[Federal Register Volume 67, Number 169 (Friday, August 30, 2002)]
[Notices]
[Pages 56092-56114]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-22018]



[[Page 56091]]

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Part IV





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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Medicare Program; Hospice Wage Index Fiscal Year 2003; Notice

  Federal Register / Vol. 67, No. 169 / Friday, August 30, 2002 / 
Notices  

[[Page 56092]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1211-N]
RIN 0938-AL41


Medicare Program; Hospice Wage Index Fiscal Year 2003

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

ACTION: Notice.

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SUMMARY: This notice announces the annual update to the hospice wage 
index as required by statute. This update is effective October 1, 2002 
through September 30, 2003. The wage index is used to reflect local 
differences in wage levels. The hospice wage index methodology and 
values are based on recommendations of a negotiated rulemaking advisory 
committee and were originally published in the Federal Register on 
August 8, 1997.

EFFECTIVE DATE: October 1, 2002.

FOR FURTHER INFORMATION CONTACT: Lynn Riley, (410) 786-1286.

SUPPLEMENTARY INFORMATION

I. Background

A. Statute and Regulations

    Hospice care is an approach to treatment that recognizes that the 
impending death of an individual warrants a change in the focus from 
curative care to palliative care (relief of pain and other 
uncomfortable symptoms). The goal of hospice care is to help terminally 
ill individuals continue life with minimal disruption to normal 
activities while remaining primarily in the home environment. A hospice 
uses an interdisciplinary approach to deliver medical, social, 
psychological, emotional, and spiritual services through use of a broad 
spectrum of professional and other caregivers, with the goal of making 
the individual as physically and emotionally comfortable as possible. 
Counseling and inpatient respite services are available to the family 
of the hospice patient. Hospice programs consider both the patient and 
the family as a unit of care.
    Section 1861(dd) of the Social Security Act (the Act) provides for 
coverage of hospice care for terminally ill Medicare beneficiaries who 
elect to receive care from a participating hospice. The statutory 
authority for payment to hospices participating in the Medicare program 
is contained in section 1814(i) of the Act.
    Our existing regulations under 42 CFR part 418 establish 
eligibility requirements and payment standards and procedures, define 
covered services, and delineate the conditions a hospice must meet to 
be approved for participation in the Medicare program. Subpart G of 
part 418 provides for payment to hospices based on one of four 
prospectively determined rates for each day in which a qualified 
Medicare beneficiary is under the care of a hospice. The four rate 
categories are routine home care, continuous home care, inpatient 
respite care, and general inpatient care. Payment rates are established 
for each category.
    The regulations at Sec. 418.306(c), which require the rates to be 
adjusted by a wage index, were revised in the August 8, 1997 final rule 
published in the Federal Register (62 FR 42860). This rule implemented 
a new methodology for calculating the hospice wage index based on the 
recommendations of a negotiated rulemaking committee. The committee 
reached consensus on the methodology. We included the resulting 
committee statement, describing that consensus, as an appendix to the 
August 8, 1997 final rule (62 FR 42883). The provisions of the final 
hospice wage index rule are as follows:
     The revised hospice wage index will be calculated using 
the most current available hospital wage data.
     The revised hospice wage index was phased in over a 3-year 
transition period. For the first year of the transition period, October 
1, 1997 through September 30, 1998, a blended index was calculated by 
adding two-thirds of the 1983 index value for an area to one-third of 
the revised wage index value for that area. During the second year of 
the transition period, October 1, 1998 through September 30, 1999, the 
calculation was similar, except that the blend was one-third of the 
1983 index value and two-thirds of the revised wage index value for 
that area. We fully implemented the revised wage index during the third 
transition period, October 1, 1999 through September 30, 2000.
     All hospice wage index values of 0.8 or greater are 
subject to a budget-neutrality adjustment to ensure that we do not pay 
more in the aggregate than we would have paid under the original 1983 
wage index. The budget-neutrality adjustment is calculated by 
multiplying the hospice wage index for a given area by the budget-
neutrality adjustment factor. The budget-neutrality adjustment is to be 
applied annually, both during and after the transition period.
     All hospice wage index values below 0.8 receive the 
greater of the following adjustments: the wage index floor, a 15-
percent increase, subject to a maximum wage index value of 0.8; or the 
budget-neutrality adjustment.
     The wage index is to be updated annually, in the Federal 
Register, based on the most current available hospital wage data. These 
data will include any changes to the definitions of Metropolitan 
Statistical Areas (MSA).
    Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended 
section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice 
rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to 
be updated by a factor equal to the market basket index, minus 1 
percentage point. However, section 131(a) of the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) changed the 
payment rates for FYs 2001 and 2002 by increasing the FY 2001 rate by 
0.5 percent and the FY 2002 rate by 0.75 percent. Section 131(b) of the 
BBRA states that any additional payments made under section 131(a) of 
the BBRA shall not be included in updating the hospice rates after 
those 2 years.
    Section 321(a) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (BIPA) amended section 
1814(i)(1)(C)(ii)(VI) of the Act by increasing Medicare hospice rates 
for FY 2001 by 5 percentage points. This amendment was applicable to 
hospice care furnished on or after April 1, 2001. Section 321(b) of the 
BIPA further stipulated that the 5-percent increase in Medicare hospice 
rates during the period beginning on April 1, 2001 through September 
30, 2001 were to be treated as the payment rates in effect during FY 
2001. This means that the 5-percent increase was made to the base that 
is updated annually according to a statutorily dictated percentage of 
the market basket update, as provided in section 1814(i) of the Act. 
The new Medicare rates for this time period were announced through HCFA 
Program Memorandum (PM) A-01-04 on January 16, 2001.
    Also, section 321(d) of the BIPA specified that the Secretary of 
Health and Human Services use 1.0043 as the hospice wage index value 
for the Wichita, Kansas MSA in calculating payments for a hospice 
program providing hospice care in this MSA during FY 2000.
    Payment rates for FY 2003 will be updated according to section 
1814(i) of the Act. The FY 2003 rates will be the full market basket 
percentage increase for the FY. This rate update will be implemented 
through a separate PM and is not part of this notice.

[[Page 56093]]

B. Update to the Hospice Wage Index

    This annual update is effective October 1, 2002 through September 
30, 2003. In accordance with the agreement we signed with other members 
of the Hospice Wage Index Negotiated Rulemaking Committee, we are using 
the most current hospital data available to us, including any changes 
to the definitions of MSAs. The FY 2002 hospital wage index was the 
most current hospital wage data available when the FY 2003 wage index 
values were calculated. We used the pre-reclassified and pre-floor 
hospital area wage index data.
    All wage index values are adjusted by a budget-neutrality factor of 
1.063422 and are subject to the wage index floor adjustment, if 
applicable. We have completed all of the calculations described above 
and have included them in the wage index values reflected in both 
Tables A and B below. A detailed description of the method used to 
compute the hospice wage index is contained in both the September 4, 
1996 proposed rule published in the Federal Register (61 FR 46579) and 
the August 8, 1997 final rule published in the Federal Register (62 FR 
42860).
1. Metropolitan Statistical Areas
    As explained in the September 4, 1996 hospice wage index proposed 
rule, each hospice's labor market area would be established by the MSA 
definitions issued by the Office of Management and Budget (OMB) on 
December 28, 1992 based on the 1990 census, and updated by OMB based on 
the decennial census. Any changes to the MSA definitions would be 
effective annually and announced in the final rule updating the hospice 
wage index.
2. MSA Wage Index Values Lower Than Rural Values
    As explained above, any area not included in an MSA is considered 
to be nonurban and receives the statewide rural rate. We are aware that 
in the past, a number of MSAs have had wage index values that were 
lower than their rural statewide value. This difference is due to 
variations in local wage data as compared to national wage data. The 
hospice wage index is computed by dividing the hourly wage rate for an 
MSA or nonurban area by a national hourly wage rate. Nonurban areas 
could receive a higher wage index value than urban areas in the same 
State if the hourly wage rate in the nonurban area increased at a 
greater rate.

