[Federal Register Volume 69, Number 166 (Friday, August 27, 2004)]
[Notices]
[Pages 52710-52721]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-19697]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1264-N]
RIN 0938-AM78


Medicare Program; Hospice Wage Index for Fiscal Year 2005

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

ACTION: Notice.

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

SUMMARY: This notice announces the annual update to the hospice wage 
index as required by statute. This fiscal year 2005 update is effective 
from October 1, 2004 through September 30, 2005. The wage index is used 
to reflect local differences in wage levels. The hospice wage index 
methodology and values are based on recommendations of a negotiated 
rulemaking advisory committee and were originally published in the 
August 8, 1997 Federal Register.

EFFECTIVE DATE: October 1, 2004.

FOR FURTHER INFORMATION CONTACT: Terri Deutsch, (410) 786-9462.

SUPPLEMENTARY INFORMATION:

I. Background

    Hospice care is an approach to treatment that recognizes that the 
impending death of an individual warrants a change in the focus from 
curative care to palliative care (relief of pain and other 
uncomfortable symptoms). The goal of hospice care is to help terminally 
ill individuals continue life with minimal disruption to normal 
activities while remaining primarily in the home environment. A hospice 
uses an interdisciplinary approach to deliver medical, social, 
psychological, emotional, and spiritual services through use of a broad 
spectrum of professional and other caregivers, with the goal of making 
the individual as physically and emotionally comfortable as possible. 
Counseling and inpatient respite services are available to the family 
of the hospice patient. Hospice programs consider both the patient and 
the family as a unit of care.
    Section 1861(dd) of the Social Security Act (the Act) provides for 
coverage of hospice care for terminally ill Medicare beneficiaries who 
elect to receive care from a participating hospice. The statutory 
authority for payment to hospices participating in the Medicare program 
is contained in section 1814(i) of the Act.
    Our existing regulations under 42 CFR part 418 establish 
eligibility requirements and payment standards and procedures, define 
covered services, and delineate the conditions a hospice must meet to 
be approved for participation in the Medicare program. Subpart G of 
part 418 provides for payment to hospices based on one of four 
prospectively determined rates for each day in which a qualified 
Medicare beneficiary is under the care of a hospice. The four rate 
categories are routine home care, continuous home care, inpatient 
respite care, and general inpatient care. Payment rates are established 
for each category.
    The regulations at Sec.  418.306(c), which require the rates to be 
adjusted by a wage index, were revised in the August 8, 1997 final rule 
(62 FR 42860). This rule implemented a new methodology for calculating 
the hospice wage index based on the recommendations of a negotiated 
rulemaking committee. The committee reached consensus on the 
methodology. We included the resulting committee statement, describing 
that consensus, as an appendix to the August 8, 1997 final rule (62 FR 
42883). The provisions of the final hospice wage index rule are as 
follows:
     The revised hospice wage index will be calculated using 
the most current available hospital wage data.
     The revised hospice wage index was phased in over a 3-year 
transition period.
    For the first year of the transition period, October 1, 1997 
through September 30, 1998, a blended index was calculated by adding 
two-thirds of the 1983 index value for an area to one-third of the 
revised wage index value for that area. During the second year of the 
transition period, October 1, 1998 through September 30, 1999, the 
calculation was similar, except that the blend was one-third of the 
1983 index value and two-thirds of the revised wage index value for 
that area. We fully implemented the revised wage index during the third 
year of the transition period,October 1, 1999 through September 30, 
2000.
    Payments to hospices under the wage index (as published in the 
August 8, 1997 final hospice wage index rule) are subject to a budget-
neutrality adjustment to ensure that aggregate adjustments to payment 
using the new wage index, irrespective of other payment adjustments, 
are not greater than they would have been had the original 1983 wage 
index been applied. To achieve this budget neutrality, the hospice wage 
index is multiplied by a budget-neutrality factor. The budget-
neutrality factor is computed and applied annually. The hospice budget-
neutrality adjustment is not applied uniformly to all providers in 
calculating payments. Based on the methodology developed and signed by 
the negotiated rulemaking committee and adopted by CMS, a hospice's 
area wage index is adjusted using either the budget-neutrality factor 
or the hospice wage index floor described below.
    Hospice wage index values of 0.8 or greater are multiplied by the 
budget-neutrality factor.
    Hospice wage index values below 0.8 are adjusted by the greater of: 
(1) The hospice budget-neutrality factor; or (2) the hospice wage index 
floor (a 15 percent increase, subject to a maximum wage index value of 
0.8).
    The wage index is to be updated annually, in the Federal Register, 
based on the most current available hospital wage data. These data will 
include any changes to the definitions of Metropolitan Statistical 
Areas (MSAs). We acknowledge that on June 6, 2003, the Office of 
Management and Budget (OMB) issued an OMB Bulletin(No. 03-04) 
announcing revised definitions for MSAs, new definitions for 
Micropolitan Statistical Areas and Combined Statistical Areas, and 
guidance on using the statistical definitions. A copy of the Bulletin 
may be obtained at the following Internet address: http://www.whitehouse.gov/omb/bulletins/b03-04.html. These new definitions 
will not apply to the 2005 fiscal year (FY) wage index used in this 
Federal Register notice because we use the FY 2004 hospital wage index 
that does not reflect these revisions. The new definitions will be 
addressed in the FY 2006 wage index.
    Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended

[[Page 52711]]

section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice 
rates for FYs 1998 through 2002. Hospice rates were to be updated by a 
factor equal to the market basket index, minus 1 percentage point. 
However, neither the BBA nor subsequent legislation specified the 
market basket adjustment to be used to compute payment for FY 2005. 
Therefore, payment rates for FY 2005 will be updated according to 
section 1814(i)(1)(C)(ii)(VII) of the Act, which states that the update 
to the payment rates after 2002 will be the market basket percentage 
for the FY. Accordingly, the FY 2005 update to the payment rates will 
be the full market basket percentage increase for FY 2005. This rate 
update is implemented through a separate Recurring Update Notification 
published July 2004 and is not part of this notice. Historically, the 
rate update has been published through a separate program memorandum 
issued annually in July to provide adequate time to implement system 
change requirements. The wage index in this notice is applied to the 
labor portion of the rates published in the Recurring Update 
Notification in order for providers to determine their payment rates.

II. Provisions of the Notice

A. Update to the Hospice Wage Index

    This annual update is effective October 1, 2004 through September 
30, 2005. In accordance with the agreement we signed with other members 
of the Hospice Wage Index Negotiated Rulemaking Committee, we are using 
the most current hospital data available to us. The FY 2004 hospital 
wage index was the most current hospital wage data available when the 
FY 2005 wage index values were calculated. We used the pre-reclassified 
and pre-floor hospital area wage index data.
    All wage index values are adjusted by a budget-neutrality factor of 
1.065819 and are subject to the wage index floor adjustment, if 
applicable. We have completed all of the calculations described above 
and have included them in the wage index values reflected in both 
Tables A and B below. A detailed description of the method used to 
compute the hospice wage index is contained in both the September 4, 
1996 proposed rule (61 FR 46579) and the August 8, 1997 final rule (62 
FR 42860).

