......  Replacement of lower    1.0027    0.9593    0.9229    0.7945        16        16        14        14
             extremity joint
             M=40-46 and C=5-31.
0806......  Replacement of lower    1.3681    1.3088    1.2592    1.0840        21        20        19        18
             extremity joint
             M=12-39 and C=5-31.
0901......  Other orthopedic        0.6988    0.6390    0.6025    0.5213        12        11        11        11
             M=54-84.
0902......  Other orthopedic        0.9496    0.8684    0.8187    0.7084        15        15        14        13
             M=47-53.
0903......  Other orthopedic        1.1987    1.0961    1.0334    0.8942        18        18        17        16
             M=38-46.
0904......  Other orthopedic        1.6272    1.4880    1.4029    1.2138        23        23        23        21
             M=12-37.
1001......  Amputation, lower       0.7821    0.7821    0.7153    0.6523        13        13        12        13
             extremity M=61-84.
1002......  Amputation, lower       0.9998    0.9998    0.9144    0.8339        15        15        14        15
             extremity M=52-60.
1003......  Amputation, lower       1.2229    1.2229    1.1185    1.0200        18        17        17        18
             extremity M=46-51.
1004......  Amputation, lower       1.4264    1.4264    1.3046    1.1897        20        20        19        19
             extremity M=39-45.
1005......  Amputation, lower       1.7588    1.7588    1.6086    1.4670        21        25        23        23
             extremity M=12-38.
1101......  Amputation, non-        1.2621    0.7683    0.7149    0.6631        18        11        13        12
             lower extremity
             M=52-84.
1102......  Amputation, non-        1.9534    1.1892    1.1064    1.0263        25        18        17        18
             lower extremity
             M=38-51.
1103......  Amputation, non-        2.6543    1.6159    1.5034    1.3945        33        23        22        25
             lower extremity
             M=12-37.
1201......  Osteoarthritis M=55-    0.7219    0.5429    0.5103    0.4596        13        10        11         9
             84 and C=34-35.
1202......  Osteoarthritis M=55-    0.9284    0.6983    0.6563    0.5911        16        11        13        13
             84 and C=5-33.
1203......  Osteoarthritis M=48-    1.0771    0.8101    0.7614    0.6858        18        15        14        13
             54.
1204......  Osteoarthritis M=39-    1.3950    1.0492    0.9861    0.8882        22        19        16        17
             47.
1205......  Osteoarthritis M=12-    1.7874    1.3443    1.2634    1.1380        27        21        21        20
             38.
1301......  Rheumatoid, other       0.7719    0.6522    0.6434    0.5566        13        14        13        11
             arthritis M=54-84.
1302......  Rheumatoid, other       0.9882    0.8349    0.8237    0.7126        16        14        14        14
             arthritis M=47-53.
1303......  Rheumatoid, other       1.3132    1.1095    1.0945    0.9469        20        18        16        17
             arthritis M=36-46.
1304......  Rheumatoid, other       1.8662    1.5768    1.5555    1.3457        25        25        29        22
             arthritis M=12-35.
1401......  Cardiac M=56-84.....    0.7190    0.6433    0.5722    0.5156        15        12        11        11
1402......  Cardiac M=48-55.....    0.9902    0.8858    0.7880    0.7101        13        15        13        13

[[Page 49931]]

 
1403......  Cardiac M=38-47.....    1.2975    1.1608    1.0325    0.9305        21        19        16        16
1404......  Cardiac M=12-37.....    1.8013    1.6115    1.4335    1.2918        30        24        21        20
1501......  Pulmonary M=61-84...    0.8032    0.7633    0.6926    0.6615        15        13        13        13
1502......  Pulmonary M=48-60...    1.0268    0.9758    0.8855    0.8457        17        17        14        15
1503......  Pulmonary M=36-47...    1.3242    1.2584    1.1419    1.0906        21        20        18        18
1504......  Pulmonary M=12-35...    2.0598    1.9575    1.7763    1.6965        30        28        30        26
1601......  Pain syndrome M=45-     0.8707    0.8327    0.7886    0.6603        15        14        13        13
             84.
1602......  Pain syndrome M=12-     1.3320    1.2739    1.2066    1.0103        21        20        20        18
             44.
1701......  Major multiple          0.9996    0.9022    0.8138    0.7205        16        14        11        13
             trauma without
             brain or spinal
             cord injury M=46-84.
1702......  Major multiple          1.4755    1.3317    1.2011    1.0634        21        21        20        18
             trauma without
             brain or spinal
             cord injury M=33-45.
1703......  Major multiple          2.1370    1.9288    1.7396    1.5402        33        28        27        24
             trauma without
             brain or spinal
             cord injury M=12-32.
1801......  Major multiple          0.7445    0.7445    0.6862    0.6282        12        12        12        10
             trauma with brain
             or spinal cord
             injury M=45-84 and
             C=33-35.
1802......  Major multiple          1.0674    1.0674    0.9838    0.9007        16        16        16        16
             trauma with brain
             or spinal cord
             injury M=45-84 and
             C=5-32.
1803......  Major multiple          1.6350    1.6350    1.5069    1.3797        22        25        20        22
             trauma with brain
             or spinal cord
             injury M=26-44.
1804......  Major multiple          2.9140    2.9140    2.6858    2.4589        41        29        40        40
             trauma with brain
             or spinal cord
             injury M=12-25.
1901......  Guillian Barre M=47-    1.1585    1.0002    0.9781    0.8876        15        15        16        15
             84.
1902......  Guillian Barre M=31-    2.1542    1.8598    1.8188    1.6505        27        27        27        24
             46.
1903......  Guillian Barre M=12-    3.1339    2.7056    2.6459    2.4011        41        35        30        40
             30.
2001......  Miscellaneous M=54-     0.8371    0.7195    0.6705    0.6029        12        13        11        12
             84.
2002......  Miscellaneous M=45-     1.1056    0.9502    0.8855    0.7962        15        15        14        14
             53.
2003......  Miscellaneous M=33-     1.4639    1.2581    1.1725    1.0543        20        18        18        18
             44.
2004......  Miscellaneous M=12-     1.7472    1.5017    1.3994    1.2583        30        22        21        22
             32 and A>=82.
2005......  Miscellaneous M=12-     2.0799    1.7876    1.6659    1.4979        33        25        24        24
             32 and A=81.
2101......  Burns M=46-84.......    1.0357    0.9425    0.8387    0.8387        18        18        15        16
2102......  Burns M=12-45.......    2.2508    2.0482    1.8226    1.8226        31        26        26        29
5001......  Short-stay cases,     ........  ........  ........    0.1651  ........  ........  ........         3
             length of stay is 3
             days or fewer.
5101......  Expired, orthopedic,  ........  ........  ........    0.4279  ........  ........  ........         8
             length of stay is
             13 days or fewer.
5102......  Expired, orthopedic,  ........  ........  ........    1.2390  ........  ........  ........        23
             length of stay is
             14 days or more.
5103......  Expired, not          ........  ........  ........    0.5436  ........  ........  ........         9
             orthopedic, length
             of stay is 15 days
             or fewer.
5104......  Expired, not          ........  ........  ........    1.7100  ........  ........  ........        28
             orthopedic, length
             of stay is 16 days
             or more.
----------------------------------------------------------------------------------------------------------------

D. IRF Market Basket Index

    Section 1886(j)(3)(C) of the Act requires the Secretary to 
establish an increase factor that reflects changes over time in the 
prices of an appropriate mix of goods and services included in the 
covered IRF services, which is referred to as a market basket index. 
Accordingly, in updating the FY 2003 payment rates set forth in this 
notice, we apply an appropriate increase factor to the FY 2002 IRF PPS 
payment rates that is equal to the IRF market basket. In constructing 
the IRF market basket, we use the methodology set forth in Appendix D 
of the August 7, 2001 final rule. For this notice, the projected FY 
2003 IRF market basket increase factor is 3 percent.

E. Update of Payment Rates Under the PPS for IRFs for FY 2003

    Once we calculate the increase factor, we can determine the updated 
Federal prospective payments for FY 2003. In accordance with 
Sec. 412.624(c)(3)(ii), we apply the increase factor (3 percent) to the 
budget neutral conversion factor for FY 2002 ($11,838). This results in 
an updated standardized payment amount for FY 2003 of $12,193. The FY 
2003 standardized payment amount is applied to each CMG weight shown in 
Table 1 to compute the unadjusted IRF prospective payment rates for FY 
2003.
    Table 2, Federal Prospective Payments for Case-Mix Groups (CMGs) 
for FY 2003, displays the CMGs, the comorbidity tiers, and the 
corresponding unadjusted IRF prospective payment rates for FY 2003.

                  Table 2.--Federal Prospective Payments for Case-Mix Groups (CMGs) for FY 2003
----------------------------------------------------------------------------------------------------------------
                                Payment rate tier  Payment rate tier  Payment rate tier      Payment rate no
              CMG                       1                  2                  3               comorbidities
----------------------------------------------------------------------------------------------------------------
0101..........................            5825.82            5217.38            4972.31                  4705.28
0102..........................            7932.77            7104.86            6770.77                  6407.42
0103..........................           10115.31            9059.40            8632.64                  8169.31
0104..........................           10982.24            9836.09            9372.76                  8870.41

[[Page 49932]]