C. Tables

              Table A.--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
                                 Urban area (constituent
          MSA Code No.              counties or county    Wage index \2\
                                     equivalents) \1\
------------------------------------------------------------------------
0040...........................  Abilene, TX............          0.8470
                                 Taylor, TX.............
0060...........................  Aguadilla, PR..........          0.5385
                                 Aguada, PR.............
                                 Aguadilla, PR..........
                                 Moca, PR...............
0080...........................  Akron, OH..............          1.0502
                                 Portage, OH............
                                 Summit, OH.............
0120...........................  Albany, GA.............          1.1315
                                 Dougherty, GA..........
                                 Lee, GA................
0160...........................  Albany-Schenectady-              0.9039
                                  Troy, NY.
                                 Albany, NY.............
                                 Montgomery, NY.........
                                 Rensselaer, NY.........
                                 Saratoga, NY...........
                                 Schenectady, NY........
                                 Schoharie, NY..........
0200...........................  Albuquerque, NM........          1.0378
                                 Bernalillo, NM.........
                                 Sandoval, NM...........
                                 Valencia, NM...........
0220...........................  Alexandria, LA.........          0.8538
                                 Rapides, LA............
0240...........................  Allentown-Bethlehem-             1.0716
                                  Easton, PA.
                                 Carbon, PA.............
                                 Lehigh, PA.............
                                 Northampton, PA........
0280...........................  Altoona, PA............          0.9705
                                 Blair, PA..............
0320...........................  Amarillo, TX...........          0.9263
                                 Potter, TX.............
                                 Randall, TX............
0380...........................  Anchorage, AK..........          1.3367
                                 Anchorage, AK..........
0440...........................  Ann Arbor, MI..........          1.1802
                                 Lenawee, MI............
                                 Livingston, MI.........
                                 Washtenaw, MI..........
0450...........................  Anniston, AL...........          0.8801
                                 Calhoun, AL............

[[Page 56094]]

 
0460...........................  Appleton-Oshkosh-                0.9827
                                  Neenah, WI.
                                 Calumet, WI............
                                 Outagamie, WI..........
                                 Winnebago, WI..........
0470...........................  Arecibo, PR............          0.8507
                                 Arecibo, PR............
                                 Camuy, PR..............
                                 Hatillo, PR............
0480...........................  Asheville, NC..........          0.9783
                                 Buncombe, NC...........
                                 Madison, NC............
0500...........................  Athens, GA.............          1.0466
                                 Clarke, GA.............
                                 Madison, GA............
                                 Oconee, GA.............
0520...........................  Atlanta, GA............          1.0696
                                 Barrow, GA.............
                                 Bartow, GA.............
                                 Carroll, GA............
                                 Cherokee, GA...........
                                 Clayton, GA............
                                 Cobb, GA...............
                                 Coweta, GA.............
                                 DeKalb, GA.............
                                 Douglas, GA............
                                 Fayette, GA............
                                 Forsyth, GA............
                                 Fulton, GA.............
                                 Gwinnett, GA...........
                                 Henry, GA..............
                                 Newton, GA.............
                                 Paulding, GA...........
                                 Pickens, GA............
                                 Rockdale, GA...........
                                 Spalding, GA...........
                                 Walton, GA.............
0560...........................  Atlantic-Cape May, NJ..          1.2009
                                 Atlantic, NJ...........
                                 Cape May, NJ...........
0580...........................  Auburn-Opelika, AL.....          0.8752
                                 Lee, AL................
0600...........................  Augusta-Aiken, GA-SC...          1.0602
                                 Columbia, GA...........
                                 McDuffie, GA...........
                                 Richmond, GA...........
                                 Aiken, SC..............
                                 Edgefield, SC..........
0640...........................  Austin-San Marcos, TX..          1.0241
                                 Bastrop, TX............
                                 Caldwell, TX...........
                                 Hays, TX...............
                                 Travis, TX.............
                                 Williamson, TX.........
0680...........................  Bakersfield, CA........          1.0123
                                 Kern, CA...............
0720...........................  Baltimore, MD..........          1.0481
                                 Anne Arundel, MD.......
                                 Baltimore, MD..........
                                 Baltimore City, MD.....
                                 Carroll, MD............
                                 Harford, MD............
                                 Howard, MD.............
                                 Queen Anne's, MD.......
0733...........................  Bangor, ME.............          1.0201
                                 Penobscot, ME..........
0743...........................  Barnstable-Yarmouth, MA          1.4490
                                 Barnstable, MA.........

[[Page 56095]]

 
0760...........................  Baton Rouge, LA........          0.8666
                                 Ascension, LA..........
                                 East Baton Rouge, LA...
                                 Livingston, LA.........
                                 West Baton Rouge, LA...
0840...........................  Beaumont-Port Arthur,            0.8977
                                  TX.
                                 Hardin, TX.............
                                 Jefferson, TX..........
                                 Orange, TX.............
0860...........................  Bellingham, WA.........          1.2576
                                 Whatcom, WA............
0870...........................  Benton Harbor, MI......          0.9451
                                 Berrien, MI............
0875...........................  Bergen-Passaic, NJ.....          1.2430
                                 Bergen, NJ.............
                                 Passaic, NJ............
0880...........................  Billings, MT...........          0.9945
                                 Yellowstone, MT........
0920...........................  Biloxi-Gulfport-                 0.8975
                                  Pascagoula, MS.
                                 Hancock, MS............
                                 Harrison, MS...........
                                 Jackson, MS............
0960...........................  Binghamton, NY.........          0.8982
                                 Broome, NY.............
                                 Tioga, NY..............
1000...........................  Birmingham, AL.........          0.9367
                                 Blount, AL.............
                                 Jefferson, AL..........
                                 St. Clair, AL..........
                                 Shelby, AL.............
1010...........................  Bismarck, ND...........          0.8490
                                 Burleigh, ND...........
                                 Morton, ND.............
1020...........................  Bloomington, IN........          0.9403
                                 Monroe, IN.............
1040...........................  Bloomington-Normal, IL.          0.9611
                                 McLean, IL.............
1080...........................  Boise City, ID.........          0.9624
                                 Ada, ID................
                                 Canyon, ID.............
1123...........................  Boston-Worcester-                1.2105
                                  Lawrence-Lowell-
                                  Brockton, MA-NH.
                                 Bristol, MA............
                                 Essex, MA..............
                                 Middlesex, MA..........
                                 Norfolk, MA............
                                 Plymouth, MA...........
                                 Suffolk, MA............
                                 Worcester, MA..........
                                 Hillsborough, NH.......
                                 Merrimack, NH..........
                                 Rockingham, NH.........
                                 Strafford, NH..........
1125...........................  Boulder-Longmont, CO...          1.0420
                                 Boulder, CO............
1145...........................  Brazoria, TX...........          0.8730
                                 Brazoria, TX...........
1150...........................  Bremerton, WA..........          1.1440
                                 Kitsap, WA.............
1240...........................  Brownsville-Harlingen-           0.9584
                                  San Benito, TX.
                                 Cameron, TX............
1260...........................  Bryan-College Station,           0.9920
                                  TX.
                                 Brazos, TX.............
1280...........................  Buffalo-Niagara Falls,           1.0059
                                  NY.
                                 Erie, NY...............
                                 Niagara, NY............
1303...........................  Burlington, VT.........          1.0510
                                 Chittenden, VT.........
                                 Franklin, VT...........
                                 Grand Isle, VT.........

[[Page 56096]]

 
1310...........................  Caguas, PR.............          0.5404
                                 Caguas, PR.............
                                 Cayey, PR..............
                                 Cidra, PR..............
                                 Gurabo, PR.............
                                 San Lorenzo, PR........
1320...........................  Canton-Massillon, OH...          0.9524
                                 Carroll, OH............
                                 Stark, OH..............
1350...........................  Casper, WY.............          1.0098
                                 Natrona, WY............
1360...........................  Cedar Rapids, IA.......          0.9251
                                 Linn, IA...............
1400...........................  Champaign-Urbana, IL...          0.9896
                                 Champaign, IL..........
1440...........................  Charleston-North                 0.9790
                                  Charleston, SC.
                                 Berkeley, SC...........
                                 Charleston, SC.........
                                 Dorchester, SC.........
1480...........................  Charleston, WV.........          0.9852
                                 Kanawha, WV............
                                 Putnam, WV.............
1520...........................  Charlotte-Gastonia-Rock          0.9928
                                  Hill, NC-SC.
                                 Cabarrus, NC...........
                                 Gaston, NC.............
                                 Lincoln, NC............
                                 Mecklenburg, NC........
                                 Rowan, NC..............
                                 Stanly, NC.............
                                 Union, NC..............
                                 York, SC...............
1540...........................  Charlottesville, VA....          1.1236
                                 Albermale, VA..........
                                 Charlottesville City,
                                  VA.
                                 Fluvanna, VA...........
                                 Greene, VA.............
1560...........................  Chattanooga, TN-GA.....          0.9963
                                 Catoosa, GA............
                                 Dade, GA...............
                                 Walker, GA.............
                                 Hamilton, TN...........
                                 Marion, TN.............
1580...........................  Cheyenne, WY...........          0.8814
                                 Laramie, WY............
1600...........................  Chicago, IL............          1.1747
                                 Cook, IL...............
                                 DeKalb, IL.............
                                 Du Page, IL............
                                 Grundy, IL.............
                                 Kane, IL...............
                                 Kendall, IL............
                                 Lake, IL...............
                                 McHenry, IL............
                                 Will, IL...............
1620...........................  Chico-Paradise, CA.....          1.0481
                                 Butte, CA..............
1640...........................  Cincinnati, OH-KY-IN...          1.0074
                                 Brown, OH..............
                                 Clermont, OH...........
                                 Hamilton, OH...........
                                 Warren, OH.............
                                 Boone, KY..............
                                 Campbell, KY...........
                                 Gallatin, KY...........
                                 Grant, KY..............
                                 Kenton, KY.............
                                 Pendleton, KY..........
                                 Dearborn, IN...........
                                 Ohio, IN...............