B. Tables

              Table A.--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
                             Urban area (constituent counties     Wage
      MSA code number           or county equivalents) \1\     index \2\
------------------------------------------------------------------------
0040.......................  Abilene, TX.....................     0.8129
                             Taylor, TX......................
0060.......................  Aguadilla, PR...................     0.4952
                             Aguada, PR......................
                             Aguadilla, PR...................
                             Moca, PR........................
0080.......................  Akron, OH.......................     0.9855
                             Portage, OH.....................
                             Summit, OH......................
0120.......................  Albany, GA......................     1.1578
                             Dougherty, GA...................
                             Lee, GA.........................
0160.......................  Albany-Schenectady-Troy, NY.....     0.9048
                             Albany, NY......................
                             Montgomery, NY..................
                             Rensselaer, NY..................
                             Saratoga, NY....................
                             Schenectady, NY.................
                             Schoharie, NY...................
0200.......................  Albuquerque, NM.................     0.9912
                             Bernalillo, NM..................
                             Sandoval, NM....................
                             Valencia, NM....................
0220.......................  Alexandria, LA..................     0.8547
                             Rapides, LA.....................
0240.......................  Allentown-Bethlehem-Easton, PA..     1.0361
                             Carbon, PA......................
                             Lehigh, PA......................
                             Northampton, PA.................
0280.......................  Altoona, PA.....................     0.9386
                             Blair, PA.......................
0320.......................  Amarillo, TX....................     0.9577
                             Potter, TX......................
                             Randall, TX.....................
0380.......................  Anchorage, AK...................     1.3020
                             Anchorage, AK...................
0440.......................  Ann Arbor, MI...................     1.1803
                             Lenawee, MI.....................
                             Livingston, MI..................
                             Washtenaw, MI...................
0450.......................  Anniston, AL....................     0.8622
                             Calhoun, AL.....................
0460.......................  Appleton-Oshkosh-Neenah, WI.....     0.9630
                             Calumet, WI.....................
                             Outagamie, WI...................
                             Winnebago, WI...................
0470.......................  Arecibo, PR.....................     0.4778
                             Arecibo, PR.....................
                             Camuy, PR.......................
                             Hatillo, PR.....................
0480.......................  Asheville, NC...................     1.0360
                             Buncombe, NC....................
                             Madison, NC.....................
0500.......................  Athens, GA......................     1.0464
                             Clarke, GA......................
                             Madison, GA.....................
                             Oconee, GA......................
0520.......................  Atlanta, GA.....................     1.0797
                             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...........     1.1506
                             Atlantic, NJ....................
                             Cape May, NJ....................
0580.......................  Auburn-Opelika, AL..............     0.9053
                             Lee, AL.........................
0600.......................  Augusta-Aiken, GA-SC............     1.0259
                             Columbia, GA....................
                             McDuffie, GA....................
                             Richmond, GA....................
                             Aiken, SC.......................
                             Edgefield, SC...................
0640.......................  Austin-San Marcos, TX...........     1.0241
                             Bastrop, TX.....................
                             Caldwell, TX....................
                             Hays, TX........................
                             Travis, TX......................
                             Williamson, TX..................
0680.......................  Bakersfield, CA.................     1.0456
                             Kern, CA........................
0720.......................  Baltimore, MD...................     1.0572
                             Anne Arundel, MD................
                             Baltimore, MD...................
                             Baltimore City, MD..............
                             Carroll, MD.....................
                             Harford, MD.....................
                             Howard, MD......................
                             Queen Anne's, MD................
0733.......................  Bangor, ME......................     1.0556
                             Penobscot, ME...................
0743.......................  Barnstable-Yarmouth, MA.........     1.3809
                             Barnstable, MA..................
0760.......................  Baton Rouge, LA.................     0.8959
                             Ascension, LA...................
                             East Baton Rouge, LA............
                             Livingston, LA..................
                             West Baton Rouge, LA............
0840.......................  Beaumont-Port Arthur, TX........     0.8978
                             Hardin, TX......................
                             Jefferson, TX...................
                             Orange, TX......................
0860.......................  Bellingham, WA..................     1.2531
                             Whatcom, WA.....................
0870.......................  Benton Harbor, MI...............     0.9455
                             Berrien, MI.....................
0875.......................  Bergen-Passaic, NJ..............     1.2462
                             Bergen, NJ......................
                             Passaic, NJ.....................
0880.......................  Billings, MT....................     0.9551
                             Yellowstone, MT.................
0920.......................  Biloxi-Gulfport-Pascagoula, MS..     0.9623
                             Hancock, MS.....................
                             Harrison, MS....................

[[Page 52712]]

 
                             Jackson, MS.....................
0960.......................  Binghamton, NY..................     0.8983
                             Broome, NY......................
                             Tioga, NY.......................
1000.......................  Birmingham, AL..................     0.9818
                             Blount, AL......................
                             Jefferson, AL...................
                             St. Clair, AL...................
                             Shelby, AL......................
1010.......................  Bismarck, ND....................     0.8489
                             Burleigh, ND....................
                             Morton, ND......................
1020.......................  Bloomington, IN.................     0.9232
                             Monroe, IN......................
1040.......................  Bloomington-Normal, IL..........     0.9413
                             McLean, IL......................
1080.......................  Boise City, ID..................     0.9815
                             Ada, ID.........................
                             Canyon, ID......................
1123.......................  Boston-Worcester-Lawrence-Lowell-    1.1972
                              Brockton, MA-NH.
                             Bristol, MA.....................
                             Essex, MA.......................
                             Middlesex, MA...................
                             Norfolk, MA.....................
                             Plymouth, MA....................
                             Suffolk, MA.....................
                             Worcester, MA...................
                             Hillsborough, NH................
                             Merrimack, NH...................
                             Rockingham, NH..................
                             Strafford, NH...................
1125.......................  Boulder-Longmont, CO............     1.0710
                             Boulder, CO.....................
1145.......................  Brazoria, TX....................     0.8673
                             Brazoria, TX....................
1150.......................  Bremerton, WA...................     1.1276
                             Kitsap, WA......................
1240.......................  Brownsville-Harlingen-San            1.0981
                              Benito, TX.
                             Cameron, TX.....................
1260.......................  Bryan-College Station, TX.......     0.9613
                             Brazos, TX......................
1280.......................  Buffalo-Niagara Falls, NY.......     1.0236
                             Erie, NY........................
                             Niagara, NY.....................
1303.......................  Burlington, VT..................     1.0343
                             Chittenden, VT..................
                             Franklin, VT....................
                             Grand Isle, VT..................
1310.......................  Caguas, PR......................     0.4782
                             Caguas, PR......................
                             Cayey, PR.......................
                             Cidra, PR.......................
                             Gurabo, PR......................
                             San Lorenzo, PR.................
1320.......................  Canton-Massillon, OH............     0.9668
                             Carroll, OH.....................
                             Stark, OH.......................
1350.......................  Casper, WY......................     0.9694
                             Natrona, WY.....................
1360.......................  Cedar Rapids, IA................     0.9458
                             Linn, IA........................
1400.......................  Champaign-Urbana, IL............     1.0559
                             Champaign, IL...................
1440.......................  Charleston-North Charleston, SC.     0.9946
                             Berkeley, SC....................
                             Charleston, SC..................
                             Dorchester, SC..................
1480.......................  Charleston, WV..................     0.9464
                             Kanawha, WV.....................
                             Putnam, WV......................
1520.......................  Charlotte-Gastonia-Rock Hill, NC-    1.0402
                              SC.
                             Cabarrus, NC....................
                             Gaston, NC......................
                             Lincoln, NC.....................
                             Mecklenburg, NC.................
                             Rowan, NC.......................
                             Stanly, NC......................
                             Union, NC.......................
                             York, SC........................
1540.......................  Charlottesville, VA.............     1.0685
                             Albemarle, VA...................
                             Charlottesville City, VA........
                             Fluvanna, VA....................
                             Greene, VA......................
1560.......................  Chattanooga, TN-GA..............     0.9684
                             Catoosa, GA.....................
                             Dade, GA........................
                             Walker, GA......................
                             Hamilton, TN....................
                             Marion, TN......................
1580.......................  Cheyenne, WY....................     0.9375
                             Laramie, WY.....................
1600.......................  Chicago, IL.....................     1.1609
                             Cook, IL........................
                             DeKalb, IL......................
                             Du Page, IL.....................
                             Grundy, IL......................
                             Kane, IL........................
                             Kendall, IL.....................
                             Lake, IL........................
                             McHenry, IL.....................
                             Will, IL........................
1620.......................  Chico-Paradise, CA..............     1.0864
                             Butte, CA.......................
1640.......................  Cincinnati, OH-KY-IN............     1.0033
                             Brown, OH.......................
                             Clermont, OH....................
                             Hamilton, OH....................
                             Warren, OH......................
                             Boone, KY.......................
                             Campbell, KY....................
                             Gallatin, KY....................
                             Grant, KY.......................
                             Kenton, KY......................
                             Pendleton, KY...................
                             Dearborn, IN....................
                             Ohio, IN........................
1660.......................  Clarksville-Hopkinsville, TN-KY.     0.8787
                             Christian, KY...................
                             Montgomery, TN..................
1680.......................  Cleveland-Lorain-Elyria, OH.....     1.0308
                             Ashtabula, OH...................
                             Cuyahoga, OH....................
                             Geauga, OH......................
                             Lake, OH........................
                             Lorain, OH......................
                             Medina, OH......................
1720.......................  Colorado Springs, CO............     1.0480
                             El Paso, CO.....................
1740.......................  Columbia, MO....................     0.9267
                             Boone, MO.......................
1760.......................  Columbia, SC....................     0.9488
                             Lexington, SC...................
                             Richland, SC....................
1800.......................  Columbus, GA-AL.................     0.9266
                             Chattahochee, GA................
                             Harris, GA......................
                             Muscogee, GA....................
                             Russell, AL.....................
1840.......................  Columbus, OH....................     1.0283
                             Delaware, OH....................
                             Fairfield, OH...................
                             Franklin, OH....................
                             Licking, OH.....................
                             Madison, OH.....................
                             Pickaway, OH....................
1880.......................  Corpus Christi, TX..............     0.9082
                             Nueces, TX......................
                             San Patricio, TX................
1890.......................  Corvallis, Oregon...............     1.2274
                             Benton, OR......................
1900.......................  Cumberland, MD-WV...............     0.8740
                             Allegany, MD....................
                             Mineral, WV.....................
1920.......................  Dallas, TX......................     1.0630
                             Collin, TX......................
                             Dallas, TX......................
                             Denton, TX......................
                             Ellis, TX.......................
                             Henderson, TX...................
                             Hunt, TX........................
                             Kaufman, TX.....................
                             Rockwall, TX....................
1950.......................  Danville, VA....................     0.9630
                             Danville City, VA...............
                             Pittsylvania, VA................
1960.......................  Davenport-Moline-Rock Island, IA-    0.9576
                              IL.
                             Scott, IA.......................
                             Henry, IL.......................
                             Rock Island, IL.................
2000.......................  Dayton-Springfield, OH..........     1.0144
                             Clark, OH.......................
                             Greene, OH......................
                             Miami, OH.......................
                             Montgomery, OH..................
2020.......................  Daytona Beach, FL...............     0.9676
                             Flagler, FL.....................
                             Volusia, FL.....................
2030.......................  Decatur, AL.....................     0.9409
                             Lawrence, AL....................
                             Morgan, AL......................
2040.......................  Decatur, IL.....................     0.8698
                             Macon, IL.......................
2080.......................  Denver, CO......................     1.1550
                             Adams, CO.......................
                             Arapahoe, CO....................
                             Denver, CO......................
                             Douglas, CO.....................
                             Jefferson, CO...................
2120.......................  Des Moines, IA..................     0.9705
                             Dallas, IA......................
                             Polk, IA........................
                             Warren, IA......................
2160.......................  Detroit, MI.....................     1.0766
                             Lapeer, MI......................
                             Macomb, MI......................

