[Federal Register Volume 68, Number 127 (Wednesday, July 2, 2003)]
[Notices]
[Pages 39764-39790]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-16397]



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Part III





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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Medicare Program; Home Health Prospective Payment System Rate Update 
for FY 2004; Notice

  Federal Register / Vol. 68, No. 127 / Wednesday, July 2, 2003 / 
Notices  

[[Page 39764]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1473-NC]
RIN 0938-AL94


Medicare Program; Home Health Prospective Payment System Rate 
Update for FY 2004

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

ACTION: Notice with comment period.

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SUMMARY: This notice with comment period sets forth an update to the 
60-day national episode rates and the national per-visit amounts under 
the Medicare prospective payment system for home health agencies. It 
also responds to public comments received on the June 28, 2002 notice 
with comment period, which set forth the home health prospective 
payment system rate update for FY 2003.

EFFECTIVE DATE: Effective Date: The rate updates in this notice with 
comment period are effective on October 1, 2003.
    Comment Period: We will consider comments if we receive them at the 
appropriate address, as provided below, no later than 5 p.m. on August 
29, 2003.

ADDRESSES: In commenting, please refer to file code CMS-1473-NC. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission. Mail written comments (one original and 
three copies) to the following address ONLY: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-1473-NC, P.O. Box 8016, Baltimore, MD 21244-8016.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and three copies) to one of the following 
addresses: Room 443-G, Hubert H. Humphrey Building, 200 Independence 
Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Chester Robinson, (410) 786-6959 or 
Susan Levy, (410) 786-9364.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: Comments received timely will be 
available for public inspection as they are received, generally 
beginning approximately 3 weeks after publication of a document, at the 
headquarters of the Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of 
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view 
public comments, phone (410) 786-7195.
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    This Federal Register document is also available from the Federal 
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Government Printing Office. The Web site address is http://www.access.gpo.gov/nara/index.html.

I. Background

Legislation on Payment to Home Health Agencies

A. Balanced Budget Act of 1997

    The Balanced Budget Act of 1997 (BBA), Pub. L. 105-33, enacted on 
August 5, 1997, significantly changed the way Medicare pays for 
Medicare home health services. Until the implementation of a home 
health prospective payment system (HH PPS) on October 1, 2000, home 
health agencies (HHAs) received payment under a cost-based 
reimbursement system. Section 4603 of the BBA governed the development 
of the HH PPS by adding section 1895 to the Social Security Act (the 
Act).
    Section 1895(b)(3)(B) of the Act requires the standard prospective 
payment amounts to be increased by a factor equal to the applicable 
home health market basket increase for FY 2004.

B. System for Payment of Home Health Services

    Generally, Medicare makes payment under the HH PPS on the basis of 
a national standardized 60-day episode payment, adjusted for case mix 
and wage index. For episodes with four or fewer visits, Medicare pays 
on the basis of a national per-visit amount by discipline, referred to 
as a low utilization payment adjustment (LUPA). Medicare also adjusts 
the 60-day episode payment for certain intervening events that give 
rise to a partial episode payment adjustment or a significant change in 
condition adjustment. For certain cases that exceed a specific cost 
threshold, an outlier adjustment may also be available. For a complete 
and full description of the HH PPS as required by the BBA and as 
refined by the Omnibus Consolidated and Emergency Supplemental 
Appropriations Act (OCESAA) for FY 1999, Pub. L. 105-277, enacted on 
October 21, 1998, and the Medicare, Medicaid and SCHIP Balanced Budget 
Refinement Act of 1999, Pub. L. 106-113, enacted on November 29, 1999, 
see the July 3, 2000 HH PPS final rule (65 FR 41128).

II. Analysis of and Responses To Comments on the Home Health 
Prospective Payment System June 28, 2002 Notice With Comment Period

    On June 28, 2002, we published a notice with comment period in the 
Federal Register (67 FR 43616) that set forth an update to the 60-day 
national episode rates and the national per-visit amounts under the 
Medicare prospective payment system for HHA for FY 2003. In this 
section, we respond to the 10 public comments that we received on the 
FY 2003 HH PPS update notice:
    Comment: Commenters disagreed with the statutory elimination of the 
10 percent rural add-on set forth in section 508 of the Medicare, 
Medicaid, and SCHIP Benefits and Improvement Protection Act of 2000 
(BIPA).
    Response: Section 508 of BIPA explicitly prescribes the time period 
(home health services furnished in a rural area ending on or after 
April 1, 2001, and before April 1, 2003) governing the 10 percent rural 
add-on. To conform to the statutory timeframe governing the rural add-
on, the FY 2003 update notice published on June 28, 2002 included the 
expiration of the 10 percent rural add-on mid FY 2003.
    Comment: Commenters believe the actuarial assumptions of the 
behavior under the interim payment system (IPS) were flawed and 
inadequate data were

[[Page 39765]]

provided to the public, thereby compromising the meaning of the public 
comments.
    Response: We do not agree with the commenters. For FY 2003, we must 
comply with section 1895(b)(3)(A)(i)(III) of the Act (as re-designated 
by section 501 of BIPA) governing the payment amount under HH PPS. 
Section 1895(b)(3)(A)(i)(III) of the Act requires the Secretary to 
determine the payment amount for FY 2003 as if there were a 15 percent 
reduction to the limits under the IPS updated to FY 2003. The IPS ended 
with the implementation of home health PPS on October 1, 2000. 
Originally, the BBA 1997 required the base year PPS rates to be budget 
neutral to the IPS with the limits reduced by 15 percent. This 
requirement was delayed in subsequent legislation until section 501 of 
BIPA made it applicable to the home health PPS payment amount for FY 
2003.
    As we explained in the FY 2003 update notice, the level by which 
actual payments to HHAs would be reduced by lowering the limits is not 
the same percent by which the IPS limits would be lowered. Our 
actuaries have used the 7 percent reduction in the PPS rates in every 
estimate for legislation since BBA 1997. Since it was the intention of 
the Congress to delay the cut it had already specified, we have simply 
captured the reductions in payments and carried those assumptions 
forward to the present. If our actuaries had attempted to impute the 
continued operation of the IPS until October 2002 given the amount of 
money available under the IPS limits that had not been spent, the 
actuaries may have well identified a larger reduction in payments. We 
did not believe such a result was the intent of the Congress.

    Comment: Some commenters urged us to postpone the FY 2003 reduction 
to the PPS rates until the Congress acts to repeal the reduction.
    Response: The FY 2003 update notice reflected the statutory 
requirements governing the home health PPS payment amount. The 
statutory requirements included both the required annual update to the 
PPS rates, according to section 1895(b)(3)(B) of the Act and section 
1895(b)(3)(A)(i)(III) of the Act reflecting the IPS estimation. Both 
sections of the statute were effective October 1, 2002 for FY 2003. As 
the statute was not revised as of October 1, 2002, the FY 2003 update 
notice appropriately reflected the statutory requirements as of that 
date.
    Comment: Some commenters raised concerns about the assumptions used 
to determine the low utilization payment adjustment and corresponding 
impact on the episode rates. Commenters urged us to refine the 
methodology governing low utilization payment adjustments.
    Response: We understand the commenter's concerns. At this time, we 
are continuing to gather HH PPS data. As we gather more data, we will 
continue to monitor this issue.
    Comment: One commenter requested a detailed explanation of the 
market basket inflation update utilized in the FY 2003 PPS rate 
setting. The commenter points out that costs of home care services have 
increased recently due to new administrative responsibilities and 
reduced economies of scale due to lowered visit volume. As a result of 
staff shortages of nurses and home health aides, labor costs have 
increased. In addition, the HHAs have experienced rising premiums for 
liability insurance, workers compensation insurance, and employee 
health insurance. The commenter believes these factors should be 
incorporated in the market basket calculations and feels that the 
market basket update relies on too many proxies and surrogates for 
actual cost increases.
    Response: We agree with the commenter that showing the detail of 
the market basket increase for each year's payment update would be 
helpful. Thus, in this year's rule, we have added a table detailing the 
FY 2004 market basket forecast, which we believe adequately reflects 
the price increases for home health services (see Table 1 in section 
III.B. of this notice).
    Comment: Some commenters suggested that it is inappropriate and 
inequitable to use the previous fiscal year's pre-floor and pre-
reclassified hospital wage index to adjust the current fiscal year's HH 
PPS rates.
    Response: We believe that the hospital wage index data we use is 
the most current data appropriate for adjusting HHA payments. As we 
have stated in both the FY 2002 and FY 2003 update notices, we use the 
most recent available pre-floor and pre-reclassified hospital wage 
index data available at the time of publication.

    Comment: A commenter requested clarification of our response to 
comments in the update notice published on June 28, 2002 in the Federal 
Register that states, ``the statute does not contemplate a 
recalculation of the initial base year after the rates are 
established.'' The commenter requested specific clarification of 
whether or not we were referring to the retrospective or prospective 
recalculation.
    Response: In our response to the comments on the June 2002 notice 
with comment period, we were referring to the commenter's request for a 
retrospective recalculation of the initial base year rates.

    Comment: A commenter is requesting specific data regarding the 
frequency of outlier payments, any Home Health Resource Group (HHRG) 
connections to outlier payments, and the range of discipline-specific 
visits occurring in outlier cases and a re-evaluation of the outlier 
methodology.
    Response: We appreciate the comment. We are still developing the 
data requested by the commenter. We anticipate releasing and/or 
publishing the data upon their completion.

    Comment: We received comments on the pre-floor and pre-reclassified 
hospital wage index. Specifically, commenters noted that a reduction in 
wage index occurred in their area.
    Response: The HH PPS uses the pre-floor and pre-reclassified 
hospital wage index. Accordingly, we refer the commenters to the annual 
acute care hospital inpatient proposed and final rules, which provide 
detailed explanations of the costs that are included in the hospital 
wage index and how the hospital wage index is calculated. The hospital 
wage index is computed annually, using data collected annually from 
hospitals' Medicare cost reports. In addition, hospital data may differ 
from year-to-year, in part, because in labor market areas with few 
hospitals, annual variations in wage index values are typical.

    Comment: A commenter urged us to develop a home health specific 
wage index.
    Response: We have previously developed a home health specific wage 
index, which the industry did not support because it was viewed less 
favorably or less accurate than the pre-floor and pre-reclassified 
hospital wage index. Specifically, the home health industry had 
concerns with the methodology used to develop a home health specific 
wage index. These concerns coupled with our lack of applicable specific 
home health wage index led to our adoption of the hospital wage index 
in developing home health PPS. We will, however, continue to review the 
feasibility of this recommendation.