[[Page 56097]]

 
1660...........................  Clarksville-                     0.8866
                                  Hopkinsville, TN-KY.
                                 Christian, KY..........
                                 Montgomery, TN.........
1680...........................  Cleveland-Lorain-                1.0057
                                  Elyria, OH.
                                 Ashtabula, OH..........
                                 Cuyahoga, OH...........
                                 Geauga, OH.............
                                 Lake, OH...............
                                 Lorain, OH.............
                                 Medina, OH.............
1720...........................  Colorado Springs, CO...          1.0362
                                 El Paso, CO............
1740...........................  Columbia, MO...........          0.9237
                                 Boone, MO..............
1760...........................  Columbia, SC...........          1.0094
                                 Lexington, SC..........
                                 Richland, SC...........
1800...........................  Columbus, GA-AL........          0.8975
                                 Chattahoochee, GA......
                                 Harris, GA.............
                                 Muscogee, GA...........
                                 Russell, AL............
1840...........................  Columbus, OH...........          1.0172
                                 Delaware, OH...........
                                 Fairfield, OH..........
                                 Franklin, OH...........
                                 Licking, OH............
                                 Madison, OH............
                                 Pickaway, OH...........
1880...........................  Corpus Christi, TX.....          0.8870
                                 Nueces, TX.............
                                 San Patricio, TX.......
1890...........................  Corvallis, Oregon......          1.2385
                                 Benton, OR.............
1900...........................  Cumberland, MD-WV......          0.8833
                                 Allegany, MD...........
                                 Mineral, WV............
1920...........................  Dallas, TX.............          1.0566
                                 Collin, TX.............
                                 Dallas, TX.............
                                 Denton, TX.............
                                 Ellis, TX..............
                                 Henderson, TX..........
                                 Hunt, TX...............
                                 Kaufman, TX............
                                 Rockwall, TX...........
1950...........................  Danville, VA...........          0.9159
                                 Danville City, VA......
                                 Pittsylvania, VA.......
1960...........................  Davenport-Moline-Rock            0.9186
                                  Island, IA-IL.
                                 Scott, IA..............
                                 Henry, IL..............
                                 Rock Island, IL........
2000...........................  Dayton-Springfield, OH.          0.9810
                                 Clark, OH..............
                                 Greene, OH.............
                                 Miami, OH..............
                                 Montgomery, OH.........
2020...........................  Daytona Beach, FL......          0.9541
                                 Flagler, FL............
                                 Volusia, FL............
2030...........................  Decatur, AL............          0.9332
                                 Lawrence, AL...........
                                 Morgan, AL.............
2040...........................  Decatur, IL............          0.8494
                                 Macon, IL..............

[[Page 56098]]

 
2080...........................  Denver, CO.............          1.0983
                                 Adams, CO..............
                                 Arapahoe, CO...........
                                 Denver, CO.............
                                 Douglas, CO............
                                 Jefferson, CO..........
2120...........................  Des Moines, IA.........          0.9336
                                 Dallas, IA.............
                                 Polk, IA...............
                                 Warren, IA.............
2160...........................  Detroit, MI............          1.1152
                                 Lapeer, MI.............
                                 Macomb, MI.............
                                 Monroe, MI.............
                                 Oakland, MI............
                                 St. Clair, MI..........
                                 Wayne, MI..............
2180...........................  Dothan, AL.............          0.8452
                                 Dale, AL...............
                                 Houston, AL............
2190...........................  Dover, DE..............          1.0949
                                 Kent, DE...............
2200...........................  Dubuque, IA............          0.9059
                                 Dubuque, IA............
2240...........................  Duluth-Superior, MN-WI.          1.0936
                                 St. Louis, MN..........
                                 Douglas, WI............
2281...........................  Dutchess County, NY....          1.1200
                                 Dutchess, NY...........
2290...........................  Eau Claire, WI.........          0.9463
                                 Chippewa, WI...........
                                 Eau Claire, WI.........
2320...........................  El Paso, TX............          0.9799
                                 El Paso, TX............
2330...........................  Elkhart-Goshen, IN.....          1.0249
                                 Elkhart, IN............
2335...........................  Elmira, NY.............          0.8949
                                 Chemung, NY............
2340...........................  Enid, OK...............          0.8887
                                 Garfield, OK...........
2360...........................  Erie, PA...............          0.9269
                                 Erie, PA...............
2400...........................  Eugene-Springfield, OR.          1.2199
                                 Lane, OR...............
2440...........................  Evansville-Henderson,            0.9054
                                  IN-KY.
                                 Posey, IN..............
                                 Vanderburgh, IN........
                                 Warrick, IN............
                                 Henderson, KY..........
2520...........................  Fargo-Moorhead, ND-MN..          0.9855
                                 Clay, MN...............
                                 Cass, ND...............
2560...........................  Fayetteville, NC.......          0.9600
                                 Cumberland, NC.........
2580...........................  Fayetteville-Springdale-         0.8981
                                  Rogers, AR.
                                 Benton, AR.............
                                 Washington, AR.........
2620...........................  Flagstaff, AZ-UT.......          1.1225
                                 Coconino, AZ...........
                                 Kane, UT...............
2640...........................  Flint, MI..............          1.1605
                                 Genesee, MI............
2650...........................  Florence, AL...........          0.8343
                                 Colbert, AL............
                                 Lauderdale, AL.........
2655...........................  Florence, SC...........          0.9275
                                 Florence, SC...........
2670...........................  Fort Collins-Loveland,           1.0682
                                  CO.
                                 Larimer, CO............
2680...........................  Ft. Lauderdale, FL.....          1.0946
                                 Broward, FL............

[[Page 56099]]

 
2700...........................  Fort Myers-Cape Coral,           0.9969
                                  FL.
                                 Lee, FL................
2710...........................  Fort Pierce-Port St.             1.0862
                                  Lucie, FL.
                                 Martin, FL.............
                                 St. Lucie, FL..........
2720...........................  Fort Smith, AR-OK......          0.8564
                                 Crawford, AR...........
                                 Sebastian, AR..........
                                 Sequoyah, OK...........
2750...........................  Fort Walton Beach, FL..          0.9573
                                 Okaloosa, FL...........
2760...........................  Fort Wayne, IN.........          0.9787
                                 Adams, IN..............
                                 Allen, IN..............
                                 De Kalb, IN............
                                 Huntington, IN.........
                                 Wells, IN..............
                                 Whitley, IN............
2800...........................  Fort Worth-Arlington,            0.9990
                                  TX.
                                 Hood, TX...............
                                 Johnson, TX............
                                 Parker, TX.............
                                 Tarrant, TX............
2840...........................  Fresno, CA.............          1.0617
                                 Fresno, CA.............
                                 Madera, CA.............
2880...........................  Gadsden, AL............          0.9350
                                  Etowah, AL............
2900...........................  Gainesville, FL........          1.0082
                                 Alachua, FL............
2920...........................  Galveston-Texas City,            1.0967
                                  TX.
                                 Galveston, TX..........
2960...........................  Gary, IN...............          1.0134
                                 Lake, IN...............
                                 Porter, IN.............
2975...........................  Glens Falls, NY........          0.8865
                                 Warren, NY.............
                                 Washington, NY.........
2980...........................  Goldsboro, NC..........          0.9261
                                 Wayne, NC..............
2985...........................  Grand Forks, ND-MN.....          0.9644
                                 Grand Forks, ND........
                                 Polk, MN...............
2995...........................  Grand Junction, CO.....          1.0176
                                 Mesa, CO...............
3000...........................  Grand Rapids-Muskegon-           1.0685
                                  Holland, MI.
                                 Allegan, MI............
                                 Kent, MI...............
                                 Muskegon, MI...........
                                 Ottawa, MI.............
3040...........................  Great Falls, MT........          0.9433
                                 Cascade, MT............
3060...........................  Greeley, CO............          1.0097
                                 Weld, CO...............
3080...........................  Green Bay, WI..........          0.9792
                                 Brown, WI..............
3120...........................  Greensboro-Winston-              1.0144
                                  Salem-High Point, NC.
                                 Alamance, NC...........
                                 Davidson, NC...........
                                 Davie, NC..............
                                 Forsyth, NC............
                                 Guilford, NC...........
                                 Randolph, NC...........
                                 Stokes, NC.............
                                 Yadkin, NC.............
3150...........................  Greenville, NC.........          0.9878
                                 Pitt, NC...............