[[Page 52713]]

 
                             Monroe, MI......................
                             Oakland, MI.....................
                             St. Clair, MI...................
                             Wayne, MI.......................
2180.......................  Dothan, AL......................     0.8251
                             Dale, AL........................
                             Houston, AL.....................
2190.......................  Dover, DE.......................     1.0450
                             Kent, DE........................
2200.......................  Dubuque, IA.....................     0.9471
                             Dubuque, IA.....................
2240.......................  Duluth-Superior, MN-WI..........     1.0840
                             St. Louis, MN...................
                             Douglas, WI.....................
2281.......................  Dutchess County, NY.............     1.1654
                             Dutchess, NY....................
2290.......................  Eau Claire, WI..................     0.9661
                             Chippewa, WI....................
                             Eau Claire, WI..................
2320.......................  El Paso, TX.....................     0.9801
                             El Paso, TX.....................
2330.......................  Elkhart-Goshen, IN..............     1.0427
                             Elkhart, IN.....................
2335.......................  Elmira, NY......................     0.8928
                             Chemung, NY.....................
2340.......................  Enid, OK........................     0.9122
                             Garfield, OK....................
2360.......................  Erie, PA........................     0.9167
                             Erie, PA........................
2400.......................  Eugene-Springfield, OR..........     1.2210
                             Lane, OR........................
2440.......................  Evansville-Henderson, IN-KY.....     0.8984
                             Posey, IN.......................
                             Vanderburgh, IN.................
                             Warrick, IN.....................
                             Henderson, KY...................
2520.......................  Fargo-Moorhead, ND-MN...........     1.0442
                             Clay, MN........................
                             Cass, ND........................
2560.......................  Fayetteville, NC................     0.9577
                             Cumberland, NC..................
2580.......................  Fayetteville-Springdale-Rogers,      0.8949
                              AR.
                             Benton, AR......................
                             Washington, AR..................
2620.......................  Flagstaff, AZ-UT................     1.2079
                             Coconino, AZ....................
                             Kane, UT........................
2640.......................  Flint, MI.......................     1.1573
                             Genesee, MI.....................
2650.......................  Florence, AL....................     0.8257
                             Colbert, AL.....................
                             Lauderdale, AL..................
2655.......................  Florence, SC....................     0.9282
                             Florence, SC....................
2670.......................  Fort Collins-Loveland, CO.......     1.0773
                             Larimer, CO.....................
2680.......................  Ft. Lauderdale, FL..............     1.0832
                             Broward, FL.....................
2700.......................  Fort Myers-Cape Coral, FL.......     1.0462
                             Lee, FL.........................
2710.......................  Fort Pierce-Port St. Lucie, FL..     1.0667
                             Martin, FL......................
                             St. Lucie, FL...................
2720.......................  Fort Smith, AR-OK...............     0.8978
                             Crawford, AR....................
                             Sebastian, AR...................
                             Sequoyah, OK....................
2750.......................  Fort Walton Beach, FL...........     0.9556
                             Okaloosa, FL....................
2760.......................  Fort Wayne, IN..................     1.0216
                             Adams, IN.......................
                             Allen, IN.......................
                             De Kalb, IN.....................
                             Huntington, IN..................
                             Wells, IN.......................
                             Whitley, IN.....................
2800.......................  Forth Worth-Arlington, TX.......     0.9975
                             Hood, TX........................
                             Johnson, TX.....................
                             Parker, TX......................
                             Tarrant, TX.....................
2840.......................  Fresno, CA......................     1.0758
                             Fresno, CA......................
                             Madera, CA......................
2880.......................  Gadsden, AL.....................     0.8746
                             Etowah, AL......................
2900.......................  Gainesville, FL.................     1.0331
                             Alachua, FL.....................
2920.......................  Galveston-Texas City, TX........     0.9890
                             Galveston, TX...................
2960.......................  Gary, IN........................     1.0029
                             Lake, IN........................
                             Porter, IN......................
2975.......................  Glens Falls, NY.................     0.9033
                             Warren, NY......................
                             Washington, NY..................
2980.......................  Goldsboro, NC...................     0.9189
                             Wayne, NC.......................
2985.......................  Grand Forks, ND-MN..............     0.9204
                             Grand Forks, ND.................
                             Polk, MN........................
2995.......................  Grand Junction, CO..............     1.0267
                             Mesa, CO........................
3000.......................  Grand Rapids-Muskegon-Holland,       1.0092
                              MI.
                             Allegan, MI.....................
                             Kent, MI........................
                             Muskegon, MI....................
                             Ottawa, MI......................
3040.......................  Great Falls, MT.................     0.9389
                             Cascade, MT.....................
3060.......................  Greeley, CO.....................     0.9989
                             Weld, CO........................
3080.......................  Green Bay, WI...................     1.0084
                             Brown, WI.......................
3120.......................  Greensboro-Winston-Salem-High        0.9769
                              Point, NC.
                             Alamance, NC....................
                             Davidson, NC....................
                             Davie, NC.......................
                             Forsyth, NC.....................
                             Guilford, NC....................
                             Randolph, NC....................
                             Stokes, NC......................
                             Yadkin, NC......................
3150.......................  Greenville, NC..................     0.9697
                             Pitt, NC........................
3160.......................  Greenville-Spartanburg-Anderson,     0.9949
                              SC.
                             Anderson, SC....................
                             Cherokee, SC....................
                             Greenville, SC..................
                             Pickens, SC.....................
                             Spartanburg, SC.................
3180.......................  Hagerstown, MD..................     0.9776
                             Washington, MD..................
3200.......................  Hamilton-Middletown, OH.........     0.9820
                             Butler, OH......................
3240.......................  Harrisburg-Lebanon-Carlisle, PA.     0.9767
                             Cumberland, PA..................
                             Dauphin, PA.....................
                             Lebanon, PA.....................
                             Perry, PA.......................
3283.......................  Hartford, CT....................     1.2316
                             Hartford, CT....................
                             Litchfield, CT..................
                             Middlesex, CT...................
                             Tolland, CT.....................
3285.......................  Hattiesburg, MS.................     0.8000
                             Forrest, MS.....................
                             Lamar, MS.......................
3290.......................  Hickory-Morganton-Lenoir, NC....     0.9850
                             Alexander, NC...................
                             Burke, NC.......................
                             Caldwell, NC....................
                             Catawba, NC.....................
3320.......................  Honolulu, HI....................     1.1828
                             Honolulu, HI....................
3350.......................  Houma, LA.......................     0.8258
                             Lafourche, LA...................
                             Terrebonne, LA..................
3360.......................  Houston, TX.....................     1.0481
                             Chambers, TX....................
                             Fort Bend, TX...................
                             Harris, TX......................
                             Liberty, TX.....................
                             Montgomery, TX..................
                             Waller, TX......................
3400.......................  Huntington-Ashland, WV-KY-OH....     1.0227
                             Boyd, KY........................
                             Carter, KY......................
                             Greenup, KY.....................
                             Lawrence, OH....................
                             Cabell, WV......................
                             Wayne, WV.......................
3440.......................  Huntsville, AL..................     0.9853
                             Limestone, AL...................
                             Madison, AL.....................
3480.......................  Indianapolis, IN................     1.0569
                             Boone, IN.......................
                             Hamilton, IN....................
                             Hancock, IN.....................
                             Hendricks, IN...................
                             Johnson, IN.....................
                             Madison, IN.....................
                             Marion, IN......................
                             Morgan, IN......................
                             Shelby, IN......................
3500.......................  Iowa City, IA...................     1.0176
                             Johnson, IA.....................
3520.......................  Jackson, MI.....................     0.9577

[[Page 52714]]

