[Federal Register Volume 68, Number 188 (Monday, September 29, 2003)]
[Rules and Regulations]
[Pages 55882-55898]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-24549]


=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 411, 413, 440, 483, 488, and 489

[CMS-1469-CN]
RIN 0938-AL90


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Correction

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

ACTION: Correction of final rule.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical errors that appeared in the 
final rule published in the Federal Register on August 4, 2003, 
entitled ``Medicare Program; Prospective Payment System and 
Consolidated Billing for Skilled Nursing Facilities.''

EFFECTIVE DATE: This correction is effective October 1, 2003.

FOR FURTHER INFORMATION CONTACT: Jeanette Kranacs, (410) 786-9385, or 
Sheila Lambowitz, (410) 786-7605.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), there were a 
number of technical errors that are identified and corrected in the 
``Correction of Errors'' section below. The provisions in this 
correction document are effective as if they had been included in the 
document published August 4, 2003. Accordingly, the corrections are 
effective October 1, 2003.
    In previous years, we have issued correction notices with respect 
to payment rates under the prospective payment system (PPS) for skilled 
nursing facilities (SNFs), reflecting minor adjustments to the hospital 
wage index relating to specific Metropolitan Statistical Areas (MSAs). 
For example, for fiscal year (FY) 2003, we issued a correction notice 
(December 27, 2002, 67 FR 79123) to update two MSA wage indexes. We did 
not recalculate the SNF budget neutrality factor as a result of these 
minor revisions.
    However, it was recently determined that computational errors in 
the hospital wage index calculation process for FY 2004 were of 
sufficient magnitude to affect all of the published PPS payment rates 
for inpatient hospital services. A description of those computational 
errors will be included in a notice specific to the hospital inpatient 
PPS. As we explained in the August 4, 2003 final rule, the SNF wage 
index values reflect the wage data used in the FY 2004 inpatient 
hospital PPS rates, and therefore, we believe it would be appropriate 
to incorporate corrections to the inpatient hospital wage index. The 
scope of the resulting corrections to the hospital wage index will, in 
turn, necessitate revising the budget neutrality factor for the SNF PPS 
for FY 2004 as well. We note that correcting these computational errors 
is a purely

[[Page 55883]]

administrative function that does not result in any change of policy or 
payment methodology.
    Accordingly, in this correction document, we are republishing the 
SNF PPS payment rate tables (that is, Tables 1 through 9, inclusive) 
that appeared in the August 4, 2003 final rule, in order to show the 
corrected rates. (We note that we are not republishing Table 10 (FY 
2004 Labor-Related Share (68 FR 46057)), as this table solely involves 
the relative importance of the various components of the labor-related 
share, and those figures have not changed from those that appeared in 
the final rule.) Further, we are republishing Table 11, which displays 
the projected impact of the FY 2004 SNF PPS payment update, including 
the variation in impact by region and by certain other facility 
characteristics. We note that the effect of the corrections being made 
in this notice is solely distributional in nature and, accordingly, 
that there is no change in the estimated aggregate expenditures for FY 
2004 as set forth in the August 4, 2003 final rule. A further 
discussion of the projected impact of the FY 2004 SNF PPS payment 
update can be found in the August 4, 2003 final rule (68 FR 46067). In 
addition, the FY 2004 budget neutrality factor of 1.005 that appeared 
in the final rule (68 FR 46047) is hereby revised to 1.0016.
    Finally, in the August 4, 2003 final rule (68 FR 46060), we added 
two radiopharmaceuticals, Zevalin and Bexxar, to the list of 
chemotherapy drugs that are excluded from consolidated billing (and, 
thus, are separately billable to Part B when furnished to a SNF 
resident during a covered Part A stay). We note that Healthcare Common 
Procedure Coding System (HCPCS) coding for Bexxar is currently in the 
process of being developed. Further, while the final rule identified 
HCPCS codes A9522 and A9523 for Zevalin, we note that the outpatient 
hospital PPS currently uses HCPCS codes G0273 and G0274 for Zevalin 
instead, and that further revision of these particular codes is 
possible in the near future. As we stated in the final rule, the 
consolidated billing exclusions will appear in a Consolidated Billing 
Annual Update Program Memorandum that we will issue at the end of CY 
2003, and will be effective as of January 1, 2004 (68 FR 46059). 
Accordingly, we are clarifying as an interpretive matter that the HCPCS 
codes to be utilized in connection with Bexxar and Zevalin include any 
successor codes that may replace the codes currently listed in the 
regulation. Such successor codes would be disseminated through program 
instructions. Once HCPCS coding has been developed for Bexxar (and has 
been definitively established for Zevalin), we will make revisions, as 
appropriate, to the particular codes that appear in the regulations 
text at Sec.  411.15(p)(2)(xii) and Sec.  489.20(s)(12).