[[Page 56100]]

 
3160...........................  Greenville-Spartanburg-          0.9802
                                  Anderson, SC.
                                 Anderson, SC...........
                                 Cherokee, SC...........
                                 Greenville, SC.........
                                 Pickens, SC............
                                 Spartanburg, SC........
3180...........................  Hagerstown, MD.........          0.8896
                                 Washington, MD.........
3200...........................  Hamilton-Middletown, OH          0.9876
                                 Butler, OH.............
3240...........................  Harrisburg-Lebanon-              1.0023
                                  Carlisle, PA.
                                 Cumberland, PA.........
                                 Dauphin, PA............
                                 Lebanon, PA............
                                 Perry, PA..............
3283...........................  Hartford, CT...........          1.2264
                                 Hartford, CT...........
                                 Litchfield, CT.........
                                 Middlesex, CT..........
                                 Tolland, CT............
3285...........................  Hattiesburg, MS........          0.8000
                                 Forrest, MS............
                                 Lamar, MS..............
3290...........................  Hickory-Morganton-               0.9961
                                  Lenoir, NC.
                                 Alexander, NC..........
                                 Burke, NC..............
                                 Caldwell, NC...........
                                 Catawba, NC............
3320...........................  Honolulu, HI...........          1.2271
                                 Honolulu, HI...........
3350...........................  Houma, LA..............          0.8481
                                 Lafourche, LA..........
                                 Terrebonne, LA.........
3360...........................  Houston, TX............          1.0242
                                 Chambers, TX...........
                                 Fort Bend, TX..........
                                 Harris, TX.............
                                 Liberty, TX............
                                 Montgomery, TX.........
                                 Waller, TX.............
3400...........................  Huntington-Ashland, WV-          1.0226
                                  KY-OH.
                                 Boyd, KY...............
                                 Carter, KY.............
                                 Greenup, KY............
                                 Lawrence, OH...........
                                 Cabell, WV.............
                                 Wayne, WV..............
3440...........................  Huntsville, AL.........          0.9446
                                 Limestone, AL..........
                                 Madison, AL............
3480...........................  Indianapolis, IN.......          1.0313
                                 Boone, IN..............
                                 Hamilton, IN...........
                                 Hancock, IN............
                                 Hendricks, IN..........
                                 Johnson, IN............
                                 Madison, IN............
                                 Marion, IN.............
                                 Morgan, IN.............
                                 Shelby, IN.............
3500...........................  Iowa City, IA..........          1.0484
                                 Johnson, IA............
3520...........................  Jackson, MI............          0.9844
                                 Jackson, MI............
3560...........................  Jackson, MS............          0.9030
                                 Hinds, MS..............
                                 Madison, MS............
                                 Rankin, MS.............
3580...........................  Jackson, TN............          0.9585
                                 Madison, TN............
                                 Chester, TN............

[[Page 56101]]

 
3600...........................  Jacksonville, FL.......          0.9808
                                 Clay, FL...............
                                 Duval, FL..............
                                 Nassau, FL.............
                                 St. Johns, FL..........
3605...........................  Jacksonville, NC.......          0.8105
                                 Onslow, NC.............
3610...........................  Jamestown, NY..........          0.8561
                                 Chautauqua, NY.........
3620...........................  Janesville-Beloit, WI..          1.0357
                                 Rock, WI...............
3640...........................  Jersey City, NJ........          1.1887
                                 Hudson, NJ.............
3660...........................  Johnson City-Kingsport-          0.9164
                                  Bristol, TN-VA.
                                 Carter, TN.............
                                 Hawkins, TN............
                                 Sullivan, TN...........
                                 Unicoi, TN.............
                                 Washington, TN.........
                                 Bristol City, VA.......
                                 Scott, VA..............
                                 Washington, VA.........
3680...........................  Johnstown, PA..........          0.9276
                                 Cambria, PA............
                                 Somerset, PA...........
3700...........................  Jonesboro, AR..........          0.8959
                                 Craighead, AR..........
3710...........................  Joplin, MO.............          0.9280
                                 Jasper, MO.............
                                 Newton, MO.............
3720...........................  Kalamazoo-Battlecreek,           1.1314
                                  MI.
                                 Calhoun, MI............
                                 Kalamazoo, MI..........
                                 Van Buren, MI..........
3740...........................  Kankakee, IL...........          1.0516
                                 Kankakee, IL...........
3760...........................  Kansas City, KS-MO.....          1.0141
                                 Johnson, KS............
                                 Leavenworth, KS........
                                 Miami, KS..............
                                 Wyandotte, KS..........
                                 Cass, MO...............
                                 Clay, MO...............
                                 Clinton, MO............
                                 Jackson, MO............
                                 Lafayette, MO..........
                                 Platte, MO.............
                                 Ray, MO................
3800...........................  Kenosha, WI............          1.0175
                                 Kenosha, WI............
3810...........................  Killeen-Temple, TX.....          0.9008
                                 Bell, TX...............
                                 Coryell, TX............
3840...........................  Knoxville, TN..........          0.9454
                                 Anderson, TN...........
                                 Blount, TN.............
                                 Knox, TN...............
                                 Loudon, TN.............
                                 Sevier, TN.............
                                 Union, TN..............
3850...........................  Kokomo, IN.............          0.9705
                                 Howard, IN.............
                                 Tipton, IN.............
3870...........................  La Crosse, WI-MN.......          0.9837
                                 Houston, MN............
                                 La Crosse, WI..........
3880...........................  Lafayette, LA..........          0.9086
                                 Acadia, LA.............
                                 Lafayette, LA..........
                                 St. Landry, LA.........
                                 St. Martin, LA.........

[[Page 56102]]

 
3920...........................  Lafayette, IN..........          0.9700
                                 Clinton, IN............
                                 Tippecanoe, IN.........
3960...........................  Lake Charles, LA.......          0.8257
                                 Calcasieu, LA..........
3980...........................  Lakeland-Winter Haven,           0.9642
                                  FL.
                                 Polk, FL...............
4000...........................  Lancaster, PA..........          0.9886
                                 Lancaster, PA..........
4040...........................  Lansing-East Lansing,            1.0265
                                  MI.
                                 Clinton, MI............
                                 Eaton, MI..............
                                 Ingham, MI.............
4080...........................  Laredo, TX.............          0.8347
                                 Webb, TX...............
4100...........................  Las Cruces, NM.........          0.9168
                                 Dona Ana, NM...........
4120...........................  Las Vegas, NV-AZ.......          1.1891
                                 Mohave, AZ.............
                                 Clarke, NV.............
                                 Nye, NV................
4150...........................  Lawrence, KS...........          0.8307
                                 Douglas, KS............
4200...........................  Lawton, OK.............          0.9233
                                 Comanche, OK...........
4243...........................  Lewiston-Auburn, ME....          0.9876
                                 Androscoggin, ME.......
4280...........................  Lexington, KY..........          0.9349
                                 Bourbon, KY............
                                 Clark, KY..............
                                 Fayette, KY............
                                 Jessamine, KY..........
                                 Madison, KY............
                                 Scott, KY..............
                                 Woodford, KY...........
4320...........................  Lima, OH...............          1.0071
                                 Allen, OH..............
                                 Auglaize, OH...........
4360...........................  Lincoln, NE............          1.0818
                                 Lancaster, NE..........
4400...........................  Little Rock-North                0.9523
                                  Little Rock, AR.
                                 Faulkner, AR...........
                                 Lonoke, AR.............
                                 Pulaski, AR............
                                 Saline, AR.............
4420...........................  Longview-Marshall, TX..          0.9115
                                 Gregg, TX..............
                                 Harrison, TX...........
                                 Upshur, TX.............
4480...........................  Los Angeles-Long Beach,          1.2706
                                  CA.
                                 Los Angeles, CA........
4520...........................  Louisville, KY-IN......          1.0133
                                 Clark, IN..............
                                 Floyd, IN..............
                                 Harrison, IN...........
                                 Scott, IN..............
                                 Bullitt, KY............
                                 Jefferson, KY..........
                                 Oldham, KY.............
4600...........................  Lubbock, TX............          0.8985
                                 Lubbock, TX............
4640...........................  Lynchburg, VA..........          0.9680
                                 Amherst, VA............
                                 Bedford, VA............
                                 Bedford City, VA.......
                                 Campbell, VA...........
                                 Lynchburg City, VA.....

