[Federal Register Volume 71, Number 14 (Monday, January 23, 2006)]
[Proposed Rules]
[Pages 3616-3752]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-488]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 412 and 424



Medicare Program; Inpatient Psychiatric Facilities Prospective Payment 
System Payment Update for Rate Year Beginning July 1, 2006 (RY 2007); 
Proposed Rule

  Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412 and 424

[CMS-1306-P]


Medicare Program; Inpatient Psychiatric Facilities Prospective 
Payment System Payment Update for Rate Year Beginning July 1, 2006 (RY 
2007)

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

ACTION: Proposed rule.

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SUMMARY: This proposed rule would update the prospective payment rates 
for Medicare inpatient hospital services provided by inpatient 
psychiatric facilities (IPFs). These changes are applicable to IPF 
discharges occurring during the rate year beginning July 1, 2006 
through June 30, 2007. We are proposing to adopt the new Office of 
Management and Budget (OMB) labor market area definitions for the 
purpose of geographic classification and the wage index. In addition, 
we are proposing other new polices and making changes to existing 
policies.

DATES: We will consider comments if we receive them at the appropriate 
address provided below, no later than 5 p.m. on March 14, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1306-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of three ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. 
(Attachments should be in Microsoft Word, WordPerfect, or Excel; 
however, we prefer Microsoft Word.)
    2. By mail. You may mail written comments (one original and two 
copies) to the following address ONLY: Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Attention: CMS-1306-
P, P.O. Box 8010, Baltimore, MD 21244.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-9994 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the Humphrey Building is not 
readily available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by mailing your 
comments to the addresses provided at the end of the ``Collection of 
Information Requirements'' section in this document.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Janet Samen, (410) 786-4533 for 
general information. Mary Lee Seifert, (410) 786-0030 for information 
regarding the market basket and labor-related share. Theresa Bean, 
(410) 786-2287 for impact. Matthew Quarrick, (410) 786-9867 for wage 
index.

SUPPLEMENTARY INFORMATION:
    Submitting Comments: We welcome comments from the public on all 
issues set forth in this rule to assist us in fully considering issues 
and developing policies. You can assist us by referencing the file code 
CMS-1306-P and the specific ``issue identifier'' that precedes the 
section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. CMS posts all electronic 
comments received before the close of the comment period on its public 
Web site as soon as possible after they have been received. Hard copy 
comments received timely will be available for public inspection as 
they are received, generally beginning approximately 3 weeks after 
publication of a document, at the headquarters of the Centers for 
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, 
Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 
p.m. To schedule an appointment to view public comments, phone 1-800-
743-3951.

Table of Contents

I. Background
    A. General and Legislative History
    B. Overview of the Establishment of the IPF PPS
    C. Applicability of the IPF PPS
II. Overview for Updating the IPF PPS
    A. Requirements for Updating the IPF PPS
    B. Proposed Updates to the IPF PPS
    C. Transition Period for Implementation of the IPF PPS
III. Proposed Updates to the IPF PPS for Rate Year beginning July 1, 
2006
    A. Calculation of the Average Per Diem Cost
    B. Determining the Standardized Budget-Neutral Federal Per Diem 
Rate
    1. Standardization of the Federal Per Diem Base Rate
    2. Calculation of the Budget Neutrality Adjustment
    a. Outlier Adjustment
    b. Stop-Loss Provision Adjustment
    c. Behavioral Offset
    3. Revision of Standardization Factor
    C. Update of the Federal Per Diem Base Rate
    1. Market Basket for IPFs Reimbursed under the IPF PPS
    a. Proposed IPF Market Basket Index
    b. Overview of the Proposed RPL Market Basket
    2. Proposed Methodology for Operating Portion of the RPL Market 
Basket
    3. Proposed Methodology for Capital Portion of the RPL Market 
Basket
    4. Proposed Labor-Related Share
IV. Update of the IPF PPS Adjustment Factors
    A. Overview of the IPF PPS Adjustment Factors
    B. Proposed Patient-Level Adjustments
    1. Proposed Adjustment for DRG Assignment
    2. Proposed Payment for Comorbid Conditions
    3. Proposed Patient Age Adjustment
    4. Proposed Variable Per Diem Adjustment
    C. Facility-Level Adjustments
    1. Wage Index Adjustment
    a. Proposed Revisions of the IPF PPS Geographic Classifications
    b. Current IPF PPS Labor Market Areas Based on MSAs
    c. Core-Based Statistical Areas
    d. Proposed Revision of the IPF PPS Labor Market Areas
    i. New England MSAs
    ii. Metropolitan Divisions
    iii. Micropolitan Areas
    e. Implementation of the Proposed Revised Labor Market Area 
under the IPF PPS
    f. Wage Index Budget Neutrality
    1. Proposed Adjustment for Rural Location
    2. Proposed Teaching Adjustment

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    3. Proposed Cost of Living Adjustment for IPFs Located in Alaska 
and Hawaii
    4. Proposed Adjustment for IPFs with a Qualifying Emergency 
Department
    a. Proposed New Source of Admission Code to Implement the ED 
Adjustment
    b. Applicability of the ED Adjustment to IPFs in Critical Access 
Hospitals
    D. Other Payment Adjustments and Policies
    1. Outlier Payments
    a. Proposed Update to the Outlier Fixed Dollar Loss Amount
    b. Proposed Statistical Accuracy of Cost-to-Charge Ratio
    2. Proposed Stop-loss Provision
    3. Patients who Receive Electroconvulsive Therapy
    4. Physician Certification and Recertification Requirements
    5. Provisions of Therapeutic Recreation in IPFs
    6. Same Day Transfers
V. Provisions of the Proposed Rule
VI. Collection of Information Requirements
VII. Regulatory Impact Analysis

Acronyms

    Because of the many terms to which we refer by acronym in this 
proposed rule, we are listing the acronyms used and their corresponding 
terms in alphabetical order below:

BBA Balanced Budget Act of 1997, (Pub. L. 105-33)
BBRA Medicare, Medicaid and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999, (Pub. L. 106-113)
BIPA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Benefits Improvement and Protection Act of 2000, (Pub. L. 106-
554)
CBSA Core-Based Statistical Areas
CCR Cost-to-charge ratio
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders Fourth 
Edition--Text Revision
DRGs Diagnosis-related groups
FY Federal fiscal year
HCRIS Hospital Cost Report Information System
ICD-9-CM International Classification of Diseases, 9th Revision, 
Clinical Modification
IPFs Inpatient psychiatric facilities
IRFs Inpatient rehabilitation facilities
LTCHs Long-term care hospitals
MedPAR Medicare provider analysis and review file
MMA Medicare Prescription Drug, Improvement and Modernization Act of 
2003, (Pub. L. 108-173)
MSA Metropolitan Statistical Area
NECMA New England County Metropolitan Area
OMB Office of Management and Budget
PIP Periodic interim payments
RY Rate Year (July 1 through June 30)
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, (Pub. L. 97-
248)

I. Background

[If you choose to comment on issues in this section, please include the 
caption ``BACKGROUND'' at the beginning of your comments.]

A. General and Legislative History

    The Congress directed implementation of a prospective payment 
system (PPS) for acute care hospitals with the enactment of Public Law 
98-21. Section 601 of the Social Security Amendments of 1983 (Pub. L. 
98-21) added a new section 1886(d) to the Social Security Act (the Act) 
that replaced the reasonable cost-based payment system for most 
hospital inpatient services with a PPS.
    Although most hospital inpatient services became subject to the 
PPS, certain hospitals, including IPFs, inpatient rehabilitation 
facilities (IRFs), long term care hospitals (LTCHs), and children's 
hospitals were excluded from the PPS for acute care hospitals. These 
hospitals and units were paid their reasonable costs for inpatient 
services, subject to a per discharge limitation or target amount under 
the authority of the Tax Equity and Fiscal Responsibility Act of 1982 
(TEFRA), Public Law 97-248. The regulations implementing the TEFRA 
(reasonable cost-based) payment provisions are located at 42 CFR part 
413. Cancer hospitals were added to the list of excluded hospitals by 
section 6004(a) of the Omnibus Budget Reconciliation Act of 1989, (Pub. 
L. 101-239).
    The Congress enacted various provisions in the Balanced Budget Act 
of 1997 (BBA) (Pub. L. 105-33), the Medicare, Medicaid, and SCHIP 
(State Children's Health Insurance Program) Balanced Budget Refinement 
Act of 1999 (BBRA) (Pub. L. 106-113), and the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 
106-554) to replace the reasonable cost-based method of reimbursement 
with a PPS for IRFs, LTCHs, and IPFs. Section 124 of the BBRA required 
implementation of the IPF PPS.
    Section 124 of the BBRA mandated that the Secretary--(1) develop a 
per diem PPS for inpatient hospital services furnished in psychiatric 
hospitals and psychiatric units; (2) include in the PPS an adequate 
patient classification system that reflects the differences in patient 
resource use and costs among psychiatric hospitals and psychiatric 
units; (3) maintain budget neutrality; (4) permit the Secretary to 
require psychiatric hospitals and psychiatric units to submit 
information necessary for the development of the PPS; and (5) submit a 
report to the Congress describing the development of the PPS. Section 
124 of the BBRA also required that the IPF PPS be implemented for cost 
reporting periods beginning on or after October 1, 2002.
    Section 405(g)(2) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (MMA) (Pub. L. 108-173) extended the IPF 
PPS to distinct part psychiatric units of critical access hospitals 
(CAHs).

B. Overview of the Establishment of the IPF PPS

    On November 28, 2003, we published a proposed rule in the Federal 
Register (68 FR 66920) that proposed to implement section 124 of the 
BBRA. In the November 15, 2004 Federal Register (69 FR 66922) our final 
rule implemented the IPF PPS for cost reporting periods beginning on or 
after January 1, 2005. Although section 124 of the BBRA directed that 
the IPF PPS be implemented for cost reporting periods beginning on or 
after October 1, 2002, we explained in the proposed and final rules 
that the creation of a PPS requires an extraordinary amount of lead-
time to create a completely new payment system and that we were unable 
to perform the analysis required in time for an October 1, 2002 
implementation, to ensure that a system based on CMS administrative 
data would fulfill the statutory mandate of section 124 of the BBRA. We 
explained that despite our best efforts, we could not engage in notice 
and comment rulemaking and achieve implementation of the IPF PPS by 
October 1, 2002.
    The November 2004 final rule (hereinafter referred to as the IPF 
PPS final rule) established regulations for the IPF PPS under 42 CFR 
412, subpart N.
    The IPF PPS established the Federal per diem base rate for each 
patient day in an IPF derived from the national average daily routine 
operating, ancillary, and capital costs in IPFs in FY 2002. The average 
per diem cost was updated to the midpoint of the first year under the 
IPF PPS, standardized to account for the overall positive effects of 
the IPF PPS payment adjustments, and adjusted for budget neutrality. 
The Federal per diem payment under the IPF PPS is comprised of the 
Federal per diem base rate described above and certain patient and 
facility payment adjustments that were found in the regression analysis 
to be associated with

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statistically significant per diem cost differences (see 69 FR 66933 
through 66936 for a description of the regression analysis). The 
patient-level adjustments include age, DRG assignment, comorbidities, 
and variable per diem adjustments to reflect the higher cost incurred 
in the early days of a psychiatric stay. Facility-level adjustments 
include adjustments for the IPF's wage index, rural location, teaching 
status, a cost of living adjustment for IPFs located in Alaska and 
Hawaii, and presence of a qualifying emergency department (ED). The IPF 
PPS provides additional payments for outlier cases, stop-loss 
protection which is applicable only during the IPF PPS transition 
period, includes special payment provisions for interrupted stays, and 
a per treatment adjustment for patients who undergo electroconvulsive 
therapy (ECT). We refer readers to the IPF PPS final rule for a 
comprehensive discussion of the research and data that supported the 
establishment of the IPF PPS.
    On April 1, 2005, we published a correction to the IPF PPS final 
rule in the Federal Register (70 FR 16724). Any reference to the IPF 
PPS final rule in this proposed rule includes the provisions in the 
correction notice. We established a CMS website that contains useful 
information regarding the IPF PPS including the proposed rule, final 
rule, and the correction notice. The website URL is http://www.cms.hhs.gov/InpatientPsychFacilPPS/ and may be accessed to download 
or view publications and other information pertinent to the IPF PPS.

C. Applicability of the IPF PPS

    The IPF PPS is applicable to freestanding psychiatric hospitals, 
including government-operated psychiatric hospitals, and distinct part 
psychiatric units of acute care hospitals and CAHs.
    The regulations at Sec.  412.402 define an IPF as a hospital that 
meets the requirements specified in Sec.  412.22, Sec.  412.23(a), 
Sec.  482.60, Sec.  482.61, and Sec.  482.62, and units that meet the 
requirements specified in Sec.  412.22, Sec.  412.25, and Sec.  412.27.
    However, the following hospitals are paid under a special payment 
provision, as described in Sec.  412.22(c) and, therefore, are not 
subject to the IPF PPS rules:
     Veterans Administration hospitals.
     Hospitals that are reimbursed under State cost control 
systems approved under 42 CFR part 403.
     Hospitals that are reimbursed in accordance with 
demonstration projects specified in section 402(a) of Public Law 90-248 
(42 U.S.C. 1395b-1) or section 222(a) of Public Law 92-603 (42 U.S.C. 
1395b-1(note)).
     Non-participating hospitals furnishing emergency services 
to Medicare beneficiaries.

II. Overview for Updating the IPF PPS

[If you choose to comment on issues in this section, please include the 
caption ``OVERVIEW FOR UPDATING THE IPF PPS'' at the beginning of your 
comments.]

A. Requirements for Updating the IPF PPS

    Section 124 of the BBRA does not specify an update strategy for the 
IPF PPS and is broadly written to give the Secretary discretion in 
establishing an update methodology. Therefore, we reviewed the update 
approach used in other hospital PPSs (specifically, the IRF and LTCH 
PPS update methodologies). As a result of this analysis, we stated in 
the IPF PPS final rule (69 FR 66966) that we would implement the IPF 
PPS using the following update strategy--(1) calculate the final 
Federal per diem base rate to be budget neutral for the 18-month period 
(that is, January 1, 2005 through June 30, 2006); (2) use a July 1 
through June 30 annual update cycle; and (3) allow the IPF PPS first 
update to be effective for discharges July 1, 2006 through June 30, 
2007. In this proposed rule, we are proposing updates to the IPF PPS 
for the period of July 1, 2006 through June 30, 2007.
    As explained in the IPF PPS final rule, we believe it is important 
to delay updating the adjustment factors derived from the regression 
analysis until we have IPF PPS data that include as much information as 
possible regarding the patient-level characteristics of the population 
that each IPF serves. For this reason, we do not intend to update the 
regression analysis and recalculate the Federal per diem base rate 
until we have analyzed 1 year of IPF PPS claims and cost report data 
(that is, no earlier than FY 2008). Until that analysis is complete, we 
stated our intention to publish a notice in the Federal Register each 
spring to update the IPF PPS as specified in Sec.  412.428 to include:
     A description of the methodology and data used to 
calculate the updated Federal per diem base payment amount.
     The rate of increase factor as described in Sec.  
412.424(a)(2)(iii), which is based on the excluded hospital with 
capital market basket under the update methodology of 1886(b)(3)(B)(ii) 
of the Act for each year.
     The best available hospital wage index and information 
regarding whether an adjustment to the Federal per diem base rate is 
needed to maintain budget neutrality.
     Updates to the fixed dollar loss amount in order to 
maintain the appropriate outlier percentage.
     Describe the ICD-9-CM coding and DRG classification 
changes discussed in the annual update to the hospital inpatient 
prospective payment system regulations.
     Update the ECT adjustment by a factor specified by CMS.

B. Proposed Updates to the IPF PPS

    As discussed above, we intended to publish a notice in the Federal 
Register in the spring of 2006 that would announce the updates to the 
IPF PPS in accordance with Sec.  412.428 rather than update through 
rulemaking (69 FR 66966). However, since the implementation of the IPF 
PPS, a new market basket index was announced in the August 2005 IPPS 
final rule. We believe that this new market basket should be 
implemented in the IPF PPS as well in order to update the system using 
the best data available. Therefore, rather than publish a notice to 
update the IPF PPS in 2006, we are proposing changes in this proposed 
rule to give interested parties the opportunity to comment.
    Furthermore, we indicated in the IPF PPS final rule (69 FR 66952) 
that we were not adopting the new labor market definitions developed by 
the OMB and adopted under the IPPS. Rather, we explained that we 
intended to use the metropolitan statistical areas (MSAs) developed by 
OMB in 1993 for the wage index under the IPF PPS. At the time we 
published the proposed IPF PPS rule, the 2003 MSA definitions had not 
been implemented for any Medicare programs. In addition, we indicated 
that we believe that the adoption of the new labor market area 
definitions may have a significant impact on the wage index applied to 
IPFs and associated payments and that we would assess the implications 
of the new MSA definitions on IPFs before proposing to adopt them.
    We believe that IPFs should be afforded an opportunity to comment 
on the use of the new labor market definitions before we adopt them 
under the IPF PPS. For this reason also, we are publishing this 
proposed rule, rather than a notice, in order to give interested 
parties an opportunity to comment on the new labor market definitions 
(see section III.C.1. of this proposed rule).

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C. Transition Period for Implementation of the IPF PPS

    In the IPF PPS final rule, we established Sec.  412.426 to provide 
for a 3-year transition period from reasonable cost-based reimbursement 
to full prospective payment for IPFs. New IPFs are paid 100 percent of 
the Federal per diem rate. However, for those IPFs that are 
transitioning to a new system, during the 3-year period as specified in 
the IPF PPS final rule, payment is based on an increasing percentage of 
the PPS payment and a decreasing percentage of each IPF's facility-
specific TEFRA reimbursement rate. The blend percentages are as 
follows:

                              Table 1.--IPF PPS Final Rule Transition Blend Factors
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                                                                                                      IPF PPS
                Transition year                 Cost reporting periods beginning    TEFRA rate     Federal rate
                                                           on or after              percentage      percentage
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1.............................................  January 1, 2005.................              75              25
2.............................................  January 1, 2006.................              50              50
3.............................................  January 1, 2007.................              25              75
                                                January 1, 2008.................               0             100
----------------------------------------------------------------------------------------------------------------

    Changes to the blend percentages occur at the beginning of an IPF's 
cost reporting period. As a result, for discharges occurring during IPF 
cost reporting periods beginning in CY 2006, IPFs would receive a 
blended payment consisting of 50 percent of the facility-specific TEFRA 
payment and 50 percent of the IPF PPS payment amount. However, 
regardless of when an IPF's cost reporting year begins, the payment 
update we are proposing would be effective for discharges occurring on 
or after July 1, 2006 through June 30, 2007. We are not proposing any 
changes to the transition approach established in the IPF PPS final 
rule.

III. Proposed Updates to the IPF PPS for Rate Year beginning July 1, 
2006

    The IPF PPS is based on a standardized Federal per diem base rate 
calculated from IPF average per diem costs and adjusted for budget-
neutrality in the implementation year. The Federal per diem base rate 
is used as the standard payment per day under the IPF PPS and is 
adjusted by the applicable wage index factor and the patient-level and 
facility-level adjustments that are applicable to the IPF stay.
    The following is an explanation of how we calculated the Federal 
per diem base rate and the standardization and budget neutrality 
factors as described in the IPF PPS final rule.

A. Calculation of the Average Per Diem Cost

[If you choose to comment on issues in this section, please include the 
caption ``PER DIEM COST'' at the beginning of your comments.]

    As indicated in the IPF PPS final rule, to calculate the Federal 
per diem base rate, we estimated the average cost per day for--(1) 
routine services from FY 2002 cost reports (supplemented with FY 2001 
cost reports if the FY 2002 cost report was missing); and (2) ancillary 
services using data from the FY 2002 Medicare claims and corresponding 
data from facility cost reports.
    For routine services, the per diem operating and capital costs were 
used to develop the average per diem cost amount. The per diem routine 
costs were obtained from each facility's Medicare cost report. To 
estimate the costs for routine services included in the Federal per 
diem base rate calculation, we added the total routine costs (including 
costs for capital) submitted on the cost report for each provider and 
divided it by the total Medicare days.
    Some average routine costs per day were determined to be aberrant, 
that is, the costs were extraordinarily high or low and most likely 
contained data errors. We provided a detailed discussion in the IPF PPS 
final rule (69 FR 66926 through 66927) of the method used to trim 
extraordinarily high or low cost values from the per diem rate 
development file in order to improve the accuracy of our results. For 
ancillary services, we calculated the costs by converting charges from 
the FY 2002 Medicare claims into costs using facility-specific, cost-
center specific cost-to-charge ratios obtained from each provider's 
applicable cost reports. We matched each provider's departmental cost-
to-charge ratios from their Medicare cost report to each charge on 
their claims reported in the MedPAR file. Multiplying the total charges 
for each type of ancillary service by the corresponding cost-to-charge 
ratio provided an estimate of the costs for all ancillary services 
received by the patient during the stay. We determined the average 
ancillary amount per day by dividing the total ancillary costs for all 
stays by the total number of covered Medicare days.
    Adding the average ancillary costs per day and the average routine 
costs per day including capital costs provided the estimated average 
per diem cost for each patient day of inpatient psychiatric care in FY 
2002.

B. Determining the Standardized Budget-Neutral Federal Per Diem Base 
Rate

[If you choose to comment on issues in this section, please include the 
caption ``BUDGET NEUTRAL BASE RATE'' at the beginning of your 
comments.]

    Section 124(a)(1) of the BBRA requires that the implementing IPF 
PPS be budget neutral. In other words, the amount of total payments 
under the IPF PPS, including any payment adjustments, must be projected 
to be equal to the amount of total payments that would have been made 
if the IPF PPS were not implemented. Therefore, in the IPF PPS final 
rule, we calculated the budget-neutrality factor by setting the total 
estimated IPF PPS payments to be equal to the total estimated payments 
that would have been made under the TEFRA methodology had the IPF PPS 
not been implemented. The IPF PPS final rule includes a step-by-step 
description of the methodology we used to estimate payments under the 
TEFRA payment system (69 FR 66930). For the IPF PPS methodology, we 
calculated the final Federal per diem base rate to be budget neutral 
during the implementation period under the IPF PPS using a July 1 
update cycle. Thus, the implementation period for the IPF PPS is the 
18-month period January 1, 2005 through June 30, 2006.
    We updated the average cost per day to the midpoint of the IPF PPS 
implementation period (that is, October 1, 2005). We used the most 
recent projection of the full percentage increase in the 1997-based 
excluded hospital with capital market basket index for FY 2003 and 
later in accordance with Sec.  413.40(c)(3)(viii). The updated average 
cost per day of $724.43 was used in the payment model to

[[Page 3620]]

establish the budget neutrality adjustment.
1. Standardization of the Federal Per Diem Base Rate
    In the IPF PPS final rule, we standardized the IPF PPS Federal per 
diem base rate in order to account for the overall positive effects of 
the IPF PPS payment adjustment factors. To standardize the IPF PPS 
payments, we compared the IPF PPS payment amounts calculated from the 
psychiatric stays in the FY 2002 MedPAR file to the projected TEFRA 
payments from the FY 2002 cost report file updated to the midpoint of 
the IPF PPS implementation period (that is October 2005). The 
standardization factor was calculated by dividing total estimated 
payments under the TEFRA payment system by estimated payments under the 
IPF PPS. The standardization factor was calculated to be 0.8367. As a 
result, in the IPF PPS final rule, the $724.43 average cost per day was 
reduced by 16.33 percent (100 percent minus 83.67 percent).
2. Calculation of the Budget Neutrality Adjustment
    To compute the budget neutrality adjustment for the IPF PPS, we 
separately identified each component of the adjustment, that is, the 
outlier adjustment, stop-loss adjustment, and behavioral offset.
a. Outlier Adjustment
    Since the IPF PPS payment amount for each IPF includes applicable 
outlier amounts, we reduced the standardized Federal per diem base rate 
to account for aggregate IPF PPS payments estimated to be made as 
outlier payments. The appropriate outlier amount was determined by 
comparing the adjusted prospective payment for the entire stay to the 
computed cost per case. If costs were above the prospective payment 
plus the adjusted fixed dollar loss threshold amount, an outlier 
payment was computed using the applicable risk-sharing percentages, as 
explained in greater detail in section IV.D.1 of this proposed rule. 
The outlier amount was computed for all stays, and the total outlier 
amount was added to the final IPF PPS payment. The outlier adjustment 
was calculated to be 2 percent. As a result, the standardized Federal 
per diem base rate was reduced by 2 percent to account for projected 
outlier payments.
b. Stop-Loss Provision Adjustment
    As explained in the IPF PPS final rule, we provide a stop-loss 
payment to ensure that an IPF's total PPS payments are no less than a 
minimum percentage of their TEFRA payment, had the IPF PPS not been 
implemented. We reduced the standardized Federal per diem base rate by 
the percentage of aggregate IPF PPS payments estimated to be made for 
stop-loss payments.
    The stop-loss payment amount was determined by comparing aggregate 
prospective payments that the provider would receive under the IPF PPS 
to aggregate TEFRA payments that the provider would have otherwise 
received without implementation of the IPF PPS. If an IPF's aggregate 
IPF PPS payments are less than 70 percent of its aggregate payments 
under TEFRA, a stop-loss payment was computed for that IPF. The stop-
loss payment amounts were computed for those IPFs that were projected 
to receive the payments, and the total amount was added to the final 
IPF PPS payment amount. As a result, the standardized Federal per diem 
base rate was reduced by 0.39 percent in order to maintain budget 
neutrality in the IPF PPS.
c. Behavioral Offset
    As explained in the IPF PPS final rule, implementation of the IPF 
PPS may result in certain changes in IPF practices especially with 
respect to coding for comorbid medical conditions. As a result, 
Medicare may incur higher payments than assumed in our calculations. 
Accounting for these effects through an adjustment is commonly known as 
a behavioral offset.
    Based on accepted actuarial practices and consistent with the 
assumptions made in other prospective payment systems, we assumed in 
determining the behavioral offset that IPFs would regain 15 percent of 
potential ``losses'' and augment payment increases by 5 percent. We 
applied this actuarial assumption, which is based on our historical 
experience with new payment systems, to the estimated ``losses'' and 
``gains'' among the IPFs. The behavioral offset for the IPF PPS was 
calculated to be 2.66 percent. As a result, we reduced the standardized 
Federal per diem base rate by 2.66 percent to maintain budget 
neutrality.
    To summarize, the $724.43 updated average per diem cost was reduced 
by 16.33 percent to account for standardization to projected TEFRA per 
diem payments for the implementation period, by 2 percent to account 
for outlier payments, by 0.39 percent to account for stop-loss 
payments, and by 2.66 percent reduction to account for the behavioral 
offset. The final standardized budget-neutral Federal per diem base 
rate for the IPF PPS implementation year was calculated to be $575.95. 
We discuss the Federal per diem base rate for RY 2007 in section III 
B.3. of this proposed rule.
3. Revision of Standardization Factor
    In reviewing the methodology used to simulate the IPF PPS payments 
used for the IPF PPS final rule, we discovered that the computer code 
incorrectly assigned non-teaching status to most teaching facilities. 
As a result, total IPF PPS payments were underestimated by about 1.36 
percent. The IPF PPS estimated payment total was used in calculating 
the IPF PPS standardization factor. The standardization factor 
indicates the proportion by which the IPF PPS per diem payment rate and 
the ECT rate must be reduced in order to make total IPF PPS payments 
equal to estimated total TEFRA payments assuming IPFs continued to be 
paid solely under TEFRA for the first PPS payment year. The 
standardization factor is calculated as the ratio of estimated total 
TEFRA payments to estimated total IPF PPS payments assuming no 
reduction to the per diem and ECT payment rates. Since the IPF PPS 
payment total should have been larger than the estimated figure, the 
standardization factor should have been smaller (0.8254 vs. 0.8367). In 
turn, the per diem rate and the ECT rate should have been reduced by 
0.8254 instead of 0.8367.
    To resolve this issue, we are proposing to amend the Federal per 
diem base rate prospectively. Using the standardization factor of 
0.8254, the base rate should have been $568.17 for the implementation 
year of the IPF PPS. It is this base rate that we propose to update 
using the market basket rate of increase of 4.5 percent and the budget-
neutral wage index factor of 1.00156 (as discussed in section IV.C.1.f. 
of this proposed rule). Applying these factors yields a proposed 
Federal per diem base rate of $594.66 for the rate year (RY) beginning 
July 1, 2006 through June 30, 2007.

C. Update of the Federal Per Diem Base Rate

[If you choose to comment on issues in this section, please include the 
caption ``UPDATE ON PER DIEM BASE RATE'' at the beginning of your 
comments.]
1. Market Basket for IPFs Reimbursed under the IPF PPS
a. Proposed IPF Market Basket Index
    The market basket index used to develop the IPF PPS is the excluded 
hospital with capital market basket. This market basket was based on 
1997 Medicare cost report data and includes data for Medicare 
participating IPFs,

[[Page 3621]]

IRFs, LTCHs, cancer, and children's hospitals.
    We are presently unable to create a separate market basket 
specifically for psychiatric hospitals due to the small number of 
facilities and the limited data that are provided (for instance, 
approximately 4 percent of psychiatric facilities reported contract 
labor cost data for 2002). However, since all IRFs, LTCHs, and IPFs are 
now paid under a PPS, we are proposing to update PPS payments made 
under the IRF PPS, the LTCH PPS, and the IPF PPS, in their respective 
Federal Register updates, using a market basket reflecting the 
operating and capital cost structures for IRFs, IPFs, and LTCHs, 
hereafter referred to as the RPL (rehabilitation, psychiatric, long-
term care) market basket. We are excluding children's and cancer 
hospitals from the RPL market basket because their payments are based 
entirely on reasonable costs subject to rate-of-increase limits 
established under the authority of section 1886(b) of the Act, which is 
implemented in Sec.  413.40 of the regulations. They are not reimbursed 
under a PPS. Also, the FY 2002 cost structures for children's and 
cancer hospitals are noticeably different than the cost structures of 
the IRFs, IPFs, and LTCHs.
    The services offered in IRFs, IPFs, and LTCHs are typically more 
labor-intensive than those offered in cancer and children's hospitals. 
Therefore, the compensation cost weights for IRFs, IPFs, and LTCHs are 
larger than those in cancer and children's hospitals. In addition, the 
depreciation cost weights for IRFs, IPFs, and LTCHs are noticeably 
smaller than those for children's and cancer hospitals.
    In the following discussion, we provide an overview on the market 
basket and describe the methodologies we propose to use for purposes of 
determining the operating and capital portions of the proposed FY 2002-
based RPL market basket.
b. Overview of the Proposed RPL Market Basket
    The proposed RPL market basket is a fixed weight, Laspeyres-type 
price index that is constructed in three steps. First, a base period is 
selected (in this case, FY 2002) and total base period expenditures are 
estimated for a set of mutually exclusive and exhaustive spending 
categories based upon type of expenditure. Then the proportion of total 
costs that each category represents is determined. These proportions 
are called cost or expenditure weights. Second, each expenditure 
category is matched to an appropriate price or wage variable, referred 
to as a price proxy. In nearly every instance, these price proxies are 
price levels derived from publicly available statistical series that 
are published on a consistent schedule, preferably at least on a 
quarterly basis.
    Finally, the expenditure weight for each cost category is 
multiplied by the level of its respective price proxy for a given 
period. The sum of these products (that is, the expenditure weights 
multiplied by their price levels) for all cost categories yields the 
composite index level of the market basket in a given period. Repeating 
this step for other periods produces a series of market basket levels 
over time. Dividing an index level for a given period by an index level 
for an earlier period produces a rate of growth in the input price 
index over that time period.
    A market basket is described as a fixed-weight index because it 
answers the question of how much it would cost, at another time, to 
purchase the same mix of goods and services purchased to provide 
hospital services in a base period. The effects on total expenditures 
resulting from changes in the quantity or mix of goods and services 
(intensity) purchased subsequent to the base period are not measured. 
In this manner, the market basket measures only pure price change. Only 
when the index is rebased would the quantity and intensity effects be 
captured in the cost weights. Therefore, we rebase the market basket 
periodically so that cost weights reflect changes in the mix of goods 
and services that hospitals purchase (hospital inputs) to furnish 
patient care between base periods.
    The terms rebasing and revising, while often used interchangeably, 
actually denote different activities. Rebasing means moving the base 
year for the structure of costs of an input price index (for example, 
shifting the base year cost structure from FY 1997 to FY 2002). 
Revising means changing data sources, methodology, or price proxies 
used in the input price index. We propose to rebase and revise the 
market basket used to update the IPF PPS.
2. Proposed Methodology for Operating Portion of the RPL Market Basket
    The operating portion of the proposed FY 2002-based RPL market 
basket consists of several major cost categories derived from the FY 
2002 Medicare cost reports for IRFs, IPFs, and LTCHs: wages, drugs, 
professional liability insurance, and a residual. We choose to use FY 
2002 as the base year because we believe this is the most recent, 
complete year of Medicare cost report data and is consistent with the 
data year on which the IPF PPS is based. Due to insufficient Medicare 
cost report data for IRFs, IPFs, and LTCHs, we propose to develop cost 
weights for benefits, contract labor, and blood and blood products 
using the FY 2002-based IPPS market basket (70 FR 23384), which we 
explain in more detail later in this section. For example, less than 30 
percent of IRFs, IPFs, and LTCHs reported benefit cost data in FY 2002. 
We have noticed an increase in cost data for these expense categories 
over the last 4 years. The next time we rebase the RPL market basket 
there may be sufficient IRFs, IPFs, and LTCHs cost report data to 
develop the weights for these expenditure categories.
    Since the cost weights for the RPL market basket are based on 
facility costs, we are proposing to limit our sample to hospitals with 
a Medicare average length of stay (LOS) within a comparable range of 
the total facility average LOS. We believe this provides a more 
accurate reflection of the structure of costs for Medicare covered 
days. Our goal is to measure cost shares that are reflective of case 
mix and practice patterns associated with providing services to 
Medicare beneficiaries.
    We propose to use those cost reports for IRFs and LTCHs whose 
Medicare average LOS is within 15 percent (that is, 15 percent higher 
or lower) of the total facility average LOS for the hospital. This is 
the same edit applied to the FY 1992-based and FY 1997-based excluded 
hospital with capital market basket. We are proposing 15 percent 
because it includes those LTCHs and IRFs whose Medicare LOS is within 
approximately 5 days of the facility LOS.
    However, we are proposing to use a less stringent measure of 
Medicare LOS for IPFs whose average LOS is within 30 or 50 percent 
(depending on the total facility average LOS) of the total facility 
average LOS. Using this less stringent edit allows us to increase our 
sample size by over 150 cost reports and produce a cost weight more 
consistent with the overall facility. The edit we applied to IPFs when 
developing the FY 1997-based excluded hospital with capital market 
basket was based on the best available data at the time.
    The detailed cost categories under the residual (that is, the 
remaining portion of the market basket after excluding wages and 
salaries, drugs, and professional liability cost weights) are derived 
from the FY 2002-based IPPS market basket and the 1997 Benchmark Input-
Output (I-O) Tables published by the Bureau of Economic Analysis, U.S. 
Department of Commerce. The FY 2002-based IPPS market basket was 
developed using FY 2002 Medicare hospital cost reports with the most

[[Page 3622]]

recent and detailed cost data (see the IPPS final rule in the August 
12, 2005 Federal Register (70 FR 47388)). The 1997 Benchmark I-O is the 
most recent, comprehensive source of cost data for all hospitals. The 
proposed RPL cost weights for benefits, contract labor, and blood and 
blood products were derived using the FY 2002-based IPPS market basket. 
For example, the ratio of the benefit cost weight to the wages and 
salaries cost weight in the FY 2002-based IPPS market basket was 
applied to the RPL wages and salaries cost weight to derive a benefit 
cost weight for the RPL market basket. The remaining proposed RPL 
operating cost categories were derived using the 1997 Benchmark I-O 
Tables, aged to 2002 using relative price changes. (The methodology we 
used to age the data involves applying the annual price changes from 
the price proxies to the appropriate cost categories. We repeat this 
practice for each year.) Therefore, using this methodology, roughly 59 
percent of the proposed RPL market basket is accounted for by wages, 
drugs, and professional liability insurance data from FY 2002 Medicare 
cost report data for IRFs, LTCHs, and IPFs.
    Table 2 below sets forth the complete proposed 2002-based RPL 
market basket including cost categories, weights, and price proxies. 
For comparison purposes, the corresponding FY 1997-based excluded 
hospital with capital market basket is listed as well.
    Wages and salaries are 52.895 percent of total costs in the 
proposed FY 2002-based RPL market basket compared to 47.335 percent for 
the FY 1997-based excluded hospital with capital market basket. 
Employee benefits are 12.982 percent in the proposed FY 2002-based RPL 
market basket compared to 10.244 percent for the FY 1997-based excluded 
hospital with capital market basket. As a result, compensation costs 
(wages and salaries plus employee benefits) for the proposed FY 2002-
based RPL market basket are 65.877 percent of costs compared to 57.579 
percent for the FY 1997-based excluded hospital with capital market 
basket. Of the 8 percentage-point difference between the compensation 
shares, approximately 3 percentage points are due to the proposed new 
base year (FY 2002 instead of FY 1997), 3 percentage points are due to 
revised length of stay edit, and the remaining 2 percentage points are 
due to the proposed exclusion of other hospitals (that is, only 
including IPFs, IRFs, and LTCHs in the market basket).
    Following the table is a summary outlining the choice of the 
proxies we propose to use for the operating portion of the market 
basket. The price proxies for the capital portion are described in more 
detail in the capital methodology section (see section III.C.3 of this 
proposed rule).

   Table 2.--Proposed FY 2002-Based RPL Market Basket Cost Categories, Weights, and Proxies With FY 1997-Based
                        Excluded Hospital With Capital Market Basket Used for Comparison
----------------------------------------------------------------------------------------------------------------
                                              FY 1997-based
                                                excluded       Proposed FY
             Expense categories               hospital with  2002-based RPL   Proposed FY 2002 RPL market basket
                                             capital market   market basket             price proxies
                                                 basket
----------------------------------------------------------------------------------------------------------------
Total......................................         100.000         100.000  ...................................
Compensation...............................          57.579          65.877  ...................................
    Wages and Salaries*....................          47.335          52.895  ECI-Wages and Salaries, Civilian
                                                                              Hospital Workers.
    Employee Benefits*.....................          10.244          12.982  ECI-Benefits, Civilian Hospital
                                                                              Workers.
    Professional Fees, Non-Medical.........           4.423           2.892  ECI-Compensation for Professional,
                                                                              Specialty & Technical Workers.
Utilities..................................           1.180           0.656  ...................................
    Electricity............................           0.726           0.351  PPI-Commercial Electric Power.
    Fuel Oil, Coal, etc....................           0.248           0.108  PPI-Refined Petroleum Products.
    Water and Sewage.......................           0.206           0.197  CPI-U--Water & Sewage Maintenance.
Professional Liability Insurance...........           0.733           1.161  CMS Professional Liability Premium
                                                                              Index.
All Other Products and Services............          27.117          19.265  ...................................
All Other Products.........................          17.914          13.323  ...................................
Pharmaceuticals............................           6.318           5.103  PPI Prescription Drugs.
    Food: Direct Purchase..................           1.122           0.873  PPI Processed Foods & Feeds.
    Food: Contract Service.................           1.043           0.620  CPI-U Food Away From Home.
    Chemicals..............................           2.133           1.100  PPI Industrial Chemicals.
    Blood and Blood Products**.............           0.748  ..............  ...................................
    Medical Instruments....................           1.795           1.014  PPI Medical Instruments &
                                                                              Equipment.
    Photographic Supplies..................           0.167           0.096  PPI Photographic Supplies.
    Rubber and Plastics....................           1.366           1.052  PPI Rubber & Plastic Products.
    Paper Products.........................           1.110           1.000  PPI Converted Paper & Paperboard
                                                                              Products.
    Apparel................................           0.478           0.207  PPI Apparel.
    Machinery and Equipment................           0.852           0.297  PPI Machinery & Equipment.
    Miscellaneous..........................           0.783           1.963  PPI Finished Goods less Food &
                                                                              Energy.
All Other Services.........................           9.203           5.942  ...................................
    Telephone..............................           0.348           0.240  CPI-U Telephone Services.
    Postage................................           0.702           0.682  CPI-U Postage.
All Other: Labor Intensive.................           4.453           2.219  ECI-Compensation for Intensive
                                                                              Private Service Occupations.
All Other: Non-labor Intensive.............           3.700           2.800  CPI-U All Items.
Capital-Related Costs......................           8.968          10.149  ...................................
    Depreciation...........................           5.586           6.186  ...................................
    Fixed Assets...........................           3.503           4.250  Boeckh Institutional Construction
                                                                              23-year useful life.
    Movable Equipment......................           2.083           1.937  WPI Machinery & Equipment 11-year
                                                                              useful life.
Interest Costs.............................           2.682           2.775  ...................................
    Nonprofit..............................           2.280           2.081  Average yield on domestic municipal
                                                                              bonds (Bond Buyer 20 bonds)
                                                                              vintage- weighted (23 years).

[[Page 3623]]

 
    For Profit.............................           0.402           0.694  Average yield on Moody's Aaa bonds
                                                                              vintage weighted (23 years).
Other Capital-Related Costs................           0.699           1.187  CPI-U Residential Rent.
----------------------------------------------------------------------------------------------------------------
* Labor-related.
** Blood and blood-related products is included in miscellaneous products.
Note: Due to rounding, weights may not sum to total.

    Below we provide the proxies that we are proposing to use for the 
FY 2002-based RPL market basket. With the exception of the Professional 
Liability proxy, all the proposed price proxies for the operating 
portion of the proposed RPL market basket are based on Bureau of Labor 
Statistics (BLS) data and are grouped into one of the following BLS 
categories:
     Producer Price Indexes--Producer Price Indexes (PPIs) 
measure price changes for goods sold in other than retail markets. PPIs 
are preferable price proxies for goods that hospitals purchase as 
inputs in producing their outputs because the PPIs better reflect the 
prices faced by hospitals. For example, we use a special PPI for 
prescription drugs, rather than the Consumer Price Index (CPI) for 
prescription drugs because hospitals generally purchase drugs directly 
from the wholesaler. The PPIs that we use measure price change at the 
final stage of production.
     Consumer Price Indexes--Consumer Price Indexes (CPIs) 
measure change in the prices of final goods and services bought by the 
typical consumer. Because they may not represent the price faced by a 
producer, we use CPIs only if an appropriate PPI is not available, or 
if the expenditures are more similar to those of retail consumers in 
general rather than purchases at the wholesale level. For example, the 
CPI for food purchases away from home is used as a proxy for contracted 
food services.
     Employment Cost Indexes--Employment Cost Indexes (ECIs) 
measure the rate of change in employee wage rates and employer costs 
for employee benefits per hour worked. These indexes are fixed-weight 
indexes and strictly measure the change in wage rates and employee 
benefits per hour. Appropriately, they are not affected by shifts in 
employment mix.
    We evaluated the price proxies using the criteria of reliability, 
timeliness, availability, and relevance. Reliability indicates that the 
index is based on valid statistical methods and has low sampling 
variability. Timeliness implies that the proxy is published regularly, 
preferably at least once a quarter. Availability means that the proxy 
is publicly available. Finally, relevance means that the proxy is 
applicable and representative of the cost category weight to which it 
is applied. The CPIs, PPIs, and ECIs selected by us to be proposed in 
this regulation meet these criteria.
    We note that the proxies are the same as those used for the FY 
1997-based excluded hospital with capital market basket. Because these 
proxies meet our criteria of reliability, timeliness, availability, and 
relevance, we believe they continue to be the best measure of price 
changes for the cost categories. For further discussion on the FY 1997-
based excluded hospital with capital market basket, see the IPPS final 
rule published in the Federal Register on August 1, 2002 (67 FR at 
50042).

Wages and Salaries

    For measuring the price growth of wages in the proposed FY 2002-
based RPL market basket, we propose to use the ECI for wages and 
salaries for civilian hospital workers as the proxy for wages in the 
RPL market basket.
Employee Benefits
    The proposed FY 2002-based RPL market basket uses the ECI for 
employee benefits for civilian hospital workers.

Nonmedical Professional Fees

    The ECI for compensation for professional and technical workers in 
private industry would be applied to this category since it includes 
occupations such as management and consulting, legal, accounting, and 
engineering services.

Fuel, Oil, and Gasoline

    The percentage change in the price of gas fuels as measured by the 
PPI (Commodity Code 0552) would be applied to this component.

Electricity

    The percentage change in the price of commercial electric power as 
measured by the PPI (Commodity Code 0542) would be applied to 
this component.
Water and Sewage
    The percentage change in the price of water and sewage maintenance 
as measured by the Consumer Price Index (CPI) for all urban consumers 
(CPI Code CUUR0000SEHG01) would be applied to this component.

Professional Liability Insurance

    The proposed FY 2002-based RPL market basket would use the 
percentage change in hospital professional liability insurance (PLI) 
premiums as estimated by the CMS Hospital Professional Liability Index 
for the proxy of this category. In the FY 1997-based excluded hospital 
with capital market basket, the same proxy was used.
    We continue to research options for improving our proxy for 
professional liability insurance. This research includes exploring 
various options for expanding our current survey, including the 
identification of another entity that would be willing to work with us 
to collect more complete and comprehensive data. We are also exploring 
other options such as third party or industry data that might assist us 
in creating a more precise measure of PLI premiums. At this time we 
have not identified a preferred option, therefore no change is proposed 
for the proxy in this proposed rule.

Pharmaceuticals

    The percentage change in the price of prescription drugs as 
measured by the PPI (PPI Code PPI32541DRX) would be used as a 
proxy for this cost category. This is a special index produced by BLS 
as a proxy in the 1997-based excluded hospital with capital market 
basket.

[[Page 3624]]

Food, Direct Purchases

    The percentage change in the price of processed foods and feeds as 
measured by the PPI (Commodity Code 02) would be applied to 
this component.

Food, Contract Service

    The percentage change in the price of food purchased away from home 
as measured by the CPI for all urban consumers (CPI Code 
CUUR0000SEFV) would be applied to this component.

Chemicals

    The percentage change in the price of industrial chemical products 
as measured by the PPI (Commodity Code 061) would be applied 
to this component. While the chemicals hospitals purchase include 
industrial as well as other types of chemicals, the industrial 
chemicals component constitutes the largest proportion by far. Thus we 
believe that Commodity Code 061 is the appropriate proxy.

Medical Instruments

    The percentage change in the price of medical and surgical 
instruments as measured by the PPI (Commodity Code 1562) would 
be applied to this component.

Photographic Supplies

    The percentage change in the price of photographic supplies as 
measured by the PPI Commodity Code 1542) would be applied to 
this component.

Rubber and Plastics

    The percentage change in the price of rubber and plastic products 
as measured by the PPI (Commodity Code 07) would be applied to 
this component.

Paper Products

    The percentage change in the price of converted paper and 
paperboard products as measured by the PPI (Commodity Code 
0915) would be applied to this component.

Apparel

    The percentage change in the price of apparel as measured by the 
PPI (Commodity Code 381) would be applied to this component.

Machinery and Equipment

    The percentage change in the price of machinery and equipment as 
measured by the PPI (Commodity Code 11) would be applied to 
this component.

Miscellaneous Products

    The percentage change in the price of all finished goods less food 
and energy as measured by the PPI (Commodity Code SOP3500) 
would be applied to this component. Using this index would remove the 
double-counting of food and energy prices, which are captured elsewhere 
in the market basket. The weight for this cost category is higher, in 
part, than in the 1997-based index because the weight for blood and 
blood products (1.188) is added to it. In the 1997-based excluded 
hospital with capital market basket, we included a separate cost 
category for blood and blood products, using the BLS PPI for blood and 
derivatives as a price proxy. A review of recent trends in the PPI for 
blood and derivatives suggests that its movements may not be consistent 
with the trends in blood costs faced by hospitals. While this proxy did 
not match exactly with the product hospitals are buying, its trend over 
time appears to be reflective of the historical price changes of blood 
purchased by hospitals. However, an apparent divergence over recent 
years led us to reevaluate whether the PPI for blood and derivatives 
was an appropriate measure of the changing price of blood. We ran test 
market baskets classifying blood in three separate cost categories: 
blood and blood products, contained within chemicals as was done for 
the 1992-based excluded hospital with capital market basket, and within 
miscellaneous products. These categories use as proxies the following 
PPIs: The PPI for blood and blood products, the PPI for chemicals, and 
the PPI for finished goods less food and energy, respectively. Of these 
three proxies, the PPI for finished goods less food and energy moved 
most like the recent blood cost and price trends. In addition, the 
impact on the overall market basket by using different proxies for 
blood was negligible, mostly due to the relatively small weight for 
blood in the market basket.
    Therefore, we are proposing to use the PPI for finished goods less 
food and energy for the blood proxy because we believe it more 
appropriately proxies the price changes (not quantities or required 
tests) associated with blood purchased by hospitals. We will continue 
to evaluate this proxy for its appropriateness and will explore the 
development of alternative price indexes to proxy the price changes 
associated with this cost.

Telephone

    The percentage change in the price of telephone services as 
measured by the CPI for all urban consumers (CPI Code 
CUUR0000SEED) would be applied to this component.

Postage

    The percentage change in the price of postage as measured by the 
CPI for all urban consumers (CPI Code CUUR0000SEEC01) would be 
applied to this component.

All Other Services, Labor Intensive

    The percentage change in the ECI for compensation paid to service 
workers employed in private industry would be applied to this 
component.