II. Correction of Errors

    In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), make the 
following corrections:

Corrections to Preamble

    1. On page 46040, Tables 1 and 2 are revised to read as follows:

                            Table 1.--FY 2004 Unadjusted Federal Rate Per Diem--Urban
----------------------------------------------------------------------------------------------------------------
                                                  Nursing-- case- Therapy-- case- Therapy-- non-
                 Rate component                         mix             mix          case- mix     Non-case- mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount.................................         $129.52          $97.56          $12.85          $66.10
----------------------------------------------------------------------------------------------------------------


                            Table 2.--FY 2004 Unadjusted Federal Rate Per Diem--Rural
----------------------------------------------------------------------------------------------------------------
                                                  Nursing-- case- Therapy-- case- Therapy-- non-
                 Rate component                         mix             mix          case- mix     Non-case- mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount.................................         $123.74         $112.50          $13.72          $67.33
----------------------------------------------------------------------------------------------------------------

    2. On pages 46042 through 46043, Table 3 is revised to read as 
follows:

BILLING CODE 4120-01-P

[[Page 55884]]

[GRAPHIC] [TIFF OMITTED] TR29SE03.054


[[Page 55885]]


[GRAPHIC] [TIFF OMITTED] TR29SE03.055

    3. On Pages 46044 through 46045, Table 4 is revised to read as 
follows:

[[Page 55886]]

[GRAPHIC] [TIFF OMITTED] TR29SE03.056


[[Page 55887]]


[GRAPHIC] [TIFF OMITTED] TR29SE03.057

    4. On page 46047, in the third column; in the first paragraph, the 
budget neutrality factor of ``1.005'' that appears in the penultimate 
sentence is revised to read ``1.0016''.
    5. On page 46048, Table 5 is revised to read as follows:

[[Page 55888]]

[GRAPHIC] [TIFF OMITTED] TR29SE03.058

    6. On page 46049, Table 6 is revised to read as follows:

[[Page 55889]]

[GRAPHIC] [TIFF OMITTED] TR29SE03.059


[[Page 55890]]


    7. On Pages 46050 through 46056, Table 7 is revised to read as 
follows:

                  Table 7.--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
   Urban area  (constituent counties or  county equivalents)      index
------------------------------------------------------------------------
0040 Abilene, TX..............................................    0.7627
  Taylor, TX
0060 Aguadilla, PR............................................    0.4306
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080 Akron, OH................................................    0.9246
  Portage, OH
  Summit, OH
0120 Albany, GA...............................................    1.0863
  Dougherty, GA
  Lee, GA
0160 Albany-Schenectady-Troy, NY..............................    0.8489
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200 Albuquerque, NM..........................................    0.9300
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220 Alexandria, LA...........................................    0.8019
  Rapides, LA
0240 Allentown-Bethlehem-Easton, PA...........................    0.9721
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280 Altoona, PA..............................................    0.8806
  Blair, PA
0320 Amarillo, TX.............................................    0.8986
  Potter, TX
  Randall, TX
0380 Anchorage, AK............................................    1.2216
  Anchorage, AK
0440 Ann Arbor, MI............................................    1.1074
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450 Anniston, AL.............................................    0.8090
  Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI..............................    0.9035
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470 Arecibo, PR..............................................    0.4155
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480 Asheville, NC............................................    0.9720
  Buncombe, NC
  Madison, NC
0500 Athens, GA...............................................    0.9818
  Clarke, GA
  Madison, GA
  Oconee, GA
0520 Atlanta, GA..............................................    1.0130
  Barrow, GA
  Bartow, GA
  Carroll, GA
  Cherokee, GA
  Clayton, GA
  Cobb, GA
  Coweta, GA
  De Kalb, GA
  Douglas, GA
  Fayette, GA
  Forsyth, GA
  Fulton, GA
  Gwinnett, GA
  Henry, GA
  Newton, GA
  Paulding, GA
  Pickens, GA
  Rockdale, GA
  Spalding, GA
  Walton, GA
0560 Atlantic City-Cape May, NJ...............................    1.0795
  Atlantic City, NJ
  Cape May, NJ
0580 Auburn-Opelika, AL.......................................    0.8494
  Lee, AL
0600 Augusta-Aiken, GA-SC.....................................    0.9625
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640 Austin-San Marcos, TX....................................    0.9609
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680 Bakersfield, CA..........................................    0.9810
  Kern, CA
0720 Baltimore, MD............................................    0.9919
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Annes, MD
0733 Bangor, ME...............................................    0.9904
  Penobscot, ME
0743 Barnstable-Yarmouth, MA..................................    1.2956
  Barnstable, MA
0760 Baton Rouge, LA..........................................    0.8406
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX.................................    0.8424
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860 Bellingham, WA...........................................    1.1757
  Whatcom, WA
0870 Benton Harbor, MI........................................    0.8871
  Berrien, MI
0875 Bergen-Passaic, NJ.......................................    1.1692
  Bergen, NJ
  Passaic, NJ
0880 Billings, MT.............................................    0.8961
  Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS...........................    0.9029
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960 Binghamton, NY...........................................    0.8428
  Broome, NY
  Tioga, NY
1000 Birmingham, AL...........................................    0.9212
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010 Bismarck, ND.............................................    0.7965
  Burleigh, ND
  Morton, ND
1020 Bloomington, IN..........................................    0.8662
  Monroe, IN
1040 Bloomington-Normal, IL...................................    0.8832
  McLean, IL
1080 Boise City, ID...........................................    0.9209
  Ada, ID
  Canyon, ID
1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.........    1.1233
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125 Boulder-Longmont, CO.....................................    1.0049
  Boulder, CO
1145 Brazoria, TX.............................................    0.8137
  Brazoria, TX
1150 Bremerton, WA............................................
  Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX.....................    1.0303
  Cameron, TX
1260 Bryan-College Station, TX................................    0.9019
  Brazos, TX
1280 Buffalo-Niagara Falls, NY................................    0.9604
  Erie, NY
  Niagara, NY
1303 Burlington, VT...........................................    0.9704
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310 Caguas, PR...............................................    0.4158
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320 Canton-Massillon, OH.....................................    0.9071
  Carroll, OH
  Stark, OH
1350 Casper, WY...............................................    0.9095
  Natrona, WY
1360 Cedar Rapids, IA.........................................    0.8874
  Linn, IA
1400 Champaign-Urbana, IL.....................................    0.9907