[[Page 56103]]

 
4680...........................  Macon, GA..............          0.9525
                                 Bibb, GA...............
                                 Houston, GA............
                                 Jones, GA..............
                                 Peach, GA..............
                                 Twiggs, GA.............
4720...........................  Madison, WI............          1.0993
                                 Dane, WI...............
4800...........................  Mansfield, OH..........          0.9260
                                 Crawford, OH...........
                                 Richland, OH...........
4840...........................  Mayaguez, PR...........          0.5589
                                 Anasco, PR.............
                                 Cabo Rojo, PR..........
                                 Hormigueros, PR........
                                 Mayaguez, PR...........
                                 Sabana Grande, PR......
                                 San German, PR.........
4880...........................  McAllen-Edinburg-                0.8909
                                  Mission, TX.
                                 Hidalgo, TX............
4890...........................  Medford-Ashland, OR....          1.0968
                                 Jackson, OR............
4900...........................  Melbourne-Titusville-            1.0542
                                  Palm Bay, FL.
                                 Brevard, Fl............
4920...........................  Memphis, TN-AR-MS......          0.9547
                                 Crittenden, AR.........
                                 DeSoto, MS.............
                                 Fayette, TN............
                                 Shelby, TN.............
                                 Tipton, TN.............
4940...........................  Merced, CA.............          1.0578
                                 Merced, CA.............
5000...........................  Miami, FL..............          1.0581
                                 Dade, FL...............
5015...........................  Middlesex-Somerset-              1.2196
                                  Hunterdon, NJ.
                                 Hunterdon, NJ..........
                                 Middlesex, NJ..........
                                 Somerset, NJ...........
5080...........................  Milwaukee-Waukesha, WI.          1.0603
                                 Milwaukee, WI..........
                                 Ozaukee, WI............
                                 Washington, WI.........
                                 Waukesha, WI...........
5120...........................  Minneapolis-St. Paul,            1.1623
                                  MN-WI.
                                 Anoka, MN..............
                                 Carver, MN.............
                                 Chisago, MN............
                                 Dakota, MN.............
                                 Hennepin, MN...........
                                 Isanti, MN.............
                                 Ramsey, MN.............
                                 Scott, MN..............
                                 Sherbune, MN...........
                                 Washington, MN.........
                                 Wright, MN.............
                                 Pierce, WI.............
                                 St. Croix, WI..........
5140...........................  Missoula, MT...........          0.9958
                                 Missoula, MT...........
5160...........................  Mobile, AL.............          0.8595
                                 Baldwin, AL............
                                 Mobile, AL.............
5170...........................  Modesto, CA............          1.1506
                                 Stanislaus, CA.........
5190...........................  Monmouth-Ocean, NJ.....          1.1539
                                 Monmouth, NJ...........
                                 Ocean, NJ..............
5200...........................  Monroe, LA.............          0.8721
                                 Ouachita, LA...........

[[Page 56104]]

 
5240...........................  Montgomery, AL.........          0.8000
                                 Autauga, AL............
                                 Elmore, AL.............
                                 Montgomery, AL.........
5280...........................  Muncie, IN.............          1.0569
                                 Delaware, IN...........
5330...........................  Myrtle Beach, SC.......          0.9327
                                 Horry, SC..............
5345...........................  Naples, FL.............          1.0314
                                 Collier, FL............
5360...........................  Nashville, TN..........          1.0373
                                 Cheatham, TN...........
                                 Davidson, TN...........
                                 Dickson, TN............
                                 Robertson, TN..........
                                 Rutherford TN..........
                                 Sumner, TN.............
                                 Williamson, TN.........
                                 Wilson, TN.............
5380...........................  Nassau-Suffolk, NY.....          1.4508
                                 Nassau, NY.............
                                 Suffolk, NY............
5483...........................  New Haven-Bridgeport-            1.3014
                                  Stamford-Waterbury-
                                  Danbury, CT.
                                 Fairfield, CT..........
                                 New Haven, CT..........
5523...........................  New London-Norwich, CT.          1.2257
                                 New London, CT.........
5560...........................  New Orleans, LA........          0.9609
                                 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...........          1.5342
                                 Bronx, NY..............
                                 Kings, NY..............
                                 New York, NY...........
                                 Putnam, NY.............
                                 Queens, NY.............
                                 Richmond, NY...........
                                 Rockland, NY...........
                                 Westchester, NY........
5640...........................  Newark, NJ.............          1.2359
                                 Essex, NJ..............
                                 Morris, NJ.............
                                 Sussex, NJ.............
                                 Union, NJ..............
                                 Warren, NJ.............
5660...........................  Newburgh, NY-PA........          1.1818
                                 Orange, NY.............
                                 Pike, PA...............
5720...........................  Norfolk-Virginia Beach-          0.9123
                                  Newport News, VA-NC.
                                 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...............

[[Page 56105]]

 
5775...........................  Oakland, CA............          1.6291
                                 Alameda, CA............
                                 Contra Costa, CA.......
5790...........................  Ocala, FL..............          1.0162
                                 Marion, FL.............
5800...........................  Odessa-Midland, TX.....          1.0745
                                 Ector, TX..............
                                 Midland, TX............
5880...........................  Oklahoma City, OK......          0.9245
                                 Canadian, OK...........
                                 Cleveland, OK..........
                                 Logan, OK..............
                                 McClain, OK............
                                 Oklahoma, OK...........
                                 Pottawatomie, OK.......
5910...........................  Olympia, WA............          1.2070
                                 Thurston, WA...........
5920...........................  Omaha, NE-IA...........          1.0328
                                 Pottawattamie, IA......
                                 Cass, NE...............
                                 Douglas, NE............
                                 Sarpy, NE..............
                                 Washington, NE.........
5945...........................  Orange County, CA......          1.1828
                                 Orange, CA.............
5960...........................  Orlando, FL............          1.0254
                                 Lake, FL...............
                                 Orange, FL.............
                                 Osceola, FL............
                                 Seminole, FL...........
5990...........................  Owensboro, KY..........          0.8863
                                 Daviess, KY............
6015...........................  Panama City, FL........          0.9636
                                 Bay, FL................
6020...........................  Parkersburg-Marietta,            0.8649
                                  WV-OH.
                                 Washington, OH.........
                                 Wood, WV...............
6080...........................  Pensacola, FL..........          0.8891
                                 Escambia, FL...........
                                 Santa Rosa, FL.........
6120...........................  Peoria-Pekin, IL.......          0.9329
                                 Peoria, IL.............
                                 Tazewell, IL...........
                                 Woodford, IL...........
6160...........................  Philadelphia, PA-NJ....          1.1641
                                 Burlington, NJ.........
                                 Camden, NJ.............
                                 Gloucester, NJ.........
                                 Salem, NJ..............
                                 Bucks, PA..............
                                 Chester, PA............
                                 Delaware, PA...........
                                 Montgomery, PA.........
                                 Philadelphia, PA.......
6200...........................  Phoenix-Mesa, AZ.......          1.0249
                                 Maricopa, AZ...........
                                 Pinal, AZ..............
6240...........................  Pine Bluff, AR.........          0.8396
                                 Jefferson, AR..........
6280...........................  Pittsburgh, PA.........          1.0166
                                 Allegheny, PA..........
                                 Beaver, PA.............
                                 Butler, PA.............
                                 Fayette, PA............
                                 Washington, PA.........
                                 Westmoreland, PA.......
6323...........................  Pittsfield, MA.........          1.0930
                                 Berkshire, MA..........
6340...........................  Pocatello, ID..........          1.0047
                                 Bannock, ID............

[[Page 56106]]

 
6360...........................  Ponce, PR..............          0.6001
                                 Guayanilla, PR.........
                                 Juana Diaz, PR.........
                                 Penuelas, PR...........
                                 Ponce, PR..............
                                 Villalba, PR...........
                                 Yauco, PR..............
6403...........................  Portland, ME...........          1.0025
                                 Cumberland, ME.........
                                 Sagadahoc, ME..........
                                 York, ME...............
6440...........................  Portland-Vancouver, OR-          1.1816
                                  WA.
                                 Clackamas, OR..........
                                 Columbia, OR...........
                                 Multnomah, OR..........
                                 Washington, OR.........
                                 Yamhill, OR............
                                 Clark, WA..............
6483...........................  Providence-Warwick-              1.1490
                                  Pawtucket, RI.
                                 Bristol, RI............
                                 Kent, RI...............
                                 Newport, RI............
                                 Providence, RI.........
                                 Washington, RI.........
6520...........................  Provo-Orem, UT.........          1.0467
                                 Utah, UT...............
6560...........................  Pueblo, CO.............          0.9150
                                 Pueblo, CO.............
6580...........................  Punta Gorda, FL........          0.9587
                                 Charlotte, FL..........
6600...........................  Racine, WI.............          0.9925
                                 Racine, WI.............
6640...........................  Raleigh-Durham-Chapel            1.0441
                                  Hill, NC.
                                 Chatham, NC............
                                 Durham, NC.............
                                 Franklin, NC...........
                                 Johnston, NC...........
                                 Orange, NC.............
                                 Wake, NC...............
6660...........................  Rapid City, SD.........          0.9431
                                 Pennington, SD.........
6680...........................  Reading, PA............          1.0191
                                 Berks, PA..............
6690...........................  Redding, CA............          1.1862
                                 Shasta, CA.............
6720...........................  Reno, NV...............          1.1082
                                 Washoe, NV.............
6740...........................  Richland-Kennewick-              1.1655
                                  Pasco, WA.
                                 Benton, WA.............
                                 Franklin, WA...........
6760...........................  Richmond-Petersburg, VA          1.0292
                                 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                    1.1817
                                  Bernardino, CA.
                                 Riverside, CA..........
                                 San Bernardino, CA.....