All Other Services, Nonlabor Intensive

    The percentage change in the all items component of the CPI for all 
urban consumers (CPI Code  CUUR0000SA0) would be applied to 
this component.
3. Proposed Methodology for Capital Portion of the RPL Market Basket
    Unlike for the operating costs of the proposed FY 2002-based RPL 
market basket, we did not have IRF, IPF, and LTCH FY 2002 Medicare cost 
report data for the capital cost weights, due to a change in the FY 
2002 reporting requirements. Rather, we used these hospitals' 
expenditure data for the capital cost categories of depreciation, 
interest, and other capital expenses for FY 2001, and aged the data to 
a FY 2002 base year using relevant price proxies.
    We calculated weights for the proposed RPL market basket capital 
costs using the same set of Medicare cost reports used to develop the 
operating share for IRFs, IPFs, and LTCHs. The resulting proposed 
capital weight for the FY 2002 base year is 10.149 percent. This is 
based on FY 2001 Medicare cost report data for IRFs, IPFs, and LTCHs, 
aged to FY 2002 using relevant price proxies.
    Lease expenses are not a separate cost category in the market 
basket, but are distributed among the cost categories of depreciation, 
interest, and other, reflecting the assumption that the underlying cost 
structure of leases is similar to capital costs in general. We assumed 
10 percent of lease expenses are overhead and assigned them to the 
other capital expenses cost category as overhead. We base this 
assignment of 10 percent of lease expenses to overhead on the common 
assumption that overhead is 10 percent of costs. The remaining lease 
expenses were distributed to the three cost categories based on the 
weights of depreciation, interest, and other capital expenses not 
including lease expenses.
    Depreciation contains two subcategories: building and fixed 
equipment and movable equipment. The split between building and fixed 
equipment and movable equipment was determined using the FY 2001 
Medicare

[[Page 3625]]

cost reports for IRFs, IPFs, and LTCHs. This methodology was also used 
to compute the 1997-based index (67 FR at 50044).
    The total interest expense cost category is split between the 
government/nonprofit and for-profit hospitals. The 1997-based excluded 
hospital with capital market basket allocated 85 percent of the total 
interest cost weight to the government nonprofit interest, proxies by 
average yield on domestic municipal bonds, and 15 percent to for-profit 
interest, proxies by average yield on Moody's Aaa bonds.
    We propose to derive the split using the relative FY 2001 Medicare 
cost report data for PPS hospitals on interest expenses for the 
government/nonprofit and for-profit hospitals. Due to insufficient 
Medicare cost report data for IPFs, IRFs, and LTCHs, we propose to use 
the same split used in the IPPS capital input price index. We believe 
it is important that this split reflect the latest relative cost 
structure of interest expenses for hospitals and, therefore, we propose 
to use a 75-25 split to allocate interest expenses to government/
nonprofit and for-profit (70 FR at 47408).
    Since capital is acquired and paid for over time, capital expenses 
in any given year are determined by both past and present purchases of 
physical and financial capital. The vintage-weighted capital index is 
intended to capture the long-term consumption of capital, using vintage 
weights for depreciation (physical capital) and interest (financial 
capital). These vintage weights reflect the purchase patterns of 
building and fixed equipment and movable equipment over time. 
Depreciation and interest expenses are determined by the amount of past 
and current capital purchases. Therefore we are proposing to use the 
vintage weights to compute vintage-weighted price changes associated 
with depreciation and interest expense.
    Vintage weights are an integral part of the proposed FY 2002-based 
RPL market basket. Capital costs are inherently complicated and are 
determined by complex capital purchasing decisions, over time, based on 
such factors as interest rates and debt financing. In addition, capital 
is depreciated over time instead of being consumed in the same period 
it is purchased. The capital portion of the proposed FY 2002-based RPL 
market basket would reflect the annual price changes associated with 
capital costs, and would be a useful simplification of the actual 
capital investment process. By accounting for the vintage nature of 
capital, we are able to provide an accurate, stable annual measure of 
price changes. Annual non-vintage price changes for capital are 
unstable due to the volatility of interest rate changes and, therefore, 
do not reflect the actual annual price changes for Medicare capital-
related costs. The capital component of the proposed FY 2002-based RPL 
market basket would reflect the underlying stability of the capital 
acquisition process and provide hospitals with the ability to plan for 
changes in capital payments.
    To calculate the vintage weights for depreciation and interest 
expenses, we needed a time series of capital purchases for building and 
fixed equipment and movable equipment. We found no single source that 
provides the best time series of capital purchases by hospitals for all 
of the above components of capital purchases. The early Medicare Cost 
Reports did not have sufficient capital data to meet this need. While 
the American Hospital Association (AHA) Panel Survey provided a 
consistent database back to 1963, it did not provide annual capital 
purchases. However, the AHA Panel Survey provided a time series of 
depreciation expenses through 1997 which could be used to infer capital 
purchases over time. From 1998 to 2001, hospital depreciation expenses 
were calculated by multiplying the AHA Annual Survey total hospital 
expenses by the ratio of depreciation to total hospital expenses from 
the Medicare cost reports. Beginning in 2001, the AHA Annual Survey 
began collecting depreciation expenses. We hope to be able to use these 
data in future rebasings.
    In order to estimate capital purchases from AHA data on 
depreciation and interest expenses, the expected life for each cost 
category (building and fixed equipment, movable equipment, and debt 
instruments) is needed. Due to insufficient Medicare cost report data 
for IPFs, IRFs, and LTCHs, we propose to use FY 2001 Medicare Cost 
Reports for IPPS hospitals to determine the expected life of building 
and fixed equipment and movable equipment. We believe this data source 
reflects the latest relative cost structure of depreciation expenses 
for hospitals and is analogous to IPFs, IRFs, and LTCHs. The expected 
life of any piece of equipment can be determined by dividing the value 
of the asset (excluding fully depreciated assets) by its current year 
depreciation amount. This calculation yields the estimated useful life 
of an asset if depreciation were to continue at current year levels, 
assuming straight-line depreciation. From the FY 2001 Medicare cost 
reports for IPPS hospitals the expected life of building and fixed 
equipment was determined to be 23 years, and the expected life of 
movable equipment was determined to be 11 years.
    We also propose to use the fixed and movable weights derived from 
FY 2001 Medicare cost reports for IPFs, IRFs, and LTCHs to separate the 
depreciation expenses into annual amounts of building and fixed 
equipment depreciation and movable equipment depreciation. By 
multiplying the annual depreciation amounts by the expected life 
calculations from the FY 2001 Medicare cost reports, year-end asset 
costs for building and fixed equipment and movable equipment were 
determined. We then calculated a time series back to 1963 of annual 
capital purchases by subtracting the previous year asset costs from the 
current year asset costs. From this capital purchase time series we 
were able to calculate the vintage weights for building and fixed 
equipment, movable equipment, and debt instruments. An explanation of 
each of these sets of vintage weights follows.
    For proposed building and fixed equipment vintage weights, the real 
annual capital purchase amounts for building and fixed equipment 
derived from the AHA Panel Survey were used. The real annual purchase 
amount was used to capture the actual amount of the physical 
acquisition, net of the effect of price inflation. This real annual 
purchase amount for building and fixed equipment was produced by 
deflating the nominal annual purchase amount by the building and fixed 
equipment price proxy, the Boeckh Institutional Construction Index. 
This is the same proxy used for the FY 1997-based excluded hospital 
with capital market basket. We believe this proxy continues to meet our 
criteria of reliability, timeliness, availability, and relevance. Since 
building and fixed equipment has an expected life of 23 years, the 
vintage weights for building and fixed equipment are deemed to 
represent the average purchase pattern of building and fixed equipment 
over 23-year periods. With real building and fixed equipment purchase 
estimates back to 1963, sixteen 23-year periods could be averaged to 
determine the average vintage weights for building and fixed equipment 
that are representative of average building and fixed equipment 
purchase patterns over time. Vintage weights for each 23-year period 
are calculated by dividing the real building and fixed capital purchase 
amount in any given year by the total amount of purchases in the 23-
year period. This calculation is done for each year in the 23-year 
period, and for each of the

[[Page 3626]]

sixteen 23-year periods. The average of each year across the sixteen 
23-year periods is used to determine the 2002 average building and 
fixed equipment vintage weights.
    For proposed movable equipment vintage weights, the real annual 
capital purchase amounts for movable equipment derived from the AHA 
Panel Survey were used to capture the actual amount of the physical 
acquisition, net of price inflation. This real annual purchase amount 
for movable equipment was calculated by deflating the nominal annual 
purchase amount by the movable equipment price proxy, the PPI for 
Machinery and Equipment. This is the same proxy used for the FY 1997-
based excluded hospital with capital market basket. We believe this 
proxy, which meets our criteria, is the best measure of price changes 
for this cost category. Since movable equipment has an expected life of 
11 years, the vintage weights for movable equipment are deemed to 
represent the average purchase pattern of movable equipment over an 11-
year period. With real movable equipment purchase estimates available 
back to 1963, twenty-eight 11-year periods could be averaged to 
determine the average vintage weights for movable equipment that are 
representative of average movable equipment purchase patterns over 
time. Vintage weights for each 11-year period would be calculated by 
dividing the real movable capital purchase amount for any given year by 
the total amount of purchases in the 11-year period. This calculation 
is done for each year in the 11-year period, and for each of the 
twenty-eight 11-year periods. The average of the twenty-eight 11-year 
periods would be used to determine the FY 2002 average movable 
equipment vintage weights.
    For proposed interest vintage weights, the nominal annual capital 
purchase amounts for total equipment (building and fixed and movable) 
derived from the AHA Panel and Annual Surveys were used. Nominal annual 
purchase amounts were used to capture the value of the debt instrument. 
Since hospital debt instruments have an expected life of 23 years, the 
vintage weights for interest are deemed to represent the average 
purchase pattern of total equipment over 23-year periods. With nominal 
total equipment purchase estimates available back to 1963, sixteen 23-
year periods could be averaged to determine the average vintage weights 
for interest that are representative of average capital purchase 
patterns over time. Vintage weights for each 23-year period would be 
calculated by dividing the nominal total capital purchase amount for 
any given year by the total amount of purchases in the 23-year period. 
This calculation would be done for each year in the 23-year period and 
for each of the sixteen 23-year periods. The average of the sixteen 23-
year periods would be used to determine the FY 2002 average interest 
vintage weights. The vintage weights for the index are presented in 
Table 3 below.
    In addition to the price proxies for depreciation and interest 
costs described above in the vintage weighted capital section, we 
propose to use the CPI-U for Residential Rent as a price proxy for 
other capital-related costs. The price proxies for each of the capital 
cost categories are the same as those used for the IPPS final rule (67 
FR at 50044) capital input price index.

                 Table 3.--Proposed CMS FY 2002-Based RPL Market Basket Capital Vintage Weights
----------------------------------------------------------------------------------------------------------------
                                                                                                     Interest:
                                                                   Fixed assets       Movable        Capital-
                              Year                                   (23 year       assets (11      related (23
                                                                     weights)      year weights)   year weights)
----------------------------------------------------------------------------------------------------------------
1...............................................................           0.021           0.065           0.010
2...............................................................           0.022           0.071           0.012
3...............................................................           0.025           0.077           0.014
4...............................................................           0.027           0.082           0.016
5...............................................................           0.029           0.086           0.019
6...............................................................           0.031           0.091           0.023
7...............................................................           0.033           0.095           0.026
8...............................................................           0.035           0.100           0.029
9...............................................................           0.038           0.106           0.033
10..............................................................           0.040           0.112           0.036
11..............................................................           0.042           0.117           0.039
12..............................................................           0.045  ..............           0.043
13..............................................................           0.047  ..............           0.048
14..............................................................           0.049  ..............           0.053
15..............................................................           0.051  ..............           0.056
16..............................................................           0.053  ..............           0.059
17..............................................................           0.056  ..............           0.062
18..............................................................           0.057  ..............           0.064
19..............................................................           0.058  ..............           0.066
20..............................................................           0.060  ..............           0.070
21..............................................................           0.060  ..............           0.071
22..............................................................           0.061  ..............           0.074
23..............................................................           0.061  ..............           0.076
                                                                 -----------------
    Total.......................................................           1.000           1.000           1.000
----------------------------------------------------------------------------------------------------------------

    The proposed rate year (that is, beginning July 1, 2006) update for 
the IPF PPS using the proposed FY 2002-based RPL market basket and 
Global Insight's 3rd quarter 2005 forecast would be 4.5 percent. This 
reflects increases in both the operating and capital portions of the 
market basket from the 18-month period (that is, January 1, 2005 
through June 30, 2006). Global Insight, Inc. is a nationally recognized 
economic and financial forecasting firm that contracts with CMS to 
forecast the components of the market baskets. Using the current FY 
1997-based excluded hospital with capital market basket (66 FR 41427), 
Global Insight's 3rd quarter 2005 forecast for

[[Page 3627]]

the proposed rate year beginning July 1, 2006 would be 4.5 percent. 
Table 4 below compares the proposed FY 2002-based RPL market basket and 
the FY 1997-based excluded hospital with capital market basket percent 
changes. For both the historical and forecasted periods between RY 2000 
and RY 2008, the difference between the two market baskets is minor 
with the exception of RY 2002, where the proposed FY 2002-based RPL 
market basket increased three tenths of a percentage point higher than 
the FY 1997-based excluded hospital with capital market basket. This is 
primarily due to the proposed FY 2002-based RPL having a larger 
compensation (that is, the sum of wages and salaries and benefits) cost 
weight than the FY 1997-based index and the price changes associated 
with compensation costs increasing much faster than the prices of other 
market basket components. Also contributing is the ``all other nonlabor 
intensive'' cost weight, which is smaller in the proposed FY 2002-based 
RPL market basket than in the FY 1997-based index, as well as the 
slower price changes associated with these costs.

  Table 4.--Proposed FY 2002-based RPL Market Basket and FY 1997-Based
Excluded Hospital With Capital Market Basket, Percent Changes: 2000-2008
------------------------------------------------------------------------
                                                           FY 1997-based
                                             Proposed        excluded
             Rate year (RY)                 rebased FY       hospital
                                          2002-based RPL   market basket
                                           market basket   with capital
------------------------------------------------------------------------
Historical data:
    RY 2000.............................             2.8             2.7
    RY 2001.............................             3.8             3.9
    RY 2002.............................             4.1             3.8
    RY 2003.............................             3.8             3.7
    RY 2004.............................             3.6             3.6
        Average RY 2000-2004............             3.6             3.5
Forecast:
    RY 2005.............................             3.8             3.9
    RY 2006.............................             3.7             3.8
    RY 2007.............................             3.6             3.6
    RY 2008.............................             3.5             3.5
        Average RY 2005-2008............             3.7            3.7
------------------------------------------------------------------------
Source: Global Insight, Inc. 3rd Qtr 2005, @USMACRO/CNTL0905 @CISSIM/
  TL0805.SIM
Note: The RY forecasts are based on the standard 12-month period of July
  1 to June 30. For this proposed rule, we are moving from an 18-month
  period to a 12-month period.

4. Proposed Labor-Related Share
    As described in section IV.C.1 of this proposed rule, due to the 
variations in costs and geographic wage levels, we are proposing that 
payment rates under the IPF PPS continue to be adjusted by a geographic 
wage index. This wage index would apply to the labor-related portion of 
the proposed Federal per diem base rate, hereafter referred to as the 
labor-related share.
    The labor-related share is determined by identifying the national 
average proportion of operating costs that are related to, influenced 
by, or vary with the local labor market. Using our current definition 
of labor-related, the labor-related share is the sum of the relative 
importance of wages and salaries, fringe benefits, professional fees, 
labor-intensive services, and a portion of the capital share from an 
appropriate market basket.
    We are proposing to use the FY 2002-based RPL market basket costs 
to determine the proposed labor-related share for the IPF PPS. The 
proposed labor-related share for RY 2007 would be the sum of the 
proposed RY 2007 relative importance of each labor-related cost 
category, and would reflect the different rates of price change for 
these cost categories between the base year (FY 2002) and RY 2007. The 
sum of the proposed relative importance for RY 2007 for operating costs 
(wages and salaries, employee benefits, professional fees, and labor-
intensive services) would be 71.845, as shown in Table 5 below. The 
portion of capital that is influenced by the local labor market would 
be estimated to be 46 percent, which is the same percentage used in the 
FY 1997-based IRF and IPF payment systems. Since the relative 
importance for capital would be 8.866 (RY 2007) percent of the proposed 
FY 2002-based RPL market basket in RY 2007, we are proposing to take 46 
percent of 8.866 percent to determine the proposed labor-related share 
of capital for RY 2007. The result would be 4.078 percent, which we 
propose to add to 71.845 percent for the operating cost amount to 
determine the total proposed labor-related share for RY 2007. Thus, the 
labor-related share that we propose to use for IPF PPS in RY 2007 would 
be 75.923 percent. This proposed labor-related share is determined 
using the same methodology as employed in calculating all previous IPF 
labor-related shares (69 FR at 66952).
    Table 5 below shows the proposed RY 2007 relative importance labor-
related share using the proposed FY 2002-based RPL market basket and 
the FY 1997-based excluded hospital with capital market basket. We note 
that the revised and rebased labor-related share would benefit those 
hospitals with a wage index greater than or equal to 1.000.

[[Page 3628]]



  Table 5.--Total Labor-Related Share--Relative Importance for RY 2007
------------------------------------------------------------------------
                                                              FY 1997
                                           FY 2002-based     excluded
                                            RPL market     hospital with
                                              basket      capital market
              Cost category                  relative         basket
                                            importance       relative
                                           (Percent) RY     importance
                                               2007        (Percent) RY
                                                               2007
------------------------------------------------------------------------
Wages and salaries......................          52.761          48.301
Employee benefits.......................          14.008          11.517
Professional fees.......................           2.903           4.527
All other labor-intensive services......           2.173           4.457
-----------------------------------------
    Subtotal............................          71.845          68.802
-----------------------------------------
Labor-related share of capital costs....           4.078           3.225
                                         -----------------
        Total...........................          75.923          72.027
------------------------------------------------------------------------

IPFs Paid Based on a Blend of the Reasonable Cost-based Payments

    Under the broad authority of sections 1886(b)(3)(A) and (b)(3)(B) 
of the Act and as stated in the FY 2006 IPPS final rule (70 FR 47399), 
for IPFs that are transitioning to the fully Federal prospective 
payment rate, we are now using the rebased and revised FY 2002-based 
excluded hospital market basket to update the reasonable cost-based 
portion of their payments. We rebase the market basket periodically so 
that the cost weights reflect changes in the mix of goods and services 
that hospitals purchase to furnish inpatient care between base periods. 
We chose FY 2002 as the base year for the excluded hospital market 
basket because we believe this is the most recent, complete year of 
Medicare cost report data.
    The reasonable cost-based payments, subject to TEFRA limits, are 
determined on a FY basis. For purposes of the update factor for FY 
2006, the portion of the IPF PPS transitional blend payment based on 
reasonable costs was determined by updating the IPF's TEFRA limit by 
the FY 2002-based excluded hospital market basket (or 3.8 percent) (70 
FR 47691).
    As discussed in section III.B.3 of this proposed rule, the proposed 
Federal per diem base rate is $594.66 for the RY beginning July 1, 2006 
and ending June 30, 2007.

IV. Update of the IPF PPS Adjustment Factors

[If you choose to comment on issues in this section, please include the 
caption ``ADJUSTMENT FACTORS'' at the beginning of your comments.]

A. Overview of the IPF PPS Adjustment Factors

    In developing the IPF PPS, in order to ensure that the IPF PPS 
would be able to account adequately for each IPF's case-mix, we 
performed an extensive regression analysis of the relationship between 
the per diem costs and certain patient and facility characteristics to 
determine those characteristics associated with statistically 
significant cost differences on a per diem basis. For characteristics 
with statistically significant cost differences, we used the regression 
coefficients of those variables to determine the size of the 
corresponding payment adjustments.
    The IPF PPS payment adjustments were derived from a regression 
analysis of 100 percent of the FY 2002 MedPAR data file which contained 
483,038 cases. We propose to use the same results of this regression 
analysis for this proposed rule. For a more detailed description of the 
data file used for the regression analysis, see the IPF PPS final rule.
    We computed a per diem cost for each Medicare inpatient psychiatric 
stay, including routine operating, ancillary, and capital components 
using information from the FY 2002 MedPAR file and data from the FY 
2002 Medicare cost reports. To calculate the cost per day for each 
inpatient psychiatric stay, routine costs were estimated by multiplying 
the routine cost per day from the IPF's FY 2002 Medicare cost report by 
the number of Medicare covered days on the FY 2002 MedPAR stay record. 
Ancillary costs were estimated by multiplying each departmental cost-
to-charge ratio by the corresponding ancillary charges on the MedPAR 
stay record. The total cost per day was calculated by summing routine 
and ancillary costs for the stay and dividing it by the number of 
Medicare covered days for each day of the stay.
    As discussed in more detail in section IV.C.5 of this proposed 
rule, the IPF PPS includes a payment adjustment for IPFs with 
qualifying Emergency Departments (EDs), and IPFs that are part of acute 
care hospitals and CAHs with qualifying EDs. As a result, ED costs were 
excluded from the dependent variable used in the cost regression in 
order to remove the effects of ED costs from other payment adjustment 
factors with which ED costs may be correlated and thus avoid overpaying 
ED costs.
    The log of per diem cost, like most health care cost measures, 
appeared to be normally distributed. Therefore, the natural logarithm 
of the per diem cost was the dependent variable in the regression 
analysis. We included variables in the regression to control for 
psychiatric hospitals that do not bill ancillary costs and for ECT 
costs that we pay separately. The per diem cost was adjusted for 
differences in labor cost across geographic areas using the FY 2005 
hospital wage index unadjusted for geographic reclassifications, in 
order to be consistent with our use of the market basket labor share in 
applying the wage index adjustment.
    As discussed in the IPF PPS final rule (69 FR 66936), we computed a 
wage adjustment factor for each case by multiplying the Medicare 2005 
hospital wage index based on MSA definitions defined by OMB in 1993 for 
each facility by the labor-related share and adding the non-labor 
share. We used the 1997-based excluded hospital with capital market 
basket to determine the labor-related share. The per diem cost for each 
case was divided by this factor before taking the natural logarithm. 
The payment adjustment for the wage index was computed consistently 
with the wage adjustment factor, which is equivalent to separating the 
per diem cost into a labor portion and a non-labor portion and 
adjusting the labor portion by the wage index.

[[Page 3629]]

    With the exception of the teaching adjustment, the independent 
variables were specified as one or more categorical variables. Once the 
regression model was finalized based on the log normal variables, the 
regression coefficients for these variables were converted to payment 
adjustment factors by treating each coefficient as an exponent of the 
base ``e'' for natural logarithms, which is approximately equal to 
2.718. The payment adjustment factors represent the proportional effect 
of each variable relative to a reference variable. As a result of the 
regression analysis, we established patient-level payment adjustments 
for age, DRG assignment based on patients' principal diagnoses, 
selected comorbidities, and a day of stay adjustment (the variable per 
diem adjustments) to reflect higher resource use in the early days of 
an IPF stay. We also established facility-level payment adjustments for 
wage area, rural location, teaching status, cost of living adjustment 
for IPFs located in Alaska and Hawaii, and an adjustment for IPFs with 
a qualifying ED. We do not intend to update the regression analysis 
until we can analyze 1 year of IPF PPS claims and cost report data 
(that is, no earlier than RY 2008). CMS plans to monitor claims and 
payment data independently from cost report data to assess issues, or 
whether changes in case-mix or payment shifts have occurred between 
free-standing governmental, non-profit, and private psychiatric 
hospitals, and/or psychiatric units of general hospital, and other 
impact issues of importance to psychiatric facilities.

B. Proposed Patient-Level Adjustments

[If you choose to comment on issues in this section, please include the 
caption ``PATIENT-LEVEL ADJUSTMENTS'' at the beginning of your 
comments.]

    We provided payment adjustments for the following payment-level 
characteristics in the IPF PPS final rule: DRG assignment of the 
patient's principal diagnosis, selected comorbidities, patient age, and 
the variable per diem adjustments.
1. Proposed Adjustment for DRG Assignment
    The IPF PPS includes payment adjustments for the psychiatric DRG 
assigned to the claim based on each patient's principal diagnosis. In 
the IPF PPS final rule, we explained that the IPF PPS includes 15 
diagnosis-related group (DRG) adjustment factors (69 FR 66936). The 
adjustment factors were expressed relative to the most frequently 
reported DRG in FY 2002, that is, DRG 430. The coefficient values and 
adjustment factors were derived from the regression analysis.
    In accordance with Sec.  412.27, payment under the IPF PPS is made 
for claims with a principal diagnosis included in the Diagnostic and 
Statistical Manual of Mental Disorder--Fourth Edition--Text Revision 
(DSM-IV-TR) or Chapter Five of the International Classification of 
Diseases--9th Revision--Clinical Modifications (ICD-9-CM). The 
Standards for Electronic Transaction final rule published in the 
Federal Register on August 17, 2000 (65 FR 50312), adopted the ICD-9-CM 
as the designated code set for reporting diseases, injuries, 
impairments, other health related problems, their manifestations, and 
causes of injury, disease, impairment, or other health-related 
problems. As a result, the DSM-IV-TR, while essential for the diagnosis 
and treatment of mentally ill patients, may not be reported on Medicare 
claims. However, in order to recognize the importance of the DSM-IV-TR 
in mental health treatment, we updated the reference to the DSM in 
Sec.  412.27 from DSM-III-TR to DSM-IV-TR in the IPF PPS final rule. As 
a result, under the revised Sec.  412.27, IPFs that are distinct part 
psychiatric units of acute care hospitals and CAHs may only admit 
patients who have a principal diagnosis in the DSM-IV-TR or Chapter 
Five of the ICD-9-CM although DSM codes may not be reported on medical 
claims.
    IPF claims with a principal diagnosis included in Chapter Five of 
the ICD-9-CM or the DSM-IV-TR will be paid the Federal per diem base 
rate payment under the IPF PPS. Psychiatric principal diagnoses that do 
not group to one of the 15 designated DRGs receive the Federal per diem 
base rate and all other applicable adjustments, but the payment does 
not include a DRG adjustment. Only those claims with diagnoses that 
group to one of these psychiatric DRGs would receive a DRG adjustment.
    We believe it is vital to maintain the same diagnostic coding and 
DRG classification for IPFs that is used under the IPPS for providing 
the same psychiatric care. As we explained in the IPF PPS proposed rule 
(68 FR 66924), all changes to the ICD-9-CM coding system that would 
impact the IPF PPS are addressed annually in the IPPS proposed and 
final rules published each year. The updated codes are effective 
October 1 of each year and must be used to report diagnostic or 
procedure information. The official version of the ICD-9-CM is 
available on CD-ROM from the U.S. Government Printing Office. The FY 
2005 version can be ordered by contacting the Superintendent of 
Documents, U.S. Government Printing Office, Department 50, Washington, 
D.C. 20402-9329, telephone number (202) 512-1800. The stock number is 
017-022-01544-7, and the price is $25.00. In addition, private vendors 
publish the ICD-9-CM. Questions concerning the ICD-9-CM should be 
directed to Patricia E. Brooks, Co-Chairperson, ICD-9-CM Coordination 
and Maintenance Committee, CMS, Center for Medicare Management, 
Purchasing Policy Group, Division of Acute Care, Mailstop C4-08-06, 
7500 Security Boulevard, Baltimore, Maryland 21244-1850. Questions and 
comments may be sent via e-mail to: [email protected].
    Further information concerning the Official Version of the ICD-9-CM 
can be found in the IPPS final regulation, ``Changes to the Hospital 
Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates; Final 
Rule,'' in the August 12, 2005 Federal Register (70 FR 47278) and at 
http://www.cms.hhs.gov/QuarterlyProviderUpdates/downloads/cms1500f.pdf.
    The following two tables below list the FY 2006 new ICD diagnosis 
codes and FY 2006 revised diagnosis code titles, respectively. These 
tables are only a listing of FY 2006 changes and do not reflect all of 
the currently valid and applicable ICD codes classified in the DRGs. 
Table 6 below lists the new FY 2006 ICD diagnosis codes that are 
classified to one of the 15 DRGs that are provided a DRG adjustment in 
the IPF PPS. When coded as a principal code or diagnosis, these codes 
would receive the correlating DRG adjustment.

                                 Table 6.--FY 2006 New Diagnosis Codes Diagnosis
----------------------------------------------------------------------------------------------------------------
                Diagnosis code                                     Description                          DRG
----------------------------------------------------------------------------------------------------------------
291.82........................................  Alcohol-induced sleep disorders.................   521, 522, 523
292.85........................................  Drug-induced sleep disorders....................   521, 522, 523
327.00........................................  Organic insomnia, unspecified...................             432

[[Page 3630]]

 
327.01........................................  Insomnia due to medical condition classified                 432
                                                 elsewhere.
327.02........................................  Insomnia due to mental disorder.................             432
327.09........................................  Other organic insomnia..........................             432
327.10........................................  Organic hypersomnia, unspecified................             432
327.11........................................  Idiopathic hypersomnia with long sleep time.....             432
327.12........................................  Idiopathic hypersomnia without long sleep time..             432
327.13........................................  Recurrent hypersomnia...........................             432
327.14........................................  Hypersomnia due to medical condition classified              432
                                                 elsewhere.
327.15........................................  Hypersomnia due to mental disorder..............             432
327.19........................................  Other organic hypersomnia.......................             432
----------------------------------------------------------------------------------------------------------------

    Table 7 below lists ICD diagnosis codes whose titles have been 
modified in FY 2006. Title changes do not impact the DRG adjustment. 
When used as a principal diagnosis, these codes would still receive the 
correlating DRG adjustment.

                 Table 7.--Revised Diagnosis Code Titles
------------------------------------------------------------------------
        Diagnosis code                 Description              DRG
------------------------------------------------------------------------
307.45........................  Circadian rhythm sleep               432
                                 disorder of nonorganic
                                 origin.
780.52........................  Insomnia, unspecified...             432
780.54........................  Hypersomnia, unspecified             432
780.55........................  Disruption of 24 hour                432
                                 sleep wake cycle,
                                 unspecified.
780.58........................  Sleep related movement               432
                                 disorder, unspecified.
------------------------------------------------------------------------

    In addition to the aforementioned, in the August 2005 IPPS final 
rule, we finalized ICD code 305.1, Tobacco Use Disorder, in order to 
designate this code as a noncovered Medicare service when reported as 
the principal diagnosis. Below we have republished the explanation that 
was included in the IPPS final rule (70 FR 47312) and published on the 
CMS website at http://www.cms.hhs.gov/ QuarterlyProviderUpdates/
downloads/cms1500f.pdf.

    We have become aware of the possible need to add code 305.1 
(Tobacco use disorder) to the MCE in order to make admissions for 
tobacco use disorder a noncovered Medicare service when code 305.1 
is reported as the principal diagnosis. On March 22, 2005, CMS 
published a final decision memorandum and related national coverage 
determination (NCD) on smoking cessation counseling services on its 
Web site: (http://www.cms.hhs.gov/coverage/). Among other things, 
this NCD provides that: `Inpatient hospital stays with the principal 
diagnosis of 305.1, Tobacco Use Disorder, are not reasonable and 
necessary for the effective delivery of tobacco cessation counseling 
services. Therefore, we will not cover tobacco cessation services if 
tobacco cessation is the primary reason for the patient's hospital 
stay.' Therefore, in order to maintain internal consistency with CMS 
programs and decisions, we proposed to add code 305.1 to the MCE 
edit ``Questionable Admission--Principal Diagnosis Only'' in order 
to make tobacco use disorder a noncovered admission. (70 FR 47312).

    In order to maintain consistency with the IPPS, for discharges on 
or after October 1, 2005, ICD code 305.1, Tobacco Use Disorder, would 
not be a covered principal diagnosis under the IPF PPS.
    Although we are updating the IPF PPS to reflect ICD-9-CM coding 
changes and DRG classification changes discussed in the annual update 
to the IPPS, we are proposing that the DRG adjustment factors currently 
being paid to IPFs would remain the same for discharges occurring 
during the rate year July 1, 2006 through June 30, 2007. As indicated 
in the IPF PPS final rule, we do not intend to update the regression 
analysis until we have analyzed 1 year of IPF PPS claims and cost 
report data. As a result, we are proposing to adopt the DRG adjustments 
that are currently being paid as indicated in Table 8 below.

          Table 8.--FY 2006 Proposed DRGs and Adjustment Factor
------------------------------------------------------------------------
                                                            Adjustment
              DRG                    DRG definition           factor
------------------------------------------------------------------------
DRG 424.......................  O.R. Procedure with                 1.22
                                 Principal Diagnosis of
                                 Mental Illness.
DRG 425.......................  Acute Adjustment                    1.05
                                 Reaction & Psychosocial
                                 Dysfunction.
DRG 426.......................  Depressive Neurosis.....            0.99
DRG 427.......................  Neurosis, Except                    1.02
                                 Depressive.
DRG 428.......................  Disorders of Personality            1.02
                                 & Impulse Control.
DRG 429.......................  Organic Disturbances &              1.03
                                 Mental Retardation.
DRG 430.......................  Psychoses...............            1.00
DRG 431.......................  Childhood Mental                    0.99
                                 Disorders.
DRG 432.......................  Other Mental Disorder               0.92
                                 Diagnoses.
DRG 433.......................  Alcohol/Drug Abuse or               0.97
                                 Dependence, Leave
                                 Against Medical Advice
                                 (LAMA).
DRG 521.......................  Alcohol/Drug Abuse or               1.02
                                 Dependence with CC.
DRG 522.......................  Alcohol/Drug Abuse or               0.98
                                 Dependence with
                                 Rehabilitation Therapy
                                 without CC.
DRG 523.......................  Alcohol/Drug Abuse or               0.88
                                 Dependence without
                                 Rehabilitation Therapy
                                 without CC.
DRG 12........................  Degenerative Nervous                1.05
                                 System Disorders.

[[Page 3631]]

 
DRG 23........................  Non-traumatic Stupor &              1.07
                                 Coma.
------------------------------------------------------------------------

    Section Sec.  412.424(d) separately identifies both ``Diagnosis-
related group assignment'' and ``Principal diagnosis'' as patient level 
adjustments. Since publication of the IPF PPS final rule, we have 
received inquiries related to whether the IPF PPS includes two patient-
level payment adjustments for principal diagnosis, an adjustment for 
the diagnosis-related group assignment and a separate adjustment for 
providing a principal diagnosis in general. We intended that the IPF 
PPS provide one patient-level adjustment for principal diagnosis, that 
is ``Diagnosis-related group assignment.''
    In order to clarify our policy, we are proposing to modify the 
language in section Sec.  412.424(d). We are proposing to delete sub-
paragraph Sec.  412.424(d)(2)(iii).
2. Proposed Payment for Comorbid Conditions
    In the IPF PPS final rule, we established 17 comorbidity categories 
and identified the ICD-9-CM diagnosis codes that generate a payment 
adjustment under the IPF PPS.
    Comorbidities are specific patient conditions that are secondary to 
the patient's primary diagnosis, and that require treatment during the 
stay. Diagnoses that relate to an earlier episode of care and have no 
bearing on the current hospital stay are excluded and not reported on 
IPF claims. Comorbid conditions must co-exist at the time of admission, 
develop subsequently, affect the treatment received, affect the length 
of stay or affect both treatment and length of stay.
    The intent of the comorbidity adjustments was to recognize the 
increased cost associated with comorbid conditions by providing 
additional payments for certain concurrent medical or psychiatric 
conditions that are expensive to treat. An IPF may receive only one 
comorbidity adjustment per comorbidity category, but it may receive an 
adjustment for more than one comorbidity category. Billing instructions 
require that IPFs must enter the full ICD-9-CM codes for up to 8 
additional diagnoses if they co-exist at the time of admission or 
developed subsequently.
    The comorbidity adjustments were determined based on regression 
analysis using the diagnoses reported by hospitals as other diagnoses 
in FY 2002. The principal diagnoses were used to establish the DRG 
adjustment and were not accounted for in establishing the comorbidity 
category adjustments, except where ICD-9-CM ``code first'' instructions 
apply. As we explained in the IPF PPS final rule, the code first rule 
applies when a condition has both an underlying etiology and a 
manifestation due to the underlying etiology. For these conditions, the 
ICD-9-CM has a coding convention that requires the underlying 
conditions to be sequenced first followed by the manifestation. 
Whenever a combination exists, there is a ``use additional code'' note 
at the etiology code and a ``code first'' note at the manifestation 
code.
    Although we are updating the IPF PPS to reflect updates to the ICD-
9-CM codes, we are proposing that the comorbidity adjustment factors 
currently in effect would remain in effect for the rate year beginning 
July 1, 2006. As we indicated in the IPF PPS final rule, we do not 
intend to update the regression analysis until we have analyzed 1 year 
of IPF PPS claims and cost report data. The proposed comorbidity 
adjustments are shown in Table 9 below.
    As previously discussed in the DRG section, we believe it is 
essential to maintain the same diagnostic coding set for IPFs that is 
used under the IPPS for providing the same psychiatric care. Therefore, 
we are proposing to use the most current FY 2006 ICD codes. They are 
reflected in the FY 2006 GROUPER, version 23.0 and are effective for 
discharges occurring on or after October 1, 2005.
    Table 9 lists the updated FY 2006 new ICD diagnosis codes that 
impact the comorbidity adjustment under the IPF PPS and Table 10 lists 
the invalid ICD codes no longer applicable for the comorbidity 
adjustment. Table 9 only lists the FY 2006 new codes and does not 
reflect all of the currently valid ICD codes applicable for the IPF PPS 
comorbidity adjustment.
    We note that ICD diagnosis code 585 Chronic Renal Failure was 
modified in two ways--(1) by expanding the level of specificity to 
include seven new codes; and (2) by changing the original code of 585 
to invalid, thereby leaving the remaining more specific codes 
reportable. Since diagnosis code 585 is no longer valid, we are 
proposing to eliminate this code from the comorbidity category ``Renal 
Failure, Chronic.''
    ICD diagnosis code 585 chronic Renal Failure is defined in the ICD-
9-CM as ``Progressive, persistent inadequate kidney function 
characterized by anuria, accumulation of urea and other nitrogenous 
bodies in the blood, nausea, vomiting, gastrointestinal bleeding, and 
yellowish-brown discoloration of the skin.'' This code included the 
various stages of chronic kidney disease, but it is no longer valid. 
The new codes listed below reflect the various stages of chronic kidney 
failure. Since diagnosis code 585 is no longer valid, we are proposing 
to eliminate it from the comorbidity category, ``Renal Failure, 
Chronic''.
    We are proposing to provide comorbidity adjustments for 585.3, 
``Chronic kidney disease, Stage III (moderate),'' 585.4, ``Chronic 
kidney disease, Stage IV (severe),'' 585.5, ``Chronic kidney disease, 
Stage V,'' 585.6, ``End Stage renal disease,'' and 585.9, ``Chronic 
kidney disease, unspecified.'' However, since the purpose of the 
comorbidity adjustment is to account for the higher resource costs 
associated with comorbid conditions that are expensive to treat on a 
per diem basis, we are not proposing a comorbidity adjustment for 
585.1, ``Chronic kidney disease, Stage I'' and 585.2, ``Chronic kidney 
disease, Stage II (mild).''
    We believe that these conditions (585.1 and 585.2) are less costly 
to treat on a per diem basis because patients with these conditions are 
either asymptomatic or may have only mild symptoms. These conditions 
represent a minimal to mild decrease in kidney function that is almost 
completely compensated such that the only finding is typically an 
abnormal laboratory test. Unlike patients with more significant kidney 
dysfunction, these patients do not usually require more costly patient 
care interventions such as additional lab tests to monitor renal 
function, special pharmacy attention to reduced dosages or kidney-
sparing medications, or fluid and electrolyte precautions with special 
diets, frequent weights, Input/Output balance, and fluid restriction. 
As such, the resources and costs that these patients require for staff 
time,

[[Page 3632]]

medications and supplies, and administrative services are expected to 
be similar to other patients without these conditions.

                    Table 9.--FY 2006 New ICD Codes Applicable for the Comorbidity Adjustment
----------------------------------------------------------------------------------------------------------------
            Diagnosis code                      Description                DRG           Comorbidity category
----------------------------------------------------------------------------------------------------------------
585.3.................................  Chronic kidney disease,             315-316  Renal Failure, Chronic.
                                         Stage III (moderate).
585.4.................................  Chronic kidney disease,             315-316  Renal Failure, Chronic.
                                         Stage IV (severe).
585.5.................................  Chronic kidney disease,             315-316  Renal Failure, Chronic.
                                         Stage V.
585.6.................................  End stage renal disease....         315-316  Renal Failure, Chronic.
585.9.................................  Chronic kidney disease,             315-316  Renal Failure, Chronic.
                                         unspecified.
V46.13................................  Encounter for weaning from              467  Chronic Obstructive
                                         respirator [ventilator].                     Pulmonary Disease.
V46.14................................  Mechanical complication of              467  Chronic Obstructive
                                         respirator [ventilator].                     Pulmonary Disease.
----------------------------------------------------------------------------------------------------------------

    In Table 10 below, we list the FY 2006 invalid ICD diagnosis code 
585 that we are proposing to remove from the comorbidity adjustment 
under the IPF PPS. This table does not reflect all of the currently 
valid ICD codes applicable for the IPF PPS comorbidity adjustment.

            Table 10.--FY 2006 Invalid ICD Codes No Longer Applicable for the Comorbidity Adjustment
----------------------------------------------------------------------------------------------------------------
            Diagnosis code                      Description                DR            Comorbidity category
----------------------------------------------------------------------------------------------------------------
585...................................  Chronic renal failure......          315-36  Renal Failure, Chronic.
----------------------------------------------------------------------------------------------------------------

    We are aware that ICD code 404.03, Hypertensive Heart and Renal 
Disease, Malignant, with Heart Failure and Renal Failure, has caused 
confusion since this ICD code is currently used to code an adjustment 
in two separate IPF comorbidity categories, (that is, both ``Renal 
Failure, Chronic'' and ``Cardiac Conditions''). After a careful review 
of this code, we believe that it more appropriately corresponds to the 
``Cardiac Conditions'' comorbidity than to the ``Renal Failure, 
Chronic'' comorbidity. Therefore, to be more clinically cohesive and to 
eliminate confusion, we are proposing to remove ICD code 404.03 from 
the comorbidity adjustment category ``Renal Failure, Chronic,'' but 
retaining it in the ``Cardiac Conditions'' comorbidity category. Since 
both comorbidity categories have the same adjustment factor of 1.11, no 
negative payment consequence would result from this change.
    The seventeen comorbidity categories for which we are proposing to 
provide an adjustment, their respective codes including the new FY 2006 
ICD codes, and their respective adjustment factors are listed below in 
Table 11.

              Table 11.--FY 2006 Diagnosis Codes and Adjustment Factors for Comorbidity Categories
----------------------------------------------------------------------------------------------------------------
                                                                                                    Adjustment
          Description of comorbidity                              ICD-9CM Code                        factor
----------------------------------------------------------------------------------------------------------------
Development Disabilities......................  317, 3180, 3181, 3182, and 319..................            1.04
Coagulation Factor deficits...................  2860 through 2864...............................            1.13
Tracheotomy...................................  51900--through 51909 and V440...................            1.06
Renal Failure, Acute..........................  5845 through 5849, 63630, 63631, 63632, 63730,              1.11
                                                 63731, 63732, 6383, 6393, 66932, 66934, 9585.
Renal Failure, Chronic........................  40301, 40311, 40391, 40402, 40412, 40413, 40492,            1.11
                                                 40493, 5853, 5854, 5855, 5856, 5859, 586, V451,
                                                 V560, V561, and V562.
Oncology Treatment............................  1400 through 2399 with a radiation therapy code             1.07
                                                 92.21-92.29 or chemotherapy code 99.25.
Uncontrolled Diabetes-Mellitus with or without  25002, 25003, 25012, 25013, 25022, 25023, 25032,            1.05
 complications.                                  25033, 25042, 25043, 25052, 25053, 25062,
                                                 25063, 25072, 25073, 25082, 25083, 25092, and
                                                 25093.
Severe Protein calorie malnutrition...........  260 through 262.................................            1.13
Eating and Conduct Disorders..................  3071, 30750, 31203, 31233, and 31234............            1.12
Infectious Disease............................  01000 through 04110, 042, 04500 through 05319,              1.07
                                                 05440 through 05449, 0550 through 0770, 0782
                                                 through 07889, and 07950 through 07959.
Drug and/or Alcohol Induced Mental Disorders..  2910, 2920, 29212, 2922, 30300, and 30400.......            1.03
Cardiac Conditions............................  3910, 3911, 3912, 40201, 40403, 4160, 4210,                 1.11
                                                 4211, and 4219.
Gangrene......................................  44024 and 7854..................................            1.10
Chronic Obstructive Pulmonary Disease.........  49121, 4941, 5100, 51883, 51884, V4611 and                  1.12
                                                 V4612, V4613 and V4614.
Artificial Openings--Digestive and Urinary....  56960 through 56969, 9975, and V441 through V446            1.08
Severe Musculoskeletal and Connective Tissue    6960, 7100, 73000 through 73009, 73010 through              1.11
 Diseases.                                       73019, and 73020 through 73029.
Poisoning.....................................  96500 through 96509, 9654, 9670 through 9699,               1.11
                                                 9770, 9800 through 9809, 9830 through 9839,
                                                 986, 9890 through 9897.
----------------------------------------------------------------------------------------------------------------


[[Page 3633]]

3. Proposed Patient Age Adjustments
    As explained in the IPF PPS final rule, we analyzed the impact of 
age on per diem cost by examining the age variable (that is, the range 
of ages) for payment adjustments.
    In general, we found that the cost per day increases with 
increasing age. The older age groups are more costly than the under 45 
years of age group, the differences in per diem cost increase for each 
successive age group, and the differences are statistically 
significant.
    Based on the results of the regression analysis, we established 8 
adjustment factors for age beginning with age groupings, 45 and under 
50, 50 and under 55, 55 and under 60, 60 and under 65, 65 and under 70, 
70 and under 75, 75 and under 80, and 80 years of age and over. 
Patients under 45 years of age are assigned an age adjustment factor of 
1.00. As we indicated in the IPF PPS final rule, we do not intend to 
update the regression analysis until we can analyze 1 year of IPF PPS 
claims and cost report data. As a result, in this proposed rule, we are 
proposing to adopt the patient age adjustments currently in effect and 
shown in Table 12 below.

             Table 12.--Age Groupings and Adjustment Factors
------------------------------------------------------------------------
                                                              Adjustment
                            Age                                 factor
------------------------------------------------------------------------
Under 45...................................................         1.00
45 and under 50............................................         1.01
50 and under 55............................................         1.02
55 and under 60............................................         1.04
60 and under 65............................................         1.07
65 and under 70............................................         1.10
70 and under 75............................................         1.13
75 and under 80............................................         1.15
80 and over................................................         1.17
------------------------------------------------------------------------

4. Proposed Variable Per Diem Adjustments
    We explained in the IPF PPS final rule that cost regressions 
indicated that per diem cost declines as the length of stay increases 
(69 FR 66947). The variable per diem adjustments to the Federal per 
diem base rate account for ancillary and administrative costs that 
occur disproportionately in the first days after admission to an IPF.
    We used regression analysis to estimate the average differences in 
per diem cost among stays of different length. Regression analysis 
simultaneously controls for cost differences associated with the other 
variables (for example, age, DRG, and presence of specific 
comorbidities). The regression coefficients measure the relative 
average cost per day for stays of differing lengths compared to a 
reference group's length of stay. We analyzed through cost regression, 
the relative cost per day for day 1 through day 30. We determined that 
the average per diem cost declined smoothly until the 22nd day. As a 
result of this analysis, we established variable per diem adjustments 
that begin on day 1 and decline gradually until day 21 of a patient's 
stay. For day 22 and thereafter, the variable per diem adjustment 
remains the same each day for the remainder of the stay. However, the 
adjustment applied to day 1 depends upon whether the IPF has a 
qualifying Emergency Department (ED). If an IPF has a qualifying ED, it 
receives a 1.31 adjustment for day 1 of each patient stay. If an IPF 
does not have a qualifying ED, it receives a 1.19 adjustment for day 1 
of the stay. The ED adjustment is explained in more detail in section 
IV.C.5. of this proposed rule.
    As we indicated in the IPF PPS final rule, we do not intend to make 
changes to the regression analysis until we can analyze 1 year of IPF 
PPS claims and cost report data. As a result, for the rate year 
beginning July 1, 2006, we are proposing to adopt the variable per diem 
adjustment factors currently in effect. Table 13 below shows the 
variable per diem adjustments we are proposing for updating the IPF 
PPS. Higher payments for the early days of stay in IPFs are not fully 
compensated by the lower payments after day 10, but are paid for by the 
standardization portion which is applied to the federal per diem base 
rate.

