[Federal Register Volume 71, Number 79 (Tuesday, April 25, 2006)]
[Proposed Rules]
[Pages 23996-24472]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-3629]



[[Page 23995]]

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

Part II

Book 2 of 2 Books

Pages 23995-24550





Department of Health and Human Services





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



Centers for Medicare & Medicaid Services



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



42 CFR Parts 409, 410 et al.



Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2007 Rates; Proposed Rule

  Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / 
Proposed Rules  

[[Page 23996]]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 410, 412, 413, 424, 485, and 489

[CMS-1488-P]
RIN 0938-AO12


Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2007 Rates

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

ACTION: Proposed rule.

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

SUMMARY: We are proposing to revise the Medicare hospital inpatient 
prospective payment systems (IPPS) for operating and capital-related 
costs to implement changes arising from our continuing experience with 
these systems, and to implement a number of changes made by the Deficit 
Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum 
to this proposed rule, we describe the proposed changes to the amounts 
and factors used to determine the rates for Medicare hospital inpatient 
services for operating costs and capital-related costs. We also are 
setting forth proposed rate-of-increase limits as well as proposed 
policy changes for hospitals and hospital units excluded from the IPPS 
that are paid in full or in part on a reasonable cost basis subject to 
these limits. These proposed changes would be applicable to discharges 
occurring on or after October 1, 2006.
    In this proposed rule, we discuss our proposals to refine the 
diagnosis-related group (DRG) system under the IPPS to better recognize 
severity of illness among patients--for FY 2007, we are proposing to 
use a hospital-specific relative value cost center weighting 
methodology to adjust DRG relative weights and in FY 2008 (if not 
earlier), to implement consolidated severity-adjusted DRGs or 
alternative severity adjustment methods.
    Among the other policy changes that we are proposing to make are 
changes related to: limited revisions of the reclassification of cases 
to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage 
data, including the occupational mix data, used to compute the wage 
index; applications for new technologies and medical services add-on 
payments; payments to hospitals for the direct and indirect costs of 
graduate medical education; submission of hospital quality data; 
payments to sole community hospitals and Medicare-dependent, small 
rural hospitals; and provisions governing emergency services under the 
Emergency Medical Treatment and Labor Act of 1986 (EMTALA).
    We are also inviting comments on a number of issues including 
performance-based hospital payments for services and health information 
technology, as well as how to improve data transparency for consumers.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on June 12, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1488-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. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period''. (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular 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-1488-P, P.O. Box 8011, Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send 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-1488-P, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. 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) 786-7195 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 Hubert H. 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 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: 

Marc Hartstein, (410) 786-4548, Operating Prospective Payment, 
Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and 
Technology Add-On Payments, Hospital Geographic Reclassifications, Sole 
Community Hospital, Disproportionate Share Hospital, and Medicare-
Dependent, Small Rural Hospital Issues.
Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded 
Hospitals, Graduate Medical Education, Critical Access Hospitals, and 
Long-Term Care (LTC)-DRG Issues.
Siddhartha Mazumdar, (410) 786-6673, Rural Community Hospital 
Demonstration Issues.
Sheila Blackstock, (410) 786-3502, Quality Data for Annual Payment 
Update Issues.
Thomas Valuck, (410) 786-7479, Hospital Value-Based Purchasing Issues.
Frederick Grabau, (410) 786-0206, Services in Foreign Hospitals Issues.
Brian Reitz, (410) 786-5001, Obsolete Paper Claims Forms Issues.

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-1488-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

[[Page 23997]]

the comment period are available for viewing by the public, including 
any personally identifiable or confidential business information that 
is included in a comment. We post all comments received before the 
close of the comment period on the following Web site as soon as 
possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on CMS 
Regulations'' on that Web site to view public comments.
    Comments received timely will also 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.

Electronic Access

    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. Free public access is available on a Wide 
Area Information Server (WAIS) through the Internet and via 
asynchronous dial-in. Internet users can access the database by using 
the World Wide Web; the Superintendent of Documents' home page address 
is http://www.gpoaccess.gov/, by using local WAIS client software, or 
by telnet to swais.access.gpo.gov, then login as guest (no password 
required). Dial-in users should use communications software and modem 
to call (202) 512-1661; type swais, then login as guest (no password 
required).

Acronyms

AHA American Hospital Association
AHIMA American Health Information Management Association
AHRO Agency for Health Care Research and Quality
AMI Acute myocardial infarction
AOA American Osteopathic Association
APR DRG All Patient Refined Diagnosis Related Group System
ASC Ambulatory surgical center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Public Law 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999, Public Law 106-113
BIPA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Benefits Improvement and Protection Act of 2000, Public Law 
106-554
BLS Bureau of Labor Statistics
CAH Critical access hospital
CART CMS Abstraction & Reporting Tool
CBSAs Core-based statistical areas
CC Complication or comorbidity
CDAC Clinical Data Abstraction Center
CIPI Capital input price index
CPI Consumer price index
CMI Case-mix index
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
COBRA Consolidated Omnibus Reconciliation Act of 1985, Public Law 99-
272
CPI Consumer price index
CRNA Certified registered nurse anesthetist
CY Calendar year
DRA Deficit Reduction Act of 2005, Public Law 109-171
DRG Diagnosis-related group
DSH Disproportionate share hospital
ECI Employment cost index
EMR Electronic medical record
EMTALA Emergency Medical Treatment and Labor Act of 1986, Public Law 
99-272
FDA Food and Drug Administration
FFY Federal fiscal year
FIPS Federal information processing standards
FQHC Federally qualified health center
FTE Full-time equivalent
FY Fiscal year
GAAP Generally Accepted Accounting Principles
GAF Geographic Adjustment Factor
GME Graduate medical education
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems
HCFA Health Care Financing Administration
HCRIS Hospital Cost Report Information System
HHA Home health agency
HHS Department of Health and Human Services
HIC Health insurance card
HIPAA Health Insurance Portability and Accountability Act of 1996, 
Public Law 104-191
HIPC Health Information Policy Council
HIS Health information system
HIT Health information technology
HMO Health maintenance organization
HSA Health savings account
HSCRC Maryland Health Services Cost Review Commission
HSRV Hospital-specific relative value
HSRVcc Hospital-specific relative value cost center
HQA Hospital Quality Alliance
HQI Hospital Quality Initiative
HwH Hospital-within-a-hospital
ICD-9-CM International Classification of Diseases, Ninth Revision, 
Clinical Modification
ICD-10-PCS International Classification of Diseases, Tenth Edition, 
Procedure Coding System
ICU Intensive care unit
IHS Indian Health Service
IME Indirect medical education
IOM Institute of Medicine
IPF Inpatient psychiatric facility
IPPS Acute care hospital inpatient prospective payment system
IRF Inpatient rehabilitation facility
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LAMCs Large area metropolitan counties
LTC-DRG Long-term care diagnosis-related group
LTCH Long-term care hospital
MCE Medicare Code Editor
MCO Managed care organization
MCV Major cardiovascular condition
MDC Major diagnostic category
MDH Medicare-dependent, small rural hospital
MedPAC Medicare Payment Advisory Commission
MedPAR Medicare Provider Analysis and Review File
MEI Medicare Economic Index
MGCRB Medicare Geographic Classification Review Board
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 
2003, Public Law 108-173
MRHFP Medicare Rural Hospital Flexibility Program
MSA Metropolitan Statistical Area
NAICS North American Industrial Classification System
NCD National coverage determination
NCHS National Center for Health Statistics
NCQA National Committee for Quality Assurance
NCVHS National Committee on Vital and Health Statistics
NECMA New England County Metropolitan Areas
NICU Neonatal intensive care unit
NQF National Quality Forum
NTIS National Technical Information Service
NVHRI National Voluntary Hospital Reporting Initiative
OES Occupational employment statistics
OIG Office of the Inspector General
OMB Executive Office of Management and Budget
O.R. Operating room

[[Page 23998]]

OSCAR Online Survey Certification and Reporting (System)
PRM Provider Reimbursement Manual
PPI Producer price index
PMSAs Primary metropolitan statistical areas
PPS Prospective payment system
PRA Per resident amount
ProPAC Prospective Payment Assessment Commission
PRRB Provider Reimbursement Review Board
PS&R Provider Statistical and Reimbursement (System)
QIG Quality Improvement Group, CMS
QIO Quality Improvement Organization
RHC Rural health clinic
RHQDAPU Reporting hospital quality data for annual payment update
RNHCI Religious Nonmedical Health care Institution
RRC Rural referral center
RUCAs Rural-urban commuting area codes
RY Rate year
SAF Standard Analytic File
SCH Sole community hospital
SFY State fiscal year
SIC Standard Industrial Classification
SNF Skilled nursing facility
SOCs Standard occupational classifications
SOM State Operations Manual
SSA Social Security Administration
SSI Supplemental Security Income
TAG Technical Advisory Group
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248
UHDDS Uniform hospital discharge data set

Table of Contents

I. Background
    A. Summary
    1. Acute Care Hospital Inpatient Prospective Payment System 
(IPPS)
    2. Hospitals and Hospital Units Excluded From the IPPS
    a. Inpatient Rehabilitation Facilities (IRFs)
    b. Long-Term Care Hospitals (LTCHs)
    c. Inpatient Psychiatric Facilities (IPFs)
    3. Critical Access Hospitals (CAHs)
    4. Payments for Graduate Medical Education (GME)
    B. Provisions of the Deficit Reduction Act of 2005 (DRA)
    C. Major Contents of this Proposed Rule
    1. Proposed DRG Reclassifications and Recalibrations of Relative 
Weights
    2. Proposed Changes to the Hospital Wage Index
    3. Other Decisions and Proposed Changes to the IPPS for 
Operating Costs and GME Costs
    4. Proposed Changes to the PPS for Capital-Related Costs
    5. Proposed Changes for Hospitals and Hospital Units Excluded 
From the IPPS
    6. Payment for Services Furnished Outside the United States
    7. Payment for Blood Clotting Factor Administered to Inpatients 
With Hemophilia
    8. Limitation on Payments to Skilled Nursing Facilities for Bad 
Debt
    9. Determining Proposed Prospective Payment Operating and 
Capital Rates and Rate-of-Increase Limits
    10. Impact Analysis
    11. Recommendation of Update Factors for Operating Cost Rates of 
Payment for Inpatient Hospital Services
    12. Discussion of Medicare Payment Advisory Commission 
Recommendations
    13. Appendix C--Combinations of Consolidated Severity-Adjusted 
DRGs and Appendix D--Crosswalk of Consolidated Severity-Adjusted 
DRGs to Respective APR DRGs
II. Proposed Changes to DRG Classifications and Relative Weights
    A. Background
    B. DRG Reclassifications
    1. General
    2. Yearly Review for Making DRG Changes
    3. Refinement of DRGs Based on Severity of Illness
    C. Proposals for Revisions to the DRG System Used Under the IPPS
    1. MedPAC Recommendations
    2. Refinement of the Relative Weight Calculation
    3. Refinement of DRGs Based on Severity of Illness
    a. Comparison of the CMS DRG System and the APR DRG System
    b. Consolidated Severity-Adjusted DRGs for Use in the IPPS
    c. Changes to Case-Mix Index (CMI) From a New DRG System
    4. Effect of Consolidated Severity-Adjusted DRGs on the Outlier 
Threshold
    5. Impact of Refinement of DRG System on Payments
    6. Conclusions
    D. Proposed Changes to Specific DRG Classifications
    1. Pre-MDCs: Pancreas Transplants
    2. MDC 1 (Diseases and Disorders of the Nervous System)
    a. Implantation of Intracranial Neurostimulator System for Deep 
Brain Stimulation (DBS)
    b. Carotid Artery Stents
    3. MDC 5 (Diseases and Disorders of the Circulatory System)
    a. Insertion of Epicardial Leads for Defibrillator Devices
    b. Application of Major Cardiovascular Diagnoses (MCVs) List to 
Defibrillator DRGs
    4. MDC 8 (Diseases and Disorders of the Musculoskeletal System 
and Connective Tissue)
    a. Hip and Knee Replacements
    b. Spinal Fusion
    c. ChariteTM Spinal Disc Replacement Device
    5. MDC 18 (Infectious and Parasitic Diseases (Systemic or 
Unspecified Sites)): Severe Sepsis
    6. Medicare Code Editor (MCE) Changes
    a. Newborn Diagnoses Edit
    b. Diagnoses Allowed for Females Only Edit
    c. Diagnoses Allowed for Males Only Edit
    d. Manifestations Not Allowed as Principal Diagnosis Edit
    e. Nonspecific Principal Diagnosis Edit
    f. Unacceptable Principal Diagnosis Edit
    g. Nonspecific O.R. Procedures Edit
    h. Noncovered Procedures Edit
    i. Bilateral Procedure Edit
    7. Surgical Hierarchies
    8. Refinement of Complications and Comorbidities (CC) List
    a. Background
    b. Comprehensive Review of the CC List
    c. CC Exclusions List Proposed for FY 2007
    9. Review of Procedure Codes in DRGs 468, 476, and 477
    a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs
    b. Reassignment of Procedures Among DRGs 468, 476, and 477
    c. Adding Diagnosis or Procedure Codes to MDCs
    10. Changes to the ICD-9-CM Coding System
    E. Proposed Recalibration of DRG Weights
    F. Proposed LTC-DRG Reclassifications and Relative Weights for 
LTCHs for FY 2007
    1. Background
    2. Proposed Changes in the LTC-DRG Classifications
    a. Background
    b. Patient Classifications into DRGs
    3. Development of the Proposed FY 2007 LTC-DRG Relative Weights
    a. General Overview of Development of the LTC-DRG Relative 
Weights
    b. Data
    c. Hospital-Specific Relative Value Methodology
    d. Proposed Low-Volume LTC-DRGs
    4. Steps for Determining the Proposed FY 2007 LTC-DRG Relative 
Weights
    G. Proposed Add-On Payments for New Services and Technologies
    1. Background
    2. Public Input Before Publication of This Notice of Proposed 
Rulemaking on Add-On Payments
    3. FY 2007 Status of Technologies Approved for FY 2006 Add-On 
Payments
    a. Kinetra[supreg] Implantable Neurostimulator for Deep Brain 
Stimulation
    b. Endovascular Graft Repair of the Thoracic Aorta
    c. Restore[supreg] Rechargeable Implantable Neurostimulator
    4. FY 2007 Applicants for New Technology Add-On Payments
    a. C-Port[supreg] Distal Anastomosis System
    b. NovoSeven[supreg] for Intracerebral Hemorrhage
    c. X STOP Interspinous Process Decompression System
III. Proposed Changes to the Hospital Wage Index
    A. Background
    B. Core-Based Statistical Areas for the Proposed Hospital Wage 
Index
    C. Proposed Occupational Mix Adjustment to the Proposed FY 2007 
Index
    1. Development of Data for the Proposed Occupational Mix 
Adjustment
    2. Calculation of the Proposed FY 2007 Occupational Mix 
Adjustment Factor and the Proposed FY 2007 Occupational Mix Adjusted 
Wage Index

[[Page 23999]]

    D. Worksheet S-3 Wage Data for the Proposed FY 2007 Wage Index 
Update
    E. Verification of Worksheet S-3 Wage Data
    F. Computation of the Proposed FY 2007 Unadjusted Wage Index
    G. Computation of the Proposed FY 2007 Blended Wage Index
    H. Proposed Revisions to the Wage Index Based on Hospital 
Redesignations
    1. General
    2. Effects of Reclassification
    3. FY 2007 MGCRB Reclassifications
    4. Proposed FY 2007 Redesignations Under Section 1886(d)(8)(B) 
of the Act
    5. Reclassifications Under Section 508 of Pub. L. 108-173
    6. Proposed Wage Indices for Reclassified Hospitals and Proposed 
Reclassification Budget Neutrality Factor
    I. Proposed FY 2007 Wage Index Adjustment Based on Commuting 
Patterns of Hospital Employees
    J. Process for Requests for Wage Index Data Corrections
    K. Labor-Related Share for the Wage Index for FY 2007
    L. Proxy for the Hospital Market Basket
IV. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs and GME Costs
    A. Reporting of Hospital Quality Data for Annual Hospital 
Payment Update
    1. Background
    2. New Procedures for Hospital Reporting of Quality Data
    3. Electronic Medical Records
    B. Value-Based Purchasing
    1. Introduction
    2. Premier Hospital Quality Incentive Demonstration
    3. RHQDAPU Program
    a. Section 501(b) of Pub. L. 108-173 (MMA)
    b. Section 5001(a) of Pub. L. 109-171 (DRA)
    4. Plan for Implementing Hospital Value-Based Purchasing 
Beginning With FY 2009
    a. Measure Development and Refinement
    b. Data Infrastructure
    c. Incentive Methodology
    d. Public Reporting
    5. Considerations Related to Certain Conditions, Including 
Hospital-Acquired Infections
    6. Promoting Effective Use of Health Information Technology
    C. Sole Community Hospitals (SCHs) and Medicare-Dependent, Small 
Rural Hospitals (MDHs)
    1. Background
    2. Volume Decrease Adjustment for SCHs and MDHs
    a. HAS/Monitrend Data
    b. HAS/Monitrend Data Book Replacement Alternative
    3. Mandatory Reporting Requirements for Any Changes in the 
Circumstances Under Which a Hospital Was Designated as an SCH or MDH
    4. Proposed Payment Changes for MDHs Under the DRA of 2005
    a. Background
    b. Proposed Regulation Changes
    5. Proposed Technical Change
    D. Rural Referral Centers
    1. Case-Mix Index
    2. Discharges
    E. Indirect Medical Education (IME) Adjustment
    1. Background
    2. IME Adjustment Factor for FY 2007
    3. Technical Change to Revise Cross-Reference
    F. Payment Adjustment for Disproportionate Share Hospitals 
(DSHs)
    1. Background
    2. Technical Corrections
    3. Proposed Reinstatement of Inadvertently Deleted Provisions on 
DSH Payment Adjustment Factors
    4. Enhanced DSH Adjustment for MDHs
    G. Geographic Reclassifications
    1. Background
    2. Reclassifications under Section 508 of Pub. L. 108-173
    3. Multicampus Hospitals
    4. Urban Group Hospital Reclassifications
    5. Effect of Change of Ownership on Urban County Group 
Reclassifications
    6. Requested Reclassification for Hospitals Located in a Single 
Hospital MSA Surrounded by Rural Counties
    H. Payment for Direct Graduate Medical Education
    1. Background
    2. Determination of Weighted Average Per Resident Amounts (PRAs) 
for Merged Teaching Hospitals
    3. Determination of Per Resident Amounts (PRAs) for New Teaching 
Hospitals
    4. Requirements for Counting and Appropriate Documentation of 
FTE Residents: Clarification
    5. Resident Time Spent in Nonpatient Care Activities as Part of 
Approved Residency Programs
    6. Medicare GME Affiliated Groups: Technical Changes to 
Regulations
    I. Payment for the Costs of Nursing and Allied Health Education 
Activities: Clarification
    J. Hospital Emergency Services Under EMTALA
    1. Background
    2. Role of the EMTALA Technical Advisory Group (TAG)
    3. Definition of ``Labor''
    4. Application of EMTALA Requirements to Hospitals Without 
Dedicated Emergency Departments
    5. Clarification of Reference to ``Referral Centers''
    K. Other Proposed Technical Changes
    1. Proposed Cross-Reference Correction in Regulations on 
Limitations on Beneficiary Charges
    2. Proposed Cross-Reference Corrections in Regulations on 
Payment Denials Based on Admissions and Quality Reviews
    3. Proposed Cross-Reference Correction in Regulations on Outlier 
Payments
    4. Removing References to Two Paper Claims Forms
    L. Rural Community Hospital Demonstration Program
    M. Health Care Information Transparency Initiative
V. Proposed Changes to the PPS for Capital-Related Costs
    A. Background
    B. Treatment of Certain Urban Hospitals Reclassified as Rural 
Hospitals Under Sec.  412.103
    C. Other Technical Corrections Relating to the Capital PPS 
Geographic Adjustment Factors
VI. Proposed Changes for Hospitals and Hospital Units Excluded From 
the IPPS
    A. Payments to Existing Hospitals and Hospital Units
    1. Payments to Existing Excluded Hospitals and Hospital Units
    2. Separate PPS for IRFs
    3. Separate PPS for LTCHs
    4. Separate PPS for IPFs
    5. Grandfathering of Hospitals-Within-Hospitals (HwHs) and 
Satellite Facilities
    6. Proposed Changes to the Methodology for Determining LTCH 
Cost-to-Charge Ratios (CCRs) and the Reconciliation of High-Cost and 
Short-Stay Outlier Payments Under the LTCH PPS
    a. Background
    b. High-Cost Outliers
    c. Short-Stay Outliers
    7. Technical Corrections Relating to LTCHs
    8. Proposed Cross-Reference Correction in Authority Citations 
for 42 CFR 412 and 413
    B. Critical Access Hospitals (CAHs)
    1. Background
    2. Sunset of Designation of CAHs as Necessary Providers: 
Technical Correction
VII. Payment for Services Furnished Outside the United States
    A. Background
    B. Proposed Clarification of Regulations
VIII. Payment for Blood Clotting Factor Administered to Inpatients 
With Hemophilia
IX. Limitation on Payments to Skilled Nursing Facilities for Bad 
Debt
    A. Background
    B. Changes Made by Section 5004 of the DRA
    C. Proposed Regulation Changes
X. MedPAC Recommendations
XI. Other Required Information
    A. Requests for Data From the Public
    B. Collection of Information Requirements
    C. Public Comments
XII. Regulation Text
Addendum--Proposed Schedule of Standardized Amounts Effective With 
Discharges Occurring On or After October 1, 2006 and Update Factors 
and Rate-of-Increase Percentages Effective With Cost Reporting 
Periods Beginning on or After October 1, 2006
I. Summary and Background
II. Proposed Changes to Prospective Payment Rates for Hospital 
Inpatient Operating Costs for FY 2007
    A. Calculation of the Adjusted Standardized Amount
    1. Standardization of Base-Year Costs or Target Amounts
    2. Computing the Average Standardized Amount
    3. Updating the Average Standardized Amount
    4. Other Adjustments to the Average Standardized Amount
    a. Recalibration of DRG Weights and Updated Wage Index--Budget 
Neutrality Adjustment

[[Page 24000]]

    b. Reclassified Hospitals--Budget Neutrality Adjustment
    c. Outliers
    d. Rural Community Hospital Demonstration Program Adjustment 
(Section 410A of Pub. L. 108-173)
    5. Proposed FY 2007 Standardized Amount
    B. Adjustments for Area Wage Levels and Cost-of-Living
    1. Adjustment for Area Wage Levels
    2. Adjustment for Cost-of-Living in Alaska and Hawaii
    C. DRG Relative Weights
    D. Calculation of the Proposed Prospective Payment Rates for FY 
2007
    1. Federal Rate
    2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)
    a. Calculation of Hospital-Specific Rate
    b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-
Specific Rates for FY 2007
    3. General Formula for Calculation of Proposed Prospective 
Payment Rates for Hospitals Located in Puerto Rico Beginning On or 
After October 1, 2006 and Before October 1, 2007
    a. Puerto Rico Rate
    b. National Rate
III. Proposed Changes to Payment Rates for Acute Care Hospital 
Inpatient Capital-Related Costs for FY 2007
    A. Determination of Proposed Federal Hospital Inpatient Capital-
Related Prospective Payment Rate Update
    1. Projected Capital Standard Federal Rate Update
    a. Description of the Update Framework
    b. Comparison of CMS and MedPAC Update Recommendation
    2. Proposed Outlier Payment Adjustment Factor
    3. Proposed Budget Neutrality Adjustment Factor for Changes in 
DRG Classifications and Weights and the GAF
    4. Proposed Exceptions Payment Adjustment Factor
    5. Proposed Capital Standard Federal Rate for FY 2007
    6. Proposed Special Capital Rate for Puerto Rico Hospitals
    B. Calculation of the Proposed Inpatient Capital-Related 
Prospective Payments for FY 2007
    C. Capital Input Price Index
    1. Background
    2. Forecast of the CIPI for FY 2007
IV. Payment Rates for Excluded Hospitals and Hospital Units: 
Proposed Rate-of-Increase Percentages
    A. Payments to Existing Excluded Hospitals and Units
    B. New Excluded Hospitals and Units
V. Proposed Payment for Blood Clotting Factor Administered to 
Inpatients With Hemophilia
Tables
    Table 1A--National Adjusted Operating Standardized Amounts, 
Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share 
If Wage Index Is Greater Than 1)
    Table 1B--National Adjusted Operating Standardized Amounts, 
Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If 
Wage Index Is Less Than or Equal to 1)
    Table 1C--Adjusted Operating Standardized Amounts for Puerto 
Rico, Labor/Nonlabor
    Table 1D--Capital Standard Federal Payment Rate
    Table 2--Hospital Case-Mix Indexes for Discharges Occurring in 
Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal 
Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 
2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage 
Data); Wage Indexes and 3-Year Average of Hospital Average Hourly 
Wages
    Table 3A--FY 2007 and 3-Year Average Hourly Wage for Urban Areas 
by CBSA
    Table 3B--FY 2007 and 3-Year Average Hourly Wage for Rural Areas 
by CBSA
    Table 4A-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Urban Areas by CBSA--FY2007
    Table 4A-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Urban Areas by CBSA for the Period April 1 through 
September 30, 2007
    Table 4B--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Rural Areas by CBSA--FY 2007
    Table 4C-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Hospitals That Are Reclassified by CBSA--FY 2007
    Table 4C-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Hospitals That Are Reclassified by CBSA for the 
Period April 1 Through September 30, 2007
    Table 4F--Puerto Rico Wage Index and Capital Geographic 
Adjustment Factor (GAF) by CBSA--FY 2007
    Table 4J--Out-Migration Wage Adjustment--FY 2007
    Table 5--List of Diagnosis-Related Groups (DRGs), Relative 
Weighting Factors, and Geometric and Arithmetic Mean Length of Stay 
(LOS)
    Table 6A--New Diagnosis Codes
    Table 6B--New Procedure Codes
    Table 6C--Invalid Diagnosis Codes
    Table 6D--Invalid Procedure Codes
    Table 6E--Revised Diagnosis Code Titles
    Table 6F--Revised Procedure Code Titles
    Table 6G--Additions to the CC Exclusions List
    Table 6H--Deletions from the CC Exclusions List
    Table 7A--Medicare Prospective Payment System Selected 
Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 
GROUPER V23.0
    Table 7B--Medicare Prospective Payment System Selected 
Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 
GROUPER V24.0
    Table 8A--Statewide Average Operating Cost-to-Charge Ratios--
March 2006
    Table 8B--Statewide Average Capital Cost-to-Charge Ratios--March 
2006
    Table 8C--Proposed Statewide Average Total Cost-to-Charge Ratios 
for LTCHs--March 2006
    Table 9A--Hospital Reclassifications and Redesignations by 
Individual Hospital and CBSA--FY 2007
    Table 9B--Hospital Reclassifications and Redesignation by 
Individual Hospital Under Section 508 of Pub. L. 108-173--FY 2007
    Table 9C--Hospitals Redesignated as Rural Under Section 
1886(d)(8)(E) of the Act--FY 2007
    Table 10--Geometric Mean Plus the Lesser of .75 of the National 
Adjusted Operating Standardized Payment Amount (Increased to Reflect 
the Difference Between Costs and Charges) or .75 of One Standard 
Deviation of Mean Charges by Diagnosis-Related Groups (DRGs)--March 
2006
    Table 11--Proposed FY 2007 LTC-DRGs, Relative Weights, Geometric 
Average Length of Stay, and \5/6\ths of the Geometric Average Length 
of Stay
Appendix A--Regulatory Impact Analysis
I. Overall Impact
II. Objectives
III. Limitations on Our Analysis
IV. Hospitals Included In and Excluded From the IPPS
V. Effects on Excluded Hospitals and Hospital Units
VI. Quantitative Effects of the Proposed Policy Changes Under the 
IPPS for Operating Costs
    A. Basis and Methodology of Estimates
    B. Analysis of Table I
    C. Effects on the Hospitals that Failed the Quality Data 
Submission Process (Column 2)
    D. Effects of the DRA Provision Related to MDHs (Column 3)
    E. Effects of the Changes to the DRG Reclassifications and 
Relative Cost-Based Weights (Column 4)
    F. Effects of Proposed Wage Index Changes (Column 5)
    G. Combined Effects of Proposed DRG and Wage Index Changes, 
Including Budget Neutrality Adjustment (Column 6)
    H. Effects of the 3-Year Provision Allowing Urban Hospitals that 
Were Converted to Rural as a Result of the FY 2005 Labor Market Area 
Changes to Maintain the Wage Index of the Urban Labor Market Area in 
Which They Were Formerly Located (Column 7)
    I. Effects of MGCRB Reclassifications (Column 8)
    J. Effects of the Proposed Wage Index Adjustment for Out-
Migration (Column 9)
    K. Effects of All Changes (Column 10)
    L. Effects of Policy on Payment Adjustments for Low-Volume 
Hospitals
    M. Impact Analysis of Table II
VII. Effects of Other Proposed Policy Changes
    A. Effects of LTC-DRG Reclassifications and Relative Weights for 
LTCHs
    B. Effects of Proposed New Technology Add-On Payments
    C. Effects of Requirements for Hospital Reporting of Quality 
Data for Annual Hospital Payment Update
    D. Effects of Other Proposed Policy Changes Affecting Sole 
Community Hospitals (SCHs) and Medicare-Dependent, Small Rural 
Hospitals (MDHs)
    E. Effects of Proposed Policy on Payment for Direct Costs of 
Graduate Medical Education

[[Page 24001]]

    1. Determination of Weighted Average GME PRAs for Merged 
Teaching Hospitals
    2. Determination of PRAs for New Teaching Hospitals
    3. Requirements for Counting and Appropriate Documentation of 
FTE Residents
    4. Resident Time Spent in Nonpatient Care Activities as Part of 
an Approved Residency Program
    F. Effects of Proposed Policy Changes Relating to Emergency 
Services Under EMTALA
    G. Effects of Policy on Rural Community Hospital Demonstration 
Program
    H. Effects of Proposed Policy on Hospitals-Within-Hospitals and 
Satellite Facilities
    I. Effects of Proposed Policy Changes to the Methodology for 
Determining LTCH CCRs and the Reconciliation LTCH PPS Outlier 
Payments
    J. Effects of Proposed Policy on Payment for Services Furnished 
Outside the United States
    K. Effects of Proposed Policy on Limitation on Payments to SNFs
VIII. Effects of Proposed Changes in the Capital PPS
    A. General Considerations
    B. Results
IX. Alternatives Considered
X. Overall Conclusion
XI. Accounting Statement
XII. Executive Order 12866
Appendix B--Recommendation of Update Factors for Operating Cost 
Rates of Payment for Inpatient Hospital Services
I. Background
II. Inpatient Hospital Update for FY 2007
III. Secretary's Recommendation
IV. MedPAC Recommendation for Assessing Payment Adequacy and 
Updating Payments in Traditional Medicare
Appendix C--Combinations of Proposed Consolidated Severity-Adjusted 
DRGs
Appendix D--Crosswalk of Proposed Consolidated Severity-Adjusted 
DRGs to Respective APR DRGs

I. Background

A. Summary

1. Acute Care Hospital Inpatient Prospective Payment System (IPPS)
    Section 1886(d) of the Social Security Act (the Act) sets forth a 
system of payment for the operating costs of acute care hospital 
inpatient stays under Medicare Part A (Hospital Insurance) based on 
prospectively set rates. Section 1886(g) of the Act requires the 
Secretary to pay for the capital-related costs of hospital inpatient 
stays under a prospective payment system (PPS). Under these PPSs, 
Medicare payment for hospital inpatient operating and capital-related 
costs is made at predetermined, specific rates for each hospital 
discharge. Discharges are classified according to a list of diagnosis-
related groups (DRGs).
    The base payment rate is comprised of a standardized amount that is 
divided into a labor-related share and a nonlabor-related share. The 
labor-related share is adjusted by the wage index applicable to the 
area where the hospital is located; and if the hospital is located in 
Alaska or Hawaii, the nonlabor-related share is adjusted by a cost-of-
living adjustment factor. This base payment rate is multiplied by the 
DRG relative weight.
    If the hospital treats a high percentage of low-income patients, it 
receives a percentage add-on payment applied to the DRG-adjusted base 
payment rate. This add-on payment, known as the disproportionate share 
hospital (DSH) adjustment, provides for a percentage increase in 
Medicare payments to hospitals that qualify under either of two 
statutory formulas designed to identify hospitals that serve a 
disproportionate share of low-income patients. For qualifying 
hospitals, the amount of this adjustment may vary based on the outcome 
of the statutory calculations.
    If the hospital is an approved teaching hospital, it receives a 
percentage add-on payment for each case paid under the IPPS, known as 
the indirect medical education (IME) adjustment. This percentage 
varies, depending on the ratio of residents to beds.
    Additional payments may be made for cases that involve new 
technologies or medical services that have been approved for special 
add-on payments. To qualify, a new technology or medical service must 
demonstrate that it is a substantial clinical improvement over 
technologies or services otherwise available, and that, absent an add-
on payment, it would be inadequately paid under the regular DRG 
payment.
    The costs incurred by the hospital for a case are evaluated to 
determine whether the hospital is eligible for an additional payment as 
an outlier case. This additional payment is designed to protect the 
hospital from large financial losses due to unusually expensive cases. 
Any outlier payment due is added to the DRG-adjusted base payment rate, 
plus any DSH, IME, and new technology or medical service add-on 
adjustments.
    Although payments to most hospitals under the IPPS are made on the 
basis of the standardized amounts, some categories of hospitals are 
paid the higher of a hospital-specific rate based on their costs in a 
base year (the higher of FY 1982, FY 1987, FY 1996, or FY 2002) or the 
IPPS rate based on the standardized amount. For example, sole community 
hospitals (SCHs) are the sole source of care in their areas, and 
Medicare-dependent, small rural hospitals (MDHs) are a major source of 
care for Medicare beneficiaries in their areas. Both of these 
categories of hospitals are afforded this special payment protection in 
order to maintain access to services for beneficiaries. (Until FY 2007, 
an MDH has received the IPPS rate plus 50 percent of the difference 
between the IPPS rate and its hospital-specific rate if the hospital-
specific rate is higher than the IPPS rate. In addition, an MDH does 
not have the option of using FY 1996 as the base year for its hospital-
specific rate. As discussed below, for discharges occurring on or after 
October 1, 2007, but before October 1, 2011, an MDH will receive the 
IPPS rate plus 75 percent of the difference between the IPPS rate and 
its hospital-specific rate, if the hospital-specific rate is higher 
than the IPPS rate.)
    Section 1886(g) of the Act requires the Secretary to pay for the 
capital-related costs of inpatient hospital services ``in accordance 
with a prospective payment system established by the Secretary.'' The 
basic methodology for determining capital prospective payments is set 
forth in our regulations at 42 CFR 412.308 and 412.312. Under the 
capital PPS, payments are adjusted by the same DRG for the case as they 
are under the operating IPPS. Capital PPS payments are also adjusted 
for IME and DSH, similar to the adjustments made under the operating 
IPPS. In addition, hospitals may receive outlier payments for those 
cases that have unusually high costs.
    The existing regulations governing payments to hospitals under the 
IPPS are located in 42 CFR Part 412, Subparts A through M.
2. Hospitals and Hospital Units Excluded From the IPPS
    Under section 1886(d)(1)(B) of the Act, as amended, certain 
specialty hospitals and hospital units are excluded from the IPPS. 
These hospitals and units are: rehabilitation hospitals and units; 
long-term care hospitals (LTCHs); psychiatric hospitals and units; 
children's hospitals; and cancer hospitals. Religious nonmedical health 
care institutions (RNHCIs) are also excluded from the IPPS. Various 
sections of the Balanced Budget Act of 1997 (Pub. L. 105-33), the 
Medicare, Medicaid and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106-113), and 
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 
Act of 2000 (Pub. L. 106-554) provide for the implementation of PPSs 
for rehabilitation hospitals and units (referred to as inpatient 
rehabilitation facilities (IRFs)), LTCHs, and psychiatric hospitals and 
units (referred to as

[[Page 24002]]

inpatient psychiatric facilities (IPFs)), as discussed below. 
Children's hospitals, cancer hospitals, and RNHCIs continue to be paid 
solely under a reasonable cost-based system.
    The existing regulations governing payments to excluded hospitals 
and hospital units are located in 42 CFR Parts 412 and 413.
a. Inpatient Rehabilitation Facilities (IRFs)
    Under section 1886(j) of the Act, as amended, rehabilitation 
hospitals and units (IRFs) have been transitioned from payment based on 
a blend of reasonable cost reimbursement subject to a hospital-specific 
annual limit under section 1886(b) of the Act and the adjusted facility 
Federal prospective payment rate for cost reporting periods beginning 
on or after January 1, 2002 through September 30, 2002, to payment at 
100 percent of the Federal rate effective for cost reporting periods 
beginning on or after October 1, 2002. IRFs subject to the blend were 
also permitted to elect payment based on 100 percent of the Federal 
rate. The existing regulations governing payments under the IRF PPS are 
located in 42 CFR Part 412, Subpart P.
b. Long-Term Care Hospitals (LTCHs)
    Under the authority of sections 123(a) and (c) of Pub. L. 106-113 
and section 307(b)(1) of Pub. L. 106-554, LTCHs that do not meet the 
definition of ``new'' under Sec.  412.23(e)(4) are being transitioned 
from being paid for inpatient hospital services based on a blend of 
reasonable cost-based reimbursement under section 1886(b) of the Act to 
100 percent of the Federal rate during a 5-year period, beginning with 
cost reporting periods that start on or after October 1, 2002. These 
LTCHs that do not meet the definition of ``new'' may elect to be paid 
based on 100 percent of the Federal prospective payment rate instead of 
a blended payment in any year during the 5-year transition. For cost 
reporting periods beginning on or after October 1, 2006, LTCHs will be 
paid 100 percent of the Federal rate. The existing regulations 
governing payment under the LTCH PPS are located in 42 CFR Part 412, 
Subpart O.
c. Inpatient Psychiatric Facilities (IPFs)
    Under the authority of sections 124(a) and (c) of Pub. L. 106-113, 
inpatient psychiatric facilities (IPFs) (formerly psychiatric hospitals 
and psychiatric units of acute care hospitals) are paid under the IPF 
PPS. Under the IPF PPS, some IPFs are transitioning from being paid for 
inpatient hospital services based on a blend of reasonable cost-based 
payment and a Federal per diem payment rate, effective for cost 
reporting periods beginning on or after January 1, 2005 (November 15, 
2004 IPF PPS final rule (69 FR 66922) and January 23, 2006 IPF PPS 
proposed rule (71 FR 3616)). For cost reporting periods beginning on or 
after January 1, 2008, all IPFs will be paid 100 percent of the Federal 
per diem payment amount. The existing regulations governing payment 
under the IPF PPS are located in 42 CFR 412, Subpart N.
3. Critical Access Hospitals (CAHs)
    Under sections 1814, 1820, and 1834(g) of the Act, payments are 
made to critical access hospitals (CAHs) (that is, rural hospitals or 
facilities that meet certain statutory requirements) for inpatient and 
outpatient services based on 101 percent of reasonable cost. Reasonable 
cost is determined under the provisions of section 1861(v)(1)(A) of the 
Act and existing regulations under 42 CFR Parts 413 and 415.
4. Payments for Graduate Medical Education (GME)
    Under section 1886(a)(4) of the Act, costs of approved educational 
activities are excluded from the operating costs of inpatient hospital 
services. Hospitals with approved graduate medical education (GME) 
programs are paid for the direct costs of GME in accordance with 
section 1886(h) of the Act; the amount of payment for direct GME costs 
for a cost reporting period is based on the hospital's number of 
residents in that period and the hospital's costs per resident in a 
base year. The existing regulations governing payments to the various 
types of hospitals are located in 42 CFR Part 413.

B. Provisions of the Deficit Reduction Act of 2005 (DRA)

    On February 8, 2006, the Deficit Reduction Act of 2005 (DRA), Pub. 
L. 109-171, was enacted. Pub. L. 109-171 made a number of changes to 
the Act relating to prospective payments to hospitals and other 
providers for inpatient services. This proposed rule would implement 
amendments made by the following sections of Pub. L. 109-171:
     Section 5001(a), which, effective for FY 2007 and 
subsequent years, expands the requirements for hospital quality data 
reporting.
     Section 5003, which makes various improvements to the MDH 
program. It extends special payment provisions, requires MDHs to use FY 
2002 as their base year for determining whether use of their hospital-
specific rate enhances payment (but permits them to continue to use 
either their 1982 or 1987 hospital-specific rate if using either of 
those rates results in higher payments), and removes the application of 
the 12-percent cap on the DSH payment adjustment factor for MDHs.
     Section 5004, which reduces certain allowable SNF bad debt 
payments by 30 percent. Payments for the bad debts of full-benefit, 
dual eligible individuals are not reduced.
    In this proposed rule, we also discuss and invite comments on the 
requirements of section 5001(b) of Pub. L. 109-171, which require us to 
develop a plan to implement, beginning with FY 2009, a value-based 
purchasing plan for section 1886(d) hospitals. This discussion also 
includes the provisions of section 5001(c) of Pub. L. 109-171, which 
requires a quality adjustment in DRG payments for certain hospital-
acquired conditions, effective for FY 2008.

C. Major Contents of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the 
Medicare IPPS for operating costs and for capital-related costs in FY 
2007. We also are setting forth proposed changes relating to payments 
for GME costs, payments to certain hospitals and units that continue to 
be excluded from the IPPS and paid on a reasonable cost basis, and 
payments for SCHs and MDHs. The changes being proposed would be 
effective for discharges occurring on or after October 1, 2006, unless 
otherwise noted.
    The following is a summary of the major changes that we are 
proposing to make:
1. Proposed DRG Reclassifications and Recalibrations of Relative 
Weights
    In section II. of the preamble to this proposed rule, as required 
by section 1886(d)(4)(C) of the Act, we are proposing limited revisions 
to the DRG classifications structure. In this section, we respond to 
several recommendations made by MedPAC intended to improve the DRG 
system. We are also proposing to use, for FY 2007, hospital-specific 
relative values for 10 cost centers to compute DRG relative weights. In 
addition, we are proposing to use consolidated severity-adjusted DRGs 
or alternative severity adjustment methods in FY 2008 (if not earlier).
    We also are presenting our reevaluation of certain FY 2006 
applicants for add-on payments for high-cost new medical services and 
technologies, and our analysis of FY 2007 applicants (including public 
input,

[[Page 24003]]

as directed by Pub. L. 108-173, obtained in a town hall meeting).
    We are proposing the annual update of the long-term care diagnosis-
related group (LTC-DRG) classifications and relative weights for use 
under the LTCH PPS for FY 2007.
2. Proposed Changes to the Hospital Wage Index
    In section III. of the preamble to this proposed rule, we are 
proposing revisions to the wage index and the annual update of the wage 
data. Specific issues addressed include the following:
     The FY 2007 wage index update, using wage data from cost 
reporting periods that began during FY 2003.
     The proposed FY 2007 occupational mix adjustment to the 
wage index.
     The proposed revisions to the wage index based on hospital 
redesignations and reclassifications.
     The proposed adjustment to the wage index for FY 2007 
based on commuting patterns of hospital employees who reside in a 
county and work in a different area with a higher wage index.
     The timetable for reviewing and verifying the wage data 
that will be in effect for the proposed FY 2007 wage index.
     The labor-related share for the FY 2007 wage index, 
including the labor-related share for Puerto Rico.
3. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs, GME Costs, and Promoting Hospitals' Effective Use of Health 
Information Technology
    In section IV. of the preamble to this proposed rule, we discuss a 
number of provisions of the regulations in 42 CFR Parts 412 and 413 
including the following:
     The reporting of hospital quality data as a condition for 
receiving the full annual payment update increase.
     Proposed changes in payments to SCHs and MDHs.
     Proposed updated national and regional case-mix values and 
discharges for purposes of determining rural referral center status.
     The statutorily-required IME adjustment factor for FY 
2007.
     Proposed changes relating to hospitals' geographic 
classifications, including reclassifications under section 508 of Pub. 
L. 108-173, multicampus hospitals, urban group hospital 
reclassification and the effect of change in ownership on urban county 
group reclassifications.
     Proposed changes and clarifications relating to GME that 
address determining the per resident amounts (PRAs) for merged 
hospitals and new teaching hospitals, counting and appropriate 
documentation of FTE residents, and counting of resident time spent in 
nonpatient care activities as part of approved residency programs.
     Proposed changes relating to payment for costs of nursing 
and allied health education programs.
     Proposed changes relating to requirements for emergency 
services for hospitals under EMTALA.
     Discussion of the third year of implementation of the 
Rural Community Hospital Demonstration Program.
    We also are inviting comments on promoting hospitals' effective use 
of health information technology.
4. Proposed Changes to the PPS for Capital-Related Costs
    In section V. of the preamble to this proposed rule, we discuss the 
payment policy requirements for capital-related costs and capital 
payments to hospitals and propose several technical corrections to the 
regulations.
5. Proposed Changes for Hospitals and Hospital Units Excluded From the 
IPPS
    In section VI. of the preamble to this proposed rule, we discuss 
payments to excluded hospitals and hospital units, proposed policy 
changes regarding increases or decreases in square footage or decreases 
in the number of beds of the ``grandfathering'' HwHs and satellite 
facilities, proposed changes to the methodology for determining LTCH 
CCRs and the reconciliation of high-cost and short-stay outlier 
payments under the LTCH PPS, and a proposed technical change relating 
to the designation of CAHs as necessary providers.
6. Payments for Services Furnished Outside the United States
    In section VII. of the preamble to this proposed rule, we set forth 
proposed changes to clarify what is considered ``outside the United 
States'' for Medicare payment purposes.
7. Payment for Blood Clotting Factor Administered to Inpatients With 
Hemophilia
    In section VIII. of the preamble to this proposed rule, we discuss 
the proposed changes in payment for blood clotting factor administered 
to Medicare beneficiaries with hemophilia for FY 2007.
8. Limitation on Payments to Skilled Nursing Facilities for Bad Debt
    In section IX. of the preamble to this proposed rule, we propose to 
implement section 5004 of Pub. L. 109-171 relating to reduction in 
payments to SNFs for bad debt.
9. Determining Proposed Prospective Payment Operating and Capital Rates 
and Rate-of-Increase Limits
    In the Addendum to this proposed rule, we set forth proposed 
changes to the amounts and factors for determining the FY 2007 
prospective payment rates for operating costs and capital-related 
costs. We also establish the proposed threshold amounts for outlier 
cases. In addition, we address the proposed update factors for 
determining the rate-of-increase limits for cost reporting periods 
beginning in FY 2007 for hospitals and hospital units excluded from the 
PPS.
10. Impact Analysis
    In Appendix A of this proposed rule, we set forth an analysis of 
the impact that the proposed changes would have on affected hospitals.
11. Recommendation of Update Factors for Operating Cost Rates of 
Payment for Inpatient Hospital Services
    In Appendix B of this proposed rule, as required by sections 
1886(e)(4) and (e)(5) of the Act, we provided our recommendations of 
the appropriate percentage changes for FY 2007 for the following:
     A single average standardized amount for all areas for 
hospital inpatient services paid under the IPPS for operating costs 
(and hospital-specific rates applicable to SCHs and MDHs).
     Target rate-of-increase limits to the allowable operating 
costs of hospital inpatient services furnished by hospitals and 
hospital units excluded from the IPPS.
12. Discussion of Medicare Payment Advisory Commission Recommendations
    Under section 1805(b) of the Act, MedPAC is required to submit a 
report to Congress, no later than March 1 of each year, in which MedPAC 
reviews and makes recommendations on Medicare payment policies. 
MedPAC's March 2006 recommendation concerning hospital inpatient 
payment policies addressed the update factor for inpatient hospital 
operating costs and capital-related costs under the IPPS and for 
hospitals and distinct part hospital units excluded from the IPPS. This 
recommendation is addressed in Appendix B of this proposed rule. For 
further information relating specifically to the MedPAC March 2006 
reports or to obtain a copy of the reports, contact MedPAC at (202) 
220-3700 or visit

[[Page 24004]]

MedPAC's Web site at: www.medpac.gov.
13. Appendix C and Appendix D
    In Appendix C of this proposed rule, we list the combinations of 
the consolidated severity-adjusted DRGs that we are proposing to 
implement on FY 2008 (if not earlier), as discussed in section II.C. of 
the preamble of this proposed rule. In Appendix D of this proposed 
rule, we provide a crosswalk of the proposed consolidated severity-
adjusted DRG system to the respective All Patient Related Diagnosis-
Related Group (APR DRG) system.

II. Proposed Changes to DRG Classifications and Relative Weights

    (If you choose to comment on issues in this section, please include 
the caption ``DRG Reclassifications'' at the beginning of your 
comment.)

A. Background

    Section 1886(d) of the Act specifies that the Secretary shall 
establish a classification system (referred to as DRGs) for inpatient 
discharges and adjust payments under the IPPS based on appropriate 
weighting factors assigned to each DRG. Therefore, under the IPPS, we 
pay for inpatient hospital services on a rate per discharge basis that 
varies according to the DRG to which a beneficiary's stay is assigned. 
The formula used to calculate payment for a specific case multiplies an 
individual hospital's payment rate per case by the weight of the DRG to 
which the case is assigned. Each DRG weight represents the average 
resources required to care for cases in that particular DRG, relative 
to the average resources used to treat cases in all DRGs.
    Congress recognized that it would be necessary to recalculate the 
DRG relative weights periodically to account for changes in resource 
consumption. Accordingly, section 1886(d)(4)(C) of the Act requires 
that the Secretary adjust the DRG classifications and relative weights 
at least annually. These adjustments are made to reflect changes in 
treatment patterns, technology, and any other factors that may change 
the relative use of hospital resources.

B. DRG Reclassifications

1. General
    For FY 2007, we are proposing only limited changes to the current 
DRG classifications, as discussed in section II.D. of the preamble to 
this proposed rule, that would be applicable to discharges occurring on 
or after October 1, 2006. We are limiting our proposed changes because, 
as discussed in detail in section II.C. of the preamble to this 
proposed rule, we are focusing our efforts on addressing the 
recommendations made last year by MedPAC to refine the entire CMS DRG 
system by taking into account severity of illness (if not earlier) and 
applying hospital-specific relative value (HSRV) weights to DRGs.
    Currently, cases are classified into CMS DRGs for payment under the 
IPPS based on the principal diagnosis, up to eight additional 
diagnoses, and up to six procedures performed during the stay. In a 
small number of DRGs, classification is also based on the age, sex, and 
discharge status of the patient. The diagnosis and procedure 
information is reported by the hospital using codes from the 
International Classification of Diseases, Ninth Revision, Clinical 
Modification (ICD-9-CM).
    The process of forming the DRGs was begun by dividing all possible 
principal diagnoses into mutually exclusive principal diagnosis areas, 
referred to as Major Diagnostic Categories (MDCs). The MDCs were formed 
by physician panels as the first step toward ensuring that the DRGs 
would be clinically coherent. The diagnoses in each MDC correspond to a 
single organ system or etiology and, in general, are associated with a 
particular medical specialty. Thus, in order to maintain the 
requirement of clinical coherence, no final DRG could contain patients 
in different MDCs. Most MDCs are based on a particular organ system of 
the body. For example, MDC 6 is Diseases and Disorders of the Digestive 
System. This approach is used because clinical care is generally 
organized in accordance with the organ system affected. However, some 
MDCs are not constructed on this basis because they involve multiple 
organ systems (for example, MDC 22 (Burns)). For FY 2006, cases are 
assigned to one of 526 DRGs in 25 MDCs. The table below lists the 25 
MDCs.

                   Major Diagnostic Categories (MDCs)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
1.................................  Diseases and Disorders of the
                                     Nervous System.
2.................................  Diseases and Disorders of the Eye.
3.................................  Diseases and Disorders of the Ear,
                                     Nose, Mouth, and Throat.
4.................................  Diseases and Disorders of the
                                     Respiratory System.
5.................................  Diseases and Disorders of the
                                     Circulatory System.
6.................................  Diseases and Disorders of the
                                     Digestive System.
7.................................  Diseases and Disorders of the
                                     Hepatobiliary System and Pancreas.
8.................................  Diseases and Disorders of the
                                     Musculoskeletal System and
                                     Connective Tissue.
9.................................  Diseases and Disorders of the Skin,
                                     Subcutaneous Tissue and Breast.
10................................  Endocrine, Nutritional and Metabolic
                                     Diseases and Disorders.
11................................  Diseases and Disorders of the Kidney
                                     and Urinary Tract.
12................................  Diseases and Disorders of the Male
                                     Reproductive System.
13................................  Diseases and Disorders of the Female
                                     Reproductive System.
14................................  Pregnancy, Childbirth, and the
                                     Puerperium.
15................................  Newborns and Other Neonates with
                                     Conditions Originating in the
                                     Perinatal Period.
16................................  Diseases and Disorders of the Blood
                                     and Blood Forming Organs and
                                     Immunological Disorders.
17................................  Myeloproliferative Diseases and
                                     Disorders and Poorly Differentiated
                                     Neoplasms.
18................................  Infectious and Parasitic Diseases
                                     (Systemic or Unspecified Sites).
19................................  Mental Diseases and Disorders.
20................................  Alcohol/Drug Use and Alcohol/Drug
                                     Induced Organic Mental Disorders.
21................................  Injuries, Poisonings, and Toxic
                                     Effects of Drugs.
22................................  Burns.
23................................  Factors Influencing Health Status
                                     and Other Contacts with Health
                                     Services.
24................................  Multiple Significant Trauma.
25................................  Human Immunodeficiency Virus
                                     Infections.
------------------------------------------------------------------------


[[Page 24005]]

    In general, cases are assigned to an MDC based on the patient's 
principal diagnosis before assignment to a DRG. However, for FY 2006, 
there are nine DRGs to which cases are directly assigned on the basis 
of ICD-9-CM procedure codes. These DRGs are for heart transplant or 
implant of heart assist systems, liver and/or intestinal transplants, 
bone marrow transplants, lung transplants, simultaneous pancreas/kidney 
transplants, and pancreas transplants, and for tracheostomies. Cases 
are assigned to these DRGs before they are classified to an MDC. The 
table below lists the nine current pre-MDCs.

               Pre-Major Diagnostic Categories (Pre-MDCs)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
DRG 103...........................  Heart Transplant or Implant of Heart
                                     Assist System.
DRG 480...........................  Liver Transplant and/or Intestinal
                                     Transplant.
DRG 481...........................  Bone Marrow Transplant.
DRG 482...........................  Tracheostomy for Face, Mouth, and
                                     Neck Diagnoses.
DRG 495...........................  Lung Transplant.
DRG 512...........................  Simultaneous Pancreas/Kidney
                                     Transplant.
DRG 513...........................  Pancreas Transplant.
DRG 541...........................  ECMO or Tracheostomy with Mechanical
                                     Ventilation 96+ Hours or Principal
                                     Diagnosis Except for Face, Mouth,
                                     and Neck Diagnosis with Major O.R.
DRG 542...........................  Tracheostomy with Mechanical
                                     Ventilation 96+ Hours or Principal
                                     Diagnosis Except for Face, Mouth,
                                     and Neck Diagnosis without Major
                                     O.R.
------------------------------------------------------------------------

    Once the MDCs were defined, each MDC was evaluated to identify 
those additional patient characteristics that would have a consistent 
effect on the consumption of hospital resources. Because the presence 
of a surgical procedure that required the use of the operating room 
would have a significant effect on the type of hospital resources used 
by a patient, most MDCs were initially divided into surgical DRGs and 
medical DRGs. Surgical DRGs are based on a hierarchy that orders 
operating room (O.R.) procedures or groups of O.R. procedures by 
resource intensity. Medical DRGs generally are differentiated on the 
basis of diagnosis and age (0 to 17 years of age or greater than 17 
years of age). Some surgical and medical DRGs are further 
differentiated based on the presence or absence of a complication or a 
comorbidity (CC).
    Generally, nonsurgical procedures and minor surgical procedures 
that are not usually performed in an operating room are not treated as 
O.R. procedures. However, there are a few non-O.R. procedures that do 
affect DRG assignment for certain principal diagnoses, for example, 
extracorporeal shock wave lithotripsy for patients with a principal 
diagnosis of urinary stones.
    Once the medical and surgical classes for an MDC were formed, each 
class of diagnoses was evaluated to determine if complications, 
comorbidities, or the patient's age would consistently affect the 
consumption of hospital resources. Physician panels classified each 
diagnosis code based on whether the diagnosis, when present as a 
secondary condition, would be considered a substantial CC. A 
substantial CC was defined as a condition which, because of its 
presence with a specific principal diagnosis, would cause an increase 
in the length of stay by at least one day in at least 75 percent of the 
patients. Each medical and surgical class within an MDC was tested to 
determine if the presence of any substantial CC would consistently 
affect the consumption of hospital resources.
    A patient's diagnosis, procedure, discharge status, and demographic 
information is fed into the Medicare claims processing systems and 
subjected to a series of automated screens called the Medicare Code 
Editor (MCE). The MCE screens are designed to identify cases that 
require further review before classification into a DRG.
    After patient information is screened through the MCE and any 
further development of the claim is conducted, the cases are classified 
into the appropriate DRG by the Medicare GROUPER software program. The 
GROUPER program was developed as a means of classifying each case into 
a DRG on the basis of the diagnosis and procedure codes and, for a 
limited number of DRGs, demographic information (that is, sex, age, and 
discharge status).
    After cases are screened through the MCE and assigned to a DRG by 
the GROUPER, the PRICER software calculates a base DRG payment. The 
PRICER calculates the payment for each case covered by the IPPS based 
on the DRG relative weight and additional factors associated with each 
hospital, such as IME and DSH adjustments. These additional factors 
increase the payment amount to hospitals above the base DRG payment.
    The records for all Medicare hospital inpatient discharges are 
maintained in the Medicare Provider Analysis and Review (MedPAR) file. 
The data in this file are used to evaluate possible DRG classification 
changes and to recalibrate the DRG weights. However, in the July 30, 
1999 IPPS final rule (64 FR 41500), we discussed a process for 
considering non-MedPAR data in the recalibration process. In order for 
us to consider using particular non-MedPAR data, we must have 
sufficient time to evaluate and test the data. The time necessary to do 
so depends upon the nature and quality of the non-MedPAR data 
submitted. Generally, however, a significant sample of the non-MedPAR 
data should be submitted by mid-October for consideration in 
conjunction with the next year's proposed rule. This allows us time to 
test the data and make a preliminary assessment as to the feasibility 
of using the data. Subsequently, a complete database should be 
submitted by early December for consideration in conjunction with the 
next year's proposed rule.
    The limited changes that we are proposing to the DRG classification 
system for FY 2007 for the FY 2007 GROUPER, version 24.0 and to the 
methodology used to recalibrate the DRG weights are set forth under 
section II.E. of this proposed rule. Unless otherwise noted in this 
proposed rule, our DRG analysis is based on data from the December 2005 
update of the FY 2005 MedPAR file, which contains hospital bills 
received through December 31, 2005, for discharges occurring in FY 
2005.
2. Yearly Review for Making DRG Changes
    Many of the changes to the DRG classifications are the result of 
specific issues brought to our attention by interested parties. We 
encourage individuals with concerns about DRG classifications to bring 
those concerns to our attention in a timely manner so they can be 
carefully considered for possible

[[Page 24006]]

inclusion in the annual proposed rule and, if included, may be 
subjected to public review and comment. Therefore, similar to the 
timetable for interested parties to submit non-MedPAR data for 
consideration in the DRG recalibration process, concerns about DRG 
classification issues should be brought to our attention no later than 
early December in order to be considered and possibly included in the 
next annual proposed rule updating the IPPS.
    The actual process of forming the DRGs was, and continues to be, 
highly iterative, involving a combination of statistical results from 
test data combined with clinical judgment. For purposes of this 
proposed rule, in deciding whether to create a separate DRG, we 
consider whether the resource consumption and clinical characteristics 
of the patients with a given set of conditions are significantly 
different than the remaining patients in the existing DRG. We evaluate 
patient care costs using average charges and lengths of stay as proxies 
for costs and rely on the judgment of our medical officers to decide 
whether patients are clinically distinct or similar to other patients 
in the DRG. In evaluating resource costs, we consider both the absolute 
and percentage differences in average charges between the cases we are 
selecting for review and the remainder of cases in the DRG. We also 
consider variation in charges within these groups; that is, whether 
observed average differences are consistent across patients or 
attributable to cases that are extreme in terms of charges or length of 
stay, or both. Further, we also consider the number of patients who 
will have a given set of characteristics and generally prefer not to 
create a new DRG unless it will include a substantial number of cases.

C. Proposals for Revisions to the DRG System Used Under the IPPS

1. MedPAC Recommendations
    In the FY 2006 IPPS final rule, we discussed a number of 
recommendations made by MedPAC regarding revisions to the DRG system 
used under the IPPS (70 FR 47473 through 47482).
    In Recommendation 1-3 in the 2005 Report to Congress on Physician-
Owned Specialty Hospitals, MedPAC recommended that CMS:
     Refine the current DRGs to more fully capture differences 
in severity of illness among patients, including--
     Base the DRG relative weights on the estimated cost of 
providing care.
     Base the weights on the national average of the hospital-
specific relative values (HSRVs) for each DRG (using hospital-specific 
costs to derive the HSRVs).
     Adjust the DRG relative weights to account for differences 
in the prevalence of high-cost outlier cases.
     Implement the case-mix measurement and outlier policies 
over a transitional period.
    As we noted in the FY 2006 IPPS final rule, we had insufficient 
time to complete a thorough evaluation of these recommendations for 
full implementation in FY 2006. However, we did adopt severity-weighted 
cardiac DRGs in FY 2006 to address public comments on this issue and 
the specific concerns of MedPAC regarding cardiac surgery DRGs. We also 
indicated that we planned to further consider all of MedPAC's 
recommendations and thoroughly analyze options and their impacts on the 
various types of hospitals in the FY 2007 IPPS proposed rule. Following 
the publication of the FY 2006 IPPS final rule, we contracted with 3M 
Health Information Systems to assist us in performing this analysis.
    Beginning with MedPAC's relative weight recommendations, we 
analyzed MedPAC's recommendations to move to a cost-based HSRV 
weighting methodology. In performing this portion of the analysis, we 
studied hospital cost report data, departmental cost-to-charge ratios 
(CCRs), MedPAR claims data, and HSRV weighting methodology. Our 
intention in undertaking this portion of the analysis was to find an 
administratively feasible approach to improving the accuracy of the DRG 
weights. As we describe in detail below, we believe some changes can be 
made to MedPAC's methodology for determining the relative weights that 
will make it more feasible to replicate on an annual basis but will 
result in similar impacts.
    In conjunction with analyzing MedPAC's relative weight 
recommendations, we looked at refining the current DRG system to better 
recognize severity of illness. Starting with the APR DRG GROUPER used 
by MedPAC in its analysis, we studied Medicare claims data. Based on 
this analysis, we developed a consolidated severity-adjusted DRG 
GROUPER that we believe could be a better alternative for recognizing 
severity of illness among the Medicare population. We note that 
MedPAC's recommendations with regard to revising the DRGs to better 
recognize severity of illness may have implications for the outlier 
threshold, the measurement of real case-mix versus apparent case-mix, 
and the IME and the DSH adjustments. We will discuss these implications 
in more detail in the following sections.
    As we present below, we believe that the recommendations made by 
MedPAC, or some variants of them, have significant promise to improve 
the accuracy of the payment rates in the IPPS. For instance, the 
percent of DRGs with payment-to-cost ratios between 0.95 and 1.05 will 
increase substantially from adoption of these recommendations.\1\ We 
agree with MedPAC about exploring possible refinements to our payment 
methodology even in the absence of concerns about the proliferation of 
specialty hospitals. In the FY 2006 final rule, we indicated that until 
we had completed further analysis of the options and their effects, we 
could not predict the extent to which changing to APR DRGs would 
provide payment equity between specialty and general hospitals. In 
fact, we cautioned that any system that groups cases will always 
present some opportunities for providers to specialize in cases they 
believe to have higher margins. We believe that improving payment 
accuracy should reduce these opportunities, and potentially reduce the 
incentives that Medicare payments may provide for the further 
development of specialty hospitals.
---------------------------------------------------------------------------

    \1\ Medicare Payment Advisory Commission: Report to the 
Congress; Physician-Owned Specialty Hospitals, March 2005, p. 37.
---------------------------------------------------------------------------

    We considered MedPAC's recommendation to adjust the relative 
weights to account for differences in the prevalence of outlier cases. 
However, we placed most of our attention and resources on the 
recommendations related to refinement of the current DRGs to more fully 
capture differences in severity of illness among patients as we do not 
have the statutory authority to make the specific changes to our 
outlier policy that MedPAC recommended. While we have not made MedPAC's 
recommendation regarding outliers a central focus of our analysis, we 
do intend to examine this issue in more detail in the future. In the 
following sections II.C.2. through C.6. of this proposed rule, we 
present our analysis and discuss a number of issues related to the 
MedPAC recommendations. We also present the estimated impacts of 
implementing the recommendations and conclude with a specific proposal 
for FY 2007 and some proposed intended actions for implementation for 
FY 2008. We also are soliciting comments on other possible proposals or 
actions in FY 2007, FY 2008, or a combination of both.

[[Page 24007]]

2. Refinement of the Relative Weight Calculation
    (If you choose to comment on issues in this section, please include 
the caption ``HSRV Weights'' at the beginning of your comment.)
    MedPAC made two recommendations with respect to the DRG relative 
weight calculation. First, MedPAC recommended that CMS base the DRG 
relative weights on the estimated cost of providing care. Second, 
MedPAC recommended that CMS base the weights on the national average of 
the HSRVs in each DRG (using hospital-specific costs to derive the 
HSRVs). Because both of these recommendations address the relative 
weight calculation, we are addressing them together. The work we have 
done to address these recommendations is discussed below.
    MedPAC recommended that CMS replace its charge-based relative 
weight methodology with cost-based HSRV weights as it believed that the 
charge-based relative weight methodology that CMS has utilized since 
1983 has introduced bias into the weights due to differential markups 
for ancillary services among the DRGs. In analyzing claims data, it is 
evident to us that some hospital types (for example, teaching 
hospitals) are systematically more expensive overall than the average 
hospital and certain case types are more commonly treated at these more 
expensive facilities. This fact results in an upward bias in the 
weights for these types of cases. The HSRV methodology recommended by 
MedPAC would help reduce the bias that may be present in the national 
relative weights due to differences in case-mix adjusted costs.
    Under the HSRV method recommended by MedPAC, charges are 
standardized for each provider by converting its charges for each case 
to hospital-specific relative charge values and then adjusting those 
values for the hospital's case-mix. The first step in this process 
involves dividing the charge for each case at the hospital by the 
average charge for all cases at the hospital in which the case was 
treated. The hospital-specific relative charge value, by definition, 
averages 1.0 for each hospital. The resulting ratio is then multiplied 
by the hospital's case-mix index (CMI). In this way, each hospital's 
relative charge value is adjusted by its case-mix to an average that 
reflects the complexity of the cases it treats relative to the 
complexity of the cases treated by all other hospitals.
    Our analysis of departmental-level CCRs from the Medicare cost 
report data has shown that charges for routine days, intensive care 
days, and various ancillary services are not marked up by a consistent 
amount. For example, the markup amounts for cardiology services are 
higher than average. Because charges are the current basis for the DRG 
relative weights, the practice of differential markups can lead to bias 
in the DRG weights because various DRGs use, on average, more or less 
of particular ancillary services. MedPAC believes that the bias in the 
national DRG relative weights that may arise as a result of 
differential markups across various cost centers can be removed by 
moving from charge-based to cost-based weights.
    Based on the analysis we have conducted, we agree that it may be 
appropriate to adjust the DRG relative weights to account for the 
differences in charge markups across cost centers and to adopt an HSRV 
methodology. However, we have several concerns about the methodology 
used by MedPAC. MedPAC's methodology to reduce hospital charges to cost 
is administratively burdensome, not only to develop, but also to 
maintain.
    First, MedPAC developed CCRs for individual hospitals at the most 
detailed department level. Specifically, in calculating costs as the 
basis for the relative weights, MedPAC applied hospital-specific CCRs 
from each provider's cost report to the line item charges on the claims 
that the hospital submitted during the same time period. This 
methodology required matching cost report data to claims data, and 
because cost report data take longer to compile and file, the method 
necessitates using older claims data to set relative weights. The most 
recent complete set of Medicare cost reports available to us is from FY 
2003. Thus, if we were to model the exact approach used by MedPAC and 
use claims data for a matching year, we would be using claims data from 
FY 2003. If we set DRG weights for FY 2007 using our current charge-
based method, we would use FY 2005 hospital claims to set the proposed 
relative weights. In addition, MedPAC's hospital-specific approach 
required detailed cost center distinctions for each hospital that are 
difficult to define, map, and apply. This approach also required the 
use of the Standard Analytic File (SAF) because MedPAR data that we 
currently use to set DRG weights did not have the necessary level of 
detail. Using the SAF increases processing time and adds further 
complexity to the process of setting the relative weights.
    Second, because MedPAC applied these CCRs at the individual claim 
level, missing or invalid data resulted in MedPAC deleting a large 
number of claims (approximately 10 percent) from the relative weight 
calculation. Lastly, MedPAC acknowledged that its method was too 
difficult to replicate on an annual basis and suggested that the 
weights be recalculated once every 5 years with other adjustments based 
on charges during the intervening years.
    We have developed an alternative to MedPAC's approach that we 
believe would achieve similar results in a more administratively 
feasible manner. This method involves developing hospital-specific 
charge relative weights at the cost center level to remove the bias 
introduced by hospital characteristics (that is, teaching, 
disproportionate share, location, and size, among others) and then 
scaling the weights to costs using the national cost center charge 
ratios developed from the cost report data. After studying Medicare 
cost report data, we established 10 cost center categories based upon 
broad hospital accounting definitions. In our cost center categories, 
there are 8 ancillary cost groups in addition to routine day costs and 
intensive care day costs, and each category represents at least 5 
percent of the charges in the claims data. The specific cost report 
lines that contribute to each category and the corresponding charge 
lines from the MedPAR claims data are itemized in Table A below.
    We believe this alternative approach, which we are labeling as the 
HSRV cost center (HSRVcc) methodology, has several advantages. First, 
the use of national average rather than hospital-specific CCRs avoids 
the complexity encountered with cost center CCRs at the hospital level 
and allows us to retain more data for use in the relative weight 
calculation. In addition, the methodology eliminates the need to match 
claims to the time period of the CCRs, resulting in the ability to use 
more timely claims data. Furthermore, the alternative approach makes it 
more feasible to update the relative weights annually using a single 
methodology. We do not have to replicate the methodology once every 5 
years and make adjustments based on changes in charges in the 
intervening years.
    In developing an alternative method of calculating DRG weights, we 
utilized two data sources: claims data and cost report data. The claims 
data are taken from the FY 2004 MedPAR file. This file is based on 
fully coded diagnostic and procedure data for all Medicare inpatient 
hospital bills. The FY 2004 MedPAR data include discharges occurring 
between October 1, 2003, and September 30, 2004, based on bills 
received by CMS through March 30, 2005, from all hospitals subject to 
the IPPS. The full FY 2004 MedPAR file

[[Page 24008]]

includes data for approximately 13,673,607 Medicare discharges. We 
excluded discharges for Medicare beneficiaries enrolled in a 
Medicare+Choice managed care plan from the analysis. In addition, we 
excluded data for any hospital that was paid under the IPPS during FY 
2004 but became a CAH at any time before February 28, 2005; data from 
IPFs, IRFs, and LTCHs; data from Maryland hospitals; data from Indian 
Health Service hospitals; and data from all-inclusive rate providers. 
The Medicare cost report data used in the analysis were from FY 2003, 
the most recent full set of data available. Under our alternative 
methodology, we calculated DRG weights from MedPAR and cost report data 
as follows:
a. Step One: Clean the Data
    (1) All of the claims were grouped using Version 23.0 of the CMS 
DRGs.
     The transplant cases that were used to establish the 
alternative relative weights for heart and heart-lung, liver and/or 
intestinal, and lung transplants (DRGs 103, 480, and 495 under the 
current Version 23.0 GROUPER) were limited to those Medicare-approved 
transplant centers that have cases in the FY 2004 MedPAR file. 
(Medicare coverage for heart, heart and lung, liver and/or intestinal, 
and lung transplants is limited to those facilities that have received 
approval from CMS as transplant centers.)
     Organ acquisition for kidney, heart, heart-lung, liver, 
lung, pancreas, and intestinal (or multivisceral organs) transplants 
continue to be paid on a reasonable cost basis. Because these 
acquisition costs are paid separately from the prospective payment 
rate, it is necessary to subtract the acquisition charges from the 
total charges on each transplant bill that showed acquisition charges 
before adjusting the charges under the HSRVcc methodology and before 
eliminating statistical outliers.
    (2) The FY 2004 MedPAR data were edited to exclude claims for 
hospitals with no cost report data. Claims with total charges or total 
length of stay less than or equal to zero were eliminated. Claims that 
had an amount in the total charge field that differed by more or less 
than $10 from the sum of charges for routine days, intensive care, 
pharmacy, special equipment, therapy, operating room, cardiology, 
laboratory, radiology, and other services were deleted. In addition, we 
deleted claims for providers that had charges only in the routine days 
and intensive care days cost centers and had no charges in any of the 
eight ancillary cost centers. These claims were deleted because we 
believe the charges for the eight ancillary cost centers were included 
in the routine days and intensive care days cost centers. Had we 
included these claims, the charges for the routine days and intensive 
care days would have been inflated. After applying these edits, we 
identified 11,142,651 claims that we used in this analysis.
    (3) Statistical outliers were eliminated by removing all cases that 
were beyond 3.0 standard deviations from the mean of the log 
distribution of both the charges per case and the charges per day for 
each DRG.
b. Step Two: Compute HSRVs for Each Cost Center for Each DRG
    Once the MedPAR data were edited, we sorted the data by provider so 
that charges could be standardized under the HSRVcc methodology. To do 
this, an average charge was computed for each provider for each of 10 
proposed cost centers (see Table A). The average charge was computed by 
summing the charges for each cost center and dividing by the transfer-
adjusted case count for each provider. A transfer case, identified by 
discharge code, DRG, and length of stay, was counted as a fraction of a 
case based on the ratio of its length of stay plus 1 day relative to 
the geometric mean length of stay for that DRG. That is, a transfer 
case with a length of stay of 2 days in a DRG with a geometric mean 
length of stay of 6 days would be counted as 3 (2 days plus 1 extra 
day) divided by 6 or 0.5 of a total case. This treatment of transfer 
cases is consistent with payment rules.
    After computing the average charge for each provider for each cost 
center, the cost center charges on each claim were divided by the 
provider's average charge for the matching cost center across all 
services. For example, the routine day charges on each individual claim 
were divided by the average routine day charge for the provider across 
all services, the intensive care unit charges on the same claim were 
divided by the average intensive care unit charge for the provider 
across all services, and so on.
    By using a hospital's relative charge structure, we found that the 
resulting weights did not reflect differences in charges among 
providers for factors such as location, size, wages, relative 
efficiency, average markup, IME adjustment, DSH adjustment, and the 
variety of cases treated. Therefore, once charge weights were computed 
at the hospital cost center level, they were multiplied by the 
provider's CMI. We made this adjustment for the CMI to rescale the 
hospital-specific relative charge values which, by definition, averaged 
to 1.0 for each cost center. We believed that the CMI was a reasonable 
scale factor to use to further adjust the relative charges to reflect 
the complexity of cases treated by the provider. We assigned a starting 
CMI of 1 to the cost center for each provider. However, an alternative 
starting CMI could have been assigned because the algorithm is not 
sensitive to starting values of CMI.
    After the relative charges (cost center claim charge divided by the 
average cost center charge for the provider) were multiplied by the 
hospital's matching cost center CMI, they were summed by DRG. The 
transfer adjusted case count for each DRG was also summed. Average 
charges by DRG were calculated for each cost center by taking the sum 
of the relative CMI-adjusted charges for that DRG and dividing by the 
transfer-adjusted case count for that DRG. A national average charge 
for each cost center was calculated summing all relative CMI-adjusted 
charges in the trimmed MedPAR data set and dividing by the total 
transfer-adjusted case count. We then created a set of cost center DRG 
weights by dividing the national average charge for each DRG for each 
cost center by the national average charge for that cost center. The 
result was a set of 10 weights for each DRG. These 10 weights are then 
assigned to each claim, and a new CMI is created for each provider. 
Then the relative charges for each cost center on the claim (total 
charge for cost center is divided by the provider's average charge for 
that cost center) are multiplied by this new CMI and the weights are 
iterated until the national average CMI for each cost center stops 
changing between iterations. In preparing the proposed weights for 
their simulation, we used a transfer-adjusted CMI that was computed by 
taking the sum of the transfer-adjusted weights and dividing by a full 
case count, where the transfer-adjusted weight is computed by 
multiplying the transfer-adjusted case count (length of stay for the 
claim plus 1 day divided by geometric mean length of stay for the DRG) 
by the DRG weight.
    Table A below illustrates the charge line items from MedPAR that 
were included in each cost center charge group. In addition, it shows 
the corresponding line items from Worksheet C, Part 1, columns 5, 6, 
and 7 of the Medicare cost reports. The name of each cost report line 
item appears as it is listed in the Hospital Cost Report Information 
System (HCRIS) cost report database record layout which is available 
for download via the Web site: www.cms.hhs.gov.
BILLING CODE 4120-01-P

[[Page 24009]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.000


[[Page 24010]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.001

c. Step Three: Compute CCRs From the Cost Reports for Each of the 10 
Cost Center Groups Identified in Table A
    After the iteration process was completed, we removed the effects 
of differential markups within cost centers. The first step in this 
process was to develop national cost center CCRs. Taking FY 2003 cost 
report data, we edited the data to remove data for CAHs, IPFs, IRFs, 
LTCHs, Maryland hospitals, Indian Health Service hospitals, and all 
inclusive rate hospitals, and cost reports that represented time 
periods of less than 1 year (365 days). We then created CCRs for each 
provider for each group of cost centers (see Table A for line items 
used in the calculations) while removing any cost center CCRs that were 
greater than 10 or less than .01, as we believe that these CCRs are 
outside of a reasonable range. We then took the logs of all of the cost 
center CCRs and removed any cost center CCRs where the log of the cost 
center CCR was greater or less than the mean log plus/minus 1.96 
standard deviations of the log of that cost center CCR. We used 1.96 
standard deviations as a trim factor because the logs of the cost 
center CCRs are normally distributed and 1.96 standard deviations 
represent the 95th percentile of the T-Distribution for large sample 
size, for which 2,000 to 3,000 hospitals qualify. Once the cost report 
data were trimmed, we calculated the geometric mean CCR for each cost 
center.

[[Page 24011]]

d. Step Four: Sum the Average Charge for Each Cost Center From the 
MedPAR Data and Apply the National CCRs From the MedPAR File
    Once the national average CCRs from Step Three were computed, they 
were multiplied by the total unadjusted charges for the matching cost 
centers in the MedPAR file. The estimated costs were then summed to 
derive a total cost for all cases across the Nation. The percentage 
that each cost center was contributing to the overall total costs is 
calculated by dividing the individual cost center cost by the total. 
For example, the total cost for routine days was divided by the total 
cost for all cases to arrive at 0.29, which indicated that routine 
costs were responsible for approximately 29 percent of total costs. The 
10 scaling factors sum to 1.0.
e. Step Five: Adjust Relative Weights From Step Two to Cost by Applying 
Scaling Factors From Step Four
    For each DRG, the cost center weights are multiplied by these 
scaling factors (that is, the routine day weight is multiplied by the 
routine day scaling factor, the intensive care unit weight is 
multiplied by the intensive care unit scaling factor, and so on). After 
the weights are adjusted by the scaling factor, they are summed by DRG 
to create one final weight for each DRG.
f. Step Six: Normalize the Weights
    In order to compare the weights calculated in Step Five to the 
charge-based weights that are in effect in FY 2006, the weights were 
normalized by the FY 2006 normalization factor of 1.47462 (70 FR 
47332). This factor was applied to the charge-based weights from FY 
2006 to ensure that recalibration by itself neither increases nor 
decreases total payments under the IPPS. We used the same normalization 
factor that we applied for purposes of calculating the DRG relative 
weights in the FY 2006 IPPS final rule because we used the same FY 2004 
MedPAR data and FY 2003 cost report data that we used to set the FY 
2006 DRG relative weights. We note that we likely will have more recent 
data available when we determine the DRG relative weights for the FY 
2007 IPPS final rule.
3. Refinement of DRGs Based on Severity of Illness
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Severity of Illness'' at the beginning of your 
comment.)
    For purposes of the following discussions, the term ``CMS DRGs'' 
means the DRG system we currently use under the IPPS; the term ``APR 
DRGs'' means the severity DRG system designed by 3M Health Information 
Systems that currently is used by the State of Maryland; and the term 
``consolidated severity-adjusted DRGs'' means the DRG system based on a 
consolidated version of the APR DRGs (as described in detail below). 
Although we discuss the consolidated severity-adjusted DRGs in this 
proposed rule, we are interested in public comments on whether there 
are alternative DRG systems that could result in better recognition of 
severity than the consolidated severity-adjusted DRGs we are proposing. 
We refer to adopting consolidated severity-adjusted DRGs numerous times 
in this proposed rule. As we make clear in the detailed discussion 
below, there are still further changes that we believe may be important 
to make to this proposed system before it is ready for adoption. In the 
remainder of this proposed rule, ``consolidated severity-adjusted 
DRGs'' refers to the DRG system we have analyzed. However, it is 
possible that the public comment process will present compelling 
evidence that there are potential alternatives to the consolidated 
severity-adjusted DRG system for us to consider that could more 
effectively recognize severity of illness.
    In the FY 2006 IPPS final rule (70 FR 47474), we stated that we 
would consider making changes to the CMS DRGs to better reflect 
severity of illness among patients. We indicated that we would conduct 
a comprehensive review of the CC list as well as consider the 
possibility of using the APR DRGs for FY 2007. We did not adopt APR 
DRGs for FY 2006 because such an adoption would represent a significant 
undertaking that could have a substantial effect on all hospitals. 
There was insufficient time between the release of the MedPAC reports 
in March 2005 and the publication of the FY 2006 IPPS final rule for us 
to analyze fully a change of this magnitude. Instead, we adopted a more 
limited policy by implementing severity-adjusted cardiac DRGs.
    After publication of the FY 2006 IPPS final rule, CMS contracted 
with 3M Health Information Systems to further analyze the MedPAC 
recommendations in support of our consideration of possible changes to 
the IPPS for FY 2007. Under one task of this contract, 3M Health 
Information Systems analyzed the feasibility of using a revised DRG 
system under the IPPS that is modeled on the APR DRGs Version 23 to 
better recognize severity of illness. The APR DRGs have been used 
successfully as the basis of Belgium's hospital prospective global 
budgeting system since 2002. The State of Maryland began using APR DRGs 
as the basis of its all-payer hospital payment system in July 2005. 
More than a third of the hospitals in the United States are already 
using APR DRG software to analyze comparative hospital performance. 
Many major health information system vendors have integrated this 
system into their products. Several State agencies utilize the APR DRGs 
for the public dissemination of comparative hospital performance 
reports. APR DRGs have been widely applied in policy and health 
services research. In addition to being used in research by MedPAC, the 
APR DRGs also contain a separate measure of risk of mortality that is 
used in the Quality Indicators of the Agency for Healthcare Research 
and Quality, the Premier Hospital Quality Incentive Demonstration 
discussed in section IV.B. of this preamble, and the Joint Commission 
on Accreditation of Healthcare Organizations (JCAHO) hospital 
accreditation survey process (Shared Visions-New Pathways).
    Below we present a comparison of the CMS DRG system and the APR DRG 
system.
a. Comparison of the CMS DRG System and the APR DRG System
    The CMS DRG and APR DRG systems have a similar basic structure. 
There are 25 MDCs in both systems. The DRG assignments for both systems 
are based on the reporting of ICD-9-CM diagnosis and procedure codes. 
Both DRG systems are composed of a base DRG that describes the reason 
for hospital admission and a subdivision of the base DRG based on other 
patient attributes that affect the care of the patient. For surgical 
patients, the base DRG is defined based on the type of procedure 
performed. For medical patients, the base DRG is defined based on the 
principal diagnosis. In Version 23.0 of the CMS DRG system, there are 
367 base DRGs and 526 total DRGs. In Version 23 of the APR DRG system, 
there are 314 base DRGs and 1,258 total APR DRGs. Some of the base DRGs 
in the two systems are virtually identical. For example, there is no 
significant difference between the base DRG under both systems for 
medical treatment of congestive heart failure. For other base DRGs, 
there are substantial differences. For example, in the CMS DRG system, 
there are two base DRGs for appendectomy (simple and complex); in the 
APR DRG system, there is only one base DRG for appendectomy (the 
relative complexity of the patient is addressed in the subsequent 
subdivision

[[Page 24012]]

of the base DRG into severity of illness subclasses).
    The focus of the CMS DRGs is on complexity. Complexity is defined 
as the relative volume and types of diagnostic, therapeutic, and bed 
services required for the treatment of a particular illness. Thus, the 
focus of payment in the CMS DRG system reflects the relative resource 
use needed by the patient in one DRG group compared to another. 
Resource use is generally correlated with severity of illness but an 
intensive resource use does not necessarily indicate a high level of 
severity in every case. It is possible that some patients will be 
resource-intensive and require high-cost services even though they are 
less severely ill than other patients. The CMS DRG system subdivides 
the base DRGs using age and the presence of a secondary diagnosis that 
represents a CC. The age subdivisions primarily relate to pediatric 
patients (those who are less than 18 years of age). Patients are 
assigned to the CC subgroup if they have at least one secondary 
diagnosis that is considered a CC. The diagnoses that are designated as 
CCs are the same across all base DRGs. The subdivisions of the base CMS 
DRGs are not uniform: some base DRGs have no subdivision; some base 
DRGs have a two-way subdivision based on the presence of a CC; and 
other base DRGs have a three-way subdivision based on a pediatric 
subdivision followed by a CC subdivision of the adult patients. In 
addition, some base DRGs in MDC 5 (Diseases and Disorders of the 
Circulatory System) have a subdivision based on the presence of a major 
cardiovascular condition or complex diagnosis.
    The APR DRG system subdivides the base DRGs by adding four severity 
of illness subclasses to each DRG. Under the APR DRG system, severity 
of illness is defined as the extent of physiologic decompensation or 
organ system loss of function. The underlying clinical principle of APR 
DRGs is that the severity of illness of a patient is highly dependent 
on the patient's underlying problem and that patients with high 
severity of illness are usually characterized by multiple serious 
diseases or illnesses. The assessment of the severity of illness of a 
patient is specific to the base APR DRG to which a patient is assigned. 
In other words, the determination of the severity of illness is 
disease-specific. High severity of illness is primarily determined by 
the interaction of multiple diseases. Patients with multiple comorbid 
conditions involving multiple organ systems are assigned to the higher 
severity of illness subclasses. The four severity of illness subclasses 
under the APR DRG system are numbered sequentially from 1 to 4, 
indicating minor (1), moderate (2), major (3), and extreme (4) severity 
of illness.
    The APR DRG system does not subdivide base DRGs based on the age of 
the patient. Instead, patient age is used in the determination of the 
severity of illness subclass. In the CMS DRG system, the CC list is 
generally the same across all base DRGs. However, there are CC list 
exclusions for secondary diagnoses that are related to the principal 
diagnosis. In the APR DRG system, the significance of a secondary 
diagnosis is dependent on the base DRG. For example, an infection is 
considered more significant for an immune-suppressed patient than for a 
patient with a broken arm. The logic of the CC subdivision in the CMS 
DRG system is a simple binary split for the presence or absence of a 
CC. In the APR DRG system, the determination of the severity subclass 
is based on an 18-step process that takes into account secondary 
diagnoses, principal diagnosis, age, and procedures. The 18 steps are 
divided into three phases. There are six steps in Phase I, three steps 
in Phase II, and nine steps in Phase III.
    The diagram below illustrates the three-phase process for 
determining patient severity of illness subclass.
BILLING CODE 4120-01-P

[[Page 24013]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.002

BILLING CODE 4120-01-C

[[Page 24014]]

    Under the CMS DRG system, a patient is assigned to the DRG with CC 
if there is at least one secondary diagnosis present that is a CC. 
There is no recognition of the impact of multiple CCs. Under the APR 
DRG system, high severity of illness is primarily determined by the 
interaction of multiple diseases. Under the CMS DRG system, patients 
are assigned to an MDC based on their principal diagnosis. While the 
principal diagnosis is generally used to assign the patient to an MDC 
in the APR DRG system, there is a rerouting step that assigns some 
patients to another MDC. For example, lower leg amputations can be 
performed for circulatory, endocrine, or musculoskeletal principal 
diagnoses. Instead of having three separate amputation base DRGs in 
different MDCs as is done in the CMS DRG system, the APR DRG system 
reroutes all of these amputation patients into a single base APR DRG in 
the musculoskeletal MDC. The CMS DRG system uses death as a variable in 
the DRG definitions but the APR DRG system does not. Both DRG systems 
are based on the information contained in the Medicare Uniform Bill. 
The APR DRG system requires the same information used by the current 
CMS DRG system. No changes to the claims form or the data reported 
would be necessary if CMS were to adopt APR DRGs or a variant of them.
    The CMS DRG structure makes some DRG modifications difficult to 
accommodate. For example, high severity diseases that occur in low 
volume are difficult to accommodate because the only choice is to form 
a separate base DRG with relatively few patients. Such an approach 
would lead to a proliferation of low-volume DRGs. Alternatively, these 
cases may be included in DRGs with other patients that are dissimilar 
clinically or in costs. Requests for new base DRGs formed on the use of 
a specific technology may also be difficult to accommodate. Base DRGs 
formed based on the use of a specific technology would result in the 
payment weight for the DRG being dominated by the price set by the 
manufacturer for the technology.
    The structure of the APR DRGs provides a means of addressing high 
severity cases that occur in low volume through assignment of the case 
to a severity of illness subclass. However, the APR DRG structure does 
not currently accommodate distinctions based on complexity. 
Technologies that represent increased complexity, but not necessarily 
greater severity of illness, are not explicitly recognized in the APR 
DRG system. For example, in the CMS DRGs, there are separate DRGs for 
coronary angioplasty with or without insertion of stents. The APR DRGs 
do not make such a differentiation. The insertion of the stent makes 
the patient's case more complex but does not mean the patient is more 
severely ill. However, the inability to insert a stent may be 
indicative of a patient's more advanced coronary artery disease. 
Although such conflicts are relatively few in number, they do represent 
an underlying difference between the two systems. If Medicare were to 
adopt a severity DRG system based on the APR DRG logic but assign cases 
based on complexity as well as severity as we do under the current 
Medicare DRG system, such a distinction would represent a departure 
from the exclusive focus on severity of illness that currently forms 
the basis of assigning cases in the APR DRG system.
    Section 1886(d)(4) of the Act specifies that the Secretary must 
adjust the classifications and weighting factors at least annually to 
reflect changes in treatment patterns, technology, and other factors 
that may change the relative use of hospital resources. Therefore, we 
believe a method of recognizing technologies that represent increased 
complexity, but not necessarily greater severity of illness, should be 
included in the system. We plan to develop criteria for determining 
when it is appropriate to recognize increased complexity in the 
structure of the DRG system and how these criteria interact with the 
existing statutory provisions for new technology add-on payments. We 
invite public comments on this particular issue.
    Another difference between the CMS DRG system and the APR DRG 
system is the assignment of diagnosis codes in category 996 
(Complications peculiar to certain specified procedures). The CMS DRG 
system treats virtually all of these codes as CCs. With the exceptions 
of complications of organ transplant and limb reattachments, these 
complication codes do not contribute to the severity of illness 
subclass in the APR DRG system. While these codes could be added to the 
severity logic, the appropriateness of recognizing codes such as code 
998.4 (Foreign body accidentally left during a procedure) as a factor 
in payment calculation could create the appearance of incentives for 
less than optimal quality. Although there is no direct recognition of 
the codes under the 996 category, the precise complication, in general, 
can be coded separately and could contribute to the severity of illness 
subclass assignment.
    Table B below summarizes the differences between the two DRG 
systems:

    Table B.--Comparison of the CMS DRG System and the APR DRG System
------------------------------------------------------------------------
             Element                CMS DRG system      APR DRG system
------------------------------------------------------------------------
Number of base DRGs.............  367...............  314.
Total number of DRGs............  526...............  1,258.
Number of CC (severity)           2.................  4.
 subclasses.
Multiple CCs recognized.........  No................  Yes.
CC assignment specific to base    No................  Yes.
 DRG.
Logic of CC subdivision.........  Presence or         18-step process.
                                   absence.
Logic of MDC assignment.........  Principal           Principal
                                   diagnosis.          diagnosis with
                                                       rerouting.
Death used in DRG definitions...  Yes...............  No.
Data requirements...............  Hospital claims...  Hospital claims.
------------------------------------------------------------------------

    To illustrate the differences between the two DRG systems, we 
compare in Table C below four cases that have been assigned to CMS DRGs 
and APR DRGs. In all four cases, the patient is a 67-year-old who is 
admitted for diverticulitis of the colon and who has a multiple 
segmental resection of the large intestine performed. ICD-9-CM 
diagnosis code 562.11 (Diverticulitis of colon (without mention of 
hemorrhage)) and ICD-9-CM procedure code 45.71 (Multiple segmental 
resection of large intestine) would be reported to capture this case. 
In both DRG systems, the patient would be assigned to the base DRG for 
major small and large bowel procedures. These four cases would fall

[[Page 24015]]

into two different CMS DRGs and four different APR DRGs. We include 
Medicare average charges in the table to illustrate the differences in 
hospital resource use.
    Case 1: The patient receives only a secondary diagnosis of an ulcer 
of anus and rectum (ICD-9-CM diagnosis code 569.41). Under the CMS DRG 
system, the patient is assigned to base DRG 149 (Major Small and Large 
Bowel Procedures Without CC). Under the APR DRG system, the patient is 
assigned to base DRG 221 (Major Small and Large Bowel Procedures) with 
a severity of illness subclass of 1 (minor).
    Case 2: The patient receives a secondary diagnosis of an ulcer of 
anus and rectum and an additional secondary diagnosis of unspecified 
intestinal obstruction (ICD-9-CM diagnosis code 560.9). Under the CMS 
DRG system, the patient is assigned to DRG 148 (Major Small and Large 
Bowel Procedures With CC). Under the APR DRG system, the patient is 
assigned to base DRG 221 and the severity of illness subclass increases 
to 2 (moderate).
    Case 3: The patient receives multiple secondary diagnoses of an 
ulcer of anus and rectum, unspecified intestinal obstruction, acute 
myocarditis (ICD-9-CM diagnosis code 422.99), and atrioventricular 
block, complete (ICD-9-CM diagnosis code 426.0). Under the CMS DRG 
system, the patient is assigned to DRG 148. Under the APR DRG system, 
the patient is assigned to base DRG 221 and the severity of illness 
subclass increases to 3 (major).
    Case 4: The patient receives multiple secondary diagnoses of an 
ulcer of anus and rectum, unspecified intestinal obstruction, acute 
myocarditis, atrioventricular block, complete, and the additional 
diagnosis of acute renal failure, unspecified (ICD-9-CM diagnosis code 
584.9). Under the CMS DRG system, the patient is assigned to DRG 148. 
Under the APR DRG system, the patient is assigned to base DRG 221 and 
the severity of illness subclass increases to 4 (extreme).

        Table C.--Example of Sample Cases Assigned Under the CMS DRG System and Under the APR DRG System
----------------------------------------------------------------------------------------------------------------
                                                  CMS DRG system                        APR DRG system
   Principal diagnosis code: 562.11   --------------------------------------------------------------------------
        Procedure code: 45.71                                      Average                              Average
                                             DRG  assigned         charge         DRG  assigned         charge
----------------------------------------------------------------------------------------------------------------
Case 1--Secondary Diagnosis: 569.41..  149 without CC..........     $25,147  221 with severity of        $25,988
                                                                              illness subclass 1.
Case 2--Secondary Diagnoses: 569.41,   148 with CC.............      59,519  221 with severity of         38,209
 560.9.                                                                       illness subclass 2.
Case 3--Secondary Diagnoses: 569.41,   148 with CC.............      59,519  221 with severity of         66,597
 560.9, 422.99, 426.0.                                                        illness subclass 3.
Case 4--Secondary Diagnoses: 569.41,   148 with CC.............      59,519  221 with severity of        130,750
 560.9, 422.99, 426.0, 584.9.                                                 illness subclass 4.
----------------------------------------------------------------------------------------------------------------

    The largest significant difference in average charges is seen in 
case 4 where the average charge under the APR DRG assigned to the 
patient ($130,750) is more than double the average charge under the CMS 
DRG assigned to the patient ($59,519).
b. Consolidated Severity-Adjusted DRGs for Use in the IPPS
    APR DRGs were developed to encompass all-payer patient populations. 
As a result, we found that, for the Medicare population, some of the 
APR DRGs have very low volume. MedPAC noted that the larger number of 
DRGs under a severity-weighted system might mean that CMS would be 
faced with establishing weights in many categories that have few cases 
and, thus, potentially creating unstable estimates. While volume is an 
important consideration in evaluating any potential consolidation of 
APR DRGs for use under the IPPS, we believe that hospital resource use 
and clinical interpretability also need to be taken into consideration. 
For example, any consolidation of severity of illness subclasses within 
a base DRG should be restricted to contiguous severity of illness 
subclasses. Thus, it would not be reasonable clinically to combine 
severity of illness subclasses 1 and 4 solely because both consist of 
low-volume cases. We analyzed consolidating APR DRGs by either 
combining the base DRGs or the severity of illness subclasses within a 
base DRG. For consolidation across base APR DRGs, we considered patient 
volume, similarity of hospital charges across all four severity of 
illness subclasses and clinical similarity of the base APR DRGs. For 
consolidations of severity of illness subclasses within a base DRG, we 
considered patient volume and the similarity of hospital charges 
between severity of illness subclasses. In considering how to 
consolidate severity of illness subclasses, we believed it was 
important to use uniform criteria across all DRGs to avoid creating 
confusing and difficult to interpret results. That is, we were 
concerned about inconsistencies in the number of severity levels across 
different DRGs.
    The objective to simultaneously take into consideration patient 
volume and average charges often produced conflict. Table D below 
contains the overall patient volume and average charge by APR DRG 
severity of illness subclass. While severity of illness subclass 4 
(extreme) has had the lowest patient volume of 5.80 percent, we found 
that the dramatically different average charges between severity of 
illness subclass 3 (major) and subclass 4 (extreme) patients of 
approximately $32,426 and $81,952, respectively, would make it 
difficult to consolidate severity of illness subclass 3 and 4 patients. 
Conversely, we found that, while the average charge difference between 
severity of illness subclass 1 (minor) and 2 (moderate) patients was 
much smaller, of approximately $17,649 and $20,021, respectively, the 
majority of patient volume (68.08 percent) is in these two subclasses. 
Thus, low patient volume and small average charge differences rarely 
coincided.

[[Page 24016]]



          Table D.--Overall Average Charges and Patient Volume by APR DRG Severity of Illness Subclass
----------------------------------------------------------------------------------------------------------------
                                                      APR DRG         APR DRG         APR DRG         APR DRG
                                                    severity of     severity of     severity of     severity of
                                     All cases        illness         illness         illness         illness
                                                    subclass 1      subclass 2      subclass 3      subclass 4
----------------------------------------------------------------------------------------------------------------
Count...........................      11,142,651          21.47%          46.61%          26.12%           5.80%
Average Charges.................         $26,342         $17,649         $20,021         $32,426         $81,952
----------------------------------------------------------------------------------------------------------------

    There were also few opportunities to consolidate base DRGs. For 
base DRGs for which there was a clinical basis for considering a 
consolidation, there were usually significant differences in average 
charges for one or more of the severity of illness subclasses. APR DRGs 
already represented a considerable consolidation of base DRGs (314) 
compared to CMS DRGs (367). Thus, we expected that further base DRG 
consolidation would be difficult.
    We reviewed the patient volume and average charges across APR DRGs 
and found that medical cases assigned severity of illness subclass 4 
within an MDC have similar average charges. We observed the same 
pattern in average charges across severity of illness subclass 4 
surgical patients within an MDC. The data suggest that, in cases with a 
severity of illness of subclass 4, the severity of the cases had more 
impact on hospital resource use than the reason for admission (that is, 
the base APR DRG within an MDC). Thus, we believe that, within each 
MDC, the severity of illness subclass 4 medical and surgical patients, 
respectively, could be consolidated into a single group.
    In some MDCs, it was not possible to consolidate into a single 
medical and a single surgical severity of illness subclass 4 group. In 
these MDCs, more than one group was necessary. For instance, Table E 
below contains the patient volume and average charges for severity of 
illness subclass 4 cases in MDC 11 (Diseases and Disorders of the 
Kidney and Urinary Tract). Taking into consideration volume and average 
charges, except for APR DRG 440 (Kidney Transplant), surgical cases 
assigned severity of illness subclass 4 in MDC 11 could be consolidated 
into a single group having 5,492 patients and an average charge of 
$107,258. However, we decided not to include kidney transplant patients 
in this severity of illness 4 subclass due to their very high average 
charges (approximately $203,732 or more than $100,000 greater than 
other patients in MDC 11 having a severity of illness 4 subclass). 
Average charges within the consolidated severity of illness 4 surgical 
DRG in MDC 11 show some variation but are much higher than the 
corresponding average charges for the severity of illness subgroup 3 
patients of $48,863. Thus, our analysis suggests that the data support 
maintaining three severity of illness levels for each base DRG in MDC 
11; a separate severity of illness 4 subclass for all patients other 
than those having kidney transplant; and a separate DRG for kidney 
transplants.

          Table E.--Summary Statistics for Surgical Cases With Severity of Illness Subclass 4 in MDC 11
----------------------------------------------------------------------------------------------------------------
                                                                     Number of    Average length   Average total
                             APR DRG                                   cases          of stay         charges
----------------------------------------------------------------------------------------------------------------
440 (Kidney Transplant).........................................             378            18.0        $203,732
441 (Major Bladder Procedures)..................................             528            21.5         128,729
442 (Kidney & Urinary Tract Procedure for Malignancy)...........             833            16.6         101,501
443 (Kidney & Urinary Tract Procedure for Non-Malignancy).......             966            18.4         103,905
444 (Renal Dialysis Access Device Procedure Only Severity of                 935            18.3         104,249
 Illness Subclass 4)............................................
445 (Other Bladder Procedures)..................................             186            15.2          80,197
446 (Urethral & Transurethral Procedure--Severity of Illness                 492            13.4          73,110
 Subclass 4)....................................................
447 (Other Kidney, Urinary Tract & Related Procedures)..........           1,552            19.3         121,011
----------------------------------------------------------------------------------------------------------------

    The consolidation of severity of illness 4 subclass APR DRG into 
fewer groups was done for all MDCs except MDC 15 (Newborn and Other 
Neonates With Conditions Originating in the Perinatal Period), MDC 19 
(Mental Diseases and Disorders), and MDC 20 (Alcohol/Drug Use and 
Alcohol/Drug Induced Organic Mental Disorders). In the 22 MDCs in which 
the severity of illness subclass 4 consolidation was applied, the 
number of separate severity of illness subclass 4 groups was reduced 
from 262 to 69.
    For MDC 14 (Pregnancy, Childbirth, and Puerperium), the base APR 
DRGs were consolidated from 12 to 6. Severity of illness subclass 1 
through 3 were retained, and severity of illness subclass 4 was 
consolidated into a single APR DRG, except for cesarean section and 
vaginal deliveries, which were maintained as separate APR DRGs. This 
consolidation reduced the total number of obstetric APR DRGs from 48 to 
22.
    The Medicare patient volume in MDC 15 was very low, allowing for a 
more aggressive consolidation. For MDC 15, we consolidated 28 base APR 
DRGs into 7 base consolidated severity-adjusted DRGs. For each of the 7 
consolidated base MDC 15 DRGs, we combined severity of illness 
subclasses 1 and 2 into one DRG and severity of illness subclass 3 and 
4 into another one. This consolidation reduced the total number of MDC 
15 DRGs from 112 in the APR DRG system to 14 consolidated severity-
adjusted DRGs.
    In MDC 19, we consolidated 12 base DRGs into 4 base DRGs. We 
retained the 4 severity of illness subclasses in MDC 19 for each of the 
4 base DRGs. In MDC 20, the base APR DRG for patients who left against 
medical advice has severity of illness subclass 1 and 2 consolidated 
and severity of illness subclass 3 and 4 consolidated. The remaining 4 
base DRGs were consolidated into 1 base DRG and retained in 4 severity 
of illness subclasses.
    We did not consolidate any of the pre-MDC subclass 4 APR DRGs such 
as Heart Transplant. As explained earlier, pre-MDC DRGs are DRGs to 
which cases are directly assigned on the basis of ICD-9-CM procedure 
codes. These DRGs are for liver and/or intestinal transplants, heart 
and/or lung

[[Page 24017]]

transplants, bone marrow transplants, pancreas transplants, and 
tracheotomies. For the pre-MDC DRGs, except for Bone Marrow Transplant, 
we consolidated severity of illness subclasses 1 and 2 into one DRG. In 
addition, the three base APR DRGs for Human Immunodeficiency Virus 
(HIV) with multiple or major HIV-related conditions had severity of 
illness subclasses 1 and 2 consolidated.
    In total, we reduced 1,258 APR DRGs to 861 consolidated severity-
adjusted DRGs. In Appendix C of this proposed rule, we present the 861 
unique combinations of consolidated severity-adjusted DRGs.
    Table F below includes a description of the consolidations that we 
did within each individual MDC and includes information about the total 
number of DRGs that were eliminated from the APR DRGs to develop the 
consolidated severity-adjusted DRGs.
BILLING CODE 4120-01-P

[[Page 24018]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.003

BILLING CODE 4120-01-C

[[Page 24019]]

    Appendix D of this proposed rule shows the crosswalk of each 
consolidated severity-adjusted DRG to its respective APR DRG. We 
numbered the DRGs sequentially and incorporated the severity of illness 
subclass into the DRG description. However, within the range of 
sequential numbers used for an MDC, we retained some unused numbers to 
allow for future DRG expansion. By using a three-digit number for the 
consolidated severity-adjusted DRGs, we also avoid the need for 
reprogramming of computer systems that would be necessary to 
accommodate a change from the current three-digit DRG number to 
separate fields for the base consolidated severity-adjusted DRG number 
and the severity of illness subclass.
    Severity DRGs represent a significant change from our current DRG 
system. In addition to changing the way claims are grouped, severity 
DRGs introduce other issues requiring additional analysis, including 
possible increases in reported case-mix and changes to the outlier 
threshold. Our analysis of these issues is outlined below.
c. Changes to CMI From a New DRG System
    After the 1983 implementation of the IPPS DRG classification 
system, CMS observed unanticipated growth in inpatient hospital case-
mix (the average relative weight of all inpatient hospital cases) that 
is used as proxy measurement for severity of illness. There are three 
factors that determine changes in a hospital's CMI:
    (1) Admitting and treating a more resource intensive patient-mix 
(due, for example, to technical changes that allow treatment of 
previously untreatable conditions and/or an aging population);
    (2) Providing services (such as higher cost surgical treatments, 
medical devices, and imaging services) on an inpatient basis that 
previously were more commonly furnished in an outpatient setting; and
    (3) Changes in documentation (more complete medical records) and 
coding practice (more accurate and complete coding of the information 
contained in the medical record).
    Changes in CMI as a result of improved documentation and coding do 
not represent real increases in underlying resource demands. For the 
implementation of the IPPS in 1983, improved documentation and coding 
were found to be the primary cause in the underprojection of CMI 
increases, accounting for as much as 2 percent in the annual rate of 
CMI growth observed post-PPS.\2\
---------------------------------------------------------------------------

    \2\ Carter, Grace M. and Ginsburg, Paul: The Medicare Case Mix 
Index Increase, Medical Practice Changes, Aging and DRG Creep, Rand, 
1985.
---------------------------------------------------------------------------

    We believe that adoption of consolidated severity-adjusted DRGs 
would create a risk of increased aggregate levels of payment as a 
result of increased documentation and coding. MedPAC notes that 
``refinements in DRG definitions have sometimes led to substantial 
unwarranted increase in payments to hospitals, reflecting more complete 
reporting of patients' diagnoses and procedures.'' MedPAC further notes 
that ``refinements to the DRG definitions and weights would 
substantially strengthen providers' incentives to accurately report 
patients' comorbidities and complications.'' To address this issue, 
MedPAC recommended that the Secretary ``project the likely effect of 
reporting improvements on total payments and make an offsetting 
adjustment to the national average base payment amounts.'' \3\
---------------------------------------------------------------------------

    \3\ Medicare Payment Advisory Commission: Report to Congress on 
Physician-Owned Specialty Hospitals, March 2005, p. 42.
---------------------------------------------------------------------------

    The Secretary has broad discretion under section 1886(d)(3)(A)(vi) 
of the Act to adjust the standardized amount so as to eliminate the 
effect of changes in coding or classification of discharges that do not 
reflect real changes in case-mix. While we modeled the changes to the 
DRG system and relative weights to ensure budget neutrality, we are 
concerned that the large increase in the number of DRGs will provide 
opportunities for hospitals to do more accurate documentation and 
coding of information contained in the medical record. Coding that has 
no effect on payment under the current DRG system may result in a case 
being assigned to a higher paid DRG under the consolidated severity-
adjusted system. Thus, more accurate and complete documentation and 
coding may occur under the consolidated severity-adjusted system 
because it will result in higher payments under the more sophisticated 
DRG system. We are soliciting comments on this issue.
4. Effect of Consolidated Severity-Adjusted DRGs on the Outlier 
Threshold
    (If you choose to comment on issues in this section, please include 
the caption ``Cost-Based Weights: Outlier Threshold'' at the beginning 
of your comment.)
    In its March 2005 Report to Congress on Physician-Owned Specialty 
Hospitals, MedPAC recommended that Congress amend the law to give the 
Secretary authority to adjust the DRG relative weights to account for 
the differences in the prevalence of high-cost outlier cases. MedPAC 
recommended DRG-specific outlier thresholds that are financed by each 
DRG rather than through an across-the-board adjustment to the 
standardized amounts. Furthermore, in comments that MedPAC submitted 
during the comment period for the FY 2006 IPPS proposed rule, MedPAC 
stated its belief that the current policy makes DRGs with a high 
prevalence of outliers profitable for two reasons: (1) These DRGs 
receive more in outlier payments than the 5.1 percent that is removed 
from the national standardized amount; and (2) the relative weight 
calculation results in these DRGs being overvalued because of the high 
standardized charges of outlier cases. MedPAC also noted that, under 
its recommendations, outlier thresholds in each DRG would reduce the 
distortion in the relative weights that comes from including the 
outlier cases in the calculation of the weight and would correct the 
differences in profitability that stem from using a uniform outlier 
offset for all cases. MedPAC added that its recommendation would help 
make relative profitability more uniform across all DRGs.
    In the FY 2006 IPPS final rule (70 FR 47481), we responded to 
MedPAC's recommendation on outliers by noting that a change in policy 
to replace the 5.1 percent offset to the standardized amount would 
require a change in law. However, because the Secretary has broad 
discretion to consider all factors that change the relative use of 
hospital resources in the calculation of the DRG relative weights, we 
stated we would consider changes that would reduce or eliminate the 
effect of high-cost outliers on the DRG relative weights. At this time, 
we have not completed a detailed analysis of MedPAC's outlier 
recommendation because we do not have the authority to adopt such a 
change under current law. Instead, we have focused our resources on 
analyzing MedPAC's recommendations with respect to adopting severity 
DRGs and calculating cost-based HSRV weights that can be adopted 
without a change in law. While we intend to study MedPAC's 
recommendation in more detail at a future date, we note that the 
changes described above with respect to adopting a consolidated 
severity-adjusted DRG system would have important implications for the 
outlier threshold.
    As noted above, we have completed a detailed analysis that would 
increase

[[Page 24020]]

the number of DRGs from 526 under the current CMS DRG system to 861 
under a consolidated severity-adjusted DRG system. Using FY 2004 
Medicare charge data, 3M Health Information Systems simulated the 
effect of adopting consolidated severity-adjusted DRGs in conjunction 
with cost-based HSRV weights (described below) on the FY 2006 outlier 
threshold using the same estimation parameters used by CMS in the FY 
2006 final rule (that is, the charge inflation factor of 14.94 percent) 
(70 FR 47494). Under these assumptions, 3M Health Information Systems 
estimated that the outlier threshold would be reduced from $23,600 
under the current system to $18,758 under a consolidated severity-
adjusted DRG system. By increasing the number of DRGs to better 
recognize severity, the DRG system itself would provide better 
recognition for cases that are currently paid as outliers. That is, 
many cases that are high-cost outlier cases under the current DRG 
system would be paid using a severity of illness subclass 3 or 4 under 
the consolidated severity-adjusted DRGs and could potentially be paid 
as nonoutlier cases.
5. Impact of Refinement of DRG System on Payments
    Using the FY 2004 MedPAR claims data, we simulated the payment 
impacts of moving to the consolidated severity-adjusted DRG GROUPER and 
the alternative HSRVcc method for developing HSRV weights. These 
payment simulations do not make any adjustments for changes in coding 
or case-mix. For purposes of this analysis, estimated payments were 
held budget neutral to the estimated FY 2006 payments because we have a 
statutory requirement to make any changes to the weights or GROUPER 
budget neutral. Based on the results of this impact analysis, we are 
proposing to adopt both the HSRVcc weighting methodology and the 
consolidated severity-adjusted DRGs. However, for reasons described in 
more detail below, we are proposing to implement the HSRVcc weighting 
methodology we described above for FY 2007 and future fiscal years and 
the consolidated severity-adjusted DRG GROUPER for implementation in FY 
2008 (if not earlier). Although we are proposing to adopt each of these 
changes to the IPPS sequentially, the changes should be viewed as part 
of a unified effort to improve Medicare's inpatient hospital payment 
system. Our findings in support of these proposals are discussed below.
    In examining the effects of moving to consolidated severity-
adjusted DRGs with HSRVcc relative weights, the primary impact of the 
changes generally results from a redistribution of the relative weights 
from the surgical DRGs to the medical DRGs. In Table G below, we show 
an analysis of the total case-mix change for the medical and surgical 
DRGs. We are comparing the percent change in case-mix between the FY 
2006 DRGs with HSRVcc relative weights and the FY 2006 GROUPER with the 
FY 2006 charge-based relative weights. We also show the percent change 
in case-mix between the consolidated severity-adjusted DRGs with HSRVcc 
relative weights and the FY 2006 GROUPER with the FY 2006 charge-based 
relative weights and the percent change between the consolidated 
severity-adjusted DRGs with HSRVcc relative weights and the FY 2006 
DRGs with HSRVcc relative weights.

                   Table G.--Percent Change in Case-Mix Among Medical and Surgical DRGs by MDC
----------------------------------------------------------------------------------------------------------------
                                                                                  Percent change
                                                                                    in case-mix
                                                                  Percent change      due to       Total impact
                 MDC description                       Cases        in case-mix    consolidated     all changes
                                                                   due to HSRVcc     severity-       (percent)
                                                                                   adjusted DRGs
----------------------------------------------------------------------------------------------------------------
Medical.........................................       7,832,185             6.0             1.3             7.3
Surgical........................................       3,301,570            -5.7            -1.3            -6.9
----------------------------------------------------------------------------------------------------------------

    Surgical DRGs experience a decline of 5.7 percent in weights, while 
medical DRGs overall increase by approximately 6 percent when we apply 
the HSRVcc method to the FY6 DRGs. Adoption of the consolidated 
severity-adjusted DRGs also shows a redistribution of payment from the 
surgical to the medical DRGs, but to a much lesser extent. The 
redistribution of payments from adopting the HSRVcc weighting 
methodology can be explained by the much lower CCRs for ancillary cost 
centers that account for a higher proportion of total charges in the 
surgical DRGs than the medical DRGs. Table H below shows department 
charges as a percent of total charges and the CCRs for the two routine 
cost centers (routine days and intensive care unit) and eight ancillary 
cost centers that we used to develop the cost-based weights.

         Table H.--Departmental Charges as Percent of Total Charges for Medical and Surgical DRGs and Departmental Cost-to-Charge Ratios (CCRs)
                                                                      [In percent]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                          Routine    Intensive  Supplies &
                                            days     care unit   equipment   Therapy      Lab      Radiology    Other       O.R.     Pharmacy   Cardiac
--------------------------------------------------------------------------------------------------------------------------------------------------------
Cost-to-Charge Ratio...................         85          72          34         35         25          24         51         37         26         20
Medical................................         24          12           5          7         14          10          7          1         16          5
Surgical...............................         10          10          23          4          8           5          4         17         13          6
--------------------------------------------------------------------------------------------------------------------------------------------------------

    As the above Table H shows, the routine cost centers account for 36 
percent (24 percent for routine days and 12 percent for intensive care 
unit) and 20 percent (10 percent for routine days and 10 percent for 
intensive care unit) of total charges in the medical and surgical DRGs, 
respectively. These departments have CCRs that range from

[[Page 24021]]

85 (routine days) to 72 percent (intensive care unit). However, the 
markup over costs is much higher in the ancillary than in the routine 
cost centers. The CCRs in the ancillary departments range from 20 
percent (cardiac) to 51 percent (other). Ancillary cost centers account 
for 64 percent of total charges in the medical and 80 percent of total 
charges in the surgical DRGs. Thus, because ancillary departments have 
higher markups and account for a larger proportion of total charges in 
the medical than the surgical DRGs, adopting HSRVcc redistributes 
payments to the more routine-intensive medical DRGs. Table H supports 
the hypothesis that the charge-based relative weight methodology 
results in high payments to surgical DRGs that use more ancillary 
services relative to medical DRGs that use more routine services. By 
changing the relative weight methodology from the charge-based to the 
HSRVcc method, the weights will more closely reflect actual relative 
costs.
    In addition to examining the change in weights by MDC for the 
medical and surgical DRGs, we also looked at the percent change to the 
relative weights for several DRGs that account for the high Medicare 
spending. Again, the payment impacts illustrate that a change from the 
charge-based relative weights to the HSRVcc weighting methodology will 
result in significant payment redistribution for selected DRGs. Table I 
below also shows payment reductions from adopting HSRVcc for several 
DRGs where ancillary charges represent a high proportion of total 
charges and the ancillary department has a low CCR. For instance, Table 
I shows a 30-percent reduction in payment for DRG 558 from adopting 
HSRVcc weights. For this DRG, charges for the medical supplies and the 
cardiac care represent over 60 percent of average total hospital 
charges. These cost centers have low CCRs (34 and 20 percent for 
medical supplies and cardiology respectively). For this DRG, routine 
cost center charges account for only 7 percent of total hospital 
charges. Thus, similar to the MDC analysis presented above, payment for 
this DRG can be expected to decline because ancillary departments with 
higher markups account for a larger proportion of total charges.
    The data are similar for many of the other DRGs presented in Table 
I that are showing large reductions in the relative weights from 
adopting the HSRVcc weighting methodology. Conversely, Table I shows 
payment increases from adopting HSRVcc for DRGs where routine charges 
represent a high proportion of total charges. These departments have 
high CCRs. Below we illustrate the charges by cost center as a percent 
of total charges for DRGs 558 and 089.