[[Page 55891]]

 
  Champaign, IL
1440 Charleston-North Charleston, SC..........................    0.9332
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480 Charleston, WV...........................................    0.8880
  Kanawha, WV
  Putnam, WV
1520 Charlotte-Gastonia-Rock Hill, NC-SC......................    0.9760
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540 Charlottesville, VA......................................    1.0025
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560 Chattanooga, TN-GA.......................................    0.9086
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580 Cheyenne, WY.............................................    0.8796
  Laramie, WY
1600 Chicago, IL..............................................    1.0892
  Cook, IL
  De Kalb, IL
  Du Page, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620 Chico-Paradise, CA.......................................    1.0193
  Butte, CA
1640 Cincinnati, OH-KY-IN.....................................    0.9413
  Dearborn, IN
  Ohio, IN
  Boone, KY
  Campbell, KY
  Gallatin, KY
  Grant, KY
  Kenton, KY
  Pendleton, KY
  Brown, OH
  Clermont, OH
  Hamilton, OH
  Warren, OH
1660 Clarksville-Hopkinsville, TN-KY..........................    0.8244
  Christian, KY
  Montgomery, TN
1680 Cleveland-Lorain-Elyria, OH..............................    0.9671
  Ashtabula, OH
  Geauga, OH
  Cuyahoga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720 Colorado Springs, CO.....................................    0.9833
  El Paso, CO
1740 Columbia, MO.............................................    0.8695
  Boone, MO
1760 Columbia, SC.............................................    0.8902
  Lexington, SC
  Richland, SC
1800 Columbus, GA-AL..........................................    0.8694
  Russell, AL
  Chattanoochee, GA
  Harris, GA
  Muscogee, GA
1840 Columbus, OH.............................................    0.9648
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880 Corpus Christi, TX.......................................    0.8521
  Nueces, TX
  San Patricio, TX
1890 Corvallis, OR............................................    1.1516
  Benton, OR
1900 Cumberland, MD-WV........................................    0.8200
  Allegany, MD
  Mineral, WV
1920 Dallas, TX...............................................    0.9974
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950 Danville, VA.............................................    0.9035
  Danville City, VA
  Pittsylvania, VA
1960 Davenport-Moline-Rock Island, IA-IL......................    0.8985
  Scott, IA
  Henry, IL
  Rock Island, IL
2000 Dayton-Springfield, OH...................................    0.9518
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020 Daytona Beach, FL........................................    0.9078
  Flagler, FL
  Volusia, FL
2030 Decatur, AL..............................................    0.8828
  Lawrence, AL
  Morgan, AL
2040 Decatur, IL..............................................    0.8161
  Macon, IL
2080 Denver, CO...............................................    1.0837
  Adams, CO
  Arapahoe, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120 Des Moines, IA...........................................    0.9106
  Dallas, IA
  Polk, IA
  Warren, IA
2160 Detroit, MI..............................................    1.0101
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180 Dothan, AL...............................................    0.7741
  Dale, AL
  Houston, AL
2190 Dover, DE................................................    0.9805
  Kent, DE
2200 Dubuque, IA..............................................    0.8886
  Dubuque, IA
2240 Duluth-Superior, MN-WI...................................    1.0171
  St. Louis, MN
  Douglas, WI
2281 Dutchess County, NY......................................    1.0934
  Dutchess, NY
2290 Eau Claire, WI...........................................    0.9064
  Chippewa, WI
  Eau Claire, WI
2320 El Paso, TX..............................................    0.9196
  El Paso, TX
2330 Elkhart-Goshen, IN.......................................    0.9783
  Elkhart, IN
2335 Elmira, NY...............................................    0.8377
  Chemung, NY
2340 Enid, OK.................................................    0.8559
  Garfield, OK
2360 Erie, PA.................................................    0.8601
  Erie, PA
2400 Eugene-Springfield, OR...................................    1.1456
  Lane, OR
2440 Evansville-Henderson, IN-KY..............................    0.8429
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520 Fargo-Moorhead, ND-MN....................................    0.9797
  Clay, MN
  Cass, ND
2560 Fayetteville, NC.........................................    0.8986
  Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR.......................    0.8396
  Benton, AR
  Washington, AR
2620 Flagstaff, AZ-UT.........................................    1.1333
  Coconino, AZ
  Kane, UT
2640 Flint, MI................................................    1.0858
  Genesee, MI
2650 Florence, AL.............................................    0.7747
  Colbert, AL
  Lauderdale, AL
2655 Florence, SC.............................................    0.8709
  Florence, SC
2670 Fort Collins-Loveland, CO................................    1.0108
  Larimer, CO
2680 Ft. Lauderdale, FL.......................................    1.0163
  Broward, FL
2700 Fort Myers-Cape Coral, FL................................    0.9816
  Lee, FL
2710 Fort Pierce-Port St. Lucie, FL...........................    1.0008
  Martin, FL
  St. Lucie, FL
2720 Fort Smith, AR-OK........................................    0.8424