                Table 13.--Variable Per Diem Adjustments
------------------------------------------------------------------------
                                                              Adjustment
                        Day-of-stay                             factor
------------------------------------------------------------------------
Day 1-IPF Without a Qualified ED...........................         1.19
Day 1-IPF With a Qualified ED..............................         1.31
Day 2......................................................         1.12
Day 3......................................................         1.08
Day 4......................................................         1.05
Day 5......................................................         1.04
Day 6......................................................         1.02
Day 7......................................................         1.01
Day 8......................................................         1.01
Day 9......................................................         1.00
Day 10.....................................................         1.00
Day 11.....................................................         0.99
Day 12.....................................................         0.99
Day 13.....................................................         0.99
Day 14.....................................................         0.99
Day 15.....................................................         0.98
Day 16.....................................................         0.97
Day 17.....................................................         0.97
Day 18.....................................................         0.96
Day 19.....................................................         0.95
Day 20.....................................................         0.95
Day 21.....................................................         0.95
After Day 21...............................................         0.92
------------------------------------------------------------------------

C. Facility-Level Adjustments

[If you choose to comment on issues in this section, please include the 
caption ``FACILITY-LEVEL ADJUSTMENTS'' at the beginning of your 
comments.]
    The IPF PPS includes facility-level adjustments for the wage index, 
IPFs located in rural areas, teaching IPFs, cost of living adjustments 
for IPFs located in Alaska and Hawaii, and IPFs with a qualifying ED.
1. Wage Index Adjustment
a. Proposed Revisions of IPF PPS Geographic Classifications
    In the IPF PPS final rule, we explained that in establishing an 
adjustment for area wage levels, the labor-related portion of an IPF's 
Federal prospective payment is adjusted by using an appropriate wage 
index. We also explained that an IPF's wage index is determined based 
on the location of the IPF in an urban or rural area as defined in 
Sec.  412.62(f)(1)(ii) and (f)(1)(iii), respectively. An urban area 
under the IPF PPS is defined at Sec.  412.62(f)(1)(ii)(A) and (B). In 
general, an urban area is defined as a Metropolitan Statistical Area 
(MSA) or New England County Metropolitan Area (NECMA) as defined by the 
Office of Management and Budget (OMB). In addition, a few counties 
located outside of MSAs are considered urban as specified at Sec.  
412.62(f)(1)(ii)(B). Under Sec.  412.62(f)(1)(iii), a rural area is 
defined as any area outside of an urban area. The geographic 
classifications defined in Sec.  412.62(f)(1)(ii) and (f)(1)(iii), were 
used under the IPPS from FYs 1984 through 2004 (Sec.  412.62(f) and 
Sec.  412.63(b)), and have been used under the IPF PPS since it was 
implemented for cost reporting periods beginning on or after January 1, 
2005.
    Under the IPPS, the wage index is calculated and assigned to 
hospitals on the basis of the labor market area in which the hospital 
is located or geographically reclassified to in accordance with 
sections 1886(d)(8) and (d)(10) of the Act. Under the IPF PPS, the wage 
index is calculated using IPPS wage index data (as discussed below in 
section IV C.1.d of this preamble) on the basis of the labor market 
area in which the IPF is located, without taking into account 
geographic reclassification under sections 1886(d)(8) and (d)(10) of

[[Page 3634]]

the Act and without applying the ``rural floor'' established under 
section 4410 of the BBA. (Section 4410 of the BBA provides that for the 
purposes of section 1886(d)(3)(E) of the Act, the area wage index 
applicable to hospitals located in an urban area of a State may not be 
less than the area wage index applicable to hospitals located in rural 
areas in the State. This provision is commonly referred to as the 
``rural floor'' under the IPPS.) However, when we established the IPF 
PPS, we did not apply the rural floor to IPFs. For this reason, the 
hospital wage index used for IPFs is commonly referred to as the ``pre-
floor'' hospital wage index indicating that the ``rural floor'' 
provision of the BBA is not applied. As a result, the applicable IPF 
wage index value is assigned to the IPF on the basis of the labor 
market area in which the IPF is geographically located.
    As noted above, the current IPF PPS labor market areas are defined 
based on the definitions of MSAs, Primary MSAs (PMSAs), and NECMAs 
issued by the OMB (commonly referred to collectively as ``MSAs''). The 
MSA definitions, which are discussed in greater detail below, are 
currently used under the IPF PPS and other PPSs (that is, the IRF PPS, 
the LTCH PPS, and the PPSs for home health agencies (HHA PPS) and 
skilled nursing facilities (SNF PPS)). In the FY 2005 IPPS final rule 
(69 FR 49026 through 49034), revised labor market area definitions were 
adopted under the IPPS (Sec.  412.64(b)), which were effective October 
1, 2004. These new standards, called Core-Based Statistical Areas 
(CBSAs), were announced by the OMB late in 2000 and are discussed in 
greater detail below.
b. Current IPF PPS Labor Market Areas Based on MSAs
    When we published the IPF PPS final rule, we explained that we were 
not adopting the new statistical area definitions defined by OMB for 
the following reasons. First, the change in labor market areas under 
the IPPS had not changed at the time we published the IPF PPS proposed 
rule on November 28, 2003. As a result, IPFs and other interested 
parties were not afforded an opportunity to comment on the use of the 
new labor market area definitions under the IPF PPS. Second, we wanted 
to conduct a thorough analysis of the impact of the new labor market 
area definitions on payments under the IPF PPS. Finally, in the IPF PPS 
final rule, we indicated our intent to publish in a proposed rule any 
changes we were considering for new labor market definitions.
    The analysis of the impact of the new labor market definitions has 
been completed and we are proposing to adopt new labor market area 
definitions under the IPF PPS. As a result, we believe it is helpful to 
provide a detailed description of the current IPF PPS labor market 
areas, in order to better understand the proposed changes to the IPF 
PPS labor market areas presented in this proposed rule.
    As mentioned earlier, since the implementation of the IPF PPS, we 
have used labor market areas to further characterize urban and rural 
areas as determined under Sec.  412.62(f)(1)(ii) and (iii). To this 
end, we have defined labor market areas under the IPF PPS based on the 
definitions of MSAs, PMSAs, and NECMAs issued by the OMB in 1993, which 
is consistent with the IPPS approach prior to FY 2005. We note that OMB 
also defines Consolidated MSAs (CMSAs). A CMSA is a metropolitan area 
with a population of 1 million or more, comprising two or more PMSAs 
(identified by their separate economic and social character). However, 
for purposes of the wage index, we use the PMSAs rather than CMSAs 
because they allow a more precise breakdown of labor costs. If a 
metropolitan area is not designated as part of a PMSA, we use the 
applicable MSA.
    These different designations use counties as the building blocks 
upon which they are based. Therefore, under the IPF PPS, hospitals are 
assigned to either an MSA, PMSA, or NECMA based on whether the county 
in which the IPF is located is part of that area. All of the counties 
in a State outside a designated MSA, PMSA, or NECMA are designated as 
rural.
c. Core-Based Statistical Areas
    The OMB reviews its Metropolitan Area definitions preceding each 
decennial census. As discussed in the FY 2005 IPPS final rule (69 FR 
49026), in the fall of 1998, OMB chartered the Metropolitan Area 
Standards Review Committee to examine the Metropolitan Area standards 
and develop recommendations for possible changes to those standards. 
Three notices related to the review of the standards, providing an 
opportunity for public comment on the recommendations of the Committee, 
were published in the Federal Register on the following dates: December 
21, 1998 (63 FR 70526); October 20, 1999 (64 FR 56628); and August 22, 
2000 (65 FR 51060).
    In the December 27, 2000 Federal Register (65 FR 82228 through 
82238), OMB announced its new standards. In that notice, OMB defines a 
Core-Based Statistical Area (CBSA), beginning in 2003, as ``a 
geographic entity associated with at least one core of 10,000 or more 
population, plus adjacent territory that has a high degree of social 
and economic integration with the core as measured by commuting ties. 
The standards designate and define two categories of CBSAs: 
Metropolitan Statistical Areas and Micropolitan Statistical Areas.'' 
(65 FR 82236 through 82238).
    According to the OMB, MSAs are based on urbanized areas of 50,000 
or more population, and Micropolitan Statistical Areas (referred to in 
this discussion as Micropolitan Areas) are based on urban clusters of 
at least 10,000 population, but less than 50,000 population. Counties 
that do not fall within CBSAs (either MSAs or Micropolitan Areas) are 
deemed ``Outside CBSAs.'' In the past, OMB defined MSAs around areas 
with a minimum core population of 50,000, and smaller areas were 
``Outside MSAs.'' On June 6, 2003, the OMB announced the new CBSAs, 
comprised of MSAs and the new Micropolitan Areas based on Census 2000 
data. (A copy of the announcement may be obtained at the following 
Internet address: http://www.whitehouse.gov/omb/bulletins/fy04/b04-03.html.)
    The new CBSA designations recognize 49 new MSAs and 565 new 
Micropolitan Areas, and extensively revise the composition of many of 
the existing MSAs. There are 1,090 counties in MSAs under the new CBSA 
designations (previously, there were 848 counties in MSAs). Of these 
1,090 counties, 737 are in the same MSA as they were prior to the 
change in designations, 65 are in a different MSA, and 288 were not 
previously designated to any MSA. There are 674 counties in 
Micropolitan Areas. Of these, 41 were previously in an MSA, while 633 
were not previously designated to an MSA. There are five counties that 
previously were designated to an MSA but are no longer designated to 
either an MSA or a new Micropolitan Area: Carter County, KY; St. James 
Parish, LA; Kane County, UT; Culpepper County, VA; and King George 
County, VA. For a more detailed discussion of the conceptual basis of 
the new CBSAs, refer to the FY 2005 IPPS final rule (67 FR 49026 
through 49034).
d. Proposed Revision of the IPF PPS Labor Market Areas
    In its June 6, 2003 announcement, OMB cautioned that these new 
definitions ``should not be used to develop and implement Federal, 
State, and local nonstatistical programs and policies without full 
consideration of the effects of using these definitions for such 
purposes. These areas should not serve as a general-purpose geographic

[[Page 3635]]

framework for nonstatistical activities, and they may or may not be 
suitable for use in program funding formulas.''
    We currently use MSAs to define labor market areas for purposes of 
Medicare wage indices in the IPF PPS since its implementation for cost 
reporting periods beginning on or after January 1, 2005. Until 
recently, MSAs were used to define labor market areas for purposes of 
the wage index for many of the other Medicare payment systems (for 
example, IRF PPS, SNF PPS, HHA PPS, and Outpatient PPS). While we 
recognize MSAs are not designed specifically to define labor market 
areas, we believe they represent a useful proxy for this purpose, 
because they are based upon characteristics we believe also generally 
reflect the characteristics of unified labor market areas. For example, 
CBSAs consist of a core population plus an adjacent territory that 
reflects a high degree of social and economic integration. This 
integration is measured by commuting ties, thus demonstrating that 
these areas may draw workers from the same general areas. In addition, 
the most recent CBSAs reflect the most up-to-date information. Our 
analysis and discussion here are focused on issues related to adopting 
the new CBSA designations to define labor market areas for the purposes 
of the IPF PPS.
    Historically, Medicare PPSs have utilized Metropolitan Area 
definitions developed by the OMB. As noted above, the labor market 
areas currently used under the IPF PPS are based on the Metropolitan 
Area definitions issued by the OMB and the OMB reviews its Metropolitan 
Area definitions preceding each decennial census to reflect more recent 
population changes. The CBSAs are OMB's latest Metropolitan Area 
definitions based on the Census 2000 data. Because we believe that the 
OMB's latest Metropolitan Area designations more accurately reflect the 
local economies and wage levels of the areas in which hospitals are 
currently located, we adopted revised labor market area designations 
based on the OMB's CBSA designations under the IPPS effective October 
1, 2004. When we implemented the wage index adjustment at Sec.  
412.424(d)(1)(i) under the IPF PPS final rule (69 FR 66952 through 
66954), we explained that the IPF PPS wage index adjustment was 
intended to reflect the relative hospital wage levels in the geographic 
area of the hospital as compared to the national average hospital wage 
level. The OMB's CBSA designations based on Census 2000 data reflect 
the most recent available geographic classifications (Metropolitan Area 
definitions). Therefore, we are proposing to revise the labor market 
area definitions used under the IPF PPS based on the OMB's CBSA 
designations. This change would ensure that the IPF PPS wage index 
adjustment most appropriately accounts for and reflects the relative 
hospital wage levels in the geographic area of the hospital as compared 
to the national average hospital wage level.
    Specifically, we are proposing to revise the IPF PPS labor market 
definitions based on the OMB's new CBSA designations (as discussed in 
greater detail below) effective for IPF PPS discharges occurring on or 
after July 1, 2006. Accordingly, we are proposing to revise Sec.  
412.402, definitions for rural and urban areas, effective for 
discharges occurring on or after July 1, 2006 would be defined in Sec.  
412.64(b)(1)(ii)(A) through (C). These definitions are the labor market 
definitions based on OMB's CBSA designations. For clarity, we are 
proposing to revise the regulation text to explicitly reference urban 
and rural definitions for a cost reporting period beginning on or after 
January 1, 2005, with respect to discharges occurring during the period 
covered by such cost reports but before July 1, 2006 under Sec.  
412.62(f)(1)(ii) and Sec.  412.62(f)(1)(iii).
    We note that these are the same labor market area definitions 
(based on the OMB's new CBSA designations) implemented for acute care 
hospitals under the IPPS at Sec.  412.64(b), which were effective for 
those hospitals beginning October 1, 2004 as discussed in the FY 2005 
IPPS final rule (69 FR 49026-49034). The IPF PPS uses the acute care 
inpatient hospitals' wage data in calculating the IPF PPS wage index. 
However, unlike the IPPS, and similar to other Medicare payment systems 
(for example, SNF PPS and IRF PPS), the IPF PPS uses the pre-floor, 
pre-reclassified hospital wage index.
    Below, we discuss the composition of the proposed IPF PPS labor 
market areas based on OMB's new CBSA designations. It should be noted 
that OMB's new CBSA designations are comprised of several county-based 
area definitions as explained above, which include Metropolitan Areas, 
Micropolitan Areas, and areas ``outside CBSAs.'' We implemented the IPF 
PPS using two types of labor market areas, that is, urban and rural. In 
this proposed rule, we are proposing to adopt the revised labor market 
areas based on OMB's new CBSA-based designations. We are also proposing 
to continue to have 2 types of labor market areas (urban and rural). In 
the discussion that follows, we explain our proposal to recognize 
Metropolitan Areas, which include New England MSAs and Metropolitan 
Divisions, as urban. We also explain our proposal to recognize 
Micropolitan Areas and areas ``outside CBSAs'' as rural. The following 
discussion describes the proposed methodology for mapping OMB's CBSA-
based designations into the IPF PPS (urban area or rural area) format.
i. New England MSAs
    As stated above, we currently use NECMAs to define labor market 
areas in New England, because these are county-based designations, 
rather than the 1990 MSA definitions for New England, which used minor 
civil divisions such as cities and towns. Under the current MSA 
definitions, NECMAs provided more consistency in labor market 
definitions for New England compared with the rest of the country, 
where MSAs are county-based. Under the new CBSAs, the OMB has now 
defined the MSAs and Micropolitan Areas in New England on the basis of 
counties. The OMB also established New England City and Town Areas, 
which are similar to the previous New England MSAs.
    In order to create consistency across all IPF labor market areas, 
we are proposing to use the county-based areas for all MSAs in the 
nation, including those in New England. The OMB has now defined the New 
England area based on counties, creating a city- and town-based system 
as an alternative. We believe that adopting county-based labor market 
areas for the entire country except those in New England would lead to 
inconsistencies in our designations. Adopting county-based labor market 
areas for the entire country provides consistency and stability in 
Medicare program payment because all of the labor market areas 
throughout the country, including New England, would be defined using 
the same system (that is, counties) rather than different systems in 
different areas of the county, and minimizes programmatic complexity.
    In addition, we have consistently employed a county-based system 
for New England for precisely that reason: to maintain consistency with 
the labor market definitions used throughout the country. Since we have 
never used cities and towns for defining IPF labor market areas, 
employing a county-based system in New England maintains that 
consistent practice. We note that this is consistent with the 
implementation of the CBSA-based designations under the IPPS for New 
England (69 FR 49028). Accordingly, for the IPF PPS, we are proposing 
to use the New England MSAs as determined under the proposed new CBSA-
based labor market area definitions in defining the

[[Page 3636]]

proposed revised IPF PPS labor market areas.
ii. Metropolitan Divisions
    Under OMB's new CBSA designations, a Metropolitan Division is a 
county or group of counties within a CBSA that contains a core 
population of at least 2.5 million, representing an employment center, 
plus adjacent counties associated with the main county or counties 
through commuting ties. A county qualifies as a main county if 65 
percent or more of its employed residents work within the county and 
the ratio of the number of jobs located in the county to the number of 
employed residents is at least 0.75. A county qualifies as a secondary 
county if 50 percent or more, but less than 65 percent, of its employed 
residents work within the county and the ratio of the number of jobs 
located in the county to the number of employed residents is at least 
0.75. After all the main and secondary counties are identified and 
grouped, each additional county that already has qualified for 
inclusion in the MSA falls within the Metropolitan Division associated 
with the main/secondary county or counties with which the county at 
issue has the highest employment interchange measure. Counties in a 
Metropolitan Division must be contiguous (65 FR 82236).
    The construct of relatively large MSAs being comprised of 
Metropolitan Divisions is similar to the current construct of CMSAs 
comprised of PMSAs. As noted above, in the past, the OMB designated 
CMSAs as Metropolitan Areas with a population of 1 million or more and 
comprised of two or more PMSAs. Under the IPF PPS, we currently use the 
PMSAs rather than CMSAs to define labor market areas because they 
comprise a smaller geographic area with potentially varying labor costs 
due to different local economies. We believe that CMSAs may be too 
large of an area with a relatively large number of hospitals, to 
accurately reflect the local labor costs of all of the individual 
hospitals included in that relatively ``large'' area. A large market 
area designation increases the likelihood of including many hospitals 
located in areas with very different labor market conditions within the 
same market area designation. This variation could increase the 
difficulty in calculating a single wage index that would be relevant 
for all hospitals within the market area designation. Similarly, we 
believe that MSAs with a population of 2.5 million or greater may be 
too large of an area to accurately reflect the local labor costs of all 
of the individual hospitals included in that relatively ``large'' area. 
Furthermore, as indicated above, Metropolitan Divisions represent the 
closest approximation to PMSAs, the building block of the current IPF 
PPS labor market area definitions, and therefore, would most accurately 
maintain our current structuring of the IPF PPS labor market areas. 
Therefore, as implemented under the IPPS (69 FR 49029), we are 
proposing to use the Metropolitan Divisions where applicable (as 
described below) under the proposed new CBSA-based labor market area 
definitions.
    In addition to being comparable to the organization of the labor 
market areas under current MSA designations (that is, the use of PMSAs 
rather than CMSAs), we believe that using Metropolitan Divisions where 
applicable (as described below) under the IPF PPS would result in a 
more accurate adjustment for the variation in local labor market areas 
for IPFs. Specifically, if we would recognize the relatively ``larger'' 
CBSA that comprises two or more Metropolitan Divisions as an 
independent labor market area for purposes of the wage index, it would 
be too large and would include the data from too many hospitals to 
compute a wage index that would accurately reflect the various local 
labor costs of all of the individual hospitals included in that 
relatively ``large'' CBSA. As mentioned earlier, a large market area 
designation increases the likelihood of including many hospitals 
located in areas with very different labor market conditions within the 
same market area designation. This variation could increase the 
difficulty in calculating a single wage index that would be relevant 
for all hospitals within the market area designation. Rather, by 
proposing to recognize Metropolitan Divisions where applicable (as 
described below) under the proposed new CBSA-based labor market area 
definitions under the IPF PPS, we believe that in addition to more 
accurately maintaining the current structuring of the IPF PPS labor 
market areas, the local labor costs would be more accurately reflected, 
thereby resulting in a wage index adjustment that better reflects the 
variation in the local labor costs of the local economies of the IPFs 
located in these relatively ``smaller'' areas.
    Below we describe where Metropolitan Divisions would be applicable 
under the proposed new CBSA-based labor market area definitions under 
the IPF PPS.
    Under OMB's new CBSA-based designations, there are 11 MSAs 
containing Metropolitan Divisions: Boston; Chicago; Dallas; Detroit; 
Los Angeles; Miami; New York; Philadelphia; San Francisco; Seattle; and 
Washington, DC. Although these MSAs were also CMSAs under the prior 
definitions, in some cases these areas have been significantly altered. 
Under the current IPF PPS MSA designations, Boston is a single NECMA. 
Under the proposed CBSA-based labor market area designations, it would 
be comprised of four Metropolitan Divisions. Los Angeles would go from 
four PMSAs under the current IPF PPS MSA designations to two 
Metropolitan Divisions under the proposed CBSA-based labor market area 
designations because two MSAs became separate MSAs. The New York CMSA 
would go from 15 PMSAs under the current IPF PPS MSA designations down 
to only four Metropolitan Divisions under the proposed CBSA-based labor 
market area designations. The five PMSAs in Connecticut under the 
current IPF PPS MSA designations would become separate MSAs under the 
proposed CBSA-based labor market area designations, and the number of 
PMSAs in New Jersey under the current IPF PPS MSA designations would go 
from five to two, with the consolidation of two New Jersey PMSAs 
(Bergen-Passaic and Jersey City) into the New York-Wayne-White Plains, 
NY-NJ Division, under the proposed CBSA-based labor market area 
designations. In San Francisco, under the proposed CBSA-based labor 
market area designations, there are only two Metropolitan Divisions. 
Currently, there are six PMSAs, some of which are now separate MSAs 
under the current IPF PPS labor market area designations.
    Under the current IPF PPS labor market area designations, 
Cincinnati, Cleveland, Denver, Houston, Milwaukee, Portland, 
Sacramento, and San Juan are all designated as CMSAs, but would no 
longer be designated as CMSAs under the proposed CBSA-based labor 
market area designations. As noted previously, the population threshold 
to be designated as a CMSA under the current IPF PPS labor market area 
designations is 1 million. In most of these cases, counties currently 
in a PMSA under the current IPF PPS labor market area designations 
would become separate, independent MSAs under the proposed CBSA-based 
labor market area designations.
iii. Micropolitan Areas
    Under OMB's new CBSA-based designations, Micropolitan Areas are 
essentially a third area definition consisting primarily of currently 
rural areas, but also include some or all of

[[Page 3637]]

areas that are currently designated as an urban MSA. As discussed in 
greater detail in the FY 2005 IPPS final rule (69 FR 49029 through 
49032), how these areas are treated would have significant impacts on 
the calculation and application of the wage index. Specifically, 
whether or not Micropolitan Areas are included as part of the 
respective statewide rural wage indices would impact the value of 
statewide rural wage index of any State that contains a Micropolitan 
Area because a hospital's classification as urban or rural affects 
which hospitals' wage data are included in the statewide rural wage 
index. As discussed above in section IV.C.1.b. we combine all of the 
counties in a State outside a designated urban area together to 
calculate the statewide rural wage index for each State.
    Including Micropolitan Areas as part of the statewide rural labor 
market area would result in an increase to the statewide rural wage 
index because hospitals located in those Micropolitan Areas typically 
have higher labor costs than other rural hospitals in the State. 
Alternatively, if Micropolitan Areas would be recognized as independent 
labor market areas, because there would be so few hospitals in each 
labor market area, the wage indices for IPFs in those areas could 
become relatively unstable as they would change considerably from year 
to year.
    We currently use MSAs to define urban labor market areas and group 
all the hospitals in counties within each State that are not assigned 
to an MSA together into a statewide rural labor market area. We have 
used the terms ``urban'' and ``rural'' wage indexes in the past for 
ease of reference. However, the introduction of Micropolitan Areas by 
the OMB potentially complicates this terminology because these areas 
include many hospitals that are currently included in the statewide 
rural labor market areas.
    We are proposing to treat Micropolitan Areas as rural labor market 
areas under the IPF PPS for the reasons outlined below. That is, 
counties that are assigned to a Micropolitan Area under the CBSA-based 
designations would be treated the same as other ``rural'' counties that 
are not assigned to either an MSA (Metropolitan Statistical Area) or a 
Micropolitan Area. Therefore, in determining an IPF's applicable wage 
index (based on IPPS hospital wage index data), we are proposing that 
an IPF in a Micropolitan Area under OMB's CBSA-based designations would 
be classified as ``rural'' and would be assigned the statewide rural 
wage index for the State in which it resides.
    In the FY 2005 IPPS final rule (69 FR 49029 through 49032), we 
discuss our evaluation of the impact of treating Micropolitan Areas as 
part of the statewide rural labor market area instead of treating 
Micropolitan Areas as independent labor market areas for hospitals paid 
under the IPPS. As discussed in that same final rule, one of the 
reasons Micropolitan Areas have such a dramatic impact on the wage 
index is because Micropolitan Areas encompass smaller populations than 
MSAs. In addition, they tend to include fewer hospitals per 
Micropolitan Area. Currently, there are only 25 MSAs with one hospital 
in the MSA. However, under the new proposed CBSA-based definitions, 
there are 373 Micropolitan Areas with one hospital, and 49 MSAs with 
only one hospital.
    Since Micropolitan Areas encompass smaller populations than MSAs, 
they tend to include fewer hospitals per Micropolitan Area, recognizing 
Micropolitan Areas as independent labor market areas would generally 
increase the potential for dramatic shifts in those areas' wage indices 
from one year to the next because a single hospital (or group of 
hospitals) could have a disproportionate effect on the wage index of 
the area. The large number of labor market areas with only one hospital 
and the increased potential for dramatic shifts in the wage indexes 
from 1 year to the next is a problem for several reasons. First, it 
creates instability in the wage index from year to year for a large 
number of hospitals. Second, it reduces the averaging effect (averaging 
effect allows for more data points to be used to calculate a 
representative standard of measured labor costs within a market area.) 
lessening some of the incentive for hospitals to operate efficiently. 
This incentive is inherent in a system based on the average hourly 
wages for a large number of hospitals, as hospitals could profit more 
by operating below that average. In labor market areas with a single 
hospital, high wage costs are passed directly into the wage index with 
no counterbalancing averaging with lower wages paid at nearby competing 
hospitals. Third, it creates an arguably inequitable system when so 
many hospitals have wage indexes based solely on their own wages, while 
other hospitals' wage indexes are based on an average hourly wage 
across many hospitals.
    For the reasons noted above, and consistent with the treatment of 
these areas under the IPPS, we are proposing not to adopt Micropolitan 
Areas as independent labor market areas under the IPF PPS. However, we 
are proposing that Micropolitan Areas, under the CBSA-based labor 
market area definitions, would be considered part of the statewide 
rural labor market area. Accordingly, we are proposing that the IPF PPS 
statewide rural wage index would be determined using acute-care IPPS 
hospital wage data (the rationale for using IPPS hospital wage data is 
discussed in greater detail above in section IV.C.1.d.iii of this 
proposed rule) from hospitals located in non-MSA areas (for example, 
rural areas, including Micropolitan Areas) and that statewide rural 
wage index would be assigned to IPFs located in those non-MSA areas.
e. Implementation of the Proposed Revised Labor Market Areas Under the 
IPF PPS
    Section 124 of the BBRA, is broadly written and gives the Secretary 
discretion in developing and making adjustments to the IPF PPS.
    When the revised labor market areas based on the OMB's new CBSA-
based designations were adopted under the acute care hospital IPPS 
beginning on October 1, 2004, a transition to the new labor market area 
designations was established due to the scope and substantial 
implications of these new boundaries and to buffer the subsequent 
significant impacts it may have on payments to numerous hospitals. As 
discussed in the FY 2005 IPPS final rule (69 FR 49032), during FY 2005, 
a blend of wage indexes is calculated for those acute care IPPS 
hospitals experiencing a drop in their wage indexes because of the 
adoption of the new labor market areas.
    While we recognize that, just like IPPS hospitals, some IPFs may 
experience decreases in their wage index as a result of the proposed 
labor market area changes, our analysis shows that a majority of IPFs 
either expect no change in wage index or an increase in wage index 
based on CBSA definitions. In addition, a very small number of IPFs 
(fewer than 3 percent) would experience a decline of 5 percent or more 
in the wage index based on CBSA designations. We also found that a very 
small number of IPFs (approximately 5 percent) would experience a 
change in either rural or urban designation under the CBSA-based 
definitions. Since a majority of IPFs would not be significantly 
impacted by the proposed labor market areas, we believe it is not 
necessary to propose a transition to the proposed new CBSA-based labor 
market area for the purposes of the IPF PPS wage index.
    In addition, because we are in the midst of a transition to a full 
wage-index

[[Page 3638]]

adjustment under the IPF PPS, we believe that the effects on the IPF 
PPS wage index from the proposed changes to the IPF PPS labor market 
areas definitions would be mitigated. Specifically, most IPFs would be 
in their FY 2006 cost reporting period and therefore would be in the 
second year of the 3-year phase-in of the IPF PPS wage index adjustment 
when the revised labor market area designations would be applied. 
During the second year of the transition to the IPF PPS, the applicable 
wage index value is one-half (50 percent) of the applicable full IPF 
PPS wage index adjustment. Since most IPFs would be in the second year 
of the 3-year phase-in of the wage index adjustment, for most IPFs, the 
labor-related portion of the standard Federal rate is only adjusted by 
50 percent of the applicable full wage index (that is, one-half wage 
index value). As noted above, the IPF PPS wage index adjustment is made 
by multiplying the labor-related share of the IPF PPS standard Federal 
per diem base rate by the applicable wage index value, and the proposed 
IPF PPS labor related-share is 75.923 percent. Consequently, for most 
IPFs, only 38 percent of the standard Federal per diem base rate is 
affected by the wage index adjustment (75.923 percent x 0.50 = 37.9615 
percent), and the proposed revision to the labor market area 
definitions based on OMB's new CBSA-based designations would only have 
a minimal impact on IPF PPS payments. Therefore, because the impact of 
the proposed revision to the labor market area definitions would only 
have a minimal impact on IPF PPS payments, we do not believe it is 
necessary to propose a transition policy for the proposed revision to 
the IPF PPS labor market area definitions.
    For the reasons discussed above, we are not proposing a transition 
under the IPF PPS from the current MSA-based labor market areas 
designations to the new CBSA-based labor market area designations. 
Rather, we are proposing under the IPF PPS to adopt the new CBSA-based 
labor market area definitions beginning with the July 1, 2006 IPF PPS 
rate year without a transition period.
    As discussed below, the IPPS adopted a hold-harmless policy and an 
``out-commuting'' adjustment. We are also not proposing a hold harmless 
policy or an ``out-commuting'' adjustment under the IPF PPS from the 
current MSA-based labor market areas designations to the new CBSA-based 
labor market area designations as discussed below. We are proposing to 
adopt the new CBSA-based labor market area definitions beginning with 
the July 1, 2006 IPF PPS rate year without a hold harmless policy and 
without an ``out-commuting'' adjustment.
    We believe that our proposed policies are appropriate for IPFs 
because, despite some similarities between the IPF PPS and the IPPS, 
there are clear distinctions between the payment systems, particularly 
regarding wage index issues. Where a wage index adjustment has been a 
stable feature of the acute care hospital IPPS since its 1983 
implementation and had utilized the prior MSA-based labor market area 
designation for over 10 years, this is not the case for the IPF PPS, 
which has only been implemented since January 1, 2005.
    The most significant distinction between acute care hospitals under 
the IPPS and IPFs under the IPF PPS, is that acute care hospitals have 
been paid using full wage index adjusted payments since 1983 and had 
used the previous IPPS MSA-based labor market area designations for 
over 10 years, whereas under the IPF PPS, a wage index adjustment is 
being phased-in over a 3-year period. As previously explained, the 
impact that the wage index can have on IPF PPS payments is limited at 
this point, since only a small percentage of the IPF PPS Federal per 
diem base rate is affected by the wage index (approximately 38 percent 
in most cases) because of the 3-year phase-in of the wage index 
adjustment. In contrast, a transition policy to the revised IPPS labor 
market area definitions under the IPPS was appropriate because there is 
no phase-in of a wage index adjustment under the IPPS and the full 
labor-related share of the IPPS standardized amount (that is, Federal 
rate) is affected by the IPPS wage index adjustment, which resulted in 
a more significant projected impact for acute care hospitals under the 
IPPS.
    As discussed in the August 11, 2004 IPPS final rule (69 FR 49032), 
during FY 2005, a hold harmless policy was implemented to minimize the 
overall impact of hospitals that were in FY 2004 designated as urban 
under the MSA designations, but would become rural under the CBSA 
designations. In the same final rule, hospitals were afforded a 3-year 
hold harmless policy because the IPPS determined that acute-care 
hospitals that changed designations from urban to rural would be 
substantially impacted by the significant change in wage index. 
Currently, under the IPF PPS urban facilities that become rural would 
receive the rural facility adjustment (that is, 17 percent). As 
discussed in section IV.C.2 of this proposed rule, we are proposing to 
keep the rural adjustment at 17 percent. The rural facility adjustment 
would be applied in the same way to urban facilities that would become 
rural under the CBSA-based definitions, if we were to adopt them. Thus, 
we believe that the impact on any urban facilities that become rural 
under the new definitions would be mitigated by the rural adjustment. 
Therefore, we do not believe it is appropriate or necessary to adopt a 
hold harmless policy for facilities that would experience a change in 
designation under the CBSA-based definitions.
    In addition, we note that section 505 of the MMA established new 
section 1886(d)(13) of the Act. The new section 1886(d)(13) of the Act 
requires that the Secretary establish a process to make adjustments to 
the hospital wage index based on commuting patterns of hospital 
employees. We believe that this requirement for an ``out-commuting'' or 
``out-migration'' adjustment applies specifically to the IPPS. 
Therefore, we are not proposing an adjustment for the IPF PPS.
    We note that for the CBSA designations, we identified some 
geographic areas where there were no hospitals, and thus no hospital 
wage index data on which to base the calculation of the July 1, 2006 
rate year IPF PPS proposed wage index. In addressing this situation, we 
are proposing approaches that we believe serve as proxies for hospital 
wage data and would provide an appropriate standard that accounts for 
geographic variation in labor costs.
    The first situation involves rural locations in Massachusetts and 
Puerto Rico. We have determined that there are no rural hospitals in 
those locations. Since there is no reasonable proxy for more recent 
rural data within those areas, we are proposing to use last year's wage 
index value for rural Massachusetts and rural Puerto Rico. This 
approach is consistent with other Medicare PPSs (for example, SNF PPS 
and IRF PPS).
    The second situation has to do with the urban area of Hinesville, 
GA (CBSA 25980). Under the proposed new labor market areas there are no 
urban hospitals within this area. We propose to use all of the urban 
areas within the State to serve as a reasonable proxy for the urban 
areas without specific hospital wage index data in determining the IPF 
PPS wage index. Therefore, in this proposed rule, we are calculating 
the urban wage index value for purposes of the wage index for these 
areas without urban hospital data as the average wage index for all 
urban areas within the State. This approach is consistent with other 
Medicare PPSs

[[Page 3639]]

(for example, SNF PPS and IRF PPS). We could not apply a similar 
averaging in rural areas because in the rural areas there are no State 
rural hospital wage data available for averaging on a State-wide basis. 
We solicit comments on these approaches to calculating the wage index 
values for areas without hospitals for RY 2007 and subsequent years.
    To facilitate an understanding of the proposed policies related to 
the proposed change to the IPF PPS labor market areas discussed above, 
in the MSA/CBSA Crosswalk included as Addendum B of this proposed rule, 
we are providing a listing of each Social Security Administration (SSA) 
State and county location code; State and county name; existing MSA-
based labor market area designation; MSA-based wage index value; CBSA-
based labor market area; and the new CBSA-based wage index value. We 
are also providing in Addenda C1 and C2 the proposed wage index for 
urban and rural areas based on CBSA labor market areas.
f. Wage Index Budget Neutrality
    Any proposed adjustment or update to the IPF wage index would be 
made in a budget neutral manner that assures that the estimated 
aggregated payments under this subsection in the RY beginning July 1, 
2006 are not greater or less than those that would have been made in 
the year without such an adjustment. Therefore, we would calculate a 
budget-neutral wage index adjustment factor. We propose to calculate 
this factor using the following steps:
    Steps 1: Determine the total amount of the estimated IPF PPS 
payments for the implementation year using the labor-related share and 
wage indices from FY 2005 (based on MSAs).
    Step 2: Calculate the total amount of estimated IPF PPS payments 
for RY 2007 using the proposed labor-related share and wage indices 
from FY 2006 (based on CBSAs).
    Step 3: Divide the amount calculated in Step 1 by the amount 
calculated in Step 2 which yields a RY 2007 budget-neutral wage 
adjustment of 1.00156.
    This factor would be applied in the update of the Federal per diem 
base rate for RY 2007.
1. Proposed Adjustment for Rural Location
    In the IPF PPS Final Rule (69 FR 66954), we provided a 17 percent 
payment adjustment for IPFs located in a rural area. This adjustment 
was based on the regression analysis which indicated that the per diem 
cost of rural facilities was 17 percent higher than that of urban 
facilities after accounting for the influence of the other variables 
included in the regression. Many rural IPFs are small psychiatric units 
within small general acute care hospitals. We also stated in the IPF 
PPS final rule that small-scale facilities are more costly on a per 
diem basis because there are minimum levels of fixed costs that cannot 
be avoided, and they do not have the economies of size advantage.
    Based on the results of our regression analysis for the final rule 
using the most recent complete data available (that is, FY 2002 data), 
we provided a payment adjustment for IPFs located in rural areas of 17 
percent. In this proposed rule, we are not proposing to change this 
adjustment factor. In addition, we stated that we do not intend to 
conduct another regression analysis until we are able to analyze 1 year 
of IPF PPS claims and cost report data. At that time, we can compare 
rural and urban IPFs to determine how much more costly rural facilities 
are on a per diem basis under the IPF PPS. In the meantime, we are 
proposing to apply a 17 percent payment adjustment for IPFs located in 
a rural area as defined at Sec.  412.64(b)(1)(ii)(C).
2. Proposed Teaching Adjustment
    In the IPF PPS final rule, we established a facility-level 
adjustment for IPFs that are, or are part of, teaching institutions. 
The teaching status adjustment accounts for the higher indirect 
operating costs experienced by facilities that participate in graduate 
medical education (GME) programs. We have received numerous requests 
for clarification of the IPF PPS teaching adjustment, especially with 
regard to comparisons with the IPPS IME adjustment that were included 
in the IPF PPS final rule. As a result, we are including an expanded 
explanation of the IPF PPS teaching status adjustment and are proposing 
clarifying changes to Sec.  412.424(d)(1)(iii) regarding the teaching 
adjustment.
    Medicare makes direct GME payments (for direct costs such as 
resident and teaching physician salaries, and other direct teaching 
costs) to all teaching hospitals including those paid under the IPPS, 
and those that were once paid under the TEFRA rate-of-increase limits 
but are now paid under other PPSs. These direct GME payments are made 
separately from payments for hospital operating costs and are not part 
of the PPSs. However, the direct GME payments do not address the higher 
indirect operating costs experienced by teaching hospitals. For 
teaching hospitals paid under the TEFRA rate-of-increase limits, 
Medicare did not make separate medical education payments because 
payments to these hospitals were based on the hospitals' reasonable 
costs. Since payments under TEFRA were based on hospitals' reasonable 
costs, the higher indirect costs that might be associated with teaching 
programs would automatically have been factored into the TEFRA 
payments.
    As previously mentioned, we conducted regression analysis of FY 
2002 IPF data as the basis for the payment adjustments included in the 
IPF PPS final rule. In conducting the analysis, we used the resident 
counts reported on hospital cost reports (worksheet S-3, Part 1, line 
12, column 7 for freestanding psychiatric hospitals and worksheet S-3, 
Part 1, line 14 (or line 14.01 for subprovider 2), column 7 for 
psychiatric units of acute care hospitals). That is, for the 
freestanding psychiatric hospitals, we used the number of residents and 
interns reported for the entire hospital. For the psychiatric units of 
acute care hospitals, we used the number of residents and interns 
reported for the psychiatric unit, which are reported separately on the 
cost report from the number reported for the rest of the hospital.
    The regression analysis (with the logarithm of costs as the 
dependent variable) showed that the indirect teaching cost variable is 
significant in explaining the higher costs of IPFs that have teaching 
programs. We calculated the teaching adjustment based on the IPF's 
``teaching variable,'' which is one plus the ratio of the number of 
full-time equivalent (FTE) residents training in the IPF (subject to 
limitations described below) to the IPF's average daily census (ADC).
    In the cost regressions conducted for the IPF PPS final rule, the 
logarithm of the teaching variable had a coefficient value of 0.5150. 
We converted this cost effect to a teaching payment adjustment by 
treating the regression coefficient as an exponent and raising the 
teaching variable to a power equal to the coefficient value. In other 
words, the teaching adjustment is calculated by raising the teaching 
variable (1 + FTE residents/ADC) to the 0.5150 power. To compute the 
percentage increase in the IPF PPS payment attributable to the teaching 
adjustment (that is, the amount to be reconciled at cost report 
settlement), raise the teaching variable (1 + FTE residents/ADC) to the 
0.5150 power. For example, for an IPF with a teaching variable of 0.10 
and using a coefficient value of 0.5150, the per diem payment would 
increase by 5.03 percent; for an IPF with a teaching variable of 0.05, 
the per diem payment would increase by 2.54 percent. We note

[[Page 3640]]

that the coefficient value of 0.5150 was based on regression analysis 
holding all other components of the payment system constant.
    In addition, we established the teaching adjustment in a manner 
that limited the incentives for IPFs to add FTE residents for the 
purpose of increasing their teaching adjustment. We imposed a cap on 
the number of FTE residents that may be counted for purposes of 
calculating the teaching adjustment, similar to that established by 
sections 4621 (IME FTE cap for IPPS hospitals) and 4623 (direct GME FTE 
cap for all hospitals) of the BBA. We emphasize that the cap limits the 
number of FTE residents that teaching IPFs may count for the purposes 
of calculating the IPF PPS teaching adjustment, not the number of 
residents teaching institutions can hire or train.
    The FTE resident cap is applied the same way in freestanding 
teaching psychiatric hospitals and in distinct part psychiatric units 
with GME programs. Similar to the regulations for counting FTE 
residents under the IPPS as described in Sec.  412.105(f), we 
calculated the number of FTE residents that trained in the IPF during a 
``base year'' and use that FTE resident number as the cap. An IPF's FTE 
resident cap would ultimately be determined based on the final 
settlement of the IPF's most recent cost report filed before November 
15, 2004 (that is, the publication date of the IPF PPS final rule).
    Similar to teaching hospitals under the IPPS, IPFs that first begin 
training residents after November 15, 2004 initially receive an FTE cap 
of ``0''. The FTE caps for teaching IPFs (whether they are new or 
existing IPFs) that start training residents in a new GME program (may 
be subsequently adjusted in accordance with the IPPS policies described 
in Sec.  412.105(f)(1)(vii) and GME policies described in Sec.  
413.79(e)(1)(i) and (ii). For purposes of this section, a new medical 
residency training program means a medical residency that receives 
initial accreditation by the appropriate accrediting body or begins 
training residents on or after November 15, 2004. However, contrary to 
the policy for IME FTE resident caps under the IPPS, we do not allow 
IPFs to aggregate the FTE resident caps used to compute the IPF PPS 
teaching adjustment through affiliation agreements. We included these 
policies because we believe it is important to limit the total pool of 
resident FTE cap positions within the IPF community and avoid 
incentives for IPFs to add FTE residents in order to increase their 
payments.
    Residents with less than full-time status and residents rotating 
through the psychiatric hospital or unit for less than a full year are 
counted in proportion to the time they spend in their assignment with 
the IPF (for example, a resident on a full-time, 3-month rotation to 
the IPF would be counted as 0.25 FTE for purposes of counting residents 
to calculate the ratio). No FTE resident time counted for purposes of 
the IPPS IME adjustment is counted for purposes of the teaching status 
adjustment for the IPF PPS.
    As noted previously, the denominator used to calculate the teaching 
adjustment under the IPF PPS is the IPF's average daily census (ADC) 
from the current cost reporting period. We chose to use the ADC because 
it is closely related to the IPF's patient load, which affects the 
number of interns and residents the IPF can train. We also believe the 
ADC is a measure that can be defined precisely and is difficult to 
manipulate. Although the IPPS IME adjustment uses the hospital's number 
of beds as the denominator, the capital PPS (as specified at Sec.  
412.322) and the IRF PPS (as specified at Sec.  412.624(e)(4) both use 
the ADC as the denominator for the indirect medical education and 
teaching adjustments, respectively.
    If a psychiatric hospital's or unit's FTE count of residents in a 
given year is higher than the FTE count in the base year (the base year 
being used to establish the cap), we base payments in that year on the 
lower number (the cap amount). This approach is consistent with the IME 
adjustment under the IPPS and the teaching adjustment under the IRF 
PPS. The IPF remains free to add FTE residents above the cap amount, 
but it cannot count the number of FTE residents above the cap for 
purposes of calculating the teaching adjustment. This means that the 
cap serves as an upper limit on the number of FTE residents that may be 
counted for purposes of calculating the teaching status adjustment. 
IPFs can adjust their number of FTE residents counted for purposes of 
calculating the teaching adjustment as long as they remain under the 
cap. On the other hand, if a psychiatric hospital or unit were to have 
fewer FTE residents in a given year than in the base year (that is, 
fewer residents than its FTE resident cap), teaching adjustment 
payments in that year would be based on the lower number (that is, the 
current year's FTE count of resident).
    In response to inquiries about how the teaching adjustment is 
applied under the IPF PPS, we are proposing to add a new paragraph 
Sec.  412.424(d)(1)(iii)(E) to clarify that the teaching adjustment is 
made on a claim basis as an interim payment and the final payment for 
the claim would be made in full during the final settlement of the cost 
report. The difference between those interim payments and the actual 
teaching adjustment amount computed in the cost report would be 
adjusted through lump sum payments/recoupments when the cost report is 
filed and later settled.
    As noted in section III.B.3 of this proposed rule, in reviewing the 
methodology used to simulate the IPF PPS payments used for the IPF PPS 
final rule, we discovered that the computer code incorrectly assigned 
non-teaching status to most teaching facilities. As a result, total IPF 
PPS payments were underestimated by about 1.36 percent. To resolve the 
issue, as discussed in section III.B.3 of this proposed rule, we are 
proposing to amend the Federal per diem base rate prospectively for all 
IPFs.
    As with other adjustment factors derived through the regression 
analysis, we do not intend to rerun the regression analysis until we 
can analyze 1 year of IPF PPS claims and cost report data. Until then, 
we are proposing to retain the 0.5150 teaching adjustment to the 
Federal per diem base rate.
3. Proposed Cost of Living Adjustment for IPFs Located in Alaska and 
Hawaii
    The IPF PPS includes a payment adjustment for IPFs located in 
Alaska and Hawaii based upon the county in which the IPF is located. As 
we explained in the IPF PPS final rule, the FY 2002 data demonstrated 
that IPFs in Alaska and Hawaii had per diem costs that were 
disproportionately higher than other IPFs. Other Medicare prospective 
payment systems (for example, IPPS and IRF PPS) have adopted a cost of 
living adjustment (COLA) to account for the cost differential of care 
furnished in Alaska and Hawaii. We analyzed the effect of applying a 
COLA to payments for IPFs located in Alaska and Hawaii. The results of 
our analysis demonstrated that a COLA for IPFs located in Alaska and 
Hawaii would improve payment equity for these facilities. As a result 
of this analysis, we provided a COLA adjustment in the IPF PPS final 
rule.
    In general, the COLA would account for the higher costs in the IPF 
and eliminate the projected loss that IPFs in Alaska and Hawaii would 
experience absent the COLA. A COLA adjustment for IPFs located in 
Alaska and Hawaii is made by multiplying the non-labor share of the 
Federal per diem base rate by the applicable COLA factor based on the 
county in which the IPF is located.
    Table 14 lists the specific COLA for Alaska and Hawaii IPFs. The 
COLA factors were obtained from the U.S.

[[Page 3641]]

Office of Personnel Management (OPM). The COLA factors are published on 
the U.S. Office of Personnel Management (OPM) website (http://www.opm.gov/oca/cola/rates.asp). We are proposing to adopt the COLA 
adjustments obtained from OPM. We propose to update the COLA factors if 
OPM updates them and as updated by OPM. Any change in the COLA factors 
would be made in one of our IPF PPS RY update documents. We are 
proposing to amend Sec.  412.428 to update the COLA factors if 
appropriate.

       Table 14.--Proposed COLA Factors for Alaska and Hawaii IPFs
------------------------------------------------------------------------
                         Location                               COLA
------------------------------------------------------------------------
Alaska:
  All areas...............................................        1.25
Hawaii:
  Honolulu County.........................................        1.25
  Hawaii County...........................................        1.165
  Kauai County............................................        1.2325
  Maui County.............................................        1.2375
  Kalawao County..........................................        1.2375
------------------------------------------------------------------------

4. Proposed Adjustment for IPFs With a Qualifying Emergency Department 
(ED)
    Currently, the IPF PPS includes a facility-level adjustment for 
IPFs with qualifying EDs. As explained in the IPF PPS final rule, we 
provide an adjustment to the standardized Federal per diem base rate to 
account for the costs associated with maintaining a full-service ED. 
The adjustment is intended to account for ED costs allocated to the 
hospital's distinct part psychiatric unit for preadmission services 
otherwise payable under Medicare Part B furnished to a beneficiary 
during the day immediately preceding the date of admission to the IPF 
(see Sec.  413.40(c)) and the overhead cost of maintaining the ED. This 
payment is a facility-level adjustment that applies to all IPF 
admissions (with the one exception as described below), regardless of 
whether a particular patient receives preadmission services in the 
hospital's ED.
    The ED adjustment is incorporated into the variable per diem 
adjustment for the first day of each stay for IPFs with a qualifying 
ED. That is, IPFs with a qualifying ED receive a 31 percent adjustment 
as the variable per diem adjustment for day 1 of each stay. If an IPF 
does not have a qualifying ED, it receives a 19 percent adjustment as 
the variable per diem adjustment for day 1 of each patient stay.
    While any IPF with a qualifying ED receives the adjustment, the 
adjustment is paid most often to IPFs that are psychiatric units of 
acute care hospitals or CAHs because these providers are more likely to 
have an ED that meets the definition of a qualified ED in Sec.  
412.424(d)(1)(v). We defined a qualifying ED in order to avoid 
providing the ED adjustment to an intake unit that is not comparable to 
a full-service ED with respect to the array of emergency services 
available or cost. We defined a qualifying ED as one that is staffed 
and equipped to furnish a comprehensive array of emergency services and 
that meets the definition of a ``dedicated emergency department'' as 
specified in Sec.  489.24(b) and the definition of ``provider-based 
status'' as specified in Sec.  413.65. We intended that a qualifying ED 
provide a comprehensive array of medical and psychiatric services.
    Therefore, in order to clarify that a comprehensive array of 
emergency services includes medical as well as psychiatric services, we 
are proposing to amend Sec.  412.424(d)(1)(V)(A).
    As specified in Sec.  489.24, a dedicated ED means ``any department 
or facility of the hospital, regardless of whether it is located on or 
off the main hospital campus, that meets at least one of the following 
requirements:
     It is licensed by the State in which it is located under 
applicable State law as an emergency room or emergency department;
     It is held out to the public (by name, posted signs, 
advertising, or other means) as a place that provides care for 
emergency medical conditions on an urgent basis without requiring a 
previously scheduled appointment; or
     During the calendar year immediately preceding the 
calendar year in which a determination under this section is being 
made, based on a representative sample of patient visits that occurred 
during the calendar year, it provides at least one-third of all its 
outpatient visits for the treatment of emergency medical conditions on 
an urgent basis without requiring a previously scheduled appointment.''
    As specified in Sec.  413.65, provider-based status means ``the 
relationship between a main provider and a provider-based entity or a 
department of a provider, remote location of a hospital, or satellite 
facility that complies with the provisions.'' Including provider-based 
status in the definition of a qualifying ED reflects the common 
ownership of the hospital and the distinct part psychiatric unit.
    As discussed in the IPF PPS final rule, three steps were involved 
in the calculation of the ED adjustment factor.
    Step 1: We estimated the proportion by which the ED costs of a case 
would increase the cost of the first day of the stay. Using the IPFs 
with ED admissions in FY 2002, we divided their average ED cost per 
stay admitted through the ED ($198) by their average cost per day 
($715), which equals 0.28.
    Step 2: We adjusted the factor estimated in Step 1 to account for 
the fact that we would pay the higher first day adjustment for all 
cases in the qualifying IPFs, not just the cases admitted through the 
ED. Since on average, 44 percent of the cases in IPFs with ED 
admissions are admitted through the ED, we multiplied 0.28 by 0.44, 
which equals 0.12.
    Step 3: We added the adjusted factor calculated in the previous 2 
steps to the variable per diem adjustment derived from the regression 
equation that we used to derive our other payment adjustment factors. 
The first day payment factor from this regression is 1.19. Adding the 
0.12, we obtained a first day variable per diem adjustment for IPFs 
with a qualifying ED equal to 1.31.
    The ED adjustment is made on every qualifying claim except as 
described below. As specified in Sec.  412.424(d)(1)(V)(B), the ED 
adjustment is not made where a patient is discharged from an acute care 
hospital or CAH and admitted to the same hospital's or CAH's 
psychiatric unit. An ED adjustment is not made in this case because the 
costs associated with ED services are reflected in the DRG payment to 
the acute care hospital or through the reasonable cost payment made to 
the CAH. As we explained in the IPF PPS final rule, if we provided the 
ED adjustment in these cases, the hospital would be paid twice for the 
overhead costs of the ED (69 FR 66960).
    Therefore, when patients are discharged from an acute care hospital 
or CAH and admitted to the same hospital's or CAH's psychiatric unit, 
the IPF receives the 1.19 adjustment factor as the variable per diem 
adjustment for the first day of the patient's stay in the IPF. As with 
other adjustment factors under the IPF PPS, we do not intend to conduct 
a new regression analysis for this IPF PPS update. Rather, we intend to 
wait until we can analyze 1 year of IPF PPS claims and cost report 
data. Therefore, we are proposing to retain the 1.31 adjustment factor 
for IPFs with qualifying EDs for the rate year beginning July 1, 2006. 
As we indicated in the final rule, in FY 2002, one third of the IPFs 
admissions were through the ED. Commenters on the IPF PPS proposed rule 
indicated that the percentage of admissions through the ED were 
understated. We plan to monitor claims data to determine the number of 
IPF admissions admitted through the ED.

[[Page 3642]]

a. Proposed New Source of Admission Code To Implement the ED Adjustment
    In order to ensure that the ED adjustment is not paid for patients 
who are discharged from an acute care hospital or CAH and admitted to 
the same hospital's or CAH's psychiatric unit, we directed IPFs to 
enter source of admission code 4 (transfers from hospital inpatient) on 
those claims. The source of admission code is a required field on 
Medicare claims and indicates the source of the patient admissions. 
However, as we have implemented the IPF PPS, we have realized that 
admission code 4 is too broad to distinguish these claims because it 
reflects transfers from any acute care hospital or CAH. Currently, 
where admission code 4 is entered on a claim, the ED adjustment is not 
paid, even if the patient is transferred from a different acute 
hospital or CAH.
    In order to pay these IPF claims appropriately, CMS requested a new 
source of admission code from the National Uniform Billing Committee to 
identify transfers from the same hospital or CAH. On June 7, 2005, the 
National Uniform Billing Committee granted our request to establish a 
new source of admission code to indicate transfers from the same 
hospital or CAH. The new source of admission code ``D'' is effective 
April 1, 2006. We are proposing that the new code would be used by IPFs 
to identify IPF patients who have been transferred to the IPF from the 
same hospital or CAH. Claims with source of admission code ``D'' would 
not receive the ED adjustment.
b. Applicability of the ED Adjustment to IPFs in Critical Access 
Hospitals
    The BBA created the CAH program, designed to represent a separate 
provider type to provide acute care services in rural areas. Generally, 
in order to qualify as a CAH, a hospital must be located in a rural 
area, provide 24-hour emergency care services, have an average length 
of stay of 96 hours or less, operate up to 25 beds for inpatient 
critical access care, be located more than 35 miles from a hospital or 
another CAH or more than 15 miles in mountainous terrain or only 
secondary roads, or be certified by the State as of December 31, 2005 
as being a ``necessary provider'' of health care services to residents 
in the area.
    Section 405(g) of the MMA authorizes CAHs to establish distinct 
part psychiatric and rehabilitation units of up to 10 beds effective 
for cost reporting periods beginning on or after October 1, 2004. 
Services in these units are paid under the payment methodology that 
would apply if such services were provided in a distinct part 
psychiatric or rehabilitation unit of a hospital. As a result, IPFs 
that are distinct part units of CAHs are paid the same as if they were 
a distinct part unit of a hospital. Otherwise, the CAH is paid on a 
reasonable cost basis for inpatient critical access services.
    In the IPF PPS final rule, we amended Sec. 413.70(e) to clarify 
that payments for services of distinct part psychiatric units in CAHs 
are made in accordance with the IPF PPS. In order to pay CAHs the same 
as other IPFs, CAHs would be subject to the 1-day preadmission services 
bundling provision specified in Sec.  413.40(c)(2) for patients who are 
admitted to the CAH's IPF. As a result, the cost of preadmission 
services, including ED services furnished to CAH IPF patients would be 
allocated to the IPF.

D. Other Payment Adjustments and Policies

[If you choose to comment on issues in this section, please include the 
caption ``OTHER ADJUSTMENTS AND POLICIES'' at the beginning of your 
comments.]