                                                                      Illustration
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                  Supplies
                                            Routine                 and                            Radiology
                                              days       ICU     equipment   Therapy   Laboratory               Other       O.R.     Pharmacy   Cardiac
                                           (percent)  (percent)             (percent)   (percent)  (percent)  (percent)  (percent)  (percent)  (percent)
                                                                 (percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
CCRs.....................................         85         72         34         35          25         24         51         37         26         20
DRG 558..................................          2          5         39          0           3          2          1          2          8         29
DRG 089..................................         25          9          7          9          14          8          6          1         19          3
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Table I below shows a 30-percent reduction in payment for DRG 558 
from adopting HSRVcc weights. For this DRG, charges for the medical 
supplies and the cardiac care represent nearly 80 percent of average 
total hospital charges. These cost centers have low CCRs (34 percent 
and 20 percent for medical supplies and cardiology, respectively). For 
this DRG, routine cost center charges account for only 7 percent of 
total hospital charges. Thus, similar to the MDC analysis presented 
above, payment for this DRG can be expected to decline because 
ancillary departments with higher markups account for a larger 
proportion of total charges. The data are similar for many of the other 
DRGs presented in Table I that are showing large reductions in the 
relative weights from adopting HSRVcc. Conversely, routine charges 
account for a higher proportion of total charges for the DRGs that are 
showing large increases in payments. For instance, payment for DRG 089 
is increasing nearly 10 percent from adoption of HSRVcc weights. 
Routine day charges account for 34 percent of total charges for DRG 
089. Thus, because routine charges represent a high proportion of total 
charges and these cost centers have relatively low markups, the HSRVcc 
methodology will lead to higher payments for this DRG.

BILLING CODE 4120-01-P

[[Page 24022]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.004


[[Page 24023]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.005

BILLING CODE 4120-01-C

[[Page 24024]]

    Our payment impacts were similar to MedPAC's in both magnitude and 
direction. Table J below compares our impact estimates to those 
simulated by MedPAC \4\ using our alternative HSRVcc weighting 
methodology and the consolidated severity-adjusted DRG GROUPER.
---------------------------------------------------------------------------

    \4\ Medicare Payment Advisory Commission: Report to Congress on 
Physician-Owned Specialty Hospitals, March 2005, p. 39.

   Table J.--Comparison of MedPAC's Table of Combined Payment Impact of Severity-Adjusted DRGs and Cost-Based,
                        Hospital-Specific Relative Values (HSRVs) to the CMS/3M Analysis
                       [The percent changes estimated by CMS/3M are shown in parenthesis.]
----------------------------------------------------------------------------------------------------------------
                                                                     Decrease/
                                     Decrease        Decrease        increase        Increase        Increase
        Type of hospital          greater than -    between -5%     between -1%     between +1%    greater than
                                        5%            and -1%         and 1%          and +5%           +5%
----------------------------------------------------------------------------------------------------------------
Specialty:
    Heart.......................       87% (95%)        13% (5%)         0% (0%)         0% (0%)         0% (0%)
    Orthopedic..................       76% (91%)        24% (2%)         0% (2%)         0% (2%)         0% (2%)
    Surgical....................       N/A (67%)       N/A (17%)        N/A (0%)       N/A (17%)        N/A (0%)
All Other IPPS:
    Urban.......................         7% (8%)       22% (25%)       16% (19%)       33% (31%)       22% (17%)
    Rural.......................        8% (11%)       25% (35%)       17% (20%)       33% (26%)        16% (9%)
    High IME/DSH................        8% (10%)       28% (25%)       14% (15%)       25% (28%)      24% (23%)
----------------------------------------------------------------------------------------------------------------
**Numbers may not add to 100 percent due to rounding.

    As shown in Table J above, the shifts in payment from MedPAC's 
method compared to the alternative approach that we developed are 
fairly similar. Both methods introduce refinements to the DRG GROUPER 
and relative weight methods that expand the DRG groups and create 
greater homogeneity among the cases within each DRG. These changes will 
significantly reduce payments to hospitals that specialize in certain 
DRGs experiencing a reduction in payment. There are also payment 
impacts across all other hospitals. Although some urban (17 percent) 
and rural (9 percent) providers are estimated to receive increases of 
greater than 5 percent from these combined changes, 8 percent of urban 
hospitals and 11 percent of rural hospitals are expected to experience 
decreases of greater than 5 percent in payment and an additional 25 
percent of urban providers and 35 percent of rural providers are 
expected to experience a decrease of between 1 and 5 percent.
    Table K below shows the impact on specific categories of hospitals 
of adopting HSRVcc weights and the consolidated severity-adjusted DRGs. 
As illustrated in Table K, cardiac specialty hospitals and orthopedic 
specialty hospitals may experience an 11.2 and 4.4 percent decline in 
payments, respectively, from the move to the HSRVcc weighting method 
alone. Urban hospitals experience a small decline of 0.3 but rural 
hospitals experience a gain of 2.7 percent. While urban hospitals as a 
group are not expected to experience a change in overall payments with 
the combined introduction of the consolidated severity-adjusted DRGs 
and the HSRVcc weighting methodology, rural hospitals would likely 
experience a 0.4 percent decline in payments.

 Table K.--Payment Impact of Hospital-Specific Cost Weights and Consolidated Severity-Adjusted DRGs by Hospital
                                                      Type
----------------------------------------------------------------------------------------------------------------
                                                                                  Percent change
                                                                                    in case-mix
                                     Number of                    Percent change      due to       Total impact
                                     hospitals         Cases        in case-mix    consolidated     all changes
                                                                   due to HSRVcc     severity-
                                                                                   adjusted DRGs
----------------------------------------------------------------------------------------------------------------
Specialty Hospital Type:
    Cardiac.....................              19          44,203           -11.2            -0.5           -11.7
    Orthopedic..................              43          11,097            -4.4            -5.2            -9.4
    Surgery.....................              12           1,840             0.3            -7.4            -7.2
All Other IPPS:
    Urban.......................           1,959       7,148,362            -0.3             0.3               0
    Rural.......................             880       1,444,664             2.7            -3.1            -0.4
    High IME/DSH................             734       2,492,485               0             0.4             0.4
----------------------------------------------------------------------------------------------------------------

    In Table L, we provide a more detailed impact analysis by hospital 
type. Column 1 shows the estimated impact of moving from the current 
charge-based relative weight methodology to the HSRVcc method. 
Hospitals with more than 60 percent of Medicare patients are projected 
to receive the greatest benefit in payments with a 7.6 percent 
increase. Hospitals with less than 50 beds are estimated to experience 
an additional 4.1 percent increase, and hospitals with 50 to 100 beds 
are also projected to benefit with a 2.54 percent increase.
    Payments to major and other teaching hospitals are estimated to 
decrease by 1.1 percent and 1 percent, respectively,

[[Page 24025]]

while payments to nonteaching hospitals are estimated to increase by 
1.3 percent. Hospitals with less than 20 percent DSH payments will 
experience declines in payment from 0.48 to 1.45 percent, while 
hospitals with DSH payments greater than 50 percent will experience a 
2.3 percent increase. Because we are proposing to implement the HSRVcc 
weighting methodology for FY 2007, we are also showing the impact of 
this proposal on FY 2007 payments in the impact section in the Addendum 
to this proposed rule. We note that the impact section models adopting 
the HSRVcc in isolation using FY 2005 Medicare charge data. The impacts 
shown here were simulated with FY 2004 Medicare charge data. Thus, the 
payment changes shown in this section from adopting HSRVcc may differ 
from those shown in the impact section in the Addendum to this proposed 
rule.
    Column 2 shows the estimated incremental impacts of transitioning 
from the FY 2006 GROUPER with HSRVcc relative weights to the 
consolidated severity-adjusted DRG GROUPER with HSRVcc relative 
weights. Hospitals with high Medicare patient percentages experience 
the largest payment increases of 1.1 percent, followed by hospitals in 
the East North Central Region where increases are estimated at 0.9 
percent. Hospitals with less than 50 beds, rural hospitals, and 
hospitals with 50 to 100 beds experience the greatest estimated 
decreases in payment of 5.2, 3.1, and 2.8 percent, respectively.
    Column 3 shows the estimated total impact of moving from the FY 
2006 GROUPER with the current charge-based relative weights to the 
consolidated severity-adjusted DRG GROUPER with HSRVcc relative 
weights. While large urban hospitals are expected to gain 0.7 percent 
from the combined changes, other urban hospitals and rural hospitals 
are projected to experience declines of 0.7 percent and 0.4 percent, 
respectively. Hospitals with high percentages of Medicare patients 
would see the greatest increase in payments, while hospitals with low 
DSH percentages, hospitals with under 50 beds, and hospitals in the 
West North Central Region are projected to experience the greatest 
decreases.

 Table L.--Payment Impact of Hospital-Specific Cost Weights and Consolidated Severity-Adjusted DRGs by Hospital
                                                    Category
----------------------------------------------------------------------------------------------------------------
                                                                                  Percent change
                                                                                    in case-mix
                                                                  Percent change      due to       Total impact
                                     Number of         Cases        in case mix    consolidated     all changes
                                     hospitals                     due to HSRVcc     severity-          (3)
                                                                        (1)        adjusted DRGs
                                                                                        (2)
----------------------------------------------------------------------------------------------------------------
Geographic Location:
    Large Urban.................           1,454       5,159,405            -0.1             0.7             0.7
    Other Urban.................           1,158       4,313,598            -0.7             0.0            -0.7
    Rural.......................           1,035       1,669,648             2.8            -3.1            -0.4
Census:
    New England.................             150         550,391             0.3            -0.5            -0.2
    Middle Atlantic.............             473       1,750,452             0.1            -0.5            -0.4
    South Atlantic..............             556       2,191,787            -0.2             0.4             0.2
    East North Central..........             541       1,973,092            -0.1             0.9             0.8
    East South Central..........             368         973,664             0.3            -1.3            -1.0
    West North Central..........             314         846,046            -0.5            -0.8            -1.3
    West South Central..........             572       1,332,819            -0.1            -0.1            -0.2
    Mountain....................             234         502,128            -0.6             0.6            -0.1
    Pacific.....................             439       1,022,272             0.6             0.3             0.9
Bed Size:
    Less than 50 beds...........             761         423,096             4.1            -5.2            -1.3
    50-100 beds.................             717       1,028,840             2.5            -2.8            -0.3
    100-200 beds................           1,096       2,895,808             1.8            -0.6             1.2
    200-300 beds................             509       2,396,739             0.0             0.5             0.5
    300-400 beds................             269       1,666,872            -0.9             0.7            -0.2
    400-500 beds................             138       1,017,724            -1.5             0.7            -0.8
    Greater than 500 beds.......             157       1,713,572            -1.8             0.8            -1.0
Teaching Status:
    Major Teaching..............             268       1,552,985            -1.1             0.5            -0.5
    Other Teaching..............             760       3,856,302            -0.9             0.6            -0.3
    Non Teaching................           2,619       5,733,364             1.3            -0.8             0.5
Disproportionate Share:
    %DSH Less than 5%...........             202         339,171            -1.4            -0.8            -2.2
    %DSH 5-10%..................             335       1,048,420            -0.6            -0.1            -0.7
    %DSH 10-15%.................             460       1,429,319            -0.6             0.1            -0.4
    %DSH 15-20%.................             582       2,061,387            -0.5            -0.1            -0.6
    %DSH 20-25%.................             528       1,812,743             0.1            -0.1             0.0
    %DSH 25-30%.................             455       1,497,940             0.0             0.2             0.2
    %DSH 30-40%.................             516       1,586,376             0.0             0.0            -0.1
    %DSH 40-50%.................             262         693,815             0.6            -0.1             0.4
    %DSH Greater than 50%.......             307         673,480             2.3             0.5             2.9
Percent Medicare Discharges:
    Less than 10% Medicare Cases           1,194       3,210,704            -0.7            -0.1            -0.8
    10%-20% Medicare Cases......           1,471       5,109,042             0.1             0.0             0.0
    20%-30% Medicare Cases......             617       1,934,947            -0.1             0.1            -0.1
    30%-40% Medicare Cases......             226         617,518             0.9             0.1             1.0
    40%-50% Medicare Cases......              86         197,882             2.0             0.8             2.8

[[Page 24026]]

 
    50%-60% Medicare Cases......              39          55,346             5.2             1.1             6.4
    Greater than 60% Medicare                 14          17,212             7.6            -0.2             7.4
     Cases......................
----------------------------------------------------------------------------------------------------------------

6. Conclusions
    As we describe in more detail below, we believe that adopting 
HSRVcc weights and the consolidated severity-adjusted DRGs as 
recommended by MedPAC has the potential to result in significant 
improvements to Medicare's IPPS payments. This rule proposes the HSRVcc 
methodology effective for FY 2007.
    Because we believe that accounting more appropriately for severity 
of illness may significantly improve the effectiveness of the IPPS, we 
are also proposing implementation of the consolidated severity-adjusted 
DRGs or alternative severity adjustment methods in FY 2008 (if not 
earlier). In developing this proposal, we considered a range of 
alternatives outlined below, and we are soliciting comments on both the 
proposal and the alternatives. We ask commenters to consider both the 
consolidated severity-adjusted DRGs and alternative severity adjustment 
methods for accounting for severity more comprehensively in the DRG 
payment system. For example, under one alternative, we would implement 
the consolidated severity-adjusted DRGs in FY 2007 along with the 
HSRVcc weighting methodology. In this event, as discussed above, to 
maintain budget neutrality, we would also implement in FY 2007 an 
adjustment to the standardized amounts to eliminate the effect of 
changes in coding or classification of discharges that do not reflect 
real changes in case-mix. Under another alternative, as proposed, we 
would adopt and implement consolidated severity-adjusted DRGs in FY 
2008. Under yet another alternative, we would consider partially 
implementing the consolidated severity-adjusted DRGs in FY 2007 and 
complete implementation in FY 2008. However, there are practical 
difficulties associated with partial implementation of consolidated 
severity-adjusted DRGs because cases in a single DRG under the current 
CMS DRG system may group to multiple DRGs and MDCs under a consolidated 
severity-adjusted DRG system. Conversely, cases that group to multiple 
MDCs and DRGs under the current system may group to a single MDC and 
DRG under the current system. We welcome public comments on this issue.
    One potential alternative to partially adopting consolidated 
severity-adjusted DRGs would involve applying a clinical severity 
concept to an expanded set of DRGs in FY 2007. For example, we have 
received correspondence that raised the concern that hospitals may have 
incentives under the current DRG system to avoid severely ill, 
resource-intensive back and spine surgical cases (as discussed in 
section II.D.3.b. of this proposed rule; the correspondence 
specifically requested that we apply a clinical severity concept to DRG 
546). Other surgical DRGs may not accurately recognize case severity. 
Because of the frequency of DRG use and the potential for risk 
selection, certain DRGs may be particularly important in creating a 
financial incentive for hospitals to select a less severely ill patient 
whose case would be assigned to the same DRG as a more severely ill 
patient.
    Therefore, while we are proposing to adopt the consolidated 
severity-adjusted DRGs in FY 2008, we are considering whether to make 
more limited changes to the current DRG system to better recognize 
severity of illness in FY 2007. In the FY 2006 IPPS final rule (70 FR 
47474 through 47478), we took steps to better recognize severity of 
illness among cardiovascular patients. For all DRGs except cardiac 
DRGs, we currently distinguish between more complex and less complex 
cases based on the presence or absence of a CC. However, the diagnoses 
that we designate as CCs are the same across all base DRGs. Because the 
CC list is not dependent on the patient's underlying condition, CCs may 
not accurately recognize severity in a given case. The changes we made 
in FY 2006 to the cardiac DRGs significantly improved recognition of 
severity between patients by distinguishing between more and less 
severe cases based on the presence or absence of a major cardiovascular 
condition (MCV). We are considering whether a similar approach applied 
to other DRGs would improve payment.
    Much like the approach we took last year to identify MCV conditions 
that represented higher severity in cardiovascular patients, we plan to 
examine which conditions identify more severely ill cases in selected 
MDCs and DRGs. We are soliciting comments as to whether it would be 
appropriate to adopt these types of limited changes in FY 2007 as an 
intermediate step to adopting consolidated severity-adjusted DRGs in FY 
2008. We also encourage commenters to send suggestions regarding this 
method for modifying the DRGs. Under the final alternative, we would 
implement the consolidated severity-adjusted DRGs in FY 2007 and the 
HSRVcc methodology in FY 2008. As the impacts presented in this 
proposed rule are based on the latest and best available data, we 
believe the estimated yearly impacts due to implementing the HSRVcc 
methodology in FY 2007 described in the regulatory impact section of 
Appendix A of this proposed rule would be similar to the annual impact 
of adopting the HSRVcc methodology in FY 2008.
    With respect to the relative weight calculations, we believe that 
adopting HSRVcc weights has the potential to significantly improve 
payment equity between DRGs. As MedPAC notes, ``a survey of hospitals' 
charging practices suggest that hospitals use diverse strategies for 
setting service charges and raising them over time.'' MedPAC found that 
data from the Medicare cost reports indicate that hospital markups for 
ancillary services (for example, operating room, radiology, and 
laboratory) are generally higher than for routine services (for 
example, intensive care unit and room and board).\5\ Thus, MedPAC has 
concluded that the relative weights for DRGs that use more ancillary 
services may be too high compared to other DRGs where the routine costs 
account for a higher proportion of hospital costs. We agree.

[[Page 24027]]

The CCRs that we are using to develop the HSRVccs support MedPAC's 
conclusion. As indicated above, we summarized hospital-level cost and 
charge information to 2 routine and 8 ancillary departmental cost 
centers and found that national average routine cost center CCRs ranged 
from 72 percent (intensive care unit days) to 85 percent (routine 
days), while ancillary cost center CCRs ranged from 20 percent 
(cardiology) to 37 percent (operating room).
---------------------------------------------------------------------------

    \5\ Ibid., p. 26.
---------------------------------------------------------------------------

    MedPAC also found that relative profitability ratios were higher 
among cardiovascular surgical DRGs than the medical DRGs.\6\ We believe 
the relative profitability of the surgical cardiovascular DRGs has been 
an important factor in the development of specialty heart hospitals. 
Our payment impact analysis indicates that this issue will be addressed 
by adopting HSRVccs. Moving from the current system of charge-based 
weights to HSRVcc weights increases payment in the medical DRGs 
relative to the surgical DRGs. We expected this result, given that 
routine costs will generally account for a higher proportion of total 
costs in the medical DRGs than in the surgical DRGs. Adopting HSRVcc 
weights would result in the most significant improvement in hospital 
payment-to-cost ratios among the changes to the IPPS recommended by 
MedPAC.\7\ For these reasons described above, we are proposing to adopt 
HSRVccs for FY 2007.
---------------------------------------------------------------------------

    \6\ Ibid., p. 29.
    \7\ Ibid., p. 37.
---------------------------------------------------------------------------

    Based on our analysis, we concur with MedPAC that the modified 
version of the APR DRGs would account more completely for differences 
in severity of illness and associated costs among hospitals. MedPAC 
observed some modest improvements in hospitals' payment-to-cost ratios 
from adopting APR DRGs.\8\ We modeled the consolidated severity-
adjusted DRGs discussed above and observed a 12-percent increase in the 
explanatory power (or R-square statistic) of the DRG system to explain 
total hospital charges. That is, we found more uniformity among 
hospital total charges within the consolidated severity-adjusted DRG 
system than we did with Medicare's current DRG system. While we believe 
the consolidated severity-adjusted DRG system that we described above 
has the potential to improve the IPPS, we have the following concerns 
about adopting these changes for FY 2007, which is why we have proposed 
not adopting the changes in FY 2007. However, we recognize that there 
may be countervailing views, and we specifically seek comment on the 
wisdom of adopting consolidated severity-adjusted DRGs in FY 2007. 
Below are our concerns with immediate implementation of consolidated 
severity-adjusted DRGs:
---------------------------------------------------------------------------

    \8\ Ibid., p. 37.
---------------------------------------------------------------------------

     These changes would represent a major change to how 
hospitals are paid for Medicare inpatient services. Given the number of 
new DRGs and logic for assigning cases in a consolidated severity-
adjusted DRG system, we believe it may be appropriate to provide 
hospitals with additional time to plan for these changes. We also are 
considering whether hospitals should have more than the 60-day public 
comment period and the additional 60-day delay between the publication 
of the final rule and implementation on October 1, 2006, to fully 
understand and plan for the changes that we are proposing. Further, we 
welcome public comment on the changes we are proposing;
     If, based on analysis of data and public comments 
received, we were to make significant revisions in the final rule to 
the consolidated severity-adjusted DRGs we describe above, hospitals 
would have only 60 total days between the publication of the final rule 
and the October 1, 2006 effective date of the IPPS rule to understand 
and plan for the new DRG system.
     While we modeled the changes to the DRG system and 
relative weights to reflect budget neutrality, we believe the large 
increase in the number of DRGs would provide opportunities for 
hospitals to more accurately and completely code the information 
contained in the medical record. Coding that has no effect on payment 
under the current DRG system may result in a case being assigned to a 
higher paid DRG under the consolidated severity-adjusted DRG system. 
Thus, more accurate and complete coding may occur under the new system 
because the more sophisticated DRG system would mean that more 
comprehensive coding could result in higher payments. Section 
1886(d)(3)(A)(vi) of the Act provides the Secretary with the authority 
to adjust the standardized amounts to account for the effect of coding 
or classification changes that do not reflect real changes in case-mix. 
We are interested in public comments on this issue.
     As described above, adoption of a consolidated severity-
adjusted DRG system could have implications for the outlier threshold.
     As we indicated in the introduction to this section, 
adoption of a consolidated severity-adjusted DRG system also raises 
issues regarding the IME and DSH adjustments. It is possible that a 
consolidated severity-adjusted DRG system would have important 
implications for these payment adjustments. We believe further study of 
this issue is warranted.
     To this point, we have only considered one alternative DRG 
system to better recognize severity of illness. It is possible that the 
public comment process will present compelling evidence that there are 
potential alternatives to the consolidated severity-adjusted DRG system 
that could also better recognize severity of illness.
    Therefore, for the reasons indicated above, we are seeking comment 
on the most effective approach to address severity of illness in the 
IPPS. However, we reserve the option to adopt consolidated severity-
adjusted DRGs in FY 2007, based upon the comments that we receive. 
Between now and the eventual implementation, we will carefully study 
the additional impact of these DRGs on payment accuracy after our 
proposed refinements in relative weights are implemented, as well as 
their impact on hospitals before reaching a final decision.
    Given the changes we are proposing, we believe that hospitals would 
be interested in understanding how a given case would be assigned to a 
consolidated severity-adjusted DRG under the new system. In order to 
facilitate understanding of the underlying severity DRG concepts and 
logic, we are providing a link below to 3M's Web site for the duration 
of the comment period where users can access information related to the 
proposed consolidated severity-adjusted DRGs. Users will have access to 
a tool that allows them to build case examples using this proposed DRG 
classification system. The report produced by the tool will provide a 
detailed explanation of how the severity of illness was assigned and 
the diagnostic and demographic factors affecting that assignment. In 
addition, users will be able to view the APR DRG Definitions Manual, a 
report showing the mapping from the standard APR DRGs to the 
consolidated severity-adjusted DRGs, a report showing basic APR DRG 
statistics, and other APR DRG background and educational materials. 
This site can be accessed at http://www.aprdrgassign.com.
    In addition to the above information, CMS makes available for 
purchase the Expanded Modified MedPAR data that were used in simulating 
the policies proposed in the IPPS rule. If readers have already ordered 
the proposed rule data, we are in the process of filling the orders and 
will be providing the FY

[[Page 24028]]

2005 MedPAR data that were used to model the proposed changes to the 
DRGs and relative weights for FY 2007 as well as the FY 2004 MedPAR 
data that we used to model the consolidated severity-adjusted DRGs that 
we are proposing to implement in FY 2008 (if not earlier). If readers 
have not ordered the proposed rule MedPAR data but are interested in 
receiving them, we encourage them to order the data as soon as possible 
by following the directions provided below. We will process orders in 
the order they are received. For information on how to order the 
Expanded Modified MedPAR, go to the following Web site: http://www.cms.hhs.gov/LimitedDataSets/ and click on MedPAR Limited Data Set 
(LDS)--Hospital (National). This Web page will describe the file and 
provide directions to further detailed instructions for how to order. 
Persons placing orders must send the following: Letter of Request, LDS 
Data Use Agreement and Research Protocol (see Web site for further 
instructions), LDS Form, and a check for $3,655 to: Centers for 
Medicare & Medicaid Services, Public Use Files, Accounting Division, 
P.O. Box 7520, Baltimore, MD 21207-0520.
    We are seeking public comments on both of these proposals and 
whether we should provide a transition to the HSRVcc weights. The 
proposed changes to the relative weights, in some cases, could result 
in significant changes to hospital payments. Using FY 2005 MedPAR data, 
we computed an estimated FY 2006 CMI (based on FY 2006 relative 
weights) and an estimated FY 2007 CMI (based on the FY 2007 weights 
that we are proposing in this proposed rule) and looked at the percent 
change from FY 2006 to FY 2007. Table M shows the number of hospitals 
in each category that can expect to experience increases or decreases 
in CMI of more than 5 percent and also shows the number of providers 
expected to experience smaller changes in case-mix.
    Overall, we estimate that 134 providers may experience decreases in 
payment of greater than 5 percent, while 1,003 providers may expect 
increases of greater than 5 percent. Approximately 54 percent of rural 
hospitals may receive increases in their CMI of greater than 5 percent. 
However, as discussed in the previous section, the eventual 
implementation of a consolidated severity-adjusted DRG system in FY 
2008 (if not earlier) would offset these increases for some types of 
cases or categories of hospitals. For this reason, we are considering 
whether to provide a transition to the HSRVcc weights. Under such a 
transition, we would blend the HSRVcc weights with the charge-based 
weights over a period of 2, 3, or 4 years. For instance, if we were to 
implement the HSRVcc methodology over 2 years, we would blend 1/2 of 
the HSRVcc weights with 1/2 of the charge-based weights. Such a 
transition would result in an impact of 50 percent of moving directly 
to the HSRVcc weights. If we were to establish a longer transition to 
the HSRVcc weights, we would blend charge-based with hospital-specific 
cost weights calculated under the consolidated severity-adjusted DRGs. 
As discussed in the previous sentences, we are presenting an example of 
a 2-year transition because the payment impact of consolidated 
severity-adjusted DRGs and the HSRVcc weights go in different 
directions for some types of cases or categories of hospitals. Thus, a 
2-year transition provides the shortest time period for achieving the 
improvements to the IPPS we have analyzed. However, we welcome public 
comments on this issue.

       TABLE M.--Percent Change in Case-Mix Index Between FY 2006 and FY 2007 Based on FY 2005 MedPAR Data
----------------------------------------------------------------------------------------------------------------
                                                                                                      Number of
                                                  Number of    Number of    Number of    Number of    providers
                                     Number of    providers    providers    providers    providers       with
                                     hospitals    with more    with loss     with 1%     with gain     greater
                                                   than 5%     between 1    loss to 1%   between 1     than 5%
                                                     loss        and 5%        gain        and 5%        gain
                                            (1)          (2)          (3)          (4)          (5)          (6)
----------------------------------------------------------------------------------------------------------------
All Hospitals.....................        3,522          134          581          394        1,410        1,003
By Geographic Location:
    Urban hospitals...............        2,517          127          540          356        1,030          464
    Large urban areas (populations        1,391           63          238          191          639          260
     over 1 million)..............
    Other urban areas (populations        1,126           64          302          165          391          204
     of 1 million or fewer).......
    Rural hospitals...............        1,005            7           41           38          380          539
Bed Size (Urban):
    0-99 beds.....................          590           46           58           26          191          269
    100-199 beds..................          865           22          103           87          490          163
    200-299 beds..................          482           20          133          102          205           22
    300-499 beds..................          414           28          164           93          120            9
    500 or more beds..............          166           11           82           48           24            1
Bed Size (Rural):
    0-49 beds.....................          349            2            5            3           67          272
    50-99 beds....................          366            1            4            5          155          201
    100-149 beds..................          179            1           14           10           92           62
    150-199 beds..................           64            2            6           14           40            2
    200 or more beds..............           47            1           12            6           26            2
Urban by Region:
    New England...................          127            2           22            6           75           22
    Middle Atlantic...............          353           15           50           39          194           55
    South Atlantic................          381           19           86           39          179           58
    East North Central............          388           14          100           68          145           61
    East South Central............          163            8           36           19           51           49
    West North Central............          156           15           49           28           39           25
    West South Central............          350           27           85           68           99           71
    Mountain......................          143           12           42           36           42           11

[[Page 24029]]

 
    Pacific.......................          404           13           69           51          188           83
    Puerto Rico...................           52            2            1            2           18           29
Rural by Region:
    New England...................           19            0            1            0           15            3
    Middle Atlantic...............           72            1            2            2           34           33
    South Atlantic................          175            0            2            4           67          102
    East North Central............          125            3            5            3           69           45
    East South Central............          181            1            5            9           37          129
    West North Central............          118            0           15            5           57           41
    West South Central............          191            1            6            9           40          135
    Mountain......................           80            1            5            4           35           35
    Pacific.......................           44            0            0            2           26           16
By Payment Classification:
    Urban hospitals...............        2,539          128          538          353        1,042          478
    Large urban areas (populations        1,400           63          238          191          644          264
     over 1 million)..............
    Other urban areas (populations        1,139           65          300          162          398          214
     of 1 million or fewer).......
    Rural areas...................          983            6           43           41          368          525
Teaching Status:
    Nonteaching...................        2,449           80          262          194        1,008          905
    Fewer than 100 residents......          836           42          237          147          318           92
    100 or more residents.........          237           12           82           53           84            6
Urban DSH:
    Non-DSH.......................          854           71          165           95          364          159
    100 or more beds..............        1,513           52          374          256          645          186
    Less than 100 beds............          333            8           12           12           98          203
Rural DSH:
    SCH...........................          383            0            6            5          106          266
    RRC...........................          196            3           23           24          124           22
Other Rural:
    100 or more beds..............           55            0            0            2           26           27
    Less than 100 beds............          188            0            1            0           47          140
Urban teaching and DSH:
    Both teaching and DSH.........          809           38          248          156          290           77
    Teaching and no DSH...........          198           13           57           37           81           10
    No teaching and DSH...........        1,037           22          138          112          453          312
    No teaching and no DSH........          495           55           95           48          218           79
Rural Hospital Types:
    Non special status hospitals..          288            1            6            5           88          188
    RRC...........................          140            3           20           18           86           13
    SCH...........................          341            0            6            7          113          215
    MDH...........................          126            0            0            1           29           96
    SCH and RRC...................           80            2           10           10           47           11
    MDH and RRC...................            8            0            1            0            5            2
Type of Ownership:
    Voluntary.....................        2,087           65          406          248          895          473
    Proprietary...................          831           61          139           96          292          243
    Government....................          604            8           36           50          223          287
Medicare Utilization as a Percent
 of Inpatient Days:
    0-25..........................          252            8           26           23          130           65
    25-50.........................        1,302           54          312          200          475          261
    50-65.........................        1,490           45          210          147          669          419
    Over 65.......................          459           25           33           24          129          248
    Unknown.......................           19            2            0            0            7           10
Urban Hospitals Reclassified by
 the Medicare Geographic
 Classification Review Board:
    First Half FY 2007                      319           17           72           37          146           47
     Reclassifications............
    Urban Nonreclassified, First          2,119          109          444          312          846          408
     Half FY 2007.................
    All Urban Hospitals                     339           17           75           37          160           50
     Reclassified Second Half FY
     2007.........................
    Urban Nonreclassified                 2,099          109          441          312          832          405
     Hospitals Second Half FY 2007
    All Rural Hospitals                     385            5           30           34          210          106
     Reclassified Full Year FY
     2007.........................
    Rural Nonreclassified                   604            2           11            4          163          424
     Hospitals Full Year FY 2007..
    All Section 401 Reclassified             38            0            2            3           11           22
     Hospitals....................

[[Page 24030]]

 
    Other Reclassified Hospitals             54            1            0            0           24           29
     (Section 1886(d)(8)(B))......
    Section 508 Hospitals.........           95            1           24            7           45           18
----------------------------------------------------------------------------------------------------------------

    We also recognize the change from the current Medicare DRGs to a 
consolidated severity-adjusted DRG system would represent significant 
changes for hospitals. While we have considered the possibility of 
blending the two DRG systems, we do not believe there is a practical 
and simple mechanism to transition from the CMS DRGs to a consolidated 
severity-adjusted DRG system. Our payments would be a blend of two 
different relative weights that would have to be determined using two 
different DRG systems. The systems and legal implications of such a 
transition could be significant. First, we believe that the use of two 
DRG systems would involve significant administrative complexity and 
expense for the Nation's hospitals, fiscal intermediaries, and CMS. 
Second, we would likely have to establish two sets of Medicare rates 
with one set specific to each DRG system. In addition to complicating 
the ratesetting process and making it unclear to hospitals how 
Medicare's IPPS rates for a year were determined, we are uncertain how 
we would:
     Apply the budget neutrality requirement under section 
1886(d)(4)(C)(iii) of the Act for changes to DRG classifications and 
weighting factors.
     Determine the outlier threshold under section 
1886(d)(5)(A)(iv) and the amounts removed for outliers from the IPPS 
standardized amounts under section 1886(d)(3)(B) of the Act.
    While we believe there are significant administrative, technical, 
and legal difficulties associated with making a blended transition from 
one DRG system to another, we welcome public comments on this issue as 
well.

D. Proposed Changes to Specific DRG Classifications

1. Pre-MDCs: Pancreas Transplants
    (If you choose to comment on issues in this section, please include 
the caption ``Pancreas Transplants'' at the beginning of your comment.)
    On July 1, 1999, we issued coverage policy which specified that 
pancreas transplants were only covered when performed simultaneously 
with or after a Medicare covered kidney transplant. A noncoverage 
policy for pancreas transplant remained in effect for patients who had 
not experienced end stage renal failure secondary to diabetes. On July 
29, 2005, we opened a national coverage determination (NCD) to 
determine whether pancreas transplant alone, that is, without a kidney 
transplant, is a reasonable and necessary service for Medicare 
beneficiaries. On January 26, 2006, we published the proposed decision 
memorandum for pancreas transplants on our Web site at http://www.cms.hhs.gov.mcd/viewdraftdecisionmemo.asp?id=166, stating that the 
evidence is adequate to conclude that pancreas transplant alone is 
reasonable and necessary for Medicare beneficiaries under limited 
circumstances.
    Medicare coverage of pancreas transplants alone is proposed to be 
limited to transplants in those facilities that are Medicare-approved 
for kidney transplantation. A listing of approved transplant centers 
can be found at http://www.cms.hhs.gov/AprovedTransplantCenters/. In 
addition to other criteria listed in the draft decision memorandum, 
patients must have a diagnosis of Type I diabetes.
    Because we have issued a proposed NCD and a final NCD is not 
expected to be completed until late April 2006, which is after the 
publication date of this proposed rule, we are using this proposed rule 
to indicate the coding changes that we would make to DRG 513 (Pancreas 
Transplant) in FY 2007 if limited coverage of pancreas transplants 
alone is established. If the final NCD indicates that a pancreas 
transplant alone is not a reasonable and necessary service, in the IPPS 
final rule, we will not adopt the changes we are currently proposing to 
make to DRG 513 to implement the NCD. In addition, we are also 
indicating the conforming changes that we would make to the MCE 
``NonCovered Procedure'' edit if Medicare coverage is established for 
pancreas transplants alone. That discussion can be found in the section 
II.D.6. of this preamble, which describes proposed changes to the MCE.
    Because of the potential decision to cover pancreas transplants 
alone, the logic for the determination of patient case assignment to 
DRG 513 would have to be modified to remove the requirement that 
patients also have kidney disease. Therefore, if the NDC is finalized, 
DRG 513 would consist of the following logic: List A (the diabetes 
codes) of the required principal or secondary diagnosis codes would 
remain the same, as would the required operating room procedures (codes 
52.80 (Pancreatic transplant NOS), and 52.82, (Homotransplant of 
pancreas)). List B would be removed from the logic; the following codes 
would no longer be required as a principal or secondary diagnosis:
     403.01, Hypertensive kidney disease, malignant, with 
chronic kidney disease.
     403.11, Hypertensive kidney disease, benign, with chronic 
kidney disease.
     403.91, Hypertensive kidney disease, unspecified, with 
chronic kidney disease.
     404.02, Hypertensive heart and kidney disease, malignant, 
with chronic kidney disease.
     404.03, Hypertensive heart and kidney disease, malignant, 
with heart failure and chronic kidney disease.
     404.12, Hypertensive heart and kidney disease, benign, 
with chronic kidney disease.
     404.13, Hypertensive heart and kidney disease, benign, 
with heart failure and chronic kidney disease.
     404.92, Hypertensive heart and kidney disease, 
unspecified, with chronic kidney disease.
     404.93, Hypertensive heart and kidney disease, 
unspecified, with heart failure and chronic kidney disease.

[[Page 24031]]

     585.1, Chronic kidney disease, Stage I.
     585.2, Chronic kidney disease, Stage II (mild).
     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.
     585.9, Chronic kidney disease, unspecified.
     V42.0, Organ or tissue replaced by transplant, kidney.
     V43.89, Organ or tissue replaced by other means, other 
organ or tissue, other.
    We note that DRG 513 would remain in the Pre-MDC hierarchy.
2. MDC 1 (Diseases and Disorders of the Nervous System)
a. Implantation of Intracranial Neurostimulator System for Deep Brain 
Stimulation (DBS)
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Neurostimulators'' at the beginning of your 
comment.)
    Deep-brain stimulation (DBS) is designed to deliver electrical 
stimulation to the subthalamic nucleus or internal globus pallidus to 
ameliorate symptoms caused by abnormal neurotransmitter levels that 
lead to abnormal cell-to-cell electrical impulses in Parkinson's 
disease and essential tremor. DBS implants for essential tremor are 
unilateral, with neurostimulation leads on one side of the brain. DBS 
implants for Parkinson's disease are bilateral, requiring implantation 
of neurostimulation leads in both the left and right sides of the 
brain.
    The implantation of a full DBS system requires two types of 
procedures. First, surgeons implant leads containing electrodes into 
the targeted sections of the brain where neurostimulation therapy is to 
be delivered. Second, a neurostimulator pulse generator is implanted in 
the pectoral region and extensions from the neurostimulator pulse 
generator are then tunneled under the skin along the neck and connected 
with the proximal ends of the leads implanted in the brain. Hospitals 
stage the two procedures required for a full-system DBS implant.
    In FY 2005, to better account for these two types of procedures, we 
revised procedure code 02.93 (Implantation or replacement of 
intracranial neurostimulator lead(s)) for the lead placement and 
created three new procedures codes for the pulse generator: 86.94 
(Insertion or replacement of single array neurostimulator pulse 
generator); 86.95 (Insertion or replacement of dual array 
neurostimulator pulse generator); and 86.96 (Insertion or replacement 
of other neurostimulator pulse generator). We published the new 
procedure codes and revised procedure code titles in Tables 6B and 6F 
of the FY 2005 IPPS final rule (69 FR 49627 and 49641).
    In FY 2006, we made further refinements to the pulse generator 
codes to identify rechargeable pulse generators. We published the new 
procedure codes and revised procedure code titles in Tables 6B and 6F 
of the FY 2006 IPPS final rule (70 FR 47637 and 47639). The current 
list of pulse generators codes are:
     86.94 (Insertion or replacement of single array 
neurostimulator pulse generator, not specified as rechargeable);
     86.95 (Insertion or replacement of dual array 
neurostimulator pulse generator, not specified as rechargeable);
     86.96 (Insertion or replacement of other neurostimulator 
pulse generator);
     86.97 (Insertion or replacement of single array 
neurostimulator rechargeable generator); and
     86.98 (Insertion or replacement of dual array 
neurostimulator rechargeable generator).
    Kinetra[supreg] is an implantable dual array neurostimulator pulse 
generator that is approved for a new technology add-on payment through 
FY 2006. For more information about the new technology add-on payment, 
please refer to section II.G.3.a. of this preamble.
    Medtronic, the manufacturer of Kinetra[supreg], argues that the new 
technology add-on payment provision is designed to recognize the higher 
costs of new medical innovations for the initial period the technology 
is available on the market, and until the associated costs and charges 
related to the technology are available in the MedPAR database and can 
be used to recalibrate the DRG weights. Medtronic also argues that, 
once a technology is no longer eligible for new technology add-on 
payments, the new technology add-on payment provision is designed to 
support the reclassification of the technology to other clinically 
coherent DRGs with comparable resource costs.
    With the conclusion of the new technology add-on payment, Medtronic 
is concerned that Kinetra[supreg] will be inadequately paid in DRG 1 
(Craniotomy Age >17 With CC) or DRG 2 (Craniotomy Age >17 Without CC) 
under MDC 1. Medtronic recommended that CMS reassign the full-system 
Kinetra[supreg] implants to DRG 543 (Craniotomy with Implant of Chemo 
Agent or Acute Complex CNS Principal Diagnosis) under MDC 1. To 
accommodate this recommendation, procedure codes 02.93 and 86.95 would 
have to be reassigned to DRG 543 and the title for DRG 543 would have 
to be revised to ``Craniotomy with Implantation of Major Device or 
Acute Complex CNS Principal Diagnosis.'' Medtronic argued that DRG 543 
would be a ``clinically-consistent DRG that more appropriately reflects 
the resource utilization associated with full-system [deep brain 
stimulation] procedures.'' Medtronic also emphasized that its proposal 
would only apply to full-system Kinetra[supreg] implants when both the 
leads and generators are implanted during a single inpatient stay or 
procedure codes 02.93 and 86.95 both appear on the claim. Medtronic 
believes the current DRG assignment is appropriate for partial system 
implants.
    Medtronic provided an analysis of FY 2004 MedPAR data. Procedure 
code 86.95 was not created until FY 2005 so Medtronic used procedure 
codes 02.93 and 86.09 (Other incision of skin and subcutaneous tissue) 
to identify the full system. It identified 193 cases assigned to DRG 1 
with average charges of approximately $69,155, and 532 cases assigned 
to DRG 2 with average charges of approximately $56,113.
    We have reviewed the latest data for the full-system DBS implants 
assigned to DRG 1 or DRG 2 in the FY 2005 MedPAR file. We identified 
cases with procedure codes 02.93 and 86.95 for full-system dual array 
cases. We also identified cases with reported codes 02.93 and 86.96 for 
those full-system cases where the type of pulse generator was not 
specified. The following table displays our results:

----------------------------------------------------------------------------------------------------------------
                                                                                 Average length
                             DRG                               Number of cases      of stay      Average charges
----------------------------------------------------------------------------------------------------------------
DRG 1--All Cases.............................................           23,037             9.61          $55,494
DRG 1--Cases with 02.93 and 86.95 (Kinetra[supreg])..........               51             5.18           73,020
DRG 1--Cases with 02.93 and 86.96 (Unspecified)..............              101             4.86           53,356
DRG 2--All Cases.............................................            9,707             4.41           32,791

[[Page 24032]]

 
DRG 2--Cases with 02.93 and 86.95 (Kinetra[supreg])..........              146             2.40           59,414
DRG 2--Cases with 02.93 and 86.96 (Unspecified)..............              249             2.12           47,047
DRG 543--All cases...........................................            5,192            11.71           71,138
----------------------------------------------------------------------------------------------------------------

    The data show that approximately one-quarter of the full-system 
dual array neurostimulator pulse generator cases are assigned to DRG 1 
and approximately three-quarters of these cases are assigned to DRG 2. 
In both DRGs, the average length of stay was shorter for the full-
system array neurostimulator pulse generator cases than for all other 
cases. However, the average charges for the full-system dual array 
neurostimulator pulse generator cases are approximately $18,000 and 
$27,000 higher than the average charges for DRGs 1 and 2, respectively. 
The average charges for these cases in DRG 1 are comparable to those 
for DRG 543. However, the more commonly occurring cases in DRG 2 have 
average charges that are less than those in DRG 543 by nearly $12,000. 
We reviewed all of the procedures that will result in a case being 
assigned to DRGs 1 and 2. Unlike the full-system DBS implants, we 
believe for most of the cases assigned to these DRGs, there will be no 
device cost to the hospital. For this reason, we believe the higher 
average charges and lower length of stay for cases involving full-
system dual array neurostimulator pulse generators are likely accounted 
for by the cost of the device. While it is possible that the cost of 
the device itself will make the full-system DBS implants more expensive 
than other cases in the DRG, the hospital's charge markup may also 
explain the higher charges but lower average length of stay. As 
indicated in section II.G.3.a.of this proposed rule, the national 
average CCR for medical equipment and supplies is approximately 34 
percent. Thus, the actual cost to the hospital of the case including 
the full-system dual array neurostimulator pulse generator may be much 
lower than the charges would suggest.
    With respect to whether the cost of the technology itself, absent a 
charge markup, makes the case more expensive, we intend to address this 
issue as we make further refinements to the severity DRG system we are 
proposing to implement in FY 2008 (if not earlier), as discussed in 
section II.C. of this preamble. As we indicate in section II.C. of this 
proposed rule, the consolidated severity-adjusted DRG system that we 
are proposing does not currently assign a case to a higher weighted DRG 
based on use of a technology that represents increased complexity but 
not necessarily greater severity of illness. The data above indicate 
that approximately three-quarters of the patients who receive a full-
system dual array neurostimulator pulse generator do not have a CC. 
Thus, it appears that these patients would be more likely to be 
assigned to a lower severity of illness class based solely on 
diagnosis. However, the implant of a full-system dual array 
neurostimulator pulse generator may increase complexity and resource 
use even though the patient is not more severely ill. As we also 
explain in section II.C. of this proposed rule, we believe that the 
consolidated severity-adjusted DRG system we are proposing would need 
to be further refined to assign cases based on complexity as well as 
severity to account for technologies like the full-system dual array 
neurostimulator pulse generator implants that increase costs. We plan 
to further develop the consolidated severity-adjusted DRGs between now 
and its implementation to address this issue.
b. Carotid Artery Stents
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Carotid Artery Stents'' at the beginning of your 
comment.)
    Stroke is the third leading cause of death in the United States and 
the leading cause of serious, long-term disability. Approximately 70 
percent of all strokes occur in people age 65 and older. The carotid 
artery, located in the neck, is the principal artery supplying the head 
and neck with blood. Accumulation of plaque in the carotid artery can 
lead to stroke either by decreasing the blood flow to the brain or by 
having plaque break free and lodge in the brain or in other arteries to 
the head. The percutaneous transluminal angioplasty (PTA) procedure 
involves inflating a balloon-like device in the narrowed section of the 
carotid artery to reopen the vessel. A carotid stent is then deployed 
in the artery to prevent the vessel from closing or restenosing. A 
distal filter device (embolic protection device) may also be present, 
which is intended to prevent pieces of plaque from entering the 
bloodstream.
    Effective July 1, 2001, Medicare covers PTA of the carotid artery 
concurrent with carotid stent placement when furnished in accordance 
with the FDA-approved protocols governing Category B Investigational 
Device Exemption (IDE) clinical trials. PTA of the carotid artery, when 
provided solely for the purpose of carotid artery dilation concurrent 
with carotid stent placement, is considered to be a reasonable and 
necessary service only when provided in the context of such clinical 
trials and, therefore, is considered a covered service for the purposes 
of these trials. Performance of PTA in the carotid artery when used to 
treat obstructive lesions outside of approved protocols governing 
Category B IDE clinical trials remained noncovered until the release of 
the October 12, 2004 NCD for PTA of the carotid artery in post-approval 
studies. This decision extended coverage of PTA in the carotid artery 
concurrent with placement of an FDA-approved carotid stent for an FDA-
approved indication when furnished in accordance with the FDA-approved 
protocols governing post-approval studies. On March 17, 2005, CMS 
released the NCD extending coverage to patients at high risk for 
carotid endarterectomy (CEA) who also have symptomatic carotid artery 
stenosis >= 70 percent. Procedures must be performed in CMS-approved 
facilities and with FDA-approved carotid artery stenting with distal 
embolic protection. (Section 20.7 of the NCD manual, which may be 
viewed at the Web site: http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf.)
    We established codes for carotid artery stenting procedures for use 
with discharges occurring on or after October 1, 2004, for inpatients 
who are enrolled in an FDA-approved clinical trial and are using on-
label FDA-approved stents and embolic protection devices. These codes 
are as follows:
     00.61 (Percutaneous angioplasty or atherectomy of 
precerebral (extracranial vessel(s)); and
     00.63 (Percutaneous insertion of carotid artery stent(s)).
    We assigned procedure code 00.61 to four MDCs and seven DRGs. The 
most likely scenario is that in which cases are assigned to MDC 1 
(Diseases and Disorders of the Nervous System) in DRGs 533 
(Extracranial Procedures with CC) and 534 (Extracranial Procedures 
without CC). Other DRG assignments

[[Page 24033]]

can be found in Table 6B of the Addendum to the FY 2005 IPPS final rule 
(69 FR 49624).
    As part of our annual DRG review, for the FY 2006 final rule (70 FR 
47300), we used proxy codes to evaluate the costs and DRG assignments 
for carotid artery stenting because codes 00.61 and 00.63 were only 
approved for use beginning October 1, 2004, and MedPAR data for this 
period were not yet available. We used procedure code 39.50 
(Angioplasty or atherectomy of other noncoronary vessel(s)) in 
combination with procedure code 39.90 (Insertion of nondrug-eluting 
peripheral vessel stent(s)) in DRGs 533 and 534 as the proxy codes for 
carotid artery stenting. For this evaluation, we used principal 
diagnosis code 433.10 (Occlusion and stenosis of carotid artery, 
without mention of cerebral infarction) to reflect the clinical trial 
criteria. Based on the results of our review, for FY 2006, we did not 
find sufficient evidence to warrant a DRG change at that time.
    Manufacturer representatives have suggested that we assign all 
carotid stenting cases to DRG 533 only, bypassing DRG 534. We have 
reviewed the FY 2005 MedPAR data on all cases in DRGs 533 and 534 and 
on those cases containing code 00.61 in combination with 00.63. The 
following table displays our results:

----------------------------------------------------------------------------------------------------------------
                                                                                 Average length
                             DRG                               Number of cases   of stay (days)  Average charges
----------------------------------------------------------------------------------------------------------------
DRG 533--All cases...........................................           44,031             3.65          $26,376
DRG 533 with codes 00.61 and 00.63 reported..................            2,400             2.94           33,344
DRG 533 with code 00.61 and without 00.63....................               99             5.95           46,591
DRG 534--All cases...........................................           40,381             1.72           17,196
DRG 534 with codes 00.61 and 00.63 reported..................            2,056             1.52           25,000
DRG 534 with code 00.61 and without 00.63....................               55             2.31           27,895
----------------------------------------------------------------------------------------------------------------

    We found that 5.5 and 5.1 percent of the cases in DRGs 533 and 534, 
respectively, involved placement of a carotid artery stent. In both 
DRGs, the average length of stay was shorter for the carotid stenting 
cases than for all other cases. However, the average charges for the 
carotid stent cases were higher by $6,968 in DRG 533 and $7,804 in DRG 
534. We reviewed all of the procedures that would result in a case 
being assigned to DRGs 533 and 534. Unlike the carotid artery stent 
placements, we believe that, for most of the cases assigned to these 
DRGs, there will be no device cost to the hospital. For this reason, we 
believe the higher average charges and lower length of stay for the 
cases involving carotid artery stents are likely accounted for by the 
cost of the device. While it is possible that the cost of the device 
itself will make the stent cases more expensive than other cases in the 
DRG, the hospital's charge markup may also explain the higher charges 
but lower average length of stay. As indicated elsewhere in this 
proposed rule, the national average CCR for medical equipment and 
supplies is approximately 34 percent. Thus, the actual cost to the 
hospital of the case including the carotid stent may be much lower than 
the charges would suggest.
    With respect to whether the cost of the technology itself, absent a 
charge markup, makes the case more expensive, we intend to address this 
issue as we make further refinements to the severity-adjusted DRG 
system we describe above. As we indicate in section II.C. of the 
preamble of this proposed rule, the consolidated severity-adjusted DRG 
system that we are proposing does not currently assign a case to a 
higher weighted DRG based on use of a technology that represents 
increased complexity but not necessarily greater severity of illness. 
The use of a carotid stent or stents may increase complexity and 
resource use even though the patient is not more severely ill. We 
believe that the consolidated severity-adjusted DRG system we are 
proposing would need to be further refined to assign cases based on 
complexity as well as severity to account for technologies such as 
carotid stents that increase costs. For this reason, we believe that 
this issue of assignment of carotid stent cases may be better addressed 
in the consolidated severity-adjusted DRG system that we are proposing 
in FY 2008 (if not earlier) than through a change to the current DRG 
assignment for these cases.
3. MDC 5 (Diseases and Disorders of the Circulatory System)
a. Insertion of Epicardial Leads for Defibrillator Devices
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Epicardial Leads'' at the beginning of your 
comment.)
    We received a comment indicating that a change in coding advice for 
the insertion of epicardial leads for CRT-D defibrillator devices 
affects DRG assignment. The commenter noted that the Third Quarter 2005 
issue of the American Hospital Association's publication Coding Clinic 
for ICD-9-CM instructs coders to assign code 37.74 (Insertion or 
replacement of epicardial lead [electrode] into atrium) for pacemaker 
or defibrillator leads inserted through use of a thoracotomy into the 
epicardium. While the use of code 37.74 is standard coding practice for 
pacemakers, the advice is new for defibrillators. This coding advice 
was discussed at the ICD-9-CM Coordination and Maintenance Committee 
meeting held on September 29 and 30, 2005. Participants at the 
Committee meeting proposed modifications for the code category 37.7 
(insertion, revision, replacement, and removal of pacemaker leads; 
insertion of temporary pacemaker system; and revision of cardiac device 
pocket). These modifications involved expanding the category so that 
the codes for leads would no longer be restricted to pacemakers. This 
change would guide coders to use code 37.74 for the insertion of 
epicardial leads for both defibrillators and pacemakers. This change 
was adopted for the ICD-9-CM and will become effective on October 1, 
2006.
    The commenter pointed out that this coding advice would restrict 
some defibrillator cases from being assigned to the defibrillator DRGs. 
Specifically, the commenter expressed concerns about the DRG logic for 
the following DRGs:
     DRG 515 (Cardiac Defibrillator Implant without Cardiac 
Catheter.
     DRG 535 (Cardiac Defibrillator Implant with Cardiac 
Catheter with AMI/Heart Failure/Shock).
     DRG 536 (Cardiac Defibrillator Implant with Cardiac 
Catheter without AMI/Heart Failure/Shock).
    Cases are assigned to one of these three DRGs when a total 
defibrillator system, including both the device and one or more leads, 
is implanted. The implant could be represented by the ICD-9-CM codes 
for the total system, that is, code 00.51 (Implantation of cardiac 
resynchronization defibrillator,

[[Page 24034]]

total system [CRT-D]) or code 37.94 (Implantation or replacement of 
automatic cardioverter/defibrillator, total system [AICD]). Cases can 
also be assigned to DRGs 515, 535, and 536 when a combination of a 
device and a lead code is reported. The following combinations of 
defibrillator device and lead codes are present in the current DRG 
logic:
     00.52 (Implantation or replacement of transvenous lead 
[electrode] into left ventricular coronary venous system) and 00.54 
(Implantation or replacement of cardiac resynchronization 
defibrillator, pulse generator device only [CRT-D]).
     37.95 (Implantation of automatic cardioverter/
defibrillator lead(s) only) and 00.54 (Implantation or replacement of 
cardiac resynchronization defibrillator, pulse generator device only 
[CRT-D]).
     37.95 (Implantation of automatic cardioverter/
defibrillator lead(s) only) and 37.96 (Implantation of automatic 
cardioverter/defibrillator pulse generator only).
     37.97 (Replacement of automatic cardioverter/defibrillator 
lead(s) only) and 00.54 (Implantation or replacement of cardiac 
resynchronization defibrillator, pulse generator device only [CRT-D]).
     37.97 (Replacement of automatic cardioverter/defibrillator 
lead(s) only) and 37.98 (Replacement of automatic cardioverter/
defibrillator pulse generator only).
    A DRG logic issue has arisen concerning the instruction to use code 
37.74 to capture epicardial leads inserted with CRT-D defibrillators. 
The new combination of a defibrillator device with an epicardial lead 
(code 37.74) is not included in DRGs 515, 535, and 536. The commenter 
recommended that the following combinations be added to DRGs 515, 535, 
and 536 so that all types of defibrillator device and lead combinations 
would be included: code 37.74 and code 00.54; code 37.74 and code 
37.96; and code 37.74 and code 37.98.
    We agree that these three combinations should be added to the list 
of combination codes included in DRGs 515, 535, and 536. This would 
result in all combinations of defibrillator devices and leads being 
assigned to one of the defibrillator DRGs. Therefore, we are proposing 
to add these three combinations to the list of procedure combinations 
under DRGs 515, 535, and 536.
b. Application of Major Cardiovascular Diagnoses (MCVs) List to 
Defibrillator DRGs
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: MCVs and Defibrillators'' at the beginning of your 
comment.)
    In the FY 2006 IPPS final rule (70 FR 47289 and 47474 through 
47479), we addressed a comment we had received in response to the FY 
2006 proposed rule which noted that section 507(c) of Pub. L. 108-173 
required MedPAC to conduct a study to determine how the DRG system 
should be updated to better reflect the cost of delivering care in a 
hospital setting. The commenter noted that MedPAC reported that the 
``cardiac surgery DRGs have high relative profitability ratios.'' While 
the commenter acknowledged that it may take time to conduct and 
complete a thorough evaluation of the MedPAC payment recommendations 
for all DRGs, the commenter strongly encouraged CMS to revise the 
cardiac DRGs through patient severity refinement as part of the IPPS 
final rule effective for FY 2006.
    In response to this comment, we performed an extensive review of 
the cardiovascular DRGs in MDC 5, particularly those DRGs that were 
commonly billed by specialty hospitals. We observed that there was some 
overlap between the lists of cardiovascular complications and complex 
diagnoses and that these lists were already used to segregate patients 
into DRGs that use greater resources. Because the hospital industry 
already was familiar with the major complication and complex diagnosis 
lists used within the cardiovascular DRGs, we began our analysis with 
these two overlapping lists.
    The two lists were originally developed for the current DRG system 
because they contained conditions that could have an impact on the 
resources needed to treat a patient with cardiovascular complications. 
Many of the conditions were cardiovascular diagnoses and, therefore, 
would be classified to MDC 5. However, we determined that some of the 
diagnoses were not cardiovascular, but would still have an impact on a 
patient with cardiovascular complications. The conditions that were not 
cardiovascular diagnoses were not assigned to MDC 5 if they were the 
principal diagnosis.
    We reviewed the conditions on the two overlapping lists and 
identified conditions that we believed would lead to a more complicated 
patient stay requiring greater resource use. We referred to these 
conditions as ``major cardiovascular conditions (MCVs).'' The MCVs 
could be present as either a principal diagnosis or a secondary 
diagnosis and lead to greater resource consumption. The complete list 
of MCVs was published in the FY 2006 IPPS final rule (70 FR 47477 and 
47478).
    In the FY 2006 IPPS final rule, we also adopted new DRGs 547 
through 558, effective October 1, 2006 (70 FR 47475 and 47476). 
However, we emphasized that the refinements to the DRGs were being 
taken as an interim step to better recognize severity in the DRG system 
for FY 2006 until we could complete a more comprehensive analysis of 
the APR DRG system and the CC list as part of a complete analysis of 
the MedPAC recommendations that we planned to perform for FY 2007 (and 
which is addressed in section II.C. of the preamble of this proposed 
rule).
    Since publication of the FY 2006 IPPS final rule, we have received 
a question from a commenter as to why we did not apply the MCV list to 
the following defibrillator DRGs: 515, 535, and 536. The commenter 
noted that the pacemaker DRGs were revised using the MCV list, but the 
defibrillator DRGs were not.
    As noted above, for FY 2006, we created new DRGs 546 through 558 to 
identify cases with more costly and severely ill patients as an interim 
step to evaluating severity DRGs. We analyzed for the first time past 
year data on cases within MDC 5 and presented data that showed 
significant difference for patients in certain DRGs based on the 
presence of absence of an MCV. This split did not work for the 
defibrillator DRGs, as we could not identify groups with significantly 
different resource use. For instance, splitting DRG 515 based on the 
presence of an MCV would lead to two groups with differences in charges 
of only $3,430 ($89,341 for those with an MCV and $85,911 for those 
without an MCV). In the data we displayed in the FY 2006 IPPS final 
rule, the differences for DRGs selected for an MCV split ranged from 
$10,319 to $21,035. Splitting DRG 515 based on an MCV would produce a 
difference in charges of only 10.1 percent as compared to differences 
of 28.7 to 47.7 percent for DRGs 547 through 558. Therefore, the data 
did not support including DRG 515 among those split based on the 
presence or absence of an MCV. Similar results were found when DRG 536 
was split by an MCV. There was only an 8.1 percent difference in 
charges between the two groups. We also identified other problems with 
splitting DRG 535 based on the presence or absence of an MCV. Some of 
the codes a claim must include for the case

[[Page 24035]]

to be grouped to DRG 535 under our current system are also codes on the 
MCV list. Therefore, applying the MCV list to DRG 535 would result in 
all cases being assigned to the DRG with an MCV and none to the DRG 
without an MCV. For these reasons, we did not subdivide DRGs 515, 535, 
and 536 based on the presence or absence of an MCV.
    We have decided not to propose additional refinements of the DRGs 
based on MCVs for FY 2007 because of our efforts to propose a broader 
refinement of the DRG system that would focus on consolidated severity-
adjusted DRGs, as discussed in detail in section II.C. of this proposed 
rule. However, as discussed further in section II.C. of this preamble, 
we are soliciting comments on whether it would be appropriate in FY 
2007 to apply a clinical severity concept to an expanded set of DRGs, 
similar to the approach we used in FY 2006 to refine cardiac DRGs based 
on the presence or absence of an MCV.
4. MDC 8 (Diseases and Disorders of the Musculoskeletal System and 
Connective Tissue)
a. Hip and Knee Replacements
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Hip and Knee Replacements'' at the beginning of 
your comment.)
    In the FY 2006 final rule (70 FR 47303), we deleted DRG 209 (Major 
Joint and Limb Reattachment Procedures of Lower Extremity) and created 
new DRGs 544 (Major Joint Replacement or Reattachment of Lower 
Extremity) and 545 (Revision of Hip or Knee Replacement) to help 
resolve payment issues for hospitals that perform revisions of joint 
replacements because we found revisions of joint replacements to be 
significantly more resource intensive than original hip and knee 
replacements. DRG 544 includes the following code assignments:
     81.51, Total hip replacement.
     81.52, Partial hip replacement.
     81.54, Total knee replacement.
     81.56, Total ankle replacement.
     84.26, Foot reattachment.
     84.27, Lower leg or ankle reattachment.
     84.28, Thigh reattachment.
    DRG 545 includes the following procedure code assignments:
     00.70, Revision of hip replacement, both acetabular and 
femoral components.
     00.71, Revision of hip replacement, acetabular component.
     00.72, Revision of hip replacement, femoral component.
     00.73, Revision of hip replacement, acetabular liner and/
or femoral head only.
     00.80, Revision of knee replacement, total (all 
components).
     00.81, Revision of knee replacement, tibial component.
     00.82, Revision of knee replacement, femoral component.
     00.83, Revision of knee replacement, patellar component.
     00.84, Revision of knee replacement, tibial insert 
(liner).
     81.53, Revision of hip replacement, not otherwise 
specified.
     81.55, Revision of knee replacement, not otherwise 
specified.
    In the FY 2006 IPPS final rule (70 FR 47305), we indicated that the 
American Association of Orthopaedic Surgeons had requested that, once 
we receive claims data using the two DRG procedure code assignments, we 
closely examine data from the use of the codes under the two DRGs to 
determine if future additional DRG modifications are needed.
    After publication of the FY 2006 IPPS final rule, a number of 
hospitals and coding personnel advised us that the DRG logic for DRG 
471 (Bilateral or Multiple Major Joint Procedures of Lower Extremity), 
which utilizes the new and revised hip and knee procedure codes under 
DRGs 544 and 545, also includes codes that describe procedures that are 
not bilateral or that do not involve multiple major joints. DRG 471 was 
developed to include cases where major joint procedures such as 
revisions or replacements were performed either bilaterally or on two 
joints of one lower extremity. We changed the logic for DRG 471 last 
year for the first time when we added the new and revised codes. The 
commenters indicated that, by adding the more detailed codes that do 
not include total revisions or replacements to the list of major joint 
procedures to DRG 471, we are assigning cases to DRG 471 that do not 
have bilateral or multiple joint procedures. For example, when a 
hospital reports a code for revision of the tibial component (code 
00.81) and patellar component of the right knee (code 00.83), the 
current DRG logic assigns the case to DRG 471. The commenters indicated 
that this code assignment is incorrect because only one joint has 
undergone surgery, but two components were used. One commenter 
indicated that ICD-9-CM does not identify left/right laterality. 
Therefore, it is difficult to use the current coding structure to 
determine if procedures are performed on the same leg or on both legs. 
The commenters raised concern about whether CMS intended to pay 
hospitals using DRG 471 for procedures performed on one joint. The 
commenters indicated that the DRG assignments for these codes would 
also make future data analysis misleading. The commenters recommended 
removing codes from DRG 471 that do not specifically identify bilateral 
or multiple joint procedures so that DRG 471 will only include cases 
involving the more resource intensive cases of bilateral or multiple 
total joint replacements and revisions.
    We agree that the new and revised joint procedure codes should not 
be assigned to DRG 471 unless they include bilateral and multiple 
joints. Therefore, we are proposing to remove the following codes from 
DRG 471 that do not capture bilateral and multiple joint revisions or 
replacements:
     00.71, Revision of hip replacement, acetabular component.
     00.72, Revision of hip replacement, femoral component.
     00.73, Revision of hip replacement, acetabular liner and/
or femoral head only.
     00.81, Revision of knee replacement, tibial component.
     00.82, Revision of knee replacement, femoral component.
     00.83, Revision of knee replacement, patellar component.
     00.84, Revision of total knee replacement, tibial insert 
(liner).
     81.53, Revision of hip replacement, not otherwise 
specified.
     81.55, Revision of knee replacement, not otherwise 
specified.
    The proposed revised DRG 471 would then contain only the following 
codes:
     00.70, Revision of hip replacement, both acetabular and 
femoral components.
     00.80, Revision of knee replacement, total (all 
components).
     81.51, Total hip replacement.
     81.52, Partial hip replacement.
     81.54, Total knee replacement.
     81.56, Total ankle replacement.
    As a result of the proposed removal of the identified codes from 
DRG 471, we are proposing that one or more of the following hip or knee 
revision codes would be assigned to DRG 545: 00.71, 00.72, 00.73, 
00.81, 00.82, 00.83, 00.84, 81.53, and 81.55. This list includes 
partial revisions of the knee and hip as well as unspecified joint 
procedures such as code 81.55 where it is not clear if the revision is 
total or partial.
    We plan to perform extensive data analysis on the new and revised 
joint procedure codes as we receive billing data to determine if future 
refinements of these DRGs are needed. In addition, as indicated in 
section II.C. of this

[[Page 24036]]

preamble, we are proposing to adopt a consolidated severity-adjusted 
DRG system for the IPPS. We encourage commenters to evaluate how the 
new and revised joint procedures are addressed in the consolidated 
severity-adjusted DRG system. If changes to these procedures are 
warranted based on public comments and our continuing analysis, we will 
evaluate them as we further develop our plans for adopting the 
consolidated severity-adjusted DRGs.
b. Spinal Fusion
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Spinal Fusion'' at the beginning of your comment.)
    In the FY 2006 IPPS final rule (70 FR 47307), we created new DRG 
546 (Spinal Fusions Except Cervical with Curvature of the Spine or 
Malignancy). DRG 546 is composed of all noncervical spinal fusions 
previously assigned to DRGs 497 (Spinal Fusion Except Cervical with CC) 
and 498 (Spinal Fusion Except Cervical without CC) that have a 
principal or secondary diagnosis of curvature of the spine or a 
principal diagnosis of a malignancy. The principal diagnosis codes that 
lead to DRG 546 assignment are the following:
     170.2, Malignant neoplasm of vertebral column, excluding 
sacrum and coccyx.
     198.5, Secondary malignant neoplasm of bone and bone 
marrow.
     213.2, Benign neoplasm of bone and articular cartilage; 
vertebral column, excluding sacrum and coccyx.
     238.0, Neoplasm of uncertain behavior of other and 
unspecified sites and tissues; Bone and articular cartilage.
     239.2, Neoplasms of unspecified nature; bone, soft tissue, 
and skin.
     732.0, Juvenile osteochondrosis of spine.
     733.13, Pathologic fracture of vertebrae.
     737.0, Adolescent postural kyphosis.
     737.10, Kyphosis (acquired) (postural).
     737.11, Kyphosis due to radiation.
     737.12, Kyphosis, postlaminectomy.
     737.19, Kyphosis (acquired), other.
     737.20, Lordosis (acquired) (postural).
     737.21, Lordosis, postlaminectomy.
     737.22, Other postsurgical lordosis.
     737.29, Lordosis (acquired), other.
     737.30, Scoliosis [and kyphoscoliosis], idiopathic.
     737.31, Resolving infantile idiopathic scoliosis.
     737.32, Progressive infantile idiopathic scoliosis.
     737.33, Scoliosis due to radiation.
     737.34, Thoracogenic scoliosis.
     737.39, Other kyphoscoliosis and scoliosis.
     737.8, Other curvatures of spine.
     737.9, Unspecified curvature of spine.
     754.2, Congenital scoliosis.
     756.51, Osteogenesis imperfecta.
    The secondary diagnoses that will lead to DRG 546 assignment are:
     737.40, Curvature of spine, unspecified.
     737.41, Curvature of spine associated with other 
conditions, kyphosis.
     737.42, Curvature of spine associated with other 
conditions, lordosis.
     737.43, Curvature of spine associated with other 
conditions, scoliosis.
    After publication of the FY 2006 IPPS final rule, we received a 
comment stating that creating new DRG 546 was insufficient to address 
clinical severity and resource differences among spinal fusion cases 
that involve fusing multiple levels of the spine. Specifically, the 
commenter suggested that the spinal fusion DRGs be further modified to 
incorporate Bone Morphogenic Protein (BMP), code 84.52 (Insertion of 
recombinant bone morphogenetic protein). The commenter also suggested 
that CMS apply a clinical severity concept to all back and spine 
surgical cases similar to the approach that we used for the MCVs to 
refine the cardiac DRGs in the final rule for FY 2006. The commenter 
recommended recognizing additional conditions that reflect higher 
resource needs, regardless of whether they are principal or secondary 
diagnoses. The commenter also suggested that the spine DRGs be further 
subdivided based on the use of specific spinal devices such as 
artificial discs. These changes would entail the creation of 10 new 
spine DRGs in addition to other changes requested.
    We agree that it is important to recognize severity when 
classifying patients into specific DRGs. In response to recommendations 
made by MedPAC last year that are discussed in section II.C. of this 
proposed rule, we are conducting a comprehensive analysis of the entire 
DRG system to determine whether to undertake significant reform to 
better recognize severity of illness. At this time, we believe it is 
premature to develop a severity adjustment for spine surgeries while we 
are considering a more systematic approach to capturing severity of 
illness across all DRGs. We also believe it would be premature to 
propose revisions to DRG 546 because this DRG was created on October 1, 
2005, and we do not yet have data to analyze its impact. Given the 
number of innovations occurring in spinal surgery over the last several 
years (for example, artificial spinal disc prostheses, kyphoplasty, and 
vertebroplasty), we agree that additional analysis of the spine DRGs 
would be warranted if we were to continue with the current DRG system 
and not adopt consolidated severity-adjusted DRGs. However, as 
discussed above, we are proposing to develop a severity-adjusted DRG 
system. For this reason, we are not further researching this issue for 
FY 2007. However, we encourage commenters to examine the proposed 
consolidated severity-adjusted DRG system described in section II.C. of 
the preamble of this proposed rule to determine whether there is a 
better recognition of severity of illness and resource use in that 
system.
c. Charite\TM\ Spinal Disc Replacement Device
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: CHARITE\TM\'' at the beginning of your comment.)
    CHARITE\TM\ is a prosthetic intervertebral disc. On October 26, 
2004, the FDA approved the CHARITE\TM\ Artificial Disc for single level 
spinal arthroplasty in skeletally mature patients with degenerative 
disc disease between L4 and S1. On October 1, 2004, we created new 
procedure codes for the insertion of spinal disc prostheses (codes 
84.60 through 84.69). We provided the DRG assignments for these new 
codes in Table 6B of the FY 2005 IPPS proposed rule (69 FR 28673). We 
received a number of comments on the proposed rule recommending that we 
change the assignments for these codes from DRG 499 (Back and Neck 
Procedures Except Spinal Fusion With CC) and DRG 500 (Back and Neck 
Procedures Except Spinal Fusion Without CC) to the DRGs for spinal 
fusion, DRG 497 (Spinal Fusion Except Cervical With CC) and DRG 498 
(Spinal Fusion Except Cervical Without CC) for procedures on the lumbar 
spine and to DRGs 519 and 520 for procedures on the cervical spine. In 
the FY 2005 IPPS final rule (69 FR 48938), we indicated that DRGs 497 
and 498 are limited to spinal fusion procedures. Because the surgery 
involving the CHARITE\TM\ is not a spinal fusion, we decided not to 
include this procedure in these DRGs. However, we stated that we would 
continue to analyze this issue and solicited further public comments on 
the DRG assignment for spinal disc prostheses.
    In the FY 2006 final rule (70 FR 47353), we noted that, if a 
product

[[Page 24037]]

meets all of the criteria for Medicare to pay for the product as a new 
technology under section 1886(d)(5)(K) of the Act, there is a clear 
preference expressed in the statute for us to assign the technology to 
a DRG based on similar clinical or anatomical characteristics or costs. 
However, for FY 2006, we did not find that CHARITE\TM\ met the 
substantial clinical improvement criterion and, thus, did not qualify 
as a new technology. Consequently, we did not address the DRG 
classification request made under the authority of this provision of 
the Act.
    However, we did evaluate whether to reassign CHARITE\TM\ to 
different DRGs using the Secretary's authority under section 1886(d)(4) 
of the Act (70 FR 47308). We indicated that we did not have Medicare 
charge information to evaluate DRG changes for cases involving an 
implant of a prosthetic intervertebral disc like CHARITE\TM\ and did 
not make a change in its DRG assignments. We stated that we would 
consider whether changes to the DRG assignments for CHARITE\TM\ were 
warranted for FY 2007, once we had information from Medicare's data 
system that would assist us in evaluating the costs of these patients.
    For the FY 2007 IPPS update, we received a comment regarding the 
DRG assignments for the CHARITETM Artificial Disc, code 
84.65 (Insertion of total spinal disc prosthesis, lumbosacral). The 
commenter had previously submitted an application for the 
CHARITETM Artificial Disc for new technology add-on payments 
for FY 2006 and had requested a reassignment of cases involving 
CHARITETM implantation to DRGs 497 and 498. The commenter 
asked that we examine claims data for FY 2005 and reassign procedure 
code 84.65 from DRGs 499 and 500 into DRGs 497 and 498. The commenter 
again stated the view that cases with the CHARITETM 
Artificial Disc reflect comparable resource use and similar clinical 
indications as do those in DRGs 497 and 498. If CMS were to reject 
reassignment of the CHARITETM Artificial Disc to DRGs 497 
and 498, the commenter suggested creating two separate DRGs for lumbar 
disc replacements.
    On February 16, 2006, we posted a proposed NCD memorandum regarding 
lumber artificial disc replacement with a focus of the 
CHARITETM Lumber Artificial Disc for public comment on the 
CMS Web site. This is part of the process for issuing an NCD. In this 
memorandum, we proposed to issue an NCD. We are seeking public comment 
on our proposed determination that the evidence is not adequate to 
conclude that lumbar artificial disc replacement with the 
CHARITETM Lumber Artificial Disc is reasonable and 
necessary. This proposed decision memorandum can be found at: http://www.cms.hhs.gov/mcd/viewnca.asp?where=index&nca_id=170&basket=nca:00292N:170:Lumbar+Artificial+Disc+Replacement:Open:New:5 Open:New:5. 
After considering the public comments and any additional evidence, we 
will make a final determination and issue a final NCD.
    The proposed NCD states that lumber artificial disc replacement 
with the CHARITETM Lumber Artificial Disc is generally not 
indicated in patients over 65 years old. Further, it states that there 
is insufficient evidence among either the aged or disabled Medicare 
population to make a reasonable and necessary determination for 
coverage. With an NCD pending to make spinal arthroplasty with 
CHARITETM noncovered, we do not believe it is appropriate at 
this time to reassign procedure code 84.65 from DRGs 499 and 500 to 
DRGs 497 and 498.
5. MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified 
Sites)): Severe Sepsis
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Severe Sepsis'' at the beginning of your comment.)
    In FYs 2005 and 2006, we considered requests for the creation of a 
separate DRG for the diagnosis of severe sepsis. Severe sepsis is 
described by ICD-9-CM code 995.92 (Systemic inflammatory response 
syndrome due to infection with organ dysfunction). Patients admitted 
with sepsis as a principal diagnosis currently are assigned to DRG 416 
(Septicemia Age > 17) and DRG 417 (Septicemia Age 0-17) in MDC 18 
(Infectious and Parasitic Diseases (Systemic or Unspecified Sites)). 
The commenter requested that all cases in which severe sepsis is 
present on admission, as well as those cases in which it develops after 
admission (which are currently classified elsewhere), be included in 
this new DRG. In both FY 2005 and FY 2006 (69 FR 48975 and 70 FR 
47309), we did not believe the current clinical definition of severe 
sepsis was specific enough to identify a meaningful cohort of patients 
in terms of clinical coherence and resource utilization to warrant a 
separate DRG. Sepsis is found across hundreds of medical and surgical 
DRGs, and the term ``organ dysfunction'' implicates numerous currently 
existing diagnosis codes. While we recognize that Medicare 
beneficiaries with severe sepsis are quite ill and require extensive 
hospital resources, in the past we have not found that they can be 
identified adequately to justify removing them from all of the other 
DRGs in which they appear. For this reason, we did not create a new DRG 
for severe sepsis for FY 2005 or FY 2006. We indicated that we would 
continue to work with National Center for Health Statistics (NCHS) to 
improve the codes so that our data on these patients improve. We also 
indicated that we would continue to examine data on these patients as 
we consider future modifications.
    For this FY 2007 proposed rule, we again received a request to 
consider creating a separate DRG for patients diagnosed with severe 
sepsis. The information and data available to us from hospital bills 
with respect to identifying patients with severe sepsis have not 
changed since last year. However, the NCHS discussed modifications to 
the current ICD-9-CM diagnosis codes for systemic inflammatory response 
syndrome (SIRS), codes 995.91 through 995.94 (which include severe 
sepsis) at the September 29-30, 2005 ICD-9-CM Coordination and 
Maintenance Committee meeting. During the meeting, it became clear that 
there is still confusion surrounding the use of these codes. As a 
result of the meeting and the comments received, the Committee made 
modifications to the set of SIRS codes. These modifications are 
reflected in Table 6E, Revised Diagnosis Code Titles, of the Addendum 
to this proposed rule.
    We believe that implementation of the modified SIRS diagnosis codes 
and the updated coding guidelines over the next year could begin the 
process of improving data for this group of patients. The desired 
outcome is to be able to better evaluate Medicare beneficiaries with 
severe sepsis with regard to their clinical coherence, resource 
utilization, and charges. Therefore, at this time, we are not proposing 
to create a new DRG for severe sepsis for FY 2007. We also note that we 
are proposing to adopt a consolidated severity-adjusted DRG system, as 
discussed in section II.C. of this preamble. The underlying clinical 
principle of the proposed consolidated severity-adjusted DRG system is 
that the severity of illness of a patient is highly dependent on the 
patient's underlying problem and that patients with high severity of 
illness are usually characterized by multiple serious diseases or 
illnesses. The assessment of the severity of illness of a patient is 
specific to the base DRG to which a patient is assigned. In other 
words, the determination of the severity of illness is disease-
specific. High severity of

[[Page 24038]]

illness is primarily determined by the interaction of multiple 
diseases. Patients with multiple comorbid conditions involving multiple 
organ systems are assigned to the higher severity of illness 
subclasses. Thus, patients with severe sepsis and organ dysfunction are 
likely to be classified as severity of illness subclass 3 or 4 under 
the proposed DRG system, depending on the other comorbid conditions or 
underlying problems the patient may have at that time. It is possible 
that the consolidated severity-adjusted DRG system that we are planning 
to adopt would better recognize the extensive resources that hospitals 
use to treat patients with severe sepsis. We encourage commenters to 
examine the consolidated severity-adjusted DRGs described in section 
II.C. of this proposed rule to determine whether there is a better 
recognition of severity of illness and resource use in that proposed 
system.
6. Medicare Code Editor (MCE) Changes
    (If you choose to comment on issues in this section, please include 
the caption ``Medicare Code Editor'' at the beginning of your comment.)
    As explained under section II.B.1. of this preamble, the Medicare 
Code Editor (MCE) is a software program that detects and reports errors 
in the coding of Medicare claims data. Patient diagnoses, procedure(s), 
discharge status, and demographic information go into the Medicare 
claims processing systems and are subjected to a series of automated 
screens. The MCE screens are designed to identify cases that require 
further review before classification into a DRG.
    For FY 2007, we are proposing to make the following changes to the 
MCE edits:
a. Newborn Diagnoses Edit
    We are proposing to add code 780.92 (Excessive crying of infant 
(baby)) to the ``Newborn Diagnoses'' edit in the MCE. This edit is 
structured for patients with an age of ``0''. In the Tabular portion of 
the ICD-9-CM diagnosis codes, the ``excludes'' note at code 780.92 
states that this code ``excludes excessive crying of child, adolescent 
or adult'' and sends the coder to code 780.95 (Other excessive crying. 
(The new title of this code, shown on Table 6E of the Addendum to this 
proposed rule is ``Excessive crying of child, adolescent, or adult).) 
To make a conforming change, we also are proposing that code 780.92 be 
removed from the ``Pediatric Diagnoses--Age 0 Through 17'' edit.
b. Diagnoses Allowed for Females Only Edit
    The following codes are now invalid codes, as shown in Table 6C of 
the Addendum to this proposed rule. Therefore, we are proposing to 
remove them from the ``Diagnosis Allowed for Females Only'' edit in the 
MCE.
     616.8, Other specified inflammatory diseases of cervix, 
vagina, and vulva.
     629.8, Other specified disorders of female genital organs.
    Codes 616.8 and 629.8 have been expanded to the fifth-digit level. 
Therefore, we are proposing to place the following expanded codes in 
the ``Diagnoses Allowed for Females Only'' edit.
     616.81, Mucositis (ulcerative) of cervix, vagina, and 
vulva.
     616.89, Other inflammatory disease of cervix, vagina, and 
vulva.
     629.81, Habitual aborter without current pregnancy.
     629.89, Other specified disorders of female genital 
organs.
    The following two codes have revised descriptions (as shown in 
Table 6E of the Addendum to this proposed rule) which specify gender. 
Therefore, we are proposing to add them to ``Diagnoses Allowed for 
Females Only'' edit.
     V26.31, Testing of female for genetic disease carrier 
status.
     V26.32, Other genetic testing of female.
c. Diagnoses Allowed for Males Only Edit
    Code 608.2 (Torsion of testis) is now an invalid code (as shown in 
Table 6C of the Addendum to this proposed rule). Therefore, we are 
proposing to remove it from the ``Diagnoses Allowed for Males Only'' 
edit. This code has been expanded to the fifth-digit level. Therefore, 
we are proposing to place the following expanded codes in the 
``Diagnoses Allowed for Males Only'' edit:
     608.20, Torsion of testis, unspecified.
     608.21, Extravaginal torsion of spermatic cord.
     608.22 Intravaginal torsion of spermatic cord.
     608.23, Torsion of appendix testis.
     608.24, Torsion of appendix epididymis.
    The following codes have been created effective for FY 2007 and are 
gender specific. Therefore, we are proposing to add them to the 
``Diagnosis Allowed for Males Only'' edit.
     V26.34, Testing of male for genetic disease carrier 
status.
     V26.35, Encounter for testing of male partner of habitual 
aborter.
     V26.39, Other genetic testing of male.
d. Manifestations Not Allowed as Principal Diagnosis Edit
    We are proposing to add the following codes to the ``Manifestations 
Not Allowed as Principal Diagnosis'' edit in the MCE:
     362.03, Nonproliferative diabetic retinopathy, NOS.
     362.04, Mild nonproliferative diabetic retinopathy.
     362.05, Moderate nonproliferative diabetic retinopathy.
     362.06, Severe nonproliferative diabetic retinopathy.
     362.07, Diabetic macular edema.
    In addition, we are proposing to remove code 525.10 (Acquired 
absence of teeth, unspecified) from this edit in the MCE.
e. Nonspecific Principal Diagnosis Edit
    We are proposing to add the following codes to the ``Nonspecific 
Principal Diagnosis'' edit in the MCE:
     255.10, Hyperaldosteronism, unspecified.
     323.9, Unspecified causes of encephalitis, myelitis, and 
encephalomyelitis.
     770.10, Fetal and newborn aspiration, unspecified.
     780.31, Febrile convulsions (simple), unspecified.
    Codes 255.10, 323.9, and 780.31 appear on Table 6E, Revised 
Diagnosis Codes, and are being included in this edit because of their 
revised descriptions. Code 770.10 was inadvertently left off this list 
for FY 2006 when the code was created.
f. Unacceptable Principal Diagnosis Edit
    Most V-codes describe an individual's health status, but these 
codes are not usually a current illness or injury. Therefore, most V-
codes are included in the ``Unacceptable Principal Diagnosis'' edit. 
The following codes became invalid (as shown in Table 6C of the 
Addendum to this proposed rule) for FY 2007, and we are proposing to 
remove them from this edit:
     V18.5, Family history, digestive disorders.
     V58.3, Attention to surgical dressings and sutures.
     V72.1, Examination of ears and hearing.
    The following V-codes represent either fifth-digit extensions of 
the above codes, or new codes that were created effective October 1, 
2006 (Table 6A of the Addendum to this proposed rule). Therefore, we 
are proposing to add the following codes to the ``Unacceptable 
Principal Diagnosis'' edit:

[[Page 24039]]

     V18.51, Family history, colonic polyps.
     V18.59, Family history, other digestive disorders.
     V26.34, Testing of male for genetic disease carrier 
status.
     V26.35, Encounter for testing of male partner of habitual 
aborter.
     V26.39, Other genetic testing of male.
     V45.86, Bariatric surgery status.
     V58.30, Encounter for change or removal of nonsurgical 
wound dressing.
     V58.31, Encounter for change or removal of surgical wound 
dressing.
     V58.32, Encounter for removal of sutures.
     V72.11, Encounter for hearing examination following failed 
hearing screening.
     V72.19, Other examination of ears and hearing.
     V82.71, Screening for genetic disease carrier status.
     V82.79, Other genetic screening.
     V85.51, Body mass index, pediatric, less than 5th 
percentile for age.
     V85.52, Body mass index, pediatric, 5th percentile to less 
than 85th percentile for age.
     V85.53, Body mass index, pediatric, 85th percentile to 
less than 95th percentile for age.
     V85.54, Body mass index, pediatric, greater than or equal 
to 95th percentile for age.
     V86.0, Estrogen receptor positive status [ER+].
     V86.1, Estrogen receptor negative status [ER-].
g. Nonspecific O.R. Procedures Edit
    We are proposing to remove code 00.29 (Intravascular imaging 
unspecified vessel(s)) from the ``Nonspecific O.R. Procedure'' edit in 
the MCE. This code was erroneously placed in this edit; it is not 
considered an O.R. procedure.
h. Noncovered Procedures Edit
    Under the proposed changes to DRG 513 (Pancreas Transplant) under 
the Pre-MDCs described in section II.D.1. of this preamble, a patient 
must have a history of medically uncontrollable, insulin-dependent 
diabetes mellitus, that is, Type I diabetes mellitus. Therefore, to 
conform the ``Noncovered Procedures'' Edit in the MCE to these proposed 
changes, we are proposing to revise Diagnosis List 1 in this edit to 
include only the following codes:
     250.01, Diabetes mellitus without mention of complication, 
type I [juvenile type], not stated as uncontrolled.
     250.03, Diabetes mellitus without mention of complication, 
type I [juvenile type], uncontrolled.
     250.11, Diabetes with ketoacidosis, type I [juvenile 
type], not stated as uncontrolled.
     250.13, Diabetes with ketoacidosis, type I [juvenile 
type], uncontrolled.
     250.21, Diabetes with hyperosmolarity, type I [juvenile 
type], not stated as uncontrolled.
     250.23, Diabetes with hyperosmolarity, type I [juvenile 
type], uncontrolled.
     250.31, Diabetes with other coma, type I [juvenile type], 
not stated as uncontrolled.
     250.33, Diabetes with other coma, type I [juvenile type], 
uncontrolled.
     250.41, Diabetes with renal manifestations, type I 
[juvenile type], not stated as uncontrolled.
     250.43, Diabetes with renal manifestations, type I 
[juvenile type], uncontrolled.
     250.51, Diabetes with ophthalmic manifestations, type I 
[juvenile type], not stated as uncontrolled.
     250.53, Diabetes with ophthalmic manifestations, type I 
[juvenile type], uncontrolled.
     250.61, Diabetes with neurological manifestations, type I 
[juvenile type], not stated as uncontrolled.
     250.63, Diabetes with neurological manifestations, type I 
[juvenile type], uncontrolled.
     250.71, Diabetes with peripheral circulatory disorders, 
type I [juvenile type], not stated as uncontrolled.
     250.73, Diabetes with peripheral circulatory disorders, 
type I [juvenile type], uncontrolled.
     250.81, Diabetes with other specified manifestations, type 
I [juvenile type], not stated as uncontrolled.
     250.83, Diabetes with other specified manifestations, type 
I [juvenile type], uncontrolled.
     250.91, Diabetes with unspecified complication, type I 
[juvenile type], not stated as uncontrolled.
     250.93, Diabetes with unspecified complication, type I 
[juvenile type], uncontrolled.
    In addition, we are proposing to remove Diagnosis List 2 from the 
``Noncovered Procedures'' edit, which is comprised of the following 
codes:
     403.01, Hypertensive kidney disease, malignant, with 
chronic kidney disease.
     403.11, Hypertensive kidney disease, benign, with chronic 
kidney disease.
     403.91, Hypertensive kidney disease, unspecified, with 
chronic kidney disease.
     404.02, Hypertensive heart and kidney disease, malignant, 
with chronic kidney disease.
     404.03, Hypertensive heart and kidney disease, malignant, 
with heart failure and chronic kidney disease.
     404.12, Hypertensive heart and kidney disease, benign, 
with chronic kidney disease.
     404.13, Hypertensive heart and kidney disease, benign, 
with heart failure and chronic kidney disease.
     404.92, Hypertensive heart and kidney disease, 
unspecified, with chronic kidney disease.
     404.93, Hypertensive heart and kidney disease, 
unspecified, with heart failure and chronic kidney disease.
     585.1, Chronic kidney disease, Stage I.
     585.2, Chronic kidney disease, Stage II (mild).
     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.
     585.9, Chronic kidney disease, unspecified.
     V42.0, Organ or tissue replaced by transplant, kidney.
     V43.89, Organ or tissue replaced by other means, other 
organ or tissue, other.
i. Bilateral Procedure Edit
    We are proposing to remove the following codes from the ``Bilateral 
Procedure'' edit, as these are adjunct codes. They are not O.R. codes 
recognized by the GROUPER as procedures, and the edit was created in 
error last year.
     00.74, Hip replacement bearing surface, metal on 
polyethylene.
     00.75, Hip replacement bearing surface, metal-on-metal.
     00.76, Hip replacement bearing surface, ceramic-on-
ceramic.
7. Surgical Hierarchies
    (If you choose to comment on issues in this section, please include 
the caption ``DRGs: Surgical Hierarchies'' at the beginning of your 
comments.)
    Some inpatient stays entail multiple surgical procedures, each one 
of which, occurring by itself, could result in assignment of the case 
to a different DRG within the MDC to which the principal diagnosis is 
assigned. Therefore, it is necessary to have a decision rule within the 
GROUPER by which these cases are assigned to a single DRG. The surgical 
hierarchy, an ordering of surgical classes from most resource-intensive 
to least resource-intensive, performs that function. Application of 
this hierarchy ensures that cases involving multiple surgical

[[Page 24040]]

procedures are assigned to the DRG associated with the most resource-
intensive surgical class.
    Because the relative resource intensity of surgical classes can 
shift as a function of DRG reclassification and recalibrations, we 
reviewed the surgical hierarchy of each MDC, as we have for previous 
reclassifications and recalibrations, to determine if the ordering of 
classes coincides with the intensity of resource utilization.
    A surgical class can be composed of one or more DRGs. For example, 
in MDC 11, the surgical class ``kidney transplant'' consists of a 
single DRG (DRG 302) and the class ``kidney, ureter and major bladder 
procedures'' consists of three DRGs (DRGs 303, 304, and 305). 
Consequently, in many cases, the surgical hierarchy has an impact on 
more than one DRG. The methodology for determining the most resource-
intensive surgical class involves weighting the average resources for 
each DRG by frequency to determine the weighted average resources for 
each surgical class. For example, assume surgical class A includes DRGs 
1 and 2 and surgical class B includes DRGs 3, 4, and 5. Assume also 
that the average charge of DRG 1 is higher than that of DRG 3, but the 
average charges of DRGs 4 and 5 are higher than the average charge of 
DRG 2. To determine whether surgical class A should be higher or lower 
than surgical class B in the surgical hierarchy, we would weight the 
average charge of each DRG in the class by frequency (that is, by the 
number of cases in the DRG) to determine average resource consumption 
for the surgical class. The surgical classes would then be ordered from 
the class with the highest average resource utilization to that with 
the lowest, with the exception of ``other O.R. procedures'' as 
discussed below.
    This methodology may occasionally result in assignment of a case 
involving multiple procedures to the lower-weighted DRG (in the 
highest, most resource-intensive surgical class) of the available 
alternatives. However, given that the logic underlying the surgical 
hierarchy provides that the GROUPER search for the procedure in the 
most resource-intensive surgical class, in cases involving multiple 
procedures, this result is sometimes unavoidable.
    We note that, notwithstanding the foregoing discussion, there are a 
few instances when a surgical class with a lower average charge is 
ordered above a surgical class with a higher average charge. For 
example, the ``other O.R. procedures'' surgical class is uniformly 
ordered last in the surgical hierarchy of each MDC in which it occurs, 
regardless of the fact that the average charge for the DRG or DRGs in 
that surgical class may be higher than that for other surgical classes 
in the MDC. The ``other O.R. procedures'' class is a group of 
procedures that are only infrequently related to the diagnoses in the 
MDC, but are still occasionally performed on patients in the MDC with 
these diagnoses. Therefore, assignment to these surgical classes should 
only occur if no other surgical class more closely related to the 
diagnoses in the MDC is appropriate.
    A second example occurs when the difference between the average 
charges for two surgical classes is very small. We have found that 
small differences generally do not warrant reordering of the hierarchy 
because, as a result of reassigning cases on the basis of the hierarchy 
change, the average charges are likely to shift such that the higher-
ordered surgical class has a lower average charge than the class 
ordered below it.
    Based on the changes under the HSVRcc weighting methodology that we 
are proposing for FY 2007, as discussed in section II.C.2. of this 
preamble, we are proposing to revise the surgical hierarchy for Pre-
MDCs, MDC 1 (Diseases and Disorders of the Nervous System), MDC 2 
(Diseases and Disorders of the Eye), MDC 3 (Diseases and Disorders of 
the Ear, Nose, Mouth and Throat), MDC 8 (Diseases and Disorders of the 
Musculoskeletal System and Connective Tissue), MDC 10 (Endocrine, 
Nutritional and Metabolic Diseases and Disorders), and MDC 13 (Diseases 
and Disorders of the Female Reproductive System) as follows. In our 
analysis, we looked at the number of cases and the arithmetic mean.
    In Pre-MDCs, we are proposing to reorder DRG 481 (Bone Marrow 
Transplant) above DRG 513 (Pancreas Transplant).
    In MDC 1, we are proposing to reorder DRGs 531-532 (Spinal 
Procedures, with CC and without CC, respectively) above DRGs 529-530 
(Ventricular Shunt Procedures, with CC and without CC, respectively).
    In MDC 2, we are proposing to reorder DRG 42 (Intraocular 
Procedures Except Retina, Iris and Lens) above DRG 36 (Retinal 
Procedures).
    In MDC 3, we are proposing to reorder DRGs 168-169 (Mouth 
Procedures, with CC and without CC, respectively) above DRG 57 (T&A 
Procedures, Except Tonsillectomy and/or Adenoidectomy Only, Age > 17) 
and DRG 58 (T&A Procedures, Except Tonsillectomy and/or Adenoidectomy 
Only, Age 0-17).
    In MDC 8, we are proposing to reorder DRG 213 (Amputation for 
Musculoskeletal System and Connective Tissue Disorders) above DRG 216 
(Biopsies of Musculoskeletal System and Connective Tissue).
    In MDC 10, we are proposing to reorder DRG 285 (Amputation of Lower 
Limb for Endocrine, Nutritional and Metabolic Diseases and Disorders) 
above DRG 288 (O.R. Procedures for Obesity).
    In MDC 13, we are proposing to reorder DRG 363 (D&C, Conization and 
Radio-Implant, for Malignancy) and DRG 364 (D&C, Conization and Radio-
Implant, Except for Malignancy) above DRG 360 (Vagina, Cervix, and 
Vulva Procedures).
8. Refinement of Complications and Comorbidities (CC) List
    (If you choose to comment on issues in this section, please include 
the caption ``CC List'' at the beginning of your comment.)
a. Background
    As indicated earlier in this preamble, under the IPPS DRG 
classification system, we have developed a standard list of diagnoses 
that are considered complications or comorbidities (CCs). Historically, 
we developed this list using physician panels that classified each 
diagnosis code based on whether the diagnosis, when present as a 
secondary condition, would be considered a substantial complication or 
comorbidity. A substantial complication or comorbidity was defined as a 
condition that, because of its presence with a specific principal 
diagnosis, would cause an increase in the length of stay by at least 1 
day in at least 75 percent of the patients.
b. Comprehensive Review of the CC List
    In previous years, we have made changes to the standard list of 
CCs, either by adding new CCs or deleting CCs already on the list, but 
we have never conducted a comprehensive review of the list. Given the 
long period of time that had elapsed since the original CC list was 
developed, the incremental nature of changes to it, and changes in the 
way inpatient care is delivered, and in partial response to 
recommendations in MedPAC's March 2005 Report to Congress on Physician-
Owned Specialty Hospitals, for the FY 2006 IPPS final rule, we reviewed 
the 121-paired DRGs that were split on the presence or absence of a CC 
among the 3,285 diagnosis codes on the CC list. We presented the 
results of that review and summarized public comments that we received 
in the FY 2006 proposed rule on the review results in the FY 2006 IPPS 
final rule (70 FR 47313 through 47315). Further analysis of the CC list

[[Page 24041]]

and refinement to recognize the effects of differences in severity of 
illness among patients is discussed in section II.C. of this preamble 
as part of our efforts to develop a consolidated severity-adjusted DRG 
system for use in the IPPS. However, as further discussed in section 
II.C. of the preamble to this proposed rule, we are soliciting comments 
on whether it would be appropriate in FY 2007 to apply to an expanded 
set of DRGs a clinical severity concept similar to the approach we used 
in FY 2006 to refine cardiac DRGs based on the presence or absence of 
an MCV.
c. CC Exclusions List Proposed for FY 2007
    In the September 1, 1987 final notice (52 FR 33143) concerning 
changes to the DRG classification system, we modified the GROUPER logic 
so that certain diagnoses included on the standard list of CCs would 
not be considered valid CCs in combination with a particular principal 
diagnosis. We created the CC Exclusions List for the following reasons: 
(1) To preclude coding of CCs for closely related conditions; (2) to 
preclude duplicative or inconsistent coding from being treated as CCs; 
and (3) to ensure that cases are appropriately classified between the 
complicated and uncomplicated DRGs in a pair. As we indicated above, we 
developed a list of diagnoses, using physician panels, to include those 
diagnoses that, when present as a secondary condition, would be 
considered a substantial complication or comorbidity. In previous 
years, we have made changes to the list of CCs, either by adding new 
CCs or deleting CCs already on the list. At this time, we are not 
proposing to delete any of the diagnosis codes on the CC list for FY 
2007.
    In the May 19, 1987 proposed notice (52 FR 18877) and the September 
1, 1987 final notice (52 FR 33154), we explained that the excluded 
secondary diagnoses were established using the following five 
principles:
     Chronic and acute manifestations of the same condition 
should not be considered CCs for one another.
     Specific and nonspecific (that is, not otherwise specified 
(NOS)) diagnosis codes for the same condition should not be considered 
CCs for one another.
     Codes for the same condition that cannot coexist, such as 
partial/total, unilateral/bilateral, obstructed/unobstructed, and 
benign/malignant, should not be considered CCs for one another.
     Codes for the same condition in anatomically proximal 
sites should not be considered CCs for one another.
     Closely related conditions should not be considered CCs 
for one another.
    The creation of the CC Exclusions List was a major project 
involving hundreds of codes. We have continued to review the remaining 
CCs to identify additional exclusions and to remove diagnoses from the 
master list that have been shown not to meet the definition of a CC.\9\
---------------------------------------------------------------------------

    \9\ See the FY 1989 final rule (53 FR 38485, September 30, 
1988), for the revision made for the discharges occurring in FY 
1989; the FY 1990 final rule (54 FR 36552, September 1, 1989), for 
the FY 1990 revision; the FY 1991 final rule (55 FR 36126, September 
4, 1990), for the FY 1991 revision; the FY 1992 final rule (56 FR 
43209, August 30, 1991) for the FY 1992 revision; the FY 1993 final 
rule (57 FR 39753),September 1, 1992), for the FY 1993 revision; the 
FY 1994 final rule (58 FR 46278, September 1, 1993), for the FY 1994 
revisions; the FY 1995 final rule (59 FR 45334, September 1, 1994), 
for the FY 1995 revisions; the FY 1996 final rule (60 FR 45782, 
September 1, 1995), for the FY 1996 revisions; the FY 1997 final 
rule (61 FR 46171, August 30, 1996), for the FY 1997 revisions; the 
FY 1998 final rule (62 FR 45966, August 29, 1997) for the FY 1998 
revisions; the FY 1999 final rule (63 FR 40954, July 31, 1998), for 
the FY 1999 revisions; the FY 2001 final rule (65 FR 47064, August 
1, 2000), for the FY 2001 revisions; the FY 2002 final rule (66 FR 
39851, August 1, 2001), for the FY 2002 revisions; the FY 2003 final 
rule (67 FR 49998, August 1, 2002), for the FY 2003 revisions; the 
FY 2004 final rule (68 FR 45364, August 1, 2003), for the FY 2004 
revisions; the FY 2005 final rule (69 FR 49848, August 11, 2004), 
for the FY 2005 revisions; and the FY 2006 final rule (70 FR 47640, 
August 12, 2005), for the FY 2006 revisions. In the FY 2000 final 
rule (64 FR 41490, July 30, 1999, we did not modify the CC 
Exclusions List because we did not make any changes to the ICD-9-CM 
codes for FY 2000.
---------------------------------------------------------------------------

    We are proposing to make limited revisions to the CC Exclusions 
List to take into account the changes that will be made in the ICD-9-CM 
diagnosis coding system effective October 1, 2006. (See section 
II.D.10. of this preamble for a discussion of ICD-9-CM changes.) We are 
proposing these changes in accordance with the principles established 
when we created the CC Exclusions List in 1987.
    Tables 6G and 6H in the Addendum to this proposed rule contain the 
revisions to the CC Exclusions List that would be effective for 
discharges occurring on or after October 1, 2006. Each table shows the 
principal diagnoses with changes to the excluded CCs. Each of these 
principal diagnoses is shown with an asterisk, and the additions or 
deletions to the CC Exclusions List are provided in an indented column 
immediately following the affected principal diagnosis.
    CCs that are added to the list are in Table 6G--Additions to the CC 
Exclusions List. Beginning with discharges on or after October 1, 2006, 
the indented diagnoses will not be recognized by the GROUPER as valid 
CCs for the asterisked principal diagnosis.
    CCs that are deleted from the list are in Table 6H--Deletions from 
the CC Exclusions List. Beginning with discharges on or after October 
1, 2006, the indented diagnoses will be recognized by the GROUPER as 
valid CCs for the asterisked principal diagnosis.
    Copies of the original CC Exclusions List applicable to FY 1988 can 
be obtained from the National Technical Information Service (NTIS) of 
the Department of Commerce. It is available in hard copy for $152.50 
plus shipping and handling. A request for the FY 1988 CC Exclusions 
List (which should include the identification accession number (PB) 88-
133970) should be made to the following address: National Technical 
Information Service, United States Department of Commerce, 5285 Port 
Royal Road, Springfield, VA 22161; or by calling (800) 553-6847.
    Users should be aware of the fact that all revisions to the CC 
Exclusions List (FYs 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 
1997, 1998, 1999, 2001, 2002, 2003, 2004, 2005, and 2006) and those in 
Tables 6G and 6H of this proposed rule for FY 2007 must be incorporated 
into the list purchased from NTIS in order to obtain the CC Exclusions 
List applicable for discharges occurring on or after October 1, 2006.
    (Note: There was no CC Exclusions List in FY 2000 because we did 
not make changes to the ICD-9-CM codes for FY 2000.)
    Alternatively, the complete documentation of the GROUPER logic, 
including the current CC Exclusions List, is available from 3M/Health 
Information Systems (HIS), which, under contract with CMS, is 
responsible for updating and maintaining the GROUPER program. The 
current DRG Definitions Manual, Version 23.0, is available for $225.00, 
which includes $15.00 for shipping and handling. Version 24.0 of this 
manual, which will include the final FY 2007 DRG changes, will be 
available in hard copy for $250.00. Version 24.0 of the manual is also 
available on a CD for $200.00; a combination hard copy and CD is 
available for $400.00. These manuals may be obtained by writing 3M/HIS 
at the following address: 100 Barnes Road, Wallingford, CT 06492; or by 
calling (203) 949-0303. Please specify the revision or revisions 
requested.
9. Review of Procedure Codes in DRGs 468, 476, and 477
    Each year, we review cases assigned to DRG 468 (Extensive O.R. 
Procedure Unrelated to Principal Diagnosis), DRG 476 (Prostatic O.R. 
Procedure Unrelated

[[Page 24042]]

to Principal Diagnosis), and DRG 477 (Nonextensive O.R. Procedure 
Unrelated to Principal Diagnosis) to determine whether it would be 
appropriate to change the procedures assigned among these DRGs.
    DRGs 468, 476, and 477 are reserved for those cases in which none 
of the O.R. procedures performed are related to the principal 
diagnosis. These DRGs are intended to capture atypical cases, that is, 
those cases not occurring with sufficient frequency to represent a 
distinct, recognizable clinical group. DRG 476 is assigned to those 
discharges in which one or more of the following prostatic procedures 
are performed and are unrelated to the principal diagnosis:
     60.0, Incision of prostate.
     60.12, Open biopsy of prostate.
     60.15, Biopsy of periprostatic tissue.
     60.18, Other diagnostic procedures on prostate and 
periprostatic tissue.
     60.21, Transurethral prostatectomy.
     60.29, Other transurethral prostatectomy.
     60.61, Local excision of lesion of prostate.
     60.69, Prostatectomy, not elsewhere classified.
     60.81, Incision of periprostatic tissue.
     60.82, Excision of periprostatic tissue.
     60.93, Repair of prostate.
     60.94, Control of (postoperative) hemorrhage of prostate.
     60.95, Transurethral balloon dilation of the prostatic 
urethra.
     60.96, Transurethral destruction of prostate tissue by 
microwave thermotherapy.
     60.97, Other transurethral destruction of prostate tissue 
by other thermotherapy.
     60.99, Other operations on prostate.
    All remaining O.R. procedures are assigned to DRGs 468 and 477, 
with DRG 477 assigned to those discharges in which the only procedures 
performed are nonextensive procedures that are unrelated to the 
principal diagnosis.\10\
---------------------------------------------------------------------------

    \10\ The original list of the ICD-9-CM procedure codes for the 
procedures we consider nonextensive procedures, if performed with an 
unrelated principal diagnosis, was published in Table 6C in section 
IV. of the Addendum to the FY 1989 final rule (53 FR 38591). As part 
of the FY 1991 final rule (55 FR 36135), the FY 1992 final rule (56 
FR 43212), the FY 1993 final rule (57 FR 23625), the FY 1994 final 
rule (58 FR 46279), the FY 1995 final rule (59 FR 45336), the FY 
1996 final rule (60 FR 45783), the FY 1997 final rule (61 FR 46173), 
and the FY 1998 final rule (62 FR 45981), we moved several other 
procedures from DRG 468 to DRG 477, and some procedures from DRG 477 
to DRG 468. No procedures were moved in FY 1999, as noted in the 
final rule (63 FR 40962); in FY 2000 (64 FR 41496); in FY 2001 (65 
FR 47064); or in FY 2002 (66 FR 39852). In the FY 2003 final rule 
(67 FR 49999) we did not move any procedures from DRG 477. However, 
we did move procedure codes from DRG 468 and placed them in more 
clinically coherent DRGs. In the FY 2004 final rule (68 FR 45365), 
we moved several procedures from DRG 468 to DRGs 476 and 477 because 
the procedures are nonextensive. In the FY 2005 final rule (69 FR 
48950), we moved one procedure from DRG 468 to 477. In addition, we 
added several existing procedures to DRGs 476 and 477. In the FY 
2006 (70 FR 47317), we moved one procedure from DRG 468 and assigned 
it to DRG 477.
---------------------------------------------------------------------------

    For FY 2007, we are not proposing to change the procedures assigned 
among these DRGs.
a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs
    We annually conduct a review of procedures producing assignment to 
DRG 468 or DRG 477 on the basis of volume, by procedure, to see if it 
would be appropriate to move procedure codes out of these DRGs into one 
of the surgical DRGs for the MDC into which the principal diagnosis 
falls. The data are arrayed two ways for comparison purposes. We look 
at a frequency count of each major operative procedure code. We also 
compare procedures across MDCs by volume of procedure codes within each 
MDC.
    We identify those procedures occurring in conjunction with certain 
principal diagnoses with sufficient frequency to justify adding them to 
one of the surgical DRGs for the MDC in which the diagnosis falls. 
Based on this year's review, we are not proposing to remove any 
procedures in DRGs 468 or 477 to one of the surgical DRGs for FY 2007.
b. Reassignment of Procedures Among DRGs 468, 476, and 477
    We also annually review the list of ICD-9-CM procedures that, when 
in combination with their principal diagnosis code, result in 
assignment to DRGs 468, 476, and 477, to ascertain if any of those 
procedures should be reassigned from one of these three DRGs to another 
of the three DRGs based on average charges and the length of stay. We 
look at the data for trends such as shifts in treatment practice or 
reporting practice that would make the resulting DRG assignment 
illogical. If we find these shifts, we would propose to move cases to 
keep the DRGs clinically similar or to provide payment for the cases in 
a similar manner. Generally, we move only those procedures for which we 
have an adequate number of discharges to analyze the data.
    We are not proposing to move any procedure codes from DRG 476 to 
DRGs 468 or 477, or from DRG 477 to DRGs 468 or 476 for FY 2007.
c. Adding Diagnosis or Procedure Codes to MDCs
    Based on our review this year, we are not proposing to add any 
diagnosis codes to MDCs for FY 2007.
10. Changes to the ICD-9-CM Coding System
    As described in section II.B.1. of this preamble, the ICD-9-CM is a 
coding system used for the reporting of diagnoses and procedures 
performed on a patient. In September 1985, the ICD-9-CM Coordination 
and Maintenance Committee was formed. This is a Federal 
interdepartmental committee, co-chaired by the National Center for 
Health Statistics (NCHS), the Centers for Disease Control and 
Prevention, and CMS, charged with maintaining and updating the ICD-9-CM 
system. The Committee is jointly responsible for approving coding 
changes, and developing errata, addenda, and other modifications to the 
ICD-9-CM to reflect newly developed procedures and technologies and 
newly identified diseases. The Committee is also responsible for 
promoting the use of Federal and non-Federal educational programs and 
other communication techniques with a view toward standardizing coding 
applications and upgrading the quality of the classification system.
    The Official Version of the ICD-9-CM contains the list of valid 
diagnosis and procedure codes. (The Official Version of the ICD-9-CM is 
available from the Government Printing Office on CD-ROM for $25.00 by 
calling (202) 512-1800.) The Official Version of the ICD-9-CM is no 
longer available in printed manual form from the Federal Government; it 
is only available on CD-ROM. Users who need a paper version are 
referred to one of the many products available from publishing houses.
    The NCHS has lead responsibility for the ICD-9-CM diagnosis codes 
included in the Tabular List and Alphabetic Index for Diseases, while 
CMS has lead responsibility for the ICD-9-CM procedure codes included 
in the Tabular List and Alphabetic Index for Procedures.
    The Committee encourages participation in the above process by 
health-related organizations. In this regard, the Committee holds 
public meetings for discussion of educational issues and proposed 
coding changes. These meetings provide an opportunity for 
representatives of recognized organizations in the coding field, such 
as the American Health Information Management Association (AHIMA), the 
American Hospital Association (AHA),

[[Page 24043]]

and various physician specialty groups, as well as individual 
physicians, health information management professionals, and other 
members of the public, to contribute ideas on coding matters. After 
considering the opinions expressed at the public meetings and in 
writing, the Committee formulates recommendations, which then must be 
approved by the agencies.
    The Committee presented proposals for coding changes for 
implementation in FY 2007 at a public meeting held on September 29-30, 
2005, and finalized the coding changes after consideration of comments 
received at the meetings and in writing by December 2, 2005. Those 
coding changes are announced in Tables 6A through 6F in the Addendum to 
this proposed rule. The Committee held its 2006 meeting on March 23-24, 
2006. Proposed new codes for which there was a consensus of public 
support and for which complete tabular and indexing changes can be made 
by May 2006 will be included in the October 1, 2006 update to ICD-9-CM. 
Code revisions that were discussed at the March 23-24, 2006 Committee 
meeting could not be finalized in time to include them in this FY 2007 
IPPS proposed rule. These additional codes will be included in Tables 
6A through 6F of the final rule and will be marked with an asterisk 
(*).
    Copies of the minutes of the procedure codes discussions at the 
Committee's September 29-30, 2005 meeting can be obtained from the CMS 
Web site: http://new.cms.hhs.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. The minutes of the diagnosis codes discussions at the 
September 29-30, 2005 meeting are found at: http://www.cdc.gov/nchs/icd9.htm. Paper copies of these minutes are no longer available and the 
mailing list has been discontinued. These Web sites also provide 
detailed information about the Committee, including information on 
requesting a new code, attending a Committee meeting, and timeline 
requirements and meeting dates.
    We encourage commenters to address suggestions on coding issues 
involving diagnosis codes to: Donna Pickett, Co-Chairperson, ICD-9-CM 
Coordination and Maintenance Committee, NCHS, Room 2402, 3311 Toledo 
Road, Hyattsville, MD 20782. Comments may be sent by E-mail to: 
[email protected].
    Questions and comments concerning the procedure codes should be 
addressed to: Patricia E. Brooks, Co-Chairperson, ICD-9-CM Coordination 
and Maintenance Committee, CMS, Center for Medicare Management, 
Hospital and Ambulatory Policy Group, Division of Acute Care, C4-08-06, 
7500 Security Boulevard, Baltimore, MD 21244-1850. Comments may be sent 
by E-mail to: [email protected].
    The ICD-9-CM code changes that have been approved will become 
effective October 1, 2006. The new ICD-9-CM codes are listed, along 
with their DRG classifications, in Tables 6A and 6B (New Diagnosis 
Codes and New Procedure Codes, respectively) in the Addendum to this 
proposed rule. As we stated above, the code numbers and their titles 
were presented for public comment at the ICD-9-CM Coordination and 
Maintenance Committee meetings. Both oral and written comments were 
considered before the codes were approved. In this proposed rule, we 
are only soliciting comments on the proposed classification of these 
new codes.
    For codes that have been replaced by new or expanded codes, the 
corresponding new or expanded diagnosis codes are included in Table 6A. 
New procedure codes are shown in Table 6B. Diagnosis codes that have 
been replaced by expanded codes or other codes or have been deleted are 
in Table 6C (Invalid Diagnosis Codes). These invalid diagnosis codes 
will not be recognized by the GROUPER beginning with discharges 
occurring on or after October 1, 2006. Table 6D contains invalid 
procedure codes. These invalid procedure codes will not be recognized 
by the GROUPER beginning with discharges occurring on or after October 
1, 2006. Revisions to diagnosis code titles are in Table 6E (Revised 
Diagnosis Code Titles), which also includes the DRG assignments for 
these revised codes. Table 6F includes revised procedure code titles 
for FY 2007.
    In the September 7, 2001 final rule implementing the IPPS new 
technology add-on payments (66 FR 46906), we indicated we would attempt 
to include proposals for procedure codes that would describe new 
technology discussed and approved at the April meeting as part of the 
code revisions effective the following October. As stated previously, 
ICD-9-CM codes discussed at the March 23-24, 2006 Committee meeting 
that received consensus and that can be finalized by May 2006, will be 
included in Tables 6A through 6F of the Addendum to the final rule.
    Section 503(a) of Pub. L. 108-173 included a requirement for 
updating ICD-9-CM codes twice a year instead of a single update on 
October 1 of each year. This requirement was included as part of the 
amendments to the Act relating to recognition of new technology under 
the IPPS. Section 503(a) amended section 1886(d)(5)(K) of the Act by 
adding a clause (vii) which states that the ``Secretary shall provide 
for the addition of new diagnosis and procedure codes in April 1 of 
each year, but the addition of such codes shall not require the 
Secretary to adjust the payment (or diagnosis-related group 
classification) * * * until the fiscal year that begins after such 
date.'' This requirement improves the recognition of new technologies 
under the IPPS system by providing information on these new 
technologies at an earlier date. Data will be available 6 months 
earlier than would be possible with updates occurring only once a year 
on October 1.
    While section 1886(d)(5)(K)(vii) of the Act states that the 
addition of new diagnosis and procedure codes on April 1 of each year 
shall not require the Secretary to adjust the payment, or DRG 
classification under section 1886(d) of the Act until the fiscal year 
that begins after such date, we have to update the DRG software and 
other systems in order to recognize and accept the new codes. We also 
publicize the code changes and the need for a mid-year systems update 
by providers to capture the new codes. Hospitals also have to obtain 
the new code books and encoder updates, and make other system changes 
in order to capture and report the new codes.
    The ICD-9-CM Coordination and Maintenance Committee holds its 
meetings in the Spring and Fall in order to update the codes and the 
applicable payment and reporting systems by October 1 of each year. 
Items are placed on the agenda for the ICD-9-CM Coordination and 
Maintenance Committee meeting if the request is received at least 2 
months prior to the meeting. This requirement allows time for staff to 
review and research the coding issues and prepare material for 
discussion at the meeting. It also allows time for the topic to be 
publicized in meeting announcements in the Federal Register as well as 
on the CMS Web site. The public decides whether or not to attend the 
meeting based on the topics listed on the agenda. Final decisions on 
code title revisions are currently made by March 1 so that these titles 
can be included in the IPPS proposed rule. A complete addendum 
describing details of all changes to ICD-9-CM, both tabular and index, 
are publicized on CMS and NCHS Web pages in May of each year. 
Publishers of coding books and software use this information to modify 
their products that are used by health care providers. This 5-month 
time period has proved to be necessary

[[Page 24044]]

for hospitals and other providers to update their systems.
    A discussion of this timeline and the need for changes are included 
in the December 4-5, 2005 ICD-9-CM Coordination and Maintenance 
Committee minutes. The public agreed that there was a need to hold the 
fall meetings earlier, in September or October, in order to meet the 
new implementation dates. The public provided comment that additional 
time would be needed to update hospital systems and obtain new code 
books and coding software. There was considerable concern expressed 
about the impact this new April update would have on providers.
    In the FY 2005 IPPS final rule, we implemented section 
1886(d)(5)(K)(vii) of the Act, as added by section 503(a) of Public Law 
108-173, by developing a mechanism for approving, in time for the April 
update, diagnosis and procedure code revisions needed to describe new 
technologies and medical services for purposes of the new technology 
add-on payment process. We also established the following process for 
making these determinations. Topics considered during the Fall ICD-9-CM 
Coordination and Maintenance Committee meeting are considered for an 
April 1 update if a strong and convincing case is made by the requester 
at the Committee's public meeting. The request must identify the reason 
why a new code is needed in April for purposes of the new technology 
process. The participants at the meeting and those reviewing the 
Committee meeting summary report are provided the opportunity to 
comment on this expedited request. All other topics are considered for 
the October 1 update. Participants at the Committee meeting are 
encouraged to comment on all such requests. There were no requests for 
an expedited April l, 2006 implementation of an ICD-9-CM code at the 
September 29-30, 2005 Committee meeting. Therefore, there were no new 
ICD-9-CM codes implemented on April 1, 2006.
    We believe that this process captures the intent of section 
1886(d)(5)(K)(vii) of the Act. This requirement was included in the 
provision revising the standards and process for recognizing new 
technology under the IPPS. In addition, the need for approval of new 
codes outside the existing cycle (October 1) arises most frequently and 
most acutely where the new codes will capture new technologies that are 
(or will be) under consideration for new technology add-on payments. 
Thus, we believe this provision was intended to expedite data 
collection through the assignment of new ICD-9-CM codes for new 
technologies seeking higher payments.
    Current addendum and code title information is published on the CMS 
Web page at: http://www.cms.hhs.gov/icd9ProviderDiagnosticCodes. 
Information on ICD-9-CM diagnosis codes, along with the Official ICD-9-
CM Coding Guidelines, can be found on the Web page at: http://www.cdc.gov/nchs/icd9.htm. Information on new, revised, and deleted 
ICD-9-CM codes is also provided to the AHA for publication in the 
Coding Clinic for ICD-9-CM. AHA also distributes information to 
publishers and software vendors.
    CMS also sends copies of all ICD-9-CM coding changes to its 
contractors for use in updating their systems and providing education 
to providers.
    These same means of disseminating information on new, revised, and 
deleted ICD-9-CM codes will be used to notify providers, publishers, 
software vendors, contractors, and others of any changes to the ICD-9-
CM codes that are implemented in April. The code titles are adopted as 
part of the ICD-9-CM Coordination and Maintenance Committee process. 
Thus, although we publish the code titles in the IPPS proposed and 
final rules, they are not subject to comment in the proposed or final 
rules. We will continue to publish the October code updates in this 
manner within the IPPS proposed and final rules. For codes that are 
implemented in April, we will assign the new procedure code to the same 
DRG in which its predecessor code was assigned so there will be no DRG 
impact as far as DRG assignment. This mapping was specified by section 
1886(d)(5)(K)(vii) of the Act as added by section 503(a) of Pub. L. 
108-173. Any midyear coding updates will be available through the 
websites indicated above and through the Coding Clinic for ICD-9-CM. 
Publishers and software vendors currently obtain code changes through 
these sources in order to update their code books and software systems. 
We will strive to have the April 1 updates available through these Web 
sites 5 months prior to implementation (that is, early November of the 
previous year), as is the case for the October 1 updates. Codebook 
publishers are evaluating how they will provide any code updates to 
their subscribers. Some publishers may decide to publish mid-year book 
updates. Others may decide to sell an addendum that lists the changes 
to the October 1 code book. Coding personnel should contact publishers 
to determine how they will update their books. CMS and its contractors 
will also consider developing provider education articles concerning 
this change to the effective date of certain ICD-9-CM codes.