III. Provisions of this Notice With Comment Period

A. National Standardized 60-Day Episode Rate

    Medicare HH PPS has been effective since October 1, 2000. As set 
forth in the final rule published July 3, 2000 in the Federal Register 
(65 FR 41128), the unit

[[Page 39766]]

of payment under Medicare HH PPS is a national standardized 60-day 
episode rate. As set forth in 42 CFR 484.220, we adjust the national 
standardized 60-day episode rate by case mix and wage index based on 
the site of service for the beneficiary. The FY 2004 HH PPS rates use 
the same case-mix methodology and application of the wage index 
adjustment to the labor portion of the HH PPS rates as set forth in the 
July 3, 2000 final rule. We multiply the national 60-day episode rate 
by the patient's applicable case-mix weight. We divide the case-mix 
adjusted amount into a labor and non-labor portion. We multiply the 
labor portion by the applicable wage index based on the site of service 
of the beneficiary. The labor portion of the rate continues to be 
.77668 and the non-labor portion of the rate continues to be .22332. We 
add the wage-adjusted portion to the non-labor portion yielding the 
case-mix and wage-adjusted 60-day episode rate subject to applicable 
adjustments.
    For FY 2004, we use again the design and case-mix methodology 
described in section III.G of the HH PPS July 3, 2000 final rule (65 FR 
41192 through 41203). For FY 2004, we base the wage index adjustment to 
the labor portion of the PPS rates on the most recent pre-floor and 
pre-reclassified hospital wage index available at the time of 
publication of this notice, which is discussed in section III.C of this 
notice with comment period.
    As discussed in the July 3, 2000 HH PPS final rule, for episodes 
with four or fewer visits, Medicare pays the national per-visit amount 
by discipline, referred to as a LUPA. We update the national per-visit 
amounts by discipline annually by the applicable home health market 
basket. We adjust the national per-visit amount by the appropriate wage 
index based on the site of service for the beneficiary as set forth in 
Sec.  484.230. We adjust the labor portion of the updated national per-
visit amounts by discipline used to calculate the LUPA by the most 
recent pre-floor and pre-reclassified hospital wage index available at 
the time of publication of this notice, as discussed in section III.C 
of this notice with comment period.
    Medicare pays the 60-day case-mix and wage-adjusted episode payment 
on a split percentage payment approach. The split percentage payment 
approach includes an initial percentage payment and a final percentage 
payment as set forth in Sec.  484.205(b)(1) and (b)(2). We may base the 
initial percentage payment on the submission of a request for 
anticipated payment and the final percentage payment on the submission 
of the claim for the episode, as discussed in regulations in Sec.  
409.43. The claim for the episode that the HHA submits for the final 
percentage payment determines the total payment amount for the episode 
and whether we make an applicable adjustment to the 60-day case-mix and 
wage-adjusted episode payment. The end date of the 60-day episode as 
reported on the claim determines the rate level at which Medicare will 
pay the claim for the fiscal period.
    In summary, we may adjust the 60-day case-mix and wage adjusted 
episode payment based on the information submitted on the claim to 
reflect the following:

    [sbull] A low utilization payment provided on a per-visit basis as 
set forth in Sec.  484.205(c) and Sec.  484.230.
    [sbull] A partial episode payment adjustment as set forth in Sec.  
484.205(d) and Sec.  484.235.
    [sbull] A significant change in condition adjustment as set forth 
in Sec.  484.205(e) and Sec.  484.237.
    [sbull] An outlier payment as set forth in Sec.  484.205(f) and 
Sec.  484.240.

This notice with comment period reflects the updated FY 2004 rates that 
are effective October 1, 2003.

B. Structure and Methodology for FY 2004 Market Basket

    On July 1, 1996, we published a notice with comment period (61 FR 
34349) in the Federal Register that fully explained the structure and 
methodology of the current home health market basket. The home health 
market basket captures the ``pure price'' change between payment years 
associated with providing home health services. In column 1 of Table 1, 
we have provided the 1993-based cost category components. In column 2 
of Table 1, the weights in the home health market basket represent the 
average cost structure for freestanding HHAs for a base year, currently 
1993. The weights are derived using Medicare Cost Reports for 
freestanding HHAs, augmented with additional information from the U.S. 
Department of Commerce, Bureau of Economic Analysis' Input-Output 
Tables. In column 3 of Table 1, the proxies used in the home health 
market basket are selected for their representativeness in tracking 
pure price changes and are generally publicly available price series 
from the U.S. Bureau of Labor Statistics. In column 4 of Table 1, the 
home health market basket percent change, or update, for FY 2004 is 
calculated as the weighted average of these specific price proxy 
changes. We feel that the home health market basket accurately reflects 
the price changes facing HHAs in providing an efficient level of care.
    Market baskets are periodically rebased and revised to a more 
current base year. To this end, we have been monitoring the most 
recently available data (for proposes of this analysis, we used 1999 
data) on the distribution of costs in providing home health services 
and the appropriateness of our price proxies. Though this work is still 
very preliminary, the distribution of costs through 1999 does not 
appear to be dramatically different than the distribution of costs in 
the 1993 base year. We will continue to monitor these data, 
particularly data for the periods after prospective payment began, to 
determine the most appropriate time to rebase and revise the home 
health market basket. In Table 1 below, we set forth the 1993-based 
cost categories, weights, price proxies, and FY 2004 updates for the 
market basket forecast. In Table 2 below, we have provided a comparison 
of the FY 2003 and FY 2004 updates to the home health market basket.

  Table 1.--1993-Based Cost Categories, Weights, Price Proxies, and FY
                              2004 Updates
------------------------------------------------------------------------
                                1993-based
                                  market                       FY 2004
        Cost category             basket      Price proxy       update
                                  weight                      (percent)
------------------------------------------------------------------------
Total........................      100.000  ...............          3.3
Compensation, including             77.668  ...............          3.6
 allocated Contract Services'
 labor.
Wages and salaries, including       64.226  HHA                      3.4
 allocated contract services'                Occupational
 labor.                                      Wage Index.
Employee benefits, including        13.442  HHA                      4.7
 allocated contract services'                Occupational
 labor.                                      Benefits Index.
Operations & Maintenance.....        0.832  CPI-U Fuel &             0.5
                                             Other
                                             Utilities.
Administrative & General,            9.569  ...............          2.7
 including allocated contract
 services' non-labor.
Telephone....................        0.725  CPI-U Telephone          0.6

[[Page 39767]]

 
Paper & Printing.............        0.529  CPI-U Household          1.7
                                             Paper, Paper
                                             Products &
                                             Stationery
                                             Supplies.
Postage......................        0.724  CPI-U Postage..          1.8
Other Administrative &               7.591  CPI-U Services.          3.0
 General, including allocated
 contract services' non-labor.
Transportation...............        3.405  CPI-U Private           -0.4
                                             Transportation.
Capital-Related..............        3.204  ...............          2.6
Insurance....................        0.560  CPI-U Household          3.6
                                             Insurance.
Fixed Capital................        1.764  CPI-U Owner's            3.3
                                             Equivalent
                                             Rent.
Movable Capital..............        0.880  PPI Machinery &          0.1
                                             Equipment.
Other Expenses, including            5.322  CPI-U All Items         2.7
 allocated contract services'                Less Food &
 nonlabor.                                   Energy.
------------------------------------------------------------------------
Source: Global Insights Inc., 1st Qtr, 2003; @USMACRO/MODTREND @CISSIM/
  TL0203.SIM Historical data through 4TH Qtr, 2002


             Table 2.--1993-Based Cost Categories, Weights, and FY 2003 Update Versus FY 2004 Update
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                                                                                        FY03 update  FY04 update
                                                                            1993-based     (as of       (as of
                                                                              market     2001: 4th    2003: 1st
                              Cost category                                   basket      quarter      quarter
                                                                              weight     forecast)    forecast)
                                                                                         (percent)    (percent)
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Total....................................................................     1000.000          3.2          3.3
Compensation, including allocated Contract Services' labor...............       77.668          3.4          3.6
Wages and salaries, including allocated contract services' labor.........       64.226          3.4          3.4
Employee benefits, including allocated contract services' labor..........       13.442          3.4          4.7
Operations & Maintenance.................................................        0.832          0.9          0.5
Administrative & General, including allocated contract services' non-            9.569          2.9          2.7
 labor...................................................................
Telephone................................................................        0.725          0.4          0.6
Paper & Printing.........................................................        0.529          0.9          1.7
Postage..................................................................        0.724          3.6          1.8
Other Administrative & General, including allocated contract services'           7.591          3.1          3.0
 non-labor...............................................................
Transportation...........................................................        3.405          0.9         -0.4
Capital-Related..........................................................        3.204          2.5          2.6
Insurance................................................................        0.560          3.0          3.6
Fixed Capital............................................................        1.764          3.4          3.3
Movable Capital..........................................................        0.880         -0.3          0.1
Other Expenses, including allocated contract services' nonlabor..........        5.322          2.7          2.7
----------------------------------------------------------------------------------------------------------------
Source: Global Insights Inc., 1st Qtr, 2003; @USMACRO/MODTREND @CISSIM/TL0203.SIM Historical data through 4th
  Qtr, 2002; and 4th Qtr, 2001, @USMACRO/MODTREND @CISSIM/TRENDLONG1101 Historical data through 3rd Qtr, 2001.

C. FY 2004 Update to the Home Health Market Basket Index

    Section 1895(b)(3)(B) of the Act requires the standard prospective 
payment amounts to be increased by a factor equal to the applicable 
home health market basket increase for FY 2004. This requirement has 
been codified in regulations in Sec.  484.225.
    [sbull] FY 2004 Adjustments
    In calculating the annual update for the FY 2004 60-day episode 
rates, we first looked at the FY 2003 rates as a starting point. The FY 
2003 national 60-day episode rate is $2,159.39.
    In order to calculate the FY 2004 national 60-day episode rate, we 
multiplied the FY 2003 national 60-day episode rate (2,159.39) by the 
applicable home health market basket update for FY 2004. The home 
health market basket increase for FY 2004 is 3.3 percent. We increased 
the FY 2003 amount by the FY 2004 home health market basket increase 
($2,159.39 + 3.3 percent) to yield the updated FY 2004 national 60-day 
episode rate ($2,230.65) (see Table 3 below).

Table 3.--National 60-Day Episode Amounts Updated by the Applicable Home
  Health Market Basket FY 2004 Prior to Case-Mix Adjustment, Wage Index
     Adjustment Based on the Site of Service for the Beneficiary or
                      Applicable Payment Adjustment
------------------------------------------------------------------------
                                                Multiply by
                                                    the        Final FY
                                                 applicable      2004
  Total prospective payment amount per 60-day   home health    updated
              episode for FY 2003                  market    national 60-
                                                   basket    day episode
                                                  increase       rate
------------------------------------------------------------------------
$2,159.39.....................................       x1.033    $2,230.65
------------------------------------------------------------------------

    [sbull] National Per-Visit Amounts Used To Pay LUPAs and Compute 
Imputed Costs Used in Outlier Calculations.
    As discussed previously in this notice with comment period, the 
policies governing the LUPAs and outlier calculations set forth in the 
July 3, 2000 HH PPS final rule will continue during FY 2004. In 
calculating the annual update for the FY 2004 national per-visit 
amounts we use to pay LUPAs and to compute the imputed costs in outlier 
calculations, we again looked at the FY 2003 rates as a starting point. 
We then multiply those amounts by the applicable home health market 
basket increase for FY 2004 to yield the updated per-visit amounts for 
each home health discipline for FY 2004. (See Table 4 below.)

[[Page 39768]]



  Table 4.--National Per-Visit Amounts for LUPAs and Outlier Calculations Updated by the Applicable Home Health
     Market Basket Increase for FY 2004 Prior to Wage Index Adjustment Based on the Site of Service for the
                                                   Beneficiary
----------------------------------------------------------------------------------------------------------------
                                                                                                    Final per-
                                                                    Final per-      Multiply by    visit payment
                                                                   visit amounts    applicable      amount per
                  Home health discipline types                      per 60-day      home health   discipline for
                                                                  episode for FY   market basket    FY 2004 for
                                                                  2003 for LUPAs                       LUPAs
----------------------------------------------------------------------------------------------------------------
Home Health Aide................................................          $42.68          x1.033          $44.09
Medical Social Services.........................................          151.11          x1.033          156.10
Occupational Therapy............................................          103.77          x1.033          107.19
Physical Therapy................................................          103.07          x1.033          106.47
Skilled Nursing.................................................           94.27          x1.033           97.38
Speech-Language Pathology.......................................          112.00          x1.033          115.70
----------------------------------------------------------------------------------------------------------------

C. Hospital Wage Index

    Sections 1895(b)(4)(A)(ii) and (b)(4)(C) of the Act require the 
Secretary to establish area wage adjustment factors that reflect the 
relative level of wages and wage-related costs applicable to the 
furnishing of home health services and to provide appropriate 
adjustments to the episode payment amounts under HH PPS to account for 
area wage differences. We apply the appropriate wage index value to the 
labor portion of the HH PPS rates based on the geographic area in which 
the beneficiary received home health services. We determine each HHA's 
labor market area based on definitions of Metropolitan Statistical 
Areas (MSAs) issued by the Office of Management and Budget (OMB).
    As discussed previously and set forth in the July 3, 2000 final 
rule, the statute provides that the wage adjustment factors may be the 
factors used by the Secretary for purposes of section 1886(d)(3)(E) of 
the Act for hospital wage adjustment factors. Again, as discussed in 
the July 3, 2000 final rule, we used the most recent pre-floor and pre-
reclassified hospital wage index available at the time of publication 
of this notice to adjust the labor portion of the HH PPS rates based on 
the geographic area in which the beneficiary receives the home health 
services. We believe the use of the most recent available pre-floor and 
pre-reclassified hospital wage index data results in the appropriate 
adjustment to the labor portion of the costs as required by statute. 
(See addenda A and B of this notice with comment period, respectively, 
for the rural and urban hospital wage indexes. Furthermore, we have 
added an addendum C that shows a side-by-side comparison of the FY 2002 
pre-floor and pre-reclassified hospital wage index and FY 2003 pre-
floor and pre-reclassified hospital wage index for the FY 2004 HH PPS 
update notice. We believe that addendum C provides a clear illustration 
of changes in the wage index from FY 2002 and FY 2003.)