 
0105..........................           13825.64           12381.99           11799.17                 11166.35
0106..........................           17010.45           15233.93           14515.77                 13737.85
0107..........................           19702.67           17645.71           16814.15                 15911.87
0108..........................           21309.71           19085.70           18185.86                 17210.42
0109..........................           23045.99           20640.31           19667.31                 18612.61
0110..........................           24721.31           22141.27           21097.55                 19966.04
0111..........................           25469.96           22811.88           21736.46                 20570.81
0112..........................           30216.69           27062.36           25786.98                 24404.29
0113..........................           27281.84           24434.77           23282.53                 22033.97
0114..........................           33289.33           29814.32           28409.69                 26885.57
0201..........................            9375.20            8871.63            8198.57                  7523.08
0202..........................           13632.99           12901.41           11922.32                 10940.78
0203..........................           15944.79           15088.84           13943.91                 12796.55
0204..........................           20159.91           19077.17           17629.86                 16178.89
0205..........................           30604.43           28960.81           26762.42                 24560.36
0301..........................           11772.34           10045.81            9626.37                  8772.86
0302..........................           16677.59           14231.67           13636.65                 12429.54
0303..........................           22864.31           19511.24           18696.75                 17040.94
0304..........................           34031.88           29040.07           27829.30                 25362.66
0401..........................           11317.54           10627.42           10025.08                  8422.92
0402..........................           17327.47           16270.34           15348.55                 12895.32
0403..........................           28635.26           26888.00           25363.88                 21310.93
0404..........................           42952.28           40332.01           38045.82                 31965.17
0501..........................            9254.49            8504.62            7596.24                  6539.11
0502..........................           11532.14           10596.94            9465.43                  8148.58
0503..........................           14159.73           13012.37           11623.59                 10005.58
0504..........................           20434.25           18777.22           16773.91                 14438.95
0505..........................           30865.36           28362.14           25334.62                 21809.62
0601..........................           10722.52            8230.28            8058.35                  7253.62
0602..........................           14605.99           11211.46           10977.36                  9882.43
0603..........................           18738.20           14382.86           14082.92                 12677.06
0604..........................           24440.87           18760.15           18368.75                 16534.93
0701..........................            8553.39            8542.42            8181.50                  7267.03
0702..........................           11295.60           11279.74           10804.22                  9595.89
0703..........................           13384.26           13365.97           12802.65                 11371.19
0704..........................           15226.62           15205.89           14564.54                 12935.55
0705..........................           17996.87           17972.48           17215.30                 15290.02
0801..........................            5985.54            5725.83            5508.80                  4743.08
0802..........................            6909.77            6609.83            6359.87                  5474.66
0803..........................            8481.45            8113.22            7805.96                  6719.56
0804..........................           11319.98           10828.60           10418.92                  8969.17
0805..........................           12225.92           11696.74           11252.92                  9687.34
0806..........................           16681.24           15958.20           15353.43                 13217.21
0901..........................            8520.47            7791.33            7346.28                  6356.21
0902..........................           11578.47           10588.40            9982.41                  8637.52
0903..........................           14615.75           13364.75           12600.25                 10902.98
0904..........................           19840.45           18143.18           17105.56                 14799.86
1001..........................            9536.15            9536.15            8721.65                  7953.49
1002..........................           12190.56           12190.56           11149.28                 10167.74
1003..........................           14910.82           14910.82           13637.87                 12436.86
1004..........................           17392.10           17392.10           15906.99                 14506.01
1005..........................           21445.05           21445.05           19613.66                 17887.13
1101..........................           15388.79            9367.88            8716.78                  8085.18
1102..........................           23817.81           14499.92           13490.34                 12513.68
1103..........................           32363.88           19702.67           18330.96                 17003.14
1201..........................            8802.13            6619.58            6222.09                  5603.90
1202..........................           11319.98            8514.37            8002.27                  7207.28
1203..........................           13133.08            9877.55            9283.75                  8361.96
1204..........................           17009.24           12792.90           12023.52                 10829.82
1205..........................           21793.77           16391.05           15404.64                 13875.63
1301..........................            9411.78            7952.27            7844.98                  6786.62
1302..........................           12049.12           10179.94           10043.37                  8688.73
1303..........................           16011.85           13528.13           13345.24                 11545.55
1304..........................           22754.58           19225.92           18966.21                 16408.12
1401..........................            8766.77            7843.76            6976.83                  6286.71
1402..........................           12073.51           10800.56            9608.08                  8658.25
1403..........................           15820.42           14153.63           12589.27                 11345.59
1404..........................           21963.25           19649.02           17478.67                 15750.92
1501..........................            9793.42            9306.92            8444.87                  8065.67
1502..........................           12519.77           11897.93           10796.90                 10311.62
1503..........................           16145.97           15343.67           13923.19                 13297.69

[[Page 49933]]

 
1504..........................           25115.14           23867.80           21658.43                 20685.42
1601..........................           10616.45           10153.11            9615.40                  8051.04
1602..........................           16241.08           15532.66           14712.07                 12318.59
1701..........................           12188.12           11000.52            9922.66                  8785.06
1702..........................           17990.77           16237.42           14645.01                 12966.04
1703..........................           26056.44           23517.86           21210.94                 18779.66
1801..........................            9077.69            9077.69            8366.84                  7659.64
1802..........................           13014.81           13014.81           11995.47                 10982.24
1803..........................           19935.56           19935.56           18373.63                 16822.68
1804..........................           35530.40           35530.40           32747.96                 29981.37
1901..........................           14125.59           12195.44           11925.97                 10822.51
1902..........................           26266.16           22676.54           22176.63                 20124.55
1903..........................           38211.64           32989.38           32261.46                 29276.61
2001..........................           10206.76            8772.86            8175.41                  7351.16
2002..........................           13480.58           11585.79           10796.90                  9708.07
2003..........................           17849.33           15340.01           14296.29                 12855.08
2004..........................           21303.61           18310.23           17062.88                 15342.45
2005..........................           25360.22           21796.21           20312.32                 18263.89
2101..........................           12628.29           11491.90           10226.27                 10226.27
2102..........................           27444.00           24973.70           22222.96                 22222.96
5001..........................  .................  .................  .................                  2013.06
5101..........................  .................  .................  .................                  5217.38
5102..........................  .................  .................  .................                 15107.13
5103..........................  .................  .................  .................                  6628.11
5104..........................  .................  .................  .................                 20850.03
----------------------------------------------------------------------------------------------------------------

F. Area Wage Adjustment

    Section 1886(j)(6) of the Act requires the Secretary to adjust the 
proportion (as estimated by the Secretary from time to time) of 
rehabilitation facilities' costs that are attributable to wages and 
wage-related costs for area differences in wage levels by a factor 
(established by the Secretary) reflecting the relative hospital wage 
level in the geographic area of the rehabilitation facility compared to 
the national average wage level for such facilities. Not later than 
October 1, 2001 and at least every 36 months thereafter, the Secretary 
is required to update the factor under the preceding sentence on the 
basis of information available to the Secretary (and updated as 
appropriate) of the wages and wage-related costs incurred in furnishing 
rehabilitation services. Any adjustments or updates made under section 
1886(j)(6) of the Act shall be made in a budget neutral manner.
    For the FY 2003 IRF PPS payment rates set forth in this notice, we 
are applying the same wage adjustment as used for the FY 2002 IRF PPS 
rates. This includes both the labor-related share and wage indices as 
specified in the August 7, 2001 final rule. In the August 7, 2001 final 
rule, we established a wage index based on FY 1997 acute care hospital 
wages to adjust the FY 2002 IRF payment rates. Although the statute 
permits the Secretary to adjust the labor-related share and wage index 
from time to time, we are not adjusting these figures at this time. It 
is our intention to update the annual wage index and the labor-related 
share as soon as feasible. However, we must first develop a methodology 
to incorporate a budget neutrality adjustment for calculating these 
figures in order to be consistent with the statute. Once we have 
developed a proposed methodology, we plan to discuss it in a future 
proposed rule allowing the public an opportunity to comment on its 
design and application. We believe that continuing to apply the wage 
index and labor-related share used in FY 2002, provides an appropriate 
adjustment to account for geographic variation in wage levels, 
consistent with the statute.
    To calculate the wage-adjusted facility payments for the payment 
rates set forth in this notice, the Federal prospective payment is 
multiplied by the labor-related percentage (72.395) to determine the 
labor-related portion of the Federal prospective payments. This labor-
related portion is then multiplied by the applicable IRF wage index 
shown in Table 3A for urban areas and Table 3B for rural areas. These 
tables shown below are identical to Table 3A and 3B that were published 
in the August 7, 2001 final rule (66 FR 41397 through 41404).

                  Table 3A.--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                   Wage
MSA and urban area (constituent counties or county equivalents)   index
------------------------------------------------------------------------
0040  Abilene, TX..............................................   0.8240
    Taylor, TX
0060  Aguadilla, PR............................................   0.4391
    Aguada, PR
    Aguadilla, PR
    Moca, PR
0080  Akron, OH................................................   0.9541
    Portage, OH
    Summit, OH
0120  Albany, GA...............................................   0.9893
    Dougherty, GA
    Lee, GA
0160  Albany-Schenectady-Troy, NY..............................   0.8480
    Albany, NY
    Montgomery, NY
    Rensselaer, NY
    Saratoga, NY
    Schenectady, NY
    Schoharie, NY
0200  Albuquerque, NM..........................................   0.9146
    Bernalillo, NM
    Sandoval, NM
    Valencia, NM
0220  Alexandria, LA...........................................   0.8121
    Rapides, LA
0240  Allentown-Bethlehem-Easton, PA...........................   0.9839
    Carbon, PA
    Lehigh, PA
    Northampton, PA
0280  Altoona, PA..............................................   0.9317
    Blair, PA
0320  Amarillo, TX.............................................   0.8673
    Potter, TX
    Randall, TX
0380  Anchorage, AK............................................   1.2775

[[Page 49934]]