 
                             Jackson, MI.....................
3560.......................  Jackson, MS.....................     0.8907
                             Hinds, MS.......................
                             Madison, MS.....................
                             Rankin, MS......................
3580.......................  Jackson, TN.....................     0.9575
                             Madison, TN.....................
                             Chester, TN.....................
3600.......................  Jacksonville, FL................     1.0156
                             Clay, FL........................
                             Duval, FL.......................
                             Nassau, FL......................
                             St. Johns, FL...................
3605.......................  Jacksonville, NC................     0.9106
                             Onslow, NC......................
3610.......................  Jamestown, NY...................     0.8273
                             Chautauqua, NY..................
3620.......................  Janesville-Beloit, WI...........     0.9893
                             Rock, WI........................
3640.......................  Jersey City, NJ.................     1.1847
                             Hudson, NJ......................
3660.......................  Johnson City-Kingsport-Bristol,      0.8796
                              TN-VA.
                             Carter, TN......................
                             Hawkins, TN.....................
                             Sullivan, TN....................
                             Unicoi, TN......................
                             Washington, TN..................
                             Bristol City, VA................
                             Scott, VA.......................
                             Washington, VA..................
3680.......................  Johnstown, PA...................     0.8695
                             Cambria, PA.....................
                             Somerset, PA....................
3700.......................  Jonesboro, AR...................     0.8307
                             Craighead, AR...................
3710.......................  Joplin, MO......................     0.9252
                             Jasper, MO......................
                             Newton, MO......................
3720.......................  Kalamazoo-Battlecreek, MI.......     1.1191
                             Calhoun, MI.....................
                             Kalamazoo, MI...................
                             Van Buren, MI...................
3740.......................  Kankakee, IL....................     1.1105
                             Kankakee, IL....................
3760.......................  Kansas City, KS-MO..............     1.0354
                             Johnson, KS.....................
                             Leavenworth, KS.................
                             Miami, KS.......................
                             Wyandotte, KS...................
                             Cass, MO........................
                             Clay, MO........................
                             Clinton, MO.....................
                             Jackson, MO.....................
                             Lafayette, MO...................
                             Platte, MO......................
                             Ray, MO.........................
3800.......................  Kenosha, WI.....................     1.0403
                             Kenosha, WI.....................
3810.......................  Killeen-Temple, TX..............     0.9762
                             Bell, TX........................
                             Coryell, TX.....................
3840.......................  Knoxville, TN...................     0.9401
                             Anderson, TN....................
                             Blount, TN......................
                             Knox, TN........................
                             Loudon, TN......................
                             Sevier, TN......................
                             Union, TN.......................
3850.......................  Kokomo, IN......................     0.9640
                             Howard, IN......................
                             Tipton, IN......................
3870.......................  La Crosse, WI-MN................     0.9856
                             Houston, MN.....................
                             La Crosse, WI...................
3880.......................  Lafayette, LA...................     0.8728
                             Acadia, LA......................
                             Lafayette, LA...................
                             St. Landry, LA..................
                             St. Martin, LA..................
3920.......................  Lafayette, IN...................     0.9631
                             Clinton, IN.....................
                             Tippecanoe, IN..................
3960.......................  Lake Charles, LA................     0.8357
                             Calcasieu, LA...................
3980.......................  Lakeland-Winter Haven, FL.......     0.9391
                             Polk, FL........................
4000.......................  Lancaster, PA...................     0.9893
                             Lancaster, PA...................
4040.......................  Lansing-East Lansing, MI........     1.0353
                             Clinton, MI.....................
                             Eaton, MI.......................
                             Ingham, MI......................
4080.......................  Laredo, TX......................     0.8624
                             Webb, TX........................
4100.......................  Las Cruces, NM..................     0.9260
                             Dona Ana, NM....................
4120.......................  Las Vegas, NV-AZ................     1.2287
                             Mohave, AZ......................
                             Clarke, NV......................
                             Nye, NV.........................
4150.......................  Lawrence, KS....................     0.9248
                             Douglas, KS.....................
4200.......................  Lawton, OK......................     0.8811
                             Comanche, OK....................
4243.......................  Lewiston-Auburn, ME.............     1.0001
                             Androscoggin, ME................
4280.......................  Lexington, KY...................     0.9257
                             Bourbon, KY.....................
                             Clark, KY.......................
                             Fayette, KY.....................
                             Jessamine, KY...................
                             Madison, KY.....................
                             Scott, KY.......................
                             Woodford, KY....................
4320.......................  Lima, OH........................     1.0149
                             Allen, OH.......................
                             Auglaize, OH....................
4360.......................  Lincoln, NE.....................     1.0693
                             Lancaster, NE...................
4400.......................  Little Rock-North Little Rock,       0.9510
                              AR.
                             Faulkner, AR....................
                             Lonoke, AR......................
                             Pulaski, AR.....................
                             Saline, AR......................
4420.......................  Longview-Marshall, TX...........     0.9713
                             Gregg, TX.......................
                             Harrison, TX....................
                             Upshur, TX......................
4480.......................  Los Angeles-Long Beach, CA......     1.2571
                             Los Angeles, CA.................
4520.......................  Louisville, KY-IN...............     0.9850
                             Clark, IN.......................
                             Floyd, IN.......................
                             Harrison, IN....................
                             Scott, IN.......................
                             Bullitt, KY.....................
                             Jefferson, KY...................
                             Oldham, KY......................
4600.......................  Lubbock, TX.....................     0.8816
                             Lubbock, TX.....................
4640.......................  Lynchburg, VA...................     0.9735
                             Amherst, VA.....................
                             Bedford, VA.....................
                             Bedford City, VA................
                             Campbell, VA....................
                             Lynchburg City, VA..............
4680.......................  Macon, GA.......................     0.9542
                             Bibb, GA........................
                             Houston, GA.....................
                             Jones, GA.......................
                             Peach, GA.......................
                             Twiggs, GA......................
4720.......................  Madison, WI.....................     1.0940
                             Dane, WI........................
4800.......................  Mansfield, OH...................     0.9784
                             Crawford, OH....................
                             Richland, OH....................
4840.......................  Mayaguez, PR....................     0.5514
                             Anasco, PR......................
                             Cabo Rojo, PR...................
                             Hormigueros, PR.................
                             Mayaguez, PR....................
                             Sabana Grande, PR...............
                             San German, PR..................
4880.......................  McAllen-Edinburg-Mission, TX....     0.8933
                             Hidalgo, TX.....................
4890.......................  Medford-Ashland, OR.............     1.1481
                             Jackson, OR.....................
4900.......................  Melbourne-Titusville-Palm Bay,       1.0419
                              FL.
                             Brevard, FL.....................
4920.......................  Memphis, TN-AR-MS...............     0.9602
                             Crittenden, AR..................
                             DeSoto, MS......................
                             Fayette, TN.....................
                             Shelby, TN......................
                             Tipton, TN......................
4940.......................  Merced, CA......................     1.0328
                             Merced, CA......................
5000.......................  Miami, FL.......................     1.0545
                             Dade, FL........................
5015.......................  Middlesex-Somerset-Hunterdon, NJ     1.2114
                             Hunterdon, NJ...................
                             Middlesex, NJ...................
                             Somerset, NJ....................
5080.......................  Milwaukee-Waukesha, WI..........     1.0645
                             Milwaukee, WI...................
                             Ozaukee, WI.....................
                             Washington, WI..................
                             Waukesha, WI....................
5120.......................  Minneapolis-St. Paul, MN-WI.....     1.1725
                             Anoka, MN.......................
                             Carver, MN......................
                             Chisago, MN.....................
                             Dakota, MN......................
                             Hennepin, MN....................
                             Isanti, MN......................

[[Page 52715]]