[[Page 56107]]

 
6800...........................  Roanoke, VA............          0.8902
                                 Botetourt, VA..........
                                 Roanoke, VA............
                                 Roanoke City, VA.......
                                 Salem City, VA.........
6820...........................  Rochester, MN..........          1.2189
                                 Olmsted, MN............
6840...........................  Rochester, NY..........          0.9940
                                 Genesee, NY............
                                 Livingston, NY.........
                                 Monroe, NY.............
                                 Ontario, NY............
                                 Orleans, NY............
                                 Wayne, NY..............
6880...........................  Rockford, IL...........          0.9788
                                 Boone, IL..............
                                 Ogle, IL...............
                                 Winnebago, IL..........
6895...........................  Rocky Mount, NC........          0.9687
                                 Edgecombe, NC..........
                                 Nash, NC...............
6920...........................  Sacramento, CA.........          1.2581
                                 El Dorado, CA..........
                                 Placer, CA.............
                                 Sacramento, CA.........
6960...........................  Saginaw-Bay City-                1.0198
                                  Midland, MI.
                                 Bay, MI................
                                 Midland, MI............
                                 Saginaw, MI............
6980...........................  St. Cloud, MN..........          1.0476
                                 Benton, MN.............
                                 Stearns, MN............
7000...........................  St. Joseph, MO.........          0.8391
                                 Andrew, MO.............
                                 Buchanan, MO...........
7040...........................  St. Louis, MO-IL.......          0.9497
                                 Franklin, MO...........
                                 Jefferson, MO..........
                                 Lincoln, MO............
                                 St. Charles, MO........
                                 St. Louis, MO..........
                                 St. Louis City, MO.....
                                 Warren, MO.............
                                 Clinton, IL............
                                 Jersey, IL.............
                                 Madison, IL............
                                 Monroe, IL.............
                                 St. Clair, IL..........
7080...........................  Salem, OR..............          1.0646
                                 Marion, OR.............
                                 Polk, OR...............
7120...........................  Salinas, CA............          1.5615
                                 Monterey, CA...........
7160...........................  Salt Lake City-Ogden,            1.0489
                                  UT.
                                 Davis, UT..............
                                 Salt Lake, UT..........
                                 Weber, UT..............
7200...........................  San Angelo, TX.........          0.8713
                                 Tom Green, TX..........
7240...........................  San Antonio, TX........          0.9128
                                 Bexar, TX..............
                                 Comal, TX..............
                                 Guadalupe, TX..........
                                 Wilson, TX.............
7320...........................  San Diego, CA..........          1.1979
                                 San Diego, CA..........
7360...........................  San Francisco, CA......          1.5037
                                 Marin, CA..............
                                 San Francisco, CA......
                                 San Mateo, CA..........

[[Page 56108]]

 
7400...........................  San Jose, CA...........          1.5093
                                 Santa Clara, CA........
7440...........................  San Juan-Bayamon, PR...          0.5476
                                 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-                 1.1687
                                  Atascadero-Paso
                                  Robles, CA.
                                 San Luis Obispo, CA....
7480...........................  Santa Barbara-Santa              1.1487
                                  Maria-Lompoc, CA.
                                 Santa Barbara, CA......
7485...........................  Santa Cruz-Watsonville,          1.4856
                                  CA.
                                 Santa Cruz, CA.........
7490...........................  Santa Fe, NM...........          1.0841
                                 Los Alamos, NM.........
                                 Santa Fe, NM...........
7500...........................  Santa Rosa, CA.........          1.3861
                                 Sonoma, CA.............
7510...........................  Sarasota-Bradenton, FL.          1.0730
                                 Manatee, FL............
                                 Sarasota, FL...........
7520...........................  Savannah, GA...........          1.0653
                                 Bryan, GA..............
                                 Chatham, GA............
                                 Effingham, GA..........
7560...........................  Scranton-Wilkes-Barre-           0.9234
                                  Hazleton, PA.
                                 Columbia, PA...........
                                 Lackawanna, PA.........
                                 Luzerne, PA............
                                 Wyoming, PA............
7600...........................  Seattle-Bellevue-                1.2082
                                  Everett, WA.
                                 Island, WA.............
                                 King, WA...............
                                 Snohomish, WA..........
7610...........................  Sharon, PA.............          0.8429
                                 Mercer, PA.............
7620...........................  Sheboygan, WI..........          0.8961
                                 Sheboygan, WI..........
7640...........................  Sherman-Denison, TX....          0.9967
                                 Grayson, TX............
7680...........................  Shreveport-Bossier               0.9624
                                  City, LA.
                                 Bossier, LA............
                                 Caddo, LA..............
                                 Webster, LA............

[[Page 56109]]

 
7720...........................  Sioux City, IA-NE......          0.9323
                                 Woodbury, IA...........
                                 Dakota, NE.............
7760...........................  Sioux Falls, SD........          0.9719
                                 Lincoln, SD............
                                 Minnehaha, SD..........
7800...........................  South Bend, IN.........          1.0627
                                 St. Joseph, IN.........
7840...........................  Spokane, WA............          1.1345
                                 Spokane, WA............
7880...........................  Springfield, IL........          0.9226
                                 Menard, IL.............
                                 Sangamon, IL...........
7920...........................  Springfield, MO........          0.9110
                                 Christian, MO..........
                                 Greene, MO.............
                                 Webster, MO............
8003...........................  Springfield, MA........          1.1571
                                 Hampden, MA............
                                 Hampshire, MA..........
8050...........................  State College, PA......          0.9712
                                 Centre, PA.............
8080...........................  Steubenville-Weirton,            0.9185
                                  OH-WV.
                                 Jefferson, OH..........
                                 Brooke, WV.............
                                 Hancock, WV............
8120...........................  Stockton-Lodi, CA......          1.1501
                                 San Joaquin, CA........
8140...........................  Sumter, SC.............          0.8288
                                 Sumter, SC.............
8160...........................  Syracuse, NY...........          1.0231
                                 Cayuga, NY.............
                                 Madison, NY............
                                 Onondaga, NY...........
                                 Oswego, NY.............
8200...........................  Tacoma, WA.............          1.2353
                                 Pierce, WA.............
8240...........................  Tallahassee, FL........          0.9068
                                 Gadsden, FL............
                                 Leon, FL...............
8280...........................  Tampa-St. Petersburg-            0.9491
                                  Clearwater, FL.
                                 Hernando, FL...........
                                 Hillsborough, FL.......
                                 Pasco, FL..............
                                 Pinellas, FL...........
8320...........................  Terre Haute, IN........          0.9073
                                 Clay, IN...............
                                 Vermillion, IN.........
                                 Vigo, IN...............
8360...........................  Texarkana, AR-                   0.8855
                                  Texarkana, TX.
                                 Miller, AR.............
                                 Bowie, TX..............
8400...........................  Toledo, OH.............          1.0431
                                 Fulton, OH.............
                                 Lucas, OH..............
                                 Wood, OH...............
8440...........................  Topeka, KS.............          0.9477
                                 Shawnee, KS............
8480...........................  Trenton, NJ............          1.1077
                                 Mercer, NJ.............
8520...........................  Tucson, AZ.............          0.9536
                                 Pima, AZ...............
8560...........................  Tulsa, OK..............          0.9467
                                 Creek, OK..............
                                 Osage, OK..............
                                 Rogers, OK.............
                                 Tulsa, OK..............
                                 Wagoner, OK............
8600...........................  Tuscaloosa, AL.........          0.8689
                                 Tuscaloosa, AL.........
8640...........................  Tyler, TX..............          1.0252
                                 Smith, TX..............