 
    Anchorage, AK
0440  Ann Arbor, MI............................................   1.1093
    Lenawee, MI
    Livingston, MI
    Washtenaw, MI
0450  Anniston,AL..............................................   0.8284
    Calhoun, AL
0460  Appleton-Oshkosh-Neenah, WI..............................   0.9052
    Calumet, WI
    Outagamie, WI
    Winnebago, WI
0470  Arecibo, PR..............................................   0.4525
    Arecibo, PR
    Camuy, PR
    Hatillo, PR
0480  Asheville, NC............................................   0.9479
    Buncombe, NC
    Madison, NC
0500  Athens, GA...............................................   0.9739
    Clarke, GA
    Madison, GA
    Oconee, GA
0520  Atlanta, GA..............................................   1.0097
    Barrow, GA
    Bartow, GA
    Carroll, GA
    Cherokee, GA
    Clayton, GA
    Cobb, GA
    Coweta, GA
    De Kalb, GA
    Douglas, GA
    Fayette, GA
    Forsyth, GA
    Fulton, GA
    Gwinnett, GA
    Henry, GA
    Newton, GA
    Paulding, GA
    Pickens, GA
    Rockdale, GA
    Spalding, GA
    Walton, GA
0560  Atlantic City-Cape May, NJ...............................   1.1167
    Atlantic City, NJ
    Cape May, NJ
0580  Auburn-Opelika, AL.......................................   0.8079
    Lee, AL
0600  Augusta-Aiken, GA-SC.....................................   0.9127
    Columbia, GA
    McDuffie, GA
    Richmond, GA
    Aiken, SC
    Edgefield, SC
0640  Austin-San Marcos, TX....................................   0.9540
    Bastrop, TX
    Caldwell, TX
    Hays, TX
    Travis, TX
    Williamson, TX
0680  Bakersfield, CA..........................................   0.9684
    Kern, CA
0720  Baltimore, MD............................................   0.9223
    Anne Arundel, MD
    Baltimore, MD
    Baltimore City, MD
    Carroll, MD
    Harford, MD
    Howard, MD
    Queen Annes, MD
0733  Bangor, ME...............................................   0.9550
    Penobscot, ME
0743  Barnstable-Yarmouth, MA..................................   1.3801
    Barnstable, MA
0760  Baton Rouge, LA..........................................   0.8796
    Ascension, LA
    East Baton Rouge
    Livingston, LA
    West Baton Rouge, LA
0840  Beaumont-Port Arthur, TX.................................   0.8734
    Hardin, TX
    Jefferson, TX
    Orange, TX
0860  Bellingham, WA...........................................   1.1439
    Whatcom, WA
0870  Benton Harbor, MI........................................   0.8671
    Berrien, MI
0875  Bergen-Passaic, NJ.......................................   1.1818
    Bergen, NJ
    Passaic, NJ
0880  Billings, MT.............................................   0.9604
    Yellowstone, MT
0920  Biloxi-Gulfport-Pascagoula, MS...........................   0.8236
    Hancock, MS
    Harrison, MS
    Jackson, MS
0960  Binghamton, NY...........................................   0.8600
    Broome, NY
    Tioga, NY
1000  Birmingham, AL...........................................   0.8360
    Blount, AL
    Jefferson, AL
    St. Clair, AL
    Shelby, AL
1010  Bismarck, ND.............................................   0.7625
    Burleigh, ND
    Morton, ND
1020  Bloomington, IN..........................................   0.8733
    Monroe, IN
1040  Bloomington-Normal, IL...................................   0.9095
    McLean, IL
1080  Boise City, ID...........................................   0.9006
    Ada, ID
    Canyon, ID
1123  Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.........   1.1086
    Bristol, MA
    Essex, MA
    Middlesex, MA
    Norfolk, MA
    Plymouth, MA
    Suffolk, MA
    Worcester, MA
    Hillsborough, NH
    Merrimack, NH
    Rockingham, NH
    Strafford, NH
1125  Boulder-Longmont, CO.....................................   0.9731
    Boulder, CO
1145  Brazoria, TX.............................................   0.8658
    Brazoria, TX
1150  Bremerton, WA............................................   1.0975
    Kitsap, WA
1240  Brownsville-Harlingen-San Benito, TX.....................   0.8714
    Cameron, TX
1260  Bryan-College Station, TX................................   0.8237
    Brazos, TX
1280  Buffalo-Niagara Falls, NY................................   0.9455
    Erie, NY
    Niagara, NY
1303  Burlington, VT...........................................   1.0840
    Chittenden, VT
    Franklin, VT
    Grand Isle, VT
1310  Caguas, PR...............................................   0.4548
    Caguas, PR
    Cayey, PR
    Cidra, PR
    Gurabo, PR
    San Lorenzo, PR
1320  Canton-Massillon, OH.....................................   0.8480
    Carroll, OH
    Stark, OH
1350  Casper, WY...............................................   0.8724
    Natrona, WY
1360  Cedar Rapids, IA.........................................   0.8716
    Linn, IA
1400  Champaign-Urbana, IL.....................................   0.9189
    Champaign, IL
1440  Charleston-North Charleston, SC..........................   0.9029
    Berkeley, SC
    Charleston, SC
    Dorchester, SC
1480  Charleston, WV...........................................   0.9235
    Kanawha, WV
    Putnam, WV
1520  Charlotte-Gastonia-Rock Hill, NC-SC......................   0.9321
    Cabarrus, NC
    Gaston, NC
    Lincoln, NC
    Mecklenburg, NC
    Rowan, NC
    Stanly, NC
    Union, NC
    York, SC
1540  Charlottesville, VA......................................   1.0581
    Albemarle, VA
    Charlottesville City, VA
    Fluvanna, VA
    Greene, VA
1560  Chattanooga, TN-GA.......................................   0.9790
    Catoosa, GA
    Dade, GA
    Walker, GA
    Hamilton, TN
    Marion, TN
1580  Cheyenne, WY.............................................   0.8308
    Laramie, WY
1600  Chicago, IL..............................................   1.1092
    Cook, IL
    De Kalb, IL
    Du Page, IL
    Grundy, IL
    Kane, IL
    Kendall, IL
    Lake, IL
    McHenry, IL
    Will, IL
1620  Chico-Paradise, CA.......................................   0.9918
    Butte, CA
1640  Cincinnati, OH-KY-IN.....................................   0.9349
    Dearborn, IN
    Ohio, IN
    Boone, KY
    Campbell, KY

[[Page 49935]]

 
    Gallatin, KY
    Grant, KY
    Kenton, KY
    Pendleton, KY
    Brown, OH
    Clermont, OH
    Hamilton, OH
    Warren, OH
1660  Clarksville-Hopkinsville, TN-KY..........................   0.8173
    Christian, KY
    Montgomery, TN
1680  Cleveland-Lorain-Elyria, OH..............................   0.9528
    Ashtabula, OH
    Geauga, OH
    Cuyahoga, OH
    Lake, OH
    Lorain, OH
    Medina, OH
1720  Colorado Springs, CO.....................................   0.9698
    El Paso, CO
1740  Columbia MO..............................................   0.8920
    Boone, MO
1760  Columbia, SC.............................................   0.9557
    Lexington, SC
    Richland, SC
1800  Columbus, GA-AL..........................................   0.8531
    Russell, AL
    Chattanoochee, GA
    Harris, GA
    Muscogee, GA
1840  Columbus, OH.............................................   0.9573
    Delaware, OH
    Fairfield, OH
    Franklin, OH
    Licking, OH
    Madison, OH
    Pickaway, OH
1880  Corpus Christi, TX.......................................   0.8746
    Nueces, TX
    San Patricio, TX
1890  Corvallis, OR............................................   1.1326
    Benton, OR
1900  Cumberland, MD-WV........................................   0.8369
    Allegany MD
    Mineral WV
1920  Dallas, TX...............................................   0.9792
    Collin, TX
    Dallas, TX
    Denton, TX
    Ellis, TX
    Henderson, TX
    Hunt, TX
    Kaufman, TX
    Rockwall, TX
1950  Danville, VA.............................................   0.8589
    Danville City, VA
    Pittsylvania, VA
1960  Davenport-Moline-Rock Island, IA-IL......................   0.8897
    Scott, IA
    Henry, IL
    Rock Island, IL
2000  Dayton-Springfield, OH...................................   0.9384
    Clark, OH
    Greene, OH
    Miami, OH
    Montgomery, OH
2020  Daytona Beach, FL........................................   0.9165
    Flagler, FL
    Volusia, FL
2030  Decatur, AL..............................................   0.8534
    Lawrence, AL
    Morgan, AL
2040  Decatur, IL..............................................   0.8095
    Macon, IL
2080  Denver, CO...............................................   1.0120
    Adams, CO
    Arapahoe, CO
    Denver, CO
    Douglas, CO
    Jefferson, CO
2120  Des Moines, IA...........................................   0.9073
    Dallas, IA
    Polk, IA
    Warren, IA
2160  Detroit, MI..............................................   1.0364
    Lapeer, MI
    Macomb, MI
    Monroe, MI
    Oakland, MI
    St. Clair, MI
    Wayne, MI
2180  Dothan, AL...............................................   0.7943
    Dale, AL
    Houston, AL
2190  Dover, DE................................................   1.0078
    Kent, DE
2200  Dubuque, IA..............................................   0.8746
    Dubuque, IA
2240  Duluth-Superior, MN-WI...................................   1.0032
    St. Louis, MN
    Douglas, WI
2281  Dutchess County, NY......................................   1.0187
    Dutchess, NY
2290  Eau Claire, WI...........................................   0.8761
    Chippewa, WI
    Eau Claire, WI
2320  El Paso, TX..............................................   0.9332
    El Paso, TX
2330  Elkhart-Goshen, IN.......................................   0.9145
    Elkhart, IN
2335  Elmira, NY...............................................   0.8546
    Chemung, NY
2340  Enid, OK.................................................   0.8610
    Garfield, OK
2360  Erie, PA.................................................   0.8892
    Erie, PA
2400  Eugene-Springfield, OR...................................   1.0960
    Lane, OR
2440  Evansville-Henderson, IN-KY..............................   0.8137
    Posey, IN
    Vanderburgh, IN
    Warrick, IN
    Henderson, KY
2520  Fargo-Moorhead, ND-MN....................................   0.8750
    Clay, MN
    Cass, ND
2560  Fayetteville, NC.........................................   0.8655
    Cumberland, NC
2580  Fayetteville-Springdale-Rogers, AR.......................   0.7910
    Benton, AR
    Washington, AR
2620  Flagstaff, AZ-UT.........................................   1.0681
    Coconino, AZ
    Kane, UT
2640  Flint, MI................................................   1.1153
    Genesee, MI
2650  Florence, AL.............................................   0.7616
    Colbert, AL
    Lauderdale, AL
2655  Florence, SC.............................................   0.8737
    Florence, SC
2670  Fort Collins-Loveland, CO................................   1.0620
    Larimer, CO
2680  Ft. Lauderdale, FL.......................................   1.0118
    Broward, FL
2700  Fort Myers-Cape Coral, FL................................   0.9247
    Lee, FL
2710  Fort Pierce-Port St. Lucie, FL...........................   0.9538
    Martin, FL
    St. Lucie, FL
2720  Fort Smith, AR-OK........................................   0.8052
    Crawford, AR
    Sebastian, AR
    Sequoyah, OK
2750  Fort Walton Beach, FL....................................   0.9607
    Okaloosa, FL
2760  Fort Wayne, IN...........................................   0.8647
    Adams, IN
    Allen, IN
    De Kalb, IN
    Huntington, IN
    Wells, IN
    Whitley, IN
2800  Forth Worth-Arlington, TX................................   0.9392
    Hood, TX
    Johnson, TX
    Parker, TX
    Tarrant, TX
2840  Fresno, CA...............................................   1.0057
    Fresno, CA
    Madera, CA
2880  Gadsden, AL..............................................   0.8423
    Etowah, AL
2900  Gainesville, FL..........................................   0.9741
    Alachua, FL
2920  Galveston-Texas City, TX.................................   0.9796
    Galveston, TX
2960  Gary, IN.................................................   0.9451
    Lake, IN
    Porter, IN
2975  Glens Falls, NY..........................................   0.8361
    Warren, NY
    Washington, NY
2980  Goldsboro, NC............................................   0.8423
    Wayne, NC
2985  Grand Forks, ND-MN.......................................   0.8774
    Polk, MN
    Grand Forks, ND
2995  Grand Junction, CO.......................................   0.8947
    Mesa, CO
3000  Grand Rapids-Muskegon-Holland, MI........................   1.0070
    Allegan, MI
    Kent, MI
    Muskegon, MI
    Ottawa, MI
3040  Great Falls, MT..........................................   0.9065
    Cascade, MT
3060  Greeley, CO..............................................   0.9664
    Weld, CO
3080  Green Bay, WI............................................   0.9207
    Brown, WI
3120  Greensboro-Winston-Salem-High Point, NC..................   0.9068
    Alamance, NC