[[Page 55892]]

 
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750 Fort Walton Beach, FL....................................    0.8966
  Okaloosa, FL
2760 Fort Wayne, IN...........................................    0.9585
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800 Forth Worth-Arlington, TX................................    0.9359
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840 Fresno, CA...............................................    1.0094
  Fresno, CA
  Madera, CA
2880 Gadsden, AL..............................................    0.8206
  Etowah, AL
2900 Gainesville, FL..........................................    0.9693
  Alachua, FL
2920 Galveston-Texas City, TX.................................    0.9279
  Galveston, TX
2960 Gary, IN.................................................    0.9410
  Lake, IN
  Porter, IN
2975 Glens Falls, NY..........................................    0.8475
  Warren, NY
  Washington, NY
2980 Goldsboro, NC............................................    0.8622
  Wayne, NC
2985 Grand Forks, ND-MN.......................................    0.8636
  Polk, MN
  Grand Forks, ND
2995 Grand Junction, CO.......................................    0.9633
  Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI........................    0.9469
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040 Great Falls, MT..........................................    0.8809
  Cascade, MT
3060 Greeley, CO..............................................    0.9372
  Weld, CO
3080 Green Bay, WI............................................    0.9461
  Brown, WI
3120 Greensboro-Winston-Salem-High Point, NC..................    0.9166
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150 Greenville, NC...........................................    0.9098
  Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC......................    0.9335
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180 Hagerstown, MD...........................................    0.9172
  Washington, MD
3200 Hamilton-Middletown, OH..................................    0.9214
  Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA..........................    0.9164
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283 Hartford, CT.............................................    1.1555
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285 Hattiesburg, MS..........................................    0.7307
  Forrest, MS
  Lamar, MS
3290 Hickory-Morganton-Lenoir, NC.............................    0.9242
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320 Honolulu, HI.............................................    1.1098
  Honolulu, HI
3350 Houma, LA................................................    0.7748
  Lafourche, LA
  Terrebonne, LA
3360 Houston, TX..............................................    0.9834
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400 Huntington-Ashland, WV-KY-OH.............................    0.9595
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440 Huntsville, AL...........................................    0.9245
  Limestone, AL
  Madison, AL
3480 Indianapolis, IN.........................................    0.9916
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500 Iowa City, IA............................................    0.9548
  Johnson, IA
3520 Jackson, MI..............................................    0.8986
  Jackson, MI
3560 Jackson, MS..............................................    0.8357
  Hinds, MS
  Madison, MS
  Rankin, MS
3580 Jackson, TN..............................................    0.8984
  Chester, TN
  Madison, TN
3600 Jacksonville, FL.........................................    0.9529
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605 Jacksonville, NC.........................................    0.8544
  Onslow, NC
3610 Jamestown, NY............................................    0.7762
  Chautaqua, NY
3620 Janesville-Beloit, WI....................................    0.9282
  Rock, WI
3640 Jersey City, NJ..........................................    1.1115
  Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA....................    0.8253
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680 Johnstown, PA............................................    0.8158
  Cambria, PA
  Somerset, PA
3700 Jonesboro, AR............................................    0.7794
  Craighead, AR
3710 Joplin, MO...............................................    0.8681
  Jasper, MO
  Newton, MO
3720 Kalamazoo-Battle Creek, MI...............................    1.0500
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740 Kankakee, IL.............................................    1.0419
  Kankakee, IL
3760 Kansas City, KS-MO.......................................    0.9715
  Johnson, KS
  Leavenworth, KS
  Miami, KS
  Wyandotte, KS
  Cass, MO
  Clay, MO
  Clinton, MO
  Jackson, MO
  Lafayette, MO
  Platte, MO
  Ray, MO
3800 Kenosha, WI..............................................    0.9761
  Kenosha, WI
3810 Killeen-Temple, TX.......................................    0.9159
  Bell, TX
  Coryell, TX
3840 Knoxville, TN............................................    0.8820
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850 Kokomo, IN...............................................    0.9045

[[Page 55893]]