    The IPF PPS includes the following payment adjustments: (1) An 
outlier policy to promote access to IPF care for those patients who 
require expensive care and to limit the financial risk of IPFs treating 
unusually costly patients; (2) a stop-loss provision, applicable during 
the transition period, to reduce financial risk to IPFs projected to 
experience substantial reductions in Medicare payments under the IPF 
PPS; (3) an interrupted stay policy to avoid overpaying stays that 
include a brief absence from the IPF followed by readmission to the 
IPF; and (4) a payment for patients who receive ECT. We are proposing 
to update those policies in this proposed rule. We are also proposing 
clarifications to the physician certification and recertification 
requirements in order to ensure consistent practices across IPFs. In 
addition, we are clarifying coverage of recreation therapy.
1. Outlier Payments
    In the IPF PPS final rule, we implemented regulations at Sec.  
412.424(d)(3)(i) to provide a payment adjustment for IPF stays that 
have extraordinarily high costs. Providing additional payments for 
outlier cases to IPFs that are beyond the IPF's control strongly 
improves the accuracy of the IPF PPS in determining resource costs at 
the patient and facility level because facilities receive additional 
compensation over and above the adjusted Federal prospective payment 
amount for uniquely high-cost cases. These additional payments reduce 
the financial losses that would otherwise be caused by treating 
patients who require more costly care and, therefore, reduce the 
incentives to under-serve these patients.
    Under the IPF PPS, outlier payments are made on a per case basis 
rather than on a per diem basis because it is the overall financial 
``gain'' or ``loss'' of the case, and not of individual days, that 
determines an IPF's financial risk. In addition, because patient-level 
charges (from which costs are estimated) are typically aggregated for 
the entire IPF stay, they are not reported in a manner that would 
permit accurate accounting on a daily basis.
    Currently, we make outlier payments for discharges in which an 
IPF's estimated total cost for a case exceeds a fixed dollar loss 
threshold amount (multiplied by the IPF's facility-level adjustments) 
plus the Federal per diem payment amount for the case.
    In instances when the case qualifies for an outlier payment, we pay 
80 percent of the difference between the estimated cost for the case 
and the adjusted threshold amount for days 1 through 9 of the stay 
(consistent with the median length of stay for IPFs in FY 2002), and 60 
percent of the difference for day 10 and thereafter. We established the 
80 percent and 60 percent loss sharing ratios because we were concerned 
that a single ratio established at 80 percent (like other Medicare 
hospital PPSs) might provide an incentive under the IPF per diem 
payment system to increase length of stay in order to receive 
additional payments. After establishing the loss sharing ratios, we 
determined the current fixed dollar loss threshold amount of $5,700 
through payment simulations designed to compute a dollar loss beyond 
which payments are estimated to meet the 2 percent outlier spending 
target.
a. Proposed Update to the Outlier Fixed Dollar Loss Threshold Amount
    As indicated in section II.A of this proposed rule, in accordance 
with the update methodology described in Sec.  412.428(d), we are 
proposing to update the fixed dollar loss threshold amount used under 
the IPF PPS outlier policy. Based on the regression analysis and 
payment simulations used to develop the IPF PPS, we established a 2 
percent outlier policy to make an appropriate balance between 
protecting IPFs from extraordinarily costly cases while ensuring the 
adequacy of the Federal

[[Page 3643]]

per diem base rate for all other cases that are not outlier cases.
    We continue to believe a 2 percent outlier policy is an appropriate 
target percentage and are proposing to retain the 2 percent outlier 
policy. However, we believe it is necessary to update the fixed dollar 
loss threshold amount because analysis of the latest available data 
indicates adjusting the fixed dollar loss amount is necessary in order 
to maintain an outlier percentage that equals 2 percent of total 
estimated IPF PPS payments. We intend to continue to analyze estimated 
outlier payments for subsequent years using the best available data in 
order to maintain estimated outlier payments at 2 percent of total 
estimated IPF PPS payments.
    We have determined that in certain sections of the IPF PPS final 
rule, we used the phrase ``Fixed-dollar loss threshold'' and, in other 
sections, we used the phrase ``Fixed-dollar loss amount'' to describe 
the dollar amount by which the costs of a case exceed payment in order 
to qualify for an outlier payment. In order to avoid confusion 
regarding these phrases, we are proposing to use the term ``fixed-
dollar loss threshold amount'' when we are referring to the dollar 
amount by which the costs of a case exceed payment in order to qualify 
for an outlier payment.
    As a result of this clarification, in Sec.  412.402, we are 
proposing to revise the term ``Fixed dollar loss threshold'' to ``Fixed 
dollar loss threshold amount.'' We are also proposing clarifying 
changes to Sec.  412.424(d)(3)(i) and Sec.  412.424(d)(3)(i)(A) to 
state that we would provide an outlier payment if an IPF's estimated 
total cost for a case exceeds a ``fixed dollar loss threshold amount'' 
plus the total IPF adjusted payment amount for the stay, and that it is 
the fixed dollar loss threshold amount that is adjusted by the IPF's 
facility-level adjustments.
    Aside from updating the terminology ``fixed dollar loss threshold 
amount'' and making the conforming changes to the regulation text 
described above, we are not proposing any other changes to the outlier 
policy. Therefore, we would continue to adjust the fixed dollar loss 
threshold amount by the applicable facility-level payment adjustments 
and add this amount to the IPF PPS payment amount in order to determine 
if a case qualifies for an outlier payment. For cases that meet the 
threshold amount, we would pay 80 percent for days 1 through 9 and 60 
percent for day 10 and thereafter.
    In the IPF PPS final rule, we described the process by which we 
calculate the outlier fixed dollar loss threshold amount. We are 
proposing to continue to use this process in this proposed rule. We 
begin by simulating aggregate payments with and without an outlier 
policy, and applying an iterative process to a fixed dollar loss amount 
that would result in outlier payments being equal to 2 percent of total 
simulated payments under the simulation. Based on this process, we are 
proposing $6200 as the fixed dollar loss threshold amount in the 
outlier calculation in order to maintain the proposed 2 percent outlier 
policy.
    We note that the simulation analysis used to calculate the proposed 
$6200 fixed dollar loss threshold amount includes all of the proposed 
changes to the IPF PPS discussed in this proposed rule. As a result, 
for the RY beginning July 1, 2006, the final fixed dollar loss 
threshold amount is subject to change in the final rule depending on 
the policies contained in the final rule.
b. Proposed Statistical Accuracy of Cost-to-Charge Ratios
    As stated previously, under the IPF PPS, an outlier payment is made 
if an IPF's cost for a stay exceeds a fixed dollar loss threshold 
amount. In order to establish an IPF's cost for a particular case, we 
multiply the IPF's reported charges on the discharge bill by their 
overall cost to charge ratio (CCR). This approach to determining a 
provider's cost is consistent with the approach used under the IPPS and 
other prospective payment systems. In FY 2004, we implemented changes 
to the IPPS outlier policy used to determine CCRs for acute care 
hospitals because we became aware that payment vulnerabilities resulted 
in inappropriate outlier payments. Under the IPPS, we established a 
statistical measure of accuracy for CCRs in order to ensure that 
aberrant CCR data did not result in inappropriate outlier payments. As 
we indicated in the IPF PPS final rule, because we believe the IPF 
outlier policy is susceptible to the same payment vulnerabilities as 
the IPPS, we adopted an approach to ensure the statistical accuracy of 
CCRs under the IPF PPS. Therefore, we adopted the following two 
procedures in the IPF PPS final rule:
     We calculated two national ceilings, one for IPFs located 
in rural areas and one for IPFs located in urban areas. We computed the 
ceilings by first calculating the national average and the standard 
deviation of the CCR for both urban and rural IPFs.
    To determine the rural and urban ceilings, we multiplied each of 
the standard deviations by 3 and added the result to the appropriate 
national CCR average (either rural or urban). The current upper 
threshold CCR for IPFs is 1.8853 for rural IPFs, and 1.8040 for urban 
IPFs, based upon MSA-based geographic designations. If an IPF's CCR is 
above the applicable ceiling, the ratio is considered statistically 
inaccurate and we assign the appropriate national (either rural or 
urban) median CCR to the IPF.
    Additional information regarding the national median CCRs is 
included in the IPF PPS final rule (69 FR 66961).
     We do not apply the applicable national median CCR when an 
IPF's CCR falls below a floor. We made this decision because using the 
national median CCR in place of the provider's actual CCR would 
overstate the IPF's costs. We are proposing to apply the national CCRs 
to the following situations:
    ++ New IPFs that have not yet submitted their first Medicare cost 
report.
    ++ IPFs whose operating or capital CCR is in excess of 3 standard 
deviations above the corresponding national geometric mean (that is, 
above the ceiling).
    ++ Other IPFs for whom the fiscal intermediary obtains inaccurate 
or incomplete data with which to calculate either an operating or 
capital CCR or both.
    The current national CCRs were estimated to be 0.7115 for rural 
IPFs and 0.5658 for urban IPFs and would be used in each of the three 
situations cited above. These estimates were based on the IPF's 
location (either urban or rural) using the MSA-based geographic 
designations. For new facilities, we are proposing to use these 
national ratios until the facility's actual CCR can be computed using 
the first tentatively settled or final settled cost report, which would 
then be used for the subsequent cost report period.
    We are not proposing any changes to the procedures for ensuring the 
statistical accuracy of CCRs in RY 2007. However, we are proposing to 
update the national urban and rural CCRs (ceilings and medians) for 
IPFs for RY 2007 based on the full calendar year 2005 CCRs entered in 
the Provider-Specific File. In addition, we are proposing that the 
updated ceilings and national median CCRs would be based on CBSA-based 
geographic designations because the CBSAs are the geographic 
designations we are proposing to adopt for purposes of computing the 
proposed wage index adjustment to IPF payments beginning July 1, 2006. 
We would include the updated ceiling and national median CCRs in the 
final RY 2007 regulations.

[[Page 3644]]

    In subsequent years, we are proposing to update the national urban 
and rural CCRs (median and ceilings) based on the previous full 
calendar year's Provider-Specific File. These CCRs would be announced 
in each year's annual notice of prospective payment rates published in 
the Federal Register. We are proposing to add a new paragraph (g) to 
Sec.  412.428 to clarify that we intend to update the national urban 
and rural ceilings and medians as part of the annual update of the IPF 
PPS and to specify when the national median urban and rural CCRs would 
be used.
1. Proposed Stop-Loss Provision
    In the IPF PPS final rule, we implemented a stop-loss policy to 
reduce financial risk for those facilities expected to experience 
substantial reductions in Medicare payments during the IPF PPS 
transition period. This stop-loss policy guarantees that each facility 
receives total IPF PPS payments that are no less than 70 percent of its 
TEFRA payments, had the IPF PPS not been implemented.
    This policy is applied to the IPF PPS portion of Medicare payments 
during the 3-year transition. Hence, during year 1, three-quarters of 
the payment were based on TEFRA and one-quarter on the IPF PPS. Under 
the 70 percent policy, 75 percent of total payment is TEFRA payments, 
and the 25 percent is IPF PPS payments, which are at least 70 percent 
of the TEFRA payments. The resulting 92.5 percent of TEFRA payments in 
year 1 is the sum of 75 percent and 25 percent times 70 percent.
    In year 2, one-half of the payment will be based on TEFRA and one-
half on the IPF PPS. In year 3, one-quarter of the payment will be 
based on TEFRA and three-quarters on the IPF PPS. In year 4 of the IPF 
PPS, Medicare payments are based 100 percent on the IPF PPS.
    The combined effects of the transition and the stop-loss policies 
will be to ensure that the total estimated IPF PPS payments were no 
less than 92.5 percent in year 1, 85 percent in year 2, and 77.5 
percent in year 3.
    The 70 percent of TEFRA payment stop-loss policy will require a 
reduction in the Federal per diem and ECT base rates of 0.39 percent in 
order to make the stop-loss payments budget neutral. We estimate that 
about 10 percent of IPFs would receive stop-loss payments under the 70 
percent policy.
    We are not proposing to make any changes to the stop-loss policy.
2. Patients Who Receive Electroconvulsive Therapy (ECT)
    In developing the IPF PPS, we received numerous public comments 
recommending that we include a payment adjustment for patients who 
receive ECT treatments during their IPF stay because furnishing ECT 
treatment, either directly or under arrangements, adds significantly to 
the cost of these stays. When we analyzed the FY 2002 MedPAR data, we 
found that ECT cases comprised about 6 percent of all cases and that 
almost 95 percent of ECT cases were treated in IPFs that are 
psychiatric units of acute care hospitals. Even among psychiatric 
units, ECT cases are concentrated among a relatively small number of 
facilities. Overall, approximately 450 facilities had cases with ECT. 
Among these facilities, we estimated the mean number of ECT cases per 
facility to be approximately 25. In addition, approximately one-half of 
the IPFs providing ECT had no more than 15 cases in FY 2002.
    Our analysis confirmed that cases with ECT are substantially more 
costly than cases without ECT. We found that on a per case basis, ECT 
cases are approximately twice as expensive as non-ECT cases ($16,287 
compared to $7,684). Most of this difference is due to variation in 
length of stay (20.5 days for ECT cases compared to 11.6 days for non-
ECT cases). In addition, the ancillary costs per case for ECT cases are 
$2,740 higher than those for non-ECT cases.
    Although we are able to determine the cost of stays with ECT, we 
are unable to develop an ECT cost per treatment using the FY 2002 IPF 
claims data because the claims do not include the number of treatments. 
As a result, in the IPF PPS final rule, we established the following 
methodology for calculating the IPF PPS ECT payment adjustment.
    We established an ECT base rate using the pre-scaled and pre-
adjusted median hospital cost for CPT procedure code 90870 used for 
payment under hospital outpatient PPS (OPPS), based on hospital claims 
data. The median cost for all OPPS services are posted after 
publication of the OPPS proposed rule at the following address: http://www.cms.hhs.gov/hospitaloutpatientPPS. We used unadjusted hospital 
claims data under the OPPS, that is, the pre-scaled and pre-adjusted 
median hospital cost per treatment, to establish the ECT base rate 
because we did not want the ECT payment under the IPF PPS to be 
affected by factors that are relevant to OPPS but not specifically 
applicable to IPFs. The median cost ($311.88) was then standardized and 
adjusted for budget neutrality, resulting in an ECT payment adjustment 
of $247.96 per treatment. The ECT base rate is adjusted for wage and 
COLA differences in the same manner that we adjust the Federal per diem 
base rate.
    In order to receive the payment adjustment, IPFs must indicate on 
their claims the revenue code for ECT (901), along with the total 
number of units (ECT treatments) provided to the patient during their 
IPF stay. In addition, IPFs must include the ICD-9-CM procedure code 
for ECT (94.27) and the date of the last ECT treatment the patient 
received.
    As we stated in the IPF PPS final rule, although we established the 
ECT adjustment as a distinct payment under the IPF PPS, our preferred 
approach would be to include a patient level adjustment as a component 
of the model (for example, determined through the regression analyses) 
to account for the higher costs associated with ECT (69 FR 66951). 
Although our analysis will continue, we do not intend to redo the 
regression analysis until we are able to analyze 1 year of IPF PPS 
claims and cost report data. However, we believe the data currently 
being submitted by IPFs may permit development of an IPF-specific ECT 
base rate, rather than using hospital outpatient claims data.
    It is important to note that since ECT treatment is a specialized 
procedure, not all providers are equipped to provide the treatment. 
Therefore, many patients who need ECT treatment during their IPF stay 
must be referred to other providers to receive the ECT treatments, and 
then return to the IPF. In accordance with Sec.  412.404(d)(3), in 
these cases where the IPF is not able to furnish necessary treatment 
directly, the IPF would furnish ECT under arrangements with another 
provider. While a patient is an inpatient of the IPF, the IPF is 
responsible for all services furnished, including those furnished under 
arrangements by another provider. As a result, the IPF claim for these 
cases should reflect the services furnished under arrangements by other 
providers.
    Therefore, in accordance with the update methodology specified in 
Sec.  412.428(f), we are proposing to update the ECT base rate using 
the pre-scaled pre-adjusted hospital median cost for ECT used for the 
CY 2006 update of the OPPS. The median cost would then be standardized, 
adjusted for budget neutrality, and adjusted for wage and COLA 
differences in the same manner that we adjust the per diem rate.
    We are proposing to pay the median cost for an ECT treatment, 
posted as part of the calendar year (CY) 2006 OPPS update, which is 
based on CY 2004 outpatient hospital claims. The median cost is 
$324.44. After applying the standardization factor and the wage index 
budget neutrality factor (as

[[Page 3645]]

described in section III.C.1.f. of this proposed rule), the adjusted 
proposed ECT payment for RY 2007 is $268.21.
    We would monitor this area to ensure that the increased payments 
for ECT do not lead to changes in the frequency of utilization by 
reviewing the CY 2005 MedPAR claims data.
3. Physician Certification and Recertification Requirements
    Since the publication of the IPF PPS final rule, we have received 
inquiries related to physician certification and recertification. It 
appears that some psychiatric units in acute care hospitals have been 
following the timeframes that are applicable to the acute care hospital 
of which they are a part (as specified in Sec.  424.13) rather than 
those that apply to psychiatric hospitals (as specified in Sec.  
424.14).
    To eliminate the confusion that we believe may be caused by the 
titles of Sec.  424.13 and Sec.  424.14, to ensure consistency in 
compliance of the requirements among all IPFs, we are proposing to 
revise the title of Sec.  424.14 from ``Requirements for inpatient 
services of psychiatric hospitals'' to ``Requirements for inpatient 
services of inpatient psychiatric facilities.'' We are proposing that 
for the purposes of payment under the IPF PPS, all IPFs would follow 
the physician certification and recertification requirements as 
specified in Sec.  424.14.
    In the IPF proposed rule published on November 28, 2003 (68 FR 
66920), we proposed to--(1) amend Sec.  424.14 to state that in 
recertifying a patient's need for continued inpatient care in an IPF, a 
physician must indicate that the patient continues to need, on a daily 
basis, inpatient psychiatric care (furnished directly by or requiring 
the supervision of IPF personnel) or other professional services that, 
as a practical matter, can be provided only on an inpatient basis; and 
(2) revise Sec.  424.14(d) to require that a physician recertify a 
patient's continued need for inpatient psychiatric care on the 10th day 
following admission to the IPF rather than the 18th day following 
admission to the IPF (68 FR 66939).
    However, in the IPF PPS final rule, we did not include the proposed 
physician recertification requirement changes because most of the 
public comments we received on this issue did not support the proposed 
changes and indicated that there are inconsistencies in the timeframes 
currently required for IPFs that warranted additional analysis. 
Instead, we stated that we would continue to require that a physician 
recertify a patient's continued need for inpatient psychiatric care on 
the 18th day following admission to the IPF.
    Since publication of the final rule, we have received additional 
inquiries related to the physician certification and recertification 
timeframes that currently apply to IPFs. As noted above, it appears 
that some psychiatric units in acute care hospitals have been following 
the timeframes that are applicable to the acute care hospital of which 
they are a part (as specified in Sec.  424.13) rather than those that 
apply to psychiatric hospitals (as specified in Sec.  424.14). Section 
424.13(d) requires the initial certification no later than as of the 
12th day of hospitalization and the first recertification is required 
no later than as of the 18th day of hospitalization. Section Sec.  
424.14(d) requires certification at the time of admission or as soon 
thereafter as is reasonable and practicable and the first 
recertification is required as of the 18th day of hospitalization.
    We are proposing that, for purposes of payment under the IPF PPS, 
all IPFs (distinct part units of acute care hospitals and CAHs and 
psychiatric hospitals) would meet the following physician certification 
and recertification timeframes. We would revise Sec.  424.14(d) to 
provide that the initial physician certification would be required at 
the time of admission or as soon thereafter as is reasonable and 
practicable and the first recertification would be required as of the 
12th day of hospitalization. Subsequent recertifications would be 
required at intervals established by the hospital's UR committee (on a 
case-by-case basis if desired), but no less frequently than every 30 
days. We chose the 12th day because it is more in line with the average 
LOS and it is current practice for certification in psychiatric units.
    We have also received inquiries from Fiscal Intermediaries 
requesting guidance on the content requirement of physician 
certifications at Sec.  424.14(c), relating to the medical necessity of 
continued inpatient psychiatric care. As a result, we are proposing to 
add language to clarify that for purposes of payment under the IPF PPS, 
the physician would also recertify that the patient continues to need, 
on a daily basis, active treatment furnished directly by or requiring 
the supervision of inpatient psychiatric facility personnel.
4. Provision of Therapeutic Recreation in IPFs
    Before the implementation of the IPPS payment methodology, Medicare 
coverage guidelines gave specific recognition to therapeutic recreation 
in inpatient psychiatric hospitals. The guidelines in Sec.  3102.1.A of 
the Medicare Intermediary Manual, Part 3 (MIM-3), and in Sec.  212.1 of 
the Medicare Hospital Manual (which now appear in the CMS Internet 
Online Manual at Pub. 100-02, Chapter 2, Sec. Sec.  20.1ff.) 
specifically identify therapeutic recreation as one of the services 
that can constitute ``active treatment'' in this setting when they 
are--
     Provided under an individualized treatment or diagnostic 
plan;
     Reasonably expected to improve the patient's condition or 
for the purpose of diagnosis; and
     Supervised and evaluated by a physician.
    However, these guidelines refer to therapeutic recreation in terms 
of being an ``adjunctive'' therapy, indicating that even in this 
setting, it would not independently serve as a patient's sole or 
primary form of therapeutic treatment, but rather, would be furnished 
in support of (but subordinate to) some other, primary form of therapy.
    When the IPPS was developed in 1983, to the extent that therapeutic 
recreation and other services had been furnished during the IPPS base 
period, the bundled IPPS payment for that setting would reflect these 
costs. However, during the IPPS rulemaking process, we received public 
comments stating ``* * * concern that the cost-saving incentives of the 
prospective payment system would lead hospitals paid under the system 
to stop providing recreational therapy services.'' In response, in the 
January 3, 1984 IPPS final rule (49 FR 242) we indicated that 
implementation of the IPPS would not, in fact, prohibit the provision 
of recreational therapy services, and that ``* * * these services will 
continue to be covered to the same extent they always have been under 
existing Medicare policies''.
    In implementing the IPPS regulations, we included criteria for 
identifying certain types of institutions (for example, psychiatric 
hospitals) that would be excluded from the IPPS and, thus, would 
continue to be paid under some other methodology. The regulations also 
introduced criteria for identifying an IPPS-excluded inpatient 
psychiatric unit housed within a larger acute-care hospital that would 
itself be subject to the IPPS. One of these identifying criteria at 42 
CFR 405.471(c)(4)(ii)(B) (later recodified at 42 CFR 412.27(b)) was the 
provision, through the use of qualified personnel, of a number of 
specified types of services, including psychological services, social 
work services,

[[Page 3646]]

psychiatric nursing, occupational therapy, and recreational therapy.
    As we explained in the IPPS interim final rule published on 
September 1, 1983 (48 FR 39758), the regulations designated these 
particular services because their provision ``* * * is typical of units 
which treat patients whose characteristics are like those in 
psychiatric hospitals. Consequently, the provision of these services is 
an identifier of such a patient population''. We note that the 
designation of these particular services in this context did not serve 
to define the scope of their coverage under Medicare, nor to mandate 
their provision in this setting, but merely to identify them as being 
characteristic of the type of psychiatric unit that would qualify for 
exclusion from the IPPS.
    At the same time the IPPS was being developed, a parallel evolution 
was taking place in the certification requirements that facilities must 
meet in order to participate in the Medicare program: A shift from 
primarily ``process-oriented'' requirements to more ``outcome-
oriented'' requirements, which focus more on direct indicators of the 
quality of care actually being furnished to the facility's patients (as 
reflected in the presence of positive results and the absence of 
negative ones), and less on the specific ``process'' through which the 
facility achieves the desired outcome.
    In order to participate in the Medicare program, psychiatric 
hospitals not only had to meet the conditions of participation (COPs) 
that apply to general, acute-care hospitals, but additionally had to 
meet special conditions related to medical records and staffing. 
Consistent with the recognition of therapeutic recreation as 
constituting active treatment in this one particular setting (as 
discussed above), the original COPs for psychiatric hospitals at 42 CFR 
405.1038(g) mandated the presence of qualified therapists, assistants, 
or aides ``* * * sufficient in number to provide comprehensive 
therapeutic activities, including at least occupational, recreational 
and physical therapy, as needed, to assure that appropriate treatment 
is rendered for each patient, and to establish and maintain a 
therapeutic milieu.'' Furthermore, 42 CFR 405.1038(g)(3) further 
specified that ``recreational or activity therapy services are 
available under the direct supervision of a member of the staff who has 
demonstrated competence in therapeutic recreation programs,'' and 
Sec. Sec.  405.1038(g)(4) and (5) went on to prescribe additional 
standards regarding therapy assistants or aides and overall staffing 
for recreational and activity therapy.
    However, when the special medical record and staffing COPs for 
psychiatric hospitals were subsequently recodified at 42 CFR 482.62(g), 
the specific references to recreation therapy were deleted and replaced 
with a more general requirement to provide a therapeutic activities 
program. In response to public comments that recommended us to restore 
the deleted requirements, we indicated that we believe that the deleted 
requirements concerning therapeutic activities were overly and 
unnecessarily prescriptive and that the hospital should have the 
flexibility to determine which activities are most appropriate to its 
patient population and to determine the criteria to be met by employees 
providing these services. (see the IPPS PPS rule published on June 17, 
1986 (51 FR 22032)).
    When the 1986 COP changes applicable to psychiatric hospitals were 
made, we inadvertently retained specific references to recreation 
therapy in Sec.  412.27. Since the intent of Sec.  412.27(b) is to 
identify services provided in psychiatric units that are characteristic 
of services furnished in psychiatric hospitals, we believe it is no 
longer appropriate to include references to specific therapies in Sec.  
412.27. In order to have consistent requirements among IPFs, we are 
proposing to remove recreational therapy from Sec.  412.27(b).
    Although we are proposing to remove the specific reference to 
recreation therapy, we want to emphasize that recreation therapy is, 
and would continue to be, an accepted therapeutic intervention in 
psychiatric treatment. In addition, we believe the IPF PPS base rate 
which was developed using FY 2002 data, reflects the provision of 
recreation therapy.
5. Same Day Transfers
    Currently, when a transfer, discharge, or death occurs on the same 
day as an admission to an IPF, the IPF PPS PRICER does not recognize 
any covered IPF days and the IPF claims are suspended. Based on review 
of a limited sample of the IPF and subsequent IPPS claims, it appears 
that many of these patients are first seen in a hospital's ED, are 
admitted to the hospital's psychiatric unit and, later the same day, 
determined to be too medically compromised to be managed in the 
psychiatric unit. This scenario may occur because the patient presents 
at the ED and is admitted to the psychiatric unit in the middle of the 
night, and when the patient's admission to the unit is reviewed by a 
psychiatrist the next morning, the physician determines that the 
patient should be discharged for acute care. In other cases, a patient 
may have been admitted to a freestanding psychiatric hospital based on 
the information furnished by an ED of an acute care hospital. However, 
after admission, the psychiatric hospital staff evaluates the patient 
and determines that the patient has medical needs that they are not 
staffed or equipped to meet.
    The Provider Reimbursement Manual addresses the same day transfer 
issue from the perspective of counting Medicare days for the purpose of 
Medicare cost reporting. Section 2205 indicates that only full patient 
days may be used to apportion inpatient routine care service costs and 
that a day begins at midnight and ends 24 hours later. However, section 
2205.1 explains how to count a day if the day of admission and the day 
of discharge are the same. Section 2205.1 indicates that when a patient 
is admitted and then transferred from one participating provider to 
another before midnight of the same day, a day (except for utilization 
purposes) is counted at both providers. A day of Medicare utilization 
is charged only for the admission to the second provider. This 
distinction is important for psychiatric admissions because IPF stays 
are subject to the 190-day lifetime limit on inpatient psychiatric 
care.
    Section 1812(b) of the Act and 42 CFR 409.62 indicate that payment 
is not available for inpatient psychiatric hospital services furnished 
beyond the 190-day lifetime limit. Thus, Medicare coverage of IPF 
services, specifically IPF services furnished in freestanding 
psychiatric hospitals is limited to 190 days. In consideration of the 
limit on coverage of IPF services, where there is a same day transfer 
between Medicare participating providers, we only count the second 
admission for utilization purposes. Therefore, the initial admission to 
the IPF does not count against a beneficiary's lifetime psychiatric 
services limit.
    We have some concerns regarding same day transfers from an IPF. 
Under TEFRA, a hospital receives its cost up to the hospital's TEFRA 
limit. The TEFRA limit is based on the hospital's average cost per 
discharge in a base period. When an admission and discharge occur on 
the same day, the hospital's cost is unlikely to exceed the TEFRA 
limit, so the hospital receives its cost for the day. These same day 
transfers also improve the hospital's payment under TEFRA by slightly 
reducing its cost per discharge. We are also concerned that when the 
transfer occurs in the same hospital, this practice circumvents 
bundling rules

[[Page 3647]]

under the IPPS, in that it unbundles the ED charges from the IPPS claim 
and allocates the ED costs to the psychiatric unit even though the 
patient may have been inappropriately admitted to the unit.
    Based on the review of IPF PPS claims we conducted, it did not 
appear that the admissions to the IPF were medically reasonable and 
necessary. However, we believe it is important to base a decision 
regarding coverage of these days on a comprehensive review of the 
claims. Therefore, we are not proposing a change in payment policy in 
this proposed rule. However, we are considering several alternative 
methods for addressing same day transfers under the IPF PPS which are 
described below. Any change to treatment of same day transfers would be 
made prospectively.
    We could treat these days as covered days under the IPF PPS. 
However, under the IPF PPS, a 19 percent adjustment to the base rate is 
applied to day 1 of the stay to reflect the additional administrative 
and clinical costs associated with admission and the day 1 adjustment 
is increased to 31 percent when the IPF has a qualifying ED. The IPF 
may also receive, for example, a teaching adjustment or rural 
adjustment, for these partial days of care. Several of the claims in 
our analysis indicate a stay of 2 hours. We are concerned that this 
approach would overpay IPFs and encourage inappropriate admissions and 
transfers.
    Another option would be to make no PPS payment, but continue making 
TEFRA payments during the IPF PPS transition period. For example, for 
cost reporting periods beginning in 2006, IPFs will receive a blended 
payment consisting of 50 percent PPS and 50 percent TEFRA. Therefore, 
under this approach we would allow some payment for these days for cost 
reporting periods in 2006 and 2007, but once the IPF PPS transition 
period is over, the IPFs would receive no payment for these days. We 
think this approach would encourage changes in admission practices in 
order to avoid the need to transfer patients. However, once the IPF PPS 
transition is over, there would be no payment mechanism to pay IPFs for 
stays in which there is a circumstance, not reasonably foreseeable by 
the admitting IPF such as a serious change in health status on the day 
of admission.
    We could treat these same day transfer cases as covered days under 
the IPF PPS but limit payment to the Federal per diem base rate or some 
other payment amount, for example, half the Federal per diem base rate. 
This approach would limit payment to IPFs in order to provide an 
incentive for IPFs to make medical clearance determinations as early in 
the IPF stay as possible. However, we are concerned that this approach 
would not lead to changes in admission practices to avoid inappropriate 
admissions and the need for subsequent transfers.
    It is important to note that the cost for these days was included 
in the cost reports used to develop the IPF PPS, and, as a result, the 
average cost per day that was used to establish the Federal per diem 
base rate is higher than it would otherwise have been had those days 
not been included.
    We specifically request public comment from IPFs on this issue to 
help us to develop a payment policy that pays IPFs appropriately for 
these days and provides an incentive to avoid same day transfers 
wherever possible.

V. Provisions of the Proposed Rule

[If you choose to comment on issues in this section, please include the 
caption ``PROVISIONS'' at the beginning of your comments.]

    We are proposing to make revisions to the regulation in order to 
implement the proposed prospective payment for IPFs for discharges 
occurring during the RY beginning July 1, 2006. As part of the update, 
we are proposing to incorporate OMB's revised definitions for MSAs and 
its new definitions of Micropolitan Statistical Areas and Core-Based 
Statistical Areas. In addition, we are proposing the following--
     Update payments for IPF facilities using a market basket 
reflecting the operating and capital cost structures for the RPL market 
basket.
     Develop cost weights for benefits, contract labor, and 
blood and blood products using the FY 2002-based IPPS market.
     Provide weights and proxies for the FY 2002-based RPL 
market basket.
     Indicate the methodology for the capital portion of the FY 
2002-based RPL market basket.
     Update the outlier threshold amount to maintain total 
outlier payments at 2 percent of total estimated payments.
     Use source code ``D'' to identify IPF patients who have 
been transferred to the IPF from the same hospital or CAH.
     Retain the 17 percent adjustment for IPFs located in rural 
areas, the 1.31 adjustment for IPFs with a qualifying ED, the 0.5150 
teaching adjustment to the Federal per diem base rate, and the DRG 
adjustment factor currently being paid to IPFs for discharges occurring 
during RY 2007.
     Update the payment rate for ECT.
     Update the DRG listing and comorbidity categories to 
reflect the ICD-9-CM revisions effective October 1, 2005.
    In addition to discussing these general issues in the IPF PPS 2007 
RY, we also proposed making the following specific revisions to the 
existing text of the regulations. Specifically, we are proposing to 
make conforming changes in 42 CFR part 412 and 424 as discussed through 
out this preamble.
    In Sec.  412.27, we are proposing to revise paragraph (b) to remove 
the reference to recreational therapy.
    In Sec.  412.402, we are proposing to revise the heading of ``Fixed 
dollar loss-threshold'' to ``Fixed dollar loss threshold amount'' and 
revise the definitions of ``Fixed dollar loss threshold amount'', 
``Qualifying emergency department'', ``Rural area'' and ``Urban area.'' 
For consistency, we are proposing to make conforming changes to these 
terminologies wherever they appear in the regulations text.
    In Sec.  412.424, we are also proposing to add paragraph 
(d)(1)(iii)(E) to clarify that the teaching adjustment is made on a 
claim basis as an interim payment and the final payment in full is made 
during the final settlement of the cost report. For clarity, we are 
proposing to revise paragraph (d)(2) introductory text. The current 
language in (d)(2)(iii) would become the introductory text for 
paragraph (d)(2) and paragraph (d)(2)(iii) would be removed. In 
addition, we are proposing to revise Sec.  412.424(d)(3)(i)(A) to 
clarify that an outlier payment is made if an IPF's estimated total 
cost for a case exceeds a fixed dollar loss threshold amount plus the 
Federal payment amount for the case.
    In Sec.  412.426(a), we are proposing to correct the cross 
reference to the Federal per diem payment amount. We incorrectly 
referenced the Federal per diem base rate at Sec.  424.424(c). The 
correct cross reference to the Federal per diem payment amount is Sec.  
424.424(d).
    In Sec.  412.428, we are proposing to revise paragraph (b) to 
specify that for discharges occurring on or after January 1, 2005 but 
before July 1, 2006 the rate of increase factor for the Federal portion 
of the payment is based on the FY 1997-based excluded hospital with 
capital market basket and for discharges occurring on or after July 1, 
2006, the rate of increase factor for the Federal portion of the 
payment is based on the FY 2002-based RPL market basket.
    In addition, we are proposing to add a new paragraph (g) to state 
that we would update the national urban and rural cost to charge ratio 
median and ceiling. Paragraph (1) through (3) would

[[Page 3648]]

specify the types of IPFs in which to apply the national cost to charge 
ratio. Furthermore, we are proposing to add a new paragraph (h) to 
update the cost of living adjustment factors if appropriate.
    In Sec.  424.14, we are proposing to revise the title to read, 
``Requirements for inpatient services of inpatient psychiatric 
facilities,'' to ensure consistency in compliance with the requirements 
among all IPFs. We are proposing to add a new paragraph (c)(3) to 
clarify for purposes of payment under the IPF PPS, that the physician 
would also recertify that the patient continues to need, on a daily 
basis, active inpatient psychiatric care (furnished directly by or 
requiring the supervision of inpatient psychiatric facility personnel) 
or other professional services that can only be provided on an 
inpatient basis.
    In addition, we are revising paragraph (d)(2) to state that the 
first recertification is required as of the 12th day of 
hospitalization. Subsequent recertifications are required at intervals 
established by the UR committee (on a case-by-case basis if it so 
chooses), but no less frequently than every 30 days.

VI. Collection of Information Requirement

[If you choose to comment on issues in this section, please include the 
caption ``INFORMATION COLLECTION'' at the beginning of your comments.]

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

VII. Regulatory Impact Analysis

[If you choose to comment on issues in this section, please include the 
caption ``IMPACT'' at the beginning of your comments.]

A. Overall Impact

    We have examined the impact of this proposed rule 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 Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (UMRA) (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    Based on the impact analysis, we estimate the expenditures from the 
IPF PPS implementation year to the 2007 IPF PPS RY will be increased by 
$180 million. The updates to the IPF labor-related share and wage 
indices are made in a budget neutral manner and thus have no effect on 
estimated costs to the Medicare program. Therefore, the estimated 
increased cost to the Medicare program is the result of a combination 
of the updated IPF market baskets, which is offset by the transition 
blend and the revision of the standardization factor.
    CMS notes that aspects of the transition, including the stop-loss 
policy and the transition to the 50/50 percent blend in the 2007 IPF 
PPS RY and the transition to the 75/25 percent blend in the 2008 IPF 
PPS RY, were included in the 2004 final rule and are thus not 
incremental to this rulemaking. Nevertheless, it is essential to 
analyze the impact of the transition blend in order to calculate the 
increase in cost to the Medicare program.
    The impact of the transition blend is an approximately .2 percent 
(about $10 million) decrease in overall payments for the 2007 IPF PPS 
RY and the distribution of that impact is summarized in Table 15. 
Therefore, the impact attributable to the policy changes proposed in 
this rulemaking, primarily the market basket update and the 
standardization correction, is approximately $180 million in the 2007 
IPF PPS RY.
    Since costs to the Medicare program are estimated to be greater 
than $100 million, this proposed rule is considered a major economic 
rule, as defined in 5 U.S.C. 40(2).
    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 governmental 
jurisdictions. Most IPFs and most other providers and suppliers are 
considered 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 that set forth size 
standards for health care industries at 65 FR 69432.)
    HHS considers that a substantial number of entities are affected if 
the rule impacts more than 5 percent of the total number of small 
entities as it does in this rule. We included all freestanding 
psychiatric hospitals (79 are non-profit hospitals) in the analysis 
since their total revenues do not exceed the $29 million threshold. We 
also included psychiatric units of small hospitals, that is, those 
hospitals with fewer than 100 beds. We did not include psychiatric 
units within larger hospitals in the analysis because we believe this 
proposed rule would not significantly impact total revenues of the 
entire hospital that supports the unit. We have provided the following 
RFA analysis in section B to emphasize that, although the proposed rule 
would impact a substantial number of IPFs that were identified as small 
entities, we do not believe it would have a significant economic 
impact. Based on the analysis of the 1063 psychiatric facilities that 
were classified as small entities as described above, we estimate the 
combined impact of the IPF PPS will be a 4.6-percent increase in 
payments in RY 2007 relative to their payments in the implementation 
year of the IPF PPS. Based on the information available, we believe 
that Medicare payments may constitute a small portion of governmental 
IPF's revenue stream. We have prepared the impact analysis in section 
VI.B.2 to describe the impact of the proposed rule in order to provide 
a factual basis for our conclusions regarding small business impact.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a proposed 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 603 
of the RFA. With the exception of hospitals located in certain New 
England counties, for purposes of section 1102(b) of the Act, we 
previously defined a small rural hospital as a hospital with fewer than 
100 beds that is located outside of a Metropolitan Statistical Area 
(MSA) or New England County Metropolitan Area (NECMA). However, under 
the new labor market definitions that we are proposing to adopt, we 
would no longer employ NECMAs to define urban areas in New England. 
Therefore, for purposes of this analysis, we now define a small rural 
hospital as a hospital with fewer than 100 beds that is located outside 
of an MSA. We have determined that this proposed rule would have a 
substantial impact on hospitals classified as located in rural areas. 
As discussed earlier in this preamble, we are proposing to continue to 
provide a payment adjustment of 17 percent for IPFs

[[Page 3649]]

located in rural areas. In addition, we have established a 3-year 
transition to the new system to allow IPFs an opportunity to adjust to 
the new system. Therefore, the impacts shown in Table 15 below reflect 
the adjustments that are designed to minimize or eliminate any 
potentially significant negative impact that the IPF PPS may otherwise 
have on small rural IPFs.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any proposed rule whose mandates require spending in any 1 year 
of $100 million in 1995 dollars, updated annually for inflation. That 
threshold level is currently approximately $120 million. This proposed 
rule would not mandate any requirements for State, local, or tribal 
governments, nor would it affect private sector costs.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule that imposes 
substantial direct requirement costs on State and local governments, 
preempts State law, or otherwise has Federalism implications.
    We have reviewed this proposed rule under the criteria set forth in 
Executive Order 13132 and have determined that the proposed rule would 
not have any substantial impact on the rights, roles, and 
responsibilities of State, local, or tribal governments.

B. Anticipated Effects of the Proposed Rule

    We discuss below the impact of this proposed rule on the Federal 
Medicare budget and on IPFs.
1. Budgetary Impact
    As discussed in detail in the IPF PPS final rule and summarized in 
section III.B. of this proposed rule, we applied a budget neutrality 
factor to the Federal per diem and ECT base rates to ensure that total 
payments under the IPF PPS in the implementation period would equal the 
amount that would have been paid if the IPF PPS had not been 
implemented. In addition, as discussed in section IV.C.1 of this 
proposed rule, we are proposing to adopt the new CBSAs and labor market 
share in a budget neutral manner by applying a wage index budget 
neutrality factor to the Federal per diem and ECT base rates. Thus, the 
budgetary impact to the Medicare program by the update of the IPF PPS 
will be the combination of the proposed market basket updates (see 
section III.C of this proposed rule), the proposed revision of the 
standardization factor (see section III.B.3 of this proposed rule), and 
the planned update of the payment blend discussed below.
2. Impacts on Providers
    To understand the impact of the changes to the IPF PPS discussed in 
this proposed rule on providers, it is necessary to compare estimated 
payments under the IPF PPS rates and factors for the 2007 IPF rate year 
to estimated payments under the IPF PPS rates and factors for the IPF 
PPS implementation year. The estimated payments for the IPF 
implementation year are a blend of: 75 percent of the facility-specific 
TEFRA payment and 25 percent of the IPF PPS payment with stop loss 
payment. The estimated payments for the 2007 IPF rate year are a blend 
of: 50 percent of the facility-specific TEFRA payment and 50 percent of 
the IPF PPS payment with stop loss payment. We determined the percent 
change of estimated 2007 IPF PPS rate year payments to estimated IPF 
PPS implementation year payments for each category of IPFs. In 
addition, for each category of IPFs, we have included the estimated 
percent change in payments resulting from the revision of the 
standardization factor (as discussed in section III.B.3 of this 
proposed rule, the ratio of estimated total TEFRA payments to estimated 
total PPS payments in the implementation year was overestimated and 
therefore needed to be reduced. We are proposing to apply the revised 
standardization factor prospectively to the Federal per diem base rate 
and ECT amount), the wage index changes for the 2007 IPF PPS rate year, 
the proposed market basket update to IPF PPS payments, and the 
transition blend for the 2007 rate year of the IPF PPS payment and the 
facility-specific TEFRA payment.
    To illustrate the impacts of the proposed RY 2007 changes, our 
analysis begins with an implementation year baseline simulation model 
based on FY 2002 IPF payments inflated to 2005 with market baskets; the 
estimated outlier payments in 2005; the estimated stop-loss payments in 
2005; the MSA designations for IPFs based on OMB's MSA definitions 
before June 2003; the 2005 MSA wage index; the implementation year 
labor-market share; and the implementation year percentage amount of 
the rural adjustment. During the simulation, the outlier payment is 
maintained at the target of 2 percent of total PPS payments.
    Each of the following proposed changes is added incrementally to 
this baseline model in order for us to isolate the effects of each 
change:
     IPF PPS payments adjusted by the revised standardization 
factor.
     The new CBSAs based on new geographic area definitions 
announced by OMB in June 2003 and the RY 2007 proposed budget-neutral 
labor-related share and wage index adjustment.
     A blended market basket update of 4.7 percent resulting in 
an update to the hospital-specific TEFRA target amount and an update to 
the IPF PPS base rates as discussed below.
    ++ As discussed in section III.C.4 of this proposed rule and in the 
IPPS final rule published August 12, 2005 (70 FR 47707), we established 
an update factor of 3.8 percent effective for cost reporting periods 
beginning on or after October 1, 2005 using the 2002-based excluded 
hospital market basket. The 3.8 percent update is applied to the IPF's 
target cost per discharge established under TEFRA for cost reporting 
periods beginning on or after October 1, 2005. However, since the 
midpoints of the 2007 rate year and the IPF PPS implementation period 
are 15 months apart, the TEFRA payment increase is projected to be 4.8 
percent.
    ++ An update to the Federal per diem base rate of 4.5 percent based 
on the 2002-based RPL market basket (see section III.C.1.b of this 
proposed rule). The market basket update is based on a 15-month time 
period (from the midpoint of the IPF PPS implementation period to the 
midpoint of the 2007 rate year).
     The transition to 50 percent IPF PPS payment and 50 
percent facility-specific TEFRA payment.
    Our final comparison illustrates the percent change in payments 
from the IPF PPS implementation year (that is, January 1, 2005 to June 
30, 2006) to RY 2007 (that is, July 1, 2006 to June 30, 2007).

[[Page 3650]]



                                                              Table 15.--Projected Impacts
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                         Standardization     CBSA wage
                    Facility by type                        Number of         factor         index and     Market basket    Transition         Total
                                                           facilities       correction      labor share                        blend
(1)                                                                 (2)              (3)             (4)             (5)             (6)             (7)
--------------------------------------------------------
All Facilities.........................................           1,806            -0.3%            0.0%            4.7%           -0.2%            4.2%
By Type of Ownership:
    Psychiatric Hospitals..............................
        Government.....................................             178            -0.4%            0.0%            4.7%           11.0%           15.7%
        Non-profit.....................................              79            -0.3%            0.1%            4.7%            1.6%            6.1%
        For-profit.....................................             150            -0.4%            0.1%            4.7%            4.3%            8.9%
        Psychiatric Units..............................           1,399            -0.3%            0.0%            4.7%           -1.8%            2.5%
Rural..................................................             384            -0.3%           -0.2%            4.7%           -1.1%            3.0%
Urban..................................................           1,422            -0.3%            0.0%            4.7%           -0.1%            4.3%
By Urban or Rural Classification:
    Urban by Facility Type.............................
    Psychiatric Hospitals..............................
        Government.....................................             144            -0.4%            0.1%            4.7%           10.8%           15.6%
        Non-profit.....................................              73            -0.3%            0.1%            4.7%            1.7%            6.2%
        For-profit.....................................             143            -0.4%            0.1%            4.7%            4.4%            9.0%
        Psychiatric Units..............................           1,062            -0.3%            0.0%            4.7%           -1.7%            2.6%
    Rural by Facility Type.............................
    Psychiatric Hospitals..............................
        Government.....................................              34            -0.5%           -0.3%            4.7%           11.8%           16.1%
        Non-profit.....................................               6            -0.3%            0.3%            4.7%           -0.7%            3.9%
        For-profit.....................................               7            -0.2%           -0.1%            4.7%           -1.8%            2.4%
        Psychiatric Units..............................             337            -0.3%           -0.2%            4.7%           -2.2%            1.8%
By Teaching Status:
    Non-teaching.......................................           1,537            -0.3%            0.0%            4.7%           -0.3%            4.0%
        Less than 10% interns and residents to beds....             148            -0.3%            0.0%            4.7%            0.4%            4.8%
        10% to 30% interns and residents to beds.......              72            -0.3%           -0.1%            4.7%            0.4%            4.6%
        More than 30% interns and residents to beds....              49            -0.3%            0.1%            4.7%           -0.1%            4.4%
By Region:
    New England........................................             126            -0.3%            0.0%            4.7%           -0.5%            3.9%
    Mid-Atlantic.......................................             306            -0.4%            0.1%            4.7%            2.8%            7.3%
    South Atlantic.....................................             238            -0.3%           -0.1%            4.7%            0.2%            4.5%
    East North Central.................................             325            -0.3%           -0.1%            4.7%           -1.5%            2.8%
    East South Central.................................             159            -0.3%            0.0%            4.7%           -0.2%            4.2%
    West North Central.................................             169            -0.3%           -0.2%            4.7%           -1.1%            3.1%
    West South Central.................................             237            -0.3%           -0.1%            4.7%           -2.7%            1.6%
    Mountain...........................................              83            -0.3%            0.0%            4.7%           -0.4%            4.0%
    Pacific............................................             156            -0.3%            0.3%            4.7%           -0.6%            4.1%
By Bed Size:
    Psychiatric Hospitals..............................
        Under 12 beds..................................              26            -0.1%            0.1%            4.7%           -3.8%            0.8%
        12 to 25 beds..................................              46            -0.2%           -0.1%            4.7%            0.3%            4.7%
        25 to 50 beds..................................              91            -0.4%            0.2%            4.7%            4.3%            8.9%
        50 to 75 beds..................................              82            -0.4%            0.1%            4.7%            3.8%            8.4%
        Over 75 beds...................................             162            -0.4%            0.0%            4.7%            8.5%           13.1%
    Psychiatric Units..................................
        Under 12 beds..................................             600            -0.2%            0.0%            4.7%           -4.5%           -0.2%
        12 to 25 beds..................................             474            -0.3%            0.0%            4.7%           -1.9%            2.4%
        25 to 50 beds..................................             228            -0.3%            0.0%            4.7%           -0.6%            3.7%
        50 to 75 beds..................................              58            -0.3%            0.0%            4.7%            0.1%            4.4%
        Over 75 beds...................................              39            -0.3%           -0.1%            4.7%            1.2%            5.5%
--------------------------------------------------------------------------------------------------------------------------------------------------------

3. Results
    Table 15 above displays the results of our analysis. The table 
groups IPFs into the categories listed below based on characteristics 
provided in the Online Survey and Certification and Reporting (OSCAR) 
file and the 2002 cost report data from HCRIS:
     Facility Type
     Location
     Teaching Status Adjustment
     Census Region
     Size
The top row of the table shows the overall impact on the 1,806 IPFs 
included in the analysis.
    In column 3, we present the effects of the revised standardization 
factor (refer to section III.B.3 of this proposed rule for a discussion 
of this revision). This is defined to be the comparison of the 
simulated implementation year payment under the revised budget neutral 
factor to the simulated implementation year payment under the original 
budget neutral factor. In aggregate, the proposed revision would result 
in a 0.3 percent decrease in overall payments to IPFs. There are small 
distributional effects among different categories of IPFs. For example, 
rural government psychiatric hospitals would receive the largest 
decrease of 0.5 percent while

[[Page 3651]]

rural for-profit psychiatric hospitals would receive a 0.2 percent 
decrease. Also psychiatric hospitals with over 75 beds would receive a 
decrease of 0.4 percent while psychiatric hospitals with fewer than 12 
beds would receive the smallest decrease of 0.1 percent.
    In column 4, we present the effects of the budget-neutral update to 
the labor-related share and the wage index adjustment under the new 
CBSA geographic area definitions announced by OMB in June 2003. This is 
a comparison of the simulated implementation year payment under revised 
budget neutral factor and labor-related share and wage index under CBSA 
classification to the simulated implementation year payment under 
revised budget neutral factor and labor-related share and wage index 
under current MSA classification. There is no change in aggregate 
payments to IPFs as indicated in the first row of column 4. There 
would, however, be small distributional effects among different 
categories of IPFs. For example, rural IPFs would experience a 0.2 
percent decrease in payments while urban IPFs would experience no 
change in payments. Rural government hospitals would receive the 
largest decrease of 0.3 percent while rural non-profit hospitals would 
receive the largest increase of 0.3 percent.
    In column 5, we present the effects of the proposed market basket 
update to the IPF PPS payments by applying the TEFRA and PPS updates to 
payments under revised budget neutral factor and labor-related share 
and wage index under CBSA classification. In the aggregate the proposed 
update would result in a 4.7 percent increase in overall payments to 
IPFs. This 4.7 percent reflects the current blend of the 4.8 percent 
update for IPF TEFRA payments and the 4.5 percent update for the IPF 
PPS payments.
    In column 6, we present the effects of the payment change in 
transition blend percentages to transition year 2 (TEFRA Rate 
Percentage = 50 percent, IPF PPS Federal Rate Percentage = 50 percent) 
from transition year 1 (TEFRA Rate Percentage = 75 percent, IPF PPS 
Federal Rate Percentage = 25 percent) of the IPF PPS under revised 
budget neutral factor, labor-related share and wage index under CBSA 
classification, and TEFRA and PPS updates to RY 2007. The overall 
aggregate effect, across all hospital groups, would be a 0.2 percent 
decrease in payments to IPFs. There are distributional effects of these 
changes among different categories of IPFs. The largest increases would 
be among government psychiatric hospitals, with rural government 
hospitals receiving an 11.8 percent increase and urban government 
hospitals receiving a 10.8 percent increase. Alternatively, psychiatric 
hospitals and units with fewer than 12 beds would receive the largest 
decreases of 3.8 percent and 4.5 percent respectively.
    Column 7 compares our estimates of proposed changes reflected in 
this proposed rule for RY 2007, to our estimates of payments in the 
implementation year (without these proposed changes). This column 
reflects all RY 2007 proposed changes relative to the implementation 
year, shown in columns 3 through 6. The average increase for all IPFs 
is approximately 4.2 percent. This increase includes the effects of the 
market basket updates resulting in a 4.7 percent increase in total RY 
2007 payments. It also includes a 0.3 percent decrease in RY 2007 
payments for the standardization factor revision and a 0.2 percent 
decrease in RY 2007 payments for the transition blend.
    Overall, the largest payment increase would be among government 
IPFs. Urban government psychiatric hospitals would receive a 15.6 
percent increase and rural government psychiatric hospitals would 
receive a 16.1 percent increase. Psychiatric hospitals with fewer than 
12 beds would receive a 0.8 percent increase and psychiatric units with 
fewer than 12 beds would receive a 0.2 percent decrease.
4. Effect on the Medicare Program
    Based on actuarial projections resulting from our experience with 
other PPSs, we estimate that Medicare spending (total Medicare program 
payments) for IPF services over the next 5 years would be as follows:

                      Table 16.--Estimated Payments
------------------------------------------------------------------------
                                                            Dollars in
                        Rate year                            millions
------------------------------------------------------------------------
July 1, 2006 to June 30, 2007...........................          $4,257
July 1, 2007 to June 30, 2008...........................           4,382
July 1, 2008 to June 30, 2009...........................           4,559
July 1, 2009 to June 30, 2010...........................           4,762
July 1, 2010 to June 30, 2011...........................           4,979
------------------------------------------------------------------------

    These estimates are based on the current estimate of increases in 
the excluded hospital with capital market basket as follows:
     3.6 percent for RY 2007;
     3.5 percent for RY 2008;
     3.1 percent for RY 2009;
     2.6 percent for RY 2010; and
     3.0 percent for RY 2011.
    We estimate that there would be a change in fee-for-service 
Medicare beneficiary enrollment as follows:
     -2.3 percent in RY 2007;
     -1.0 percent in RY 2008;
     0.3 percent in RY 2009;
     0.3 percent in RY 2010; and
     0.6 percent in RY 2011.
    In the implementation year we estimated aggregate payments under 
the IPF PPS to equal the estimated aggregate payments that would be 
made if the IPF PPS were not implemented. Our methodology for 
estimating payments for purposes of the budget-neutrality calculations 
uses the best available data.
    We will evaluate the accuracy of the assumptions used to compute 
the budget-neutrality calculation in the implementation year. We intend 
to analyze claims and cost report data from the implementation year of 
the IPF PPS to determine whether the factors used to develop the 
Federal per diem base rate are not significantly different from the 
actual results experienced in that year. We are planning to compare 
payments under the final IPF PPS (which relies on an estimate of cost-
based TEFRA payments using historical data from a base year and 
assumptions that trend the data to the initial implementation period) 
to estimated cost-based TEFRA payments based on actual data from the 
first year of the IPF PPS. If we find that an adjustment is necessary, 
the percent difference (either positive or negative) would be applied 
prospectively to the established prospective payment rates to ensure 
the rates accurately reflect the payment levels intended by the 
statute.
    Section 124 of Public Law 106-113 provides the Secretary broad 
authority to make an adjustment. We intend to perform this analysis 
within the first 5 years of the implementation of the IPF PPS.
5. Effect on Beneficiaries
    Under the IPF PPS, IPFs would receive payment based on the average 
resources consumed by patients for each day. We do not expect changes 
in the quality of care or access to services for Medicare beneficiaries 
under the IPF PPS. In fact, we believe that access to IPF services 
would be enhanced due to the patient and facility level adjustment 
factors, all of which are intended to adequately reimburse IPFs for 
expensive cases. Finally, the stop-loss policy is intended to assist 
IPFs during the transition. In addition, we expect that paying 
prospectively for IPF services would enhance the efficiency of the 
Medicare program.