[[Page 49936]]

 
    Davidson, NC
    Davie, NC
    Forsyth, NC
    Guilford, NC
    Randolph, NC
    Stokes, NC
    Yadkin, NC
3150  Greenville, NC...........................................   0.9402
    Pitt, NC
3160  Greenville-Spartanburg-Anderson, SC......................   0.8894
    Anderson, SC
    Cherokee, SC
    Greenville, SC
    Pickens, SC
    Spartanburg, SC
3180  Hagerstown, MD...........................................   0.9409
    Washington, MD
3200  Hamilton-Middletown, OH..................................   0.9061
    Butler, OH
3240  Harrisburg-Lebanon-Carlisle, PA..........................   0.9338
    Cumberland, PA
    Dauphin, PA
    Lebanon, PA
    Perry, PA
3283  Hartford, CT.............................................   1.1236
    Hartford, CT
    Litchfield, CT
    Middlesex, CT
    Tolland, CT
3285  Hattiesburg, MS..........................................   0.7490
    Forrest, MS
    Lamar, MS
3290  Hickory-Morganton-Lenoir, NC.............................   0.9008
    Alexander, NC
    Burke, NC
    Caldwell, NC
    Catawba, NC
3320  Honolulu, HI.............................................   1.1865
    Honolulu, HI
3350  Houma, LA................................................   0.8100
    Lafourche, LA
    Terrebonne, LA
3360  Houston, TX..............................................   0.9663
    Chambers, TX
    Fort Bend, TX
    Harris, TX
    Liberty, TX
    Montgomery, TX
    Waller, TX
3400  Huntington-Ashland, WV-KY-OH.............................   0.9876
    Boyd, KY
    Carter, KY
    Greenup, KY
    Lawrence, OH
    Cabell, WV
    Wayne, WV
3440  Huntsville, AL...........................................   0.8932
    Limestone, AL
    Madison, AL
3480  Indianapolis, IN.........................................   0.9747
    Boone, IN
    Hamilton, IN
    Hancock, IN
    Hendricks, IN
    Johnson, IN
    Madison, IN
    Marion, IN
    Morgan, IN
    Shelby, IN
3500  Iowa City, IA............................................   0.9537
    Johnson, IA
3520  Jackson, MI..............................................   0.9134
    Jackson, MI
3560  Jackson, MS..............................................   0.8749
    Hinds, MS
    Madison, MS
    Rankin, MS
3580  Jackson, TN..............................................   0.8796
    Chester, TN
    Madison, TN
3600  Jacksonville, FL.........................................   0.9186
    Clay, FL
    Duval, FL
    Nassau, FL
    St. Johns, FL
3605  Jacksonville, NC.........................................   0.7777
    Onslow, NC
3610  Jamestown, NY............................................   0.7818
    Chautaqua, NY
3620  Janesville-Beloit, WI....................................   0.9587
    Rock, WI
3640  Jersey City, NJ..........................................   1.1440
    Hudson, NJ
3660  Johnson City-Kingsport-Bristol, TN-VA....................   0.8272
    Carter, TN
    Hawkins, TN
    Sullivan, TN
    Unicoi, TN
    Washington, TN
    Bristol City, VA
    Scott, VA
    Washington, VA
3680  Johnstown, PA............................................   0.8767
    Cambria, PA
    Somerset, PA
3700  Jonesboro, AR............................................   0.7831
    Craighead, AR
3710  Joplin, MO...............................................   0.8148
    Jasper, MO
    Newton, MO
3720  Kalamazoo-Battlecreek, MI................................   1.0440
    Calhoun, MI
    Kalamazoo, MI
    Van Buren, MI
3740  Kankakee, IL.............................................   0.9902
    Kankakee, IL
3760  Kansas City, KS-MO.......................................   0.9458
    Johnson, KS
    Leavenworth, KS
    Miami, KS
    Wyandotte, KS
    Cass, MO
    Clay, MO
    Clinton, MO
    Jackson, MO
    Lafayette, MO
    Platte, MO
    Ray, MO
3800  Kenosha, WI..............................................   0.9611
    Kenosha, WI
3810  Killeen-Temple, TX.......................................   1.0164
    Bell, TX
    Coryell, TX
3840  Knoxville, TN............................................   0.8221
    Anderson, TN
    Blount, TN
    Knox, TN
    Loudon, TN
    Sevier, TN
    Union, TN
3850  Kokomo, IN...............................................   0.9518
    Howard, IN
    Tipton, IN
3870  La Crosse, WI-MN.........................................   0.9197
    Houston, MN
    La Crosse, WI
3880  Lafayette, LA............................................   0.8390
    Acadia, LA
    Lafayette, LA
    St. Landry, LA
    St. Martin, LA
3920  Lafayette, IN............................................   0.8834
    Clinton, IN
    Tippecanoe, IN
3960  Lake Charles, LA.........................................   0.7399
    Calcasieu, LA
3980  Lakeland-Winter Haven, FL................................   0.9239
    Polk, FL
4000  Lancaster, PA............................................   0.9247
    Lancaster, PA
4040  Lansing-East Lansing, MI.................................   0.9880
    Clinton, MI
    Eaton, MI
    Ingham, MI
4080  Laredo, TX...............................................   0.8168
    Webb, TX
4100  Las Cruces, NM...........................................   0.8639
    Dona Ana, NM
4120  Las Vegas, NV-AZ.........................................   1.0796
    Mohave, AZ
    Clark, NV
    Nye, NV
4150  Lawrence, KS.............................................   0.8190
    Douglas, KS
4200  Lawton, OK...............................................   0.8996
    Comanche, OK
4243  Lewiston-Auburn, ME......................................   0.9003
    Androscoggin, ME
4280  Lexington, KY............................................   0.8774
    Bourbon, KY
    Clark, KY
    Fayette, KY
    Jessamine, KY
    Madison, KY
    Scott, KY
    Woodford, KY
4320  Lima, OH.................................................   0.9320
    Allen, OH
    Auglaize, OH
4360  Lincoln, NE..............................................   0.9619
    Lancaster, NE
4400  Little Rock-North Little, AR.............................   0.8908
    Faulkner, AR
    Lonoke, AR
    Pulaski, AR
    Saline, AR
4420  Longview-Marshall, TX....................................   0.8922
    Gregg, TX
    Harrison, TX
    Upshur, TX
4480  Los Angeles-Long Beach, CA...............................   1.1984
    Los Angeles, CA
4520  Louisville, KY-IN........................................   0.9261
    Clark, IN
    Floyd, IN

[[Page 49937]]