E. Proposed Recalibration of DRG Weights

    (If you choose to comment on issues in this section, please include 
the caption ``DRG Weights'' at the beginning of your comment.)
    We are proposing to change the DRG recalibration process 
methodology for FY 2007 to move to an HSRV weighting method as 
discussed in section II.C.2. of the preamble to this proposed rule. For 
FY 2006 and years prior, we have recalibrated the DRG weights based on 
charge data for Medicare discharges using the most current charge 
information available (for example, the FY 2005 MedPAR file would have 
been used for FY 2007). Our thorough analysis of the March 2005 MedPAC 
recommendations regarding refinement of the DRG system used for the 
IPPS (see discussion of the MedPAC recommendations in section II.C.2. 
of this preamble) has shown that using gross charges as a basis for 
setting the DRG weights has introduced bias into the weighting process. 
Specifically, hospitals that are systematically more expensive than 
others (that is, teaching hospitals and specialty hospitals) tend to 
treat certain cases more commonly than others, causing the weights for 
these cases to be artificially high. In addition, hospitals may mark up 
their charges for routine days, intensive care days, and various 
ancillary services by different percentages. This practice of 
differential markups among hospital cost centers may also introduce 
bias into the weights. For instance, we have observed that ancillary 
service cost centers generally have higher charge markups than routine 
services. Thus, the charge-based relative weight methodology may result 
in high weights for DRGs that use more ancillary services relative to 
DRGs that use more routine services than would occur under a system 
where the weights are based on costs.
    As discussed in section II.C.2. of this preamble, based on our 
study of the MedPAC recommendations, we have developed an alternative 
methodology for recalibrating the DRG weights. This method involves 
applying the HSRV methodology at the cost center level (HSRVcc) to 
remove the bias introduced by hospital characteristics (that is, 
teaching, disproportionate share, location, and size, among others) and 
then scaling the weights to costs using national cost center CCRs 
derived from cost report data.
    In developing this proposed system of weights, we used two data 
sources:

[[Page 24045]]

Claims data and cost report data. As in previous years, the claims data 
source is the MedPAR file. This file is based on fully coded diagnostic 
and procedure data for all Medicare inpatient hospital bills. The FY 
2005 MedPAR data used in this proposed rule include discharges 
occurring between October 1, 2004 and September 30, 2005, based on 
bills received by CMS through December 31, 2005, from all hospitals 
subject to the IPPS and short-term acute care hospitals in Maryland 
(which are under a waiver from the IPPS under section 1814(b)(3) of the 
Act). The FY 2005 MedPAR file used in calculating the relative weights 
includes data for approximately 12,137,358 Medicare discharges. 
Discharges for Medicare beneficiaries enrolled in a Medicare+Choice 
managed care plan are excluded from this analysis. The data exclude 
CAHs, including hospitals that subsequently became CAHs after the 
period from which the data were taken. The second data source used in 
the new HSRVcc weight methodology are the FY 2003 Medicare cost report 
data files from HCRIS, which represents the most recent full set of 
cost report data available. We used the December 31, 2005 update of the 
HCRIS cost report files for FY 2003 in setting the proposed relative 
weights.
    Previously, the charge-based methodology used to calculate the DRG 
relative weights from the MedPAR data was as follows:
     To the extent possible, all the claims were regrouped 
using the DRG classification revisions that we would have proposed.
     The transplant cases that were used to establish the 
proposed relative weight for heart and heart-lung, liver and/or 
intestinal, and lung transplants (DRGs 103, 480, and 495) were limited 
to those Medicare-approved transplant centers that have cases in the FY 
2005 MedPAR file. (Medicare coverage for heart, heart-lung, liver and/
or intestinal, and lung transplants is limited to those facilities that 
have received approval from CMS as transplant centers.)
     Organ acquisition costs for kidney, heart, heart-lung, 
liver, lung, pancreas, and intestinal (or multivisceral organs) 
transplants continue to be paid on a reasonable cost basis. Because 
these acquisition costs are paid separately from the prospective 
payment rate, it would have been necessary to subtract the acquisition 
charges from the total charges on each transplant bill that showed 
acquisition charges before computing the average charge for the DRG and 
before eliminating statistical outliers.
     Charges would have been standardized to remove the effects 
of differences in area wage levels, indirect medical education and 
disproportionate share payments, and, for hospitals in Alaska and 
Hawaii, the applicable cost-of-living adjustment.
     The average standardized charge per DRG was calculated by 
summing the standardized charges for all cases in the DRG and dividing 
that amount by the number of cases classified in the DRG. A transfer 
case would have been counted as a fraction of a case based on the ratio 
of its transfer payment under the per diem payment methodology to the 
full DRG payment for non-transfer cases. That is, a transfer case 
receiving payment under the transfer methodology equal to half of what 
the case would receive as a non-transfer would be counted as 0.5 of a 
total case.
     Statistical outliers were eliminated by removing all cases 
that were beyond 3.0 standard deviations from the mean of the log 
distribution of both the charges per case and the charges per day for 
each DRG.
     The average charge for each DRG was then recomputed 
(excluding the statistical outliers) and divided by the national 
average standardized charge per case to determine the relative weight.
    These charge-based weights were then normalized by an adjustment 
factor so that the average case weight after recalibration is equal to 
the average case weight before recalibration. We will continue to apply 
this normalization adjustment as it is intended to ensure that 
recalibration by itself neither increases nor decreases total payments 
under the IPPS as required by section 1886(d)(4)(C)(iii) of the Act.
    The methodology we are proposing to calculate the DRG weights from 
the FY 2005 MedPAR and FY 2003 cost report data is as follows:
     To the extent possible, all the claims were regrouped 
using the proposed DRG classification revisions discussed in section 
II.D. of this preamble.
     The transplant cases that were used to establish the 
proposed relative weight for heart and heart-lung, liver and/or 
intestinal, and lung transplants (DRGs 103, 480, and 495) were limited 
to those Medicare-approved transplant centers that have cases in the FY 
2005 MedPAR file. (Medicare coverage for heart, heart-lung, liver and/
or intestinal, and lung transplants is limited to those facilities that 
have received approval from CMS as transplant centers.)
     Organ acquisition costs for kidney, heart, heart-lung, 
liver, lung, pancreas, and intestinal (or multivisceral organs) 
transplants continue to be paid on a reasonable cost basis. Because 
these acquisition costs are paid separately from the prospective 
payment rate, it is necessary to subtract the acquisition charges from 
the total charges on each transplant bill that showed acquisition 
charges before adjusting the charges under the HSRVcc methodology and 
before eliminating statistical outliers.
     Claims for IPPS hospitals were used in this analysis 
(claims for IPFs, IRFs, LTCHs, cancer and children's hospitals, and 
RNHCIs were dropped). Claims with total charges or total length of stay 
less than or equal to zero were dropped. Claims that had an amount in 
the total charge field that differed by more than $10.00 from the sum 
of the routine day charges, intensive care charges, pharmacy charges, 
special equipment charges, therapy services charges, operating room 
charges, cardiology charges, laboratory charges, radiology charges, and 
other service charges were also dropped. At least 96 percent of the 
providers in the MedPAR file had charges for 8 of the 10 cost centers. 
Claims for providers that did not have charges greater than zero for at 
least 8 of the 10 cost centers were dropped.
     Statistical outliers were eliminated by removing all cases 
that were beyond 3.0 standard deviations from the mean of the log 
distribution of both the charges per case and the charges per day for 
each DRG.
    Once the MedPAR data were trimmed, the data were sorted by provider 
so that charges could be standardized under the HSRVcc methodology 
(discussed in section II.C.2. of this preamble). To do this, an average 
charge was computed for each provider for each of 10 proposed cost 
centers. The average charge was computed by summing the charges for 
each cost center and dividing by the transfer adjusted case count for 
each provider. A transfer case, identified by discharge code, DRG, and 
length of stay, was counted as a fraction of a case based on the ratio 
of its length of stay plus 1 day relative to the geometric mean length 
of stay for that DRG. That is, a transfer case with a length of stay of 
2 days in a DRG with a geometric mean length of stay of 6 days would be 
counted as 3 (2 days plus 1 extra day) divided by 6 or 0.5 of a total 
case as this reflects current payment policy.
    The 10 cost centers that we are proposing to use in the HSRV weight 
calculation are shown in the following table. In addition, the table 
shows the lines on the cost report that we are proposing to use to 
create the national cost center CCRs that will be discussed later in 
this section:

[[Page 24046]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.006


[[Page 24047]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.007

BILLING CODE 4120-01-C

    After computing the average charge for each provider for each cost 
center, the cost center charges on each claim are divided by the 
provider's average charge for the matching cost center. For example, 
the routine day charges on the claim are divided by the average routine 
day charge for the provider, the intensive care unit charges on the 
claim are divided by the average intensive care unit charge for the 
provider, and so on. By using a hospital's relative charge structure, 
the resulting weights from this step do not reflect differences in 
charges among providers for factors such as location, size, wages, 
relative efficiency, average markup, IME, DSH and the variety of cases 
treated. Once these charges are adjusted by the average charge for the 
cost center, they are then multiplied by the provider's CMI.
    This adjustment for CMI is needed to rescale the hospital-specific 
relative charge values which, by definition, will average to 1.0 for 
each cost center. Because the average relative weight for a provider is 
that provider's CMI, we believe CMI is a reasonable scale factor to use 
to further adjust the relative charges to reflect the complexity of 
cases treated by the provider. A starting CMI of one was assigned to 
each cost center for each provider.
    After the relative charges (cost center claim charge divided by the 
average cost center charge for the provider) are multiplied by the 
hospital's matching cost center CMI, they are summed by DRG. The 
transfer adjusted case count for each DRG is also summed. Average 
charges by DRG are calculated for each cost center by taking the sum of 
the relative, CMI adjusted charges for that DRG and dividing by the 
transfer adjusted case count for that DRG.
    A national average charge is calculated for each cost center by 
summing all relative CMI adjusted charges in the trimmed MedPAR data 
set and dividing by the total transfer-adjusted case count. The first 
set of DRG weights is created by dividing the average charge for each 
DRG for each cost center by the national average charge for that cost 
center. The result is a set of 10 weights for each DRG. These 10 
weights are then assigned to each claim, a new CMI is created for each 
provider, the relative charges for each cost center on the claim (total 
charge for cost center is divided by the provider's

[[Page 24048]]

average charge for that cost center) are multiplied by the new CMI and 
the weights are iterated until the national average CMI for each cost 
center stops changing between iterations. In preparing the proposed 
weights for this proposed rule, we used a straight CMI calculation 
where each case was given a full weight and counted as a full case 
regardless of transfer status.
    Alternatively, we could use the method we applied in our study of 
the MedPAC recommendations (see section II.C. of this preamble) where 
we used a CMI that was computed by taking the sum of the transfer-
adjusted weights and dividing by a full case count, where the transfer-
adjusted weight is computed by multiplying the transfer-adjusted case 
count (length of stay for claim plus one day divided by geometric mean 
length of stay for the DRG) by the DRG weight. We are soliciting public 
comment on which CMI calculation would be the most appropriate to use 
in this weighting methodology.
    After the iteration process is completed, we remove the effects of 
differential markups within cost centers. To do this, we are proposing 
to use national average departmental CCRs in conjunction with the total 
charges from the trimmed MedPAR file to create scaling factors for each 
cost center. The first step in this process is to develop national cost 
center CCRs.
    Taking the FY 2003 cost report data, we removed CAHs, Maryland 
hospitals, Indian Health Service hospitals, all-inclusive rate 
hospitals, and cost reports that represented time periods of less than 
1 year (365 days). We then created CCRs for each provider for each cost 
center (see prior table for line items used in the calculations) and 
removed any cost CCRs that were greater than 10 or less than .01. We 
then took the logs of all of the cost center CCRs and removed any cost 
center CCRs where the log of the cost center CCR was greater or less 
than the mean log plus/minus 1.96 times the standard deviation for the 
log of that cost center CCR. We are proposing to use 1.96 times the 
standard deviation as a trim factor because the logs of the cost center 
CCRs are normally distributed and 1.96 times the standard deviation 
represents the 95 percentile of the T-Distribution for large sample 
size, for which 2,000 to 3,000 hospitals should qualify. Once the cost 
report data was trimmed, we calculated the geometric mean CCR for each 
cost center.
    We are proposing to use these geometric mean CCRs to create cost 
scaling factors to apply to the DRG weights. Once the national average 
CCRs are computed, they are multiplied by the total unadjusted charges 
for the matching group of cost centers in MedPAR. The resulting costs 
for each group of cost centers are then summed to derive a total cost 
for all cases across the Nation. The percentage that each cost center 
is contributing to the overall total costs is calculated by dividing 
the individual cost center cost by the total amount. For example, the 
total cost for routine days is divided by the total cost for all cases 
to arrive at 0.29, which indicates that routine costs are responsible 
for approximately 29 percent of total cost. We are proposing to use 
these percentages as scaling factors to apply to the relative weights. 
For each DRG, the cost center weights are multiplied by these scaling 
factors (that is, routine day weight is multiplied by the routine day 
scaling factor, intensive care unit weight is multiplied by the 
intensive care unit scaling factor, and so on). After the weights are 
adjusted by the scaling factor, they are summed by DRG to create one 
final weight for each DRG. Following that, they are normalized by a 
factor of 1.49216 so that the weights so that the average case weight 
after recalibration is equal to the average case weight before 
recalibration. This normalization adjustment was intended to ensure 
that recalibration by itself neither increases nor decreases total 
payments under the IPPS.
    When we recalibrated the DRG weights for previous years, we set a 
threshold of 10 cases as the minimum number of cases required to 
compute a reasonable weight. We are proposing to use that same case 
threshold in recalibrating the DRG weights for FY 2007. Using the FY 
2005 MedPAR data set, there are 40 DRGs that contain fewer than 10 
cases. Because we believe that we do not have sufficient MedPAR data to 
set accurate and stable HSRVcc weights for these low-volume DRGs, we 
are proposing to assign them the weights of similar DRGs for which we 
have more complete data. The crosswalk we are proposing to use is shown 
below. We are soliciting comment on this crosswalk.

------------------------------------------------------------------------
      Low volume DRG              DRG title           Crosswalk to DRG
------------------------------------------------------------------------
3.........................  Craniotomy Age 0-17..  2 (Craniotomy Age >17
                                                    Without CC).
30........................  Traumatic Stupor &     29 (Traumatic Stupor
                             Coma, Coma <1 HR Age   & Coma, Coma <1 HR
                             0-17.                  Age >17 Without CC).
33........................  Concussion Age 0-17..  32 (Concussion Age
                                                    >17 Without CC).
41........................  Extraocular            40 (Extraocular
                             Procedures Except      Procedures Except
                             Orbit Age 0-17.        Orbit Age >17).
48........................  Other Disorders Of     47 (Other Disorders
                             The Eye Age 0-17.      of The Eye Age >17
                                                    Without CC).
54........................  Sinus and Mastoid      53 (Sinus and Mastoid
                             Procedures Age 0-17.   Procedures Age >17).
58........................  T&A Proc, Except       57 (T&A Proc, Except
                             Tonsillectomy &/or     Tonsillectomy &/or
                             Adenoidectomy Only,    Adenoidectomy Only,
                             Age 0-17.              Age >17).
60........................  Tonsillectomy and/or   59 (Tonsillectomy and/
                             Adenoidectomy Only,    or Adenoidectomy
                             Age 0-17.              Only, Age >17).
62........................  Myringotomy W Tube     61 (Myringotomy With
                             Insertion Age 0-17.    Tube Insertion Age
                                                    >17).
74........................  Other Ear, Nose,       73 (Other Ear, Nose,
                             Mouth & Throat         Mouth & Throat
                             Diagnoses Age 0-17.    Diagnoses Age >17).
81........................  Respiratory            79 (Respiratory
                             Infections &           Infections &
                             Inflammations Age 0-   Inflammations Age
                             17.                    >17 With CC).
137.......................  Cardiac Congental &    135 (Cardiac
                             Valvular Disorders     Congental & Valvular
                             Age 0-17.              Disorders Age >17
                                                    With CC).
156.......................  Stomach, Esophageal &  155 (Stomach,
                             Duodenal Procedures    Esophageal &
                             Age 0-17.              Duodenal Procedures
                                                    Age >17 Without CC).
163.......................  Hernia Procedures Age  162 (Inguinal &
                             0-17.                  Femoral Hernia
                                                    Procedures Age >17
                                                    Without CC).
186.......................  Dental & Oral Disease  185 (Dental & Oral
                             Except Extractions &   Disease Except
                             Restorations Age 0-    Extractions &
                             17.                    Restorations, Age
                                                    >17).
220.......................  Lower Extrem & Humer   219 (Lower Extrem &
                             Proc Except Hip,       Humer Proc Except
                             Foot, Femur Age 0-17.  Hip, Foot, Femur Age
                                                    >17 Without CC).
252.......................  Fx, Sprn, Strn & Disl  251 (Fx, Sprn, Strn &
                             Of Foreman, Hand,      Disl of Foreman,
                             Foot Age 0-17.         Hand, Foot Age >17
                                                    Without CC).

[[Page 24049]]

 
255.......................  Fx, Sprn, Strn & Disl  254 Fx, Sprn, Strn &
                             Of Uparm, Lowleg Ex    Disl of Uparm,
                             Foot Age 0-17.         Lowleg Ex Foot Age
                                                    >17 Without CC).
279.......................  Cellulitis Age 0-17..  278 (Cellulitis Age
                                                    >17 Without CC).
282.......................  Trauma To The Skin,    281 (Trauma To The
                             Subcut Tiss & Breast   Skin, Subcut Tiss &
                             Age 0-17.              Breast Age >17
                                                    Without CC).
314.......................  Urethral Procedures,   313 (Urethral
                             Age 0-17.              Procedures, Age >17
                                                    Without CC).
330.......................  Urethral Stricture     329 (Urethral
                             Age 0-17.              Stricture Age >17
                                                    Without CC).
340.......................  Testes Procedures,     339 (Testes
                             Non-Malignancy Age 0-  Procedures, Non-
                             17.                    Malignancy Age >17).
343.......................  Circumcism Age 0-17..  342 (Circumcism Age
                                                    >17).
351.......................  Sterilization, Male..  352 (Other Male
                                                    Reproductive System
                                                    Diagnoses).
362.......................  Endoscopic Tubal       361 (Laparoscopy &
                             Interruption.          Incisional Tubal
                                                    Interruption).
385.......................  Neonates, Died Or      FY 2006 FR weight
                             Transferred To         (adjusted by percent
                             Another Acute Care     change in average
                             Facility.              weight of the cases
                                                    in other DRGs).
386.......................  Extreme Immaturity Or  FY 2006 FR weight
                             Respiratory Distress   (adjusted by percent
                             Syndrome, Neonate.     change in average
                                                    weight of the cases
                                                    in other DRGs).
387.......................  Prematurity With       FY 2006 FR weight
                             Major Problems.        (adjusted by percent
                                                    change in average
                                                    weight of the cases
                                                    in other DRGs).
388.......................  Prematurity Without    FY 2006 FR weight
                             Major Problems.        (adjusted by percent
                                                    change in average
                                                    weight of the cases
                                                    in other DRGs).
389.......................  Full Term Neonate      FY 2006 FR weight
                             With Major Problems.   (adjusted by percent
                                                    change in average
                                                    weight of the cases
                                                    in other DRGs).
390.......................  Neonate With Other     FY 2006 FR weight
                             Significant Problems.  (adjusted by percent
                                                    change in average
                                                    weight of the cases
                                                    in other DRGs).
391.......................  Normal Newborn.......  FY 2006 FR weight
                                                    (adjusted by percent
                                                    change in average
                                                    weight of the cases
                                                    in other DRGs).
393.......................  Splenectomy Age 0-17.  392 (Splenectomy Age
                                                    >17).
405.......................  Acute Leukemia         473 (Acute Leukemia
                             Without Major O.R.     Without Major O.R.
                             Procedure Age 0-17.    Procedure Age >17).
411.......................  History Of Malignancy  465 (Aftercare With
                             Without Endoscopy.     History of
                                                    Malignancy As
                                                    Secondary
                                                    Diagnosis).
412.......................  History Of Malignancy  465 (Aftercare With
                             With Endoscopy.        History of
                                                    Malignancy As
                                                    Secondary
                                                    Diagnosis).
446.......................  Traumatic Injury Age   445 (Traumatic Injury
                             0-17.                  Age >17 Without CC).
448.......................  Allergic Reactions     447 (Allergic
                             Age 0-17.              Reactions Age >17).
451.......................  Poisoning and Toxic    450 (Poisoning and
                             Effects Of Drugs Age   Toxic Effects of
                             0-17.                  Drugs Age >17
                                                    Without CC).
------------------------------------------------------------------------

    Section 1886(d)(4)(C)(iii) of the Act requires that, beginning with 
FY 1991, reclassification and recalibration changes be made in a manner 
that assures that the aggregate payments are neither greater than nor 
less than the aggregate payments that would have been made without the 
changes. Although normalization is intended to achieve this effect, 
equating the average case weight after recalibration to the average 
case weight before recalibration does not necessarily achieve budget 
neutrality with respect to aggregate payments to hospitals because 
payments to hospitals are affected by factors other than average case 
weight. Therefore, as we have done in past years, and as discussed in 
section II.A.4.a. of the Addendum to this proposed rule, we are making 
a budget neutrality adjustment to ensure that the requirement of 
section 1886(d)(4)(C)(iii) of the Act is met.

F. Proposed LTC-DRG Reclassifications and Relative Weights for LTCHs 
for FY 2007

    (If you choose to comment on issues in this section, please include 
the caption ``LTC-DRGs'' at the beginning of your comment.)
1. Background
    In the June 6, 2003 LTCH PPS final rule (68 FR 34122), we changed 
the LTCH PPS annual payment rate update cycle to be effective July 1 
through June 30 instead of October 1 through September 30. In addition, 
because the patient classification system utilized under the LTCH PPS 
uses the same DRGs as those currently used under the IPPS for acute 
care hospitals, in that same final rule, we explained that the annual 
update of the long-term care diagnosis-related group (LTC-DRG) 
classifications and relative weights will continue to remain linked to 
the annual reclassification and recalibration of the DRGs used under 
the IPPS. In that same final rule, we specified that we will continue 
to update the LTC-DRG classifications and relative weights to be 
effective for discharges occurring on or after October 1 through 
September 30 each year. Furthermore, we stated that we will publish the 
annual update of the LTC-DRGs in the proposed and final rules for the 
IPPS.
    In the past, the annual update to the IPPS DRGs has been based on 
the annual revisions to the ICD-9-CM codes and was effective each 
October 1. As discussed in the FY 2006 IPPS final rule (70 FR 47323 
through 47341) and in the Rate Year (RY) 2007 LTCH PPS proposed rule 
(71 FR 4652 through 4658), with the implementation of section 503(a) of 
Pub. L. 108-173, there is the possibility that one feature of the 
GROUPER software program may be updated twice during a Federal fiscal 
year (October 1 and April 1) as required by the statute for the IPPS. 
Specifically, ICD-9-CM diagnosis and procedure codes for new medical 
technology may be created and added to existing DRGs in the middle of 
the Federal fiscal year on April 1. However, this policy change will 
have no effect on the LTC-DRG relative weights, which will continue to 
be updated only once a year (October 1), nor will there be any impact 
on Medicare payments under the LTCH PPS. The use of the ICD-9-CM code 
set is also compliant with the current requirements of the Transactions 
and Code Sets Standards regulations at 45 CFR Parts 160 and 162, 
promulgated in accordance with the Health Insurance Portability and 
Accountability Act of 1996 (HIPAA), Pub. L. 104-191.
    As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4654

[[Page 24050]]

through 4658), in the health care industry, historically annual changes 
to the ICD-9-CM codes were effective for discharges occurring on or 
after October 1 each year. Thus, the manual and electronic versions of 
the GROUPER software, which are based on the ICD-9-CM codes, were also 
revised annually and effective for discharges occurring on or after 
October 1 each year. As noted above, the patient classification system 
used under the LTCH PPS (LTC-DRGs) is based on the patient 
classification system used under the IPPS (CMS DRGs), which 
historically had been updated annually and effective for discharges 
occurring on or after October 1 through September 30 each year. As also 
mentioned above, the ICD-9-CM coding update process was revised as a 
result of implementing section 503(a) of Pub. L. 108-173, which 
includes a requirement for updating ICD-9-CM codes as often as twice a 
year instead of the current process of annual updates on October 1 of 
each year (as discussed in greater detail in section II.D.10. of the 
preamble of this proposed rule). This requirement is included as part 
of the amendments to the Act relating to recognition of new medical 
technology under the IPPS. Section 503(a) of Pub. L. 108-173 amended 
section 1886(d)(5)(K) of the Act by adding a new clause (vii) which 
states that ``the Secretary shall provide for the addition of new 
diagnosis and procedure codes in [sic] April 1 of each year, but the 
addition of such codes shall not require the Secretary to adjust the 
payment (or diagnosis-related group classification) * * * until the 
fiscal year that begins after such date.'' This requirement improves 
the recognition of new technologies under the IPPS by accounting for 
those ICD-9-CM codes in the MedPAR claims data at an earlier date.
    Despite the fact that aspects of the GROUPER software may be 
updated to recognize any new technology ICD-9-CM codes, as discussed 
most recently in the RY 2007 LTCH PPS proposed rule (71 FR 4654 through 
4655), there will be no impact on either LTC-DRG assignments or 
payments under the LTCH PPS at that time. That is, changes to the LTC-
DRGs (such as the creation or deletion of LTC-DRGs) and the relative 
weights will continue to be updated in the manner and timing (October 
1) as they are now. As noted above and as described in the RY 2007 LTCH 
PPS proposed rule (71 FR 4655), updates to the GROUPER for both the 
IPPS and the LTCH PPS (with respect to relative weights and the 
creation or deletion of DRGs) are made in the annual IPPS proposed and 
final rules and are effective each October 1. We also explained that 
because we do not publish a midyear IPPS rule, any April 1 code updates 
will not be published in a midyear IPPS rule. Rather, we will assign 
any new diagnosis or procedure codes to the same DRG in which its 
predecessor code was assigned, so that there will be no impact on the 
DRG assignments (as also discussed in section II.D.10. of this 
preamble). Any coding updates will be available through the Web sites 
provided in section II.D.10. of this preamble and through the Coding 
Clinic for ICD-9-CM. Publishers and software vendors currently obtain 
code changes through these sources in order to update their code books 
and software system. If new codes are implemented on April 1, revised 
code books and software systems, including the GROUPER software 
program, will be necessary because we must use current ICD-9-CM codes. 
Therefore, for purposes of the LTCH PPS, because each ICD-9-CM code 
must be included in the GROUPER algorithm to classify each case into a 
LTC-DRG, the GROUPER software program used under the LTCH PPS would 
need to be revised to accommodate any new codes.
    In implementing section 503(a) of Pub. L. 108-173, there will only 
be an April 1 update if new technology codes are requested and 
approved. We note that any new codes created for April 1 implementation 
will be limited to those diagnosis and procedure code revisions 
primarily needed to describe new technologies and medical services. 
However, we reiterate that the process of discussing updates to the 
ICD-9-CM has been an open process through the ICD-9-CM Coordination and 
Maintenance Committee since 1995. Requestors will be given the 
opportunity to present the merits for a new code and make a clear and 
convincing case for the need to update ICD-9-CM codes for purposes of 
the IPPS new technology add-on payment process through an April 1 
update (as also discussed in section II.D.10. of this preamble).
    However, as we discussed in the RY 2007 LTCH PPS proposed rule (71 
FR 4655), at the September 29-30, 2005 ICD-9-CM Coordination and 
Maintenance Committee meeting, there were no requests for an April 1, 
2006 implementation of ICD-9-CM codes, and, therefore, the next update 
to the ICD-9-CM coding system would not occur until October 1, 2006 (FY 
2007). Presently, as there were no coding changes suggested for an 
April 1, 2006 update, the ICD-9-CM coding set implemented on October 1, 
2005, will continue through September 30, 2006 (FY 2006). The proposed 
update to the ICD-9-CM coding system for FY 2007 is discussed above in 
section II.D.10. of this preamble. Accordingly, in this proposed rule, 
as discussed in greater detail below, we are proposing revisions to the 
LTC-DRG classifications and relative weights, and to the extent that 
they are finalized, we will publish them in the corresponding IPPS 
final rule, to be effective October 1, 2006 through September 30, 2007 
(FY 2007). Furthermore, we would notify LTCHs of any revisions to the 
GROUPER software used under the IPPS and the LTCH PPS that would be 
implemented April 1, 2007. The proposed LTC-DRGs and relative weights 
for FY 2007 in this proposed rule are based on the proposed IPPS DRGs 
(GROUPER Version 24.0) discussed in section II.B. of the preamble to 
this proposed rule.
2. Proposed Changes in the LTC-DRG Classifications
a. Background
    Section 123 of Pub. L. 106-113 specifically requires that the 
agency implement a PPS for LTCHs be a per discharge system with a DRG-
based patient classification system reflecting the differences in 
patient resources and costs in LTCHs while maintaining budget 
neutrality. Section 307(b)(1) of Pub. L. 106-554 modified the 
requirements of section 123 of Pub. L. 106-113 by specifically 
requiring that the Secretary examine ``the feasibility and the impact 
of basing payment under such a system [the LTCH PPS] on the use of 
existing (or refined) hospital diagnosis-related groups (DRGs) that 
have been modified to account for different resource use of long-term 
care hospital patients as well as the use of the most recently 
available hospital discharge data.''
    In accordance with section 307(b)(1) of Pub. L. 106-554 and Sec.  
412.515 of our existing regulations, the LTCH PPS uses information from 
LTCH patient records to classify patient cases into distinct LTC-DRGs 
based on clinical characteristics and expected resource needs. The LTC-
DRGs used as the patient classification component of the LTCH PPS 
correspond to the DRGs under the IPPS for acute care hospitals. Thus, 
in this proposed rule, we are proposing to use the IPPS GROUPER Version 
24.0 for FY 2007 to process LTCH PPS claims for LTCH discharges 
occurring from October 1, 2006 through September 30, 2007. The proposed 
changes to the CMS-DRG classification system used under the IPPS for FY 
2007

[[Page 24051]]

(GROUPER Version 24.0) are discussed in section II.D. of the preamble 
to this proposed rule.
    We note that, as we discuss in section II.C.6. of the preamble to 
this proposed rule, MedPAC, in its 2005 Report to Congress on 
Physician-Owned Specialty Hospitals, recommended that CMS, among other 
things, refine the current DRGs under the IPPS to more fully capture 
differences in severity of illness among patients. As we also discuss 
in that same section, in evaluating the MedPAC recommendation for the 
IPPS, we are evaluating the APR DRG GROUPER used by MedPAC in its 
analysis. Based on this analysis, we concur with MedPAC that the 
modified version of the APR DRGs would account more completely for 
differences in severity of illness and associated costs among 
hospitals. Therefore, as discussed in greater detail in section II.C.6. 
of the preamble of this proposed rule, we are proposing to adopt the 
consolidated severity adjusted DRGs for implementation in the IPPS in 
FY 2008 (if not earlier). As discussed above in this section, the LTCH 
PPS uses the same patient classification system (DRGs). In response to 
MedPAC's recommendation that severity adjusted DRGs, such as the APR 
DRGs or a modified version of the APR DRGs, be adopted under the IPPS 
(as discussed in greater detail in section II.C. of this preamble), we 
are proposing to adopt consolidated severity-adjusted DRGs under the 
IPPS in FY 2008 (if not earlier). At that time, we would need to 
consider whether to propose revisions to the patient classification 
system under the LTCH PPS. Any proposed changes to the patient 
classification system would be done through notice and comment 
rulemaking.
    Under the LTCH PPS, we determine relative weights for each of the 
DRGs to account for the difference in resource use by patients 
exhibiting the case complexity and multiple medical problems 
characteristic of LTCH patients. In a departure from the IPPS, as we 
discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55985), 
which implemented the LTCH PPS, and the FY 2006 IPPS final rule (70 FR 
47324), we use low-volume quintiles in determining the LTC-DRG relative 
weights for LTC-DRGs with less than 25 LTCH cases, because LTCHs do not 
typically treat the full range of diagnoses as do acute care hospitals. 
Specifically, we group those low-volume LTC-DRGs (that is, LTC-DRGs 
with fewer than 25 cases) into 5 quintiles based on average charge per 
discharge. (A listing of the composition of low-volume quintiles for 
the FY 2006 LTC-DRGs (based on FY 2004 MedPAR data) appears in section 
II.G.3. of the FY 2006 IPPS final rule (70 FR 47325 through 47332).) We 
also adjust for cases in which the stay at the LTCH is less than or 
equal to five-sixths of the geometric average length of stay; that is, 
short-stay outlier cases (Sec.  412.529), as discussed below in section 
II.F.4. of this preamble.
b. Patient Classifications Into DRGs
    Generally, under the LTCH PPS, Medicare payment is made at a 
predetermined specific rate for each discharge; that is, payment varies 
by the LTC-DRG to which a beneficiary's stay is assigned. Just as cases 
are classified into DRGs for acute care hospitals under the IPPS (see 
section II.B. of this preamble), cases are classified into LTC-DRGs for 
payment under the LTCH PPS based on the principal diagnosis, up to 
eight additional diagnoses, and up to six procedures performed during 
the stay, as well as age, sex, and discharge status of the patient. The 
diagnosis and procedure information is reported by the hospital using 
the ICD-9-CM codes.
    As discussed in section II.B. of this preamble, the CMS-DRGs are 
organized into 25 major diagnostic categories (MDCs), most of which are 
based on a particular organ system of the body; the remainder involve 
multiple organ systems (such as MDC 22, Burns). Accordingly, the 
principal diagnosis determines MDC assignment. Within most MDCs, cases 
are then divided into surgical DRGs and medical DRGs. Some surgical and 
medical DRGs are further differentiated based on the presence or 
absence of CCs. (See section II.B. of this preamble for further 
discussion of surgical DRGs and medical DRGs.)
    Because the assignment of a case to a particular LTC-DRG will 
determine the amount that is paid for the case, it is important that 
the coding is accurate. As used under the IPPS, classifications and 
terminology used under the LTCH PPS are consistent with the ICD-9-CM 
and the Uniform Hospital Discharge Data Set (UHDDS), as recommended to 
the Secretary by the National Committee on Vital and Health Statistics 
(``Uniform Hospital Discharge Data: Minimum Data Set, National Center 
for Health Statistics, April 1980'') and as revised in 1984 by the 
Health Information Policy Council (HIPC) of the U.S. Department of 
Health and Human Services. We point out again that the ICD-9-CM coding 
terminology and the definitions of principal and other diagnoses of the 
UHDDS are consistent with the requirements of the Transactions and Code 
Sets Standards under HIPAA (45 CFR Parts 160 and 162).
    The emphasis on the need for proper coding cannot be overstated. 
Inappropriate coding of cases can adversely affect the uniformity of 
cases in each LTC-DRG and produce inappropriate weighting factors at 
recalibration and result in inappropriate payments under the LTCH PPS. 
LTCHs are to follow the same coding guidelines used by acute care 
hospitals to ensure accuracy and consistency in coding practices. There 
will be only one LTC-DRG assigned per long-term care hospitalization; 
it will be assigned at the time of discharge of the patient. Therefore, 
it is mandatory that the coders continue to report the same principal 
diagnosis on all claims and include all diagnosis codes for conditions 
that coexist at the time of admission, for conditions that are 
subsequently developed, or for conditions that affect the treatment 
received. Similarly, all procedures performed in a LTCH, or paid for 
under arrangements by a LTCH, during that stay are to be reported on 
each claim.
    Upon the discharge of the patient from a LTCH, the LTCH must assign 
appropriate diagnosis and procedure codes from the ICD-9-CM. Completed 
claim forms are to be submitted electronically to the LTCH's Medicare 
fiscal intermediary. Medicare fiscal intermediaries enter the clinical 
and demographic information into their claims processing systems and 
subject this information to a series of automated screening processes 
called the Medicare Code Editor (MCE). These screens are designed to 
identify cases that require further review before assignment into an 
LTC-DRG can be made.
    After screening through the MCE, each LTCH claim will be classified 
into the appropriate LTC-DRG by the Medicare LTCH GROUPER. The LTCH 
GROUPER is specialized computer software and is the same GROUPER used 
under the IPPS. After the LTC-DRG is assigned, the Medicare fiscal 
intermediary determines the prospective payment by using the Medicare 
LTCH PPS PRICER program, which accounts for LTCH hospital-specific 
adjustments and payment rates. As provided for under the IPPS, we 
provide an opportunity for the LTCH to review the LTC-DRG assignments 
made by the fiscal intermediary and to submit additional information 
within a specified timeframe (Sec.  412.513(c)).
    The LTCH GROUPER is used both to classify past cases in order to 
measure relative hospital resource consumption to establish the LTC-DRG 
weights and to classify current cases for purposes of determining 
payment. The records for all Medicare hospital inpatient

[[Page 24052]]

discharges are maintained in the MedPAR file. The data in this file are 
used to evaluate possible DRG classification changes and to recalibrate 
the DRG weights during our annual update (as discussed in section II.E. 
of this preamble). The LTC-DRG relative weights are based on data for 
the population of LTCH discharges, reflecting the fact that LTCH 
patients represent a different patient-mix than patients in short-term 
acute care hospitals.
3. Development of the Proposed FY 2007 LTC-DRG Relative Weights
a. General Overview of Development of the LTC-DRG Relative Weights
    As we stated in the August 30, 2002 LTCH PPS final rule (67 FR 
55981), one of the primary goals for the implementation of the LTCH PPS 
is to pay each LTCH an appropriate amount for the efficient delivery of 
care to Medicare patients. The system must be able to account 
adequately for each LTCH's case-mix in order to ensure both fair 
distribution of Medicare payments and access to adequate care for those 
Medicare patients whose care is more costly. To accomplish these goals, 
we adjust the LTCH PPS standard Federal prospective payment system rate 
by the applicable LTC-DRG relative weight in determining payment to 
LTCHs for each case. Under the LTCH PPS, relative weights for each LTC-
DRG are a primary element used to account for the variations in cost 
per discharge and resource utilization among the payment groups (Sec.  
412.515). To ensure that Medicare patients classified to each LTC-DRG 
have access to an appropriate level of services and to encourage 
efficiency, we calculate a relative weight for each LTC-DRG that 
represents the resources needed by an average inpatient LTCH case in 
that LTC-DRG. For example, cases in an LTC-DRG with a relative weight 
of 2 will, on average, cost twice as much as cases in an LTC-DRG with a 
weight of 1.
b. Data
    To calculate the proposed LTC-DRG relative weights for FY 2007 in 
this proposed rule, we obtained total Medicare allowable charges from 
FY 2005 Medicare LTCH bill data from the December 2005 update of the 
MedPAR file, which are the best available data at this time, and we 
used the proposed Version 24.0 of the CMS GROUPER used under the IPPS 
(as discussed in section II.B. of this preamble) to classify cases. To 
calculate the final LTC-DRG relative weights for FY 2007, we are 
proposing that, if more recent data are available (that is, data from 
the March 2006 update of the MedPAR file, for example), we would use 
that data and use the finalized Version 24.0 of the CMS GROUPER used 
under the IPPS.
    As we discussed in the FY 2006 IPPS final rule (70 FR 47325), we 
have excluded the data from LTCHs that are all-inclusive rate providers 
and LTCHs that are reimbursed in accordance with demonstration projects 
authorized under section 402(a) of Pub. L. 90-248 (42 U.S.C. 1395b-1) 
or section 222(a) of Pub. L. 92-603 (42 U.S.C. 1395b-1). Therefore, in 
the development of the proposed FY 2007 LTC-DRG relative weights, we 
have excluded the data of the 19 all-inclusive rate providers and the 3 
LTCHs that are paid in accordance with demonstration projects that had 
claims in the FY 2005 MedPAR file.
c. Hospital-Specific Relative Value Methodology
    By nature, LTCHs often specialize in certain areas, such as 
ventilator-dependent patients and rehabilitation and wound care. Some 
case types (DRGs) may be treated, to a large extent, in hospitals that 
have, from a perspective of charges, relatively high (or low) charges. 
This nonarbitrary distribution of cases with relatively high (or low) 
charges in specific LTC-DRGs has the potential to inappropriately 
distort the measure of average charges. To account for the fact that 
cases may not be randomly distributed across LTCHs, we use a hospital-
specific relative value method to calculate the LTC-DRG relative 
weights instead of the methodology used to determine the DRG relative 
weights under the IPPS described in section II.E. of this preamble. We 
believe this method will remove this hospital-specific source of bias 
in measuring LTCH average charges. Specifically, we reduce the impact 
of the variation in charges across providers on any particular LTC-DRG 
relative weight by converting each LTCH's charge for a case to a 
relative value based on that LTCH's average charge.
    Under the hospital-specific relative value method, we standardize 
charges for each LTCH by converting its charges for each case to 
hospital-specific relative charge values and then adjusting those 
values for the LTCH's case-mix. The adjustment for case-mix is needed 
to rescale the hospital-specific relative charge values (which, by 
definition, averages 1.0 for each LTCH). The average relative weight 
for a LTCH is its case-mix, so it is reasonable to scale each LTCH's 
average relative charge value by its case-mix. In this way, each LTCH's 
relative charge value is adjusted by its case-mix to an average that 
reflects the complexity of the cases it treats relative to the 
complexity of the cases treated by all other LTCHs (the average case-
mix of all LTCHs).
    In accordance with the methodology established under Sec.  412.523, 
as implemented in the August 30, 2002 LTCH PPS final rule (67 FR 55989 
through 55991), we standardize charges for each case by first dividing 
the adjusted charge for the case (adjusted for short-stay outliers 
under Sec.  412.529 as described in section II.F.4. (step 3) of this 
preamble) by the average adjusted charge for all cases at the LTCH in 
which the case was treated. Short-stay outliers under Sec.  412.529 are 
cases with a length of stay that is less than or equal to five-sixths 
the average length of stay of the LTC-DRG. The average adjusted charge 
reflects the average intensity of the health care services delivered by 
a particular LTCH and the average cost level of that LTCH. The 
resulting ratio is multiplied by that LTCH's case-mix index to 
determine the standardized charge for the case.
    Multiplying by the LTCH's case-mix index accounts for the fact that 
the same relative charges are given greater weight at a LTCH with 
higher average costs than they would at a LTCH with low average costs, 
which is needed to adjust each LTCH's relative charge value to reflect 
its case-mix relative to the average case-mix for all LTCHs. Because we 
standardize charges in this manner, we count charges for a Medicare 
patient at a LTCH with high average charges as less resource intensive 
than they would be at a LTCH with low average charges. For example, a 
$10,000 charge for a case at a LTCH with an average adjusted charge of 
$17,500 reflects a higher level of relative resource use than a $10,000 
charge for a case at a LTCH with the same case-mix, but an average 
adjusted charge of $35,000. We believe that the adjusted charge of an 
individual case more accurately reflects actual resource use for an 
individual LTCH because the variation in charges due to systematic 
differences in the markup of charges among LTCHs is taken into account.
d. Proposed Low-Volume LTC-DRGs
    In order to account for LTC-DRGs with low-volume (that is, with 
fewer than 25 LTCH cases), in accordance with the methodology 
established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), 
we group those ``low-volume LTC-DRGs'' (that is, DRGs that contained 
between 1 and 24 cases annually) into one of five categories 
(quintiles) based on average charges, for the purposes of determining 
relative weights. For this FY 2007 IPPS

[[Page 24053]]

proposed rule, we are proposing to continue to employ this treatment of 
low-volume LTC-DRGs in determining the FY 2007 LTC-DRG relative weights 
using the best available LTCH data. In this proposed rule, using LTCH 
cases from the December 2005 update of the FY 2005 MedPAR file, we 
identified 173 LTC-DRGs that contained between 1 and 24 cases. This 
list of LTC-DRGs was then divided into one of the 5 low-volume 
quintiles, each containing a minimum of 34 LTC-DRGs (173/5 = 34 with 3 
LTC-DRGs as the remainder). In accordance with our established 
methodology, we are proposing to make an assignment to a specific low-
volume quintile by sorting the low-volume LTC-DRGs in ascending order 
by average charge. For this proposed rule, this results in an 
assignment to a specific low-volume quintile of the sorted 173 low-
volume LTC-DRGs by ascending order by average charge. Because the 
number of LTC-DRGs with less than 25 LTCH cases is not evenly divisible 
by five, the average charge of the low-volume LTC-DRG was used to 
determine which low-volume quintile received the additional LTC-DRG. 
After sorting the 173 low-volume LTC-DRGs in ascending order, we are 
proposing to group the first fifth of low-volume LTC-DRGs with the 
lowest average charge into Quintile 1. The highest average charge cases 
would be grouped into Quintile 5. Because the average charge of the 
35th LTC-DRG in the sorted list is closer to the 34th proposed LTC-
DRG's average charge (assigned to Quintile 1) than to the average 
charge of the proposed 36th LTC-DRG in the sorted list (to be assigned 
to Quintile 2), we are proposing to place it into Quintile 1. This 
process was repeated through the remaining proposed low-volume LTC-DRGs 
so that 3 proposed low-volume quintile contain 35 proposed LTC-DRGs and 
2 proposed low-volume quintiles contain 34 proposed LTC-DRGs.
    In order to determine the proposed relative weights for the 
proposed LTC-DRGs with low volume for FY 2007, in accordance with the 
methodology established in the August 30, 2002 LTCH PPS final rule (67 
FR 55984), we are proposing to use the five low-volume quintiles 
described above. The composition of each of the proposed five low-
volume quintiles shown in the chart below was used in determining the 
proposed LTC-DRG relative weights for FY 2007. We would determine a 
proposed relative weight and (geometric) average length of stay for 
each of the five proposed low-volume quintiles using the formula that 
we apply to the regular proposed LTC-DRGs (25 or more cases), as 
described below in section II.F.4. of this preamble. We are proposing 
to assign the same relative weight and average length of stay to each 
of the proposed LTC-DRGs that make up that proposed low-volume 
quintile. We note that, as this system is dynamic, it is possible that 
the number and specific type of LTC-DRGs with a low volume of LTCH 
cases will vary in the future. We use the best available claims data in 
the MedPAR file to identify low-volume LTC-DRGs and to calculate the 
relative weights based on our methodology.
BILLING CODE 4120-01-P

[[Page 24054]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.008


[[Page 24055]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.009


[[Page 24056]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.010


[[Page 24057]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.011


[[Page 24058]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.012

BILLING CODE 4120-01-C
    We note that we will continue to monitor the volume (that is, the 
number of LTCH cases) in these low-volume quintiles to ensure that our 
proposed quintile assignment results in appropriate payment for such 
cases and does not result in an unintended financial incentive for 
LTCHs to inappropriately admit these types of cases.
4. Steps for Determining the Proposed FY 2007 LTC-DRG Relative Weights
    As we noted previously, the proposed FY 2007 LTC-DRG relative 
weights are determined in accordance with the methodology established 
in the August 30, 2002 LTCH PPS final rule (67 FR 55989 through 55991). 
In summary, LTCH cases must be grouped in the appropriate LTD-DRG, 
while taking into account the proposed low-volume LTD-DRGs as described 
above, before the proposed FY 2007 LTD-DRG relative weights can be 
determined. After grouping the cases in the appropriate proposed LTD-
DRG, we are proposing to calculate the relative weights for FY 2007 in 
this proposed rule by first removing statistical outliers and cases 
with a length of stay of 7 days or less, as discussed in greater detail 
below. Next, we are proposing to adjust the number of cases in each 
proposed LTD-DRG for the effect of short-stay outlier cases under Sec.  
412.529, as also discussed in greater detail below. The short-stay 
adjusted discharges and corresponding charges are used to calculate 
``relative adjusted weights'' in each proposed LTD-DRG using the 
hospital-specific relative value method described above.
    Below we discuss in detail the steps for calculating the proposed 
FY 2007 LTD-DRG relative weights. We note that, as we stated above in 
section II.F.3.b. of this preamble, we have excluded the data of all-
inclusive rate LTCHs and LTCHs that are paid in accordance with 
demonstration projects that had claims in the FY 2005 MedPAR file.
    Step 1--Remove statistical outliers.

[[Page 24059]]

    The first step in the calculation of the proposed FY 2007 LTD-DRG 
relative weights is to remove statistical outlier cases. We define 
statistical outliers as cases that are outside of 3.0 standard 
deviations from the mean of the log distribution of both charges per 
case and the charges per day for each proposed LTD-DRG. These 
statistical outliers are removed prior to calculating the proposed 
relative weights. As noted above, we believe that they may represent 
aberrations in the data that distort the measure of average resource 
use. Including those LTCH cases in the calculation of the proposed 
relative weights could result in an inaccurate proposed relative weight 
that does not truly reflect relative resource use among the proposed 
LTD-DRGs.
    Step 2--Remove cases with a length of stay of 7 days or less.
    The proposed FY 2007 LTD-DRG relative weights reflect the average 
of resources used on representative cases of a specific type. 
Generally, cases with a length of stay 7 days or less do not belong in 
a LTCH because these stays do not fully receive or benefit from 
treatment that is typical in a LTCH stay, and full resources are often 
not used in the earlier stages of admission to a LTCH. As explained 
above, if we were to include stays of 7 days or less in the computation 
of the proposed FY 2007 LTD-DRG relative weights, the value of many 
proposed relative weights would decrease and, therefore, payments would 
decrease to a level that may no longer be appropriate.
    We do not believe that it would be appropriate to compromise the 
integrity of the payment determination for those LTCH cases that 
actually benefit from and receive a full course of treatment at a LTCH, 
in order to include data from these very short-stays.
    Thus, as explained above, in determining the proposed FY 2007 LTD-
DRG relative weights, we remove LTCH cases with a length of stay of 7 
days or less.
    Step 3--Adjust charges for the effects of short-stay outliers.
    After removing cases with a length of stay of 7 days or less, we 
are left with cases that have a length of stay of greater than or equal 
to 8 days. The next step in the calculation of the proposed FY 2007 
LTD-DRG relative weights is to adjust each LTCH's charges per discharge 
for those remaining cases for the effects of short-stay outliers as 
defined in Sec.  412.529(a). (However, we note that even if a case was 
removed in Step 2 (that is, cases with a length of stay of 7 days or 
less), it was paid as a short-stay outlier if its length of stay was 
less than or equal to five-sixths of the average length of stay of the 
LTD-DRG, in accordance with Sec.  412.529.)
    We make this adjustment by counting a short-stay outlier as a 
fraction of a discharge based on the ratio of the length of stay of the 
case to the average length of stay for the proposed LTD-DRG for 
nonshort-stay outlier cases. This has the effect of proportionately 
reducing the impact of the lower charges for the short-stay outlier 
cases in calculating the average charge for the proposed LTD-DRG. This 
process produces the same result as if the actual charges per discharge 
of a short-stay outlier case were adjusted to what they would have been 
had the patient's length of stay been equal to the average length of 
stay of the proposed LTD-DRG.
    As we explained in the FY 2006 IPPS final rule (70 FR 47336), 
counting short-stay outlier cases as full discharges with no adjustment 
in determining the proposed LTC-DRG relative weights would lower the 
proposed LTC-DRG relative weight for affected proposed LTC-DRGs because 
the relatively lower charges of the short-stay outlier cases would 
bring down the average charge for all cases within a proposed LTC-DRG. 
This would result in an ``underpayment'' for nonshort-stay outlier 
cases and an ``overpayment'' for short-stay outlier cases. Therefore, 
in this proposed rule, we adjust for short-stay outlier cases under 
Sec.  412.529 in this manner because it results in more appropriate 
payments for all LTCH cases.
    Step 4--Calculate the proposed FY 2007 LTC-DRG relative weights on 
an iterative basis.
    The process of calculating the proposed LTC-DRG relative weights 
using the hospital-specific relative value methodology is iterative. 
First, for each LTCH case, we calculate a hospital-specific relative 
charge value by dividing the short-stay outlier adjusted charge per 
discharge (see step 3) of the LTCH case (after removing the statistical 
outliers (see step 1)) and LTCH cases with a length of stay of 7 days 
or less (see step 2) by the average charge per discharge for the LTCH 
in which the case occurred. The resulting ratio is then multiplied by 
the LTCH's case-mix index to produce an adjusted hospital-specific 
relative charge value for the case. An initial case-mix index value of 
1.0 is used for each LTCH.
    For each proposed LTC-DRG, the proposed FY 2007 LTC-DRG relative 
weight is calculated by dividing the average of the adjusted hospital-
specific relative charge values (from above) for the proposed LTC-DRG 
by the overall average hospital-specific relative charge value across 
all cases for all LTCHs. Using these recalculated proposed LTC-DRG 
relative weights, each LTCH's average relative weight for all of its 
cases (case-mix) is calculated by dividing the sum of all the LTCH's 
proposed LTC-DRG relative weights by its total number of cases. The 
LTCHs' hospital-specific relative charge values above are multiplied by 
these hospital-specific case-mix indexes. These hospital-specific case-
mix adjusted relative charge values are then used to calculate a new 
set of proposed LTC-DRG relative weights across all LTCHs. In this 
proposed rule, this iterative process is continued until there is 
convergence between the weights produced at adjacent steps, for 
example, when the maximum difference is less than 0.0001.
    Step 5--Adjust the proposed FY 2007 LTC-DRG relative weights to 
account for nonmonotonically increasing relative weights.
    As explained in section II.B. of this preamble, the proposed FY 
2007 CMS DRGs, on which the proposed FY 2007 LTC-DRGs are based, 
contain ``pairs'' that are differentiated based on the presence or 
absence of CCs. The proposed LTC-DRGs with CCs are defined by certain 
secondary diagnoses not related to or inherently a part of the disease 
process identified by the principal diagnosis, but the presence of 
additional diagnoses does not automatically generate a CC. As we 
discussed in the FY 2006 IPPS final rule (70 FR 47336), the value of 
monotonically increasing relative weights rises as the resource use 
increases (for example, from uncomplicated to more complicated). The 
presence of CCs in a proposed LTC-DRG means that cases classified into 
a ``without CC'' proposed LTC-DRG are expected to have lower resource 
use (and lower costs). In other words, resource use (and costs) are 
expected to decrease across ``with CC/without CC'' pairs of proposed 
LTC-DRGs.
    For a case to be assigned to a proposed LTC-DRG with CCs, more 
coded information is called for (that is, at least one relevant 
secondary diagnosis), than for a case to be assigned to a proposed LTC-
DRG ``without CCs'' (which is based on only one principal diagnosis and 
no relevant secondary diagnoses). Currently, the LTCH claims data 
include both accurately coded cases without complications and cases 
that have complications (and cost more), but were not coded completely. 
Both types of cases are grouped to a proposed LTC-DRG ``without CCs'' 
when only the principal diagnosis was coded. Since the LTCH PPS was 
only implemented

[[Page 24060]]

for cost reporting periods beginning on or after October 1, 2002 (FY 
2003), and LTCHs were previously paid under cost-based reimbursement, 
which is not based on patient diagnoses, coding by LTCHs for these 
cases may not have been as detailed as possible.
    Thus, in developing the FY 2003 LTC-DRG relative weights for the 
LTCH PPS based on FY 2001 claims data, as we discussed in the August 
30, 2002 LTCH PPS final rule (67 FR 55990), we found on occasion that 
the data suggested that cases classified to the LTC-DRG ``with CCs'' of 
a ``with CC''/``without CC'' pair had a lower average charge than the 
corresponding LTC-DRG ``without CCs.'' Similarly, as discussed in the 
FY 2006 IPPS final rule (70 FR 47336 through 47337), based on FY 2004 
claims data, we also found on occasion that the data suggested that 
cases classified to the LTC-DRG ``with CCs'' of a ``with CC''/``without 
CC'' pair have a lower average charge than the corresponding LTC-DRG 
``without CCs'' for the FY 2006 LTC-DRG relative weights.
    We believe this anomaly may be due to coding that may not have 
fully reflected all comorbidities that were present. Specifically, 
LTCHs may have failed to code relevant secondary diagnoses, which 
resulted in cases that actually had CCs being classified into a 
``without CC'' LTC-DRG. It would not be appropriate to pay a lower 
amount for the ``with CC'' LTC-DRG because, in general, cases 
classified into a ``with CC'' LTC-DRG are expected to have higher 
resource use (and higher cost) as discussed above. Therefore, 
previously when we determined the LTC-DRG relative weights in 
accordance with the methodology established in the August 30, 2002 LTCH 
PPS final rule (67 FR 55990), we grouped both the cases ``with CCs'' 
and ``without CCs'' together for the purpose of calculating the LTC-DRG 
relative weights since the implementation of the LTCH PPS in FY 2003. 
As we stated in that same final rule, we will continue to employ this 
methodology to account for nonmonotonically increasing relative weights 
until we have adequate data to calculate appropriate separate weights 
for these anomalous LTC-DRG pairs. We expect that, as was the case when 
we first implemented the IPPS, this problem will be self-correcting, as 
LTCHs submit more completely coded data in the future.
    There are three types of ``with CC'' and ``without CC'' pairs that 
could be nonmonotonic; that is, where the ``without CC'' LTC-DRG would 
have a higher average charge than the ``with CC'' proposed LTC-DRG. For 
this proposed rule, using the LTCH cases in the December 2005 update of 
the FY 2005 MedPAR file (the most recent and complete data available at 
this time), we identified one of the three types of nonmonotonic LTC-
DRG pairs. As we stated in the August 30, 2002 LTCH PPS final rule (67 
FR 55990), we believe this anomaly may be due to coding inaccuracies 
and expect that, as was the case when we first implemented the acute 
care hospital IPPS, this problem will be self-correcting, as LTCHs 
submit more completely coded data in the future.
    The first category of nonmonotonically increasing relative weights 
for LTC-DRG pairs ``with and without CCs'' contains one pair of LTC-
DRGs in which both the proposed LTC-DRG ``with CCs'' and the proposed 
LTC-DRG ``without CCs'' had 25 or more LTCH cases and, therefore, did 
not fall into one of the 5 low-volume quintiles. For those nonmonotonic 
LTC-DRG pairs, based on our established methodology (67 FR 55983 
through 55990), we would combine the LTCH cases and compute a new 
relative weight based on the case-weighted average of the combined LTCH 
cases of the LTC-DRGs. The case-weighted average charge is determined 
by dividing the total charges for all LTCH cases by the total number of 
LTCH cases for the combined LTC-DRG. This new relative weight would 
then be assigned to both of the LTC-DRGs in the pair. In this proposed 
rule, for FY 2007, there were no LTC-DRGs that fell into this category.
    The second category of nonmonotonically increasing relative weights 
for LTC-DRG pairs ``with and without CCs'' consists of one pair of LTC-
DRGs that has fewer than 25 cases, and each LTC-DRG would be grouped to 
different low-volume quintiles in which the ``without CC'' LTC-DRG is 
in a higher-weighted low-volume quintile than the ``with CC'' LTC-DRG. 
For those pairs, based on our established methodology, we would combine 
the LTCH cases and determine the case-weighted average charge for all 
LTCH cases. The case-weighted average charge is determined by dividing 
the total charges for all LTCH cases by the total number of LTCH cases 
for the combined proposed LTC-DRG. Based on the case-weighted average 
LTCH charge, we determine within which low-volume quintile the 
``combined LTC-DRG'' is grouped. Both LTC-DRGs in the pair are then 
grouped into the same low-volume quintile, thus have the same relative 
weight. In this proposed rule, for FY 2007, there are no LTC-DRGs that 
fell into this category.
    The third category of nonmonotonically increasing proposed relative 
weights for proposed LTC-DRG pairs ``with and without CCs'' consists of 
one pair of proposed LTC-DRGs where one of the proposed LTC-DRGs has 
fewer than 25 LTCH cases and is grouped to a low-volume quintile and 
the other proposed LTC-DRG has 25 or more LTCH cases and has its own 
proposed LTC-DRG relative weight, and the proposed LTC-DRG ``without 
CCs'' has the proposed higher relative weight. Based on our established 
methodology, we removed the proposed low-volume LTC-DRG from the 
proposed low-volume quintile and combined it with the other proposed 
LTC-DRG for the computation of a proposed new relative weight for each 
of these proposed LTC-DRGs. This proposed new relative weight is 
assigned to both proposed LTC-DRGs, so they each have the same proposed 
relative weight. In this proposed rule, for FY 2007, 4 ``pairs'' of 
proposed LTC-DRGs fall into this category: LTC-DRGs 94 and 95; LTC-DRGs 
96 and 97; LTC-DRGs 141 and 142; and LTC-DRGs 292 and 293.
    Step 6--Determine a proposed FY 2007 LTC-DRG relative weight for 
proposed LTC-DRGs with no LTCH cases.
    As we stated above, we determine the proposed relative weight for 
each proposed LTC-DRG using charges reported in the December 2005 
update of the FY 2005 MedPAR file. Of the 526 proposed LTC-DRGs for FY 
2007, we identified 191 proposed LTC-DRGs for which there were no LTCH 
cases in the database. That is, based on data from the FY 2005 MedPAR 
file used in this proposed rule, no patients who would have been 
classified to those proposed LTC-DRGs were treated in LTCHs during FY 
2005 and, therefore, no charge data were reported for those proposed 
LTC-DRGs. Thus, in the process of determining the proposed LTC-DRG 
relative weights, we are unable to determine weights for these 191 
proposed LTC-DRGs using the methodology described in Steps 1 through 5 
above. However, because patients with a number of the diagnoses under 
these proposed LTC-DRGs may be treated at LTCHs beginning in FY 2007, 
we are proposing to assign proposed relative weights to each of the 191 
proposed ``no volume'' LTC-DRGs based on clinical similarity and 
relative costliness to one of the remaining 335 (526-191 = 335) 
proposed LTC-DRGs for which we are able to determine proposed relative 
weights, based on FY 2005 LTCH claims data.
    As there are currently no LTCH cases in these proposed ``no 
volume'' LTC-

[[Page 24061]]

DRGs, we determined proposed relative weights for the 191 proposed LTC-
DRGs with no LTCH cases in the FY 2005 MedPAR file used in this 
proposed rule by grouping them to the appropriate proposed low-volume 
quintile. This methodology is consistent with our methodology used in 
determining proposed relative weights to account for the proposed low-
volume LTC-DRGs described above.
    Our methodology for determining the proposed relative weights for 
the proposed ``no volume'' LTC-DRGs is as follows: We crosswalk the 
proposed no volume LTC-DRGs by matching them to other similar proposed 
LTC-DRGs for which there were LTCH cases in the FY 2005 MedPAR file 
based on clinical similarity and intensity of use of resources as 
determined by care provided during the period of time surrounding 
surgery, surgical approach (if applicable), length of time of surgical 
procedure, post-operative care, and length of stay. We assign the 
proposed relative weight for the applicable proposed low-volume 
quintile to the proposed no volume LTC-DRG if the proposed LTC-DRG to 
which it is crosswalked is grouped to one of the proposed low-volume 
quintiles. If the proposed LTC-DRG to which the proposed no volume LTC-
DRG is crosswalked is not one of the proposed LTC-DRGs to be grouped to 
one of the proposed low-volume quintiles, we compare the proposed 
relative weight of the proposed LTC-DRG to which the proposed no volume 
LTC-DRG is crosswalked to the proposed relative weights of each of the 
proposed five quintiles and we assign the proposed no volume LTC-DRG 
the relative weight of the proposed low-volume quintile with the 
closest weight. For this proposed rule, a list of the proposed no 
volume FY 2007 LTC-DRGs and the proposed FY 2007 LTC-DRG to which it is 
crosswalked in order to determine the appropriate proposed low-volume 
quintile for the assignment of a proposed relative weight for FY 2007 
is shown in the chart below.
BILLING CODE 4120-01-P

[[Page 24062]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.013


[[Page 24063]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.014


[[Page 24064]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.015


[[Page 24065]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.016


[[Page 24066]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.017


[[Page 24067]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.018

BILLING CODE 4120-01-C

    To illustrate this methodology for determining the proposed 
relative weights for the proposed 191 LTC-DRGs with no LTCH cases, we 
are providing the following examples, which refer to the proposed no 
volume LTC-DRGs crosswalk information for FY 2007 provided in the chart 
above.
    Example 1: There were no cases in the FY 2005 MedPAR file used for 
this proposed rule for proposed LTC-DRG 3 (Craniotomy Age 0-17). Since 
the procedure is similar in resource use and the length and complexity 
of the procedures and the length of stay are similar, we determined 
that proposed LTC-DRG 1 (Craniotomy Age >17 with CC), which is assigned 
to proposed low-volume Quintile 1 for the purpose of determining the 
proposed FY 2007 relative weights, would display similar clinical and 
resource use. Therefore, we assign the same proposed relative weight of 
proposed LTC-DRG 1 of 1.6479 (Quintile 5) for FY 2007 (Table 11 in the 
Addendum to this proposed rule) to LTC-DRG 3.
    Example 2: There were no LTCH cases in the FY 2005 MedPAR file used 
in this proposed rule for LTC-DRG 91 (Simple Pneumonia and Pleurisy Age 
0-17). Since the severity of illness in patients with bronchitis and 
asthma is similar in patients regardless of age, we determined that 
proposed LTC-DRG 90 (Simple Pneumonia and Pleurisy Age >17 Without CC) 
would display similar clinical and resource use characteristics and 
have a similar length of stay to proposed LTC-DRG 91. There were over 
25 cases in proposed LTC-DRG 90. Therefore, it would not be assigned to 
a proposed low-volume quintile for the purpose of determining the 
proposed LTC-DRG relative weights. However, under our established 
methodology, proposed LTC-DRG 91, with no LTCH cases, would need to be 
grouped to a proposed low-volume quintile. We determined that the 
proposed low-volume quintile with the closest weight to proposed LTC-
DRG 90 (0.4981) (refer to Table 11 in the Addendum to this proposed 
rule) would be proposed low-volume Quintile 2 (0.5655) (refer to Table 
11 in the Addendum to this proposed rule). Therefore, we assign 
proposed LTC-DRG 91 a proposed relative weight of 0.5655 for FY 2007. 
We note that we will continue to monitor the volume (that is, the 
number of LTCH cases) that have few or no LTCH cases to ensure that our 
proposed no volume LTC-DRG crosswalking and relative weight assignment 
results in appropriate payments for such cases and does not result in 
an unintended financial incentive for LTCHs to inappropriately admit 
these types of cases.
    Furthermore, we are proposing to establish proposed LTC-DRG 
relative weights of 0.0000 for heart, kidney, liver, lung, pancreas, 
and simultaneous pancreas/kidney transplants (LTC-DRGs 103, 302, 480, 
495, 512, and 513, respectively) for FY 2007 because Medicare will only 
cover these procedures if they are performed at a hospital that has 
been certified for the specific procedures by Medicare and presently no 
LTCH has been so certified. Based on our research, we found that most 
LTCHs only perform minor surgeries, such as minor small and large bowel 
procedures, to the extent any surgeries are performed at all. Given the 
extensive criteria that must be met to become certified as a transplant 
center for Medicare, we believe it is unlikely that any LTCHs would 
become certified as a transplant center. In fact, in the nearly 20 
years since the implementation of the IPPS, there has never been a LTCH 
that even expressed an interest in becoming a transplant center.
    However, if in the future a LTCH applies for certification as a 
Medicare-approved transplant center, we believe that the application 
and approval procedure would allow sufficient time for us to determine 
appropriate weights for the LTC-DRGs affected. At the present time, we 
would only include these six transplant LTC-DRGs in the GROUPER program 
for administrative purposes. Because we use the same GROUPER program 
for LTCHs as is used under the IPPS, removing these LTC-DRGs would be 
administratively burdensome.
    Again, we note that as this system is dynamic, it is entirely 
possible that the number of proposed LTC-DRGs with a zero volume of 
LTCH cases based on the system will vary in the future. We used the 
best most recent available claims data in the MedPAR file to identify 
zero

[[Page 24068]]

volume LTC-DRGs and to determine the proposed relative weights in this 
proposed rule.
    Table 11 in the Addendum to this proposed rule lists the proposed 
LTC-DRGs and their respective proposed relative weights, geometric mean 
length of stay, and five-sixths of the geometric mean length of stay 
(to assist in the determination of short-stay outlier payments under 
Sec.  412.529) for FY 2007.
    We also wish to point out that in section VI.A.5. of the preamble 
of this proposed rule, we discuss our proposal to revise the 
regulations for grandfathered HwHs, grandfathered hospital satellite 
facilities, and grandfathered satellite units at Sec. Sec.  412.22(f), 
412.22(h)(3); and 412.25(e)(3), respectively. In addition, in section 
VI.A.6. of the preamble of this proposed rule, we discuss our proposal 
to revise and clarify the existing policies governing the determination 
of LTCHs' CCRs and the reconciliation of high-cost and short-stay 
outlier payments under the LTCH PPS. (We note that these proposed 
changes concerning the determination of LTCHs' CCRs and the 
reconciliation of LTCH PPS high-cost and short-stay outlier payments 
are the same as the changes proposed in the RY 2007 LTCH PPS proposed 
rule (71 FR 674 through 4676 and 4690 through 4692). As discussed in 
greater detail in that section, in response to comments and requests, 
in this IPPS proposed rule, we are presenting the same proposed changes 
to the policies governing the determination of LTCHs' CCRs and the 
reconciliation of high-cost and short-stay outlier payments, and 
providing additional information on the values of the proposed LTCH CCR 
ceiling and the proposed statewide average LTCH CCRs that would be 
effective October 1, 2006, rather than responding to comments or 
finalizing any policy changes in the RY 2007 LTCH PPS final rule.)

G. Proposed Add-On Payments for New Services and Technologies

    (If you choose to comment on issues in this section, please include 
the caption ``New Technology'' at the beginning of your comment.)
1. Background
    Sections 1886(d)(5)(K) and (L) of the Act establish a process of 
identifying and ensuring adequate payment for new medical services and 
technologies (sometimes collectively referred to in this section as 
``new technologies'') under the IPPS. Section 1886(d)(5)(K)(vi) of the 
Act specifies that a medical service or technology will be considered 
new if it meets criteria established by the Secretary after notice and 
opportunity for public comment. Section 1886(d)(5)(K)(ii)(I) of the Act 
specifies that the process must apply to a new medical service or 
technology if, ``based on the estimated costs incurred with respect to 
discharges involving such service or technology, the DRG prospective 
payment rate otherwise applicable to such discharges under this 
subsection is inadequate.''
    The regulations implementing this provision establish three 
criteria for new medical services and technologies to receive an 
additional payment. First, Sec.  412.87(b)(2) defines when a specific 
medical service or technology will be considered new for purposes of 
new medical service or technology add-on payments. The statutory 
provision contemplated the special payment treatment for new medical 
services or technologies until such time as data are available to 
reflect the cost of the technology in the DRG weights through 
recalibration. There is a lag of 2 to 3 years from the point a new 
medical service or technology is first introduced on the market and 
when data reflecting the use of the medical service or technology are 
used to calculate the DRG weights. For example, data from discharges 
occurring during FY 2005 are used to calculate the proposed FY 2007 DRG 
weights in this proposed rule. Section 412.87(b)(2) provides that a 
``medical service or technology may be considered new within 2 or 3 
years after the point at which data begin to become available 
reflecting the ICD-9-CM code assigned to the new medical service or 
technology (depending on when a new code is assigned and data on the 
new medical service or technology become available for DRG 
recalibration). After CMS has recalibrated the DRGs, based on available 
data, to reflect the costs of an otherwise new medical service or 
technology, the medical service or technology will no longer be 
considered `new' under the criterion for this section.''
    The 2-year to 3-year period during which a medical service or 
technology can be considered new would ordinarily begin with FDA 
approval, unless there was some documented delay in bringing the 
product onto the market after that approval (for instance, component 
production or drug production had been postponed until FDA approval due 
to shelf life concerns or manufacturing issues). After the DRGs have 
been recalibrated to reflect the costs of an otherwise new medical 
service or technology, the special add-on payment for new medical 
services or technology ceases (Sec.  412.87(b)(2)).
    For example, an approved new technology that received FDA approval 
in October 2005 and entered the market at that time may be eligible to 
receive add-on payments as a new technology until FY 2008 (discharges 
occurring before October 1, 2007), when data reflecting the costs of 
the technology would be used to recalibrate the DRG weights. Because 
the FY 2008 DRG weights will be calculated using FY 2006 MedPAR data, 
the costs of such a new technology would likely be reflected in the FY 
2008 DRG weights.
    Section 412.87(b)(3) further provides that, to receive special 
payment treatment, new medical services or technologies must be 
inadequately paid otherwise under the DRG system. To assess whether 
technologies would be inadequately paid under the DRGs, we establish 
thresholds to evaluate applicants for new technology add-on payments. 
In the FY 2004 IPPS final rule (68 FR 45385, August 1, 2003), we 
established the threshold at the geometric mean standardized charge for 
all cases in the DRG plus 75 percent of 1 standard deviation above the 
geometric mean standardized charge (based on the logarithmic values of 
the charges and transformed back to charges) for all cases in the DRG 
to which the new medical service or technology is assigned (or the 
case-weighted average of all relevant DRGs, if the new medical service 
or technology occurs in many different DRGs). Table 10 in the Addendum 
to the FY 2004 IPPS final rule (68 FR 45648) listed the qualifying 
threshold by DRG, based on the discharge data that we used to calculate 
the FY 2004 DRG weights.
    However, section 503(b)(1) of Pub. L. 108-173 amended section 
1886(d)(5)(K)(ii)(I) of the Act to provide for ``applying a threshold * 
* * that is the lesser of 75 percent of the standardized amount 
(increased to reflect the difference between cost and charges) or 75 
percent of 1 standard deviation for the diagnosis-related group 
involved.'' The provisions of section 503(b)(1) apply to classification 
for fiscal years beginning with FY 2005. We updated Table 10 from the 
Federal Register document that corrected the FY 2004 final rule (68 FR 
57753, October 6, 2003), which contained the thresholds that we used to 
evaluate applications for new service or technology add-on payments for 
FY 2005, using the section 503(b)(1) measures stated above, and posted 
these new thresholds on our Web site at: http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp. In the FY 2005 IPPS final rule (in 
Table 10 of the Addendum), we included the final thresholds that were 
being used to evaluate applicants for new technology add-on payments 
for FY 2006. (Refer to

[[Page 24069]]

section IV.D. of the preamble to the FY 2005 IPPS final rule (69 FR 
49084, August 11, 2004) for a discussion of a revision of the 
regulations to incorporate the change made by section 503(b)(1) of Pub. 
L. 108-173.) Table 10 of the Addendum to the FY 2006 final rule (70 FR 
47680) contained the final thresholds that are being used to evaluate 
applications for new technology add-on payments for FY 2007.
    Section 412.87(b)(1) of our existing regulations provides that a 
new technology is an appropriate candidate for an additional payment 
when it represents ``an advance that substantially improves, relative 
to technologies previously available, the diagnosis or treatment of 
Medicare beneficiaries.'' For example, a new technology represents a 
substantial clinical improvement when it reduces mortality, decreases 
the number of hospitalizations or physician visits, or reduces recovery 
time compared to the technologies previously available. (Refer to the 
September 7, 2001 final rule (66 FR 46902) for a complete discussion of 
this criterion.)
    The new medical service or technology add-on payment policy 
provides additional payments for cases with high costs involving 
eligible new medical services or technologies while preserving some of 
the incentives under the average-based payment system. The payment 
mechanism is based on the cost to hospitals for the new medical service 
or technology. Under Sec.  412.88, Medicare pays a marginal cost factor 
of 50 percent for the costs of a new medical service or technology in 
excess of the full DRG payment. If the actual costs of a new medical 
service or technology case exceed the DRG payment by more than the 50-
percent marginal cost factor of the newmedical service or technology, 
Medicare payment is limited to the DRG payment plus 50 percent of the 
estimated costs of the new technology.
    The report language accompanying section 533 of Pub. L. 106-554 
indicated Congressional intent that the Secretary implement the new 
mechanism on a budget neutral basis (H.R. Conf. Rep. No. 106-1033, 
106th Cong., 2nd Sess. at 897 (2000)). Section 1886(d)(4)(C)(iii) of 
the Act requires that the adjustments to annual DRG classifications and 
relative weights must be made in a manner that ensures that aggregate 
payments to hospitals are not affected. Therefore, in the past, we 
accounted for projected payments under the new medical service and 
technology provision during the upcoming fiscal year at the same time 
we estimated the payment effect of changes to the DRG classifications 
and recalibration. The impact of additional payments under this 
provision was then included in the budget neutrality factor, which was 
applied to the standardized amounts and the hospital-specific amounts.
    Section 1886(d)(5)(K)(ii)(III) of the Act, as amended by section 
503(d)(2) of Pub. L. 108-173, provides that there shall be no reduction 
or adjustment in aggregate payments under the IPPS due to add-on 
payments for new medical services and technologies. Therefore, add-on 
payments for new medical services or technologies for FY 2005 and later 
years are not budget neutral.
    Applicants for add-on payments for new medical services or 
technologies for FY 2008 must submit a formal request, including a full 
description of the clinical applications of the medical service or 
technology and the results of any clinical evaluations demonstrating 
that the new medical service or technology represents a substantial 
clinical improvement, along with a significant sample of data to 
demonstrate the medical service or technology meets the high-cost 
threshold, no later than October 15, 2006. Applicants must submit a 
complete database no later than December 30, 2006. Complete application 
information, along with final deadlines for submitting a full 
application, will be available at our Web site: http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp. To allow interested parties to 
identify the new medical services or technologies under review before 
the publication of the proposed rule for FY 2008, the Web site will 
also list the tracking forms completed by each applicant.
2. Public Input Before Publication of This Notice of Proposed 
Rulemaking on Add-On Payments
    Section 1886(d)(5)(K)(viii) of the Act, as amended by section 
503(b)(2) of Pub. L. 108-173, provides for a mechanism for public input 
before publication of a notice of proposed rulemaking regarding whether 
a medical service or technology represents a substantial clinical 
improvement or advancement. The process for evaluating new medical 
service and technology applications requires the Secretary to--
     Provide, before publication of a proposed rule, for public 
input regarding whether a new service or technology represents an 
advance in medical technology that substantially improves the diagnosis 
or treatment of Medicare beneficiaries.
     Make public and periodically update a list of the services 
and technologies for which applications for add-on payments are 
pending.
     Accept comments, recommendations, and data from the public 
regarding whether a service or technology represents a substantial 
clinical improvement.
     Provide, before publication of a proposed rule, for a 
meeting at which organizations representing hospitals, physicians, 
manufacturers, and any other interested party may present comments, 
recommendations, and data regarding whether a new service or technology 
represents a substantial clinical improvement to the clinical staff of 
CMS.
    In order to provide an opportunity for public input regarding add-
on payments for new medical services and technologies for FY 2007 
before publication of this FY 2007 IPPS proposed rule, we published a 
notice in the Federal Register on December 23, 2005 (70 FR 76315) and 
held a town hall meeting at the CMS Headquarters Office in Baltimore, 
MD, on February 16, 2006. In the announcement notice for the meeting, 
we stated that the opinions and alternatives provided during the 
meeting would assist us in our evaluations of applications by allowing 
public discussions of the substantial clinical improvement criterion 
for each of the FY 2007 new medical service and technology add-on 
payment applications before the publication of this FY 2007 IPPS 
proposed rule.
    Approximately 35 participants registered and attended the town hall 
meeting in person, while additional participants listened over an open 
telephone line. The participants focused on presenting data on the 
substantial clinical improvement aspect of their products, as well as 
the need for additional payments to ensure access to Medicare 
beneficiaries. In addition, we received written comments regarding the 
substantial clinical improvement criterion for the applicants. We 
considered these comments in our evaluation of each new application for 
FY 2007 in this proposed rule. We have summarized these comments or, if 
applicable, indicated that no comments were received, at the end of the 
discussion of the individual applications. We received two general 
comments about application of the newness and substantial clinical 
improvement criteria.
    Comment: AdvaMed encouraged CMS to amend the definition of 
substantial clinical improvement for the IPPS new technology provision 
to conform with the outpatient definition of substantial clinical 
improvement used in 2001. Specifically, AdvaMed requests that

[[Page 24070]]

after ``decreased pain, bleeding, or other quantifiable symptom,'' CMS 
should insert, the following language: ``such as convenience, 
durability, ease of operation or make other improvements in quality of 
life.''
    Response: We believe we addressed this concern in the FY 2006 IPPS 
final rule (70 FR 47360). We use similar standards to evaluate 
substantial clinical improvement in the IPPS and OPPS and, in both 
systems, we employ identical language to explain and elaborate on the 
kinds of considerations that are taken into account in determining 
whether a new technology represents a substantial clinical improvement. 
We do not believe a change to the regulations text is necessary.
    Comment: AdvaMed commented that CMS should not use ``substantial 
similarity'' to evaluate newness without also determining whether the 
product is a substantial clinical improvement. AdvaMed argues that CMS 
is applying a concept that is not defined in regulations. If CMS 
applies the concept as part of determining whether a product is new 
without evaluating substantial clinical improvement, AdvaMed commented 
that we should define substantial similarity through notice and comment 
rulemaking.
    Response: We addressed this comment in the FY 2006 IPPS final rule 
(70 FR 47350 through 47351). We refer readers to that final rule for a 
detailed response to this comment.
    Section 1886(d)(5)(K)(ix) of the Act, as added by section 503(c) of 
Pub. L. 108-173, requires that, before establishing any add-on payment 
for a new medical service or technology, the Secretary shall seek to 
identify one or more DRGs associated with the new technology, based on 
similar clinical or anatomical characteristics and the costs of the 
technology and assign the new technology into a DRG where the average 
costs of care most closely approximate the costs of care using the new 
technology. No add-on payment shall be made if the new technology is 
assigned to a DRG that most closely approximates its costs.
    At the time an application for new technology add-on payments is 
submitted, the DRGs associated with the new technology are identified. 
We only determine that a new DRG assignment is necessary or a new 
technology add-on payment is appropriate when the payment under these 
currently assigned DRGs is not adequate and the technology otherwise 
meets the newness, cost, and substantial clinical improvement criteria.
    In this proposed rule, we evaluate whether new technology add-on 
payments will continue in FY 2007 for the three technologies that 
currently receive such payments. In addition, we present our 
evaluations of three applications for add-on payments in FY 2007.
3. FY 2007 Status of Technologies Approved for FY 2006 Add-On Payments
a. Kinetra[supreg] Implantable Neurostimulator for Deep Brain 
Stimulation
    Medtronic, Inc. submitted an application for approval of the 
Kinetra[supreg] implantable neurostimulator device for new technology 
add-on payments for FY 2005. In the IPPS final rule for FY 2005 (69 FR 
49019, August 11, 2004), we approved Kinetra[supreg] for new technology 
add-on payments.
    As noted above, the period for which technologies are eligible to 
receive new technology add-on payments is 2 to 3 years after the 
product becomes available on the market and data reflecting the cost of 
the technology are reflected in the DRG weights. This technology 
received FDA approval on December 16, 2003. Therefore, the technology 
will be beyond the 2- to 3-year period during which it can be 
considered new during FY 2007. Therefore, we are proposing to 
discontinue add-on payments for the Kinetra[supreg] rechargeable, 
implantable neurostimulator device for FY 2007.
    The manufacturer has submitted a request that we consider a higher 
paying DRG assignment for dual array neurostimulator pulse generator 
cases. We have taken this request into consideration and have reviewed 
the FY 2005 Medicare charge data for cases that use implantable 
neurostimulator for deep brain stimulation. Our findings and a full 
discussion of this issue can be found in Section II.D.2.a. of the 
preamble of this proposed rule.
b. Endovascular Graft Repair of the Thoracic Aorta
    W. L. Gore & Associates, Inc. submitted an application for 
consideration of its Endovascular Graft Repair of the Thoracic Aorta 
(GORE TAG) for new technology add-on payments for FY 2006. The 
manufacturer argued that endovascular stent-grafting of the descending 
thoracic aorta provides a less invasive alternative to the traditional 
open surgical approach required for the management of descending 
thoracic aortic aneurysms. The GORE TAG device is a tubular stent-graft 
mounted on a catheter-based delivery system, and it replaces the 
synthetic graft normally sutured in place during open surgery. The 
device was initially identified using ICD-9-CM procedure code 39.79 
(Other endovascular repair (of aneurysm) of other vessels). The 
applicant also requested a unique ICD-9-CM procedure code. As noted in 
Table 6B of the FY 2006 IPPS final rule (70 FR 47637), new procedure 
code 39.73 (Endovascular implantation of graft in thoracic aorta) was 
assigned to this technology.
    In the FY 2006 IPPS final rule (70 FR 47356), we approved the GORE 
TAG device for new technology add-on payment for FY 2006. We noted that 
any substantially similar device that is FDA-approved before or during 
FY 2006 that uses the same ICD-9-CM procedure code as GORE TAG and 
falls into the same DRGs as those approved for new technology add-on 
payments may also receive the new technology add-on payment associated 
with this technology in FY 2006.
    FDA approved GORE TAG on March 23, 2005. The technology remains 
within the 2-to 3-year period during which it can be considered new. 
Therefore, we are proposing to continue add-on payments for the 
endovascular graft repair of the thoracic aorta for FY 2007.
c. Restore[supreg] Rechargeable Implantable Neurostimulator
    Medtronic Neurological submitted an application for new technology 
add-on payments for its Restore[supreg] Rechargeable Implantable 
Neurostimulator for FY 2006. The Restore[supreg] Rechargeable 
Implantable Neurostimulator is designed to deliver electrical 
stimulation to the spinal cord to block the sensation of pain. The 
technology standard for neurostimulators uses internal sealed batteries 
as the power source to generate the electrical current. These internal 
batteries have finite lives, and require replacement when their power 
has been completely discharged. According to the manufacturer, the 
Restore[supreg] Rechargeable Implantable Neurostimulator ``represents 
the next generation of neurostimulator technology, allowing the 
physician to set the voltage parameters in such a way that fully meets 
the patient's requirements to achieve adequate pain relief without fear 
of premature depletion of the battery.'' The applicant stated that the 
expected life of the Restore rechargeable battery is 9 years, compared 
to an average life of 3 years for conventional neurostimulator 
batteries. We approved new technology add-on payments for all 
rechargeable, implantable neurostimulators for FY

[[Page 24071]]

2006. Cases involving these devices, made by any manufacturer, are 
identified by the presence of newly created ICD-9-CM code 86.98 
(Insertion or replacement of dual array rechargeable neurostimulator 
pulse generator).
    As noted above, the period for which technologies are eligible to 
receive new technology add-on payments is 2 to 3 years after the 
product becomes available on the market and data reflecting the cost of 
the technology are reflected in the DRG weights. The FDA approved the 
Restore[supreg] Rechargeable Implantable Neurostimulator in 2005. 
However, as noted above and in the FY 2006 IPPS final rule (70 FR 
47357), at least one similar product was approved by the FDA as early 
as April 2004. Nevertheless, consistent with current policy (70 FR 
47362) and decisions for prior products (that is, bone morphogenetic 
products and CRT-D devices), we are proposing to continue new 
technology add-on payments for rechargeable, implantable 
neurostimulators in FY 2007 because the product will be beyond the 3-
year period only in the latter 6 months of the fiscal year.
4. FY 2007 Applications for New Technology Add-On Payments
a. C-Port[supreg] Distal Anastomosis System
    Cardica, Inc. submitted an application for new technology add-on 
payments for FY 2007 for its Cardica C-Port[supreg] Distal Anastomosis 
System. The manufacturer states that the C-Port[supreg] System is 
indicated for all patients requiring a vein as a conduit during a 
coronary bypass operation for bypassing a coronary artery stenosis or 
occlusion. The manufacturer contends that the C-Port[supreg] System is 
specifically designed to create a reliable and consistent end-to-side 
anastomosis between a conduit, such as a venous graft, and a small 
arterial vessel during the bypass surgery. The device consists of eight 
stainless steel clips and a delivery system. Once the vein graft has 
been loaded into the device and the device positioned against the 
target vessel, the anastomosis is created by pushing a single button. 
Cardica, Inc. states the main purpose of the device is to replace a 
conventional hand-sewn, distal anastomosis with an automated, 
compliant, mechanical anastomosis.
    The C-Port[supreg] System was granted section 510(K) approval from 
the FDA on November 10, 2005. While the device appears to meet the 
criteria for being considered new based on its FDA approval date, we 
are concerned that various forms of surgical staples and clips have 
been used for more than a decade in a wide range of surgical 
procedures. In fact, the FDA found that the C-Port[supreg] System ``is 
substantially equivalent to the predicate devices with regard to 
indications, device characteristics, method of use, labeling and 
materials.'' Thus, given its similarity to other devices currently on 
the market, we are concerned that the C-Port[supreg] System may not 
qualify as new. We welcome comments on whether this device is new and 
how it can be distinguished from predicate devices that perform the 
same or a similar function.
    We also note that there is currently no ICD-9-CM code used to 
identify how the anastomosis is performed. The surgical technique used 
to graft the bypass to the arterial vessel is part of the surgical 
procedure itself and is not separately identified in our current coding 
structure. Thus, if a new code is created, we would be creating a code 
that is a subset of the surgical procedure that identifies whether the 
graft was performed by hand-sewing or using a device like the C-
Port[supreg] System, a distinction that has been unnecessary to date 
for inpatient hospital payments. Furthermore, we note that such a 
coding distinction would only be necessary for the new technology add-
on payment period if the device met all of the criteria. Once the new 
technology add-on payments are completed, the surgical technique used 
for the anasotomosis would not need to be identified because the code 
that describes the grafting procedure would be the same whether or not 
this technology is used.
    The applicant made several arguments in support of the device 
meeting the cost criterion. Cardica, Inc. estimates that the cost of 
each device will be approximately $1,200. The applicant assumes a 
hospital markup of 100 percent, with an average use of 2.5 C-Port 
devices per case. Therefore it estimates that the total average charge 
per patient will be $6,000. The C-Port[supreg] System would be used 
when a coronary artery bypass graft is performed. Thus, we are 
assessing whether it meets the cost criterion in relation to the 
threshold for DRGs 106 (Coronary Bypass with Percutaneous Transluminal 
Coronary Angioplasty), 547 (Coronary Bypass with Cardiac Catheter with 
Major CV Diagnosis), 548 (Coronary Bypass with Cardiac Catheter without 
Major CV Diagnosis), 549 (Coronary Bypass without Cardiac Catheter with 
Major CV Diagnosis), and 550 (Coronary Bypass without Cardiac Catheter 
without Major CV Diagnosis). We note that the data analysis for this 
technology is slightly unusual, as the DRGs to which the technology 
would have been assigned in FY 2005 (the MedPAR data we are currently 
using) are DRGs 107 and 109. These DRGs were terminated in FY 2006, and 
4 new coronary bypass DRGs were created for these cases (DRGs 547, 548, 
549, and 550). The manufacturer provided estimates showing a case-
weighted threshold for DRGs 106, 547, 548, 549 and 550 of $75,373. The 
applicant projects a 20-percent market penetration for the device in FY 
2007 or its use in approximately 23,000 cases across the 5 DRGs. The 
applicant submitted data showing average standardized charges for cases 
using the C-Port[supreg] System of $80,887. Therefore, the applicant 
argued that the device meets the cost threshold for a new technology 
add-on payment. Our internal data analysis of the technology, using the 
FY 2005 MedPAR data and Table 10 thresholds for FY 2005, shows a case-
weighted threshold of $68,416. We identified cases using coronary 
bypass procedure codes 36.10, 36.11, 36.12, 36.13 and 36.14, and 
concluded that the case-weighted average standardized charge for these 
bypass cases was $79,394. Thus, our internal data also suggest that the 
device may meet the cost threshold.
    The applicant made several arguments in support of the device 
meeting the substantial clinical improvement criterion. The 
manufacturer argues that the C-Port[supreg] creates a reliable and 
fully compliant end-to-side anastomosis between a vein graft and a 
coronary artery, in less time than is required to create a hand-sewn 
distal anastomosis. The applicant also states that the C-Port[supreg] 
System integrates deployment of the anastomotic clips and creation of 
the arteriotomy, thus enabling deployment to occur without occlusion of 
blood flow through the target vessel. However, we note that the 
applicant submitted evidence suggesting that the device does not always 
produce reliable anastomoses; specifically, a study of 130 patients 
receiving 132 devices reported 13 incomplete anastomoses in 12 
patients, and the study also noted that additional manual stitches were 
required in the majority of the patients studied. Therefore, we are 
concerned that these studies suggest that the C-Port[supreg] System may 
not represent a substantial clinical improvement over the traditional 
hand-sewn technique. At the town hall meeting, the applicant noted that 
these results were associated with inexperience preparing the target 
vessel, vein thickness assessment, proper device alignment and 
anastomosis site selection rather than problems with the

[[Page 24072]]

device itself. The applicant believes that these problems will become 
infrequent as surgeons have more experience with the device. We welcome 
further information from commenters that would suggest how the product 
meets the substantial clinical improvement criterion.
    We received the following public comments at the new technology 
town hall meeting regarding whether this technology meets the 
substantial clinical improvement criteria:
    Comment: The manufacturer argued that this technology meets the 
substantial clinical improvement criterion because:
     It achieves higher patency rates at 6 months compared to 
conventional hand-sown anastomoses.
     Use of the device will result in less surgeon-to-surgeon 
variability in the quality of the anastomosis compared to hand sewing.
     The device leads to reduced operative time.
     The product allows for the creation of an anastomosis 
during minimally invasive surgery.
    In addition, we received written comments expressing support for 
approval of new technology add-on payments for the C-Port[supreg] 
System. These commenters noted that:
     The device allows the anastomosis to be completed quickly, 
reducing patient complications during surgery from ischemia.
     The device will allow for smaller incisions during heart 
surgery and physicians will not have to position their hands in the 
chest cavity in order to hand-sew the anastomosis.
     The rapidly deployed anastomosis clamp provides patients 
with a surgical alternative where one would otherwise not be available 
due to the comorbidities associated with the more invasive CABG 
procedures.
    Response: We appreciate the time and effort the applicant took to 
present at the town hall meeting. We will consider the information 
presented in the written comments and at the town hall meeting, and 
welcome objective data that will support the assertions presented above 
by the commenters.
b. NovoSeven[supreg] for Intracerebral Hemorrhage
    The Pinnacle Health Group in conjunction with Novo Nordisk Inc. 
(the manufacturer) submitted an application for new technology add-on 
payments for FY 2007 for NovoSeven[supreg] for Intracerebral 
Hemorrhage. The technology is a drug that promotes hemostasis by 
activating clotting factors. The applicant is seeking new technology 
add-on payments for the use of its product in the treatment of 
intracerebral hemorrhage (ICH) using ICD-9-CM diagnosis code 431 
(Intracerebral hemorrhage).
    On March 25, 1999, the FDA approved NovoSeven[supreg] for the 
treatment of bleeding episodes in patients with hemophilia A or B with 
inhibitors to Factor VIII or Factor IX. The applicant is now seeking 
FDA approval for the additional indication of ICH in patients without 
hemophilia or other clotting abnormalities. The applicant noted that it 
expects FDA approval sometime in the first quarter of 2007. Because the 
technology is not currently FDA approved, we are not presenting our 
full analysis on whether the technology meets the criteria for the new 
technology add-on payment in this proposed rule. However, we note that 
the applicant did submit the information below on the cost and 
substantial clinical improvement criteria.
    Cases using the NovoSeven[supreg] are assigned to DRG 14 
(Intracranial Hemorrhage or Cerebral Infraction). The applicant expects 
NovoSeven[supreg] to be used in 20 to 35 percent of patients with ICH 
diagnosis code 431 in FY 2007. The applicant searched the FY 2004 
MedPAR and found a total of 31,407 cases with a principal diagnosis 
code of ICH. The condition was present as a secondary diagnosis in 
32,730 cases. The average standardized charge per case was $18,752.12 
when ICH was the principal diagnosis and $19,045.58 when ICH was the 
secondary diagnosis. The applicant submitted data demonstrating that 
the technology costs a total of $7,265, including the costs for the 
drug, sterile water, IV supplies, nursing services, pharmaceuticals, 
and followup CT scan. However, some of these costs (for example, 
nursing and pharmacy) are not part of the drug or technology itself and 
are normal operating costs included in the Medicare DRG payment for the 
inpatient stay and cannot be considered ``new.'' Therefore, based on 
data from the applicant, the total cost for this technology is $5,997. 
We then added the revised cost of the technology to determine a total 
average standardized charge per case of $24,749.12 when ICH was the 
principal diagnosis and $25,455.58 when it was the secondary diagnosis. 
The threshold for DRG 14 is $23,807. Based on the analysis above, the 
applicant maintains that NovoSeven[supreg] meets the cost criterion 
because the average standardized charge per case exceeds the threshold 
for DRG 14.
    The applicant also maintained that the technology meets the 
substantial clinical improvement criterion. The applicant explained 
that several studies have shown a correlation between the size of the 
intracranial hematoma and the mortality rate of patients with ICH 
within 30 days. As a result, Recombinant Coagulation Factors VIIa 
(rFVIIa), such as NovoSeven[supreg], are being explored as a treatment 
option for ICH.
    The applicant further explained that NovoSeven[supreg] activates 
prothrombin to thrombin by binding factor VIIa to exposed tissue 
factor, which then activates Factor IX into IXa and Factor X into Xa. 
The applicant noted that use of rFVIIa for hemophilia patients showed 
an 84-percent efficacy rate, with only one fatality and no major 
adverse events or evidence of disseminated intravascular coagulation. 
The applicant stated that the use of rFVIIa in a nonhemophilia 
population was safe across a wide range of doses.
    In addition, a recent randomized trial published in the New England 
Journal of Medicine \11\ researched 399 patients with ICH diagnosed by 
CT within 3 hours after onset who received either placebo or one of 
three doses of NovoSeven[supreg] (40[mu]g, 80[mu]g, or 160[mu]g). Some 
of the outcomes reported from the study for those patients treated with 
NovoSeven[supreg] compared to placebo include: Mortality was reduced by 
38 percent; the odds of improving by one level on the modified Rankin 
Scale at 90 days doubled; and the proportion of patients who died or 
were severely disabled declined from 69 percent in the placebo group to 
53 percent in the treatment group (combined for all three levels of 
doses). The applicant noted that the study concluded that ultra early 
hemostatic therapy within 4 hours after the onset of ICH with rFVIIa 
significantly reduced the growth of the hemorrhage, reduced mortality, 
and improved the functional outcomes at 3 months, thus demonstrating 
substantial clinical improvement.
---------------------------------------------------------------------------

    \11\ Mayer, S.A., et al. ``Recombinant Activated Factor VII for 
Acute Intracerebral Hemorrhage.'' New England Journal of Medicine, 
Vol. 352, No. 8, pp. 777-785, 2005.
---------------------------------------------------------------------------

    We received no public comments regarding this application for new 
technology add-on payments at the town hall meeting.
c. X STOP Interspinous Process Decompression System
    St. Francis Medical Technologies submitted an application for new 
technology add-on payments for the X STOP Interspinous Process 
Decompression System for FY 2007.

[[Page 24073]]

Lumbar spinal stenosis describes a condition that occurs when the 
spaces between bones in the spine become narrowed due to arthritis and 
other age-related conditions. This narrowing, or stenosis, causes 
nerves coming from the spinal cord to be compressed, thereby causing 
symptoms including pain, numbness, and weakness. It particularly causes 
symptoms when the spine is in extension, as occurs when a patient 
stands fully upright or leans back. The X STOP device is inserted 
between the spinous processes of adjacent vertebrae in order to provide 
a minimally invasive alternative to conservative treatment (exercise 
and physical therapy) and invasive surgery (spinal fusion). It works by 
limiting the spine extension that compresses the nerve roots while 
still preserving as much motion as possible. The device is inserted in 
a relatively simple, primarily outpatient procedure using local 
anesthesia. However, in some circumstances, the physician may prefer to 
admit the patient for an inpatient stay. The manufacturer has described 
the device as providing ``a new minimally invasive, stand-alone 
alternative treatment for lumbar spinal stenosis.''
    The X STOP Interspinous Process Decompression system received 
premarket approval from the FDA on November 21, 2005. The device is 
currently described by ICD-9-CM code 84.58 (Implantation of 
Interspinous process decompression device) (excluding: fusion of spine 
(codes 81.00 through 81.08, and 81.30 through 81.39)). This ICD-9-CM 
code went into effect on October 1, 2005.
    The manufacturer provided data in support of the device meeting the 
cost threshold criterion. The applicant stated that there would be an 
average of 1.6 units used per case. Each unit costs $5,500; therefore, 
the technology is expected to cost $8,800 per case. The device is 
currently assigned to DRGs 499 (Back and Neck Procedures Except Spinal 
Fusion with CC) and 500 (Back and Neck Procedures Except Spinal Fusion 
without CC). The manufacturer projected that there would be 
approximately 424 patients eligible to receive the device in DRG 499 in 
FY 2007, while there may be approximately 1,700 patients who receive 
the device in DRG 500. The manufacturer also provided data for cases 
involved in the clinical trials. The average standardized charge for 
the cases in FY 2004 was $24,065. The weighted threshold for DRGs 499 
and 500 is $20,096. However, the manufacturer argued that because 
significantly less than 20 percent of patients receiving the X STOP 
experienced complications or had comorbidities, the threshold should be 
calculated by estimating that 20 percent of patients would be assigned 
to DRG 499 and 80 percent would to DRG 500. The manufacturer stated in 
its application that, using this methodology, the applicable threshold 
should be $19,796. Using either calculation, it appears that the 
technology meets the cost threshold for new technology add-on payments.
    The applicant also submitted information in support of its claim of 
substantial clinical improvement. The manufacturer stated that the X 
STOP device is placed between the spinous processes to limit extension 
of the symptomatic level(s), yet allowing flexion, axial rotation, and 
lateral bending (that is, the device limits pressure on the spinal 
nerves and the resulting pain symptoms when the patient is in an 
upright position or leans backward while also preserving the patient's 
ability to turn side-to-side, bend forward, and to turn to either 
side). The applicant contends that this technology provides an 
alternative with improved clinical outcomes to conservative and 
surgical treatments. The manufacturer further stated that the device 
may offer a new alternative to lumbar spinal decompression procedures 
such as laminectomy and laminotomy. Additional information included in 
the application suggests that the device preserves spinal motion and is 
superior to a spinal decompression procedure that requires concomitant 
fusion (with or without instrumentation). The applicant argued that the 
advantages over spinal decompression include reduced risk, shorter 
hospital stay, and earlier improvement in pain and function. The 
manufacturer further contends that disease progression at adjacent 
levels is minimal following X STOP implantation compared to the known 
risk associated with surgical decompression and concomitant fusion. The 
applicant stated that the X STOP is comparable to traditional surgical 
decompression of lumbar spinal stenosis with respect to improved 
quality of life postoperatively. According to the applicant, the device 
provides advantages over nonoperative care, including better symptom 
relief, improved function, and increased patient satisfaction.
    We believe that the device satisfies the newness and cost threshold 
criteria for new technology add-on payments. However, we are concerned 
that the information included with the application may raise issues 
about substantial clinical improvement. During the FDA approval 
process, the Center for Devices and Radiological Health (CDRH) Advisory 
Panel voted against premarket approval (PMA) in August 2004 because of 
concerns about proper patient selection as well as the lack of 
objective endpoints, especially radiographic endpoints. The Panel also 
mentioned the overall low clinical efficacy rate in the study 
population. The device subsequently received PMA approval, but only on 
the condition that it be used in the context of a long term (5 year) 
follow-up study. We welcome information from commenters that addresses 
the concerns raised by the CDRH Advisory Panel or other information 
bearing on the issue of whether this product meets the substantial 
clinical improvement criterion.
    We received the following public comments through the new 
technology town hall meeting process regarding this application for 
add-on payments.
    Comment: The applicant asserted that the X STOP Interspinous 
Process Decompression system has the following advantages:
     It retains spinal anatomy and all spinal structures.
     The device allows for increased function and less pain 
after implantation as evidenced by radiographic measures that showed 
increases in the spinal canal area by 18 percent, diameter by 9 
percent, and subarticular diameter (the route that the nerves exit the 
spine) by 50 percent. In lateral view: area increased by 25 percent and 
width by 41 percent.
     The X STOP is a reversible procedure that causes no damage 
to facets or disks.
     The device allows for a treatment option for patients that 
cannot undergo surgeries with general anesthesia.
     The rate of complications associated with implantation of 
the device is below 1 percent.
    Response: We will evaluate these assertions as we further consider 
this application for new technology add-on payments for the final rule. 
We also note that the study that the applicant summarized at the town 
hall meeting for the X STOP used a randomized study that targeted 
lumbar spinal stenosis patients with mild to moderate symptoms. The 
control group did not require operative care. We welcome information 
from the comments that demonstrates how the study populations showed 
substantial clinical improvement compared to the control group.
    We note that the town hall meeting produced contradictory 
information regarding whether this procedure is generally performed in 
inpatient or

[[Page 24074]]

outpatient settings. The presenter indicated that over 90 percent of 
his patients were treated as outpatients. The manufacturer noted 90 
percent of non-U.S. patients and approximately two-thirds of U.S. 
patients since FDA approval have been treated in inpatient settings. 
While the setting where the procedure is typically performed has no 
bearing on whether the product represents a substantial clinical 
improvement, we note that we believe the physician should select the 
most appropriate site to perform the procedure based on the clinical 
needs of the patient.

III. Proposed Changes to the Hospital Wage Index

A. Background

    Section 1886(d)(3)(E) of the Act requires that, as part of the 
methodology for determining prospective payments to hospitals, the 
Secretary must adjust the standardized amounts ``for area differences 
in hospital wage levels by a factor (established by the Secretary) 
reflecting the relative hospital wage level in the geographic area of 
the hospital compared to the national average hospital wage level.'' In 
accordance with the broad discretion conferred under the Act, we 
currently define hospital labor market areas based on the definitions 
of statistical areas established by the Office of Management and Budget 
(OMB). A discussion of the proposed FY 2007 hospital wage index based 
on the statistical areas, including OMB's revised definitions of 
Metropolitan Areas, appears under section III.B. of this preamble.
    Beginning October 1, 1993, section 1886(d)(3)(E) of the Act 
requires that we update the wage index annually. Furthermore, this 
section provides that the Secretary base the update on a survey of 
wages and wage-related costs of short-term, acute care hospitals. The 
survey should measure the earnings and paid hours of employment by 
occupational category, and must exclude the wages and wage-related 
costs incurred in furnishing skilled nursing services. This provision 
also requires us to make any updates or adjustments to the wage index 
in a manner that ensures that aggregate payments to hospitals are not 
affected by the change in the wage index. The proposed adjustment for 
FY 2007 is discussed in section II.B. of the Addendum to this proposed 
rule.
    As discussed below in section III.H. of this preamble, we also take 
into account the geographic reclassification of hospitals in accordance 
with sections 1886(d)(8)(B) and 1886(d)(10) of the Act when calculating 
the wage index. Under section 1886(d)(8)(D) of the Act, the Secretary 
is required to adjust the standardized amounts so as to ensure that 
aggregate payments under the IPPS after implementation of the 
provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act 
are equal to the aggregate prospective payments that would have been 
made absent these provisions. The proposed budget neutrality adjustment 
for FY 2007 is discussed in section II.A.4.b. of the Addendum to this 
proposed rule.
    Section 1886(d)(3)(E) of the Act also provides for the collection 
of data every 3 years on the occupational mix of employees for short-
term, acute care hospitals participating in the Medicare program, in 
order to construct an occupational mix adjustment to the wage index. A 
discussion of the occupational mix adjustment that we propose to apply 
beginning October 1, 2006 (the proposed FY 2007 wage index) appears 
under section III.C. of this preamble.

B. Core-Based Statistical Areas for the Proposed Hospital Wage Index

    (If you choose to comment on issues in this section, please include 
the caption ``CBSAs'' at the beginning of your comment.)
    The wage index is calculated and assigned to hospitals on the basis 
of the labor market area in which the hospital is located. In 
accordance with the broad discretion under section 1886(d)(3)(E) of the 
Act, beginning with FY 2005, we define hospital labor market areas 
based on the Core-Based Statistical Areas (CBSAs) established by OMB 
and announced in December 2003 (69 FR 49027). OMB defines a 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 (MSAs) and 
Micropolitan Statistical Areas (65 FR 82235).
    According to 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 with 
a population of at least 10,000 but less than 50,000. Counties that do 
not fall within CBSAs 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.''
    The general concept of the CBSAs is that of an area containing a 
recognized population nucleus and adjacent communities that have a high 
degree of integration with that nucleus. The purpose of the standards 
is to provide nationally consistent definitions for collecting, 
tabulating, and publishing Federal statistics for a set of geographic 
areas. CBSAs include adjacent counties that have a minimum of 25 
percent commuting to the central counties of the area. (This is an 
increase over the minimum commuting threshold of 15 percent for 
outlying counties applied in the previous MSA definition.)
    The revised CBSAs established by OMB comprised MSAs and 
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 revised 
definitions recognize 49 MSAs and 565 Micropolitan Areas, and 
extensively changed the composition of many of the MSAs that existed 
prior to the revisions.
    The revised area designations resulted in a higher wage index for 
some areas and a lower wage index for others. Further, some hospitals 
that were previously classified as urban are now in rural areas. Given 
the significant payment impacts upon some hospitals because of these 
changes, we provided a transition period to the new labor market areas 
in the FY 2005 IPPS final rule (69 FR 49027 through 49034). As part of 
that transition, we allowed urban hospitals that became rural under the 
new definitions to maintain their assignment to the MSA where they were 
previously located for the 3-year period of FY 2005, FY 2006, and FY 
2007. Specifically, these hospitals were assigned the wage index of the 
urban area to which they previously belonged. (For purposes of the wage 
index computation, the wage data of these hospitals remained assigned 
to the statewide rural area in which they are located.) The hospitals 
receiving this transition will not be considered urban hospitals; 
rather, they will maintain their status as rural hospitals. Thus, the 
hospital would not be eligible, for example, for a large urban add-on 
payment under the capital PPS. In other words, it is the wage index, 
but not the urban or rural status, of these hospitals that is being 
affected by this transition. The higher wage indices that these 
hospitals are receiving are also being taken into consideration in 
determining whether they qualify for the out-migration adjustment 
discussed in section III.I. of this preamble and the amount of any 
adjustment.

[[Page 24075]]

    FY 2007 will be the third year of this transition period. We will 
continue to assign the wage index for the urban area in which the 
hospital was previously located through FY 2007. In order to ensure 
this provision remains budget neutral, we will continue to adjust the 
standardized amount by a transition budget neutrality factor to account 
for these hospitals. Doing so is consistent with the requirement of 
section 1886(d)(3)(E) of the Act that any ``adjustments or updates [to 
the adjustment for different area wage levels] * * * shall be made in a 
manner that assures that aggregate payments * * * are not greater or 
less than those that would have been made in the year without such 
adjustment.''
    Beginning in FY 2008, these hospitals will receive their statewide 
rural wage index, although they will be eligible to apply for 
reclassification by the MGCRB both during this transition period and in 
subsequent years. These hospitals will be considered rural for 
reclassification purposes.
    Consistent with the FY 2005 and FY 2006 IPPS final rules, as we did 
beginning in FY 2006, for FY 2007 we are proposing to provide that 
hospitals receive 100 percent of their wage index based upon the CBSA 
configurations. Specifically, we will determine for each hospital a 
proposed wage index for FY 2007 employing wage index data from FY 2003 
hospital cost reports and using the CBSA labor market definitions.