 
                             Ramsey, MN......................
                             Scott, MN.......................
                             Sherbune, MN....................
                             Washington, MN..................
                             Wright, MN......................
                             Pierce, WI......................
                             St. Croix, WI...................
5140.......................  Missoula, MT....................     0.9292
                             Missoula, MT....................
5160.......................  Mobile, AL......................     0.8520
                             Baldwin, AL.....................
                             Mobile, AL......................
5170.......................  Modesto, CA.....................     1.2017
                             Stanislaus, CA..................
5190.......................  Monmouth-Ocean, NJ..............     1.1677
                             Monmouth, NJ....................
                             Ocean, NJ.......................
5200.......................  Monroe, LA......................     0.8443
                             Ouachita, LA....................
5240.......................  Montgomery, AL..................     0.8427
                             Autauga, AL.....................
                             Elmore, AL......................
                             Montgomery, AL..................
5280.......................  Muncie, IN......................     0.9353
                             Delaware, IN....................
5330.......................  Myrtle Beach, SC................     0.9712
                             Horry, SC.......................
5345.......................  Naples, FL......................     1.0434
                             Collier, FL.....................
5360.......................  Nashville, TN...................     1.0504
                             Cheatham, TN....................
                             Davidson, TN....................
                             Dickson, TN.....................
                             Robertson, TN...................
                             Rutherford TN...................
                             Sumner, TN......................
                             Williamson, TN..................
                             Wilson, TN......................
5380.......................  Nassau-Suffolk, NY..............     1.4005
                             Nassau, NY......................
                             Suffolk, NY.....................
5483.......................  New Haven-Bridgeport-Stamford-       1.3200
                              Waterbury-Danbury, CT.
                             Fairfield, CT...................
                             New Haven, CT...................
5523.......................  New London-Norwich, CT..........     1.2397
                             New London, CT..................
5560.......................  New Orleans, LA.................     0.9778
                             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....................     1.4941
                             Bronx, NY.......................
                             Kings, NY.......................
                             New York, NY....................
                             Putnam, NY......................
                             Queens, NY......................
                             Richmond, NY....................
                             Rockland, NY....................
                             Westchester, NY.................
5640.......................  Newark, NJ......................     1.2276
                             Essex, NJ.......................
                             Morris, NJ......................
                             Sussex, NJ......................
                             Union, NJ.......................
                             Warren, NJ......................
5660.......................  Newburgh, NY-PA.................     1.2267
                             Orange, NY......................
                             Pike, PA........................
5720.......................  Norfolk-Virginia Beach-Newport       0.9186
                              News, VA-NC.
                             Currituck, NC...................
                             Chesapeake City, VA.............
                             Gloucester, VA..................
                             Hampton City, VA................
                             James City, VA..................
                             Isle of Wight, VA...............
                             Mathews, VA.....................
                             Newport News City, VA...........
                             Norfolk City, VA................
                             Poquoson City, VA...............
                             Portsmouth City, VA.............
                             Suffolk City, VA................
                             Virginia Beach City VA..........
                             Williamsburg City, VA...........
                             York, VA........................
5775.......................  Oakland, CA.....................     1.5903
                             Alameda, CA.....................
                             Contra Costa, CA................
5790.......................  Ocala, FL.......................     1.0368
                             Marion, FL......................
5800.......................  Odessa-Midland, TX..............     0.9941
                             Ector, TX.......................
                             Midland, TX.....................
5880.......................  Oklahoma City, OK...............     0.9575
                             Canadian, OK....................
                             Cleveland, OK...................
                             Logan, OK.......................
                             McClain, OK.....................
                             Oklahoma, OK....................
                             Pottawatomie, OK................
5910.......................  Olympia, WA.....................     1.1685
                             Thurston, WA....................
5920.......................  Omaha, NE-IA....................     1.0386
                             Pottawattamie, IA...............
                             Cass, NE........................
                             Douglas, NE.....................
                             Sarpy, NE.......................
                             Washington, NE..................
5945.......................  Orange County, CA...............     1.2120
                             Orange, CA......................
5960.......................  Orlando, FL.....................     1.0289
                             Lake, FL........................
                             Orange, FL......................
                             Osceola, FL.....................
                             Seminole, FL....................
5990.......................  Owensboro, KY...................     0.8925
                             Daviess, KY.....................
6015.......................  Panama City, FL.................     0.8742
                             Bay, FL.........................
6020.......................  Parkersburg-Marietta, WV-OH.....     0.8568
                             Washington, OH..................
                             Wood, WV........................
6080.......................  Pensacola, FL...................     0.9280
                             Escambia, FL....................
                             Santa Rosa, FL..................
6120.......................  Peoria-Pekin, IL................     0.9309
                             Peoria, IL......................
                             Tazewell, IL....................
                             Woodford, IL....................
6160.......................  Philadelphia, PA-NJ.............     1.1599
                             Burlington, NJ..................
                             Camden, NJ......................
                             Gloucester, NJ..................
                             Salem, NJ.......................
                             Bucks, PA.......................
                             Chester, PA.....................
                             Delaware, PA....................
                             Montgomery, PA..................
                             Philadelphia, PA................
6200.......................  Phoenix-Mesa, AZ................     1.0796
                             Maricopa, AZ....................
                             Pinal, AZ.......................
6240.......................  Pine Bluff, AR..................     0.8383
                             Jefferson, AR...................
6280.......................  Pittsburgh, PA..................     0.9487
                             Allegheny, PA...................
                             Beaver, PA......................
                             Butler, PA......................
                             Fayette, PA.....................
                             Washington, PA..................
                             Westmoreland, PA................
6323.......................  Pittsfield, MA..................     1.0952
                             Berkshire, MA...................
6340.......................  Pocatello, ID...................     0.9637
                             Bannock, ID.....................
6360.......................  Ponce, PR.......................     0.5414
                             Guayanilla, PR..................
                             Juana Diaz, PR..................
                             Penuelas, PR....................
                             Ponce, PR.......................
                             Villalba, PR....................
                             Yauco, PR.......................
6403.......................  Portland, ME....................     1.0604
                             Cumberland, ME..................
                             Sagadahoc, ME...................
                             York, ME........................
6440.......................  Portland-Vancouver, OR-WA.......     1.1951
                             Clackamas, OR...................
                             Columbia, OR....................
                             Multnomah, OR...................
                             Washington, OR..................
                             Yamhill, OR.....................
                             Clark, WA.......................
6483.......................  Providence-Warwick-Pawtucket, RI     1.1699
                             Bristol, RI.....................
                             Kent, RI........................
                             Newport, RI.....................
                             Providence, RI..................
                             Washington, RI..................
6520.......................  Provo-Orem, UT..................     1.0633
                             Utah, UT........................
6560.......................  Pueblo, CO......................     0.9356
                             Pueblo, CO......................
6580.......................  Punta Gorda, FL.................     1.0136
                             Charlotte, FL...................
6600.......................  Racine, WI......................     0.9394
                             Racine, WI......................
6640.......................  Raleigh-Durham-Chapel Hill, NC..     1.0614
                             Chatham, NC.....................
                             Durham, NC......................
                             Franklin, NC....................
                             Johnston, NC....................
                             Orange, NC......................

[[Page 52716]]

 
                             Wake, NC........................
6660.......................  Rapid City, SD..................     0.9386
                             Pennington, SD..................
6680.......................  Reading, PA.....................     0.9734
                             Berks, PA.......................
6690.......................  Redding, CA.....................     1.2099
                             Shasta, CA......................
6720.......................  Reno, NV........................     1.1385
                             Washoe, NV......................
6740.......................  Richland-Kennewick-Pasco, WA....     1.1307
                             Benton, WA......................
                             Franklin, WA....................
6760.......................  Richmond-Petersburg, VA.........     0.9964
                             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....     1.2087
                             Riverside, CA...................
                             San Bernardino, CA..............
6800.......................  Roanoke, VA.....................     0.9273
                             Botetourt, VA...................
                             Roanoke, VA.....................
                             Roanoke City, VA................
                             Salem City, VA..................
6820.......................  Rochester, MN...................     1.2512
                             Olmsted, MN.....................
6840.......................  Rochester, NY...................     1.0051
                             Genesee, NY.....................
                             Livingston, NY..................
                             Monroe, NY......................
                             Ontario, NY.....................
                             Orleans, NY.....................
                             Wayne, NY.......................
6880.......................  Rockford, IL....................     1.0302
                             Boone, IL.......................
                             Ogle, IL........................
                             Winnebago, IL...................
 6895......................   Rocky Mount, NC................     0.9673
                              Edgecombe, NC..................  .........
                              Nash, NC.......................
 6920......................   Sacramento, CA.................     1.2625
                              El Dorado, CA..................
                              Placer, CA.....................
                              Sacramento, CA.................
 6960......................   Saginaw-Bay City-Midland, MI...     1.0692
                              Bay, MI........................
                              Midland, MI....................
                              Saginaw, MI....................
 6980......................   St. Cloud, MN..................     1.0132
                              Benton, MN.....................
                              Stearns, MN....................
 7000......................   St. Joseph, MO.................     1.0399
                              Andrew, MO.....................
                              Buchanan, MO...................
 7040......................   St. Louis, MO-IL...............     0.9628
                              Franklin, MO...................
                              Jefferson, MO..................
                              Lincoln, MO....................
                              St. Charles, Mo................
                              St. Louis, MO..................
                              St. Louis City, MO.............
                              Warren, MO.....................
                              Clinton, IL....................
                              Jersey, IL.....................
                              Madison, IL....................
                              Monroe, IL.....................
                              St. Clair, IL..................
 7080......................   Salem, OR......................     1.1172
                              Marion, OR.....................
                              Polk, OR.......................
 7120......................   Salinas, CA....................     1.5283
                              Monterey, CA...................
 7160......................   Salt Lake City-Ogden, UT.......     1.0565
                              Davis, UT......................
                              Salt Lake, UT..................
                              Weber, UT......................
 7200......................   San Angelo, TX.................     0.9097
                              Tom Green, TX..................
 7240......................   San Antonio, TX................     0.9454
                              Bexar, TX......................
                              Comal, TX......................
                              Guadalupe, TX..................
                              Wilson, TX.....................
 7320......................   San Diego, CA..................     1.1881
                              San Diego, CA..................
 7360......................   San Francisco, CA..............     1.5469
                              Marin, CA......................
                              San Francisco, CA..............
                              San Mateo, CA..................
 7400......................   San Jose, CA...................     1.5589
                              Santa Clara, CA................
 7440......................   San Juan-Bayamon, PR...........     0.5645
                              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 Also, PR..............
                              Vega Alta, PR..................
                              Vega Baja, PR..................
                              Yabucoa, PR....................
 7460......................   San Luis Obispo-Atascadero-Paso     1.2181
                              Robles, CA.
                              San Luis Obispo, CA............
 7480......................   Santa Barbara-Santa Maria-          1.1128
                              Lompoc, CA.
                              Santa Barbara, CA..............
 7485......................   Santa Cruz-Watsonville, CA.....     1.3794
                              Santa Cruz, CA.................
 7490......................   Santa Fe, NM...................     1.1354
                              Los Alamos, NM.................
                              Santa Fe, NM...................
 7500......................   Santa Rosa, CA.................     1.3725
                              Sonoma, CA.....................
 7510......................   Sarasota-Bradenton, FL.........     1.0620
                              Manatee, FL....................
                              Sarasota, FL...................
 7520......................   Savannah, GA...................     1.0095
                              Bryan, GA......................
                              Chatham, GA....................
                              Effingham, GA..................
 7560......................   Scranton--Wilkes-Barre--            0.8966
                              Hazleton, PA.
                              Columbia, PA...................
                              Lackawanna, PA.................
                              Luzerne, PA....................
                              Wyoming, PA....................
 7600......................   Seattle-Bellevue-Everett, WA...     1.2323
                              Island, WA.....................
                              King, WA.......................
                              Snohomish, WA..................
7610.......................  Sharon, PA......................     0.8261
                             Mercer, PA......................
7620.......................  Sheboygan, WI...................     0.9192
                             Sheboygan, WI...................
7640.......................  Sherman-Denison, TX.............     1.0338
                             Grayson, TX.....................
7680.......................  Shreveport-Bossier City, LA.....     0.9681
                             Bossier, LA.....................
                             Caddo, LA.......................
                             Webster, LA.....................
7720.......................  Sioux City, IA-NE...............     0.9585
                             Woodbury, IA....................
                             Dakota, NE......................
7760.......................  Sioux Falls, SD.................     0.9922
                             Lincoln, SD.....................
                             Minnehaha, SD...................
7800.......................  South Bend, IN..................     1.0467
                             St. Joseph, IN..................
7840.......................  Spokane, WA.....................     1.1618
                             Spokane, WA.....................
7880.......................  Springfield, IL.................     0.9533
                             Menard, IL......................
                             Sangamon, IL....................
7920.......................  Springfield, MO.................     0.9014
                             Christian, MO...................
                             Greene, MO......................
                             Webster, MO.....................
8003.......................  Springfield, MA.................     1.1237
                             Hampden, MA.....................
                             Hampshire, MA...................
8050.......................  State College, PA...............     0.9315
                             Centre, PA......................