 
  Howard, IN
  Tipton, IN
3870 La Crosse, WI-MN.........................................    0.9247
  Houston, MN
  La Crosse, WI
3880 Lafayette, LA............................................    0.8189
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920 Lafayette, IN............................................    0.8584
  Clinton, IN
  Tippecanoe, IN
3960 Lake Charles, LA.........................................    0.7841
  Calcasieu, LA
3980 Lakeland-Winter Haven, FL................................    0.8811
  Polk, FL
4000 Lancaster, PA............................................    0.9282
  Lancaster, PA
4040 Lansing-East Lansing, MI.................................    0.9714
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080 Laredo, TX...............................................    0.8091
  Webb, TX
4100 Las Cruces, NM...........................................    0.8688
  Dona Ana, NM
4120 Las Vegas, NV-AZ.........................................    1.1528
  Mohave, AZ
  Clark, NV
  Nye, NV
4150 Lawrence, KS.............................................    0.8677
  Douglas, KS
4200 Lawton, OK...............................................    0.8267
  Comanche, OK
4243 Lewiston-Auburn, ME......................................    0.9383
  Androscoggin, ME
4280 Lexington, KY............................................    0.8685
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320 Lima, OH.................................................    0.9522
  Allen, OH
  Auglaize, OH
4360 Lincoln, NE..............................................    1.0033
  Lancaster, NE
4400 Little Rock-North Little Rock, AR........................    0.8923
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420 Longview-Marshall, TX....................................    0.9113
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480 Los Angeles-Long Beach, CA...............................    1.1795
  Los Angeles, CA
4520 Louisville, KY-IN........................................    0.9242
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
 
4600 Lubbock, TX..............................................    0.8272
  Lubbock, TX
 
4640 Lynchburg, VA............................................    0.9134
  Amherst, VA
  Bedford City, VA
  Bedford, VA
  Campbell, VA
  Lynchburg City, VA
 
4680 Macon, GA................................................    0.8953
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
 
4720 Madison, WI..............................................    1.0264
  Dane, WI
 
4800 Mansfield, OH............................................    0.9180
  Crawford, OH
  Richland, OH
 
4840 Mayaguez, PR.............................................    0.4795
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
 
4880 McAllen-Edinburg-Mission, TX.............................    0.8381
  Hidalgo, TX
 
4890 Medford-Ashland, OR......................................    1.0772
  Jackson, OR
 
4900 Melbourne-Titusville-Palm Bay, FL........................    0.9776
  Brevard, FL
 
4920 Memphis, TN-AR-MS........................................    0.9009
  Crittenden, AR
  De Soto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
 
4940 Merced, CA...............................................    0.9690
  Merced, CA
 
5000 Miami, FL................................................    0.9894
  Dade, FL
 
5015 Middlesex-Somerset-Hunterdon, NJ.........................    1.1366
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
 
5080 Milwaukee-Waukesha, WI...................................    0.9988
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
 
5120 Minneapolis-St Paul, MN-WI...............................    1.1001
  Anoka, MN
  Carver, MN
  Chisago, MN
  Dakota, MN
  Hennepin, MN
  Isanti, MN
  Ramsey, MN
  Scott, MN
  Sherburne, MN
  Washington, MN
  Wright, MN
  Pierce, WI
  St. Croix, WI
5140 Missoula, MT.............................................    0.8718
  Missoula, MT
5160 Mobile, AL...............................................    0.7994
  Baldwin, AL
  Mobile, AL
5170 Modesto, CA..............................................    1.1275
  Stanislaus, CA
5190 Monmouth-Ocean, NJ.......................................    1.0956
  Monmouth, NJ
  Ocean, NJ
5200 Monroe, LA...............................................    0.7922
  Ouachita, LA
5240 Montgomery, AL...........................................    0.7907
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280 Muncie, IN...............................................    0.8775
  Delaware, IN
5330 Myrtle Beach, SC.........................................    0.9112
  Horry, SC
5345 Naples, FL...............................................    0.9790
  Collier, FL
5360 Nashville, TN............................................    0.9855
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380 Nassau-Suffolk, NY.......................................    1.3140
  Nassau, NY
  Suffolk, NY
5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT......    1.2385
  Fairfield, CT
  New Haven, CT
5523 New London-Norwich, CT...................................    1.1631
  New London, CT
5560 New Orleans, LA..........................................    0.9174
  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.............................................    1.4018

[[Page 55894]]