 
    Harrison, IN
    Scott, IN
    Bullitt, KY
    Jefferson, KY
    Oldham, KY
4600  Lubbock, TX..............................................   0.8848
    Lubbock, TX
4640  Lynchburg, VA............................................   0.8851
    Amherst, VA
    Bedford City, VA
    Bedford, VA
    Campbell, VA
    Lynchburg City, VA
4680  Macon, GA................................................   0.8848
    Bibb, GA
    Houston, GA
    Jones, GA
    Peach, GA
    Twiggs, GA
4720  Madison, WI..............................................   1.0316
    Dane, WI
4800  Mansfield, OH............................................   0.8690
    Crawford, OH
    Richland, OH
4840  Mayaguez, PR.............................................   0.4577
    Anasco, PR
    Cabo Rojo, PR
    Hormigueros, PR
    Mayaguez, PR
    Sabana Grande, PR
    San German, PR
4880  McAllen-Edinburg-Mission, TX.............................   0.8566
    Hidalgo, TX
4890  Medford-Ashland, OR......................................   1.0344
    Jackson, OR
4900  Melbourne-Titusville-Palm Bay, FL........................   0.9688
    Brevard, FL
4920  Memphis, TN-AR-MS........................................   0.8688
    Crittenden, AR
    De Soto, MS
    Fayette, TN
    Shelby, TN
    Tipton, TN
4940  Merced, CA...............................................   0.9559
    Merced, CA
5000  Miami, FL................................................   1.0110
    Dade, FL
5015  Middlesex-Somerset-Hunterdon, NJ.........................   1.0987
    Hunterdon, NJ
    Middlesex, NJ
    Somerset, NJ
5080  Milwaukee-Waukesha, WI...................................   0.9664
    Milwaukee, WI
    Ozaukee, WI
    Washington, WI
    Waukesha, WI
5120  Minneapolis-St. Paul, MN-WI..............................   1.0971
    Anoka, MN
    Carver, MN
    Chisago, MN
    Dakota, MN
    Hennepin, MN
    Isanti, MN
    Ramsey, MN
    Scott, MN
    Sherburne, MN
    Washington, MN
    Wright, MN
    Pierce, WI
    St. Croix, WI
5140  Missoula, MT.............................................   0.9274
    Missoula, MT
5160  Mobile, AL...............................................   0.8006
    Baldwin, AL
    Mobile, AL
5170  Modesto, CA..............................................   1.0401
    Stanislaus, CA
5190  Monmouth-Ocean, NJ.......................................   1.1293
    Monmouth, NJ
    Ocean, NJ
5200  Monroe, LA...............................................   0.8316
    Ouachita, LA
5240  Montgomery, AL...........................................   0.7642
    Autauga, AL
    Elmore, AL
    Montgomery, AL
5280  Muncie, IN...............................................   1.0683
    Delaware, IN
5330  Myrtle Beach, SC.........................................   0.8440
    Horry, SC
5345  Naples, FL...............................................   0.9661
    Collier, FL
5360  Nashville, TN............................................   0.9327
    Cheatham, TN
    Davidson, TN
    Dickson, TN
    Robertson, TN
    Rutherford, TN
    Sumner, TN
    Williamson, TN
    Wilson, TN
5380  Nassau-Suffolk, NY.......................................   1.3784
    Nassau, NY
    Suffolk, NY
5483  New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT......   1.2192
    Fairfield, CT
    New Haven, CT
5523  New London-Norwich, CT...................................   1.2061
    New London, CT
5560  New Orleans, LA..........................................   0.9235
    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.............................................   1.4483
    Bronx, NY
    Kings, NY
    New York, NY
    Putnam, NY
    Queens, NY
    Richmond, NY
    Rockland, NY
    Westchester, NY
5640  Newark, NJ...............................................   1.1828
    Essex, NJ
    Morris, NJ
    Sussex, NJ
    Union, NJ
    Warren, NJ
5660  Newburgh, NY-PA..........................................   1.0847
    Orange, NY
    Pike, PA
5720  Norfolk-Virginia Beach-Newport News, VA-NC...............   0.8374
    Currituck, NC
    Chesapeake City, VA
    Gloucester, VA
    Hampton City, VA
    Isle of Wight, VA
    James City, VA
    Mathews, VA
    Newport News City, VA
    Norfolk City, VA
    Poquoson City,VA
    Portsmouth City, VA
    Suffolk City, VA
    Virginia Beach City, VA
    Williamsburg City, VA
    York, VA
5775  Oakland, CA..............................................   1.5029
    Alameda, CA
    Contra Costa, CA
5790  Ocala, FL................................................   0.9243
    Marion, FL
5800  Odessa-Midland, TX.......................................   0.9206
    Ector, TX
    Midland, TX
5880  Oklahoma City, OK........................................   0.8774
    Canadian, OK
    Cleveland, OK
    Logan, OK
    McClain, OK
    Oklahoma, OK
    Pottawatomie, OK
5910  Olympia, WA..............................................   1.0689
    Thurston, WA
5920  Omaha, NE-IA.............................................   0.9470
    Pottawattamie, IA
    Cass, NE
    Douglas, NE
    Sarpy, NE
    Washington, NE
5945  Orange County, CA........................................   1.1453
    Orange, CA
5960  Orlando, FL..............................................   0.9550
    Lake, FL
    Orange, FL
    Osceola, FL
    Seminole, FL
5990  Owensboro, KY............................................   0.8159
    Daviess, KY
6015  Panama City, FL..........................................   0.9010
    Bay, FL
6020  Parkersburg-Marietta, WV-OH..............................   0.8258
    Washington, OH
    Wood, WV
6080  Pensacola, FL............................................   0.8176
    Escambia, FL
    Santa Rosa, FL
6120  Peoria-Pekin, IL.........................................   0.8494
    Peoria, IL
    Tazewell, IL
    Woodford, IL
6160  Philadelphia, PA-NJ......................................   1.0753
    Burlington, NJ
    Camden, NJ
    Gloucester, NJ
    Salem, NJ
    Bucks, PA
    Chester, PA
    Delaware, PA

[[Page 49938]]

 
    Montgomery, PA
    Philadelphia, PA
6200  Phoenix-Mesa, AZ.........................................   0.9628
    Maricopa, AZ
    Pinal, AZ
6240  Pine Bluff, AR...........................................   0.7771
    Jefferson, AR
6280  Pittsburgh, PA...........................................   0.9570
    Allegheny, PA
    Beaver, PA
    Butler, PA
    Fayette, PA
    Washington, PA
    Westmoreland, PA
6323  Pittsfield, MA...........................................   1.0130
    Berkshire, MA
6340  Pocatello, ID............................................   0.9076
    Bannock, ID
6360  Ponce, PR................................................   0.4993
    Guayanilla, PR
    Juana Diaz, PR
    Penuelas, PR
    Ponce, PR
    Villalba, PR
    Yauco, PR
6403  Portland, ME.............................................   0.9687
    Cumberland, ME
    Sagadahoc, ME
    York, ME
6440  Portland-Vancouver, OR-WA................................   1.0913
    Clackamas, OR
    Columbia, OR
    Multnomah, OR
    Washington, OR
    Yamhill, OR
    Clark, WA
6483  Providence-Warwick-Pawtucket, RI.........................   1.0771
    Bristol, RI
    Kent, RI
    Newport, RI
    Providence, RI
    Washington, RI
6520  Provo-Orem, UT...........................................   1.0014
    Utah, UT
6560  Pueblo, CO...............................................   0.8783
    Pueblo, CO
6580  Punta Gorda, FL..........................................   0.9602
    Charlotte, FL
6600  Racine, WI...............................................   0.9231
    Racine, WI
6640  Raleigh-Durham-Chapel Hill, NC...........................   0.9583
    Chatham, NC
    Durham, NC
    Franklin, NC
    Johnston, NC
    Orange, NC
    Wake, NC
6660  Rapid City, SD...........................................   0.8779
    Pennington, SD
6680  Reading, PA..............................................   0.9105
    Berks, PA
6690  Redding, CA..............................................   1.1641
    Shasta, CA
6720  Reno, NV.................................................   1.0550
    Washoe, NV
6740  Richland-Kennewick-Pasco, WA.............................   1.1460
    Benton, WA
    Franklin, WA
6760  Richmond-Petersburg, VA..................................   0.9618
    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.............................   1.1229
    Riverside, CA
    San Bernardino, CA
6800  Roanoke, VA..............................................   0.8663
    Botetourt, VA
    Roanoke, VA
    Roanoke City, VA
    Salem City, VA
6820  Rochester, MN............................................   1.1334
    Olmsted, MN
6840  Rochester, NY............................................   0.8991
    Genesee, NY
    Livingston, NY
    Monroe, NY
    Ontario, NY
    Orleans, NY
    Wayne, NY
6880  Rockford, IL.............................................   0.8819
    Boone, IL
    Ogle, IL
    Winnebago, IL
6895  Rocky Mount, NC..........................................   0.8849
    Edgecombe, NC
    Nash, NC
6920  Sacramento, CA...........................................   1.1932
    El Dorado, CA
    Placer, CA
    Sacramento, CA
6960  Saginaw-Bay City-Midland, MI.............................   0.9557
    Bay, MI
    Midland, MI
    Saginaw, MI
6980  St. Cloud, MN............................................   0.9994
    Benton, MN
    Stearns, MN
7000  St. Joseph, MO...........................................   0.9071
    Andrews, MO
    Buchanan, MO
7040  St. Louis, MO-IL.........................................   0.8947
    Clinton, IL
    Jersey, IL
    Madison, IL
    Monroe, IL
    St. Clair, IL
    Franklin, MO
    Jefferson, MO
    Lincoln, MO
    St. Charles, MO
    St. Louis, MO
    St. Louis City, MO
    Warren, MO
    Sullivan City, MO
7080  Salem, OR................................................   1.0189
    Marion, OR
    Polk, OR
7120  Salinas, CA..............................................   1.4518
    Monterey, CA
7160  Salt Lake City-Ogden, UT.................................   0.9782
    Davis, UT
    Salt Lake, UT
    Weber, UT
7200  San Angelo, TX...........................................   0.8083
    Tom Green, TX
7240  San Antonio, TX..........................................   0.8540
    Bexar, TX
    Comal, TX
    Guadalupe, TX
    Wilson, TX
7320  San Diego, CA............................................   1.1784
    San Diego, CA
7360  San Francisco, CA........................................   1.4250
    Marin, CA
    San Francisco, CA
    San Mateo, CA
7400  San Jose, CA.............................................   1.3759
    Santa Clara, CA
7440  San Juan-Bayamon, PR.....................................   0.4651
    Aguas Buenas, PR
    Barceloneta, PR
    Bayamon, PR
    Canovanas, PR
    Carolina, PR
    Catano, PR
    Ceiba, PR
    Comerio, PR
    Corozal, PR
    Dorado, PR
    Fajardo, PR
    Florida, PR
    Guaynabo, PR
    Humacao, PR
    Juncos, PR
    Los Piedras, PR
    Loiza, PR
    Luguillo, PR
    Manati, PR
    Morovis, PR
    Naguabo, PR
    Naranjito, PR
    Rio Grande, PR
    San Juan, PR
    Toa Alta, PR
    Toa Baja, PR
    Trujillo Alto, PR
    Vega Alta, PR
    Vega Baja, PR
    Yabucoa, PR
7460  San Luis Obispo-Atascadero-Paso Robles, CA...............   1.0673
    San Luis Obispo, CA
7480  Santa Barbara-Santa Maria-Lompoc, CA.....................   1.0580
    Santa Barbara, CA
7485  Santa Cruz-Watsonville, CA...............................   1.4040
    Santa Cruz, CA
7490  Santa Fe, NM.............................................   1.0538
    Los Alamos, NM
    Santa Fe, NM
7500  Santa Rosa, CA...........................................   1.2649
    Sonoma, CA
7510  Sarasota-Bradenton, FL...................................   0.9809

[[Page 49939]]

