[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.
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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
----------------------------------------------------------------------------------------------------------------
[[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