IV. 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 incorporates a statement of finding and its reasons in the 
notice issued.
    We believe it is unnecessary to undertake proposed notice and 
comment rulemaking as the statute requires annual updates to the HH PPS 
rates, the methodologies used to update the rate have been previously 
subject to public comment, and this notice reflects the application of 
previously established methodologies. This required annual update for 
the FY 2004 PPS rates is dictated by statute and does not require an 
exercise of discretion. Therefore, for good cause, we waive prior 
notice and comment procedures. As indicated previously, we are, 
however, providing a 60-day comment period for public comment.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.).

VI. Response to Comments

    Because of the large number of items of correspondence we normally 
receive on Federal Register documents published for comment, we are not 
able to acknowledge or respond to them individually. We will consider 
all comments we receive by the date and time specified in the DATES 
section of the preamble, and, if we proceed with a subsequent document, 
we will respond to the major comments in the preamble to that document.

VII. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this rule 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 Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) 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). 
The update set forth in this notice with comment period applies to 
Medicare payments under HH PPS in FY 2004. Accordingly, the following 
analysis describes the impact in FY 2004 only. We estimate that there 
will be an additional $340 million in FY 2004 expenditures attributable 
to the FY 2004 market basket increase of 3.3 percent.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and

[[Page 39769]]

government agencies. Most hospitals and most other providers and 
suppliers are small entities, either by nonprofit status or by having 
revenues of $6 million to $29 million or less annually (for details, 
see the Small Business Administration's regulation that set forth size 
standards for health care industries at 65 FR 69432). For purposes of 
the RFA, approximately 75 percent of HHAs are considered small 
businesses according to the Small Business Administration's size 
standards with total revenues of $11.5 million or less in 1 year. 
Individuals and States are not included in the definition of a small 
entity. As stated above, this notice with comment period provides an 
update to all HHAs for FY 2004 as required by statute. This notice will 
have a significant positive effect upon small entities.
    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 of a metropolitan 
statistical area (MSA) and has fewer than 100 beds. We have determined 
that this notice with comment period will not have a significant 
economic 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 expenditure in any 1 year by State, 
local, or tribal governments, in the aggregate, or by the private 
sector, of $110 million. We believe this notice will not mandate 
expenditures in that amount.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. We have reviewed this notice under the threshold criteria 
of Executive Order 13132, Federalism. We have determined that this 
notice would not have substantial direct effects on the rights, roles, 
and responsibilities of States.

B. Anticipated Effects

    In accordance with the requirements of section 1895(b)(3) of the 
Act, we publish an update for each subsequent fiscal year that will 
provide an update to the payment rates. Section 1895(b)(3) of the Act 
requires us, for FY 2004, to increase the prospective payment amounts 
by the applicable home health market basket increase. The home health 
market basket increase for FY 2004 is 3.3 percent. Taking into account 
the provisions of section 1895(b)(3) of the Act, the increase for FY 
2004 is 3.3 percent.
1. Effects on the Medicare Program
    This notice merely provides a percentage update to all Medicare 
HHAs. Therefore, we have not furnished any impact tables. We increase 
the payment to each Medicare HHA equally by the home health market 
basket update for FY 2004, as required by statute. There is no 
differential impact among provider types. The impact is in the 
aggregate. We estimate that there will be an additional $340 million in 
FY 2004 expenditures attributable to the FY 2004 market basket increase 
of 3.3 percent. Thus, the anticipated expenditures outlined in this 
notice exceed the $100 million annual threshold for a major rule as 
defined in Title 5, USC, section 804(2).
    The applicable home health market basket increase of 3.3 percent 
for FY 2004 applies to all Medicare participating in HHAs. We do not 
believe there is a differential impact due to the aggregate nature of 
the update.

                                 Table 5
------------------------------------------------------------------------
                                            Additional FY 2004 medicare
 FY 2004 update to home health PPS rates       home health estimated
           required by the act               expenditures due to annual
                                               update required by law
------------------------------------------------------------------------
Section 1895(b)(3)(B) of the Act requires  $340 million.
 HH PPS rates increased by applicable
 home health market basket increase (3.3
 percent increase).
------------------------------------------------------------------------
(Source: President's FY 2003 Budget)

2. Effects on Providers
    This notice will have a positive effect on providers of Medicare 
home health services by increasing their rate of Medicare payment. We 
do not anticipate specific effects on other providers. This notice 
reflects the statutorily required annual update to the HH PPS rates. We 
do not believe there is a differential impact due to the consistent and 
aggregate nature of the update.

C. Alternatives Considered

    As discussed in section II, this notice with comment period 
reflects an annual update to the HH PPS rates as required by statute. 
Due to the lack of discretion provided in the statutory requirements 
governing this notice with comment period, we believe the statute 
provides no latitude for alternatives other than the approach set forth 
in this notice reflecting the FY 2004 annual update to the HH PPS 
rates. Other than the positive effect of the market basket increase, 
this notice with comment will not have a significant economic impact 
nor will it impose an additional burden on small entities. When a 
regulation or notice imposes additional burden on small entities, we 
are required under the RFA to examine alternatives for reducing burden.
    Since this notice with comment period will not impose an additional 
burden, we have not examined alternatives.

D. Conclusion

    We have examined the economic impact of this notice with comment 
period on small entities and have determined that the economic impact 
is positive, significant, and that all HHAs will be affected. To the 
extent that small rural hospitals are affiliated with HHAs, the impact 
on these facilities will also be positive. Finally, we have determined 
that the economic effects described above are largely the result of the 
specific statutory provisions, which this notice serves to announce.
    In accordance with the provisions of notice with comment Executive 
Order 12866, this was reviewed by the Office of Management and Budget.

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

    Dated: February 21, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.

    Dated: March 26, 2003.
Tommy G. Thompson,
Secretary.

 Addendum A.--Wage Index for Rural Areas--Applicable Pre-Floor and Pre-
               Reclassified Hospital Wage Index (FY 2003)
------------------------------------------------------------------------
                                                                   Wage
                            MSA name                              index
------------------------------------------------------------------------
ALABAMA........................................................    .7660
ALASKA.........................................................   1.2293
ARIZONA........................................................    .8493

[[Page 39770]]

 
ARKANSAS.......................................................    .7666
CALIFORNIA.....................................................    .9840
COLORADO.......................................................    .9015
CONNECTICUT....................................................   1.2394
DELAWARE.......................................................    .9128
FLORIDA........................................................    .8814
GEORGIA........................................................    .8230
GUAM...........................................................    .9611
HAWAII.........................................................   1.0255
IDAHO..........................................................    .8747
ILLINOIS.......................................................    .8204
INDIANA........................................................    .8755
IOWA...........................................................    .8315
KANSAS.........................................................    .7923
KENTUCKY.......................................................    .8079
LOUISIANA......................................................    .7567
MAINE..........................................................    .8874
MARYLAND.......................................................    .8946
MASSACHUSETTS..................................................   1.1288
MICHIGAN.......................................................    .9000
MINNESOTA......................................................    .9151
MISSISSIPPI....................................................    .7680
MISSOURI.......................................................    .8021
MONTANA........................................................    .8481
NEBRASKA.......................................................    .8204
NEVADA.........................................................    .9577
NEW HAMPSHIRE..................................................    .9796
NEW JERSEY \1\.................................................  .......
NEW MEXICO.....................................................    .8872
NEW YORK.......................................................    .8542
NORTH CAROLINA.................................................    .8666
NORTH DAKOTA...................................................    .7788
OHIO...........................................................    .8613
OKLAHOMA.......................................................    .7590
OREGON.........................................................   1.0303
PENNSYLVANIA...................................................    .8462
PUERTO RICO....................................................    .4356
RHODE ISLAND \1\...............................................  .......
SOUTH CAROLINA.................................................    .8607
SOUTH DAKOTA...................................................    .7815
TENNESSEE......................................................    .7877
TEXAS..........................................................    .7821
UTAH...........................................................    .9312
VERMONT........................................................    .9345
VIRGINIA.......................................................    .8504
VIRGIN ISLANDS.................................................    .7845
WASHINGTON.....................................................   1.0179
WEST VIRGINIA..................................................    .7975
WISCONSIN......................................................    .9162
WYOMING........................................................   .9007
------------------------------------------------------------------------
\1\ All counties within State are classified as Urban.


   Addendum B.--FY 2003 Wage Index for Urban Areas--Pre-Floor and Pre-
                    Reclassified Hospital Wage Index
------------------------------------------------------------------------
                                                                  Wage
      MSA              Urban area (constituent counties)          index
------------------------------------------------------------------------
0040...........  Abilene, TX..................................     .7792
                 Taylor, TX
0060...........  Aguadilla, PR................................     .4587
                 Aguada, PR
                 Aguadilla, PR
                 Moca, PR
0080...........  Akron, OH....................................     .9600
                 Portage, OH
                 Summit, OH
0120...........  Albany, GA...................................    1.0594
                 Dougherty, GA
                 Lee, GA
0160...........  Albany-Schenectady-Troy, NY..................     .8384
                 Albany, NY
                 Montgomery, NY
                 Rensselaer, NY
                 Saratoga, NY
                 Schenectady, NY
                 Schoharie, NY
0200...........  Albuquerque, NM..............................     .9315
                 Bernalillo, NM
                 Sandoval, NM
                 Valencia, NM
0220...........  Alexandria, LA...............................     .7859
                 Rapides, LA
0240...........  Allentown-Bethlehem-Easton, PA...............     .9735
                 Carbon, PA
                 Lehigh, PA
                 Northampton, PA
0280...........  Altoona, PA..................................     .9225
                 Blair, PA
0320...........  Amarillo, TX, Potter, TX.....................     .9034
                 Randall, TX
0380...........  Anchorage, AK................................    1.2358
                 Anchorage, AK
0440...........  Ann Arbor, MI................................    1.1103
                 Lenawee, MI
                 Livingston, MI
                 Washtenaw, MI
0450...........  Anniston, AL.................................     .8044
                 Calhoun, AL
0460...........  Appleton-Oshkosh-Neenah, WI..................     .8997
                 Calumet, WI

[[Page 39771]]