[[Page 3652]]

6. Computer Hardware and Software
    We do not anticipate that IPFs would incur additional systems 
operating costs in order to effectively participate in the IPF PPS. We 
believe that IPFs and CAHs possess the computer hardware capability to 
handle the billing requirements under the IPF PPS. Our belief is based 
on indications that approximately 99 percent of hospital inpatient 
claims are submitted electronically. In addition, we are not adopting 
significant changes in claims processing (see section IV.C of this 
proposed rule).

C. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 17 below, we 
have prepared an accounting statement showing the classification of the 
expenditures associated with the provisions of this proposed rule. This 
table provides our best estimate of the increase in Medicare payments 
under the IPF PPS as a result of the changes presented in this proposed 
rule based on the data for 1,806 IPFs in our database. All expenditures 
are classified as transfers to Medicare providers (that is, IPFs).

      Table 17.--Accounting Statement: Classification of Estimated
      Expenditures, from the 2006 IPF PPS RY to the 2007 IPF PPS RY
                              (In millions)
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  $180.
From Whom To Whom?.....................  Federal Government To IPFs
                                          Medicare Providers.
------------------------------------------------------------------------

D. Alternatives Considered

    We considered the following alternatives in developing the update 
to the IPF PPS:
    One option we considered was incorporating a transition from MSA-
based labor market definitions to CBSA-based labor market definitions 
for the purpose of applying the area wage index. As stated in section 
IV.C.1.e of this proposed rule, we are not adopting a transition policy 
here because IPFs are already in a transition from reasonable cost 
based reimbursement to IPF PPS payments. In addition, as evident in 
Table 15 above, the wage index change does not appear to have a large 
impact on IPFs.
    We also considered increasing our outlier percentage so that 
outlier payments would be projected to be 3 percent (or higher) of 
total PPS payments. However, this approach would not target the truly 
costly cases. Instead, implementing such a policy would have the effect 
of lowering the fixed dollar loss amount, therefore spreading outlier 
payments across more IPFs. In addition, the Federal per diem base rate 
would have to be reduced by another percentage point.
    It is also worth noting that in this proposed rule, we used the 
best available complete data set (that is, FY 2002 claims and cost 
report data) to assess the impact of the various policy changes. As 
previously stated, we won't know the true impact of the wage index 
changes, the transition blend period, or the market basket increases 
until we are able to analyze 1 year of IPF PPS claims and cost report 
data.
    We considered alternative policies in order to reduce financial 
risk to facilities in the event that they experience substantial 
reductions in Medicare payments during the period of transition to the 
IPF PPS. As discussed previously in this proposed rule, we have adopted 
a provision that would guarantee each facility an average payment per 
case under the IPF PPS that is estimated to be no less than a minimum 
proportion of its average payment per case under TEFRA. We analyzed the 
impact on losses if we were to make a payment adjustment to ensure that 
the minimum IPF PPS per case payment to an IPF is at least 70 percent 
of its TEFRA payment.
    The stop-loss adjustment is applied to the IPF PPS portion of 
Medicare payments during the transition. For example, during year 2 of 
the 3-year transition period, half of the payment is based on TEFRA, 
and half of the payment is based on the Federal rate. We apply the 
stop-loss adjustment to the portion of the IPF's payments during the 
transition based on the Federal rate. We estimate that the combined 
effects of the transition and the stop-loss policies will ensure that 
per case payments relative to pre-IPF PPS TEFRA per case payments are 
no less than 92.5 percent in year 1, 85 percent in year 2, and 77.5 
percent in year 3. We estimate that about 10 percent of IPFs would 
receive additional payments under the stop-loss policy.
    The 70 percent of TEFRA stop-loss policy required a reduction in 
the per diem rate to make the stop-loss policy budget neutral during 
the implementation year. As a result, in the IPF PPS final rule, we 
made a reduction to the Federal per diem base rate of 0.4 percent in 
order to maintain budget neutrality.
    In the IPF PPS final rule, we considered an 80 percent stop-loss 
policy as well as a 70 percent policy. In order to target the stop-loss 
policy to the IPFs that experience the greatest impact relative to 
current payments and to limit the size of the reduction to the Federal 
per diem base rate, we adopted the 70 percent policy. In developing 
this proposed rule, we again considered an 80 percent stop-loss policy 
for RY 2007. Adopting an 80 percent policy would require a reduction in 
the Federal per diem base rate of over 2.5 percent, and we estimate 
that about 29 percent of IPFs would receive additional payments. We 
chose to stay with the 70 percent policy for the same reasons discussed 
in the IPF PPS final rule. Specifically, the 70 percent stop-loss 
policy targets the IPFs that experience the greatest impact relative to 
current payments, and it limits the size of the reduction to the 
Federal per diem base rate.
    In accordance with the provisions of Executive Order 12866, this 
rule was previously reviewed by OMB.

List of Subjects

42 CFR Part 412

    Administrative practice and procedure, Health facilities, Medicare, 
Puerto Rico, Reporting and recordkeeping requirements.

42 CFR Part 424

    Emergency medical services, Health facilities, Health professions, 
Medicare, Reporting and recordkeeping requirements.
    For the reasons set forth in the preamble, the Centers for Medicare 
& Medicaid Services proposes to amend 42 CFR chapter IV as follows:

[[Page 3653]]

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR HOSPITAL SERVICES

    1. The authority citation for part 412 is revised to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh), Sec. 124 of Pub. L. 106-113, 113 Stat. 
1515, and Sec. 405 of Pub. L. of 108-173, 117 Stat. 2266.

    2. Amend Sec.  412.27 by revising paragraph (b) to read as follows:


Sec.  412.27  Excluded psychiatric units: Additional requirements.

* * * * *
    (b) Furnish, through the use of qualified personnel, psychological 
services, social work services, psychiatric nursing, and occupational 
therapy.
* * * * *
    3. Section 412.402 is amended by--
    A. Republishing the introductory text.
    B. Revising the heading of ``Fixed dollar loss threshold,'' to read 
``Fixed dollar loss threshold amount.''
    C. Revising the definition of ``Fixed dollar loss threshold 
amount,'' ``Qualifying emergency department,'' ``Rural area,'' and 
``Urban area.''
    The revisions read as follows:


Sec.  412.402  Definitions.

    As used in this subpart--
* * * * *
    Fixed dollar loss threshold amount means a dollar amount which, 
when added to the Federal payment amount for case, the estimated costs 
of a case must exceed in order for the case to qualify for an outlier 
payment.
* * * * *
    Qualifying emergency department means an emergency department that 
is staffed and equipped to furnish a comprehensive array of emergency 
services and meeting the definitions of a dedicated emergency 
department as specified in Sec.  489.24(b) of this chapter and the 
definition of ``provider-based status'' as specified in Sec.  413.65 of 
this chapter.
    Rural area means for cost reporting periods beginning January 1, 
2005, with respect to discharges occurring during the period covered by 
such cost reports but before July 1, 2006, an area as defined in Sec.  
412.62(f)(1)(iii). For discharges occurring on or after July 1, 2006, 
rural area means an area as defined in Sec.  412.64(b)(1)(ii)(C).
    Urban area means for cost reporting periods beginning on or after 
January 1, 2005, with respect to discharges occurring during the period 
covered by such cost reports but before July 1, 2006, an area as 
defined in Sec.  412.62(f)(1)(ii). For discharges occurring on or after 
July 1, 2006, urban area means an area as defined in Sec.  
412.64(b)(1)(ii)(A) and Sec.  412.64(b)(1)(ii)(B).
    4. Section 412.424 is amended by--
    A. Revising paragraph (d)(1)(iii).
    B. Republishing the heading of paragraph (d)(1)(v).
    C. Revising paragraph (d)(1)(v)(A).
    D. Adding paragraph (d)(2) introductory text.
    E. Removing and reserving paragraph (d)(2)(iii).
    F. Revising paragraphs (d)(3)(i) introductory text and 
(d)(3)(i)(A).
    The revisions and additions read as follows:


Sec.  412.424  Methodology for calculating the Federal per diem payment 
amount.

* * * * *
    (d) * * *
    (1) * * *
    (iii) Teaching adjustment. CMS adjusts the Federal per diem base 
rate by a factor to account for indirect teaching costs.
    (A) An inpatient psychiatric facility's teaching adjustment is 
based on the ratio of the number of full-time equivalent residents 
training in the inpatient psychiatric facility divided by the 
facility's average daily census.
    (B) Residents with less than full-time status and residents 
rotating through the inpatient psychiatric facility for less than a 
full year will be counted in proportion to the time they spend in the 
inpatient psychiatric facility.
    (C) Except as described in paragraph (d)(1)(iii)(D) of this 
section, the actual number of current year full-time equivalent 
residents used in calculating the teaching adjustment is limited to the 
number of full-time equivalent residents in the inpatient psychiatric 
facility's most recently filed cost report filed with its fiscal 
intermediary before November 15, 2004 (base year).
    (D) If the inpatient psychiatric facility first begins training 
residents in a new approved graduate medical education program after 
November 15, 2004, the number of full-time equivalent residents 
determined under paragraph (d)(1)(iii)(C) of this section may be 
adjusted using the method described in Sec.  413.79(e)(1)(i) and (ii) 
of this chapter.
    (E) The teaching adjustment is made on a claim basis as an interim 
payment, and the final payment in full for the claim is made during the 
final settlement of the cost report.
* * * * *
    (v) Adjustment for IPF with qualifying emergency departments. (A) 
CMS adjusts the Federal per diem base rate to account for the costs 
associated with maintaining a qualifying emergency department. A 
qualifying emergency department is staffed and equipped to furnish a 
comprehensive array of emergency services (medical and psychiatric) and 
meets the requirements of Sec.  489.24(b) and Sec.  413.65 of this 
chapter.
    (2) Patient-level adjustments. The inpatient psychiatric facility 
must identify a principal psychiatric diagnosis as specified in Sec.  
412.27(a) for each patient. CMS adjusts the Federal per diem base rate 
by a factor to account for the diagnosis-related group assignment 
associated with the principal diagnosis, as specified by CMS.
* * * * *
    (3) Other adjustments. (i) Outlier payments. CMS provides an 
outlier payment if an inpatient psychiatric facility's estimated total 
cost for a case exceeds a fixed dollar loss threshold amount for an 
inpatient psychiatric facility as defined in Sec.  412.402 plus the 
Federal payment amount for the case.
    (A) The fixed dollar loss threshold amount is adjusted for the 
inpatient psychiatric facility's adjustments for wage area, teaching, 
rural locations, and cost of living adjustment for facilities located 
in Alaska and Hawaii.
* * * * *


Sec.  412.426  [Amended]

    5. In Sec.  412.426, paragraph (a) introductory text is amended by 
removing the reference ``Sec.  412.424(c)'' and adding the reference 
``Sec.  412.424(d)'' in its place.
    6. Section 412.428 is amended by--
    A. Republishing the introductory text.
    B. Revising paragraph (b) and (d).
    C. Adding a new paragraph (g).
    D. Adding a new paragraph (h).
    The revision and additions reads as follows:


Sec.  412.428  Publication of updates to the inpatient psychiatric 
facility prospective payment system.

    CMS will publish annually in the Federal Register information 
pertaining to updates to the inpatient psychiatric facility prospective 
payment system. This information includes:
* * * * *
    (b)(1) For discharges occurring on or after January 1, 2005 but 
before July 1, 2006, the rate of increase factor, described in Sec.  
412.424(a)(2)(iii), for the Federal portion of the inpatient 
psychiatric facility's payment is based on the excluded hospital with 
capital market basket under the update methodology described in section 
1886(b)(3)(B)(ii) of the Act for each year.
    (2) For discharges occurring on or after July 1, 2006, the rate of 
increase factor for the Federal portion of the

[[Page 3654]]

inpatient psychiatric facility's payment is based on the 
Rehabilitation, Psychiatric, and Long-Term Care (RPL) market basket.
    (3) For discharges occurring on or after January 1, 2005 but before 
July 1, 2006, the rate of increase factor, described in Sec.  
412.424(a)(2)(iii), for the reasonable cost portion of the inpatient 
psychiatric facility's payment is based on the 1997-based excluded 
hospital market basket under the updated methodology described in 
section 1886(b)(3)(B)(ii) of the Act for each year.
    (4) For discharges occurring on or after July 1, 2006, the rate of 
increase factor for the reasonable cost portion of the inpatient 
psychiatric facility's payment is based on the 2002-based excluded 
hospital market basket.
* * * * *
    (d) Updates to the fixed dollar loss threshold amount in order to 
maintain the appropriate outlier percentage.
* * * * *
    (g) Update the national urban and rural cost to charge ratio median 
and ceilings. CMS will apply the national cost to charge ratio to--
    (1) New inpatient psychiatric facilities that have not submitted 
their first Medicare cost report.
    (2) Inpatient psychiatric facilities whose operating or capital 
cost to charge ratio is in excess of 3 standard deviations above the 
corresponding national geometric mean.
    (3) Other inpatient psychiatric facilities for which the fiscal 
intermediary obtains inaccurate or incomplete date with which to 
calculate either an operating or capital cost to charge ratio or both.
    (h) Update the cost of living adjustment factor if appropriate.

PART 424--CONDITIONS FOR MEDICARE PAYMENT

    1. The authority citation for part 424 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. Section 424.14 is amended by--
    A. Revising the heading.
    B. Adding a new paragraph (c)(3).
    C. Revising paragraph (d)(2).
    The addition and revisions read as follows:


Sec.  424.14  Requirements for inpatient services of inpatient 
psychiatric facilities.

* * * * *
    (c) * * *
    (3) The patient continues to need, on a daily basis, active 
inpatient psychiatric care (furnished directly by or requiring the 
supervision of inpatient psychiatric facility personnel) or other 
professional services that can only be provided on an inpatient basis.
    (d) * * *
    (2) The first recertification is required as of the 12th day of 
hospitalization. Subsequent recertifications are required at intervals 
established by the UR committee (on a case-by-case basis if it so 
chooses), but no less frequently than every 30 days.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

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

    Dated: November 3, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
    Approved: January 13, 2006.
Michael O. Leavitt,
Secretary.

    Note: The following addenda will not appear in the Code of 
Federal Regulations.

Addendum A--Rate and Adjustment Factors

                              Per Diem Rate
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Federal Per Diem Base Rate.................................      $594.66
Labor Share (0.75923)......................................      $451.48
Non-Labor Share (0.24077)..................................      $143.18
------------------------------------------------------------------------


                   Fixed Dollar Loss Threshold Amount
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
                                  $6200
------------------------------------------------------------------------


                                              Facility Adjustments
----------------------------------------------------------------------------------------------------------------
 
----------------------------------------------------------------------------------------------------------------
Rural Adjustment Factor....................................  1.17.
Teaching Adjustment Factor.................................  0.5150.
Wage Index.................................................  Pre-reclass Hospital Wage Index (FY2006).
----------------------------------------------------------------------------------------------------------------


                   Cost of Living Adjustments (COLAs)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Alaska.....................................................         1.25
Hawaii
    Honolulu County........................................         1.25
    Hawaii County..........................................        1.165
    Kauai County...........................................       1.2325
    Maui County............................................       1.2375
    Kalawao County.........................................       1.2375
------------------------------------------------------------------------


                           Patient Adjustments
------------------------------------------------------------------------
 
------------------------------------------------------------------------
ECT--Per Treatment.........................................      $268.21
------------------------------------------------------------------------


[[Page 3655]]


                      Variable Per Diem Adjustments
------------------------------------------------------------------------
                                                              Adjustment
                                                                Factor
------------------------------------------------------------------------
Day 1--Facility Without a 24/7 Full-service Emergency               1.19
 Department................................................
Day 1--Facility With a 24/7 Full-service Emergency                  1.31
 Department................................................
Day 2......................................................         1.12
Day 3......................................................         1.08
Day 4......................................................         1.05
Day 5......................................................         1.04
Day 6......................................................         1.02
Day 7......................................................         1.01
Day 8......................................................         1.01
Day 9......................................................         1.00
Day 10.....................................................         1.00
Day 11.....................................................         0.99
Day 12.....................................................         0.99
Day 13.....................................................         0.99
Day 14.....................................................         0.99
Day 15.....................................................         0.98
Day 16.....................................................         0.97
Day 17.....................................................         0.97
Day 18.....................................................         0.96
Day 19.....................................................         0.95
Day 20.....................................................         0.95
Day 21.....................................................         0.95
After Day 21...............................................         0.92
------------------------------------------------------------------------


                             Age Adjustments
------------------------------------------------------------------------
                                                              Adjustment
                       Age (in years)                           Factor
------------------------------------------------------------------------
Under 45...................................................         1.00
45 and under 50............................................         1.01
50 and under 55............................................         1.02
55 and under 60............................................         1.04
60 and under 65............................................         1.07
65 and under 70............................................         1.10
70 and under 75............................................         1.13
75 and under 80............................................         1.15
80 and over................................................         1.17
------------------------------------------------------------------------


                             DRG Adjustments
------------------------------------------------------------------------
                                                                 DRG
           DRG                      DRG Definition            Adjustment
                                                                Factor
------------------------------------------------------------------------
DRG 424                    Procedure with principal                 1.22
                            diagnosis of mental illness.
DRG 425                    Acute adjustment reaction.......         1.05
DRG 426                    Depressive neurosis.............         0.99
DRG 427                    Neurosis, except depressive.....         1.02
DRG 428                    Disorders of personality........         1.02
DRG 429                    Organic disturbances............         1.03
DRG 430                    Psychosis.......................         1.00
DRG 431                    Childhood disorders.............         0.99
DRG 432                    Other mental disorders..........         0.92
DRG 433                    Alcohol/Drug use Leave against           0.97
                            Medical Advice (LAMA).
DRG 521                    Alcohol/Drug use with comorbid           1.02
                            conditions.
DRG 522                    Alcohol/Drug use without                 0.98
                            comorbid conditions.
DRG 523                    Alcohol/Drug use without                 0.88
                            rehabilitation.
DRG 12                     Degenerative nervous system              1.05
                            disorders.
DRG 23                     Non-traumatic stupor & coma.....         1.07
------------------------------------------------------------------------


                         Comorbidity Adjustments
------------------------------------------------------------------------
                                                              Adjustment
                        Comorbidity                             Factor
------------------------------------------------------------------------
Developmental Disabilities.................................         1.04
Coagulation Factor Deficit.................................         1.13
Tracheostomy...............................................         1.06

[[Page 3656]]

 
Eating and Conduct Disorders...............................         1.12
Infectious Diseases........................................         1.07
Renal Failure, Acute.......................................         1.11
Renal Failure, Chronic.....................................         1.11
Oncology Treatment.........................................         1.07
Uncontrolled Diabetes Mellitus.............................         1.05
Severe Protein Malnutrition................................         1.13
Drug/Alcohol Induced Mental Disorders......................         1.03
Cardiac Conditions.........................................         1.11
Gangrene...................................................         1.10
Chronic Obstructive Pulmonary Disease......................         1.12
Artificial Openings - Digestive & Urinary..................         1.08
Musculoskeletal & Connective Tissue Diseases...............         1.09
Poisoning..................................................         1.11
------------------------------------------------------------------------

Addendum B--RY 2007 IPF PPS Wage Index Table

----------------------------------------------------------------------------------------------------------------
                                                                     2006
 SSA State/County                         MSA                        MSA-     CBSA                     2006 CBSA-
       Code            County name       Number   MSA Urban/Rural   based    Number  CBSA Urban/Rural   based WI
                                                                      WI
----------------------------------------------------------------------------------------------------------------
01000............  Autauga County,         5240  Urban...........   0.8618    33860  Urban...........     0.8618
                    Alabama.
01010............  Baldwin County,         5160  Urban...........   0.7861    99901  Rural...........     0.7446
                    Alabama.
01020............  Barbour County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01030............  Bibb County,              01  Rural...........   0.7432    13820  Urban...........     0.8959
                    Alabama.
01040............  Blount County,          1000  Urban...........   0.9000    13820  Urban...........     0.8959
                    Alabama.
01050............  Bullock County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01060............  Butler County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01070............  Calhoun County,         0450  Urban...........   0.7682    11500  Urban...........     0.7682
                    Alabama.
01080............  Chambers County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01090............  Cherokee County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01100............  Chilton County,           01  Rural...........   0.7432    13820  Urban...........     0.8959
                    Alabama.
01110............  Choctaw County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01120............  Clarke County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01130............  Clay County,              01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01140............  Cleburne County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01150............  Coffee County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01160............  Colbert County,         2650  Urban...........   0.8272    22520  Urban...........     0.8272
                    Alabama.
01170............  Conecuh County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01180............  Coosa County,             01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01190............  Covington County,         01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01200............  Crenshaw County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01210............  Cullman County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01220............  Dale County,            2180  Urban...........   0.7701    99901  Rural...........     0.7446
                    Alabama.
01230............  Dallas County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01240............  De Kalb County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01250............  Elmore County,          5240  Urban...........   0.8618    33860  Urban...........     0.8618
                    Alabama.
01260............  Escambia County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01270............  Etowah County,          2880  Urban...........   0.7938    23460  Urban...........     0.7938
                    Alabama.
01280............  Fayette County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01290............  Franklin County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01300............  Geneva County,            01  Rural...........   0.7432    20020  Urban...........     0.7721
                    Alabama.
01310............  Greene County,            01  Rural...........   0.7432    46220  Urban...........     0.8645
                    Alabama.
01320............  Hale County,              01  Rural...........   0.7432    46220  Urban...........     0.8645
                    Alabama.
01330............  Henry County,             01  Rural...........   0.7432    20020  Urban...........     0.7721
                    Alabama.
01340............  Houston County,         2180  Urban...........   0.7701    20020  Urban...........     0.7721
                    Alabama.
01350............  Jackson County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01360............  Jefferson County,       1000  Urban...........   0.9000    13820  Urban...........     0.8959
                    Alabama.
01370............  Lamar County,             01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01380............  Lauderdale County,      2650  Urban...........   0.8272    22520  Urban...........     0.8272
                    Alabama.
01390............  Lawrence County,        2030  Urban...........   0.8469    19460  Urban...........     0.8469
                    Alabama.
01400............  Lee County, Alabama     0580  Urban...........   0.8100    12220  Urban...........     0.8100
01410............  Limestone County,       3440  Urban...........   0.9146    26620  Urban...........     0.9146
                    Alabama.
01420............  Lowndes County,           01  Rural...........   0.7432    33860  Urban...........     0.8618
                    Alabama.
01430............  Macon County,             01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01440............  Madison County,         3440  Urban...........   0.9146    26620  Urban...........     0.9146
                    Alabama.
01450............  Marengo County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01460............  Marion County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.

[[Page 3657]]

 
01470............  Marshall County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01480............  Mobile County,          5160  Urban...........   0.7861    33660  Urban...........     0.7891
                    Alabama.
01490............  Monroe County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01500............  Montgomery County,      5240  Urban...........   0.8618    33860  Urban...........     0.8618
                    Alabama.
01510............  Morgan County,          2030  Urban...........   0.8469    19460  Urban...........     0.8469
                    Alabama.
01520............  Perry County,             01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01530............  Pickens County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01540............  Pike County,              01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01550............  Randolph County,          01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01560............  Russell County,         1800  Urban...........   0.8560    17980  Urban...........     0.8560
                    Alabama.
01570............  St Clair County,        1000  Urban...........   0.9000    13820  Urban...........     0.8959
                    Alabama.
01580............  Shelby County,          1000  Urban...........   0.9000    13820  Urban...........     0.8959
                    Alabama.
01590............  Sumter County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01600............  Talladega County,         01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01610............  Tallapoosa County,        01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01620............  Tuscaloosa County,      8600  Urban...........   0.8764    46220  Urban...........     0.8645
                    Alabama.
01630............  Walker County,            01  Rural...........   0.7432    13820  Urban...........     0.8959
                    Alabama.
01640............  Washington County,        01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01650............  Wilcox County,            01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
01660............  Winston County,           01  Rural...........   0.7432    99901  Rural...........     0.7446
                    Alabama.
02013............  Aleutians County          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    East, Alaska.
02016............  Aleutians County          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    West, Alaska.
02020............  Anchorage County,       0380  Urban...........   1.1784    11260  Urban...........     1.1895
                    Alaska.
02030............  Angoon County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02040............  Barrow-North Slope        02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02050............  Bethel County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02060............  Bristol Bay Borough       02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02068............  Denali County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02070............  Bristol Bay County,       02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02080............  Cordova-Mc Carthy         02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02090............  Fairbanks County,         02  Rural...........   1.1888    21820  Urban...........     1.1408
                    Alaska.
02100............  Haines County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02110............  Juneau County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02120............  Kenai-Cook Inlet          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02122............  Kenai Peninsula           02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Borough, Alaska.
02130............  Ketchikan County,         02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02140............  Kobuk County,             02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02150............  Kodiak County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02160............  Kuskokwin County,         02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02164............  Lake and Peninsula        02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Borough, Alaska.
02170............  Matanuska County,         02  Rural...........   1.1888    11260  Urban...........     1.1895
                    Alaska.
02180............  Nome County, Alaska       02  Rural...........   1.1888    99902  Rural...........     1.1977
02185............  North Slope               02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Borough, Alaska.
02188............  Northwest Arctic          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Borough, Alaska.
02190............  Outer Ketchikan           02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02200............  Prince Of Wales           02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02201............  Prince of Wales-          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Outer Ketchikan
                    Census Area,
                    Alaska.
02210............  Seward County,            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02220............  Sitka County,             02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02230............  Skagway-Yakutat           02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02231............  Skagway-Yakutat-          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Angoon Census
                    Area, Alaska.
02232............  Skagway-Hoonah-           02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Angoon Census
                    Area, Alaska.
02240............  Southeast Fairbanks       02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02250............  Upper Yukon County,       02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02260............  Valdz-Chitna-             02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Whitier County,
                    Alaska.
02261............  Valdex-Cordove            02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Census Area,
                    Alaska.
02270............  Wade Hampton              02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02280............  Wrangell-Petersburg       02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
02282............  Yakutat Borough,          02  Rural...........   1.1888    99902  Rural...........     1.1977
                    Alaska.
02290............  Yukon-Koyukuk             02  Rural...........   1.1888    99902  Rural...........     1.1977
                    County, Alaska.
03000............  Apache County,            03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03010............  Cochise County,           03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03020............  Coconino County,        2620  Urban...........   1.1845    22380  Urban...........     1.2092
                    Arizona.
03030............  Gila County,              03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03040............  Graham County,            03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03050............  Greenlee County,          03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03055............  La Paz County,            03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03060............  Maricopa County,        6200  Urban...........   1.0127    38060  Urban...........     1.0127
                    Arizona.
03070............  Mohave County,          4120  Urban...........   1.1155    99903  Rural...........     0.8768
                    Arizona.
03080............  Navajo County,            03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03090............  Pima County,            8520  Urban...........   0.9007    46060  Urban...........     0.9007
                    Arizona.

[[Page 3658]]

 
03100............  Pinal County,           6200  Urban...........   1.0127    38060  Urban...........     1.0127
                    Arizona.
03110............  Santa Cruz County,        03  Rural...........   0.9045    99903  Rural...........     0.8768
                    Arizona.
03120............  Yavapai County,           03  Rural...........   0.9045    39140  Urban...........     0.9869
                    Arizona.
03130............  Yuma County,            9360  Urban...........   0.9126    49740  Urban...........     0.9126
                    Arizona.
04000............  Arkansas County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04010............  Ashley County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04020............  Baxter County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04030............  Benton County,          2580  Urban...........   0.8661    22220  Urban...........     0.8661
                    Arkansas.
04040............  Boone County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04050............  Bradley County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04060............  Calhoun County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04070............  Carroll County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04080............  Chicot County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04090............  Clark County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04100............  Clay County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04110............  Cleburne County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04120............  Cleveland County,         04  Rural...........   0.7744    38220  Urban...........     0.8680
                    Arkansas.
04130............  Columbia County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04140............  Conway County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04150............  Craighead County,       3700  Urban...........   0.7911    27860  Urban...........     0.7911
                    Arkansas.
04160............  Crawford County,        2720  Urban...........   0.8246    22900  Urban...........     0.8230
                    Arkansas.
04170............  Crittenden County,      4920  Urban...........   0.9416    32820  Urban...........     0.9397
                    Arkansas.
04180............  Cross County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04190............  Dallas County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04200............  Desha County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04210............  Drew County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04220............  Faulkner County,        4400  Urban...........   0.8747    30780  Urban...........     0.8747
                    Arkansas.
04230............  Franklin County,          04  Rural...........   0.7744    22900  Urban...........     0.8230
                    Arkansas.
04240............  Fulton County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04250............  Garland County,           04  Rural...........   0.7744    26300  Urban...........     0.9005
                    Arkansas.
04260............  Grant County,             04  Rural...........   0.7744    30780  Urban...........     0.8747
                    Arkansas.
04270............  Greene County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04280............  Hempstead County,         04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04290............  Hot Spring County,        04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04300............  Howard County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04310............  Independence              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    County, Arkansas.
04320............  Izard County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04330............  Jackson County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04340............  Jefferson County,       6240  Urban...........   0.8680    38220  Urban...........     0.8680
                    Arkansas.
04350............  Johnson County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04360............  Lafayette County,         04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04370............  Lawrence County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04380............  Lee County,               04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04390............  Lincoln County,           04  Rural...........   0.7744    38220  Urban...........     0.8680
                    Arkansas.
04400............  Little River              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    County, Arkansas.
04410............  Logan County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04420............  Lonoke County,          4400  Urban...........   0.8747    30780  Urban...........     0.8747
                    Arkansas.
04430............  Madison County,           04  Rural...........   0.7744    22220  Urban...........     0.8661
                    Arkansas.
04440............  Marion County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04450............  Miller County,          8360  Urban...........   0.8283    45500  Urban...........     0.8283
                    Arkansas.
04460............  Mississippi County,       04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04470............  Monroe County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04480............  Montgomery County,        04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04490............  Nevada County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04500............  Newton County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04510............  Ouachita County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04520............  Perry County,             04  Rural...........   0.7744    30780  Urban...........     0.8747
                    Arkansas.
04530............  Phillips County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04540............  Pike County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04550............  Poinsett County,          04  Rural...........   0.7744    27860  Urban...........     0.7911
                    Arkansas.
04560............  Polk County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04570............  Pope County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04580............  Prairie County,           04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04590............  Pulaski County,         4400  Urban...........   0.8747    30780  Urban...........     0.8747
                    Arkansas.
04600............  Randolph County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04610............  St Francis County,        04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04620............  Saline County,          4400  Urban...........   0.8747    30780  Urban...........     0.8747
                    Arkansas.
04630............  Scott County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04640............  Searcy County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04650............  Sebastian County,       2720  Urban...........   0.8246    22900  Urban...........     0.8230
                    Arkansas.
04660............  Sevier County,            04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.

[[Page 3659]]

 
04670............  Sharp County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04680............  Stone County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04690............  Union County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04700............  Van Buren County,         04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04710............  Washington County,      2580  Urban...........   0.8661    22220  Urban...........     0.8661
                    Arkansas.
04720............  White County,             04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04730............  Woodruff County,          04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
04740............  Yell County,              04  Rural...........   0.7744    99904  Rural...........     0.7466
                    Arkansas.
05000............  Alameda County,         5775  Urban...........   1.5346    36084  Urban...........     1.5346
                    California.
05010............  Alpine County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05020............  Amador County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05030............  Butte County,           1620  Urban...........   1.0511    17020  Urban...........     1.0511
                    California.
05040............  Calaveras County,         05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05050............  Colusa County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05060............  Contra Costa            5775  Urban...........   1.5346    36084  Urban...........     1.5346
                    County, California.
05070............  Del Norte County,         05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05080............  Eldorado County,        6920  Urban...........   1.3143    40900  Urban...........     1.2969
                    California.
05090............  Fresno County,          2840  Urban...........   1.0428    23420  Urban...........     1.0538
                    California.
05100............  Glenn County,             05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05110............  Humboldt County,          05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05120............  Imperial County,          05  Rural...........   1.0775    20940  Urban...........     0.8906
                    California.
05130............  Inyo County,              05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05140............  Kern County,            0680  Urban...........   1.0470    12540  Urban...........     1.0470
                    California.
05150............  Kings County,             05  Rural...........   1.0775    25260  Urban...........     1.0036
                    California.
05160............  Lake County,              05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05170............  Lassen County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05200............  Los Angeles County,     4480  Urban...........   1.1783    31084  Urban...........     1.1783
                    California.
05210............  Los Angeles County,     4480  Urban...........   1.1783    31084  Urban...........     1.1783
                    California.
05300............  Madera County,          2840  Urban...........   1.0428    31460  Urban...........     0.8713
                    California.
05310............  Marin County,           7360  Urban...........   1.4994    41884  Urban...........     1.4994
                    California.
05320............  Mariposa County,          05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05330............  Mendocino County,         05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05340............  Merced County,          4940  Urban...........   1.1109    32900  Urban...........     1.1109
                    California.
05350............  Modoc County,             05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05360............  Mono County,              05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05370............  Monterey County,        7120  Urban...........   1.4128    41500  Urban...........     1.4128
                    California.
05380............  Napa County,            8720  Urban...........   1.3983    34900  Urban...........     1.2643
                    California.
05390............  Nevada County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05400............  Orange County,          5945  Urban...........   1.1559    42044  Urban...........     1.1559
                    California.
05410............  Placer County,          6920  Urban...........   1.3143    40900  Urban...........     1.2969
                    California.
05420............  Plumas County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05430............  Riverside County,       6780  Urban...........   1.1027    40140  Urban...........     1.1027
                    California.
05440............  Sacramento County,      6920  Urban...........   1.3143    40900  Urban...........     1.2969
                    California.
05450............  San Benito County,        05  Rural...........   1.0775    41940  Urban...........     1.5099
                    California.
05460............  San Bernardino          6780  Urban...........   1.1027    40140  Urban...........     1.1027
                    County, California.
05470............  San Diego County,       7320  Urban...........   1.1413    41740  Urban...........     1.1413
                    California.
05480............  San Francisco           7360  Urban...........   1.4994    41884  Urban...........     1.4994
                    County, California.
05490............  San Joaquin County,     8120  Urban...........   1.1307    44700  Urban...........     1.1307
                    California.
05500............  San Luis Obispo         7460  Urban...........   1.1349    42020  Urban...........     1.1349
                    County, California.
05510............  San Mateo County,       7360  Urban...........   1.4994    41884  Urban...........     1.4994
                    California.
05520............  Santa Barbara           7480  Urban...........   1.1694    42060  Urban...........     1.1694
                    County, California.
05530............  Santa Clara County,     7400  Urban...........   1.5118    41940  Urban...........     1.5099
                    California.
05540............  Santa Cruz County,      7485  Urban...........   1.5166    42100  Urban...........     1.5166
                    California.
05550............  Shasta County,          6690  Urban...........   1.2203    39820  Urban...........     1.2203
                    California.
05560............  Sierra County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05570............  Siskiyou County,          05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05580............  Solano County,          8720  Urban...........   1.3983    46700  Urban...........     1.4936
                    California.
05590............  Sonoma County,          7500  Urban...........   1.3493    42220  Urban...........     1.3493
                    California.
05600............  Stanislaus County,      5170  Urban...........   1.1885    33700  Urban...........     1.1885
                    California.
05610............  Sutter County,          9340  Urban...........   1.0921    49700  Urban...........     1.0921
                    California.
05620............  Tehama County,            05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05630............  Trinity County,           05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05640............  Tulare County,          8780  Urban...........   1.0123    47300  Urban...........     1.0123
                    California.
05650............  Tuolumne County,          05  Rural...........   1.0775    99905  Rural...........     1.1054
                    California.
05660............  Ventura County,         8735  Urban...........   1.1622    37100  Urban...........     1.1622
                    California.
05670............  Yolo County,            9270  Urban...........   0.9950    40900  Urban...........     1.2969
                    California.
05680............  Yuba County,            9340  Urban...........   1.0921    49700  Urban...........     1.0921
                    California.
06000............  Adams County,           2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
06010............  Alamosa County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06020............  Arapahoe County,        2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
06030............  Archuleta County,         06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.

[[Page 3660]]

 
06040............  Baca County,              06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06050............  Bent County,              06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06060............  Boulder County,         1125  Urban...........   0.9734    14500  Urban...........     0.9734
                    Colorado.
06070............  Chaffee County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06080............  Cheyenne County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06090............  Clear Creek County,       06  Rural...........   0.9380    19740  Urban...........     1.0723
                    Colorado.
06100............  Conejos County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06110............  Costilla County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06120............  Crowley County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06130............  Custer County,            06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06140............  Delta County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06150............  Denver County,          2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
06160............  Dolores County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06170............  Douglas County,         2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
06180............  Eagle County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06190............  Elbert County,            06  Rural...........   0.9380    19740  Urban...........     1.0723
                    Colorado.
06200............  El Paso County,         1720  Urban...........   0.9468    17820  Urban...........     0.9468
                    Colorado.
06210............  Fremont County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06220............  Garfield County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06230............  Gilpin County,            06  Rural...........   0.9380    19740  Urban...........     1.0723
                    Colorado.
06240............  Grand County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06250............  Gunnison County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06260............  Hinsdale County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06270............  Huerfano County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06280............  Jackson County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06290............  Jefferson County,       2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
06300............  Kiowa County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06310............  Kit Carson County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06320............  Lake County,              06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06330............  La Plata County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06340............  Larimer County,         2670  Urban...........   1.0122    22660  Urban...........     1.0122
                    Colorado.
06350............  Las Animas County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06360............  Lincoln County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06370............  Logan County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06380............  Mesa County,            2995  Urban...........   0.9550    24300  Urban...........     0.9550
                    Colorado.
06390............  Mineral County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06400............  Moffat County,            06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06410............  Montezuma County,         06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06420............  Montrose County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06430............  Morgan County,            06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06440............  Otero County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06450............  Ouray County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06460............  Park County,              06  Rural...........   0.9380    19740  Urban...........     1.0723
                    Colorado.
06470............  Phillips County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06480............  Pitkin County,            06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06490............  Prowers County,           06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06500............  Pueblo County,          6560  Urban...........   0.8623    39380  Urban...........     0.8623
                    Colorado.
06510............  Rio Blanco County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06520............  Rio Grande County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06530............  Routt County,             06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06540............  Saguache County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06550............  San Juan County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06560............  San Miguel County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06570............  Sedgwick County,          06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06580............  Summit County,            06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06590............  Teller County,            06  Rural...........   0.9380    17820  Urban...........     0.9468
                    Colorado.
06600............  Washington County,        06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06610............  Weld County,            3060  Urban...........   0.9570    24540  Urban...........     0.9570
                    Colorado.
06620............  Yuma County,              06  Rural...........   0.9380    99906  Rural...........     0.9380
                    Colorado.
06630............  Broomfield County,      2080  Urban...........   1.0723    19740  Urban...........     1.0723
                    Colorado.
07000............  Fairfield County,       5483  Urban...........   1.2196    14860  Urban...........     1.2592
                    Connecticut.
07010............  Hartford County,        3283  Urban...........   1.1073    25540  Urban...........     1.1073
                    Connecticut.
07020............  Litchfield County,      3283  Urban...........   1.1073    25540  Urban...........     1.1073
                    Connecticut.
07030............  Middlesex County,       3283  Urban...........   1.1073    25540  Urban...........     1.1073
                    Connecticut.
07040............  New Haven County,       5483  Urban...........   1.2196    35300  Urban...........     1.1887
                    Connecticut.
07050............  New London County,      5523  Urban...........   1.1345    35980  Urban...........     1.1345
                    Connecticut.
07060............  Tolland County,         3283  Urban...........   1.1073    25540  Urban...........     1.1073
                    Connecticut.
07070............  Windham County,           07  Rural...........   1.1730    99907  Rural...........     1.1730
                    Connecticut.
08000............  Kent County,            2190  Urban...........   0.9776    20100  Urban...........     0.9776
                    Delaware.
08010............  New Castle County,      9160  Urban...........   1.0527    48864  Urban...........     1.0471
                    Delaware.
08020............  Sussex County,            08  Rural...........   0.9579    99908  Rural...........     0.9579
                    Delaware.

[[Page 3661]]

 
09000............  Washington DC           8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Dist Of
                    Col.
10000............  Alachua County,         2900  Urban...........   0.9388    23540  Urban...........     0.9388
                    Florida.
10010............  Baker County,             10  Rural...........   0.8677    27260  Urban...........     0.9290
                    Florida.
10020............  Bay County, Florida     6015  Urban...........   0.8005    37460  Urban...........     0.8005
10030............  Bradford County,          10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10040............  Brevard County,         4900  Urban...........   0.9839    37340  Urban...........     0.9839
                    Florida.
10050............  Broward County,         2680  Urban...........   1.0432    22744  Urban...........     1.0432
                    Florida.
10060............  Calhoun County,           10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10070............  Charlotte County,       6580  Urban...........   0.9255    39460  Urban...........     0.9255
                    Florida.
10080............  Citrus County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10090............  Clay County,            3600  Urban...........   0.9299    27260  Urban...........     0.9290
                    Florida.
10100............  Collier County,         5345  Urban...........   1.0139    34940  Urban...........     1.0139
                    Florida.
10110............  Columbia County,          10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10120............  Dade County,            5000  Urban...........   0.9750    33124  Urban...........     0.9750
                    Florida.
10130............  De Soto County,           10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10140............  Dixie County,             10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10150............  Duval County,           3600  Urban...........   0.9299    27260  Urban...........     0.9290
                    Florida.
10160............  Escambia County,        6080  Urban...........   0.8096    37860  Urban...........     0.8096
                    Florida.
10170............  Flagler County,         2020  Urban...........   0.9325    99910  Rural...........     0.8568
                    Florida.
10180............  Franklin County,          10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10190............  Gadsden County,         8240  Urban...........   0.8688    45220  Urban...........     0.8688
                    Florida.
10200............  Gilchrist County,         10  Rural...........   0.8677    23540  Urban...........     0.9388
                    Florida.
10210............  Glades County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10220............  Gulf County,              10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10230............  Hamilton County,          10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10240............  Hardee County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10250............  Hendry County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10260............  Hernando County,        8280  Urban...........   0.9233    45300  Urban...........     0.9233
                    Florida.
10270............  Highlands County,         10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10280............  Hillsborough            8280  Urban...........   0.9233    45300  Urban...........     0.9233
                    County, Florida.
10290............  Holmes County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10300............  Indian River              10  Rural...........   0.8677    46940  Urban...........     0.9434
                    County, Florida.
10310............  Jackson County,           10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10320............  Jefferson County,         10  Rural...........   0.8677    45220  Urban...........     0.8688
                    Florida.
10330............  Lafayette County,         10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10340............  Lake County,            5960  Urban...........   0.9464    36740  Urban...........     0.9464
                    Florida.
10350............  Lee County, Florida     2700  Urban...........   0.9356    15980  Urban...........     0.9356
10360............  Leon County,            8240  Urban...........   0.8688    45220  Urban...........     0.8688
                    Florida.
10370............  Levy County,              10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10380............  Liberty County,           10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10390............  Madison County,           10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10400............  Manatee County,         7510  Urban...........   0.9639    42260  Urban...........     0.9639
                    Florida.
10410............  Marion County,          5790  Urban...........   0.8925    36100  Urban...........     0.8925
                    Florida.
10420............  Martin County,          2710  Urban...........   1.0123    38940  Urban...........     1.0123
                    Florida.
10430............  Monroe County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10440............  Nassau County,          3600  Urban...........   0.9299    27260  Urban...........     0.9290
                    Florida.
10450............  Okaloosa County,        2750  Urban...........   0.8872    23020  Urban...........     0.8872
                    Florida.
10460............  Okeechobee County,        10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10470............  Orange County,          5960  Urban...........   0.9464    36740  Urban...........     0.9464
                    Florida.
10480............  Osceola County,         5960  Urban...........   0.9464    36740  Urban...........     0.9464
                    Florida.
10490............  Palm Beach County,      8960  Urban...........   1.0067    48424  Urban...........     1.0067
                    Florida.
10500............  Pasco County,           8280  Urban...........   0.9233    45300  Urban...........     0.9233
                    Florida.
10510............  Pinellas County,        8280  Urban...........   0.9233    45300  Urban...........     0.9233
                    Florida.
10520............  Polk County,            3980  Urban...........   0.8912    29460  Urban...........     0.8912
                    Florida.
10530............  Putnam County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10540............  Johns County,           3600  Urban...........   0.9299    27260  Urban...........     0.9290
                    Florida.
10550............  St Lucie County,        2710  Urban...........   1.0123    38940  Urban...........     1.0123
                    Florida.
10560............  Santa Rosa County,      6080  Urban...........   0.8096    37860  Urban...........     0.8096
                    Florida.
10570............  Sarasota County,        7510  Urban...........   0.9639    42260  Urban...........     0.9639
                    Florida.
10580............  Seminole County,        5960  Urban...........   0.9464    36740  Urban...........     0.9464
                    Florida.
10590............  Sumter County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10600............  Suwannee County,          10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10610............  Taylor County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10620............  Union County,             10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10630............  Volusia County,         2020  Urban...........   0.9325    19660  Urban...........     0.9299
                    Florida.
10640............  Wakulla County,           10  Rural...........   0.8677    45220  Urban...........     0.8688
                    Florida.
10650............  Walton County,            10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
10660............  Washington County,        10  Rural...........   0.8677    99910  Rural...........     0.8568
                    Florida.
11000............  Appling County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11010............  Atkinson County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11011............  Bacon County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.

[[Page 3662]]

 
11020............  Baker County,             11  Rural...........   0.8166    10500  Urban...........     0.8628
                    Georgia.
11030............  Baldwin County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11040............  Banks County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11050............  Barrow County,          0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11060............  Bartow County,          0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11070............  Ben Hill County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11080............  Berrien County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11090............  Bibb County,            4680  Urban...........   0.9277    31420  Urban...........     0.9443
                    Georgia.
11100............  Bleckley County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11110............  Brantley County,          11  Rural...........   0.8166    15260  Urban...........     0.9311
                    Georgia.
11120............  Brooks County,            11  Rural...........   0.8166    46660  Urban...........     0.8866
                    Georgia.
11130............  Bryan County,           7520  Urban...........   0.9461    42340  Urban...........     0.9461
                    Georgia.
11140............  Bulloch County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11150............  Burke County,             11  Rural...........   0.8166    12260  Urban...........     0.9748
                    Georgia.
11160............  Butts County,             11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11161............  Calhoun County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11170............  Camden County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11180............  Candler County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11190............  Carroll County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11200............  Catoosa County,         1560  Urban...........   0.9088    16860  Urban...........     0.9088
                    Georgia.
11210............  Charlton County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11220............  Chatham County,         7520  Urban...........   0.9461    42340  Urban...........     0.9461
                    Georgia.
11230............  Chattahoochee           1800  Urban...........   0.8560    17980  Urban...........     0.8560
                    County, Georgia.
11240............  Chattooga County,         11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11250............  Cherokee County,        0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11260............  Clarke County,          0500  Urban...........   0.9855    12020  Urban...........     0.9855
                    Georgia.
11270............  Clay County,              11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11280............  Clayton County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11281............  Clinch County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11290............  Cobb County,            0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11291............  Coffee County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11300............  Colquitt County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11310............  Columbia County,        0600  Urban...........   0.9808    12260  Urban...........     0.9748
                    Georgia.
11311............  Cook County,              11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11320............  Coweta County,          0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11330............  Crawford County,          11  Rural...........   0.8166    31420  Urban...........     0.9443
                    Georgia.
11340............  Crisp County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11341............  Dade County,            1560  Urban...........   0.9088    16860  Urban...........     0.9088
                    Georgia.
11350............  Dawson County,            11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11360............  Decatur County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11370............  De Kalb County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11380............  Dodge County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11381............  Dooly County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11390............  Dougherty County,       0120  Urban...........   0.8628    10500  Urban...........     0.8628
                    Georgia.
11400............  Douglas County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11410............  Early County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11420............  Echols County,            11  Rural...........   0.8166    46660  Urban...........     0.8866
                    Georgia.
11421............  Effingham County,       7520  Urban...........   0.9461    42340  Urban...........     0.9461
                    Georgia.
11430............  Elbert County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11440............  Emanuel County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11441............  Evans County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11450............  Fannin County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11451............  Fayette County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11460............  Floyd County,             11  Rural...........   0.8166    40660  Urban...........     0.9414
                    Georgia.
11461............  Forsyth County,         0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11462............  Franklin County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11470............  Fulton County,          0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11471............  Gilmer County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11480............  Glascock County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11490............  Glynn County,             11  Rural...........   0.8166    15260  Urban...........     0.9311
                    Georgia.
11500............  Gordon County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11510............  Grady County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11520............  Greene County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11530............  Gwinnett County,        0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11540............  Habersham County,         11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11550............  Hall County,              11  Rural...........   0.8166    23580  Urban...........     0.8874
                    Georgia.
11560............  Hancock County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11570............  Haralson County,          11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11580............  Harris County,          1800  Urban...........   0.8560    17980  Urban...........     0.8560
                    Georgia.
11581............  Hart County,              11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11590............  Heard County,             11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.

[[Page 3663]]

 
11591............  Henry County,           0520  Urban...........   0.9793    12060  Urban...........     0.9793
                    Georgia.
11600............  Houston County,         4680  Urban...........   0.9277    47580  Urban...........     0.8645
                    Georgia.
11601............  Irwin County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11610............  Jackson County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11611............  Jasper County,            11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11612............  Jeff Davis County,        11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11620............  Jefferson County,         11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11630............  Jenkins County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11640............  Johnson County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11650............  Jones County,           4680  Urban...........   0.9277    31420  Urban...........     0.9443
                    Georgia.
11651............  Lamar County,             11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11652............  Lanier County,            11  Rural...........   0.8166    46660  Urban...........     0.8866
                    Georgia.
11660............  Laurens County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11670............  Lee County, Georgia     0120  Urban...........   0.8628    10500  Urban...........     0.8628
11680............  Liberty County,           11  Rural...........   0.8166    25980  Urban...........        \1\
                    Georgia.                                                                              0.9198
11690............  Lincoln County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11691............  Long County,              11  Rural...........   0.8166    25980  Urban...........        \1\
                    Georgia.                                                                              0.9198
11700............  Lowndes County,           11  Rural...........   0.8166    46660  Urban...........     0.8866
                    Georgia.
11701............  Lumpkin County,           11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11702............  Mc Duffie County,       0600  Urban...........   0.9808    12260  Urban...........     0.9748
                    Georgia.
11703............  Mc Intosh County,         11  Rural...........   0.8166    15260  Urban...........     0.9311
                    Georgia.
11710............  Macon County,             11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11720............  Madison County,         0500  Urban...........   0.9855    12020  Urban...........     0.9855
                    Georgia.
11730............  Marion County,            11  Rural...........   0.8166    17980  Urban...........     0.8560
                    Georgia.
11740............  Meriwether County,        11  Rural...........   0.8166    12060  Urban...........     0.9793
                    Georgia.
11741............  Miller County,            11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11750............  Mitchell County,          11  Rural...........   0.8166    99911  Rural...........     0.7662
                    Georgia.
11760............  Monroe County,            11  Rural...........   .08166    31420  Urban...........     0.9443
                    Georgia.
11770............  Montgomery County,        11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11771............  Morgan County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11772............  Murray County,            11  Rural...........   .08166    19140  Urban...........     0.9079
                    Georgia.
11780............  Muscogee County,        1800  Urban...........   .08560    17980  Urban...........     0.8560
                    Georgia.
11790............  Newton County,          0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11800............  Oconee County,          0500  Urban...........   .09855    12020  Urban...........     0.9855
                    Georgia.
11801............  Oglethorpe County,        11  Rural...........   .08166    12020  Urban...........     0.9855
                    Georgia.
11810............  Paulding County,        0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11811............  Peach County,           4680  Urban...........   .09277    99911  Rural...........     0.7662
                    Georgia.
11812............  Pickens County,         0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11820............  Pierce County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11821............  Pike County,              11  Rural...........   .08166    12060  Urban...........     0.9793
                    Georgia.
11830............  Polk County,              11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11831............  Pulaski County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11832............  Putnam County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11833............  Quitman County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11834............  Rabun County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11835............  Randolph County,          11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11840............  Richmond County,        0600  Urban...........   .09808    12260  Urban...........     0.9748
                    Georgia.
11841............  Rockdale County,        0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11842............  Schley County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11850............  Screven County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11851............  Seminole County,          11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11860............  Spalding County,        0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11861............  Stephens County,          11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11862............  Stewart County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11870............  Sumter County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11880............  Talbot County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11881............  Taliaferro County,        11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11882............  Tattnall County,          11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11883............  Taylor County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11884............  Telfair County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11885............  Terrell County,           11  Rural...........   .08166    10500  Urban...........     0.8628
                    Georgia.
11890............  Thomas County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11900............  Tift County,              11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11901............  Toombs County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11902............  Towns County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11903............  Treutlen County,          11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11910............  Troup County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11911............  Turner County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11912............  Twiggs County,          4680  Urban...........   .09277    31420  Urban...........     0.9443
                    Georgia.
11913............  Union County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11920............  Upson County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.