[[Page 56110]]

 
8680...........................  Utica-Rome, NY.........          0.8857
                                 Herkimer, NY...........
                                 Oneida, NY.............
8720...........................  Vallejo-Fairfield-Napa,          1.4422
                                  CA.
                                 Napa, CA...............
                                 Solano, CA.............
8735...........................  Ventura, CA............          1.1691
                                 Ventura, CA............
8750...........................  Victoria, TX...........          0.8856
                                 Victoria, TX...........
8760...........................  Vineland-Millville-              1.1103
                                  Bridgeton, NJ.
                                 Cumberland, NJ.........
8780...........................  Visalia-Tulare-                  1.0239
                                  Porterville, CA.
                                 Tulare, CA.............
8800...........................  Waco, TX...............          0.8645
                                 McLennan, TX...........
8840...........................  Washington, DC-MD-VA-WV          1.1657
                                 District of Columbia,
                                  DC.
                                 Calvert, MD............
                                 Charles, MD............
                                 Frederick, MD..........
                                 Montgomery, MD.........
                                 Prince Georges, MD.....
                                 Alexandria City, VA....
                                 Arlington, VA
                                 Clarke, VA.............
                                 Culpeper, VA...........
                                 Fairfax, VA............
                                 Fairfax City, VA.......
                                 Falls Church City, VA..
                                 Fauquier, VA...........
                                 Fredericksburg City, VA
                                 King George, VA
                                 Loudoun, VA............
                                 Manassas City, VA......
                                 Manassas Park City, VA.
                                 Prince William, VA.....
                                 Spotsylvania, VA.......
                                 Stafford, VA...........
                                 Warren, VA.............
                                 Berkeley, WV...........
                                 Jefferson, WV..........
8920...........................  Waterloo-Cedar Falls,            0.8551
                                  IA.
                                 Black Hawk, IA.........
8940...........................  Wausau, WI.............          1.0311
                                 Marathon, WI...........
8960...........................  West Palm Beach-Boca             1.0397
                                  Raton, FL.
                                 Palm Beach, FL.........
9000...........................  Wheeling, WV-OH........          0.8491
                                 Belmont, OH............
                                 Marshall, WV...........
                                 Ohio, WV...............
9040...........................  Wichita, KS............          1.0215
                                 Butler, KS.............
                                 Harvey, KS.............
                                 Sedgwick, KS...........
9080...........................  Wichita Falls, TX......          0.8366
                                 Archer, TX.............
                                 Wichita, TX............
9140...........................  Williamsport, PA.......          0.9175
                                 Lycoming, PA...........
9160...........................  Wilmington-Newark, DE-           1.1567
                                  MD.
                                 New Castle, DE.........
                                 Cecil, MD..............
9200...........................  Wilmington, NC.........          1.0006
                                 Brunswick, NC..........
                                 New Hanover, NC........
9260...........................  Yakima, WA.............          1.1237
                                 Yakima, WA.............
9270...........................  Yolo, CA...............          1.0316
                                 Yolo, CA...............

[[Page 56111]]

 
9280...........................  York, PA...............          1.0040
                                 York, PA...............
9320...........................  Youngstown-Warren, OH..          1.0170
                                 Columbiana, OH.........
                                 Mahoning, OH...........
                                 Trumbull, OH...........
9340...........................  Yuba City, CA..........          1.1016
                                 Sutter, CA.............
                                 Yuba, CA...............
9360...........................  Yuma, AZ...............         0.9559
                                 Yuma, AZ...............
------------------------------------------------------------------------
\1\ This column lists each MSA area name and each county or county
  equivalent, in the MSA area. Counties not listed in this Table are
  considered to be Rural Areas. Wage Index values for these areas are
  found in Table B.
\2\ Wage index values are based on FY 1998 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment of 1.063422. Wage index values below 0.8 are adjusted to be
  the greater of a 15-percent increase, subject to a maximum wage index
  value of 0.8, or an adjustment by multiplying the hospital wage index
  value for a given area by the budget-neutrality adjustment. We have
  completed all of these adjustments and included them in the wage index
  values reflected in this table.


                  Table B.--Wage Index for Rural Areas
------------------------------------------------------------------------
           MSA code No.                 Nonurban area     Wage index \3\
------------------------------------------------------------------------
9901..............................  Alabama.............          0.8000
9902..............................  Alaska..............          1.2614
9903..............................  Arizona.............          0.9232
9904..............................  Arkansas............          0.8000
9905..............................  California..........          1.0272
9906..............................  Colorado............          0.9370
9907..............................  Connecticut.........          1.2843
9908..............................  Delaware............          1.0197
9910..............................  Florida.............          0.9352
9911..............................  Georgia.............          0.8821
9912..............................  Hawaii..............          1.1817
9913..............................  Idaho...............          0.9271
9914..............................  Illinois............          0.8564
9915..............................  Indiana.............          0.9274
9916..............................  Iowa................          0.8664
9917..............................  Kansas..............          0.8307
9918..............................  Kentucky............          0.8468
9919..............................  Louisiana...........          0.8078
9920..............................  Maine...............          0.9274
9921..............................  Maryland............          0.9421
9922..............................  Massachusetts.......          1.2180
9923..............................  Michigan............          0.9571
9924..............................  Minnesota...........          0.9608
9925..............................  Mississippi.........          0.8005
9926..............................  Missouri............          0.8391
9927..............................  Montana.............          0.9204
9928..............................  Nebraska............          0.8658
9929..............................  Nevada..............          1.0344
9930..............................  New Hampshire.......          1.0399
9931..............................  New Jersey \4\......  ..............
9932..............................  New Mexico..........          0.9226
9933..............................  New York............          0.9089
9934..............................  North Carolina......          0.9076
9935..............................  North Dakota........          0.8379
9936..............................  Ohio................          0.9218
9937..............................  Oklahoma............          0.8046
9938..............................  Oregon..............          1.0663
9939..............................  Pennsylvania........          0.9153
9940..............................  Puerto Rico.........          0.5520
9941..............................  Rhode Island \4\....  ..............
9942..............................  South Carolina......          0.9052
9943..............................  South Dakota........          0.8360
9944..............................  Tennessee...........          0.8431
9945..............................  Texas...............          0.8201
9946..............................  Utah................          0.9625
9947..............................  Vermont.............          1.0066
9948..............................  Virgin Islands......          0.7759
9949..............................  Virginia............          0.8764
9950..............................  Washington..........          1.0856

[[Page 56112]]

 
9951..............................  West Virginia.......          0.8579
9952..............................  Wisconsin...........          0.9641
9953..............................  Wyoming.............          0.9302
9965..............................  Guam................          1.0221
------------------------------------------------------------------------
\3\ Wage index values are based on FY 1998 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment of 1.063422. Wage index values below 0.8 are adjusted to be
  the greater of a 15-percent increase, subject to a maximum wage index
  value of 0.8, or an adjustment by multiplying the hospital wage index
  value for a given area by the budget-neutrality adjustment. We have
  completed all of these adjustments and have included them in the wage
  index values reflected in this table.
\4\ All counties within the State are classified as urban.

II. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking 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 incorporate a statement of the finding and its reasons in 
the notice issued.
    We find it unnecessary to undertake notice and comment rulemaking 
as the statute requires annual updates to the hospice payment rates. 
The methodologies used to determine the wage index have been previously 
subject to public comments, and this notice merely reflects the 
application of those previously established methodologies. Therefore, 
for good cause, we waive notice and comment procedures.

III. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this notice as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-
354), section 1102(b) of the Act, the Unfunded Mandates Reform Act of 
1995 (Pub.L. 104-4), and Executive Order 13132. In this notice, we 
identified the impact on hospices as a result of updating the hospice 
wage index for FY 2003. The methodology for computing the wage index 
was determined through a negotiated rulemaking committee and 
implemented in the August 8, 1997 Final Rule (62 FR 42860). This notice 
only updates the hospice wage index in accordance with that 
methodology. We believe these changes to be insignificant. As Table C 
below indicates, we estimate that total hospice payments will increase 
from last year by 0.3 percent, or $12,731,000.
    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more in any 1 year). We have 
determined that this notice is not an economically significant rule 
under this Executive Order.
    The RFA requires agencies to determine whether a rule will have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and government agencies. Most hospital and 
most other providers and suppliers are small entities, either by 
nonprofit status or by having revenues of $5 million or less annually. 
(For details, see the Small Business Administration's regulation that 
set forth size standards for health care industries (65 FR 69432)). For 
purposes of the RFA, most hospices are small entities. Approximately 73 
percent of Medicare certified hospices are identified as voluntary, 
government, or other agencies, and, therefore, are considered small 
entities. Because the National Hospice and Palliative Care Organization 
estimates that approximately 79 percent of hospice patients are 
Medicare beneficiaries, we have not considered other sources of revenue 
in this analysis.
    As discussed below, the estimated decreases in payment to hospices 
overall are very slight. The effects of this notice indicate that on a 
regional basis, urban hospices in the Middle Atlantic, East North 
Central, West North Central, West South Central, and Pacific regions 
will experience a slight decrease in payments. The payment decreases 
range from a minimum of 0.1 percent (East North Central region) to a 
maximum of 0.5 percent (Middle Atlantic region). The mid-range of the 
decrease in estimated payments for urban hospices falls within the 
Pacific urban region with a 0.3-percent decrease. Rural hospices in the 
Pacific region will also experience a slight decrease in payment of 0.7 
percent. Therefore, based on an analysis of the wage index changes for 
FY 2003, hospices in the urban areas of the North Central (East and 
West), South Central (West), and Middle Atlantic regions will be 
impacted the most. This payment decrease to these small entities 
indicates that this notice will have an impact on a substantial number 
of small entities. However, nationwide, hospices will receive an 
overall slight increase in estimated payments. We estimate that total 
hospice payments will increase by 0.3 percent, or $12,731,000. Urban 
hospices will receive an increase in estimated payments of 0.1 percent 
and rural hospices will receive an increase in estimated payments of 
2.1 percent. Rural hospices, with exception of the Pacific region, 
received the largest increase in payments for FY 2003. We estimate that 
rural hospice payments overall will increase by $9,860,000. 
Specifically, rural hospices in Puerto Rico are estimated to receive a 
13.6-percent increase in payments for FY 2003. This anomaly is due to 
an increase in hospital wage data for FY 2002.
    Under the Medicare hospice benefit, hospices can provide four 
different levels of care days. The majority of the days provided by a 
hospice are routine home care days. Therefore, the number of routine 
home care days can be used as a proxy for the size of the hospice, that 
is, the more days of care provided, the larger the hospice. Using 
routine home care days as a proxy for size, our analysis indicates 
that, overall, the impact of the wage index update on small hospices 
will be positive. For example, the smallest hospices (those that 
provide only up to 1,754 days of routine home care) will experience an 
approximately 4.2 percent increase in hospice payments as a result of 
the wage