 
                 Outagamie, WI
                 Winnebago, WI
0470...........  Arecibo, PR..................................     .4337
                 Arecibo, PR
                 Camuy, PR
                 Hatillo, PR
0480...........  Asheville, NC................................     .9876
                 Buncombe, NC
                 Madison, NC
0500...........  Athens, GA...................................    1.0211
                 Clarke, GA
                 Madison, GA
                 Oconee, GA
0520...........  Atlanta, GA..................................     .9991
                 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........................    1.1017
                 Atlantic, NJ
                 Cape May, NJ
0580...........  Auburn-Opelka, AL............................     .8325
                 Lee, AL
0600...........  Augusta-Aiken, GA-SC.........................    1.0264
                 Columbia, GA
                 McDuffie, GA
                 Richmond, GA
                 Aiken, SC
                 Edgefield, SC
0640...........  Austin-San Marcos, TX........................     .9637
                 Bastrop, TX
                 Caldwell, TX
                 Hays, TX
                 Travis, TX
                 Williamson, TX
0680...........  Bakersfield, CA..............................     .9899
                 Kern, CA
0720...........  Baltimore, MD................................     .9929
                 Anne Arundel, MD
                 Baltimore City, MD
                 Carroll, MD
                 Harford, MD
                 Howard, MD
                 Queen Annes, MD
0733...........  Bangor, ME...................................     .9664
                 Penobscot, ME
0743...........  Barnstable-Yarmouth, MA......................    1.3202
                 Barnstable, MA
0760...........  Baton Rouge, LA..............................     .8294
                 Ascension, LA
                 East Baton Rouge, LA
                 Livingston, LA
                 West Baton Rouge, LA
0840...........  Beaumont-Port Arthur, TX.....................     .8324

[[Page 39772]]

 
                 Hardin, TX
                 Jefferson, TX
                 Orange, TX
0860...........  Bellingham, WA...............................    1.2282
                 Whatcom, WA
0870...........  Benton Harbor, MI............................     .9042
                 Berrien, MI
0875...........  Bergen-Passaic, NJ...........................    1.2150
                 Bergen, NJ
                 Passaic, NJ
0880...........  Billings, MT.................................     .9022
                 Yellowstone, MT
0920...........  Biloxi-Gulfport-Pascagoula, MS...............     .8757
                 Hancock, MS
                 Harrison, MS
                 Jackson, MS
0960...........  Binghamton, NY...............................     .8341
                 Broome, NY
                 Tioga, NY
1000...........  Birmingham, AL...............................     .9222
                 Blount, AL
                 Jefferson, AL
                 St. Clair, AL
                 Shelby, AL
1010...........  Bismarck, ND.................................     .7972
                 Burleigh, ND
                 Morton, ND
1020...........  Bloomington, IN..............................     .8907
                 Monroe, IN
1040...........  Bloomington-Normal, IL.......................     .9109
                 McLean, IL
1080...........  Boise City, ID...............................     .9310
                 Ada, ID
                 Canyon, ID
1123...........  Boston-Worcester-Lawrence-Lowell-Brockton, MA-   1.1235
                  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.........................     .9689
                 Boulder, CO
1145...........  Brazoria, TX.................................     .8535
                 Brazoria, TX
1150...........  Bremerton, WA................................     .0944
                 Kitsap, WA
1240...........  Brownsville-Harlingen-San Benito, TX.........     .8880
                 Cameron, TX
1260...........  Bryan-College Station, TX....................     .8821
                 Brazos, TX
1280...........  Buffalo-Niagara Falls, NY....................     .9365
                 Erie, NY
                 Niagara, NY
1303...........  Burlington, VT...............................    1.0052
                 Chittenden, VT
                 Franklin, VT
                 Grand Isle, VT
1310...........  Caguas, PR...................................     .4371
                 Caguas, PR
                 Cayey, PR
                 Cidra, PR
                 Gurabo, PR
                 San Lorenzo, PR
1320...........  Canton-Massillon, OH.........................     .8932

[[Page 39773]]

 
                 Carroll, OH
                 Stark, OH
1350...........  Casper, WY...................................     .9690
                 Natrona, WY
1360...........  Cedar Rapids, IA.............................     .9056
                 Linn, IA
1400...........  Champaign-Urbana, IL.........................    1.0635
                 Champaign, IL
1440...........  Charleston-North Charleston, SC..............     .9235
                 Berkeley, SC
                 Charleston, SC
                 Dorchester, SC
1480...........  Charleston, WV...............................     .8898
                 Kanawha, WV
                 Putnam, WV
1520...........  Charlotte-Gastonia-Rock Hill, NC-SC..........     .9850
                 Cabarrus, NC
                 Gaston, NC
                 Lincoln, NC
                 Mecklenburg, NC
                 Rowan, NC
                 Stanley, NC
                 Union, NC
                 York, SC
1540...........  Charlottesville, VA..........................    1.0438
                 Albemarle, VA
                 Charlottesville City, VA
                 Fluvanna, VA
                 Greene, VA
1560...........  Chattanooga, TN-GA...........................     .8976
                 Catoosa, GA
                 Dade, GA
                 Walker, GA
                 Hamilton, TN
                 Marion, TN
                 Cheyenne, WY.................................     .8628
1580...........  Laramie, WY..................................
1600...........  Chicago, IL..................................    1.1044
                 Cook, IL
                 DeKalb, IL
                 DuPage, IL
                 Grundy, IL
                 Kane, IL
                 Kendall, IL
                 Lake, IL
                 McHenry, IL
                 Will, IL
1620...........  Chico-Paradise, CA...........................     .9745
                 Butte, CA
1640...........  Cincinnati, OH-KY-IN.........................     .9381
                 Dearborn, IN
                 Ohio, IN
                 Boone, KY
                 Campbell, KY
                 Gallatin, KY
                 Grant, KY
                 Kenton, KY
                 Pendleton, KY
                 Brown, OH
                 Clermont, OH
                 Hamilton, OH
                 Warren, OH
1660...........  Clarksville-Hopkinsville, TN-KY..............     .8406
                 Christian, KY
                 Montgomery, TN
1680...........  Cleveland-Lorain-Elyria, OH..................     .9670
                 Ashtabula, OH
                 Cuyahoga, OH
                 Geauga, OH
                 Lake, OH

[[Page 39774]]

 
                 Lorain, OH
                 Medina, OH
1720...........  Colorado Springs, CO.........................     .9916
                 El Paso, CO
1740...........  Columbia, MO.................................     .8496
                 Boone, MO
1760...........  Columbia, SC.................................     .9307
                 Lexington, SC
                 Richland, SC
1800...........  Columbus, GA-AL..............................     .8374
                 Russell, AL
                 Chattahoochee, GA
                 Harris, GA
                 Muscogee, GA
1840...........  Columbus, OH.................................     .9751
                 Delaware, OH
                 Fairfield, OH
                 Franklin, OH
                 Licking, OH
                 Madison, OH
                 Pickaway, OH
1880...........  Corpus Christi, TX...........................     .8729
                 Nueces, TX
                 San Patricio, TX
1890...........  Corvallis, OR................................    1.1453
                 Benton, OR
1900...........  Cumberland, MD-WV............................     .7847
                 Allegany, MD
                 Mineral, WV
1920...........  Dallas, TX...................................     .9998
                 Collin, TX
                 Dallas, TX
                 Denton, TX
                 Ellis, TX
                 Henderson, TX
                 Hunt, TX
                 Kaufman, TX
                 Rockwall, TX
1950...........  Danville, VA.................................     .8859
                 Danville City, VA
                 Pittsylvania, VA
1960...........  Davenport-Moline-Rock Island, IA-IL..........     .8835
                 Scott, IA
                 Henry, IL
                 Rock Island, IL
2000...........  Dayton-Springfield, OH.......................     .9282
                 Clark, OH
                 Greene, OH
                 Miami, OH
                 Montgomery, OH
2020...........  Daytona Beach, FL............................     .9062
                 Flagler, FL
                 Volusia, FL
2030...........  Dacatur, AL..................................     .8973
                 Lawrence, AL
                 Morgan, AL
2040...........  Dacatur, IL..................................     .8055
                 Macon, IL
2080...........  Denver, CO...................................    1.0601
                 Adams, CO
                 Arapahoe, CO
                 Denver, CO
                 Douglas, CO
                 Jefferson, CO
2120...........  Des Moines, IA...............................     .8791
                 Dallas, IA
                 Polk, IA
                 Warren, IA
2160...........  Detroit, MI..................................    1.0448
                 Lapeer, MI

[[Page 39775]]

 
                 Macomb, MI
                 Monroe, MI
                 Oakland, MI
                 St. Clair, MI
                 Wayne, MI
2180...........  Dothan, AL...................................     .8137
                 Dale, AL
                 Houston, AL
2190...........  Dover, DE....................................     .9356
                 Kent, DE
2200...........  Dubuque, IA..................................     .8795
                 Dubuque, IA
2240...........  Duluth-Superior, MN-WI.......................    1.0368
                 St. Louis, MN
                 Douglas, WI
2281...........  Dutchess County, NY..........................    1.0684
                 Dutchess, NY
2290...........  Eau Claire, WI...............................     .8952
                 Chippewa, WI
                 Eau Claire, WI
2320...........  El Paso, TX..................................     .9265
                 El Paso, TX
2330...........  Elkhart-Goshen, IN...........................     .9722
                 Elkhart, IN
2335...........  Elmira, NY...................................     .8416
                 Chemung, NY
2340...........  Enid, OK.....................................     .8376
                 Garfield, OK
2360...........  Erie, PA.....................................     .8925
                 Erie, PA
2400...........  Eugene-Springfield, OR.......................    1.0944
                 Lane, OR
2440...........  Evansville-Henderson, IN-KY..................     .8177
                 Posey, IN
                 Vanderburgh, IN
                 Warrick, IN
                 Henderson, KY
2520...........  Fargo-Moorhead, ND-MN........................     .9684
                 Clay, MN
                 Cass, ND
2560...........  Fayetteville, NC.............................     .8889
                 Cumberland, NC
2580...........  Fayetteville-Springdale-Rogers, AR...........     .8100
                 Benton, AR
                 Washington, AR
2620...........  Flagstaff, AZ-UT.............................    1.0682
                 Coconino, AZ
                 Kane, UT
2640...........  Flint, MI....................................    1.1135
                 Genesee, MI
2650...........  Florence, AL.................................     .7792
                 Colbert, AL
                 Lauderdale, AL
2655...........  Florence, SC.................................     .8780
                 Florence, SC
2670...........  Fort Collins-Loveland, CO....................    1.0066
                 Larimer, CO
2680...........  Ft. Lauderdale, FL...........................    1.0297
                 Broward, FL
2700...........  Fort Myers-Cape Coral, FL....................     .9680
                 Lee, FL
2710...........  Fort Pierce-Port St. Lucie, FL...............     .9823
                 Martin, FL
                 St. Lucie, FL
2720...........  Fort Smith, AR-OK............................     .7895
                 Crawford, AR
                 Sebastian, AR
                 Sequoyah, OK
2750...........  Fort Walton Beach, FL........................     .9693
                 Okaloosa, FL

[[Page 39776]]

 
2760...........  Fort Wayne, IN...............................     .9457
                 Adams, IN
                 Allen, IN
                 De Kalb, IN
                 Huntington, IN
                 Wells, IN
                 Whitley, IN
2800...........  Forth Worth-Arlington, TX....................     .9446
                 Hood, TX
                 Johnson, TX
                 Parker, TX
                 Tarrant, TX
2840...........  Fresno, CA...................................    1.0216
                 Fresno, CA
                 Madera, CA
2880...........  Gadsden, AL..................................     .8505
                 Etowah, AL
2900...........  Gainesville, FL..............................     .9871
                 Alachua, FL
2920...........  Galveston-Texas City, TX.....................     .9465
                 Galveston, TX
2960...........  Gary, IN.....................................     .9584
                 Lake, IN
                 Porter, IN
2975...........  Glens Falls, NY..............................     .8281
                 Warren, NY
                 Washington, NY
2980...........  Goldsboro, NC................................     .8892
                 Wayne, NC
2985...........  Grand Forks, ND-MN...........................     .8897
                 Polk, MN
                 Grand Forks, ND
2995...........  Grand Junction, CO...........................     .9456
                 Mesa, CO
3000...........  Grand Rapids-Muskegon-Holland, MI............     .9525
                 Allegan, MI
                 Kent, MI
                 Muskegon, MI
                 Ottawa, MI
3040...........  Great Falls, MT..............................     .8950
                 Cascade, MT
3060...........  Greeley, CO..................................     .9237
                 Weld, CO
3080...........  Green Bay, WI................................     .9502
                 Brown, WI
3120...........  Greensboro-Winston-Salem-High Point,.........     .9282
                 NC
                 Alamance, NC
                 Davidson, NC
                 Davie, NC
                 Forsyth, NC
                 Guilford, NC
                 Randolph, NC
                 Stokes, NC
                 Yadin, NC
3150...........  Greenville, NC...............................     .9100
                 Pitt, NC
3160...........  Greenville, Spartanburg-Anderson, SC.........     .9122
                 Anderson, SC
                 Cherokee, SC
                 Greenville, SC
                 Pickens, SC
                 Spartanburg, SC
3180...........  Hagerstown, MD...............................     .9268
                 Washington, MD
3200...........  Hamilton-Middletown, OH......................     .9418
                 Butler, OH
3240...........  Harrisburg-Lebanon-Carlisle, PA..............     .9223
                 Cumberland, PA
                 Dauphin, PA