 
    Manatee, FL
    Sarasota, FL
7520  Savannah, GA.............................................   0.9601
    Bryan, GA
    Chatham, GA
    Effingham, GA
7560  Scranton-Wilkes-Barre-Hazleton, PA.......................   0.8401
    Columbia, PA
    Lackawanna, PA
    Luzerne, PA
    Wyoming, PA
7600  Seattle-Bellevue-Everett, WA.............................   1.0985
    Island, WA
    King, WA
    Snohomish, WA
7610  Sharon, PA...............................................   0.7900
    Mercer, PA
7620  Sheboygan, WI............................................   0.8379
    Sheboygan, WI
7640  Sherman-Denison, TX......................................   0.8694
    Grayson, TX
7680  Shreveport-Bossier City, LA..............................   0.8705
    Bossier, LA
    Caddo, LA
    Webster, LA
7720  Sioux City, IA-NE........................................   0.8471
    Woodbury, IA
    Dakota, NE
7760  Sioux Falls, SD..........................................   0.8790
    Lincoln, SD
    Minnehaha, SD
7800  South Bend, IN...........................................   0.9848
    St. Joseph, IN
7840  Spokane, WA..............................................   1.0496
    Spokane, WA
7880  Springfield, IL..........................................   0.8656
    Menard, IL
    Sangamon, IL
7920  Springfield, MO..........................................   0.8484
    Christian, MO
    Greene, MO
    Webster, MO
8003  Springfield, MA..........................................   1.0485
    Hampden, MA
    Hampshire, MA
8050  State College, PA........................................   0.9022
    Centre, PA
8080  Steubenville-Weirton, OH-WV..............................   0.8548
    Jefferson, OH
    Brooke, WV
    Hancock, WV
8120  Stockton-Lodi, CA........................................   1.0606
    San Joaquin, CA
8140  Sumter, SC...............................................   0.8271
    Sumter, SC
8160  Syracuse, NY.............................................   0.9378
    Cayuga, NY
    Madison, NY
    Onondaga, NY
    Oswego, NY
8200  Tacoma, WA...............................................   1.1553
    Pierce, WA
8240  Tallahassee, FL..........................................   0.8482
    Gadsden, FL
    Leon, FL
8280  Tampa-St. Petersburg-Clearwater, FL......................   0.8960
    Hernando, FL
    Hillsborough, FL
    Pasco, FL
    Pinellas, FL
8320  Terre Haute, IN..........................................   0.8268
    Clay, IN
    Vermillion, IN
    Vigo, IN
8360  Texarkana, AR-Texarkana, TX..............................   0.8341
    Miller, AR
    Bowie, TX
8400  Toledo, OH...............................................   0.9742
    Fulton, OH
    Lucas, OH
    Wood, OH
8440  Topeka, KS...............................................   0.9051
    Shawnee, KS
8480  Trenton, NJ..............................................   1.0113
    Mercer, NJ
8520  Tucson, AZ...............................................   0.8785
    Pima, AZ
8560  Tulsa, OK................................................   0.8480
    Creek, OK
    Osage, OK
    Rogers, OK
    Tulsa, OK
    Wagoner, OK
8600  Tuscaloosa, AL...........................................   0.8064
    Tuscaloosa, AL
8640  Tyler, TX................................................   0.9340
    Smith, TX
8680  Utica-Rome, NY...........................................   0.8547
    Herkimer, NY
    Oneida, NY
8720  Vallejo-Fairfield-Napa, CA...............................   1.2849
    Napa, CA
    Solano, CA
8735  Ventura, CA..............................................   1.1040
    Ventura, CA
8750  Victoria, TX.............................................   0.8154
    Victoria, TX
8760  Vineland-Millville-Bridgeton, NJ.........................   1.0501
    Cumberland, NJ
8780  Visalia-Tulare-Porterville, CA...........................   0.9551
    Tulare, CA
8800  Waco, TX.................................................   0.8253
    McLennan, TX
8840  Washington, DC-MD-VA-WV..................................   1.0711
    District of Columbia, DC
    Calvert, MD
    Charles, MD
    Frederick, MD
    Montgomery, MD
    Prince Georges, MD
    Alexandria City, VA
    Arlington, VA
    Clarke, VA
    Culpepper, VA
    Fairfax, VA
    Fairfax City, VA
    Falls Church City, VA
    Fauquier, VA
    Fredericksburg City, VA
    King George, VA
    Loudoun, VA
    Manassas City, VA
    Manassas Park City, VA
    Prince William, VA
    Spotsylvania, VA
    Stafford, VA
    Warren, VA
    Berkeley, WV
    Jefferson, WV
8920  Waterloo-Cedar Falls, IA.................................   0.8404
    Black Hawk, IA
8940  Wausau, WI...............................................   0.9418
    Marathon, WI
8960  West Palm Beach-Boca Raton, FL...........................   0.9699
    Palm Beach, FL
9000  Wheeling, OH-WV..........................................   0.7665
    Belmont, OH
    Marshall, WV
    Ohio, WV
9040  Wichita, KS..............................................   0.9502
    Butler, KS
    Harvey, KS
    Sedgwick, KS
9080  Wichita Falls, TX........................................   0.7647
    Archer, TX
    Wichita, TX
9140  Williamsport, PA.........................................   0.8332
    Lycoming, PA
9160  Wilmington-Newark, DE-MD.................................   1.0826
    New Castle, DE
    Cecil, MD
9200  Wilmington, NC...........................................   0.9394
    New Hanover, NC
    Brunswick, NC
9260  Yakima, WA...............................................   0.9876
    Yakima, WA
9270  Yolo, CA.................................................   1.0199
    Yolo, CA
9280  York, PA.................................................   0.9196
    York, PA
9320  Youngstown-Warren, OH....................................   0.9477
    Columbiana, OH
    Mahoning, OH
    Trumbull, OH
9340  Yuba City, CA............................................   1.0706
    Sutter, CA
    Yuba, CA
9360  Yuma, AZ.................................................   0.9529
    Yuma, AZ
------------------------------------------------------------------------


                  Table 3B.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                         Nonurban area                            index
------------------------------------------------------------------------
Alabama.......................................................    0.7483
Alaska........................................................    1.2380
Arizona.......................................................    0.8309
Arkansas......................................................    0.7444
California....................................................    0.9857
Colorado......................................................    0.8967
Connecticut...................................................    1.1715
Delaware......................................................    0.9058
Florida.......................................................    0.8918
Georgia.......................................................    0.8326
Guam..........................................................  ........
Hawaii........................................................    1.1053
Idaho.........................................................    0.8650
Illinois......................................................    0.8152
Indiana.......................................................    0.8602
Iowa..........................................................    0.8000

[[Page 49940]]

 
Kansas........................................................    0.7574
Kentucky......................................................    0.7921
Louisiana.....................................................    0.7655
Maine.........................................................    0.8736
Maryland......................................................    0.8651
Massachusetts.................................................    1.1205
Michigan......................................................    0.8969
Minnesota.....................................................    0.8864
Mississippi...................................................    0.7481
Missouri......................................................    0.7693
Montana.......................................................    0.8679
Nebraska......................................................    0.8055
Nevada........................................................    0.9228
New Hampshire.................................................    0.9741
New Jersey \1\................................................  ........
New Mexico....................................................    0.8495
New York......................................................    0.8472
North Carolina................................................    0.8437
North Dakota..................................................    0.7676
Ohio..........................................................    0.8663
Oklahoma......................................................    0.7484
Oregon........................................................    1.0124
Pennsylvania..................................................    0.8535
Puerto Rico...................................................    0.4264
Rhode Island \1\..............................................  ........
South Carolina................................................    0.8369
South Dakota..................................................    0.7550
Tennessee.....................................................    0.7836
Texas.........................................................    0.7490
Utah..........................................................    0.9029
Vermont.......................................................    0.9266
Virginia......................................................    0.8181
Virgin Islands................................................  ........
Washington....................................................    1.0422
West Virginia.................................................    0.8206
Wisconsin.....................................................    0.8865
Wyoming.......................................................   0.8805
------------------------------------------------------------------------
\1\ All counties within the State are classified urban.

    The resulting wage-adjusted labor-related portion is added to the 
nonlabor-related portion, resulting in a wage-adjusted payment. The 
following example illustrates how a Medicare fiscal intermediary would 
calculate the wage-adjusted Federal prospective payment for IRF 
services with a hypothetical Federal prospective payment of $10,000 for 
services provided in the rehabilitation facility located in Heartland, 
USA. The IRF wage index value for facilities located in Heartland, USA 
is 1.0234. The labor-related portion (72.395 percent) of the Federal 
prospective payment is $7,239.50 = ($10,000*72.395 percent), and the 
nonlabor related portion (27.605 percent) of the Federal prospective 
payment is $2,760.50 = ($10,000*27.605 percent). Therefore, the wage-
adjusted payment calculation is as follows: $10,169.40 = 
($7,239.50*1.0234) + $2,760.50.

G. Examples of Computing the Total Adjusted IRF Prospective Payments

    We will adjust the Federal prospective payments, described above, 
to account for geographic wage variation, low-income patients and, if 
applicable, facilities located in rural areas.
    To illustrate the methodology that we will use for adjusting the 
Federal prospective payments, we provide the following example. One 
beneficiary is in rehabilitation facility A and another beneficiary is 
in rehabilitation facility B.
    Rehabilitation facility A's disproportionate share hospital (DSH) 
adjustment is 5 percent, with a low-income patient (LIP) adjustment of 
1.0239 and a wage index of 0.987, and the facility is located in a 
rural area.
    Rehabilitation facility B's DSH is 15 percent, with a LIP 
adjustment of 1.0700 and a wage index of 1.234, and the facility is 
located in an urban area. Both Medicare beneficiaries are classified to 
CMG 0111 (without comorbidities). This CMG represents a stroke with 
motor scores in the 27 to 33 range and the patient is between 82 and 88 
years old. To calculate each IRF's total adjusted Federal prospective 
payment, we compute the wage-adjusted Federal prospective payment and 
multiply the result by the appropriate DSH adjustment and the rural 
adjustment (if applicable). The following table illustrates the 
components of the adjusted payment calculation.