[[Page 56113]]

update. Overall, hospices will experience a positive increase in 
payments. Therefore, we certify that this rule will not have a 
significant impact on a substantial number of small entities, in 
accordance with the RFA. Furthermore, the wage index methodology was 
previously determined by consensus through a negotiated rulemaking 
committee that included representatives of national hospice 
associations; rural, urban, large and small hospices; multi-site 
hospices; and consumer groups. Based on all of the options considered, 
the committee agreed on the methodology described in the committee 
statement, and it was adopted into regulation in the August 8, 1997 
final rule. The committee also agreed that this was favorable for the 
hospice community, as well as for beneficiaries. In developing the 
process for updating the wage index in the 1997 final rule, we fully 
considered the impact of this methodology on small entities and 
attempted to mitigate any potential negative effects.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside an MSA and has fewer 
than 100 beds. We have determined that this rule will not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    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, and tribal governments, in the aggregate, or by the 
private sector, of $110 million or more. This notice has no 
consequential effect on State, local, or tribal governments. We believe 
the private sector costs of this notice fall below the threshold as 
well. We have determined that this rule will not have a significant 
impact on the operations of a substantial number of small rural 
hospitals.
    We have reviewed this notice under the threshold criteria of 
Executive Order 13132, Federalism, and have determined that this notice 
will not have a negative impact on the rights, roles, and 
responsibilities of State, local, or tribal governments.

B. Anticipated Effects

    We have compared estimated payments using the FY 1983 hospice wage 
index to estimated payments using the FY 2003 wage index and determined 
the current hospice rates to be budget-neutral. This impact analysis 
compares hospice payments using the FY 2002 hospice wage index to the 
estimated payments using the FY 2003 wage index. The data used in 
developing the quantitative analysis for this notice were obtained from 
the March 2002 update of the national claims history file of all bills 
submitted during FY 2001. We deleted bills from hospices that have 
since closed.
    Table C below demonstrates the results of our analysis. In Column 2 
of Table C, we indicate the number of routine home care days that were 
included in our analysis, although the analysis was performed on all 
types of hospice care. Column 3 of Table C indicates payments that were 
made using the FY 2002 wage index. Column 4 of Table C is based on FY 
2001 claims (for hospices in business during that time period) and 
estimates payments to be made to hospices using the FY 2003 wage index. 
The final column, which compares Columns 3 and 4, shows the percent 
change in estimated hospice payments made based on the category of the 
hospice.
    Table C categorizes hospices by various geographic and provider 
characteristics. The first row displays the results of the impact 
analysis for all Medicare certified hospices. The second and third rows 
of the table categorize hospices according to their geographic location 
(urban and rural). Our analysis indicated that there are 1,327 hospices 
located in urban areas and 854 hospices located in rural areas. The 
next two groupings in the table indicate the number of hospices by 
census region, also broken down by urban and rural hospices. The sixth 
grouping shows the impact on hospices based on the size of the 
hospice's program. We determined that the majority of hospice payments 
are made at the routine home care rate. Therefore, we based the size of 
each individual hospice's program on the number of routine home care 
days provided in 2001. The next grouping shows the impact on hospices 
by type of ownership. The final grouping shows the impact on hospices 
defined by whether they are provider-based or freestanding.
    The results of our analysis shows that the greatest increases in 
payment are for rural areas in the West South Central, Mountain and 
Puerto Rico regions, with a 7.2 percent, 2.5 percent, and 13.6 percent 
increase, respectively. The greatest decreases in payment are for urban 
areas in the Middle Atlantic and Pacific regions.
    The breakdown by size, type of ownership, and facility base showed 
an increase in payments to almost all hospice programs. Small hospice 
programs showed significant increases of about 4 percent, while larger 
programs experienced only a negligible increase. In terms of hospice 
base, hospital-based hospices showed the greatest estimated payment 
increase while hospices affiliated with skilled nursing facilities 
showed the smallest amount of payment increase.

                                  Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                     Number of    Payments using  Payments using  Percent Change
       By Geographic Location         Number of    Routine Home    FY 2002 Wage    FY 2003 Wage     in Hospice
                                       Hospices    Care Days in      Index in        Index in        Payments
                                                     Thousands       Thousands       Thousands
                                             (1)             (2)             (3)             (4)             (5)
----------------------------------------------------------------------------------------------------------------
 
All Hospices.......................        2,181          28,249       3,684,027       3,696,758             0.3
    Urban Hospices.................        1,327          23,705       3,207,208       3,210,078             0.1
    Rural Hospices.................          854           4,545         476,820         486,680             2.1
By Region--Urban:
    New England....................           87             755         116,018         116,611             0.5
    Middle Atlantic................          166           2,651         380,513         378,736            -0.5
    South Atlantic.................          184           5,216         755,293         759,251             0.5

[[Page 56114]]

 
    East North Central.............          224           3,861         515,761         515,007            -0.1
    East South Central.............           98           1,639         191,446         192,498             0.5
    West North Central.............           97           1,443         170,906         170,654            -0.1
    West South Central.............          183           3,337         415,324         414,764            -0.1
    Mountain.......................           89           1,635         230,315         231,781             0.6
    Pacific........................          171           2,885         410,028         408,742            -0.3
    Puerto Rico....................           28             283          21,604          22,035             2.0
By Region--Rural:
    New England....................           27              84           9,942           9,995             0.5
    Middle Atlantic................           34             200          22,721          22,770             0.2
    South Atlantic.................          127             932          99,489         101,282             1.8
    East North Central.............          139             675          72,904          73,109             0.3
    East South Central.............           88             792          78,897          80,363             1.9
    West North Central.............          180             499          53,251          53,931             1.3
    West South Central.............          105             707          64,846          69,525             7.2
    Mountain.......................           93             336          37,037          37,954             2.5
    Pacific........................           57             293          35,822          35,580            -0.7
    Puerto Rico....................            4              28           1,911           2,171            13.6
Routine Home Care Days:
    0-1,754 Days...................          342             309          35,324          36,811             4.2
    1,754-4,373 Days...............          445           1,337         149,372         151,600             1.5
    4,373-9,681 Days...............          543           3,698         433,227         437,293             0.9
    9,681+Days.....................          850          22,540       3,021,406       3,026,583             0.2
Type of Ownership:
    Voluntary......................        1,335          17,593       2,304,550       2,308,749             0.2
    Proprietary....................          626           9,872       1,286,655       1,294,446             0.6
    Government.....................          185             646          76,624          77,398             1.0
    Other..........................           35             139          16,199          16,164            -0.2
Hospice Base:
    Freestanding...................          960          17,736       2,336,621       2,344,044             0.3
    Home Health Agency.............          661           6,184         808,876         810,740             0.2
    Hospital.......................          543           4,172         514,913         518,370             0.7
    Skilled Nursing Facility.......           17             158          23,617          23,604            -0.1
----------------------------------------------------------------------------------------------------------------

C. Conclusion

    Our impact analysis compared hospice payments using the FY 2002 
wage index to the estimated payments using the FY 2003 wage index. 
Through the analysis, we estimate that total hospice payments will 
increase from last year by 0.3 percent, or $12,731.000. Additionally, 
we compared estimated payments using the FY 1983 hospice wage index to 
estimated payments using the FY 2003 wage index and determined the 
current hospice wage index to be budget neutral, as required by the 
negotiated rulemaking committee. We have determined that this rule is 
not an economically significant rule under Executive Order 12866. We do 
believe that this rule will not have a significant economic impact on a 
substantial number of small entities, but took any negative effects 
into consideration during the negotiated rulemaking process. We have 
determined that this rule will not have a significant impact on the 
operations of a substantial number of small rural hospitals. Finally, 
this rule will have no consequential effect on State, local, or tribal 
governments.

OMB Review

    In accordance with the provisions of Executive Order 12866, the 
Office of Management and Budget reviewed this regulation.

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

    Dated: June 20, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: July 23, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-22018 Filed 8-29-02; 8:45 am]
BILLING CODE 4120-01-P