 
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640 Newark, NJ...............................................    1.1518
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660 Newburgh, NY-PA..........................................    1.1509
  Orange, NY
  Pike, PA
5720 Norfolk-Virginia Beach-Newport News, VA-NC...............    0.8619
  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..............................................    1.4921
  Alameda, CA
  Contra Costa, CA
5790 Ocala, FL................................................    0.9728
  Marion, FL
5800 Odessa-Midland, TX.......................................    0.9327
  Ector, TX
  Midland, TX
5880 Oklahoma City, OK........................................    0.8984
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910 Olympia, WA..............................................    1.0963
  Thurston, WA
5920 Omaha, NE-IA.............................................    0.9745
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945 Orange County, CA........................................    1.1372
  Orange, CA
5960 Orlando, FL..............................................    0.9654
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990 Owensboro, KY............................................    0.8374
  Daviess, KY
6015 Panama City, FL..........................................    0.8202
  Bay, FL
6020 Parkersburg-Marietta, WV-OH..............................    0.8039
  Washington, OH
  Wood, WV
6080 Pensacola, FL............................................    0.8707
  Escambia, FL
  Santa Rosa, FL
6120 Peoria-Pekin, IL.........................................    0.8734
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160 Philadelphia, PA-NJ......................................    1.0883
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200 Phoenix-Mesa, AZ.........................................    1.0129
  Maricopa, AZ
  Pinal, AZ
6240 Pine Bluff, AR...........................................    0.7865
  Jefferson, AR
6280 Pittsburgh, PA...........................................    0.8901
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323 Pittsfield, MA...........................................    1.0276
  Berkshire, MA
6340 Pocatello, ID............................................    0.9042
  Bannock, ID
6360 Ponce, PR................................................    0.4708
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403 Portland, ME.............................................    0.9949
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440 Portland-Vancouver, OR-WA................................    1.1213
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483 Providence-Warwick-Pawtucket, RI.........................    1.0977
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520 Provo-Orem, UT...........................................    0.9976
  Utah, UT
6560 Pueblo, CO...............................................    0.8778
  Pueblo, CO
6580 Punta Gorda, FL..........................................    0.9510
  Charlotte, FL
6600 Racine, WI...............................................    0.8814
  Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC...........................    0.9959
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660 Rapid City, SD...........................................    0.8806
  Pennington, SD
6680 Reading, PA..............................................    0.9133
  Berks, PA
6690 Redding, CA..............................................    1.1352
  Shasta, CA
6720 Reno, NV.................................................    1.0682
  Washoe, NV
6740 Richland-Kennewick-Pasco, WA.............................    1.0609
  Benton, WA
  Franklin, WA
6760 Richmond-Petersburg, VA..................................    0.9349
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780 Riverside-San Bernardino, CA.............................    1.1341
  Riverside, CA
  San Bernardino, CA
6800 Roanoke, VA..............................................    0.8700
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820 Rochester, MN............................................    1.1739
  Olmsted, MN
6840 Rochester, NY............................................    0.9430
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880 Rockford, IL.............................................    0.9666
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895 Rocky Mount, NC..........................................    0.9076
  Edgecombe, NC
  Nash, NC
6920 Sacramento, CA...........................................    1.1845
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.............................    1.0032
  Bay, MI
  Midland, MI
  Saginaw, MI
6980 St. Cloud, MN............................................    0.9506

[[Page 55895]]

 
  Benton, MN
  Stearns, MN
7000 St. Joseph, MO...........................................    0.9757
  Andrews, MO
  Buchanan, MO
7040 St. Louis, MO-IL.........................................    0.9033
  Clinton, IL
  Jersey, IL
  Madison, IL
  Monroe, IL
  St. Clair, IL
  Franklin, MO
  Jefferson, MO
  Lincoln, MO
  St. Charles, MO
  St. Louis, MO
  St. Louis City, MO
  Warren, MO
  Sullivan City, MO
7080 Salem, OR................................................    1.0482
  Marion, OR
  Polk, OR
7120 Salinas, CA..............................................    1.4339
  Monterey, CA
7160 Salt Lake City-Ogden, UT.................................    0.9913
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200 San Angelo, TX...........................................    0.8535
  Tom Green, TX
7240 San Antonio, TX..........................................    0.8870
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320 San Diego, CA............................................    1.1147
  San Diego, CA
7360 San Francisco, CA........................................    1.4514
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400 San Jose, CA.............................................    1.4626
  Santa Clara, CA
7440 San Juan-Bayamon, PR.....................................    0.4909
 Aguas Buenas, PR
 Barceloneta, PR
 Bayamon, PR
 Canovanas, PR
 Carolina, PR
 Catano, PR
 Ceiba, PR
 Comerio, PR
 Corozal, PR
 Dorado, PR
 Fajardo, PR
 Florida, PR
 Guaynabo, PR
 Humacao, PR
 Juncos, PR
 Los Piedras, PR
 Loiza, PR
 Luguillo, PR
 Manati, PR
 Morovis, PR
 Naguabo, PR
 Naranjito, PR
 Rio Grande, PR
 San Juan, PR
 Toa Alta, PR
 Toa Baja, PR
 Trujillo Alto, PR
 Vega Alta, PR
 Vega Baja, PR
 Yabucoa, PR
7460 San Luis Obispo-Atascadero-Paso Robles, CA...............    1.1429
  San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.....................    1.0441
  Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA...............................    1.2942
  Santa Cruz, CA
7490 Santa Fe, NM.............................................    1.0653
  Los Alamos, NM
  Santa Fe, NM
7500 Santa Rosa, CA...........................................    1.2877
  Sonoma, CA
7510 Sarasota-Bradenton, FL...................................    0.9964
  Manatee, FL
  Sarasota, FL
7520 Savannah, GA.............................................    0.9472
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560 Scranton-Wilkes-Barre--Hazleton, PA......................    0.8412
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600 Seattle-Bellevue-Everett, WA.............................    1.1562
  Island, WA
  King, WA
  Snohomish, WA
7610 Sharon, PA...............................................    0.7751
  Mercer, PA
7620 Sheboygan, WI............................................    0.8624
  Sheboygan, WI
7640 Sherman-Denison, TX......................................    0.9700
  Grayson, TX
7680 Shreveport-Bossier City, LA..............................    0.9083
  Bossier, LA
  Caddo, LA
  Webster, LA
7720 Sioux City, IA-NE                                            0.8993
  Woodbury, IA
  Dakota, NE
7760 Sioux Falls, SD..........................................    0.9309
  Lincoln, SD
  Minnehaha, SD
7800 South Bend, IN...........................................    0.9821
  St. Joseph, IN
7840 Spokane, WA..............................................    1.0901
  Spokane, WA
7880 Springfield, IL..........................................    0.8944
  Menard, IL
  Sangamon, IL
7920 Springfield, MO..........................................    0.8457
  Christian, MO
  Greene, MO
  Webster, MO
8003 Springfield, MA..........................................    1.0543
  Hampden, MA
  Hampshire, MA
8050 State College, PA........................................    0.8740
  Centre, PA
8080 Steubenville-Weirton, OH-WV..............................    0.8398
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120 Stockton-Lodi, CA........................................    1.0404
  San Joaquin, CA
8140 Sumter, SC...............................................    0.8243
  Sumter, SC
8160 Syracuse, NY.............................................    0.9412
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200 Tacoma, WA...............................................    1.1116
  Pierce, WA
8240 Tallahassee, FL..........................................    0.8520
  Gadsden, FL
  Leon, FL
8280 Tampa-St. Petersburg-Clearwater, FL......................    0.9103
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320 Terre Haute, IN..........................................    0.8325
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360 Texarkana, AR-Texarkana, TX..............................    0.8150
  Miller, AR
  Bowie, TX
8400 Toledo, OH...............................................    0.9381
  Fulton, OH
  Lucas, OH
  Wood, OH
8440 Topeka, KS...............................................    0.9108
  Shawnee, KS
8480 Trenton, NJ..............................................    1.0517
  Mercer, NJ
8520 Tucson, AZ...............................................    0.8981
  Pima, AZ
8560 Tulsa, OK................................................    0.9185
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600 Tuscaloosa, AL...........................................    0.8212
  Tuscaloosa, AL
8640 Tyler, TX................................................    0.9404
  Smith, TX
8680 Utica-Rome, NY...........................................    0.8403
  Herkimer, NY
  Oneida, NY
8720 Vallejo-Fairfield-Napa, CA...............................    1.3377
  Napa, CA
  Solano, CA
8735 Ventura, CA..............................................    1.1064
  Ventura, CA
8750 Victoria, TX.............................................    0.8184
  Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.........................    1.0405
  Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA...........................    0.9794
  Tulare, CA
8800 Waco, TX.................................................    0.8394