  Table 4.--Examples of Computing an IRF's Federal Prospective Payment
------------------------------------------------------------------------
                                         Facility A        Facility B
------------------------------------------------------------------------
Federal Prospective Payment.........        $20,570.81        $20,570.81
Labor Share.........................         x  .72395         x  .72395
                                     -----------------------------------
    Labor Portion of Federal Payment      = $14,892.24      = $14,892.24
                                     -----------------------------------
    Wage Index......................          x  0.987          x  1.234
                                     -----------------------------------
Wage-Adjusted Amount................      = $14,698.64      = $18,377.02
Non-Labor Amount....................       + $5,678.57       + $5,678.57
                                     -----------------------------------
    Wage-Adjusted Federal Payment...        $20,377.21        $24,055.59
                                     -----------------------------------
    Rural Adjustment................         x  1.1914         x  1.0000
                                     -----------------------------------
    Subtotal........................      = $24,277.41      = $24,055.59
DSH Adjustment......................         x  1.0239         x  1.0700
                                     -----------------------------------
    Total Adjusted Federal                = $24,857.64      = $25,739.48
     Prospective Payment............
------------------------------------------------------------------------

    Thus, the adjusted payment for facility A will be $24,857.64, and 
the adjusted payment for facility B will be $25,739.48.
Computing Total Payments Under the IRF PPS for the Transition Period
    Section 1886(j)(1) of the Act and Sec. 412.626 describe how to 
compute a facility's payment during a transition period. Under the 
transition period, the prospective payment amount consists of a portion 
of the amount the facility would have been paid if the PPS had not been 
implemented (the facility-specific payment) and a portion of the 
adjusted Federal prospective payment. Under Sec. 412.626, for cost 
reporting periods beginning on or after January 1,

[[Page 49941]]

2002 and before October 1, 2002, payment would consist of 33\1/3\ 
percent of the amount of the facility-specific payment and 66\2/3\ 
percent of the IRF adjusted Federal prospective payment. For cost 
reporting periods beginning on or after October 1, 2002, payment would 
be 100 percent of the adjusted Federal prospective payment.
    Section 305(b)(1)(C) of the BIPA added section 1886(j)(1)(F) to the 
Act, which allows an IRF to elect to be paid 100 percent of the 
adjusted Federal prospective payment for each cost reporting period to 
which the blended payment methodology would otherwise apply. This 
provision of the BIPA is effective as though it were included upon 
enactment of the BBA.
    The FY 2003 IRF PPS rates set forth in this notice will apply to 
all discharges on or after October 1, 2002 and before October 1, 2003. 
Payment for IRFs with cost reporting periods under the transition 
methodology will consist of 66\2/3\ percent of the FY 2003 Federal 
prospective payment and 33\1/3\ percent of the facility-specific 
payment. Payment for IRFs that elected not to be paid under the 
transition methodology will consist of 100 percent of the FY 2003 
Federal prospective payment. Payment for IRFs with cost reporting 
periods beginning on or after October 1, 2002 and before October 1, 
2003 will consist of 100 percent of the FY 2003 Federal prospective 
payment.
    Based on the information used to develop the impact analysis for 
the August 7, 2001 final rule, we estimate that 48 percent of the IRFs 
have elected not to be paid under the transition payment methodology. 
Since the implementation of the IRF PPS, the number of these facilities 
has increased. Currently, there are approximately 1,181 Medicare 
certified IRFs. Using the above percentage, we estimate that 567 IRFs 
have elected not to be paid under the transition payment methodology.

II. Future Updates

    Medicare payments to IRFs are based on a predetermined national 
payment rate per discharge. Annual updates to these payment rates are 
required by section 1886(j)(3)(C) of the Act. These updates are based 
on increases to the IRF market basket amount. For FY 2003, the update 
is established at the market basket amount. The IRF market basket, or 
input price index, developed by our Office of the Actuary (OACT), is 
just one component in determining a change to the IRF cost per 
discharge amount. It captures only the pure price change of inputs 
(labor, materials, and capital) used by an IRF to produce a constant 
quantity and quality of care. Other factors also contribute to the 
change in costs per discharge, which include changes in case-mix, 
intensity, and productivity.
    An update framework, used in combination with the market basket, 
seeks to enhance the system for updating payments by addressing factors 
beyond changes in pure input price. Such a framework has been used 
under the inpatient hospital PPS for years by both CMS and the Medicare 
Payment Advisory Commission (MedPAC).
    In general, an update framework in the context of the IRF PPS would 
provide a tool for measuring and understanding changes in cost per 
discharge. This has the potential to support the continued accuracy of 
IRF payments and ensure that the IRF PPS keeps pace with changing 
economic and health care market trends. Accordingly, we are examining 
the potential for developing and using an update framework under the 
IRF PPS. It has the potential to provide information useful to policy 
makers in determining the magnitude of the annual updates.

III. Collection of Information Requirements

    The current Medicare patient assessment requirements under the IRF 
PPS are based on section 1886 (j)(2)(D) of the Act and subpart P of 
section 412 of the regulations. We published the requirements of the 
IRF patient assessment instrument (PAI) in the August 7, 2001 final 
rule. Subsequent to the publication of the final rule OMB approved the 
use of the IRF PAI with modifications that reduced the number of 
required items to be completed. These requirements will remain in 
effect for FY 2003 and are not being changed by the updates set forth 
in this notice.
    Section 412.604(c) of the regulations requires an IRF to complete 
the IRF PAI for each Medicare fee-for-service patient who is admitted 
to or discharged (or who stopped receiving Medicare Part A inpatient 
rehabilitation services) from the IRF on or after January 1, 2002. 
Section 412.606(c) requires that an IRF clinician perform a 
comprehensive, accurate, standardized, and reproducible assessment of 
each Medicare fee-for-service patient using the CMS IRF patient 
assessment instrument as part of his or her assessment. The assessment 
must include direct patient observation and communication with the 
patient, and, when appropriate and to the extent feasible, patient data 
from the patient's physician(s), family, someone personally 
knowledgeable about the patient's clinical condition or capabilities, 
the patient's clinical record, and other sources. Section 412.610(c) of 
the regulations provides for an assessment upon admission, an 
assessment upon discharge, and, if the patient is not discharged but 
stops receiving Medicare Part A covered inpatient rehabilitation 
services, an assessment at the time he or she stops receiving these 
services. Section 412.614 of the regulations requires an IRF to encode 
and transmit the IRF PAI patient data electronically to CMS. The total 
time necessary to complete and administer all required items of the IRF 
PAI is estimated to be 269,250 hours. These information collection 
requirements associated with the Inpatient Rehabilitation Facility 
Prospective Payment System are currently approved by OMB through July 
31, 2005 under OMB number 0938-0842. As we previously stated in this 
section, we are not proposing any changes to these requirements in this 
notice.

IV. Waiver of Proposed Rulemaking

    We ordinarily publish a proposed notice in the Federal Register to 
provide a period for public comment before the provisions of a notice 
such as this take effect. We can waive this procedure, however, if we 
find good cause that a notice-and-comment procedure is impracticable, 
unnecessary, or contrary to the public interest and we incorporate a 
statement of finding and its reasons in the notice issued. We find it 
is unnecessary to undertake notice and comment rulemaking as the 
statute requires annual updates, and this notice does not make any 
substantive changes in policy, but merely reflects the application of 
previously established methodologies. Therefore, under 5 U.S.C. 
553(b)(B), for good cause, we waive notice and comment procedures.

V. Regulatory Impact Analysis

A. Introduction

    The August 7, 2001 final rule established the IRF PPS for the 
payment of Medicare services for cost reporting periods beginning on or 
after January 1, 2002. We incorporated a number of elements into the 
IRF PPS, such as case-level adjustments, a wage adjustment, an 
adjustment for the percentage of low-income patients, a rural 
adjustment, and outlier payments. This notice sets forth updates of the 
IRF PPS rates contained in the August 7, 2001 final rule.
    The purpose of this notice is not to initiate policy changes with 
regard to the IRF PPS; rather, it is to provide an update to the IRF 
payment rates for discharges during FY 2003. While the

[[Page 49942]]

updates set forth in this notice will have a positive effect upon all 
IRFs, some providers may experience decreases in payments. 
Specifically, a decrease in an IRF's FY 2003 payments compared to its 
FY 2002 payments is the result of the effects of eliminating, as 
required by section 1886(j)(1) of the BBA, the blended payments and 
transitioning to the full Federal PPS rates, and not the result of the 
update to the payment rates set forth in this notice.
    In constructing these impacts, we do not attempt to predict 
behavioral responses, and we do not make adjustments for future changes 
in such variables as discharges or case-mix. We note that certain 
events may combine to limit the scope or accuracy of our impact 
analysis, because such an analysis is future-oriented and, thus, 
susceptible to forecasting errors due to other changes in the 
forecasted impact time period. Some examples of such possible events 
are newly legislated general Medicare program funding changes by the 
Congress, or changes specifically related to IRFs. In addition, changes 
to the Medicare program may continue to be made as a result of the BBA, 
the BBRA, the BIPA, or new statutory provisions. Although these changes 
may not be specific to the IRF PPS, the nature of the Medicare program 
is such that the changes may interact, and the complexity of the 
interaction of these changes could make it difficult to predict 
accurately the full scope of the impact upon IRFs.
    We have examined the impacts of this rule as required by Executive 
Order 12866 (September 1993, Regulatory Planning and Review), the 
Regulatory lexibility Act (RFA) and Impact on Small Hospitals 
(September 16, 1980, Pub. L. 96-354), section 1102(b) of the Social 
Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), 
and Executive Order 13132.
1. Executive Order 12866
    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 annually).
    We estimate that the cost to the Medicare program for IRF services 
in FY 2003 will increase by $15 million over FY 2002 levels. This 
increase is due to the combined effect of the changes to the IRF 
payment rates from FY 2002 to FY 2003, including an increase in overall 
payments of $150 million (attributed to the 3 percent increase), and a 
decrease in overall payments of $135 million due to the transition to 
100 percent of the IRF Federal payment rates. Because the cost to the 
Medicare program is less than $100 million, this notice is not 
considered a major rule as defined above.
2. Regulatory Flexibility Act (RFA) and Impact on Small Hospitals
    The RFA requires agencies to analyze the economic impact of our 
regulations on small entities. If we determine that the regulation will 
impose a significant burden on a substantial number of small entities, 
we must examine options for reducing the burden. For purposes of the 
RFA, small entities include small businesses, nonprofit organizations, 
and governmental agencies. Most hospitals are considered small 
entities, either by nonprofit status or by having receipts of $6 
million to $29 million in any 1 year. (For details, see the Small 
Business Administration's regulation that set forth size standards for 
health care industries at 65 FR 69432.) Because we lack data on 
individual hospital receipts, we cannot determine the number of small 
proprietary IRFs. Therefore, we assume that all IRFs are considered 
small entities for the purpose of the analysis that follows. Medicare 
fiscal intermediaries and carriers are not considered to be small 
entities. Individuals and States are not included in the definition of 
a small entity.
    This notice establishes a 3 percent increase to the Federal PPS 
rates. Although, as illustrated in Table 5, the combined effects of 
this update and the elimination of blended payments under the 
transition to the full Federal PPS rates results in a net decrease in 
aggregate Medicare payments to IRFs in FY 2003, the decreases 
associated with the transition's expiration are not a result of this 
notice, but rather, are specifically mandated in existing legislation. 
In addition, we do not expect an incremental increase of 3 percent to 
the Medicare Federal rates to have a significant effect on the overall 
revenues of IRFs. Most IRFs are units of hospitals that provide many 
different types of services (for example, acute care, outpatient 
services) and the rehabilitation component of their business is 
relatively minor in comparison. In addition, IRFs provide services to 
(and generate revenues from) patients other than Medicare 
beneficiaries. Accordingly, we certify that this notice will not have a 
significant impact on small entities.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis for any notice that will 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 of a Metropolitan 
Statistical Area (MSA) and has fewer than 100 beds.
    This notice will not have a significant impact on the operations of 
small rural hospitals. As indicated above, this notice establishes a 3 
percent increase to the Federal PPS rates. While the combined effects 
of this update and the elimination of blended payments under the 
transition to the full Federal PPS rates results in a net decrease in 
aggregate Medicare payments in FY 2003, the decreases associated with 
the transition's expiration are not a result of this notice, but again, 
are specifically mandated in existing legislation. In addition, we do 
not expect an incremental increase of 3 percent to the Federal rates to 
have a significant effect on overall revenues or operations since most 
rural hospitals provide many different types of services (for example, 
acute care, outpatient services) and the rehabilitation component of 
their business is relatively minor in comparison. Accordingly, we 
certify that this notice will not have a significant impact on the 
operations small rural hospitals.
3. Unfunded Mandates Reform Act
    Section 202 of the Unfunded Mandates 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, or tribal governments, in the aggregate, or by the 
private sector, of at least $110 million. This notice will not have an 
effect on the governments mentioned nor will it affect private sector 
costs.
4. Executive Order 13132
    We examined this notice in accordance with Executive Order 13132 
and determined that it will not have any negative impact on the rights, 
roles, or responsibilities of State, local, or tribal governments.
5. Overall Impact
    For the reasons stated above, we have prepared an analysis under 
the RFA and section 1102(b) of the Act because we have determined that 
this notice will not have a significant impact on small