[[Page 39777]]

 
                 Lebanon, PA
                 Perry, PA
3283...........  Hartford, CT.................................    1.1549
                 Hartford, CT
                 Litchfield, CT
                 Middlesex, CT
                 Tolland, CT
3285...........  Hattiesburg, MS..............................     .7659
                 Forrest, MS
                 Lamar, MS
3290...........  Hickory-Morganton-Lenoir, NC.................     .9028
                 Alexander, NC
                 Burke, NC
                 Caldwell, NC
                 Catawaba, NC
3320...........  Honolulu, HI.................................    1.1457
                 Honolulu, HI
3350...........  Houma, LA....................................     .8385
                 Lafourche, LA
                 Terrebonne, LA
3360...........  Houston, TX..................................     .9892
                 Chambers, TX
                 Fort Bend, TX
                 Harris, TX
                 Liberty, TX
                 Montgomery, TX
                 Waller, TX
3400...........  Huntington-Ashland, WV-KY-OH.................     .9636
                 Boyd, KY
                 Carter, KY
                 Grenup, KY
                 Lawrence, OH
                 Cabell, WV
                 Wayne, WV
3440...........  Huntsville, AL...............................     .8903
                 Limestone, AL
                 Madison, AL
3480...........  Indianapolis, IN.............................     .9717
                 Boone, IN
                 Hamilton, IN
                 Hancoock, IN
                 Hendricks, IN
                 Johnson, IN
                 Madison, IN
                 Marion, IN
                 Morgan, IN
                 Shelby, IN
3500...........   Iowa City, IA...............................     .9587
                 Johnson, IA
3520...........  Jackson, MI..................................     .9532
                 Jackson, MI
3560...........  Jackson, MS..................................     .8607
                 Hinds, MS
                 Madison, MS
                 Rankin MS
3580...........  Jackson, TN..................................     .9275
                 Madison, TN
                 Chester, TN
3600...........  Jacksonville, FL.............................     .9381
                 Clay, FL
                 Duval, FL
                 Nassau, FL
                 St. Johns, FL
3605...........  Jacksonville, NC.............................     .8239
                 Onslow, NC
3610...........  Jamestown, NY................................     .7976
                 Chautauqua, NY
3620...........  Janesville-Beloit, WI........................     .9849
                 Rock, WI
3640...........  Jersey City, NJ..............................    1.1190

[[Page 39778]]

 
                 Hudson, NJ
3660...........  Johnson City-Kingsport-Bristol, TN-VA........     .8268
                 Carter, TN
                 Hawkins, TN
                 Sullivan, TN
                 Unicoi, TN
                 Washington, TN
                 Bristol City, VA
                 Scott, VA
                 Washington, VA
3680...........  Johnstown, PA................................     .8329
                 Cambria, PA
                 Somerset, PA
3700...........  Jonesboro, AR................................     .7749
                 Craighead, AR
3710...........  Joplin, MO...................................     .8613
                 Jasper, MO
                 Newton, MO
3720...........  Kalamazoo-Battlecreek, MI....................    1.0595
                 Calhoun, MI
                 Kalamazoo, MI
                 Van Buren, MI
3740...........  Kankakee, IL.................................    1.0790
                 Kankakee, IL
3760...........  Kansas City, KS-MO...........................     .9736
                 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..................................     .9686
                 Kenosha, WI
3810...........  Killeen-Temple, TX...........................    1.0399
                 Bell, TX
                 Coryell, TX
3840...........  Knoxville, TN................................     .8970
                 Anderson, TN
                 Blount, TN
                 Knox, TN
                 Loudon, TN
                 Sevier, TN
                 Union, TN
3850...........  Kokomo, IN...................................     .8971
                 Howard, IN
                 Tipton, IN
3870...........  La Crosse, WI-MN.............................     .9400
                 Houston, MN
                 La Crosse, WI
3880...........  Lafayette, LA................................     .8475
                 Acadia, LA
                 Lafayette, LA
                 St. Landry, LA
                 St. Martin, LA
3920...........  Lafayette, IN................................     .9278
                 Clinton, IN
                 Tippecanoe, IN
3960...........  Lake Charles, LA.............................     .7965
                 Calcasieu, LA
3980...........  Lakeland-Winter Haven, FL....................     .9357
                 Polk, FL
4000...........  Lancaster, PA................................     .9078
                 Lancaster, PA
4040...........  Lansing-East Lansing, MI.....................     .9726
                 Clinton, MI

[[Page 39779]]

 
                 Eaton, MI
                 Ingham, MI
4080...........  Laredo, TX...................................     .8472
                 Webb, TX
4100...........  Las Cruces, NM...............................     .8745
                 Dona Ana, NM
4120...........  Las Vegas, NV-AZ.............................    1.1521
                 Mohave, AZ
                 Clark, NV
                 Nye, NV
4150...........  Lawrence, KS.................................     .7983
                 Douglas, KS
4200...........  Lawton, OK...................................     .8315
                 Comanche, OK
4243...........  Lewiston-Auburn, ME..........................     .9179
                 Androscoggin, ME
4280...........  Lexington, KY................................     .8581
                 Bourbon, KY
                 Clark, KY
                 Fayette, KY
                 Jessamine, KY
                 Madison, KY
                 Scott, KY
                 Woodford, KY
                 Lima, OH.....................................     .9483
4320...........  Allen, OH....................................
                 Auglaize, OH
4360...........  Lincoln, NE..................................     .9892
                 Lancaster, NE
4400...........  Little Rock-North Little Rock, AR............     .9097
                 Faulkner, AR
                 Lonoke, AR
                 Pulaski, AR
                 Saline, AR
4420...........  Longview-Marshall, TX........................     .8629
                 Gregg, TX
                 Harrison, TX
                 Upshur, TX
4480...........  Los Angeles-Long Beach, CA...................    1.2001
                 Los Angeles, CA
4520...........  Louisville, KY-IN............................     .9276
                 Clark, IN
                 Floyd, IN
                 Harrison, IN
                 Scott, IN
                 Bullitt, KY
                 Jefferson, KY
                 Oldham, KY
4600...........  Lubbock, TX..................................     .9646
                 Lubbock, TX
4640...........  Lynchburg, VA................................     .9219
                 Amherst, VA
                 Bedford, VA
                 Bedford City, VA
                 Campbell, VA
                 Lynchburg City, VA
4680...........  Macon, GA....................................     .9204
                 Bibb, GA
                 Houston, GA
                 Jones, GA
                 Peach, GA
                 Twiggs, GA
4720...........  Madison, WI..................................    1.0467
                 Dane, WI
4800...........  Mansfield, OH................................     .8900
                 Crawford, OH                                   ........
                 Richland, OH                                   ........
4840...........  Mayaguez, PR.................................     .4914
                 Anasco, PR                                     ........
                 Cabo Rojo, PR                                  ........

[[Page 39780]]

 
                 Hormigueros, PR                                ........
                 Mayaguez, PR                                   ........
                 Sabana Grande, PR                              ........
                 San German, PR                                 ........
4880...........  McAllen-Edinburg-Mission, TX.................     .8428
                 Hidalgo, TX                                    ........
4890...........  Medford-Ashland, OR..........................    1.0498
                 Jackson, OR                                    ........
4900...........  Melbourne-Titusville-Palm Bay, FL............    1.0253
                 Brevard, FL                                    ........
4920...........  Memphis, TN-AR-MS............................     .8920
                 Crittenden, AR                                 ........
                 DeSoto, MS                                     ........
                 Fayette, TN                                    ........
                 Shelby, TN                                     ........
                 Tipton, TN                                     ........
4940...........  Merced, CA...................................     .9837
                 Merced, CA                                     ........
5000...........  Miami, FL....................................     .9802
                 Dade, FL                                       ........
5015...........  Middlesex-Somerset-Hunterdon, NJ.............    1.1213
                 Hunterdon, NJ                                  ........
                 Middlesex, NJ                                  ........
                 Somerset, NJ                                   ........
5080...........  Milwaukee-Waukesha, WI.......................     .9893
                 Milwaukee, WI                                  ........
                 Ozaukee, WID
                 Washington, WI                                 ........
                 Waukesha, WI                                   ........
5120...........  Minneapolis-St. Paul, MN-WI..................    1.0903
                 Anoka, MN                                      ........
                 Carver, MN                                     ........
                 Chisago, MN                                    ........
                 Dakota, MN                                     ........
                 Hennepin, MN                                   ........
                 Isanti, MN                                     ........
                 Ramsey, MN                                     ........
                 Scott, MN                                      ........
                 Sherburne, MN                                  ........
                 Washington, MN                                 ........
                 Wright, MN                                     ........
                 Pierce, WI                                     ........
                 St. Croix, WI                                  ........
5140...........  Missoula, MT.................................     .9157
                 Missoula, MT                                   ........
5160...........  Mobile, AL...................................     .8108
                 Baldwin, AL                                    ........
                 Mobile, AL                                     ........
5170...........  Modesto, CA..................................    1.0498
                 Stanislaus, CA                                 ........
5190...........  Monmouth-Ocean, NJ...........................    1.0674
                 Monmouth, NJ                                   ........
                 Ocean, NJ                                      ........
5200...........  Monroe, LA...................................     .8137
                 Ouachita, LA                                   ........
5240...........  Montgomery, AL...............................     .7734
                 Autauga, AL                                    ........
                 Elmore, AL                                     ........
                 Montgomery, AL                                 ........
5280...........  Muncie, IN...................................     .9284
                 Delaware, IN                                   ........
5330...........  Myrtle Beach, SC.............................     .8976
                 Horry, SC                                      ........
5345...........  Naples, FL...................................     .9754
                 Collier, FL                                    ........
5360...........  Nashville, TN................................     .9578
                 Cheatham, TN
                 Davidson, TN
                 Dickson, TN
                 Robertson, TN

[[Page 39781]]