C. Proposed Occupational Mix Adjustment to the Proposed FY 2007 Index

    (If you choose to comment on issues in this section, please include 
the caption ``Occupational Mix Adjustment'' at the beginning of your 
comment.)
    As stated earlier, section 1886(d)(3)(E) of the Act provides for 
the collection of data every 3 years on the occupational mix of 
employees for each short-term, acute care hospital participating in the 
Medicare program, in order to construct an occupational mix adjustment 
to the wage index, for application beginning October 1, 2004 (the FY 
2005 wage index). The purpose of the occupational mix adjustment is to 
control for the effect of hospitals' employment choices on the wage 
index. For example, hospitals may choose to employ different 
combinations of registered nurses, licensed practical nurses, nursing 
aides, and medical assistants for the purpose of providing nursing care 
to their patients. The varying labor costs associated with these 
choices reflect hospital management decisions rather than geographic 
differences in the costs of labor.
1. Development of Data for the Proposed Occupational Mix Adjustment
    In the FY 2005 IPPS final rule (69 FR 49034), we discussed in 
detail the data we used to calculate the occupational mix adjustment to 
the FY 2005 wage index. For the proposed FY 2007 wage index, we are 
proposing to use the same CMS Wage Index Occupational Mix Survey and 
Bureau of Labor Statistics (BLS) data that we used for the FYs 2005 and 
2006 wage indices, with two exceptions. The CMS survey requires 
hospitals to report the number of total paid hours for directly hired 
and contract employees in occupations that provide the following 
services: Nursing, physical therapy, occupational therapy, respiratory 
therapy, pharmacy, dietary and medical and clinical laboratory. These 
services each include several standard occupational classifications 
(SOCs), as defined by the BLS' Occupational Employment Statistics (OES) 
survey. For the proposed FY 2007 wage index, we are using revised 
survey data for 16 hospitals that took advantage of the opportunity we 
afforded hospitals to submit changes to their occupational mix data 
during the FY 2007 wage index data collection process (see the 
discussion of wage data corrections process under section III.J. of 
this preamble). We also excluded survey data for hospitals that became 
designated as CAHs since the original survey data were collected and 
for hospitals for which there are no corresponding cost report data for 
the FY 2007 wage index. The proposed FY 2007 wage index includes 
occupational mix data from 3,362 out of 3,580 hospitals (93.9 percent 
response rate). The results of the occupational mix survey are included 
in the chart below.
BILLING CODE 4120-01-P

[[Page 24076]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.019


[[Page 24077]]


[GRAPHIC] [TIFF OMITTED] TP25AP06.020

BILLING CODE 4120-01-C
2. Calculation of the Proposed FY 2007 Occupational Mix Adjustment 
Factor and the Proposed FY 2007 Occupational Mix Adjusted Wage Index
    For the proposed FY 2007 wage index, we are proposing to use the 
same methodology that we used to calculate the occupational mix 
adjustment to the FY 2005 and FY 2006 wage indices (69 FR 49042 and 70 
FR 47367). We are proposing to use the following steps for calculating 
the proposed FY 2007 occupational mix adjustment factor and the 
proposed FY 2007 occupational mix adjusted wage index:
    Step 1--For each hospital, the percentage of the general service 
category attributable to an SOC is determined by dividing the SOC hours 
by the general service category's total hours. Repeat this calculation 
for each of the 19 SOCs.
    Step 2--For each hospital, the weighted average hourly rate for an 
SOC is determined by multiplying the percentage of the general service 
category (from Step 1) by the national average hourly rate for that SOC 
from the 2001 BLS OES survey, which was used in calculating the 
occupational mix adjustment for the FY 2005 wage index. The 2001 OES 
survey is BLS' latest available hospital-specific survey. (See Chart 4 
in the FY 2005 IPPS final rule, 69 FR 49038.) Repeat this calculation 
for each of the 19 SOCs.

[[Page 24078]]

    Step 3--For each hospital, the hospital's adjusted average hourly 
rate for a general service category is computed by summing the weighted 
hourly rate for each SOC within the general category. Repeat this 
calculation for each of the seven general service categories.
    Step 4--For each hospital, the occupational mix adjustment factor 
for a general service category is calculated by dividing the national 
adjusted average hourly rate for the category by the hospital's 
adjusted average hourly rate for the category. (The national adjusted 
average hourly rate is computed in the same manner as Steps 1 through 
3, using instead, the total SOC and general service category hours for 
all hospitals in the occupational mix survey database.) Repeat this 
calculation for each of the seven general service categories. If the 
hospital's adjusted rate is less than the national adjusted rate 
(indicating the hospital employs a less costly mix of employees within 
the category), the occupational mix adjustment factor will be greater 
than 1.0000. If the hospital's adjusted rate is greater than the 
national adjusted rate, the occupational mix adjustment factor will be 
less than 1.0000.
    Step 5--For each hospital, the occupational mix adjusted salaries 
and wage-related costs for a general service category are calculated by 
multiplying the hospital's total salaries and wage-related costs (from 
Step 5 of the unadjusted wage index calculation in section III.F. of 
this preamble) by the percentage of the hospital's total workers 
attributable to the general service category and by the general service 
category's occupational mix adjustment factor (from Step 4 above). 
Repeat this calculation for each of the seven general service 
categories. The remaining portion of the hospital's total salaries and 
wage-related costs that is attributable to all other employees of the 
hospital is not adjusted for occupational mix.
    Step 6--For each hospital, the total occupational mix adjusted 
salaries and wage-related costs for a hospital are calculated by 
summing the occupational mix adjusted salaries and wage-related costs 
for the seven general service categories (from Step 5) and the 
unadjusted portion of the hospital's salaries and wage-related costs 
for all other employees. To compute a hospital's occupational mix 
adjusted average hourly wage, divide the hospital's total occupational 
mix adjusted salaries and wage-related costs by the hospital's total 
hours (from Step 4 of the unadjusted wage index calculation in section 
III.F. of this preamble).
    Step 7--To compute the occupational mix adjusted average hourly 
wage for an urban or rural area, sum the total occupational mix 
adjusted salaries and wage-related costs for all hospitals in the area, 
then sum the total hours for all hospitals in the area. Next, divide 
the area's occupational mix adjusted salaries and wage-related costs by 
the area's hours.
    Step 8--To compute the national occupational mix adjusted average 
hourly wage, sum the total occupational mix adjusted salaries and wage-
related costs for all hospitals in the Nation, then sum the total hours 
for all hospitals in the Nation. Next, divide the national occupational 
mix adjusted salaries and wage-related costs by the national hours. The 
proposed national occupational mix adjusted average hourly wage for FY 
2007 is $29.6213. (This figure represents a 100 percent adjustment for 
occupational mix.)
    Step 9--To compute the occupational mix adjusted wage index, divide 
each area's occupational mix adjusted average hourly wage (Step 7) by 
the national occupational mix adjusted average hourly wage (Step 8).
    Step 10--To compute the Puerto Rico specific occupational mix 
adjusted wage index, follow Steps 1 through 9 above. The proposed 
Puerto Rico occupational mix adjusted average hourly wage for FY 2007 
is $12.9490. (This figure represents a 100 percent adjustment for 
occupational mix.)
    An example of the occupational mix adjustment was included in the 
FY 2005 IPPS final rule (69 FR 49043).
    For the FY 2006 final wage index, we used the unadjusted wage data 
for hospitals that did not submit occupational mix survey data. For 
calculation purposes, this equates to applying the national SOC mix to 
the wage data for these hospitals, because hospitals having the same 
mix as the Nation would have an occupational mix adjustment factor 
equaling 1.0000. In the FYs 2005 and 2006 IPPS final rule (69 FR 49035 
and 70 FR 47368), we noted that we would revisit this matter with 
subsequent collections of the occupational mix data. Because we are 
using essentially the same survey data for the proposed FY 2007 
occupational mix adjustment that we used for FYs 2005 and 2006, with 
the only exceptions as stated in section III.C.1. of this preamble, we 
are treating the wage data for hospitals that did not respond to the 
survey in this same manner for the proposed FY 2007 wage index.
    In implementing an occupational mix adjusted wage index based on 
the above calculation, the proposed wage index values for 17 rural 
areas (36.2 percent) and 204 urban areas (52.8 percent) would decrease 
as a result of the adjustment. Five rural areas (10.6 percent) and 106 
urban areas (27.5 percent) would experience a decrease of 1 percent or 
greater in their wage index values. The largest negative impact for a 
rural area would be 1.8 percent and for an urban area, 4.2 percent. 
Meanwhile, 30 rural areas (63.8 percent) and 178 urban areas (46.1 
percent) would experience an increase in their wage index values. 
Although these results show that rural hospitals would gain the most 
from an occupational mix adjustment to the wage index, their gains may 
not be as great as might have been expected. Further, it might not have 
been anticipated that approximately one-third of rural hospitals would 
actually fare worse under the adjustment. Overall, a fully implemented 
occupational mix adjusted wage index would have a redistributive effect 
on Medicare payments to hospitals.
    In the FY 2006 IPPS final rule (70 FR 47368), we indicated that, 
for future data collections, we would revise the occupational mix 
survey to allow hospitals to provide both salaries and hours data for 
each of the employment categories that are included on the survey. We 
also indicated that we would assess whether future occupational mix 
surveys should be based on the calendar year or if the data should be 
collected on a fiscal year basis as part of the Medicare cost report. 
(One logistical problem is that cost report data are collected yearly, 
but occupational mix survey data are collected only every 3 years.)
    In a document published in the Federal Register on October 14, 2005 
(70 FR 60092), we proposed a new survey, the 2006 Medicare Wage Index 
Occupational Mix Survey. The 2006 survey provides for the collection of 
data on hospital-specific wages and hours for a 6-month reporting 
period (January 1, 2006 through June 30, 2006), as well as additional 
clarification of the definitions for the occupational categories, an 
expansion of the registered nurse category to include functional 
subcategories, the exclusion of average hourly rate data associated 
with advance practice nurses, and the transfer of each general service 
category that comprised less than 4 percent of total hospital employees 
in the 2003 survey to the ``all other occupations'' category. The 
results of the 2006 occupational mix survey will be used to adjust the 
IPPS wage index beginning with FY 2008. On February 10, 2006, we

[[Page 24079]]

published in the Federal Register a notice with a 30-day comment period 
for the 2006 survey (71 FR 7047). We will provide a full discussion of 
the 2006 survey design, the survey results, and the methodology for 
calculating and applying the new occupational mix adjustment in the FY 
2008 IPPS proposed rule.
    In our continuing efforts to meet the information needs of the 
public, we are providing via the Internet three additional public use 
files (PUFs) for the proposed occupational mix adjusted wage index 
concurrently with the publication of this proposed rule: (1) A file 
including each hospital's unadjusted and adjusted average hourly wage 
(FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted Average 
Hourly Wage by Provider); (2) a file including each CBSA's adjusted and 
unadjusted average hourly wage (FY 2007 Proposed Rule Occupational Mix 
Adjusted and Unadjusted Average Hourly Wage and Pre-Reclassified Wage 
Index by CBSA); and (3) a file including each hospital's occupational 
mix adjustment factors by occupational category (Provider Occupational 
Mix Adjustment Factors for Each Occupational Category). These 
additional files are posted on the Internet at http://www.cms.hhs.gov/AcuteInpatientPPS. We also plan to post these files via the Internet 
with future applications of the occupational mix adjustment.

D. Worksheet S-3 Wage Data for the Proposed FY 2007 Wage Index Update

    (If you choose to comment on issues in this section, please include 
the caption ``Wage Data'' at the beginning of your comment.)
    The proposed FY 2007 wage index values (effective for hospital 
discharges occurring on or after October 1, 2006 and before October 1, 
2007) in section II.B. of the Addendum to this proposed rule are based 
on the data collected from the Medicare cost reports submitted by 
hospitals for cost reporting periods beginning in FY 2003 (the FY 2006 
wage index was based on FY 2002 wage data).
    The proposed FY 2007 wage index includes the following categories 
of data associated with costs paid under the IPPS (as well as 
outpatient costs):
     Salaries and hours from short-term, acute care hospitals 
(including paid lunch hours and hours associated with military leave 
and jury duty).
     Home office costs and hours.
     Certain contract labor costs and hours (which includes 
direct patient care, certain top management, pharmacy, laboratory, and 
nonteaching physician Part A services).
     Wage-related costs, including pensions and other deferred 
compensation costs.
    Consistent with the wage index methodology for FY 2006, the 
proposed wage index for FY 2007 also excludes the direct and overhead 
salaries and hours for services not subject to IPPS payment, such as 
SNF services, home health services, costs related to GME (teaching 
physicians and residents) and certified registered nurse anesthetists 
(CRNAs), and other subprovider components that are not paid under the 
IPPS. The proposed FY 2007 wage index also excludes the salaries, 
hours, and wage-related costs of hospital-based rural health clinics 
(RHCs), and Federally qualified health centers (FQHCs) because Medicare 
pays for these costs outside of the IPPS (68 FR 45395). In addition, 
salaries, hours, and wage-related costs of CAHs are excluded from the 
wage index, for the reasons explained in the FY 2004 IPPS final rule 
(68 FR 45397).
    Data collected for the IPPS wage index are also currently used to 
calculate wage indices applicable to other providers, such as SNFs, 
home health agencies, and hospices. In addition, they are used for 
prospective payments to IRFs, IPFs, and LTCHs, and for hospital 
outpatient services. We note that, in the IPPS rules, we do not address 
comments pertaining to the wage indices for non-IPPS providers. Such 
comments should be made in response to separate proposed rules for 
those providers.

E. Verification of Worksheet S-3 Wage Data

    (If you choose to comment on this section, please include the 
caption ``Wage Data'' at the beginning of your comment.)
    The wage data for the proposed FY 2007 wage index were obtained 
from Worksheet S-3, Parts II and III of the FY 2003 Medicare cost 
reports. Instructions for completing the Worksheet S-3, Parts II and 
III are in the Provider Reimbursement Manual, Part I, sections 3605.2 
and 3605.3. The data file used to construct the proposed wage index 
includes FY 2003 data submitted to us as of March 1, 2006. As in past 
years, we performed an intensive review of the wage data, mostly 
through the use of edits designed to identify aberrant data.
    We asked our fiscal intermediaries to revise or verify data 
elements that resulted in specific edit failures. Some unresolved data 
elements are included in the calculation of the proposed FY 2007 wage 
index. We instructed the fiscal intermediaries to complete their data 
verification of questionable data elements and to transmit any changes 
to the wage data no later than April 14, 2006. We believe all 
unresolved data elements will be resolved by the date the final rule is 
issued. The revised data will be reflected in the final rule.
    Also, as part of our editing process, we removed the data for 215 
hospitals from our database: 178 hospitals designated as CAHs between 
February 18, 2005, the cutoff date for exclusion of CAHs from the FY 
2006 wage index, and February 17, 2006, the cutoff date for CAH 
exclusion for the FY 2007 wage index (that is, 7 or more days prior to 
the posting of the preliminary February 24, 2006 PUF), and 30 hospitals 
were low Medicare utilization hospitals or failed edits that could not 
be corrected because the hospitals terminated the program or changed 
ownership. In addition, we removed the wage data for 7 hospitals with 
incomplete or inaccurate data resulting in zero or negative, or 
otherwise aberrant, average hourly wages. We have notified the fiscal 
intermediaries of these hospitals and will continue to work with the 
fiscal intermediaries to correct these data until we finalize our 
database to compute the final wage index. The data for these hospitals 
will be included in the final wage index if we receive corrected data 
that pass our edits. As a result, the proposed FY 2007 wage index is 
calculated based on FY 2003 wage data from 3,580 hospitals.
    In constructing the proposed FY 2007 wage index, we include the 
wage data for facilities that were IPPS hospitals in FY 2003, even for 
those facilities that have since terminated their participation in the 
program as hospitals, as long as those data do not fail any of our 
edits for reasonableness. We believe that including the wage data for 
these hospitals is, in general, appropriate to reflect the economic 
conditions in the various labor market areas during the relevant past 
period. However, we exclude the wage data for CAHs as discussed in 68 
FR 45397.
    Section 4410 of Pub. L. 105-33 provides that, for the purposes of 
section 1886(d)(3)(E) of the Act, for discharges occurring on or after 
October 1, 1997, the area wage index applicable to any hospital that is 
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.'' In the August 
11, 2004 IPPS final rule (69 FR 49109), we discussed situations where a 
State has only urban areas and no geographically rural areas, or a 
State has geographically rural areas but no IPPS hospitals are located 
in those rural

[[Page 24080]]

areas. As a result, these States did not have rural IPPS hospitals from 
which to compute and apply a ``rural floor.'' In that final rule, we 
developed a policy for imputing a ``rural floor'' for these States, 
effective for the FYs 2005, 2006, and 2007 wage indices, so that a 
``rural floor'' could be applicable to IPPS urban hospitals in those 
States in the same manner that a ``rural floor'' is applicable to IPPS 
urban hospitals in States that have IPPS rural hospitals. We revised 
the regulations at Sec.  412.64(h) to describe the methodology for 
computing the imputed ``rural floors'' for these States and to define 
an all-urban State. Specifically, Sec.  412.64(h)(5) defines an all-
urban State as ``a State with no rural areas * * * or a State in which 
there are no hospitals classified as rural. A State with rural areas 
and with hospitals reclassified as rural under Sec.  412.103 is not an 
all-urban State.''
    We have received questions as to what area wage index CMS would 
apply in the instance where a new rural IPPS hospital opens in a State 
that has an imputed ``rural floor'' because it has rural areas but had 
no hospitals classified as rural. In addition, we have been asked 
whether a new IPPS hospital could submit its wages and hours data to be 
used in computing the wage index, even though the hospital did not file 
a cost report as an IPPS provider for the cost report base year that is 
used in calculating that wage index.
    A new hospital can be an entirely new facility that did not exist 
before, or it can be a hospital that participated in Medicare under a 
previous provider number, but has acquired a new Medicare provider 
number (such as when a CAH converts to IPPS status, or vice versa). As 
a new IPPS hospital (in this case, rural), the hospital would not yet 
have filed any wages and hours data on a Medicare cost report. Even in 
the situation where a new IPPS hospital previously participated in 
Medicare as another provider type (such as a CAH) and was able to 
develop its wages and hours data for the wage index base year, 
consistent with section 1886(d)(3)(E) of the Act which specifies that 
the wage index must be based on data from short-term, acute care 
hospitals, CMS could not include the hospital's wages and hours from a 
period during which the hospital was not an IPPS provider. Furthermore, 
even once the hospital files its first Medicare cost report under the 
new IPPS provider number, that first cost report is not used in 
computing the wage index for the hospital's geographic area until 4 
years later. This is because a current fiscal year's wage index is 
computed from cost reports that are 4 years prior to that current 
fiscal year. Consequently, the only wage index that would be available 
for such a new IPPS rural hospital in the first 3 years of the 
hospital's existence is the imputed ``rural floor.'' Therefore, if a 
new rural IPPS hospital opens in a State that has an imputed ``rural 
floor'' and has rural areas, the hospital would receive the imputed 
``rural floor'' as its wage index until its first cost report is 
contemporaneous with the cost reporting period being used to develop a 
given fiscal year's wage index.

F. Computation of the Proposed FY 2007 Unadjusted Wage Index

    (If you choose to comment on issues in this section, please include 
the caption ``Unadjusted Wage Index'' at the beginning of your 
comment.)
    The method used to compute the proposed FY 2007 wage index without 
an occupational mix adjustment follows:
    Step 1--As noted above, we based the proposed FY 2007 wage index on 
wage data reported on the FY 2003 Medicare cost reports. We gathered 
data from each of the non-Federal, short-term, acute care hospitals for 
which data were reported on the Worksheet S-3, Parts II and III of the 
Medicare cost report for the hospital's cost reporting period beginning 
on or after October 1, 2002 and before October 1, 2003. In addition, we 
included data from some hospitals that had cost reporting periods 
beginning before October 2002 and reported a cost reporting period 
covering all of FY 2003. These data were included because no other data 
from these hospitals would be available for the cost reporting period 
described above, and because particular labor market areas might be 
affected due to the omission of these hospitals. However, we generally 
describe these wage data as FY 2003 data. We note that, if a hospital 
had more than one cost reporting period beginning during FY 2003 (for 
example, a hospital had two short cost reporting periods beginning on 
or after October 1, 2002 and before October 1, 2003), we included wage 
data from only one of the cost reporting periods, the longer, in the 
wage index calculation. If there was more than one cost reporting 
period and the periods were equal in length, we included the wage data 
from the later period in the wage index calculation.
    Step 2--Salaries--The method used to compute a hospital's average 
hourly wage excludes certain costs that are not paid under the IPPS. In 
calculating a hospital's average salaries plus wage-related costs, we 
subtracted from Line 1 (total salaries) the GME and CRNA costs reported 
on Lines 2, 4.01, 6, and 6.01, the Part B salaries reported on Lines 3, 
5 and 5.01, home office salaries reported on Line 7, and excluded 
salaries reported on Lines 8 and 8.01 (that is, direct salaries 
attributable to SNF services, home health services, and other 
subprovider components not subject to the IPPS). We also subtracted 
from Line 1 the salaries for which no hours were reported. To determine 
total salaries plus wage-related costs, we added to the net hospital 
salaries the costs of contract labor for direct patient care, certain 
top management, pharmacy, laboratory, and nonteaching physician Part A 
services (Lines 9 and 10), home office salaries and wage-related costs 
reported by the hospital on Lines 11 and 12, and nonexcluded area wage-
related costs (Lines 13, 14, and 18).
    We note that contract labor and home office salaries for which no 
corresponding hours are reported were not included. In addition, wage-
related costs for nonteaching physician Part A employees (Line 18) are 
excluded if no corresponding salaries are reported for those employees 
on Line 4.
    Step 3--Hours--With the exception of wage-related costs, for which 
there are no associated hours, we computed total hours using the same 
methods as described for salaries in Step 2.
    Step 4--For each hospital reporting both total overhead salaries 
and total overhead hours greater than zero, we then allocated overhead 
costs to areas of the hospital excluded from the wage index 
calculation. First, we determined the ratio of excluded area hours (sum 
of Lines 8 and 8.01 of Worksheet S-3, Part II) to revised total hours 
(Line 1 minus the sum of Part II, Lines 2, 3, 4.01, 5, 5.01, 6, 6.01, 
7, and Part III, Line 13 of Worksheet S-3). We then computed the 
amounts of overhead salaries and hours to be allocated to excluded 
areas by multiplying the above ratio by the total overhead salaries and 
hours reported on Line 13 of Worksheet S-3, Part III. Next, we computed 
the amounts of overhead wage-related costs to be allocated to excluded 
areas using three steps: (1) We determined the ratio of overhead hours 
(Part III, Line 13) to revised hours (Line 1 minus the sum of Lines 2, 
3, 4.01, 5, 5.01, 6, 6.01, 7, 8, and 8.01); (2) we computed overhead 
wage-related costs by multiplying the overhead hours ratio by wage-
related costs reported on Part II, Lines 13, 14, and 18; and (3) we 
multiplied the computed overhead wage-related costs by the above 
excluded area hours ratio. Finally, we subtracted the computed overhead 
salaries, wage-related costs, and hours associated with excluded areas 
from the

[[Page 24081]]

total salaries (plus wage-related costs) and hours derived in Steps 2 
and 3.
    Step 5--For each hospital, we adjusted the total salaries plus 
wage-related costs to a common period to determine total adjusted 
salaries plus wage-related costs. To make the wage adjustment, we 
estimated the percentage change in the employment cost index (ECI) for 
compensation for each 30-day increment from October 14, 2002, through 
April 15, 2004, for private industry hospital workers from the BLS' 
Compensation and Working Conditions. We use the ECI because it reflects 
the price increase associated with total compensation (salaries plus 
fringes) rather than just the increase in salaries. In addition, the 
ECI includes managers as well as other hospital workers. This 
methodology to compute the monthly update factors uses actual quarterly 
ECI data and assures that the update factors match the actual quarterly 
and annual percent changes. The factors used to adjust the hospital's 
data were based on the midpoint of the cost reporting period, as 
indicated below.

                    Midpoint of Cost Reporting Period
------------------------------------------------------------------------
                                                             Adjustment
                    After                        Before        factor
------------------------------------------------------------------------
10/14/2002..................................    11/15/2002       1.06058
11/14/2002..................................    12/15/2002       1.05679
12/14/2002..................................    01/15/2003       1.05304
01/14/2003..................................    02/15/2003       1.04915
02/14/2003..................................    03/15/2003       1.04513
03/14/2003..................................    04/15/2003       1.04108
04/14/2003..................................    05/15/2003       1.03713
05/14/2003..................................    06/15/2003       1.03325
06/14/2003..................................    07/15/2003       1.02948
07/14/2003..................................    08/15/2003       1.02584
08/14/2003..................................    09/15/2003       1.02231
09/14/2003..................................    10/15/2003       1.01878
10/14/2003..................................    11/15/2003       1.01510
11/14/2003..................................    12/15/2003       1.01127
12/14/2003..................................    01/15/2004       1.00743
01/14/2004..................................    02/15/2004       1.00367
02/14/2004..................................    03/15/2004       1.00000
03/14/2004..................................    04/15/2004       0.99644
------------------------------------------------------------------------

    For example, the midpoint of a cost reporting period beginning 
January 1, 2003 and ending December 31, 2003 is June 30, 2003. An 
adjustment factor of 1.02948 would be applied to the wages of a 
hospital with such a cost reporting period. In addition, for the data 
for any cost reporting period that began in FY 2003 and covered a 
period of less than 360 days or more than 370 days, we annualized the 
data to reflect a 1-year cost report. Dividing the data by the number 
of days in the cost report and then multiplying the results by 365 
accomplishes annualization.
    Step 6--Each hospital was assigned to its appropriate urban or 
rural labor market area before any reclassifications under section 
1886(d)(8)(B), section 1886(d)(8)(E), or section 1886(d)(10) of the 
Act. Within each urban or rural labor market area, we added the total 
adjusted salaries plus wage-related costs obtained in Step 5 for all 
hospitals in that area to determine the total adjusted salaries plus 
wage-related costs for the labor market area.
    Step 7--We divided the total adjusted salaries plus wage-related 
costs obtained under both methods in Step 6 by the sum of the 
corresponding total hours (from Step 4) for all hospitals in each labor 
market area to determine an average hourly wage for the area.
    Step 8--We added the total adjusted salaries plus wage-related 
costs obtained in Step 5 for all hospitals in the Nation and then 
divided the sum by the national sum of total hours from Step 4 to 
arrive at a national average hourly wage. Using the data as described 
above, the proposed national average hourly wage is $29.6008.
    Step 9--For each urban or rural labor market area, we calculated 
the hospital wage index value by dividing the area average hourly wage 
obtained in Step 7 by the national average hourly wage computed in Step 
8.
    Step 10--Following the process set forth above, we developed a 
separate Puerto Rico-specific wage index for purposes of adjusting the 
Puerto Rico standardized amounts. (The national Puerto Rico 
standardized amount is adjusted by a wage index calculated for all 
Puerto Rico labor market areas based on the national average hourly 
wage as described above.) We added the total adjusted salaries plus 
wage-related costs (as calculated in Step 5) for all hospitals in 
Puerto Rico and divided the sum by the total hours for Puerto Rico (as 
calculated in Step 4) to arrive at an overall proposed average hourly 
wage of $12.9564 for Puerto Rico. For each labor market area in Puerto 
Rico, we calculated the Puerto Rico-specific wage index value by 
dividing the area average hourly wage (as calculated in Step 7) by the 
overall Puerto Rico average hourly wage.
    Step 11--Section 4410 of Pub. L. 105-33 provides that, for 
discharges on or after October 1, 1997, the area wage index applicable 
to any hospital that is 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 that State. (For all-urban States, we established an imputed 
floor (69 FR 49109). Furthermore, this wage index floor is to be 
implemented in such a manner as to ensure that aggregate IPPS payments 
are not greater or less than those that would have been made in the 
year if this section did not apply. For FY 2007, this change affects 
187 hospitals in 62 urban areas. The areas affected by this provision 
are identified by a footnote in Tables 4A-1 and 4A-2 in the Addendum of 
this proposed rule.

G. Computation of the Proposed FY 2007 Blended Wage Index

    (If you choose to comment on issues in this section, please include 
the caption ``Blended Wage Index'' at the beginning of your comment.)
    For the final FY 2005 and FY 2006 wage indices, we used a blend of 
the occupational mix adjusted wage index and the unadjusted wage index. 
Specifically, we adjusted 10 percent of the FY 2005 and FY 2006 wage 
index adjustment factor by a factor reflecting occupational mix. We 
refer readers to the FY 2005 IPPS final rule at 69 FR 49052 and the FY 
2006 IPPS final rule at 70 FR 47376 for a detailed discussion of the 
blended wage index. For FY 2007, we are proposing to apply the same 
blended wage index as we did in FYs 2005 and 2006, so that 10 percent 
of the wage index is adjusted by a factor reflecting occupational mix. 
We believe this is prudent policy because we are relying on the same 
survey data used in FYs 2005 and 2006.
    In computing the occupational mix adjustment for the proposed FY 
2007 wage index, we used the occupational mix survey data that we 
collected for the FY 2006 wage index, replacing the survey data for 16 
hospitals that submitted revised data, and excluding the survey data 
for hospitals with no corresponding Worksheet S-3 wage data for the FY 
2007 wage index.
    With 10 percent of the proposed FY 2007 wage index adjusted for 
occupational mix, the proposed national average hourly wage is $29.6029 
and the Puerto Rico-specific average hourly wage is $12.9557. The wage 
index values for 17 rural areas (36.2 percent) and 200 urban areas 
(51.8 percent) would decrease as a result of the adjustment. These 
decreases would be minimal; the largest negative impact for a rural 
area would be 0.18 percent and for an urban area, 0.42 percent. 
Conversely, 29 rural areas (61.7 percent) and 173 urban areas (44.8 
percent) would benefit from this adjustment, with 1 urban area 
increasing 2.2 percent and 2 rural areas increasing 0.38 percent. As 
there are no significant differences between the FY 2006 and the FY 
2007 occupational mix survey data and results, we believe it is 
appropriate to again apply the occupational mix to 10 percent of the 
proposed FY 2007 wage index. (See Appendix A to this proposed rule for

[[Page 24082]]

further analysis of the impact of the occupational mix adjustment on 
the proposed FY 2007 wage index.)
    The proposed wage index values for FY 2007 (except those for 
hospitals receiving wage index adjustments under section 505 of Pub. L. 
108-173) are shown in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F in the 
Addendum to this proposed rule.
    Tables 3A and 3B in the Addendum to this proposed rule list the 3-
year average hourly wage for each labor market area before the 
redesignation of hospitals, based on FYs 2005, 2006, 2007 cost 
reporting periods. Table 3A lists these data for urban areas and Table 
3B lists these data for rural areas. In addition, Table 2 in the 
Addendum to this proposed rule includes the adjusted average hourly 
wage for each hospital from the FY 2001 and FY 2002 cost reporting 
periods, as well as the FY 2003 period used to calculate the proposed 
FY 2007 wage index. The 3-year averages are calculated by dividing the 
sum of the dollars (adjusted to a common reporting period using the 
method described previously) across all 3 years, by the sum of the 
hours. If a hospital is missing data for any of the previous years, its 
average hourly wage for the 3-year period is calculated based on the 
data available during that period.
    The proposed wage index values in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-
2, and 4F and the average hourly wages in Tables 2, 3A, and 3B in the 
Addendum to this proposed rule include the proposed occupational mix 
adjustment.

H. Proposed Revisions to the Wage Index Based on Hospital 
Redesignations

    (If you choose to comment on issues in this section, please include 
the caption ``Hospital Redesignations and Reclassifications'' at the 
beginning of your comment.)
1. General
    Under section 1886(d)(10) of the Act, the Medicare Geographic 
Classification Review Board (MGCRB) considers applications by hospitals 
for geographic reclassification for purposes of payment under the IPPS. 
Hospitals must apply to the MGCRB to reclassify by September 1 of the 
year preceding the year during which reclassification is sought. 
Generally, hospitals must be proximate to the labor market area to 
which they are seeking reclassification and must demonstrate 
characteristics similar to hospitals located in that area. The MGCRB 
issues its decisions by the end of February for reclassifications that 
become effective for the following fiscal year (beginning October 1). 
The regulations applicable to reclassifications by the MGCRB are 
located in Sec. Sec.  412.230 through 412.280.
    Section 1886(d)(10)(D)(v) of the Act provides that, beginning with 
FY 2001, a MGCRB decision on a hospital reclassification for purposes 
of the wage index is effective for 3 fiscal years, unless the hospital 
elects to terminate the reclassification. Section 1886(d)(10)(D)(vi) of 
the Act provides that the MGCRB must use the 3 most recent years' 
average hourly wage data in evaluating a hospital's reclassification 
application for FY 2003 and any succeeding fiscal year.
    Section 304(b) of Pub. L. 106-554 provides that the Secretary must 
establish a mechanism under which a statewide entity may apply to have 
all of the geographic areas in the State treated as a single geographic 
area for purposes of computing and applying a single wage index, for 
reclassifications beginning in FY 2003. The implementing regulations 
for this provision are located at Sec.  412.235.
    Section 1886(d)(8)(B) of the Act requires the Secretary to treat a 
hospital located in a rural county adjacent to one or more urban areas 
as being located in the MSA to which the greatest number of workers in 
the county commute, if the rural county would otherwise be considered 
part of an urban area under the standards for designating MSAs and if 
the commuting rates used in determining outlying counties were 
determined on the basis of the aggregate number of resident workers who 
commute to (and, if applicable under the standards, from) the central 
county or counties of all contiguous MSAs. In light of the new CBSA 
definitions and the Census 2000 data that we implemented for FY 2005 
(69 FR 49027), we undertook to identify those counties meeting these 
criteria. The eligible counties are identified under section III.H.4. 
of this preamble.
2. Effects of Reclassification
    Section 1886(d)(8)(C) of the Act provides that the application of 
the wage index to redesignated hospitals is dependent on the 
hypothetical impact that the wage data from these hospitals would have 
on the wage index value for the area to which they have been 
redesignated. These requirements for determining the wage index values 
for redesignated hospitals is applicable both to the hospitals located 
in rural counties deemed urban under section 1886(d)(8)(B) of the Act 
and hospitals that were reclassified as a result of the MGCRB decisions 
under section 1886(d)(10) of the Act. Therefore, as provided in section 
1886(d)(8)(C) of the Act,\12\ the wage index values were determined by 
considering the following:
---------------------------------------------------------------------------

    \12\ Although section 1886(d)(8)(C)(iv)(I) of the Act also 
provides that the wage index for an urban area may not decrease as a 
result of redesignated hospitals if the urban area wage index is 
already below the wage index for rural areas in the State in which 
the urban area is located, the provision was effectively made moot 
by section 4410 of Pub. L. 105-33, which provides that the area wage 
index applicable to any hospital that is 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 that State. For all-urban 
States, CMS established an imputed floor (69 FR 49109). Also, 
section 1886(d)(8)(C)(iv)(II) of the Act provides that an urban 
area's wage index may not decrease as a result of redesignated 
hospitals if the urban area is located in a State that is composed 
of a single urban area.
---------------------------------------------------------------------------

     If including the wage data for the redesignated hospitals 
would reduce the wage index value for the area to which the hospitals 
are redesignated by 1 percentage point or less, the area wage index 
value determined exclusive of the wage data for the redesignated 
hospitals applies to the redesignated hospitals.
     If including the wage data for the redesignated hospitals 
reduces the wage index value for the area to which the hospitals are 
redesignated by more than 1 percentage point, the area wage index 
determined inclusive of the wage data for the redesignated hospitals 
(the combined wage index value) applies to the redesignated hospitals.
     If including the wage data for the redesignated hospitals 
increases the wage index value for the urban area to which the 
hospitals are redesignated, both the area and the redesignated 
hospitals receive the combined wage index value. Otherwise, the 
hospitals located in the urban area receive a wage index excluding the 
wage data of hospitals redesignated into the area.
     The wage data for a reclassified urban hospital is 
included in both the wage index calculation of the area to which the 
hospital is reclassified (subject to the rules described above) and the 
wage index calculation of the urban area where the hospital is 
physically located.
     Rural areas whose wage index values would be reduced by 
excluding the wage data for hospitals that have been redesignated to 
another area continue to have their wage index values calculated as if 
no redesignation had occurred (otherwise, redesignated rural hospitals 
are excluded from the calculation of the rural wage index).
     The wage index value for a redesignated rural hospital 
cannot be reduced below the wage index value for the rural areas of the 
State in which the hospital is located.
     In cases where urban hospitals have reclassified to rural 
areas under 42 CFR

[[Page 24083]]

412.103, the urban hospital wage data are: (a) Included in the rural 
wage index calculation, unless doing so would reduce the rural wage 
index; and (b) included in the urban area where the hospital is 
physically located.
3. FY 2007 MGCRB Reclassifications
    At the time this proposed rule was constructed, the MGCRB had 
completed its review of FY 2007 reclassification requests. There are 
214 hospitals approved by the MGCRB for wage index reclassifications 
for FY 2007. Because MGCRB wage index reclassifications are effective 
for 3 years, hospitals reclassified during FY 2005 or FY 2006 are 
eligible to continue to be reclassified based on prior 
reclassifications to current MSAs during FY 2007. There were 299 
hospitals reclassified for wage index for FY 2006, and 395 hospitals 
reclassified for wage index for FY 2005. Some of the hospitals that 
reclassified for FY 2005 and FY 2006 have elected not to continue their 
reclassifications in FY 2007 because, under the revised labor market 
area definitions, they are now physically located in the areas to which 
they previously reclassified. Of all of the hospitals approved for 
reclassification for FY 2005, FY 2006, and FY 2007, 766 hospitals are 
in a reclassification status for FY 2007.
    Prior to FY 2004, hospitals had been able to apply to be 
reclassified for purposes of either the wage index or the standardized 
amount. Section 401 of Pub. L. 108-173 established that all hospitals 
will be paid on the basis of the large urban standardized amount, 
beginning with FY 2004. Consequently, all hospitals are paid on the 
basis of the same standardized amount, which made such 
reclassifications moot. Although there could still be some benefit in 
terms of payments for some hospitals under the DSH payment adjustment 
for operating IPPS, section 402 of Pub. L. 108-173 equalized DSH 
payment adjustments for rural and urban hospitals, with the exception 
that the rural DSH adjustment is capped at 12 percent (except that RRCs 
and, effective for discharges occurring on or after October 1, 2006, 
MDHs have no cap). (A detailed discussion of this application appears 
in section IV.I. of the preamble of the FY 2005 IPPS final rule (69 FR 
49085). The exclusion of MDHs from the 12 percent DSH cap under Pub. L. 
109-171 is discussed under Section IV.F.4. of this preamble.)
    Under Sec.  412.273, hospitals that have been reclassified by the 
MGCRB are permitted to withdraw their applications within 45 days of 
the publication of a proposed rule. The request for withdrawal of an 
application for reclassification or termination of an existing 3-year 
reclassification that would be effective in FY 2007 must be received by 
the MGCRB within 45 days of the publication of this proposed rule. If a 
hospital elects to withdraw its wage index application after the MGCRB 
has issued its decision, but within 45 days of the publication of the 
proposed rule, it may later cancel its withdrawal in a subsequent year 
and request the MGCRB to reinstate its wage index reclassification for 
the remaining fiscal year(s) of the 3-year period (Sec.  
412.273(b)(2)(i)). The request to cancel a prior withdrawal must be in 
writing to the MGCRB no later than the deadline for submitting 
reclassification applications for the following fiscal year (Sec.  
412.273(d)). For further information about withdrawing, terminating, or 
canceling a previous withdrawal or termination of a 3-year 
reclassification for wage index purposes, we refer the reader to Sec.  
412.273, as well as the August 1, 2002 IPPS final rule (67 FR 50065) 
and the August 1, 2001 IPPS final rule (66 FR 39887).
    Changes to the wage index that result from withdrawals of requests 
for reclassification, wage index corrections, appeals, and the 
Administrator's review process will be incorporated into the wage index 
values published in the final rule. These changes may affect not only 
the wage index value for specific geographic areas, but also the wage 
index value redesignated hospitals receive; that is, whether they 
receive the wage index that includes the data for both the hospitals 
already in the area and the redesignated hospitals. Further, the wage 
index value for the area from which the hospitals are redesignated may 
be affected.
    Applications for FY 2008 reclassifications are due to the MGCRB by 
September 1, 2006. We note that this is also the deadline for canceling 
a previous wage index reclassification withdrawal or termination under 
Sec.  412.273(d). Applications and other information about MGCRB 
reclassifications may be obtained, beginning in mid-July 2006, via the 
CMS Internet Web site at: http://www.cms.hhs.gov/mgcrb/, or by calling 
the MGCRB at (410) 786-1174. The mailing address of the MGCRB is: 2520 
Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670.
4. Proposed FY 2007 Redesignations Under Section 1886(d)(8)(B) of the 
Act
    Beginning October 1, 1988, section 1886(d)(8)(B) of the Act 
required us to treat a hospital located in a rural county adjacent to 
one or more urban areas as being located in the MSA if certain criteria 
were met. Prior to FY 2005, the rule was that a rural county adjacent 
to one or more urban areas would be treated as being located in the MSA 
to which the greatest number of workers in the county commute, if the 
rural county would otherwise be considered part of an urban area under 
the standards published in the Federal Register on January 3, 1980 (45 
FR 956) for designating MSAs (and New England County Metropolitan Areas 
(NECMAs)), and if the commuting rates used in determining outlying 
counties (or, for New England, similar recognized areas) were 
determined on the basis of the aggregate number of resident workers who 
commute to (and, if applicable under the standards, from) the central 
county or counties of all contiguous MSAs (or NECMAs). Hospitals that 
met the criteria using the January 3, 1980 version of these OMB 
standards were deemed urban for purposes of the standardized amounts 
and for purposes of assigning the wage data index.
    Effective beginning FY 2005, we use OMB's 2000 CBSA standards and 
the Census 2000 data to identify counties qualifying for redesignation 
under section 1886(d)(8)(B) for the purpose of assigning the wage index 
to the urban area. The chart below contains the listing of the rural 
counties designated as urban under section 1886(d)(8)(B) of the Act 
that we are proposing to use for FY 2007. For discharges occurring on 
or after October 1, 2006, hospitals located in the first column of this 
chart will be redesignated for purposes of using the wage index of the 
urban area listed in the second column.

 Rural Counties Redesignated as Urban Under Section 1886(d)(8)(B) of the
                                   Act
                  [Based on CBSAs and Census 2000 Data]
------------------------------------------------------------------------
              Rural county                             CBSA
------------------------------------------------------------------------
Cherokee, AL...........................  Rome, GA.
Macon, AL..............................  Auburn-Opelika, AL.

[[Page 24084]]

 
Talladega, AL..........................  Anniston-Oxford, AL.
Hot Springs, AR........................  Hot Springs, AR.
Windham, CT............................  Hartford-West Hartford-East
                                          Hartford, CT.
Bradford, FL...........................  Gainesville, FL.
Flagler, FL............................  Deltona-Daytona Beach-Ormond
                                          Beach, FL.
Hendry, FL.............................  West Palm Beach-Boca Raton-
                                          Boynton, FL.
Levy, FL...............................  Gainesville, FL.
Walton, FL.............................  Fort Walton Beach-Crestview-
                                          Destin, FL.
Banks, GA..............................  Gainesville, GA.
Chattooga, GA..........................  Chattanooga, TN-GA.
Jackson, GA............................  Atlanta-Sandy Springs-Marietta,
                                          GA.
Lumpkin, GA............................  Atlanta-Sandy Springs-Marietta,
                                          GA.
Morgan, GA.............................  Atlanta-Sandy Springs-Marietta,
                                          GA.
Peach, GA..............................  Macon, GA.
Polk, GA...............................  Atlanta-Sandy Springs-Marietta,
                                          GA.
Talbot, GA.............................  Columbus, GA-AL.
Bingham, ID............................  Idaho Falls, ID.
Christian, IL..........................  Springfield, IL.
DeWitt, IL.............................  Bloomington-Normal, IL.
Iroquois, IL...........................  Kankakee-Bradley, IL.
Logan, IL..............................  Springfield, IL.
Mason, IL..............................  Peoria, IL.
Ogle, IL...............................  Rockford, IL.
Clinton, IN............................  Lafayette, IN.
Henry, IN..............................  Indianapolis, IN.
Spencer, IN............................  Evansville, IN-KY.
Starke, IN.............................  Gary, IN.
Warren, IN.............................  Lafayette, IN.
Boone, IA..............................  Ames, IA.
Buchanan, IA...........................  Waterloo-Cedar Falls, IA.
Cedar, IA..............................  Iowa City, IA.
Allen, KY..............................  Bowling Green, KY.
Assumption Parish, LA..................  Baton Rouge, LA.
St. James Parish, LA...................  Baton Rouge, LA.
Allegan, MI............................  Holland-Grand Haven, MI.
Montcalm, MI...........................  Grand Rapids-Wyoming, MI.
Oceana, MI.............................  Muskegon-Norton Shores, MI.
Shiawassee, MI.........................  Lansing-East Lansing, MI.
Tuscola, MI............................  Saginaw-Saginaw Township North,
                                          MI.
Fillmore, MN...........................  Rochester, MN.
Dade, MO...............................  Springfield, MO.
Pearl River, MS........................  Gulfport-Biloxi, MS.
Caswell, NC............................  Burlington, NC.
Granville, NC..........................  Durham, NC.
Harnett, NC............................  Raleigh-Cary, NC.
Lincoln, NC............................  Charlotte-Gastonia-Concord, NC-
                                          SC.
Polk, NC...............................  Spartanburg, NC.
Los Alamos, NM.........................  Santa Fe, NM.
Lyon, NV...............................  Carson City, NV.
Cayuga, NY.............................  Syracuse, NY.
Columbia, NY...........................  Albany-Schenectady-Troy, NY.
Genesee, NY............................  Rochester, NY.
Greene, NY.............................  Albany-Schenectady-Troy, NY.
Schuyler, NY...........................  Ithaca, NY.
Sullivan, NY...........................  Poughkeepsie-Newburgh-
                                          Middletown, NY.
Wyoming, NY............................  Buffalo-Niagara Falls, NY.
Ashtabula, OH..........................  Cleveland-Elyria-Mentor, OH.
Champaign, OH..........................  Springfield, OH.
Columbiana, OH.........................  Youngstown-Warren-Boardman, OH-
                                          PA.
Cotton, OK.............................  Lawton, OK.
Linn, OR...............................  Corvallis, OR.
Adams, PA..............................  York-Hanover, PA.
Clinton, PA............................  Williamsport, PA.
Greene, PA.............................  Pittsburgh, PA.
Monroe, PA.............................  Allentown-Bethlehem-Easton, PA-
                                          NJ.
Schuylkill, PA.........................  Reading, PA.
Susquehanna, PA........................  Binghamton, NY.
Clarendon, SC..........................  Sumter, SC.
Lee, SC................................  Sumter, SC.
Oconee, SC.............................  Greenville, SC.
Union, SC..............................  Spartanburg, SC.

[[Page 24085]]

 
Meigs, TN..............................  Cleveland, TN.
Bosque, TX.............................  Waco, TX.
Falls, TX..............................  Waco, TX.
Fannin, TX.............................  Dallas-Plano-Irving, TX.
Grimes, TX.............................  College Station-Bryan, TX.
Harrison, TX...........................  Longview, TX.
Henderson, TX..........................  Dallas-Plano-Irving, TX.
Milam, TX..............................  Austin-Round Rock, TX.
Van Zandt, TX..........................  Dallas-Plano-Irving, TX.
Willacy, TX............................  Brownsville-Harlingen, TX.
Buckingham, VA.........................  Charlottesville, VA.
Floyd, VA..............................  Blacksburg-Christiansburg-
                                          Radford, VA.
Middlesex, VA..........................  Virginia Beach-Norfolk-Newport
                                          News, VA.
Page, VA...............................  Harrisonburg, VA.
Shenandoah, VA.........................  Winchester, VA-WV.
Island, WA.............................  Seattle-Bellevue-Everett, WA.
Mason, WA..............................  Olympia, WA.
Wahkiakum, WA..........................  Longview, WA.
Jackson, WV............................  Charleston, WV.
Roane, WV..............................  Charleston, WV.
Green, WI..............................  Madison, WI.
Green Lake, WI.........................  Fond du Lac, WI.
Jefferson, WI..........................  Milwaukee-Waukesha-West Allis,
                                          WI.
Walworth, WI...........................  Milwaukee-Waukesha-West Allis,
                                          WI.
------------------------------------------------------------------------

    As in the past, hospitals redesignated under section 1886(d)(8)(B) 
of the Act are also eligible to be reclassified to a different area by 
the MGCRB. Affected hospitals are permitted to compare the reclassified 
wage index for the labor market area in Tables 4C-1 and 4C-2 in the 
Addendum of this proposed rule into which they have been reclassified 
by the MGCRB to the wage index for the area to which they are 
redesignated under section 1886(d)(8)(B) of the Act. Hospitals may 
withdraw from an MGCRB reclassification within 45 days of the 
publication of this proposed rule.
5. Reclassifications Under Section 508 of Pub. L. 108-173
    Under section 508 of Pub. L. 108-173, a qualifying hospital could 
appeal the wage index classification otherwise applicable to the 
hospital and apply for reclassification to another area of the State in 
which the hospital is located (or, at the discretion of the Secretary, 
to an area within a contiguous State). We implemented this process 
through notices published in the Federal Register on January 6, 2004 
(69 FR 661), and February 13, 2004 (69 FR 7340). Such reclassifications 
are applicable to discharges occurring during the 3-year period 
beginning April 1, 2004, and ending March 31, 2007. Under section 
508(b), reclassifications under this process do not affect the wage 
index computation for any area or for any other hospital and cannot be 
effected in a budget neutral manner.
    Some hospitals currently receiving a section 508 reclassification 
are eligible to reclassify to that same area under the standard 
reclassification process as a result of the new labor market 
definitions that we adopted for FY 2005. The governing regulations 
indicate that ``if a hospital is already reclassified to a given 
geographic area for wage index purposes for a 3-year period, and 
submits an application to the same area for either the second or third 
year of the 3-year period, that application will not be approved.'' 
However in the FY 2006 IPPS final rule (70 FR 47382), we stated that 
hospitals that indicated in their FY 2007 MGCRB applications that they 
agreed to waive their section 508 reclassification for the first 6 
months of FY 2007 if they were granted a 3-year reclassification under 
the traditional MGCRB process will not be subject to the rule cited 
above. Thus, in applying for a 3-year MGCRB reclassification beginning 
in FY 2007, hospitals that are already reclassified to the same area 
under section 508 should have indicated in their MGCRB reclassification 
requests that if they receive the MGCRB reclassification, they would 
forfeit the section 508 reclassification for the first 6 months of FY 
2007.
    Under 1886(d)(10)(D)(v) of the Act, CMS has the authority to 
``establish procedures'' under which a hospital may elect to terminate 
a reclassification before the end of a 3-year period. In the FY 2006 
IPPS final rule (70 FR 47382), we discussed our decision to exercise 
this authority to establish a procedural rule for section 508 hospitals 
to retain their section 508 reclassification through its expiration on 
March 31, 2007, and reclassify under the regulations at 42 CFR Part 
412, Subpart L, for the second half of FY 2007. The following 
procedural rules will apply for section 508 hospitals that wish to 
reclassify for the second half of FY 2007 (April 1, 2007, through 
September 30, 2007):
    For section 508 hospitals applying for individual reclassification 
under Sec.  412.230--
    (a) Hospitals must have applied for reclassification through the 
MGCRB by the September 1, 2005 deadline.
    (b) Section 508 hospitals that are approved by the MGCRB for 
reclassification will have 45 days from the date this FY 2007 IPPS 
proposed rule is published to cancel their section 1886(d)(10) 
reclassification for either the first 6 months of FY 2007 or for the 
entire fiscal year. Hospitals should note that if they fail to cancel 
their section 1886(d)(10) reclassification by the deadline, they will 
not receive their section 508 wage adjustment in FY 2007. To further 
clarify--
     Hospitals that cancel their section 1886(d)(10) 
reclassification for the first 6 months receive their section 508 
reclassification for October 1, 2006, through March 31, 2007, and their 
section 1886(d)(10) reclassification for

[[Page 24086]]

April 1, 2007, through September 30, 2009.
     Hospitals that cancel their section 1886(d)(10) 
reclassification for the entire year will receive their section 508 
reclassification for October 1, 2006, through March 31, 2007 and their 
home area wage index for April 1, 2007, through September 30, 2007.
     Hospitals that do not cancel their section 1886(d)(10) 
reclassification will receive their section 1886(d)(10) 
reclassification, not their section 508 reclassification, for the 
entire fiscal year.
    Hospital groups that include a section 508 hospital were also 
permitted to submit section 1886(d)(10) reclassification applications 
by the September 1, 2005 deadline. However, in order for a group 
reclassification to be approved, either of the following conditions 
needed to be met:
    (a) The section 508 hospital that is part of the group waived its 
section 508 reclassification for the first half of FY 2007. This is 
necessary because the regulations at Sec. Sec.  412.232 and 412.234 
state that all hospitals in a county must apply for reclassification as 
a group. The hospitals either agreed to receive the same 
reclassification or failed to qualify as a group. The Administrator 
upheld this policy in an MGCRB appeal for FY 2006.
    (b) Each member of the group agreed, in writing, at the time the 
application was submitted September 1, 2005, that they cancelled the 
group reclassification if granted for the first 6 months of FY 2007. 
The section 1886(d)(10) reclassification then is effective only from 
April 1, 2007, through September 30, 2007. In the FY 2006 final rule, 
we stated that, under this scenario, the section 508 hospital receives 
its section 508 reclassification from October 1, 2006, through March 
31, 2007, and the remainder of the group receives the home wage index 
for that time period. For April 1, 2007, through September 30, 2009, 
the section 508 hospital and the remainder of the group receive the 
group reclassification. The group may also cancel the April 1, 2007 
through September 30, 2009 group reclassification within 45 days of 
publication of this proposed rule.
    We will apply a similar rule for purposes of the out-migration 
adjustment for FY 2007 discussed in section III.I. of this preamble. 
The statute states that a hospital cannot receive an out-migration 
adjustment if it is reclassified under section 1886(d)(10) of the Act. 
Therefore, eligible hospitals that are not reclassified during any part 
of FY 2007 will, by default, receive an out-migration adjustment during 
that time period. If the hospital is reclassified for all of FY 2007, 
the hospital will be ineligible for the out-migration adjustment. If a 
hospital has a half fiscal year reclassification, the hospital will be 
eligible for the out-migration adjustment for the portion of the fiscal 
year that it is not reclassified.
    The procedural rules described in the FY 2006 IPPS final rule were 
intended to address specific circumstances where individual and group 
reclassifications involve a section 508 hospital. The rules were 
designed to recognize the special circumstances of section 508 hospital 
reclassifications ending mid-year during FY 2007 and were intended to 
provide flexibility in our regulations that would allow previously 
approved reclassifications to continue through March 31, 2007, and new 
reclassifications to begin April 1, 2007, upon the conclusion of the 
section 508 reclassifications. We have received questions about the 
application of these special procedural rules to non-section 508 
hospitals that are part of group applications that previously were 
awarded an individual reclassification that continues into FY 2007. 
These hospitals are concerned that the procedural rules imply that such 
prior reclassification would be terminated beginning October 1, 2006, 
because the rules specify that ``the remainder of the group receives 
the home wage index'' for the period October 1, 2006, through March 31, 
2007, if the group reclassification application specified that the 
section 1886(d)(10) group reclassification would not begin until April 
1, 2007. We did not specifically contemplate preexisting individual 
reclassifications when we drafted the special procedural rules for 
group reclassifications that involve section 508 hospitals. However, we 
did not intend to adopt a less favorable policy for non-section 508 
hospitals in a group with a pending individual geographic 
reclassification than we did for section 508 hospitals. Thus, we are 
clarifying our procedural rule with respect to non-section 508 
hospitals with preexisting individual reclassifications that are part 
of group reclassifications that include a section 508 hospital.
    For the first half of FY 2007, we intend to either apply (a) the 
area wage index where the hospital is physically located if there is no 
reclassification pending, or (b) the hospital's individual 
reclassification wage index if the hospital was part of a group awarded 
a group reclassification and the group followed the procedural rules 
for postponing reclassification until April 1, 2007. However, once the 
hospital begins its new section 1886(d)(10) reclassification for the 
period April 1, 2007, through September 30, 2009, any prior 
reclassifications are permanently terminated, consistent with 42 CFR 
412.274(b)(2)(ii). In fact, because any withdrawal of the group 
reclassification must be received within 45 days of the publication of 
this proposed rule, failure to meet this deadline would effectively 
permanently terminate any remaining years of the individual 
reclassification. Further, a non-section 508 hospital that is part of a 
group reclassification that includes a section 508 hospital that will 
not begin until April 1, 2007, will have the option of canceling its 
preexisting reclassification for the entire year consistent with 
section 412.274(b)(1)(ii) within 45 days of publication of this 
proposed rule. Under this scenario, the hospital would receive its home 
wage index for the first half of the year and the approved group 
reclassification wage index for the second half of the year. We are 
also reiterating that the special procedural rules that we have adopted 
for half fiscal year reclassifications and terminations are intended 
only to address the special circumstances created by section 508 of 
Pub. L. 108-173 with respect to reclassifications beginning and ending 
mid-way through a fiscal year. These special procedural rules do not 
change any of the permanent provisions currently in effect with respect 
to reclassifications under subpart L of 42 CFR Part 412.
    As an example: Suppose Hospital A is a non-section 508 hospital 
that was part of a group reclassification application for FYs 2007 
through 2009 and such group contained a section 508 hospital. In 
accordance with our special section 508 procedural rule, the entire 
group would be considered to have agreed it would waive its group 
reclassification for the first half of FY 2007. Hospital A also is 
currently (for FY 2006) reclassified from Area X to Area Y for FYs 2006 
through 2008. For the first half of FY 2007, Hospital A will continue 
to receive its individual reclassification to Area Y; for the second 
half of FY 2007, it will receive the group reclassification.
    Hospital A may terminate its individual reclassification 
(termination must be received within 45 days of publication of this 
proposed rule), in which case it will receive its home wage index for 
the first half of FY 2007 and the group reclassification for the second 
half. Acceptance of the group reclassification effectively permanently 
terminates the individual reclassification to Area Y.
    Hospital A's group also has the option of withdrawing its group 
reclassification (withdrawal must be received within 45 days of 
publication of this proposed rule

[[Page 24087]]

and all members of the group must agree). If such withdrawal occurs, 
the default rule is that Hospital A receives its FYs 2006 through 2008 
individual reclassification for all of FY 2007.
    If Hospital A wishes to receive its home wage index (plus any out-
migration adjustment, if applicable), it must also terminate the 
individual reclassification for all of FY 2007 (termination must be 
received within 45 days of publication of this proposed rule).
    We show the reclassifications effective under the one-time appeal 
process in Table 9B in the Addendum to this proposed rule. All section 
1886(d)(10) reclassifications are listed in Table 9A in the Addendum to 
this proposed rule.
6. Proposed Wage Indices for Reclassified Hospitals and Proposed 
Reclassification Budget Neutrality Factor
    Under the procedural rules described under section III.H.5. of this 
preamble, different wage indices may be in effect for the first 6 
months and the second 6 months of FY 2007. Specifically, section 508 
hospitals that were approved for individual reclassification under 
Sec.  412.230 have the opportunity to cancel their section 1886(d)(10) 
reclassification for the first 6 months within 45 days of the 
publication of this proposed rule and receive their section 508 
reclassifications for October 1, 2006, through March 31, 2007, and 
their section 1886(d)(10) reclassifications for April 1, 2007, through 
September 30, 2009. The special procedural rule also applied to urban 
county group applications including a section 508 hospital. In order 
for the hospital to retain its section 508 reclassification for the 
first 6 months, each member of the group must have agreed in writing, 
at the time the application was submitted, that they cancel the group 
reclassification if granted for the first 6 months of FY 2007. Under 
this scenario, the section 508 hospital receives its section 508 
reclassification from October 1, 2006, through March 31, 2007, and the 
remainder of the group receives their preexisting individual 
reclassification or home wage index for that time period. For April 1, 
2007, through September 30, 2009, the section 508 hospital and the 
remainder of the group receive the group reclassification.
    The half fiscal year section 1886(d)(10) reclassifications 
permitted under these procedural rules present issues related to the 
calculation of the reclassified wage indices and reclassification 
budget neutrality factor. Section 1886(d)(8)(C) of the Act provides 
requirements for determining the wage index values for both hospitals 
located in rural counties deemed urban under section 1886(d)(8)(B) of 
the Act and hospitals that were reclassified as a result of the MGCRB 
decisions under section 1886(d)(10) of the Act. As provided in the 
statute, we are required to calculate a separate wage index for 
hospitals reclassified to an area if including the wage data for the 
reclassified hospitals would reduce the area wage index by more than 1 
percent. Conceivably, we could calculate one reclassified wage index 
for FY 2007 that would include the wage data of hospitals that are 
reclassified to the area for any part of FY 2007. However, we are aware 
of situations in which including the wage data from hospitals only 
reclassifying for the second half of the fiscal year would change the 
wage index for reclassified hospitals for the entire fiscal year, even 
though the reclassification would only be in effect during the second 
half of the fiscal year. We believe it would be unfair to have wage 
indices affected for the first half of the fiscal year by including the 
wage data for hospital reclassifications in effect only for the second 
half of the fiscal year. We believe that the most equitable approach to 
this issue would be to calculate separate wage indices for reclassified 
hospitals for the first and second half of FY 2007. Therefore, we are 
proposing to issue two separate reclassified wage indices for affected 
areas (one effective from October 1, 2006, through March 31, 2007, and 
a second reclassified wage index effective April 1, 2007, through 
September 30, 2007). The reclassified wage indices would be calculated 
based on the wage data for hospitals reclassified to the area in the 
respective half of the fiscal year.
    The half fiscal year reclassifications also have implications for 
budget neutrality. The overall effect of geographic reclassification is 
required by section 1886(d)(8)(D) of the Act to be budget neutral. We 
apply an adjustment to the IPPS standardized amounts to ensure that the 
effects of geographic reclassification are budget neutral. Because we 
are proposing to calculate two separate reclassification wage indices 
for the first half and the second half of FY 2007, it is conceivable 
that we could apply budget neutrality separately for first and second 
half fiscal year reclassifications. Under this scenario, we would issue 
two separate IPPS standardized amounts for FY 2007. However, we believe 
this approach would be administratively burdensome and perhaps cause 
confusion in the provider community. For this reason, we are proposing 
an alternative approach. We are proposing to calculate one budget 
neutrality adjustment that reflects the average of the adjustments 
required for first and second half fiscal year reclassifications, 
respectively, as discussed in section II.A.4.b. of the Addendum to this 
proposed rule.

I. Proposed FY 2007 Wage Index Adjustment Based on Commuting Patterns 
of Hospital Employees

    (If you choose to comment on issues in this section, please include 
the caption ``Out-Migration Adjustment'' at the beginning of your 
comment.)
    In accordance with the broad discretion under section 1886(d)(13) 
of the Act, as added by section 505 of Pub. L. 108-173, beginning with 
FY 2005, we established a process to make adjustments to the hospital 
wage index based on commuting patterns of hospital employees. The 
process, outlined in the FY 2005 IPPS final rule (69 FR 49061), 
provides for an increase in the wage index for hospitals located in 
certain counties that have a relatively high percentage of hospital 
employees who reside in the county but work in a different county (or 
counties) with a higher wage index. Such adjustments to the wage index 
are effective for 3 years, unless a hospital requests to waive the 
application of the adjustment. A county will not lose its status as a 
qualifying county due to wage index changes during the 3-year period, 
and counties will receive the same wage index increase for those 3 
years. However, a county that qualifies in any given year may no longer 
qualify after the 3-year period, or it may qualify but receive a 
different adjustment to the wage index level. Hospitals that receive 
this adjustment to their wage index are not eligible for 
reclassification under section 1886(d)(8) or section 1886(d)(10) of the 
Act. Adjustments under this provision are not subject to the IPPS 
budget neutrality requirements under section 1886(d)(3)(E) or section 
1886(d)(8)(D) of the Act.
    Hospitals located in counties that qualify for the wage index 
adjustment are to receive an increase in the wage index that is equal 
to the average of the differences between the wage indices of the labor 
market area(s) with higher wage indices and the wage index of the 
resident county, weighted by the overall percentage of hospital workers 
residing in the qualifying county who are employed in any labor market 
area with a higher wage index. We have employed the prereclassified 
wage indices in making these calculations.
    We are proposing that hospitals located in the qualifying counties

[[Page 24088]]

identified in Table 4J in the Addendum to this proposed rule that have 
not already reclassified through section 1886(d)(10) of the Act, 
redesignated through section 1886(d)(8) of the Act, received a section 
508 reclassification, or requested to waive the application of the out-
migration adjustment will receive the wage index adjustment listed in 
the table for FY 2007. We used the same formula described in the FY 
2005 final rule (69 FR 49064) to calculate the out-migration 
adjustment. This proposed adjustment was calculated as follows:
    Step 1. Subtract the wage index for the qualifying county from the 
wage index for the higher wage area(s).
    Step 2. Divide the number of hospital employees residing in the 
qualifying county who are employed in such higher wage index area by 
the total number of hospital employees residing in the qualifying 
county who are employed in any higher wage index area. Multiply this 
result by the result obtained in Step 1.
    Step 3. Sum the products resulting from Step 2 (if the qualifying 
county has workers commuting to more than one higher wage area).
    Step 4. Multiply the result from Step 3 by the percentage of 
hospital employees who are residing in the qualifying county and who 
are employed in any higher wage index area.
    The proposed adjustments calculated for qualifying hospitals are 
listed in Table 4J in the Addendum to this proposed rule. These 
adjustments would be effective for each county for a period of 3 fiscal 
years. Hospitals that received the adjustment in FY 2006 will be 
eligible to retain that same adjustment for FY 2007. For hospitals in 
newly qualified counties, adjustments to the wage index are effective 
for 3 years, beginning with discharges occurring on or after October 1, 
2006.
    As previously noted, hospitals receiving the wage index adjustment 
under section 1886(d)(13)(F) of the Act are not eligible for 
reclassification under sections 1886(d)(8) or (d)(10) of the Act, or 
under section 508 of Pub. L. 108-173, unless they waive such out-
migration adjustment. As announced in the FYs 2005 and 2006 final 
rules, hospitals redesignated under section 1886(d)(8) of the Act or 
reclassified under section 1886(d)(10) of the Act or under section 508 
of Pub. L. 108-173 will be deemed to have chosen to retain their 
redesignation or reclassification, unless they explicitly notify CMS 
that they elect to receive the out-migration adjustment instead within 
45 days from the publication of this proposed rule. Waiver notification 
should be sent to the following address: Centers for Medicare and 
Medicaid Services, Center for Medicare Management, Attention: Wage 
Index Adjustment Waivers, Division of Acute Care, Room C4-08-06, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    In addition, under Sec.  412.273, hospitals that have been 
reclassified by the MGCRB are permitted to terminate existing 3-year 
reclassifications within 45 days of publication of this proposed rule. 
Hospitals that are eligible to receive the out-migration wage index 
adjustment and that withdraw their application for reclassification 
automatically receive the wage index adjustment listed in Table 4J in 
the Addendum to this proposed rule. Requests for withdrawal of an 
application for reclassification or termination of an existing 3-year 
reclassification will be effective in FY 2007 and must be received by 
the MGCRB within 45 days of the publication of this proposed rule. 
Requests to waive section 1886(d)(8) redesignations for FY 2007 must be 
received by CMS within 45 days of the publication of this proposed 
rule. In addition, hospitals that wished to retain their redesignation/
reclassification under section 1886(d)(8), section 1886(d)(10), or 
section 508 (instead of receiving the out-migration adjustment) for FY 
2007 do not need to submit a formal request to CMS; they will 
automatically retain their redesignation/reclassification status for FY 
2007. Hospitals should carefully review the wage index adjustment that 
they would receive under this provision (as listed in Table 2 in the 
Addendum to this proposed rule) in comparison to the wage index 
adjustment that they would receive under the MGCRB reclassification 
(Table 9 in the Addendum to this proposed rule).

J. Process for Requests for Wage Index Data Corrections

    (If you choose to comment on issues in this section, please include 
the caption ``Wage Index Data Corrections'' at the beginning of your 
comment.)
    In the FY 2005 IPPS final rule (68 FR 27194), we revised the 
process and timetable for application for development of the wage 
index, beginning with the FY 2005 wage index. The preliminary and 
unaudited Worksheet S-3 wage data and occupational mix survey files for 
FY 2007 were made available on October 7, 2005, through the Internet on 
the CMS Web site at: http://www.cms.hhs.gov/AcuteInpatientPPS. In a 
memorandum dated October 7, 2005, we instructed all Medicare fiscal 
intermediaries to inform the IPPS hospitals they service of the 
availability of the wage index data files and the process and timeframe 
for requesting revisions (including the specific deadlines listed 
below). We also instructed the fiscal intermediaries to advise 
hospitals that these data are also made available directly through 
their representative hospital organizations.
    If a hospital wished to request a change to its data as shown in 
the October 7, 2005 wage and occupational mix data files, the hospital 
was to submit corrections along with complete, detailed supporting 
documentation to its fiscal intermediary by December 5, 2005. Hospitals 
were notified of this deadline and of all other possible deadlines and 
requirements, including the requirement to review and verify their data 
as posted on the preliminary wage index data file on the Internet, 
through the October 7, 2005 memorandum referenced above.
    In the October 7, 2005 memorandum, we also specified that a 
hospital could only request revisions to the occupational mix data for 
the reporting period that the hospital used in its original FY 2005 
wage index occupational mix survey. That is, a hospital that submitted 
occupational mix data for the 12-month reporting period could not 
switch to submitting data for the 4-week reporting period and vice 
versa. Further, a hospital could not submit an occupational mix survey 
for the periods beginning before January 1, 2003, or after January 11, 
2004. In addition, a hospital that did not submit an occupational mix 
survey for the FY 2005 wage index was not permitted to submit a survey 
for the FY 2007 wage index.
    The fiscal intermediaries notified the hospitals by mid-February 
2006 of any changes to the wage index data as a result of the desk 
reviews and the resolution of the hospitals' early December 2005 change 
requests. The fiscal intermediaries also submitted the revised data to 
CMS by mid-February 2006. CMS published the proposed wage index PUFs 
that included hospitals' revised wage data on February 24, 2006. Also, 
in a memorandum dated February 14, 2006, we instructed fiscal 
intermediaries to notify all hospitals regarding the availability of 
the proposed wage index PUFs and the criteria and process for 
requesting corrections and revisions to the wage index data. Hospitals 
had until March 13, 2006, to submit requests to the fiscal 
intermediaries for reconsideration of adjustments made by the fiscal 
intermediaries as a result of the desk review, and to correct errors

[[Page 24089]]

due to CMS's or the fiscal intermediary's mishandling of the wage index 
data. Hospitals were also required to submit sufficient documentation 
to support their requests.
    After reviewing requested changes submitted by hospitals, fiscal 
intermediaries are to transmit any additional revisions resulting from 
the hospitals' reconsideration requests by April 14, 2006. The deadline 
for a hospital to request CMS intervention in cases where the hospital 
disagreed with the fiscal intermediary's policy interpretations is 
April 21, 2006.
    Hospitals should also examine Table 2 in the Addendum to this 
proposed rule. Table 2 contains each hospital's adjusted average hourly 
wage used to construct the wage index values for the past 3 years, 
including the FY 2003 data used to construct the proposed FY 2007 wage 
index. We note that the hospital average hourly wages shown in Table 2 
only reflect changes made to a hospital's data and transmitted to CMS 
by March 1, 2006.
    We will release a final wage data PUF in early May 2006 to hospital 
associations and the public on the Internet at http://www.cms.hhs.gov/AcuteInpatientPPS. The May 2006 PUF will be made available solely for 
the limited purpose of identifying any potential errors made by CMS or 
the fiscal intermediary in the entry of the final wage data that result 
from the correction process described above (revisions submitted to CMS 
by the fiscal intermediaries by April 14, 2006). If, after reviewing 
the May 2006 final file, a hospital believes that its wage data are 
incorrect due to a fiscal intermediary or CMS error in the entry or 
tabulation of the final wage data, it should send a letter to both its 
fiscal intermediary and CMS outlining why the hospital believes an 
error exists and to provide all supporting information, including 
relevant dates (for example, when it first became aware of the error). 
CMS and the fiscal intermediaries must receive these requests no later 
than June 12, 2006. (We note that the June 12, 2006 date is revised 
from the June 9, 2006 date originally specified in the October 7, 2005 
letter to hospitals.) Requests mailed to CMS should be sent to: Centers 
for Medicare & Medicaid Services, Center for Medicare Management, 
Attention: Wage Index Team, Division of Acute Care, C4-08-06, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    Each request also must be sent to the fiscal intermediary. The 
fiscal intermediary will review requests upon receipt and contact CMS 
immediately to discuss its findings.
    At this point in the process, that is, after the release of the May 
2006 wage index data file, changes to the hospital wage data will only 
be made in those very limited situations involving an error by the 
fiscal intermediary or CMS that the hospital could not have known about 
before its review of the final wage index data file. Specifically, 
neither the intermediary nor CMS will approve the following types of 
requests:
     Requests for wage data corrections that were submitted too 
late to be included in the data transmitted to CMS by fiscal 
intermediaries on or before April 14, 2006.
     Requests for correction of errors that were not, but could 
have been, identified during the hospital's review of the February 24, 
2006 wage index data file.
     Requests to revisit factual determinations or policy 
interpretations made by the fiscal intermediary or CMS during the wage 
index data correction process.
    Verified corrections to the wage index received timely by CMS and 
the fiscal intermediaries (that is, by June 12, 2006) will be 
incorporated into the final wage index to be published by August 1, 
2006, to be effective October 1, 2006.
    We created the processes described above to resolve all substantive 
wage index data correction disputes before we finalize the wage and 
occupational mix data for the FY 2007 payment rates. Accordingly, 
hospitals that do not meet the procedural deadlines set forth above 
will not be afforded a later opportunity to submit wage index data 
corrections or to dispute the fiscal intermediary's decision with 
respect to requested changes. Specifically, our policy is that 
hospitals that do not meet the procedural deadlines set forth above 
will not be permitted to challenge later, before the Provider 
Reimbursement Review Board, the failure of CMS to make a requested data 
revision. (See W. A. Foote Memorial Hospital v. Shalala, No. 99-CV-
75202-DT (E.D. Mich. 2001) and Palisades General Hospital v. Thompson, 
No. 99-1230 (D.D.C. 2003.) We refer the reader also to the FY 2000 
final rule (64 FR 41513) for a discussion of the parameters for 
appealing to the Provider Reimbursement Review Board for wage index 
data corrections.
    Again, we believe the wage index data correction process described 
above provides hospitals with sufficient opportunity to bring errors in 
their wage index data to the fiscal intermediaries' attention. 
Moreover, because hospitals will have access to the final wage index 
data by early May 2006, they have the opportunity to detect any data 
entry or tabulation errors made by the fiscal intermediary or CMS 
before the development and publication of the final FY 2007 wage index 
by August 1, 2006, and the implementation of the FY 2007 wage index on 
October 1, 2006. If hospitals avail themselves of the opportunities 
afforded to provide and make corrections to the wage data, the wage 
index implemented on October 1 should be accurate. Nevertheless, in the 
event that errors are identified by hospitals and brought to our 
attention after June 12, 2006, we retain the right to make midyear 
changes to the wage index under very limited circumstances.
    Specifically, in accordance with Sec.  412.64(k)(1) of our existing 
regulations, we make midyear corrections to the wage index for an area 
only if a hospital can show that: (1) The fiscal intermediary or CMS 
made an error in tabulating its data; and (2) the requesting hospital 
could not have known about the error or did not have an opportunity to 
correct the error, before the beginning of the fiscal year. For 
purposes of this provision, ``before the beginning of the fiscal year'' 
means by the June deadline for making corrections to the wage data for 
the following fiscal year's wage index. This provision is not available 
to a hospital seeking to revise another hospital's data that may be 
affecting the requesting hospital's wage index for the labor market 
area. As indicated earlier, since CMS makes the wage data available to 
a hospital on the CMS Web site prior to publishing both the proposed 
and final IPPS rules, and the fiscal intermediaries notify hospitals 
directly of any wage data changes after completing their desk reviews, 
we do not expect that midyear corrections would be necessary. However, 
under our current policy, if the correction of a data error changes the 
wage index value for an area, the revised wage index value will be 
effective prospectively from the date the correction is made.
    In the FY 2006 IPPS final rule (70 FR 47385), we revised Sec.  
412.64(k)(2) to specify that, effective on October 1, 2005, that is 
beginning with the FY 2006 wage index, a change to the wage index can 
be made retroactive to the beginning of the Federal fiscal year only 
when: (1) The fiscal intermediary or CMS made an error in tabulating 
data used for the wage index calculation; (2) the hospital knew about 
the error and requested that the fiscal intermediary and CMS correct 
the error using the established process and within the established 
schedule for requesting corrections to the wage data, before the 
beginning of the fiscal year for the applicable IPPS update (that is, 
by the June 12, 2006 deadline for the FY 2007 wage index); and (3) CMS 
agreed

[[Page 24090]]

that the fiscal intermediary or CMS made an error in tabulating the 
hospital's wage data and the wage index should be corrected.
    In those circumstances where a hospital requests a correction to 
its wage data before CMS calculates the final wage index (that is, by 
the June deadline), and CMS acknowledges that the error in the 
hospital's wage data was caused by CMS's or the fiscal intermediary's 
mishandling of the data, we believe that the hospital should not be 
penalized by our delay in publishing or implementing the correction. As 
with our current policy, we indicated that the provision is not 
available to a hospital seeking to revise another hospital's data. In 
addition, the provision cannot be used to correct prior years' wage 
data; it can only be used for the current Federal fiscal year. In other 
situations, we continue to believe that it is appropriate to make 
prospective corrections to the wage index in those circumstances where 
a hospital could not have known about or did not have the opportunity 
to correct the fiscal intermediary's or CMS's error before the 
beginning of the fiscal year (that is, by the June deadline). We note 
that, as with prospective changes to the wage index, the final 
retroactive correction will be made irrespective of whether the change 
increases or decreases a hospital's payment rate. In addition, we note 
that the policy of retroactive adjustment will still apply in those 
instances where a judicial decision reverses a CMS denial of a 
hospital's wage data revision request.

K. Labor-Related Share for the Wage Index for FY 2007

    (If you choose to comment on issues in this section, please include 
the caption ``Labor-Related Share'' at the beginning of your comment.)
    Section 1886(d)(3)(E) of the Act directs the Secretary to adjust 
the proportion of the national prospective payment system base payment 
rates that are attributable to wages and wage-related costs by a factor 
that reflects the relative differences in labor costs among geographic 
areas. It also directs the Secretary to estimate from time to time the 
proportion of hospital costs that are labor-related: ``The Secretary 
shall adjust the proportion (as estimated by the Secretary from time to 
time) of hospitals' costs which are attributable to wages and wage-
related costs of the DRG prospective payment rates * * *'' We refer to 
the portion of hospital costs attributable to wages and wage-related 
costs as the labor-related share. The labor-related share of the 
prospective payment rate is adjusted by an index of relative labor 
costs, which is referred to as the wage index.
    In its June 2001 Report to Congress, MedPAC recommended that the 
Secretary ``should reevaluate current assumptions about the proportion 
of providers' costs that reflect resources purchased in local and 
national markets.'' (Report to the Congress: Medicare in Rural America, 
Recommendation 4D, page 80.) MedPAC recommended that the labor-related 
share include the weights for wages and salaries, fringe benefits, 
contract labor, and other labor-related costs for locally purchased 
inputs only. MedPAC noted that this would likely result in a lower 
labor-related share, which would decrease the amount of the national 
base payment amount adjusted by the wage index. As a result, hospitals 
located in low-wage markets (those with a wage index less than 1.0) 
would receive higher payments, while those located in high-wage labor 
markets would receive lower payments.
    In our proposed and final rules updating the IPPS for FY 2003 (67 
FR 31447, May 9, 2002 and 67 FR 50041, August 1, 2002), we discussed 
the methodology that we have used to determine the labor-related share. 
We noted that, at that time, the results of employing that methodology 
suggested that an increase in the labor-related share (from 71.066 
percent to 72.495 percent) was warranted. However, we decided not to 
propose such an increase in the labor-related share until we conducted 
further research to determine whether a different methodology for 
determining the labor-related share should be adopted.
    Section 403 of Pub. L. 108-173 amended section 1886(d)(3)(E) of the 
Act to provide that the Secretary must employ 62 percent as the labor-
related share unless this ``would result in lower payments to a 
hospital than would otherwise be made.'' However, this provision of 
Pub. L. 108-173 did not change the legal requirement that the Secretary 
estimate ``from time to time'' the proportion of hospitals' costs that 
are ``attributable to wages and wage-related costs.'' In fact, section 
404 of Pub. L. 108-173 required the Secretary to develop a frequency 
for revising the weights used in the hospital market basket, including 
the labor-related share, to reflect the most current data more 
frequently than once every 5 years. We believe that this reflected 
Congressional intent that hospitals receive payment based on either a 
62-percent labor-related share, or the labor-related share estimated 
from time to time by the Secretary, depending on which labor-related 
share resulted in a higher payment.
    Section 404 further required us to include in the final IPPS rule 
for FY 2006 an explanation of the reasons for, and options considered, 
in determining the frequency for revising the weights used in the 
hospital market basket, including the labor-related share. In addition, 
we have continued our research into the assumptions employed in 
calculating the labor-related share. Our research involves analyzing 
the compensation share separately for urban and rural hospitals, using 
regression analysis to determine the proportion of costs influenced by 
the area wage index, and exploring alternative methodologies to 
determine whether all or only a portion of professional fees and 
nonlabor intensive services should be considered labor-related.
    In the FY 2006 IPPS final rule (70 FR 47392), we presented our 
analysis and conclusions regarding the frequency and methodology for 
updating the labor-related share for FY 2006. We also recalculated a 
labor-related share of 69.731 percent, using the FY 2002-based PPS 
market basket for discharges occurring on or after October 1, 2005. In 
addition, we implemented this revised and rebased labor-related share 
in a budget neutral manner, but consistent with section 1886(d)(3)(E) 
of the Act, we did not take into account the additional payments that 
would be made as a result of hospitals with a wage index less than or 
equal to 1.0 being paid using a labor-related share lower than the 
labor-related share of hospitals with a wage index greater than 1.0.
    The labor-related share is used to determine the proportion of the 
national PPS base payment rate to which the area wage index is applied. 
In this proposed rule, we are not making any changes to the national 
average proportion of operating costs that are attributable to wages 
and salaries, fringe benefits, professional fees, contract labor, and 
labor intensive services. Therefore, we are continuing to use a labor-
related share of 69.731 percent for discharges occurring on or after 
October 1, 2006, as reflected in Tables 1A and 1B in the Addendum to 
this proposed rule. We note that section 403 of Pub. L. 108-173 amended 
sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act to provide that 
the Secretary must employ 62 percent as the labor-related share unless 
this employment ``would result in lower payments to a hospital than 
would otherwise be made.''
    We also are continuing to use a labor-related share for the Puerto 
Rico-specific standardized amounts of 58.7 percent for discharges 
occurring on or after

[[Page 24091]]

October 1, 2006. Consistent with our methodology for determining the 
national labor-related share, we added the Puerto Rico-specific 
relative weights for wages and salaries, fringe benefits, contract 
labor, nonmedical professional fees, and other labor-intensive services 
to determine the labor-related share. Puerto Rico hospitals are paid 
based on 75 percent of the national standardized amounts and 25 percent 
of the Puerto Rico-specific standardized amounts. For Puerto Rico 
hospitals, the national labor-related share will always be 62 percent 
because the wage index for all Puerto Rico hospitals is less than 1.0. 
A Puerto Rico-specific wage index is applied to the Puerto Rico-
specific portion of payments to the hospitals. The labor-related share 
of a hospital's Puerto Rico-specific rate will be either 62 percent or 
the Puerto Rico-specific labor-related share depending on which results 
in higher payments to the hospital. If the hospital has a Puerto Rico-
specific wage index of greater than 1.0, we will set the hospital's 
rates using a labor-related share of 62 percent for the 25 percent 
portion of the hospital's payment determined by the Puerto Rico 
standardized amounts because this amount will result in higher 
payments. Conversely, a hospital with a Puerto Rico-specific wage index 
of less than 1.0 will be paid using the Puerto Rico-specific labor-
related share of 58.7 percent of the Puerto Rico-specific rates because 
the lower labor-related share will result in higher payments. The 
Puerto Rico labor-related share of 58.7 percent for FY 2007 is 
reflected in the Table 1C of the Addendum of this proposed rule.

L. Proxy for the Hospital Market Basket

    (If you choose to comment on issues in this section, please include 
the caption ``Hospital Market Basket Proxy'' at the beginning of your 
comment.)
    In the FY 2006 IPPS final rule (70 FR 47387), we changed the base 
year cost structure for the IPPS hospital index for the hospital market 
basket for operating costs from FY 1997 to FY 2002. As discussed in 
that final rule, the IPPS hospital index primarily uses the BLS data as 
price proxies, which are grouped in one of the three BLS categories. 
The categories are Producer Price Indexes (PPIs), Consumer Price 
Indexes (CPIs), and Employment Cost Indexes (ECIs), discussed in detail 
in the FY 2006 IPPS final rule (70 FR 47388 through 47391). We evaluate 
the price proxies using the criteria of reliability, timeliness, 
availability, and relevance. The PPIs, CPIs, and ECIs selected by us 
and used for this proposed rule meet these criteria as described in the 
FY 2006 IPPS final rule. We believe they continue to be the best 
measures of price changes for the cost categories.
    Beginning April 2006 with the publication of March 2006 data, the 
BLS' ECI will use a different classification system, the North American 
Industrial Classification System (NAICS), instead of the Standard 
Industrial Codes (SIC), which will no longer exist. We have 
consistently used the ECI as the data source for our wages and salaries 
and other price proxies in the IPPS market basket and are not making 
any changes to the usage at this time. However, we are soliciting 
comments on our continued use of the BLS ECI data in light of the BLS 
change in system usage to the NAICS-based ECI.

IV. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs and GME Costs

A. Reporting of Hospital Quality Data for Annual Hospital Payment 
Update (Sec.  412.64(d)(2))

    (If you choose to comment on issues in this section, please include 
the caption ``Hospital Quality Data'' at the beginning of your 
comment.)
1. Background
    Section 5001(a) of Public Law 109-171 (DRA of 2005) sets out new 
requirements for the Reporting Hospital Quality Data for Annual Payment 
Update (RHQDAPU) program. The RHQDAPU program was established to 
implement section 501(b) of Public Law 108-173 (MMA). It builds on our 
ongoing voluntary Hospital Quality Initiative which is intended to 
empower consumers with quality of care information to make more 
informed decisions about their health care while also encouraging 
hospitals and clinicians to improve the quality of care.
    Section 5001(a) of Public Law 109-171 revises the mechanism used to 
update the standardized amount for payment for hospital inpatient 
operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the 
Act provide that the payment update for FY 2007 and each subsequent 
fiscal year will be reduced by 2.0 percentage points for any 
``subsection (d) hospital'' that does not submit certain quality data 
in a form and manner, and at a time, specified by the Secretary.
    New sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act require 
that we expand the ``starter set'' of 10 quality measures that we have 
used since 2003. In expanding these measures, we must begin to adopt 
the baseline set of performance measures as set forth in a 2005 report 
issued by the Institute of Medicine (IOM) of the National Academy of 
Sciences under section 238(b) of Public Law 108-173, effective for 
payments beginning with FY 2007. The IOM measures include the Hospital 
Quality Alliance (HQA) measures, the Hospital Consumer Assessment of 
Healthcare Providers and Systems (HCAHPS[reg]) patient perspective 
survey, and three structural measures. We discuss the IOM report more 
fully in section IV.B. of the preamble to this proposed rule.
    New sections 1886(b)(3)(B)(viii)(V) and (VI) of the Act require 
that, effective for payments beginning with FY 2008, we add other 
quality measures that reflect consensus among affected parties, and 
provide the Secretary with the discretion to replace any quality 
measures or indicators in appropriate cases, such as where all 
hospitals are effectively in compliance with a measure, or the measures 
or indicators have been subsequently shown to not represent the best 
clinical practice. Thus, the Secretary has broad discretion to replace 
measures on the basis that they are not appropriate.
    New section 1886(b)(3)(B)(viii)(VII) of the Act requires that we 
establish procedures for making quality data available to the public 
after ensuring that a hospital has the opportunity to review, in 
advance, its data that are to be made public. In addition, this section 
requires that we report quality measures of process, structure, 
outcome, patients' perspective on care, efficiency, and costs of care 
that relate to services furnished in inpatient settings on the CMS Web 
site.
    Like the provisions of section 501(b) of Public Law 108-173, the 
provisions of section 5001(a) of Public Law 109-171 do not apply to 
hospitals and hospital units excluded from the IPPS, or to payments to 
hospitals under other prospective payment systems such as the hospital 
outpatient PPS. New section 1886(b)(3)(B(viii)(I) of the Act also 
provides that any reduction will apply only with respect to the fiscal 
year involved, and will not be taken into account for computing the 
applicable percentage increase for a subsequent fiscal year.
    Initially, section 1886(b)(3)(B)(vii) of the Act provided for a 
reduction of 0.4 percentage points to the update percentage increase 
for each of FYs 2005 through 2007 for any ``subsection (d) hospital'' 
that did not submit data on the starter set of 10 quality measures 
established by the Secretary of Health and Human Services as of 
November 1, 2003. Section 5001(a) of Public Law 109-171 limits the 0.4 
percentage point reduction to FY 2005 and FY 2006, and

[[Page 24092]]

establishes a 2.0 percentage point reduction for FY 2007 and subsequent 
fiscal years.
    The starter set of 10 quality measures we established as of 
November 1, 2003 are:

Heart Attack (Acute Myocardial Infarction)

     Was aspirin given to the patient upon arrival to the 
hospital?
     Was aspirin prescribed when the patient was discharged?
     Was a beta-blocker given to the patient upon arrival to 
the hospital?
     Was a beta-blocker prescribed when the patient was 
discharged?
     Was an ACE inhibitor given for the patient with heart 
failure?

Heart Failure (HF)

     Did the patient get an assessment of his or her heart 
function?
     Was an ACE inhibitor given to the patient?

Pneumonia (PNE)

     Was an antibiotic given to the patient in a timely way?
     Had the patient received a pneumococcal vaccination?
     Was the patient's oxygen level assessed?
    We adopted these measures after the Secretary of HHS initiated a 
partnership with several collaborators intended to promote hospital 
quality improvement and public reporting of hospital quality 
information. These collaborators include the American Hospital 
Association, the Federation of American Hospitals, the Association of 
American Medical Colleges, the Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO), the National Quality Forum (NQF), the 
American Medical Association, the Consumer-Purchaser Disclosure 
Project, the American Association of Retired Persons, the American 
Federation of Labor-Congress of Industrial Organizations, the Agency 
for Healthcare Research and Quality, as well as CMS, Quality 
Improvement Organizations (QIOs), and others.
    This collaboration, originally known as the National Voluntary 
Hospital Reporting Initiative, is now known as the HQA. Hospital data 
are submitted through the QualityNet Exchange secure Web site 
(www.qnetexchange.org). This Web site meets or exceeds all current 
Health Insurance Portability and Accountability Act requirements. Data 
from this initiative were initially used to populate the Hospital 
Compare Web site, www.hospitalcompare.hhs.gov. This Web site assists 
beneficiaries and the general public by providing information on 
hospital quality of care for consumers who need to select a hospital. 
It further serves to encourage consumers to work with their doctors and 
hospitals to discuss the quality of care they provide to patients, 
thereby providing an additional incentive to improve the quality of 
that care.
    This starter set of 10 quality measures has been endorsed by the 
NQF and is a subset of measures currently collected for the JCAHO as 
part of its certification program. We chose these 10 quality measures 
in order to collect data that will: (1) Provide useful and valid 
information about hospital quality to the public; (2) provide hospitals 
with a sense of predictability about public reporting expectations; (3) 
begin to standardize data and data collection mechanisms; and (4) 
foster hospital quality improvement. Many hospitals have participated 
in the HQA, and are continuing to submit data to the QIO Clinical 
Warehouse. Since the HQA released the starter set of 10 quality 
measures, it has continued to release additional quality measures, and 
has released 11 additional NQF-endorsed quality measures to date. Many 
HQA-participating hospitals have been voluntarily reporting on these 
additional quality measures, although only the starter set of 10 
quality measures were subject to potential reductions in hospitals' 
annual payment update percentages under section 501(b) of Public Law 
108-173.
    To implement section 501(b) of Public Law 108-173, we created the 
RHQDAPU program. Originally, the program set out the form, manner, and 
timeframes for hospitals to submit data regarding the starter set of 10 
quality measures. For the FY 2005 payment update, we permitted 
hospitals to withdraw from the RHQDAPU program at any time up to August 
1, 2004. Hospitals that withdrew from the program did not receive the 
full payment update and, instead, received a reduction of 0.4 
percentage points in their payment update. We did not establish a 
deadline for withdrawal for the FY 2006 payment update.
    For FY 2006, in order to receive a full payment update, hospitals 
were required to continuously submit to the QIO Clinical Warehouse 
abstracted data regarding the starter set of 10 quality measures each 
calendar quarter according to the schedule found on the QualityNet 
Exchange Web site. New participants were required to submit these data 
using the same schedule, starting with the quarter they began 
discharging patients. The data for each quarter had to be submitted on 
time and pass all of the edits and consistency checks required in the 
QIO Clinical Warehouse. Hospitals that did not treat a condition or 
that had very few discharges were not penalized, and they received the 
full payment update if they submitted appropriate data on each of the 
10 quality measures that they treated for patients who were discharged 
during the reporting periods.
2. New Procedures for Hospital Reporting of Quality Data
    We are proposing to amend our regulations at Sec.  412.64(d)(2) to 
reflect the 2.0 percentage point reduction in the payment update for FY 
2007 and subsequent fiscal years for hospitals that do not comply with 
requirements for reporting quality data as provided for under section 
5001(a) of Public Law 109-171. We are also revising the RHQDAPU 
program's procedures to reflect our experience with this program and to 
implement section 5001(a) of Public Law 109-171, including the new 
requirement for reporting of an expanded set of quality measures.
    In addition to publication in this proposed rule, all revised 
procedures will be added to the ``Reporting Hospital Quality Data for 
Annual Payment Update Reference Checklist'' section of the QualityNet 
Exchange Web site. This checklist also contains all of the forms to be 
completed by hospitals participating in the program. In order to 
participate in the hospital reporting initiative, hospitals must follow 
these steps:
     Identify a QualityNet Exchange Administrator who follows 
the registration process and submits the information through the QIO. 
This must be done regardless of whether the hospital uses a vendor for 
transmission of data.
     Complete the revised ``Reporting Hospital Quality Data for 
Annual Payment Update Notice of Participation'' form. All hospitals 
must send this form to their QIO, no later than August 1, 2006. In 
addition, before participating hospitals initially begin reporting 
data, they must register with the QualityNet Exchange, regardless of 
the method used for submitting data.
     Continue to collect data for all 10 ``starter set'' 
quality measures (or begin collecting such data, if newly participating 
in the program), and submit the data to the QIO Clinical Warehouse 
either using the CMS Abstraction & Reporting Tool (CART), the JCAHO 
ORYX[supreg] Core Measures Performance Measurement System, or another 
third-party vendor tool that has met the measurement specification 
requirements for data transmission to QualityNet Exchange. The QIO 
Clinical

[[Page 24093]]

Warehouse will submit the data to CMS on behalf of the hospitals. The 
submission will be done through QualityNet Exchange. Because the 
information in the QIO Clinical Warehouse is considered QIO 
information, it is subject to the stringent QIO confidentiality 
regulations in 42 CFR part 480. We are proposing that hospitals 
continue to submit data regarding the starter set of 10 quality 
measures because the existing data submission schedule that we will use 
for the FY 2007 update relies on discharges that occurred in calendar 
year (CY) 2005. Because the first three quarters of CY 2005 data 
already have been submitted, we are not proposing to require hospitals 
to submit any additional CY 2005 data to address the new quality 
measures in the anticipated expanded 21 quality measures discussed 
below. However, we again note that many hospitals have been providing 
data on these additional measures since they were first included in the 
HQA set, although these measures did not affect hospitals' annual 
payment adjustment under the RHQDAPU program implementing section 
501(b) of Public Law 108-173.
     For the FY 2007 update, hospitals also will be required to 
complete and return a written form on which they pledge to submit data 
on the following set of expanded quality measures (anticipated 21 
clinical quality measures), starting with discharges that occur in CY 
2006. These expanded quality measures are the HQA-released measures 
that the 2005 IOM report recommended we use as expanded ``starter'' 
measures. As discussed above, new section 1886(b)(3)(B)(viii)(IV) of 
the Act requires us to begin to adopt the baseline set of performance 
measures set forth in the 2005 IOM report effective for payments 
beginning with FY 2007. Hospitals will be required to submit data on 
the expanded measures to the QIO Clinical Warehouse beginning with 
discharges that occur in the first calendar quarter of 2006 (January 
through March discharges). The deadline for hospitals to submit their 
data for first quarter 2006 is August 15, 2006.
    The expanded measures are:

Heart Attack (Acute Myocardial Infarction)

     Aspirin at arrival
     Aspirin prescribed at discharge
     ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker 
(ARBs) for left ventricular systolic dysfunction
     Beta blocker at arrival
     Beta blocker prescribed at discharge
     Thrombolytic agent received within 30 minutes of hospital 
arrival
     Percutaneous Coronary Intervention (PCI) received within 
120 minutes of hospital arrival
     Adult smoking cessation advice/counseling

Heart Failure (HF)

     Left ventricular function assessment
     ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker 
(ARBs) for left ventricular systolic dysfunction
     Discharge instructions
     Adult smoking cessation advice/counseling

Pneumonia (PNE)

     Initial antibiotic received within 4 hours of hospital 
arrival
     Oxygenation assessment
     Pneumococcal vaccination status
     Blood culture performed before first antibiotic received 
in hospital
     Adult smoking cessation advice/counseling
     Appropriate initial antibiotic selection
     Influenza vaccination (collected but not publicly 
reported--subject to change)

Surgical Infection Prevention (SIP)

     Prophylactic antibiotic received within 1 hour prior to 
surgical incision
     Prophylactic antibiotics discontinued within 24 hours 
after surgery end time
    Further, as recommended in the IOM report, we will be implementing 
the HCAHPS[supreg] patient survey in October 2006, to measure patients' 
perspectives of care. HCAHPS[supreg] is designed to make ``apples to 
apples'' comparisons of patients' perspectives on hospital care 
including communications with doctors, communications with nurses, 
responsiveness of hospital staff, cleanliness and quietness of the 
hospital, pain control, communication about medicines, and discharge 
information. More information on this survey can be found on our Web 
site: www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalHCAHPSFactSheet200512.pdf. We intend to report the first three 
quarters of these survey data in late 2007 on the Web site: 
www.hospitalcompare.hhs.gov. HCAHPS[supreg] was endorsed by the NQF in 
May 2005. However, at this time, we do not anticipate including 
HCAHPS[supreg] as a part of the revised FY 2007 ``Reporting Hospital 
Quality Data for Annual Payment Update Notice of Participation'' form. 
We believe that our proposed procedure will meet the requirement of 
section 1886(b)(3)(B)(viii)(IV) of the Act that, ``for payments 
beginning with fiscal year 2007, in expanding the number of measures, 
under subclause (III), the Secretary shall begin to adopt'' the IOM 
report's set of baseline measures. Section 1886(b)(3)(B)(viii)(III) of 
the Act states that we must expand, for FY 2007 and each subsequent 
fiscal year, the set of measures that the Secretary determines to be 
``appropriate'' for the measurement of the quality of care furnished by 
hospitals in inpatient settings beyond the original quality measures 
that applied in FY 2005 and FY 2006.
    We believe that the statute gives the Secretary the discretion to 
choose what ``begin to adopt'' should involve in FY 2007 and the number 
of additional measures, if any, that would be ``appropriate'' during 
that time. In proposing our revised procedures, designing the methods 
that hospitals will use to report during FY 2007, establishing an 
anticipated set of expanded measures based on the IOM report, and 
revising RHQDAPU materials, we believe that we have met the statutory 
requirements. We will continue to explore the feasibility of adopting 
additional measures for purpose of the FY 2008 update, including the 
HCAHPS[supreg] and structure measures described in the IOM report and 
other measures that reflect consensus among affected parties, as 
required by new section 1886(b)(3)(B)(viii)(III) through (V) of the 
Act.
    For the FY 2007 update, we specify that hospitals must submit these 
complete data in accordance with the joint CMS/JCAHO sampling 
requirements located on the QualityNet Exchange Web site. These 
requirements specify that hospitals are required to submit a random 
sample or complete population of cases for each of three topics (acute 
myocardial infarction, heart failure, and pneumonia) covered by the 
starter set of 10 quality measures. These requirements include all 
Medicare and non-Medicare patients discharged from hospitals. Hospitals 
are expected to continuously meet these sampling requirements for the 
starter set of 10 quality measures for discharges in each quarter.
    We do not anticipate significant additional burden on hospitals 
regarding the starter set of 10 quality measures or the anticipated 21 
clinical quality measures because all JCAHO-accredited hospitals are 
currently required to adhere to these sampling requirements in acute 
myocardial infarction, heart failure, pneumonia, and surgical infection 
prevention for

[[Page 24094]]

accreditation and core measure reporting purposes.
    For the FY 2007 update, hospitals may withdraw from the revised 
RHQDAPU program at any time up to August 1, 2006. If a hospital 
withdraws from the program, it will receive a 2.0 percentage point 
reduction in its payment update.
    For the FY 2007 update, we will continue to require that hospitals 
meet the chart validation requirements that we implemented in the FY 
2006 IPPS final rule. There were no chart-audit validation criteria in 
place for FY 2005. Based upon our experience with the FY 2005 
submissions and our requirement for reliable and valid data, in the FY 
2006 IPPS final rule, we established additional requirements for the 
data that hospitals were required to submit in order to receive the 
full FY 2006 payment update (70 FR 47421 and 47422). These 
requirements, as well as additional information on validation 
requirements, will continue and are being placed on the QualityNet 
Exchange Web site.
    For the FY 2007 payment update, hospitals must pass our validation 
requirement of a minimum of 80 percent reliability, based upon our 
chart-audit validation process, for the first three quarters of data 
from CY 2005. These data were due to the QIO Clinical Warehouse by July 
15, 2005 (first quarter CY 2005 discharges), November 15, 2005 (second 
quarter CY 2005 discharges), and February 15, 2006 (third quarter CY 
2005 discharges).
    We use confidence intervals to determine if a hospital has achieved 
an 80-percent reliability aggregated over the three quarters. The use 
of confidence intervals allows us to establish an appropriate range 
below the 80-percent reliability threshold that demonstrates a 
sufficient level of validity to allow the data to still be considered 
valid.
    We estimate the percent reliability based upon a review of five 
charts, and then calculate the upper 95-percent confidence limit for 
that estimate. If this upper limit is above the required 80-percent 
reliability, the hospital data are considered validated. We are using 
the design-specific estimate of the variance for the confidence 
interval calculation, which, in this case, is a stratified single stage 
cluster sample, with unequal cluster sizes. (For reference, see 
Cochran, William G.: Sampling Techniques, John Wiley & Sons, New York, 
chapter 3, section 3.12 (1977); and Kish, Leslie: Survey Sampling, John 
Wiley & Sons, New York, chapter 3, section 3.3 (1964).) Each quarter is 
treated as a stratum for variance estimation purposes.
    We use a two-step process to determine if a hospital is submitting 
valid data. In the first step, we calculate the percent agreement for 
all of the variables submitted in all of the charts. If a hospital 
falls below the 80-percent cutoff, we restrict the comparison to those 
variables associated with the starter set of 10 quality measures. We 
recalculate the percent agreement and the estimated 95-percent 
confidence interval and again compare to the 80-percent cutoff point. 
If a hospital passes under this restricted set of variables, the 
hospital is considered to be submitting valid data for purposes of the 
revised RHQDAPU program.
    Under the standard appeal process, all hospitals are given the 
detailed results of the Clinical Data Abstraction Center (CDAC) 
reabstraction along with their estimated percent reliability and the 
upper bound of the 95-percent confidence interval. If a hospital does 
not meet the required 80-percent threshold, the hospital has 10 working 
days to appeal these results to their QIO. The QIO will review the 
appeal with the hospital and make a final determination on the appeal. 
The QIO receives from the hospital the element or elements that are to 
be evaluated during the appeal process, along with the hospital's 
rationale for the difference between the hospital's abstraction and the 
CDAC abstraction. In this validation appeal process, the QIO reviews 
the appeal using the medical record to evaluate the data elements that 
are being appealed. This process allows for an independent review and 
is designed to find coding errors on the part of abstractors. QIO 
appeal decisions are based on the data that the hospital submitted to 
the QIO Clinical Warehouse. The QIO has 20 calendar days to make a 
final decision. The QIO can either uphold or reverse the CDAC 
validation decision. If the QIO does not agree with the hospital's 
appeal, the original results stand. However, if the QIO agrees with the 
hospital, new validation results are calculated and provided to the 
hospital through the usual processes. This validation appeal process is 
described in detail at the QualityNet Exchange Web site.
    In reviewing the hospital data, we plan to combine the samples for 
first quarter, second quarter, and third quarter (15 cases) into a 
single stratified sample to determine whether the 80-percent 
reliability level is met. This gives us the greatest accuracy when 
estimating the reliability level. The confidence interval approach 
accounts for the variation in coding among the five charts pulled each 
quarter and for the entire year around the overall hospital mean score 
(on all individual data elements compared). The closer each case's 
reliability score is to the hospital mean score, the tighter the 
confidence interval established for that hospital. A hospital may code 
each chart equally inaccurately, achieve a tight confidence interval, 
and not pass, even though its overall score is just below the passing 
threshold (75 percent, for example). A hospital with more variation 
among charts will achieve a broader confidence interval, which may 
allow it to pass, even though some charts score very low and others 
score very high.
    We believe we have adopted the most suitable statistical tests for 
the hospital data we are trying to validate. We are particularly 
interested in comments from hospitals on this passing threshold, the 
confidence interval, and the sampling approach. Based on analytical 
results from FY 2006, we found confidence intervals using only five 
charts widely varied in size. As a result of these findings, we decided 
to combine multiple quarters of validation samples into a single 
stratified sample to shrink and/or decrease the variation and produce a 
more reliable estimate of abstraction reliability to determine if any 
changes in our methodology are required. We will make any necessary 
revisions to the sampling methodology and the statistical approach 
through manual issuances and other guidance to hospitals.
    The CMS Quality Improvement Group will continue to study methods 
for improving the validation process for hospital submission in regard 
to completeness and adherence to sampling requirements. Current 
validation sampling assesses abstraction accuracy, but submission 
completeness and adherence to sampling requirements are critical 
prerequisites to produce accurate hospital quality measures.
    For the FY 2007 update, we plan to revise and post up-to-date 
confidence interval information on the QualityNet Exchange Web site 
explaining the application of the confidence interval to the overall 
validation results. The data are being validated at several levels. 
There are consistency and internal edit checks to ensure the integrity 
of the submitted data; there are external edit checks to verify 
expectations about the volume of the data received.
    We are proposing that hospitals attest to the completeness and 
accuracy of the data submitted to the QIO Clinical Warehouse in order 
to improve aspects of the validation checks. In order to

[[Page 24095]]

meet this requirement, for each quarter, hospitals will have to sign 
off on the volume of the data submitted. We plan to provide additional 
information to explain the data completeness requirement and as well as 
a form to be completed on the QualityNet Exchange Web site.
    We will continue to display quality information for public viewing 
as required by new section 1886(b)(3)(B)(viii)(VII) of the Act. Before 
we display this information, hospitals will be permitted to review 
their information as we have it recorded.
    For hospitals that CMS has determined do not meet the RHQDAPU 
program requirements for the applicable fiscal year who wish to appeal 
this determination, the appeals process set forth in 42 CFR Part 405, 
Subpart R (a Provider Reimbursement Review Board (PRRB) appeal) 
applies. However, we believe it may be appropriate to establish a 
structured reconsideration process to precede the PRRB appeal. 
Currently, hospitals submit letters detailing their reasons for 
requesting that CMS reconsider its decision that the hospital did not 
meet the RHQDAPU program requirements. We are proposing to continue 
this process for FY 2007 RHQDAPU program decisions. However, we are 
proposing to establish a deadline of November 1, 2006, for hospitals to 
make such requests related to the FY 2007 RHQDAPU decisions, which will 
give hospitals a minimum of 30 days to submit reconsideration requests 
from the dates that the decisions are made public. Further, we are 
proposing that the November 1, 2006 deadline also would apply to FY 
2005 and FY 2006 RHQDAPU program decisions and that a November 1 
deadline would apply in all future fiscal years. CMS will officially 
respond to the letters submitted by hospitals.
    Further, we are seeking public comment specifically on the need for 
a more structured reconsideration process to precede any PRRB appeal 
for FY 2008 and subsequent fiscal years. We also are seeking comment on 
what such a process would entail. For example, we would expect that 
such a process, if established, would include--
     A limited time, such as 30 days from the public release of 
the decision, for requesting a reconsideration;
     Who in a hospital organization can request such a 
reconsideration and be notified of its outcome;
     The specific factors that CMS will consider in such a 
reconsideration, such as an inability to submit data timely due to CMS 
systems failures;
     Specific requirements for submitting a reconsideration 
request, such as a written request for reconsideration specifically 
stating all reasons and factors, including specific data elements, why 
the hospital believes it did meet the RHQDAPU program requirements;
     Specific CMS components that would participate in the 
reconsideration process; and
     The timeframe, such as 60 days, for CMS to provide its 
reconsideration decision to the hospital.
    We are also soliciting comments on the reasons for not establishing 
such a reconsideration process.
3. Electronic Medical Records
    In the FY 2006 IPPS final rule, we encouraged hospitals to take 
steps toward the adoption of electronic medical records (EMRs) that 
will allow for reporting of clinical quality data from the EMRs 
directly to a CMS data repository (70 FR 47420). We intend to begin 
working toward creating measures specifications and a system or 
mechanism, or both, that will accept the data directly without 
requiring the transfer of the raw data into an XML file as is currently 
done. The Department continues to work cooperatively with other Federal 
agencies in the development of Federal health architecture data 
standards. We encourage hospitals that are developing systems to 
conform them to both industry standards and, when developed, the 
Federal Health Architecture Data standards, and to ensure that the data 
necessary for quality measures are captured. Ideally, such systems will 
also provide point-of-care decision support that enables high levels of 
performance on the measures. Hospitals using EMRs to produce data on 
quality measures will be held to the same performance expectations as 
hospitals not using EMRs.
    Due to the low volume of comments we received on this issue in 
response to the FY 2006 IPPS rule, in this proposed rule for FY 2007, 
we again are inviting comments on these requirements and options. In 
section IV.B.6. of the preamble to this proposed rule, we are also 
inviting comments on the potential role of effective, interoperable, 
health information on technology in value-based purchasing.