[[Page 49943]]

entities or the operations of small rural hospitals.

B. Anticipated Effects of the Notice

    We discuss below the impacts of this notice on the Federal budget 
and on IRFs.
1. Budgetary Impact
    Section 1886(j)(3)(C) of the Act requires annual updates to the IRF 
PPS payment rates. We project that updating the IRF PPS for discharges 
occurring on or after October 1, 2002 and before October 1, 2003 will 
cost the Medicare program $15 million. The budgetary impact is the 
result of the combined effects associated with the payment updates and 
the effect of IRFs transitioning from the phase-in of the 
implementation payment rates to the full Federal IRF PPS payment rates.
2. Impact on Providers
    For the impact analyses shown in the August 7, 2001 final rule, we 
simulate payments for 1,024 facilities. To construct the impact 
analyses set forth in this notice, we use the latest available data. 
These data are the same data that were used in constructing the impact 
analyses displayed in the August 7, 2001 final rule. Table 5, Projected 
Impact of FY 2003 Update to the IRF PPS, which appears in section V.B.4 
of this notice, reflects the estimated monetary changes among the 
various classifications of IRFs for discharges occurring on or after 
October 1, 2002 and before October 1, 2003.
3. Calculation of the Estimated FY 2002 IRF Prospective Payments
    To estimate payments under the IRF PPS for FY 2002, we multiplied 
each facility's case-mix index by the facility's number of Medicare 
discharges, the budget neutral conversion factor, the applicable wage 
index, a low-income patient adjustment, and a rural adjustment (if 
applicable). The adjustments include the following:
     The wage adjustment, calculated as follows: (.27605 + 
(.72395  x  Wage Index)).
     The disproportionate share adjustment, calculated as 
follows:
    (1 + Disproportionate Share Percentage) raised to the power of 
.4838).
     The rural adjustment, if applicable, calculated by 
multiplying payments by 1.1914.
    After calculating the Federal rate payments for each facility, we 
blended together the appropriate percentages of the current payments 
(see discussion in August 7, 2001 final rule (66 FR 41368 through 
41369)) and the new Federal rate payments to determine the appropriate 
amount for the first year of implementation of the IRF PPS. 
Specifically, to calculate payments for an IRF with a cost reporting 
period beginning on or after January 1, 2002 and before October 1, 
2002, we combine 33\1/3\ percent of the facility's historical payment 
amount with 66\2/3\ percent of the new Federal rate payment amount. 
However, for those providers that would have received higher payments 
under 100 percent of the IRF PPS than they would have if the system had 
not been in effect, we simulated their payments as though they chose 
not to be paid under the transition payment methodology. (We estimated 
that 48 percent of the IRFs have elected not to be paid under the 
transition payment methodology.)
4. Calculation of the Estimated FY 2003 IRF Prospective Payments
    To calculate FY 2003 payments, we use the payment rates described 
in this notice that reflect the 3 percent market basket increase 
factor. Further, we use the same facility level adjustments described 
above. The impacts also reflect the transition to the fully phased-in 
IRF prospective payments.
    Table 5 illustrates the aggregate impact of the estimated FY 2003 
updated payments among the various classifications of facilities 
compared to the estimated IRF PPS payment rates applicable for FY 2002.
    The first column, Facility Classifications, identifies the type of 
facility. The second column identifies the number of facilities for 
each classification type, and the third column lists the number of 
cases. The fourth column reflects the effect of IRFs transitioning from 
the phase-in of the implementation payment rates to the full Federal 
IRF PPS payment rates, and the last column reflects the combined 
changes including the update to the FY 2002 payment rates by 3 percent.

                           Table 5.--Projected Impact of FY 2003 Update to the IRF PPS
----------------------------------------------------------------------------------------------------------------
                                                     Number of       Number of      Transition     Total change
            Facility classifications                facilities         cases         (percent)       (percent)
----------------------------------------------------------------------------------------------------------------
Total...........................................           1,024         347,809            -2.6             0.3
Urban unit......................................             725         206,926            -2.5             0.5
Rural unit......................................             131          26,507            -2.2             0.7
Urban freestanding hospital.....................             156         109,691            -2.8             0.1
Rural freestanding hospital.....................              12           4,685            -5.3            -2.5
Total urban.....................................             881         316,617            -2.6             0.4
Total rural.....................................             143          31,192            -2.8             0.2
----------------------------------------------------------------------------------------------------------------
                                                 Urban By Region
----------------------------------------------------------------------------------------------------------------
New England.....................................              32          15,039            -2.1             0.8
Middle Atlantic.................................             133          64,042            -2.3             0.7
South Atlantic..................................             112          52,980            -2.2             0.8
East North Central..............................             171          55,071            -2.6             0.3
East South Central..............................              41          23,434            -1.7             1.2
West North Central..............................              70          18,087            -2.2             0.7
West South Central..............................             154          52,346            -4.2            -1.3
Mountain........................................              56          14,655            -2.2             0.8
Pacific.........................................             112          20,963            -2.2             0.7
----------------------------------------------------------------------------------------------------------------
                                                 Rural By Region
----------------------------------------------------------------------------------------------------------------
New England.....................................               4             829            -3.9            -1.1
Middle Atlantic.................................              10           2,424            -1.0             1.9
South Atlantic..................................              20           6,192            -1.1             1.9
East North Central..............................              29           5,152            -2.8             0.1

[[Page 49944]]

 
East South Central..............................              10           3,590            -4.6            -1.8
West North Central..............................              22           3,820            -1.8             1.1
West South Central..............................              32           7,317            -4.3            -1.4
Mountain........................................               9           1,042            -0.9             2.1
Pacific.........................................               7             826            -3.4            -0.5
----------------------------------------------------------------------------------------------------------------

    As Table 5 illustrates, all IRFs will benefit from the 3 percent 
market basket increase that is applied to FY 2002 IRF PPS payment rates 
to develop the FY 2003 rates. However, the overall increase in payments 
to IRFs is diminished to 0.3 percent due to the effect of IRFs 
transitioning from the phased-in implementation payment rates to the 
full Federal IRF PPS payment rates.
    The estimated negative impacts displayed in this notice are due to 
the effect of section 1886(j)(1) of the Act that requires the 
elimination of the blended payments and transition to the full Federal 
PPS rate. The fourth column in Table 5 shows this change in estimated 
payments has an overall negative impact of 2.6 percent. This negative 
impact is due to the assumption used to develop the impact analyses. We 
assume that IRFs that would profit more under a fully Federal IRF PPS 
payment rate than under the blend methodology would have already opted 
to be paid 100 percent of the FY 2002 IRF PPS payment. Therefore, we 
presume that those IRFs that did not elect to be paid the full Federal 
IRF PPS payment rates did so because they would receive more payment 
under the blended method. Consequently, we believe the remaining IRFs 
that are transitioning from the blended payment to the full FY 2003 IRF 
PPS payment, are estimated to profit less than they would have if they 
were not paid under 100 percent of the Federal rate. This estimated 
effect is not due to the changes set forth in this notice, rather the 
impact is the result of the statutory requirements of section 
1886(j)(1) of the Act that stipulates payment for IRFs with cost 
reporting periods beginning on or after October 1, 2002 will consist of 
100 percent of the IRF PPS Federal prospective payment.
    The estimated impact changes displayed in Table 5 need to be viewed 
in light of the limitations of the data we are able to present. 
Specifically, these impacts are based on historical data that do not 
reflect any changes resulting from the implementation of the IRF PPS. 
In general, the IRF PPS creates incentives for IRFs to reduce costs. As 
a result, IRF costs per case should be less than they would have been 
before the implementation of the IRF PPS. Because of this, we believe 
impacts would be more favorable to IRFs if we were able to compare 
estimated FY 2003 IRF costs to FY 2003 IRF payments rather than 
estimated FY 2002 IRF payments to FY 2003 payments.
    In the August 7, 2001 final rule (66 FR 41359) we set forth the 
methodology for adjusting payments for IRFs located in rural areas. For 
these facilities, the IRF PPS payment rates are increased by 19.14 
percent. This adjustment will remain in effect and continue to protect 
these facilities from being unduly harmed. Therefore, the impacts shown 
reflect the rural adjustment that is designed to minimize or eliminate 
the negative impact that the IRF PPS may otherwise have on rural 
facilities.
    To summarize, all facilities will receive a favorable 3 percent 
increase in their unadjusted IRF PPS payments. The estimated negative 
impact among some of the classes of IRFs reflected in Table 5 are due 
to the effect of the existing statutory provision (to transition from 
the blended payment to the full Federal IRF PPS payment rate) rather 
than the updates set forth in this notice.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget (OMB).

    Authority: Section 1886(j) of the Social Security Act (42 U.S.C. 
1395ww(j)).

(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital Insurance)

    Dated: July 11, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: July 19, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-19468 Filed 7-31-02; 8:45 am]
BILLING CODE 4120-01-P