[[Page 55896]]

 
  McLennan, TX
8840 Washington, DC-MD-VA-WV..................................    1.0904
  District of Columbia, DC
  Calvert, MD
  Charles, MD
  Frederick, MD
  Montgomery, MD
  Prince Georges, MD
  Alexandria City, VA
  Arlington, VA
  Clarke, VA
  Culpepper, VA
  Fairfax, VA
  Fairfax City, VA
  Falls Church City, VA
  Fauquier, VA
  Fredericksburg City, VA
  King George, VA
  Loudoun, VA
  Manassas City, VA
  Manassas Park City, VA
  Prince William, VA
  Spotsylvania, VA
  Stafford, VA
  Warren, VA
  Berkeley, WV
  Jefferson, WV
8920 Waterloo-Cedar Falls, IA.................................    0.8366
  Black Hawk, IA
8940 Wausau, WI...............................................    0.9692
  Marathon, WI
8960 West Palm Beach-Boca Raton, FL...........................    0.9798
  Palm Beach, FL
9000 Wheeling, OH-WV..........................................    0.7494
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040 Wichita, KS..............................................    0.9238
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080 Wichita Falls, TX........................................    0.8341
  Archer, TX
  Wichita, TX
9140 Williamsport, PA.........................................    0.8158
  Lycoming, PA
9160 Wilmington-Newark, DE-MD.................................    1.0882
  New Castle, DE
  Cecil, MD
9200 Wilmington, NC...........................................    0.9563
  New Hanover, NC
  Brunswick, NC
9260 Yakima, WA...............................................    1.0372
  Yakima, WA
9270 Yolo, CA.................................................    0.9204
  Yolo, CA
9280 York, PA.................................................    0.9119
  York, PA
9320 Youngstown-Warren, OH....................................    0.9214
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340 Yuba City, CA............................................    1.0196
  Sutter, CA
  Yuba, CA
9360 Yuma, AZ.................................................    0.8895
  Yuma, AZ
------------------------------------------------------------------------