[[Page 3664]]

 
11921............  Walker County,          1560  Urban...........   .09088    16860  Urban...........     0.9088
                    Georgia.
11930............  Walton County,          0520  Urban...........   .09793    12060  Urban...........     0.9793
                    Georgia.
11940............  Ware County,              11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11941............  Warren County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11950............  Washington County,        11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11960............  Wayne County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11961............  Webster County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11962............  Wheeler County,           11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11963............  White County,             11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11970............  Whitfield County,         11  Rural...........   .08166    19140  Urban...........     0.9079
                    Georgia.
11971............  Wilcox County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11972............  Wilkes County,            11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11973............  Wilkinson County,         11  Rural...........   .08166    99911  Rural...........     0.7662
                    Georgia.
11980............  Worth County,             11  Rural...........   .08166    10500  Urban...........     0.8628
                    Georgia.
12005............  Kalawao County,           12  Rural...........   1.0551    99912  Rural...........     1.0551
                    Hawaii.
12010............  Hawaii County,            12  Rural...........   1.0551    99912  Rural...........     1.0551
                    Hawaii.
12020............  Honolulu County,        3320  Urban...........   1.1214    26180  Urban...........     1.1214
                    Hawaii.
12040............  Kauai County,             12  Rural...........   1.0551    99912  Rural...........     1.0551
                    Hawaii.
12050............  Maui County, Hawaii       12  Rural...........   1.0551    99912  Rural...........     1.0551
13000............  Ada County, Idaho..     1080  Urban...........   0.9052    14260  Urban...........     0.9052
13010............  Adams County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13020............  Bannock County,         6340  Urban...........   0.9351    38540  Urban...........     0.9351
                    Idaho.
13030............  Bear Lake County,         13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13040............  Benewah County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13050............  Bingham County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13060............  Blaine County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13070............  Boise County, Idaho       13  Rural...........   0.9097    14260  Urban...........     0.9052
13080............  Bonner County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13090............  Bonneville County,        13  Rural...........   0.9097    26820  Urban...........     0.9420
                    Idaho.
13100............  Boundary County,          13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13110............  Butte County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13120............  Camas County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13130............  Canyon County,          1080  Urban...........   0.9052    14260  Urban...........     0.9052
                    Idaho.
13140............  Caribou County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13150............  Cassia County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13160............  Clark County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13170............  Clearwater County,        13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13180............  Custer County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13190............  Elmore County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13200............  Franklin County,          13  Rural...........   0.9097    30860  Urban...........     0.9164
                    Idaho.
13210............  Fremont County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13220............  Gem County, Idaho..       13  Rural...........   0.9097    14260  Urban...........     0.9052
13230............  Gooding County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13240............  Idaho County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13250............  Jefferson County,         13  Rural...........   0.9097    26820  Urban...........     0.9420
                    Idaho.
13260............  Jerome County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13270............  Kootenai County,          13  Rural...........   0.9097    17660  Urban...........     0.9647
                    Idaho.
13280............  Latah County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13290............  Lemhi County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13300............  Lewis County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13310............  Lincoln County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13320............  Madison County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13330............  Minidoka County,          13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13340............  Nez Perce County,         13  Rural...........   0.9097    30300  Urban...........     0.9886
                    Idaho.
13350............  Oneida County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13360............  Owyhee County,            13  Rural...........   0.9097    14260  Urban...........     0.9052
                    Idaho.
13370............  Payette County,           13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13380............  Power County, Idaho       13  Rural...........   0.9097    38540  Urban...........     0.9351
13390............  Shoshone County,          13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13400............  Teton County, Idaho       13  Rural...........   0.9097    99913  Rural...........     0.8037
13410............  Twin Falls County,        13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13420............  Valley County,            13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
13430............  Washington County,        13  Rural...........   0.9097    99913  Rural...........     0.8037
                    Idaho.
14000............  Adams County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14010............  Alexander County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14020............  Bond County,              14  Rural...........   0.8301    41180  Urban...........     0.8954
                    Illinois.
14030............  Boone County,           6880  Urban...........   0.9984    40420  Urban...........     0.9984
                    Illinois.
14040............  Brown County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14050............  Bureau County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14060............  Calhoun County,           14  Rural...........   0.8301    41180  Urban...........     0.8954
                    Illinois.
14070............  Carroll County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.

[[Page 3665]]

 
14080............  Cass County,              14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14090............  Champaign County,       1400  Urban...........   0.9594    16580  Urban...........     0.9594
                    Illinois.
14100............  Christian County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14110............  Clark County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14120............  Clay County,              14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14130............  Clinton County,         7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Illinois.
14140............  Coles County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14141............  Cook County,            1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14150............  Crawford County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14160............  Cumberland County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14170............  De Kalb County,         1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14180............  De Witt County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14190............  Douglas County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14250............  Du Page County,         1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14310............  Edgar County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14320............  Edwards County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14330............  Effingham County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14340............  Fayette County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14350............  Ford County,              14  Rural...........   0.8301    16580  Urban...........     0.9594
                    Illinois.
14360............  Franklin County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14370............  Fulton County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14380............  Gallatin County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14390............  Greene County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14400............  Grundy County,          1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14410............  Hamilton County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14420............  Hancock County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14421............  Hardin County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14440............  Henderson County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14450............  Henry County,           1960  Urban...........   0.8724    19340  Urban...........     0.8724
                    Illinois.
14460............  Iroquois County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14470............  Jackson County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14480............  Jasper County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14490............  Jefferson County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14500............  Jersey County,          7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Illinois.
14510............  Jo Daviess County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14520............  Johnson County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14530............  Kane County,            1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14540............  Kankakee County,        3740  Urban...........   1.0721    28100  Urban...........     1.0721
                    Illinois.
14550............  Kendall County,         1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14560............  Knox County,              14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14570............  Lake County,            1600  Urban...........   1.0783    29404  Urban...........     1.0429
                    Illinois.
14580............  La Salle County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14590............  Lawrence County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14600............  Lee County,               14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14610............  Livingston County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14620............  Logan County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14630............  Mc Donough County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14640............  Mc Henry County,        1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14650............  Mclean County,          1040  Urban...........   0.9075    14060  Urban...........     0.9075
                    Illinois.
14660............  Macon County,           2040  Urban...........   0.8067    19500  Urban...........     0.8067
                    Illinois.
14670............  Macoupin County,          14  Rural...........   0.8301    41180  Urban...........     0.8954
                    Illinois.
14680............  Madison County,         7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Illinois.
14690............  Marion County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14700............  Marshall County,          14  Rural...........   0.8301    37900  Urban...........     0.8870
                    Illinois.
14710............  Mason County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14720............  Massac County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14730............  Menard County,          7880  Urban...........   0.8792    44100  Urban...........     0.8792
                    Illinois.
14740............  Mercer County,            14  Rural...........   0.8301    19340  Urban...........     0.8724
                    Illinois.
14750............  Monroe County,          7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Illinois.
14760............  Montgomery County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14770............  Morgan County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14780............  Moultrie County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14790............  Ogle County,            6880  Urban...........   0.9984    99914  Rural...........     0.8271
                    Illinois.
14800............  Peoria County,          6120  Urban...........   0.8870    37900  Urban...........     0.8870
                    Illinois.
14810............  Perry County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14820............  Piatt County,             14  Rural...........   0.8301    16580  Urban...........     0.9594
                    Illinois.
14830............  Pike County,              14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14831............  Pope County,              14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14850............  Pulaski County,           14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14860............  Putnam County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14870............  Randolph County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.

[[Page 3666]]

 
14880............  Richland County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14890............  Rock Island County,     1960  Urban...........   0.8724    19340  Urban...........     0.8724
                    Illinois.
14900............  St Clair County,        7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Illinois.
14910............  Saline County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14920............  Sangamon County,        7880  Urban...........   0.8792    44100  Urban...........     0.8792
                    Illinois.
14921............  Schuyler County,          14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14940............  Scott County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14950............  Shelby County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14960............  Stark County,             14  Rural...........   0.8301    37900  Urban...........     0.8870
                    Illinois.
14970............  Stephenson County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14980............  Tazewell County,        6120  Urban...........   0.8870    37900  Urban...........     0.8870
                    Illinois.
14981............  Union County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14982............  Vermilion County,         14  Rural...........   0.8301    19180  Urban...........     0.9028
                    Illinois.
14983............  Wabash County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14984............  Warren County,            14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14985............  Washington County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14986............  Wayne County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14987............  White County,             14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14988............  Whiteside County,         14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14989............  Will County,            1600  Urban...........   1.0783    16974  Urban...........     1.0790
                    Illinois.
14990............  Williamson County,        14  Rural...........   0.8301    99914  Rural...........     0.8271
                    Illinois.
14991............  Winnebago County,       6880  Urban...........   0.9984    40420  Urban...........     0.9984
                    Illinois.
14992............  Woodford County,        6120  Urban...........   0.8870    37900  Urban...........     0.8870
                    Illinois.
15000............  Adams County,           2760  Urban...........   0.9706    99915  Rural...........     0.8624
                    Indiana.
15010............  Allen County,           2760  Urban...........   0.9706    23060  Urban...........     0.9793
                    Indiana.
15020............  Bartholomew County,       15  Rural...........   0.8739    18020  Urban...........     0.9588
                    Indiana.
15030............  Benton County,            15  Rural...........   0.8739    29140  Urban...........     0.8736
                    Indiana.
15040............  Blackford County,         15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15050............  Boone County,           3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15060............  Brown County,             15  Rural...........   0.8739    26900  Urban...........     0.9920
                    Indiana.
15070............  Carroll County,           15  Rural...........   0.8739    29140  Urban...........     0.8736
                    Indiana.
15080............  Cass County,              15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15090............  Clark County,           4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Indiana.
15100............  Clay County,            8320  Urban...........   0.8337    45460  Urban...........     0.8304
                    Indiana.
15110............  Clinton County,         3920  Urban...........   0.8736    99915  Rural...........     0.8624
                    Indiana.
15120............  Crawford County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15130............  Daviess County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15140............  Dearborn County,        1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Indiana.
15150............  Decatur County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15160............  De Kalb County,         2760  Urban...........   0.9706    99915  Rural...........     0.8624
                    Indiana.
15170............  Delaware County,        5280  Urban...........   0.8930    34620  Urban...........     0.8930
                    Indiana.
15180............  Dubois County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15190............  Elkhart County,         2330  Urban...........   0.9627    21140  Urban...........     0.9627
                    Indiana.
15200............  Fayette County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15210............  Floyd County,           4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Indiana.
15220............  Fountain County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15230............  Franklin County,          15  Rural...........   0.8739    17140  Urban...........     0.9615
                    Indiana.
15240............  Fulton County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15250............  Gibson County,            15  Rural...........   0.8739    21780  Urban...........     0.8713
                    Indiana.
15260............  Grant County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15270............  Greene County,            15  Rural...........   0.8739    14020  Urban...........     0.8447
                    Indiana.
15280............  Hamilton County,        3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15290............  Hancock County,         3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15300............  Harrison County,        4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Indiana.
15310............  Hendricks County,       3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15320............  Henry County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15330............  Howard County,          3850  Urban...........   0.9508    29020  Urban...........     0.9508
                    Indiana.
15340............  Huntington County,      2760  Urban...........   0.9706    99915  Rural...........     0.8624
                    Indiana.
15350............  Jackson County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15360............  Jasper County,            15  Rural...........   0.8739    23844  Urban...........     0.9395
                    Indiana.
15370............  Jay County, Indiana       15  Rural...........   0.8739    99915  Rural...........     0.8624
15380............  Jefferson County,         15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15390............  Jennings County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15400............  Johnson County,         3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15410............  Knox County,              15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15420............  Kosciusko County,         15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15430............  Lagrange County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15440............  Lake County,            2960  Urban...........   0.9395    23844  Urban...........     0.9395
                    Indiana.
15450............  La Porte County,          15  Rural...........   0.8739    33140  Urban...........     0.9399
                    Indiana.
15460............  Lawrence County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15470............  Madison County,         3480  Urban...........   0.9865    11300  Urban...........     0.8586
                    Indiana.

[[Page 3667]]

 
15480............  Marion County,          3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15490............  Marshall County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15500............  Martin County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15510............  Miami County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15520............  Monroe County,          1020  Urban...........   0.8447    14020  Urban...........     0.8447
                    Indiana.
15530............  Montgomery County,        15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15540............  Morgan County,          3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15550............  Newton County,            15  Rural...........   0.8739    23844  Urban...........     0.9395
                    Indiana.
15560............  Noble County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15570............  Ohio County,            1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Indiana.
15580............  Orange County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15590............  Owen County,              15  Rural...........   0.8739    14020  Urban...........     0.8447
                    Indiana.
15600............  Parke County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15610............  Perry County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15620............  Pike County,              15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15630............  Porter County,          2960  Urban...........   0.9395    23844  Urban...........     0.9395
                    Indiana.
15640............  Posey County,           2440  Urban...........   0.8713    21780  Urban...........     0.8713
                    Indiana.
15650............  Pulaski County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15660............  Putnam County,            15  Rural...........   0.8739    26900  Urban...........     0.9920
                    Indiana.
15670............  Randolph County,          15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15680............  Ripley County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15690............  Rush County,              15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15700............  St Joseph County,       7800  Urban...........   0.9788    43780  Urban...........     0.9788
                    Indiana.
15710............  Scott County,           4520  Urban...........   0.9293    99915  Rural...........     0.8624
                    Indiana.
15720............  Shelby County,          3480  Urban...........   0.9865    26900  Urban...........     0.9920
                    Indiana.
15730............  Spencer County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15740............  Starke County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15750............  Steuben County,           15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15760............  Sullivan County,          15  Rural...........   0.8739    45460  Urban...........     0.8304
                    Indiana.
15770............  Switzerland County,       15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15780............  Tippecanoe County,      3920  Urban...........   0.8736    29140  Urban...........     0.8736
                    Indiana.
15790............  Tipton County,          3850  Urban...........   0.9508    29020  Urban...........     0.9508
                    Indiana.
15800............  Union County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15810............  Vanderburgh County,     2440  Urban...........   0.8713    21780  Urban...........     0.8713
                    Indiana.
15820............  Vermillion County,      8320  Urban...........   0.8337    45460  Urban...........     0.8304
                    Indiana.
15830............  Vigo County,            8320  Urban...........   0.8337    45460  Urban...........     0.8304
                    Indiana.
15840............  Wabash County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15850............  Warren County,            15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15860............  Warrick County,         2440  Urban...........   0.8713    21780  Urban...........     0.8713
                    Indiana.
15870............  Washington County,        15  Rural...........   0.8739    31140  Urban...........     0.9251
                    Indiana.
15880............  Wayne County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15890............  Wells County,           2760  Urban...........   0.9706    23060  Urban...........     0.9793
                    Indiana.
15900............  White County,             15  Rural...........   0.8739    99915  Rural...........     0.8624
                    Indiana.
15910............  Whitley County,         2760  Urban...........   0.9706    23060  Urban...........     0.9793
                    Indiana.
16000............  Adair County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16010............  Adams County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16020............  Allamakee County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16030............  Appanoose County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16040............  Audubon County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16050............  Benton County, Iowa       16  Rural...........   0.8594    16300  Urban...........     0.8825
16060............  Black Hawk County,      8920  Urban...........   0.8557    47940  Urban...........     0.8557
                    Iowa.
16070............  Boone County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16080............  Bremer County, Iowa       16  Rural...........   0.8594    47940  Urban...........     0.8557
16090............  Buchanan County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16100............  Buena Vista County,       16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16110............  Butler County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16120............  Calhoun County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16130............  Carroll County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16140............  Cass County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16150............  Cedar County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16160............  Cerro Gordo County,       16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16170............  Cherokee County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16180............  Chickasaw County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16190............  Clarke County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16200............  Clay County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16210............  Clayton County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16220............  Clinton County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16230............  Crawford County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16240............  Dallas County, Iowa     2120  Urban...........   0.9669    19780  Urban...........     0.9669
16250............  Davis County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16260............  Decatur County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.

[[Page 3668]]

 
16270............  Delaware County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16280............  Des Moines County,        16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16290............  Dickinson County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16300............  Dubuque County,         2200  Urban...........   0.9024    20220  Urban...........     0.9024
                    Iowa.
16310............  Emmet County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16320............  Fayette County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16330............  Floyd County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16340............  Franklin County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16350............  Fremont County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16360............  Greene County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16370............  Grundy County, Iowa       16  Rural...........   0.8594    47940  Urban...........     0.8557
16380............  Guthrie County,           16  Rural...........   0.8594    19780  Urban...........     0.9669
                    Iowa.
16390............  Hamilton County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16400............  Hancock County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16410............  Hardin County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16420............  Harrison County,          16  Rural...........   0.8594    36540  Urban...........     0.9560
                    Iowa.
16430............  Henry County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16440............  Howard County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16450............  Humboldt County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16460............  Ida County, Iowa...       16  Rural...........   0.8594    99916  Rural...........     0.8509
16470............  Iowa County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16480............  Jackson County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16490............  Jasper County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16500............  Jefferson County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16510............  Johnson County,         3500  Urban...........   0.9747    26980  Urban...........     0.9747
                    Iowa.
16520............  Jones County, Iowa.       16  Rural...........   0.8594    16300  Urban...........     0.8825
16530............  Keokuk County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16540............  Kossuth County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16550............  Lee County, Iowa...       16  Rural...........   0.8594    99916  Rural...........     0.8509
16560............  Linn County, Iowa..     1360  Urban...........   0.8825    16300  Urban...........     0.8825
16570............  Louisa County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16580............  Lucas County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16590............  Lyon County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16600............  Madison County,           16  Rural...........   0.8594    19780  Urban...........     0.9669
                    Iowa.
16610............  Mahaska County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16620............  Marion County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16630............  Marshall County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16640............  Mills County, Iowa.       16  Rural...........   0.8594    36540  Urban...........     0.9560
16650............  Mitchell County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16660............  Monona County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16670............  Monroe County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16680............  Montgomery County,        16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16690............  Muscatine County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16700............  O Brien County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16710............  Osceola County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16720............  Page County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16730............  Palo Alto County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16740............  Plymouth County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16750............  Pocahontas County,        16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16760............  Polk County, Iowa..     2120  Urban...........   0.9669    19780  Urban...........     0.9669
16770............  Pottawattamie           5920  Urban...........   0.9560    36540  Urban...........     0.9560
                    County, Iowa.
16780............  Poweshiek County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16790............  Ringgold County,          16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16800............  Sac County, Iowa...       16  Rural...........   0.8594    99916  Rural...........     0.8509
16810............  Scott County, Iowa.     1960  Urban...........   0.8724    19340  Urban...........     0.8724
16820............  Shelby County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16830............  Sioux County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16840............  Story County, Iowa.       16  Rural...........   0.8594    11180  Urban...........     0.9536
16850............  Tama County, Iowa..       16  Rural...........   0.8594    99916  Rural...........     0.8509
16860............  Taylor County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
16870............  Union County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16880............  Van Buren County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16890............  Wapello County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16900............  Warren County, Iowa     2120  Urban...........   0.9669    19780  Urban...........     0.9669
16910............  Washington County,        16  Rural...........   0.8594    26980  Urban...........     0.9747
                    Iowa.
16920............  Wayne County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509
16930............  Webster County,           16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16940............  Winnebago County,         16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16950............  Winneshiek County,        16  Rural...........   0.8594    99916  Rural...........     0.8509
                    Iowa.
16960............  Woodbury County,        7720  Urban...........   0.9416    43580  Urban...........     0.9381
                    Iowa.
16970............  Worth County, Iowa.       16  Rural...........   0.8594    99916  Rural...........     0.8509

[[Page 3669]]

 
16980............  Wright County, Iowa       16  Rural...........   0.8594    99916  Rural...........     0.8509
17000............  Allen County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17010............  Anderson County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17020............  Atchison County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17030............  Barber County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17040............  Barton County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17050............  Bourbon County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17060............  Brown County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17070............  Butler County,          9040  Urban...........   0.9175    48620  Urban...........     0.9153
                    Kansas.
17080............  Chase County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17090............  Chautauqua County,        17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17100............  Cherokee County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17110............  Cheyenne County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17120............  Clark County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17130............  Clay County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17140............  Cloud County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17150............  Coffey County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17160............  Comanche County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17170............  Cowley County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17180............  Crawford County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17190............  Decatur County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17200............  Dickinson County,         17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17210............  Doniphan County,          17  Rural...........   0.8040    41140  Urban...........     0.9519
                    Kansas.
17220............  Douglas County,         4150  Urban...........   0.8537    29940  Urban...........     0.8537
                    Kansas.
17230............  Edwards County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17240............  Elk County, Kansas.       17  Rural...........   0.8040    99917  Rural...........     0.8035
17250............  Ellis County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17260............  Ellsworth County,         17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17270............  Finney County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17280............  Ford County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17290............  Franklin County,          17  Rural...........   0.8040    28140  Urban...........     0.9476
                    Kansas.
17300............  Geary County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17310............  Gove County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17320............  Graham County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17330............  Grant County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17340............  Gray County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17350............  Greeley County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17360............  Greenwood County,         17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17370............  Hamilton County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17380............  Harper County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17390............  Harvey County,          9040  Urban...........   0.9175    48620  Urban...........     0.9153
                    Kansas.
17391............  Haskell County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17410............  Hodgeman County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17420............  Jackson County,           17  Rural...........   0.8040    45820  Urban...........     0.8920
                    Kansas.
17430............  Jefferson County,         17  Rural...........   0.8040    45820  Urban...........     0.8920
                    Kansas.
17440............  Jewell County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17450............  Johnson County,         3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Kansas.
17451............  Kearny County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17470............  Kingman County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17480............  Kiowa County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17490............  Labette County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17500............  Lane County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17510............  Leavenworth County,     3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Kansas.
17520............  Lincoln County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17530............  Linn County, Kansas       17  Rural...........   0.8040    28140  Urban...........     0.9476
17540............  Logan County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17550............  Lyon County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17560............  Mc Pherson County,        17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17570............  Marion County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17580............  Marshall County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17590............  Meade County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17600............  Miami County,           3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Kansas.
17610............  Mitchell County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17620............  Montgomery County,        17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17630............  Morris County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17640............  Morton County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17650............  Nemaha County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17660............  Neosho County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17670............  Ness County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17680............  Norton County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17690............  Osage County,             17  Rural...........   0.8040    45820  Urban...........     0.8920
                    Kansas.

[[Page 3670]]

 
17700............  Osborne County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17710............  Ottawa County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17720............  Pawnee County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17730............  Phillips County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17740............  Pottawatomie              17  Rural...........   0.8040    99917  Rural...........     0.8035
                    County, Kansas.
17750............  Pratt County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17760............  Rawlins County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17770............  Reno County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17780............  Republic County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17790............  Rice County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17800............  Riley County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17810............  Rooks County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17820............  Rush County, Kansas       17  Rural...........   0.8040    99917  Rural...........     0.8035
17830............  Russell County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17840............  Saline County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17841............  Scott County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17860............  Sedgwick County,        9040  Urban...........   0.9175    48620  Urban...........     0.9153
                    Kansas.
17870............  Seward County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17880............  Shawnee County,         8440  Urban...........   0.8920    45820  Urban...........     0.8920
                    Kansas.
17890............  Sheridan County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17900............  Sherman County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17910............  Smith County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17920............  Stafford County,          17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17921............  Stanton County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17940............  Stevens County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17950............  Sumner County,            17  Rural...........   0.8040    48620  Urban...........     0.9153
                    Kansas.
17960............  Thomas County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17970............  Trego County,             17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17980............  Wabaunsee County,         17  Rural...........   0.8040    45820  Urban...........     0.8920
                    Kansas.
17981............  Wallace County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17982............  Washington County,        17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17983............  Wichita County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17984............  Wilson County,            17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17985............  Woodson County,           17  Rural...........   0.8040    99917  Rural...........     0.8035
                    Kansas.
17986............  Wyandotte County,       3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Kansas.
18000............  Adair County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18010............  Allen County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18020............  Anderson County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18030............  Ballard County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18040............  Barren County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18050............  Bath County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18060............  Bell County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18070............  Boone County,           1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18080............  Bourbon County,         4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
18090............  Boyd County,            3400  Urban...........   0.9477    26580  Urban...........     0.9477
                    Kentucky.
18100............  Boyle County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18110............  Bracken County,           18  Rural...........   0.7858    17140  Urban...........     0.9615
                    Kentucky.
18120............  Breathitt County,         18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18130............  Breckinridge              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    County, Kentucky.
18140............  Bullitt County,         4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Kentucky.
18150............  Butler County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18160............  Caldwell County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18170............  Calloway County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18180............  Campbell County,        1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18190............  Carlisle County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18191............  Carroll County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18210............  Carter County,          3400  Urban...........   0.9477    99918  Rural...........     0.7766
                    Kentucky.
18220............  Casey County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18230............  Christian County,       1660  Urban...........   0.8284    17300  Urban...........     0.8284
                    Kentucky.
18240............  Clark County,           4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
18250............  Clay County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18260............  Clinton County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18270............  Crittenden County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18271............  Cumberland County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18290............  Daviess County,         5990  Urban...........   0.8780    36980  Urban...........     0.8780
                    Kentucky.
18291............  Edmonson County,          18  Rural...........   0.7858    14540  Urban...........     0.8211
                    Kentucky.
18310............  Elliott County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18320............  Estill County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18330............  Fayette County,         4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
18340............  Fleming County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18350............  Floyd County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.

[[Page 3671]]

 
18360............  Franklin County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18361............  Fulton County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18362............  Gallatin County,        1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18390............  Garrard County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18400............  Grant County,           1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18410............  Graves County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18420............  Grayson County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18421............  Green County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18440............  Greenup County,         3400  Urban...........   0.9477    26580  Urban...........     0.9477
                    Kentucky.
18450............  Hancock County,           18  Rural...........   0.7858    36980  Urban...........     0.8780
                    Kentucky.
18460............  Hardin County,            18  Rural...........   0.7858    21060  Urban...........     0.8802
                    Kentucky.
18470............  Harlan County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18480............  Harrison County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18490............  Hart County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18500............  Henderson County,       2440  Urban...........   0.8713    21780  Urban...........     0.8713
                    Kentucky.
18510............  Henry County,             18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18511............  Hickman County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18530............  Hopkins County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18540............  Jackson County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18550............  Jefferson County,       4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Kentucky.
18560............  Jessamine County,       4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
18570............  Johnson County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18580............  Kenton County,          1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18590............  Knott County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18600............  Knox County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18610............  Larue County,             18  Rural...........   0.7858    21060  Urban...........     0.8802
                    Kentucky.
18620............  Laurel County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18630............  Lawrence County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18640............  Lee County,               18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18650............  Leslie County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18660............  Letcher County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18670............  Lewis County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18680............  Lincoln County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18690............  Livingston County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18700............  Logan County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18710............  Lyon County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18720............  Mc Cracken County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18730............  Mc Creary County,         18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18740............  Mc Lean County,           18  Rural...........   0.7858    36980  Urban...........     0.8780
                    Kentucky.
18750............  Madison County,         4280  Urban...........   0.8988    99918  Rural...........     0.7766
                    Kentucky.
18760............  Magoffin County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18770............  Marion County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18780............  Marshall County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18790............  Martin County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18800............  Mason County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18801............  Meade County,             18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18802............  Menifee County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18830............  Mercer County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18831............  Metcalfe County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18850............  Monroe County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18860............  Montgomery County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18861............  Morgan County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18880............  Muhlenberg County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18890............  Nelson County,            18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18900............  Nicholas County,          18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18910............  Ohio County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18920............  Oldham County,          4520  Urban...........   0.9293    31140  Urban...........     0.9251
                    Kentucky.
18930............  Owen County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18931............  Owsley County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18932............  Pendleton County,       1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Kentucky.
18960............  Perry County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18970............  Pike County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18971............  Powell County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18972............  Pulaski County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18973............  Robertson County,         18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18974............  Rockcastle County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18975............  Rowan County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18976............  Russell County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18977............  Scott County,           4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
18978............  Shelby County,            18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18979............  Simpson County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.

[[Page 3672]]

 
18980............  Spencer County,           18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18981............  Taylor County,            18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18982............  Todd County,              18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18983............  Trigg County,             18  Rural...........   0.7858    17300  Urban...........     0.8284
                    Kentucky.
18984............  Trimble County,           18  Rural...........   0.7858    31140  Urban...........     0.9251
                    Kentucky.
18985............  Union County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18986............  Warren County,            18  Rural...........   0.7858    14540  Urban...........     0.8211
                    Kentucky.
18987............  Washington County,        18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18988............  Wayne County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18989............  Webster County,           18  Rural...........   0.7858    21780  Urban...........     0.8713
                    Kentucky.
18990............  Whitley County,           18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18991............  Wolfe County,             18  Rural...........   0.7858    99918  Rural...........     0.7766
                    Kentucky.
18992............  Woodford County,        4280  Urban...........   0.8988    30460  Urban...........     0.9075
                    Kentucky.
19000............  Acadia County,          3880  Urban...........   0.8251    99919  Rural...........     0.7411
                    Louisiana.
19010............  Allen County,             19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19020............  Ascension County,       0760  Urban...........   0.8643    12940  Urban...........     0.8593
                    Louisiana.
19030............  Assumption County,        19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19040............  Avoyelles County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19050............  Beauregard County,        19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19060............  Bienville County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19070............  Bossier County,         7680  Urban...........   0.8737    43340  Urban...........     0.8760
                    Louisiana.
19080............  Caddo County,           7680  Urban...........   0.8737    43340  Urban...........     0.8760
                    Louisiana.
19090............  Calcasieu County,       3960  Urban...........   0.7858    29340  Urban...........     0.7833
                    Louisiana.
19100............  Caldwell County,          19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19110............  Cameron County,           19  Rural...........   0.7340    29340  Urban...........     0.7833
                    Louisiana.
19120............  Catahoula County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19130............  Claiborne County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19140............  Concordia County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19150............  De Soto County,           19  Rural...........   0.7340    43340  Urban...........     0.8760
                    Louisiana.
19160............  East Baton Rouge        0760  Urban...........   0.8643    12940  Urban...........     0.8593
                    County, Louisiana.
19170............  East Carroll              19  Rural...........   0.7340    99919  Rural...........     0.7411
                    County, Louisiana.
19180............  East Feliciana            19  Rural...........   0.7340    12940  Urban...........     0.8593
                    County, Louisiana.
19190............  Evangeline County,        19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19200............  Franklin County,          19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19210............  Grant County,             19  Rural...........   0.7340    10780  Urban...........     0.8033
                    Louisiana.
19220............  Iberia County,            19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19230............  Iberville County,         19  Rural...........   0.7340    12940  Urban...........     0.8593
                    Louisiana.
19240............  Jackson County,           19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19250............  Jefferson County,       5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19260............  Jefferson Davis           19  Rural...........   0.7340    99919  Rural...........     0.7411
                    County, Louisiana.
19270............  Lafayette County,       3880  Urban...........   0.8251    29180  Urban...........     0.8428
                    Louisiana.
19280............  Lafourche County,       3350  Urban...........   0.7894    26380  Urban...........     0.7894
                    Louisiana.
19290............  La Salle County,          19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19300............  Lincoln County,           19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19310............  Livingston County,      0760  Urban...........   0.8643    12940  Urban...........     0.8593
                    Louisiana.
19320............  Madison County,           19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19330............  Morehouse County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19340............  Natchitoches              19  Rural...........   0.7340    99919  Rural...........     0.7411
                    County, Louisiana.
19350............  Orleans County,         5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19360............  Ouachita County,        5200  Urban...........   0.8044    33740  Urban...........     0.8031
                    Louisiana.
19370............  Plaquemines County,     5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19380............  Pointe Coupee             19  Rural...........   0.7340    12940  Urban...........     0.8593
                    County, Louisiana.
19390............  Rapides County,         0220  Urban...........   0.8033    10780  Urban...........     0.8033
                    Louisiana.
19400............  Red River County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19410............  Richland County,          19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19420............  Sabine County,            19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19430............  St Bernard County,      5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19440............  St Charles County,      5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19450............  St Helena County,         19  Rural...........   0.7340    12940  Urban...........     0.8593
                    Louisiana.
19460............  St James County,        5560  Urban...........   0.8995    99919  Rural...........     0.7411
                    Louisiana.
19470............  St John Baptist         5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    County, Louisiana.
19480............  St Landry County,       3880  Urban...........   0.8251    99919  Rural...........     0.7411
                    Louisiana.
19490............  St Martin County,       3880  Urban...........   0.8251    29180  Urban...........     0.8428
                    Louisiana.
19500............  St Mary County,           19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19510............  St Tammany County,      5560  Urban...........   0.8995    35380  Urban...........     0.8995
                    Louisiana.
19520............  Tangipahoa County,        19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19530............  Tensas County,            19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19540............  Terrebonne County,      3350  Urban...........   0.7894    26380  Urban...........     0.7894
                    Louisiana.
19550............  Union County,             19  Rural...........   0.7340    33740  Urban...........     0.8031
                    Louisiana.
19560............  Vermilion County,         19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19570............  Vernon County,            19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.

[[Page 3673]]

 
19580............  Washington County,        19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
19590............  Webster County,         7680  Urban...........   0.8737    99919  Rural...........     0.7411
                    Louisiana.
19600............  West Baton Rouge        0760  Urban...........   0.8643    12940  Urban...........     0.8593
                    County, Louisiana.
19610............  West Carroll              19  Rural...........   0.7340    99919  Rural...........     0.7411
                    County, Louisiana.
19620............  West Feliciana            19  Rural...........   0.7340    12940  Urban...........     0.8593
                    County, Louisiana.
19630............  Winn County,              19  Rural...........   0.7340    99919  Rural...........     0.7411
                    Louisiana.
20000............  Androscoggin            4243  Urban...........   0.9331    30340  Urban...........     0.9331
                    County, Maine.
20010............  Aroostook County,         20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20020............  Cumberland County,      6403  Urban...........   1.0382    38860  Urban...........     1.0382
                    Maine.
20030............  Franklin County,          20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20040............  Hancock County,           20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20050............  Kennebec County,          20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20060............  Knox County, Maine.       20  Rural...........   0.8843    99920  Rural...........     0.8843
20070............  Lincoln County,           20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20080............  Oxford County,            20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20090............  Penobscot County,       0733  Urban...........   0.9993    12620  Urban...........     0.9993
                    Maine.
20100............  Piscataquis County,       20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20110............  Sagadahoc County,       6403  Urban...........   1.0382    38860  Urban...........     1.0382
                    Maine.
20120............  Somerset County,          20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20130............  Waldo County, Maine       20  Rural...........   0.8843    99920  Rural...........     0.8843
20140............  Washington County,        20  Rural...........   0.8843    99920  Rural...........     0.8843
                    Maine.
20150............  York County, Maine.     6403  Urban...........   1.0382    38860  Urban...........     1.0382
21000............  Allegany County,        1900  Urban...........   0.9317    19060  Urban...........     0.9317
                    Maryland.
21010............  Anne Arundel            0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    County, Maryland.
21020............  Baltimore County,       0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    Maryland.
21030............  Baltimore City          0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    County, Maryland.
21040............  Calvert County,         8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Maryland.
21050............  Caroline County,          21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21060............  Carroll County,         0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    Maryland.
21070............  Cecil County,           9160  Urban...........   1.0527    48864  Urban...........     1.0471
                    Maryland.
21080............  Charles County,         8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Maryland.
21090............  Dorchester County,        21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21100............  Frederick County,       8840  Urban...........   1.0976    13644  Urban...........     1.1483
                    Maryland.
21110............  Garrett County,           21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21120............  Harford County,         0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    Maryland.
21130............  Howard County,          0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    Maryland.
21140............  Kent County,              21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21150............  Montgomery County,      8840  Urban...........   1.0976    13644  Urban...........     1.1483
                    Maryland.
21160............  Prince Georges          8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Maryland.
21170............  Queen Annes County,     0720  Urban...........   0.9897    12580  Urban...........     0.9897
                    Maryland.
21180............  St Marys County,          21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21190............  Somerset County,          21  Rural...........   0.9230    41540  Urban...........     0.9064
                    Maryland.
21200............  Talbot County,            21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
21210............  Washington County,      3180  Urban...........   0.9869    25180  Urban...........     0.9489
                    Maryland.
21220............  Wicomico County,          21  Rural...........   0.9230    41540  Urban...........     0.9064
                    Maryland.
21230............  Worcester County,         21  Rural...........   0.9230    99921  Rural...........     0.9353
                    Maryland.
22000............  Barnstable County,      0743  Urban...........   1.2600    12700  Urban...........     1.2600
                    Massachusetts.
22010............  Berkshire County,       6323  Urban...........   1.0181    38340  Urban...........     1.0181
                    Massachusetts.
22020............  Bristol County,         1123  Urban...........   1.1178    39300  Urban...........     1.0966
                    Massachusetts.
22030............  Dukes County,             22  Rural...........   1.0216    99922  Rural...........     1.0216
                    Massachusetts.
22040............  Essex County,           1123  Urban...........   1.1178    21604  Urban...........     1.0538
                    Massachusetts.
22060............  Franklin County,          22  Rural...........   1.0216    44140  Urban...........     1.0248
                    Massachusetts.
22070............  Hampden County,         8003  Urban...........   1.0263    44140  Urban...........     1.0248
                    Massachusetts.
22080............  Hampshire County,       8003  Urban...........   1.0263    44140  Urban...........     1.0248
                    Massachusetts.
22090............  Middlesex County,       1123  Urban...........   1.1178    15764  Urban...........     1.1172
                    Massachusetts.
22120............  Nantucket County,         22  Rural...........   1.0216    99922  Rural...........     1.0216
                    Massachusetts.
22130............  Norfolk County,         1123  Urban...........   1.1178    14484  Urban...........     1.1558
                    Massachusetts.
22150............  Plymouth County,        1123  Urban...........   1.1178    14484  Urban...........     1.1558
                    Massachusetts.
22160............  Suffolk County,         1123  Urban...........   1.1178    14484  Urban...........     1.1558
                    Massachusetts.
22170............  Worcester County,       1123  Urban...........   1.1178    49340  Urban...........     1.1028
                    Massachusetts.
23000............  Alcona County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23010............  Alger County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23020............  Allegan County,         3000  Urban...........   0.9445    99923  Rural...........     0.8895
                    Michigan.
23030............  Alpena County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23040............  Antrim County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23050............  Arenac County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23060............  Baraga County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23070............  Barry County,             23  Rural...........   0.8824    24340  Urban...........     0.9390
                    Michigan.
23080............  Bay County,             6960  Urban...........   0.9241    13020  Urban...........     0.9343
                    Michigan.
23090............  Benzie County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23100............  Berrien County,         0870  Urban...........   0.8879    35660  Urban...........     0.8879
                    Michigan.

[[Page 3674]]

 
23110............  Branch County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23120............  Calhoun County,         3720  Urban...........   1.0143    12980  Urban...........     0.9508
                    Michigan.
23130............  Cass County,              23  Rural...........   0.8824    43780  Urban...........     0.9788
                    Michigan.
23140............  Charlevoix County,        23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23150............  Cheboygan County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23160............  Chippewa County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23170............  Clare County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23180............  Clinton County,         4040  Urban...........   0.9794    29620  Urban...........     0.9794
                    Michigan.
23190............  Crawford County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23200............  Delta County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23210............  Dickinson County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23220............  Eaton County,           4040  Urban...........   0.9794    29620  Urban...........     0.9794
                    Michigan.
23230............  Emmet County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23240............  Genesee County,         2640  Urban...........   1.0655    22420  Urban...........     1.0655
                    Michigan.
23250............  Gladwin County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23260............  Gogebic County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23270............  Grand Traverse            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    County, Michigan.
23280............  Gratiot County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23290............  Hillsdale County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23300............  Houghton County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23310............  Huron County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23320............  Ingham County,          4040  Urban...........   0.9794    29620  Urban...........     0.9794
                    Michigan.
23330............  Ionia County,             23  Rural...........   0.8824    24340  Urban...........     0.9390
                    Michigan.
23340............  Iosco County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23350............  Iron County,              23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23360............  Isabella County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23370............  Jackson County,         3520  Urban...........   0.9304    27100  Urban...........     0.9304
                    Michigan.
23380............  Kalamazoo County,       3720  Urban...........   1.0143    28020  Urban...........     1.0381
                    Michigan.
23390............  Kalkaska County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23400............  Kent County,            3000  Urban...........   0.9445    24340  Urban...........     0.9390
                    Michigan.
23410............  Keweenaw County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23420............  Lake County,              23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23430............  Lapeer County,          2160  Urban...........   1.0147    47644  Urban...........     0.9871
                    Michigan.
23440............  Leelanau County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23450............  Lenawee County,         0440  Urban...........   1.0707    99923  Rural...........     0.8895
                    Michigan.
23460............  Livingston County,      0440  Urban...........   1.0707    47644  Urban...........     0.9871
                    Michigan.
23470............  Luce County,              23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23480............  Mackinac County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23490............  Macomb County,          2160  Urban...........   1.0147    47644  Urban...........     0.9871
                    Michigan.
23500............  Manistee County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23510............  Marquette County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23520............  Mason County,             23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23530............  Mecosta County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23540............  Menominee County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23550............  Midland County,         6960  Urban...........   0.9241    99923  Rural...........     0.8895
                    Michigan.
23560............  Missaukee County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23570............  Monroe County,          2160  Urban...........   1.0147    33780  Urban...........     0.9468
                    Michigan.
23580............  Montcalm County,          23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23590............  Montmorency County,       23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23600............  Muskegon County,        3000  Urban...........   0.9445    34740  Urban...........     0.9664
                    Michigan.
23610............  Newaygo County,           23  Rural...........   0.8824    24340  Urban...........     0.9390
                    Michigan.
23620............  Oakland County,         2160  Urban...........   1.0147    47644  Urban...........     0.9871
                    Michigan.
23630............  Oceana County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23640............  Ogemaw County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23650............  Ontonagon County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23660............  Osceola County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23670............  Oscoda County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23680............  Otsego County,            23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23690............  Ottawa County,          3000  Urban...........   0.9445    26100  Urban...........     0.9055
                    Michigan.
23700............  Presque Isle              23  Rural...........   0.8824    99923  Rural...........     0.8895
                    County, Michigan.
23710............  Roscommon County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23720............  Saginaw County,         6960  Urban...........   0.9241    40980  Urban...........     0.9088
                    Michigan.
23730............  St Clair County,        2160  Urban...........   1.0147    47644  Urban...........     0.9871
                    Michigan.
23740............  St Joseph County,         23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23750............  Sanilac County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23760............  Schoolcraft County,       23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23770............  Shiawassee County,        23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23780............  Tuscola County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
23790............  Van Buren County,       3720  Urban...........   1.0143    28020  Urban...........     1.0381
                    Michigan.
23800............  Washtenaw County,       0440  Urban...........   1.0707    11460  Urban...........     1.0859
                    Michigan.
23810............  Wayne County,           2160  Urban...........   1.0147    19804  Urban...........     1.0424
                    Michigan.

[[Page 3675]]

 
23830............  Wexford County,           23  Rural...........   0.8824    99923  Rural...........     0.8895
                    Michigan.
24000............  Aitkin County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24010............  Anoka County,           5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24020............  Becker County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24030............  Beltrami County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24040............  Benton County,          6980  Urban...........   0.9965    41060  Urban...........     0.9965
                    Minnesota.
24050............  Big Stone County,         24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24060............  Blue Earth County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24070............  Brown County,             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24080............  Carlton County,           24  Rural...........   0.9132    20260  Urban...........     1.0213
                    Minnesota.
24090............  Carver County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24100............  Cass County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24110............  Chippewa County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24120............  Chisago County,         5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24130............  Clay County,            2520  Urban...........   0.8486    22020  Urban...........     0.8486
                    Minnesota.
24140............  Clearwater County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24150............  Cook County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24160............  Cottonwood County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24170............  Crow Wing County,         24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24180............  Dakota County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24190............  Dodge County,             24  Rural...........   0.9132    40340  Urban...........     1.1131
                    Minnesota.
24200............  Douglas County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24210............  Faribault County,         24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24220............  Fillmore County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24230............  Freeborn County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24240............  Goodhue County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24250............  Grant County,             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24260............  Hennepin County,        5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24270............  Houston County,         3870  Urban...........   0.9564    29100  Urban...........     0.9564
                    Minnesota.
24280............  Hubbard County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24290............  Isanti County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24300............  Itasca County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24310............  Jackson County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24320............  Kanabec County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24330............  Kandiyohi County,         24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24340............  Kittson County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24350............  Koochiching County,       24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24360............  Lac Qui Parle             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    County, Minnesota.
24370............  Lake County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24380............  Lake Of Woods             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    County, Minnesota.
24390............  Le Sueur County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24400............  Lincoln County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24410............  Lyon County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24420............  Mc Leod County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24430............  Mahnomen County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24440............  Marshall County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24450............  Martin County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24460............  Meeker County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24470............  Mille Lacs County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24480............  Morrison County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24490............  Mower County,             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24500............  Murray County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24510............  Nicollet County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24520............  Nobles County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24530............  Norman County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24540............  Olmsted County,         6820  Urban...........   1.1131    40340  Urban...........     1.1131
                    Minnesota.
24550............  Otter Tail County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24560............  Pennington County,        24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24570............  Pine County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24580............  Pipestone County,         24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24590............  Polk County,            2985  Urban...........   0.7901    24220  Urban...........     0.7901
                    Minnesota.
24600............  Pope County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24610............  Ramsey County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24620............  Red Lake County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24630............  Redwood County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24640............  Renville County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24650............  Rice County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24660............  Rock County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24670............  Roseau County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24680............  St Louis County,        2240  Urban...........   1.0213    20260  Urban...........     1.0213
                    Minnesota.
24690............  Scott County,           5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.

[[Page 3676]]

 
24700............  Sherburne County,       5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24710............  Sibley County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24720............  Stearns County,         6980  Urban...........   0.9965    41060  Urban...........     0.9965
                    Minnesota.
24730............  Steele County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24740............  Stevens County,           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24750............  Swift County,             24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24760............  Todd County,              24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24770............  Traverse County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24780............  Wabasha County,           24  Rural...........   0.9132    40340  Urban...........     1.1131
                    Minnesota.
24790............  Wadena County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24800............  Waseca County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24810............  Washington County,      5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24820............  Watonwan County,          24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24830............  Wilkin County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24840............  Winona County,            24  Rural...........   0.9132    99924  Rural...........     0.9132
                    Minnesota.
24850............  Wright County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Minnesota.
24860............  Yellow Medicine           24  Rural...........   0.9132    99924  Rural...........     0.9132
                    County, Minnesota.
25000............  Adams County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25010............  Alcorn County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25020............  Amite County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25030............  Attala County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25040............  Benton County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25050............  Bolivar County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25060............  Calhoun County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25070............  Carroll County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25080............  Chickasaw County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25090............  Choctaw County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25100............  Claiborne County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25110............  Clarke County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25120............  Clay County,              25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25130............  Coahoma County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25140............  Copiah County,            25  Rural...........   0.7634    27140  Urban...........     0.8311
                    Mississippi.
25150............  Covington County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25160............  Desoto County,          4920  Urban...........   0.9416    32820  Urban...........     0.9397
                    Mississippi.
25170............  Forrest County,         3285  Urban...........   0.7601    25620  Urban...........     0.7601
                    Mississippi.
25180............  Franklin County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25190............  George County,            25  Rural...........   0.7634    37700  Urban...........     0.8156
                    Mississippi.
25200............  Greene County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25210............  Grenada County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25220............  Hancock County,         0920  Urban...........   0.8706    25060  Urban...........     0.8929
                    Mississippi.
25230............  Harrison County,        0920  Urban...........   0.8706    25060  Urban...........     0.8929
                    Mississippi.
25240............  Hinds County,           3560  Urban...........   0.8382    27140  Urban...........     0.8311
                    Mississippi.
25250............  Holmes County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25260............  Humphreys County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25270............  Issaquena County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25280............  Itawamba County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25290............  Jackson County,         0920  Urban...........   0.8706    37700  Urban...........     0.8156
                    Mississippi.
25300............  Jasper County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25310............  Jefferson County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25320............  Jefferson Davis           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    County,
                    Mississippi.
25330............  Jones County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25340............  Kemper County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25350............  Lafayette County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25360............  Lamar County,           3285  Urban...........   0.7601    25620  Urban...........     0.7601
                    Mississippi.
25370............  Lauderdale County,        25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25380............  Lawrence County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25390............  Leake County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25400............  Lee County,               25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25410............  Leflore County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25420............  Lincoln County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25430............  Lowndes County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25440............  Madison County,         3560  Urban...........   0.8382    27140  Urban...........     0.8311
                    Mississippi.
25450............  Marion County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25460............  Marshall County,          25  Rural...........   0.7634    32820  Urban...........     0.9397
                    Mississippi.
25470............  Monroe County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25480............  Montgomery County,        25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25490............  Neshoba County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25500............  Newton County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25510............  Noxubee County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25520............  Oktibbeha County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25530............  Panola County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.

[[Page 3677]]

 
25540............  Pearl River County,       25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25550............  Perry County,             25  Rural...........   0.7634    25620  Urban...........     0.7601
                    Mississippi.
25560............  Pike County,              25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25570............  Pontotoc County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25580............  Prentiss County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25590............  Quitman County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25600............  Rankin County,          3560  Urban...........   0.8382    27140  Urban...........     0.8311
                    Mississippi.
25610............  Scott County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25620............  Sharkey County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25630............  Simpson County,           25  Rural...........   0.7634    27140  Urban...........     0.8311
                    Mississippi.
25640............  Smith County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25650............  Stone County,             25  Rural...........   0.7634    25060  Urban...........     0.8929
                    Mississippi.
25660............  Sunflower County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25670............  Tallahatchie              25  Rural...........   0.7634    99925  Rural...........     0.7674
                    County,
                    Mississippi.
25680............  Tate County,              25  Rural...........   0.7634    32820  Urban...........     0.9397
                    Mississippi.
25690............  Tippah County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25700............  Tishomingo County,        25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25710............  Tunica County,            25  Rural...........   0.7634    32820  Urban...........     0.9397
                    Mississippi.
25720............  Union County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25730............  Walthall County,          25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25740............  Warren County,            25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25750............  Washington County,        25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25760............  Wayne County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25770............  Webster County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25780............  Wilkinson County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25790............  Winston County,           25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25800............  Yalobusha County,         25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
25810............  Yazoo County,             25  Rural...........   0.7634    99925  Rural...........     0.7674
                    Mississippi.
26000............  Adair County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26010............  Andrew County,          7000  Urban...........   0.9519    41140  Urban...........     0.9519
                    Missouri.
26020............  Atchison County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26030............  Audrain County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26040............  Barry County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26050............  Barton County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26060............  Bates County,             26  Rural...........   0.7959    28140  Urban...........     0.9476
                    Missouri.
26070............  Benton County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26080............  Bollinger County,         26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26090............  Boone County,           1740  Urban...........   0.8345    17860  Urban...........     0.8345
                    Missouri.
26100............  Buchanan County,        7000  Urban...........   0.9519    41140  Urban...........     0.9519
                    Missouri.
26110............  Butler County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26120............  Caldwell County,          26  Rural...........   0.7959    28140  Urban...........     0.9476
                    Missouri.
26130............  Callaway County,          26  Rural...........   0.7959    27620  Urban...........     0.8387
                    Missouri.
26140............  Camden County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26150............  Cape Girardeau            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    County, Missouri.
26160............  Carroll County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26170............  Carter County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26180............  Cass County,            3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26190............  Cedar County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26200............  Chariton County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26210............  Christian County,       7920  Urban...........   0.8250    44180  Urban...........     0.8237
                    Missouri.
26220............  Clark County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26230............  Clay County,            3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26240............  Clinton County,         3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26250............  Cole County,              26  Rural...........   0.7959    27620  Urban...........     0.8387
                    Missouri.
26260............  Cooper County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26270............  Crawford County,          26  Rural...........   0.7959    41180  Urban...........     0.8954
                    Missouri.
26280............  Dade County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26290............  Dallas County,            26  Rural...........   0.7959    44180  Urban...........     0.8237
                    Missouri.
26300............  Daviess County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26310............  De Kalb County,           26  Rural...........   0.7959    41140  Urban...........     0.9519
                    Missouri.
26320............  Dent County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26330............  Douglas County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26340............  Dunklin County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26350............  Franklin County,        7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26360............  Gasconade County,         26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26370............  Gentry County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26380............  Greene County,          7920  Urban...........   0.8250    44180  Urban...........     0.8237
                    Missouri.
26390............  Grundy County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26400............  Harrison County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26410............  Henry County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26411............  Hickory County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.