B. Value-Based Purchasing

    (If you choose to comment on issues in this section, please include 
the caption ``Value-Based Purchasing'' at the beginning of your 
comment.)
1. Introduction
    CMS has undertaken a number of activities to improve the quality 
and efficiency of care delivered to Medicare beneficiaries. Currently, 
there are several different fee-for-service payment systems under 
Medicare that are used to pay health professionals and other providers 
based on the number and complexity of services provided to patients. In 
general, all providers to which a specific Medicare payment system 
applies receive the same amount for a service, regardless of its 
quality or efficiency. As a result, Medicare's payment systems can 
direct more resources to hospitals that deliver care that is not of the 
highest quality or include unnecessary services (for example, 
duplicative tests and services or services to treat avoidable 
complications). Therefore, we are examining the concept of ``value-
based purchasing,'' which may use a range of incentives to achieve 
identified quality and efficiency goals, as a means of promoting better 
quality of care and more effective resource use in the Medicare payment 
systems. In considering the concept of value-based purchasing, we are 
working closely with stakeholder partners, including health 
professionals and providers. In this proposed rule, we are seeking 
public comment on value-based purchasing as related specifically to 
hospitals.
    In this section, we discuss CMS' and Congress' initial steps toward 
hospital value-based purchasing, which include the Premier Hospital 
Quality Incentive Demonstration, the RHQDAPU program authorized by 
section 501(b) of Public Law 108-173 (MMA), and the extended and 
expanded RHQDAPU program authorized by section 5001(a) of Public Law 
109-171 (DRA). (The RHQDAPU program is also discussed in section IV.A. 
of the preamble to this proposed rule.) In addition, we discuss the 
issues that must be considered in developing a plan to implement a 
value-based purchasing plan beginning with FY 2009 for Medicare 
payments for subsection (d) hospitals. This plan is required by section 
5001(b) of the DRA. For each of the required planning issues (measures, 
data infrastructure, payment methodology, and public reporting), we 
discuss CMS' activities to date and solicit comments on outstanding 
policy questions. Next, we discuss options for implementation of 
section 5001(c) of Public Law 109-171, which authorizes quality 
adjustment to DRG payments for certain conditions that were not present 
on hospital admission. We are soliciting input about detailed design 
considerations related to each of these issues and the advantages and 
disadvantages of possible approaches to

[[Page 24096]]

planning and implementing hospital value-based purchasing.
    Finally, we discuss and invite comments on how to encourage 
hospitals to effectively use health information technology to improve 
efficiency, processes, and health care outcomes, through, for example, 
adopting interoperable health information technology.
2. Premier Hospital Quality Incentive Demonstration
    One of the ways in which CMS is testing innovative potential 
approaches to improving quality is through demonstrations and pilot 
projects. The demonstration most relevant to hospitals is the Premier 
Hospital Quality Incentive Demonstration. Premier, Inc., a nationwide 
alliance of not-for-profit hospitals, submitted an unsolicited proposal 
for consideration by CMS.\13\ We have partnered with Premier to conduct 
a demonstration that is designed to test whether the quality of 
inpatient care for Medicare beneficiaries improves when financial 
incentives are provided. Under the demonstration, about 270 hospitals 
are voluntarily providing data on 34 quality measures related to 5 
clinical conditions: Heart attack, heart failure, pneumonia, coronary 
artery bypass graft, and hip and knee replacements.
---------------------------------------------------------------------------

    \13\ The Premier Hospital Quality Incentive Demonstration was 
authorized under section 402 of Public Law 90-248, Social Security 
Amendments of 1967 (42 U.S.C. 1395b-1). This section authorizes 
certain types of demonstration projects that waive compliance with 
the regular payment methods used in the Medicare program.
---------------------------------------------------------------------------

    Using the quality measures, CMS identifies hospitals with the 
highest quality performance in each of the five clinical areas. 
Hospitals scoring in the top 10 percent in each clinical area receive a 
2-percent bonus payment in addition to the regular Medicare DRG payment 
for the measured condition. Hospitals in the second highest 10 percent 
receive a 1-percent bonus payment. In the third year of the 
demonstration, hospitals that do not achieve absolute improvements 
above the demonstration's first year composite score baseline (the 
lowest 20 percent) for that condition will have their DRG payments 
reduced by 1 or 2 percent, depending on how far their performance is 
below the baseline.
    Following the first year of the demonstration (FY 2004), CMS 
awarded a total of $8.85 million to participating hospitals in the top 
two deciles for each clinical area. In the aggregate, quality of care 
improved in all five clinical areas that were measured. Preliminary 
information from the second year of the demonstration indicates that 
quality is continuing to improve, particularly for the poorest 
performing hospitals. Additional information on the Premier Hospital 
Quality Incentive Demonstration is available on the CMS Web site at: 
http://www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp.
3. RHQDAPU Program
    We believe that the acts of collecting and submitting performance 
data and of publicly reporting comparative information about hospital 
performance seems to be a strong incentive to encourage hospital 
accountability. Measurement and reporting can help focus the attention 
of hospitals and consumers on specific goals and on hospitals' 
performance relative to those goals.
a. Section 501(b) of Public Law 108-173 (MMA)
    Since 2003, we have operated the Hospital Quality Initiative,\14\ 
which is designed to stimulate improvements in hospital care by 
standardizing hospital performance measures and data transmission to 
ensure that all payers, hospitals, and oversight and accrediting 
entities use the same measures when publicly reporting on hospital 
performance. Section 501(b) of Public Law 108-173 authorized us to link 
the collection of data for an initial starter set of 10 quality 
measures to the Medicare annual update of the standardized payment 
amount for hospital inpatient operating costs (also known as the 
RHQDAPU program). For FYs 2005 and 2006, hospitals that met the RHQDAPU 
program's requirements received the full annual payment update to their 
inpatient operating costs, while hospitals that did not comply received 
an update that was reduced by 0.4 percentage points. For FY 2005, 
virtually every hospital in the country that was eligible to 
participate submitted data (98.3 percent), and approximately 96 percent 
of all participating hospitals met the requirements to receive the full 
update. The data regarding the starter set of 10 quality measures as 
well as additional, voluntarily-reported data on other quality 
measures, are available to the public through the Hospital Compare Web 
site at: http://www.hospitalcompare.hhs.gov.
---------------------------------------------------------------------------

    \14\ For more information about CMS' Hospital Quality 
Initiative, see http://www.cms.hhs.gov/HospitalQualityInits/ Inits/.
---------------------------------------------------------------------------

b. Section 5001(a) of Public Law 109-171 (DRA)
    As discussed in section IV.A. of this preamble, for FY 2007 and 
each subsequent year, section 5001(a) of Public Law 109-171 amended 
section 1886(b)(3)(B) of the Act and made changes to the program 
established under section 501(b) of Public Law 108-173. These changes 
require us to expand the number of measures for which data must be 
submitted, and to change the percentage point reduction in the annual 
payment update from 0.4 percentage points to 2.0 percentage points for 
subsection (d) hospitals that do not report the required quality 
measures in a form and manner, and at a time, specified by the 
Secretary. Effective for payments beginning with FY 2007, new section 
1886(b)(3)(B)(viii)(IV) of the Act requires the Secretary to begin to 
adopt the expanded set of performance measures set forth in the IOM's 
2005 report entitled, ``Performance Measurement: Accelerating 
Improvement.'' \15\ Those measures include the HQA measures, the 
HCAHPS[supreg] patient perspective survey, and three structural 
measures.\16\ Effective for payments beginning with FY 2008, the 
Secretary must add other measures that reflect consensus among affected 
parties and may replace existing measures as appropriate. New section 
1886(b)(3)(B)(viii)(VII) of the Act requires the Secretary to post 
hospital quality data on these measures on the CMS Web site. Additional 
information on the Hospital Quality Initiative is available on the CMS 
Web site at: http://www.cms.hhs.gov/HospitalQualityInits QualityInits.
---------------------------------------------------------------------------

    \15\ Institute of Medicine, ``Performance Measurement: 
Accelerating Improvement,'' December 1, 2005, available at http://www.iom.edu/CMS/3809/19805/31310.aspx.
    \16\ The three structural measures are: (1) Computerized 
provider order entry; (2) intensive care intensivists; and (3) 
evidence-based hospital referrals.
---------------------------------------------------------------------------

4. Plan for Implementing Hospital Value-Based Purchasing Beginning with 
FY 2009
    Section 5001(b) of Public Law 109-171 requires us to develop a plan 
to implement hospital value-based purchasing beginning with FY 2009. 
The plan must consider the following issues: (a) The ongoing 
development, selection, and modification process for measures of 
quality and efficiency in hospital inpatient settings; (b) the 
reporting, collection, and validation of quality data; (c) the 
structure of payment adjustments, including the determination of 
thresholds of improvements in quality that would

[[Page 24097]]

substantiate a payment adjustment, the size of such payments, and the 
sources of funding for the payments; and (d) the disclosure of 
information on hospital performance. Section 5001(b) of Public Law 109-
171 also calls for us to consult with affected parties and to consider 
relevant demonstrations in developing the plan. Each of these issues 
(measure development and refinement, data infrastructure, incentives, 
and public reporting) is discussed below, along with our activities to 
date and outstanding policy questions. We are seeking comments on these 
issue areas and outstanding policy questions.
a. Measure Development and Refinement
    As we explore the potential connections between performance 
measurement and incentives, we would like to better understand how to 
develop valid, meaningful, current performance measures that are 
aligned with other hospital measurement activities, and an enterprise 
for development, validation, consensus building, and maintenance of 
these measures. In addition, before measures could be used to compare 
the relative quality or cost of care provided by hospitals, we believe 
that the information would need to be appropriately adjusted to account 
for relevant differences among hospitals and among their patients. The 
availability of appropriate measures on which consensus might be 
achieved depends on the state of the art of research on measure 
development.
    We believe that it is desirable for performance measures to be 
based on appropriate evidence, effectively related to desired outcomes, 
derived in a transparent fashion involving consultation with experts 
and affected hospitals, and routinely updated. MedPAC's 2005 Report to 
Congress \17\ stated that measures should be evidence-based; that 
collecting and analyzing data should not be unduly burdensome for the 
provider or for CMS; that risk adjustment should be sufficient to deter 
providers from avoiding patients who might lower performance scores; 
that most providers should be able to improve on the measures; that 
measures should apply to a broad range of care and providers; that 
measures should capture aspects of care that are under the control of 
the providers being measured; and that areas of care being measured 
should be those needing improvement.
---------------------------------------------------------------------------

    \17\ Medicare Payment Advisory Commission: Report to Congress: 
Medicare Payment Policy, March 2005, pp. 186-187, available at: 
http://www.medpac.gov/publications/generic_report_display.cfm?report_type_id=1&sid=2&subid=0 subid=0.
---------------------------------------------------------------------------

    The IOM's December 2005 report, ``Performance Measurement: 
Accelerating Improvement'' (previously cited under footnote 
15) recommended that measure sets should build on the work of 
key public- and private-sector organizations; that national performance 
measures that have been approved through ongoing consensus processes 
led by major stakeholder groups are an appropriate starting point; that 
the limited scope of current measures should be broadened to address 
efficiency, equity, and patient-centeredness; that quality, costs, and 
outcomes of care should be measured over longer time intervals; and 
that measures be applicable to more than one setting so that providers 
can share accountability for a patient's care (pp. 8-11).
    The plan for hospital value-based purchasing mandated by Pub. L. 
109-171 must address the ongoing development, selection, and 
modification process for measures of quality and efficiency in hospital 
inpatient settings. We have worked collaboratively in defining 
consistent, meaningful performance measures for hospitals and other 
providers for a number of years. The efforts of CMS and its stakeholder 
partners to develop standardized performance measures increase the 
likelihood that the measures will be valid, reliable, and widely 
accepted as viable indicators of performance. Standardized measures 
also reduce the burden for hospitals that would otherwise have to 
report different measures to multiple entities, such as accrediting 
bodies and State agencies.
    CMS and the HQA (which includes representatives from consumers, 
hospitals, health professionals, purchasers, and accreditation 
organizations) collectively selected a starter set of 10 consensus-
derived quality measures for public reporting, which was incorporated 
into the RHQDAPU program authorized by section 501(b) of Pub. L. 108-
173. (See section IV.A. of this preamble for a detailed discussion of 
the RHQDAPU program.) The measures were endorsed by the NQF, a 
nonprofit voluntary organization that represents a broad range of 
health care stakeholders and endorses consensus-based national 
performance standards. CMS has also worked with the JCAHO to align 
hospital performance measures that we share in common, thereby reducing 
hospitals' reporting burden.
    In April and September 2005, CMS and the HQA identified additional 
NQF-endorsed measures of hospital performance. In section IV.A. of the 
preamble to this proposed rule, we list these measures and propose to 
require hospital reporting on these measures under an expanded version 
of the RHQDAPU program authorized by section 5001(a) of Pub. L. 109-
171. These measures are discussed in more detail on the CMS Web site 
at: http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalHQA2004_2007200512.pdf.
    An additional two outcome measures of 30-day mortality for heart 
attack and heart failure have been endorsed by the NQF for public 
reporting. Further, in October 2006, we will be implementing the 
HCAHPS[reg] survey of inpatient perceptions of their hospital care 
experiences, with the intention that an aggregate HCAHPS[reg] measure 
will become a publicly reported performance measure. HCAHPS[reg] was 
endorsed by the NQF in May 2005. Beyond these, we could also consider 
including measures from the Surgical Care Improvement Project, measures 
relating to a hospital's use of information technology that result in 
improved patient outcomes, implementation of data standards, and 
preventable readmissions as quality reporting measures under the 
RHQDAPU program or the hospital value-based purchasing program.
b. Data Infrastructure
    Implementing measures on which to base a value-based purchasing 
system would require an infrastructure that could collect appropriate 
information from hospitals, store and aggregate it as necessary, and 
prepare it for use in determining appropriate incentives. Hospitals 
would likely need to be able to generate appropriate data as input for 
calculation of the measures. For some measures, data that hospitals 
already submit with claims for payment or for some other administrative 
purpose may be sufficient. For other measures, hospitals might need to 
provide information regarding their structure and resources or about 
the specifics of medical care provided to patients or the outcomes of 
that care. For that information, hospitals may need special software to 
assist with data collection and secure channels by which they can 
transmit data. We are interested in receiving comments on how to 
develop an infrastructure that would facilitate the efficient 
transmission and storage of data, and especially, as discussed in 
sections IV.A.3. and IV.B.6. of the preamble to this proposed rule, in 
comments on how electronic medical and health record systems could help 
improve care and be integrated into or facilitate the data collection 
process.

[[Page 24098]]

    Implementation would require communication channels and data 
warehouses with sufficient capacity and flexibility to acquire and 
store data from hospitals. We are considering how we might validate the 
submitted data, determine incentives based on that data, and transmit 
these values to Medicare's fiscal intermediaries. The potential 
infrastructure would need to be extremely secure and afford the most 
privacy protection permitted by law. It would also need to minimize the 
burden of data collection and transmission on providers. It would need 
to be accurate, efficient, and cost-effective for CMS to administer.
    The plan for hospital value-based purchasing mandated by Pub. L. 
109-171 must address the reporting, collection, and validation of 
quality data. Over the past few years, we have developed a data 
collection and reporting infrastructure for the RHQDAPU program that 
can transmit performance measurement data via secure channels for its 
submission, storage, analysis, validation and reporting. Specifically, 
to facilitate data collection, we have developed the CART software to 
assist hospitals in the collection of clinical and administrative data 
used to measure performance improvement. CART, which is provided to 
hospitals free of charge, is a powerful application that hospitals and 
their designees can use to abstract clinical data needed for 
performance measurement from medical records. This tool was designed 
and developed by CMS with input from the JCAHO and the Medicare QIOs. 
We have also developed the QualityNet Exchange system for secure 
transmission of data to the QIO Clinical Warehouse. QNetExchange.org is 
the CMS-approved Web site for secure communications and data exchange 
between two or more of the following: Hospitals, performance 
measurement system vendors, end stage renal disease networks and 
facilities, QIOs, and CMS.
    For data warehousing, we have a claims warehouse for Medicare Part 
A data, which maintains the claims for the most recent 42 months. We 
also have a QIO Clinical Warehouse that currently contains information 
on the starter set of 10 quality measures collected under the RHQDAPU 
program, as well as additional voluntarily reported measures. We must 
assess the validity of the RHQDAPU information because of its use for 
quality improvement, public reporting, and determining hospitals' 
annual payment updates under the RHQDAPU program. Validation activities 
assess the reliability of the data that a hospital has submitted, as 
evidenced by the consistency between a hospital's abstraction and 
reabstraction by an independent party.
    We are currently using a contractor, the CDAC, to carry out the 
validation process under the RHQDAPU program. Hospitals are required to 
submit certain quality data to the QIO Clinical Warehouse within 4.5 
months of the end of each quarterly reporting period. The steps in the 
validation process are: (1) Check for duplicates; (2) draw a sample; 
(3) obtain copies of medical records; (4) request and complete CDAC 
abstraction; (5) post results on QualityNet Exchange for hospitals' 
review; and (6) resolve validation appeals. We are seeking comments on 
how the data submission and validation processes that we currently use 
for the RHQDAPU program might be adaptable to a hospital value-based 
purchasing program.
    One of the key challenges we face in considering implementation of 
hospital value-based purchasing is minimizing the length of time 
between our receipt of data and our ability to provide feedback to 
hospitals on the data. Some of the hospitals that are participating in 
the RHQDAPU program and the Premier Hospital Quality Incentive 
Demonstration have asked for more timely feedback on their performance. 
We recognize that a long delay between the provision of services and 
feedback about the quality of those services may impede both 
improvement efforts and a hospital's motivation to improve. The current 
lag time between the end of the quarterly reporting period and the 
availability of performance feedback under the RHQDAPU program is 
approximately 9 months. Hospitals have 4.5 months to complete their 
paper medical records and to submit information to the QIO Clinical 
Warehouse, which roughly coincides with JCAHO's timeline for submission 
of data to their ORYX Core Measure Performance Measurement System. 
Another 4.5 months are required to accomplish the steps in the 
validation process.
    We are considering options to decrease the overall length of time 
between our receipt of data and our ability to provide feedback to 
hospitals, and we are interested in comments on these options. First, 
we are considering whether more frequent data submissions, such as 
monthly submissions, would decrease the time between the provision of 
services and feedback about the quality of those services. We are aware 
that some hospitals and their vendors already submit quality data on a 
monthly basis to JCAHO. However, unless we reduced the sample size per 
reporting period, the process of validating each month the same number 
of records that are currently validated each quarter would increase 
costs significantly. On the other hand, if we reduced the sample size 
per reporting period, the monthly numbers might be too small to provide 
for adequate validation. Second, we could shorten the data submission 
period, which is a significant source of lag time. This option would 
require hospitals to submit information to the data warehouse more 
quickly, which could increase the possibility that hospitals would 
submit less complete data. In addition, this option would require 
coordination with JCAHO to keep submission timelines congruent, which 
reduces hospitals' reporting burden. Third, we could eliminate the 
validation appeals process, which would reduce the lag time by up to 2 
months. Fourth, we could create an expanded role for the third party 
vendors that assist hospitals with submitting quality data to CMS and 
JCAHO. For example, CMS could certify third party vendors to also 
provide standardized validation services and quick performance feedback 
to their hospital customers.
c. Incentive Methodology
    While measurement of the quality of care and of resources use may 
be advantageous in itself, we are considering whether and what kind of 
incentives can further improve outcomes. The potential design of 
incentives in a value-based purchasing system presents many choices. 
The implementation plan for hospital value-based purchasing mandated by 
Pub. L. 109-171 must address the structure of payment adjustments, 
including the determination of thresholds of improvements in quality 
that would substantiate a payment adjustment, the size of such 
payments, and the sources of funding for the value-based payments. We 
are interested in comments on the merits of and alternatives to all of 
the approaches to the design of a value-based purchasing methodology 
that are discussed below.
(1) How Should Incentives Be Structured?
    A number of options exist for the structure of potential 
incentives. The incentive methodology could include differential 
incentives depending on whether hospitals exceed a particular standard 
of performance. To reflect expectations of continued improvement among 
hospitals, the standard could be raised in predictable steps over time. 
Alternatively, incentives could be structured to reward hospitals that

[[Page 24099]]

improve from a baseline level of performance. These approaches could be 
combined to develop an incentive methodology that includes both 
attaining benchmarks and improving care.
(2) What Level of Incentive Is Needed?
    Value-based purchasing incentives should be targeted to that needed 
to achieve a desired level of performance. Our experience with 
implementing section 501(b) of Pub. L. 108-173 (discussed in section 
IV.A. of this preamble) indicates that a targeted incentive, coupled 
with active management by CMS, can encourage reporting on quality 
measures. Nearly every eligible hospital has been willing and able to 
submit the required data in order to receive the full payment update 
under the RHQDAPU program. Similarly, our experience with the Premier 
Hospital Quality Incentive Demonstration indicates that a 1 or 2 
percent bonus, coupled with potential reductions for poor performance, 
may stimulate improvement. Further experience in ascertaining how 
hospitals respond to incentives will be important for examining 
incentives over time.
(3) What Should Be the Source of Incentives?
    The President's FY 2007 Budget indicates support for identifying 
and testing ``budget-neutral incentives that will stimulate Medicare 
providers to improve performance on quality and efficiency measures.'' 
\18\ We do not believe that providing additional aggregate funding to 
finance performance-based incentives is either supportable or 
necessary. One approach might be to examine how we could identify and 
apply measurable savings achieved by reducing care that is unnecessary 
or otherwise inappropriate. For example, we may examine possibilities 
of improving care coordination, whether this could produce measurable 
savings, and whether some of the savings generated in one payment 
system could be used for incentives in another, as long as these 
reforms do not provide inappropriate incentives to stop providing 
necessary care. For instance, appropriate quality of care and effective 
resource use in hospitals and other institutional providers might 
generate savings that could be used for incentives for both physicians 
and facilities.
---------------------------------------------------------------------------

    \18\ Budget of the United States Government, Fiscal year 2007, 
available at: http://www.whitehouse.gov/omb/budget/fy2007/ fy2007/.
---------------------------------------------------------------------------

(4) What Should The Form Of Incentives Be?
    Potential approaches for incentives include making an add-on 
payment to the base payment for individual inpatient hospital services 
or providing periodic, lump-sum payments on a monthly, quarterly, or 
annual basis. Under the RHQDAPU program, hospitals that do not submit 
the required data receive a decrease in the standardized payment amount 
made for all inpatient operating costs for the applicable fiscal year. 
In a hospital value-based purchasing system, per-service payments might 
be made only in connection with the services directly associated with 
the particular measure for which the hospital achieved a good result. 
Alternatively, lump-sum payments might be made on a periodic basis to 
hospitals that achieve particular performance targets. The preferable 
approach may depend on operational concerns, the strength of incentive 
effects, and other aspects of the design. We welcome comments on this 
issue.
(5) What Should the Timing of Incentives Be in Relation to Performance?
    Any value-based purchasing system should seek a balance between 
rewarding desired performance close to when it occurs and ensuring the 
accuracy of both performance measurement and incentives. Given the lag 
times for collecting and reviewing different types of data, some 
measures may be calculated quickly after the period of performance, 
while data lag times for other measures may be longer. For instance, 
structural measures could affect incentives soon after they are 
collected. Other measures that are based on experience over a time 
interval may require some time for measured events to manifest. An 
example of this type of measure would be the rate of mortality within 
30 days of hospitalization.
(6) How Should We Develop Composite Scores?
    Encouraging improved performance could be facilitated by valid and 
reliable methods to aggregate performance data into single composite 
scores. Composite scoring may also improve consumer understanding of 
complex performance indicators by combining measures of many dimensions 
of care into a single score. One example of a composite scoring 
methodology that we used for the Premier Hospital Quality Incentive 
Demonstration (discussed in detail above) is a modification of the 
``opportunity model,'' which can be used to address individual 
weighting, missing data, and sensitivity to case volumes. For example, 
a hospital that has few or no cases for a particular dimension of care 
could receive a low score, yet that measure is equally weighted with 
others in the composite. Under the opportunity model, a composite may 
be developed for a disease category by dividing the total number of 
successful interventions by the total number of opportunities for the 
same targeted interventions. Some of the advantages of the opportunity 
model are that individual measures are weighted by the volume of 
opportunities for the associated intervention for a particular 
hospital; missing values for a particular aspect of care provided by an 
individual hospital would not prevent that hospital from being 
represented in a public report; and composite measures may easily 
accommodate the addition of individual measures.
    The ``appropriate care measure'' (ACM) is another composite scoring 
methodology, which we used in connection with the QIOs. The ACM scoring 
methodology is patient-centric. For a hospital to receive credit for 
treating a patient well, the hospital must have met the standard for 
every measure applicable to that patient's condition. There are also a 
number of proprietary composite measures, such as those used by 
Solucient, Healthgrades, CareScience, and U.S. News & World Report. We 
are interested in comments on the use of composite scoring for hospital 
value-based purchasing and on the various composite scoring 
methodologies.
    Value-based purchasing methods are still under development, and 
anticipating their potential effects on the health care system is 
difficult. We understand that unintended consequences may result from 
the implementation of these methods. We believe that we will need to 
assess incentives and evaluate their effects so that we can revise them 
quickly as we learn more about their impact on hospitals and on 
inpatient hospital services provided to Medicare beneficiaries.
d. Public Reporting
    The plan for hospital value-based purchasing mandated by Pub. L. 
109-171 must address the public disclosure of information on hospital 
performance. CMS currently provides public reporting of quality 
information through the ``Compare'' Web sites for hospitals, nursing 
homes, home health agencies,

[[Page 24100]]

and dialysis facilities.\19\ The Compare Web sites provide comparative 
quality information to consumers and others to help guide choices and 
drive improvements in the quality of care delivered in these settings. 
Besides providing Medicare beneficiaries and their health professionals 
with information to assist them in making informed health care 
decisions, public reporting of comparative performance data also 
provides information that is useful to health care consumers who are 
not Medicare beneficiaries. For example, a consumer who has a Health 
Savings Account can access CMS' Hospital Compare Web site to gather 
comparative quality information to assist in choosing a high quality 
hospital. CMS is contributing to the Administration's Consumer-Directed 
Health Care Initiative by working with our private- and public-sector 
partners to make health care information more transparent and available 
to consumers than ever before. (Refer to section IV.M. of this preamble 
for more information.) We are interested in comments on how we can 
further stimulate public reporting to increase the transparency and 
meaningfulness of healthcare performance information.
---------------------------------------------------------------------------

    \19\ See CMS' Hospital Compare Web site, available at: http://www.hospitalcompare.hhs.gov/; Nursing Home Compare Web site, 
available at: http://www.medicare.gov/NHCompare; Home Health Compare 
Web site, available at: http://www.medicare.gov/HHCompare/Home.asp; 
Dialysis Facility Compare Web site, available at: http://www.medicare.gov/Dialysis.
---------------------------------------------------------------------------

5. Considerations Related to Certain Conditions, Including Hospital-
Acquired Infections
    Medicare's IPPS encourages hospitals to treat patients efficiently. 
Hospitals receive the same DRG payment for stays that vary in length. 
In many cases, complications acquired in the hospital do not generate 
higher payments than the hospital would otherwise receive for other 
cases in the same DRG. To this extent, the IPPS does encourage 
hospitals to manage their patients well and to avoid complications, 
when possible. However, complications, such as infections, acquired in 
the hospital can trigger higher payments in two ways. First, the 
treatment of complications can increase the cost of hospital stays 
enough to generate outlier payments. However, the outlier payment 
methodology requires that hospitals experience large losses on outlier 
cases (in FY 2006, hospitals must lose $23,600 before a case qualifies 
for outlier payments, and the hospital would then only receive 80 
percent of its costs above the outlier threshold). Second, there are 
about 121 sets of DRGs that split based on the presence or absence of a 
complication or comorbidity (CC). The CC DRG in each pair would 
generate a higher Medicare payment. If an infection acquired during the 
beneficiary's hospital stay is one of the conditions on the CC list, 
the result may be a higher payment to the hospital under a CC DRG. (See 
section II.C. of this preamble for a detailed discussion of proposed 
DRG reforms.)
    Section 5001(c) of Pub. L. 109-171 requires the Secretary to 
identify, by October 1, 2007, at least two conditions that are (a) high 
cost or high volume or both, (b) result in the assignment of a case to 
a DRG that has a higher payment when present as a secondary diagnosis, 
and (c) could reasonably have been prevented through the application of 
evidence-based guidelines. For discharges occurring on or after October 
1, 2008, hospitals would not receive additional payment for cases in 
which one of the selected conditions was not present on admission. That 
is, the case would be paid as though the secondary diagnosis was not 
present. Section 5001(c) provides that we can revise the list of 
conditions from time to time, as long as it contains at least two 
conditions. Section 5001(c) also requires hospitals to submit the 
secondary diagnoses that are present at admission when reporting 
payment information for discharges on or after October 1, 2007. We are 
interested in input about which conditions and which evidence-based 
guidelines should be selected.
6. Promoting Effective Use of Health Information Technology
    We recognize the potential for health information technology (HIT) 
to facilitate improvements in the quality and efficiency of health care 
services. One recent RAND study found that broad adoption of electronic 
health records could save more than $81 billion annually and, at the 
same time, improve quality of care.\20\ The largest potential savings 
that the study identified was in the hospital setting because of 
shorter hospital stays promoted by better coordinated care; less 
nursing time spent on administrative tasks; better use of medications 
in hospitals; and better utilization of drugs, laboratory services, and 
radiology services in hospital outpatient settings. The study also 
identified potential quality gains through enhanced patient safety, 
decision support tools for evidence-based medicine, and reminder 
mechanisms for screening and preventive care. Despite such large 
potential benefits, the study found that only about 20 to 25 percent of 
hospitals have adopted HIT systems.
---------------------------------------------------------------------------

    \20\ RAND News Release: Rand Study Says Computerizing Medical 
Records Could Save $81 Billion Annually and Improve the Quality of 
Medical Care, September 14, 2005, available at: http://rand.org/news/press.05/09.14.html.
---------------------------------------------------------------------------

    It is important to note the caveats to the RAND study. The 
projected savings are across the health care sector, and any Federal 
savings would be a reduced percentage. In addition, there are 
significant assumptions made in the RAND study. National savings are 
projected in some cases based on one or two small studies. Also, the 
study assumes patient compliance, in the form of participation in 
disease management programs and following medical advice. For these 
reasons, extreme caution should be used in interpreting these results.
    In summary, there are mixed signals about the potential of HIT to 
reduce costs. Some studies have indicated that HIT adoption does not 
necessarily lead to lower costs and improved quality. In addition, some 
industry experts have stated that factors such as an aging population, 
medical advances, and increasing provider expenses would make any 
projected savings impossible.
    In his 2004 State of the Union Address, President Bush announced a 
plan to ensure that most Americans have electronic health records 
within 10 years.\21\ One part of this plan involves developing 
voluntary standards and promoting the adoption of interoperable HIT 
systems that use these standards. The 2007 Budget states that ``The 
Administration supports the adoption of health information technology 
(IT) as a normal cost of doing business to ensure patients receive high 
quality care.''
---------------------------------------------------------------------------

    \21\ Transforming Health Care: The President's Health 
Information Technology Plan, available at: http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html.
---------------------------------------------------------------------------

    Over the past several years, CMS has undertaken several activities 
to promote the adoption and effective use of HIT in coordination with 
other Federal agencies and with the Office of the National Coordinator 
for Health Information Technology. One of those activities is promotion 
of data standards for clinical information, as well as for claims and 
administrative data. In addition, through our 8th Scope of Work 
contract with the QIOs, we are offering assistance to hospitals on how 
to adopt and redesign care processes to effectively use HIT to improve 
the quality of care for Medicare beneficiaries, including computerized 
physician order entry (CPOE) and bar coding systems. In section IV.A.3. 
of the

[[Page 24101]]

preamble to this proposed rule, we again invite comments on 
streamlining the submission of clinical quality data by using 
standards-based electronic medical records. (We use the term 
``electronic medical records'' in section IV.A.3. of the preamble to 
this proposed rule instead of the term ``electronic health records'' 
that is used in this section in order to maintain consistency with our 
request for comments in the FY 2006 IPPS final rule.) Finally, our 
Premier Hospital Quality Incentive Demonstration provides additional 
financial payments for hospitals that achieve improvements in quality, 
which effective HIT systems can facilitate.
    We are considering the role of interoperable HIT systems in 
increasing the quality of hospital services while avoiding unnecessary 
costs. As noted above, the Administration supports the adoption of HIT 
as a normal cost of doing business. While payments under the IPPS do 
not vary depending on the adoption and use of HIT, hospitals that 
leverage HIT to provide better quality services may more efficiently 
reap the reward of any resulting cost savings. In addition, the 
adoption and use of HIT may contribute to improved processes and 
outcomes of care, including shortened hospital stays and the avoidance 
of adverse drug reactions. We are seeking comments on our statutory 
authority to encourage the adoption and use of HIT. We also are seeking 
comments on the appropriate role of HIT in any value-based purchasing 
program, beyond the intrinsic incentives of the IPPS, to provide 
efficient care, encourage the avoidance of unnecessary costs, and 
increase quality of care. In addition, we are seeking comments on 
promotion of the use of effective HIT through hospital conditions of 
participation, perhaps by adding a requirement that hospitals use HIT 
that is compliant with and certified in its use of the HIT standards 
adopted by the Secretary. We anticipate that the American Health 
Information Community will provide advice to the Secretary on these 
issues.

C. Sole Community Hospitals (SCHs) (Sec.  412.92) and Medicare-
Dependent, Small Rural Hospitals (MDHs) (Sec.  412.108)

1. Background
    Under the IPPS, special payment protections are provided to a sole 
community hospital (SCH). Section 1886(d)(5)(D)(iii) of the Act defines 
an SCH as a hospital that, by reason of factors such as isolated 
location, weather conditions, travel conditions, absence of other like 
hospitals (as determined by the Secretary), or historical designation 
by the Secretary as an essential access community hospital, is the sole 
source of inpatient hospital services reasonably available to Medicare 
beneficiaries. The regulations that set forth the criteria that a 
hospital must meet to be classified as an SCH are located in Sec.  
412.92.
    Under the IPPS, separate special payment protections also are 
provided to a Medicare-dependent, small rural hospital (MDH). Section 
1886(d)(5)(G)(iv) of the Act defines an MDH as a hospital that is 
located in a rural area, has not more than 100 beds, is not an SCH, and 
that has a high percentage of Medicare discharges (not less than 60 
percent in its 1987 cost reporting year or in 2 of its most recent 3 
audited and settled Medicare cost reporting years). The regulations 
that set forth the criteria that a hospital must meet to be classified 
as an MDH are located in Sec.  412.108.
    Although SCHs and MDHs are paid under special payment 
methodologies, they are section 1886(d) hospitals. Like all section 
1886(d) IPPS hospitals, SCHs and MDHs are paid for their discharges 
based on the DRG weights calculated under section 1886(d)(4) of the 
Act.
    Effective with hospital cost reporting periods beginning on or 
after October 1, 2000, section 1886(d)(5)(D)(i) of the Act (as amended 
by section 6003(e) of Pub. L. 101-239) and section 1886(b)(3)(I) of the 
Act (as added by section 405 of Pub. L. 106-113 and further amended by 
section 213 of Pub. L. 106-554), provide that SCHs are paid based on 
whichever of the following rates yields the greatest aggregate payment 
to the hospital for the cost reporting period:
     The Federal rate applicable to the hospital;
     The updated hospital-specific rate based on FY 1982 costs 
per discharge;
     The updated hospital-specific rate based on FY 1987 costs 
per discharge; or
     The updated hospital-specific rate based on FY 1996 costs 
per discharge.
    For purposes of payment to SCHs for which the FY 1996 hospital-
specific rate yields the greatest aggregate payment, payments for 
discharges during FYs 2001, 2002, and 2003 were based on a blend of the 
FY 1996 hospital-specific rate and the greater of the Federal rate or 
the updated FY 1982 or FY 1987 hospital-specific rate. For discharges 
during FY 2004 and subsequent fiscal years, payments based on the FY 
1996 hospital-specific rate are 100 percent of the updated FY 1996 
hospital-specific rate.
    For each cost reporting period, the fiscal intermediary determines 
which of the payment options will yield the highest rate of payment to 
the SCH. Payments are automatically made at the highest rate using the 
best data available at the time the fiscal intermediary makes the 
determination. However, it may not be possible for the fiscal 
intermediary to determine in advance precisely which of the rates will 
yield the highest payment by year's end. In many instances, it is not 
possible to forecast the outlier payments, the amount of the DSH 
adjustment, or the IME adjustment, all of which are applicable only to 
payments based on the Federal rate. The fiscal intermediary makes a 
final adjustment at the close of the cost reporting period after it 
determines precisely which of the payment rates would yield the highest 
payment to the hospital.
    If an SCH disagrees with the fiscal intermediary's determination 
regarding the final amount of program payment to which it is entitled, 
it has the right to appeal the fiscal intermediary's decision in 
accordance with the procedures set forth in Subpart R of Part 405, 
which concern provider payment determinations and appeals.
    Through and including FY 2006, under section 1886(d)(5)(G) of the 
Act, MDHs are paid based on the Federal national rate or, if higher, 
the Federal national rate plus 50 percent of the difference between the 
Federal national rate and the updated hospital-specific rate based on 
FY 1982 or FY 1987 costs per discharge, whichever is higher. However, 
section 5003 of Pub. L. 109-171 (DRA) modified these rules for 
discharges occurring on or after October 1, 2006. Section 5003(c) 
changed the 50-percent adjustment to 75 percent. Section 5003(b) 
requires that an MDH use the 2002 cost reporting year as its base year 
(that is, the FY 2002 hospital-specific rate), if that use results in a 
higher payment. An MDH does not have the option to use its FY 1996 
hospital-specific rate. We discuss our proposed changes to implement 
section 5003 of the DRA in section IV.C.4 of this preamble.
2. Volume Decrease Adjustment for SCHs and MDHs
    (If you choose to comment on the issues in this section, please 
include the caption (``SCH/MDH Volume Decrease Adjustment'' at the 
beginning of your comment.)
    Section 1886(d)(5)(D)(ii) of the Act requires that the Secretary 
make a payment adjustment to an SCH that experiences a decrease of more 
than 5 percent in its total number of inpatient discharges from one 
cost reporting period to the next, if the circumstances

[[Page 24102]]

leading to the decline in discharges were beyond the SCH's control. 
Section 1886(d)(5)(G)(iii) of the Act requires that the Secretary make 
a payment adjustment to an MDH that experiences a decrease of more than 
5 percent in its total number of inpatient discharges from one cost 
reporting period to the next, if the circumstances leading to the 
decline in discharges were beyond the MDH's control. These adjustments 
were designed to compensate an SCH or MDH for the fixed costs it incurs 
in the year following the reduction in discharges (this is, the second 
year), which it may be unable to reduce. Such costs include the 
maintenance of necessary core staff and services.
    However, we believe that not all staff costs can be considered 
fixed costs. Using a standardized formula specified by us, the SCH or 
MDH must demonstrate that it appropriately adjusted the number of staff 
in inpatient areas of the hospital based on the decrease in the number 
of inpatient days. This formula examines nursing staff in particular. 
If an SCH or MDH has an excess number of nursing staff, the cost of 
maintaining those staff members is deducted from the total adjustment. 
One exception to this policy is that no SCH or MDH may reduce its 
number of staff to a level below what is required by State or local 
law. In other words, an SCH or MDH will not be penalized for 
maintaining a level of staff that is consistent with State or local 
requirements.
    The process for determining the amount of the volume decrease 
adjustment can be found in section 2810.1 of the Provider Reimbursement 
Manual. Fiscal intermediaries are responsible for establishing whether 
an SCH or MDH is eligible for a volume decrease adjustment and, if so, 
the amount of the adjustment. To qualify for this adjustment, the SCH 
or MDH must demonstrate that: (a) A 5 percent or more decrease of total 
discharges has occurred; and (b) the circumstance that caused the 
decrease in discharges was beyond the control of the hospital. Once the 
fiscal intermediary has established that the SCH or MDH satisfies these 
two requirements, it will calculate the adjustment. The adjustment 
amount is determined by subtracting the second year's DRG payment from 
the lesser of: (a) The second year's costs minus any adjustment for 
excess staff; or (b) the previous year's costs multiplied by the 
appropriate IPPS update factor minus any adjustment for excess staff. 
The SCH or MDH receives the difference in a lump-sum payment.
    The adjustment for excess staff is currently broken into two parts: 
The routine acute care area (excluding intensive care unit areas) 
excess staff adjustment and the intensive care unit excess staff 
adjustment. (For purposes of this section of the preamble, any 
subsequent references to the routine acute care area of an SCH or MDH 
refer to the routine acute care area excluding any intensive care unit 
areas.) In order to determine whether or not the hospital is 
appropriately staffing its routine acute care and its intensive care 
unit area, the fiscal intermediary compares the hospital's actual 
number of nursing staff in each area with the staffing of like-size 
hospitals in the same census region.
    Currently, fiscal intermediaries obtain average nurse staffing data 
from the American Hospital Association's HAS/Monitrend Data Book. (More 
information on the HAS/Monitrend Data Book follows.) If a hospital 
employs more than the reported average number of nurses in the routine 
acute care or intensive care unit area for hospitals of its size and 
census region, the fiscal intermediary reduces the amount of the 
adjustment by the cost of maintaining the additional staff. The amount 
of the reduction is calculated by multiplying the actual number of 
nursing staff above the reported average by the average nurse salary 
for that hospital as reported on the Medicare cost report. The complete 
process for determining the amount of the adjustment can be found at 
section 2810.1 of the Provider Reimbursement Manual.
    Representatives from several SCH and MDH hospitals have contacted 
CMS with concerns regarding the current use of the HAS/Monitrend data 
for determining the volume decrease adjustment for SCHs and MDHs. 
Because the most recent HAS/Monitrend Data Book was published in 1989 
and is no longer updated, the hospitals expressed concern that the 
information in the publication is too outdated for current use. 
Therefore, in this proposed rule, we are presenting for public comment 
a new methodology for calculating the adjustment for excess staff under 
section IV.C.2.b. of this preamble.
a. HAS/Monitrend Data
    From the mid-1960's to 1989, the Healthcare Administrative Services 
Division of the American Hospital Association (AHA) published 
biannually the HAS/Monitrend Data Book, a collection of aggregate 
hospital statistics. Hospitals completed surveys based on 6 months of 
data; these data were categorized into one of five bed-size groups and 
into one of nine census regions. The bed size groups were 0-49, 50-99, 
100-199, 200-399, and 400 or more beds. The census regions include: (1) 
New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode 
Island, and Vermont); (2) Middle Atlantic (New Jersey, New York, and 
Pennsylvania); (3) South Atlantic (Delaware, District of Columbia, 
Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, 
and West Virginia); (4) East North Central (Illinois, Indiana, 
Michigan, Ohio, and Wisconsin); (5) East South Central (Alabama, 
Kentucky, Mississippi, and Tennessee); (6) West North Central (Iowa, 
Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota); 
(7) West South Central (Arkansas, Louisiana, Oklahoma, and Texas); (8) 
Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, 
and Wyoming); and (9) Pacific (Alaska, California, Hawaii, Oregon, and 
Washington).
    The survey collected data on nearly 400 items pertaining to 
utilization, resource allocation, departmental productivity, 
departmental direct expenses, and staffing. In order for aggregate data 
to be published for a category, at least three hospitals in the same 
census region and bed-size group had to have responded to the survey. 
For the final 1989 publication, 996 acute care hospitals completed the 
survey. CMS has used the HAS/Monitrend Data Book since 1984 to 
determine the volume decrease adjustment for SCHs; the data also have 
been used for the volume decrease adjustment for MDHs since 1990. In 
particular, CMS has used the HAS/Monitrend data on the number of paid 
nursing hours per patient day (``paid hours/patient day'') in both the 
general acute care area (``Medical and Surgical Units'') and the 
intensive care unit (``Med & Surg Intensive Care Unit''). More 
information on the HAS/Monitrend Data Book is available from the 
American Hospital Association, 840 North Lake Shore Drive, Chicago, 
Illinois 60611.
b. HAS/Monitrend Data Book Replacement Alternative
    Below, we are proposing an alternative method for determining an 
SCH's or MDH's target number of core staff using data from the Medicare 
cost report and the occupational mix survey. However, this methodology 
would only establish one combined average number of nursing hours per 
patient day for both the inpatient routine care and the intensive care 
unit areas. We are proposing to use the Medicare cost report and 
occupational mix survey data beginning with requests for adjustments 
for FY 2008 cost reports. We welcome

[[Page 24103]]

comments from the public on this proposal.
(1) Occupational Mix Survey
    As discussed in section III.C. of the preamble to this proposed 
rule, the CMS occupational mix survey collects from each hospital data 
on the mix of employees in the areas of the hospital payable under the 
IPPS for a limited number of hospital occupational categories. These 
categories (nursing, therapy, medical and clinical laboratory, dietary, 
and pharmacy) each include several SOCs, as defined by the BLS, that 
may be used by hospitals with different mixes to provide specific 
aspects of patient care. For example, hospitals may choose to employ 
different combinations of registered nurses, licensed practical nurses, 
and nurses' aides for the purpose of providing nursing care to their 
patients. The varying labor costs associated with these choices reflect 
hospital management decisions rather than geographic differences in the 
costs of labor. The data collected on the survey are used to adjust 
hospitals' wage data to account for each hospital's SOC mix within the 
general occupational categories. Hospitals completed the first 
occupational mix survey using FY 2003 data. A second survey will be 
completed this year (FY 2006).
    Under this proposed method, we would calculate the nursing hours 
per inpatient day for each SCH or MDH by dividing the number of paid 
nursing hours (for registered nurses, licensed practical nurses, and 
nursing aides) reported on the occupational mix survey by the number of 
inpatient days reported on the Medicare cost report. The results would 
be grouped into the same bed-size groups and census regions as the HAS/
Monitrend Data Book. CMS would publish the mean number of nursing hours 
per patient day for each census region and bed-size group in the 
Federal Register. (We are proposing to include licensed practical nurse 
and nursing aide hours as well as registered nurse hours to reflect the 
various levels of nursing staff employed by hospitals to provide direct 
patient care.)
    The results that would be published in the Federal Register would 
be the target number of core nursing hours per patient day. For 
purposes of the volume decrease adjustment, the published data would be 
utilized in the same way as the HAS/Monitrend data: the fiscal 
intermediary would multiply the SCH's or MDH's number of inpatient days 
by the applicable published hours per patient day. This figure would be 
divided by the average number of worked hours per year per nurse (for 
example, 2,080 for a standard 40-hour week). The result would be the 
target number of core nursing staff for the particular SCH or MDH. If 
necessary, the cost of any excess staff (number of FTEs that exceed the 
published number) would be removed from the second year's costs or, if 
applicable, the previous year's costs multiplied by the IPPS update 
factor when determining the volume decrease adjustment. Because we are 
considering registered nurses, licensed practical nurses, and nursing 
aides, the fiscal intermediary would calculate the excess staff 
adjustment by multiplying the number of excess staff by the average 
salary among the three groups, taking into account how many registered 
nurses, licensed practical nurses, and nursing aides work at the 
facility. (For instance, if the hospital's average salary for a 
registered nurse is $50,000 and the hospital's average salary for a 
licensed practical nurse is $30,000 and the hospital employs 5 
registered nurses, 3 licensed practical nurses, and no nursing aides, 
the calculated average salary would be $42,500 for one FTE (((5 x 
$50,000) + (3 x $30,000))/8 = $42,500).
    We are proposing to use the results of the FY 2006 occupational mix 
survey and begin applying the proposed methodology for adjustments 
resulting from a decrease in discharges between FYs 2007 to 2008. 
Because the occupational mix survey is conducted once every 3 years, we 
would update the data set every 3 years. We are proposing to use the FY 
2006 survey results and not to utilize the FY 2003 survey results to 
take into account comments we received in response to the first set of 
results from the occupational mix survey, and to ensure that hospitals 
have had some experience with the occupational mix survey before it is 
used in determining these adjustments. Because we have used the HAS/
Monitrend data for so many years, we believe it is appropriate to 
continue to use these data for one more year and wait for the results 
of the FY 2006 survey. This will give hospitals an opportunity to have 
some experience with the occupational mix survey before it is used in 
these adjustments, and will allow us to compare the data from the FY 
2006 occupational mix survey with the data reported in the 2003 survey, 
if necessary. However, for purposes of describing how we would 
implement this methodology, we have applied the proposed calculation to 
the FY 2003 occupational mix survey data. While we are not proposing to 
use the FY 2003 data, we believe that it is the best data available at 
this time to help explain our proposed methodology.
    To calculate the results below, we merged the FY 2003 occupational 
mix survey results into the FY 2003 cost report file. We eliminated all 
observations for non-IPPS providers, providers who failed to complete 
the occupational mix survey, and providers for which provider numbers, 
bed counts and/or day counts were missing. We also only included 
providers with 12 months' worth of data. This resulted in a pool of 
approximately 3,541 providers.
    For each provider in this pool, we calculated the number of nursing 
hours by adding the number of registered nurse, license practical 
nurse, and nursing aide hours reported on the occupational mix survey. 
We divided the result of this calculation by the total number of 
inpatient days reported on the cost report to determine the number of 
nursing hours per patient day.
    For purposes of calculating the census regional averages for the 
various bed-size groups, we are proposing to only include observations 
that fall within 3 standard deviations of the mean of all observations, 
thus removing potential outliers in the data. Below are the results of 
this calculation.
    We realize that, in the chart, some results may appear to be 
anomalous (for example, 0-49 beds for census regions 4, 6, and 8). We 
believe a small number of outlier data may have skewed the mean, which 
was the basis for identifying data within 3 standard deviations to 
include in the calculations. Therefore, we are soliciting comments on 
whether we should consider another method for determining the 
appropriateness of using available data in calculating the average 
number of nursing hours per patient day. For instance, in this case, 
the results are based on the inclusion of data within 3 standard 
deviations of the mean. Alternatively, we could use another measure of 
central tendency.

[[Page 24104]]



                                                           Paid Nursing Hours per Patient Day
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                 Census region
                    Number of beds                    --------------------------------------------------------------------------------------------------
                                                           1          2          3          4          5          6          7          8          9
--------------------------------------------------------------------------------------------------------------------------------------------------------
0-49.................................................      16.38       8.33      19.26      30.76      11.72      26.70      20.50      31.00      17.39
50-99................................................      13.71      11.07      15.66      17.37      13.69      15.53      12.51      16.63      16.11
100-199..............................................      11.98      10.99      14.38      13.44      11.93      17.03      13.91      14.33      13.32
200-399..............................................      12.40      12.19      14.19      13.00      10.57      16.20      11.35      14.06      15.33
400 or more..........................................      13.32       9.42      12.77      15.39       9.51      19.70      12.36      17.64      13.32
--------------------------------------------------------------------------------------------------------------------------------------------------------

(2) American Hospital Association Annual Hospital Survey
    In the process of evaluating different sources of data to replace 
the HAS/Monitrend Data Book, we considered using the results of the 
AHA's Annual Hospital Survey. This survey includes over 700 data fields 
that cover facilities and services, utilization, finances, and 
staffing. On average, 6,000 hospitals complete the survey each year. 
Section E of the Annual Survey Database includes total facility 
staffing data. FTE counts are available for registered nurses, 
practical and vocational nurses, nursing assistive personnel, and other 
personnel. However, FTEs in outpatient areas, excluded units, and 
nursing home units within the hospital are also included in the 
aggregated FTE counts. It is not possible to separately identify how 
many of the total reported nursing FTEs are attributable to the general 
acute care facility and how many to a distinct part unit or outpatient 
facility. Due to varying staffing needs in distinct part units and 
outpatient areas, we believe that any calculation of average staffing 
for the inpatient acute care area should consist of data solely from 
this area of the hospital. Nevertheless, we are requesting comments on 
this alternative, and possible means for addressing the issue of 
staffing outside the inpatient acute care area.
3. Mandatory Reporting Requirements for Any Changes in the 
Circumstances Under Which a Hospital Was Designated as an SCH or MDH
    (If you choose to comment on the issues in this section, please 
include the caption (``SCH/MDH Changes in Qualification Status'' at the 
beginning of your comment.)
    Under Sec.  412.92(b)(3) and Sec.  412.108(b)(4) respectively, once 
a facility has been designated as an SCH or MDH, the classification 
remains in effect without need for reapproval unless there is a change 
in the hospital's circumstances. Currently, the regulations do not 
contain an explicit requirement that an SCH report to CMS a change in 
circumstances that would affect its status as an SCH. Likewise, the 
current regulations for MDHs do not contain an explicit requirement 
that an MDH report to CMS a change in the circumstances affecting its 
MDH status. However, the fiscal intermediary is required to evaluate on 
an ongoing basis whether a hospital continues to qualify for MDH 
status.
    We have become aware of several hospitals that have maintained SCH 
or MDH status after the original circumstances that led to the 
respective classification changed. We are proposing to amend Sec.  
412.92(b)(3) for SCHs and Sec.  412.108(b)(4) for MDHs to require an 
SCH or MDH to report to its appropriate CMS Regional Office when the 
circumstances under which the hospital was approved for SCH or MDH 
status have changed. At that time, the CMS Regional Office will 
determine whether the SCH or MDH continues to meet the criteria for 
classification under Sec.  412.92 or Sec.  412.108. If an SCH or MDH no 
longer meets these criteria, the CMS Regional Office will issue a 
letter canceling the classification within 30 days of its 
determination. If the circumstances affecting a hospital's SCH or MDH 
classification change and the hospital does not disclose the 
information to the CMS Regional Office, CMS will cancel the hospital's 
SCH or MDH designation effective on the earliest discernable date on 
which the fiscal intermediary can determine that the hospital no longer 
met the criteria for classification.
    For MDHs, this reporting requirement is in addition to the fiscal 
intermediary's ongoing evaluations of whether a hospital continues to 
qualify for MDH status as set out in our existing regulations at Sec.  
412.108(b)(5).
4. Proposed Payment Changes for MDHs Under the DRA of 2005 (Proposed 
Sec.  412.79 and Existing Sec. Sec.  412.90(j) and 412.108)
    (If you choose to comment on this section, please include the 
caption ``Payments to MDHs'' at the beginning of your comment.)
a. Background
    Under Sec.  412.108(a) of our regulations, in order to be 
classified as an MDH, a hospital must: (1) Be located in a rural area 
(as defined in 42 CFR Part 412, Subpart D); (2) have 100 or fewer beds 
(as defined at Sec.  412.105(b)) during the cost reporting period; (3) 
must not be classified as an SCH (as defined in Sec.  412.92); and (4) 
have no less than 60 percent of its inpatient days or discharges 
attributable to inpatients receiving Medicare Part A benefits during 
either its cost reporting period beginning in FY 1987, or in two of the 
last three of its audited cost reports that have been settled.
    MDHs have been eligible for a series of special payment rates under 
the IPPS. Section 6003(f) of Pub. L. 101-239 created the first IPPS 
special payment methodology for MDHs. Effective for cost reporting 
periods beginning on or after April 1, 1990, and ending on or before 
March 31, 1993, an MDH was paid based on whichever of the following 
rates yielded the greatest aggregate payment for the cost reporting 
period:
     The Federal payment rate applicable to the MDH;
     The MDH's updated hospital-specific rate based on its FY 
1982 base period costs per discharge; or
     The MDH's updated hospital-specific rate based on its FY 
1987 base period costs per discharge.
    Section 13501(e)(1) Pub. L. 103-66 extended the MDH payment 
provisions through 1994 and provided that, for discharges occurring 
after March 31, 1993, if an MDH's applicable hospital-specific rate 
exceeded the Federal payment rate, the additional payment was limited 
to 50 percent of the amount by which the applicable updated hospital-
specific rate exceeded the Federal rate. These provisions expired 
effective for cost reporting periods beginning on or after October 1, 
1994.
    Section 4204(a)(3) of Pub. L. 105-33 amended sections 
1886(d)(5)(G)(i) and (d)(5)(G)(ii)(II) of the Act to reinstate these 
special MDH payment provisions, including the 50-percent limitation, 
for cost reporting periods ``beginning on or after October 1, 1997, and 
before October 1, 2001.'' Section 321(b)(1) of Pub. L. 106-113 made a 
technical

[[Page 24105]]

amendment to these provisions of the Act (which describes the time 
periods for which some of the special payment provisions apply and the 
time periods during which a hospital may be considered an MDH under 
section 1886(d)(1)(G)(iv) of the Act) by striking the language 
``beginning on or after October 1, 1997, and before October 1, 2001'' 
and replacing it with ``discharges occurring on or after October 1, 
1997, and before October 1, 2001''. This change was made effective as 
if included in Pub. L. 105-33. Pub. L. 106-113 also provided for a 5-
year extension of the MDH special payment provisions. Section 404(a) of 
that law further amended sections 1886(d)(1)(G)(i) and 
(d)(1)(G)(ii)(II) of the Act by striking the phrase ``and before 
October 1, 2001'' and inserting the phrase ``and before October 1, 
2006''.
    Section 5003(a) of Pub. L. 109-171 (DRA of 2005) amended the MDH 
special payment provisions in the Act. It amended section 1886(d)(5)(G) 
of the Act and made a conforming amendment under section 1886(b)(3)(D) 
of the Act to provide for another 5-year extension of the special MDH 
payment methodology. Under this extension, a revised special MDH 
payment methodology will apply for discharges occurring on or after 
October 1, 2006, and before October 1, 2011.
    As stated earlier, currently, MDHs are paid using whichever rate 
yields the greatest aggregate payment: The Federal payment rate or, if 
higher, the Federal payment rate plus 50 percent of the difference 
between the Federal payment rate and the updated hospital-specific rate 
based on FY 1982 or FY 1987 base period costs per discharge.
    Section 5003(b) of Pub. L. 109-171 provides that, for discharges 
occurring on or after October 1, 2006, and before October 1, 2011, an 
MDH's updated hospital-specific rate will be the FY 2002 base period 
costs per discharges if the FY 2002 based hospital-specific rate 
results in a payment increase. In cases where no payment increase 
results from using FY 2002 hospital-specific rate, an MDH will continue 
to be paid based on the higher of its updated FY 1982 or FY 1987 
hospital-specific rates, if using one of those rates results in a 
payment higher than that under the Federal payment rate. (Unlike an 
SCH, an MDH does not have the option of using its updated FY 1996 
hospital-specific rate.)
    Under section 5003(c) of Pub. L. 109-171, for discharges occurring 
on or after October 1, 2006, and before October 1, 2011, if an MDH's 
applicable hospital-specific rate exceeded the Federal payment rate, 
the additional payment is limited to 75 percent (as opposed to the 
previous 50 percent) of the amount by which the applicable updated 
hospital-specific rate exceeded the Federal rate.
    Section 5003(d) of Pub. L. 109-171 enhances the DSH adjustment for 
MDHs for discharges occurring on or after October 1, 2006. We discuss 
our proposals to implement this provision in section IV.F.4. of this 
preamble.
b. Proposed Regulation Changes
    We are proposing to amend our regulations to implement section 
5003(a) through (c) of Pub. L. 109-171. We are proposing to add a new 
Sec.  412.79 that describes how we would compute and update the MDH 
hospital-specific rate based on its FY 2002 base period. In addition, 
we are proposing to revise Sec.  412.90(j) to reflect the extension of 
the MDH special payment provisions to discharges occurring before 
October 1, 2011. We also are proposing to amend Sec.  412.108 by 
revising paragraph (a) and adding a new paragraph (c)(2)(iii) to 
reflect the changes to the special payment methodology effective for 
discharges occurring on or after October 1, 2006, and before October 1, 
2011.
    As a part of our proposed amendments to Sec.  412.90(j) and Sec.  
412.108(a), we are making two technical corrections. Section 412.90(j) 
describes when an MDH may receive a special payment adjustments, while 
Sec.  412.108(a) discusses the definition of an MDH. Each of these 
sections now refers to ``cost reporting periods beginning on or after 
April 1, 1990 and before October 1, 1994, or beginning on or after 
October 1, 1997 and before October 1, 2006''. However, as noted above, 
sections 1886(d)(5)(G)(i) and (d)(5)(G)(ii)(II) of the Act, the 
provisions of the Act from which these time periods were drawn, were 
amended by Pub. L. 106-113. Sections 321(b)(1) and 404(a) of Pub. L. 
106-113 amended sections 1886(d)(5)(G)(i) and (d)(5)(ii)(II) of the Act 
so that the phrase in each section ``beginning on or after October 1, 
1997, and before October 1, 2001'' was replaced with the phrase 
``discharges occurring on or after October 1, 1997, and before October 
1, 2006''. (Section 5003(a)(1) of Pub. L. 109-171 changed the ending 
date in these provisions from ``before October 1, 2006'' to ``before 
October 1, 2011''.)
    Therefore, we are removing the incorrect phrase ``beginning on or 
after October 1, 1997'' from each of these regulations and inserting 
the phrase, ``discharges occurring on or after October 1, 1997'', to 
conform the regulations to the statute.
5. Proposed Technical Change
    In paragraph (b)(2)(iv) of Sec.  412.92, we are proposing to 
correct the spelling of the word ``adjustment'' by changing it to 
``adjustment''.

D. Rural Referral Centers (Sec.  412.96)

    (If you choose to comment on issues in this section, please include 
the caption ``Rural Referral Centers'' at the beginning of your 
comment.)
    Under the authority of section 1886(d)(5)(C)(i) of the Act, the 
regulations at Sec.  412.96 set forth the criteria that a hospital must 
meet in order to qualify under the IPPS as a rural referral center. For 
discharges occurring before October 1, 1994, rural referral centers 
received the benefit of payment based on the other urban standardized 
amount rather than the rural standardized amount. Although the other 
urban and rural standardized amounts are the same for discharges 
occurring on or after October 1, 1994, rural referral centers continue 
to receive special treatment under both the DSH payment adjustment and 
the criteria for geographic reclassification.
    Section 402 of Pub. L. 108-173 raised the DSH adjustment for other 
rural hospitals with less than 500 beds and rural referral centers. 
Other rural hospitals with less than 500 beds are subject to a 12 
percent cap on DSH payments. Rural referral centers are not subject to 
the 12 percent cap on DSH payments that is applicable to other rural 
hospitals (with the exception of rural hospitals with 500 or more 
beds). Rural referral centers are not subject to the proximity criteria 
when applying for geographic reclassification, and they do not have to 
meet the requirement that a hospital's average hourly wage must exceed 
106 percent of the average hourly wage of the labor market area where 
the hospital is located.
    Section 4202(b) of Pub. L. 105-33 states, in part, ``[a]ny hospital 
classified as a rural referral center by the Secretary * * * for fiscal 
year 1991 shall be classified as such a rural referral center for 
fiscal year 1998 and each subsequent year.'' In the August 29, 1997 
final rule with comment period (62 FR 45999), we also reinstated rural 
referral center status for all hospitals that lost the status due to 
triennial review or MGCRB reclassification, but not to hospitals that 
lost rural referral center status because they were now urban for all 
purposes because of the OMB designation of their geographic area as 
urban. However, subsequently, in the August 1, 2000 final rule (65 FR 
47089), we indicated that we were revisiting that decision. 
Specifically, we stated that we would

[[Page 24106]]

permit hospitals that previously qualified as a rural referral center 
and lost their status due to OMB redesignation of the county in which 
they are located from rural to urban to be reinstated as a rural 
referral center. Otherwise, a hospital seeking rural referral center 
status must satisfy the applicable criteria. We used the definitions of 
``urban'' and ``rural'' specified in Subpart D of 42 CFR Part 412.
    One of the criteria under which a hospital may qualify as a rural 
referral center is to have 275 or more beds available for use (Sec.  
412.96(b)(1)(ii)). A rural hospital that does not meet the bed size 
requirement can qualify as a rural referral center if the hospital 
meets two mandatory prerequisites (a minimum CMI and a minimum number 
of discharges) and at least one of three optional criteria (relating to 
specialty composition of medical staff, source of inpatients, or 
referral volume) (Sec.  412.96(c)(1) through (c)(5)). (See also the 
September 30, 1988 Federal Register (53 FR 38513).) With respect to the 
two mandatory prerequisites, a hospital may be classified as a rural 
referral center if--
     The hospital's CMI is at least equal to the lower of the 
median CMI for urban hospitals in its census region, excluding 
hospitals with approved teaching programs, or the median CMI for all 
urban hospitals nationally; and
     The hospital's number of discharges is at least 5,000 per 
year, or, if fewer, the median number of discharges for urban hospitals 
in the census region in which the hospital is located. (The number of 
discharges criterion for an osteopathic hospital is at least 3,000 
discharges per year, as specified in section 1886(d)(5)(C)(i) of the 
Act.)
1. Case-Mix Index
    Section 412.96(c)(1) provides that CMS will establish updated 
national and regional CMI values in each year's annual notice of 
prospective payment rates for purposes of determining rural referral 
center status. The methodology we use to determine the national and 
regional CMI values is set forth in regulations at Sec.  
412.96(c)(1)(ii). The proposed national median CMI value for FY 2007 
includes all urban hospitals nationwide, and the proposed regional 
values for FY 2007 are the median values of urban hospitals within each 
census region, excluding those hospitals with approved teaching 
programs (that is, those hospitals receiving indirect medical education 
payments as provided in Sec.  412.105). These proposed values are based 
on discharges occurring during FY 2005 (October 1, 2004 through 
September 30, 2005) and include bills posted to CMS' records through 
December 2005.
    We are proposing that, in addition to meeting other criteria, if 
they are to qualify for initial rural referral center status for cost 
reporting periods beginning on or after October 1, 2006, rural 
hospitals with fewer than 275 beds must have a CMI value for FY 2005 
that is at least--
     1.3365; or
     The median CMI value (not transfer-adjusted) for urban 
hospitals (excluding hospitals with approved teaching programs as 
identified in Sec.  412.105) calculated by CMS for the census region in 
which the hospital is located.
    The proposed median CMI values by region are set forth in the 
following table:

------------------------------------------------------------------------
                                                         Case-mix index
                        Region                               value
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT)..............             1.2678
2. Middle Atlantic (PA, NJ, NY)......................             1.2701
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA,                1.1781
 WV).................................................
4. East North Central (IL, IN, MI, OH, WI)...........             1.3156
5. East South Central (AL, KY, MS, TN)...............             1.2009
6. West North Central (IA, KS, MN, MO, NE, ND, SD)...             1.2856
7. West South Central (AR, LA, OK, TX)...............             1.2445
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY).........             1.3024
9. Pacific (AK, CA, HI, OR, WA)......................             1.3620
------------------------------------------------------------------------

    The preceding numbers will be revised in the final rule to the 
extent required to reflect the updated FY 2005 MedPAR file, which will 
contain data from additional bills received through March 2006.
    Hospitals seeking to qualify as rural referral centers or those 
wishing to know how their CMI value compares to the criteria should 
obtain hospital-specific CMI values (not transfer-adjusted) from their 
fiscal intermediaries. Data are available on the Provider Statistical 
and Reimbursement (PS&R) System. In keeping with our policy on 
discharges, these CMI values are computed based on all Medicare patient 
discharges subject to DRG-based payment.
2. Discharges
    Section 412.96(c)(2)(i) provides that CMS will set forth the 
national and regional numbers of discharges in each year's annual 
notice of prospective payment rates for purposes of determining rural 
referral center status. As specified in section 1886(d)(5)(C)(ii) of 
the Act, the national standard is set at 5,000 discharges. We are 
proposing to update the regional standards based on discharges for 
urban hospitals' cost reporting periods that began during FY 2003 (that 
is, October 1, 2002 through September 30, 2003), which is the latest 
available cost report data we had at that time.
    Therefore, we are proposing that, in addition to meeting other 
criteria, a hospital, if it is to qualify for initial rural referral 
center status for cost reporting periods beginning on or after October 
1, 2006, must have as the number of discharges for its cost reporting 
period that began during FY 2003 a figure that is at least--
     5,000 (3,000 for an osteopathic hospital); or
     The median number of discharges for urban hospitals in the 
census region in which the hospital is located, as indicated in the 
following table:

------------------------------------------------------------------------
                                                           Number of
                        Region                             discharges
------------------------------------------------------------------------
1. New England (CT, ME, MA, NH, RI, VT)..............              7,360
2. Middle Atlantic (PA, NJ, NY)......................             10,170

[[Page 24107]]

 
3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA,                10,117
 WV).................................................
4. East North Central (IL, IN, MI, OH, WI)...........              8,983
5. East South Central (AL, KY, MS, TN)...............              7,427
6. West North Central (IA, KS, MN, MO, NE, ND, SD)...              7,346
7. West South Central (AR, LA, OK, TX)...............              7,060
8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY).........              9,832
9. Pacific (AK, CA, HI, OR, WA)......................              7,680
------------------------------------------------------------------------

    These numbers will be revised in the final rule based on the latest 
available cost report data.
    We note that the median number of discharges for hospitals in each 
census region is greater than the national standard of 5,000 
discharges. Therefore, 5,000 discharges is the minimum criterion for 
all hospitals.
    We reiterate that if an osteopathic hospital is to qualify for 
rural referral center status for cost reporting periods beginning on or 
after October 1, 2006, the hospital would be required to have at least 
3,000 discharges for its cost reporting period that began during FY 
2003.

E. Indirect Medical Education (IME) Adjustment (Sec.  412.105)

    (If you choose to comment on issues in this section, please include 
the caption ``IME Adjustment'' at the beginning of your comment.)
1. Background
    Section 1886(d)(5)(B) of the Act provides that prospective payment 
hospitals that have residents in an approved graduate medical education 
(GME) program receive an additional payment to reflect the higher 
indirect patient care costs of teaching hospitals relative to 
nonteaching hospitals. The regulations regarding the calculation of 
this additional payment, known as the indirect medical education (IME) 
adjustment, are located at Sec.  412.105.
    The Balanced Budget Act of 1997 (Pub. L. 105-33) established a 
limit on the number of allopathic and osteopathic residents that a 
hospital may include in its full-time equivalent (FTE) resident count 
for direct GME and IME payment purposes. Under section 1886(h)(4)(F) of 
the Act, a hospital's unweighted FTE count of residents may not exceed 
the hospital's unweighted FTE count for its most recent cost reporting 
period ending on or before December 31, 1996. Under section 
1886(d)(5)(B)(v) of the Act, the limit on the FTE resident count for 
IME purposes is effective for discharges occurring on or after October 
1, 1997. A similar limit is effective for direct GME purposes for cost 
reporting periods beginning on or after October 1, 1997.
2. IME Adjustment Factor for FY 2007
    The IME adjustment to the DRG payment is based in part on the 
applicable IME adjustment factor. The IME adjustment factor is 
calculated using a hospital's ratio of residents to beds, which is 
represented as r, and a formula multiplier, which is represented as c, 
in the following equation: c x [{1 + r{time}  \.405\ -1]. The formula 
is traditionally described in terms of a certain percentage increase in 
payment for every 10-percent increase in the resident-to-bed ratio.
    Section 502(a) of Public Law 108-173 modified the formula 
multiplier (c) to be used in the calculation of the IME adjustment. 
Prior to the enactment of Public Law 108-173, the formula multiplier 
was fixed at 1.35 for discharges occurring during FY 2003 and 
thereafter. Section 502(a) modified the formula multiplier beginning 
midway through FY 2004 and provided for a new schedule of formula 
multipliers for FY 2005 and thereafter. In the FY 2005 IPPS rule, we 
announced the schedule of formula multiplier to be used in the 
calculation of the IME adjustment and incorporated the schedule in our 
regulations at Sec.  412.105(d)(3)(viii) through (d)(3)(xii).
    In this proposed rule, we are specifying that for any discharges 
occurring during FY 2007, the formula multiplier is 1.32. We estimate 
that application of the mandated formula multiplier for FY 2007 will 
result in an increase of 5.38 percent in IME payment for every 
approximately 10-percent increase in the resident-to-bed ratio from FY 
2006 to FY 2007.
3. Technical Change To Revise Cross-Reference
    We are proposing to revise the cross-references included in 
paragraph (f)(1)(ii)(C) of Sec.  412.105 that specify the criteria for 
counting FTE residents who spend time in nonprovider settings for IME 
payment adjustment purposes. Currently, this paragraph only cites the 
criteria set forth in Sec. Sec.  413.78(c) or 413.78(d). We should have 
also cited the provisions of Sec.  413.78(e), which state that the time 
residents spend in nonprovider settings such as freestanding clinics, 
nursing homes, and physicians' offices in connection with approved 
programs may be included in determining the number of FTE residents in 
the calculation of a hospital's resident count if other applicable 
conditions specified in paragraph (e) are met.
    We note that in sections IV.H.2., 3., 4., and 5. of the preamble of 
this proposed rule, we discuss other proposed policy changes and 
clarifications to the methodology for counting FTE residents for the 
purposes of direct GME payments, which would be applicable to IME 
payments also.

F. Payment Adjustment for Disproportionate Share Hospitals (DSHs) 
(Sec.  412.106)

    (If you choose to comment on issues in this section, please include 
the caption ``DSH Adjustment'' at the beginning of your comment.)
1. Background
    Section 1886(d)(5)(F) of the Act provides for additional payments 
to subsection (d) hospitals that serve a disproportionate share of low-
income patients. The Act specifies two methods for a hospital to 
qualify for the Medicare disproportionate share hospital (DSH) 
adjustment. Under the first method, hospitals that are located in an 
urban area and have 100 or more beds may receive a DSH payment 
adjustment if the hospital can demonstrate that, during its cost 
reporting period, more than 30 percent of its net inpatient care 
revenues are derived from State and local government payments for care 
furnished to indigent patients. These hospitals are commonly known as 
``Pickle hospitals.'' The second method, which is also the most 
commonly used method for a hospital to qualify, is based on a complex 
statutory formula under which payment adjustments are based on the 
level of the hospital's DSH patient percentage, which is the sum of two 
fractions: The ``Medicare fraction'' and the ``Medicaid fraction.'' The 
Medicare fraction is computed by

[[Page 24108]]

dividing the number of patient days that are furnished to patients who 
were entitled to both Medicare Part A and Supplemental Security Income 
(SSI) benefits by the total number of patient days furnished to 
patients entitled to benefits under Medicare Part A. The Medicaid 
fraction is computed by dividing the number of patient days furnished 
to patients who, for those days, were eligible for Medicaid but were 
not entitled to benefits under Medicare Part A by the number of total 
hospital patient days in the same period.
[GRAPHIC] [TIFF OMITTED] TP25AP06.022

2. Technical Corrections
    We are proposing to make a technical correction to Sec.  
412.106(a)(1)(iii) to reflect the statutory requirement at section 
1886(d)(8)(E) of the Act that hospitals reclassified under Sec.  
412.103 are considered rural for purposes of this DSH regulation. We 
are also proposing to correct the regulation to eliminate the reference 
to Sec.  412.62(f). These corrections reflect current policy and 
already-existing statutory requirements.
3. Proposed Reinstatement of Inadvertently Deleted Provisions on DSH 
Payment Adjustment Factors
    In an interim final rule published in the Federal Register on June 
13, 2001 (66 FR 32174 and 32194) (which was finalized in the Federal 
Register on August 1, 2001 (66 FR 39827)), we incorporated into our 
regulations at Sec.  412.106(d)(2) the provisions of section 211(b) of 
Public Law 106-554. Section 211(b) amended section 1886(d)(5)(F) of the 
Act to revise the calculation of the disproportionate share percentage 
adjustment for hospitals affected by the revised DSH qualifying 
threshold percentages specified in section 211(a) of Public Law 106-
554. When the section 211 changes were incorporated into the Code of 
Federal Regulations at Sec.  412.106(d)(2), the regulation text at 
Sec.  412.106(d)(2)(v) was inadvertently deleted during the 
transcribing of the new text into the existing regulations. Section 
412.106(d)(2)(v) specifies the payment adjustment factors for hospitals 
that meet the following criteria under Sec.  412.106(c)(2) for 
discharges occurring on or after April 1, 1990, and before October 1, 
1991, and on or after October 1, 1991: Hospitals located in an urban 
area, that have 100 or more beds, and that can demonstrate that, during 
their cost reporting period, more than 30 percent of their net 
inpatient care revenues are derived from State and local government 
payments for care furnished to indigent patients.
    We are proposing to reinstate the inadvertently deleted text of 
Sec.  412.106(d)(2)(v). We note that this is a correction to the 
regulations; we are not proposing to change the payment adjustment 
factors for hospitals that meet the criteria under Sec.  412.106(c)(2).
4. Enhanced DSH Adjustment for MDHs
    The DSH adjustment factor for most categories of hospitals is 
capped at 12 percent. Urban hospitals with more than 100 beds, rural 
hospitals with more than 500 beds, and rural referral centers, are 
exempt from this cap.
    Section 5003(d) of Public Law 109-171 (DRA of 2005) amended section 
1886(d)(5)(F) of the Act to revise the DSH payment adjustment factor 
for MDHs, effective for discharges occurring on or after October 1, 
2006. Specifically, section 5003(d) amended section 
1886(d)(5)(F)(xiv)(II) of the Act to exclude MDHs from the 12-percent 
DSH adjustment factor cap.
    For all discharges occurring on or after October 1, 2006, the 
fiscal intermediary will not apply the cap when calculating the DSH 
payments. These payments will be subject to revision upon final 
settlement of the cost reporting period. We note that this change will 
not affect the calculation of the disproportionate patient percentage.
    We are proposing to amend the regulations at Sec.  412.106 to 
include this provision under proposed new paragraph (d)(2)(iv)(D).

G. Geographic Reclassifications (Sec. Sec.  412.103, 412.230, and 
412.234)

    (If you choose to comment on issues in this section, please include 
the caption ``Geographic Reclassifications'' at the beginning of your 
comment.)
1. Background
    With the creation of the MGCRB, beginning in FY 1991, under section 
1886(d)(10) of the Act, hospitals could request reclassification from 
one geographic location to another for the purpose of using the other 
area's standardized amount for inpatient operating costs or the wage 
index value, or both (September 6, 1990 interim final rule with comment 
period (55 FR 36754), June 4, 1991 final rule with comment period (56 
FR 25458), and June 4, 1992 proposed rule (57 FR 23631)). As a result 
of legislative changes under section 402(b) of Public Law 108-7, 
section 402 of Public Law 108-89, and section 401 of Public Law 108-
173, the standardized amount reclassification criterion for large urban 
and other areas is no longer necessary or appropriate and has been 
removed from our reclassification policy. We implemented this policy in 
the FY 2005 IPPS final rule (69 FR 49103). As a result, hospitals can 
request reclassification for the purposes of the wage index only and 
not the standardized amount. Implementing regulations in Subpart L of 
42 CFR part 412 (Sec. Sec.  412.230 et seq.) set forth criteria and 
conditions for reclassifications for purposes of the wage index from 
rural to urban, rural to rural, or from an urban area to another urban 
area, with special rules for SCHs and rural referral centers.
    Under section 1886(d)(8)(E) of the Act, an urban hospital may file 
an application to be treated as being located in a rural area if 
certain conditions are met. The regulations implementing this provision 
are located under Sec.  412.103.
    Effective with reclassifications for FY 2003, section 
1886(d)(10)(D)(vi)(II) of the Act provides that the MGCRB must use the 
average of the 3 years of hourly wage data from the most recently 
published data for the hospital when evaluating a hospital's request 
for reclassification. The regulations at Sec.  412.230(d)(2)(ii) 
stipulate that the wage data are taken from the CMS hospital wage 
survey used to construct the wage index in effect for prospective 
payment purposes. To evaluate applications for wage index 
reclassifications for FY 2007, the MGCRB used the 3-year average hourly 
wages published in Table 2 of the August 12, 2005 IPPS final rule (70 
FR 47508). These average hourly wages are taken from data used to 
calculate the wage indexes for FY 2004, FY 2005, and FY 2006, based on 
cost reporting periods beginning during FY 2000, FY 2001, and FY 2002, 
respectively.
2. Reclassifications Under Section 508 of Public Law 108-173
    As we discuss in section III.H.5. of the preamble of this proposed 
rule, under section 508 of Public Law 108-173, a

[[Page 24109]]

qualifying hospital could appeal the wage index classification 
otherwise applicable to the hospital and apply for reclassification to 
another area of the State in which the hospital is located (or, at the 
discretion of the Secretary, to an area within a contiguous State). 
Such reclassifications are applicable to discharges occurring during 
the 3-year period beginning April 1, 2004, and ending March 31, 2007. 
Under section 508(b), reclassifications under this process do not 
affect the wage index computation for any area or for any other 
hospital and cannot be achieved in a budget neutral manner.
    Some hospitals currently receiving a section 508 reclassification 
are eligible to reclassify to that same area under the standard 
reclassification process as a result of the new labor market 
definitions that we adopted for FY 2005. In applying for a 3-year MGCRB 
reclassification beginning in FY 2007, hospitals that are already 
reclassified to the same area under section 508 should have indicated 
in their MGCRB reclassification requests that if they receive the MGCRB 
reclassification, they would forfeit the section 508 reclassification 
for the first 6 months of FY 2007.
    We refer readers to section III.H.5. of the preamble of this 
proposed rule for a discussion of our updated procedural rules 
established under section 1886(d)(10)(D)(v) of the Act in which a 
section 508 hospital may retain its section 508 reclassification 
through its expiration on March 31, 2007, and accept a reclassification 
approved by the MGCRB for the second half of FY 2007 (April 1, 2007, 
through September 30, 2007). We also clarify the procedural rules for 
an already individually reclassified hospital that is part of a group 
that includes a section 508 hospital.
3. Multicampus Hospitals (Sec.  412.230(d)(2)(iii))
    Subsequent to the publication of the FY 2005 IPPS final rule, we 
became aware of a situation in which, as a result of the new labor 
market areas implemented in FY 2005 for the IPPS, a multicampus 
hospital previously located in a single MSA is now located in more than 
one CBSA. Under our existing policy, a multicampus hospital with 
campuses located in the same labor market area receives a single wage 
index. However, if the campuses are located in more than one labor 
market area, payment for each discharge is determined using the wage 
index value for the MSA (or Metropolitan Divisions, where applicable) 
in which the campus of the hospital is located. Prior to FY 2006, the 
criteria for a hospital being reclassified to another wage area by the 
MGCRB did not address the circumstances under which a single campus of 
a multicampus hospital may seek reclassification. The regulations 
require that a hospital provide data from the CMS hospital wage survey 
for the average hourly wage comparison that is used to support a 
request for reclassification. Because a multicampus hospital is 
required to report data for the entire hospital on a single cost 
report, there is no wage survey data for the individual hospital campus 
that can be used in a reclassification application.
    In the FY 2006 IPPS final rule (70 FR 47444 through 47446 and 
47487), we modified the reclassification rules at Sec.  
412.230(d)(2)(iii) to allow campuses of multicampus hospitals located 
in separate wage index areas to support a reclassification application 
to an area where another campus is located using the average hourly 
(composite) wage data submitted on the cost report for the entire 
multicampus hospital as its hospital-specific data. This special rule 
applies for reclassification applications for FY 2006, FY 2007, and FY 
2008 and will not be in effect for FY 2009 reclassification requests. 
Because reclassification applications to the MGCRB for FY 2009 must be 
filed in September 2007, or 1 month before the effective date of the FY 
2008 IPPS rule, we are addressing whether to propose to extend the 
special rule for multicampus hospitals beyond FY 2008 in this FY 2007 
proposed rule. In the FY 2006 IPPS final rule, we indicated that we 
would continue to explore options that would allow individual campuses 
of multicampus hospitals to submit wage data necessary for geographic 
reclassification and also monitor the number of multicampus hospitals 
affected by this provision (70 FR 47445 and 47446).
    After reviewing this situation further, we believe that if a campus 
of a multicampus hospital applies for reclassification, it should be 
required to support its application with campus specific data. Because 
a cost report is filed for an entire hospital, the campus would have to 
obtain a separate provider number and be treated for Medicare payment 
purposes as an independent entity in order to be able to provide wage 
data for the specific campus. If a hospital were to make a change in FY 
2007 to its organizational structure to provide campus specific data to 
support a reclassification application, the earliest fiscal year that 
the campus would be eligible to reclassify would be FY 2012 because the 
cost report data that are used for geographic reclassification precede 
the payment year by 5 years (that is, FY 2003 cost report data will be 
used to determine the FY 2008 geographic reclassifications).
    To our knowledge, only one hospital has used the special rule for 
multicampus hospitals. This hospital has since joined a successful FY 
2007 urban county group reclassification application to the same area 
to which it was approved under the multicampus hospital rule. Thus, 
this hospital is no longer required to meet the multicampus hospital 
rule. Given that there is only one hospital that has used this rule and 
this hospital was able to reclassify under the normal reclassification 
rules, we believe the special reclassification rule that applies to 
multicampus hospitals is no longer needed. Therefore, we are proposing 
not to extend the special rule beyond FY 2008. For reclassification 
requests for FY 2009 and thereafter, a campus of a multicampus hospital 
would be required to obtain a separate provider number in order to 
provide the required wage data from the CMS hospital wage survey for 
the average hourly wage comparison in its MGCRB reclassification 
application.
4. Urban Group Hospital Reclassifications (Sec.  412.234(a)(3)(iii))
    Section 412.234(a)(3)(iii) of the regulations sets forth criteria 
for urban hospitals to be reclassified as a group for FY 2007 and 
thereafter. Under these criteria, ``hospitals located in counties that 
are in the same Combined Statistical Area (CSA) (under the MSA 
definitions announced by the OMB on June 6, 2003) as the urban area to 
which they seek redesignation qualify as meeting the proximity 
requirement for reclassification to the urban area to which they seek 
redesignation.''
    Last year, several commenters brought to our attention that, while 
the CSA standard allows for urban county group reclassifications in 
large urban areas throughout the United States (including 10 of the 11 
CBSAs containing Metropolitan Divisions), the CSA standard precludes 
urban county group reclassifications between three Metropolitan 
Divisions within one CBSA in Florida. They urged us to modify our 
policy to also allow hospitals located in counties that are in the same 
CBSA (in the case of Metropolitan Divisions) as the area to which they 
seek redesignation to be considered to have met the proximity 
requirement. We agree with the commenter's proposed modification. The 
proximity standard for group reclassifications is intended to allow all

[[Page 24110]]

of a county's hospitals to reclassify to an adjacent area where there 
is sufficient economic integration that there can be an expectation 
that both areas are competing in a similar labor market area. We 
believe there is sufficient economic integration between Metropolitan 
Divisions within a CBSA that urban county reclassifications within a 
CBSA or a CSA should be permitted. A CBSA, as defined by the OMB, is 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.''
    Therefore, we are proposing to revise Sec.  412.234(a)(3) by adding 
a new paragraph (iv) to expand the proximity criteria to allow urban 
county groups to apply for reclassification to another area within the 
same CBSA. We are proposing to require that, beginning with FY 2008, 
hospitals must be located in counties that are in the same CSA or CBSA 
(under the MSA definitions announced by OMB on June 6, 2003) as the 
urban area to which they seek redesignation to qualify as meeting the 
proximity requirement for reclassification to the urban area to which 
they seek redesignation.
5. Effect of Change of Ownership on Urban County Group 
Reclassifications (Sec. Sec.  412.230, 412.234, and 489.18)
    We have received questions asking for clarification of our policy 
regarding whether newly constructed hospitals and hospitals that do not 
accept assignment of the previous owner's provider agreement can join 
an urban county group reclassification.
    The Medicare regulations at Sec.  412.230 require that, for 
individual hospital reclassifications, a hospital must provide a 
weighted 3-year average of its average hourly wages using data from the 
CMS hospital wage survey used to construct the wage index in effect for 
prospective payment purposes. Section 489.18(c) of the regulations 
provides that, when there is a change of ownership, the existing 
provider agreement will automatically be assigned to the new owner when 
there is a change of ownership as defined in the rules. Section 
412.230(d)(2)(iv) of the regulations specifies that, in situations 
where a hospital becomes a new provider and the existing hospital's 
provider agreement is not assigned under Sec.  489.18, the wage data 
associated with the previous hospital's provider number will not be 
used in calculating the new hospital's 3-year average hourly wage. This 
policy is consistent with how we treat hospitals whose ownership has 
changed for other Medicare payment purposes. The regulations also state 
that once a new hospital has accumulated at least 1 year of wage data 
using survey data from the CMS hospital wage survey used to determine 
the wage index, it is eligible to apply for reclassification on the 
basis of those data.
    While the regulations preclude a new provider from individually 
reclassifying until the hospital accumulates at least 1 year of wage 
data from the CMS hospital wage survey used to determine the wage 
index, a new provider may join a group reclassification under Sec.  
412.234. Under Sec.  412.234, all hospitals in an urban county must 
apply for redesignation as a group. If we did not permit a new hospital 
to join group reclassifications, all hospitals in the county would not 
be part of the reclassification application and the urban county group 
would be precluded from reclassifying for 3 years until the new 
hospital accumulated at least 1 year of wage data. We believe it would 
be inequitable to preclude a group reclassification merely because 
there was one newly constructed hospital or one hospital in the county 
changed ownership and did not accept the prior owner's provider 
agreement. Alternatively, we believe that allowing group applications 
without a new hospital would be inconsistent with our regulations and 
unfair to new hospitals because it would put them at a competitive 
disadvantage with other hospitals in the county. Because such 
reclassifications are effective for 3 years, a new hospital that was 
not allowed to join a group reclassification would have to accept a 
lower wage index than all other hospitals in the county with which it 
competes for labor for up to 3 years.
6. Requested Reclassification for Hospitals Located in a Single 
Hospital MSA Surrounded by Rural Counties
    In the FY 2006 IPPS final rule (70 FR 47448), we presented a 
commenter's concern about the special circumstances of a hospital 
located in a single hospital MSA surrounded by rural counties in 
relation to the wage index and the rules governing geographic 
reclassification. The commenter stated that an isolated hospital in a 
single hospital MSA is at a competitive disadvantage because the rural 
hospitals that surround the hospital have been reclassified to higher 
wage index areas or have been designated as rural referral centers, 
SCHs, MDHs, or CAHs. The urban hospital is ineligible for 
reclassification to a higher wage index area either as an individual 
hospital or as part of a group under the existing regulations. The 
commenter emphasized that this concern is especially significant given 
the fact that an isolated hospital in a single hospital MSA is the only 
hospital in its urban area, and, therefore, has an even greater 
obligation to the communities it serves.
    The commenter advocated a change to the urban county group 
reclassification regulations whereby a hospital in a single hospital 
MSA surrounded by rural counties would be able to reclassify to the 
closest urban area that is part of a CSA located in the same State as 
the hospital. We did not adopt this suggested policy under the IPPS for 
FY 2006 because we did not believe it would be prudent to adopt the 
suggested policy in a final rule without first soliciting public 
comment.
    The commenter's suggestion presents a number of issues on which we 
seek comment. First a single hospital in an urban area receives a wage 
index value that directly reflects the wages it pays, undiluted by 
those of any other hospital. Thus, it would appear that in such cases, 
the wage index is operating with substantial precision in adjusting the 
wage-related portion of the payment to accord with the actual wage 
experience of the hospital in question. We have sought comment on the 
circumstances facing single hospitals in urban areas in past 
rulemaking. The justification for reclassifying a hospital that is 
receiving a wage index reflecting its own wages in this way is not 
readily apparent. Second, it is open to question why this hospital's 
situation provides justification for special treatment under the wage 
index. We understand it is one of two 1886(d) hospitals located in an 
urban county entirely surrounded by rural counties and that it is 
within a modest distance of a number of hospitals that have received 
one form or another of special payment status relating to their rural 
locations. We are interested in receiving comment on whether these 
aspects indicate the need for a special wage index reclassification 
provision. Third, the commenter's suggested policy would allow a 
hospital to reclassify to a labor market area that is further away than 
other, closer urban labor market areas. We are concerned that such a 
reclassification would be inconsistent with the proximity standard we 
have generally used to reflect local labor markets. Each of these 
aspects of the suggested policy might affect a significant number of 
other hospitals and thus be viewed as having widespread precedent that 
we invite comment upon.

[[Page 24111]]

H. Payment for Direct Graduate Medical Education

1. Background
    (If you choose to comment on issues in this section, please include 
the caption ``GME Payments'' at the beginning of your comment.)
    Section 1886(h) of the Act, as added by section 9202 of the 
Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 
99-272) and implemented in regulations at existing Sec. Sec.  413.75 
through 413.83, establishes a methodology for determining payments to 
hospitals for the costs of approved graduate medical education (GME) 
programs. Section 1886(h)(2) of the Act, as added by COBRA, sets forth 
a methodology for the determination of a hospital-specific, base-period 
per resident amount (PRA) that is calculated by dividing a hospital's 
allowable costs of GME for a base period by its number of residents in 
the base period. The base period is, for most hospitals, the hospital's 
cost reporting period beginning in FY 1984 (that is, the period 
beginning between October 1, 1983, through September 30, 1984). 
Medicare direct GME payments are calculated by multiplying the PRA 
times the weighted number of full-time equivalent (FTE) residents 
working in all areas of the hospital (and nonhospital sites, when 
applicable), and the hospital's Medicare share of total inpatient days. 
The base year PRA is updated each year for inflation. However, as 
specified in section 1886(h)(2)(D)(ii) of the Act, for cost reporting 
periods beginning on or after October 1, 1993, through September 30, 
1995, each hospital-specific PRA for the previous cost reporting period 
is not updated for inflation for any FTE residents who are not either a 
primary care or an obstetrics and gynecology resident. As a result, 
hospitals that train primary care and obstetrics and gynecology 
residents, as well as nonprimary care residents in FY 1994 or FY 1995, 
have two separate PRAs: One for primary care and obstetrics and 
gynecology residents and one for nonprimary care residents.
    Pub. L. 106-113 amended section 1886(h)(2) of the Act, effective 
October 1, 2000, to establish a methodology for the use of a national 
average PRA in computing direct GME payments for cost reporting periods 
beginning on or after October 1, 2000. Specifically, Pub. L. 106-113 
established a ``floor'' for FY 2001 such that a hospital-specific PRA 
should not be less than 70 percent of the locality-adjusted national 
average PRA. In addition, it established a ``ceiling'' that froze or 
limited the annual inflation adjustment to a hospital-specific PRA if 
the PRA exceeded 140 percent of the locality-adjusted national average 
PRA. Section 511 of Pub. L. 106-554 increased the ``floor'' established 
by Pub. L. 106-113 to equal 85 percent of the locality-adjusted 
national average PRA for PRAs in existence in FY 2002. Existing 
regulations at Sec.  413.77(d)(2)(iii) specify that, for purposes of 
calculating direct GME payments, each hospital-specific PRA is compared 
to the floor (for FY 2001 and FY 2002) and the ceiling (for FY 2001 
through 2013) to determine whether a hospital-specific PRA should be 
revised. We note that, under existing regulations at Sec.  413.77(c), 
if a hospital-specific PRA for FY 2001 or FY 2002 is revised due to 
application of the floor PRA, the revised PRA is the starting point for 
the PRA in future years, subject to the annual inflation adjustment and 
any other applicable adjustments.
    Section 1886(h)(4)(F) of the Act established caps on the number of 
allopathic and osteopathic residents that hospitals may count for 
purposes of calculating direct GME payments. For most hospitals, the 
caps were the number of allopathic and osteopathic FTE residents 
training in the hospital's most recent cost reporting period ending on 
or before December 31, 1996. Section 422 of Pub. L. 108-173 amended 
section 1886(h)(7) of the Act and provided for reductions to the 
resident caps of teaching hospitals that were training a number of FTE 
residents below their cap in a reference period, and authorized a 
``redistribution'' of FTE resident slots to hospitals that could 
demonstrate a likelihood of using the additional resident slots within 
the first three cost reporting periods beginning on or after July 1, 
2005.
2. Determination of Weighted Average Per Resident Amounts (PRAs) for 
Merged Teaching Hospitals (Sec.  413.77)
    (If you choose to comment on issues in this section, please include 
the caption ``GME: PRA for Merged Hospitals'' at the beginning of your 
comment.)
    As stated in the background section above, in accordance with 
section 1886(h) of the Act, Medicare pays teaching hospitals for the 
direct costs of GME based on the per resident direct GME costs in a 
base year. For most hospitals, the base year is FY 1984 (cost reporting 
periods beginning between October 1, 1983, and September 30, 1984). 
Although section 1886(h) of the Act provides for the establishment of a 
PRA for a hospital that trained residents in the 1984 base year, the 
statute does not address how to treat the PRA(s) of teaching hospitals 
that subsequently merge.
    Our policy has always been that when two or more teaching hospitals 
merge, we determine a weighted PRA for the surviving merged hospital 
using direct GME costs and resident data from the base year cost report 
for each teaching hospital involved in the merger. This policy was 
detailed in Questions and Answers on Medicare GME Payments Issued on 
November 8, 1990: ``[When] two hospitals merge * * * the merged 
hospital's per resident amount * * * [is] based on the weighted average 
of the per resident amounts of both hospitals.'' We believe this is an 
equitable way to determine a PRA for the surviving merged hospital 
because it is based on the relative costs and sizes of the GME training 
programs in the respective facilities. Moreover, we believe this policy 
minimizes the role Medicare GME payments play in the choice of the 
surviving hospital entity. For example, there is no incentive to choose 
the surviving hospital based in part on the hospitals' relative PRAs.
    To calculate the weighted average PRA for the merged entity, the 
fiscal intermediary begins by determining the base year PRAs and the 
base year FTE resident counts of the hospitals that merge. The weighted 
average PRA is calculated by adding the product of each hospital's base 
year PRA and its base year FTE resident count, and dividing that number 
by the total number of the base year FTE residents for those hospitals.
    When our current methodology was first established for calculating 
the new PRA for a merged hospital, we adopted a policy to use base year 
PRAs and FTE resident counts. It was appropriate and workable to use 
data from the PRA base year because the base year data (usually for the 
1984 fiscal year) associated with the hospital-specific PRAs were 
easily accessible. However, these data are now often over 20 years old 
and it has become administratively burdensome for both CMS and the 
fiscal intermediaries to access base year information in calculating 
the weighted average of the PRAs for merged hospitals.
    In addition to it being administratively burdensome to use base 
year cost report data, where a hospital has two PRAs--one for primary 
care and obstetrics and gynecology residents and another for nonprimary 
care residents, these two PRAs are not being taken into account in 
developing the weighted average PRA for the merged hospital. As 
discussed earlier, hospitals that were training nonprimary care 
residents in FYs 1994 and 1995

[[Page 24112]]

have a separate nonprimary care PRA because there was no update for 
inflation applied to the PRA for nonprimary care residents in those 
years (Sec.  413.77(c)(2)). Accordingly, many teaching hospitals 
currently have two PRAs: One for primary care and obstetrics and 
gynecology residents and one for all other residents. (Hospitals that 
first train residents after FY 1995 would only have a single PRA, even 
if they train both primary care residents and nonprimary care 
residents.) Because the current methodology for calculating the 
weighted average PRA for a merged teaching hospital is based solely on 
data from the PRA base year (which is usually prior to the years during 
which the PRAs were not adjusted for inflation to reflect nonprimary 
care residents), this methodology does not take into account that the 
merged hospitals may currently have more than one PRA.
    Effective for cost reporting periods beginning on or after October 
1, 2006, rather than use direct GME count of residents and PRA from 
hospitals' base year cost reports, we are proposing to simplify and 
revise the weighted average PRA methodology for determining a merged 
teaching hospital's PRA by using FTE resident data and PRA data from 
the most recently settled cost reports of the merging hospitals. It is 
less administratively burdensome to use these data, since these data 
are more recent and, therefore, more accessible. In addition, these 
data would reflect both a primary care and obstetrics and gynecology 
PRA and, if applicable, a nonprimary care resident PRA.
    We note that prior to FY 2003, our policy for calculating the PRA 
for a new teaching hospital was to calculate the PRA based on the lower 
of the new teaching hospital's actual cost per resident in its base 
period or a weighted average of all the PRAs of existing teaching 
hospitals in the same geographic wage area, as that term is used under 
the prospective payment system (existing Sec.  413.77(e)(1)). (For ease 
of discussion, we refer to a hospital that did not participate in 
Medicare or that did not have any approved medical residency training 
programs during the period beginning between October 1, 1983, through 
September 30, 1984, and has since commenced participating in Medicare 
and begun training residents in an approved program, as a ``new 
teaching hospital.'') The weighted average PRA of teaching hospitals 
within a particular geographic wage area was determined using the base 
year PRA and the base year FTE resident count of each respective 
teaching hospital within the geographic wage area. However, as 
discussed in the August 1, 2002 IPPS final rule (67 FR 50067) effective 
October 1, 2002, we revised our policy to use PRAs and FTE resident 
data from the most recently settled cost reports of teaching hospitals 
in the same CBSA as the new teaching hospitals, rather than data from 
the 1984 base year (existing Sec.  413.77(e)(1)(ii)(B)). We revised 
this policy for establishing PRAs for new teaching hospitals because it 
is less administratively burdensome to use data from the hospitals' 
most recently settled cost reports and because the more recent data 
takes into account that hospitals have a primary care PRA and a 
nonprimary care PRA. In this proposed rule, we are proposing a similar 
policy revision for establishing a merged teaching hospital's PRA.
    We are proposing that the fiscal intermediaries would use the 
following steps to calculate the weighted average PRA for the merged 
teaching hospital:
    Step 1: Identify the primary care and obstetrics and gynecology FTE 
resident count, the nonprimary care FTE resident count for hospitals 
with two PRAs, or the single FTE resident count for hospitals with a 
single PRA, for each teaching hospital involved in the merger. (Use the 
sum of the FTE resident counts from line 3.07, line 3.08, and line 3.11 
of the hospital's most recently settled Medicare cost report, CMS 2552-
96, Worksheet E-3, Part IV.)
    Step 2: Identify the PRAs (either a hospital's primary care and 
obstetrics and gynecology PRA and nonprimary care PRA or, if 
applicable, a hospital's single PRA) from the most recently settled 
cost report for each hospital involved in the merger, and update the 
PRAs using the CPI-U inflation factor to coincide with the fiscal year 
end of the surviving teaching hospital. For example, if the surviving 
teaching hospital's fiscal year end is December 31, 2006, and the most 
recently settled cost report of the teaching hospital(s) involved in 
the merger is June 30, 2003, the PRAs from this cost report would be 
updated for inflation to December 31, 2006.
    Step 3: Calculate the weighted average PRA for the single merged 
hospital using the PRAs and FTE resident counts from Step 1 and Step 2. 
For each teaching hospital in the merger:
    (a) For hospitals with two PRAs, multiply the primary care PRA by 
the number of primary care and obstetrics and gynecology FTE residents.
    (b) For hospitals with two PRAs, multiply the nonprimary care PRA 
by the number of nonprimary care FTE residents.
    (c) For hospitals with a single PRA, multiple the single PRA by the 
hospital's total number of FTE residents.
    (d) Add the products from applicable Steps 3(a), (b), and (c) for 
all teaching hospitals that merged.
    (e) Add the number of FTE residents from Step 1 for all hospitals.
    (f) Divide the sum from Step 3(d) by the sum from Step 3(e). The 
result is the weighted average PRA for the merged hospital.
    As mentioned above, many hospitals currently have two PRAs, one for 
primary care residents and another for nonprimary care residents. An 
advantage to using data from the most recently settled cost reports of 
the hospitals involved in a merger is that the two PRAs are taken into 
account in determining the weighted average PRA for the merged 
hospital. Because two PRAs would be taken into account under this 
proposal, we considered whether a primary care PRA and a nonprimary 
care PRA should therefore be determined for the merged hospital. 
Although it would be possible to determine and retain two PRAs for a 
merged hospital when one or more hospitals involved in the merger had 
two PRAs, we are not proposing to do so. We are proposing that a single 
PRA also be determined for the merged hospital in this situation 
because it is more administratively straightforward for the fiscal 
intermediaries and the merged hospitals and since the merged hospital 
itself was not in existence in the years that the two PRAs were 
established (FY 1994 and FY 1995), we do not believe it is necessary to 
retain the two PRAs. Furthermore, because the two existing PRAs are 
taken into account when establishing the single PRA for the merged 
hospital, and the statutory provision that resulted in the creation of 
two PRAs has no continuing effect (because the updates were prohibited 
only for FY 1994 and FY 1995), we see no compelling reason to continue 
to carry two PRAs for a merged hospital.
    The following is an example of how to calculate a weighted average 
PRA under this proposed revised methodology:
    Example: Assume that Hospital A, Hospital B, and Hospital C merge 
and Hospital B with a fiscal year end of December 31, 2006, is the 
surviving hospital. In their respective most recently settled cost 
reports, Hospital A has 200 primary care and obstetrics and gynecology 
FTE residents and 150 nonprimary care FTE residents, and Hospital B has 
50 primary care and obstetrics and gynecology FTE residents and 60 
nonprimary care FTE residents.

[[Page 24113]]

Hospital C became a teaching hospital in 2000 and has 25 FTE residents. 
After updating the primary care and nonprimary care PRAs for inflation 
by the CPI-U to December 31, 2006, Hospital A has a primary care PRA of 
$120,000 and a nonprimary care PRA of $115,000, Hospital B has a 
primary care PRA of $100,000 and a nonprimary care PRA of $97,000, and 
Hospital C has a single PRA of $90,000.
    (a) Primary care:
    Hospital A: $120,000 x 200 FTEs = $24,000,000
    Hospital B: $100,000 x 50 FTEs = $5,000,000
    (b) Nonprimary care:
    Hospital A: $115,000 x 150 FTEs = $17,250,000
    Hospital B: $97,000 x 60 FTEs = $5,820,000
    (c) Single PRA: Hospital C: $90,000 x 25 FTEs = $2,250,000
    (d) $24,000,000 + $5,000,000 + $17,250,000 + $5,820,000 + 
$2,250,000 = $54,320,000
    (e) 200 + 50 + 150 + 60 + 25 = 485 total FTEs
    (f) $54,320,000/485 FTEs = $112,000, the weighted average of the 
hospitals involved in the merger for fiscal year end December 31, 2006.
3. Determination of Per Resident Amounts (PRAs) for New Teaching 
Hospitals (Sec.  413.77(e))
    (If you choose to comment on issues in this section, please include 
the caption GME: PRA for New Teaching Hospitals'' at the beginning of 
your comment.)
    As we discussed earlier in the background portion of this section, 
the hospital-specific, base-period PRA used in the payment methodology 
for determining Medicare direct GME payments is calculated by dividing 
a hospital's allowable direct costs of GME in a base period by its 
number of residents in that base period. In the case of a hospital that 
did not train residents in its FY 1984 cost reporting period, a PRA is 
determined by comparing and taking the lower of a PRA based on direct 
GME costs and FTE residents in a base year or the updated weighted mean 
value of PRAs of all hospitals located in the same geographic wage 
area. For ease of discussion, we refer to a hospital that did not 
participate in Medicare or have any approved medical residency training 
programs during the base period beginning between October 1, 1983, 
through September 30, 1984, and has since commenced participating in 
Medicare and begun training residents in an approved program, as a 
``new teaching hospital.'' A new teaching hospital's PRA is established 
by using the lower of its hospital-specific PRA based on the actual 
allowable direct GME costs and FTE residents during a base period as 
defined in Sec.  413.77(e) or the updated weighted mean value of PRAs 
of other teaching hospitals in the same geographic area.
    Existing regulations at Sec.  413.77(e) specify that the base year 
for establishing a PRA for a new teaching hospital is the first cost 
reporting period in which the new teaching hospital participates in 
Medicare and the residents are on duty during the first month of that 
period. If the new teaching hospital begins training residents but does 
not have residents on duty during the first month of the first cost 
reporting period in which training occurs, the new teaching hospital is 
paid on a reasonable cost basis under Sec.  413.77(e) for any GME costs 
incurred by that hospital during that period. The intent of this policy 
for new teaching hospitals is to make a more accurate determination of 
a PRA based on the hospital's per resident direct GME costs in a cost 
reporting period in which GME costs have been incurred for that entire 
period. As we noted in a response to comments in a final rule published 
in the Federal Register on September 29, 1989 (54 FR 40310), we believe 
that where the new teaching hospital's cost reporting period begins on 
a date other than July 1 (the beginning of the academic year), for 
example, October 1 or January 1, the cost reporting period that 
includes costs and resident counts from the first year of the training 
program may not be reflective of the actual average costs per resident 
of the program because the full complement of residents might not be on 
duty, and those that are on duty might be receiving a salary for as few 
as 1 or 2 months of the cost reporting period. In the usual case, 
training in the program would continue into the following cost 
reporting period and residents would thus be on duty in the first month 
of this next cost reporting period. Consequently, our existing 
regulations at Sec.  413.77(e)(1) specify that the PRA is to be 
determined by using the cost and resident data from the first cost 
reporting period during which residents are training in the first month 
of the cost reporting period.
    It has come to our attention that, in rare instances, it is 
possible for a new teaching hospital, either through happenstance or by 
purposeful gaming of the policy, to continue to be reimbursed for 
direct GME costs on a reasonable cost basis even beyond the first cost 
reporting period during which residents begin training at the hospital 
as long as no residents are on duty at the new teaching hospital in the 
first month of the subsequent cost reporting period(s). We believe this 
scenario is contrary to the statutory intent of section 1886(h) of the 
Act, which instructs that instead of payment on a reasonable cost 
basis, the Secretary is to determine and base direct GME payments on a 
PRA for each hospital with a residency program. For that reason, we are 
proposing to revise Sec.  413.77(e)(1) and (e)(1)(i) to provide that we 
will make a PRA determination even where residents are not on duty in 
the first month of a cost reporting period but where residents began 
training at the hospital in the prior cost reporting period. Effective 
for cost reporting periods beginning on or after October 1, 2006, if a 
new teaching hospital begins training residents in a cost reporting 
period beginning on or after October 1, 2006, and no residents are on 
duty during the first month of that period, the fiscal intermediary 
establishes a PRA for the hospital using: (1) The cost and resident 
data from the cost reporting period immediately following the one for 
which GME training at the hospital was first reported (that is, the 
base period); or (2) the updated weighted mean value of PRAs of all 
hospitals located in the same geographic wage area. We note that, as 
with existing policy, the proposed base year need not be a full cost 
reporting year. Even where that cost reporting period may be a short 
(less than 12 months) cost reporting period, we believe an appropriate 
PRA will be determined since the number of FTEs will be commensurate 
with the costs incurred in this short cost reporting period.
4. Requirements for Counting and Appropriate Documentation of FTE 
Residents: Clarification (Sec. Sec.  413.75(d), 413.78(b) and (e), 
413.80, and 413.81)
    (If you choose to comment on issues in this section, please include 
the caption ``FTE Resident Count and Documentation'' at the beginning 
of your comment.)
    Despite the fact that current policies concerning the counting of 
FTE residents for IME and direct GME payment purposes have been in 
effect since October 1985, we continue to receive questions on the 
proper counting and appropriate documentation for FTE residents for IME 
and direct GME payment purposes. As a result of these continuing 
questions, we are clarifying in this proposed rule the policies that 
apply in determining hospitals' FTE resident counts for Medicare GME 
payment purposes.

[[Page 24114]]

    In the existing regulations at Sec.  413.78(b) for direct GME 
payments, we specify that no individual may be counted as more than one 
FTE, and that a hospital cannot claim the time spent by residents 
training at another hospital. Therefore, if a resident spends time 
training in more than one hospital or except as provided at Sec.  
413.78(e) in a nonprovider setting, the resident counts as a partial 
FTE based on the proportion of time the resident trains at the hospital 
or nonprovider setting to the resident's total time worked. (The same 
provisions apply to part-time residents as specified in Sec.  
413.78(b).) A similar policy exists at Sec.  412.105(f)(1)(ii) and 
(iii) for purposes of counting FTE residents for IME payment purposes. 
As we have explained in previous Federal Register documents (55 FR 
36064, September 4, 1990 and 67 FR 50077, August 1, 2002), these 
policies apply even when a hospital actually incurs the cost of 
training the resident(s) at another hospital(s). For example, during a 
cost reporting year, a full-time resident trains at Hospital A for 6 
months and trains at Hospital B for 6 months. Hospital A is paying the 
salary and fringe benefits of the resident for the entire year. In this 
case, each hospital would only count 0.5 of an FTE for that resident. 
Hospital A would not be able to count the entire FTE for that resident, 
regardless of the fact that it incurred all of the training costs for 
the resident during that training year.
    We also have become aware of issues that have arisen due to a 
hospital's failure to document the number of FTE residents claimed on 
its cost report. Proper documentation is required so that Medicare 
fiscal intermediaries can determine where and when a resident(s) is 
training and to allow the fiscal intermediary to make payment to the 
hospital based on the percentage of time the resident(s) spends at each 
training facility to the total time trained. A rotation schedule is the 
primary documentation that can support the direct GME and IME resident 
counts but other similar documentation may be acceptable. The following 
is a situation of which we learned that illustrates how inadequate 
documentation resulted in inappropriate counting of FTEs. Two 
hospitals, Hospital C and D, were ``associated'' with each other, with 
residents training at both hospitals. However, instead of 
differentiating between the number of FTEs and the actual amount of 
time spent at each hospital, Hospitals C and D totaled their respective 
FTEs and split them 50/50. Splitting the FTE count 50/50 resulted in 
inappropriate payment to both hospitals. Hospitals are not permitted to 
decide among themselves how their FTEs will be counted. A hospital may 
not count a greater number of FTE residents than is actually training 
at the hospital (or its nonhospital sites) during the year. Each 
hospital must maintain its own records which demonstrate, for the 
entire cost reporting period, the amount of time that the resident 
trained at the hospital and, if applicable, a nonhospital site. 
Furthermore, to the extent that residents train in nonhospital sites, 
the hospital claiming the FTEs in the nonhospital site must meet the 
requirements at Sec.  413.78(e).
    Situations such as the one described above involving Hospital C and 
Hospital D are particularly harmful when one or more of the hospitals 
involved incorrectly report FTEs in the cost reporting period used to 
establish one or more of the hospitals' FTE resident caps, and as a 
result, the caps are incorrectly established. Unless the incorrect caps 
are revised pursuant to our regulations regarding review and revision 
of agency determinations, those caps will be applied to the hospital(s) 
in future years. For instance, we have learned of situations where a 
hospital's FTE resident caps were established incorrectly a number of 
years earlier and, due to administrative finality of settled cost 
reports, can no longer be adjusted. However, going forward, the 
hospital's count of FTEs must be based on where the residents are 
training and can only reflect the number of residents actually training 
in the hospital (or its nonhospital sites).
    In order to ensure that FTEs are being properly counted, hospitals 
are required to furnish specific documentation to support the number of 
FTE residents included in the hospital's FTE count. Section 413.75(d) 
specifies the requirements concerning documentation of FTE residents. 
Proper documentation must include the following information: The name 
and social security number of the resident; the type of residency 
program in which the individual participates and the number of years 
the resident has completed in all types of residency programs; the 
dates the resident is assigned to the hospital and any hospital-based 
providers (similar to the rotation schedule); the dates the resident is 
assigned to other hospitals, or other freestanding providers, and any 
nonprovider setting during the cost reporting period, if any; and the 
name of the employer paying the resident's salary. In addition, the 
documentation should include the name of the medical, osteopathic, 
dental, or podiatric school from which the resident graduated and the 
date of graduation, and whether the resident is a foreign medical 
graduate, including documentation concerning whether the resident has 
satisfied the regulatory requirements for foreign medical graduates at 
Sec.  413.80. The information must be certified by an official of the 
hospital and, if different, an official responsible for administering 
the residency program. Again, proper documentation on where and when a 
FTE resident is training during a cost reporting period is essential in 
order for the hospital to receive direct GME and IME payments based on 
the proper number of FTE resident(s). Inaccurate, incomplete, or 
inappropriate documentation will lead to Medicare disallowing certain 
FTE residents from being counted for purposes of direct GME and IME 
payments. We note that we are not expanding or making any changes to 
current policy for proper documentation of FTEs. Rather, we are 
clarifying the existing regulations concerning proper counting and 
documentation of FTEs.
5. Resident Time Spent in Nonpatient Care Activities as Part of 
Approved Residency Programs (Sec. Sec.  413.9 and 413.78(a))
    In section IV.H.4. of this preamble, we discussed the importance of 
properly documenting where and when residents are training in a 
particular hospital or nonhospital site, in order for that hospital to 
count those FTE residents for purposes of direct GME and IME payment. 
In addition, it is important for hospitals to be able to document the 
activities in which residents are engaged because there are certain 
activities that are not allowable for direct GME or IME payment 
purposes, even though those activities may be performed as part of an 
approved residency program. Specifically, it has come to our attention 
that there may be some confusion in the provider community as to 
whether the time that residents spend in nonpatient care activities 
that are part of the approved residency program may be counted for the 
purpose of direct GME and IME payments. We have most recently received 
questions as to whether the time residents spend in nonhospital sites 
in didactic activities such as journal clubs or classroom lectures may 
be included in determining the allowable FTE resident counts. To 
respond to these inquiries and to resolve any confusion, we are 
clarifying our policy concerning the counting of time spent in 
nonpatient care activities for the purpose of direct GME and IME 
payments in both hospital and nonhospital settings.
    With respect to training in nonhospital settings, the time that

[[Page 24115]]

residents spend in nonpatient care activities as part of an approved 
program, including didactic activities, cannot be included in a 
hospital's direct GME or IME FTE resident count. This longstanding 
policy is based on the statutory requirements for counting FTE 
residents training in nonhospital sites. For the purpose of direct GME 
payments, providers have been allowed since July 1, 1987, to count the 
time residents spend training in nonhospital sites under certain 
conditions. Section 1886(h)(4)(E) of the Act specifies that the 
implementing regulations concerning computation of direct GME for 
training in nonhospital sites ``shall provide that only time spent in 
activities relating to patient care shall be counted and that all the 
time so spent by a resident under an approved medical residency 
training program shall be counted towards the determination of full-
time equivalency, without regard to the setting in which the activities 
are performed, if the hospital incurs all, or substantially all, of the 
costs for the training program in that setting'' (emphasis added).
    For IME payment purposes, hospitals were first allowed to count the 
time residents spend training in nonhospital sites for discharges 
occurring on or after October 1, 1997. Section 1886(d)(5)(B)(iv) of the 
Act was amended by Pub. L. 105-33 in 1997 to provide that ``all the 
time spent by an intern or resident in patient care activities under an 
approved medical residency program at an entity in a nonhospital 
setting shall be counted towards the determination of full-time 
equivalency if the hospital incurs all, or substantially all, of the 
costs for the training program in that setting'' (emphasis added).
    We understand that, as part of an approved medical residency 
program, residents are often required to participate in didactic and 
``scholarly'' activities such as educational conferences, journal 
clubs, and seminars. Some of these activities may take place in 
nonhospital sites, such as freestanding clinics or physicians' offices, 
or in conference rooms at nonhospital settings. In implementing section 
1886(h)(4)(E) of the Act for direct GME payment purposes, we 
specifically stated that ``only time spent in activities relating to 
patient care may be counted [in nonhospital sites]'' (54 FR 40292, 
September 29, 1989). In 1998, when we implemented the statute allowing 
FTE residents to be counted in nonhospital sites for IME, we reiterated 
that a hospital may only count resident training time ``in nonhospital 
sites for indirect and direct GME, respectively, if the resident is 
involved in patient care'' (63 FR 40986, July 31, 1998). While we have 
not explicitly defined in regulations ``patient care activities,'' we 
have applied the plain meaning of that term. In addition, we note that 
the scope of the term ``patient care'' had been well-established in the 
Medicare program even prior to issuance of the first rules on counting 
FTE residents for purposes of direct GME and IME payments. For example, 
prior to the IPPS, acute care hospitals were paid by Medicare for 
inpatient services based on their reasonable operating costs, or costs 
relating to the provision of reasonable and necessary ``patient care.'' 
The longstanding regulation at 42 CFR 413.9, entitled ``Costs related 
to patient care,'' states that ``all payments to providers of services 
must be based on the reasonable cost of services covered under Medicare 
and related to the care of beneficiaries.'' Thus, the scope of costs 
recognized as reasonable under Medicare had been limited to those 
relating to ``patient care,'' or to those relating to covered services 
for the care of beneficiaries. Although the agency appears to have made 
a conflicting statement in a letter directed to a particular individual 
implying that didactic time spent in nonhospital settings could be 
counted for direct GME and IME, that statement was inaccurate. We have 
applied and continue to apply the plain meaning of the statutory terms 
``patient care activities'' and ``activities relating to patient care'' 
in the context of approved GME programs. That is, the plain meaning of 
patient care activities would certainly not encompass didactic 
activities. Rather, the plain meaning refers to the care and treatment 
of particular patients, or to services for which a physician or other 
practitioner may bill. Time spent by residents in such patient care 
activities may be counted for direct GME and IME payment purposes in 
the nonhospital site. Time spent by residents in other activities in 
the nonhospital site that do not involve the care and treatment of 
particular patients, such as didactic or ``scholarly'' activities, is 
not allowable for direct GME and IME payment purposes.
    We note that there is a difference in the rules for counting FTE 
resident time for IME and direct GME payments when residents are 
training in a hospital. For direct GME payment purposes, under Sec.  
413.78(a), ``residents in an approved program working in all areas of 
the hospital complex may be counted.'' As explained in the September 
29, 1989 Federal Register document (54 FR 40286), the hospital complex 
consist of the hospital and the hospital-based providers and 
subproviders. Therefore, the distinction between patient care 
activities and nonpatient care activities is not relevant to direct GME 
FTE count determinations when the residents are training in the 
hospital complex. However, for IME payment purposes, consistent with 
the regulations at Sec.  413.9, only time spent in patient care 
activities in the hospital may be counted. It has been our longstanding 
policy that, regardless of the site of training, ``* * * we do not 
include residents in the IME count to the extent that the residents are 
not involved in furnishing patient care * * *'' (66 FR 39897, August 1, 
2001).
6. Medicare GME Affiliated Groups: Technical Changes to Regulations
    (If you choose to comment on issues in this section, please include 
the caption ``GME Affiliated Group Technical Changes'' at the beginning 
of your comment.)
    In the FY 2005 IPPS final rule (69 FR 49112 and 49254 through 
49265), we redesignated the contents of Sec.  413.86 (which contained 
the regulations governing Medicare payment for direct GME) as 
Sec. Sec.  413.75 through 413.83 and made corresponding cross-reference 
changes in the text of these regulations. We have discovered that under 
the definition of ``Medicare GME affiliated group'' under Sec.  
413.75(b), we incorrectly cited the cross-reference to the rotation 
requirements for GME affiliated groups in paragraphs (1), (2), and (3), 
as ``Sec.  413.79(g)(2)''. In this proposed rule, we are proposing to 
correct the cross-reference for the rotation requirements in paragraphs 
(2) and (3) of the definition to read ``Sec.  413.79(f)(2)''.
    In the FY 2006 IPPS final rule (70 FR 47457 and 47489), we made 
additional changes in certain sections of the GME redesignated 
regulations to correct cross-references to other parts of 42 CFR 
Chapter IV relating to the definitions of the ``urban'' and ``rural'' 
location of a hospital. In one of the corrections, in paragraph (1) 
under the definition of ``Medicare GME affiliated group'' under Sec.  
413.75(b), we inadvertently dropped the language in that paragraph 
relating to the rotational requirements for these groups, including the 
incorrect cross-reference to Sec.  413.79(g)(2). We are proposing to 
correct the language of paragraph (1) under the definition of 
``Medicare GME affiliated group'' under Sec.  413.75(b) by adding the 
dropped language and correcting the cross-reference to read ``Sec.  
413.79(f)(2).''
    In the FY 2006 IPPS final rule (70 FR 47454 and 47489), we revised

[[Page 24116]]

Sec.  413.79(e)(1)(iv) to provide that a new urban teaching hospital 
that qualifies for an adjustment to its FTE cap for a newly approved 
program may enter into a Medicare GME affiliation agreement, but only 
if the resulting adjustments to its direct GME and IME caps are 
``positive adjustments.'' We specified in the preamble of that final 
rule that this provision is effective for affiliation agreements 
entered into on or after October 1, 2005. However, we inadvertently did 
not include this effective date in the regulation text. We are 
proposing to revise Sec.  413.79(e)(1)(iv) to include the effective 
date as part of the text of that section.
    In addition, we are proposing to correct a cross-reference in the 
introductory text of paragraph (f) of Sec.  413.79 relating to Medicare 
GME affiliated groups. The cross-reference to ``paragraph (e)(3)'' of 
Sec.  413.79 should read ``paragraph (d)'' of that section. This 
proposed change is necessary to accurately cite the reference to our 
rules regarding the 3-year rolling average.