[[Page 52717]]

 
8080.......................  Steubenville-Weirton, OH-WV.....     0.8951
                             Jefferson, OH...................
                             Brooke, WV......................
                             Hancock, WV.....................
8120.......................  Stockton-Lodi, CA...............     1.1089
                             San Joaquin, CA.................
8140.......................  Sumter, SC......................     0.8786
                             Sumter, SC......................
8160.......................  Syracuse, NY....................     1.0031
                             Cayuga, NY......................
                             Madison, NY.....................
                             Onondaga, NY....................
                             Oswego, NY......................
8200.......................  Tacoma, WA......................     1.1848
                             Pierce, WA......................
8240.......................  Tallahassee, FL.................     0.9081
                             Gadsden, FL.....................
                             Leon, FL........................
8280.......................  Tampa-St. Petersburg-Clearwater,     0.9702
                              FL.
                             Hernando, FL....................
                             Hillsborough, FL................
                             Pasco, FL.......................
                             Pinellas, FL....................
8320.......................  Terre Haute, IN.................     0.8873
                             Clay, IN........................
                             Vermillion, IN..................
                             Vigo, IN........................
8360.......................  Texarkana, AR-Texarkana, TX.....     0.8686
                             Miller, AR......................
                             Bowie, TX.......................
8400.......................  Toledo, OH......................     0.9998
                             Fulton, OH......................
                             Lucas, OH.......................
                             Wood, OH........................
8440.......................  Topeka, KS......................     0.9707
                             Shawnee, KS.....................
8480.......................  Trenton, NJ.....................     1.1209
                             Mercer, NJ......................
8520.......................  Tucson, AZ......................     0.9572
                             Pima, AZ........................
8560.......................  Tulsa, OK.......................     0.9790
                             Creek, OK.......................
                             Osage, OK.......................
                             Rogers, OK......................
                             Tulsa, OK.......................
                             Wagoner, OK.....................
8600.......................  Tuscaloosa, AL..................     0.8753
                             Tuscaloosa, AL..................
8640.......................  Tyler, TX.......................     1.0023
                             Smith, TX.......................
8680.......................  Utica-Rome, NY..................     0.8956
                             Herkimer, NY....................
                             Oneida, NY......................
8720.......................  Vallejo-Fairfield-Napa, CA......     1.4257
                             Napa, CA........................
                             Solano, CA......................
8735.......................  Ventura, CA.....................     1.1792
                             Ventura, CA.....................
8750.......................  Victoria, TX....................     0.8723
                             Victoria, TX....................
8760.......................  Vineland-Millville-Bridgeton, NJ     1.1090
                             Cumberland, NJ..................
8780.......................  Visalia-Tulare-Porterville, CA..     1.0439
                             Tulare, CA......................
8800.......................  Waco, TX........................     0.8946
                             McLennan, TX....................
8840.......................  Washington, DC-MD-VA-WV.........     1.1622
                             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........     0.8917
                             Black Hawk, IA..................
8940.......................  Wausau, WI......................     1.0330
                             Marathon, WI....................
8960.......................  West Palm Beach-Boca Raton, FL..     1.0443
                             Palm Beach, FL..................
9000.......................  Wheeling, WV-OH.................     0.8000
                             Belmont, OH.....................
                             Marshall, WV....................
                             Ohio, WV........................
9040.......................  Wichita, KS.....................     0.9846
                             Butler, KS......................
                             Harvey, KS......................
                             Sedgwick, KS....................
9080.......................  Wichita Falls, TX...............     0.8890
                             Archer, TX......................
                             Wichita, TX.....................
9140.......................  Williamsport, PA................     0.8695
                             Lycoming, PA....................
9160.......................  Wilmington-Newark, DE-MD........     1.1598
                             New Castle, DE..................
                             Cecil, MD.......................
9200.......................  Wilmington, NC..................     1.0192
                             Brunswick, NC...................
                             New Hanover, NC.................
9260.......................  Yakima, WA......................     1.1055
                             Yakima, WA......................
9270.......................  Yolo, CA........................     0.9810
                             Yolo, CA........................
9280.......................  York, PA........................     0.9719
                             York, PA........................
9320.......................  Youngstown-Warren, OH...........     0.9820
                             Columbiana, OH..................
                             Mahoning, OH....................
                             Trumbull, OH....................
9340.......................  Yuba City, CA...................     1.0867
                             Sutter, CA......................
                             Yuba, CA........................
9360.......................  Yuma, AZ........................     0.9480
                             Yuma, AZ........................
------------------------------------------------------------------------
\1\ This column lists each MSA area name and each county or county
  equivalent, in the MSA area. Counties not listed in this Table are
  considered to be rural areas. Wage Index values for these areas are
  found in Table B.
\2\ Wage index values are based on FY 2000 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment calculated by multiplying the hospital wage index value for
  a given area by a budget-neutrality factor of 1.065819. Wage index
  values below 0.8 are adjusted to be the greater of a 15-percent
  increase, subject to a maximum wage index value of 0.8, or a budget-
  neutrality adjustment calculated by multiplying the hospital wage
  index value for a given area by the budget-neutrality factor. We have
  completed all of these adjustments and included them in the wage index
  values reflected in this table.