[[Page 3678]]

 
26412............  Holt County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26440............  Howard County,            26  Rural...........   0.7959    17860  Urban...........     0.8345
                    Missouri.
26450............  Howell County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26460............  Iron County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26470............  Jackson County,         3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26480............  Jasper County,          3710  Urban...........   0.8582    27900  Urban...........     0.8582
                    Missouri.
26490............  Jefferson County,       7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26500............  Johnson County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26510............  Knox County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26520............  Laclede County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26530............  Lafayette County,       3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26540............  Lawrence County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26541............  Lewis County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26560............  Lincoln County,         7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26570............  Linn County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26580............  Livingston County,        26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26590............  Mc Donald County,         26  Rural...........   0.7959    22220  Urban...........     0.8661
                    Missouri.
26600............  Macon County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26601............  Madison County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26620............  Maries County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26630............  Marion County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26631............  Mercer County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26650............  Miller County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26660............  Mississippi County,       26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26670............  Moniteau County,          26  Rural...........   0.7959    27620  Urban...........     0.8387
                    Missouri.
26680............  Monroe County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26690............  Montgomery County,        26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26700............  Morgan County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26710............  New Madrid County,        26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26720............  Newton County,          3710  Urban...........   0.8582    27900  Urban...........     0.8582
                    Missouri.
26730............  Nodaway County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26740............  Oregon County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26750............  Osage County,             26  Rural...........   0.7959    27620  Urban...........     0.8387
                    Missouri.
26751............  Ozark County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26770............  Pemiscot County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26780............  Perry County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26790............  Pettis County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26800............  Phelps County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26810............  Pike County,              26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26820............  Platte County,          3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26821............  Polk County,              26  Rural...........   0.7959    44180  Urban...........     0.8237
                    Missouri.
26840............  Pulaski County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26850............  Putnam County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26860............  Ralls County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26870............  Randolph County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26880............  Ray County,             3760  Urban...........   0.9490    28140  Urban...........     0.9476
                    Missouri.
26881............  Reynolds County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26900............  Ripley County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26910............  St Charles County,      7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26911............  St Clair County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26930............  St Francois County,       26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26940............  St Louis County,        7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26950............  St Louis City           7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    County, Missouri.
26960............  Ste Genevieve             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    County, Missouri.
26970............  Saline County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26980............  Schuyler County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26981............  Scotland County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26982............  Scott County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26983............  Shannon County,           26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26984............  Shelby County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26985............  Stoddard County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26986............  Stone County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26987............  Sullivan County,          26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26988............  Taney County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26989............  Texas County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26990............  Vernon County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26991............  Warren County,          7040  Urban...........   0.8962    41180  Urban...........     0.8954
                    Missouri.
26992............  Washington County,        26  Rural...........   0.7959    41180  Urban...........     0.8954
                    Missouri.
26993............  Wayne County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
26994............  Webster County,         7920  Urban...........   0.8250    44180  Urban...........     0.8237
                    Missouri.
26995............  Worth County,             26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.

[[Page 3679]]

 
26996............  Wright County,            26  Rural...........   0.7959    99926  Rural...........     0.7900
                    Missouri.
27000............  Beaverhead County,        27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27010............  Big Horn County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27020............  Blaine County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27030............  Broadwater County,        27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27040............  Carbon County,            27  Rural...........   0.8762    13740  Urban...........     0.8834
                    Montana.
27050............  Carter County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27060............  Cascade County,         3040  Urban...........   0.9052    24500  Urban...........     0.9052
                    Montana.
27070............  Chouteau County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27080............  Custer County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27090............  Daniels County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27100............  Dawson County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27110............  Deer Lodge County,        27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27113............  Yellowstone               27  Rural...........   0.8762    99927  Rural...........     0.8762
                    National Park,
                    Montana.
27120............  Fallon County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27130............  Fergus County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27140............  Flathead County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27150............  Gallatin County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27160............  Garfield County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27170............  Glacier County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27180............  Golden Valley             27  Rural...........   0.8762    99927  Rural...........     0.8762
                    County, Montana.
27190............  Granite County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27200............  Hill County,              27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27210............  Jefferson County,         27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27220............  Judith Basin              27  Rural...........   0.8762    99927  Rural...........     0.8762
                    County, Montana.
27230............  Lake County,              27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27240............  Lewis And Clark           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    County, Montana.
27250............  Liberty County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27260............  Lincoln County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27270............  Mc Cone County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27280............  Madison County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27290............  Meagher County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27300............  Mineral County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27310............  Missoula County,        5140  Urban...........   0.9473    33540  Urban...........     0.9473
                    Montana.
27320............  Musselshell County,       27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27330............  Park County,              27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27340............  Petroleum County,         27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27350............  Phillips County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27360............  Pondera County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27370............  Powder River              27  Rural...........   0.8762    99927  Rural...........     0.8762
                    County, Montana.
27380............  Powell County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27390............  Prairie County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27400............  Ravalli County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27410............  Richland County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27420............  Roosevelt County,         27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27430............  Rosebud County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27440............  Sanders County,           27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27450............  Sheridan County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27460............  Silver Bow County,        27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27470............  Stillwater County,        27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27480............  Sweet Grass County,       27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27490............  Teton County,             27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27500............  Toole County,             27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27510............  Treasure County,          27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27520............  Valley County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27530............  Wheatland County,         27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27540............  Wibaux County,            27  Rural...........   0.8762    99927  Rural...........     0.8762
                    Montana.
27550............  Yellowstone County,     0880  Urban...........   0.8834    13740  Urban...........     0.8834
                    Montana.
28000............  Adams County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28010............  Antelope County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28020............  Arthur County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28030............  Banner County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28040............  Blaine County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28050............  Boone County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28060............  Box Butte County,         28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28070............  Boyd County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28080............  Brown County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28090............  Buffalo County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28100............  Burt County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28110............  Butler County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28120............  Cass County,            5920  Urban...........   0.9560    36540  Urban...........     0.9560
                    Nebraska.

[[Page 3680]]

 
28130............  Cedar County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28140............  Chase County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28150............  Cherry County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28160............  Cheyenne County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28170............  Clay County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28180............  Colfax County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28190............  Cuming County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28200............  Custer County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28210............  Dakota County,          7720  Urban...........   0.9416    43580  Urban...........     0.9381
                    Nebraska.
28220............  Dawes County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28230............  Dawson County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28240............  Deuel County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28250............  Dixon County,             28  Rural...........   0.8657    43580  Urban...........     0.9381
                    Nebraska.
28260............  Dodge County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28270............  Douglas County,         5920  Urban...........   0.9560    36540  Urban...........     0.9560
                    Nebraska.
28280............  Dundy County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28290............  Fillmore County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28300............  Franklin County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28310............  Frontier County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28320............  Furnas County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28330............  Gage County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28340............  Garden County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28350............  Garfield County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28360............  Gosper County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28370............  Grant County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28380............  Greeley County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28390............  Hall County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28400............  Hamilton County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28410............  Harlan County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28420............  Hayes County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28430............  Hitchcock County,         28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28440............  Holt County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28450............  Hooker County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28460............  Howard County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28470............  Jefferson County,         28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28480............  Johnson County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28490............  Kearney County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28500............  Keith County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28510............  Keya Paha County,         28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28520............  Kimball County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28530............  Knox County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28540............  Lancaster County,       4360  Urban...........   1.0214    30700  Urban...........     1.0214
                    Nebraska.
28550............  Lincoln County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28560............  Logan County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28570............  Loup County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28580............  Mc Pherson County,        28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28590............  Madison County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28600............  Merrick County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28610............  Morrill County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28620............  Nance County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28630............  Nemaha County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28640............  Nuckolls County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28650............  Otoe County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28660............  Pawnee County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28670............  Perkins County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28680............  Phelps County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28690............  Pierce County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28700............  Platte County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28710............  Polk County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28720............  Redwillow County,         28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28730............  Richardson County,        28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28740............  Rock County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28750............  Saline County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28760............  Sarpy County,           5920  Urban...........   0.9560    36540  Urban...........     0.9560
                    Nebraska.
28770............  Saunders County,          28  Rural...........   0.8657    36540  Urban...........     0.9560
                    Nebraska.
28780............  Scotts Bluff              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    County, Nebraska.
28790............  Seward County,            28  Rural...........   0.8657    30700  Urban...........     1.0214
                    Nebraska.
28800............  Sheridan County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28810............  Sherman County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28820............  Sioux County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28830............  Stanton County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.

[[Page 3681]]

 
28840............  Thayer County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28850............  Thomas County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28860............  Thurston County,          28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28870............  Valley County,            28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28880............  Washington County,      5920  Urban...........   0.9560    36540  Urban...........     0.9560
                    Nebraska.
28890............  Wayne County,             28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28900............  Webster County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28910............  Wheeler County,           28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
28920............  York County,              28  Rural...........   0.8657    99928  Rural...........     0.8657
                    Nebraska.
29000............  Churchill County,         29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29010............  Clark County,           4120  Urban...........   1.1155    29820  Urban...........     1.1437
                    Nevada.
29020............  Douglas County,           29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29030............  Elko County, Nevada       29  Rural...........   0.9687    99929  Rural...........     0.9065
29040............  Esmeralda County,         29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29050............  Eureka County,            29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29060............  Humboldt County,          29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29070............  Lander County,            29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29080............  Lincoln County,           29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29090............  Lyon County, Nevada       29  Rural...........   0.9687    99929  Rural...........     0.9065
29100............  Mineral County,           29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29110............  Nye County, Nevada.     4120  Urban...........   1.1155    99929  Rural...........     0.9065
29120............  Carson City County,       29  Rural...........   0.9687    16180  Urban...........     1.0234
                    Nevada.
29130............  Pershing County,          29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
29140............  Storey County,            29  Rural...........   0.9687    39900  Urban...........     1.0982
                    Nevada.
29150............  Washoe County,          6720  Urban...........   1.0982    39900  Urban...........     1.0982
                    Nevada.
29160............  White Pine County,        29  Rural...........   0.9687    99929  Rural...........     0.9065
                    Nevada.
30000............  Belknap County, New       30  Rural...........   1.0817    99930  Rural...........     1.0817
                    Hampshire.
30010............  Carroll County, New       30  Rural...........   1.0817    99930  Rural...........     1.0817
                    Hampshire.
30020............  Cheshire County,          30  Rural...........   1.0817    99930  Rural...........     1.0817
                    New Hampshire.
30030............  Coos County, New          30  Rural...........   1.0817    99930  Rural...........     1.0817
                    Hampshire.
30040............  Grafton County, New       30  Rural...........   1.0817    99930  Rural...........     1.0817
                    Hampshire.
30050............  Hillsboro County,       1123  Urban...........   1.1178    31700  Urban...........     1.0354
                    New Hampshire.
30060............  Merrimack County,       1123  Urban...........   1.1178    31700  Urban...........     1.0354
                    New Hampshire.
30070............  Rockingham County,      1123  Urban...........   1.1178    40484  Urban...........     1.0374
                    New Hampshire.
30080............  Strafford County,       1123  Urban...........   1.1178    40484  Urban...........     1.0374
                    New Hampshire.
30090............  Sullivan County,          30  Rural...........   1.0817    99930  Rural...........     1.0817
                    New Hampshire.
31000............  Atlantic County,        0560  Urban...........   1.1496    12100  Urban...........     1.1615
                    New Jersey.
31100............  Bergen County, New      0875  Urban...........   1.1651    35644  Urban...........     1.3188
                    Jersey.
31150............  Burlington County,      6160  Urban...........   1.0922    15804  Urban...........     1.0517
                    New Jersey.
31160............  Camden County, New      6160  Urban...........   1.0922    15804  Urban...........     1.0517
                    Jersey.
31180............  Cape May County,        0560  Urban...........   1.1496    36140  Urban...........     1.1011
                    New Jersey.
31190............  Cumberland County,      8760  Urban...........   0.9827    47220  Urban...........     0.9827
                    New Jersey.
31200............  Essex County, New       5640  Urban...........   1.1834    35084  Urban...........     1.1883
                    Jersey.
31220............  Gloucester County,      6160  Urban...........   1.0922    15804  Urban...........     1.0517
                    New Jersey.
31230............  Hudson County, New      3640  Urban...........   1.1338    35644  Urban...........     1.3188
                    Jersey.
31250............  Hunterdon County,       5015  Urban...........   1.1167    35084  Urban...........     1.1883
                    New Jersey.
31260............  Mercer County, New      8480  Urban...........   1.0834    45940  Urban...........     1.0834
                    Jersey.
31270............  Middlesex County,       5015  Urban...........   1.1167    20764  Urban...........     1.1249
                    New Jersey.
31290............  Monmouth County,        5190  Urban...........   1.1260    20764  Urban...........     1.1249
                    New Jersey.
31300............  Morris County, New      5640  Urban...........   1.1834    35084  Urban...........     1.1883
                    Jersey.
31310............  Ocean County, New       5190  Urban...........   1.1260    20764  Urban...........     1.1249
                    Jersey.
31320............  Passaic County, New     0875  Urban...........   1.1651    35644  Urban...........     1.3188
                    Jersey.
31340............  Salem County, New       6160  Urban...........   1.0922    48864  Urban...........     1.0471
                    Jersey.
31350............  Somerset County,        5015  Urban...........   1.1167    20764  Urban...........     1.1249
                    New Jersey.
31360............  Sussex County, New      5640  Urban...........   1.1834    35084  Urban...........     1.1883
                    Jersey.
31370............  Union County, New       5640  Urban...........   1.1834    35084  Urban...........     1.1883
                    Jersey.
31390............  Warren County, New      5640  Urban...........   1.1834    10900  Urban...........     0.9818
                    Jersey.
32000............  Bernalillo County,      0200  Urban...........   0.9684    10740  Urban...........     0.9684
                    New Mexico.
32010............  Catron County, New        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32020............  Chaves County, New        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32025............  Cibola County, New        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32030............  Colfax County, New        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32040............  Curry County, New         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32050............  De Baca County, New       32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32060............  Dona Ana County,        4100  Urban...........   0.8467    29740  Urban...........     0.8467
                    New Mexico.
32070............  Eddy County, New          32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32080............  Grant County, New         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32090............  Guadalupe County,         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    New Mexico.
32100............  Harding County, New       32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32110............  Hidalgo County, New       32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32120............  Lea County, New           32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.

[[Page 3682]]

 
32130............  Lincoln County, New       32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32131............  Los Alamos County,      7490  Urban...........   1.0748    99932  Rural...........     0.8635
                    New Mexico.
32140............  Luna County, New          32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32150............  Mc Kinley County,         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    New Mexico.
32160............  Mora County, New          32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32170............  Otero County, New         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32180............  Quay County, New          32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32190............  Rio Arriba County,        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    New Mexico.
32200............  Roosevelt County,         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    New Mexico.
32210............  Sandoval County,        0200  Urban...........   0.9684    10740  Urban...........     0.9684
                    New Mexico.
32220............  San Juan County,          32  Rural...........   0.8563    22140  Urban...........     0.8509
                    New Mexico.
32230............  San Miguel County,        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    New Mexico.
32240............  Santa Fe County,        7490  Urban...........   1.0748    42140  Urban...........     1.0920
                    New Mexico.
32250............  Sierra County, New        32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32260............  Socorro County, New       32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32270............  Taos County, New          32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32280............  Torrance County,          32  Rural...........   0.8563    10740  Urban...........     0.9684
                    New Mexico.
32290............  Union County, New         32  Rural...........   0.8563    99932  Rural...........     0.8635
                    Mexico.
32300............  Valencia County,        0200  Urban...........   0.9684    10740  Urban...........     0.9684
                    New Mexico.
33000............  Albany County, New      0160  Urban...........   0.8559    10580  Urban...........     0.8589
                    York.
33010............  Allegany County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33020............  Bronx County, New       5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    York.
33030............  Broome County, New      0960  Urban...........   0.8562    13780  Urban...........     0.8562
                    York.
33040............  Cattaraugus County,       33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33050............  Cayuga County, New      8160  Urban...........   0.9492    99933  Rural...........     0.8154
                    York.
33060............  Chautauqua County,      3610  Urban...........   0.7544    99933  Rural...........     0.8154
                    New York.
33070............  Chemung County, New     2335  Urban...........   0.8250    21300  Urban...........     0.8250
                    York.
33080............  Chenango County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33090............  Clinton County, New       33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33200............  Columbia County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33210............  Cortland County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33220............  Delaware County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33230............  Dutchess County,        2281  Urban...........   1.0475    39100  Urban...........     1.0891
                    New York.
33240............  Erie County, New        1280  Urban...........   0.9511    15380  Urban...........     0.9511
                    York.
33260............  Essex County, New         33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33270............  Franklin County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33280............  Fulton County, New        33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33290............  Genesee County, New     6840  Urban...........   0.9049    99933  Rural...........     0.8154
                    York.
33300............  Greene County, New        33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33310............  Hamilton County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33320............  Herkimer County,        8680  Urban...........   0.8358    46540  Urban...........     0.8358
                    New York.
33330............  Jefferson County,         33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33331............  Kings County, New       5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    York.
33340............  Lewis County, New         33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33350............  Livingston County,      6840  Urban...........   0.9049    40380  Urban...........     0.9121
                    New York.
33360............  Madison County, New     8160  Urban...........   0.9492    45060  Urban...........     0.9574
                    York.
33370............  Monroe County, New      6840  Urban...........   0.9049    40380  Urban...........     0.9121
                    York.
33380............  Montgomery County,      0160  Urban...........   0.8559    99933  Rural...........     0.8154
                    New York.
33400............  Nassau County, New      5380  Urban...........   1.2719    35004  Urban...........     1.2719
                    York.
33420............  New York County,        5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    New York.
33500............  Niagara County, New     1280  Urban...........   0.9511    15380  Urban...........     0.9511
                    York.
33510............  Oneida County, New      8680  Urban...........   0.8358    46540  Urban...........     0.8358
                    York.
33520............  Onondaga County,        8160  Urban...........   0.9492    45060  Urban...........     0.9574
                    New York.
33530............  Ontario County, New     6840  Urban...........   0.9049    40380  Urban...........     0.9121
                    York.
33540............  Orange County, New      5660  Urban...........   1.1207    39100  Urban...........     1.0891
                    York.
33550............  Orleans County, New     6840  Urban...........   0.9049    40380  Urban...........     0.9121
                    York.
33560............  Oswego County, New      8160  Urban...........   0.9492    45060  Urban...........     0.9574
                    York.
33570............  Otsego County, New        33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33580............  Putnam County, New      5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    York.
33590............  Queens County, New      5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    York.
33600............  Rensselaer County,      0160  Urban...........   0.8559    10580  Urban...........     0.8589
                    New York.
33610............  Richmond County,        5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    New York.
33620............  Rockland County,        5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    New York.
33630............  St Lawrence County,       33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33640............  Saratoga County,        0160  Urban...........   0.8559    10580  Urban...........     0.8589
                    New York.
33650............  Schenectady County,     0160  Urban...........   0.8559    10580  Urban...........     0.8589
                    New York.
33660............  Schoharie County,       0160  Urban...........   0.8559    10580  Urban...........     0.8589
                    New York.
33670............  Schuyler County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33680............  Seneca County, New        33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33690............  Steuben County, New       33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33700............  Suffolk County, New     5380  Urban...........   1.2719    35004  Urban...........     1.2719
                    York.

[[Page 3683]]

 
33710............  Sullivan County,          33  Rural...........   0.8395    99933  Rural...........     0.8154
                    New York.
33720............  Tioga County, New       0960  Urban...........   0.8562    13780  Urban...........     0.8562
                    York.
33730............  Tompkins County,          33  Rural...........   0.8395    27060  Urban...........     0.9793
                    New York.
33740............  Ulster County, New        33  Rural...........   0.8395    28740  Urban...........     0.9255
                    York.
33750............  Warren County, New      2975  Urban...........   0.8559    24020  Urban...........     0.8559
                    York.
33760............  Washington County,      2975  Urban...........   0.8559    24020  Urban...........     0.8559
                    New York.
33770............  Wayne County, New       6840  Urban...........   0.9049    40380  Urban...........     0.9121
                    York.
33800............  Westchester County,     5600  Urban...........   1.3464    35644  Urban...........     1.3188
                    New York.
33900............  Wyoming County, New       33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
33910............  Yates County, New         33  Rural...........   0.8395    99933  Rural...........     0.8154
                    York.
34000............  Alamance County, N      3120  Urban...........   0.9018    15500  Urban...........     0.8905
                    Carolina.
34010............  Alexander County, N     3290  Urban...........   0.8921    25860  Urban...........     0.8921
                    Carolina.
34020............  Alleghany County, N       34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34030............  Anson County, N           34  Rural...........   0.8462    16740  Urban...........     0.9750
                    Carolina.
34040............  Ashe County, N            34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34050............  Avery County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34060............  Beaufort County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34070............  Bertie County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34080............  Bladen County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34090............  Brunswick County, N     9200  Urban...........   0.9582    48900  Urban...........     0.9582
                    Carolina.
34100............  Buncombe County, N      0480  Urban...........   0.9737    11700  Urban...........     0.9285
                    Carolina.
34110............  Burke County, N         3290  Urban...........   0.8921    25860  Urban...........     0.8921
                    Carolina.
34120............  Cabarrus County, N      1520  Urban...........   0.9715    16740  Urban...........     0.9750
                    Carolina.
34130............  Caldwell County, N      3290  Urban...........   0.8921    25860  Urban...........     0.8921
                    Carolina.
34140............  Camden County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34150............  Carteret County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34160............  Caswell County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34170............  Catawba County, N       3290  Urban...........   0.8921    25860  Urban...........     0.8921
                    Carolina.
34180............  Chatham County, N       6640  Urban...........   1.0034    20500  Urban...........     1.0244
                    Carolina.
34190............  Cherokee County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34200............  Chowan County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34210............  Clay County, N            34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34220............  Cleveland County, N       34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34230............  Columbus County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34240............  Craven County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34250............  Cumberland County,      2560  Urban...........   0.9416    22180  Urban...........     0.9416
                    N Carolina.
34251............  Currituck County, N     5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    Carolina.
34270............  Dare County, N            34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34280............  Davidson County, N      3120  Urban...........   0.9018    99934  Rural...........     0.8540
                    Carolina.
34290............  Davie County, N         3120  Urban...........   0.9018    49180  Urban...........     0.8944
                    Carolina.
34300............  Duplin County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34310............  Durham County, N        6640  Urban...........   1.0034    20500  Urban...........     1.0244
                    Carolina.
34320............  Edgecombe County, N     6895  Urban...........   0.8915    40580  Urban...........     0.8915
                    Carolina.
34330............  Forsyth County, N       3120  Urban...........   0.9018    49180  Urban...........     0.8944
                    Carolina.
34340............  Franklin County, N      6640  Urban...........   1.0034    39580  Urban...........     0.9691
                    Carolina.
34350............  Gaston County, N        1520  Urban...........   0.9715    16740  Urban...........     0.9750
                    Carolina.
34360............  Gates County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34370............  Graham County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34380............  Granville County, N       34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34390............  Greene County, N          34  Rural...........   0.8462    24780  Urban...........     0.9425
                    Carolina.
34400............  Guilford County, N      3120  Urban...........   0.9018    24660  Urban...........     0.9104
                    Carolina.
34410............  Halifax County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34420............  Harnett County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34430............  Haywood County, N         34  Rural...........   0.8462    11700  Urban...........     0.9285
                    Carolina.
34440............  Henderson County, N       34  Rural...........   0.8462    11700  Urban...........     0.9285
                    Carolina.
34450............  Hertford County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34460............  Hoke County, N            34  Rural...........   0.8462    22180  Urban...........     0.9416
                    Carolina.
34470............  Hyde County, N            34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34480............  Iredell County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34490............  Jackson County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34500............  Johnston County, N      6640  Urban...........   1.0034    39580  Urban...........     0.9691
                    Carolina.
34510............  Jones County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34520............  Lee County, N             34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34530............  Lenoir County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34540............  Lincoln County, N       1520  Urban...........   0.9715    99934  Rural...........     0.8540
                    Carolina.
34550............  Mc Dowell County, N       34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34560............  Macon County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34570............  Madison County, N       0480  Urban...........   0.9737    11700  Urban...........     0.9285
                    Carolina.
34580............  Martin County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34590............  Mecklenburg County,     1520  Urban...........   0.9715    16740  Urban...........     0.9750
                    N Carolina.
34600............  Mitchell County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.

[[Page 3684]]

 
34610............  Montgomery County,        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34620............  Moore County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34630............  Nash County, N          6895  Urban...........   0.8915    40580  Urban...........     0.8915
                    Carolina.
34640............  New Hanover County,     9200  Urban...........   0.9582    48900  Urban...........     0.9582
                    N Carolina.
34650............  Northampton County,       34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34660............  Onslow County, N        3605  Urban...........   0.8236    27340  Urban...........     0.8236
                    Carolina.
34670............  Orange County, N        6640  Urban...........   1.0034    20500  Urban...........     1.0244
                    Carolina.
34680............  Pamlico County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34690............  Pasquotank County,        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34700............  Pender County, N          34  Rural...........   0.8462    48900  Urban...........     0.9582
                    Carolina.
34710............  Perquimans County,        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34720............  Person County, N          34  Rural...........   0.8462    20500  Urban...........     1.0244
                    Carolina.
34730............  Pitt County, N          3150  Urban...........   0.9425    24780  Urban...........     0.9425
                    Carolina.
34740............  Polk County, N            34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34750............  Randolph County, N      3120  Urban...........   0.9018    24660  Urban...........     0.9104
                    Carolina.
34760............  Richmond County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34770............  Robeson County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34780............  Rockingham County,        34  Rural...........   0.8462    24660  Urban...........     0.9104
                    N Carolina.
34790............  Rowan County, N         1520  Urban...........   0.9715    99934  Rural...........     0.8540
                    Carolina.
34800............  Rutherford County,        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34810............  Sampson County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34820............  Scotland County, N        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34830............  Stanly County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34840............  Stokes County, N        3120  Urban...........   0.9018    49180  Urban...........     0.8944
                    Carolina.
34850............  Surry County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34860............  Swain County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34870............  Transylvania              34  Rural...........   0.8462    99934  Rural...........     0.8540
                    County, N Carolina.
34880............  Tyrrell County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34890............  Union County, N         1520  Urban...........   0.9715    16740  Urban...........     0.9750
                    Carolina.
34900............  Vance County, N           34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34910............  Wake County, N          6640  Urban...........   1.0034    39580  Urban...........     0.9691
                    Carolina.
34920............  Warren County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34930............  Washington County,        34  Rural...........   0.8462    99934  Rural...........     0.8540
                    N Carolina.
34940............  Watauga County, N         34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34950............  Wayne County, N         2980  Urban...........   0.8775    24140  Urban...........     0.8775
                    Carolina.
34960............  Wilkes County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34970............  Wilson County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
34980............  Yadkin County, N        3120  Urban...........   0.9018    49180  Urban...........     0.8944
                    Carolina.
34981............  Yancey County, N          34  Rural...........   0.8462    99934  Rural...........     0.8540
                    Carolina.
35000............  Adams County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35010............  Barnes County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35020............  Benson County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35030............  Billings County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35040............  Bottineau County, N       35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35050............  Bowman County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35060............  Burke County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35070............  Burleigh County, N      1010  Urban...........   0.7574    13900  Urban...........     0.7574
                    Dakota.
35080............  Cass County, N          2520  Urban...........   0.8486    22020  Urban...........     0.8486
                    Dakota.
35090............  Cavalier County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35100............  Dickey County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35110............  Divide County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35120............  Dunn County, N            35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35130............  Eddy County, N            35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35140............  Emmons County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35150............  Foster County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35160............  Golden Valley             35  Rural...........   0.7261    99935  Rural...........     0.7261
                    County, N Dakota.
35170............  Grand Forks County,     2985  Urban...........   0.7901    24220  Urban...........     0.7901
                    N Dakota.
35180............  Grant County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35190............  Griggs County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35200............  Hettinger County, N       35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35210............  Kidder County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35220............  La Moure County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35230............  Logan County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35240............  Mc Henry County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35250............  Mc Intosh County, N       35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35260............  Mc Kenzie County, N       35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35270............  Mc Lean County, N         35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35280............  Mercer County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35290............  Morton County, N        1010  Urban...........   0.7574    13900  Urban...........     0.7574
                    Dakota.
35300............  Mountrail County, N       35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35310............  Nelson County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.

[[Page 3685]]

 
35320............  Oliver County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35330............  Pembina County, N         35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35340............  Pierce County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35350............  Ramsey County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35360............  Ransom County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35370............  Renville County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35380............  Richland County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35390............  Rolette County, N         35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35400............  Sargent County, N         35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35410............  Sheridan County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35420............  Sioux County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35430............  Slope County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35440............  Stark County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35450............  Steele County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35460............  Stutsman County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35470............  Towner County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35480............  Traill County, N          35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35490............  Walsh County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35500............  Ward County, N            35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35510............  Wells County, N           35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
35520............  Williams County, N        35  Rural...........   0.7261    99935  Rural...........     0.7261
                    Dakota.
36000............  Adams County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36010............  Allen County, Ohio.     4320  Urban...........   0.9119    30620  Urban...........     0.9225
36020............  Ashland County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36030............  Ashtabula County,       1680  Urban...........   0.9183    99936  Rural...........     0.8826
                    Ohio.
36040............  Athens County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36050............  Auglaize County,        4320  Urban...........   0.9119    99936  Rural...........     0.8826
                    Ohio.
36060............  Belmont County,         9000  Urban...........   0.7161    48540  Urban...........     0.7161
                    Ohio.
36070............  Brown County, Ohio.     1640  Urban...........   0.9734    17140  Urban...........     0.9615
36080............  Butler County, Ohio     3200  Urban...........   0.8951    17140  Urban...........     0.9615
36090............  Carroll County,         1320  Urban...........   0.8935    15940  Urban...........     0.8935
                    Ohio.
36100............  Champaign County,         36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36110............  Clark County, Ohio.     2000  Urban...........   0.8980    44220  Urban...........     0.8396
36120............  Clermont County,        1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Ohio.
36130............  Clinton County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36140............  Columbiana County,      9320  Urban...........   0.8848    99936  Rural...........     0.8826
                    Ohio.
36150............  Coshocton County,         36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36160............  Crawford County,        4800  Urban...........   0.9891    99936  Rural...........     0.8826
                    Ohio.
36170............  Cuyahoga County,        1680  Urban...........   0.9183    17460  Urban...........     0.9213
                    Ohio.
36190............  Darke County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36200............  Defiance County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36210............  Delaware County,        1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36220............  Erie County, Ohio..       36  Rural...........   0.8921    41780  Urban...........     0.9019
36230............  Fairfield County,       1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36240............  Fayette County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36250............  Franklin County,        1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36260............  Fulton County, Ohio     8400  Urban...........   0.9574    45780  Urban...........     0.9574
36270............  Gallia County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36280............  Geauga County, Ohio     1680  Urban...........   0.9183    17460  Urban...........     0.9213
36290............  Greene County, Ohio     2000  Urban...........   0.8980    19380  Urban...........     0.9064
36300............  Guernsey County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36310............  Hamilton County,        1640  Urban...........   0.9734    17140  Urban...........     0.9615
                    Ohio.
36330............  Hancock County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36340............  Hardin County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36350............  Harrison County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36360............  Henry County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36370............  Highland County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36380............  Hocking County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36390............  Holmes County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36400............  Huron County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36410............  Jackson County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36420............  Jefferson County,       8080  Urban...........   0.7819    48260  Urban...........     0.7819
                    Ohio.
36430............  Knox County, Ohio..       36  Rural...........   0.8921    99936  Rural...........     0.8826
36440............  Lake County, Ohio..     1680  Urban...........   0.9183    17460  Urban...........     0.9213
36450............  Lawrence County,        3400  Urban...........   0.9477    26580  Urban...........     0.9477
                    Ohio.
36460............  Licking County,         1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36470............  Logan County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36480............  Lorain County, Ohio     1680  Urban...........   0.9183    17460  Urban...........     0.9213
36490............  Lucas County, Ohio.     8400  Urban...........   0.9574    45780  Urban...........     0.9574
36500............  Madison County,         1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36510............  Mahoning County,        9320  Urban...........   0.8848    49660  Urban...........     0.8603
                    Ohio.

[[Page 3686]]

 
36520............  Marion County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36530............  Medina County, Ohio     1680  Urban...........   0.9183    17460  Urban...........     0.9213
36540............  Meigs County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36550............  Mercer County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36560............  Miami County, Ohio.     2000  Urban...........   0.8980    19380  Urban...........     0.9064
36570............  Monroe County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36580............  Montgomery County,      2000  Urban...........   0.8980    19380  Urban...........     0.9064
                    Ohio.
36590............  Morgan County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36600............  Morrow County, Ohio       36  Rural...........   0.8921    18140  Urban...........     0.9860
36610............  Muskingum County,         36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36620............  Noble County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36630............  Ottawa County, Ohio       36  Rural...........   0.8921    45780  Urban...........     0.9574
36640............  Paulding County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36650............  Perry County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36660............  Pickaway County,        1840  Urban...........   0.9874    18140  Urban...........     0.9860
                    Ohio.
36670............  Pike County, Ohio..       36  Rural...........   0.8921    99936  Rural...........     0.8826
36680............  Portage County,         0080  Urban...........   0.8982    10420  Urban...........     0.8982
                    Ohio.
36690............  Preble County, Ohio       36  Rural...........   0.8921    19380  Urban...........     0.9064
36700............  Putnam County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36710............  Richland County,        4800  Urban...........   0.9891    31900  Urban...........     0.9891
                    Ohio.
36720............  Ross County, Ohio..       36  Rural...........   0.8921    99936  Rural...........     0.8826
36730............  Sandusky County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36740............  Scioto County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36750............  Seneca County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36760............  Shelby County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36770............  Stark County, Ohio.     1320  Urban...........   0.8935    15940  Urban...........     0.8935
36780............  Summit County, Ohio     0080  Urban...........   0.8982    10420  Urban...........     0.8982
36790............  Trumbull County,        9320  Urban...........   0.8848    49660  Urban...........     0.8603
                    Ohio.
36800............  Tuscarawas County,        36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36810............  Union County, Ohio.       36  Rural...........   0.8921    18140  Urban...........     0.9860
36820............  Van Wert County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36830............  Vinton County, Ohio       36  Rural...........   0.8921    99936  Rural...........     0.8826
36840............  Warren County, Ohio     1640  Urban...........   0.9734    17140  Urban...........     0.9615
36850............  Washington County,      6020  Urban...........   0.8270    37620  Urban...........     0.8270
                    Ohio.
36860............  Wayne County, Ohio.       36  Rural...........   0.8921    99936  Rural...........     0.8826
36870............  Williams County,          36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
36880............  Wood County, Ohio..     8400  Urban...........   0.9574    45780  Urban...........     0.9574
36890............  Wyandot County,           36  Rural...........   0.8921    99936  Rural...........     0.8826
                    Ohio.
37000............  Adair County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37010............  Alfalfa County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37020............  Atoka County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37030............  Beaver County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37040............  Beckham County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37050............  Blaine County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37060............  Bryan County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37070............  Caddo County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37080............  Canadian County,        5880  Urban...........   0.9025    36420  Urban...........     0.9031
                    Oklahoma.
37090............  Carter County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37100............  Cherokee County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37110............  Choctaw County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37120............  Cimarron County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37130............  Cleveland County,       5880  Urban...........   0.9025    36420  Urban...........     0.9031
                    Oklahoma.
37140............  Coal County,              37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37150............  Comanche County,        4200  Urban...........   0.7872    30020  Urban...........     0.7872
                    Oklahoma.
37160............  Cotton County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37170............  Craig County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37180............  Creek County,           8560  Urban...........   0.8587    46140  Urban...........     0.8543
                    Oklahoma.
37190............  Custer County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37200............  Delaware County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37210............  Dewey County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37220............  Ellis County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37230............  Garfield County,        2340  Urban...........   0.8666    99937  Rural...........     0.7581
                    Oklahoma.
37240............  Garvin County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37250............  Grady County,             37  Rural...........   0.7442    36420  Urban...........     0.9031
                    Oklahoma.
37260............  Grant County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37270............  Greer County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37280............  Harmon County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37290............  Harper County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37300............  Haskell County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37310............  Hughes County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37320............  Jackson County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.

[[Page 3687]]

 
37330............  Jefferson County,         37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37340............  Johnston County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37350............  Kay County,               37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37360............  Kingfisher County,        37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37370............  Kiowa County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37380............  Latimer County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37390............  Le Flore County,          37  Rural...........   0.7442    22900  Urban...........     0.8230
                    Oklahoma.
37400............  Lincoln County,           37  Rural...........   0.7442    36420  Urban...........     0.9031
                    Oklahoma.
37410............  Logan County,           5880  Urban...........   0.9025    36420  Urban...........     0.9031
                    Oklahoma.
37420............  Love County,              37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37430............  Mc Clain County,        5880  Urban...........   0.9025    36420  Urban...........     0.9031
                    Oklahoma.
37440............  Mc Curtain County,        37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37450............  Mc Intosh County,         37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37460............  Major County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37470............  Marshall County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37480............  Mayes County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37490............  Murray County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37500............  Muskogee County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37510............  Noble County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37520............  Nowata County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37530............  Okfuskee County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37540............  Oklahoma County,        5880  Urban...........   0.9025    36420  Urban...........     0.9031
                    Oklahoma.
37550............  Okmulgee County,          37  Rural...........   0.7442    46140  Urban...........     0.8543
                    Oklahoma.
37560............  Osage County,           8560  Urban...........   0.8587    46140  Urban...........     0.8543
                    Oklahoma.
37570............  Ottawa County,            37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37580............  Pawnee County,            37  Rural...........   0.7442    46140  Urban...........     0.8543
                    Oklahoma.
37590............  Payne County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37600............  Pittsburg County,         37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37610............  Pontotoc County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37620............  Pottawatomie            5880  Urban...........   0.9025    99937  Rural...........     0.7581
                    County, Oklahoma.
37630............  Pushmataha County,        37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37640............  Roger Mills County,       37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37650............  Rogers County,          8560  Urban...........   0.8587    46140  Urban...........     0.8543
                    Oklahoma.
37660............  Seminole County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37670............  Sequoyah County,        2720  Urban...........   0.8246    22900  Urban...........     0.8230
                    Oklahoma.
37680............  Stephens County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37690............  Texas County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37700............  Tillman County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37710............  Tulsa County,           8560  Urban...........   0.8587    46140  Urban...........     0.8543
                    Oklahoma.
37720............  Wagoner County,         8560  Urban...........   0.8587    46140  Urban...........     0.8543
                    Oklahoma.
37730............  Washington County,        37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37740............  Washita County,           37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37750............  Woods County,             37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
37760............  Woodward County,          37  Rural...........   0.7442    99937  Rural...........     0.7581
                    Oklahoma.
38000............  Baker County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38010............  Benton County,          1890  Urban...........   1.0729    18700  Urban...........     1.0729
                    Oregon.
38020............  Clackamas County,       6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Oregon.
38030............  Clatsop County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38040............  Columbia County,        6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Oregon.
38050............  Coos County, Oregon       38  Rural...........   1.0052    99938  Rural...........     0.9826
38060............  Crook County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38070............  Curry County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38080............  Deschutes County,         38  Rural...........   1.0052    13460  Urban...........     1.0786
                    Oregon.
38090............  Douglas County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38100............  Gilliam County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38110............  Grant County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38120............  Harney County,            38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38130............  Hood River County,        38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38140............  Jackson County,         4890  Urban...........   1.0225    32780  Urban...........     1.0225
                    Oregon.
38150............  Jefferson County,         38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38160............  Josephine County,         38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38170............  Klamath County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38180............  Lake County, Oregon       38  Rural...........   1.0052    99938  Rural...........     0.9826
38190............  Lane County, Oregon     2400  Urban...........   1.0818    21660  Urban...........     1.0818
38200............  Lincoln County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38210............  Linn County, Oregon       38  Rural...........   1.0052    99938  Rural...........     0.9826
38220............  Malheur County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38230............  Marion County,          7080  Urban...........   1.0442    41420  Urban...........     1.0442
                    Oregon.
38240............  Morrow County,            38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38250............  Multnomah County,       6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Oregon.
38260............  Polk County, Oregon     7080  Urban...........   1.0442    41420  Urban...........     1.0442

[[Page 3688]]

 
38270............  Sherman County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38280............  Tillamook County,         38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38290............  Umatilla County,          38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38300............  Union County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38310............  Wallowa County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38320............  Wasco County,             38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38330............  Washington County,      6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Oregon.
38340............  Wheeler County,           38  Rural...........   1.0052    99938  Rural...........     0.9826
                    Oregon.
38350............  Yamhill County,         6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Oregon.
39000............  Adams County,             39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39010............  Allegheny County,       6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    Pennsylvania.
39070............  Armstrong County,         39  Rural...........   0.8319    38300  Urban...........     0.8845
                    Pennsylvania.
39080............  Beaver County,          6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    Pennsylvania.
39100............  Bedford County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39110............  Berks County,           6680  Urban...........   0.9686    39740  Urban...........     0.9686
                    Pennsylvania.
39120............  Blair County,           0280  Urban...........   0.8944    11020  Urban...........     0.8944
                    Pennsylvania.
39130............  Bradford County,          39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39140............  Bucks County,           6160  Urban...........   1.0922    37964  Urban...........     1.1038
                    Pennsylvania.
39150............  Butler County,          6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    Pennsylvania.
39160............  Cambria County,         3680  Urban...........   0.8086    27780  Urban...........     0.8354
                    Pennsylvania.
39180............  Cameron County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39190............  Carbon County,          0240  Urban...........   0.9845    10900  Urban...........     0.9818
                    Pennsylvania.
39200............  Centre County,          8050  Urban...........   0.8356    44300  Urban...........     0.8356
                    Pennsylvania.
39210............  Chester County,         6160  Urban...........   1.0922    37964  Urban...........     1.1038
                    Pennsylvania.
39220............  Clarion County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39230............  Clearfield County,        39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39240............  Clinton County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39250............  Columbia County,        7560  Urban...........   0.8524    99939  Rural...........     0.8291
                    Pennsylvania.
39260............  Crawford County,          39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39270............  Cumberland County,      3240  Urban...........   0.9233    25420  Urban...........     0.9313
                    Pennsylvania.
39280............  Dauphin County,         3240  Urban...........   0.9233    25420  Urban...........     0.9313
                    Pennsylvania.
39290............  Delaware County,        6160  Urban...........   1.0922    37964  Urban...........     1.1038
                    Pennsylvania.
39310............  Elk County,               39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39320............  Erie County,            2360  Urban...........   0.8737    21500  Urban...........     0.8737
                    Pennsylvania.
39330............  Fayette County,         6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    Pennsylvania.
39340............  Forest County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39350............  Franklin County,          39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39360............  Fulton County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39370............  Greene County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39380............  Huntingdon County,        39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39390............  Indiana County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39400............  Jefferson County,         39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39410............  Juniata County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39420............  Lackawanna County,      7560  Urban...........   0.8524    42540  Urban...........     0.8540
                    Pennsylvania.
39440............  Lancaster County,       4000  Urban...........   0.9694    29540  Urban...........     0.9694
                    Pennsylvania.
39450............  Lawrence County,          39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39460............  Lebanon County,         3240  Urban...........   0.9233    30140  Urban...........     0.8459
                    Pennsylvania.
39470............  Lehigh County,          0240  Urban...........   0.9845    10900  Urban...........     0.9818
                    Pennsylvania.
39480............  Luzerne County,         7560  Urban...........   0.8524    42540  Urban...........     0.8540
                    Pennsylvania.
39510............  Lycoming County,        9140  Urban...........   0.8364    48700  Urban...........     0.8364
                    Pennsylvania.
39520............  Mc Kean County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39530............  Mercer County,          7610  Urban...........   0.7793    49660  Urban...........     0.8603
                    Pennsylvania.
39540............  Mifflin County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39550............  Monroe County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39560............  Montgomery County,      6160  Urban...........   1.0922    37964  Urban...........     1.1038
                    Pennsylvania.
39580............  Montour County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39590............  Northampton County,     0240  Urban...........   0.9845    10900  Urban...........     0.9818
                    Pennsylvania.
39600............  Northumberland            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    County,
                    Pennsylvania.
39610............  Perry County,           3240  Urban...........   0.9233    25420  Urban...........     0.9313
                    Pennsylvania.
39620............  Philadelphia            6160  Urban...........   1.0922    37964  Urban...........     1.1038
                    County,
                    Pennsylvania.
39630............  Pike County,            5660  Urban...........   1.1207    35084  Urban...........     1.1883
                    Pennsylvania.
39640............  Potter County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39650............  Schuylkill County,        39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39670............  Snyder County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39680............  Somerset County,        3680  Urban...........   0.8086    99939  Rural...........     0.8291
                    Pennsylvania.
39690............  Sullivan County,          39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39700............  Susquehanna County,       39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39710............  Tioga County,             39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39720............  Union County,             39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39730............  Venango County,           39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39740............  Warren County,            39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.

[[Page 3689]]

 
39750............  Washington County,      6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    Pennsylvania.
39760............  Wayne County,             39  Rural...........   0.8319    99939  Rural...........     0.8291
                    Pennsylvania.
39770............  Westmoreland            6280  Urban...........   0.8860    38300  Urban...........     0.8845
                    County,
                    Pennsylvania.
39790............  Wyoming County,         7560  Urban...........   0.8524    42540  Urban...........     0.8540
                    Pennsylvania.
39800............  York County,            9280  Urban...........   0.9347    49620  Urban...........     0.9347
                    Pennsylvania.
40010............  Adjuntas County,          40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40020............  Aguada County,          0060  Urban...........   0.4876    10380  Urban...........     0.4738
                    Puerto Rico.
40030............  Aguadilla County,       0060  Urban...........   0.4876    10380  Urban...........     0.4738
                    Puerto Rico.
40040............  Aguas Buenas            7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    County, Puerto
                    Rico.
40050............  Aibonito County,          40  Rural...........   0.3604    41980  Urban...........     0.4621
                    Puerto Rico.
40060............  Anasco County,          4840  Urban...........   0.4243    10380  Urban...........     0.4738
                    Puerto Rico.
40070............  Arecibo County,         0470  Urban...........   0.4112    41980  Urban...........     0.4621
                    Puerto Rico.
40080............  Arroyo County,            40  Rural...........   0.3604    25020  Urban...........     0.3181
                    Puerto Rico.
40090............  Barceloneta County,     7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40100............  Barranquitas              40  Rural...........   0.3604    41980  Urban...........     0.4621
                    County, Puerto
                    Rico.
40110............  Bayamon County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40120............  Cabo Rojo County,       4840  Urban...........   0.4243    41900  Urban...........     0.4650
                    Puerto Rico.
40130............  Caguas County,          1310  Urban...........   0.4120    41980  Urban...........     0.4621
                    Puerto Rico.
40140............  Camuy County,           0470  Urban...........   0.4112    41980  Urban...........     0.4621
                    Puerto Rico.
40145............  Canovanas County,       7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40150............  Carolina County,        7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40160............  Catano County,          7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40170............  Cayey County,           1310  Urban...........   0.4120    41980  Urban...........     0.4621
                    Puerto Rico.
40180............  Ceiba County,           7440  Urban...........   0.4752    21940  Urban...........     0.4153
                    Puerto Rico.
40190............  Ciales County,            40  Rural...........   0.3604    41980  Urban...........     0.4621
                    Puerto Rico.
40200............  Cidra County,           1310  Urban...........   0.4120    41980  Urban...........     0.4621
                    Puerto Rico.
40210............  Coamo County,             40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40220............  Comerio County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40230............  Corozal County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40240............  Culebra County,           40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40250............  Dorado County,          7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40260............  Fajardo County,         7440  Urban...........   0.4752    21940  Urban...........     0.4153
                    Puerto Rico.
40265............  Florida County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40270............  Guanica County,           40  Rural...........   0.3604    49500  Urban...........     0.4408
                    Puerto Rico.
40280............  Guayama County,           40  Rural...........   0.3604    25020  Urban...........     0.3181
                    Puerto Rico.
40290............  Guayanilla County,      6360  Urban...........   0.4881    49500  Urban...........     0.4408
                    Puerto Rico.
40300............  Guaynabo County,        7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40310............  Gurabo County,          1310  Urban...........   0.4120    41980  Urban...........     0.4621
                    Puerto Rico.
40320............  Hatillo County,         0470  Urban...........   0.4112    41980  Urban...........     0.4621
                    Puerto Rico.
40330............  Hormigueros County,     4840  Urban...........   0.4243    32420  Urban...........     0.4020
                    Puerto Rico.
40340............  Humacao County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40350............  Isabela County,           40  Rural...........   0.3604    10380  Urban...........     0.4738
                    Puerto Rico.
40360............  Jayuya County,            40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40370............  Juana Diaz County,      6360  Urban...........   0.4881    38660  Urban...........     0.4939
                    Puerto Rico.
40380............  Juncos County,          7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40390............  Lajas County,             40  Rural...........   0.3604    41900  Urban...........     0.4650
                    Puerto Rico.
40400............  Lares County,             40  Rural...........   0.3604    10380  Urban...........     0.4738
                    Puerto Rico.
40410............  Las Marias County,        40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40420............  Las Piedras County,     7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40430............  Loiza County,           7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40440............  Luquillo County,        7440  Urban...........   0.4752    21940  Urban...........     0.4153
                    Puerto Rico.
40450............  Manati County,          7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40460............  Maricao County,           40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40470............  Maunabo County,           40  Rural...........   0.3604    41980  Urban...........     0.4621
                    Puerto Rico.
40480............  Mayaguez County,        4840  Urban...........   0.4243    32420  Urban...........     0.4020
                    Puerto Rico.
40490............  Moca County, Puerto     0060  Urban...........   0.4876    10380  Urban...........     0.4738
                    Rico.
40500............  Morovis County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40510............  Naguabo County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40520............  Naranjito County,       7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40530............  Orocovis County,          40  Rural...........   0.3604    41980  Urban...........     0.4621
                    Puerto Rico.
40540............  Patillas County,          40  Rural...........   0.3604    25020  Urban...........     0.3181
                    Puerto Rico.
40550............  Penuelas County,        6360  Urban...........   0.4881    49500  Urban...........     0.4408
                    Puerto Rico.
40560............  Ponce County,           6360  Urban...........   0.4881    38660  Urban...........     0.4939
                    Puerto Rico.
40570............  Quebradillas              40  Rural...........   0.3604    41980  Urban...........     0.4621
                    County, Puerto
                    Rico.
40580............  Rincon County,            40  Rural...........   0.3604    10380  Urban...........     0.4738
                    Puerto Rico.
40590............  Rio Grande County,      7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40610............  Sabana Grande           4840  Urban...........   0.4243    41900  Urban...........     0.4650
                    County, Puerto
                    Rico.
40620............  Salinas County,           40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40630............  San German County,      4840  Urban...........   0.4243    41900  Urban...........     0.4650
                    Puerto Rico.
40640............  San Juan County,        7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40650............  San Lorenzo County,     1310  Urban...........   0.4120    41980  Urban...........     0.4621
                    Puerto Rico.