I. Payment for the Costs of Nursing and Allied Health Education 
Activities: Clarification (Sec.  413.85)

    (If you choose to comment on issues in this section, please include 
the caption ``Nursing and Allied Health Education Activities'' at the 
beginning of your comment.)
    In addition to direct GME and IME payments to hospitals for the 
direct and indirect costs incurred for their graduate medical education 
programs in medicine, osteopathy, dentistry, and podiatry, Medicare 
makes payments to hospitals for two other categories of education-
related costs for which different payment policies apply:
     Approved nursing and allied health education programs 
operated by the hospital. The costs of these programs are excluded from 
the definition of inpatient hospital operating costs and are not 
included in the calculation of the per discharge payment rates for 
hospitals paid under the IPPS, or in the calculation of payments to 
hospitals and hospital units excluded from the IPPS that are subject to 
the rate-of-increase ceiling. These costs are separately identified and 
``passed through'' (that is, paid separately on a reasonable cost 
basis).
     All other costs that can be categorized as educational 
programs and activities (for example, continuing education, on the job 
training, or seminars). These costs are considered to be part of the 
hospitals' normal operating costs and payment for these costs is 
included in the per discharge payment amount for hospitals subject to 
the IPPS, the IRF PPS, or the LTCH PPS and the prospective per diem 
payment amount for facilities under the IPF PPS. Similarly, these costs 
are considered to be part of the hospitals' normal operating costs and 
are included as reasonable costs that are subject to the TEFRA rate-of-
increase limits applicable to hospitals that continue to receive 
payments subject to those limits, including cancer and children's 
hospitals.
    Regulations governing payment for the costs of approved and allied 
health education activities are located at 42 CFR 413.85.
    In the FY 2004 IPPS final rule (68 FR 45429), we revised the 
regulations at Sec.  413.85(h)(3) to further clarify the difference 
between provider-operated and continuing education programs. We revised 
the regulations to state that, effective October 1, 2003, programs in 
which employees participate that do not lead to the ability to practice 
and begin employment in a nursing or allied health specialty are also 
treated as normal operating costs. We now realize that when we revised 
Sec.  413.85(h)(3) to include this clarification, we inadvertently did 
not specify that the provision was applicable to trainees as well as 
employees. In the preamble of the FY 2004 IPPS final rule, we stated 
that because Sec.  413.85(h)(3) refers to education that will not lead 
to the ability to practice and begin employment, we intended the 
provisions to apply not only to employees but to trainees as well. 
Therefore, in this proposed rule, we are proposing to make a technical 
change to Sec.  413.85(h)(3) to make it applicable to both employees 
and trainees. This proposed technical change would clarify that the 
educational activities in which employees or trainees participate, but 
that do not lead to the ability to practice and begin employment in a 
nursing or allied health specialty, are treated as normal operating 
costs. We note that we are not proposing to expand or make any changes 
to the current payment policy for nursing and allied health education 
activities; rather, we are merely proposing to clarify the language of 
the existing regulations.

J. Hospital Emergency Services Under EMTALA (Sec.  489.24)

    (If you choose to comment on issues in this section, please include 
the caption ``EMTALA'' at the beginning of your comment.)
1. Background
    Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose 
specific obligations on certain Medicare-participating hospitals and 
CAHs. (Throughout this section of this proposed rule, when we reference 
the obligation of a ``hospital'' under these sections of the Act and in 
our regulations, we mean to include CAHs as well.) These obligations 
concern individuals who come to a hospital emergency department and 
request examination or treatment for medical conditions, and apply to 
all of these individuals, regardless of whether they are beneficiaries 
of any program under the Act.
    The statutory provisions cited above are frequently referred to as 
the Emergency Medical Treatment and Labor Act (EMTALA), also known as 
the patient antidumping statute. EMTALA was passed in 1986 as part of 
the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), 
Pub. L. 99-272. Congress enacted these antidumping provisions in the 
Social Security Act to ensure that individuals with emergency medical 
conditions are not denied essential lifesaving services because of a 
perceived inability to pay.
    Under section 1866(a)(1)(I)(i) of the Act, a hospital that fails to 
fulfill its EMTALA obligations under these provisions may be liable for 
termination of its Medicare provider agreement, which would result in 
loss of all Medicare and Medicaid payments.
    In general, section 1867 of the Act sets forth requirements for 
medical screening examinations for individuals who come to the hospital 
and request examination or treatment for a medical condition. The 
section further provides that if a hospital finds that such an 
individual has an emergency condition, it is obligated to provide that 
individual with either necessary stabilizing treatment or an 
appropriate transfer to another medical facility where stabilization 
can occur.
    The EMTALA statute also outlines the obligation of hospitals to 
receive appropriate transfers from other hospitals. Section 1867(g) of 
the Act states that a participating hospital that has specialized 
capabilities or facilities (such as burn units, shock-trauma units, 
neonatal intensive care units or (with respect to rural areas) regional 
referral centers as identified by the Secretary in regulation) shall 
not refuse to accept an appropriate transfer of an individual who 
requires these specialized capabilities or facilities if the hospital 
has the capacity to treat the individual.
    The regulations implementing section 1867 of the Act are found at 
42 CFR 489.24.

[[Page 24117]]

2. Role of the EMTALA Technical Advisory Group (TAG)
    Section 945 of Pub. L. 108-173 (MMA) required the Secretary to 
establish a Technical Advisory Group (TAG) to provide the Secretary 
with advice concerning issues related to EMTALA regulations and 
implementation. Section 945 of Pub. L. 108-173 further requires that 
the EMTALA TAG be composed of 19 members, including the Administrator 
of CMS, the Inspector General of HHS, hospital representatives and 
physicians representing various specialties, patient representatives, 
and representatives of organizations involved in EMTALA enforcement.
    The EMTALA TAG was first established in 2005 and held three 
meetings during that year. At each of its meetings, the EMTALA TAG 
heard testimony from representatives of physician groups, hospital 
associations, and others regarding EMTALA issues and concerns. As 
explained more fully below in sections IV.K.3. and 4. of this preamble, 
we are proposing to revise the EMTALA regulations at Sec.  489.24 based 
on the recommendations adopted and forwarded to the Secretary by the 
EMTALA TAG.
3. Definition of ``Labor''
    As noted in the background portion of this section, the EMTALA 
statute and regulations require that if an individual comes to a 
hospital emergency department and a request is made on the individual's 
behalf for examination or treatment for a medical condition, the 
hospital is obligated to provide that individual with an appropriate 
medical screening examination within the capability of the hospital. If 
the individual is found to have an emergency medical condition, the 
hospital is obligated by EMTALA to provide either necessary stabilizing 
treatment or an appropriate transfer to another medical facility where 
stabilization can occur.
    Section 489.24(b) of the regulations defines the key terms used in 
the section. The term ``emergency medical condition'' is defined as--
    ``A medical condition manifesting itself by acute symptoms of 
sufficient severity (including severe pain, psychiatric disturbances 
and/or symptoms of substance abuse) such that the absence of immediate 
medical attention could reasonably be expected to result in placing the 
health of the individual (or, with respect to a pregnant woman, the 
health of the woman or her unborn child) in serious jeopardy; serious 
impairment to bodily functions; or serious dysfunction of any bodily 
organ or part; or with respect to a pregnant woman who is having 
contractions, that there is inadequate time to effect a safe transfer 
to another hospital before delivery; or that transfer may pose a threat 
to the health and safety of the woman or the unborn child.''
    This definition is identical to the definition of ``emergency 
medical condition'' in section 1867(e)(1) of the Act. In recognition of 
the fact that this definition gives special consideration to women in 
labor, the term ``labor'' is itself defined, in paragraph (b) of Sec.  
489.24, to mean ``the process of childbirth beginning with the latent 
or early phases of labor and continuing through the delivery of the 
placenta.'' The definition further states: ``A woman experiencing 
contractions is in true labor unless a physician certifies that, after 
a reasonable period of observation, the woman is in false labor.'' A 
woman found to be in false labor is considered not to have an emergency 
medical condition and that finding thus means that the hospital has no 
further EMTALA obligation to her.
    The CMS interpretative guidelines used by State surveyors in EMTALA 
investigations provide that once an individual has presented to a 
hospital seeking emergency care, the determination as to whether an 
emergency medical condition exists is made by the examining 
physician(s) or other qualified medical person actually caring for the 
individual at the treating facility. The guidelines further provide 
that the medical screening examination must be conducted by one or more 
individuals who are determined to be qualified by the hospital bylaws 
or rules and regulations and who meet the hospital condition of 
participation in 42 CFR 482.55 regarding emergency services personnel 
and direction. (Of course, these individuals would not be expected or 
permitted to perform any screening functions other than those which 
they are allowed to perform under State scope of practice laws.) 
However, consistent with the definition of ``labor'' at Sec.  
489.24(b), the guidelines also state that if a qualified medical person 
other than a physician determines that a woman is in false labor, a 
physician must certify the diagnosis. The guidelines permit this 
certification to be made based either on actual examination of the 
patient or on a telephone consultation with the qualified medical 
person who actually examined the patient. (Medicare State Operations 
Manual, Appendix V--Interpretive Guidelines--Responsibility of 
Participating Hospitals in Emergency Cases, TAG A-406.)
    At its meeting held on June 15-17, 2005, the EMTALA TAG heard 
testimony from representatives of both physician and nonphysician 
professional societies regarding the competence of practitioners other 
than physicians to certify false labor. In particular, a representative 
of the American College of Nurse-Midwives stated that the current 
requirement that allows only a physician to certify false labor is 
overly restrictive and does not adequately recognize the training and 
competence of certified nurse-midwives. Testimony was also presented by 
the American College of Obstetricians and Gynecologists, which 
recommended amending the EMTALA regulations to allow certified nurse-
midwives and other qualified medical persons to determine whether a 
woman is in false labor.
    After extensive consideration of the issue, the members of the 
EMTALA TAG voted to recommend to the Secretary that the definition of 
``labor'' at Sec.  489.24(b) be amended to permit certified nurse-
midwives and other qualified medical personnel to certify false labor. 
The TAG recommended deleting the second sentence, which states that a 
woman experiencing contractions is in true labor unless a physician 
certifies that, after a reasonable time of observation, the woman is in 
false labor.
    We agree with the TAG's recommendation that other health care 
practitioners besides physicians should be allowed to certify false 
labor, and believe that the recommendation is consistent with CMS' 
current policy regarding who may conduct medical screening 
examinations. However, we do not believe such a change can be best 
accomplished by simply deleting the second sentence of the current 
definition of ``labor'' in the existing regulations because doing so 
would also remove the explicit statement that a woman experiencing 
contractions is in labor unless she has been found to be in false 
labor. To achieve the principal objective of the EMTALA TAG 
recommendation without compromising the protections of EMTALA for women 
having contractions, we are proposing to modify the definition of 
``labor'' in Sec.  489.24(b) by revising the second sentence of that 
definition to state that a woman experiencing contractions is in true 
labor unless a physician, certified nurse-midwife, or other qualified 
medical person acting within his or her scope of practice as defined in 
hospital medical staff bylaws and State law, certifies that, after a 
reasonable time of

[[Page 24118]]

observation, the woman is in false labor. The effect of this change 
would be to have a single, uniform policy on the personnel who are 
authorized to make a determination as to whether an individual has an 
emergency medical condition.
4. Application of EMTALA Requirements to Hospitals Without Dedicated 
Emergency Departments
    Section 489.24(b) of the regulations outlines when a hospital will 
be considered to be a hospital with a ``dedicated emergency 
department'' and makes it clear that only a hospital with a dedicated 
emergency department has an EMTALA responsibility with respect to an 
individual for whom no appropriate transfer is sought but who comes to 
the hospital seeking examination or treatment for a medical condition. 
However, it has come to CMS' attention that our policy regarding the 
application of EMTALA to hospitals that have specialized capabilities 
but are without dedicated emergency departments may be less well 
understood as it relates to individuals for whom an appropriate 
transfer is sought.
    It has been CMS' longstanding policy that any Medicare-
participating hospital with a specialized capability must, in 
accordance with section 1867(g) of the Act, accept, within the capacity 
of the hospital, an appropriate transfer from a requesting hospital. 
This policy has been applied to hospitals without regard to whether 
they have dedicated emergency departments. In fact, in the past, CMS 
has taken enforcement actions against hospitals with specialized 
capabilities that failed to accept appropriate transfers under EMTALA 
when the hospitals had the capacity to treat the transferred 
individuals.
    At its meeting held on October 26-28, 2005, the EMTALA TAG heard 
testimony from representatives of physician groups, hospital 
associations, and others regarding EMTALA compliance by specialty 
hospitals that typically do not have dedicated emergency departments. 
After extensive consideration and discussion of the issues raised and 
views presented, the members of the EMTALA TAG voted to recommend to 
the Secretary that hospitals with specialized capabilities (as defined 
in Sec.  489.24(f) of the regulation) that do not have a dedicated 
emergency department be bound by the same responsibility to accept an 
appropriate transfer under EMTALA as hospitals with a dedicated 
emergency department.
    We agree with the EMTALA TAG's assessment. We believe that the 
recommendation is consistent with CMS' current policy and highlights 
the need to clarify CMS' policy regarding hospitals with specialized 
capabilities. Therefore, in this proposed rule, we are proposing to 
modify the regulations at Sec.  489.24(f) to specifically indicate that 
any participating hospital with specialized capabilities or facilities, 
even if it does not have a dedicated emergency department, may not 
refuse to accept an appropriate transfer if the hospital has the 
capacity to treat the individual. We note that this proposed revision 
does not reflect any change in current CMS policy. We further note that 
the revision would not require hospitals without dedicated emergency 
departments to open dedicated emergency departments nor would it impose 
any EMTALA obligation on those hospitals with respect to individuals 
who come to the hospital as their initial point of entry into the 
medical system seeking a medical screening examination or treatment for 
a medical condition. Although this proposed revision seeks only to 
clarify, rather than change, current policy, we nevertheless, welcome 
comments on what effect, if any, commenters believe this proposed 
clarification may have on EMTALA compliance and patient health and 
safety.
5. Clarification of Reference to ``Referral Centers''
    The language of the existing regulations at Sec.  489.24(f) 
duplicates the language of section 1867(g) of the Act in that it 
identifies, as an example of a hospital with specialized capabilities, 
``(with respect to rural areas) regional referral centers identified by 
the Secretary in regulation)''. Because the term ``regional referral 
centers'' is not used elsewhere in the Medicare regulations, it is 
unclear whether the reference is to referral centers as defined in 42 
CFR 412.96, which must be located in rural areas and meet other 
criteria spelled out in that section, or to any facilities that are 
located in rural areas and accept patients on referral. To maintain 
consistency in the Medicare regulations and avoid confusion as to which 
facilities are considered to have specialized capabilities for purposes 
of EMTALA, we are proposing to amend Sec.  489.24 by clarifying that 
``regional referral centers'' are those centers meeting the 
requirements of Sec.  412.96.

K. Other Proposed Technical Changes

1. Proposed Cross-Reference Correction in Regulations on Limitations on 
Beneficiary Charges (Sec.  412.42)
    (If you choose to comment on issues in this section, please include 
the caption ``Cross-Reference Sec.  412.42'' at the beginning of your 
comment.)
    We are proposing to amend Sec.  412.42 to correct an obsolete 
cross-reference. Paragraph (d) of Sec.  412.42 contains a cross-
reference to ``Sec.  405.310(k).'' This section was redesignated as 
Sec.  411.15(k) in 1989 (54 FR 41737, October 11, 1989). We are 
proposing to amend paragraph (d) of Sec.  412.42 to delete the obsolete 
cross-reference and insert the correct cross-reference.
2. Proposed Cross-Reference Corrections in Regulations on Payment 
Denials Based on Admissions and Quality Reviews (Sec.  412.48)
    (If you choose to comment on issues in this section, please include 
the caption ``Cross-Reference Sec.  412.48'' at the beginning of your 
comment.)
    We are proposing to amend Sec.  412.48 to correct an obsolete 
cross-reference. Paragraph (b) of Sec.  412.48 contains a cross-
reference to ``Sec. Sec.  405.330 through 405.332''. Section 405.330 
was redesignated as Sec.  411.400, and Sec.  405.332 was redesignated 
as Sec.  411.402 in 1989 (54 FR 41746, October 11, 1989). (There was no 
Sec.  405.331.) We are proposing to amend paragraph (b) of Sec.  412.48 
to delete the obsolete cross-references and to insert the correct 
cross-references.
3. Proposed Cross-Reference Correction in Regulations on Outlier 
Payments (Sec.  412.84)
    (If you choose to comment on issues in this section, please include 
the caption ``Technical Correction: Outliers'' at the beginning of your 
comment.)
    On June 9, 2003, we published a final rule in the Federal Register 
(68 FR 34494) that amended the portion of the hospital IPPS regulations 
that sets out the methodology for determining payments for 
extraordinarily high-cost cases (outliers). We changed the methodology 
because we concluded that, in certain cases, hospitals were 
dramatically and inappropriately increasing charges, thereby inflating 
CCRs, resulting in overestimation of these hospitals' costs per case, a 
critical factor in determining outlier payments.
    As a part of these methodology changes, we required that outlier 
payments be reconciled using a hospital's settled cost report for the 
cost reporting year in which the outlier discharge occurred. This 
approach

[[Page 24119]]

meant that there would be some delay in computing the final outlier 
payment. To address this issue, we added Sec.  412.84(m), which 
provided that reconciled outlier payments would be adjusted to account 
for the time value of any underpayments or overpayments.
    We inadvertently included in paragraph (m) of Sec.  412.84 a cross-
reference to paragraph (h)(3) of Sec.  412.84. The cross-reference 
should be to paragraph (i)(4), which sets out the requirement for 
reconciling outlier payments when the cost report for the year in which 
the discharge occurred is settled. We are proposing to amend paragraph 
(m) of Sec.  412.84 to correct the cross-reference to read ``paragraph 
(i)(4)'' of Sec.  412.84.
4. Removing References to Two Paper Claims Forms
    (If you choose to comment of the issues in this section, please 
include the caption ``Claims Forms References'' at the beginning of 
your comment.)
    Section 1862(a)(22) of the Act generally requires electronic 
submission of initial Medicare claims requesting payment for items and 
services. Section 1862(h) of the Act provides for limited exceptions 
when paper claims still may be used. Our existing regulations at 42 CFR 
424.32 set out the requirements for submitting electronic and paper 
claims for payment, as well as when the exceptions apply and paper 
forms still may be used. Our existing regulations at paragraph (b) of 
Sec.  424.32 list six forms that are to be used for submitting paper 
claims.
    We have evaluated the use of two of these forms, Form CMS-1490U 
(Request for Medicare Payment by Organization) and Form CMS-1491 
(Request for Medicare Payment--Ambulance). We found that these forms 
have limited use, we would incur expensive costs in redesigning these 
forms to comply with other reporting requirements, and that an 
alternate form is available to claim payments. For these reasons, we 
intend to no longer use these forms. Therefore, we are proposing to 
remove the references to these forms from paragraph (b) of Sec.  
424.32.
    Form CMS-1490U is a paper claim form used by employers, unions, 
employer-employee organizations that pay physicians and suppliers for 
their services to employees, group practice prepayment plans, and 
health maintenance organizations. Form CMS-1490U is used to claim 
payment from carriers for bills already paid by these entities. We 
concluded that this form should no longer be used for several reasons. 
It is duplicative of Form CMS-1500 (Health Insurance Claim Form), which 
also may be used to claim payment for these services. We have 
encouraged suppliers to submit their paper claims using the Form CMS-
1500. Unlike Form CMS-1500, Form CMS-1490U cannot accommodate an 
additional reporting requirement, the National Provider Identifier 
(NPI), without an expensive redesign. Finally, according to our 
records, relatively few suppliers currently use the form. The CMS 
component that supplies blank copies of this form for users reported 
that, between 2002 and 2005, only 2,550 copies of Form CMS-1490U were 
ordered by carriers. A 2005 survey of Part B carriers indicated that 
requests for the form are very low and that receipts of the form vary 
from very few to none.
    Form CMS-1491 is a paper claim form used by ambulance suppliers to 
apply for payment for ambulance services. We concluded that this form 
should no longer be used for several reasons. It also is duplicative of 
Form CMS-1500, which also may be used to claim payment for ambulance 
services. In addition, we have encouraged suppliers to submit their 
paper ambulance claims using the Form CMS-1500. Unlike Form CMS-1500, 
Form CMS-1491 cannot accommodate the NPI without an expensive redesign 
and usage of this form is low. A recent survey of carriers, initiated 
by Joint Signature Memorandum RO-2324, Request for Information 
Concerning the CMS-1491, issued October 30, 2003, from the Centers for 
Medicare Management, was conducted to ascertain the usage of Form CMS-
1491. The results of the survey showed that fewer than 2 percent (1.71 
percent) of all suppliers of ambulance services currently use the Form 
CMS-1491. CMS received approximately 240,000 ambulance claims using 
Form CMS-1491 during the period from October 1, 2002, to September 30, 
2003. These data were used for the most recent OMB renewal under the 
Paperwork Reduction Act. Since the last OMB renewal approval in 2001, 
CMS has printed a total of 1,620,000 forms at a cost of $42,890.

L. Rural Community Hospital Demonstration Program

    (If you choose to comment on issues in this section, please include 
the caption ``Rural Community Hospital Demonstration Program'' at the 
beginning of your comment.)
    In accordance with the requirements of section 410A(a) of Pub. L. 
108-173, the Secretary has established a 5-year demonstration program 
(beginning with selected hospitals' first cost reporting period 
beginning on or after October 1, 2004) to test the feasibility and 
advisability of establishing ``rural community hospitals'' for Medicare 
payment purposes for covered inpatient hospital services furnished to 
Medicare beneficiaries. A rural community hospital, as defined in 
section 410A(f)(1), is a hospital that:
     Is located in a rural area (as defined in section 
1886(d)(2)(D) of the Act) or is treated as being located in a rural 
area under section 1886(d)(8)(E) of the Act;
     Has fewer than 51 beds (excluding beds in a distinct part 
psychiatric or rehabilitation unit) as reported in its most recent cost 
report;
     Provides 24-hour emergency care services; and
     Is not designated or eligible for designation as a CAH.
    As we indicated in the FY 2005 IPPS final rule (69 FR 49078), in 
accordance with sections 410A(a)(2) and (a)(4) of Pub. L.108-173 and 
using 2002 data from the U.S. Census Bureau, we identified 10 States 
with the lowest population density from which to select hospitals: 
Alaska, Idaho, Montana, Nebraska, Nevada, New Mexico, North Dakota, 
South Dakota, Utah, and Wyoming (Source: U.S. Census Bureau Statistical 
Abstract of the United States: 2003). Nine rural community hospitals 
located within these States are currently participating in the 
demonstration program for FY 2007. (Of the 13 hospitals that 
participated in the first 2 years of the demonstration program, 4 
hospitals located in Nebraska have withdrawn from the program; they 
have become CAHs.)
    Under the demonstration program, participating hospitals are paid 
the reasonable costs of providing covered inpatient hospital services 
(other than services furnished by a psychiatric or rehabilitation unit 
of a hospital that is a distinct part), applicable for discharges 
occurring in the first cost reporting period beginning on or after the 
October 1, 2004, implementation date of the demonstration program. 
Payments to the participating hospitals will be the lesser amount of 
the reasonable cost or a target amount in subsequent cost reporting 
periods. The target amount in the second cost reporting period is 
defined as the reasonable costs of providing covered inpatient hospital 
services in the first cost reporting period, increased by the inpatient 
prospective payment update factor (as defined in section 1886(b)(3)(B) 
of the Act) for that particular cost reporting period. The target 
amount in subsequent cost reporting periods is defined as the preceding 
cost reporting period's target

[[Page 24120]]

amount, increased by the inpatient prospective payment update factor 
(as defined in section 1886(b)(3)(B) of the Act) for that particular 
cost reporting period.
    Covered inpatient hospital services are inpatient hospital services 
(defined in section 1861(b) of the Act), and include extended care 
services furnished under an agreement under section 1883 of the Act.
    Section 410A of Pub. L. 108-173 requires that ``in conducting the 
demonstration program under this section, the Secretary shall ensure 
that the aggregate payments made by the Secretary do not exceed the 
amount which the Secretary would have paid if the demonstration program 
under this section was not implemented.'' Generally, when CMS 
implements a demonstration program on a budget neutral basis, the 
demonstration program is budget neutral in its own terms; in other 
words, the aggregate payments to the participating providers do not 
exceed the amount that would be paid to those same providers in the 
absence of the demonstration program. This form of budget neutrality is 
viable when, by changing payments or aligning incentives to improve 
overall efficiency, or both, a demonstration program may reduce the use 
of some services or eliminate the need for others, resulting in reduced 
expenditures for the demonstration program's participants. These 
reduced expenditures offset increased payments elsewhere under the 
demonstration program, thus ensuring that the demonstration program as 
a whole is budget neutral or yields savings. However, the small scale 
of this demonstration program, in conjunction with the payment 
methodology, makes it extremely unlikely that this demonstration 
program could be viable under the usual form of budget neutrality. 
Specifically, cost-based payments to the nine participating small rural 
hospitals are likely to increase Medicare outlays without producing any 
offsetting reduction in Medicare expenditures elsewhere. Therefore, a 
rural community hospital's participation in this demonstration program 
is unlikely to yield benefits to the participant if budget neutrality 
were to be implemented by reducing other payments for these providers.
    In order to achieve budget neutrality for this demonstration 
program for FY 2007, we are proposing to adjust the national inpatient 
PPS rates by an amount sufficient to account for the added costs of 
this demonstration program. We are proposing to apply budget neutrality 
across the payment system as a whole rather than merely across the 
participants in this demonstration program. As we discussed in the FY 
2005 and FY 2006 IPPS final rules (69 FR 49183 and 70 FR 47462), we 
believe that the language of the statutory budget neutrality 
requirements permits the agency to implement the budget neutrality 
provision in this manner. For FY 2007, using the most recent cost 
report data (that is, data for FY 2004), adjusted to account for the 
increased estimated costs for the remaining nine participating 
hospitals, we estimate that the proposed adjusted amount would be 
$9,197,870. This proposed estimated adjusted amount reflects the 
estimated difference between the participating hospitals' costs and the 
IPPS payment based on data from the hospitals' cost reports. We discuss 
the proposed payment rate adjustment that would be required to ensure 
the budget neutrality of the demonstration program for FY 2007 in 
section II.A.4. of the Addendum to this proposed rule.

M. Health Care Information Transparency Initiative

    (If you choose to comment of issues in this section, please include 
the caption ``Transparency of Health Care Information'' at the 
beginning of your comment.)
    The United States faces a dilemma in health care. Although the rate 
of increase in health care spending slowed last year, costs are still 
growing at an unsustainable rate. The United States spends $1.9 
trillion on health care, or 16 percent of the gross domestic product 
(GDP). By 2015, projections are that health care will consume 20 
percent of GDP. The Medicare program alone consumes 3.4 percent of the 
GDP; by 2040, it will consume 8.1 percent of the GDP and by 2070, 14 
percent of the GDP.
    Part of the reason health care costs are rising so quickly is that 
most consumers of health care--the patients--are frequently not aware 
of the actual cost of their care. Health insurance shields them from 
the full cost of services, and they do have only limited information 
about the quality and costs of their care. Consequently, consumers do 
not have the incentive or means to carefully shop for providers 
offering the best value. Thus, providers of care are not subject to the 
competitive pressures that exist in other markets for offering quality 
services at the best possible price. Reducing the rate of increase in 
health care prices and avoiding health services of little value could 
help to stem the growth in health care spending, and potentially 
translate into fewer individuals who are unable to afford health 
insurance. Part of the President's health care agenda is to expand 
Health Savings Accounts (HSAs), which would provide consumers with 
greater financial incentives to compare providers in terms of price and 
quality, and choose those that offer the best value.
    In order to exercise such choices, consumers must have accessible 
and useful information on price and quality of health care items and 
services. Typically, health care providers do not publicly quote or 
publish their prices. Moreover, list prices, or charges, generally 
differ from the actual prices negotiated and paid by different health 
plans. Thus, even if consumers were financially motivated to shop for 
the best price, it would be very difficult at the current time for them 
to access usable information.
    Similarly, individuals have very little information available to 
them about the quality of care that they receive. Although there are 
preliminary steps underway to rectify that fact, including the hospital 
quality reporting initiative in which a significant number of acute 
care hospitals are participating (see sections IV.A and IV.B of this 
preamble), those data are nascent and consumers lack sufficient 
information on which to base a judgment about where to receive care 
based on quality of care.
    For these reasons, the Department intends to launch a major health 
care information transparency initiative in 2006. This effort will 
build on steps already taken by CMS to make quality and price 
information available. For example, we currently collect quality 
information and publish it through the CMS Hospital Compare Web site, 
which we reference in other parts of this proposed rule. We also make 
available unprecedented information on the prices of drugs to 
beneficiaries in the Medicare prescription drug plan for each pharmacy 
in the United States.
    We intend to take further steps to collect and publish useful 
information on quality and cost. The Department intends to identify 
several regions in the United States where health care costs are high, 
and where there is significant interest in reducing health care costs 
and improving health care quality. The Department will use its 
leadership role in health care policy to help lead change in those 
areas.
    The Secretary also has significant regulatory authority as well. In 
this proposed rule, we are soliciting comments on several proposals 
that the Secretary might adopt to increase the transparency of quality 
and pricing

[[Page 24121]]

information, and how this can be used to attenuate the growth in health 
care costs. In addition, we are soliciting comments from the public on 
additional ways that we could use our regulatory authority to enhance 
transparency of quality and pricing information.
    Several possibilities exist. First, we could publish a list of 
hospital charges either for every region of the country or for selected 
regions of the country. In addition, we could publish the rates that 
Medicare actually pays to a particular hospital for every DRG or for 
selected DRGs that could be adjusted to take into account the 
hospital's labor market area, teaching hospital status, and DSH status. 
Some might argue that publishing these payment rates does not provide 
meaningful information to consumers because Medicare payment rates are 
not set by the market, but rather by a statutory payment formula. In 
addition, providing information on hospital payments only does not 
disclose the true cost of an episode of care because it would not take 
into account the cost of physician services, laboratory tests, and 
other procedures that go along with hospital charges. On the other 
hand, Medicare payment rates may provide a helpful benchmark, 
especially for uninsured individuals, to determine whether the charges 
they see on a hospital bill bear any relationship to what third-party 
fee-for-service payors pay to the hospital.
    A second option would be for the Secretary to use his authority to 
establish conditions of participation for hospitals to propose a rule 
that relates to charges for uninsured patients. For example, the 
conditions of participation could include a requirement that hospitals 
post their prices and/or post their policies regarding discounts or 
other assistance for uninsured patients.
    Yet another alternative to posting Medicare DRG payment rates would 
be to make publicly available the total Medicare payments for an 
episode of care. For example, one of the most common inpatient hospital 
procedures under the Medicare program (based on total dollars spent) is 
hip replacement surgery. Under this proposal, we could make publicly 
available the expected total payment for an episode of care for hip 
replacement surgery, including the inpatient hospital stay, physician 
payments (including the surgeon and the anesthesiologist), and payments 
for post-acute care services such as services provided in an IRF, SNF, 
or LTCH. We are currently assessing methods for making such information 
available and are seeking comments on how to do so as quickly and 
effectively as possible.
    We are seeking comment on any ways in which the Department can 
encourage transparency in health care quality and pricing whether 
through its leadership on voluntary initiative or through regulatory 
requirements. We also are seeking comment on the Department's statutory 
authority to impose such requirements. Discussion of particular options 
in this proposed rule should not be taken as an indication that the 
Department will adopt any of these proposals. Rather, the proposals are 
included here to foster comment on possible options to promote the aims 
of transparency of quality and pricing information and the Department's 
authority and ability potentially to implement these options. The 
Department is anxious to receive comments on any of these proposals, or 
on other options that may be available that the Department could adopt 
either through voluntary initiatives or through its regulatory 
authority.

V. Proposed Changes to the PPS for Capital-Related Costs

    (If you choose to comment on issues in this section, please include 
the caption ``Capital PPS'' at the beginning of your comment.)

A. Background

    Section 1886(g) of the Act requires the Secretary to pay for the 
capital-related costs of inpatient acute hospital services ``in 
accordance with a PPS established by the Secretary.'' Under the 
statute, the Secretary has broad authority in establishing and 
implementing the PPS for hospital inpatient capital-related costs. We 
initially implemented the PPS for capital-related costs in the August 
30, 1991 IPPS final rule (56 FR 43358), in which we established a 10-
year transition period to change the payment methodology for Medicare 
hospital inpatient capital-related costs from a reasonable cost-based 
methodology to a prospective methodology (based fully on the Federal 
rate).
    Federal fiscal year (FFY) 2001 was the last year of the 10-year 
transition period established to phase in the PPS for hospital 
inpatient capital-related costs. For cost reporting periods beginning 
in FY 2002, capital PPS payments are based solely on the Federal rate 
for most acute care hospitals (other than certain new hospitals and 
hospitals receiving certain exception payments). The basic methodology 
for determining capital prospective payments using the Federal rate is 
set forth in Sec.  412.312. For the purpose of calculating payments for 
each discharge, the standard Federal rate is adjusted as follows:
    (Standard Federal Rate) x (DRG Weight) x (Geographic Adjustment 
Factor (GAF)) x (Large Urban Add-on, if applicable) x (COLA for 
hospitals located in Alaska and Hawaii) x (1 + Capital DSH Adjustment 
Factor + Capital IME Adjustment Factor, if applicable).
    Hospitals also may receive outlier payments for those cases that 
qualify under the threshold established for each fiscal year as 
specified in Sec.  412.312(c) of the regulations.
    The regulations at Sec.  412.348(f) provide that a hospital may 
request an additional payment if the hospital incurs unanticipated 
capital expenditures in excess of $5 million due to extraordinary 
circumstances beyond the hospital's control. This policy was originally 
established for hospitals during the 10-year transition period, but as 
we discussed in the August 1, 2002 IPPS final rule (67 FR 50102), we 
revised the regulations at Sec.  412.312 to specify that payments for 
extraordinary circumstances are also made for cost reporting periods 
after the transition period (that is, cost reporting periods beginning 
on or after October 1, 2001). Additional information on the exception 
payment for extraordinary circumstances in Sec.  412.348(f) can be 
found in the FY 2005 IPPS final rule (69 FR 49185 and 49186).
    During the transition period, under Sec. Sec.  412.348(b) through 
(e), eligible hospitals could receive regular exception payments. These 
exception payments guaranteed a hospital a minimum payment percentage 
of its Medicare allowable capital-related costs depending on the class 
of hospital (Sec.  412.348(c)), but were available only during the 10-
year transition period. After the end of the transition period, 
eligible hospitals can no longer receive this exception payment. 
However, even after the transition period, eligible hospitals receive 
additional payments under the special exceptions provisions at Sec.  
412.348(g), which guarantees all eligible hospitals a minimum payment 
of 70 percent of its Medicare allowable capital-related costs provided 
that special exceptions payments do not exceed 10 percent of total 
capital IPPS payments. Special exceptions payments may be made only for 
the 10 years from the cost reporting year in which the hospital 
completes its qualifying project, and the hospital must have completed 
the project no later than the hospital's cost reporting period 
beginning before October 1, 2001. Thus, an eligible hospital may 
receive special exceptions payments for up to 10 years beyond the end 
of the capital PPS transition period. Hospitals eligible for

[[Page 24122]]

special exceptions payments were required to submit documentation to 
the intermediary indicating the completion date of their project. (For 
more detailed information regarding the special exceptions policy under 
Sec.  412.348(g), refer to the August 1, 2001 IPPS final rule (66 FR 
39911 through 39914) and the August 1, 2002 IPPS final rule (67 FR 
50102).)
    Under the PPS for capital-related costs, Sec.  412.300(b) of the 
regulations defines a new hospital as a hospital that has operated 
(under current or previous ownership) for less than 2 years. (For more 
detailed information, see the August 30, 1991 final rule (56 FR 
43418).) During the 10-year transition period, a new hospital was 
exempt from the capital PPS for its first 2 years of operation and was 
paid 85 percent of its reasonable costs during that period. Originally, 
this provision was effective only through the transition period and, 
therefore, ended with cost reporting periods beginning in FY 2002. 
Because we believe that special protection to new hospitals is also 
appropriate even after the transition period, as discussed in the 
August 1, 2002 IPPS final rule (67 FR 50101), we revised the 
regulations at Sec.  412.304(c)(2) to provide that, for cost reporting 
periods beginning on or after October 1, 2002, a new hospital (defined 
under Sec.  412.300(b)) is paid 85 percent of its Medicare allowable 
capital-related costs through its first 2 years of operation, unless 
the new hospital elects to receive fully prospective payment based on 
100 percent of the Federal rate. (Refer to the August 1, 2001 IPPS 
final rule (66 FR 39910) for a detailed discussion of the statutory 
basis for the system, the development and evolution of the system, the 
methodology used to determine capital-related payments to hospitals 
both during and after the transition period, and the policy for 
providing exception payments.)
    Section 412.374 provides for the use of a blended payment amount 
for prospective payments for capital-related costs to hospitals located 
in Puerto Rico. Accordingly, under the capital PPS, we compute a 
separate payment rate specific to Puerto Rico hospitals using the same 
methodology used to compute the national Federal rate for capital-
related costs. In general, hospitals located in Puerto Rico are paid a 
blend of the applicable capital PPS Puerto Rico rate and the applicable 
capital PPS Federal rate.
    Prior to FY 1998, hospitals in Puerto Rico were paid a blended 
capital PPS rate that consisted of 75 percent of the capital PPS Puerto 
Rico specific rate and 25 percent of the capital PPS Federal rate. 
However, effective October 1, 1997 (FY 1998), in conjunction with the 
change to the operating PPS blend percentage for Puerto Rico hospitals 
required by section 4406 of Pub. L. 105-33, we revised the methodology 
for computing capital PPS payments to hospitals in Puerto Rico to be 
based on a blend of 50 percent of the capital PPS Puerto Rico rate and 
50 percent of the capital PPS Federal rate. Similarly, in conjunction 
with the change in operating PPS payments to hospitals in Puerto Rico 
for FY 2005 required by section 504 of Pub. L. 108-173, we again 
revised the methodology for computing capital PPS payments to hospitals 
in Puerto Rico to be based on a blend of 25 percent of the capital PPS 
Puerto Rico rate and 75 percent of the capital PPS Federal rate 
effective for discharges occurring on or after October 1, 2004.

B. Treatment of Certain Urban Hospitals Reclassified as Rural Hospitals 
Under Sec.  412.103

    We are proposing technical changes to Sec. Sec.  412.316(b) and 
412.320(a)(1) to clarify that hospitals reclassified as rural under 
Sec.  412.103 are not eligible for the large urban add-on payment or 
for the capital DSH adjustment. These proposed changes would reflect 
our historic policy that hospitals reclassified as rural under Sec.  
412.103 also will be considered rural under the capital PPS. Since the 
genesis of the capital PPS in FY 1992, the same geographic 
classifications used under the operating PPS also have been used under 
the capital PPS.
    These proposed changes and clarifications are necessary because we 
inadvertently made an error when we updated our capital PPS regulations 
to incorporate OMB's new CBSA definitions for IPPS hospital labor 
market areas beginning in FY 2005. In the FY 2005 IPPS final rule (69 
FR 49187 through 49188), in order to incorporate the new CBSA 
designations and the provisions of the newly established Sec.  412.64, 
which incorporated the CBSA-based geographic classifications, we 
revised Sec.  412.316(b) and Sec.  412.320 to specify that, effective 
for discharges occurring on or after October 1, 2004, the capital PPS 
payment adjustments are based on the geographic classifications under 
Sec.  412.64. However, Sec.  412.64 does not reference the provisions 
of Sec.  412.103 regarding the urban-to-rural reclassifications, as was 
previously found in Sec.  412.63(b)(1).
    We believe that this error must be corrected in order to maintain 
our historic policy for treating urban-to-rural hospital 
reclassifications under the operating PPS the same for purposes of the 
capital PPS. Therefore, we are proposing to specify under Sec. Sec.  
412.316(b)(2) and (b)(3) and 412.320(a)(1)(ii) and (a)(1)(iii) that, 
for discharges on or after October 1, 2006, hospitals that are 
reclassified from urban to rural under Sec.  412.103 would be 
considered rural.

C. Other Technical Corrections Relating to the Capital PPS Geographic 
Adjustment Factors

    We are proposing to make technical corrections to the regulations 
under paragraphs (a) and (c) of Sec.  412.316. Specifically, we are 
proposing to make a technical change under Sec.  412.316(a) to correct 
the cross-reference to ``Sec.  412.63(k)'' to clarify that the same 
wage index that applies to hospitals under the operating PPS is used to 
determine the geographic adjustment factor (GAF) under the capital PPS. 
We would cross-refer instead to subpart D of Part 412 to capture the 
applicable requirements in their entirety. This technical correction 
does not change any current payment policies because the regulation, as 
written, makes clear that the GAF adjustment for local cost variation 
under the capital PPS is based on a hospital's operating PPS wage index 
value. Thus, the same payment policies that are in effect prior to FY 
2007 (that is, the GAF is based on a hospital's operating PPS wage 
index value) would continue in effect for FY 2007 and beyond; the only 
change in the regulation would be a correction of the erroneous cross-
reference.
    In addition, we are proposing to make a technical correction under 
Sec.  412.316(c) to correct the cross-reference to ``Sec.  412.115'' to 
clarify that, for hospitals located in Alaska and Hawaii, the same COLA 
factor that applies to these hospitals under the operating PPS is used 
to determine the COLA factor under the capital PPS. The existing 
regulation erroneously references the COLA factor used to determine 
payment under Sec.  412.115, which is not related to the operating PPS 
COLA factor or any other payment factors. Again, we would cross-refer 
instead to subpart D of Part 412 to capture the applicable requirements 
in their entirety. This proposed technical correction would not change 
any current payment policy; rather it would make clear that the capital 
PPS COLA factor is based on the hospital's COLA factor under the 
operating PPS. This proposed technical correction reflects our historic 
policy that the COLA factor under the capital PPS is based on the 
hospital's operating PPS COLA factor, which is how the capital PPS COLA

[[Page 24123]]

factor has been determined since the implementation of the capital PPS 
in FY 1992. Thus, the same payment policy that has been in effect prior 
to FY 2007 (that is, the use of the operating PPS COLA factor as shown 
in the table in section II.B.2 of the Addendum of this proposed rule in 
determining a hospital's capital PPS COLA factor) would continue to be 
in effect for FY 2007 and beyond; the only change in the regulation 
would be a correction of the erroneous cross-reference.

VI. Proposed Changes for Hospitals and Hospital Units Excluded From the 
IPPS

    (If you choose to comment on issues in this section, please include 
the caption ``Excluded Hospitals and Units'' at the beginning of your 
comment.)

A. Payments to Excluded Hospitals and Hospital Units (Sec.  413.40)

1. Payments to Existing and New Excluded Hospitals and Hospital Units
    Historically, hospitals and hospital units excluded from the 
prospective payment system received payment for inpatient hospital 
services they furnished on the basis of reasonable costs, subject to a 
rate-of-increase ceiling. An annual per discharge limit (the target 
amount as defined in Sec.  413.40(a)) was set for each hospital or 
hospital unit based on the hospital's own cost experience in its base 
year. The target amount was multiplied by the Medicare discharges and 
applied as an aggregate upper limit (the ceiling as defined in Sec.  
413.40(a)) on total inpatient operating costs for a hospital's cost 
reporting period. Prior to October 1, 1997, these payment provisions 
applied consistently to all categories of excluded providers 
(rehabilitation hospitals and units (now referred to as IRFs), 
psychiatric hospitals and units (now referred to as IPFs), LTCHs, 
children's hospitals, and cancer hospitals).
    Payment for children's hospitals and cancer hospitals that are 
excluded from the IPPS continues to be subject to the rate-of-increase 
ceiling based on the hospital's own historical cost experience. (We 
note that, in accordance with Sec.  403.752(a) of the regulations, 
RNHCIs are also subject to the rate-of-increase limits established 
under Sec.  413.40 of the regulations.) For IPFs, IRFs, and LTCHs, 
reasonable cost payment provisions changed significantly for cost 
reporting periods beginning on or after October 1, 1997.
    Section 1886(b)(3)(H) of the Act established caps on the target 
amounts for cost reporting periods beginning on or after October 1, 
1997, through September 30, 2002, for certain existing hospitals and 
hospital units excluded from the IPPS. Section 413.40(c)(4)(iii) of the 
implementing regulations states that ``In the case of a psychiatric 
hospital or unit, rehabilitation hospital or unit, or long-term care 
hospital, the target amount is the lower of amounts specified in 
paragraph (c)(4)(iii)(A) or (c)(4)(iii)(B) of this section.'' 
Accordingly, in general, for ``existing'' IPFs, IRFs, or LTCHs for the 
applicable 5-year period, the target amount is the lower of: the 
hospital-specific target amount (Sec.  413.40(c)(4)(iii)(A)) or the 
75th percentile cap (Sec.  413.40(c)(4)(iii)(B)).
    For cost reporting periods beginning on or after October 1, 2002, 
all IRFs are paid 100 percent of the adjusted Federal rate under the 
IRF PPS. Therefore, an IRF, considered existing under section 
1886(b)(3)(H) of the Act would have no portion of its payment subject 
to Sec.  413.40(c)(4)(ii) of the regulations for cost reporting periods 
beginning on or after October 1, 2002.
    For cost reporting periods beginning on or after October 1, 2002, 
to the extent an IPF or LTCH has all or a portion of its payment 
determined under reasonable cost principles, the target amounts for the 
reasonable cost-based portion of the payment are determined in 
accordance with section 1886(b)(3)(A)(ii) of the Act and the 
regulations at Sec.  413.40(c)(4)(ii). Section 413.40(c)(4)(ii) states, 
``Subject to the provisions of [Sec.  413.40] paragraph (c)(4)(iii) of 
this section, for subsequent cost reporting periods, the target amount 
equals the hospital's target amount for the previous cost reporting 
period increased by the update factor for the subject cost reporting 
period unless the provisions of [Sec.  413.40] paragraph (c)(5)(ii) of 
this section apply.'' Thus, because Sec.  413.40(c)(4)(ii) indicates 
that the provisions of that paragraph are subject to the provisions of 
Sec.  413.40(c)(4)(iii), which are applicable only for cost reporting 
periods beginning on or after October 1, 1997, through September 30, 
2002, the target amount for FY 2003 is determined by updating the 
target amount for FY 2002 by the applicable update factor. For example, 
if a provider was paid the cap amount in FY 2002, the target amount for 
FY 2003 would be the amount paid in FY 2002, updated to FY 2003 (that 
is, the target amount from the previous year increased by the 
applicable update factor). As discussed below, IPFs, IRFs, and LTCHs 
are now paid under separate PPSs, although some are subject to 
transition payment provisions.
    In addition, a new method of determining the payment amount for 
``new'' excluded providers was established under section 1886(b)(7) of 
the Act. The law was applicable for three classes of excluded 
providers--IRFs, IPFs, and LTCHs--with a first cost reporting period 
beginning on or after October 1, 1997. For the first two cost reporting 
periods, these ``new'' excluded providers would be paid the lesser of 
their net inpatient operating costs or 110 percent of the national 
median of target amounts for its class of hospitals for cost reporting 
periods ending during FY 1996. This amount was updated to the first 
cost reporting period the hospital received payment, and adjusted for 
differences in area wage levels, as implemented in the regulations at 
Sec.  413.40(f)(2)(ii). For the third and subsequent cost reporting 
periods, Sec.  413.40(c)(4)(v) applies.
    The 110 percent of the national median payment limits for new 
providers under TEFRA (Sec.  413.40(f)(2)(ii)) do not apply to those 
LTCHs or IPFs whose first cost reporting period begins on or after the 
date the particular class of hospitals implemented their respective PPS 
because they are paid 100 percent of their Federal PPS rate. IRFs are 
paid 100 percent of the Federal rate under the IRF PPS for cost 
reporting periods beginning on or after October 1, 2002. Therefore, the 
110 percent of the median payment limitations are not applicable to 
IRFs for cost reporting periods beginning on or after that date.
2. Separate PPS for IRFs
    Section 1886(j) of the Act, as added by section 4421(a) of Pub. L. 
105-33, provided for the phase-in of a case-mix adjusted PPS for 
inpatient hospital services furnished by IRFs for cost reporting 
periods beginning on or after October 1, 2000, and before October 1, 
2002, with payments based entirely on the adjusted Federal prospective 
payment for cost reporting periods beginning on or after October 1, 
2002. Section 1886(j) of the Act was amended by section 125 of Pub. L. 
106-113 to require the Secretary to use a discharge as the payment unit 
under the PPS for inpatient hospital services furnished by IRFs and to 
establish classes of patient discharges by functional-related groups. 
Section 305 of Pub. L. 106-554 further amended section 1886(j) of the 
Act to allow IRFs, subject to the blend methodology, to elect to be 
paid the full Federal prospective payment rather than the transitional 
period payments specified in the Act.
    On August 7, 2001, we issued a final rule in the Federal Register 
(66 FR 41316) establishing the PPS for IRFs, effective for cost 
reporting periods beginning on or after January 1, 2002.

[[Page 24124]]

There was a transition period for cost reporting periods beginning on 
or after January 1, 2002, and ending before October 1, 2002. For cost 
reporting periods beginning on or after October 1, 2002, payments are 
based entirely on the adjusted Federal prospective payment rate 
determined under the IRF PPS.
3. Separate PPS for LTCHs
    In accordance with the requirements of section 123 of Pub. L. 106-
113, as modified by section 307(b) of Pub. L. 106-554, we established a 
per discharge, DRG-based PPS for LTCHs as described in section 
1886(d)(1)(B)(iv) of the Act for cost reporting periods beginning on or 
after October 1, 2002, in a final rule issued on August 30, 2002 (67 FR 
55954). The LTCH PPS uses information from LTCH hospital patient 
records to classify patients into distinct LTC-DRGs based on clinical 
characteristics and expected resource needs. Separate payments are 
calculated for each LTC-DRG with additional adjustments applied.
    On May 7, 2004, we issued in the Federal Register a final rule (69 
FR 25673) that updated the payment rates for the LTCH PPS and made 
policy changes effective for a new LTCH PPS rate year of July 1, 2004 
through June 30, 2005. For the LTCH PPS rate year of July 1, 2005 
through June 30, 2006, we issued in the Federal Register a final rule 
(70 FR 24168) that further updated the payment rates and made policy 
changes. The 5-year period for LTCHs to transition from reasonable 
cost-based reimbursement to the fully Federal prospective rate will end 
with cost reporting periods beginning on or after October 1, 2005, and 
before October 1, 2006.
4. Separate PPS for IPFs
    In accordance with section 124 of the BBRA and section 405(g)(2) of 
Pub. L. 108-173, we established a PPS for inpatient hospital services 
furnished in IPFs (that is, psychiatric hospitals and psychiatric units 
of acute care hospitals). On November 15, 2004, we issued in the 
Federal Register a final rule (69 FR 66922) that established the IPF 
PPS, effective for IPF cost reporting periods beginning on or after 
January 1, 2005. Under the final rule, we compute a Federal per diem 
base rate to be paid to all IPFs for inpatient psychiatric services 
based on the sum of the average routine operating, ancillary, and 
capital costs for each patient day of psychiatric care in an IPF, 
adjusted for budget neutrality. The Federal per diem base rate is 
adjusted to reflect certain patient characteristics, including age, 
specified DRGs, selected high-cost comorbidities, days of the stay, and 
certain facility characteristics, including a wage index adjustment, 
rural location, indirect teaching costs, the presence of a full-service 
emergency department, and COLAs for IPFs located in Alaska and Hawaii. 
We have established a 3-year transition period during which IPFs whose 
first cost reporting periods began before January 1, 2005, will be paid 
based on a blend of reasonable cost-based payment and IPF PPS payments. 
For cost reporting periods beginning on or after January 1, 2008, all 
IPFs will be paid 100 percent of the Federal per diem payment amount.
5. Grandfathering of Hospitals-Within-Hospitals (HwHs) and Satellite 
Facilities
    (If you choose to comment on this section, please include the 
caption ``Hospitals-Within-Hospitals'' at the beginning of your 
comment.)
    Existing regulations at 42 CFR 412.22(e) define a hospital-within-
a-hospital (HwH) as a hospital that occupies space in a building also 
used by another hospital, or in one or more separate buildings located 
on the same campus as buildings used by another hospital. In order to 
be paid outside of the IPPS as an excluded hospital, a HwH is required 
to demonstrate compliance with requirements at Sec.  412.22(e)(1) 
through (e)(3), as applicable, which were established to create 
operational and organizational separateness between the HwH and the 
host hospital with which it is co-located.
    The existing regulations at Sec.  412.22(h), relating to satellite 
facilities of hospitals excluded from the IPPS, define a satellite 
facility as a part of a hospital that provides inpatient services in a 
building also used by another hospital, or in one or more entire 
buildings located on the same campus as buildings used by another 
hospital. Section 412.25(e), relating to satellite facilities of 
excluded hospital units, defines a satellite facility as a part of a 
hospital unit that provides inpatient services in a building also used 
by another hospital, or in one or more entire buildings located on the 
same campus as buildings used by another hospital.
    There are significant similarities between the definition of a 
satellite facility and the definition of a HwH as it relates to their 
co-location with other Medicare hospital-level providers (hosts). There 
are also similarities in our policy concerns about the potential for 
patient-shifting (and its consequences for the Medicare program) 
between the co-located entities and their hosts. Regarding HwHs and 
satellite facilities, particularly LTCH HwHs and satellite facilities 
of LTCHs, which were the original entities that we regulated beginning 
with FY 1995, we have repeatedly expressed our concerns (for example, 
in the FY 2005 IPPS final rule (69 FR 49191)) that a HwH's or a 
satellite facility's ``configuration could result in patient admission, 
treatment, and discharge patterns that are guided more by attempts to 
maximize Medicare payments than by patient welfare.'' (69 FR 48916 and 
49191). We further believe that ``the unregulated linking of an IPPS 
hospital and a hospital excluded from the IPPS could lead to two 
Medicare payments for what was essentially one episode of patient 
care.'' (69 FR 48916 and 49191). Therefore, we established 
``separateness and control'' criteria to govern these relationships 
with host hospitals, at Sec.  412.22(e) for HwHs, and at Sec. Sec.  
412.22(h) and 412.25(e) for satellite facilities of excluded hospitals 
and satellite facilities of hospital units, respectively. Moreover, for 
each type of entity, we provided for the ``grandfathering'' of existing 
facilities, thereby exempting those that were in existence prior to the 
establishment of the ``separateness and control'' requirements from 
compliance with the criteria. At Sec.  412.22(f), we provided for the 
grandfathering of HwHs that were in existence on or before September 
30, 1995 or for HwHs that changed the terms and conditions under which 
they operated between September 30, 1995 and before October 1, 2003, 
and continued to operate under the terms and conditions in effect on 
September 30, 2003. At Sec.  412.22(h)(3) and (h)(4) we grandfathered 
of satellite facilities that were part of a hospital, that were in 
existence on September 30, 1999, and that met certain other conditions. 
Further, at Sec.  412.25(e)(3) and (e)(4), we grandfathered satellite 
facilities that were part of a hospital unit, were in existence on 
September 30, 1999, and that met certain other conditions.
    The regulations addressing ``separateness and control'' policies 
for each of the above types of entities are presently not entirely 
uniform. This situation has arisen, in part, because the policies were 
implemented at different times and also because there are differences 
among the types of entities. (For example, in the FY 2003 IPPS final 
rule (67 FR 49982 and 50105), we included a detailed discussion of the 
``performance of basic functions'' test utilized for HwHs and how this 
test was not applicable to satellite facilities.) There are also 
differences between

[[Page 24125]]

specific features of the grandfathering provisions for HwHs and 
satellite facilities, despite the fact that, as noted above, the intent 
of each of the grandfathering provisions was the same (for HwHs at 
Sec.  412.22(f), for satellite facilities of hospitals at Sec.  
412.22(h)(3)(i) and (h)(4), and for satellite facilities of hospital 
units at Sec.  412.25(e)(3) and (e)(4)). The regulations exempt certain 
of these entities from compliance with the ``separateness and control'' 
criteria governing the relationships with their host hospitals as long 
as they continue to operate under the same ``terms and conditions,'' 
including the number of beds and square footage considered to be part 
of the hospital or satellite facility, for purposes of Medicare 
participation and payment in effect as of the date that they were 
grandfathered.
    This particular policy was adopted because we believed that those 
entities that were designated as grandfathered, versus those that were 
required to meet the ``separateness and control'' requirements, should 
not be permitted to alter their operations from the ``snapshot in 
time'' taken when they were grandfathered and thus benefit even more 
from this status. (LTCH HwHs and satellite facilities of LTCHs that are 
not grandfathered are also subject to a payment adjustment at Sec.  
412.534 related to Medicare discharges of patients who were admitted 
from their host hospitals.) In other words, we believed that 
grandfathered facilities received a benefit not enjoyed by 
nongrandfathered facilities--namely, they were free from compliance 
with the ``separateness and control'' regulations and we did not want 
to allow these entities to realize additional economic advantages by 
expansion that would increase their Medicare payments by virtue of 
their grandfathered status. Furthermore, it has been our policy that if 
a grandfathered HwH or satellite facility of the HwH chooses not to 
operate under the same terms and conditions in effect as of its 
grandfathering, it could still be paid under the applicable excluded 
hospital payment system if it changed its relationship with its host to 
the extent that it has come into compliance with the applicable 
``separateness and control'' requirements.
    Because the underlying rationale for the grandfathering policies 
for both HwHs and satellite facilities of HwHs is the same, upon review 
of these various provisions, we believe that, where appropriate, the 
grandfathering provisions should be consistent. Under the authority of 
section 1871(a)(1) of the Act, which authorizes the Secretary to 
prescribe such regulations as may be necessary to carry out the 
administration of the Medicare program, we are proposing the following 
revisions to make the policies consistent. As set forth below, we are 
proposing to revise the HwH provision at Sec.  412.22(f) to include an 
exception to the requirement that a grandfathered HwH be operated under 
the terms and conditions in effect on October 1, 2003, that corresponds 
to the existing exceptions for HwH satellite facilities and for 
satellite facilities of hospital units at Sec.  412.22(h)(4) and 
412.25(e)(4), respectively. (As provided in Sec.  412.22(f), the 
original September 1, 1995, ``snapshot in time'' date for grandfathered 
HwHs was extended to hospitals that changed the terms and conditions 
under which they operated between September 1, 1995, and before October 
1, 2003, in the FY 2004 IPPS final rule (68 FR 45462).) Specifically, 
we are proposing a corresponding change to the HwH grandfathering 
provision at Sec.  412.22(f)(3) that would allow for increases or 
decreases in square footage, or decreases in the number of beds of the 
HwH that are needed for specific circumstances beyond the control of 
the facility. We are specifying that increases or decreases in square 
footage or decreases in the number of beds that are required because of 
the relocation of a facility to permit construction or renovation 
necessary for compliance with Federal, State, or local law affecting 
the physical facility or because of catastrophic events such as fires, 
floods, earthquakes, or tornadoes. (64 FR 14535) We are proposing to 
add some phraseology to the existing provision in Sec.  412.22(h)(4) 
for consistency with the regulations for grandfathered satellite 
facilities cited above.
    As noted above, our existing grandfathering regulations at 
Sec. Sec.  412.22(f), 412.22(h)(3) and (h)(4), and 412.25(e)(3) and 
(e)(4) require that the grandfathered entity make no change in either 
its square footage or number of beds in order to retain its 
grandfathered status. In establishing grandfathering provisions, 
generally, we intended to protect certain existing hospitals and 
satellite facilities from ``the potentially adverse impact of recent, 
more specific regulations that we now believe to be essential to the 
goals of the Medicare program'' (68 FR 45463). Moreover, it was our 
intention that our ``snapshot in time'' policy prevented grandfathered 
entities that were advantaged more than their nongrandfathered peer 
facilities as a result of their protected status from realizing 
additional benefits by changing their ``terms and conditions'' that 
could increase their Medicare reimbursement. However, as noted above, 
we did provide that a grandfathered HwH or satellite facility would 
have the option of changing square footage or number of beds if it 
decided to forego its grandfathered status and comply with the 
applicable ``separateness and control'' regulations.
    Recently, several grandfathered LTCH HwHs and satellite facilities 
questioned whether a decrease in their square footage or their number 
of beds would result in negating their grandfathered status, because 
compliance with the each of the above cited grandfathering provisions 
require that they continue to operate under the same terms and 
conditions, including the number of beds and square footage considered 
to be part of the hospital, the satellite facility, or the hospital 
unit in effect on the day that the grandfathering policy was 
implemented. We also have been urged to modify our policies to allow 
these grandfathered entities to increase in square footage and number 
of beds without requiring compliance with the ``separateness and 
control'' policies discussed above. Clearly, under existing 
regulations, a decrease or an increase in square footage or number of 
beds would result in a loss of status as a grandfathered HwH or 
hospital satellite facility (unless Sec.  412.22(h)(4) or Sec.  
412.25(b)(3) applies) because the existing regulations prohibit any 
change in the terms and conditions of operation, as described above.
    We had two objectives in establishing our grandfathering policy. 
The first was to allow existing HwHs and satellite facilities to 
continue to be paid outside of the IPPS, despite the fact that, among 
other factors, no demonstration of operational or organizational 
separateness between these grandfathered entities and their host 
hospitals were required, as they were for HwHs established after 
September 30, 1995, and for satellite facilities established after 
September 30, 1999. However, the second objective was to ensure that 
these entities would not make changes that would lead to increased 
costs to the Medicare program. The nexus of these two objectives has 
been the basis of our ``snapshot in time'' policy discussed above. (For 
HwHs, as noted above, the ``snapshot in time'' date for changes in 
``terms and conditions'' was extended to before October 1, 2003, if the 
HwH changed its terms and conditions under which it operated after 
September 30, 1995, but before October 1, 2003, in the FY 2004 IPPS 
final rule (68 FR 45462).)
    As a result of the requests that we reconsider our policy for an 
HwH or

[[Page 24126]]

satellite facility that decreases or increases square footage or number 
of beds, we revisited the requirement for grandfathered entities to 
continue to operate under the ``same terms and conditions'' in effect 
when they were grandfathered. We have determined that, although 
increases in square footage or number of beds would confer additional 
benefits on grandfathered entities, as compared with those HwHs and 
satellite facilities that were required to comply with ``separateness 
and control'' policies at Sec. Sec.  412.22(e), 412.22(h), and 
412.25(e) by allowing expansion and result in additional costs to the 
Medicare program, this would not be the case regarding a decrease in 
either the square footage or the numbers of beds because a decrease in 
the number of beds or square footage would not result in additional 
costs to the Medicare program. Therefore, we are proposing revisions to 
the regulations at Sec.  412.22(f) for grandfathered HwHs and at 
Sec. Sec.  412.22(h) and 412.25(e)(5) for grandfathered satellites of 
hospitals and satellites of hospital units, respectively, to allow 
these entities to decrease their square footage or number of beds, or 
both, without jeopardizing their grandfathered status. Specifically, we 
are proposing to add a new paragraph (f)(3) to Sec.  412.22; a new 
paragraph (h)(5) to Sec.  412.22(h) (existing paragraphs (h)(5) through 
(h)(7) would be redesignated as paragraphs (h)(6) through (h)(8), 
respectively); and a new paragraph (e)(5) to Sec.  412.25 (existing 
paragraph (e)(5) would be redesignated as paragraph (e)(6)). We are 
also proposing to revise the introductory text to paragraph (f) of 
Sec.  412.22; paragraphs (h)(1), (h)(3), and (h)(4) of Sec.  412.22; 
and paragraph (e)(3) of Sec.  412.25.
    Because grandfathered HwHs or grandfathered satellite facilities 
may be co-located with an acute care hospital or may be co-located with 
another excluded hospital (69 FR 49198), we want to emphasize that 
under our proposed policy revisions described above, where the HwH or 
satellite facility decreases its number of beds or square footage, 
there could be an impact on the host hospital if it is also 
grandfathered from compliance with the ``separateness and control'' 
requirements. (Because excluded hospitals are prohibited from having 
excluded hospital units under Sec.  412.25(a)(1)(ii), this discussion 
is limited to HwHs and satellite facilities of hospitals.) For example, 
if grandfathered HwH ``A'' is co-located with another hospital excluded 
from the IPPS, hospital ``B'' (which is a rehabilitation hospital), a 
decrease in the number of beds in hospital ``A'' could impact the 
grandfathered status of hospital ``B'' if hospital ``B'' absorbed the 
extra beds. In such a case, if the determination were made that 
hospital ``B'' would expand, in order to maintain status as an excluded 
hospital, hospital ``B'' would then have to meet the applicable 
``separateness and control'' requirements at Sec.  412.22(e).
6. Proposed Changes to the Methodology for Determining LTCH Cost-to-
Charge Ratios (CCRs) and the Reconciliation of High-Cost and Short-Stay 
Outlier Payments Under the LTCH PPS
a. Background
    In the June 9, 2003 high-cost outlier final rule (68 FR 34498), we 
made revisions to our policies concerning the determination of LTCHs' 
CCRs and the reconciliation of high-cost and short-stay outlier 
payments under the LTCH PPS. As we stated in that final rule, (68 FR 
34507), because the LTCH PPS high-cost outlier and short-stay outlier 
policies are modeled after the IPPS outlier policy, we believe they are 
susceptible to the same payment vulnerabilities and, therefore, merited 
revision. Specifically, because we believe that a hospital has the 
ability to inappropriately increase its outlier payments during the 
time lag between the current charges and the CCR from the settled cost 
report, through dramatic charge increases, we established new 
regulations under the LTCH PPS that would allow fiscal intermediaries 
to use more up-to-date data when determining the CCRs for each LTCH. We 
revised our regulations to specify that fiscal intermediaries will use 
either the most recent settled cost report or the most recent tentative 
settled cost report, whichever is from the later cost reporting period, 
because, in many cases, using CCRs from tentative settled cost report 
reduces the time lag for updating CCRs by a year or more.
    However, even the later CCRs calculated from the tentative settled 
cost reports would overestimate costs for hospitals that have continued 
to increase charges much faster than costs during the time between the 
tentative settled cost report and the time when the claim is processed. 
Therefore, we also revised the regulations to specify that, in the 
event more recent charge data indicate that an alternative CCR would be 
more appropriate, CMS has the authority to direct the fiscal 
intermediary to change the LTCH's CCR to reflect the change evidenced 
by the more recent data. In addition, we further revised the 
regulations to allow a hospital to contact its fiscal intermediary to 
request that its CCR, otherwise applicable, be changed if the LTCH 
presents substantial evidence that its CCR is inaccurate. (68 FR 34497 
and 34506 through 34508)
    Also in the June 9, 2003 final rule, we noted that as hospitals 
raise their charges faster than their costs increase, over time their 
CCRs will decline. If hospitals continue to increase charges at a 
faster rate than their costs increase over a long period of time, or if 
they increase charges at extreme rates, their CCRs may fall below the 
range considered reasonable and fiscal intermediaries may assign a 
statewide average CCR. These statewide averages are generally 
considerably higher than the threshold. Therefore, prior to the change 
in the regulations, these hospitals benefited from an artificially high 
ratio being applied to their already high charges. Furthermore, 
hospitals could continue to increase charges faster than costs, without 
any further downward adjustment to their CCR. Consequently, in that 
same final rule, we revised the regulations to specify that a fiscal 
intermediary may use a statewide average CCR if it is unable to 
determine an accurate CCR in one of three circumstances (discussed in 
greater detail below). (68 FR 34499 through 34500 and 34506 through 
34507)
    In addition, in the June 9, 2003 final rule (68 FR 34500 through 
34501 and 34506 through 34508), we noted that we had become 
increasingly aware that some hospitals had taken advantage of the 
former outlier policy by increasing their charges at extremely high 
rates, knowing that there would be a time lag before their CCRs would 
be adjusted to reflect the higher charges. We believed that even the 
revisions to the regulations described above would not completely 
eliminate all such opportunity. We explained that we believed that a 
hospital would still be able to dramatically increase its charges by 
far above the rate-of-increase in costs during any given year. Because 
this possibility was of great concern, we added a provision to our 
regulations to provide that outlier payments would become subject to 
reconciliation when hospitals' cost reports are settled.
    Because we continue to have these same concerns, in the RY 2007 
LTCH PPS proposed rule (71 FR 4648, 4674 through 4676, and 4690 through 
4692), we discussed our current methodology for determining hospitals' 
CCRs under the LTCH PPS high-cost and short-stay outlier policies, and 
we presented proposals to refine our methodology for determining the 
annual CCR ceiling and

[[Page 24127]]

statewide average CCRs. In that same proposed rule, we also discussed 
our existing policy for the reconciliation of LTCH PPS high-cost and 
short-stay outlier payments, along with our proposal to codify in 
Subpart O of 42 CFR Part 412 those policies, including proposed 
modifications and editorial clarifications to those existing policies.
    Historically, annual updates to LTCH CCR ceiling and statewide 
average CCRs have been effective on October 1. In that RY 2007 LTCH PPS 
proposed rule, we proposed that the proposed revisions to the policies 
governing the determination of LTCHs' CCRs and the reconciliation of 
high-cost and short-stay outlier payments would be effective October 1, 
2006. In addition, our proposal stated that the LTCH CCR ceiling and 
statewide average CCRs that would be effective October 1, 2006, would 
be presented in the annual IPPS proposed and final rules.
    We received a few specific comments concerning the proposed changes 
to the policies governing the determination of LTCHs' CCRs. Several 
other commenters referenced one of the specific comments on the 
proposed changes to the methodology for determining LTCH CCRs in their 
own comments on the RY 2007 LTCH PPS proposed rule. Based on one 
commenter's synopsis of our proposed changes concerning the 
determination of LTCH's CCRs, we believe that the commenters clearly 
understood the nature and purpose of the proposed changes. However, the 
commenter pointed out that, in the RY 2007 LTCH PPS proposed rule, we 
did not provide an analysis of the effect of this proposed change, nor 
did we provide an example of the new CCR values under this proposed 
methodology. Another commenter did not ``object in concept to the 
proposed combination of [IPPS] operating and capital cost-to-charge 
ratios'' (to compute a ``total'' CCR for each IPPS hospital by adding 
together each hospital's operating CCR and its capital CCR) from which 
to compute the LTCH CCR ceiling and applicable statewide average CCRs. 
However, the commenter also pointed out that we did not provide any 
impact data and requested that we defer adoption of that proposed 
change until such data are provided for comment.
    Therefore, we are proposing in this IPPS proposed rule the same 
changes to the policies governing the determination of LTCHs' CCRs and 
the reconciliation of high-cost and short-stay outlier payments that we 
proposed in the RY 2007 LTCH PPS proposed rule. We are including in 
this proposed rule the values of the proposed LTCH CCR ceiling 
(discussed below in this section) and the proposed statewide average 
LTCH CCRs (as shown in Table 8C of the Addendum to this IPPS proposed 
rule) that would be effective October 1, 2006, based on our proposed 
policy changes (along with the values of the proposed LTCH CCRs that 
would be determined under our current methodology).
b. High-Cost Outliers
    Under the broad authority conferred upon the Secretary by section 
123 of the BBRA as amended by section 307(b) of BIPA, when we 
implemented the LTCH PPS, we established an adjustment for additional 
payments for outlier cases that have extraordinarily high-costs 
relative to the costs of most discharges at Sec.  412.525(a). Providing 
additional payments for outliers strongly improves the accuracy of the 
LTCH PPS in determining resource costs at the patient level and 
hospital level. Specifically, under Sec.  412.525(a), we make outlier 
payments for any discharge if the estimated cost of the case exceeds 
the adjusted LTCH PPS payment for the LTC-DRG plus a fixed-loss amount. 
Under the LTCH PPS high-cost outlier policy, the LTCH's loss is limited 
to the fixed-loss amount and a fixed percentage of costs above the 
marginal cost factor. We calculate the estimated cost of a case by 
multiplying the overall hospital CCR by the Medicare allowable covered 
charge. In accordance with Sec.  412.525(a)(3), we pay outlier cases 80 
percent of the difference between the estimated cost of the patient 
case and the outlier threshold (the sum of the adjusted Federal 
prospective payment for the LTC-DRG and the fixed-loss amount).
(1) CCR Ceiling
    As noted above, we determine the estimated cost of the case by 
multiplying the LTCH's overall CCR by the Medicare allowable charges 
for the case. As we discussed in greater detail in the June 9, 2003 
IPPS high-cost outlier final rule (68 FR 34506 through 34516), because 
the LTCH PPS high-cost outlier policy (Sec.  412.525) is modeled after 
the IPPS outlier policy, we believed that it and the short-stay outlier 
policy (Sec.  412.529) are susceptible to the same payment 
vulnerabilities that became evident under the IPPS and, therefore, 
merited revision. Thus, we revised the high-cost outlier policy at 
Sec.  412.525(a) and the short-stay policy at Sec.  412.529 in that 
same final rule for the determination of LTCHs' CCRs and the 
reconciliation of outlier payments.
    Under the LTCH PPS, a single prospective payment per discharge is 
made for both inpatient operating and capital-related costs. Therefore, 
we compute a single ``overall'' or ``total'' CCR for LTCHs based on the 
sum of their operating and capital-related costs (as described in 
Chapter 3, section 150.24, of the Medicare Claims Processing Manual 
(CMS Pub. 100-4) as compared to total charges. Specifically, a LTCH's 
CCR is calculated by dividing an LTCH's total Medicare costs (that is, 
the sum of its operating and capital inpatient routine and ancillary 
costs) divided by its total Medicare charges (that is, the sum of its 
operating and capital inpatient routine and ancillary charges). 
(Instructions regarding the changes established in the June 9, 2003 
IPPS high-cost outlier final rule for both LTCHs and IPPS hospitals can 
be found in Program Transmittal A-03-058 (Change Request 2785; July 3, 
2003)).
    As a result of the changes established in the June 9, 2003 IPPS 
high-cost outlier final rule, as we discussed in previous LTCH PPS 
final rules (RY 2004, 68 FR 34144 through 34146; RY 2005, 69 FR 25687 
through 25690; and RY 2006, 70 FR 24192 through 24194), under our 
current policy, an LTCH is assigned the applicable statewide average 
CCR if, among other things, an LTCH's CCR is found to be in excess of 
the applicable maximum CCR threshold (that is, the combined IPPS 
operating and capital CCR ceiling). As we explained in that same final 
rule (68 FR 34507), CCRs above this threshold are most likely due to 
faulty data reporting or entry, and, therefore, these CCRs should not 
be used to identify and make payments for outlier cases. Such data are 
clearly errors and should not be relied upon. Thus, under our 
established policy, if an LTCH's CCR is above the applicable ceiling, 
the applicable combined IPPS statewide average CCR is assigned to the 
LTCH instead of the CCR computed from data in its most recent (settled 
or tentatively settled) cost report.
    As we explained in the RY 2006 LTCH PPS final rule (70 FR 24192), 
we believe it is appropriate to use the combined IPPS operating and 
capital CCR ceiling and the applicable combined IPPS statewide average 
CCRs in determining LTCHs' CCRs because LTCHs' cost and charge 
structures are similar to that of IPPS acute care hospitals. For 
instance, LTCHs are certified as acute care hospitals, as set forth in 
section 1861(e) of the Act, to participate as a hospital in the 
Medicare program, and these hospitals, in general, are paid as LTCHs 
only because their Medicare average length of stay is greater than 25 
days (Sec.  412.23(e)). Furthermore, as also explained in that

[[Page 24128]]

same final rule, prior to qualifying as a LTCH under Sec.  
412.23(e)(2)(i), a hospital generally is paid as an acute care hospital 
under the IPPS during the period in which it demonstrates that it has 
an average length of stay of greater than 25 days. In addition, because 
there are less than 400 LTCHs, and they are unevenly geographically 
distributed throughout the United States, there may not be sufficient 
LTCH CCR data to determine an appropriate LTCH PPS CCR ceiling using 
LTCH data.
    As noted above, under the LTCH PPS, there is a single prospective 
payment per discharge for both inpatient operating and capital-related 
costs, and therefore, we compute a single ``overall'' or ``total'' CCR 
for LTCHs based on the sum of their Medicare operating and capital-
related costs and charges. However, under the IPPS, Medicare per 
discharge payments to acute care hospitals for the costs of inpatient 
operating services are made under the ``operating IPPS'' and per 
discharge payments to acute care hospitals for inpatient capital-
related costs are made under the ``capital IPPS.'' Because separate 
payments are made to acute care hospitals under the IPPS for operating 
and capital-related costs, separate operating and capital CCRs are 
calculated and used in determining IPPS high-cost outlier payments. 
Accordingly, under the IPPS, a separate ``operating'' CCR ceiling and a 
``capital'' CCR ceiling are determined annually. As we explained above 
and as stated in annual instructions (Program Transmittal A-02-093 
(Change Request 2288, September 27, 2002); Program Transmittal A-03-073 
(Change Request 2891, August 22, 2003); Program Transmittal 309 (Change 
Request 3459, October 1, 2004); and Program Transmittal 692 (Change 
Request 4046, September 30, 2005)), under our current policy, if a 
LTCH's CCR is above the applicable ``combined'' IPPS operating and 
capital CCR ceiling (that is, adding the separate IPPS operating 
ceiling and the capital CCR ceiling together), the applicable statewide 
average CCR is assigned to the LTCH. For instance, for FY 2006, the 
IPPS operating CCR ceiling is 1.254 and the IPPS capital CCR ceiling is 
0.169 (70 FR 47496). Therefore, under our current policy, the 
``combined'' operating and capital CCR ceiling is 1.423 (1.254 + 0.169 
= 1.423) as specified in Program Transmittal 692 (Change Request 4046, 
September 30, 2005).
    Because LTCHs have a single ``total'' CCR (rather than separate 
operating and capital CCRs), under the broad authority of section 123 
of the BBRA and section 307(b)(1) of BIPA, we are proposing to revise 
Sec.  412.525(a)(4) to specify that, for discharges occurring on or 
after October 1, 2006, if, among other things, a LTCH's CCR is in 
excess of the LTCH CCR ceiling (which would be calculated as 3 standard 
deviations above the corresponding national geometric mean total CCR 
(established and published annually by CMS)), the fiscal intermediary 
may use a statewide average CCR (also established annually by CMS and 
discussed in more detail below). (We note, as discussed in greater 
detail below in this section, in conjunction with this proposed change 
in the calculation of the LTCH CCR ceiling, we are also proposing a 
change in our methodology for calculating the applicable statewide 
average CCRs under the LTCH PPS to be based on hospital-specific 
``total'' CCRs.)
    Specifically, under proposed revised Sec.  412.525(a)(4)(iv)(C)(2), 
for discharges occurring on or after October 1, 2006, we are proposing 
that we would determine the single ``total'' CCR ceiling, based on IPPS 
CCR data, by first calculating the total (that is, operating and 
capital) CCR for each hospital and then determining the average total 
CCR for all hospitals. For example, if a hospital's operating CCR is 
0.432 and its capital CCR is 0.027, its total CCR would be 0.459 (0.432 
+ 0.027 = 0.459). This calculation would be repeated for all hospitals 
in order to determine total CCRs for all hospitals. Next, those total 
CCRs would be used to determine the average total CCR and standard 
deviation across all hospitals. The LTCH CCR ceiling would then be 
established at 3 standard deviations from the mean total CCR, rather 
than determining the LTCH total CCR ceiling by adding the separate IPPS 
operating CCR and capital CCR ceilings, which are each separately 
determined at 3 standard deviations from the average operating CCR and 
average capital CCR, respectively, as we do under our current policy 
(as demonstrated above).
    Under this proposed policy, we would use the same IPPS CCR data 
that we currently use to annually determine the separate IPPS operating 
CCR and capital CCR ceilings (that we add together under our current 
policy to determine the annual CCR ceiling for LTCHs) to compute IPPS 
hospital-specific total CCRs that would be used to determine the single 
LTCH total CCR ceiling. We believe that determining a LTCH CCR ceiling 
based on IPPS total (operating and capital-related) Medicare costs and 
charges rather than adding the separate IPPS CCR ceilings determined 
from operating CCRs and capital CCRs, respectively, would be more 
consistent with the LTCH PPS single payment, which does not 
differentiate payments between operating and capital-related costs. Our 
rationale for proposing to continue to use IPPS data to determine the 
LTCH CCR ceiling annually continues to be the same as the one stated 
above.
    To summarize, our current methodology (that is, using the 
``combined'' IPPS CCR ceiling) calculates two separate IPPS CCRs (an 
operating CCR and a capital CCR) by taking 3 standard deviations from 
the average of all IPPS operating CCRs and 3 standard deviations from 
the average of all IPPS capital CCRs separately to determine the IPPS 
operating CCR ceiling and IPPS capital CCR ceiling, respectively. Then 
we added the IPPS operating CCR ceiling and the IPPS capital CCR 
ceiling together to get a combined'' LTCH CCR ceiling. The proposed 
methodology would add each IPPS hospital's operating CCR and its 
capital CCR together first to get a ``total'' CCR for each IPPS 
hospital, and then determine the average (that is, national geometric 
mean) of all of those total CCRs across all IPPS hospitals. Next we 
would take 3 standard deviations above the corresponding national 
geometric mean total CCR to calculate the LTCH CCR ceiling. The 
underlying data upon which this calculation is based, that is, the IPPS 
CCRs, would remain the same.
    Based on the most recent complete IPPS total CCR data from the 
December 2005 update to the Provider-Specific File, we are proposing a 
total CCR ceiling of 1.313 under the LTCH PPS that would be effective 
October 1, 2006. We note that this proposed ceiling was determined 
based on the same data used to determine the separate proposed IPPS 
operating CCR ceiling (1.25) and the proposed IPPS capital CCR ceiling 
(0.158) discussed in section II.A.4.c. of the Addendum to this proposed 
rule. Furthermore, we are proposing that, if more recent data are 
available (that is, data from the March 2006 update to the Provider-
Specific File, for example), we would use those data to determine the 
final total CCR ceiling under the LTCH PPS for FY 2007 using the 
proposed methodology described above.
    The LTCH CCR ceiling determined under our current ``combined'' 
methodology would result in a slightly higher LTCH CCR ceiling (that 
is, 1.25 + 0.158 = 1.408) for FY 2007 compared to the proposed 
``total'' CCR ceiling of 1.313 for FY 2007. However, we note that, 
based on CCRs from the December 2005 update of the Provider-Specific 
File, there were no LTCHs that have a CCR that is greater than the 
proposed ceiling of 1.313 (the highest LTCH CCR in the database of 363 
LTCHs is 1.132).

[[Page 24129]]

    As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4675), 
we are proposing to amend Sec.  412.525 by adding a new paragraph 
(a)(4)(iv)(C)(2) to reflect the refined methodology for determining the 
annual CCR ceiling under the LTCH PPS. We are proposing that the 
revision would be effective for discharges occurring on or after 
October 1, 2006, rather than July 1, 2006, because we are proposing to 
continue to use the same IPPS data used to determine the individual 
IPPS operating and capital CCR ceilings established and published 
annually in the IPPS proposed and final rules. Because both the 
separate IPPS operating and capital CCRs ceilings and the LTCH 
``total'' CCR ceiling would be determined using the same data, we 
believe it would be administratively expedient to continue to establish 
the LTCH CCR ceiling to be effective for discharges occurring on or 
after October 1 of each year. (As stated previously, this is consistent 
with our current policy, where the LTCH CCR ceiling is updated annually 
on October 1.) Therefore, under this proposal, the public would 
continue to consult the annual IPPS proposed and final rules for 
changes to the LTCH CCR ceiling that would be effective for discharges 
occurring on or after October 1. Under this proposal, the current LTCH 
CCR ceiling established for discharges occurring on or after October 1, 
2005, in the FY 2006 IPPS final rule would remain in effect for 
discharges occurring on or before September 30, 2006.
(2) Statewide Average CCRs
    In the June 9, 2003 IPPS high-cost outlier final rule, we also 
established our existing policy for discharges occurring on or after 
August 8, 2003, that, in addition to assigning the applicable statewide 
average CCR to a LTCH whose CCR is above the ceiling, the fiscal 
intermediary may use the applicable statewide average CCR for LTCHs for 
whom data with which to calculate a CCR are not available (for example, 
missing or faulty data) or for new LTCHs that have not yet submitted 
their first Medicare cost report. (For this purpose, a ``new'' LTCH is 
defined as an entity that has not accepted assignment of an existing 
hospital's provider agreement in accordance with Sec.  489.18.) We note 
that, consistent with our current policy, either CMS or the hospital 
may request the use of a different (higher or lower) CCR based on 
substantial evidence that such a CCR more accurately reflects the 
hospital's actual costs and charges. This applies to new LTCHs (as 
defined above) as well. For instance, CMS may determine that the 
applicable statewide average CCR should not be applied to hospitals 
that convert from acute care IPPS hospitals to LTCHs (and receive a new 
LTCH provider number). Rather, the cost and charge data from the IPPS 
hospital's cost report (even if they are for more or less than a 12-
month cost reporting period) would be used to determine the LTCH's CCR.
    Thus, in addition to proposing to revise our methodology for 
determining the annual CCR ceiling under the LTCH PPS for discharges 
occurring on or after October 1, 2006, under the broad authority of 
section 123 of the BBRA and section 307(b)(1) of BIPA, we are proposing 
to revise Sec.  412.525(a)(4), for discharges occurring on or after 
October 1, 2006, to codify in Subpart O of 42 CFR Part 412 the 
remaining LTCH PPS high-cost policy changes that were established in 
the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 
34513), including proposed modifications and editorial clarifications 
to those existing policies established in that final rule, which are 
discussed in greater detail below in this section. We are proposing 
these additional revisions to Sec.  412.525(a)(4) because we believe 
that making these revisions would more precisely describe the 
application of those policies as they relate to the determination of 
LTCH CCRs and because these proposed changes would be consistent with 
the proposed changes to the calculation of the LTCH CCR ceiling 
discussed above in this section.
    Specifically, we are proposing to specify in new Sec.  
412.525(a)(4)(iv)(C) that the fiscal intermediary may use a statewide 
average CCR, which would be established annually by CMS, if it is 
unable to determine an accurate CCR for a LTCH in one of the following 
three circumstances: (1) New LTCHs that have not yet submitted their 
first Medicare cost report (for this purpose, consistent with current 
policy, a new LTCH would be defined as an entity that has not accepted 
assignment of an existing hospital's provider agreement in accordance 
with Sec.  489.18); (2) LTCHs whose CCR is in excess of the LTCH CCR 
ceiling (that is, 3 standard deviations above the corresponding 
national geometric mean total CCR, as discussed in greater detail 
previously in this proposed rule); and (3) other LTCHs for whom data 
with which to calculate a CCR are not available (for example, missing 
or faulty data). (Other sources of data that the fiscal intermediary 
may consider in determining an LTCH's CCR included data from a 
different cost reporting period for the LTCH, data from the cost 
reporting period preceding the period in which the hospital began to be 
paid as an LTCH (that is, the period of at least 6 months that it was 
paid as a short-term acute care hospital), or data from other 
comparable LTCHs, such as LTCHs in the same chain or in the same 
region.)
    In addition, under proposed Sec.  412.525(a)(4)(iv)(C), for 
discharges occurring on or after October 1, 2006, we are proposing that 
we would annually establish statewide average ``total'' CCRs (as 
explained below in this section) for use under the LTCH PPS based on 
IPPS data rather than assigning the combined (operating and capital-
related) statewide average CCRs (Transmittal 692 (Change Request 4046, 
September 30, 2005)). Specifically, under this proposed policy, we 
would use the same IPPS CCR data that we currently use to annually 
establish the separate IPPS operating and capital statewide CCRs (that 
we add together under our current policy to determine the applicable 
``combined'' statewide average CCR for LTCHs) to compute statewide 
average total CCRs by first calculating the total (that is, operating 
and capital) CCR for each hospital and then determining the weighted 
average total CCR for all hospitals in each State rather than adding 
together the separate applicable IPPS operating and capital statewide 
weighted average CCRs as we do under our current policy.
    We also are proposing that these statewide average ``total'' 
(operating and capital) CCRs that would be used under the LTCH PPS 
would continue to be published annually in the IPPS proposed and final 
rules, and, therefore, the public would continue to consult the annual 
IPPS proposed and final rules for changes to the applicable statewide 
average total CCRs that would be effective for discharges occurring on 
or after October 1. Under this proposal, the current applicable 
statewide average operating and capital CCRs, established for 
discharges occurring on or after October 1, 2005, would remain in 
effect for discharges occurring on or before September 30, 2006. Our 
rationale for proposing to establish statewide average ``total'' CCRs 
(as described above in this section) based on IPPS data under proposed 
Sec.  412.525(a)(4)(iv)(C) is the same as the one stated above for 
proposing to use IPPS data to determine a ``total'' LTCH CCR ceiling.
    Under the current methodology, we determine a ``combined'' 
statewide average CCRs for LTCHs located in rural areas of a State that 
accounts for operating and capital costs and charges and a ``combined'' 
statewide average CCRs for LTCHs located in urban areas of a State that 
accounts for operating and capital-related costs and charges. In

[[Page 24130]]

order to calculate a combined statewide average CCR under our current 
methodology, we must first calculate separate statewide average 
operating CCRs and capital CCRs. Under the IPPS, two statewide average 
operating CCRs are computed for each State: a statewide average CCR for 
rural areas and a statewide average CCR for urban areas. One statewide 
average capital CCR is computed for each State (applicable to both 
urban and rural areas). We use the same capital CCR for urban and rural 
areas because capital costs are the same regardless of geographic 
location. Below, we outline our existing methodology for calculating 
the combined statewide average CCR for a rural LTCH:
    Step 1: Calculate the weighted average operating CCR for all IPPS 
hospitals located in rural areas of the State (as shown in the third 
column of Table 8A of the Addendum to this proposed rule).
    Step 2: Calculate the weighted average capital CCR for all IPPS 
hospitals located in the State (both rural and urban areas) (as shown 
in Table 8B of the Addendum to this proposed rule).
    Step 3: Add the weighted average rural operating CCR (Step 1) 
together with the weighted average capital CCR (Step 2) in order to 
arrive at a ``combined'' statewide average CCR for LTCHs in rural areas 
of the State.
    For example, for a rural LTCH located in Alabama, under our current 
methodology, the ``combined'' statewide average CCR for FY 2007 would 
be 0.360, computed as the operating statewide rural average CCR of 
0.334 (Table 8A of the Addendum to this proposed rule) plus the capital 
statewide average CCR 0.026 (Table 8B of the Addendum to this proposed 
rule). This same methodology is applied when determining the 
``combined'' statewide average CCR for LTCHs located in urban areas 
under our current methodology, except that in Step 1 we substitute the 
average operating CCR for all rural IPPS hospitals with the weighted 
average operating CCR for all urban IPPS hospitals for the State (as 
shown in the second column of Table 8A of the Addendum to this proposed 
rule) and in Step 3, we add the weighted average urban operating CCR in 
Step 1 to the weighted average capital CCR in Step 2 in order to arrive 
at a ``combined'' statewide average CCR for LTCHs in urban areas of the 
State.
    Under our proposed methodology for calculating a statewide average 
``total'' CCR under the LTCH PPS that accounts for operating and 
capital-related costs and charges, first, for each IPPS hospital, we 
would add its operating CCR and its capital CCR together to determine 
its ``total'' CCR. Then we would use the ``total'' CCRs for all urban 
IPPS hospitals in the State to compute a statewide average total CCR 
for the urban areas of a State, and we would use the ``total'' CCR for 
all rural IPPS hospitals in the State to compute a statewide average 
CCR for the rural areas of a State. Below, we outline our proposed 
methodology for calculating the total statewide average CCR for a rural 
LTCH:
    Step 1: Calculate the total CCR for each rural IPPS hospital by 
adding together its operating CCR and its capital CCR.
    Step 2: Calculate the weighted average total CCR for all rural IPPS 
hospitals in the State (as shown in the third column of Table 8C of the 
Addendum to this proposed rule). For example, for a rural LTCH located 
in Alabama, under our proposed methodology, the proposed ``total'' 
statewide average CCR for FY 2007 would be 0.365 (Table 8C of the 
Addendum to this proposed rule). This same proposed methodology would 
be applied when determining the ``total'' statewide average CCR for 
LTCHs located in urban areas, except that we would replace ``rural IPPS 
hospitals'' with ``urban IPPS hospitals'' in Steps 1 and 2. (The total 
statewide average CCRs for urban LTCHs is shown in the second column of 
Table 8A of the Addendum to this proposed rule.) Under this proposal, 
the underlying data, that is, the IPPS CCRs, would remain the same.
    Based on the most recent complete IPPS total CCR data from the 
December 2005 update of the Provider-Specific File, the proposed LTCH 
PPS statewide average CCRs that would be effective October 1, 2006, are 
presented in Table 8C of the Addendum to this proposed rule. (We note 
that, as is the case under the IPPS, all areas in the District of 
Columbia, New Jersey, Puerto Rico, and Rhode Island are classified as 
urban, and therefore, there are no proposed rural statewide average 
total CCRs listed for those jurisdictions in Table 8C of the Addendum 
to this proposed rule. We also note that, as is the case under the 
IPPS, although Massachusetts has areas that are designated as rural, 
there are no short-term acute care IPPS hospitals or LTCHs located in 
those areas as of March 2006, and therefore, there is no proposed rural 
statewide average total CCR listed for rural Massachusetts in Table 8C 
of the Addendum of this proposed rule.) Furthermore, we are proposing 
that, if more recent data are available (that is, data from the March 
2006 update of the Provider-Specific File, for example), we would use 
those data to determine the final LTCH PPS statewide average CCRs for 
FY 2007 using the proposed methodology describe above.
    Comparing the proposed statewide average ``total'' CCRs in Table 8C 
of the Addendum to this proposed rule to the ``combined'' statewide 
average CCRs that would be calculated using our existing methodology 
from the proposed operating PPS statewide average CCRs in Table 8A of 
the Addendum to this proposed rule and the proposed capital PPS 
statewide average CCRs in Table 8B of the Addendum to this proposed 
rule shows that the proposed changes to our methodology for determining 
LTCH statewide average CCRs would result in only minor changes in the 
average CCR for each State. In particular, the largest decrease in a 
statewide average CCR (with the exception of Maryland, as discussed 
below) would be in urban Indiana (-1.9 percent). However, there are 
currently no LTCHs located in Indiana. The largest increase in a 
statewide average CCR would be in urban District of Columbia (2.8 
percent), and there are currently only 2 LTCHs located in the District 
of Columbia.
    We are proposing to determine the urban and rural statewide average 
total CCRs for Maryland LTCHs paid under the LTCH PPS using, as a 
proxy, the national average total CCR for urban IPPS hospitals and the 
national average total CCR for rural IPPS hospitals, respectively. We 
are proposing this proxy because we believe that the CCR data on the 
Provider-Specific File for Maryland hospitals may not be accurate. We 
believe that the CCR data based on Maryland hospitals' cost report and 
charge data may not be accurate because acute care hospitals in 
Maryland are operating under a waiver of the Medicare's ratesetting 
methodologies for inpatient and outpatient services under the 
authorities of sections 1814(b)(3) and 1833(a)(2) of the Act. The 
State's Health Services Cost Review Commission (HSCRC) is the 
regulatory body that establishes hospital-specific rates for all 
hospital services in Maryland.
    Because all Maryland short-term acute care hospitals are paid based 
on the hospital-specific rates set by the HSCRC rather than under the 
IPPS, CCRs are not required to determine their Medicare payments (as 
they are for other acute care hospitals that are not governed under the 
waiver at sections 1814(b)(3) and 1833(a)(2) of the Act, and who are 
reimbursed for their treatment of Medicare patients under the IPPS). 
Therefore, CCRs in the Provider-Specific File for Maryland acute care 
hospitals, for the most part, are missing (because they are not used 
for payment). Those CCRs that are input into the Provider-

[[Page 24131]]

Specific File for Maryland acute care hospitals by the fiscal 
intermediary are most likely unaudited because they are not used for 
making payments. For all these reasons, we are concerned that CCRs for 
Medicare acute care hospitals located in Maryland that are in the 
Provider-Specific File may not be reliable. Therefore, we believe that 
they should not be used as proxies for setting the statewide average 
total CCRs for Maryland LTCHs.
    We believe it would be more appropriate to establish statewide 
average total CCRs for Maryland LTCHs based on national average total 
CCRs of IPPS hospitals that were audited by fiscal intermediaries. We 
are proposing to establish statewide average total CCRs for Maryland 
LTCHs based on the national average total CCRs of all IPPS hospitals 
because we believe that the average of the CCRs of all the IPPS 
hospitals across the country that were audited by fiscal intermediaries 
would be based on sufficient rigorous complete data that would be a 
representative proxy for the ratio of costs-to-charges of LTCHs in 
Maryland that are subject to LTCH PPS. (We note that, under our 
proposal, the fiscal intermediary may assign the statewide average CCR 
in one of three circumstances (that is, ``new'' LTCHs, as defined 
above; LTCHs with a CCR that is in excess of the LTCH ceiling; and 
LTCHs with unavailable data, as discussed above)).
    However, we are soliciting comments or suggestions for an 
alternative proxy statewide average CCR to use for LTCHs that are 
located in Maryland and are paid under the LTCH PPS.
(3) Data Used to Determine a CCR
    Similar to our current policy, we are also proposing to specify 
under proposed new Sec.  412.525(a)(4)(iv)(B) that, for discharges 
occurring on or after October 1, 2006, the CCR applied at the time a 
claim is processed would be based on either the most recent settled 
cost report or the most recent tentatively settled cost report, 
whichever is from the latest cost reporting period. Furthermore, we are 
proposing under proposed new Sec.  412.525(a)(4)(iv)(A) to state that 
CMS may specify an alternative to the CCR computed under proposed new 
Sec.  412.525(a)(4)(iv)(B); that is, the CCR computed from the most 
recent settled cost report or the most recent tentatively settled cost 
report, whichever is later, or a hospital may also request that the 
fiscal intermediary use a different (higher or lower) CCR based on 
substantial evidence presented by the hospital. These proposed 
revisions to our policy for determining a LTCH's CCR for discharges 
occurring on or after October 1, 2006, under proposed revised new Sec.  
412.525(a)(4)(iv)(A) and (B) are similar to our existing policy 
established in the June 9, 2003 IPPS high-cost outlier final rule (68 
FR 34506 through 34513). In addition, we are proposing a technical 
correction to existing Sec.  412.525(a)(3) to change the plural 
reference from cost-to-charge ``ratios'' to the singular reference to a 
cost-to-charge ``ratio'' because, under the LTCH PPS, a single (total) 
CCR is computed for LTCHs.
(4) Reconciliation of High-Cost Outlier Payments Upon Cost Report 
Settlement
    In the June 9, 2003 high-cost outlier final rule (68 FR 34508 
through 34512), we established a policy for LTCHs that provided that, 
effective for LTCH PPS discharges occurring on or after August 8, 2003, 
any reconciliation of outlier payments will be based upon the actual 
CCR computed from the costs and charges incurred in the period during 
which the discharge occurs. In that same final rule, we also 
established that, for discharges occurring on or after August 8, 2003, 
at the time of any reconciliation, outlier payments may be adjusted to 
account for the time value of any underpayments or overpayments based 
upon a widely available index to be established in advance by the 
Secretary and will be applied from the midpoint of the cost reporting 
period to the date of reconciliation. These changes regarding the 
reconciliation of outlier payments under the LTCH PPS were made in 
conjunction with the changes regarding the determination of LTCHs' CCRs 
that we established under Sec.  412.525(a)(4) in the June 9, 2003 IPPS 
high-cost outlier final rule, as discussed in greater detail in section 
IV.D.3.b. of this preamble. (We note that the instructions for 
implementing these regulations under both the IPPS and the LTCH PPS are 
discussed in further detail in Program Transmittal A-03-058. Additional 
information on the administration of the reconciliation process under 
the IPPS is provided in Program Transmittal 707 (Change Request 3966, 
October 12, 2005). We note that, in addition to the proposed changes to 
the high-cost outlier and short-stay outlier policies presented in this 
proposed rule, we are currently developing additional instructions on 
the administration of the existing reconciliation process under the 
LTCH PPS that would be similar to the IPPS reconciliation process.)
    As discussed above, we are proposing, for discharges occurring on 
or after October 1, 2006, to codify into the LTCH PPS section of the 
regulations (Subpart O of 42 CFR Part 412) the provisions governing the 
determination of LTCHs' CCRs, including proposed modifications and 
editorial clarifications to our existing methodology for determining 
the annual LTCH CCR ceiling and applicable statewide average CCRs under 
the LTCH PPS.
    In this proposed rule, under the broad authority of section 123 of 
the BBRA and section 307(b)(1) of BIPA, we are also proposing to revise 
Sec.  412.525(a)(4), for discharges occurring on or after October 1, 
2006, to codify in Subpart O of 42 CFR Part 412 the provisions 
discussed above concerning the reconciliation of LTCH PPS outlier 
payments, including proposed editorial clarifications discussed in 
greater detail below in this section, that would more precisely 
describe the application of those policies. We are proposing the 
additional revisions to Sec.  412.525(a)(4) concerning the 
reconciliation of outlier payments, which are discussed in greater 
detail below in this section, because these proposed changes would be 
consistent with the proposed changes to the calculation of the LTCH CCR 
ceiling discussed above.
    Specifically, at proposed new Sec.  412.525(a)(4)(iv)(D), similar 
to our current policy, we are proposing to specify that, for discharges 
occurring on or after October 1, 2006, any reconciliation of outlier 
payments would be based on the CCR calculated based on a ratio of costs 
to charges computed from the relevant cost report and charge data 
determined at the time the cost report coinciding with the discharge is 
settled. In addition, at proposed new Sec.  412.525(a)(4)(iv)(E), 
similar to our current policy, we are proposing to specify that, for 
discharges occurring on or after October 1, 2006, at the time of any 
reconciliation, outlier payments may be adjusted to account for the 
time value of any underpayments or overpayments. Consistent with our 
current policy, we also are proposing that such an adjustment would be 
based upon a widely available index to be established in advance by the 
Secretary and would be applied from the midpoint of the cost reporting 
period to the date of reconciliation.
    We are proposing to make these additions to Sec.  412.525(a)(4) 
because we believe that such proposed changes reinforce the concept 
that the LTCH PPS has a single payment rate for inpatient operating and 
capital-related costs (as discussed in greater detail previously), and 
because we believe it would be more appropriate and administratively 
simpler to include all of the regulatory provisions concerning the 
determination of LTCH PPS outlier payments applicable under the LTCH

[[Page 24132]]

PPS regulations in Subpart O of 42 CFR Part 412.
c. Short-Stay Outliers
(1) Background
    When we implemented the LTCH PPS, under Sec.  412.529, we 
established a special payment policy for short-stay outlier cases, that 
is, LTCH PPS cases with a length of stay that is less than or equal to 
five-sixths of the geometric average length of stay for each LTC-DRG. 
As noted previously, generally LTCHs are defined by statute as having 
an average length of stay of greater than 25 days. We believe that a 
short-stay outlier payment adjustment results in more appropriate 
payments, because these cases most likely would not receive a full 
course of a LTCH-level of treatment in such a short period of time and 
a full LTC-DRG payment may not always be appropriate. Under the 
existing short-stay outlier policy at Sec.  412.529, for LTCH PPS 
discharges with a length of stay of up to and including five-sixths the 
geometric average length of stay for the LTC-DRG, in general, we adjust 
the per discharge payment under the LTCH PPS by the least of 120 
percent of the estimated cost of the case, 120 percent of the LTC-DRG 
specific per diem amount multiplied by the length of stay of that 
discharge, or the full LTC-DRG payment. (We note we have proposed 
changes to this general payment formula in the RY 2007 LTCH PPS 
proposed rule (71 FR 4679).) Consistent with the LTCH PPS high-cost 
outlier policy, we calculate the estimated cost of a case by 
multiplying the overall hospital CCR by the Medicare allowable covered 
charge.
(2) Determination of LTCH CCRs and Reconciliation
    In the June 9, 2003 IPPS outlier final rule (68 FR 34507), we 
revised the short-stay policy at Sec.  412.529 (and the high-cost 
outlier policy at Sec.  412.525(a)) because, as we discussed above in 
this section, we believed that the short-stay outlier (and high-cost 
outlier) policy are susceptible to the same payment vulnerabilities 
that became evident under the IPPS and, therefore, merited revision. 
Therefore, in the regulations under existing Sec.  412.529(c)(5)(ii) 
and (iii), we established a policy for the determination of LTCH CCRs 
and the reconciliation of short-stay outlier payments, for discharges 
occurring on or after August 8, 2003 (Sec.  412.529(c)(5)(ii)) and 
October 1, 2003 (Sec.  412.529(c)(5)(iii)), respectively. (As noted 
above in this section, in that same final rule, we established the same 
changes to the high-cost outlier policy at existing Sec.  
412.525(a)(4)(ii) and (iii).)
    As we discuss above in this section, we are proposing to revise the 
existing regulations at Sec.  412.525(a)(4) to codify in Subpart O of 
42 CFR Part 412 the provisions governing the determination of LTCHs' 
CCRs, including proposed modifications and editorial clarifications to 
our existing methodology for determining the annual LTCH CCR ceiling 
and applicable statewide average CCRs under the LTCH PPS, and the 
provisions governing the reconciliation of high-cost outlier payments.
    We are proposing these changes, as we discuss in greater detail 
below in this section, because we believe that such proposed changes 
would be more consistent with the LTCH PPS single payment rate, and 
because we believe it would be more appropriate and administratively 
simpler to include the regulatory provisions that pertain only to LTCHs 
for the determination of LTCH PPS outlier payments applicable under the 
LTCH PPS regulations in Subpart O of 42 CFR Part 412 (as opposed to 
Subpart A). Because CCRs are also used in determining short-stay 
outlier payments under Sec.  412.529, we are proposing, under the broad 
authority of section 123 of the BBRA as amended by section 307(b)(1) of 
BIPA, to revise Sec.  412.529(c) consistent with the proposed changes 
to Sec.  412.525(a)(4) discussed above in this section.
    Specifically, we are proposing in new Sec.  412.529(c)(5)(iv)(C)(2) 
to specify that, for discharges occurring on or after October 1, 2006, 
if, among other things, a LTCH's CCR is in excess of the LTCH CCR 
ceiling (which would be calculated as 3 standard deviations above the 
corresponding national geometric mean CCR (established and published 
annually by CMS)), the fiscal intermediary may use a statewide average 
CCR (also established annually by CMS). (We note that, similar to our 
current policy, we are also proposing under proposed Sec. Sec.  
412.529(c)(5)(iv)(C)(1) and (3) that the fiscal intermediary may use a 
statewide average CCR in two other circumstances, which are discussed 
in greater detail below in this section.)
    Under our current methodology for determining the LTCH CCR ceiling, 
we add together the separate IPPS operating CCR ceiling and IPPS 
capital CCR ceiling, which are determined at 3 standard deviations from 
the average operating CCR and average capital CCR, respectively. Under 
proposed Sec.  412.529(c)(5)(iv)(C)(2), for discharges occurring on or 
after October 1, 2006, we are proposing that we would determine the 
single ``total'' CCR ceiling (as we proposed under the high-cost 
outlier policy at proposed Sec.  412.525(a)(4)(iv)(C)(2), as explained 
previously in this section) by first calculating the total (that is, 
operating and capital) CCR for each IPPS hospital and then determining 
the average total CCR for all IPPS hospitals. For example, if an IPPS 
hospital's operating CCR is 0.432 and its capital CCR is 0.027, its 
total CCR would be 0.459 (0.432 + 0.027 = 0.459). This calculation 
would be repeated for all IPPS hospitals in order to determine a total 
CCR for each IPPS hospital. Next, those total CCRs would be used to 
determine the average total CCR. Once the average total CCR across all 
IPPS hospitals is determined, we would take 3 standard deviations above 
the corresponding national geometric mean total CCR (in the previous 
step) to determine the LTCH CCR ceiling. This proposed change is 
similar to the proposed change to the LTCH PPS high-cost outlier policy 
discussed previously in this section. (We note, as discussed in greater 
detail below in this section, in conjunction with this proposed change 
in the calculation of the LTCH CCR ceiling, we are also proposing a 
change in our methodology for calculating the applicable statewide 
average CCRs under the LTCH PPS to be based on ``total'' hospital-
specific CCRs.)
    Specifically, we are proposing under the short-stay outlier policy 
at proposed new Sec.  412.529(c)(5)(iv)(C) to use the same IPPS CCR 
data that we currently use to annually determine the separate IPPS 
operating CCR and capital CCR ceilings (that we add together under our 
current policy to determine the annual CCR ceiling for LTCHs) to 
compute the single LTCH ``total'' CCR ceiling based on IPPS hospital-
specific total (operating and capital-related) Medicare costs and 
charges, as explained above in this section.
    In other words, our current methodology (that is, using the 
``combined'' IPPS CCR ceiling) calculates two separate IPPS CCRs (an 
operating CCR and a capital-related CCR) by taking 3 standard 
deviations from the average of all IPPS operating CCRs and 3 standard 
deviations from the average of all IPPS capital CCRs separately to 
determine the IPPS operating CCR ceiling and the IPPS capital CCR 
ceiling, respectively. Then we added the IPPS operating CCR ceiling and 
the IPPS capital CCR ceiling together to get a ``combined'' LTCH PPS 
ceiling. The proposed methodology would add each IPPS hospital's 
operating CCR and its capital CCR together first, to get a ``total'' 
CCR and then take the average of all of those total

[[Page 24133]]

CCRs across all IPPS hospitals to calculate a ceiling (that is, 3 
standard deviations above the corresponding national geometric mean 
total CCR). The underlying data, upon which this calculation is based, 
that is, the IPPS CCRs, would remain the same.
    As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4691), 
under this proposal, the total CCR ceiling would continue to be 
published annually in the IPPS proposed and final rules and, therefore, 
the public should continue to consult the annual IPPS proposed and 
final rules for changes to the applicable LTCH PPS statewide average 
total CCRs that would be effective for discharges occurring on or after 
October 1, 2006 (because, under this proposal the current applicable 
combined statewide average CCRs, established for discharges occurring 
on or after October 1, 2005 in the FY 2006 IPPS final rule, would 
remain in effect for discharges occurring on or before September 30, 
2006.) The rationale for this proposed change to the short-stay outlier 
policy at proposed Sec.  412.529(c)(5)(iv)(C) mirrors the rationale 
provided for the proposed changes to the high-cost outlier policy at 
proposed Sec.  412.525(a)(4)(iv)(C) discussed above in this section.
    Therefore, in this proposed rule, based on the most recent complete 
IPPS total CCR data from the December 2005 update of the Provider-
Specific File, we are proposing a total CCR ceiling of 1.313 under the 
LTCH PPS that would be effective October 1, 2006. We note that this 
proposed ceiling was determined based on the same data used to 
determine to the separate proposed IPPS operating CCR ceiling (1.25) 
and the proposed IPPS capital CCR ceiling (0.158) discussed in section 
II.A.4.c. of the Addendum to this proposed rule. Furthermore, we are 
proposing that, if more recent data are available (that is, data from 
the March 2006 update of the Provider-Specific File, for example), we 
would use that data to determine the final total CCR ceiling under the 
LTCH PPS for FY 2007 using the proposed methodology described above. As 
noted previously in this section, the LTCH CCR ceiling determined under 
our current ``combined'' methodology would result in a slightly higher 
LTCH CCR ceiling (that is. 1.25 + 0.158 = 1.408) for FY 2007 compared 
to the proposed ``total'' CCR ceiling of 1.313 for FY 2007. However, we 
note that, based on CCRs from the December 2005 update of the Provider-
Specific File, there were no LTCHs that have a CCR that is greater than 
the proposed ceiling of 1.313 (the highest LTCH CCR in the database of 
363 LTCHs is 1.132).
    Consistent with the proposed changes to Sec. Sec.  
412.525(a)(4)(iv)(A) through (C), under the broad authority of section 
123 of the BBRA and section 307(b)(1) of BIPA, we are also proposing at 
new Sec. Sec.  412.529(c)(5)(iv)(A) through (C), for discharges 
occurring on or after October 1, 2006, to codify in Subpart O of 42 CFR 
Part 412 the remaining LTCH PPS short-stay outlier policy changes 
concerning the determination of LTCHs' CCRs that were established in 
the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 
34513), including proposed modifications and editorial clarifications 
to those existing policies established in that final rule in order to 
more precisely describe the application of those policies as they 
relate to LTCHs.
    Specifically, similar to our current policy and consistent with the 
proposed changes to the high-cost outlier policy at Sec.  412.525(a)(4) 
discussed previously in this section, we are proposing in Sec.  
412.529(c)(5)(iv)(C) to specify that the fiscal intermediary may use a 
statewide average CCR, which would be established annually by CMS, if 
it is unable to determine an accurate CCR for a LTCH in one of the 
following three circumstances: (1) New LTCHs that have not yet 
submitted their first Medicare cost report (for this purpose, 
consistent with current policy, a new LTCH would be defined as an 
entity that has not accepted assignment of an existing hospital's 
provider agreement in accordance with Sec.  489.18); (2) LTCHs whose 
CCRs are in excess of the LTCH CCR ceiling (that is, 3 standard 
deviations above the corresponding national geometric mean total CCR); 
and (3) other LTCHs for whom data with which to calculate a CCR are not 
available (for example, missing or faulty data). (As noted above, other 
sources of data that the fiscal intermediary may consider in 
determining a LTCH's CCR include data from a different cost reporting 
period for the LTCH, data from the cost reporting period preceding the 
period in which the hospital began to be paid as a LTCH (that is, the 
period of at least 6 months that it was paid as a short-term acute care 
hospital), or data from other comparable LTCHs, such as other LTCHs in 
the same chain or in the same region. As also noted above and 
consistent with our current regulations, either CMS or the hospital may 
request the use of a different (higher or lower) CCR based on 
substantial evidence that such a CCR more accurately reflects the 
hospital's actual costs and charges. This applies to new LTCHs (as 
defined above) as well. For instance, CMS may determine that the 
applicable statewide average CCR should not be applied to hospitals 
that convert from acute care IPPS hospitals to LTCHs (and receive a new 
LTCH provider number). Rather, the cost and charge data from the IPPS 
hospital's cost report (even if it is for more or less than a 12-month 
cost reporting period) would be used to determine the LTCH's CCR.)
    In addition, similar to our current practice and consistent with 
the proposed change to the high-cost outlier policy discussed 
previously in this proposed rule under Sec.  412.525(a)(4)(iv)(C), we 
are proposing that, under Sec.  412.529(c)(5)(iv)(C), for discharges 
occurring on or after October 1, 2006, we would annually establish 
statewide average ``total'' CCRs for use under the LTCH PPS based on 
IPPS data by first calculating the total (that is, operating and 
capital) CCR for each hospital and then determining the weighted 
average total CCR for all hospitals in each State rather than assigning 
the combined (operating and capital) statewide weighted average CCRs, 
as we do under our current policy. Specifically, in proposing to 
compute statewide average total CCRs, we would use the same IPPS CCR 
data that we currently use to annually establish the separate IPPS 
operating statewide average CCRs and capital statewide CCRs (that we 
add together under our current policy to determine the applicable 
``combined'' statewide average CCR for LTCHs) to compute statewide 
average total CCRs as explained above in this section.
    To summarize, our current methodology (that is, using the 
``combined'' IPPS operating and capital statewide average CCRs) 
calculates two separate IPPS average CCRs for each State (an operating 
statewide average CCR (one average CCR for urban areas and another 
average CCR for rural areas) and a capital statewide average (for all 
areas within each State)) by taking the weighted average of all IPPS 
operating CCRs in each State (for urban areas and for rural areas 
separately) and the weighted average of all IPPS capital CCRs in each 
State (for all areas), and then adding the two averages together for 
the particular State to get a ``combined'' statewide average CCR (one 
for urban areas and one for rural areas). The proposed methodology 
would add each IPPS hospital's operating CCR and its capital CCR 
together first, and then takes the weighted average of all of those 
total CCRs for all urban IPPS hospitals in the State to get the urban 
statewide average CCR and for all rural IPPS hospitals in the State to 
get the rural statewide average CCR. This process is repeated for each 
State

[[Page 24134]]

(except Maryland, as discussed below). The underlying data, that is, 
the IPPS CCRs, would remain the same. In this proposed rule, based on 
the most recent complete IPPS total CCR data from the December 2005 
update of the Provider-Specific File, the proposed LTCH PPS statewide 
average CCRs that would be effective October 1, 2006 are presented in 
Table 8C of the Addendum to this proposed rule. (We note that, as is 
the case under the IPPS, all areas in the District of Columbia, New 
Jersey, Puerto Rico, and Rhode Island are classified as urban, and 
therefore, there are no proposed rural statewide average total CCRs 
listed for those jurisdictions in Table 8C of the Addendum to this 
proposed rule. We also note that, as is the case under the IPPS, 
although Massachusetts has areas that are designated as rural, there 
are no short-term acute care IPPS hospitals or LTCHs located in those 
areas as of March 2006, and therefore, there is no proposed rural 
statewide average total CCR listed for rural Massachusetts in Table 8C 
of the Addendum of this proposed rule.)
    Furthermore, as stated above, we are proposing that, if more recent 
data are available (that is, data from the March 2006 update of the 
Provider-Specific File, for example), we would use those data to 
determine the final LTCH PPS statewide average CCRs for FY 2007 using 
the proposed methodology described above.
    As we also noted above, we are proposing to determine the urban and 
rural statewide average total CCRs for Maryland LTCHs paid under the 
LTCH PPS using, as a proxy, the national average total CCR for urban 
IPPS hospitals and the national average total CCR for rural IPPS 
hospitals, respectively. We are proposing this proxy because we believe 
that the CCR data on the Provider-Specific File for Maryland hospitals 
may not be accurate. As discussed in greater detail above, we believe 
that the CCR data in the Provider-Specific File based on Maryland 
short-term acute care hospitals' cost report and charge data may not be 
reliable because acute care hospitals in Maryland are waived from 
Medicare's ratesetting methodologies for inpatient and outpatient 
services under the authorities of sections 1814(b)(3) and 1833(a)(2) of 
the Act. The State's HSCRC is the regulatory body that establishes 
hospital-specific rates for all hospital services in Maryland. Because 
Maryland hospitals are paid based on the hospitals-specific rates set 
by HSCRC rather than under the IPPS, CCRs are not required to determine 
their Medicare payments (as they are for other acute care hospitals 
that are not governed under the waiver in sections 1814(b)(3) and 
1833(a)(2) of the Act, and who are reimbursed for their treatment of 
Medicare patients under the IPPS). Therefore, as discussed above, CCRs 
in the Provider-Specific File for Maryland acute care hospitals, for 
the most part, are missing or unaudited (because they are not used for 
making payments).
    Thus, we believe it would be more appropriate to establish 
statewide average total CCRs for Maryland LTCHs based on a national 
average total CCRs of IPPS hospitals that were audited by fiscal 
intermediaries. We are proposing to establish statewide average total 
CCRs for Maryland based on the national average total CCRs of all IPPS 
hospitals because we believe that the average of the CCRs of all of the 
IPPS hospitals across the country that were audited by fiscal 
intermediaries would be based on sufficient rigorous complete data that 
would be a representative proxy for the ratio of costs to charges of 
LTCHs located in Maryland that are subject to the LTCH PPS. (We note, 
that under our proposal, the fiscal intermediary may assign the 
statewide average CCR in one of three circumstances (that is, ``new'' 
LTCHs, as defined above; LTCHs with a CCR that is in excess of the LTCH 
CCR ceiling; and LTCHs with unavailable data, as discussed above).) 
However, we are soliciting comments on suggestions for an alternative 
proxy statewide average CCR to use for LTCHs that are located in 
Maryland that are paid under the LTCH PPS.
    In addition, under this proposal, the statewide average total CCRs 
would continue to be published annually in the IPPS proposed and final 
rules and, therefore, the public would continue to consult the annual 
IPPS proposed and final rules for changes to the applicable LTCH PPS 
statewide average total CCRs that would be effective for discharges 
occurring on or after October 1, 2006 (because, under this proposal, 
the current applicable combined statewide average CCRs, established for 
discharges occurring on or after October 1, 2005, in the FY 2006 IPPS 
final rule, would remain in effect for discharges occurring on or 
before September 30, 2006). Our rationale for this proposed change to 
the short-stay outlier policy at proposed Sec.  412.529(c)(5)(iv)(C) 
mirrors the rationale provided for the proposed changes to the high-
cost outlier policy at proposed Sec.  412.525(a)(4)(iv)(C) discussed in 
greater detail above in this section.
    We also are proposing under Sec.  412.529(c)(5)(iv)(B), similar to 
our current policy and consistent with the proposed change to the high-
cost outlier policy discussed above, for discharges occurring on or 
after October 1, 2006, that the CCR applied at the time a claim is 
processed would be based on either the most recent settled cost report 
or the most recent tentative settled cost report, whichever is from the 
latest cost reporting period. We are proposing under Sec.  
412.529(c)(5)(iv)(A) that CMS may specify an alternative to the CCR 
computed from the most recent settled cost report or the most recent 
tentative settled cost report, whichever is later, or a hospital may 
also request that its fiscal intermediary use a different (higher or 
lower) CCR based on substantial evidence presented by the hospital. As 
noted previously in this proposed rule, these proposed revisions to our 
policy for determining a LTCH's CCR for discharges occurring on or 
after October 1, 2006, under proposed revised Sec.  
412.529(c)(5)(iv)(A) and (B) are similar to our existing policy 
established in the June 9, 2003 IPPS high-cost outlier final rule (68 
FR 34506 through 34513) and consistent with the proposed changes to the 
high-cost outlier policy previously discussed in this proposed rule.
    Furthermore, similar to our current policy and consistent with the 
proposed change to the high-cost outlier policy discussed previously in 
this section, under the broad authority under section 123 of the BBRA 
as amended by section 307(b) of BIPA, we are also proposing under Sec.  
412.529(c)(5)(iv), for discharges occurring on or after October 1, 
2006, to codify in the LTCH PPS regulations (Subpart O of 42 CFR Part 
412) the outlier reconciliation provisions that were established in the 
June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 
34513), including proposed editorial clarifications to those provisions 
(which are the same as the proposed changes to the high-cost outlier 
policy discussed above in this section).
    Specifically, under proposed Sec.  412.529(c)(5)(iv)(D), similar to 
our current policy and consistent with the proposed change to the high-
cost outlier policy, we are proposing to specify that, for discharges 
occurring on or after October 1, 2006, any reconciliation of outlier 
payments would be based on the CCR calculated based on a ratio of costs 
to charges computed from the relevant cost report and charge data 
determined at the time the cost report coinciding with the discharge is 
settled. In addition, at proposed Sec.  412.529(c)(5)(iv)(E), similar 
to our current policy and consistent with the proposed change to the 
high-cost outlier policy, we are proposing to specify that, for 
discharges occurring on or after October 1, 2006, at the time of any 
reconciliation, outlier payments may be

[[Page 24135]]

adjusted to account for the time value of any underpayments or 
overpayments. This adjustment would be based upon a widely available 
index that would be established in advance by the Secretary and would 
be applied from the midpoint of the cost reporting period to the date 
of reconciliation. Our rationale for these proposed changes to the 
short-stay outlier policy at proposed Sec.  412.529(c)(5)(iv)(D) and 
(E) mirrors the rationale provided for the proposed changes to the 
high-cost outlier policy at proposed Sec.  412.525(a)(4)(iv)(D) and 
(E), discussed in greater detail above in this section.
7. Technical Corrections Relating to LTCHs
    We are proposing to make the following technical changes to various 
sections of the regulations relating to LTCHs to update or correct 
cross-references or to include inadvertently omitted provisions:
    a. In the following sections, we are proposing to correct several 
incorrect cross-references in the existing regulations:
     In Sec.  412.505(b)(1), changing the cross-reference 
``Sec.  412.22(e) and (h)(5)'' to the phrase ``Sec.  412.22(e)(3) and 
(h)(6), if applicable''.
     In Sec.  412.508(c)(3), changing the cross-reference 
``Sec.  1001.301'' to ``Sec.  1001.201.''
     In Sec.  412.541(b)(2)(i), changing the cross-reference 
``Sec.  412.533(b)'' to ``Sec.  412.533(a)(5) and Sec.  412.533(c)'' to 
correctly refer to the provisions on the determination of the LTCH PPS 
rates.
    b. We are proposing to revise Sec.  412.511 to change the cross-
reference ``Sec.  412.22(e) and (h)(5)'' to the phrase ``Sec.  
412.22(e)(3) and (h)(6)'' and to clarify the requirement that LTCHs 
must meet under Sec. Sec.  412.22(e)(3) and (h)(6) to report co-
location status as part of its overall reporting requirements.
    c. We are proposing to revise Sec.  412.525(d) by adding new 
paragraphs (d)(3) and (d)(4) to specify two additional payment 
adjustments to the per discharge payments under the LTCH PPS that were 
inadvertently omitted; that is, the special payment under the onsite 
transfer and readmission policy at Sec.  412.532 and the special 
payment provisions for LTCH HwHs and satellites of LTCHs at Sec.  
412.534.
    d. We are proposing to revise Sec.  412.532(a)(2) to correct the 
cross-reference to the definition of a satellite facility by changing 
``Sec.  412.22(f)'' to ``Sec.  412.22(h)''. In addition, we are 
proposing to revise paragraph (b) of Sec.  412.532 to include satellite 
facilities and SNFs as part of the definition of entities that may be 
``co-located'' or ``onsite'' with a hospital. In existing Sec.  
412.532, (a)(2) and (a)(3), we include satellite facilities and SNFs, 
respectively, within the onsite provider payment policy as entities 
that may be co-located with a LTCH, but omitted to mention them in 
Sec.  412.533(b) as being included when we defined ``co-located or 
onsite'' facilities. We are proposing to conform Sec.  412.532(b) to 
include their mention.
8. Proposed Cross-Reference Correction in Authority Citations for 42 
CFR Parts 412 and 413
    As stated earlier, on November 15, 2004, we published in the 
Federal Register the final rule establishing a PPS for IPFs (69 FR 
66922). As a part of that rule, we amended the authority citations for 
42 CFR parts 412 and 413 to include references to section 124 of Public 
Law 106-113. Section 124 directed us to take various actions regarding 
a per diem PPS for IPFs. We included incorrect cross-references to the 
United States Statutes at Large citation for this provision. We are 
proposing to amend the authority citations for parts 412 and 413 by 
removing the incorrect cross-reference to ``113 Stat. 1515'' and 
inserting the correct cross-reference ``113 Stat. 1501A-332''.