                  Table B.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
      MSA code number                  Nonurban area           index \3\
------------------------------------------------------------------------
9901.......................  Alabama.........................     0.8000
9902.......................  Alaska..........................     1.2668
9903.......................  Arizona.........................     0.9880
9904.......................  Arkansas........................     0.8243
9905.......................  California......................     1.0687
9906.......................  Colorado........................     0.9942
9907.......................  Connecticut.....................     1.2985
9908.......................  Delaware........................     1.0186
9910.......................  Florida.........................     0.9454
9911.......................  Georgia.........................     0.8920
9912.......................  Hawaii..........................     1.0613
9913.......................  Idaho...........................     0.9565
9914.......................  Illinois........................     0.8797
9915.......................  Indiana.........................     0.9405
9916.......................  Iowa............................     0.8970
9917.......................  Kansas..........................     0.8563
9918.......................  Kentucky........................     0.8498
9919.......................  Louisiana.......................     0.8000
9920.......................  Maine...........................     0.9392
9921.......................  Maryland........................     0.9726
9922.......................  Massachusetts...................     1.1119
9923.......................  Michigan........................     0.9469
9924.......................  Minnesota.......................     0.9944
9925.......................  Mississippi.....................     0.8290
9926.......................  Missouri........................     0.8411
9927.......................  Montana.........................     0.9379
9928.......................  Nebraska........................     0.9403
9929.......................  Nevada..........................     1.0451
9930.......................  New Hampshire...................     1.0690
9931.......................  New Jersey \4\..................  .........
9932.......................  New Mexico......................     0.8814
9933.......................  New York........................     0.9087
9934.......................  North Carolina..................     0.9015

[[Page 52718]]

 
9935.......................  North Dakota....................     0.8290
9936.......................  Ohio............................     0.9401
9937.......................  Oklahoma........................     0.8033
9938.......................  Oregon..........................     1.0652
9939.......................  Pennsylvania....................     0.8929
9940.......................  Puerto Rico.....................     0.4621
9941.......................  Rhode Island \4\................  .........
9942.......................  South Carolina..................     0.9057
9943.......................  South Dakota....................     0.8734
9944.......................  Tennessee.......................     0.8405
9945.......................  Texas...........................     0.8292
9946.......................  Utah............................     0.9565
9947.......................  Vermont.........................     0.9920
9948.......................  Virgin Islands..................     0.8000
9949.......................  Virginia........................     0.9057
9950.......................  Washington......................     1.1072
9951.......................  West Virginia...................     0.8546
9952.......................  Wisconsin.......................     0.9916
9953.......................  Wyoming.........................     0.9710
9965.......................  Guam............................     1.0244
------------------------------------------------------------------------
\3\ Wage index values are based on FY 2000 hospital cost report data
  before reclassification. This wage index is further adjusted. Wage
  index values greater than 0.8 are subject to a budget-neutrality
  adjustment calculated by multiplying the hospital wage index value for
  a given area by a budget-neutrality factor of 1.065819. Wage index
  values below 0.8 are adjusted to be the greater of a 15-percent
  increase, subject to a maximum wage index value of 0.8, or a budget-
  neutrality adjustment calculated by multiplying the hospital wage
  index value for a given area by the budget-neutrality factor. We have
  completed all of these adjustments and included them in the wage index
  values reflected in this table.
\4\ All counties within the State are classified as urban.

III. Waiver of Proposed Rulemaking

    Under the Administrative Procedure Act (5 U.S.C. section 
(553(b)(B)), we may waive notice and comment rulemaking procedures if 
we find good cause to do so (that is, notice and comment procedures are 
impracticable, unnecessary, or contrary to the public interest) and the 
agency incorporates a statement of the finding and the reasons for 
waiver in the notice issued. We are waiving notice and comment 
rulemaking before the provisions of this notice take effect.
    We find it unnecessary to undertake notice and comment rulemaking 
because the methodologies used to determine the hospice wage index have 
been previously subjected to public comments, and this notice merely 
reflects the application of those previously established methodologies. 
In this notice, we are not changing the methodologies, but merely 
performing the ministerial function of applying methodologies 
previously subject to notice and public comment. Therefore, we believe 
it is unnecessary to engage in notice and comment rulemaking and, for 
good cause, we waive notice and comment procedures.
    We also believe that good cause exists to waive notice and comment 
rulemaking because it is in the public interest to make this notice 
effective on October 1, 2004. The statute in 1814(i)(1)(C)(ii)(VII) of 
the Act requires annual updates to the hospice payment rates and wage 
indices. In addition, the Federal Regulations at 42 CFR 418.306(b)(2) 
and (c) require annual updates to hospice wage indices and require that 
such updates be effective for the FY, beginning on October 1. We do not 
have sufficient time to engage in notice and comment rulemaking before 
that date. Moreover, if we do not make this notice effective on the 
implementation date of October 1, 2004, the hospice agencies would be 
required to continue to use the previous 2004 FY wage index for the 
2005 payment rates.
    Therefore, for the reasons stated above, we find there is good 
cause to waive notice and comment procedures of the Administrative 
Procedure Act.

IV. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this notice as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-
354), section 1102(b) of the Act, the Unfunded Mandates Reform Act of 
1995 (Pub. L. 104-4), and Executive Order 13132. In this notice, we 
identified the impact on hospices as a result of updating the hospice 
wage index. The methodology for computing the wage index for FY 2005 
was determined through a negotiated rulemaking committee and 
implemented in the August 8, 1997 final rule (62 FR 42860). This notice 
only updates the hospice wage index in accordance with that 
methodology. We believe these changes to be insignificant. As Table C 
below indicates, we estimate that the total hospice payments will 
increase from last year by 1.0 percent, or $60,113,000. We have 
compared estimated payments using the FY 1983 hospice wage index to 
estimated payments using the FY 2005 wage index and determined the 
current hospice wage index to be budget neutral. Budget neutrality 
means that, in a given year, estimated aggregate payments for Medicare 
hospice services using the FY 2005 Wage Index will equal estimated 
aggregate payments that would have been made for the same services if 
the 1983 wage index had remained in effect. Budget neutrality to 1983 
does not imply that estimated payments will not increase since the 
budget neutrality applies only to the wage index portion and not the 
total payment rate, which accommodates inflation.
    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). 
We have determined that this notice is not an economically significant 
rule under this Executive Order.
    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 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 in any 1 year (for details, see the Small 
Business Administration's regulation at 65 FR 69432, that sets forth 
size standards for health care industries). For purposes of the RFA, 
most hospices are small entities. As indicated in Table C below, there 
are 2,385 hospices. Approximately 70 percent of Medicare certified 
hospices are identified as voluntary, government, or other agencies, 
and, therefore, are considered small entities. Because the National 
Hospice and Palliative Care Organization estimates that approximately 
79 percent of hospice patients are Medicare beneficiaries, we have not 
considered other sources of revenue in this analysis.
    As discussed below, rural hospices will receive an increase in 
payment that is greater than urban hospices. Overall rural hospices 
will receive an increase of 2.9 percent and urban hospices will receive 
an increase of 0.7 percent. All hospices, both urban and rural, will 
receive a 1.0 percent increase in payment representing an increase of 
$60,113,000. Urban hospices in East North Central and Puerto Rico 
regions will experience a decrease of 0.2 percent and 0.3 percent 
respectively. New England and Puerto Rico rural regions will also 
experience a decrease of 0.5 and 4.1 percent respectively. Of the urban 
hospices, the West South Central

[[Page 52719]]

and Mountain regions will experience the greatest increase of 1.7 
percent and 1.8 percent, respectively. The remaining urban regions will 
experience an increase in payment ranging from 0.3 percent in the 
Middle Atlantic region to a 0.9 percent increase in New England. Of the 
rural hospices, the East South Central and West North Central regions 
will experience the greatest increase of all hospices with 6.5 percent 
and 4.0 percent, respectively. The remaining rural hospices, with the 
exception of New England and Puerto Rico, will experience an increase 
in payment ranging from 1.0 percent for the Pacific region to 2.3 
percent in the South Atlantic region. Puerto Rico will experience 
decreased payment in both its urban and rural areas. Overall, Puerto 
Rico rural hospices will receive the largest decrease of all hospices 
with a decrease of 4.1 percent. Most regions, however, will experience 
an increase in payment in both urban and rural regions. Therefore, 
based upon analysis of the wage index changes for FY 2005, the urban 
and rural Puerto Rico, urban East North Central and rural New England 
hospices will be most negatively impacted. The remaining urban and 
rural regions will be positively impacted. The payment decreases in 
certain areas indicate that this notice will have an impact on a small 
number of small entities. However, nationwide, hospices will receive an 
overall increase in estimated payments. We estimate that total hospice 
payments will increase by 1.0 percent, or $60,113,000. Rural hospices, 
with the exception of Puerto Rico and New England regions, will receive 
the largest increase in payments for FY 2005. We estimate that rural 
hospice payments overall will increase by $23,336,000. We believe the 
anomaly of Puerto Rico rural region, with the greatest decrease overall 
in payment, the rural East South Central region increase of 6.5 
percent, and the rural West North Central region increase of 4.0 
percent are attributable to hospital wages in these geographic areas.
    Under the Medicare hospice benefit, hospices can provide four 
different levels of care days. The majority of the days provided by a 
hospice are routine home care days. Therefore, the number of routine 
home care days can be used as a proxy for the size of the hospice, that 
is, the more days of care provided, the larger the hospice. Using 
routine home care days as a proxy for size, our analysis indicates that 
the impact of the wage index update on small hospices (those that 
provide up to 1,754 days of routine home care) will experience a 10.2 
percent increase. Rural Puerto Rico with 4 hospices and 150,000 routine 
care days will experience a decrease of 4.1 percent while rural East 
South Central with 111 hospices and 1,541,000 routine home care days, 
which represents the highest number of routine home days, will have an 
increase of 6.5 percent. Rural South Atlantic and East North Central, 
each with 139 hospices and 1,390 and 924,000 routine home care days, 
respectively, will experience an increase of 2.3 percent and 1.4 
percent, respectively. Rural New England region with 27 hospices and 
the lowest number of routine home care days of 111,000 will experience 
a 0.5 percent decrease.
    Furthermore, the wage index methodology was previously determined 
by consensus, through a negotiated rulemaking committee that included 
representatives of national hospice associations; rural, urban, large 
and small hospices; multi-site hospices; and consumer groups. Based on 
all of the options considered, the committee agreed on the methodology 
described in the committee statement, and it was adopted into 
regulation in the August 8, 1997 final rule. The committee also agreed 
that this was favorable for the hospice community, as well as for 
beneficiaries. In developing the process for updating the wage index in 
the 1997 final rule, we fully considered the impact of this methodology 
on small entities and attempted to mitigate any potential negative 
effects.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside an MSA and has fewer 
than 100 beds.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in an expenditure in any 1 year by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $110 million or more. This notice has no substantial 
effect on State, local or tribal governments or on the private sector. 
We have determined that this notice will not have a significant impact 
on the operations of a substantial number of small rural hospitals.
    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, and have determined that this 
notice will not have an impact on the rights, roles, and 
responsibilities of State, local, or tribal governments.