[[Page 3690]]

 
40660............  San Sebastian             40  Rural...........   0.3604    10380  Urban...........     0.4738
                    County, Puerto
                    Rico.
40670............  Santa Isabel              40  Rural...........   0.3604    99940  Rural...........     0.4047
                    County, Puerto
                    Rico.
40680............  Toa Alta County,        7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40690............  Toa Baja County,        7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40700............  Trujillo Alto           7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    County, Puerto
                    Rico.
40710............  Utuado County,            40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40720............  Vega Alta County,       7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40730............  Vega Baja County,       7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40740............  Vieques County,           40  Rural...........   0.3604    99940  Rural...........     0.4047
                    Puerto Rico.
40750............  Villalba County,        6360  Urban...........   0.4881    38660  Urban...........     0.4939
                    Puerto Rico.
40760............  Yabucoa County,         7440  Urban...........   0.4752    41980  Urban...........     0.4621
                    Puerto Rico.
40770............  Yauco County,           6360  Urban...........   0.4881    49500  Urban...........     0.4408
                    Puerto Rico.
41000............  Bristol County,         6483  Urban...........   1.1058    39300  Urban...........     1.0966
                    Rhode Island.
41010............  Kent County, Rhode      6483  Urban...........   1.1058    39300  Urban...........     1.0966
                    Island.
41020............  Newport County,         6483  Urban...........   1.1058    39300  Urban...........     1.0966
                    Rhode Island.
41030............  Providence County,      6483  Urban...........   1.1058    39300  Urban...........     1.0966
                    Rhode Island.
41050............  Washington County,      6483  Urban...........   1.1058    39300  Urban...........     1.0966
                    Rhode Island.
42000............  Abbeville County, S       42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42010............  Aiken County, S         0600  Urban...........   0.9808    12260  Urban...........     0.9748
                    Carolina.
42020............  Allendale County, S       42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42030............  Anderson County, S      3160  Urban...........   0.9615    11340  Urban...........     0.8997
                    Carolina.
42040............  Bamberg County, S         42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42050............  Barnwell County, S        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42060............  Beaufort County, S        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42070............  Berkeley County, S      1440  Urban...........   0.9245    16700  Urban...........     0.9245
                    Carolina.
42080............  Calhoun County, S         42  Rural...........   0.8631    17900  Urban...........     0.9057
                    Carolina.
42090............  Charleston County,      1440  Urban...........   0.9245    16700  Urban...........     0.9245
                    S Carolina.
42100............  Cherokee County, S      3160  Urban...........   0.9615    99942  Rural...........     0.8638
                    Carolina.
42110............  Chester County, S         42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42120............  Chesterfield              42  Rural...........   0.8631    99942  Rural...........     0.8638
                    County, S Carolina.
42130............  Clarendon County, S       42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42140............  Colleton County, S        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42150............  Darlington County,        42  Rural...........   0.8631    22500  Urban...........     0.8947
                    S Carolina.
42160............  Dillon County, S          42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42170............  Dorchester County,      1440  Urban...........   0.9245    16700  Urban...........     0.9245
                    S Carolina.
42180............  Edgefield County, S     0600  Urban...........   0.9808    12260  Urban...........     0.9748
                    Carolina.
42190............  Fairfield County, S       42  Rural...........   0.8631    17900  Urban...........     0.9057
                    Carolina.
42200............  Florence County, S      2655  Urban...........   0.9042    22500  Urban...........     0.8947
                    Carolina.
42210............  Georgetown County,        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    S Carolina.
42220............  Greenville County,      3160  Urban...........   0.9615    24860  Urban...........     1.0027
                    S Carolina.
42230............  Greenwood County, S       42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42240............  Hampton County, S         42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42250............  Horry County, S         5330  Urban...........   0.8934    34820  Urban...........     0.8934
                    Carolina.
42260............  Jasper County, S          42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42270............  Kershaw County, S         42  Rural...........   0.8631    17900  Urban...........     0.9057
                    Carolina.
42280............  Lancaster County, S       42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42290............  Laurens County, S         42  Rural...........   0.8631    24860  Urban...........     1.0027
                    Carolina.
42300............  Lee County, S             42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42310............  Lexington County, S     1760  Urban...........   0.9082    17900  Urban...........     0.9057
                    Carolina.
42320............  Mc Cormick County,        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    S Carolina.
42330............  Marion County, S          42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42340............  Marlboro County, S        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42350............  Newberry County, S        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42360............  Oconee County, S          42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42370............  Orangeburg County,        42  Rural...........   0.8631    99942  Rural...........     0.8638
                    S Carolina.
42380............  Pickens County, S       3160  Urban...........   0.9615    24860  Urban...........     1.0027
                    Carolina.
42390............  Richland County, S      1760  Urban...........   0.9082    17900  Urban...........     0.9057
                    Carolina.
42400............  Saluda County, S          42  Rural...........   0.8631    17900  Urban...........     0.9057
                    Carolina.
42410............  Spartanburg County,     3160  Urban...........   0.9615    43900  Urban...........     0.9172
                    S Carolina.
42420............  Sumter County, S        8140  Urban...........   0.8377    44940  Urban...........     0.8377
                    Carolina.
42430............  Union County, S           42  Rural...........   0.8631    99942  Rural...........     0.8638
                    Carolina.
42440............  Williamsburg              42  Rural...........   0.8631    99942  Rural...........     0.8638
                    County, S Carolina.
42450............  York County, S          1520  Urban...........   0.9715    16740  Urban...........     0.9750
                    Carolina.
43010............  Aurora County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43020............  Beadle County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43030............  Bennett County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43040............  Bon Homme County, S       43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43050............  Brookings County, S       43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43060............  Brown County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43070............  Brule County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43080............  Buffalo County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.

[[Page 3691]]

 
43090............  Butte County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43100............  Campbell County, S        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43110............  Charles Mix County,       43  Rural...........   0.8551    99943  Rural...........     0.8560
                    S Dakota.
43120............  Clark County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43130............  Clay County, S            43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43140............  Codington County, S       43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43150............  Corson County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43160............  Custer County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43170............  Davison County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43180............  Day County, S             43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43190............  Deuel County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43200............  Dewey County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43210............  Douglas County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43220............  Edmunds County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43230............  Fall River County,        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    S Dakota.
43240............  Faulk County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43250............  Grant County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43260............  Gregory County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43270............  Haakon County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43280............  Hamlin County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43290............  Hand County, S            43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43300............  Hanson County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43310............  Harding County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43320............  Hughes County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43330............  Hutchinson County,        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    S Dakota.
43340............  Hyde County, S            43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43350............  Jackson County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43360............  Jerauld County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43370............  Jones County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43380............  Kingsbury County, S       43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43390............  Lake County, S            43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43400............  Lawrence County, S        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43410............  Lincoln County, S       7760  Urban...........   0.9635    43620  Urban...........     0.9635
                    Dakota.
43420............  Lyman County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43430............  Mc Cook County, S         43  Rural...........   0.8551    43620  Urban...........     0.9635
                    Dakota.
43440............  Mc Pherson County,        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    S Dakota.
43450............  Marshall County, S        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43460............  Meade County, S           43  Rural...........   0.8551    39660  Urban...........     0.8987
                    Dakota.
43470............  Mellette County, S        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43480............  Miner County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43490............  Minnehaha County, S     7760  Urban...........   0.9635    43620  Urban...........     0.9635
                    Dakota.
43500............  Moody County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43510............  Pennington County,      6660  Urban...........   0.8987    39660  Urban...........     0.8987
                    S Dakota.
43520............  Perkins County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43530............  Potter County, S          43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43540............  Roberts County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43550............  Sanborn County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43560............  Shannon County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43570............  Spink County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43580............  Stanley County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43590............  Sully County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43600............  Todd County, S            43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43610............  Tripp County, S           43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43620............  Turner County, S          43  Rural...........   0.8551    43620  Urban...........     0.9635
                    Dakota.
43630............  Union County, S           43  Rural...........   0.8551    43580  Urban...........     0.9381
                    Dakota.
43640............  Walworth County, S        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43650............  Washabaugh County,        43  Rural...........   0.8551    99943  Rural...........     0.8560
                    S Dakota.
43670............  Yankton County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
43680............  Ziebach County, S         43  Rural...........   0.8551    99943  Rural...........     0.8560
                    Dakota.
44000............  Anderson County,        3840  Urban...........   0.8397    28940  Urban...........     0.8441
                    Tennessee.
44010............  Bedford County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44020............  Benton County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44030............  Bledsoe County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44040............  Blount County,          3840  Urban...........   0.8397    28940  Urban...........     0.8441
                    Tennessee.
44050............  Bradley County,           44  Rural...........   0.7935    17420  Urban...........     0.8139
                    Tennessee.
44060............  Campbell County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44070............  Cannon County,            44  Rural...........   0.7935    34980  Urban...........     0.9790
                    Tennessee.
44080............  Carroll County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44090............  Carter County,          3660  Urban...........   0.8007    27740  Urban...........     0.7937
                    Tennessee.
44100............  Cheatham County,        5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44110............  Chester County,         3580  Urban...........   0.8964    27180  Urban...........     0.8964
                    Tennessee.

[[Page 3692]]

 
44120............  Claiborne County,         44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44130............  Clay County,              44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44140............  Cocke County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44150............  Coffee County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44160............  Crockett County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44170............  Cumberland County,        44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44180............  Davidson County,        5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44190............  Decatur County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44200............  De Kalb County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44210............  Dickson County,         5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44220............  Dyer County,              44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44230............  Fayette County,         4920  Urban...........   0.9416    32820  Urban...........     0.9397
                    Tennessee.
44240............  Fentress County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44250............  Franklin County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44260............  Gibson County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44270............  Giles County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44280............  Grainger County,          44  Rural...........   0.7935    34100  Urban...........     0.7961
                    Tennessee.
44290............  Greene County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44300............  Grundy County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44310............  Hamblen County,           44  Rural...........   0.7935    34100  Urban...........     0.7961
                    Tennessee.
44320............  Hamilton County,        1560  Urban...........   0.9088    16860  Urban...........     0.9088
                    Tennessee.
44330............  Hancock County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44340............  Hardeman County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44350............  Hardin County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44360............  Hawkins County,         3660  Urban...........   0.8007    28700  Urban...........     0.8054
                    Tennessee.
44370............  Haywood County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44380............  Henderson County,         44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44390............  Henry County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44400............  Hickman County,           44  Rural...........   0.7935    34980  Urban...........     0.9790
                    Tennessee.
44410............  Houston County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44420............  Humphreys County,         44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44430............  Jackson County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44440............  Jefferson County,         44  Rural...........   0.7935    34100  Urban...........     0.7961
                    Tennessee.
44450............  Johnson County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44460............  Knox County,            3840  Urban...........   0.8397    28940  Urban...........     0.8441
                    Tennessee.
44470............  Lake County,              44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44480............  Lauderdale County,        44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44490............  Lawrence County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44500............  Lewis County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44510............  Lincoln County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44520............  Loudon County,          3840  Urban...........   0.8397    28940  Urban...........     0.8441
                    Tennessee.
44530............  Mc Minn County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44540............  Mc Nairy County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44550............  Macon County,             44  Rural...........   0.7935    34980  Urban...........     0.9790
                    Tennessee.
44560............  Madison County,         3580  Urban...........   0.8964    27180  Urban...........     0.8964
                    Tennessee.
44570............  Marion County,          1560  Urban...........   0.9088    16860  Urban...........     0.9088
                    Tennessee.
44580............  Marshall County,          44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44590............  Maury County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44600............  Meigs County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44610............  Monroe County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44620............  Montgomery County,      1660  Urban...........   0.8284    17300  Urban...........     0.8284
                    Tennessee.
44630............  Moore County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44640............  Morgan County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44650............  Obion County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44660............  Overton County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44670............  Perry County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44680............  Pickett County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44690............  Polk County,              44  Rural...........   0.7935    17420  Urban...........     0.8139
                    Tennessee.
44700............  Putnam County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44710............  Rhea County,              44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44720............  Roane County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44730............  Robertson County,       5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44740............  Rutherford County,      5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44750............  Scott County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44760............  Sequatchie County,        44  Rural...........   0.7935    16860  Urban...........     0.9088
                    Tennessee.
44770............  Sevier County,          3840  Urban...........   0.8397    99944  Rural...........     0.7895
                    Tennessee.
44780............  Shelby County,          4920  Urban...........   0.9416    32820  Urban...........     0.9397
                    Tennessee.
44790............  Smith County,             44  Rural...........   0.7935    34980  Urban...........     0.9790
                    Tennessee.
44800............  Stewart County,           44  Rural...........   0.7935    17300  Urban...........     0.8284
                    Tennessee.
44810............  Sullivan County,        3660  Urban...........   0.8007    28700  Urban...........     0.8054
                    Tennessee.
44820............  Sumner County,          5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.

[[Page 3693]]

 
44830............  Tipton County,          4920  Urban...........   0.9416    32820  Urban...........     0.9397
                    Tennessee.
44840............  Trousdale County,         44  Rural...........   0.7935    34980  Urban...........     0.9790
                    Tennessee.
44850............  Unicoi County,          3660  Urban...........   0.8007    27740  Urban...........     0.7937
                    Tennessee.
44860............  Union County,           3840  Urban...........   0.8397    28940  Urban...........     0.8441
                    Tennessee.
44870............  Van Buren County,         44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44880............  Warren County,            44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44890............  Washington County,      3660  Urban...........   0.8007    27740  Urban...........     0.7937
                    Tennessee.
44900............  Wayne County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44910............  Weakley County,           44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44920............  White County,             44  Rural...........   0.7935    99944  Rural...........     0.7895
                    Tennessee.
44930............  Williamson County,      5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
44940............  Wilson County,          5360  Urban...........   0.9808    34980  Urban...........     0.9790
                    Tennessee.
45000............  Anderson County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45010............  Andrews County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45020............  Angelina County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45030............  Aransas County,           45  Rural...........   0.7931    18580  Urban...........     0.8550
                    Texas.
45040............  Archer County,          9080  Urban...........   0.8365    48660  Urban...........     0.8285
                    Texas.
45050............  Armstrong County,         45  Rural...........   0.7931    11100  Urban...........     0.9156
                    Texas.
45060............  Atascosa County,          45  Rural...........   0.7931    41700  Urban...........     0.8980
                    Texas.
45070............  Austin County,            45  Rural...........   0.7931    26420  Urban...........     0.9996
                    Texas.
45080............  Bailey County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45090............  Bandera County,           45  Rural...........   0.7931    41700  Urban...........     0.8980
                    Texas.
45100............  Bastrop County,         0640  Urban...........   0.9437    12420  Urban...........     0.9437
                    Texas.
45110............  Baylor County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45113............  Bee County, Texas..       45  Rural...........   0.7931    99945  Rural...........     0.8003
45120............  Bell County, Texas.     3810  Urban...........   0.8526    28660  Urban...........     0.8526
45130............  Bexar County, Texas     7240  Urban...........   0.8984    41700  Urban...........     0.8980
45140............  Blanco County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45150............  Borden County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45160............  Bosque County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45170............  Bowie County, Texas     8360  Urban...........   0.8283    45500  Urban...........     0.8283
45180............  Brazoria County,        1145  Urban...........   0.8563    26420  Urban...........     0.9996
                    Texas.
45190............  Brazos County,          1260  Urban...........   0.8900    17780  Urban...........     0.8900
                    Texas.
45200............  Brewster County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45201............  Briscoe County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45210............  Brooks County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45220............  Brown County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45221............  Burleson County,          45  Rural...........   0.7931    17780  Urban...........     0.8900
                    Texas.
45222............  Burnet County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45223............  Caldwell County,        0640  Urban...........   0.9437    12420  Urban...........     0.9437
                    Texas.
45224............  Calhoun County,           45  Rural...........   0.7931    47020  Urban...........     0.8160
                    Texas.
45230............  Callahan County,          45  Rural...........   0.7931    10180  Urban...........     0.7896
                    Texas.
45240............  Cameron County,         1240  Urban...........   0.9804    15180  Urban...........     0.9804
                    Texas.
45250............  Camp County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45251............  Carson County,            45  Rural...........   0.7931    11100  Urban...........     0.9156
                    Texas.
45260............  Cass County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45270............  Castro County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45280............  Chambers County,        3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45281............  Cherokee County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45290............  Childress County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45291............  Clay County, Texas.       45  Rural...........   0.7931    48660  Urban...........     0.8285
45292............  Cochran County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45300............  Coke County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45301............  Coleman County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45310............  Collin County,          1920  Urban...........   1.0205    19124  Urban...........     1.0228
                    Texas.
45311............  Collingsworth             45  Rural...........   0.7931    99945  Rural...........     0.8003
                    County, Texas.
45312............  Colorado County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45320............  Comal County, Texas     7240  Urban...........   0.8984    41700  Urban...........     0.8980
45321............  Comanche County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45330............  Concho County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45340............  Cooke County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45341............  Coryell County,         3810  Urban...........   0.8526    28660  Urban...........     0.8526
                    Texas.
45350............  Cottle County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45360............  Crane County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45361............  Crockett County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45362............  Crosby County,            45  Rural...........   0.7931    31180  Urban...........     0.8783
                    Texas.
45370............  Culberson County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45380............  Dallam County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45390............  Dallas County,          1920  Urban...........   1.0205    19124  Urban...........     1.0228
                    Texas.
45391............  Dawson County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45392............  Deaf Smith County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.

[[Page 3694]]

 
45400............  Delta County, Texas       45  Rural...........   0.7931    19124  Urban...........     1.0228
45410............  Denton County,          1920  Urban...........   1.0205    19124  Urban...........     1.0228
                    Texas.
45420............  De Witt County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45421............  Dickens County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45430............  Dimmit County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45431............  Donley County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45440............  Duval County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45450............  Eastland County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45451............  Ector County, Texas     5800  Urban...........   0.9741    36220  Urban...........     0.9884
45460............  Edwards County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45470............  Ellis County, Texas     1920  Urban...........   1.0205    19124  Urban...........     1.0228
45480............  El Paso County,         2320  Urban...........   0.8977    21340  Urban...........     0.8977
                    Texas.
45490............  Erath County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45500............  Falls County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45510............  Fannin County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45511............  Fayette County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45520............  Fisher County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45521............  Floyd County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45522............  Foard County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45530............  Fort Bend County,       3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45531............  Franklin County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45540............  Freestone County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45541............  Frio County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45542............  Gaines County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45550............  Galveston County,       2920  Urban...........   0.9635    26420  Urban...........     0.9996
                    Texas.
45551............  Garza County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45552............  Gillespie County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45560............  Glasscock County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45561............  Goliad County,            45  Rural...........   0.7931    47020  Urban...........     0.8160
                    Texas.
45562............  Gonzales County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45563............  Gray County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45564............  Grayson County,         7640  Urban...........   0.9507    43300  Urban...........     0.9507
                    Texas.
45570............  Gregg County, Texas     4420  Urban...........   0.8888    30980  Urban...........     0.8730
45580............  Grimes County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45581............  Guadaloupe County,      7240  Urban...........   0.8984    41700  Urban...........     0.8980
                    Texas.
45582............  Hale County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45583............  Hall County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45590............  Hamilton County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45591............  Hansford County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45592............  Hardeman County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45600............  Hardin County,          0840  Urban...........   0.8412    13140  Urban...........     0.8412
                    Texas.
45610............  Harris County,          3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45620............  Harrison County,        4420  Urban...........   0.8888    99945  Rural...........     0.8003
                    Texas.
45621............  Hartley County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45630............  Haskell County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45631............  Hays County, Texas.     0640  Urban...........   0.9437    12420  Urban...........     0.9437
45632............  Hemphill County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45640............  Henderson County,       1920  Urban...........   1.0205    99945  Rural...........     0.8003
                    Texas.
45650............  Hidalgo County,         4880  Urban...........   0.8934    32580  Urban...........     0.8934
                    Texas.
45651............  Hill County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45652............  Hockley County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45653............  Hood County, Texas.     2800  Urban...........   0.9522    99945  Rural...........     0.8003
45654............  Hopkins County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45660............  Houston County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45661............  Howard County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45662............  Hudspeth County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45670............  Hunt County, Texas.     1920  Urban...........   1.0205    19124  Urban...........     1.0228
45671............  Hutchinson County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45672............  Irion County, Texas       45  Rural...........   0.7931    41660  Urban...........     0.8271
45680............  Jack County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45681............  Jackson County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45690............  Jasper County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45691............  Jeff Davis County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45700............  Jefferson County,       0840  Urban...........   0.8412    13140  Urban...........     0.8412
                    Texas.
45710............  Jim Hogg County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45711............  Jim Wells County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45720............  Johnson County,         2800  Urban...........   0.9522    23104  Urban...........     0.9486
                    Texas.
45721............  Jones County, Texas       45  Rural...........   0.7931    10180  Urban...........     0.7896
45722............  Karnes County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45730............  Kaufman County,         1920  Urban...........   1.0205    19124  Urban...........     1.0228
                    Texas.
45731............  Kendall County,           45  Rural...........   0.7931    41700  Urban...........     0.8980
                    Texas.

[[Page 3695]]

 
45732............  Kenedy County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45733............  Kent County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45734............  Kerr County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45740............  Kimble County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45741............  King County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45742............  Kinney County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45743............  Kleberg County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45744............  Knox County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45750............  Lamar County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45751............  Lamb County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45752............  Lampasas County,          45  Rural...........   0.7931    28660  Urban...........     0.8526
                    Texas.
45753............  La Salle County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45754............  Lavaca County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45755............  Lee County, Texas..       45  Rural...........   0.7931    99945  Rural...........     0.8003
45756............  Leon County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45757............  Liberty County,         3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45758............  Limestone County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45759............  Lipscomb County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45760............  Live Oak County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45761............  Llano County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45762............  Loving County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45770............  Lubbock County,         4600  Urban...........   0.8783    31180  Urban...........     0.8783
                    Texas.
45771............  Lynn County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45772............  Mc Culloch County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45780............  Mc Lennan County,       8800  Urban...........   0.8518    47380  Urban...........     0.8518
                    Texas.
45781............  Mc Mullen County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45782............  Madison County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45783............  Marion County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45784............  Martin County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45785............  Mason County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45790............  Matagorda County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45791............  Maverick County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45792............  Medina County,            45  Rural...........   0.7931    41700  Urban...........     0.8980
                    Texas.
45793............  Menard County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45794............  Midland County,         5800  Urban...........   0.9741    33260  Urban...........     0.9514
                    Texas.
45795............  Milam County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45796............  Mills County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45797............  Mitchell County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45800............  Montague County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45801............  Montgomery County,      3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45802............  Moore County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45803............  Morris County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45804............  Motley County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45810............  Nacogdoches County,       45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45820............  Navarro County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45821............  Newton County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45822............  Nolan County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45830............  Nueces County,          1880  Urban...........   0.8550    18580  Urban...........     0.8550
                    Texas.
45831............  Ochiltree County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45832............  Oldham County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45840............  Orange County,          0840  Urban...........   0.8412    13140  Urban...........     0.8412
                    Texas.
45841............  Palo Pinto County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45842............  Panola County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45843............  Parker County,          2800  Urban...........   0.9522    23104  Urban...........     0.9486
                    Texas.
45844............  Parmer County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45845............  Pecos County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45850............  Polk County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45860............  Potter County,          0320  Urban...........   0.9156    11100  Urban...........     0.9156
                    Texas.
45861............  Presidio County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45870............  Rains County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45871............  Randall County,         0320  Urban...........   0.9156    11100  Urban...........     0.9156
                    Texas.
45872............  Reagan County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45873............  Real County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45874............  Red River County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45875............  Reeves County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45876............  Refugio County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45877............  Roberts County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45878............  Robertson County,         45  Rural...........   0.7931    17780  Urban...........     0.8900
                    Texas.
45879............  Rockwall County,        1920  Urban...........   1.0205    19124  Urban...........     1.0228
                    Texas.
45880............  Runnels County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45881............  Rusk County, Texas.       45  Rural...........   0.7931    30980  Urban...........     0.8730

[[Page 3696]]

 
45882............  Sabine County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45883............  San Augustine             45  Rural...........   0.7931    99945  Rural...........     0.8003
                    County, Texas.
45884............  San Jacinto County,       45  Rural...........   0.7931    26420  Urban...........     0.9996
                    Texas.
45885............  San Patricio            1880  Urban...........   0.8550    18580  Urban...........     0.8550
                    County, Texas.
45886............  San Saba County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45887............  Schleicher County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45888............  Scurry County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45889............  Shackelford County,       45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45890............  Shelby County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45891............  Sherman County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45892............  Smith County, Texas     8640  Urban...........   0.9168    46340  Urban...........     0.9168
45893............  Somervell County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45900............  Starr County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45901............  Stephens County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45902............  Sterling County,          45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45903............  Stonewall County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45904............  Sutton County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45905............  Swisher County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45910............  Tarrant County,         2800  Urban...........   0.9522    23104  Urban...........     0.9486
                    Texas.
45911............  Taylor County,          0040  Urban...........   0.8054    10180  Urban...........     0.7896
                    Texas.
45912............  Terrell County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45913............  Terry County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45920............  Throckmorton              45  Rural...........   0.7931    99945  Rural...........     0.8003
                    County, Texas.
45921............  Titus County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45930............  Tom Green County,       7200  Urban...........   0.8271    41660  Urban...........     0.8271
                    Texas.
45940............  Travis County,          0640  Urban...........   0.9437    12420  Urban...........     0.9437
                    Texas.
45941............  Trinity County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45942............  Tyler County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45943............  Upshur County,          4420  Urban...........   0.8888    30980  Urban...........     0.8730
                    Texas.
45944............  Upton County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45945............  Uvalde County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45946............  Val Verde County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45947............  Van Zandt County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45948............  Victoria County,        8750  Urban...........   0.8160    47020  Urban...........     0.8160
                    Texas.
45949............  Walker County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45950............  Waller County,          3360  Urban...........   1.0091    26420  Urban...........     0.9996
                    Texas.
45951............  Ward County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45952............  Washington County,        45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45953............  Webb County, Texas.     4080  Urban...........   0.8068    29700  Urban...........     0.8068
45954............  Wharton County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45955............  Wheeler County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45960............  Wichita County,         9080  Urban...........   0.8365    48660  Urban...........     0.8285
                    Texas.
45961............  Wilbarger County,         45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45962............  Willacy County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45970............  Williamson County,      0640  Urban...........   0.9437    12420  Urban...........     0.9437
                    Texas.
45971............  Wilson County,          7240  Urban...........   0.8984    41700  Urban...........     0.8980
                    Texas.
45972............  Winkler County,           45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45973............  Wise County, Texas.       45  Rural...........   0.7931    23104  Urban...........     0.9486
45974............  Wood County, Texas.       45  Rural...........   0.7931    99945  Rural...........     0.8003
45980............  Yoakum County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45981............  Young County, Texas       45  Rural...........   0.7931    99945  Rural...........     0.8003
45982............  Zapata County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
45983............  Zavala County,            45  Rural...........   0.7931    99945  Rural...........     0.8003
                    Texas.
46000............  Beaver County, Utah       46  Rural...........   0.8762    99946  Rural...........     0.8118
46010............  Box Elder County,         46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46020............  Cache County, Utah.       46  Rural...........   0.8762    30860  Urban...........     0.9164
46030............  Carbon County, Utah       46  Rural...........   0.8762    99946  Rural...........     0.8118
46040............  Daggett County,           46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46050............  Davis County, Utah.     7160  Urban...........   0.9340    36260  Urban...........     0.9029
46060............  Duchesne County,          46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46070............  Emery County, Utah.       46  Rural...........   0.8762    99946  Rural...........     0.8118
46080............  Garfield County,          46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46090............  Grand County, Utah.       46  Rural...........   0.8762    99946  Rural...........     0.8118
46100............  Iron County, Utah..       46  Rural...........   0.8762    99946  Rural...........     0.8118
46110............  Juab County, Utah..       46  Rural...........   0.8762    39340  Urban...........     0.9500
46120............  Kane County, Utah..     2620  Urban...........   1.1845    99946  Rural...........     0.8118
46130............  Millard County,           46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46140............  Morgan County, Utah       46  Rural...........   0.8762    36260  Urban...........     0.9029
46150............  Piute County, Utah.       46  Rural...........   0.8762    99946  Rural...........     0.8118
46160............  Rich County, Utah..       46  Rural...........   0.8762    99946  Rural...........     0.8118
46170............  Salt Lake County,       7160  Urban...........   0.9340    41620  Urban...........     0.9421
                    Utah.

[[Page 3697]]

 
46180............  San Juan County,          46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46190............  Sanpete County,           46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46200............  Sevier County, Utah       46  Rural...........   0.8762    99946  Rural...........     0.8118
46210............  Summit County, Utah       46  Rural...........   0.8762    41620  Urban...........     0.9421
46220............  Tooele County, Utah       46  Rural...........   0.8762    41620  Urban...........     0.9421
46230............  Uintah County, Utah       46  Rural...........   0.8762    99946  Rural...........     0.8118
46240............  Utah County, Utah..     6520  Urban...........   0.9500    39340  Urban...........     0.9500
46250............  Wasatch County,           46  Rural...........   0.8762    99946  Rural...........     0.8118
                    Utah.
46260............  Washington County,        46  Rural...........   0.8762    41100  Urban...........     0.9392
                    Utah.
46270............  Wayne County, Utah.       46  Rural...........   0.8762    99946  Rural...........     0.8118
46280............  Weber County, Utah.     7160  Urban...........   0.9340    36260  Urban...........     0.9029
47000............  Addison County,           47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47010............  Bennington County,        47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47020............  Caledonia County,         47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47030............  Chittenden County,      1303  Urban...........   0.9410    15540  Urban...........     0.9410
                    Vermont.
47040............  Essex County,             47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47050............  Franklin County,        1303  Urban...........   0.9410    15540  Urban...........     0.9410
                    Vermont.
47060............  Grand Isle County,      1303  Urban...........   0.9410    15540  Urban...........     0.9410
                    Vermont.
47070............  Lamoille County,          47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47080............  Orange County,            47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47090............  Orleans County,           47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47100............  Rutland County,           47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47110............  Washington County,        47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47120............  Windham County,           47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
47130............  Windsor County,           47  Rural...........   0.9830    99947  Rural...........     0.9830
                    Vermont.
48010............  St Croix County,          48  Rural...........   0.7615    99948  Rural...........     0.7615
                    Virgin Islands.
48020............  St Thomas-John            48  Rural...........   0.7615    99948  Rural...........     0.7615
                    County, Virgin
                    Islands.
49000............  Accomack County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49010............  Albemarle County,       1540  Urban...........   1.0187    16820  Urban...........     1.0187
                    Virginia.
49011............  Alexandria City         8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49020............  Alleghany County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49030............  Amelia County,            49  Rural...........   0.8417    40060  Urban...........     0.9328
                    Virginia.
49040............  Amherst County,         4640  Urban...........   0.8691    31340  Urban...........     0.8691
                    Virginia.
49050............  Appomattox County,        49  Rural...........   0.8417    31340  Urban...........     0.8691
                    Virginia.
49060............  Arlington County,       8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49070............  Augusta County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49080............  Bath County,              49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49088............  Bedford City            4640  Urban...........   0.8691    31340  Urban...........     0.8691
                    County, Virginia.
49090............  Bedford County,         4640  Urban...........   0.8691    31340  Urban...........     0.8691
                    Virginia.
49100............  Bland County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49110............  Botetourt County,       6800  Urban...........   0.8387    40220  Urban...........     0.8374
                    Virginia.
49111............  Bristol City            3660  Urban...........   0.8007    28700  Urban...........     0.8054
                    County, Virginia.
49120............  Brunswick County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49130............  Buchanan County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49140............  Buckingham County,        49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49141............  Buena Vista City          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49150............  Campbell County,        4640  Urban...........   0.8691    31340  Urban...........     0.8691
                    Virginia.
49160............  Caroline County,          49  Rural...........   0.8417    40060  Urban...........     0.9328
                    Virginia.
49170............  Carroll County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49180............  Charles City            6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49190............  Charlotte County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49191............  Charlottesville         1540  Urban...........   1.0187    16820  Urban...........     1.0187
                    City County,
                    Virginia.
49194............  Chesapeake County,      5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    Virginia.
49200............  Chesterfield            6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49210............  Clarke County,          8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49211............  Clifton Forge City        49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49212............  Colonial Heights        6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49213............  Covington City            49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49220............  Craig County,             49  Rural...........   0.8417    40220  Urban...........     0.8374
                    Virginia.
49230............  Culpeper County,        8840  Urban...........   1.0976    99949  Rural...........     0.8013
                    Virginia.
49240............  Cumberland County,        49  Rural...........   0.8417    40060  Urban...........     0.9328
                    Virginia.
49241............  Danville City           1950  Urban...........   0.8489    19260  Urban...........     0.8489
                    County, Virginia.
49250............  Dickenson County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49260............  Dinniddie County,       6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49270............  Emporia County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49280............  Essex County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49288............  Fairfax City            8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49290............  Fairfax County,         8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49291............  Falls Church City       8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49300............  Fauquier County,        8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49310............  Floyd County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.

[[Page 3698]]

 
49320............  Fluvanna County,        1540  Urban...........   1.0187    16820  Urban...........     1.0187
                    Virginia.
49328............  Franklin City             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49330............  Franklin County,          49  Rural...........   0.8417    40220  Urban...........     0.8374
                    Virginia.
49340............  Frederick County,         49  Rural...........   0.8417    49020  Urban...........     1.0214
                    Virginia.
49342............  Fredericksburg City     8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49343............  Galax City County,        49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49350............  Giles County,             49  Rural...........   0.8417    13980  Urban...........     0.7954
                    Virginia.
49360............  Gloucester County,      5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    Virginia.
49370............  Goochland County,       6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49380............  Grayson County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49390............  Greene County,          1540  Urban...........   1.0187    16820  Urban...........     1.0187
                    Virginia.
49400............  Greensville County,       49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49410............  Halifax County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49411............  Hampton City            5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49420............  Hanover County,         6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49421............  Harrisonburg City         49  Rural...........   0.8417    25500  Urban...........     0.9088
                    County, Virginia.
49430............  Henrico County,         6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49440............  Henry County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49450............  Highland County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49451............  Hopewell City           6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49460............  Isle Of Wight           5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49470............  James City Co           5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49480............  King And Queen            49  Rural...........   0.8417    40060  Urban...........     0.9328
                    County, Virginia.
49490............  King George County,     8840  Urban...........   1.0976    99949  Rural...........     0.8013
                    Virginia.
49500............  King William              49  Rural...........   0.8417    40060  Urban...........     0.9328
                    County, Virginia.
49510............  Lancaster County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49520............  Lee County,               49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49522............  Lexington County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49530............  Loudoun County,         8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49540............  Louisa County,            49  Rural...........   0.8417    40060  Urban...........     0.9328
                    Virginia.
49550............  Lunenburg County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49551............  Lynchburg City          4640  Urban...........   0.8691    31340  Urban...........     0.8691
                    County, Virginia.
49560............  Madison County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49561............  Martinsville City         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49563............  Manassas City           8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49565............  Manassas Park City      8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49570............  Mathews County,         5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    Virginia.
49580............  Mecklenburg County,       49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49590............  Middlesex County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49600............  Montgomery County,        49  Rural...........   0.8417    13980  Urban...........     0.7954
                    Virginia.
49610............  Nansemond County,         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49620............  Nelson County,            49  Rural...........   0.8417    16820  Urban...........     1.0187
                    Virginia.
49621............  New Kent County,        6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49622............  Newport News City       5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49641............  Norfolk City            5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49650............  Northampton County,       49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49660............  Northumberland            49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49661............  Norton City County,       49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49670............  Nottoway County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49680............  Orange County,            49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49690............  Page County,              49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49700............  Patrick County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49701............  Petersburg City         6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49710............  Pittsylvania            1950  Urban...........   0.8489    19260  Urban...........     0.8489
                    County, Virginia.
49711............  Portsmouth City         5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49712............  Poquoson City           5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49720............  Powhatan County,        6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    Virginia.
49730............  Prince Edward             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49740............  Prince George           6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49750............  Prince William          8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49770............  Pulaski County,           49  Rural...........   0.8417    13980  Urban...........     0.7954
                    Virginia.
49771............  Radford City              49  Rural...........   0.8417    13980  Urban...........     0.7954
                    County, Virginia.
49780............  Rappahannock              49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49790............  Richmond County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49791............  Richmond City           6760  Urban...........   0.9328    40060  Urban...........     0.9328
                    County, Virginia.
49800............  Roanoke County,         6800  Urban...........   0.8387    40220  Urban...........     0.8374
                    Virginia.
49801............  Roanoke City            6800  Urban...........   0.8387    40220  Urban...........     0.8374
                    County, Virginia.
49810............  Rockbridge County,        49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49820............  Rockingham County,        49  Rural...........   0.8417    25500  Urban...........     0.9088
                    Virginia.
49830............  Russell County,           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49838............  Salem County,           6800  Urban...........   0.8387    40220  Urban...........     0.8374
                    Virginia.

[[Page 3699]]

 
49840............  Scott County,           3660  Urban...........   0.8007    28700  Urban...........     0.8054
                    Virginia.
49850............  Shenandoah County,        49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49860............  Smyth County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49867............  South Boston City         49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49870............  Southampton County,       49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49880............  Spotsylvania            8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    County, Virginia.
49890............  Stafford County,        8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49891............  Staunton City             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49892............  Suffolk City            5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49900............  Surry County,             49  Rural...........   0.8417    47260  Urban...........     0.8799
                    Virginia.
49910............  Sussex County,            49  Rural...........   0.8417    40060  Urban...........     0.9328
                    Virginia.
49920............  Tazewell County,          49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49921............  Virginia Beach City     5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49930............  Warren County,          8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
49950............  Washington County,      3660  Urban...........   0.8007    28700  Urban...........     0.8054
                    Virginia.
49951............  Waynesboro City           49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49960............  Westmoreland              49  Rural...........   0.8417    99949  Rural...........     0.8013
                    County, Virginia.
49961............  Williamsburg City       5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    County, Virginia.
49962............  Winchester City           49  Rural...........   0.8417    49020  Urban...........     1.0214
                    County, Virginia.
49970............  Wise County,              49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49980............  Wythe County,             49  Rural...........   0.8417    99949  Rural...........     0.8013
                    Virginia.
49981............  York County,            5720  Urban...........   0.8799    47260  Urban...........     0.8799
                    Virginia.
50000............  Adams County,             50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50010............  Asotin County,            50  Rural...........   1.0217    30300  Urban...........     0.9886
                    Washington.
50020............  Benton County,          6740  Urban...........   1.0619    28420  Urban...........     1.0619
                    Washington.
50030............  Chelan County,            50  Rural...........   1.0217    48300  Urban...........     1.0070
                    Washington.
50040............  Clallam County,           50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50050............  Clark County,           6440  Urban...........   1.1266    38900  Urban...........     1.1266
                    Washington.
50060............  Columbia County,          50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50070............  Cowlitz County,           50  Rural...........   1.0217    31020  Urban...........     0.9579
                    Washington.
50080............  Douglas County,           50  Rural...........   1.0217    48300  Urban...........     1.0070
                    Washington.
50090............  Ferry County,             50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50100............  Franklin County,        6740  Urban...........   1.0619    28420  Urban...........     1.0619
                    Washington.
50110............  Garfield County,          50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50120............  Grant County,             50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50130............  Grays Harbor              50  Rural...........   1.0217    99950  Rural...........     1.0510
                    County, Washington.
50140............  Island County,          7600  Urban...........   1.1567    99950  Rural...........     1.0510
                    Washington.
50150............  Jefferson County,         50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50160............  King County,            7600  Urban...........   1.1567    42644  Urban...........     1.1577
                    Washington.
50170............  Kitsap County,          1150  Urban...........   1.0675    14740  Urban...........     1.0675
                    Washington.
50180............  Kittitas County,          50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50190............  Klickitat County,         50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50200............  Lewis County,             50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50210............  Lincoln County,           50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50220............  Mason County,             50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50230............  Okanogan County,          50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50240............  Pacific County,           50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50250............  Pend Oreille              50  Rural...........   1.0217    99950  Rural...........     1.0510
                    County, Washington.
50260............  Pierce County,          8200  Urban...........   1.0742    45104  Urban...........     1.0742
                    Washington.
50270............  San Juan County,          50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50280............  Skagit County,            50  Rural...........   1.0217    34580  Urban...........     1.0454
                    Washington.
50290............  Skamania County,          50  Rural...........   1.0217    38900  Urban...........     1.1266
                    Washington.
50300............  Snohomish County,       7600  Urban...........   1.1567    42644  Urban...........     1.1577
                    Washington.
50310............  Spokane County,         7840  Urban...........   1.0905    44060  Urban...........     1.0905
                    Washington.
50320............  Stevens County,           50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50330............  Thurston County,        5910  Urban...........   1.0927    36500  Urban...........     1.0927
                    Washington.
50340............  Wahkiakum County,         50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50350............  Walla Walla County,       50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50360............  Whatcom County,         0860  Urban...........   1.1731    13380  Urban...........     1.1731
                    Washington.
50370............  Whitman County,           50  Rural...........   1.0217    99950  Rural...........     1.0510
                    Washington.
50380............  Yakima County,          9260  Urban...........   1.0155    49420  Urban...........     1.0155
                    Washington.
51000............  Barbour County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51010............  Berkeley County, W      8840  Urban...........   1.0976    25180  Urban...........     0.9489
                    Virginia.
51020............  Boone County, W           51  Rural...........   0.7900    16620  Urban...........     0.8445
                    Virginia.
51030............  Braxton County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51040............  Brooke County, W        8080  Urban...........   0.7819    48260  Urban...........     0.7819
                    Virginia.
51050............  Cabell County, W        3400  Urban...........   0.9477    26580  Urban...........     0.9477
                    Virginia.
51060............  Calhoun County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51070............  Clay County, W            51  Rural...........   0.7900    16620  Urban...........     0.8445
                    Virginia.
51080............  Doddridge County, W       51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51090............  Fayette County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.

[[Page 3700]]

 
51100............  Gilmer County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51110............  Grant County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51120............  Greenbrier County,        51  Rural...........   0.7900    99951  Rural...........     0.7717
                    W Virginia.
51130............  Hampshire County, W       51  Rural...........   0.7900    49020  Urban...........     1.0214
                    Virginia.
51140............  Hancock County, W       8080  Urban...........   0.7819    48260  Urban...........     0.7819
                    Virginia.
51150............  Hardy County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51160............  Harrison County, W        51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51170............  Jackson County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51180............  Jefferson County, W     8840  Urban...........   1.0976    47894  Urban...........     1.0926
                    Virginia.
51190............  Kanawha County, W       1480  Urban...........   0.8445    16620  Urban...........     0.8445
                    Virginia.
51200............  Lewis County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51210............  Lincoln County, W         51  Rural...........   0.7900    16620  Urban...........     0.8445
                    Virginia.
51220............  Logan County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51230............  Mc Dowell County, W       51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51240............  Marion County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51250............  Marshall County, W      9000  Urban...........   0.7161    48540  Urban...........     0.7161
                    Virginia.
51260............  Mason County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51270............  Mercer County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51280............  Mineral County, W       1900  Urban...........   0.9317    19060  Urban...........     0.9317
                    Virginia.
51290............  Mingo County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51300............  Monongalia County,        51  Rural...........   0.7900    34060  Urban...........     0.8420
                    W Virginia.
51310............  Monroe County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51320............  Morgan County, W          51  Rural...........   0.7900    25180  Urban...........     0.9489
                    Virginia.
51330............  Nicholas County, W        51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51340............  Ohio County, W          9000  Urban...........   0.7161    48540  Urban...........     0.7161
                    Virginia.
51350............  Pendleton County, W       51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51360............  Pleasants County, W       51  Rural...........   0.7900    37620  Urban...........     0.8270
                    Virginia.
51370............  Pocahontas County,        51  Rural...........   0.7900    99951  Rural...........     0.7717
                    W Virginia.
51380............  Preston County, W         51  Rural...........   0.7900    34060  Urban...........     0.8420
                    Virginia.
51390............  Putnam County, W        1480  Urban...........   0.8445    16620  Urban...........     0.8445
                    Virginia.
51400............  Raleigh County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51410............  Randolph County, W        51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51420............  Ritchie County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51430............  Roane County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51440............  Summers County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51450............  Taylor County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51460............  Tucker County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51470............  Tyler County, W           51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51480............  Upshur County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51490............  Wayne County, W         3400  Urban...........   0.9477    26580  Urban...........     0.9477
                    Virginia.
51500............  Webster County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51510............  Wetzel County, W          51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
51520............  Wirt County, W            51  Rural...........   0.7900    37620  Urban...........     0.8270
                    Virginia.
51530............  Wood County, W          6020  Urban...........   0.8270    37620  Urban...........     0.8270
                    Virginia.
51540............  Wyoming County, W         51  Rural...........   0.7900    99951  Rural...........     0.7717
                    Virginia.
52000............  Adams County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52010............  Ashland County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52020............  Barron County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52030............  Bayfield County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52040............  Brown County,           3080  Urban...........   0.9483    24580  Urban...........     0.9483
                    Wisconsin.
52050............  Buffalo County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52060............  Burnett County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52070............  Calumet County,         0460  Urban...........   0.9239    11540  Urban...........     0.9288
                    Wisconsin.
52080............  Chippewa County,        2290  Urban...........   0.9201    20740  Urban...........     0.9201
                    Wisconsin.
52090............  Clark County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52100............  Columbia County,          52  Rural...........   0.9478    31540  Urban...........     1.0659
                    Wisconsin.
52110............  Crawford County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52120............  Dane County,            4720  Urban...........   1.0754    31540  Urban...........     1.0659
                    Wisconsin.
52130............  Dodge County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52140............  Door County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52150............  Douglas County,         2240  Urban...........   1.0213    20260  Urban...........     1.0213
                    Wisconsin.
52160............  Dunn County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52170............  Eau Claire County,      2290  Urban...........   0.9201    20740  Urban...........     0.9201
                    Wisconsin.
52180............  Florence County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52190............  Fond Du Lac County,       52  Rural...........   0.9478    22540  Urban...........     0.9640
                    Wisconsin.
52200............  Forest County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52210............  Grant County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52220............  Green County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52230............  Green Lake County,        52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52240............  Iowa County,              52  Rural...........   0.9478    31540  Urban...........     1.0659
                    Wisconsin.
52250............  Iron County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.

[[Page 3701]]

 
52260............  Jackson County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52270............  Jefferson County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52280............  Juneau County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52290............  Kenosha County,         3800  Urban...........   0.9760    29404  Urban...........     1.0429
                    Wisconsin.
52300............  Kewaunee County,          52  Rural...........   0.9478    24580  Urban...........     0.9483
                    Wisconsin.
52310............  La Crosse County,       3870  Urban...........   0.9564    29100  Urban...........     0.9564
                    Wisconsin.
52320............  Lafayette County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52330............  Langlade County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52340............  Lincoln County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52350............  Manitowoc County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52360............  Marathon County,        8940  Urban...........   0.9590    48140  Urban...........     0.9590
                    Wisconsin.
52370............  Marinette County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52380............  Marquette County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52381............  Menominee County,         52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52390............  Milwaukee County,       5080  Urban...........   1.0146    33340  Urban...........     1.0146
                    Wisconsin.
52400............  Monroe County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52410............  Oconto County,            52  Rural...........   0.9478    24580  Urban...........     0.9483
                    Wisconsin.
52420............  Oneida County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52430............  Outagamie County,       0460  Urban...........   0.9239    11540  Urban...........     0.9288
                    Wisconsin.
52440............  Ozaukee County,         5080  Urban...........   1.0146    33340  Urban...........     1.0146
                    Wisconsin.
52450............  Pepin County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52460............  Pierce County,          5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Wisconsin.
52470............  Polk County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52480............  Portage County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52490............  Price County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52500............  Racine County,          6600  Urban...........   0.8997    39540  Urban...........     0.8997
                    Wisconsin.
52510............  Richland County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52520............  Rock County,            3620  Urban...........   0.9538    27500  Urban...........     0.9538
                    Wisconsin.
52530............  Rusk County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52540............  St Croix County,        5120  Urban...........   1.1075    33460  Urban...........     1.1075
                    Wisconsin.
52550............  Sauk County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52560............  Sawyer County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52570............  Shawano County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52580............  Sheboygan County,       7620  Urban...........   0.8911    43100  Urban...........     0.8911
                    Wisconsin.
52590............  Taylor County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52600............  Trempealeau County,       52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52610............  Vernon County,            52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52620............  Vilas County,             52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52630............  Walworth County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52640............  Washburn County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52650............  Washington County,      5080  Urban...........   1.0146    33340  Urban...........     1.0146
                    Wisconsin.
52660............  Waukesha County,        5080  Urban...........   1.0146    33340  Urban...........     1.0146
                    Wisconsin.
52670............  Waupaca County,           52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52680............  Waushara County,          52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
52690............  Winnebago County,       0460  Urban...........   0.9239    36780  Urban...........     0.9183
                    Wisconsin.
52700............  Wood County,              52  Rural...........   0.9478    99952  Rural...........     0.9509
                    Wisconsin.
53000............  Albany County,            53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53010............  Big Horn County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53020............  Campbell County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53030............  Carbon County,            53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53040............  Converse County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53050............  Crook County,             53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53060............  Fremont County,           53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53070............  Goshen County,            53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53080............  Hot Springs County,       53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53090............  Johnson County,           53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53100............  Laramie County,         1580  Urban...........   0.8775    16940  Urban...........     0.8775
                    Wyoming.
53110............  Lincoln County,           53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53120............  Natrona County,         1350  Urban...........   0.9026    16220  Urban...........     0.9026
                    Wyoming.
53130............  Niobrara County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53140............  Park County,              53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53150............  Platte County,            53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53160............  Sheridan County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53170............  Sublette County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53180............  Sweetwater County,        53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53190............  Teton County,             53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53200............  Uinta County,             53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53210............  Washakie County,          53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
53220............  Weston County,            53  Rural...........   0.9257    99953  Rural...........     0.9257
                    Wyoming.
65010............  Agana County, Guam.       65  Rural...........   0.9611    99965  Rural...........     0.9611
65020............  Agana Heights             65  Rural...........   0.9611    99965  Rural...........     0.9611
                    County, Guam.

[[Page 3702]]

 
65030............  Agat County, Guam..       65  Rural...........   0.9611    99965  Rural...........     0.9611
65040............  Asan County, Guam..       65  Rural...........   0.9611    99965  Rural...........     0.9611
65050............  Barrigada County,         65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65060............  Chalan Pago County,       65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65070............  Dededo County, Guam       65  Rural...........   0.9611    99965  Rural...........     0.9611
65080............  Inarajan County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65090............  Maite County, Guam.       65  Rural...........   0.9611    99965  Rural...........     0.9611
65100............  Mangilao County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65110............  Merizo County, Guam       65  Rural...........   0.9611    99965  Rural...........     0.9611
65120............  Mongmong County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65130............  Ordot County, Guam.       65  Rural...........   0.9611    99965  Rural...........     0.9611
65140............  Piti County, Guam..       65  Rural...........   0.9611    99965  Rural...........     0.9611
65150............  Santa Rita County,        65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65160............  Sinajana County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65170............  Talofofo County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65180............  Tamuning County,          65  Rural...........   0.9611    99965  Rural...........     0.9611
                    Guam.
65190............  Toto County, Guam..       65  Rural...........   0.9611    99965  Rural...........     0.9611
65200............  Umatac County, Guam       65  Rural...........   0.9611    99965  Rural...........     0.9611
65210............  Yigo County, Guam..       65  Rural...........   0.9611    99965  Rural...........     0.9611
65220............  Yona County, Guam..       65  Rural...........   0.9611    99965  Rural...........    0.9611
----------------------------------------------------------------------------------------------------------------
*Transition wage index value should be used with the CBSA urban/rural designation for rate calculation purposes.
 
\1\At this time, there are no hospitals located in these CBSA-based urban areas on which to base a wage index.
  Therefore, the transition wage index value is based on the average transition wage index for all urban areas
  within the state.


[[Page 3703]]

Addendum C--Wage Index Tables

    In this addendum, we provide the tables referred to throughout the 
preamble to this proposed rule. Tables 1 and 2 below provide the 
proposed CBSA-based wage index values for urban and rural providers.
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Table 2.--Proposed Wage Index Based on CBSA Labor Market Areas for Rural
                                  Areas
------------------------------------------------------------------------
                                                                   Wage
         CBSA Code                      Nonurban Area             Index
------------------------------------------------------------------------
01.........................  Alabama...........................   0.7446
02.........................  Alaska............................   1.1977
03.........................  Arizona...........................   0.8768
04.........................  Arkansas..........................   0.7466
05.........................  California........................   1.1054
06.........................  Colorado..........................   0.9380
07.........................  Connecticut.......................   1.1730
08.........................  Delaware..........................   0.9579
10.........................  Florida...........................   0.8568
11.........................  Georgia...........................   0.7662
12.........................  Hawaii............................   1.0551
13.........................  Idaho.............................   0.8037
14.........................  Illinois..........................   0.8271
15.........................  Indiana...........................   0.8624
16.........................  Iowa..............................   0.8509
17.........................  Kansas............................   0.8035
18.........................  Kentucky..........................   0.7766
19.........................  Louisiana.........................   0.7411
20.........................  Maine.............................   0.8843
21.........................  Maryland..........................   0.9353
22.........................  Massachusetts.....................   1.0216
23.........................  Michigan..........................   0.8895
24.........................  Minnesota.........................   0.9132
25.........................  Mississippi.......................   0.7674
26.........................  Missouri..........................   0.7900
27.........................  Montana...........................   0.8762
28.........................  Nebraska..........................   0.8657
29.........................  Nevada............................   0.9065
30.........................  New Hampshire.....................   1.0817
31.........................  New Jersey\1\.....................
32.........................  New Mexico........................   0.8635
33.........................  New York..........................   0.8154
34.........................  North Carolina....................   0.8540
35.........................  North Dakota......................   0.7261
36.........................  Ohio..............................   0.8826
37.........................  Oklahoma..........................   0.7581
38.........................  Oregon............................   0.9826
39.........................  Pennsylvania......................   0.8291
40.........................  Puerto Rico\1\....................   0.4047
41.........................  Rhode Island\1\...................
42.........................  South Carolina....................   0.8638
43.........................  South Dakota......................   0.8560
44.........................  Tennessee.........................   0.7895
45.........................  Texas.............................   0.8003
46.........................  Utah..............................   0.8118
47.........................  Vermont...........................   0.9830
48.........................  Virgin Islands....................   0.7615
49.........................  Virginia..........................   0.8013
50.........................  Washington........................   1.0510
51.........................  West Virginia.....................   0.7717
52.........................  Wisconsin.........................   0.9509
53.........................  Wyoming...........................   0.9257
65.........................  Guam..............................  0.9611
------------------------------------------------------------------------
\1\All counties within the State are classified as urban, with the
  exception of Massachusetts and Puerto Rico. Massachusetts and Puerto
  Rico have areas designated as rural, however, no short-term, acute
  care hospitals are located in the area(s) for FY 2006. Because more
  recent data is not available for those areas, we are using last year's
  wage index value.

[FR Doc. 06-488 Filed 1-13-06; 4:01 pm]
BILLING CODE 4120-01-P