B. Critical Access Hospitals (CAHs)

    (If you choose to comment on this section, please include the 
caption ``CAHs'' at the beginning of your comment.)
1. Background
    Section 1820 of the Act provides for the establishment of Medicare 
Rural Hospital Flexibility Programs (MRHFPs), under which individual 
States may designate certain facilities as critical access hospitals 
(CAHs). Facilities that are so designated and meet the CAH conditions 
of participation under 42 CFR part 485, Subpart F, will be certified as 
CAHs by CMS. Regulations governing payments to CAHs for services to 
Medicare beneficiaries are located in 42 CFR part 413.
2. Sunset of Designation of CAHs as Necessary Providers: Technical 
Correction
    Under section 1820(c)(2)(B)(i) of the Act, a CAH is required to be 
located more than a 35-mile drive (or in the case of mountainous 
terrain or only secondary roads, a 15-mile drive) from a hospital or 
another CAH, unless the CAH is certified by the State as a necessary 
provider of health care services to residents in the area. Section 
405(h) of Public Law 108-173 amended section 1820(c)(2)(B)(i)(II) of 
the Act by adding language that terminated a State's authority to waive 
the location requirement for a CAH by designating the CAH as a 
necessary provider, effective January 1, 2006. As a result of this 
amendment, as of January 1, 2006, States are no longer able to 
designate CAH status based upon a determination that an entity is a 
necessary provider of health care. However, section 405(h) of Public 
Law 108-173 also included a grandfathering provision for CAHs that are 
certified as necessary providers prior to January 1, 2006. Under this 
provision, a CAH that is designated as a necessary provider in its 
State's rural health plan prior to January 1, 2006, is permitted to 
maintain its necessary provider designation.
    The regulations that specify the location requirements for CAHs 
described above are set forth at 42 CFR 485.610(c). To implement the 
amendment made by section 405(h) of Public Law 108-173, we published a 
final rule in the Federal Register on August 11, 2004 (69 FR 49271) to 
revise the regulations under paragraph (c) of Sec.  485.610. In that 
revision, we inadvertently included an erroneous date: In the second 
sentence of paragraph (c), we stated that a CAH that is designated as a 
necessary provider as of October 1, 2006, will maintain its necessary 
provider designation after October 1, 2006. Although a correction 
notice was published in the Federal Register on October 7, 2004 (69 FR 
60252), the notice corrected only the second citation of the date in 
that paragraph. As a result, the second sentence of Sec.  485.610(c) 
continues to state, incorrectly, that a CAH that is designated as a 
necessary provider as of October 1, 2006, will maintain its necessary 
provider designation as of January 1, 2006.
    To avoid further confusion, and to ensure that the regulations 
implementing the CAH location requirement under section 
1820(c)(2)(B)(i)(II) of the Act specify that requirement accurately, we 
are proposing to revise the second sentence of Sec.  485.610(c) to 
state that a CAH that was designated as a necessary provider on or 
before December 31, 2005, will maintain its necessary provider 
designation as of January 1, 2006. We note that this change would 
merely correct the previous error and does not reflect any change in 
our policy as to how the statutory provision is implemented.

[[Page 24136]]

VII. Payment for Services Furnished Outside the United States

    (If you choose to comment on this section, please include the 
caption ``Services Outside the United States'' at the beginning of your 
comment.)

A. Background

    Section 1862(a)(4) of the Act generally prohibits payment under 
Medicare for items and services furnished outside the United States. 
Under sections 1861(x) and 210(i) of the Act, ``United States'' is 
defined to include the 50 States, the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, and America Samoa. Furthermore, under 
Public Law 94-241, ``those laws which provide Federal services and 
financial assistance programs'' apply to the Northern Mariana Islands 
to the same extent as they do to Guam. In addition, we have interpreted 
the term ``United States'' as including U.S. territorial waters. We 
consider shipboard services furnished in a port of the United States or 
within 6 hours before arrival at, or departure from, a port of the 
United States to be furnished in the United States territorial waters. 
(54 FR 41723) Therefore, in our regulations at Sec.  411.9(a), we 
define the United States to include the 50 States, the District of 
Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, the 
Northern Mariana Islands, and for purposes of services furnished on 
board ship, the territorial waters adjoining the land areas of the 
United States. This general prohibition has exceptions, under which 
payment may be made for inpatient hospital services, emergency 
inpatient hospital services, and for physician and ambulance services 
associated with these hospital services that are furnished outside the 
United States.
    Payment may be made for inpatient hospital services if a Medicare 
beneficiary who is a United States resident received these services at 
a hospital located outside of the United States that either was closer 
to, or was substantially more accessible from, the beneficiary's 
residence than the nearest United States hospital that was adequately 
equipped and available to treat the beneficiary. Payment may be made 
for emergency inpatient hospital services if a beneficiary was in the 
United States (or in Canada while traveling between Alaska and another 
State without unreasonable delay and by the most direct route) when the 
emergency arose, and the hospital located outside the United States was 
closer to, or substantially more accessible from, the place where the 
emergency arose than the nearest available adequately equipped hospital 
within the United States. Payment may be made for physician and 
ambulance services furnished in connection with these inpatient and 
emergency inpatient hospital services. Our existing regulations that 
implement these statutory provisions are located at 42 CFR 409.3, 
409.5, 410.14, 410.66, 411.9, 413.74 and Subparts G and H of Part 424.

B. Proposed Clarification of Regulations

    Services that fall under these exceptions typically are furnished 
in Canada or Mexico. However, in accordance with section 1814(f) of the 
Act and the definition of the term ``United States'' (42 CFR 411.9(a)), 
it is permissible for Medicare to pay for services furnished in foreign 
countries other than Canada and Mexico. For example, if a Medicare 
beneficiary who is in Guam needed emergency inpatient hospital services 
and the nearest available hospital adequately equipped to treat that 
beneficiary was located in the Philippines, Medicare payment would be 
permitted for the services.
    Several of our existing regulations (Sec. Sec.  409.3, 409.5, 
410.66, and 413.74) specifically refer to services furnished in Canada 
and Mexico and do not indicate that it is permissible for Medicare 
payment to be made for services furnished in other foreign countries. 
The references in these sections also are more limited than the 
provisions of 42 CFR part 424, subpart H, the portion of our 
regulations that addresses treatment furnished in a foreign country. 
Therefore, we are proposing to amend those regulations that refer to 
Canada and Mexico in order to conform them to the Act and to our other 
regulations addressing these situations.
    We also are proposing to make some related technical changes. In 
Sec. Sec.  409.3(e) and 424.123(c)(2), we are proposing to change the 
references from the Joint Commission on Accreditation of Hospitals 
(JCAH) to the Joint Commission on Accreditation of Healthcare 
Organizations (JCAHO), the current name of that organization. In Sec.  
424.121(c), we are proposing to change the obsolete cross-reference 
from Sec.  405.313 to the correct cross-reference, Sec.  411.9.

VIII. Payment for Blood Clotting Factor Administered to Inpatients With 
Hemophilia

    (If you choose to comment on the issues in this section, please add 
the caption ``Blood Clotting Factor'' at the beginning of your 
comment.)
    Section 1886(a)(4) of the Act excludes the costs of administering 
blood clotting factors to inpatients with hemophilia from the 
definition of ``operating costs of inpatient hospital services.'' 
Section 6011(b) of Pub. L. 101-239 states that the Secretary of Health 
and Human Services shall determine the payment amount made to hospitals 
under Medicare Part A for the costs of administering blood clotting 
factors to individuals with hemophilia by multiplying a predetermined 
price per unit of blood clotting factor by the number of units provided 
to the individual. The regulations governing payment for blood clotting 
factors furnished to hospital inpatients and for payment for the 
furnishing fee are located in Sec. Sec.  412.2(f)(8) and 412.115(b).
    In FY 2005, we made payments for blood clotting factors furnished 
to inpatients at 95 percent of average wholesale price (AWP), 
consistent with the rates then paid under section 1842(o) of the Act 
for Medicare Part B drugs (including blood clotting factor furnished to 
beneficiaries who are not inpatients).
    Section 303 of Pub. L. 108-173 added section 1847A to the Act. 
Effective January 1, 2005, this section requires that almost all 
Medicare Part B drugs not paid on a cost or prospective basis be paid 
at 106 percent of average sales price (ASP), while section 1842(o)(5) 
of the Act provides for a Medicare Part B payment of a furnishing fee 
for blood clotting factor. On November 15, 2004, we published 
regulations in the Federal Register (69 FR 66310 through 66319) that 
implemented the provisions of section 1847A of the Act. These 
regulations are codified at Subpart K of Part 414 and Sec.  410.63, 
respectively.
    The furnishing fee is updated each calendar year as specified by 
section 1842(o)(5) of the Act. The furnishing fee for clotting factor 
for years after CY 2005 is equal to the fee for the previous year 
increased by the percentage increase in the consumer price index (CPI) 
for medical care for the 12-month period ending with June of the 
previous year. This requirement is set forth in our regulations at 
Sec.  410.63.
    In the FY 2006 IPPS final rule (70 FR 47473), we amended our 
regulations at Sec. Sec.  412.2(f)(8) and 412.115(b) to state that, for 
discharges occurring on or after October 1, 2005, we make payment for 
blood clotting factor administered to hospital inpatients using the 
Medicare Part B payment amounts for blood clotting factor as determined 
under subpart K of 42 CFR part 414 and for the furnishing fee as 
determined under Sec.  410.63.

[[Page 24137]]

    On November 21, 2005, we issued regulations in the Federal Register 
(70 FR 70225) updating the furnishing fee payment amount for CY 2006. 
We announced that the increase in the CPI for medical care for the 12 
months ending June 30, 2005 was 4.2 percent. Consequently, the 
furnishing fee for CY 2006, initially established effective January 1, 
2005, at $0.14 per unit of clotting factor, for CY 2006 was set at 
$0.146 per individual unit (I.U.) for blood clotting factor. We 
indicated in the preamble to that rule that while ``the furnishing fee 
payment rate is calculated at 3 digits, the actual amount paid to 
providers and suppliers is rounded to 2 digits.''
    The fiscal intermediaries continue to use the Medicare Part B Drug 
Pricing File to make payments for blood clotting factor. The furnishing 
fee is included in the ASP price per unit sent with the Medicare Part B 
Drug Pricing File that is updated annually. By using the Medicare Part 
B Drug Pricing File, Medicare will be making consistent payments for 
blood clotting factor provided to inpatients and outpatients. For 
further updates on pricing, we refer readers to the Medicare Part B 
drug pricing regulations.

IX. Limitation on Payments to Skilled Nursing Facilities for Bad Debt

A. Background

    Under section 1861(v)(1) of the Act and Sec.  413.89 of our 
existing regulations, Medicare may pay for uncollectible deductible and 
coinsurance amounts to those entities eligible to receive payment for 
bad debt. Under our existing regulations, Medicare generally pays 100 
percent of allowable bad debt amounts to SNFs, CAHs, rural health 
clinics, federally qualified health clinics, community mental health 
clinics, health maintenance organizations reimbursed on a cost basis, 
competitive medical plans, and health care prepayment plans. To 
determine if bad debt amounts are allowable, the requirements at Sec.  
413.89 and the Provider Reimbursement Manual (PRM) (CMS Pub.15 Part 1, 
Chapter 3) must be met.
    However, under our existing regulations, Medicare payments for 
allowable bad debt amounts for hospitals are reduced by 30 percent. 
Moreover, Medicare does not pay for bad debt amounts arising from 
anesthetists' services paid under a fee schedule. In addition, although 
Medicare pays end-stage renal disease (ESRD) facilities 100 percent of 
allowable bad debt claims, these payments are capped at facilities' 
unrecovered cost (Sec.  413.178 of the regulations).

B. Changes Made by Section 5004 of Pub. L. 109-171

    Section 5004 of Pub. L. 109-171 (DRA of 2005) amended section 
1861(v)(1) of the Act to mandate that, for cost reporting periods 
beginning on or after October 1, 2005, Medicare payments to SNFs for 
certain allowable bad debt amounts be reduced. Specifically, for 
patients that are not full-benefit dual eligible individuals (as 
defined in section 1935(c)(6)(A)(ii) of the Act), allowable bad debt 
amounts attributable to the coinsurance amounts under the Medicare 
program are reduced by 30 percent (deductibles are not applicable to 
patients in SNFs). Allowable bad debt amounts for patients that are 
full-benefit dual eligible individuals (as defined in section 
1935(c)(6)(A)(ii) of the Act) will continue to be paid at 100 percent.

C. Proposed Regulation Changes

    We are proposing to conform the Medicare regulations under Sec.  
413.89 to the provisions of section 5004 of Pub. L. 109-171. 
Specifically, we are proposing to revise paragraph (h) by redesignating 
the existing contents as paragraph (h)(1) and add a new paragraph 
(h)(2) to reflect this payment limitation. We are proposing to include 
in proposed paragraph (h)(2) a cross-reference to the definition of 
``full-benefit dual eligible individual'' found at Sec.  423.772 of our 
regulations. In addition, we are proposing to revise Sec.  413.89(a) to 
add a cross-reference to the existing limitations on payments to 
hospitals and the new limitations on payments to SNFs found in 
paragraph (h), and to correct the cross-reference to the exception for 
payments for bad debts arising from anesthetists' services paid under a 
fee schedule from ``paragraph (h)'' to ``paragraph (i).''

X. MedPAC Recommendations

    (If you choose to comment on issues in this section, please include 
the caption ``MedPAC Update Recommendation'' at the beginning of your 
comment.)
    We are required by section 1886(e)(4)(B) of the Act to respond to 
MedPAC's IPPS recommendations in our annual proposed IPPS rule. We have 
reviewed MedPAC's March 2006 ``Report to the Congress: Medicare Payment 
Policy'' and have given it careful consideration in conjunction with 
the proposed policies set forth in this document. MedPAC's 
Recommendation 2A states that ``The Congress should increase payment 
rates for the acute inpatient and outpatient prospective payment 
systems in 2007 by the projected increase in the hospital market basket 
index less half of the Commission's expectation for productivity 
growth.'' This recommendation is discussed in Appendix B to this 
proposed rule.
    In section II.C. of the preamble of this proposed rule, we further 
address MedPac's 2005 recommendations included in Recommendation 1 in 
the March 2005 Report to Congress on Physician-Owned Specialty 
Hospitals as well as Recommendation 3, which recommended that the 
Secretary implement MedPAC's recommended policies over a transition 
period. The recommendations in Recommendation 1 relate to refining the 
DRGs used under the IPPS to more fully capture differences in severity 
of illness among patients; basing the DRG relative weights on the 
estimated cost of providing care rather than on charges; and basing the 
weights on the national average of hospitals' relative values in each 
DRG. In section II.E. of the preamble to this proposed rule, we also 
further address Recommendation 2 of the March 2005 Report on Physician-
Owned Specialty Hospitals, which recommended adjusting the DRG relative 
weights to account for differences in the prevalence of high-cost 
outlier cases.
    For further information relating specifically to the MedPAC reports 
or to obtain a copy of the reports, contact MedPAC at (202) 653-7220, 
or visit MedPAC's Web site at: http://www.medpac.gov.

XI. Other Required Information

A. Requests for Data From the Public

    In order to respond promptly to public requests for data related to 
the prospective payment system, we have established a process under 
which commenters can gain access to raw data on an expedited basis. 
Generally, the data are available in computer tape or cartridge format; 
however, some files are available on diskette as well as on the 
Internet at http://www.cms.hhs.gov/providers/hipps. Data files and the 
cost for each file, if applicable, are listed below. Anyone wishing to 
purchase data tapes, cartridges, or diskettes should submit a written 
request along with a company check or money order (payable to CMS-PUF) 
to cover the cost to the following address: Centers for Medicare & 
Medicaid Services, Public Use Files, Accounting Division, P.O. Box 
7520, Baltimore, MD 21207-0520, (410) 786-3691. Files on the Internet 
may be downloaded without charge.

[[Page 24138]]

1. CMS Wage Data
    This file contains the hospital hours and salaries for FY 2003 used 
to create the proposed FY 2007 prospective payment system wage index. 
The file will be available by the beginning of February for the NPRM 
and the beginning of May for the final rule.

------------------------------------------------------------------------
    Processing year           Wage data year          PPS fiscal year
------------------------------------------------------------------------
             2006                     2003                     2007
             2005                     2002                     2006
             2004                     2001                     2005
             2003                     2000                     2004
             2002                     1999                     2003
             2001                     1998                     2002
             2000                     1997                     2001
             1999                     1996                     2000
             1998                     1995                     1999
             1997                     1994                     1998
             1996                     1993                     1997
             1995                     1992                     1996
             1994                     1991                     1995
             1993                     1990                     1994
             1992                     1989                     1993
             1991                     1988                     1992
------------------------------------------------------------------------

    These files support the following:
     NPRM published in the Federal Register.
     Final Rule published in the Federal Register.
    Media: Diskette/most recent year on the Internet
    File Cost: $165.00 per year
    Periods Available: FY 2007 PPS Update
2. CMS Hospital Wages Indices (Formerly: Urban and Rural Wage Index 
Values Only)
    This file contains a history of all wage indices since October 1, 
1983.
    Media: Diskette/most recent year on the Internet
    File Cost: $165.00 per year
    Periods Available: FY 2007 PPS Update
3. FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW 
by Provider
    This file includes each hospital's adjusted and unadjusted average 
hourly wage.
    Media: Internet
    Periods Available: FY 2007 PPS Update
4. FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW 
and Pre-Reclassified Wage Index by CBSA
    This file includes each CBSA's adjusted and unadjusted average 
hourly wage.
    Media: Internet
    Periods Available: FY 2007 PPS Update
5. Provider Occupational Mix Adjustment Factors for Each Occupational 
Category
    This file contains each hospital's occupational mix adjustment 
factors by occupational category.
    Media: Internet
    Periods Available: FY 2007 PPS Update
6. PPS SSA/FIPS MSA State and County Crosswalk
    This file contains a crosswalk of State and county codes used by 
the Social Security Administration (SSA) and the Federal Information 
Processing Standards (FIPS), county name, and a historical list of 
Metropolitan Statistical Areas (MSAs).
    Media: Diskette/Internet
    File Cost: $165.00 per year
    Periods Available: FY 2007 PPS Update
7. Reclassified Hospitals New Wage Index (Formerly: Reclassified 
Hospitals by Provider Only)
    This file contains a list of hospitals that were reclassified for 
the purpose of assigning a new wage index. Two versions of these files 
are created each year. They support the following:
     NPRM published in the Federal Register.
     Final Rule published in the Federal Register.
    Media: Diskette/Internet
    File Cost: $165.00 per year
    Periods Available: FY 2007 PPS Update
8. PPS-IV to PPS-XII Minimum Data Set
    The Minimum Data Set contains cost, statistical, financial, and 
other information from Medicare hospital cost reports. The data set 
includes only the most current cost report (as submitted, final 
settled, or reopened) submitted for a Medicare participating hospital 
by the Medicare fiscal intermediary to CMS. This data set is updated at 
the end of each calendar quarter and is available on the last day of 
the following month.
    Media: Tape/Cartridge
    File Cost: $770.00 per year

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    and before
                                                on or after
------------------------------------------------------------------------
PPS-IV........................................     10/01/86     10/01/87
PPS-V.........................................     10/01/87     10/01/88
PPS-VI........................................     10/01/88     10/01/89
PPS-VII.......................................     10/01/89     10/01/90
PPS-VIII......................................     10/01/90     10/01/91
PPS-IX........................................     10/01/91     10/01/92
PPS-X.........................................     10/01/92     10/01/93
PPS-XI........................................     10/01/93     10/01/94
PPS-XII.......................................     10/01/94     10/01/95
------------------------------------------------------------------------


    (Note: The PPS-XIII, PPS-XIV, PPS-XV, PPS-XVI, PPS-XVII, PPS-
XVIII, PPS-XIX PPS-XX, and PPS-XXI Minimum Data Sets are part of the 
PPS-XIII, PPS-XIV, PPS-XV, PPS-XVI, PPS-XVII, PPS-XVIII, PPS-XIX, 
PPS-XX, and PPS-XXI Hospital Data Set Files (refer to item 10 
below).)

9. PPS-IX to PPS-XII Capital Data Set
    The Capital Data Set contains selected data for capital-related 
costs, interest expense and related information and complete balance 
sheet data from the Medicare hospital cost report. The data set 
includes only the most current cost report (as submitted, final settled 
or reopened) submitted for a Medicare certified hospital by the 
Medicare fiscal intermediary to CMS. This data set is updated at the 
end of each calendar quarter and is available on the last day of the 
following month.
    Media: Tape/Cartridge
    File Cost: $770.00 per year

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    and before
                                                on or after
------------------------------------------------------------------------
PPS-IX........................................     10/01/91     10/01/92
PPS-X.........................................     10/01/92     10/01/93
PPS-XI........................................     10/01/93     10/01/94
PPS-XII.......................................     10/01/94     10/01/95
------------------------------------------------------------------------


    (Note: The PPS-XIII, PPS-XIV, PPS-XV, PPS-XVI, PPS-XVII, PPS-
XVIII, PPS-XIX PPS-XX, and PPS-XXI Capital Data Sets are part of the 
PPS-XIII, PPS-XIV, PPS-XV, PPS-XVI, PPS-XVII, PPS-XVIII, PPS-XIX, 
PPS XX, and PPS-XXI Hospital Data Set Files (refer to item 10 
below).)

10. PPS-XIII to PPS-XXI Hospital Data Set
    The file contains cost, statistical, financial, and other data from 
the Medicare Hospital Cost Report. The data set includes only the most 
current cost report (as submitted, final settled, or reopened) 
submitted for a Medicare-certified hospital by the Medicare fiscal 
intermediary to CMS. The data set is updated at the end of each 
calendar quarter and is available on the last day of the following 
month.
    Media: Diskette/Internet
    File Cost: $2,500.00

------------------------------------------------------------------------
                                                  Periods
                                                 beginning    and before
                                                on or after
------------------------------------------------------------------------
PPS-XIII......................................     10/01/95     10/01/96
PPS-XIV.......................................     10/01/96     10/01/97
PPS-XV........................................     10/01/97     10/01/98
PPS-XVI.......................................     10/01/98     10/01/99
PPS-XVII......................................     10/01/99     10/01/00
PPS-XVIII.....................................     10/01/00     10/01/01
PPS-XIX.......................................     10/01/01     10/01/02
PPS-XX........................................     10/01/02     10/01/03
PPS-XXI.......................................     10/01/03     10/01/04
------------------------------------------------------------------------


[[Page 24139]]

11. Provider-Specific File
    This file is a component of the PRICER program used in the fiscal 
intermediary's system to compute DRG payments for individual bills. The 
file contains records for all prospective payment system eligible 
hospitals, including hospitals in waiver States, and data elements used 
in the prospective payment system recalibration processes and related 
activities. Beginning with December 1988, the individual records were 
enlarged to include pass-through per diems and other elements.
    Media: Diskette/Internet
    File Cost: $265.00
    Periods Available: FY 2007 PPS Update
12. CMS Medicare Case-Mix Index File
    This file contains the Medicare case-mix index by provider number 
as published in each year's update of the Medicare hospital inpatient 
prospective payment system. The case-mix index is a measure of the 
costliness of cases treated by a hospital relative to the cost of the 
national average of all Medicare hospital cases, using DRG weights as a 
measure of relative costliness of cases. Two versions of this file are 
created each year. They support the following:
     NPRM published in the Federal Register.
     Final rule published in the Federal Register.
    Media: Diskette/most recent year on Internet
    Price: $165.00 per year/per file
    Periods Available: FY 1985 through FY 2007
13. DRG Relative Weights (Formerly Table 5 DRG)
    This file contains a listing of DRGs, DRG narrative descriptions, 
relative weights, and geometric and arithmetic mean lengths of stay as 
published in the Federal Register. The hard copy image has been copied 
to diskette. There are two versions of this file as published in the 
Federal Register:
     NPRM.
     Final rule.
    Media: Diskette/Internet
    File Cost: $165.00
    Periods Available: FY 2007 PPS Update
14. PPS Payment Impact File
    This file contains data used to estimate payments under Medicare's 
hospital inpatient prospective payment systems for operating and 
capital-related costs. The data are taken from various sources, 
including the Provider-Specific File, Minimum Data Sets, and prior 
impact files. The data set is abstracted from an internal file used for 
the impact analysis of the changes to the prospective payment systems 
published in the Federal Register. This file is available for release 1 
month after the proposed and final rules are published in the Federal 
Register.
    Media: Diskette/Internet
    File Cost: $165.00
    Periods Available: FY 2007 PPS Update
15. AOR/BOR Tables
    This file contains data used to develop the DRG relative weights. 
It contains mean, maximum, minimum, standard deviation, and coefficient 
of variation statistics by DRG for length of stay and standardized 
charges. The BOR tables are ``Before Outliers Removed'' and the AOR is 
``After Outliers Removed.'' (Outliers refer to statistical outliers, 
not payment outliers.)
    Two versions of this file are created each year. They support the 
following:
     NPRM published in the Federal Register.
     Final rule published in the Federal Register.
    Media: Diskette/Internet
    File Cost: $165.00
    Periods Available: FY 2007 PPS Update
16. Prospective Payment System (PPS) Standardizing File
    This file contains information that standardizes the charges used 
to calculate relative weights to determine payments under the 
prospective payment system. Variables include wage index, cost-of-
living adjustment (COLA), case-mix index, disproportionate share, and 
the Metropolitan Statistical Area (MSA). The file supports the 
following:
     NPRM published in the Federal Register.
     Final rule published in the Federal Register.
    Media: Internet.
    File Cost: No charge.
    Periods Available: FY 2007 PPS Update.
    For further information concerning these data tapes, contact the 
CMS Public Use Files Hotline at (410) 786-3691.
    Commenters interested in obtaining or discussing any other data 
used in constructing this rule should contact Mark Hartstein at (410) 
786-4548.

B. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995 (PRA), we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the PRA requires that we 
solicit comment on the following issues:
     The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
     The accuracy of our estimate of the information collection 
burden.
     The quality, utility, and clarity of the information to be 
collected.
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    The following information collection requirements included in this 
proposed rule and their associated burdens are subject to the PRA.
    We are soliciting public comment on each of the issues for the 
following sections of this document that contain information collection 
requirements.

Section 412.64--Reporting of Hospital Quality Data for Annual Hospital 
Payment Update

    Section 412.64(d)(2) requires hospitals, in order to qualify for 
the full annual market basket update, to submit quality data on a 
quarterly basis to CMS, as specified by CMS. In this proposed rule, we 
are setting out the specific requirements related to the data that must 
be submitted for the update for FY 2007.
    The burden associated with this section is the time and effort 
associated with collecting, copying and submitting the data. We 
estimate that there will be approximately 4,000 respondents per year. 
Of this number, approximately 3,600 hospitals are JCAHO-accredited and 
are currently collecting measures and submitting data to the JCAHO on a 
quarterly basis. Of the JCAHO-accredited hospitals, approximately 3,300 
are collecting the same measures CMS will be collecting for public 
reporting. Therefore, there will be no additional burden for these 
hospitals. Only approximately 300 of the JCAHO-accredited hospitals 
will need to collect an additional topic in addition to the data 
already collected for maintaining JCAHO accreditation. In addition, 
there are approximately 400 hospitals that do not participate in the 
JCAHO accreditation process. These hospitals will have the additional 
burden of collecting data on all three topics.
    For JCAHO-accredited hospitals that are not already collecting all 
of the required measures, we estimate it will take 25 hours per month 
per topic for collection. We expect the burden for all

[[Page 24140]]

of these hospitals to total 102,000 hours per year, including time 
allotted for overhead. For non-JCAHO accredited hospitals, we estimate 
the burden to be 136,000 hours per year. This estimate also includes 
overhead. The total number of burden hours for all hospitals combined 
is 238,000. The number of respondents will vary according to the level 
of voluntary participation. One hundred percent of the data may be 
collected electronically.
    Our validation process requires participating hospitals to submit 5 
charts per quarter. The burden associated with this requirement is the 
time and effort associated with collecting, copying, and submitting 
these charts. It will take approximately 2 hours per hospital to submit 
the 5 charts per quarter. There will be a total of approximately 19,000 
charts (3,800 hospitals x 5 charts per hospital) submitted by the 
hospitals to CMS per quarter for a total burden of 7,600 hours per 
quarter and a total annual burden of 30,400 hours.
    The burden associated with the requirements under Sec.  412.64 are 
currently approved under OMB Number 0938-0918. OMB approval will expire 
on December 31, 2008.

Proposed Revised Sec.  412.92(b)(3) Special Treatment: Sole Community 
Hospitals

    Proposed revised Sec.  412.92(b)(3) would require an approved SCH 
to notify the appropriate CMS Regional Office of any change which would 
affect its classification as an SCH.
    The burden associated with this requirement is the time and effort 
it would take for the SCH to provide such notification to the CMS 
Regional Office. We estimate that on an annual basis it would take an 
SCH 1 hour to provide notification. While this requirement is subject 
to the PRA, we believe the requirement is exempt because it impacts 
less than 10 SCHs.

Proposed Revised Sec.  412.108(b)(4) Special Treatment: Medicare-
Dependent, Small Rural Hospitals

    Proposed revised Sec.  412.108(b)(4) would require an approved MDH 
to notify the appropriate CMS Regional Office of any change which would 
affect its status as an MDH.
    The burden associated with this requirement is the time and effort 
it would take for the MDH to provide such notification to the CMS 
Regional Office. We estimate that on an annual basis it would take an 
MDH 1 hour to provide notification. While this requirement is subject 
to the PRA, we believe the requirement is exempt because it impacts 
less than 10 MDHs.
    If you comment on these information collection and recordkeeping 
requirements, please mail the copies directly to the following:

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Regulations Development Group, 
Attn.: Melissa Musutto, CMS-1488-P. Room C4-26-05, 7500 Security 
Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget Room 10235, New Executive Office Building, Washington, DC 20503, 
Attn.: Carolyn Lovett, CMS Desk Officer, CMS-1488-P, [email protected]. Fax (202) 395-5167.

C. Public Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to 
those comments in the preamble to that document.

XII. Regulation Text

List of Subjects

42 CFR Part 409

    Health Facilities, Medicare.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Rural areas, X-rays.

42 CFR Part 412

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

42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Puerto Rico, 
Reporting and recordkeeping requirements.

42 CFR Part 424

    Emergency medical services, Health facilities, Health professions, 
Medicare.

42 CFR Part 485

    Grant programs-health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

42 CFR Part 489

    Health facilities, Medicare, Reporting and recordkeeping 
requirements.
    For the reasons stated in the preamble of this proposed rule, the 
Centers for Medicare & Medicaid Services is proposing to amend 42 CFR 
Chapter IV as follows:

PART 409--HOSPITAL INSURANCE BENEFITS

    1. The authority citation for part 409 continues to read as 
follows:

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

    2. Section 409.3 is amended by revising paragraph (e) under the 
definition of ``Qualified hospital'' to read as follows:


Sec.  409.3  Definitions.

* * * * *
    Qualified hospital means a facility that--* * *
    (e) If it is a foreign hospital, is licensed, or approved as 
meeting the standard for licensing, by the appropriate foreign 
licensing agency, and for purposes of furnishing nonemergency services 
to U.S. residents, is accredited by the Joint Commission on 
Accreditation of Healthcare Organizations (JCAHO), or by a foreign 
program under standards that CMS finds to be equivalent to those of 
JCAHO.
    3. Section 409.5 is revised to read as follows:


Sec.  409.5  General description of benefits.

    Hospital insurance (Part A of Medicare) helps pay for inpatient 
hospital or inpatient CAH services and posthospital SNF care. It also 
pays for home health services and hospice care. There are limitations 
on the number of days of care that Medicare can pay for and there are 
deductible and coinsurance amounts for which the beneficiary is 
responsible. For each type of service, certain conditions must be met 
as specified in the pertinent sections of this subpart and in part 418 
of this chapter regarding hospice care. Conditions for payment of 
emergency inpatient services furnished by a nonparticipating U.S. 
hospital and for services furnished in a foreign country are set forth 
in subparts G and H of part 424 of this chapter.

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

    4. The authority citation for part 410 continues to read as 
follows:

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


[[Page 24141]]


    5. Section 410.66 is revised to read as follows:


Sec.  410.66  Emergency outpatient services furnished by a 
nonparticipating hospital and services furnished in a foreign country.

    Conditions for payment of emergency inpatient services furnished by 
a nonparticipating U.S. hospital and for services furnished in a 
foreign country are set forth in subparts G and H of part 424 of this 
chapter.

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL 
SERVICES

    6. 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), and sec. 124 of Pub. L. 106-113 (113 Stat. 
1501A-332).

    7. Section 412.22 is amended by--
    a. Revising the introductory text of paragraph (f).
    b. Adding a new paragraph (f)(3).
    c. Revising paragraph (h)(1).
    d. In paragraph (h)(2), removing the phrase ``(h)(3), (h)(6), and 
(h)(7) of this section'' and adding the phrase ``(h)(3), (h)(7), and 
(h)(8) of this section'' in its place.
    e. Revising the introductory text of paragraph (h)(3).
    f. Revising paragraph (h)(4).
    g. Redesignating paragraphs (h)(5), (h)(6), and (h)(7) as 
paragraphs (h)(6), (h)(7), and (h)(8), respectively.
    h. Adding a new paragraph (h)(5).
    The revisions and addition read as follows:


Sec.  412.22  Excluded hospitals and hospital units: General rules.

* * * * *
    (f) Application for certain hospitals. Except as provided in 
paragraph (f)(3) of this section, if a hospital was excluded from the 
prospective payment systems under the provisions of this section on or 
before September 30, 1995, and at that time occupied space in a 
building also used by another hospital, or in one or more buildings 
located on the same campus as buildings used by another hospital, the 
criteria in paragraph (e) of this section do not apply to the hospital 
as long as the hospital--
* * * * *
    (3) For cost reporting periods beginning on or after October 1, 
2006, in applying the provisions of paragraph (f)(1) or (f)(2) of this 
section, any hospital that was excluded from the prospective payment 
systems under the provisions of this section on or before September 30, 
1995, and at that time occupied space in a building also used by 
another hospital, or in one or more buildings located on the same 
campus as buildings used by another hospital--
    (i) May decrease its square footage or number of beds, or both, 
without affecting the provisions of paragraph (f)(1) or (f)(2) of this 
section;
    (ii) May increase or decrease the square footage or decrease the 
number of beds considered to be part of the hospital at any time, if 
these changes are made necessary by relocation of the hospital--
    (A) To permit construction or renovation necessary for compliance 
with changes in Federal, State, or local law affecting the physical 
facility; or
    (B) Because of catastrophic events such as fires, floods, 
earthquakes, or tornadoes.
* * * * *
    (h) Satellite facilities. (1) For purposes of paragraphs (h)(2) 
through (h)(5) of this section, a satellite facility is a part of a 
hospital that provides inpatient services in a building also used by 
another hospital, or in one or more entire buildings located on the 
same campus as buildings used by another hospital.
* * * * *
    (3) Except as provided in paragraphs (h)(4) and (h)(5) of this 
section, the provisions of paragraph (h)(2) of this section do not 
apply to--
* * * * *
    (4) In applying the provisions of paragraph (h)(3) of this section, 
any hospital structured as a satellite facility on September 30, 1999, 
may increase or decrease the square footage of the satellite facility 
or may decrease the number of beds in the satellite facility considered 
to be part of the satellite facility at any time, if these changes are 
made necessary by relocation of a facility --
    (i) To permit construction or renovation necessary for compliance 
with changes in Federal, State, or local law affecting the physical 
facility; or
    (ii) Because of catastrophic events such as fires, floods, 
earthquakes, or tornadoes.
    (5) For cost reporting periods beginning on or after October 1, 
2006, in applying the provisions of paragraph (h)(3) of this section, a 
satellite facility may decrease its number of beds or square footage, 
or both, without affecting the provisions of paragraph (h)(3) of this 
section.
* * * * *
    8. Section 412.25 is amended by--
    a. In paragraph (e)(2), removing the cross-reference ``(e)(5)'' and 
adding the cross-reference ``(e)(6)'' in its place.
    b. Revising paragraph (e)(3).
    c. Redesignating paragraph (e)(5) as paragraph (e)(6).
    d. Adding a new paragraph (e)(5).
    The revision and addition read as follows:


Sec.  412.25  Excluded hospital units: Common requirements.

* * * * *
    (e) * * *
    (3) Except as specified in paragraphs (e)(4) and (e)(5) of this 
section, the provisions of paragraph (e)(2) of this section do not 
apply to any unit structured as a satellite facility on September 30, 
1999, and excluded from the prospective payment systems on that date, 
to the extent the unit continues operating under the same terms and 
conditions, including the number of beds and square footage considered 
to be part of the unit, in effect on September 30, 1999.
* * * * *
    (5) For cost reporting periods beginning on or after October 1, 
2006, in applying the provisions of paragraph (e)(3) of this section, a 
satellite facility may decrease its number of beds or square footage, 
or both, without affecting the provision of paragraph (e)(3) of this 
section.
* * * * *


Sec.  412.42  [Amended]

    9. In paragraph (d) of Sec.  412.42, the cross-reference ``Sec.  
405.310(k)'' is removed, and the cross-reference ``Sec.  411.15(k)'' is 
added in its place.


Sec.  412.48  [Amended]

    10. In paragraph (b) of Sec.  412.48, the cross-reference 
``Sec. Sec.  405.330 through 405.332'' is removed and the cross-
reference ``Sec.  411.400 and Sec.  411.402'' is added in its place.
    11. Section 412.64 is amended by--
    a. Revising paragraph (d)(2).
    b. Adding a new paragraph (h)(6).
    The revision and addition read as follows:


Sec.  412.64  Federal rates for inpatient operating costs for Federal 
fiscal year 2005 and subsequent fiscal years.

* * * * *
    (d) * * *
    (2)(i) In the case of a ``subsection (d) hospital,'' as defined 
under section 1886(d)(1)(B) of the Act, that does not submit quality 
data on a quarterly basis to CMS, in the form and manner specified by 
CMS, the applicable percentage change specified in paragraph (d)(1) of 
this section is reduced:
    (A) For fiscal years 2005 and 2006, by 0.4 percentage points; and

[[Page 24142]]

    (B) For fiscal year 2007 and subsequent fiscal years, by 2.0 
percentage points.
    (ii) Any reduction of the percentage change will apply only to the 
fiscal year involved and will not be taken into account in computing 
the applicable percentage change for a subsequent fiscal year.
* * * * *
    (h) * * *
    (6) If a new rural hospital that is subject to the hospital 
inpatient prospective payment system opens in a State that has an 
imputed rural floor and has rural areas, CMS uses the imputed floor as 
the hospital's wage index until the hospital's first cost report as an 
inpatient prospective payment system provider is contemporaneous with 
the cost reporting period being used to develop a given fiscal year's 
wage index.
* * * * *
    12. A new Sec.  412.79 is added to Subpart E to read as follows:


Sec.  412.79  Determination of the hospital-specific rate for inpatient 
operating costs for Medicare-dependent, small rural hospitals based on 
a Federal fiscal year 2002 base period.

    (a) Base-period costs--(1) General rule. Except as provided in 
paragraph (a)(2) of this section, for each MDH, the intermediary 
determines the MDH's Medicare Part A allowable inpatient operating 
costs, as described in Sec.  412.2(c), for the 12-month or longer cost 
reporting period ending on or after October 1, 2001, and before October 
1, 2002.
    (2) Exceptions. (i) If the MDH's last cost reporting period ending 
before October 1, 2002, is for less than 12 months, the base period is 
the MDH's most recent 12-month or longer cost reporting period ending 
before that short cost reporting period.
    (ii) If the MDH does not have a cost reporting period ending on or 
after October 1, 2001, and before October 1, 2002, and does have a cost 
reporting period beginning on or after October 1, 2000, and before 
October 1, 2001, that cost reporting period is the base period unless 
the cost reporting is for less than 12 months. In that case, the base 
period is the MDH's most recent 12-month or longer cost reporting 
period ending before that short cost reporting period.
    (b) Costs on a per discharge basis. The intermediary determines the 
MDH's average base-period operating cost per discharge by dividing the 
total operating costs by the number of discharges in the base period. 
For purposes of this section, a transfer as described in Sec.  412.4(b) 
is considered to be a discharge.
    (c) Case-mix adjustment. The intermediary divides the average base-
period cost per discharge by the MDH's case-mix index for the base 
period.
    (d) Updating base period costs. For purposes of determining the 
updated base-period costs for cost reporting periods beginning in 
Federal fiscal year 2002, the update factor is determined using the 
methodology set forth in Sec.  412.73(c)(14) and (c)(15).
    (e) DRG adjustment. The applicable hospital-specific cost per 
discharge is multiplied by the appropriate DRG weighting factor to 
determine the hospital-specific base payment amount (target amount) for 
a particular covered discharge.
    (f) Notice of hospital-specific rate. The intermediary furnishes 
the MDH a notice of its hospital-specific rate which contains a 
statement of the hospital's Medicare Part A allowable inpatient 
operating costs, number of Medicare discharges, and case-mix index 
adjustment factor used to determine the hospital's cost per discharge 
for the Federal fiscal year 2002 base period.
    (g) Right to administrative and judicial review. An intermediary's 
determination of the hospital-specific rate for a hospital is subject 
to administrative and judicial review. Review is available to an MDH 
upon receipt of the notice of the hospital-specific rate. The notice is 
treated as a final intermediary determination of the amount of program 
reimbursement for purposes of subpart R of Part 405 of this chapter, 
governing provider reimbursement determinations and appeals.
    (h) Modification of hospital-specific rate. (1) The intermediary 
recalculates the hospital-specific rate to reflect the following:
    (i) Any modifications that are determined as a result of 
administrative or judicial review of the hospital-specific rate 
determinations; or
    (ii) Any additional costs that are recognized as allowable costs 
for the MDH's base period as a result of administrative or judicial 
review of the base-period notice of amount of program reimbursement.
    (2) With respect to either the hospital-specific rate determination 
or the amount of program reimbursement determination, the actions taken 
on administrative or judicial review that provide a basis for 
recalculations of the hospital-specific rate include the following:
    (i) A reopening and revision of the MDH's base-period notice of 
amount of program reimbursement under Sec. Sec.  405.1885 through 
405.1889 of this chapter.
    (ii) A prehearing order or finding issued during the provider 
payment appeals process by the appropriate reviewing authority under 
Sec.  405.1821 or Sec.  405.1853 of this chapter that resolved a matter 
at issue in the MDH's base-period notice of amount of program 
reimbursement.
    (iii) An affirmation, modification, or reversal of a Provider 
Reimbursement Review Board decision by the Administrator of CMS under 
Sec.  405.1875 of this chapter that resolved a matter at issue in the 
hospital's base-period notice of amount of program reimbursement.
    (iv) An administrative or judicial review decision under Sec. Sec.  
405.1831, 405.1871, or 405.1877 of this chapter that is final and no 
longer subject to review under applicable law or regulations by a 
higher reviewing authority, and that resolved a matter at issue in the 
hospital's base-period notice of amount of program reimbursement.
    (v) A final, nonappealable court judgment relating to the base-
period costs.
    (3) The adjustments to the hospital-specific rate made under 
paragraphs (h)(1) and (2) of this section are effective retroactively 
to the time of the intermediary's initial determination of the rate.
    (i) Maintaining budget neutrality. CMS makes an adjustment to the 
hospital-specific rate to ensure that changes to the DRG 
classifications and recalibrations of the DRG relative weights are made 
in a manner so that aggregate payments to section 1886(d) hospitals are 
not affected.


Sec.  412.84  [Amended]

    13. In paragraph (m) of Sec.  412.84, the cross-reference 
``paragraph (h)(3)'' is removed and the cross-reference ``paragraph 
(i)(4)'' is added in its place.
    14. Section 412.90 is amended by revising paragraph (j) to read as 
follows:


Sec.  412.90  General rules.

* * * * *
    (j) Medicare-dependent, small rural hospitals. For cost reporting 
periods beginning on or after April 1, 1990, and before October 1, 
1994, and for discharges occurring on or after October 1, 1997, and 
before October 1, 2011, CMS adjusts the prospective payment rates for 
inpatient operating costs determined under subparts D and E of this 
part if a hospital is classified as a Medicare-dependent, small rural 
hospital.
* * * * *
    15. Section 412.92 is amended by--

[[Page 24143]]

    a. In paragraph (b)(2)(iv) of Sec.  412.92, the word ``djustment'' 
is removed and the word ``adjustment'' is added in its place.
    b. Revising paragraph (b)(3) to read as follows:


Sec.  412.92  Special treatment: Sole community hospitals.

* * * * *
    (b) * * *
    (3) Duration of classification. An approved classification as a 
sole community hospital remains in effect without need for reapproval 
unless there is a change in the circumstances under which the 
classification was approved. An approved sole community hospital must 
notify the appropriate CMS regional office of any change that would 
affect its classification as a sole community hospital. If CMS 
determines that a sole community hospital failed to comply with this 
requirement, CMS will cancel the hospital's classification as a sole 
community hospital effective on the earliest discernable date that the 
fiscal intermediary can determine that the hospital no longer met the 
criteria for such classification.
* * * * *


Sec.  412.105  [Amended]

    16. In paragraph (f)(1)(ii)(C) of Sec.  412.105, the cross-
reference ``Sec.  413.78(c) or Sec.  413.78(d)'' is removed and the 
cross-reference ``Sec.  413.78(c), Sec.  413.78(d), or Sec.  
413.78(e)'' is added in its place.
    17. Section 412.106 is amended by--
    a. Revising paragraph (a)(1)(iii).
    b. Republishing the introductory text of paragraph (d)(2)(iv).
    c. Revising paragraph (d)(2)(iv)(C)(3).
    d. Adding a new paragraph (d)(2)(iv)(D).
    e. Adding a new paragraph (d)(2)(v).
    The revision and additions read as follows:


Sec.  412.106  Special treatment: Hospitals that serve a 
disproportionate share of low-income patients.

    (a) * * *
    (1) * * *
    (iii) The hospital's location, in an urban or rural area, is 
determined in accordance with the definitions in Sec.  412.64, except 
that a reclassification that results from an urban hospital 
reclassified as rural as set forth in Sec.  412.103 is classified as 
rural.
* * * * *
    (d) * * *
    (2) * * *
    (iv) If the hospital meets the criteria of paragraph (c)(1)(iv) of 
this section--
* * * * *
    (C) * * *
    (3) Except as provided in paragraph (d)(2)(iv)(D) of this section, 
the maximum payment adjustment factor is 12 percent.
    (D) Effective for discharges occurring on or after October 1, 2006, 
for a hospital that is classified as a Medicare-dependent, small rural 
hospital under Sec.  412.108, the payment adjustment factor limitation 
specified in paragraph (d)(2)(iv)(C)(3) does not apply.
    (v) If the hospital meets the criteria of paragraph (c)(2) of this 
section, the payment adjustment factor is as follows:
    (A) 30 percent for discharges occurring on or after April 1, 1990, 
and before October 1, 1991.
    (B) 35 percent for discharges occurring on or after October 1, 
1991.
* * * * *
    18. Section 412.108 is amended by--
    a. Revising paragraph (a)(1) introductory text.
    b. Revising paragraph (b)(4).
    c. Adding a new paragraph (c)(2)(iii).
    The revisions and addition read as follows:


Sec.  412.108  Special Treatment: Medicare-dependent, small rural 
hospitals.

    (a) Criteria for classification as a Medicare-dependent, small 
rural hospital.--(1) General considerations. For cost reporting periods 
beginning on or after April 1, 1990, and ending before October 1, 1994, 
or for discharges occurring on or after October 1, 1997, and before 
October 1, 2011, a hospital is classified as a Medicare-dependent, 
small rural hospital if it is located in a rural area (as defined in 
subpart D of this part) and meets all of the following conditions:
* * * * *
    (b) * * *
    (4) A determination of MDH status made by the fiscal intermediary 
is effective 30 days after the date the fiscal intermediary provides 
written notification to the hospital. An approved MDH status 
determination remains in effect unless there is a change in the 
circumstances under which the status was approved. An approved MDH must 
notify the appropriate CMS regional office of any change that would 
affect its status as an MDH. If CMS determines that an MDH failed to 
comply with this requirement, CMS will cancel the hospital's MDH status 
effective on the earliest discernable date that the fiscal intermediary 
can determine that the hospital no longer met the criteria for such 
status.
* * * * *
    (c) * * *
    (2) * * *
    (iii) For discharges occurring during cost reporting periods (or 
portions thereof) beginning on or after October 1, 2006, and before 
October 1, 2011, 75 percent of the amount that the Federal rate 
determined under paragraph (c)(1) of this section is exceeded by the 
highest of the following:
    (A) The hospital-specific rate as determined under Sec.  412.73.
    (B) The hospital-specific rate as determined under Sec.  412.75.
    (C) The hospital-specific rate as determined under Sec.  412.79.
* * * * *
    19. Section 412.234 is amended by--
    a. In paragraph (a)(3)(ii), removing the term ``fiscal year'' and 
adding the term ``Federal fiscal year'' in its place.
    b. Revising paragraph (a)(3)(iii).
    c. Adding a new paragraph (a)(3)(iv).
    The revisions and addition read as follows:


Sec.  412.234  Criteria for all hospitals in an urban county seeking 
redesignation to another urban area.

    (a) * * *
    (3) * * *
    (iii) For Federal fiscal year 2007, hospitals located in counties 
that are in the same Combined Statistical Area (CSA) (under the MSA 
definitions announced by the OMB on June 6, 2003) as the urban area to 
which they seek redesignation qualify as meeting the proximity 
requirement for reclassification to the urban area to which they seek 
redesignation.
    (iv) For Federal fiscal year 2008 and thereafter, hospitals located 
in counties that are in the same Combined Statistical Area (CSA) or 
Core-Based Statistical Area (CBSA) (under the MSA definitions announced 
by the OMB on June 6, 2003) as the urban area to which they seek 
redesignation qualify as meeting the proximity requirements for 
reclassification to the urban area to which they seek redesignation.
* * * * *
    20. Section 412.316 is amended by--
    a. Revising paragraph (a).
    b. Revising paragraph (b)(2).
    c. Adding a new paragraph (b)(3).
    d. Revising paragraph (c).
    The revisions and addition read as follows:


Sec.  412.316  Geographic adjustment factors.

    (a) Local cost variation. CMS adjusts for local cost variation 
based on the hospital wage index value that is applicable to the 
hospital under subpart D of this part. The adjustment factor equals the 
hospital wage index value applicable to the hospital raised to the 
.6848 power and is applied to 100 percent of the Federal rate.

[[Page 24144]]

    (b) * * *
    (2) For discharges occurring on or after October 1, 2004, the 
definition of large urban area under Sec.  412.63(c)(6) continues to be 
in effect for purposes of the payment adjustment under this section, 
based on the geographic classification under Sec.  412.64, except as 
provided for in paragraph (b)(3) of this section.
    (3) For purposes of this section, the geographic classifications 
specified under Sec.  412.64 apply, except that, effective for 
discharges occurring on or after October 1, 2006, for an urban hospital 
that is reclassified as rural as set forth in Sec.  412.103, the 
geographic classification is rural.
    (c) Cost-of-living adjustment. CMS provides an additional payment 
to a hospital located in Alaska and Hawaii equal to [0.3152 x (the 
cost-of-living adjustment factor used to determine payments under 
subpart D of this part-1)] percent.
    21. Section 412.320 is amended by--
    a. Revising paragraph (a)(1)(ii).
    b. Adding a new paragraph (a)(1)(iii).
    The revision and addition read as follows:


Sec.  412.320  Disproportionate share adjustment factor.

    (a) * * *
    (1) * * *
    (ii) For discharges occurring on or after October 1, 2004, the 
payment adjustment under this section is based on the geographic 
classifications specified under Sec.  412.64, except as provided for in 
paragraph (a)(1)(iii) of this section.
    (iii) For purposes of this section, the geographic classifications 
specified under Sec.  412.64 apply, except that, effective for 
discharges occurring on or after October 1, 2006, for an urban hospital 
that is reclassified as rural as set forth in Sec.  412.103, the 
geographic classification is rural.
* * * * *
    22. Section 412.505 is amended by revising paragraph (b)(1) to read 
as follows:


Sec.  412.505  Conditions for payment under the prospective payment 
system for long-term care hospitals.

* * * * *
    (b) General requirements. (1) Effective for cost reporting periods 
beginning on or after October 1, 2002, a long-term care hospital must 
meet the conditions for payment of this section, Sec.  412.22(e)(3) and 
(h)(6), if applicable, and Sec.  412.507 through Sec.  412.511 to 
receive payment under the prospective payment system described in this 
subpart for inpatient hospital services furnished to Medicare 
beneficiaries.
* * * * *


Sec.  412.508  [Amended]

    23. In paragraph (c)(3) of Sec.  412.508, the cross-reference 
``Sec.  1001.301'' is removed and the cross-reference ``1001.201'' is 
added in its place.
    24. Section 412.511 is revised to read as follows:


Sec.  412.511  Reporting and recordkeeping requirements.

    A long-term care hospital participating in the prospective payment 
system under this subpart must meet the requirement of Sec. Sec.  
412.22(e)(3) and 412.22(h)(6) to report co-located status, if 
applicable, and the recordkeeping and cost reporting requirements of 
Sec. Sec.  413.20 and 413.24 of this subchapter.
    25. Section 412.525 is amended by--
    a. Revising paragraph (a)(3).
    b. Revising paragraph (a)(4)(ii).
    c. Revising paragraph (a)(4)(iii).
    d. Adding a new paragraph (a)(4)(iv).
    e. Adding a new paragraph (d)(3).
    f. Adding a new paragraph (d)(4).
    The revisions and additions read as follows:


Sec.  412.525  Adjustments to the Federal prospective payment.

    (a) * * *
    (3) The additional payment equals 80 percent of the difference 
between the estimated cost of the patient's care (determined by 
multiplying the hospital-specific cost-to-charge ratio by the Medicare 
allowable covered charge) and the sum of the adjusted LTCH PPS Federal 
prospective payment and the fixed-loss amount.
    (4) * * *
    (ii) For discharges occurring on or after August 8, 2003, and 
before October 1, 2006, high-cost outlier payments are subject to the 
provisions of Sec.  412.84(i)(1), (i)(3), and (i)(4) and (m) for 
adjustments of cost-to-charge ratios.
    (iii) For discharges occurring on or after October 1, 2003, and 
before October 1, 2006, high-cost outlier payments are subject to the 
provisions of Sec.  412.84(i)(2) for adjustments to cost-to-charge 
ratios.
    (iv) For discharges occurring on or after October 1, 2006, high-
cost outlier payments are subject to the following provisions:
    (A) CMS may specify an alternative to the cost-to-charge ratio 
otherwise applicable under paragraph (a)(4)(iv)(B) of this section. A 
hospital may also request that its fiscal intermediary use a different 
(higher or lower) cost-to-charge ratio based on substantial evidence 
presented by the hospital. A request must be approved by the CMS 
Regional Office.
    (B) The cost-to-charge ratio applied at the time a claim is 
processed is based on either the most recent settled cost report or the 
most recent tentatively settled cost report, whichever is from the 
latest cost reporting period.
    (C) The fiscal intermediary may use a statewide average cost-to-
charge ratio, which CMS establishes annually, if it is unable to 
determine an accurate cost-to-charge ratio for a hospital in one of the 
following circumstances:
    (1) A new hospital that has not yet submitted its first Medicare 
cost report. (For this purpose, a new hospital is defined as an entity 
that has not accepted assignment of an existing hospital's provider 
agreement in accordance with Sec.  489.18 of this chapter.)
    (2) A hospital whose cost-to-charge ratio is in excess of 3 
standard deviations above the corresponding national geometric mean 
cost to charge ratio. CMS establishes and publishes this mean annually.
    (3) Any other hospital for which data to calculate a cost-to-charge 
ratio are not available.
    (D) Any reconciliation of outlier payments is based on the cost-to-
charge ratio calculated based on a ratio of costs to charges computed 
from the relevant cost report and charge data determined at the time 
the cost report coinciding with the discharge is settled.
    (E) At the time of any reconciliation under paragraph (a)(4)(iv)(D) 
of this section, outlier payments may be adjusted to account for the 
time value of any underpayments or overpayments. Any adjustment is 
based upon a widely available index to be established in advance by the 
Secretary, and is applied from the midpoint of the cost reporting 
period to the date of reconciliation.
* * * * *
    (d) * * *
    (3) Patients who are transferred to onsite providers and readmitted 
to a long-term care hospital, as provided for in Sec.  412.532.
    (4) Long-term care hospitals-within-hospitals and satellites of 
long-term care hospitals as provided in Sec.  412.534.
    26. Section 412.529 is amended by revising paragraph (c)(5) to read 
as follows:


Sec.  412.529  Special payment provision for short-stay outliers.

* * * * *
    (c) * * *
    (5)(i) For discharges occurring on or after October 1, 2002, and 
before August 8, 2003, no reconciliations are made to

[[Page 24145]]

short-stay outlier payments upon cost report settlement to account for 
differences between cost-to-charge ratio and the actual cost-to-charge 
ratio of the case.
    (ii) For discharges occurring on or after August 8, 2003, and 
before October 1, 2006, short-stay outlier payments are subject to the 
provisions of Sec.  412.84(i)(1), (i)(3), and (i)(4) and (m) for 
adjustments of cost-to-charge ratios.
    (iii) For discharges occurring on or after October 1, 2003, and 
before October 1, 2006, short-stay outlier payments are subject to the 
provisions of Sec.  412.84(i)(2) for adjustments to cost-to-charge 
ratios.
    (iv) For discharges occurring on or after October 1, 2006, short-
stay outlier payments are subject to the following provisions:
    (A) CMS may specify an alternative to the cost-to-charge ratio 
otherwise applicable under paragraph (c)(5)(iv)(B) of this section. A 
hospital may also request that its fiscal intermediary use a different 
(higher or lower) cost-to-charge ratio based on substantial evidence 
presented by the hospital. This request must be approved by the CMS 
Regional Office.
    (B) The cost-to-charge ratio applied at the time a claim is 
processed is based on either the most recent settled cost report or the 
most recent tentatively settled cost report, whichever is from the 
latest cost reporting period.
    (C) The fiscal intermediary may use a statewide average cost-to-
charge ratio, which CMS establishes annually, if it is unable to 
determine an accurate cost-to-charge ratio for a hospital in one of the 
following circumstances:
    (1) A new hospital that has not yet submitted its first Medicare 
cost report. (For this purpose, a new hospital is defined as an entity 
that has not accepted assignment of an existing hospital's provider 
agreement in accordance with Sec.  489.18 of this chapter.)
    (2) A hospital whose cost-to-charge ratio is in excess of 3 
standard deviations above the corresponding national geometric mean. 
CMS establishes and publishes this mean annually.
    (3) Any other hospital for which data to calculate a cost-to-charge 
ratio are not available.
    (D) Any reconciliation of outlier payments is based on the cost-to-
charge ratio calculated based on a ratio of costs to charges computed 
from the relevant cost report and charge data determined at the time 
the cost report coinciding with the discharge is settled.
    (E) At the time of any reconciliation under paragraph (c)(5)(iv)(D) 
of this section, outlier payments may be adjusted to account for the 
time value of any underpayments or overpayments. Any adjustment is 
based upon a widely available index to be established in advance by the 
Secretary, and is applied from the midpoint of the cost reporting 
period to the date of reconciliation.
    27. Section 412.532 is amended by--
    a. Revising paragraph (a)(2).
    b. Revising paragraph (b).
    The revisions read as follows:


Sec.  412.532  Special payment provisions for patients who are 
transferred to onsite providers and readmitted to a long-term care 
hospital.

    (a) * * *
    (2) A satellite facility, as defined in Sec.  412.22(h), that is 
co-located with the long-term care hospital.
* * * * *
    (b) As used in this section, ``co-located'' or ``onsite'' facility 
means a hospital, satellite facility, unit, or SNF that occupies space 
in a building also used by another hospital or unit or in one or more 
buildings on the same campus, as defined in Sec.  413.65(a)(2) of this 
subchapter, as buildings used by another hospital or unit.
* * * * *


Sec.  412.541  [Amended]

    28. In Sec.  412.541, paragraph (b)(2)(i), remove the cross-
reference ``Sec.  412.533(b)'' and add in its place ``Sec.  
412.533(a)(5) and Sec.  412.533(c)''.

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT 
RATES FOR SKILLED NURSING FACILITIES

    29. The authority citation for part 413 is revised to read as 
follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and 
(n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act 
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. 
L. 106-133 (113 Stat. 1501A-332).

    30. Section 413.74 is amended by revising paragraph (a) to read as 
follows:


Sec.  413.74  Payment to a foreign hospital.

    (a) Principle. Section 1814(f) of the Act provides for the payment 
of emergency and nonemergency inpatient hospitals services furnished by 
foreign hospitals to Medicare beneficiaries. Subpart H of part 424 of 
this chapter, together with this section, specifies the conditions for 
payment.
* * * * *
    31. Section 413.75 is amended by--
    a. In paragraph (b), revising paragraph (1) under the definition of 
``Medicare GME affiliated group''.
     b. In paragraph (b), removing the cross-reference ``Sec.  
413.79(g)(2)'' under paragraph (2) of the definition of ``Medicare GME 
affiliated group'' and adding the cross-reference ``Sec.  
413.79(f)(2)'' in its place.
    c. In paragraph (b), removing the cross-reference ``Sec.  
413.79(g)(2)'' under paragraph (3) of the definition of ``Medicare GME 
affiliated group'' and adding the cross-reference ``Sec.  
413.79(f)(2)'' in its place.
    The revision reads as follows:


Sec.  413.75  Direct GME payments: General requirements.

* * * * *
    (b) * * *
    Medicare GME affiliated group means--
    (1) Two or more hospitals that are located in the same urban or 
rural area (as those terms are defined in subpart D of Part 412 of this 
subchapter) or in a contiguous area and meet the rotation requirements 
in Sec.  413.79(f)(2).
* * * * *
    32. Section 413.77 is amended by revising paragraphs (e)(1) 
introductory text and (e)(1)(i) to read as follows:


Sec.  413.77  Direct GME payments: Determination of per resident 
amounts.

* * * * *
    (e) Exceptions--(1) Base period for certain hospitals. If a 
hospital did not have any approved medical residency training programs 
or did not participate in Medicare during the base period, but either 
condition changes in a cost reporting period beginning on or after July 
1, 1985, the fiscal intermediary establishes a per resident amount for 
the hospital using the information from the first cost reporting period 
during which the hospital participates in Medicare and the residents 
are on duty during the first month of that period. Effective for cost 
reporting periods beginning on or after October 1, 2006, if a hospital 
did not have any approved medical residency training programs or did 
not participate in Medicare during the base period, but either 
condition changes in a cost reporting period beginning on or after 
October 1, 2006, and the residents are not on duty during the first 
month of that period, the fiscal intermediary establishes a per 
resident amount for the hospital using the information from the first 
cost reporting period immediately following the cost reporting period 
during which the hospital participates in Medicare and residents began 
training at the hospital. The per resident

[[Page 24146]]

amount is based on the lower of the amount specified in paragraph 
(e)(1)(i) or paragraph (e)(1)(ii) of this section, subject to the 
provisions of paragraph (e)(1)(iii) of this section. Any GME costs 
incurred by the hospital during the cost reporting period prior to the 
base period used for calculating the PRA are reimbursed on a reasonable 
cost basis.
    (i) The hospital's actual cost per resident incurred in connection 
with the GME program(s) based on the cost and resident data from the 
hospital's base year cost reporting period as established in paragraph 
(e)(1) of this section.
* * * * *
    33. Section 413.79 is amended by--
    a. Revising paragraph (e)(1)(iv).
    b. In the introductory text of paragraph (f), removing the cross-
reference ``paragraph (e)(3) of this section'' and adding the cross-
reference ``paragraph (d) of this section'' in its place.
    The revision reads as follows:


Sec.  413.79  Direct GME payments: Determination of the weighted number 
of FTE residents.

* * * * *
    (e) * * *
    (1) * * *
    (iv) Effective for affiliation agreements entered into on or after 
October 1, 2005, an urban hospital that qualifies for an adjustment to 
its FTE cap under paragraph (e)(1) of this section is permitted to be 
part of a Medicare GME affiliated group for purposes of establishing an 
aggregate FTE cap only if the adjustment that results from the 
affiliation is an increase to the urban hospital's FTE cap.
* * * * *
    34. Section 413.85 is amended by revising paragraph (h)(3) to read 
as follows:


Sec.  413.85  Costs of approved nursing and allied health education 
activities.

* * * * *
    (h) * * *
    (3) Educational seminars, workshops, and continuing education 
programs in which the employees or trainees participate that enhance 
the quality of medical care or operating efficiency of the provider 
and, effective October 1, 2003, do not lead to the ability to practice 
and begin employment in a nursing or allied health specialty.
* * * * *
    35. Section 413.89 is amended by--
    a. Revising paragraph (a).
    b. Revising paragraph (h).
    The revisions read as follows:


Sec.  413.89  Bad debts, charity, and courtesy allowances.

    (a) Principle. Bad debts, charity, and courtesy allowances are 
deductions from revenue and are not to be included in allowable cost. 
However, subject to the limitations described under paragraph (h) of 
this section and the exception for anesthetists' services described 
under paragraph (i) of this section, bad debts attributable to the 
deductibles and coinsurance amounts are reimbursable under the program.
* * * * *
    (h) Limitations on bad debts. (1) Hospitals. In determining 
reasonable costs for hospitals, the amount of bad debt otherwise 
treated as allowable costs (as defined in paragraph (e) of this 
section) is reduced by--
    (i) For cost reporting periods beginning during fiscal year 1998, 
by 25 percent;
    (ii) For cost reporting periods beginning during fiscal year 1999, 
by 40 percent;
    (iii) For cost reporting periods beginning during fiscal year 2000, 
by 45 percent; and
    (iv) For cost reporting periods beginning during a subsequent 
fiscal year, by 30 percent.
    (2) Skilled nursing facilities. For cost reporting periods 
beginning during fiscal year 2006 or during a subsequent fiscal year, 
the amount of skilled nursing facility bad debts for coinsurance 
otherwise treated as allowable costs (as defined in paragraph (e) of 
this section) for services furnished to a patient who is not a full-
benefit dual eligible individual (as defined in Sec.  423.772) is 
reduced by 30 percent.
* * * * *

PART 424--CONDITIONS FOR MEDICARE PAYMENT

    36. 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).


Sec.  424.32  [Amended]

    37. In Sec.  424.32, in paragraph (b), the phrase ``CMS-1490U-
Request for Medicare Payment by Organization. (For use by an 
organization requesting payment for medical services.)'' is removed and 
the phrase ``CMS-1491-Request for Medicare Payment-Ambulance. (For use 
by an organization requesting payment for ambulance services.)'' is 
removed.


Sec.  424.121  [Amended]

    38. In Sec.  424.121, paragraph (c) is amended by removing the 
cross-reference ``Sec.  405.313'' and adding the cross-reference 
``Sec.  411.9'' in its place.
    39. Section 424.123 is amended by revising paragraph (c)(2) to read 
as follows:


Sec.  424.123  Conditions for payment for nonemergency inpatient 
hospital services furnished by a hospital closer to the individual's 
residence.

* * * * *
    (c) * * *
    (2) Accredited by the Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO) or accredited or approved by a program 
of the country where it is located under standards the CMS finds to be 
essentially equivalent to those of the JCAHO.
* * * * *

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    40. The authority citation for part 485 continues to read as 
follows:

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


Sec.  485.610  [Amended]

    41. In paragraph (c) of Sec.  485.610, the phrase ``as of October 
1, 2006'' is removed and the phrase ``on or before December 31, 2005'' 
is added in its place.

PART 489--PROVIDER AGREEMENTS AND SUPPLIER APPROVAL

    42. The authority citation for part 489 continues to read as 
follows:

    Authority: Secs. 1102, 1819, 1861, 1864(m), 1866, 1869, and 187l 
of the Social Security Act (42 U.S.C. 1302, 1395i-3, 1395x, 
1395aa(m), 1395cc, 1395ff, and 1395hh).

    43. Section 489.24 is amended by--
    a. Revising the definition of ``Labor'' under paragraph (b).
    b. Revising paragraph (f).
    The revisions read as follows:


Sec.  489.24  Special responsibilities of Medicare hospitals in 
emergency cases.

* * * * *
    (b) * * *
    Labor means the process of childbirth beginning with the latent or 
early phase of labor and continuing through the delivery of the 
placenta. A woman experiencing contractions is in true labor unless a 
physician, certified nurse-midwife, or other qualified medical person 
acting within his or her scope of practice as defined in hospital 
medical staff bylaws and State law, certifies that, after a reasonable 
time of observation, the woman is in false labor.
* * * * *

[[Page 24147]]

    (f) Recipient hospital responsibilities. A participating hospital 
that has specialized capabilities or facilities (including, but not 
limited to, facilities such as burn units, shock-trauma units, neonatal 
intensive care units, or (with respect to rural areas) regional 
referral centers, which, for purposes of this subpart, means hospitals 
meeting the requirements of referral centers found at Sec.  412.96 of 
this chapter) may not refuse to accept from a referring hospital within 
the boundaries of the United States an appropriate transfer of an 
individual who requires such specialized capabilities or facilities if 
the receiving hospital has the capacity to treat the individual. This 
requirement applies to any participating hospital with specialized 
capabilities, regardless of whether the hospital has a dedicated 
emergency department.
* * * * *

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

    Dated: March 30, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.

    Dated: April 10, 2006.
Michael O. Leavitt,
Secretary.

    [Editorial Note: The following Addendum and appendices will not 
appear in the Code of Federal Regulations.]

Addendum--Proposed Schedule of Standardized Amounts Effective With 
Discharges Occurring On or After October 1, 2006 and Update Factors and 
Rate-of-Increase Percentages Effective With Cost Reporting Periods 
Beginning On or After October 1, 2006

    (If you choose to comment on issues in this section, please 
include the caption ``Operating Payment Rates'' at the beginning of 
your comment.)

I. Summary and Background

    In this Addendum, we are setting forth the proposed amounts and 
factors for determining prospective payment rates for Medicare 
hospital inpatient operating costs and Medicare hospital inpatient 
capital-related costs. We are also setting forth the proposed rate-
of-increase percentages for updating the target amounts for 
hospitals and hospital units excluded from the IPPS.
    For discharges occurring on or after October 1, 2006, except for 
SCHs, MDHs, and hospitals located in Puerto Rico, each hospital's 
payment per discharge under the IPPS has been based on 100 percent 
of the Federal national rate, which has been based on the national 
adjusted standardized amount. This amount reflects the national 
average hospital cost per case from a base year, updated for 
inflation.
    SCHs are paid based on whichever of the following rates yields 
the greatest aggregate payment: the Federal national rate; the 
updated hospital-specific rate based on FY 1982 costs per discharge; 
the updated hospital-specific rate based on FY 1987 costs per 
discharge; or the updated hospital-specific rate based on FY 1996 
costs per discharge.
    Under section 1886(d)(5)(G) of the Act, MDHs were paid for FY 
2006 based on the Federal national rate or, if higher, the Federal 
national rate plus 50 percent of the difference between the Federal 
national rate and the updated hospital-specific rate based on FY 
1982 or FY 1987 costs per discharge, whichever is higher. (MDHs do 
not have the option to use their FY 1996 hospital-specific rate.) 
Section 5003(a)(1) of Pub. L. 109-171 extended and modified the MDH 
special payment provision which was previously set to expire on 
October 1, 2006, to discharges occurring on or after October 1, 
2006, but before October 1, 2011. Under section 5003(b) of Pub. L. 
109-171, if the change results in an increase to its target amount, 
MDHs must rebase their hospital-specific rates to their FY 2002 cost 
reports. In addition, under section 5003(c) of Pub. L. 109-171, MDHs 
will now be paid based on the Federal national rate or, if higher, 
the Federal national rate plus 75 percent of the difference between 
the Federal national rate and the updated hospital-specific rate. 
Further, based upon section 5003(d) of Pub. L. 109-171, MDHs will no 
longer be subject to the 12-percent cap on their DSH payment 
adjustment factor.
    For hospitals in Puerto Rico, the payment per discharge is based 
on the sum of 25 percent of a Puerto Rico rate that reflects base 
year average costs per case of Puerto Rico hospitals and 75 percent 
of the Federal national rate. (See section II.D.3. of this Addendum 
for a complete description.)
    As discussed below in section II. of this Addendum, we are 
proposing to make changes in the determination of the prospective 
payment rates for Medicare inpatient operating costs for FY 2007. 
The proposed changes, to be applied effective with discharges 
occurring on or after October 1, 2006, affect the calculation of the 
Federal rates. In section III. of this Addendum, we discuss our 
proposed changes for determining the prospective payment rates for 
Medicare inpatient capital-related costs for FY 2007. Section IV. of 
this Addendum sets forth our proposed changes for determining the 
rate-of-increase limits for hospitals excluded from the IPPS for FY 
2007. Section V. of this Addendum sets forth proposed policies on 
payment for blood clotting factors administered to hemophilia 
inpatients. The tables to which we refer in the preamble of this 
proposed rule are presented in section VI. of this Addendum.

II. Proposed Changes to Prospective Payment Rates for Hospital 
Inpatient Operating Costs for FY 2007

    The basic methodology for determining prospective payment rates 
for hospital inpatient operating costs for FY 2005 and subsequent 
fiscal years is set forth at Sec.  412.64. The basic methodology for 
determining the prospective payment rates for hospital inpatient 
operating costs for hospitals located in Puerto Rico for FY 2005 and 
subsequent fiscal years is set forth at Sec. Sec.  412.211 and 
412.212. Below we discuss the factors used for determining the 
prospective payment rates.
    In summary, the proposed standardized amounts set forth in 
Tables 1A, 1B, 1C, and 1D of section VI. of this Addendum reflect--
     Equalization of the standardized amounts for urban and 
other areas at the level computed for large urban hospitals during 
FY 2004 and onward, as provided for under section 1886(d)(3)(A)(iv) 
of the Act, updated by the applicable percentage increase required 
under sections 1886(b)(3)(B)(i)(XX) and 1886(b)(3)(B)(viii) of the 
Act.
     The two labor-related shares that are applicable to the 
standardized amounts and Puerto Rico-specific standardized amounts, 
depending on whether the hospital's payments would be higher with a 
lower (in the case of a wage index less than or equal to 1.0000) or 
higher (in the case of a wage index above 1.0000) labor share, as 
provided for under sections 1886(d)(3)(E), and 1886(d)(9)(C)(iv) of 
the Act.
     Proposed updates of 3.4 percent for all areas (that is, 
the full market basket percentage increase of 3.4 percent), as 
required by section 1886(b)(3)(B)(i)(XX) of the Act, as amended by 
section 5001 of Pub. L. 109-171, and reflecting the requirements of 
section 1886(b)(3)(B)(viii) of the Act, as added by section 
5001(a)(3) of Pub. L. 109-171, to reduce the applicable percentage 
increase by 2.0 percentage points for a hospital that fails to 
submit data, in a form and manner specified by the Secretary, 
relating to the quality of inpatient care furnished by the hospital;
     An adjustment to ensure the proposed DRG recalibration 
and wage index update and changes are budget neutral, as provided 
for under sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, 
by applying new budget neutrality adjustment factors to the 
standardized amount;
     An adjustment to ensure the effects of the special 
transition measures adopted in relation to the implementation of new 
labor market areas are budget neutral;
     An adjustment to ensure the effects of geographic 
reclassification are budget neutral, as provided for in section 
1886(d)(8)(D) of the Act, by removing the FY 2006 budget neutrality 
factor and applying a revised factor;
     An adjustment to apply the new outlier offset by 
removing the FY 2006 outlier offset and applying a new offset;
     An adjustment to ensure the effects of the rural 
community hospital demonstration required under section 410A of Pub. 
L. 108-173 are budget neutral, as required under section 410A(c)(2) 
of Pub. L. 108-173.

A. Calculation of the Adjusted Standardized Amount

1. Standardization of Base-Year Costs or Target Amounts

    The national standardized amount is based on per discharge 
averages of adjusted

[[Page 24148]]

hospital costs from a base period (section 1886(d)(2)(A) of the Act) 
or, for Puerto Rico, adjusted target amounts from a base period 
(section 1886(d)(9)(B)(i) of the Act), updated and otherwise 
adjusted in accordance with the provisions of section 1886(d) of the 
Act. The September 1, 1983 interim final rule (48 FR 39763) 
contained a detailed explanation of how base-year cost data (from 
cost reporting periods ending during FY 1981) were established in 
the initial development of standardized amounts for the IPPS. The 
September 1, 1987 final rule (52 FR 33043 and 33066) contains a 
detailed explanation of how the target amounts were determined, and 
how they are used in computing the Puerto Rico rates.
    Sections 1886(d)(2)(B) and (d)(2)(C) of the Act require us to 
update base-year per discharge costs for FY 1984 and then 
standardize the cost data in order to remove the effects of certain 
sources of cost variations among hospitals. These effects include 
case-mix, differences in area wage levels, cost-of-living 
adjustments for Alaska and Hawaii, indirect medical education costs, 
and costs to hospitals serving a disproportionate share of low-
income patients.
    In accordance with section 1886(d)(3)(E) of the Act, the 
Secretary estimates, from time-to-time, the proportion of hospitals' 
costs that are attributable to wages and wage-related costs. The 
standardized amount is divided into labor-related and nonlabor-
related amounts; only the proportion considered the labor-related 
amount is adjusted by the wage index. Section 1886(d)(3)(E) of the 
Act requires that 62 percent of the standardized amount be adjusted 
by the wage index, unless doing so would result in lower payments to 
a hospital than would otherwise be made. (Section 
1886(d)(9)(C)(iv)(II) of the Act extends this provision to the 
labor-related share for hospitals located in Puerto Rico.)
    For FY 2007, we are proposing not to adjust the national and 
Puerto Rico-specific labor-related and nonlabor-related share from 
the percentages established in FY 2006. Accordingly, we are 
proposing to adjust 62 percent of the national standardized amount 
for all hospitals whose wage indexes are less than or equal to 
1.0000. For all hospitals whose wage values are greater than 1.0000, 
we are proposing to adjust 69.7 percent of the national standardized 
amount by the hospitals' wage indexes. For hospitals in Puerto Rico, 
we are proposing to adjust 58.7 percent of the Puerto Rico-specific 
standardized amount for all hospitals whose Puerto Rico-specific 
wage indexes are less than or equal to 1.0000. For Puerto Rico 
hospitals whose Puerto Rico-specific wage index values are greater 
than 1.0000, we are proposing to adjust 62 percent of the Puerto 
Rico-specific standardized amount.
    The proposed standardized amounts appear in Table 1A, 1B, and 1C 
of the Addendum to this proposed rule.

2. Computing the Average Standardized Amount

    Section 1886(d)(3)(A)(iv) of the Act requires that, beginning 
with FY 2004 and thereafter, an equal standardized amount is to be 
computed for all hospitals at the level computed for large urban 
hospitals during FY 2003, updated by the applicable percentage 
update. Section 1886(d)(9)(A) of the Act equalizes the Puerto Rico-
specific urban and rural area rates. Accordingly, we are using this 
proposed rule to provide for a single national standardized amount 
and a single Puerto Rico standardized amount for FY 2007.

3. Updating the Average Standardized Amount

    In accordance with section 1886(d)(3)(A)(iv)(II) of the Act, we 
are proposing to update the equalized standardized amount for FY 
2007 by the full estimated market basket percentage increase for 
hospitals in all areas, as specified in section 1886(b)(3)(B)(i)(XX) 
of the Act, as amended by section 5001(a)(1) of Pub. L. 109-171. The 
percentage change in the market basket reflects the average change 
in the price of goods and services purchased by hospitals to furnish 
inpatient care. The most recent forecast of the hospital market 
basket increase for FY 2007 is 3.4 percent. Thus, for FY 2007, the 
proposed update to the average standardized amount is 3.4 percent 
for hospitals in all areas.
    Section 1886(b)(3)(B) of the Act specifies the mechanism used to 
update the standardized amount for payment for inpatient hospital 
operating costs. Section 1886(b)(3)(B)(viii) of the Act, as added by 
section 5001(a)(3) of Pub. L. 109-171, provides for a reduction of 
2.0 percentage points to the update percentage increase (also known 
as the market basket update) for FY 2007 and each subsequent fiscal 
year for any ``subsection (d) hospital'' that does not submit 
quality data as discussed in section IV.A. of the preamble of this 
proposed rule. The proposed standardized amounts in Tables 1A 
through 1C of section VI. of this Addendum reflect these 
differential amounts.
    Although the update factors for FY 2007 are set by law, we are 
required by section 1886(e)(4) of the Act to recommend, taking into 
account MedPAC's recommendations, appropriate update factors for FY 
2007 for both IPPS hospitals and hospitals and hospital units 
excluded from the IPPS. Our recommendation on the update factors 
(which is required by sections 1886(e)(4)(A) and (e)(5)(A) of the 
Act) is set forth in Appendix B of this proposed rule.

4. Other Adjustments to the Average Standardized Amount

    As in the past, we are proposing to adjust the FY 2007 
standardized amount to remove the effects of the FY 2006 geographic 
reclassifications and outlier payments before applying the proposed 
FY 2007 updates. We then apply the new offsets for outliers and 
geographic reclassifications to the proposed standardized amount for 
FY 2007.
    We do not remove the prior year's budget neutrality adjustments 
for reclassification and recalibration of the DRG weights and for 
updated wage data because, in accordance with sections 
1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, estimated aggregate 
payments after the changes in the DRG relative weights and wage 
index should equal estimated aggregate payments prior to the 
changes. If we removed the prior year adjustment, we would not 
satisfy these conditions.
    Budget neutrality is determined by comparing aggregate IPPS 
payments before and after making the changes that are required to be 
budget neutral (for example, reclassifying and recalibrating the 
DRGs, updating the wage data, and geographic reclassifications). We 
include outlier payments in the payment simulations because outliers 
may be affected by changes in these payment parameters.
    We are also proposing to adjust the standardized amount this 
year by an amount estimated to ensure that aggregate IPPS payments 
do not exceed the amount of payments that would have been made in 
the absence of the rural community hospital demonstration required 
under section 410A of Pub. L. 108-173. This demonstration is 
required to be budget neutral under section 410A(c)(2) of Pub. L. 
108-173.

a. Recalibration of DRG Weights and Updated Wage Index--Budget 
Neutrality Adjustment

    Section 1886(d)(4)(C)(iii) of the Act specifies that, beginning 
in FY 1991, the annual DRG reclassification and recalibration of the 
relative weights must be made in a manner that ensures that 
aggregate payments to hospitals are not affected. As discussed in 
section II. of the preamble, we normalized the recalibrated DRG 
weights by an adjustment factor, so that the average case weight 
after recalibration is equal to the average case weight prior to 
recalibration. However, equating the average case weight after 
recalibration to the average case weight before recalibration does 
not necessarily achieve budget neutrality with respect to aggregate 
payments to hospitals because payments to hospitals are affected by 
factors other than average case weight. Therefore, as we have done 
in past years, we are proposing to make a budget neutrality 
adjustment to ensure that the requirement of section 
1886(d)(4)(C)(iii) of the Act is met.
    Section 1886(d)(3)(E) of the Act requires us to update the 
hospital wage index on an annual basis beginning October 1, 1993. 
This provision also requires us to make any updates or adjustments 
to the wage index in a manner that ensures that aggregate payments 
to hospitals are not affected by the change in the wage index. For 
FY 2007, we are proposing to continue to adjust 10 percent of the 
wage index factor for occupational mix. We describe the proposed 
occupational mix adjustment in section III.C. of the preamble to 
this proposed rule. Because section 1886(d)(3)(E) of the Act 
requires us to update the wage index on a budget neutral basis, we 
are including the effects of this proposed occupational mix 
adjustment on the wage index in our budget neutrality calculations.
    In FY 2005, those urban hospitals that became rural under the 
new labor market area definitions were assigned the wage index of 
the urban area in which they were located under the previous labor 
market definitions for a 3-year period of FY 2005, FY 2006, and FY 
2007. Because we are in the third year of this 3-year transition, we 
are proposing to adjust the standardized amounts for FY 2007 to 
ensure budget neutrality for this policy. We discuss this proposed

[[Page 24149]]

adjustment in section III.B. of the preamble to this proposed rule.
    Section 4410 of Pub. L. 105-33 provides that, for discharges on 
or after October 1, 1997, the area wage index applicable to any 
hospital that is not located in a rural area may not be less than 
the area wage index applicable to hospitals located in rural areas 
in that State. This provision is required by section 4410(b) of Pub. 
L. 105-33 to be budget neutral. Therefore, we include the effects of 
this provision in our calculation of the proposed wage update budget 
neutrality factor. As discussed in the FY 2006 IPPS final rule (70 
FR 47493), FY 2007 is the third and final year of the 3-year 
provision that uses an imputed wage index floor for States that have 
no rural areas and States that have geographic rural areas, but that 
have no hospitals actually classified as rural. We are also 
proposing to adjust for the effects of this provision in our 
calculation of the wage update budget neutrality factor.
    To comply with the requirement that DRG reclassification and 
recalibration of the relative weights be budget neutral, and the 
requirement that the updated wage index be budget neutral, we used 
FY 2005 discharge data to simulate payments and compared aggregate 
payments using the FY 2006 relative weights and wage indexes to 
aggregate payments using the proposed FY 2007 relative weights and 
wage indexes. The same methodology was used for the FY 2006 budget 
neutrality adjustment.
    Based on this comparison, we computed a proposed budget 
neutrality adjustment factor equal to 0.998363. We also are 
proposing to adjust the Puerto Rico-specific standardized amount for 
the effect of DRG reclassification and recalibration. We computed a 
proposed budget neutrality adjustment factor for the Puerto Rico-
specific standardized amount equal to 0.998963. These proposed 
budget neutrality adjustment factors are applied to the standardized 
amounts without removing the effects of the FY 2006 budget 
neutrality adjustments. In addition, as discussed in section IV.E. 
of the preamble to this proposed rule, we are applying the same 
proposed DRG reclassification and recalibration budget neutrality 
factor of 0.998963 to the hospital-specific rates that are to be 
effective for cost reporting periods beginning on or after October 
1, 2006.
    Using the same data, we calculated a proposed transition budget 
neutrality adjustment to account for the ``hold harmless'' policy 
under which urban hospitals that became rural under the new labor 
market area definitions were assigned the wage index of the urban 
area in which they were located under the previous labor market area 
definitions for a 3-year period of FY 2005, FY 2006, and FY 2007 
(see Table 2 in section VI. of this Addendum). Using the pre-
reclassified wage index, we simulated payments under the new labor 
market area definitions and compared them to simulated payments 
under the ``hold harmless'' policy. Based on this comparison, we 
computed a proposed transition budget neutrality adjustment of 
0.999591.

b. Reclassified Hospitals--Budget Neutrality Adjustment

    Section 1886(d)(8)(B) of the Act provides that, effective with 
discharges occurring on or after October 1, 1988, certain rural 
hospitals are deemed urban. In addition, section 1886(d)(10) of the 
Act provides for the reclassification of hospitals based on 
determinations by the MGCRB. Under section 1886(d)(10) of the Act, a 
hospital may be reclassified for purposes of the wage index.
    Under section 1886(d)(8)(D) of the Act, the Secretary is 
required to adjust the standardized amount to ensure that aggregate 
payments under the IPPS after implementation of the provisions of 
sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act are equal 
to the aggregate prospective payments that would have been made 
absent these provisions. We note that neither the wage index 
reclassifications provided under section 508 of Pub. L. 108-173 nor 
the wage index adjustments provided under section 1886(d)(13) of the 
Act are budget neutral. Section 508(b) of Pub. L. 108-173 provides 
that the wage index reclassifications approved under section 508(a) 
of Pub. L. 108-173 ``shall not be effected in a budget neutral 
manner.'' Section 1886(d)(13)(H) of the Act similarly provides that 
any increase in a wage index under section 1886(d)(13) shall not be 
taken into account ``in applying any budget neutrality adjustment 
with respect to such index'' under section 1886(d)(8)(D) of the Act. 
To calculate this proposed budget neutrality factor, we used FY 2005 
discharge data to simulate payments, and compared total IPPS 
payments prior to any reclassifications under sections 1886(d)(8)(B) 
and (C) and 1886(d)(10) of the Act to total IPPS payments after such 
reclassifications. Based on these simulations, we are proposing to 
apply an adjustment factor of 0.991727 to ensure that the effects of 
this reclassification are budget neutral.
    The proposed adjustment factor is applied to the standardized 
amount after removing the effects of the FY 2006 budget neutrality 
adjustment factor. We note that the proposed FY 2007 adjustment 
reflects FY 2007 wage index reclassifications approved by the MGCRB 
or the Administrator, and the effects of MGCRB reclassifications 
approved in FY 2005 and FY 2006 (section 1886(d)(10)(D)(v) of the 
Act makes wage index reclassifications effective for 3 years).

c. Outliers

    Section 1886(d)(5)(A) of the Act provides for payments in 
addition to the basic prospective payments for ``outlier'' cases 
involving extraordinarily high costs. To qualify for outlier 
payments, a case must have costs greater than the sum of the 
prospective payment rate for the DRG, any IME and DSH payments, any 
new technology add-on payments, and the ``outlier threshold'' or 
``fixed loss'' amount (a dollar amount by which the costs of a case 
must exceed payments in order to qualify for an outlier payment). We 
refer to the sum of the prospective payment rate for the DRG, any 
IME and DSH payments, any new technology add-on payments, and the 
outlier threshold as the outlier ``fixed-loss cost threshold.'' To 
determine whether the costs of a case exceed the fixed-loss cost 
threshold, a hospital's cost-to-charge ratio is applied to the total 
covered charges for the case to convert the charges to costs. 
Payments for eligible cases are then made based on a marginal cost 
factor, which is a percentage of the costs above the fixed-loss cost 
threshold. The marginal cost factor for FY 2007 is 80 percent--the 
same marginal cost factor we have used since FY 1995 (59 FR 45367).
    In accordance with section 1886(d)(5)(A)(iv) of the Act, outlier 
payments for any year are projected to be not less than 5 percent 
nor more than 6 percent of total operating DRG payments plus outlier 
payments. Section 1886(d)(3)(B) of the Act requires the Secretary to 
reduce the average standardized amount by a factor to account for 
the estimated proportion of total DRG payments made to outlier 
cases. Similarly, section 1886(d)(9)(B)(iv) of the Act requires the 
Secretary to reduce the average standardized amount applicable to 
hospitals in Puerto Rico to account for the estimated proportion of 
total DRG payments made to outlier cases. More information on 
outlier payments may be found on the CMS Web site at http://www.cms.hhs.gov/AcuteInpatientPPS/04_outlier.asp#TopOfPage TopOfPage.

i. Proposed FY 2007 Outlier Fixed-Loss Cost Threshold

    For FY 2007, we are proposing to use the same methodology used 
for FY 2006 (70 FR 47493) to calculate the outlier threshold. As we 
have done in the past, to calculate the proposed FY 2007 outlier 
threshold, we simulated payments by applying proposed FY 2007 rates 
and policies using cases from the FY 2005 MedPAR files. Therefore, 
in order to determine the proposed FY 2007 outlier threshold, we are 
proposing to inflate the charges on the MedPAR claims by 2 years, 
from FY 2005 to FY 2007.
    In certain years in the past, we have inflated MedPAR claims by 
calculating a 2-year average annual rate-of-change in charges-per-
case using the charge data for the two most recent years for which 
we had relatively complete MedPAR data. As discussed in the FY 2006 
IPPS final rule (70 FR 47494), however, we believe that charge data 
from FY 2003 may be distorted due to the atypically high rate of 
hospital charge inflation during FY 2003. Therefore, we are not 
proposing to inflate charges using a 2-year average annual rate-of-
change from FY 2003 to FY 2004 and FY 2004 to FY 2005.
    Instead, we are proposing to continue to use a refined 
methodology that takes into account the lower inflation in hospital 
charges that is occurring as a result of the outlier final rule (68 
FR 34494), which changed our methodology for determining outlier 
payments by implementing the use of more current and accurate CCRs. 
Our refined methodology uses more recent data that reflects the 
rate-of-change in hospital charges under the new outlier policy. 
Specifically, we are proposing to establish the proposed FY 2007 
outlier threshold as follows: Using the latest data available, we 
propose to calculate the 1-year average annualized rate-of-change in 
charges-per-case from the last quarter of FY 2004 in combination 
with the

[[Page 24150]]

first quarter of FY 2005 (July 1, 2004 through December 31, 2004) to 
the last quarter of FY 2005 in combination with the first quarter of 
FY 2006 (July 1, 2005 through December 31, 2005). This rate of 
change was 7.57 percent (1.0757) or 15.15 percent (1.1515) over 2 
years.
    As we have done in the past, we are proposing to establish the 
proposed FY 2007 outlier threshold using hospital cost-to-charge 
ratios from the December 2005 update to the Provider-Specific File--
the most recent available at the time of this proposed rule. This 
file includes cost-to-charge ratios that reflect implementation of 
the changes to the policy for determining the applicable cost-to-
charge ratios that became effective August 8, 2003 (68 FR 34494).
    Using this methodology, we are proposing to establish an outlier 
fixed-loss cost threshold for FY 2007 equal to the prospective 
payment rate for the DRG, plus any IME and DSH payments, and any 
add-on payments for new technology, plus $25,530.
    We note that the case-weighted national average cost-to-charge 
ratio declined by approximately 1 percent from the March 2005 to the 
December 2005 update of the Provider-Specific File. Hospital charges 
continue to increase at a steady rate of growth between 7 and 8 
percent over each of the last 2 years, resulting in a decline to the 
cost-to-charge ratios that are used to compute the outlier 
threshold. Using lower cost-to-charge ratios from the December 2005 
Provider-Specific File, in combination with the FY 2005 MedPAR 
claims and inflated charges, contributes to a higher proposed 
outlier threshold for FY 2007 compared to FY 2006.
    As we did in establishing the FY 2006 outlier threshold (70 FR 
47494), in our projection of FY 2007 outlier payments, we are not 
making an adjustment for the possibility that hospitals' cost-to-
charge ratios and outlier payments may be reconciled upon cost 
report settlement. We continue to believe that, due to the policy 
implemented in the June 9, 2003 outlier final rule, cost-to-charge 
ratios will no longer fluctuate significantly and, therefore, few 
hospitals will actually have these ratios reconciled upon cost 
report settlement. In addition, it is difficult to predict which 
specific hospitals will have cost-to-charge ratios and outlier 
payments reconciled in their cost reports in any given year. We also 
note that reconciliation occurs because hospitals' actual cost-to-
charge ratios for the cost reporting period are different than the 
interim cost-to-charge ratios used to calculate outlier payments 
when a bill is processed. Our simulations assume that cost-to-charge 
ratios accurately measure hospital costs and, therefore, are more 
indicative of post-reconciliation than pre-reconciliation outlier 
payments. As a result, we are proposing to continue to omit any 
assumptions about the effects of reconciliation from the outlier 
threshold calculation.

ii. Other Changes Concerning Outliers

    As stated in the FY 1994 IPPS final rule (58 FR 46348, September 
1, 1993), we establish outlier thresholds that are applicable to 
both hospital inpatient operating costs and hospital inpatient 
capital-related costs. When we modeled the combined operating and 
capital outlier payments, we found that using a common set of 
thresholds resulted in a lower percentage of outlier payments for 
capital-related costs than for operating costs. We project that the 
thresholds for FY 2007 will result in outlier payments equal to 5.1 
percent of operating DRG payments and 4.87 percent of capital 
payments based on the Federal rate.
    In accordance with section 1886(d)(3)(B) of the Act, we are 
proposing to reduce the proposed FY 2007 standardized amount by the 
same percentage to account for the projected proportion of payments 
paid to outliers.
    The proposed outlier adjustment factors that would be applied to 
the standardized amount for FY 2007 are as follows:

------------------------------------------------------------------------
                                        Operating
                                       standardized     Capital Federal
                                         amounts              rate
------------------------------------------------------------------------
National..........................           0.948984           0.951305
Puerto Rico.......................           0.970984           0.968473
------------------------------------------------------------------------

    We are proposing to apply the outlier adjustment factors to the 
FY 2007 rates after removing the effects of the FY 2006 outlier 
adjustment factors on the standardized amount.
    To determine whether a case qualifies for outlier payments, we 
apply hospital-specific cost-to-charge ratios to the total covered 
charges for the case. Operating and capital costs for the case are 
calculated separately by applying separate operating and capital 
cost-to-charge ratios. These costs are then combined and compared 
with the outlier fixed-loss cost threshold.
    The outlier final rule (68 FR 34494) eliminated the application 
of the statewide average cost-to-charge ratios for hospitals whose 
cost-to-charge ratios fall below 3 standard deviations from the 
national mean cost-to-charge ratio. However, for those hospitals for 
which the fiscal intermediary computes operating cost-to-charge 
ratios greater than 1.25 or capital cost-to-charge ratios greater 
than 0.158, or hospitals for whom the fiscal intermediary is unable 
to calculate a cost-to-charge ratio (as described at Sec.  
412.84(i)(3) of our regulations), we are still using statewide 
average cost-to-charge ratios to determine whether a hospital 
qualifies for outlier payments.\22\ Table 8A in section VI. of this 
Addendum contains the proposed statewide average operating cost-to-
charge ratios for urban hospitals and for rural hospitals for which 
the fiscal intermediary is unable to compute a hospital-specific 
cost-to-charge ratio within the above range. Effective for 
discharges occurring on or after October 1, 2006, these proposed 
statewide average ratios would replace the ratios published in the 
IPPS final rule for FY 2006 (70 FR 47672). Table 8B in section VI. 
of this Addendum contains the proposed comparable statewide average 
capital cost-to-charge ratios. Again, the proposed cost-to-charge 
ratios in Tables 8A and 8B would be used during FY 2007 when 
hospital-specific cost-to-charge ratios based on the latest settled 
cost report are either not available or are outside the range noted 
above. For an explanation of Table 8C, please see section VI. of 
this Addendum.
---------------------------------------------------------------------------

    \22\ These figures represent 3.0 standard deviations from the 
mean of the log distribution of cost-to-charge ratios for all 
hospitals.
---------------------------------------------------------------------------

    We finally note that we published a manual update (Change 
Request 3966) to outliers on October 12, 2005. The manual update 
covered an array of topics, including cost-to-charge ratios, 
reconciliation, and the time value of money. To download and view 
the manual update, please visit http://www.cms.hhs.gov/transmittals/downloads/R707CP.pdf.

iii. FY 2005 and FY 2006 Outlier Payments

    In the FY 2006 IPPS final rule (70 FR 47496), we stated that, 
based on available data, we estimated that actual FY 2005 outlier 
payments would be approximately 4.1 percent of actual total DRG 
payments. This estimate was computed based on simulations using the 
FY 2004 MedPAR file (discharge data for FY 2004 bills). That is, the 
estimate of actual outlier payments did not reflect actual FY 2005 
bills, but instead reflected the application of FY 2005 rates and 
policies to available FY 2004 bills.
    Our current estimate, using available FY 2005 bills, is that 
actual outlier payments for FY 2005 were approximately 4.10 percent 
of actual total DRG payments. Thus, the data indicate that, for FY 
2005, the percentage of actual outlier payments relative to actual 
total payments is lower than we projected before FY 2005 (and, thus, 
is less than the percentage by which we reduced the standardized 
amounts for FY 2005). We note that, for FY 2006, the outlier 
threshold was lowered to $23,600 compared to $25,800 for FY 2005. 
The outlier threshold was lower in FY 2006 than FY 2005 as a result 
of slower growth in hospital charge inflation following 
implementation of the outlier final rule that went into effect on 
August 9, 2003. Nevertheless, consistent with the policy and 
statutory interpretation we have maintained since the inception of 
the IPPS, we do not plan to make retroactive adjustments to outlier 
payments to ensure that total outlier payments for FY 2005 are equal 
to 5.1 percent of total DRG payments.
    We currently estimate that actual outlier payments for FY 2006 
will be approximately 4.71 percent of actual total DRG payments, 
0.39 percentage point lower than the 5.1 percent we projected in 
setting the outlier

[[Page 24151]]

policies for FY 2006. This estimate is based on simulations using 
the FY 2005 MedPAR file (discharge data for FY 2005 bills). We used 
these data to calculate an estimate of the actual outlier percentage 
for FY 2006 by applying FY 2006 rates and policies, including an 
outlier threshold of $23,600 to available FY 2005 bills. Even though 
we are estimating payments below the 5.1 percent threshold for FY 
2006, our simulations using FY 2005 Medicare data show consistent 
levels of charge inflation and a need to increase the threshold for 
FY 2007 to ensure that 5.1 percent of total IPPS payments are paid 
as outliers. However, our current estimate of the outlier threshold 
for FY 2007 may change in the final rule based on updated data.

iv. Technical Changes

    Subpart F of Part 412 of the existing regulations discusses 
payment for outlier cases and special payment for new technology. We 
have become aware of an inadvertent mistake in Sec.  412.84(m). 
Currently, Sec.  412.84(m) discusses the application of the time 
value of money when a hospital's outlier payments are reconciled. 
When referencing reconciliation, the section by mistake references 
paragraph (h)(3) instead of paragraph (i)(4). We are proposing to 
revise Sec.  412.84(m) to reference the current policy under 
paragraph (i)(4).

d. Rural Community Hospital Demonstration Program Adjustment (Section 
410A of Pub. L. 108-173)

    Section 410A of Pub. L. 108-173 requires the Secretary to 
establish a demonstration that will modify reimbursement for 
inpatient services for up to 15 small rural hospitals. Section 
410A(c)(2) of Pub. L. 108-173 requires that ``in conducting the 
demonstration program under this section, the Secretary shall ensure 
that the aggregate payments made by the Secretary do not exceed the 
amount which the Secretary would have paid if the demonstration 
program under this section was not implemented.'' As discussed in 
section IV.M. of the preamble to this proposed rule, we are 
proposing to satisfy this requirement by adjusting national IPPS 
rates by a factor that is sufficient to account for the added costs 
of this demonstration. We estimate that the average additional 
annual payment that will be made to each participating hospital 
under the demonstration will be approximately $1,021,985. We based 
this estimate on the recent historical experience of the difference 
between inpatient cost and payment for hospitals that are 
participating in the demonstration. For 9 participating hospitals, 
the total annual impact of the demonstration program is estimated to 
be $9,197,870. The required adjustment to the Federal rate used in 
calculating Medicare inpatient prospective payments as a result of 
the demonstration is 0.999905.
    In order to achieve budget neutrality, we are proposing to 
adjust national IPPS rates by an amount sufficient to account for 
the added costs of this demonstration. In other words, we are 
proposing to apply budget neutrality across the payment system as a 
whole rather than merely across the participants of this 
demonstration. We believe that the language of the statutory budget 
neutrality requirement permits the agency to implement the budget 
neutrality provision in this manner. This is because the statutory 
language requires that ``aggregate payments made by the Secretary do 
not exceed the amount which the Secretary would have paid if the 
demonstration * * * was not implemented,'' but does not identify the 
range across which aggregate payments must be held equal.

5. Proposed FY 2007 Standardized Amount

    The adjusted standardized amount is divided into labor-related 
and nonlabor-related portions. Tables 1A and 1B in section VI. of 
this Addendum contain the national standardized amount that we are 
proposing to apply to all hospitals, except hospitals in Puerto 
Rico. The Puerto Rico-specific amounts are shown in Table 1C. The 
amounts shown in Tables 1A and 1B differ only in that the labor-
related share applied to the standardized amounts in Table 1A is 
69.7 percent, and the labor-related share applied to the 
standardized amounts in Table 1B is 62 percent. In accordance with 
sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act, we are 
applying the labor-related share of 62 percent, unless the 
application of that percentage would result in lower payments to a 
hospital than would otherwise be made. The effect of this 
application is that the labor-related share of the standardized 
amount is 62 percent for all hospitals (other than those in Puerto 
Rico) whose wage indexes are less than or equal to 1.0000.
    In addition, Tables 1A and 1B include proposed standardized 
amounts reflecting the full 3.4 percent proposed update for FY 2007, 
and proposed standardized amounts reflecting the 2.0 percentage 
point reduction to the proposed update (a 1.4 percent update) 
applicable for hospitals that fail to submit quality data consistent 
with section 1886(b)(3)(B)(viii) of the Act.
    The following table illustrates the proposed changes from the FY 
2006 national average standardized amount. The first column shows 
the proposed changes from the FY 2006 standardized amounts for 
hospitals that satisfy the quality data submission requirement for 
receiving the full update (3.4 percent). The second column shows the 
proposed changes for hospitals receiving the reduced update (1.4 
percent). The first row of the table shows the proposed updated 
(through FY 2006) average standardized amount after restoring the FY 
2006 offsets for outlier payments, demonstration budget neutrality, 
the wage index transition budget neutrality and geographic 
reclassification budget neutrality. The DRG reclassification and 
recalibration and wage index budget neutrality factor is cumulative. 
Therefore, we did not remove the FY 2006 budget neutrality factors 
for DRG reclassification and recalibration from the amounts in the 
table. We have added separate rows to this table to reflect the 
different labor-related shares that apply to hospitals.

  Comparison of FY 2006 Standardized Amounts to Proposed FY 2007 Single
         Standardized Amount With Full Update and Reduced Update
------------------------------------------------------------------------
                                   Full update  (3.4    Reduced update
                                       percent)          (1.4 percent)
------------------------------------------------------------------------
FY 2006 Base Rate, after          Labor: $3,505.76..  Labor: $3,505.76.
 removing reclassification        Nonlabor:           Nonlabor:
 budget neutrality,                $1,524.03.          $1,524.03.
 demonstration budget
 neutrality, wage index
 transition budget neutrality
 factors and outlier offset
 (based on the proposed labor
 and nonlabor market share
 percentage for FY 2007).
Proposed FY 2007 Update Factor..  1.034.............  1.014.
Proposed FY 2007 DRG              0.998363..........  0.998363.
 Recalibrations and Wage Index
 Budget Neutrality Factor.
Proposed FY 2007                  0.991727..........  0.991727.
 Reclassification Budget
 Neutrality Factor.
Adjusted for Blend of FY 2006     Labor: $3,589.08..  Labor: $3,519.67.
 DRG Recalibration and Wage       Nonlabor:           Nonlabor:
 Index Budget Neutrality Factors.  $1,560.25.          $1,530.07.
Proposed FY 2007 Outlier Factor.  0.948984..........  0.948984.
Proposed FY 2007 Labor Market     0.999591..........  0.999591.
 Wage Index Transition Budget
 Neutrality Factor.
Proposed Rural Demonstration      0.999905..........  0.999905.
 Budget Neutrality Factor.
Proposed Rate for FY 2007 (after  Labor: $3,028.19..  Labor: $2,969.62.
 multiplying FY 2006 base rate    Nonlabor:           Nonlabor:
 by above factors) where the       $1,855.98.          $1,820.08.
 wage index is less than or
 equal to 1.0000.
Proposed Rate for FY 2007 (after  Labor: $3,404.27..  Labor: $3,338.42.
 multiplying FY 2006 base rate    Nonlabor:           Nonlabor:
 by above factors) where the       $1,479.90.          $1,451.28.
 wage index is greater than
 1.0000.
------------------------------------------------------------------------

    Under section 1886(d)(9)(A)(ii) of the Act, the Federal portion 
of the Puerto Rico payment rate is based on the discharge-weighted 
average of the national large urban standardized amount (as set 
forth in Table 1A). The proposed labor-related and

[[Page 24152]]

nonlabor-related portions of the national average standardized 
amounts for Puerto Rico hospitals for FY 2007 are set forth in Table 
1C of section VI. of this Addendum. This table also includes the 
Puerto Rico standardized amounts. The labor-related share applied to 
the Puerto Rico specific standardized amount is 58.7 percent, or 62 
percent, depending on which is more advantageous to the hospital. 
(Section 1886(d)(9)(C)(iv) of the Act, as amended by section 403(b) 
of Pub. L. 108-173, provides that the labor-related share for 
hospitals in Puerto Rico will be 62 percent, unless the application 
of that percentage would result in lower payments to the hospital.)

B. Adjustments for Area Wage Levels and Cost-of-Living

    Tables 1A through 1C, as set forth in section VI. of this 
Addendum, contain the labor-related and nonlabor-related shares that 
we are proposing to use to calculate the prospective payment rates 
for hospitals located in the 50 States, the District of Columbia, 
and Puerto Rico for FY 2007. This section addresses two types of 
adjustments to the standardized amounts that are made in determining 
the proposed prospective payment rates as described in this 
Addendum.

1. Adjustment for Area Wage Levels

    Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require 
that we make an adjustment to the labor-related portion of the 
national and Puerto Rico prospective payment rates, respectively, to 
account for area differences in hospital wage levels. This 
adjustment is made by multiplying the labor-related portion of the 
adjusted standardized amounts by the appropriate wage index for the 
area in which the hospital is located. In section III. of the 
preamble to this proposed rule, we discuss the data and methodology 
for the proposed FY 2007 wage index. The proposed FY 2007 wage 
indexes are set forth in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F 
of section VI. of this Addendum.

2. Adjustment for Cost-of-Living in Alaska and Hawaii

    Section 1886(d)(5)(H) of the Act authorizes an adjustment to 
take into account the unique circumstances of hospitals in Alaska 
and Hawaii. Higher labor-related costs for these two States are 
taken into account in the adjustment for area wages described above. 
For FY 2007, we are proposing to adjust the payments for hospitals 
in Alaska and Hawaii by multiplying the nonlabor-related portion of 
the standardized amount by the appropriate adjustment factor 
contained in the table below. If the Office of Personnel Management 
releases revised cost-of-living adjustment factors before July 1, 
2006, we will publish them in the final rule and use them in 
determining FY 2007 payments.

 Table of Cost-of-Living Adjustment Factors: Alaska and Hawaii Hospitals
------------------------------------------------------------------------
                                                               Cost of
                                                               living
                           Area                              adjustment
                                                               factor
------------------------------------------------------------------------
Alaska-All areas..........................................        1.25
Hawaii:
  County of Honolulu......................................        1.25
  Hawaii..................................................        1.165
  County of Kauai.........................................        1.2325
  County of Maui..........................................        1.2375
  County of Kalawao.......................................        1.2375
------------------------------------------------------------------------

    (The above factors are based on data obtained from the U.S. 
Office of Personnel Management.)