    8. On Page 46056, Table 8 is revised as follows:

                  TABLE 8.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                          Rural area                             index
------------------------------------------------------------------------
Alabama......................................................     0.7492
Alaska.......................................................     1.1886
Arizona......................................................     0.9270
Arkansas.....................................................     0.7734
California...................................................     1.0027
Colorado.....................................................     0.9328
Connecticut..................................................     1.2183
Delaware.....................................................     0.9557
Florida......................................................     0.8870
Georgia......................................................     0.8595
Guam.........................................................     0.9611
Hawaii.......................................................     0.9958
Idaho........................................................     0.8974
Illinois.....................................................     0.8254
Indiana......................................................     0.8824
Iowa.........................................................     0.8416
Kansas.......................................................     0.8034
Kentucky.....................................................     0.7973
Louisiana....................................................     0.7458
Maine........................................................     0.8812
Maryland.....................................................     0.9125
Massachusetts................................................     1.0432
Michigan.....................................................     0.8884
Minnesota....................................................     0.9330
Mississippi..................................................     0.7778
Missouri.....................................................     0.7892
Montana......................................................     0.8800
Nebraska.....................................................     0.8822
Nevada.......................................................     0.9806
New Hampshire................................................     1.0030
New Jersey\1\................................................  .........
New Mexico...................................................     0.8270
New York.....................................................     0.8526
North Carolina...............................................     0.8458
North Dakota.................................................     0.7778
Ohio.........................................................     0.8820
Oklahoma.....................................................     0.7537
Oregon.......................................................     0.9994
Pennsylvania.................................................     0.8378
Puerto Rico..................................................     0.4018
Rhode Island\1\..............................................  .........
South Carolina...............................................     0.8498
South Dakota.................................................     0.8195
Tennessee....................................................     0.7886
Texas........................................................     0.7780
Utah.........................................................     0.8974
Vermont......................................................     0.9307
Virginia.....................................................     0.8498
Virgin Islands...............................................     0.7195
Washington...................................................     1.0388
West Virginia................................................     0.8018
Wisconsin....................................................     0.9304
Wyoming......................................................    0.9110
------------------------------------------------------------------------
\1\ All counties within the State are classified urban.

    9. On Page 46057, in the second column, in the first line, 
``$20,379.'' is revised to read ``$20,371.''
    10. On Page 46057, Table 9 is revised to read as follows:

                                                     Table 9.--SNF XYZ: Located in State College, PA
                                                                  [Wage Index: 0.8740]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     Percent     Medi-care
                   RUG  group                        Labor      Wage index   Adj. labor   Non-labor    Adj. rate    adjustment      days       Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVC.............................................      $267.32       0.8740      $233.64       $82.70      $316.34    * $337.53           14       $4,725
RHA.............................................      $206.58       0.8740      $180.55       $63.91      $244.46    * $260.84           16       $4,173
SSC.............................................      $172.07       0.8740      $150.39       $53.24      $203.63  * * $244.36           30       $7,331
IA2.............................................      $116.68       0.8740      $101.98       $36.10      $138.03      $138.08           30       $4,142
                                                 --------------
    Total.......................................  ...........  ...........  ...........  ...........  ...........  ...........           90     $20,371
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects a 6.7 percent adjustment from section 314 of the BIPA.
* * Reflects a 20 percent adjustment from section 101(a) of the BBRA.

    11. On Page 46069, Table 11 is revised to read as follows:

[[Page 55897]]

[GRAPHIC] [TIFF OMITTED] TR29SE03.060


[[Page 55898]]



III. Waiver of Proposed Rulemaking and Delayed Effective Date

    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 take effect. We can waive this procedure, 
however, if we find good cause that notice-and-comment procedure is 
impracticable, unnecessary, or contrary to the public interest and 
incorporate a statement of the finding and the reasons for it into the 
notice issued. We can also waive the 30-day delayed effective date of 
the Administrative Procedure Act (5 U.S.C. 553(d)) when there is good 
cause to do so and we publish in the rule an explanation of our good 
cause.
    We find it unnecessary to undertake notice-and-comment rulemaking 
because this notice merely provides technical corrections to the 
regulations. We are not changing our payment methodology, but rather, 
are simply implementing correctly the payment methodology that we 
previously proposed, received comment on, and subsequently finalized. 
Thus, because the public has already had the opportunity to comment on 
the payment methodology being used to calculate wage indexes, 
additional comment would be unnecessary.
    Further, it would be impracticable at this point in time either to 
solicit additional comments or to delay the effective date of these 
changes beyond October 1, 2003. The Social Security Act, in 
subparagraphs (G) and (H) of section 1888(e)(4), requires the updated 
SNF PPS rates to be in place at the beginning of each Federal fiscal 
year. Since the fiscal year begins on October 1, 2003, it is imperative 
that we ensure that the correct rates are in place and effective by 
October 1, 2003, and it would not have been possible to publish a 
notice and receive comments on it in the brief period of time between 
discovering our error and the October 1, 2003 effective date for the 
updated SNF PPS rates.
    Finally, we believe that engaging in notice and comment prior to 
making these corrections or delaying the effective date beyond October 
1, 2003 would be contrary to the public interest. As a matter of good 
public policy, the rates used in the SNF PPS should not be based on 
wage indexes that we now know were miscalculated. The public interest 
is served by ensuring that the rates used in the SNF PPS are correct 
and that such rates are in effect for the entire fiscal year. Thus, it 
would be contrary to the public interest to delay implementing such 
corrected rates in order either to engage in notice-and-comment 
rulemaking or to provide for a 30-day delay in the effective date. 
Therefore, we find good cause to waive notice-and-comment procedures, 
as well as the 30-day delay in effective date.

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

    Dated: September 24, 2003.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 03-24549 Filed 9-26-03; 8:45 am]
BILLING CODE 4120-01-P