B. Anticipated Effects

    We have compared estimated payments using the FY 1983 hospice wage 
index to estimated payments using the FY 2005 wage index and determined 
the current hospice wage index to be budget neutral. This impact 
analysis compares hospice payments using the FY 2004 hospice wage index 
to the estimated payments using the FY 2005 wage index. The data used 
in developing the quantitative analysis for this notice were obtained 
from the March 2004 update of the national claims history file of all 
bills submitted during FY 2003. We deleted bills from hospices that 
have since closed.
    Table C below demonstrates the results of our analysis. In column 2 
of Table C, we indicate the number of routine home care days that were 
included in our analysis, although the analysis was performed on all 
types of hospice care. Column 3 of Table C indicates payments that were 
made using the FY 2004 wage index. Column 4 of Table C is based on FY 
2004 claims (for hospices in business during that time period) and 
estimates payments to be made to hospices using the FY 2005 wage index. 
The final column, which compares columns 3 and 4, shows the percent 
change in estimated hospice payments made based on the category of the 
hospice.
    Table C categorizes hospices by various geographic and provider 
characteristics. The first row displays the results of the impact 
analysis for all Medicare certified hospices. The second and third rows 
of the table categorize hospices according to their geographic location 
(urban and rural). Our analysis indicted that there are 1,469 hospices 
located in urban areas and 916 hospices located in rural areas. The 
next two groupings in the table indicate the number of hospices by 
census region, also broken down by urban and rural hospices. The sixth 
grouping shows the impact on hospices based on the size of the 
hospice's program. We determined that the majority of hospice payments 
are made at the routine home care rate. Therefore, we based the size of 
each individual hospice's program on the number of routine home care 
days

[[Page 52720]]

provided in 2003. The next grouping shows the impact on hospices by 
type of ownership. The final grouping shows the impact on hospices 
defined by whether they are provider-based or freestanding.
    The results of our analysis shows that the majority of hospices are 
in urban areas and provide the vast majority of routine home care days. 
However, rural hospices will receive a larger percent increase in 
payment of 2.9 percent in contrast to 0.7 percent for urban hospices.
    The greatest increases in payment are for rural East South Central 
and West North Central regions with a 6.5 percent and 4.0 percent 
increase, respectively. Four regions will experience a decrease in 
payment with the greatest decrease in payment for rural Puerto Rico 
with a 4.1 percent decrease followed by rural New England, urban Puerto 
Rico, and urban East North Central regions with 0.5 percent, 0.3 
percent, and 0.2 percent decreases, respectively. The remainder of the 
urban areas varies from an increase of 0.3 percent in the Middle 
Atlantic region to an increase of 1.8 percent in the Mountain region.
    The breakdown by size indicates an increase of 10.2 percent in 
payment for hospices with routine home care days under 1,754 followed 
by a 4.5 percent increase in moderate size hospices with 1,754 to 4,373 
days and an increase of 0.8 percent for large size hospitals.
    Proprietary-owned hospices will experience the highest increase of 
1.4 percent while voluntary owned hospices with the largest number of 
routine home care days will receive 0.8 percent increase in payment.
    Freestanding agency based hospices with the highest number of 
routine home care days and with the largest number of hospice agencies 
will have the highest increase of a 1.1 percent payment increase. In 
contrast, skilled nursing facility based hospices will have an increase 
of 0.3 percent, which represents the lowest number of routine home care 
days.

                                  Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
                                                                                           Estimated
                                                                Number of    Payments      payments     Percent
                                                    Number of    routine     using FY      using FY    change in
                                                     hospices   home care    2004 wage     2005 wage    hospice
                                                       (1)       days in     index in      index in     payments
                                                                thousands    thousands     thousands      (5)
                                                                   (2)          (3)           (4)
----------------------------------------------------------------------------------------------------------------
(BY GEOGRAPHIC LOCATION):
    ALL HOSPICES..................................      2,385      42,728     5,873,005     5,933,118        1.0
        URBAN HOSPICES............................      1,469      35,552     5,072,557     5,109,334        0.7
        RURAL HOSPICES............................        916       7,177       800,448       823,784        2.9
    BY REGION--URBAN:
        NEW ENGLAND...............................         91       1,049       171,309       172,885        0.9
        MIDDLE ATLANTIC...........................        172       3,562       532,324       533,710        0.3
        SOUTH ATLANTIC............................        205       7,421     1,167,357     1,175,429        0.7
        EAST NORTH CENTRAL........................        240       5,231       751,343       750,026       -0.2
        EAST SOUTH CENTRAL........................        107       2,638       335,046       337,478        0.7
        WEST NORTH CENTRAL........................        110       2,446       305,713       307,835        0.7
        WEST SOUTH CENTRAL........................        223       5,718       716,376       728,268        1.7
        MOUNTAIN..................................        104       2,684       399,776       406,833        1.8
        PACIFIC...................................        187       4,376       658,216       661,869        0.6
        PUERTO RICO...............................         30         427        35,098        35,000       -0.3
    BY REGION--RURAL:
        NEW ENGLAND...............................         27         111        14,399        14,334       -0.5
        MIDDLE ATLANTIC...........................         36         230        27,634        28,053        1.5
        SOUTH ATLANTIC............................        139       1,390       161,998       165,728        2.3
        EAST NORTH CENTRAL........................        139         924       106,674       108,215        1.4
        EAST SOUTH CENTRAL........................        111       1,541       161,972       172,497        6.5
        WEST NORTH CENTRAL........................        180         859        95,425        99,252        4.0
        WEST SOUTH CENTRAL........................        120       1,088       113,083       115,326        2.0
        MOUNTAIN..................................        102         530        62,304        63,432        1.8
        PACIFIC...................................         58         353        45,320        45,780        1.0
        PUERTO RICO...............................          4         150        11,640        11,167       -4.1
    ROUTINE HOME CARE DAYS:
        0-1,754 DAYS..............................        343         301        33,025        36,401       10.2
        1,754-4,373 DAYS..........................        400       1,236       144,480       150,910        4.5
        4,373-9,681 DAYS..........................        517       3,504       431,211       436,948        1.3
        9,681 + DAYS..............................      1,122      35,702     5,033,559     5,075,608        0.8
    TYPE OF OWNERSHIP:
        VOLUNTARY.................................      1,319      23,772     3,320,004     3,345,602        0.8
        PROPRIETARY...............................        844      17,972     2,427,181     2,460,362        1.4
        GOVERNMENT................................        187         879       112,468       113,682        1.1
        OTHER.....................................         35         106        13,351        13,473        0.9
    HOSPICE BASE:
        FREESTANDING..............................      1,186      28,948     4,050,201     4,051,763        1.1
        HOME HEALTH AGENCY........................        634       8,075     1,105,167     1,113,613        0.8
        HOSPITAL..................................        549       5,524       733,743       739,760        0.8
        SKILLED NURSING FACILITY..................         16         182        28,893        28,983        0.3
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[[Page 52721]]

C. Conclusion

    Our impact analysis compared hospice payments by using the FY 2004 
wage index to the estimated payments using the FY 2005 wage index. 
Through the analysis, we estimate that total hospice payments will 
increase from last year by 1.0 percent or by $60,113,000. Additionally, 
we compared estimated payments using the FY 1983 hospice wage index to 
estimated payments using the FY 2005 wage index and determined the 
current hospice wage index to be budget neutral, as required by the 
negotiated rulemaking committee. We have determined that this rule is 
not an economically significant rule under Executive Order 12866. 
Although we believe that this rule will not have a significant economic 
impact on a substantial number of small entities, we took any negative 
effects into consideration during the negotiated rulemaking process. We 
have determined that this notice will not have a significant impact on 
the operations of a substantial number of small rural hospitals. 
Finally, this notice will not have a consequential effect on State, 
local, or tribal governments.

OMB Review

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

    Authority: Section 1814(i) of the Social Security Act (42 U.S.C. 
1395f (i)(1))

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

    Dated:
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Dated:
Tommy G. Thompson,
Secretary.
[FR Doc. 04-19697 Filed 8-26-04; 8:45 am]
BILLING CODE 4120-01-P