 
                 Rutherford, TN
                 Sumner, TN
                 Williamson, TN
                 Wilson, TN
5380...........  Nassau-Suffolk, NY...........................    1.3357
                 Nassau, NY
                 Suffolk, NY
5483...........  New Haven-Bridgeport-Stamford-Waterbury-         1.2408
                  Danbury, CT.
                 Fairfield, CT
                 New Haven, CT
5523...........  New London-Norwich, CT.......................    1.1767
                 New London, CT
5560...........  New Orleans, LA..............................     .9046
                 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.................................    1.4414
                 Bronx, NY
                 Kings, NY
                 New York, NY
                 Putnam, NY
                 Queens, NY
                 Richmond, NY
                 Rockland, NY
                 Westchester, NY
5640...........  Newark, NJ...................................    1.1381
                 Essex, NJ
                 Morris, NJ
                 Sussex, NJ
                 Union, NJ
                 Warren, NJ
5660...........  Newburgh, NY--PA.............................    1.1387
                 Orange, NY
                 Pike, PA
5720...........  Norfolk-Virginia Beach-Newport News, VA-NC...     .8574
                 Currituck, NC
                 Chesapeake City, VA
                 Gloucester, VA
                 Hampton City, VA
                 Isle of Wight, VA
                 James City, VA
                 Mathews, VA
                 Newport News City, VA
                 Norfolk City, VA
                 Poquoson City, VA
                 Portsmouth City, VA
                 Suffolk City, VA
                 Virginia Beach City VA
                 Williamsburg City, VA
                 York, VA
5775...........  Oakland, CA..................................    1.5072
                 Alameda, CA
                 Contra Costa, CA
5790...........  Ocala, FL....................................     .9402
                 Marion, FL
5800...........  Odessa-Midland, TX...........................     .9397
                 Ector, TX
                 Midland, TX
5880...........  Oklahoma City, OK............................     .8900
                 Canadian, OK
                 Cleveland, OK
                 Logan, OK
                 McClain, OK
                 Oklahoma, OK
                 Pottawatomie, OK

[[Page 39782]]

 
5910...........  Olympia, WA..................................    1.0960
                 Thurston, WA
5920...........  Omaha, NE-IA.................................     .9978
                 Pottawattamie, IA
                 Cass, NE
                 Douglas, NE
                 Sarpy, NE
                 Washington, NE
5945...........  Orange County, CA............................    1.1474
                 Orange, CA
5960...........  Orlando, FL..................................     .9640
                 Lake, FL
                 Orange, FL
                 Osceola, FL
                 Seminole, FL
5990...........  Owensboro, KY................................     .8344
                 Daviess, KY
6015...........  Panama City, FL..............................     .8865
                 Bay, FL
6020...........  Parkersburg-Marietta, WV-OH..................     .8127
                 Washington, OH
                 Wood, WV
6080...........  Pensacola, FL................................     .8645
                 Escambia, FL
                 Santa Rosa, FL
6120...........  Peoria-Pekin, IL.............................     .8739
                 Peoria, IL
                 Tazewell, IL
                 Woodford, IL
6160...........  Philadelphia, PA-NJ..........................    1.0713
                 Burlington, NJ
                 Camden, NJ
                 Gloucester, NJ
                 Salem, NJ
                 Bucks, PA
                 Chester, PA
                 Delaware, PA
                 Mongtomery, PA
                 Philadelphia, PA
6200...........  Phoenix-Mesa, AZ.............................     .9820
                 Maricopa, AZ
                 Pinal, AZ
6240...........  Pine Bluff, AR...............................     .7962
                 Jefferson, AR
6280...........  Pittsburgh, PA...............................     .9365
                 Allegheny, PA
                 Beaver, PA
                 Butler, PA
                 Fayette, PA
                 Washington, PA
                 Westmoreland, PA
6323...........  Pittsfield, MA...............................    1.0235
                 Berkshire, MA
6340...........  Pocatello, ID................................     .9372
                 Bannock, ID
6360...........  Ponce, PR....................................     .5169
                 Guayanilla, PR
                 Juana Diaz, PR
                 Penuelas, PR
                 Ponce, PR
                 Villalba, PR
                 Yauco, PR
6403...........  Portland, ME.................................     .9794
                 Cumberland, ME
                 Sagadahoc, ME
                 York, ME
6440...........  Portland-Vancouver, OR-WA....................    1.0667
                 Clackamas, OR
                 Columbia, OR
                 Multnomah, OR

[[Page 39783]]

 
                 Washington, OR
                 Yamhill, OR
                 Clark, WA
6483...........  Providence-Warwick-Pawtucket, RI.............    1.0854
                 Bristol, RI
                 Kent, RI
                 Newport, RI
                 Providence, RI
                 Washington, RI
6520...........  Provo-Orem, UT...............................     .9984
                 Utah, UT
6560...........  Pueblo, CO...................................     .8820
                 Pueblo, CO
6580...........  Punta Gorda, FL..............................     .9218
                 Charlotte, FL
6600...........  Racine, WI...................................     .9334
                 Racine, WI
6640...........  Raleigh-Durham-Chapel Hill, NC...............     .9990
                 Chatham, NC
                 Durham, NC
                 Franklin, NC
                 Johnston, NC
                 Orange, NC
                 Wake, NC
6660...........  Rapid City, SD...............................     .8846
                 Pennington, SD
6680...........  Reading, PA..................................     .9295
                 Berks, PA
6690...........  Redding, CA..................................    1.1135
                 Shasta, CA
6720...........  Reno, NV.....................................    1.0648
                 Washoe, NV
6740...........  Richland-Kennewick-Pasco, WA.................    1.1491
                 Benton, WA
                 Franklin, WA
6760...........  Richmond-Petersburg, VA......................     .9477
                 Charles City County, VA
                 Chesterfield, VA
                 Colonia Heights City, VA
                 Dinwiddie, VA
                 Goochland, VA
                 Hanover, VA
                 Henrico, VA
                 Hopewell City, VA
                 New Kent, VA
                 Petersburg City, VA
                 Powhatan, VA
                 Prince George, VA
                 Richmond City, VA
6780...........  Riverside-San Bernardino, CA.................    1.1365
                 Riverside, CA
                 San Bernardino, CA
6800...........  Roanoke, VA..................................     .8614
                 Botetourt, VA
                 Roanoke, VA
                 Roanoke City, VA
                 Salem City, VA
6820...........  Rochester, MN................................    1.2139
                 Olmsted, MN
6840...........  Rochester, NY................................     .9194
                 Genesee, NY
                 Livingston, NY
                 Monroe, NY
                 Ontario, NY
                 Orleans, NY
                 Wayne, NY
6880...........  Rockford, IL.................................     .9625
                 Boone, IL
                 Ogle, IL
                 Winnebago, IL

[[Page 39784]]

 
6895...........  Rocky Mount, NC..............................     .9228
                 Edgecombe, NC
                 Nash, NC
6920...........  Sacramento, CA...............................    1.1500
                 El Dorado, CA
                 Placer, CA
                 Sacramento, CA
6960...........  Saginaw-Bay City-Midland, MI.................     .9650
                 Bay, MI
                 Midland, MI
                 Saginaw, MI
6980...........  St. Cloud, MN................................     .9700
                 Benton, MN
                 Stearns, MN
7000...........  St. Joseph, MO...............................     .8021
                 Andrew, MO
                 Buchanan, MO
7040...........  St. Louis, MO-IL.............................     .8855
                 Clinton, IL
                 Jersey, IL
                 Madison, IL
                 Monroe, IL
                 St. Clair, IL
                 Franklin, MO
                 Jefferson, MO
                 Lincoln, MO
                 St. Charles, MO
                 St. Louis, MO
                 St. Louis City, MO
                 Warren, MO
7080...........  Salem, OR....................................    1.0367
                 Marion, OR
                 Polk, OR
7120...........  Salinas, CA..................................    1.4623
                 Monterey, CA
7160...........  Salt Lake City-Ogden, UT.....................     .9945
                 Davis, UT
                 Salt Lake, UT
                 Weber, UT
7200...........  San Angelo, TX...............................     .8374
                 Tom Green, TX
7240...........  San Antonio, TX..............................     .8753
                 Bexar, TX
                 Comal, TX
                 Guadalupe, TX
                 Wilson, TX
7320...........  San Diego, CA................................    1.1131
                 San Diego, CA
7360...........  San Francisco, CA............................    1.4142
                 Marin, CA
                 San Francisco, CA
                 San Mateo, CA
7400...........  San Jose, CA.................................    1.4145
                 Santa Clara, CA
7440...........  San Juan-Bayamon, PR.........................     .4741
                 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

[[Page 39785]]

 
                 Los Piedras, PR
                 Loiza, PR
                 Luguillo, PR
                 Manati, PR
                 Morovis, PR
                 Naguabo, PR
                 Naranjito, PR
                 Rio Grande, PR
                 San Juan, PR
                 Toa Alta, PR
                 Toa Baja, PR
                 Trujillo Alto, PR
                 Vega Alta, PR
                 Vega Baja, PR
                 Yabucoa, PR
7460...........  San Luis Obispo-Atascadero-Paso..............    1.1271
                 Robles, CA
                 San Luis Obispo, CA
7480...........  Santa Barbara-Santa Maria-Lompoc, CA.........    1.0481
                 Santa Barbara, CA
7485...........  Santa Cruz-Watsonville, CA...................    1.3646
                 Santa Cruz, CA
7490...........  Santa Fe, NM.................................    1.0712
                 Los Alamos, NM
                 Santa Fe, NM
7500...........  Santa Rosa, CA...............................    1.3046
                 Sonoma, CA
7510...........  Sarasota-Bradenton, FL.......................     .9425
                 Manatee, FL
                 Sarasota, FL
7520...........  Savannah, GA.................................     .9376
                 Bryan, GA
                 Chatham, GA
                 Effingham, GA
7560...........  Scranton-Wilkes-Barre-Hazleton, PA...........     .8599
                 Columbia, PA
                 Lackawanna, PA
                 Luzerne, PA
                 Wyoming, PA
7600...........  Seattle-Bellevue-Everett, WA.................    1.1474
                 Island, WA
                 King, WA
                 Snohomish, WA
7610...........  Sharon, PA...................................     .7869
                 Mercer, PA
7620...........  Sheboygan, WI................................     .8697
                 Sheboygan, WI
7640...........  Sherman-Denison, TX..........................     .9255
                 Grayson, TX
7680...........  Shreveport-Bossier City, LA..................     .8987
                 Bossier, LA
                 Caddo, LA
                 Webster, LA
7720...........  Sioux City, IA-NE............................     .9046
                 Woodbury, IA
                 Dakota, NE
7760...........  Sioux Falls, SD..............................     .9257
                 Lincoln, SD
                 Minnehaha, SD
7800...........  South Bend, IN...............................     .9802
                 St. Joseph, IN
7840...........  Spokane, WA..................................    1.0852
                 Spokane, WA
7880...........  Springfield, IL..............................     .8659
                 Menard, IL
                 Sangamon, IL
7920...........  Springfield, MO..............................     .8424
                 Christian, MO
                 Greene, MO
                 Webster, MO

[[Page 39786]]

 
8003...........  Springfield, MA..............................    1.0927
                 Hampden, MA
                 Hampshire, MA
8050...........  State College, PA............................     .8941
                 Centre, PA
8080...........  Steubenville-Weirton, OH-WV..................     .8804
                 Jefferson, OH
                 Brooke, WV
                 Hancock, WV
8120...........  Stockton-Lodi, CA............................    1.0506
                 San Joaquin, CA
8140...........  Sumter, SC...................................     .8273
                 Sumter, SC
8160...........  Syracuse, NY.................................     .9714
                 Cayuga, NY
                 Madison, NY
                 Onondaga, NY
                 Oswego, NY
8200...........  Tacoma, WA...................................    1.0940
                 Pierce, WA
8240...........  Tallahassee, FL..............................     .8504
                 Gadsden, FL
                 Leon, FL
8280...........  Tampa-St. Petersburg-Clearwater, FL..........     .9065
                 Hernando, FL
                 Hillsborough, FL
                 Pasco, FL
                 Pinellas, FL
8320...........  Terre Haute, IN..............................     .8599
                 Clay, IN
                 Vermillion, IN
                 Vigo, IN
8360...........  Texarkana, AR-Texarkana, TX..................     .8088
                 Miller, AR
                 Bowie, TX
8400...........  Toledo, OH...................................     .9810
                 Fulton, OH
                 Lucas, OH
                 Wood, OH
8440...........  Topeka, KS...................................     .9199
                 Shawnee, KS
8480...........  Trenton, NJ..................................    1.0432
                 Mercer, NJ
8520...........  Tucson, AZ...................................     .8911
                 Pima, AZ
8560...........  Tulsa, OK....................................     .8332
                 Creek, OK
                 Osage, OK
                 Rogers, OK
                 Tulsa, OK
                 Wagoner, OK
8600...........  Tuscaloosa, AL...............................     .8130
                 Tuscaloosa, AL
8640...........  Tyler, TX....................................     .9521
                 Smith, TX
8680...........  Utica-Rome, NY...............................     .8465
                 Herkimer, NY
                 Oneida, NY
8720...........  Vallejo-Fairfield-Napa, CA...................    1.3354
                 Napa, CA
                 Solano, CA
8735...........  Ventura, CA..................................    1.1096
                 Ventura, CA
8750...........  Victoria, TX.................................     .8756
                 Victoria, TX
8760...........  Vineland-Millville-Bridgeton, NJ.............    1.0031
                 Cumberland, NJ
8780...........  Visalia-Tulare-Porterville, CA...............     .9429
                 Tulare, CA
8800...........  Waco, TX.....................................     .8073

[[Page 39787]]

 
                 McLennan, TX
8840...........  Washington, DC-MD-VA-WV......................    1.0851
                 District of Columbia, DC
                 Calvert, MD
                 Charles, MD
                 Frederick, MD
                 Montgomery, MD
                 Prince Georges, MD
                 Alexandria City, VA
                 Arlington, VA
                 Clarke, VA
                 Culpeper, VA
                 Fairfax, VA
                 Fairfax City, VA
                 Falls Church City, VA
                 Fauquier, VA
                 Fredericksburg City, VA
                 King George, VA
                 Loudoun, VA
                 Manassas City, VA
                 Manassas Park City, VA
                 Prince William, VA
                 Spotsylvania, VA
                 Stafford, VA
                 Warren, VA
                 Berkeley, WV
                 Jefferson, WV
8920...........  Waterloo-Cedar Falls, IA.....................     .8069
                 Black Hawk, IA
8940...........  Wausau, WI...................................     .9782
                 Marathon, WI
8960...........  West Palm Beach-Boca Raton, FL...............     .9939
                 Palm Beach, FL
9000...........  Wheeling, WV-OH..............................     .7670
                 Belmont, OH
                 Marshall, WV
                 Ohio, WV
9040...........  Wichita, KS..................................     .9520
                 Butler, KS
                 Harvey, KS
                 Sedgwick, KS
9080...........  Wichita Falls, TX............................     .8498
                 Archer, TX
                 Wichita, TX
9140...........   Williamsport, PA............................     .8544
                  Lycoming, PA
9160...........  Wilmington-Newark, DE-MD.....................    1.1173
                 New Castle, DE
                 Cecil, MD
9200...........  Wilmington, NC...............................     .9640
                 New Hanover, NC
                 Brunswick, NC
9260...........  Yakima, WA...................................    1.0569
                  Yakima, WA
9270...........  Yolo, CA.....................................     .9434
                 Yolo, CA
9280...........  York, PA.....................................     .9026
                 York, PA
9320...........  Youngstown-Warren, OH........................     .9358
                 Columbiana, OH
                 Mahoning, OH
                 Trumbull, OH
9340...........  Yuba City, CA................................    1.0276
                 Sutter, CA
                 Yuba, CA
9360...........  Yuma, AZ.....................................     .8589
                 Yuma, AZ
------------------------------------------------------------------------


[[Page 39788]]


 Addendum C.--Comparison of Pre-Floor and Pre-Reclassified Hospital Wage
                      Index for FY 2002 and FY 2003
------------------------------------------------------------------------
                                                               Percent
           Rural area            FY 2002 wage  FY 2003 wage   change, FY
                                     index         index       2002-FY
-----------------------------------------------------------------2003---
ALABAMA........................        0.7339        0.766          4.37
ALASKA.........................        1.1862        1.2293         3.63
ARIZONA........................        0.8681        0.8493        -2.17
ARKANSAS.......................        0.7489        0.7666         2.36
CALIFORNIA.....................        0.9659        0.984          1.87
COLORADO.......................        0.8811        0.9015         2.32
CONNECTICUT....................        1.2077        1.2394         2.62
DELAWARE.......................        0.9589        0.9128        -4.81
FLORIDA........................        0.8794        0.8814         0.23
GEORGIA........................        0.8295        0.823         -0.78
GUAM...........................        0.9611        0.9611         0.00
HAWAII.........................        1.1112        1.0255        -7.71
IDAHO..........................        0.8718        0.8747         0.33
ILLINOIS.......................        0.8053        0.8204         1.88
INDIANA........................        0.8721        0.8755         0.39
IOWA...........................        0.8147        0.8315         2.06
KANSAS.........................        0.7812        0.7923         1.42
KENTUCKY.......................        0.7963        0.8079         1.46
LOUISIANA......................        0.7596        0.7567        -0.38
MAINE..........................        0.8721        0.8874         1.75
MARYLAND.......................        0.8859        0.8946         0.98
MASSACHUSETTS..................        1.1454        1.1288        -1.45
MICHIGAN.......................        0.9           0.9            0.00
MINNESOTA......................        0.9035        0.9151         1.28
MISSISSIPPI....................        0.7528        0.768          2.02
MISSOURI.......................        0.7891        0.8021         1.65
MONTANA........................        0.8655        0.8481        -2.01
NEBRASKA.......................        0.8142        0.8204         0.76
NEVADA.........................        0.9727        0.9577        -1.54
NEW HAMPSHIRE..................        0.9779        0.9796         0.17
NEW JERSEY.....................  ............  ............  ...........
NEW MEXICO.....................        0.8676        0.8872         2.26
NEW YORK.......................        0.8547        0.8542        -0.06
NORTH CAROLINA.................        0.8535        0.8666         1.53
------------------------------------------------------------------------


------------------------------------------------------------------------
                                                               Percent
                                    FY 2002       FY 2003    change,  FY
         Non-Urban area           wage index    wage index     2002-FY
                                                                 2003
--------------------------------------------------------------(percent)-
NORTH DAKOTA...................        0.7879        0.7788        -1.15
OHIO...........................        0.8668        0.8613        -0.63
OKLAHOMA.......................        0.7566        0.759          0.32
OREGON.........................        1.0027        1.0303         2.75
PENNSYLVANIA...................        0.8607        0.8462        -1.68
PUERTO RICO....................        0.48          0.4356        -9.25
RHODE ISLAND...................  ............  ............  ...........
SOUTH CAROLINA.................        0.8512        0.8607         1.12
SOUTH DAKOTA...................        0.7861        0.7815        -0.59
TENNESSEE......................        0.7928        0.7877        -0.64
TEXAS..........................        0.7712        0.7821         1.41
UTAH...........................        0.9051        0.9312         2.88
VERMONT........................        0.9466        0.9345        -1.28
VIRGINIA.......................        0.8241        0.8504         3.19
VIRGIN ISLANDS.................        0.6747        0.7845        16.27
WASHINGTON.....................        1.0209        1.0179        -0.29
WEST VIRGINIA..................        0.8067        0.7975        -1.14
WISCONSIN......................        0.9066        0.9162         1.06
WYOMING........................        0.8747        0.9007         2.97
------------------------------------------------------------------------


------------------------------------------------------------------------
                                                                Percent
                                          FY 2002    FY 2003    change,
               Urban MSA                    wage       wage     FY 2002-
                                           index      index     FY 2003
------------------------------------------------------------------------
0040...................................     0.7965     0.7792    -2.17
0060...................................     0.4683     0.4587    -2.05
0080...................................     0.9876     0.96      -2.79

[[Page 39789]]

 
0120...................................     1.064      1.0594    -0.43
0160...................................     0.85       0.8384    -1.36
0200...................................     0.9759     0.9315    -4.55
0220...................................     0.8029     0.7859    -2.12
0240...................................     1.0077     0.9735    -3.39
0280...................................     0.9126     0.9225     1.08
0320...................................     0.8711     0.9034     3.71
0380...................................     1.257      1.2358    -1.69
0440...................................     1.1098     1.1103     0.05
0450...................................     0.8276     0.8044    -2.80
0460...................................     0.9241     0.8997    -2.64
0470...................................     0.463      0.4337    -6.33
0480...................................     0.92       0.9876     7.35
0500...................................     0.9842     1.0211     3.75
0520...................................     1.0058     0.9991    -0.67
0560...................................     1.1293     1.1017    -2.44
0580...................................     0.823      0.8325     1.15
0600...................................     0.997      1.0264     2.95
0640...................................     0.963      0.9637     0.07
0680...................................     0.9519     0.9899     3.99
0720...................................     0.9856     0.9929     0.74
0733...................................     0.9593     0.9664     0.74
0743...................................     1.3626     1.3202    -3.11
0760...................................     0.8149     0.8294     1.78
0840...................................     0.8442     0.8324    -1.40
0860...................................     1.1826     1.2282     3.86
0870...................................     0.8887     0.9042     1.74
0875...................................     1.1689     1.215      3.94
0880...................................     0.9352     0.9022    -3.53
0920...................................     0.844      0.8757     3.76
0960...................................     0.8446     0.8341    -1.24
1000...................................     0.8808     0.9222     4.70
1010...................................     0.7984     0.7972    -0.15
1020...................................     0.8842     0.8907     0.74
1040...................................     0.9038     0.9109     0.79
1080...................................     0.905      0.931      2.87
1123...................................     1.1383     1.1235    -1.30
1125...................................     0.9799     0.9689    -1.12
1145...................................     0.8209     0.8535     3.97
1150...................................     1.0758     1.0944     1.73
1240...................................     0.9012     0.888     -1.46
1260...................................     0.9328     0.8821    -5.44
1280...................................     0.9459     0.9365    -0.99
1303...................................     0.9883     1.0052     1.71
1310...................................     0.4699     0.4371    -6.98
1320...................................     0.8956     0.8932    -0.27
1350...................................     0.9496     0.969      2.04
1360...................................     0.8699     0.9056     4.10
1400...................................     0.9306     1.0635    14.28
1440...................................     0.9206     0.9235     0.32
1480...................................     0.9264     0.8898    -3.95
1520...................................     0.9336     0.985      5.51
1540...................................     1.0566     1.0438    -1.21
1560...................................     0.9369     0.8976    -4.19
1580...................................     0.8288     0.8628     4.10
1600...................................     1.1046     1.1044    -0.02
1620...................................     0.9856     0.9745    -1.13
1640...................................     0.9473     0.9381    -0.97
1660...................................     0.8337     0.8406     0.83
1680...................................     0.9457     0.967      2.25
1720...................................     0.9744     0.9916     1.77
1740...................................     0.8686     0.8496    -2.19
1760...................................     0.9492     0.9307    -1.95
1800...................................     0.844      0.8374    -0.78
1840...................................     0.9565     0.9751     1.94
1880...................................     0.8341     0.8729     4.65
1890...................................     1.1646     1.1453    -1.66
1900...................................     0.8306     0.7847    -5.53
1920...................................     0.9936     0.9998     0.62
1950...................................     0.8613     0.8859     2.86
1960...................................     0.8638     0.8835     2.28
2000...................................     0.9225     0.9282     0.62
2020...................................     0.8972     0.9062     1.00
2030...................................     0.8775     0.8973     2.26
2040...................................     0.7987     0.8055     0.85
2080...................................     1.0328     1.0601     2.64
2120...................................     0.8779     0.8791     0.14
2160...................................     1.0487     1.0448    -0.37
2180...................................     0.7948     0.8137     2.38
2190...................................     1.0296     0.9356    -9.13
2200...................................     0.8519     0.8795     3.24
2240...................................     1.0284     1.0368     0.82
2281...................................     1.0532     1.0684     1.44
2290...................................     0.8899     0.8952     0.60
2320...................................     0.9215     0.9265     0.54
2330...................................     0.9638     0.9722     0.87
2335...................................     0.8415     0.8416     0.01
2340...................................     0.8357     0.8376     0.23
2360...................................     0.8716     0.8925     2.40
2400...................................     1.1471     1.0944    -4.59
2440...................................     0.8514     0.8177    -3.96
2520...................................     0.9267     0.9684     4.50
2560...................................     0.9027     0.8889    -1.53
2580...................................     0.8445     0.81      -4.09
2620...................................     1.0556     1.0682     1.19
2640...................................     1.0913     1.1135     2.03
2650...................................     0.7845     0.7792    -0.68
2655...................................     0.8722     0.878      0.66
2670...................................     1.0045     1.0066     0.21
2680...................................     1.0293     1.0297     0.04
2700...................................     0.9374     0.968      3.26
2710...................................     1.0214     0.9823    -3.83
2720...................................     0.8053     0.7895    -1.96
2750...................................     0.9002     0.9693     7.68
2760...................................     0.9203     0.9457     2.76
2800...................................     0.9394     0.9446     0.55
2840...................................     0.9984     1.0216     2.32
2880...................................     0.8792     0.8505    -3.26
2900...................................     0.9481     0.9871     4.11
2920...................................     1.0313     0.9465    -8.22
2960...................................     0.953      0.9584     0.57
2975...................................     0.8336     0.8281    -0.66
2980...................................     0.8709     0.8892     2.10
2985...................................     0.9069     0.8897    -1.90
2995...................................     0.9569     0.9456    -1.18
3000...................................     1.0048     0.9525    -5.21
3040...................................     0.887      0.895      0.90
3060...................................     0.9495     0.9237    -2.72
3080...................................     0.9208     0.9502     3.19
3120...................................     0.9539     0.9282    -2.69
3150...................................     0.9289     0.91      -2.03
3160...................................     0.9217     0.9122    -1.03
3180...................................     0.8365     0.9268    10.79
3200...................................     0.9287     0.9418     1.41
3240...................................     0.9425     0.9223    -2.14
3283...................................     1.1533     1.1549     0.14
3285...................................     0.7476     0.7659     2.45
3290...................................     0.9367     0.9028    -3.62
3320...................................     1.1539     1.1457    -0.71
3350...................................     0.7975     0.8385     5.14
3360...................................     0.9631     0.9892     2.71
3400...................................     0.9616     0.9636     0.21
3440...................................     0.8883     0.8903     0.23
3480...................................     0.9698     0.9717     0.20
3500...................................     0.9859     0.9587    -2.76
3520...................................     0.9257     0.9532     2.97
3560...................................     0.8491     0.8607     1.37
3580...................................     0.9013     0.9275     2.91
3600...................................     0.9223     0.9381     1.71
3605...................................     0.7622     0.8239     8.09
3610...................................     0.805      0.7976    -0.92
3620...................................     0.9739     0.9849     1.13
3640...................................     1.1178     1.119      0.11
3660...................................     0.8617     0.8268    -4.05
3680...................................     0.8723     0.8329    -4.52
3700...................................     0.8425     0.7749    -8.02
3710...................................     0.8727     0.8613    -1.31
3720...................................     1.0639     1.0595    -0.41
3740...................................     0.9889     1.079      9.11
3760...................................     0.9536     0.9736     2.10
3800...................................     0.9568     0.9686     1.23
3810...................................     0.9764     1.0399     6.50
3840...................................     0.889      0.897      0.90
3850...................................     0.9126     0.8971    -1.70
3870...................................     0.925      0.94       1.62
3880...................................     0.8544     0.8475    -0.81
3920...................................     0.9121     0.9278     1.72
3960...................................     0.7765     0.7965     2.58
3980...................................     0.9067     0.9357     3.20
4000...................................     0.9296     0.9078    -2.35
4040...................................     0.9653     0.9726     0.76
4080...................................     0.7849     0.8472     7.94
4100...................................     0.8621     0.8745     1.44
4120...................................     1.1182     1.1521     3.03
4150...................................     0.7812     0.7923     1.42
4200...................................     0.8682     0.8315    -4.23
4243...................................     0.9287     0.9179    -1.16
4280...................................     0.8791     0.8581    -2.39
4320...................................     0.947      0.9483     0.14
4360...................................     1.0173     0.9892    -2.76
4400...................................     0.8955     0.9097     1.59
4420...................................     0.8571     0.8629     0.68
4480...................................     1.1948     1.2001     0.44
4520...................................     0.9529     0.9276    -2.66
4600...................................     0.8449     0.9646    14.17
4640...................................     0.9103     0.9219     1.27
4680...................................     0.8957     0.9204     2.76
4720...................................     1.0337     1.0467     1.26
4800...................................     0.8708     0.89       2.20
4840...................................     0.486      0.4914     1.11
4880...................................     0.8378     0.8428     0.60
4890...................................     1.0314     1.0498     1.78
4900...................................     0.9913     1.0253     3.43
4920...................................     0.8978     0.892     -0.65
4940...................................     0.9947     0.9837    -1.11
5000...................................     0.995      0.9802    -1.49
5015...................................     1.1469     1.1213    -2.23
5080...................................     0.9971     0.9893    -0.78
5120...................................     1.093      1.0903    -0.25
5140...................................     0.9364     0.9157    -2.21
5160...................................     0.8082     0.8108     0.32
5170...................................     1.082      1.0498    -2.98
5190...................................     1.0851     1.0674    -1.63
5200...................................     0.8201     0.8137    -0.78
5240...................................     0.7359     0.7734     5.10
5280...................................     0.9939     0.9284    -6.59
5330...................................     0.8771     0.8976     2.34
5345...................................     0.9699     0.9754     0.57
5360...................................     0.9754     0.9578    -1.80
5380...................................     1.3643     1.3357    -2.10
5483...................................     1.2238     1.2408     1.39
5523...................................     1.1526     1.1767     2.09
5560...................................     0.9036     0.9046     0.11
5600...................................     1.4427     1.4414    -0.09
5640...................................     1.1622     1.1381    -2.07
5660...................................     1.1113     1.1387     2.47
5720...................................     0.8579     0.8574    -0.06
5775...................................     1.5319     1.5072    -1.61
5790...................................     0.9556     0.9402    -1.61
5800...................................     1.0104     0.9397    -7.00
5880...................................     0.8694     0.89       2.37
5910...................................     1.135      1.096     -3.44
5920...................................     0.9712     0.9978     2.74

[[Page 39790]]

 
5945...................................     1.1123     1.1474     3.16
5960...................................     0.9642     0.964     -0.02
5990...................................     0.8334     0.8344     0.12
6015...................................     0.9061     0.8865    -2.16
6020...................................     0.8133     0.8127    -0.07
6080...................................     0.8361     0.8645     3.40
6120...................................     0.8773     0.8739    -0.39
6160...................................     1.0947     1.0713    -2.14
6200...................................     0.9638     0.982      1.89
6240...................................     0.7895     0.7962     0.85
6280...................................     0.956      0.9365    -2.04
6323...................................     1.0278     1.0235    -0.42
6340...................................     0.9448     0.9372    -0.80
6360...................................     0.5218     0.5169    -0.94
6403...................................     0.9427     0.9794     3.89
6440...................................     1.1111     1.0667    -4.00
6483...................................     1.0805     1.0854     0.45
6520...................................     0.9843     0.9984     1.43
6560...................................     0.8604     0.882      2.51
6580...................................     0.9015     0.9218     2.25
6600...................................     0.9333     0.9334     0.01
6640...................................     0.9818     0.999      1.75
6660...................................     0.8869     0.8846    -0.26
6680...................................     0.9583     0.9295    -3.01
6690...................................     1.1155     1.1135    -0.18
6720...................................     1.0421     1.0648     2.18
6740...................................     1.096      1.1491     4.84
6760...................................     0.9678     0.9477    -2.08
6780...................................     1.1112     1.1365     2.28
6800...................................     0.8371     0.8614     2.90
6820...................................     1.1462     1.2139     5.91
6840...................................     0.9347     0.9194    -1.64
6880...................................     0.9204     0.9625     4.57
6895...................................     0.9109     0.9228     1.31
6920...................................     1.1831     1.15      -2.80
6960...................................     0.959      0.965      0.63
6980...................................     0.9851     0.97      -1.53
7000...................................     0.7891     0.8021     1.65
7040...................................     0.8931     0.8855    -0.85
7080...................................     1.0011     1.0367     3.56
7120...................................     1.4684     1.4623    -0.42
7160...................................     0.9863     0.9945     0.83
7200...................................     0.8193     0.8374     2.21
7240...................................     0.8584     0.8753     1.97
7320...................................     1.1265     1.1131    -1.19
7360...................................     1.414      1.4142     0.01
7400...................................     1.4193     1.4145    -0.34
7440...................................     0.4762     0.4741    -0.44
7460...................................     1.099      1.1271     2.56
7480...................................     1.0802     1.0481    -2.97
7485...................................     1.397      1.3646    -2.32
7490...................................     1.0194     1.0712     5.08
7500...................................     1.3034     1.3046     0.09
7510...................................     1.009      0.9425    -6.59
7520...................................     1.0018     0.9376    -6.41
7560...................................     0.8683     0.8599    -0.97
7600...................................     1.1361     1.1474     0.99
7610...................................     0.7926     0.7869    -0.72
7620...................................     0.8427     0.8697     3.20
7640...................................     0.9373     0.9255    -1.26
7680...................................     0.905      0.8987    -0.70
7720...................................     0.8767     0.9046     3.18
7760...................................     0.9139     0.9257     1.29
7800...................................     0.9993     0.9802    -1.91
7840...................................     1.0668     1.0852     1.72
7880...................................     0.8676     0.8659    -0.20
7920...................................     0.8567     0.8424    -1.67
8003...................................     1.0881     1.0927     0.42
8050...................................     0.9133     0.8941    -2.10
8080...................................     0.8637     0.8804     1.93
8120...................................     1.0815     1.0506    -2.86
8140...................................     0.7794     0.8273     6.15
8160...................................     0.9621     0.9714     0.97
8200...................................     1.1616     1.094     -5.82
8240...................................     0.8527     0.8504    -0.27
8280...................................     0.8925     0.9065     1.57
8320...................................     0.8532     0.8599     0.79
8360...................................     0.8327     0.8088    -2.87
8400...................................     0.9809     0.981      0.01
8440...................................     0.8912     0.9199     3.22
8480...................................     1.0416     1.0432     0.15
8520...................................     0.8967     0.8911    -0.62
8560...................................     0.8902     0.8332    -6.40
8600...................................     0.8171     0.813     -0.50
8640...................................     0.9641     0.9521    -1.24
8680...................................     0.8329     0.8465     1.63
8720...................................     1.3562     1.3354    -1.53
8735...................................     1.0994     1.1096     0.93
8750...................................     0.8328     0.8756     5.14
8760...................................     1.0441     1.0031    -3.93
8780...................................     0.9628     0.9429    -2.07
8800...................................     0.8129     0.8073    -0.69
8840...................................     1.0962     1.0851    -1.01
8920...................................     0.8041     0.8069     0.35
8940...................................     0.9696     0.9782     0.89
8960...................................     0.9777     0.9939     1.66
9000...................................     0.7985     0.767     -3.94
9040...................................     0.9606     0.952     -0.90
9080...................................     0.7867     0.8498     8.02
9140...................................     0.8628     0.8544    -0.97
9160...................................     1.0877     1.1173     2.72
9200...................................     0.9409     0.964      2.46
9260...................................     1.0567     1.0569     0.02
9270...................................     0.9701     0.9434    -2.75
9280...................................     0.9441     0.9026    -4.40
9320...................................     0.9563     0.9358    -2.14
9340...................................     1.0359     1.0276    -0.80
9360...................................     0.8989     0.8589    -4.45
------------------------------------------------------------------------

[FR Doc. 03-16397 Filed 6-27-03; 8:45 am]
BILLING CODE 4120-01-P