C. DRG Relative Weights

    As discussed in section II. of the preamble of this proposed 
rule, we have developed a classification system for all hospital 
discharges, assigning them into DRGs, and have developed relative 
weights for each DRG that reflect the resource utilization of cases 
in each DRG relative to Medicare cases in other DRGs. Table 5 of 
section VI. of this Addendum contains the relative weights that we 
are proposing to use for discharges occurring in FY 2007. These 
factors have been recalibrated as explained in section II. of the 
preamble of this proposed rule.

D. Calculation of the Proposed Prospective Payment Rates for FY 
2007

General Formula for Calculation of Prospective Payment Rates for FY 
2007

    The proposed operating prospective payment rate for all 
hospitals paid under the IPPS located outside of Puerto Rico, except 
SCHs and MDHs, for FY 2007 equals the Federal rate based on the 
corresponding amounts in Table 1A or Table 1B in section VI. of this 
Addendum.
    The proposed prospective payment rate for SCHs for FY 2007 
equals the higher of the applicable Federal rate (from Table 1A or 
Table 1B) or the hospital-specific rate as described below. The 
proposed prospective payment rate for MDHs for FY 2007 equals the 
higher of the Federal rate, or the Federal rate plus 75 percent of 
the difference between the Federal rate and the hospital-specific 
rate as described below. The proposed prospective payment rate for 
Puerto Rico for FY 2007 equals 25 percent of the Puerto Rico rate 
from Table 1C in section VI. of this Addendum plus 75 percent of the 
applicable national rate from Table 1A or Table 1B in section VI. of 
this Addendum.

1. Federal Rate

    For discharges occurring on or after October 1, 2006 and before 
October 1, 2007, except for SCHs, MDHs, and hospitals in Puerto 
Rico, payment under the IPPS is based exclusively on the Federal 
rate.
    The Federal rate is determined as follows:
    Step 1--Select the appropriate average standardized amount 
considering the applicable wage index (Table 1A for wage indexes 
greater than 1.0000 and Table 1B for wage indexes less than or equal 
to 1.0000) and whether the hospital has submitted qualifying quality 
data (full update for qualifying hospitals, update minus 2.0 
percentage points for nonqualifying hospitals).
    Step 2--Multiply the labor-related portion of the standardized 
amount by the applicable wage index for the geographic area in which 
the hospital is located or the area to which the hospital is 
reclassified (see Tables 4A-1, 4A-2, 4B, 4C-1, and 4C-2 of section 
VI. of this Addendum).
    Step 3--For hospitals in Alaska and Hawaii, multiply the 
nonlabor-related portion of the standardized amount by the 
appropriate cost-of-living adjustment factor.
    Step 4--Add the amount from Step 2 and the nonlabor-related 
portion of the standardized amount (adjusted, if appropriate, under 
Step 3).
    Step 5--Multiply the final amount from Step 4 by the relative 
weight corresponding to the appropriate DRG (see Table 5 of section 
VI. of this Addendum).
    The Federal rate as determined in Step 5 may then be further 
adjusted if the hospital qualifies for either the IME or DSH 
adjustment. In addition, for hospitals that qualify for a low-volume 
payment adjustment under section 1886(d)(12) of the Act, the payment 
in Step 5 would be increased by 25 percent.

2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)

a. Calculation of Hospital-Specific Rate

    Section 1886(b)(3)(C) of the Act provides that SCHs are paid 
based on whichever of the following rates yields the greatest 
aggregate payment: the Federal rate; the updated hospital-specific 
rate based on FY 1982 costs per discharge; the updated hospital-
specific rate based on FY 1987 costs per discharge; or the updated 
hospital-specific rate based on FY 1996 costs per discharge.
    As discussed above, MDHs must rebase their hospital-specific 
rates to their FY 2002 cost reports if doing so results in higher 
payments. In addition, effective for discharges occurring on or 
after October 1, 2006, MDHs are paid based on the Federal national 
rate or, if higher, the Federal national rate plus 75 percent of the 
difference between the Federal national rate and the greater of the 
updated hospital-specific rates based on either FY 1982, FY 1987 or 
FY 2002 costs per discharge. Further, MDHs will no longer be subject 
to the 12-percent cap on their DSH payment adjustment factor.
    Hospital-specific rates have been determined for each of these 
hospitals based on the FY 1982 costs per discharge, the FY 1987 
costs per discharge, or, for SCHs, the FY 1996 costs per discharge 
or for MDHs the FY 2002 cost per discharge. For a more detailed 
discussion of the calculation of the hospital-specific rates, we 
refer the reader to the FY 1984 IPPS interim final rule (September 
1, 1983, 48 FR 39772); the April 20, 1990 final rule with comment 
(55 FR 15150); the FY 1991 IPPS final rule (September 4, 1990, 55 FR 
35994); and the FY 2001 IPPS final rule (August 1, 2000, 65 FR 
47082). In addition, for both SCHs and MDHs, the hospital-specific 
rate is adjusted by the budget neutrality adjustment factor (that 
is, by the proposed recalibration budget neutrality

[[Page 24153]]

factor of 0.998963) as discussed in section IV.C. of the preamble to 
this proposed rule. The resulting rate would be used in determining 
the payment rate an SCH or MDH would receive for its discharges 
beginning on or after October 1, 2006.

b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-
Specific Rates for FY 2007

    We are proposing to increase the hospital-specific rates by 3.4 
percent (the hospital market basket percentage increase) for SCHs 
and MDHs for FY 2007. Section 1886(b)(3)(C)(iv) of the Act provides 
that the update factor applicable to the hospital-specific rates for 
SCHs is equal to the update factor provided under section 
1886(b)(3)(B)(iv) of the Act, which, for SCHs in FY 2007, is the 
market basket rate-of-increase. Section 1886(b)(3)(D) of the Act 
provides that the update factor applicable to the hospital-specific 
rates for MDHs also equals the update factor provided under section 
1886(b)(3)(B)(iv) of the Act, which, for FY 2007, is the market 
basket rate-of-increase.

3. General Formula for Calculation of Proposed Prospective Payment 
Rates for Hospitals Located in Puerto Rico Beginning On or After 
October 1, 2006 and Before October 1, 2007

    Section 1886(d)(9)(E)(iv) of the Act provides that, effective 
for discharges occurring on or after October 1, 2004, hospitals 
located in Puerto Rico are paid based on a blend of 75 percent of 
the national prospective payment rate and 25 percent of the Puerto 
Rico-specific rate.

a. Puerto Rico Rate

    The Puerto Rico prospective payment rate is determined as 
follows:
    Step 1--Select the appropriate average standardized amount 
considering the applicable wage index (see Table 1C).
    Step 2--Multiply the labor-related portion of the standardized 
amount by the appropriate Puerto Rico-specific wage index (see Table 
4F of section VI. of the Addendum).
    Step 3--Add the amount from Step 2 and the nonlabor-related 
portion of the standardized amount.
    Step 4--Multiply the amount from Step 3 by the appropriate DRG 
relative weight. (see Table 5 of section IV. of the Addendum).
    Step 5--Multiply the result in Step 4 by 25 percent.

b. National Rate

    The national prospective payment rate is determined as follows:
    Step 1--Select the appropriate average standardized amount 
considering the applicable wage index (see Table 1C).
    Step 2--Multiply the labor-related portion of the standardized 
amount by the applicable wage index for the geographic area in which 
the hospital is located or the area to which the hospital is 
reclassified (see Table 4F of section VI. of this Addendum).
    Step 3--Add the amount from Step 2 and the nonlabor-related 
portion of the national average standardized amount.
    Step 4--Multiply the amount from Step 3 by the appropriate DRG 
relative weight (see Table 5 of section VI. of the Addendum).
    Step 5--Multiply the result in Step 4 by 75 percent.
    The sum of the Puerto Rico rate and the national rate computed 
above equals the prospective payment for a given discharge for a 
hospital located in Puerto Rico. This rate may then be further 
adjusted if the hospital qualifies for either the IME or DSH 
adjustment.

III. Proposed Changes to Payment Rates for Acute Care Hospital 
Inpatient Capital-Related Costs for FY 2007

    (If you choose to comment on issues in this section, please 
include the caption ``Capital Payment Rate'' at the beginning of 
your comment.)
    The PPS for acute care hospital inpatient capital-related costs 
was implemented for cost reporting periods beginning on or after 
October 1, 1991. Effective with that cost reporting period, 
hospitals were paid during a 10-year transition period (which 
extended through FY 2001) to change the payment methodology for 
Medicare acute care hospital inpatient capital-related costs from a 
reasonable cost-based methodology to a prospective methodology 
(based fully on the Federal rate).
    The basic methodology for determining Federal capital 
prospective rates is set forth in regulations at Sec. Sec.  412.308 
through 412.352. Below we discuss the factors that we are proposing 
to use to determine the capital Federal rate for FY 2007, which 
would be effective for discharges occurring on or after October 1, 
2006. The 10-year transition period ended with hospital cost 
reporting periods beginning on or after October 1, 2001 (FY 2002). 
Therefore, for cost reporting periods beginning in FY 2002, all 
hospitals (except ``new'' hospitals under Sec.  412.304(c)(2)) are 
paid based on 100 percent of the capital Federal rate. For FY 1992, 
we computed the standard Federal payment rate for capital-related 
costs under the IPPS by updating the FY 1989 Medicare inpatient 
capital cost per case by an actuarial estimate of the increase in 
Medicare inpatient capital costs per case. Each year after FY 1992, 
we update the capital standard Federal rate, as provided at Sec.  
412.308(c)(1), to account for capital input price increases and 
other factors. The regulations at Sec.  412.308(c)(2) provide that 
the capital Federal rate is adjusted annually by a factor equal to 
the estimated proportion of outlier payments under the capital 
Federal rate to total capital payments under the capital Federal 
rate. In addition, Sec.  412.308(c)(3) requires that the capital 
Federal rate be reduced by an adjustment factor equal to the 
estimated proportion of payments for (regular and special) 
exceptions under Sec.  412.348. Section 412.308(c)(4)(ii) requires 
that the capital standard Federal rate be adjusted so that the 
effects of the annual DRG reclassification and the recalibration of 
DRG weights and changes in the geographic adjustment factor are 
budget neutral.
    For FYs 1992 through 1995, Sec.  412.352 required that the 
capital Federal rate also be adjusted by a budget neutrality factor 
so that aggregate payments for inpatient hospital capital costs were 
projected to equal 90 percent of the payments that would have been 
made for capital-related costs on a reasonable cost basis during the 
fiscal year. That provision expired in FY 1996. Section 
412.308(b)(2) describes the 7.4 percent reduction to the capital 
rate that was made in FY 1994, and Sec.  412.308(b)(3) describes the 
0.28 percent reduction to the capital rate made in FY 1996 as a 
result of the revised policy of paying for transfers. In FY 1998, we 
implemented section 4402 of Pub. L. 105-33, which required that, for 
discharges occurring on or after October 1, 1997, and before October 
1, 2002, the unadjusted capital standard Federal rate is reduced by 
17.78 percent. As we discussed in the FY 2003 IPPS final rule (67 FR 
50102) and implemented in Sec.  412.308(b)(6), a small part of that 
reduction was restored effective October 1, 2002.
    To determine the appropriate budget neutrality adjustment factor 
and the regular exceptions payment adjustment during the 10-year 
transition period, we developed a dynamic model of Medicare 
inpatient capital-related costs; that is, a model that projected 
changes in Medicare inpatient capital-related costs over time. With 
the expiration of the budget neutrality provision, the capital cost 
model was only used to estimate the regular exceptions payment 
adjustment and other factors during the transition period. As we 
explained in the FY 2002 IPPS final rule (66 FR 39911), beginning in 
FY 2002, an adjustment for regular exception payments is no longer 
necessary because regular exception payments were only made for cost 
reporting periods beginning on or after October 1, 1991, and before 
October 1, 2001 (see Sec.  412.348(b)). Because payments are no 
longer being made under the regular exception policy effective with 
cost reporting periods beginning in FY 2002, we no longer use the 
capital cost model. The capital cost model and its application 
during the transition period are described in Appendix B of the FY 
2002 IPPS final rule (66 FR 40099).
    Section 412.374 provides for the use of a blended payment system 
for payments to Puerto Rico hospitals under the PPS for acute care 
hospital inpatient capital-related costs. Accordingly, under the 
capital PPS, we compute a separate payment rate specific to Puerto 
Rico hospitals using the same methodology used to compute the 
national Federal rate for capital-related costs. In accordance with 
section 1886(d)(9)(A) of the Act, under the PPS for acute care 
hospital operating costs, hospitals located in Puerto Rico are paid 
for operating costs under a special payment formula. Prior to FY 
1998, hospitals in Puerto Rico were paid a blended operating rate 
that consisted of 75 percent of the applicable standardized amount 
specific to Puerto Rico hospitals and 25 percent of the applicable 
national average standardized amount. Similarly, prior to FY 1998, 
hospitals in Puerto Rico were paid a blended capital rate that 
consisted of 75 percent of the applicable capital Puerto Rico-
specific rate and 25 percent of the applicable capital Federal rate. 
However, effective October 1, 1997, in accordance with section 4406 
of

[[Page 24154]]

Pub. L. 105-33, operating payments to hospitals in Puerto Rico were 
revised to be based on a blend of 50 percent of the applicable 
standardized amount specific to Puerto Rico hospitals and 50 percent 
of the applicable national average standardized amount. In 
conjunction with this change to the operating blend percentage, 
effective with discharges occurring on or after October 1, 1997, we 
also revised the methodology for computing capital payments to 
hospitals in Puerto Rico to be based on a blend of 50 percent of the 
Puerto Rico capital rate and 50 percent of the capital Federal rate.
    As we discussed in the FY 2005 IPPS final rule (69 FR 49185), 
section 504 of Pub. L. 108-173 increased the national portion of the 
operating IPPS payments for Puerto Rico hospitals from 50 percent to 
62.5 percent and decreased the Puerto Rico portion of the operating 
IPPS payments from 50 percent to 37.5 percent for discharges 
occurring on or after April 1, 2004 through September 30, 2004 (see 
the March 26, 2004 One-Time Notification (Change Request 3158)). In 
addition, section 504 of Pub. L. 108-173 provided that the national 
portion of operating IPPS payments for Puerto Rico hospitals is 
equal to 75 percent and the Puerto Rico portion of operating IPPS 
payments is equal to 25 percent for discharges occurring on or after 
October 1, 2004. Consistent with that change in operating IPPS 
payments to hospitals in Puerto Rico, for FY 2005 (as we discussed 
in the FY 2005 IPPS final rule), we revised the methodology for 
computing capital payments to hospitals located in Puerto Rico to be 
based on a blend of 25 percent of the Puerto Rico capital rate and 
75 percent of the capital Federal rate for discharges occurring on 
or after October 1, 2004.

A. Determination of Proposed Federal Hospital Inpatient Capital-
Related Prospective Payment Rate Update

    In the FY 2006 IPPS final rule (70 FR 47503), we established a 
capital Federal rate of $420.65 for FY 2006. In the discussion that 
follows, we explain the factors that we are proposing to use to 
determine the FY 2007 capital Federal rate. In particular, we 
explain why the proposed FY 2007 capital Federal rate would increase 
approximately 0.9 percent compared to the FY 2006 capital Federal 
rate. However, we estimate aggregate capital payments would decrease 
by 0.4 percent during this same period. This decrease is due to a 
decrease in the estimated total number of Medicare fee-for-service 
discharges for FY 2007 as compared to the estimated total number of 
Medicare fee-for-service discharges in FY 2006. We are estimating a 
decrease in Medicare fee-for-service discharges in FY 2007 as 
compared to FY 2006, in part because we are projecting an increase 
in beneficiary Medicare managed care enrollment as a result of the 
implementation of several provisions of Pub. L. 108-173. Therefore, 
although we are projecting that capital PPS payments per discharge 
would increase slightly from FY 2006 to FY 2007, we project that 
aggregate capital PPS payments would decrease for the same period.
    Total payments to hospitals under the IPPS are relatively 
unaffected by changes in the capital prospective payments. Since 
capital payments constitute about 10 percent of hospital payments, a 
1-percent change in the capital Federal rate yields only about 0.1 
percent change in actual payments to hospitals. As noted above, 
aggregate payments under the capital IPPS are estimated to decrease 
slightly in FY 2007 compared to FY 2006.

1. Projected Capital Standard Federal Rate Update

a. Description of the Update Framework

    Under Sec.  412.308(c)(1), the capital standard Federal rate is 
updated on the basis of an analytical framework that takes into 
account changes in a capital input price index (CIPI) and several 
other policy adjustment factors. Specifically, we have adjusted the 
projected CIPI rate-of-increase as appropriate each year for case-
mix index-related changes, for intensity, and for errors in previous 
CIPI forecasts. The proposed update factor for FY 2007 under that 
framework is 0.8 percent based on the best data available at this 
time. The proposed update factor is based on a projected 0.8 percent 
increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 
percent adjustment for case-mix, a 0.0 percent adjustment for the FY 
2005 DRG reclassification and recalibration, and a forecast error 
correction of 0.0 percent. As discussed below in section III.C. of 
this Addendum, we believe that the CIPI is the most appropriate 
input price index for capital costs to measure capital price changes 
in a given year. We also explain the basis for the FY 2007 CIPI 
projection in that same section of this Addendum. Below we describe 
the proposed policy adjustments that have been applied.
    The case-mix index is the measure of the average DRG weight for 
cases paid under the IPPS. Because the DRG weight determines the 
prospective payment for each case, any percentage increase in the 
case-mix index corresponds to an equal percentage increase in 
hospital payments.
    The case-mix index can change for any of several reasons:
     The average resource use of Medicare patients changes 
(``real'' case-mix change);
     Changes in hospital coding of patient records result in 
higher weight DRG assignments (``coding effects''); and
     The annual DRG reclassification and recalibration 
changes may not be budget neutral (``reclassification effect'').
    We define real case-mix change as actual changes in the mix (and 
resource requirements) of Medicare patients as opposed to changes in 
coding behavior that result in assignment of cases to higher 
weighted DRGs but do not reflect higher resource requirements. The 
capital update framework includes the same case-mix index adjustment 
used in the former operating IPPS update framework (as discussed in 
the May 18, 2005 IPPS proposed rule for FY 2005 (69 FR 28816)). (We 
are no longer using an update framework in making a recommendation 
for updating the operating IPPS standardized amounts as discussed in 
section II, of Appendix B in the FY 2006 IPPS final rule (70 FR 
47707).)
    For FY 2007, we are projecting a 1.0 percent total increase in 
the case-mix index. We estimate that the real case-mix increase 
would also equal 1.0 percent in FY 2007. The net adjustment for 
change in case-mix is the difference between the projected increase 
in case-mix and the projected total increase in case-mix. Therefore, 
the proposed net adjustment for case-mix change in FY 2007 is 0.0 
percentage points.
    The capital update framework also contains an adjustment for the 
effects of DRG reclassification and recalibration. This adjustment 
is intended to remove the effect on total payments of prior year 
changes to the DRG classifications and relative weights, in order to 
retain budget neutrality for all case-mix index-related changes 
other than those due to patient severity. Due to the lag time in the 
availability of data, there is a 2-year lag in data used to 
determine the adjustment for the effects of DRG reclassification and 
recalibration. For example, we are adjusting for the effects of the 
FY 2005 DRG reclassification and recalibration as part of our 
proposed update for FY 2007. We estimate that FY 2005 DRG 
reclassification and recalibration would result in a 0.0 percent 
change in the case-mix when compared with the case-mix index that 
would have resulted if we had not made the reclassification and 
recalibration changes to the DRGs. Therefore, we are proposing to 
make a 0.0 percent adjustment for DRG reclassification and 
recalibration in the update for FY 2007 to maintain budget 
neutrality.
    The capital update framework also contains an adjustment for 
forecast error. The input price index forecast is based on 
historical trends and relationships ascertainable at the time the 
update factor is established for the upcoming year. In any given 
year, there may be unanticipated price fluctuations that may result 
in differences between the actual increase in prices and the 
forecast used in calculating the update factors. In setting a 
prospective payment rate under the framework, we make an adjustment 
for forecast error only if our estimate of the change in the capital 
input price index for any year is off by 0.25 percentage points or 
more. There is a 2-year lag between the forecast and the measurement 
of the forecast error. A forecast error of -0.1 percentage point was 
calculated for the FY 2005 update. That is, current historical data 
indicate that the forecasted FY 2005 CIPI used in calculating the FY 
2005 update factor (0.7 percent) slightly overstated the actual 
realized price increases (0.6 percent) by 0.1 percentage point. This 
slight overprediction was mostly due to an underestimation in the 
deceleration of the average yield of the long-term municipal bonds. 
The forecast correctly anticipated the deceleration of the municipal 
bond rates; however, it underestimated the magnitude of the 
deceleration resulting from the relatively looser Federal monetary 
policy (that is, delaying interest rate hikes). However, because 
this estimation of the change in the CIPI is less than 0.25 
percentage points, it is not reflected in the update recommended 
under this framework. Therefore, we are proposing to make a 0.0 
percent adjustment for forecast error in the update for FY 2007.

[[Page 24155]]

    Under the capital IPPS update framework, we also make an 
adjustment for changes in intensity. We calculate this adjustment 
using the same methodology and data that were used in the framework 
used in the past under the operating IPPS. The intensity factor for 
the operating update framework reflects how hospital services are 
utilized to produce the final product, that is, the discharge. This 
component accounts for changes in the use of quality-enhancing 
services, for changes in within-DRG severity, and for expected 
modification of practice patterns to remove noncost-effective 
services.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services) and changes in real case-mix. The use 
of total charges in the calculation of the intensity factor makes it 
a total intensity factor; that is, charges for capital services are 
already built into the calculation of the factor. Therefore, we have 
incorporated the intensity adjustment from the operating update 
framework into the capital update framework. Without reliable 
estimates of the proportions of the overall annual intensity 
increases that are due, respectively, to ineffective practice 
patterns and to the combination of quality-enhancing new 
technologies and within-DRG complexity, we assume, as in the 
operating update framework, that one-half of the annual increase is 
due to each of these factors. The capital update framework thus 
provides an add-on to the input price index rate of increase of one-
half of the estimated annual increase in intensity, to allow for 
within-DRG severity increases and the adoption of quality-enhancing 
technology.
    We have developed a Medicare-specific intensity measure based on 
a 5-year average. Past studies of case-mix change by the RAND 
Corporation (``Has DRG Creep Crept Up? Decomposing the Case Mix 
Index Change Between 1987 and 1988'' by G. M. Carter, J. P. 
Newhouse, and D. A. Relles, R-4098-HCFA/ProPAC (1991)) suggest that 
real case-mix change was not dependent on total change, but was 
usually a fairly steady 1.0 to 1.4 percent per year. We use 1.4 
percent as the upper bound because the RAND study did not take into 
account that hospitals may have induced doctors to document medical 
records more completely in order to improve payment.
    We calculate case-mix constant intensity as the change in total 
charges per admission, adjusted for price level changes (the CPI for 
hospital and related services), and changes in real case-mix. As we 
noted above, in accordance with Sec.  412.308(c)(1)(ii), we began 
updating the capital standard Federal rate in FY 1996 using an 
update framework that takes into account, among other things, 
allowable changes in the intensity of hospital services. For FYs 
1996 through 2001, we found that case-mix constant intensity was 
declining and we established a 0.0 percent adjustment for intensity 
in each of those years. For FYs 2002 and 2003, we found that case-
mix constant intensity was increasing and we established a 0.3 
percent adjustment and 1.0 percent adjustment for intensity, 
respectively. For FYs 2004 and 2005, we found that the charge data 
appeared to be skewed (as discussed in greater detail below) and we 
established a 0.0 percent adjustment in each of those years. 
Furthermore, we stated that we would continue to apply a 0.0 percent 
adjustment for intensity until any increase in charges can be tied 
to intensity rather than attempts to maximize outlier payments.
    As noted above, our intensity measure is based on a 5-year 
average, and therefore, the proposed intensity adjustment for FY 
2007 is based on data from the 5-year period FY 2001 through FY 
2005. We found a dramatic increase in hospital charges for each of 
those 5 years without a corresponding increase in the hospital case-
mix index. These findings are similar to the considerable increase 
in hospitals' charges, which we found when we were determining the 
intensity factor in the FY 2004, FY 2005 and FY 2006 update 
recommendations as discussed in the FY 2004 IPPS final rule (68 FR 
45482), the FY 2005 IPPS final rule (69 FR 49285) and the FY 2006 
IPPS final rule (70 FR 47500), respectively. If hospitals were 
treating new or different types of cases, which would result in an 
appropriate increase in charges per discharge, then we would expect 
hospitals' case-mix to increase proportionally.
    As we discussed in the FY 2006 IPPS final rule (70 FR 47500), 
because our intensity calculation relies heavily upon charge data 
and we believe that these charge data may be inappropriately skewed, 
we established a 0.0 percent adjustment for intensity for FY 2006.
    On June 9, 2003, we published revisions to our outlier policy 
for determining the additional payment for extraordinarily high-cost 
cases (68 FR 34494 through 34515). These revised policies were 
effective on August 8, 2003, and October 1, 2003. While it does 
appear that a response to these policy changes is beginning to 
occur, that is, the change in charges for FYs 2004 and 2005 are 
somewhat less than the previous 4 years, they still show a 
significant annual increase in charges without a corresponding 
increase in hospital case-mix. The increase in charges in FY 2004, 
for example, is approximately 12 percent, which, while less than the 
increase in the previous 3 years, is still much higher than 
increases in years prior to FY 2001. In addition, this approximate 
12-percent increase in charges for FY 2004 significantly exceeds the 
case-mix increase for the same period. Based on the approximate 12-
percent increase in charges for FY 2004, we believe residual effects 
of hospitals' charge practices prior to the implementation of the 
outlier policy revisions established in the June 9, 2003 final rule 
continue to appear in the data because hospitals may not have had 
enough time to adopt changes in their behavior in response to the 
new outlier policy. Thus, we believe that the FY 2004 and FY 2005 
charge data may still be skewed. Because the intensity adjustment is 
based on a 5-year average, and although the new outlier policy was 
generally effective in FY 2004, we believe it still will be several 
years before all the effects of hospitals attempting to maximize 
outlier payments are removed from the intensity calculation. 
Therefore, we are proposing a 0.0 percent adjustment for intensity 
for FY 2007. In the past (FYs 1996 through 2001) when we found 
intensity to be declining, we believed a zero (rather than negative) 
intensity adjustment was appropriate. Similarly, we believe that it 
is appropriate to apply a zero intensity adjustment for FY 2007 
until any increase in charges can be tied to intensity rather than 
to attempts to maximize outlier payments.
    Above, we described the basis of the components used to develop 
the proposed 0.8 percent capital update factor for FY 2007 as shown 
in the table below.

     CMS Proposed FY 2007 Update Factor to the Capital Federal Rate
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Capital Input Price Index....................................        0.8
Intensity....................................................        0.0
Case-Mix Adjustment Factors:
  Real Across DRG Change.....................................        1.0
  Projected Case-Mix Change..................................       -1.0
                                                              ----------
    Subtotal.................................................        0.0
Effect of FY 2005 Reclassification and Recalibration.........        0.0
Forecast Error Correction....................................        0.0
                                                              ----------
    Total Proposed Update....................................        0.8
------------------------------------------------------------------------

b. Comparison of CMS and MedPAC Update Recommendation

    In the past, MedPAC has included update recommendations for 
capital PPS in a Report to Congress. In its March 2006 Report to 
Congress, MedPAC did not make an update recommendation for capital 
PPS payments for FY 2007. However, in that same report, MedPAC made 
an update recommendation for hospital inpatient and outpatient 
services (page 46). MedPAC reviews inpatient and outpatient services 
together because they are so closely interrelated. For FY 2007, 
MedPAC recommended an increase in the payment rate for the operating 
IPPS by the projected increase in the hospital market basket index, 
less half of MedPAC's expectation for productivity growth (or 0.45 
percent, based on its assessment of beneficiaries' access to care 
and changes in hospital capacity, volume of services, access to 
capital, quality of care, and the relationship of Medicare payments 
and hospitals' costs. In addition, MedPAC recommended combining the 
annual rate update with an incentive payment policy for quality. 
(MedPAC's Report to the Congress: Medicare Payment Policy, March 
2006, Section 2A.)

2. Proposed Outlier Payment Adjustment Factor

    Section 412.312(c) establishes a unified outlier methodology for 
inpatient operating and inpatient capital-related costs. A single 
set of thresholds is used to identify outlier cases for both 
inpatient operating and inpatient capital-related payments. Section 
412.308(c)(2) provides that the standard Federal rate for inpatient 
capital-related costs be reduced by an adjustment factor equal to 
the estimated proportion of capital-related outlier payments to 
total inpatient capital-related PPS payments. The outlier thresholds 
are set so that operating outlier payments are projected to be 5.1 
percent of total operating DRG payments.

[[Page 24156]]

    In the FY 2006 IPPS final rule (70 FR 47501), we estimated that 
outlier payments for capital would equal 4.85 percent of inpatient 
capital-related payments based on the capital Federal rate in FY 
2006. Based on the thresholds as set forth in section II.A.4.c. of 
this Addendum, we estimate that outlier payments for capital-related 
costs would equal 4.87 percent for inpatient capital-related 
payments based on the Federal rate in FY 2007. Therefore, we are 
proposing to apply an outlier adjustment factor of 0.9513 to the 
capital Federal rate. Thus, the percentage of capital outlier 
payments to total capital standard payments for FY 2007 would be 
slightly higher than the percentages for FY 2006.
    The outlier reduction factors are not built permanently into the 
capital rates; that is, they are not applied cumulatively in 
determining the capital Federal rate. The proposed FY 2007 outlier 
adjustment of 0.9513 is a -0.02 percent change from the FY 2006 
outlier adjustment of 0.9515. Therefore, the net change in the 
outlier adjustment to the proposed capital Federal rate for FY 2007 
is 0.9998 (0.9513/0.9915). Thus, the proposed outlier adjustment 
decreases the proposed FY 2007 capital Federal rate by 0.02 percent 
compared with the FY 2006 outlier adjustment.

3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG 
Classifications and Weights and the GAF

    Section 412.308(c)(4)(ii) requires that the capital Federal rate 
be adjusted so that aggregate payments for the fiscal year based on 
the capital Federal rate after any changes resulting from the annual 
DRG reclassification and recalibration and changes in the GAF are 
projected to equal aggregate payments that would have been made on 
the basis of the capital Federal rate without such changes. Because 
we implemented a separate GAF for Puerto Rico, we apply separate 
budget neutrality adjustments for the national GAF and the Puerto 
Rico GAF. We apply the same budget neutrality factor for DRG 
reclassifications and recalibration nationally and for Puerto Rico. 
Separate adjustments were unnecessary for FY 1998 and earlier 
because the GAF for Puerto Rico was implemented in FY 1998.
    In the past, we used the actuarial capital cost model (described 
in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to 
estimate the aggregate payments that would have been made on the 
basis of the capital Federal rate with and without changes in the 
DRG classifications and weights and in the GAF to compute the 
adjustment required to maintain budget neutrality for changes in DRG 
weights and in the GAF. During the transition period, the capital 
cost model was also used to estimate the regular exception payment 
adjustment factor. As we explain in section III.A.4. of this 
Addendum, beginning in FY 2002, an adjustment for regular exception 
payments is no longer necessary. Therefore, we are no longer using 
the capital cost model. Instead, we are using historical data based 
on hospitals' actual cost experiences to determine the exceptions 
payment adjustment factor for special exceptions payments.
    To determine the proposed factors for FY 2007, we compared 
(separately for the national capital rate and the Puerto Rico 
capital rate) estimated aggregate capital Federal rate payments 
based on the FY 2006 DRG relative weights and the FY 2006 GAF to 
estimated aggregate capital Federal rate payments based on the 
proposed FY 2007 relative weights and the proposed FY 2007 GAF. As 
we established in the FY 2006 IPPS final rule (70 FR 47503), the 
budget neutrality factors were 0.9920 for the national capital rate 
and 0.9959 for the Puerto Rico capital rate. In making the 
comparison, we set the exceptions reduction factor to 1.00. To 
achieve budget neutrality for the changes in the national GAF, based 
on calculations using updated data, we are proposing to apply an 
incremental budget neutrality adjustment of 1.0003 for FY 2007 to 
the previous cumulative FY 2006 adjustments of 0.9920, yielding an 
adjustment of 0.9922, through FY 2007 (calculations done on 
unrounded numbers). For the Puerto Rico GAF, we are proposing to 
apply an incremental budget neutrality adjustment of 1.0017 for FY 
2007 to the previous cumulative FY 2006 adjustment of 0.9959, 
yielding a cumulative adjustment of 0.9986 through FY 2007.
    We then compared estimated aggregate capital Federal rate 
payments based on the FY 2006 DRG relative weights and the FY 2006 
GAF to estimated aggregate capital Federal rate payments based on 
the proposed FY 2007 DRG relative weights and the proposed FY 2007 
GAF. The proposed incremental adjustment for DRG classifications and 
changes in relative weights is 1.0009 both nationally and for Puerto 
Rico. The proposed cumulative adjustments for DRG classifications 
and changes in relative weights and for changes in the GAF through 
FY 2007 are 0.9932 nationally and 0.9986 for Puerto Rico. The 
following table summarizes the adjustment factors for each fiscal 
year:
BILLING CODE 4120-01-P

[[Page 24157]]

[GRAPHIC] [TIFF OMITTED] TP25AP06.021

BILLING CODE 4120-01-C
    The methodology used to determine the proposed recalibration and 
geographic (DRG/GAF) budget neutrality adjustment factor for FY 2007 
is similar to that used in establishing budget neutrality 
adjustments under the PPS for operating costs. One difference is 
that, under the operating PPS, the budget neutrality adjustments for 
the effect of geographic reclassifications are determined separately 
from the effects of other changes in the hospital wage index and the 
DRG relative weights. Under the capital PPS, there is a single DRG/
GAF budget neutrality adjustment factor (the national capital rate 
and the Puerto Rico capital rate are determined separately) for 
changes in the GAF (including geographic reclassification) and the 
DRG relative weights. In addition, there is no adjustment for the 
effects that geographic reclassification has on the other payment 
parameters, such as the payments for serving low-income patients, 
indirect medical education payments, or the large urban add-on 
payments.
    In the FY 2006 IPPS final rule (70 FR 47503), we calculated a 
GAF/DRG budget neutrality factor of 1.0008 for FY 2006. For FY 2007, 
we are proposing to establish a GAF/DRG budget neutrality factor of 
1.0012. The GAF/DRG budget neutrality factors are built permanently 
into the capital rates; that is, they are applied cumulatively in 
determining the capital Federal rate. This follows from the 
requirement that estimated

[[Page 24158]]

aggregate payments each year be no more or less than they would have 
been in the absence of the annual DRG reclassification and 
recalibration and changes in the GAF. The incremental change in the 
proposed adjustment from FY 2006 to FY 2007 is 1.0012. The 
cumulative change in the proposed capital Federal rate due to this 
proposed adjustment is 0.9932 (the product of the incremental 
factors for FYs 1993 though 2006 and the proposed incremental factor 
of 1.0012 for FY 2007). (We note that averages of the incremental 
factors that were in effect during FYs 2005 and 2006, respectively, 
were used in the calculation of the proposed cumulative adjustment 
of 1.0012 for FY 2007.)
    This proposed factor accounts for DRG reclassifications and 
recalibration and for changes in the GAF. It also incorporates the 
effects on the proposed GAF of FY 2007 geographic reclassification 
decisions made by the MGCRB compared to FY 2006 decisions. However, 
it does not account for changes in payments due to changes in the 
DSH and IME adjustment factors or in the large urban add-on.

4. Proposed Exceptions Payment Adjustment Factor

    Section 412.308(c)(3) requires that the capital standard Federal 
rate be reduced by an adjustment factor equal to the estimated 
proportion of additional payments for both regular exceptions and 
special exceptions under Sec.  412.348 relative to total capital PPS 
payments. In estimating the proportion of regular exception payments 
to total capital PPS payments during the transition period, we used 
the actuarial capital cost model originally developed for 
determining budget neutrality (described in Appendix B of the FY 
2002 IPPS final rule (66 FR 40099)) to determine the exceptions 
payment adjustment factor, which was applied to both the Federal and 
hospital-specific capital rates.
    An adjustment for regular exception payments is no longer 
necessary in determining the proposed FY 2007 capital Federal rate 
because, in accordance with Sec.  412.348(b), regular exception 
payments were only made for cost reporting periods beginning on or 
after October 1, 1991 and before October 1, 2001. Accordingly, as we 
explained in the FY 2002 IPPS final rule (66 FR 39949), in FY 2002 
and subsequent fiscal years, no payments will be made under the 
regular exceptions provision. However, in accordance with Sec.  
412.308(c), we still need to compute a budget neutrality adjustment 
for special exception payments under Sec.  412.348(g). We describe 
our methodology for determining the exceptions adjustment used in 
calculating the proposed FY 2007 capital Federal rate below.
    Under the special exceptions provision specified at Sec.  
412.348(g)(1), eligible hospitals include SCHs, urban hospitals with 
at least 100 beds that have a disproportionate share percentage of 
at least 20.2 percent or qualify for DSH payments under Sec.  
412.106(c)(2), and hospitals with a combined Medicare and Medicaid 
inpatient utilization of at least 70 percent. An eligible hospital 
may receive special exceptions payments if it meets: (1) A project 
need requirement as described at Sec.  412.348(g)(2), which, in the 
case of certain urban hospitals, includes an excess capacity test as 
described at Sec.  412.348(g)(4); (2) an age of assets test as 
described at Sec.  412.348(g)(3); and (3) a project size requirement 
as described at Sec.  412.348(g)(5).
    Based on information compiled from our fiscal intermediaries, 
six hospitals have qualified for special exceptions payments under 
Sec.  412.348(g). Since we have cost reports ending in FY 2005 for 
all of these hospitals, we calculated the adjustment based on actual 
cost experience. Using data from cost reports ending in FY 2005 from 
the December 2005 update of the HCRIS data, we divided the capital 
special exceptions payment amounts for the six hospitals that 
qualified for special exceptions by the total capital PPS payment 
amounts (including special exception payments) for all hospitals. 
Based on the data from cost reports ending in FY 2005, this ratio is 
rounded to 0.0003. Because we have not received all cost reports 
ending in FY 2005, we also divided the FY 2005 special exceptions 
payments by the total capital PPS payment amounts for all hospitals 
with cost reports ending in FY 2004. This ratio also rounds to 
0.0003. Because special exceptions are budget neutral, we are 
proposing to offset the capital Federal rate by 0.03 percent for 
special exceptions payments for FY 2007. Therefore, the proposed 
exceptions adjustment factor is equal to 0.9997 (1--0.0003) to 
account for special exceptions payments in FY 2007.
    In the FY 2006 IPPS final rule (70 FR 47503), we estimated that 
total (special) exceptions payments for FY 2006 would equal 0.03 
percent of aggregate payments based on the capital Federal rate. 
Therefore, we applied an exceptions adjustment factor of 0.9997 (1--
0.0003) in determining the FY 2006 capital Federal rate. As we 
stated above, we estimate that exceptions payments in FY 2007 will 
equal 0.03 percent of aggregate payments based on the proposed FY 
2007 capital Federal rate. Therefore, we are proposing to apply an 
exceptions payment adjustment factor of 0.9997 to the capital 
Federal rate for FY 2007. The proposed exceptions adjustment factor 
for FY 2007 is the same as the factor used in determining the FY 
2006 capital Federal rate in the FY 2006 IPPS final rule (70 FR 
47503). The exceptions reduction factors are not built permanently 
into the capital rates; that is, the factors are not applied 
cumulatively in determining the capital Federal rate. Therefore, the 
net change in the exceptions adjustment factor used in determining 
the proposed FY 2007 capital Federal rate is 1.0000 (0.9997/0.9997).

5. Proposed Capital Standard Federal Rate for FY 2007

    In the FY 2006 IPPS final rule (70 FR 47503), we established a 
capital Federal rate of $420.65 for FY 2006. In this proposed rule, 
we are proposing to establish a capital Federal rate of $424.42 for 
FY 2007. The proposed capital Federal rate for FY 2007 was 
calculated as follows:
     The proposed FY 2007 update factor is 1.0080; that is, 
the proposed update is 0.8 percent.
     The proposed FY 2007 budget neutrality adjustment 
factor that is applied to the capital standard Federal payment rate 
for proposed changes in the DRG relative weights and in the GAF is 
1.0012.
     The proposed FY 2007 outlier adjustment factor is 
0.9513.
     The proposed FY 2007 (special) exceptions payment 
adjustment factor is 0.9997.
    Because the proposed capital Federal rate has already been 
adjusted for differences in case-mix, wages, cost-of-living, 
indirect medical education costs, and payments to hospitals serving 
a disproportionate share of low-income patients, we are not 
proposing to make additional adjustments in the capital standard 
Federal rate for these factors, other than the budget neutrality 
factor for changes in the DRG relative weights and the GAF.
    We are providing a chart that shows how each of the proposed 
factors and adjustments for FY 2007 affected the computation of the 
proposed FY 2007 capital Federal rate in comparison to the average 
FY 2006 capital Federal rate. The proposed FY 2007 update factor has 
the effect of increasing the proposed capital Federal rate by 0.80 
percent compared to the average FY 2006 Federal rate. The proposed 
GAF/DRG budget neutrality factor has the effect of increasing the 
proposed capital Federal rate by 0.12 percent. The proposed FY 2007 
outlier adjustment factor has the effect of decreasing the proposed 
capital Federal rate by 0.02 percent compared to the average FY 2006 
capital Federal rate. The proposed FY 2007 exceptions payment 
adjustment factor remains unchanged from the FY 2006 exceptions 
payment adjustment factor, and therefore, has a 0.0 percent net 
effect on the proposed FY 2007 capital Federal rate. The combined 
effect of all the proposed changes is to increase the proposed 
capital Federal rate by 0.90 percent compared to the average FY 2006 
capital Federal rate.

                                      Comparison of Factors and Adjustments
                    [FY 2006 Capital Federal Rate and Proposed FY 2007 Capital Federal Rate]
----------------------------------------------------------------------------------------------------------------
                                                                           Proposed FY                 Percent
                                                                FY 2006        2007        Change       change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\...........................................       1.0080       1.0080       1.0080         0.80
GAF/DRG Adjustment Factor \1\...............................       1.0008       1.0012       1.0012         0.12

[[Page 24159]]

 
Outlier Adjustment Factor \2\...............................       0.9515       0.9513       0.9998        -0.02
Exceptions Adjustment Factor \2\............................       0.9997       0.9997       0.0000         0.00
Capital Federal Rate........................................      $420.65      $424.42       1.0090         0.90
Outlier Adjustment Factor \2\...............................       0.9515       0.9513       0.9998        -0.02
----------------------------------------------------------------------------------------------------------------
\1\ The proposed update factor and the GAF/DRG budget neutrality factors are built permanently into the capital
  rates. Thus, for example, the incremental change from FY 2006 to FY 2007 resulting from the application of the
  proposed 1.0012 GAF/DRG budget neutrality factor for FY 2007 is 1.0012.
\2\ The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built
  permanently into the capital rates; that is, these factors are not applied cumulatively in determining the
  capital rates. Thus, for example, the net change resulting from the application of the proposed FY 2007
  outlier adjustment factor would be 0.9513/0.9515, or 0.9998.

6. Proposed Special Capital Rate for Puerto Rico Hospitals

    Section 412.374 provides for the use of a blended payment system 
for payments to Puerto Rico hospitals under the PPS for acute care 
hospital inpatient capital-related costs. Accordingly, under the 
capital PPS, we compute a separate payment rate specific to Puerto 
Rico hospitals using the same methodology used to compute the 
national Federal rate for capital-related costs. Under the broad 
authority of section 1886(g) of the Act, as discussed in section VI. 
of the preamble of this proposed rule, beginning with discharges 
occurring on or after October 1, 2004, capital payments to hospitals 
in Puerto Rico are based on a blend of 25 percent of the Puerto Rico 
capital rate and 75 percent of the capital Federal rate. The Puerto 
Rico capital rate is derived from the costs of Puerto Rico hospitals 
only, while the capital Federal rate is derived from the costs of 
all acute care hospitals participating in the IPPS (including Puerto 
Rico).
    To adjust hospitals' capital payments for geographic variations 
in capital costs, we apply a GAF to both portions of the blended 
capital rate. The GAF is calculated using the operating IPPS wage 
index and varies, depending on the labor market area or rural area 
in which the hospital is located. We use the Puerto Rico wage index 
to determine the GAF for the Puerto Rico part of the capital-blended 
rate and the national wage index to determine the GAF for the 
national part of the blended capital rate.
    Because we implemented a separate GAF for Puerto Rico in FY 
1998, we also apply separate budget neutrality adjustments for the 
national GAF and for the Puerto Rico GAF. However, we apply the same 
budget neutrality factor for DRG reclassifications and recalibration 
nationally and for Puerto Rico. As we stated above in section 
III.A.4. of this Addendum, for Puerto Rico, the proposed GAF budget 
neutrality factor is 1.0017, while the proposed DRG adjustment is 
1.0009, for a combined proposed cumulative adjustment of 0.9986.
    In computing the payment for a particular Puerto Rico hospital, 
the Puerto Rico portion of the capital rate (25 percent) is 
multiplied by the Puerto Rico-specific GAF for the labor market area 
in which the hospital is located, and the national portion of the 
capital rate (75 percent) is multiplied by the national GAF for the 
labor market area in which the hospital is located (which is 
computed from national data for all hospitals in the United States 
and Puerto Rico). In FY 1998, we implemented a 17.78 percent 
reduction to the Puerto Rico capital rate as a result of Pub. L. 
105-33. In FY 2003, a small part of that reduction was restored.
    For FY 2006, before application of the GAF, the special capital 
rate for Puerto Rico hospitals was $201.93 for discharges occurring 
on or after October 1, 2005 through September 30, 2006. With the 
changes we are proposing to make to the factors used to determine 
the capital rate, the proposed FY 2007 special capital rate for 
Puerto Rico is $202.98.

B. Calculation of the Proposed Inpatient Capital-Related 
Prospective Payments for FY 2007

    Because the 10-year capital PPS transition period ended in FY 
2001, all hospitals (except ``new'' hospitals under Sec.  412.324(b) 
and under Sec.  412.304(c)(2)) are paid based on 100 percent of the 
capital Federal rate in FY 2006. The applicable capital Federal rate 
was determined by making adjustments as follows:
     For outliers, by dividing the capital standard Federal 
rate by the outlier reduction factor for that fiscal year; and
     For the payment adjustments applicable to the hospital, 
by multiplying the hospital's GAF, disproportionate share adjustment 
factor, and IME adjustment factor, when appropriate.
    For purposes of calculating payments for each discharge during 
FY 2007, the capital standard Federal rate is adjusted as follows: 
(Standard Federal Rate) x (DRG weight) x (GAF) x (Large Urban Add-
on, if applicable) x (COLA for hospitals located in Alaska and 
Hawaii) x (1 + Disproportionate Share Adjustment Factor + IME 
Adjustment Factor, if applicable). The result is the adjusted 
capital Federal rate.
    Hospitals also may receive outlier payments for those cases that 
qualify under the thresholds established for each fiscal year. 
Section 412.312(c) provides for a single set of thresholds to 
identify outlier cases for both inpatient operating and inpatient 
capital-related payments. The proposed outlier thresholds for FY 
2007 are in section II.A.4.c. of this Addendum. For FY 2007, a case 
qualifies as a cost outlier if the cost for the case plus the IME 
and DSH payments is greater than the prospective payment rate for 
the DRG plus $25,530.
    An eligible hospital may also qualify for a special exceptions 
payment under Sec.  412.348(g) for up through the 10th year beyond 
the end of the capital transition period if it meets: (1) A project 
need requirement described at Sec.  412.348(g)(2), which in the case 
of certain urban hospitals includes an excess capacity test as 
described at Sec.  412.348(g)(4); and (2) a project size requirement 
as described at Sec.  412.348(g)(5). Eligible hospitals include 
SCHs, urban hospitals with at least 100 beds that have a DSH patient 
percentage of at least 20.2 percent or qualify for DSH payments 
under Sec.  412.106(c)(2), and hospitals that have a combined 
Medicare and Medicaid inpatient utilization of at least 70 percent. 
Under Sec.  412.348(g)(8), the amount of a special exceptions 
payment is determined by comparing the cumulative payments made to 
the hospital under the capital PPS to the cumulative minimum payment 
level. This amount is offset by: (1) Any amount by which a 
hospital's cumulative capital payments exceed its cumulative minimum 
payment levels applicable under the regular exceptions process for 
cost reporting periods beginning during which the hospital has been 
subject to the capital PPS; and (2) any amount by which a hospital's 
current year operating and capital payments (excluding 75 percent of 
operating DSH payments) exceed its operating and capital costs. 
Under Sec.  412.348(g)(6), the minimum payment level is 70 percent 
for all eligible hospitals.
    During the transition period, new hospitals (as defined under 
Sec.  412.300) were exempt from the capital PPS for their first 2 
years of operation and were paid 85 percent of their reasonable 
costs during that period. Effective with the third year of operation 
through the remainder of the transition period, under Sec.  
412.324(b), we paid the hospitals under the appropriate transition 
methodology (if the hold-harmless methodology were applicable, the 
hold-harmless payment for assets in use during the base period would 
extend for 8 years, even if the hold-harmless payments extend beyond 
the normal transition period).
    Under Sec.  412.304(c)(2), for cost reporting periods beginning 
on or after October 1, 2002, we pay a new hospital 85 percent of its 
reasonable costs during the first 2 years of operation unless it 
elects to receive payment based on 100 percent of the capital 
Federal rate. Effective with the third year of

[[Page 24160]]

operation, we pay the hospital based on 100 percent of the capital 
Federal rate (that is, the same methodology used to pay all other 
hospitals subject to the capital PPS).

C. Capital Input Price Index

1. Background

    Like the operating input price index, the capital input price 
index (CIPI) is a fixed-weight price index that measures the price 
changes associated with capital costs during a given year. The CIPI 
differs from the operating input price index in one important 
aspect--the CIPI reflects the vintage nature of capital, which is 
the acquisition and use of capital over time. Capital expenses in 
any given year are determined by the stock of capital in that year 
(that is, capital that remains on hand from all current and prior 
capital acquisitions). An index measuring capital price changes 
needs to reflect this vintage nature of capital. Therefore, the CIPI 
was developed to capture the vintage nature of capital by using a 
weighted-average of past capital purchase prices up to and including 
the current year.
    We periodically update the base year for the operating and 
capital input prices to reflect the changing composition of inputs 
for operating and capital expenses. The CIPI was last rebased to FY 
2002 in the FY 2006 IPPS final rule (70 FR 47387).

2. Forecast of the CIPI for FY 2007

    Based on the latest forecast by Global Insight, Inc. (first 
quarter of 2006), we are forecasting the CIPI to increase 0.8 
percent in FY 2007. This reflects a projected 1.4 percent increase 
in vintage-weighted depreciation prices (building and fixed 
equipment, and movable equipment) and a 3.0 percent increase in 
other capital expense prices in FY 2007, partially offset by a 2.3 
percent decline in vintage-weighted interest expenses in FY 2007. 
The weighted average of these three factors produces the 0.8 percent 
increase for the CIPI as a whole in FY 2007.

IV. Payment Rates for Excluded Hospitals and Hospital Units: Proposed 
Rate-of-Increase Percentages

    (If you choose to comment on issues in this section, please 
include the caption ``Excluded Hospitals Rate of Increase'' at the 
beginning of your comment.)

A. Payments to Existing Excluded Hospitals and Units

    As discussed in section VI. of the preamble of this proposed 
rule, the inpatient operating costs of children's hospitals and 
cancer hospitals that are excluded from the IPPS are paid on the 
basis of reasonable cost subject to the rate-of-increase ceiling 
established under the authority of sections 1886(b)(3)(A)(i) and 
(ii) of the Act and Sec.  413.40 of the regulations. The ceiling is 
based on a target amount per discharge under TEFRA. In addition, in 
accordance with Sec.  403.752(a) of the regulations, RNHCIs also are 
paid under Sec.  413.40 which uses section 1886(b)(3)(B)(ii) of the 
Act to update the percentage increase in the rate of increase 
limits. The most recent proposed projected forecast of the market 
basket percentage increase for FY 2007 for children's hospitals, 
cancer hospitals, and RNHCIs using the IPPS market basket (70 FR 
47396 through 47405) is 3.4 percent.
    LTCHs, rehabilitation hospitals and units, and psychiatric 
hospitals and units, historically, were excluded from the IPPS and 
subject to the rate-of-increase limits under Sec.  413.40, as well. 
However, prospective payment systems have been developed for each of 
the three types of hospitals, and each kind of hospital is currently 
paid under its own PPS, either at 100 percent of the Federal rate or 
according to a transition period methodology, if applicable. (For 
more detailed discussion of these payment methodologies, see 69 FR 
49190; 69 FR 66922; 68 FR 45674; and 67 FR 55954.)
    For cost reporting periods beginning on or after October 1, 
2002, to the extent a LTCH or a psychiatric hospital or unit has all 
or a portion of its payment determined under reasonable cost 
principles, the target amounts for the reasonable cost-based portion 
of the blended payment are determined in accordance with sections 
1886(b)(3)(A)(i) and 1886(b)(3)(B)(ii) of the Act and the 
regulations at Sec.  413.40(c)(4)(ii). Section 413.40(c)(4)(ii) 
states, ``Subject to the provisions of [Sec.  413.40], paragraph 
(c)(4)(iii) of this section, for subsequent cost reporting periods, 
the target amount equals the hospital's target amount for the 
previous cost reporting period increased by the update factor for 
the subject cost reporting period, unless the provisions of [Sec.  
413.40] paragraph (c)(5)(ii) of this section apply.'' Thus, because 
Sec.  413.40(c)(4)(ii) indicates that the provisions of that 
paragraph are subject to the provisions of Sec.  413.40(c)(4)(iii), 
which are applicable only for cost reporting periods beginning on or 
after October 1, 1997 through September 30, 2002, the target amount 
for FY 2003 is determined by updating the target amount for FY 2002 
by the applicable update factor. For example, if a provider was paid 
the cap amount for FY 2002 (Sec.  413.40(c)(4)(iii)), the target 
amount for FY 2003 would be the amount paid in FY 2002, updated to 
FY 2003 (that is, the target amount from the previous year increased 
by the applicable update factor).
    Effective for cost reporting periods beginning on or after 
October 1, 2002, IRFs are paid 100 percent of the adjusted Federal 
prospective payment rate under the IRP PPS.
    Effective for cost reporting periods beginning on or after 
October 1, 2002, LTCHs also are no longer paid on a reasonable cost 
basis, but are paid under a LTCH DRG-based PPS. In implementing the 
LTCH PPS, an existing LTCH (that is, not defined as new under Sec.  
412.23(e)(4)) could have elected to be paid based on 100 percent of 
the standard Federal prospective payment rate during the transition 
period. However, we also established a 5-year transition period from 
reasonable cost-based payments (subject to the TEFRA limit) to fully 
Federal prospective payment amounts during which an existing LTCH 
could receive a PPS-blended payment consisting of two payment 
components--one based on reasonable cost under the TEFRA payment 
system, and the other based on the standard Federal prospective 
payment rate.
    Effective for cost reporting periods that will begin on or after 
October 1, 2006, the LTCHs that receive payment based on a blended 
payment amount will no longer receive a portion of their payment 
that is based, in part, on reasonable cost subject to the rate-of-
ceiling under Sec.  413.40. This is because, in accordance with 
Sec.  412.533, LTCHs are paid 100 percent of the adjusted Federal 
prospective payment amount and zero percent of the amount calculated 
under reasonable cost principles for cost reporting periods 
beginning on or after October 1, 2006.
    As part of the PPS for existing IPFs, we have established a 3-
year transition period during which existing IPFs will be paid based 
on a blend of reasonable cost-based payment (subject to the TEFRA 
limit) and the prospective per diem payment rate. IPFs that are paid 
under a blended methodology will have the reasonable cost-based 
portion of their payment subject to a hospital target amount. The 
most recent proposed projected forecast of the market basket 
percentage increase for FY 2007 for the reasonable cost-based 
portion of an IPF's payment using the excluded hospital market 
basket (70 FR 47396 through 47405) is 3.6 percent. For cost 
reporting periods beginning on or after January 1, 2008, IPFs will 
be paid 100 percent of the Federal prospective per diem amount.
    The proposed market basket percentage increases for FY 2007 are 
made by CMS' Office of the Actuary and reflect the average change in 
the price of goods and services purchased by hospitals to furnish 
inpatient hospital care. As discussed in section IV. of the preamble 
in the FY 2006 IPPS final rule, we use the IPPS market basket for 
children's hospitals, cancer hospitals, and RNHCIs, and the excluded 
hospital market basket for LTCHs, and IPFs for the reasonable cost 
portion of its payment to the extent a portion of its PPS payment is 
based on reasonable costs. We are not proposing any changes to our 
method of calculating the hospital market basket for IPPS or for 
excluded hospitals. As we indicated above, the proposed IPPS market 
basket is 3.4 percent and the proposed excluded hospital market 
basket is 3.6 percent.

B. New Excluded Hospitals and Units

    Section 1886(b)(7) of the Act established a payment methodology 
for new (cost reporting periods beginning on or after October 1, 
1997) rehabilitation hospitals and units, psychiatric hospitals and 
units, and LTCHs. For the first two 12-month cost reporting periods, 
payment was based on the lower of the hospital's net inpatient 
operating costs or 110 percent of the national median of target 
amounts for the particular class of hospital for FY 1996, updated to 
the applicable cost reporting period, and adjusted for differences 
in area wage levels. Consequently, beginning with the FY 1998 IPPS 
final rule, we published annually in the Federal Register, the 
updated 110 percent median of the wage-neutral national target 
amounts, divided into the labor and nonlabor-related share, for each 
of the three classes of providers affected by the payment 
limitation. As explained in the FY 2006 IPPS final rule (70 FR 47466 
through 47467), the charts containing the updated 110 percent median 
payment amount

[[Page 24161]]

information are no longer needed and are discontinued.

V. Proposed Payment for Blood Clotting Factor Administered to Inpatient 
With Hemophilia

    (If you choose to comment on issues in this section, please 
include the caption ``Blood Clotting Factor Payment Rate'' at the 
beginning of your comment.)
    As discussed in section VIII. of the preamble to this proposed 
rule, in the FY 2006 IPPS final rule (70 FR 47473), we amended our 
regulations at Sec. Sec.  412.2(f)(8) and 412.115(b) to state that, 
for discharges occurring on or after October 1, 2005, we make 
payment for blood clotting factor administered to hospital 
inpatients using the Medicare Part B payment amounts for blood 
clotting factor as determined under Subpart K of 48 CFR Part 414 and 
for the furnished fee as determined under Sec.  410.63.
    In accordance with Sec.  410.63(c)(2) and our November 21, 2005 
regulations (70 FR 70225), the furnishing fee for blood clotting 
factor for CY 2006 was determined to be $0.146 per individual unit 
(I.U.). Although the furnishing fee payment rate is calculated at 3 
digits, the actual amount paid to providers and suppliers is rounded 
to 2 digits. In section VIII of the preamble to this proposed rule, 
we are proposing that the fiscal intermediaries continue to make 
payment amounts for blood clotting factor administered to hemophilia 
inpatients using the Medicare Part B payment amounts determined 
under Subpart K of 42 CFR Part 414 and that payment amounts for the 
furnishing fee for the blood clotting factor be calculated at 3 
digits, currently at $0.146 per I.U. of blood clotting factor.
    The fiscal intermediaries continue to use the Medicare Part B 
Drug Pricing File to make payments for blood clotting factors. The 
furnishing fee is included in the ASP price per unit sent with the 
Medicare Part B Drug Pricing File that is updated quarterly. By 
using the Medicare Part B Drug Pricing File, Medicare will be making 
consistent payments for blood clotting factor provided to inpatients 
and outpatients. For further updates on pricing, we refer reader to 
the Medicare Part B drug pricing regulations.

[[Page 24162]]

VI. Tables

    This section contains the tables referred to throughout the 
preamble to this proposed rule and in this Addendum. Tables 1A, 1B, 
1C, 1D, 2, 3A, 3B, 4A-1, 4A-2, 4B, 4C-1, 4C-2, 4F, 4J, 5, 6A, 6B, 
6C, 6D, 6E, 6F, 6G, 6H, 7A, 7B, 8A, 8B, 8C, 9A, 9B, 9C, 10, and 11 
are presented below. The tables presented below are as follows:

Table 1A--National Adjusted Operating Standardized Amounts, Labor/
Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If 
Wage Index Is Greater Than 1)
Table 1B--National Adjusted Operating Standardized Amounts, Labor/
Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage 
Index Is Less Than or Equal To 1)
Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico, 
Labor/Nonlabor
Table 1D--Capital Standard Federal Payment Rate
Table 2--Hospital Case-Mix Indexes for Discharges Occurring in 
Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal 
Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 
2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage 
Data); Wage Indexes and 3-Year Average of Hospital Average Hourly 
Wages
Table 3A--FY 2007 and 3-Year Average Hourly Wage for Urban Areas by 
CBSA
Table 3B--FY 2007 and 3-Year Average Hourly Wage for Rural Areas by 
CBSA
Table 4A-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Urban Areas by CBSA--FY 2007
Table 4A-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Urban Areas by CBSA for the Period April 1 through 
September 30, 2007
Table 4B--Wage Index and Capital Geographic Adjustment Factor (GAF) 
for Rural Areas by CBSA--FY 2007
Table 4C-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Hospitals That Are Reclassified by CBSA--FY 2007
Table 4C-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Hospitals That Are Reclassified by CBSA for the 
Period April 1 through September 30, 2007
Table 4F--Puerto Rico Wage Index and Capital Geographic Adjustment 
Factor (GAF) by CBSA--FY 2007
Table 4J--Out-Migration Adjustment--FY 2007
Table 5--List of Diagnosis-Related Groups (DRGs), Relative Weighting 
Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)
Table 6A--New Diagnosis Codes
Table 6B--New Procedure Codes
Table 6C--Invalid Diagnosis Codes
Table 6D--Invalid Procedure Codes
Table 6E--Revised Diagnosis Code Titles
Table 6F--Revised Procedure Code Titles
Table 6G--Additions to the CC Exclusions List
Table 6H--Deletions from the CC Exclusions List
Table 7A--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V23.0
Table 7B--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V24.0
Table 8A--Statewide Average Operating Cost-to-Charge Ratios--March 
2006
Table 8B--Statewide Average Capital Cost-to-Charge Ratios--March 
2006
Table 8C--Statewide Average Total Cost-to-Charge Ratios for LTCHs--
March 2006
Table 9A--Hospital Reclassifications and Redesignations by 
Individual Hospital and CBSA--FY 2007
Table 9B--Hospital Reclassifications and Redesignations by 
Individual Hospital Under Section 508 of Pub. L. 108-173--FY 2007
Table 9C--Hospitals Redesignated as Rural under Section 
1886(d)(8)(E) of the Act--FY 2007
Table 10--Geometric Mean Plus the Lesser of .75 of the National 
Adjusted Operating Standardized Payment Amount (Increased to Reflect 
the Difference Between Costs and Charges) or .75 of One Standard 
Deviation of Mean Charges by Diagnosis-Related Group (DRG)--March 
2006
Table 11--Proposed FY 2007 LTC-DRGs, Relative Weights, Geometric 
Average Length of Stay, and 5/6ths of the Geometric Average Length 
of Stay

                   Table 1A.--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
               [69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1]
----------------------------------------------------------------------------------------------------------------
               Full update  (3.4 percent)                              Reduced update  (1.4 percent)
----------------------------------------------------------------------------------------------------------------
       Labor-related               Nonlabor-related              Labor-related             Nonlabor-related
----------------------------------------------------------------------------------------------------------------
             $3,404.27                    $1,479.90                   $3,338.42                   $1,451.28
----------------------------------------------------------------------------------------------------------------


                   Table 1B.--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
            [62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Less Than or Equal to 1]
----------------------------------------------------------------------------------------------------------------
               Full update  (3.4 percent)                              Reduced update  (1.4 percent)
----------------------------------------------------------------------------------------------------------------
       Labor-related               Nonlabor-related              Labor-related             Nonlabor-related
----------------------------------------------------------------------------------------------------------------
             $3,028.19                    $1,855.98                   $2,969.62                   $1,820.08
----------------------------------------------------------------------------------------------------------------


               Table 1C.--Adjusted Operating Standardized Amounts For Puerto Rico, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
                                                                 Rates if wage index    Rates if wage index less
                                                                   greater than 1          than or equal to 1
                                                             ---------------------------------------------------
                                                                 Labor       Nonlabor      Labor       Nonlabor
----------------------------------------------------------------------------------------------------------------
National....................................................    $3,404.27    $1,479.90    $3,028.19    $1,855.98
Puerto Rico.................................................     1,442.78       884.28     1,365.99       961.07
----------------------------------------------------------------------------------------------------------------


[[Page 24163]]


            Table 1D.--Capital Standard Federal Payment Rate
------------------------------------------------------------------------
                                                                 Rate
------------------------------------------------------------------------
National...................................................      $424.42
Puerto Rico................................................       202.98
------------------------------------------------------------------------


 Table 2.--Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital
 Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average
                                                            of Hospital Average Hourly Wages
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              FY 2007
                                                                             wage index    FY 2007      Average      Average      Average      Average
                         Provider No.                            Case-mix   (10/1/2006-   wage index  hourly wage  hourly wage  hourly wage     hourly
                                                                index \3\    3/31/2007)   (4/1/2007-  FY 2005 \1\  FY 2006 \1\  FY 2007 \1\   wage**  (3
                                                                                          9/30/2007)                                            years)
--------------------------------------------------------------------------------------------------------------------------------------------------------
010001.......................................................       1.4947       0.7670       0.7670      20.6563      21.6546      22.0902      21.4932
010004.......................................................          ***            *            *      22.7585            *            *      22.7585
010005 h.....................................................       1.1314       0.8919       0.8919      20.4937      22.4906      23.8467      22.3126
010006.......................................................       1.4662       0.8008       0.8008      21.0241      23.4823      23.8950      22.7642
010007.......................................................       1.0715       0.7670       0.7670      16.8811      18.2430      19.0895      18.0746
010008.......................................................       0.9849       0.8035       0.8035      23.8333      20.4591      17.3246      20.3331
010009.......................................................       0.9669       0.8829       0.8829      21.6422      23.2229      23.6476      22.8732
010010 h.....................................................       1.0466       0.9286       0.9286      22.3021      21.4974      26.9296      23.3707
010011.......................................................       1.6004       0.8919       0.8919      24.8166      27.4850      28.1598      26.8482
010012.......................................................       1.2403       0.8841       0.8841      21.7622      22.7020      24.7514      23.0667
010015.......................................................       1.0209       0.7670       0.7670      20.4732      21.5111      22.2383      21.4475
010016.......................................................       1.5262       0.8919       0.8919      23.0414      25.1502      25.3918      24.5277
010018.......................................................       1.4713       0.8919       0.8919      20.5888      22.2990      23.4042      22.0807
010019.......................................................       1.2326       0.8008       0.8008      20.1336      22.0906      22.7718      21.6962
010021 h.....................................................       1.2234       0.7670       0.7670      20.7108      18.6785      19.2877      19.5086
010022.......................................................       0.9812       0.9307       0.9307      25.8797      24.5670      26.0470      25.5065
010023.......................................................       1.9126       0.8035       0.8035      23.7791      27.6174      25.9797      25.7195
010024.......................................................       1.6759       0.8035       0.8035      20.0067      20.7265      21.9289      20.8398
010025.......................................................       1.2800       0.8256       0.8256      19.8561      21.2674      22.9338      21.3262
010027.......................................................       0.7764       0.7670       0.7670      14.9585      15.3704      16.1874      15.4627
010029.......................................................       1.5817       0.8256       0.8256      21.6724      22.6976      24.0249      22.8346
010031.......................................................          ***            *            *      20.9463            *            *      20.9463
010032.......................................................       0.8957       0.7670       0.7670      18.5073      19.1555      17.6770      18.4274
010033.......................................................       2.0838       0.8919       0.8919      25.5165      26.3784      27.2283      26.3825
010034.......................................................       0.9964       0.8035       0.8035      17.1625      16.9686      16.8532      16.9851
010035.......................................................       1.2688       0.8919       0.8919      23.1319      22.2870      24.4137      23.2651
010036.......................................................       1.1331       0.7670       0.7670      20.5125      22.9747      21.3352      21.6253
010038.......................................................       1.3544       0.8040       0.8040      20.3935      21.4509      23.8325      21.9490
010039.......................................................       1.6215       0.9027       0.9027      23.4151      25.8820      26.9189      25.4404
010040.......................................................       1.6072       0.8107       0.8107      21.6708      22.8851      25.2353      23.2539
010043.......................................................       1.0549       0.8919       0.8919      19.5422      22.5945      22.3782      21.5638
010044.......................................................       1.0631       0.8919       0.8919      23.0220      21.4036      23.4140      22.5922
010045.......................................................       1.1631       0.8919       0.8919      20.5658      19.8803      21.3661      20.5979
010046.......................................................       1.5002       0.8107       0.8107      20.8935      21.6965      22.5938      21.7035
010047.......................................................       0.8900       0.7825       0.7825      19.5937      21.0604      24.7497      21.7929
010049.......................................................       1.1465       0.7670       0.7670      17.7801      20.2413      21.7057      19.9626
010050.......................................................       1.0283       0.8919       0.8919      21.5625      22.1584      23.7598      22.4501
010051.......................................................       0.8413       0.8644       0.8644      14.7053      15.2208      16.2672      15.4065
010052.......................................................       0.8875       0.7791       0.7791      21.3673      16.4959      35.3506      23.1645
010053.......................................................       1.0530            *            *      17.4160      19.0108            *      18.2193
010054.......................................................       1.0888       0.8829       0.8829      23.1894      22.5554      23.2781      23.0051
010055.......................................................       1.5338       0.7670       0.7670      19.1847      22.3800      22.4711      21.3064
010056.......................................................       1.5870       0.8919       0.8919      22.7183      23.7144      23.9525      23.4706
010058.......................................................       0.9554       0.8919       0.8919      20.3182      18.5537      18.7069      19.3775
010059.......................................................       1.0321       0.8829       0.8829      23.6963      21.3237      22.9583      22.7109
010061.......................................................       1.0134       0.8176       0.8176      20.5683      21.9370      26.4117      23.1046
010062.......................................................       1.0729       0.7670       0.7670      18.1323      18.3435      20.1842      18.8535
010064.......................................................       1.7037       0.8919       0.8919      25.4345      26.1110      25.8259      25.7663
010065.......................................................       1.4924       0.8035       0.8035      20.0108      21.3785      23.3126      21.5967
010066.......................................................       0.8390       0.7670       0.7670      17.0935      17.6152      19.9192      18.2254
010068.......................................................          ***            *            *      17.5690      19.0789      22.7410      19.7954
010069.......................................................       1.0208       0.7670       0.7670      19.6317      21.3608      22.9841      21.2452
010072.......................................................          ***            *            *      21.5419      21.8169      24.5806      22.6157
010073.......................................................       0.9714       0.7670       0.7670      16.4043      16.4168      17.2624      16.6999
010078.......................................................       1.5197       0.8040       0.8040      21.0633      21.6857      23.2584      22.0108
010079.......................................................       1.1653       0.9027       0.9027      20.4254      21.8199      22.9204      21.7330
010083 h.....................................................       1.1662       0.7999       0.7999      20.2166      22.3041      22.2041      21.5896
010084.......................................................       1.4968       0.8919       0.8919      22.5219      24.7127      26.7869      24.6686

[[Page 24164]]

 
010085.......................................................       1.3213       0.8829       0.8829      23.7007      24.4710      24.9367      24.3634
010086.......................................................       1.0963       0.7670       0.7670      19.4332      18.6081      22.6793      20.2158
010087.......................................................       1.9768       0.7955       0.7955      21.6226      22.5225      23.2584      22.4539
010089.......................................................       1.2732       0.8919       0.8919      22.2508      22.8448      25.7005      23.6155
010090.......................................................       1.7279       0.7955       0.7955      21.4322      23.6948      26.3719      23.7551
010091.......................................................       0.9676       0.7670       0.7670      19.4222      18.6912      21.7995      19.8855
010092.......................................................       1.6101       0.8644       0.8644      22.0709      24.4592      26.0211      24.1412
010095.......................................................       0.8483       0.8644       0.8644      13.4426      13.9326      14.2458      13.8767
010097.......................................................       0.7214       0.8035       0.8035      17.1735      16.7548      19.7546      17.8691
010098.......................................................       1.0614       0.7670       0.7670      19.6717      14.3076      19.7314      17.4056
010099.......................................................       1.0007       0.7670       0.7670      18.1849      18.7909      20.5469      19.1587
010100 h.....................................................       1.6896       0.7999       0.7999      20.0027      21.2915      23.6080      21.6931
010101.......................................................       1.1300       0.7978       0.7978      21.0085      21.6593      24.1741      22.2531
010102.......................................................       0.9498       0.7670       0.7670      19.9196      21.0903      24.0016      21.7005
010103.......................................................       1.9055       0.8919       0.8919      24.2201      26.1163      27.4955      25.9641
010104.......................................................       1.8131       0.8919       0.8919      24.1929      24.7394      27.7171      25.5564
010108.......................................................       1.1587       0.8035       0.8035      23.7803      28.4624      25.2790      25.7731
010109.......................................................       0.9898       0.8121       0.8121      21.7128      21.6194      17.8168      20.3493
010110.......................................................       0.7972       0.7670       0.7670      19.2706      17.5957      22.8948      19.6997
010112.......................................................       1.0411       0.7670       0.7670      17.2963      16.8902      16.6350      16.9597
010113.......................................................       1.6585       0.7955       0.7955      20.4181      21.4121      22.5051      21.4462
010114.......................................................       1.3874       0.8919       0.8919      21.5319      22.3752      24.9211      22.9538
010115.......................................................       0.8657            *            *      17.5985      21.7478            *      19.2200
010118.......................................................       1.2164       0.7785       0.7785      18.8560      19.7673      21.4598      20.1886
010119.......................................................          ***            *            *      21.8215            *            *      21.8215
010120.......................................................       0.9951       0.7670       0.7670      20.5855      20.9450      21.0977      20.8812
010121.......................................................          ***            *            *      17.0329      24.0867            *      19.3686
010125.......................................................       1.0529       0.7670       0.7670      16.8419      18.4114      21.5078      18.8306
010126.......................................................       1.1487       0.8035       0.8035      23.1856      23.1381      23.4829      23.2663
010128.......................................................       0.8668       0.7670       0.7670      17.9354      21.4201      22.0056      20.5563
010129 h.....................................................       1.0141       0.8076       0.8076      18.7821      21.3555      22.7075      21.0365
010130.......................................................       0.9442       0.8919       0.8919      18.4944      23.2488      24.8205      21.9717
010131.......................................................       1.3884       0.9027       0.9027      24.2197      25.7837      27.7993      26.0170
010137.......................................................       1.2455       0.8919       0.8919      29.7665      24.7366      26.6554      26.9261
010138.......................................................       0.6116       0.7670       0.7670      13.5082      13.8475      14.4665      13.9564
010139.......................................................       1.5878       0.8919       0.8919      24.9410      25.3014      26.7377      25.6921
010143.......................................................       1.1706       0.8919       0.8919      22.1312      22.0215      26.1276      23.4216
010144.......................................................       1.5785       0.7955       0.7955      20.6425      20.8209      22.3801      21.3097
010145.......................................................       1.3931       0.8644       0.8644      23.1976      24.9531      25.7002      24.6568
010146.......................................................       1.1068       0.8040       0.8040      19.9944      20.8917      22.8918      21.2823
010148.......................................................       0.8957       0.7670       0.7670      18.5309      20.5589      23.1208      20.7425
010149.......................................................       1.2762       0.8035       0.8035      23.1593      26.5854      25.2688      24.9404
010150.......................................................       1.0607       0.8035       0.8035      20.6738      21.6377      23.5727      21.9452
010152.......................................................       1.1816       0.7955       0.7955      22.1626      22.6202      23.0833      22.6354
010157.......................................................       1.1543       0.8008       0.8008      21.3574      24.3560      24.4951      23.3774
010158.......................................................       1.1432       0.8220       0.8220      22.4440      24.3531      24.3408      23.6867
010161.......................................................          ***            *            *      27.5119            *            *      27.5119
010162.......................................................          ***            *            *            *            *      30.6197      30.6197
010164.......................................................       1.1708       0.7978       0.7978            *            *            *            *
010165.......................................................       1.5089       0.9027       0.9027            *            *            *            *
010166.......................................................       1.7090            *            *            *            *            *            *
020001.......................................................       1.6912       1.2062       1.2062      31.6091      32.8120      35.3482      33.3208
020004.......................................................       1.1433       1.0669       1.0669      29.9926      32.0966      31.4487      31.1921
020006.......................................................       1.2733       1.2062       1.2062      33.4210      36.0540      35.6547      35.1161
020008.......................................................       1.2806       1.2062       1.2062      34.5856      35.9236      36.2733      35.6184
020012.......................................................       1.3394       1.1063       1.1063      29.3419      31.8995      32.7496      31.3425
020014.......................................................       1.1853       1.0669       1.0669      32.1233      32.0893      30.0133      31.3617
020017.......................................................       1.9918       1.2062       1.2062      32.9281      33.5852      36.7983      34.4089
020018.......................................................       0.9347       1.9343       1.9343            *            *            *            *
020019.......................................................       0.9039       1.9343       1.9343            *            *            *            *
020020.......................................................       0.8722            *            *            *            *            *            *
020024.......................................................       1.1284       1.0669       1.0669      27.9799      33.0644      29.0436      30.0116
020026.......................................................       1.6273       1.9343       1.9343            *            *            *            *
020027.......................................................       0.8979       1.9343       1.9343            *            *            *            *
030001.......................................................       1.4328       1.0307       1.0307      27.7572      29.9840      33.2450      30.4046
030002.......................................................       2.0991       1.0307       1.0307      27.9628      29.0519      30.2114      29.0057

[[Page 24165]]

 
030006.......................................................       1.6331       0.9239       0.9239      24.0169      25.8872      26.2503      25.4671
030007.......................................................       1.4120       1.1121       1.1121      26.9442      29.6174      31.2754      29.3738
030009.......................................................          ***            *            *      21.4065      22.3992      26.0201      22.5654
030010.......................................................       1.3771       0.9239       0.9239      22.8647      24.8275      28.0899      25.2470
030011.......................................................       1.4547       0.9239       0.9239      22.8422      25.1361      27.5948      25.3205
030012.......................................................       1.3826       0.9858       0.9858      25.5205      26.3859      27.7968      26.6212
030013.......................................................       1.4350       0.9179       0.9179      23.5229      25.7050      27.1721      25.5234
030014.......................................................       1.4890       1.0307       1.0307      25.1189      25.6259      28.4109      26.3536
030016.......................................................       1.2235       1.0307       1.0307      27.1583      26.7003      28.5953      27.4983
030017.......................................................       2.0967       1.0307       1.0307      24.4055      26.2452      31.2902      27.3461
030018.......................................................       1.2445       1.0307       1.0307      24.4308      28.9476      30.0034      27.5160
030019.......................................................       1.3225       1.0307       1.0307      28.4917      27.3156      30.4092      28.8240
030022.......................................................       1.5620       1.0307       1.0307      25.1461      26.4404      30.9356      27.5456
030023.......................................................       1.6994       1.1611       1.1611      28.4112      33.8333      34.3731      32.2119
030024.......................................................       2.0605       1.0307       1.0307      28.3470      31.6658      33.8834      31.3965
030027.......................................................       0.9510            *            *      21.0527      20.4031            *      20.7264
030030.......................................................       1.5508       1.0307       1.0307      24.6005      30.2712      32.7083      29.0268
030033.......................................................       1.2744       1.1121       1.1121      26.6009      26.6531      28.3920      27.2450
030036.......................................................       1.4226       1.0307       1.0307      26.5708      30.3521      31.8947      29.8589
030037.......................................................       2.2721       1.0307       1.0307      30.3907      28.6453      32.1766      30.5501
030038.......................................................       1.6855       1.0307       1.0307      26.5178      29.5509      30.7744      29.0959
030040.......................................................       0.9044       0.9158       0.9158      22.5130      24.8145      27.0303      24.8110
030043.......................................................       1.2719       0.9158       0.9158      26.0825      24.7932      24.7174      25.1254
030044.......................................................       0.8466            *            *      19.5714            *            *      19.5714
030055 h.....................................................       1.4275       1.1417       1.1417      23.1837      24.5202      27.1476      25.0481
030059.......................................................          ***            *            *      24.7676            *            *      24.7676
030060.......................................................       1.1831       0.9158       0.9158      22.3551      24.3523      25.0412      23.8848
030061.......................................................       1.6392       1.0307       1.0307      23.4722      25.5529      28.9415      26.0923
030062.......................................................       1.2655       0.9158       0.9158      21.9849      23.8068      26.5482      24.1628
030064.......................................................       1.9610       0.9239       0.9239      24.6732      25.4922      28.3696      26.2797
030065.......................................................       1.6072       1.0307       1.0307      25.6738      27.1646      29.2736      27.4560
030067.......................................................       1.0836       0.9158       0.9158      19.1332      20.4376      20.6472      20.0627
030068.......................................................       1.1530       0.9158       0.9158      19.7030      20.8846      22.1437      20.9244
030069 h.....................................................       1.3792       1.1417       1.1417      25.6243      26.3518      30.5875      27.3999
030071.......................................................       0.9063       1.4448       1.4448            *            *            *            *
030073.......................................................       0.8491       1.4448       1.4448            *            *            *            *
030074.......................................................       0.9153       1.4448       1.4448            *            *            *            *
030077.......................................................       0.8067       1.4448       1.4448            *            *            *            *
030078.......................................................       0.9638       1.4448       1.4448            *            *            *            *
030080.......................................................       1.4675       0.9239       0.9239      24.3573      25.2077      26.8022      25.4224
030083.......................................................       1.3724       1.0307       1.0307      24.9269      27.5353      28.0562      26.8708
030084.......................................................       0.8694       1.4448       1.4448            *            *            *            *
030085.......................................................       1.5851       0.9239       0.9239      23.2070      24.5792      26.3130      24.7847
030087.......................................................       1.6022       1.0307       1.0307      26.3878      26.6594      30.1137      27.8776
030088.......................................................       1.3772       1.0307       1.0307      23.2478      26.6796      28.0619      26.0537
030089.......................................................       1.5203       1.0307       1.0307      26.2166      27.1835      28.3816      27.3548
030092.......................................................       1.4300       1.0307       1.0307      25.4127      27.3203      30.6136      27.9388
030093.......................................................       1.2279       1.0307       1.0307      23.5623      25.8955      27.5072      25.9035
030094.......................................................       1.3717       1.0307       1.0307      26.9985      29.5948      32.6317      29.7783
030099.......................................................       0.8328       0.9158       0.9158      26.7996      26.3236      25.9313      26.3941
030100.......................................................       2.0714       0.9239       0.9239            *      29.0691      29.5931      29.3347
030101 h.....................................................       1.4542       1.1417       1.1417      25.0077      26.1927      27.6535      26.3284
030102.......................................................       2.6166       1.0307       1.0307            *      29.0942      29.6919      29.4041
030103.......................................................       1.6786       1.0307       1.0307      28.2832      30.1994      32.9960      30.4822
030105.......................................................       2.3179       1.0307       1.0307      27.6900      31.3094      31.9342      30.6375
030106.......................................................       1.6852       1.0307       1.0307      30.4791      34.7222      34.0269      32.6905
030107.......................................................       1.9370       1.0307       1.0307            *            *      34.7976      34.7976
030108.......................................................       2.1298       1.0307       1.0307            *            *            *            *
030109.......................................................       2.6413       1.0307       1.0307            *            *      16.7958      16.7958
030110.......................................................       1.4204       1.0307       1.0307            *            *      33.6019      33.6019
030111.......................................................       1.0628       0.9239       0.9239            *            *            *            *
030112.......................................................       1.9419       1.0307       1.0307            *            *            *            *
030113.......................................................       0.9339            *            *            *            *            *            *
030114.......................................................       1.3901            *            *            *            *            *            *
030115.......................................................       1.3316            *            *            *            *            *            *
040001.......................................................       1.0958       0.8779       0.8779      23.1475      23.7718      21.8122      22.8805

[[Page 24166]]

 
040002.......................................................       1.2276       0.7366       0.7366      19.3429      20.1384      20.4562      20.0058
040003.......................................................       1.2375            *            *      18.5000            *            *      18.5000
040004.......................................................       1.6200       0.8779       0.8779      23.3504      25.0286      26.2802      24.9024
040007.......................................................       1.7125       0.8918       0.8918      23.4565      25.7142      27.2033      25.4311
040010.......................................................       1.3944       0.8779       0.8779      22.0984      23.0274      24.1107      23.1027
040011.......................................................       1.0404       0.7366       0.7366      19.0319      20.3970      20.3176      19.9412
040014.......................................................       1.4709       0.8667       0.8667      24.0846      25.3451      26.0281      25.1431
040015.......................................................       1.0464       0.7366       0.7366      18.0793      19.2831      20.1555      19.1800
040016.......................................................       1.6831       0.8918       0.8918      22.7219      22.1228      25.7321      23.5240
040017.......................................................       1.1298       0.8599       0.8599      19.4365      21.9875      21.3748      20.9608
040018.......................................................       1.0715       0.7761       0.7761      23.8515      23.6044      24.3463      23.9210
040019.......................................................       1.1033       0.9032       0.9032      21.5316      23.7328      24.6250      23.3182
040020.......................................................       1.5722       0.9032       0.9032      20.9136      21.6603      21.9802      21.5335
040021.......................................................       1.2758       0.8918       0.8918      24.7771      25.6917      25.3027      25.2694
040022.......................................................       1.5344       0.8779       0.8779      23.7462      25.4052      27.5251      25.5185
040024.......................................................       0.6960            *            *      20.1101            *            *      20.1101
040026.......................................................       1.5365       0.8812       0.8812      24.3053      25.4072      27.5446      25.8166
040027.......................................................       1.4625       0.8345       0.8345      19.9348      21.1412      21.3991      20.8293
040029.......................................................       1.5492       0.8918       0.8918      22.8770      24.0704      24.4352      23.8327
040032.......................................................          ***            *            *      18.5171            *            *      18.5171
040035.......................................................          ***            *            *      13.4265            *            *      13.4265
040036.......................................................       1.6193       0.8918       0.8918      24.2851      26.3226      26.7026      25.8362
040039.......................................................       1.2931       0.8206       0.8206      17.7976      19.5998      20.6232      19.3622
040041.......................................................       1.1459       0.8667       0.8667      22.0188      22.1531      22.7230      22.3095
040042.......................................................       1.3639       0.9367       0.9367      18.9550      19.9627      20.6357      19.8706
040045.......................................................       0.9944            *            *      18.7952      17.2280            *      17.9500
040047.......................................................       1.1045       0.8206       0.8206      21.5334      21.9163      22.7571      22.0400
040050.......................................................       1.1711       0.7366       0.7366      15.4782      16.3930      17.6674      16.5402
040051.......................................................       0.9556       0.7366       0.7366      18.8943      19.1401            *      19.0196
040053.......................................................       1.0141            *            *      20.8153      20.7824            *      20.7984
040054.......................................................       1.1450       0.7366       0.7366      16.7370      18.2684      17.8810      17.6265
040055.......................................................       1.6026       0.7761       0.7761      22.2237      23.3156      22.5541      22.7083
040062.......................................................       1.7081       0.7761       0.7761      21.6403      23.3083      23.6394      22.8746
040066.......................................................          ***            *            *      23.4616            *            *      23.4616
040067.......................................................       1.0279       0.7366       0.7366      15.1441      16.8799      18.6028      16.7821
040069.......................................................       1.0422       0.9032       0.9032      21.7607      24.4662      24.3733      23.5051
040071.......................................................       1.4755       0.8667       0.8667      22.9350      24.3824      24.5703      23.9588
040072.......................................................       1.0619       0.7366       0.7366      20.8269      19.9009      21.6484      20.7448
040074.......................................................       1.1734       0.8918       0.8918      22.6147      25.2423      24.6178      24.0892
040075.......................................................       0.9567            *            *      16.2583      18.3254            *      17.2857
040076.......................................................       1.0182       0.8667       0.8667      21.0442      20.6272      23.0707      21.5644
040077.......................................................       0.9726            *            *      18.3261      18.2082            *      18.2646
040078.......................................................       1.6359       0.8812       0.8812      24.4589      24.5378      23.6641      24.2102
040080.......................................................       1.0378       0.7952       0.7952      21.3483      22.3392      23.4566      22.4402
040081.......................................................       0.8376       0.7366       0.7366      13.7148      15.1081      15.4211      14.7485
040084.......................................................       1.1802       0.8918       0.8918      22.6441      24.7225      27.5794      25.0806
040085.......................................................       1.0444       0.7366       0.7366      18.0756      29.8444      22.6181      22.5790
040088.......................................................       1.3259       0.8715       0.8715      21.2974      22.6183      23.0136      22.3299
040091.......................................................       1.2045       0.8133       0.8133      23.0252      23.1320      24.5553      23.5683
040100.......................................................       1.3571       0.8667       0.8667      19.3560      20.0460      20.9265      20.1488
040105.......................................................       1.0217            *            *      15.8171      18.2182            *      16.9121
040109.......................................................       1.1287            *            *      18.8624      22.8801            *      20.7540
040114.......................................................       1.7651       0.8918       0.8918      23.5628      24.8992      26.3883      24.9878
040118.......................................................       1.4456       0.7952       0.7952      24.2547      24.7363      25.7793      24.8977
040119.......................................................       1.4191       0.8667       0.8667      20.1631      21.0103      23.4451      21.5482
040126.......................................................       0.8957            *            *      12.5944      14.0701      15.4020      13.9828
040132.......................................................          ***            *            *      36.5525      28.1390            *      32.3748
040134.......................................................       2.4406       0.8918       0.8918            *      27.3412      30.4316      28.9159
040137.......................................................       1.3274       0.8918       0.8918      23.4672      25.2907      26.4443      25.0310
040138.......................................................       1.3548       0.8779       0.8779      23.3615      25.7513      28.5258      26.2151
040140.......................................................          ***            *            *      25.1224            *            *      25.1224
040141.......................................................       0.8243       0.8779       0.8779            *      24.0901      26.4956      25.3872
040142.......................................................       1.4333       0.8812       0.8812            *      27.9695      22.2893      24.7923
040143.......................................................          ***            *            *            *            *      35.7717      35.7717
040144.......................................................          ***            *            *            *            *      21.0608      21.0608
040145.......................................................       1.7845       0.7952       0.7952            *            *            *            *

[[Page 24167]]

 
040147.......................................................       1.6530            *            *            *            *            *            *
040302.......................................................       0.7642            *            *            *            *            *            *
040323.......................................................       0.6969            *            *            *            *            *            *
040324.......................................................       0.8299            *            *            *            *            *            *
050002.......................................................       1.3835       1.5669       1.5669      31.9709      34.1948      36.4919      34.3441
050006.......................................................       1.6033       1.2884       1.2884      27.6176      30.5373      34.9121      30.7219
050007.......................................................       1.4652       1.5049       1.5049      37.5804      38.7033      43.7992      40.0756
050008.......................................................       1.3291       1.5075       1.5075      36.9371      39.1539      44.3345      40.2397
050009.......................................................       1.7796       1.4527       1.4527      35.5384      39.6393      44.6602      40.0554
050013.......................................................       1.9303       1.4527       1.4527      31.7637      31.9837      36.6624      33.4866
050014.......................................................       1.1619       1.3350       1.3350      29.5726      33.0373      34.2931      32.4016
050015.......................................................       1.2530       1.1291       1.1291      30.1398      30.7940      32.9364      31.3257
050016.......................................................       1.3081       1.1719       1.1719      25.5735      26.2162      25.0655      25.5928
050017.......................................................       2.0744       1.3350       1.3350      30.5863      36.6593      41.3084      36.1871
050018.......................................................       1.1775       1.1762       1.1762      20.3179      22.3472      23.5749      22.0407
050022.......................................................       1.5578       1.1291       1.1291      28.2773      29.8632      32.3919      30.2730
050024.......................................................       1.1455       1.1371       1.1371      26.9378      27.5587      29.6260      28.0641
050025.......................................................       1.9363       1.1371       1.1371      31.7242      36.1622      34.1382      34.0294
050026.......................................................       1.5437       1.1371       1.1371      26.6406      28.3027      32.1634      29.1587
050028.......................................................       1.2579       1.1291       1.1291      21.5448      26.6160      27.9303      24.9072
050029.......................................................          ***            *            *      34.3934            *            *      34.3934
050030.......................................................       1.2571       1.1291       1.1291      22.9148      24.9707      27.3246      25.0300
050036.......................................................       1.6518       1.1291       1.1291      27.4915      32.7929      33.9665      31.5046
050038.......................................................       1.5557       1.5281       1.5281      35.0441      38.7527      42.3234      38.7342
050039.......................................................       1.6694       1.1291       1.1291      29.8179      31.6734      35.2640      32.1617
050040.......................................................       1.3231       1.1762       1.1762      31.8983      34.3279      35.1377      33.7788
050042.......................................................       1.4842       1.2884       1.2884      29.8062      33.9415      39.2888      34.3247
050043.......................................................       1.6420       1.5669       1.5669      39.6054      43.1589      46.8909      43.1599
050045.......................................................       1.2924       1.1291       1.1291      22.7051      23.8408      25.5028      24.0609
050046.......................................................       1.1753       1.1739       1.1603      25.2786      25.6875      27.3051      26.1065
050047.......................................................       1.7513       1.5075       1.5075      39.3993      40.9874      45.6968      42.1673
050054.......................................................       1.2085       1.1291       1.1291      27.1437      24.1262      21.5112      24.0692
050055.......................................................       1.2513       1.5075       1.5075      36.9386      37.5879      44.0022      39.3279
050056.......................................................       1.3372       1.1762       1.1762      29.4829      27.9330      30.8781      29.4498
050057.......................................................       1.6796       1.1291       1.1291      26.2099      29.4351      29.9720      28.5742
050058.......................................................       1.5522       1.1762       1.1762      27.3584      33.8215      34.2823      31.7862
050060.......................................................       1.5248       1.1291       1.1291      26.5515      27.3282      29.5772      27.8373
050061.......................................................          ***            *            *            *      32.2172            *      32.2172
050063.......................................................       1.3301       1.1762       1.1762      32.0515      33.3039      35.3038      33.4928
050065.......................................................       1.8339       1.1600       1.1603      33.8223      34.0280      35.1370      34.3436
050067.......................................................       1.1518       1.1731       1.1731      29.6982      31.9597      34.7752      32.3897
050069.......................................................       1.6789       1.1600       1.1603      28.6752      31.2172      34.9317      31.6324
050070.......................................................       1.3261       1.5049       1.5049      40.5645      45.3382      49.7618      45.6981
050071.......................................................       1.2702       1.5669       1.5669      41.1036      44.9464      51.5757      46.4017
050072.......................................................       1.2617       1.5669       1.5669      40.8108      44.2651      50.8845      45.8517
050073.......................................................       1.2713       1.5669       1.5669      41.3430      45.9765      51.3203      46.7321
050075.......................................................       1.1620       1.5669       1.5669      43.7101      47.2356      55.9906      49.6104
050076.......................................................       1.6785       1.5669       1.5669      43.0845      46.4990      53.7174      48.3873
050077.......................................................       1.5579       1.1371       1.1371      29.6264      32.0245      34.5870      32.2078
050078.......................................................       1.2213       1.1762       1.1762      25.6814      31.1425      32.6611      29.5911
050079.......................................................       1.5002       1.5669       1.5669      42.7385      47.8597      49.6550      46.8148
050082.......................................................       1.6455       1.1739       1.1603      28.9139      37.7783      40.5118      36.0157
050084.......................................................       1.5694       1.2038       1.2038      28.2664      33.0179      35.8900      32.2531
050088.......................................................          ***            *            *      26.4093      25.7385            *      26.0862
050089.......................................................       1.3345       1.1600       1.1603      29.4884      33.5323      35.0765      32.7927
050090.......................................................       1.2940       1.5049       1.5049      31.1774      32.9584      34.1010      32.7532
050091.......................................................       1.1259       1.1762       1.1762      30.1534      30.8560      32.2866      31.1304
050093.......................................................       1.5086       1.1291       1.1291      31.1083      33.4119      36.3766      33.6827
050096.......................................................       1.2678       1.1762       1.1762      24.2277      24.6680      29.0265      26.0314
050097.......................................................          ***            *            *      26.6788            *            *      26.6788
050099.......................................................       1.5000       1.1600       1.1603      28.7711      31.0437      34.0709      31.4119
050100.......................................................       1.8497       1.1371       1.1371      28.0303      29.6949      32.1909      30.0363
050101.......................................................       1.3351       1.5669       1.5669      35.4655      40.3195      42.6624      39.6163
050102.......................................................       1.3060       1.1291       1.1291      24.9381      29.1364      32.5557      28.7040
050103.......................................................       1.5640       1.1762       1.1762      28.7375      34.2529      34.1636      32.4158
050104.......................................................       1.3813       1.1762       1.1762      29.1240      29.7326      33.2730      30.7456

[[Page 24168]]

 
050107.......................................................       1.4706       1.1291       1.1291      27.6002      33.1358      32.9560      31.1819
050108.......................................................       1.9403       1.3350       1.3350      31.4271      35.5711      40.0597      35.9841
050110.......................................................       1.2736       1.1291       1.1291      20.0769      26.1453      27.0752      24.1400
050111.......................................................       1.3212       1.1762       1.1762      26.6345      28.1588      27.7673      27.5460
050112.......................................................       1.5308       1.1762       1.1762      34.0258      36.8026      37.1212      36.0398
050113.......................................................       1.3140       1.5049       1.5049      34.2851      33.8064      38.7793      35.6638
050114.......................................................       1.4334       1.1762       1.1762      29.2858      31.1294      33.7817      31.4992
050115.......................................................       1.4811       1.1371       1.1371      27.5207      30.9288      29.7825      29.4457
050116.......................................................       1.6951       1.1762       1.1762      28.8193      34.5110      37.0771      33.5192
050117.......................................................       2.3561       1.1884       1.1884      28.2227      32.4414      34.3628      31.0394
050118.......................................................       1.1866       1.1731       1.1731      33.0650      35.4044      40.0173      36.1567
050121.......................................................       1.2724       1.1291       1.1291      25.5962      27.9537      30.3495      28.0779
050122.......................................................       1.5554       1.2038       1.2038      29.7629      34.2416      33.7869      32.6896
050124.......................................................       1.3010       1.1762       1.1762      26.7065      28.0288      29.6897      28.1843
050125.......................................................       1.3922       1.5281       1.5281      40.9218      41.7020      40.7957      41.1327
050126.......................................................       1.4204       1.1762       1.1762      29.6203      29.3360      32.5210      30.5081
050127.......................................................       1.3341       1.3350       1.3350      23.6208      26.1222      33.3619      26.9264
050128.......................................................       1.5385       1.1371       1.1371      28.3278      31.0662      32.3557      30.6445
050129.......................................................       1.7922       1.1600       1.1603      27.8488      32.2680      36.3489      32.4090
050131.......................................................       1.3140       1.5082       1.5082      38.6834      40.5321      46.3164      41.7664
050132.......................................................       1.3868       1.1762       1.1762      29.4317      35.1544      37.0147      33.9609
050133.......................................................       1.4974       1.1461       1.1461      27.6030      31.3530      32.6669      30.5790
050135.......................................................       1.0165       1.1762       1.1762      24.9415      24.3927      22.8053      23.8553
050136.......................................................       1.2848       1.5049       1.5049      35.2834      37.4560      43.2698      38.6465
050137.......................................................       1.2925       1.1762       1.1762      36.5409      38.4827      40.4779      38.6009
050138.......................................................       2.1552       1.1762       1.1762      43.8671      46.9557      47.6585      46.1884
050139.......................................................       1.3295       1.1762       1.1762      35.1013      37.6217      39.0103      37.2783
050140.......................................................       1.4309       1.1600       1.1603      37.5473      39.6269      42.1233      39.8915
050144.......................................................       1.3888       1.1762       1.1762      32.4042      33.5109      34.0982      33.3800
050145.......................................................       1.3655       1.4457       1.4457      39.5676      42.3134      48.1345      43.3982
050148.......................................................       1.0959       1.1291       1.1291      24.7063      27.3005      28.8900      27.0245
050149.......................................................       1.4738       1.1762       1.1762      30.1596      33.2270      37.1830      33.9364
050150.......................................................       1.2309       1.3350       1.3350      31.5333      31.7560      33.9978      32.4639
050152.......................................................       1.4829       1.5075       1.5075      40.3464      43.6487      46.4718      43.5222
050153.......................................................       1.5515       1.5281       1.5281      40.4446      43.3190      43.6382      42.5499
050155.......................................................          ***            *            *      21.8829      21.8550      16.9856      19.9780
050158.......................................................       1.3045       1.1762       1.1762      33.6400      35.1326      35.7746      34.9077
050159.......................................................       1.2085       1.1739       1.1603      30.8069      31.3199      32.3724      31.5413
050167.......................................................       1.2968       1.2038       1.2038      25.9850      28.5179      30.6646      28.3647
050168.......................................................       1.6582       1.1600       1.1603      30.8036      33.2506      36.3166      33.5327
050169.......................................................       1.4331       1.1762       1.1762      26.2864      27.4644      30.0990      28.0689
050172.......................................................       1.2604       1.1291       1.1291      27.1497      28.5604      25.7654      27.0886
050173.......................................................       1.2462       1.1600       1.1603      27.6097      30.3582      29.5083      29.1194
050174.......................................................       1.6356       1.5049       1.5049      36.3117      40.1747      43.9133      40.1381
050175.......................................................       1.2512       1.1762       1.1762      31.5615      30.5733      33.4885      31.8687
050177.......................................................          ***            *            *      24.7531      25.1442      24.8662      24.9253
050179.......................................................       1.2173       1.1731       1.1731      25.8072      27.1155      30.1673      27.9651
050180.......................................................       1.5914       1.5669       1.5669      40.8101      40.2504      38.1691      39.6057
050188.......................................................       1.4277       1.5281       1.5281      39.3507      39.5110      41.5956      40.1682
050189.......................................................       1.0446       1.4457       1.4457      20.0709      29.1280      29.5245      26.1888
050191.......................................................       1.5168       1.1762       1.1762            *      34.2091      38.9681      36.4880
050192.......................................................       1.0079       1.1291       1.1291      21.2448      27.0424      27.1667      25.1695
050193.......................................................       1.2523       1.1600       1.1603      30.7341      29.6421      34.2248      31.5406
050194.......................................................       1.3621       1.5509       1.5509      38.6750      40.9096      45.2123      41.6588
050195.......................................................       1.5019       1.5669       1.5669      43.9696      48.4358      50.0403      47.5753
050196.......................................................       1.0951       1.1291       1.1291      25.2168      32.1933      33.9150      30.7046
050197.......................................................       2.0347       1.5669       1.5669      40.8832      48.9052      51.0016      46.9043
050204.......................................................       1.4560       1.1762       1.1762      25.2512      28.6423      32.1731      28.6226
050205.......................................................       1.4361       1.1762       1.1762      28.0504      27.8611      29.2978      28.4343
050207.......................................................       1.2589       1.1291       1.1291      27.0216      29.5215      30.5777      28.9980
050211.......................................................       1.2871       1.5669       1.5669      38.3319      41.2166      37.1447      38.8162
050214.......................................................          ***            *            *      24.4785      23.9972      25.6142      24.6874
050215.......................................................       1.8301       1.5281       1.5281      41.6886      43.7985      43.1523      42.9010
050217.......................................................       1.2241            *            *      23.6286            *            *      23.6286
050219.......................................................       1.1942       1.1762       1.1762      22.9226      22.4065      26.6745      24.0446
050222.......................................................       1.6433       1.1371       1.1371      26.3882      29.1094      32.9502      29.6111

[[Page 24169]]

 
050224.......................................................       1.6708       1.1600       1.1603      26.7916      29.3143      28.8640      28.3306
050225.......................................................       1.4668       1.1291       1.1291      29.5184      29.9656      34.0444      31.2944
050226.......................................................       1.5929       1.1600       1.1603      29.2259      30.5867      33.2724      31.0874
050228.......................................................       1.3599       1.5669       1.5669      40.1362      42.4226      42.9194      41.8170
050230.......................................................       1.4695       1.1600       1.1603      34.1417      32.9555      35.0745      34.0630
050231.......................................................       1.6381       1.1762       1.1762      30.1298      30.9607      32.4202      31.1914
050232.......................................................       1.6137       1.1719       1.1719      24.4383      27.4099      27.6649      26.4468
050234.......................................................       1.2181       1.1371       1.1371      29.2421      29.6560      32.7366      30.5308
050235.......................................................       1.5375       1.1762       1.1762      27.8965      29.2979      32.4385      29.8741
050236.......................................................       1.3795       1.1739       1.1603      28.1969      32.1647      34.3346      31.5469
050238.......................................................       1.4857       1.1762       1.1762      29.1481      31.1764      32.8459      31.1416
050239.......................................................       1.5990       1.1762       1.1762      28.2327      31.0963      34.5993      31.3400
050240.......................................................       1.6409       1.1762       1.1762      35.2284      35.5735      36.3640      35.7323
050242.......................................................       1.3786       1.5509       1.5509      39.7629      44.3130      47.8288      44.0747
050243.......................................................       1.5396       1.1291       1.1291      31.8153      31.4883      33.3571      32.2620
050245.......................................................       1.3396       1.1600       1.1603      27.0949      28.6527      26.3353      27.3622
050248.......................................................       1.0135       1.4457       1.4457      31.6240      35.3864      32.9444      33.3125
050251.......................................................       1.0330       1.1524       1.1524      26.5021      27.2675      28.5383      27.5142
050253.......................................................          ***            *            *      22.2450      24.0044      23.7595      23.2530
050254.......................................................       1.2518       1.3350       1.3350      24.1512      27.0041      30.9210      27.4105
050256.......................................................       1.6462       1.1762       1.1762      28.4728      29.8194      30.3954      29.5443
050257.......................................................       0.9608       1.1291       1.1291      20.8367      21.3216      18.4749      20.0450
050261.......................................................       1.3115       1.1291       1.1291      25.3005      27.3234      28.7777      27.2755
050262.......................................................       2.0841       1.1762       1.1762      36.1162      44.0256      39.3464      39.8642
050264.......................................................       1.3655       1.5669       1.5669      41.3478      41.1211      46.2652      42.9907
050267.......................................................          ***            *            *      26.7060            *            *      26.7060
050270.......................................................       0.8638       1.1371       1.1371      30.0540      32.4812      34.4844      32.3873
050272.......................................................       1.3545       1.1600       1.1603      25.9103      27.1989      29.5863      27.5860
050276.......................................................       1.2458       1.5669       1.5669      41.2251      39.3778      41.0210      40.5582
050277.......................................................       1.0130       1.1762       1.1762      35.8246      32.5213      35.8637      34.5741
050278.......................................................       1.5373       1.1762       1.1762      28.0351      29.9244      32.1019      30.1313
050279.......................................................       1.1861       1.1600       1.1603      25.5299      27.6573      29.7339      27.6818
050280.......................................................       1.6912       1.3205       1.3205      30.6723      35.2030      40.9920      35.5779
050281.......................................................       1.4270       1.1762       1.1762      26.2623      27.3824      28.5186      27.3907
050283.......................................................       1.4222       1.5669       1.5669      38.5600      43.0638      44.5318      42.1410
050286.......................................................          ***            *            *      19.4973            *            *      19.4973
050289.......................................................       1.6421       1.5049       1.5049      38.6875      41.1774      42.7353      40.9116
050290.......................................................       1.5832       1.1762       1.1762      32.6388      34.5482      38.0526      35.1131
050291.......................................................       1.8467       1.5049       1.5049      29.6162      35.3653      39.7762      34.7389
050292.......................................................       1.0868       1.1291       1.1291      27.0775      26.8879      25.7186      26.5226
050295.......................................................       1.4657       1.1291       1.1291      31.5960      36.1950      35.7270      34.7452
050296.......................................................       1.1664       1.5281       1.5281      34.9952      39.0061      42.1606      38.8925
050298.......................................................       1.1617       1.1600       1.1603      25.8232      27.7416      29.5427      27.7148
050299.......................................................       1.3599       1.1762       1.1762      27.7535      31.5435      35.3234      31.7208
050300.......................................................       1.4966       1.1600       1.1603      28.3862      30.7148      30.9822      30.1038
050301.......................................................       1.3290       1.1291       1.1291      28.5769      31.9995      33.4929      31.4366
050305.......................................................       1.4188       1.5669       1.5669      40.9978      44.8630      47.4120      44.4443
050308.......................................................       1.4727       1.5281       1.5281      38.0564      43.0691      45.3244      42.1179
050309.......................................................       1.4190       1.3350       1.3350      28.9181      34.4145      39.0822      34.4798
050312.......................................................          ***            *            *      32.6846      33.9022      39.2083      34.8872
050313.......................................................       1.2280       1.2038       1.2038      27.5321      31.8003      36.4300      32.2898
050315.......................................................       1.3061       1.1291       1.1291      26.1224      28.5933      32.5499      29.2160
050320.......................................................       1.2485       1.5669       1.5669      36.3252      40.2352      44.1674      40.1172
050324.......................................................       1.8751       1.1371       1.1371      30.9958      32.9792      35.1320      33.2026
050325.......................................................       1.1433       1.1467       1.1467      30.2280      30.6117      30.2526      30.3712
050327.......................................................       1.7507       1.1600       1.1603      29.8327      33.0087      35.2380      32.7821
050329.......................................................       1.2606       1.1291       1.1291      26.8021      26.2120      23.5644      25.4937
050331.......................................................       1.2324            *            *      20.9847      20.2692       0.0000      20.6171
050333.......................................................       1.1135       1.1291       1.1291      15.3119      23.4009      19.6469      18.9090
050334.......................................................       1.6725       1.4457       1.4457      38.7635      40.7467      44.4184      41.3547
050335.......................................................       1.4631       1.1467       1.1467      27.4046      28.9403      33.3349      29.9569
050336.......................................................       1.2386       1.2038       1.2038      25.3062      28.5659      30.4356      28.1945
050342.......................................................       1.2404       1.1291       1.1291      24.7654      26.8507      29.5020      27.1298
050348.......................................................       1.7064       1.1600       1.1603      33.2676      37.7898      31.6594      34.1821
050349.......................................................       0.9631       1.1291       1.1291      16.9251      17.4791      17.5811      17.3402
050350.......................................................       1.3701       1.1762       1.1762      29.4262      31.1833      31.8456      30.8831

[[Page 24170]]

 
050351.......................................................       1.5271       1.1762       1.1762      29.3082      30.8661      30.9044      30.3838
050352.......................................................       1.3579       1.3350       1.3350      24.2931      33.9362      36.5470      31.4422
050353.......................................................       1.5360       1.1762       1.1762      26.6332      31.8291      29.8341      29.3493
050355.......................................................          ***            *            *      11.2498            *            *      11.2498
050357.......................................................       1.4425       1.1291       1.1291      26.7265      32.3095      33.8000      30.4700
050359.......................................................       1.2211       1.1291       1.1291      23.6030      25.7739      28.7656      26.1226
050360.......................................................       1.5358       1.5082       1.5082      38.8658      37.0769      48.6833      41.5316
050366.......................................................       1.2149       1.1291       1.1291      25.7692      31.1854      34.7036      30.3816
050367.......................................................       1.4299       1.5669       1.5669      34.4959      38.7727      39.7345      38.0017
050369.......................................................       1.4248       1.1762       1.1762      27.1327      29.5697      31.1003      29.2945
050373.......................................................       1.3683       1.1762       1.1762      32.2315      31.9271      33.6616      32.6188
050376.......................................................       1.5389       1.1762       1.1762      30.7562      32.9393      33.4664      32.3997
050377.......................................................          ***            *            *      20.2484            *            *      20.2484
050378.......................................................       0.9845       1.1762       1.1762      33.9087      34.2417      34.9267      34.3818
050379.......................................................          ***            *            *      31.7645      32.9575            *      32.3515
050380.......................................................       1.6161       1.5281       1.5281      39.1098      42.0782      47.6500      42.7763
050382.......................................................       1.3883       1.1762       1.1762      26.0927      29.4323      30.3595      28.6792
050385.......................................................       1.3188       1.5049       1.5049      25.5735      34.5184      37.1708      32.3860
050390.......................................................       1.1686       1.1291       1.1291      28.7761      26.0066      28.4859      27.6662
050391.......................................................          ***            *            *      21.3012      18.1004      17.3151      18.6962
050392.......................................................       1.2184            *            *      22.7209            *            *      22.7209
050393.......................................................       1.4363       1.1762       1.1762      28.2369      30.0661      33.7433      30.5690
050394.......................................................       1.5925       1.1739       1.1603      26.0074      27.5061      28.6006      27.4286
050396.......................................................       1.5970       1.1291       1.1291      30.5470      33.5699      33.2548      32.4895
050397.......................................................       0.8840       1.1291       1.1291      27.4716      28.1640      26.3981      27.3054
050407.......................................................       1.1776       1.5075       1.5075      35.6035      37.9066      41.8534      38.5688
050410.......................................................          ***            *            *      19.4995      21.3814            *      20.4290
050411.......................................................       1.4503       1.1762       1.1762      37.3817      37.8064      39.9558      38.4595
050414.......................................................       1.2989       1.3350       1.3350      28.8561      34.6672      40.1702      34.4823
050417.......................................................       1.2539       1.1291       1.1291      25.2930      29.5031      35.5015      30.1379
050419.......................................................       1.3384            *            *      28.4471      33.3125            *      30.8677
050420.......................................................       1.1790       1.1762       1.1762      26.1838      24.9401      35.6349      28.5400
050423.......................................................       0.9624       1.1291       1.1291      28.5944      30.6416      27.2663      28.9029
050424.......................................................       2.0096       1.1371       1.1371      29.9133      31.0730      34.8883      32.0453
050425.......................................................       1.3417       1.3350       1.3350      38.5317      42.4177      49.8051      44.1546
050426.......................................................       1.3805       1.1600       1.1603      30.0077      30.6899      33.7075      31.4665
050430.......................................................       0.9578       1.1524       1.1524      24.6684      25.0607      24.1967      24.5819
050432.......................................................       1.6517       1.1762       1.1762      30.3547      30.8030      33.3848      31.5269
050433.......................................................       0.9334       1.1291       1.1291      20.7565      23.0806      21.8447      21.8898
050434.......................................................       1.1118       1.1291       1.1291      25.9506      26.1621      31.5749      28.1756
050435.......................................................       1.1492       1.1371       1.1371      32.2183      28.0306      30.8458      30.2661
050438.......................................................       1.5756       1.1762       1.1762      26.4668      27.2662      35.3830      29.8308
050441.......................................................       1.9802       1.5281       1.5281      38.2823      42.9765      45.2125      42.1714
050444.......................................................       1.3356       1.1884       1.1884      27.6971      30.5504      34.8554      31.2912
050447.......................................................       0.9565       1.1371       1.1371      21.8552      25.2573      27.5371      24.9581
050448.......................................................       1.2766       1.1291       1.1291      25.0983      27.9759      29.4935      27.5949
050454.......................................................       1.8575       1.5075       1.5075      36.8383      43.5311      39.2067      39.9010
050455.......................................................       1.5997       1.1291       1.1291      24.5314      22.7235      27.9979      25.1532
050456.......................................................       1.1131       1.1762       1.1762      22.1675      22.5630      21.7036      22.0233
050457.......................................................       1.6072       1.5075       1.5075      40.2725      45.5829      47.8507      44.5817
050464.......................................................       1.6871       1.1731       1.1731      37.1342      37.3692      39.4867      37.9820
050468.......................................................       1.4951       1.1762       1.1762      29.4280      29.5448      28.0800      28.9842
050469.......................................................       1.1606       1.1291       1.1291      27.3281      28.9079      30.0283      28.7511
050470.......................................................       1.0676       1.1291       1.1291      18.4689      24.6755      27.9194      24.0596
050471.......................................................       1.7588       1.1762       1.1762      34.5484      34.5211      36.7915      35.2853
050476.......................................................       1.4381       1.1548       1.1548      30.9974      34.6585      36.3598      33.8764
050477.......................................................       1.3548       1.1762       1.1762      34.6400      34.6995      38.0704      35.8949
050478.......................................................       1.0037       1.1291       1.1291      30.9865      33.3998      35.2408      33.2560
050481.......................................................       1.4293       1.1762       1.1762      31.9177      33.7446      37.8839      34.5090
050485.......................................................       1.6324       1.1762       1.1762      28.8459      31.4233      36.5912      32.2964
050488.......................................................       1.3306       1.5669       1.5669      40.5313      42.9904      44.2163      42.6485
050491.......................................................          ***            *            *      30.6461      32.1379      34.6829      32.1991
050492.......................................................       1.5281       1.1291       1.1291      27.4933      27.1540      28.5116      27.7452
050494.......................................................       1.4219       1.4294       1.1607      35.1457      35.9909      39.9419      37.0297
050496.......................................................       1.7826       1.5669       1.5669      38.2871      42.2672      43.6264      41.5275
050497.......................................................          ***            *            *      15.9501            *            *      15.9501

[[Page 24171]]

 
050498.......................................................       1.3331       1.3350       1.3350      28.2667      33.0298      38.4968      33.2353
050502.......................................................       1.7102       1.1762       1.1762      28.7200      29.5615      29.5347      29.2993
050503.......................................................       1.4527       1.1371       1.1371      29.2001      31.6418      34.6646      31.9860
050506.......................................................       1.6799       1.1719       1.1719      32.4509      36.0164      39.2455      36.0522
050510.......................................................       1.1963       1.5669       1.5669      44.3883      47.5510      53.3925      48.9441
050512.......................................................       1.2973       1.5669       1.5669      41.8921      46.9233      52.5188      47.8701
050515.......................................................       1.3889       1.1371       1.1371      37.4251      38.9978      40.9092      39.1963
050516.......................................................       1.4805       1.3350       1.3350      29.4936      36.2772      41.3786      35.5878
050517.......................................................       1.2150       1.1600       1.1603      23.6034      23.9007      20.4043      22.4083
050523.......................................................       1.3334       1.5669       1.5669      34.7491      35.5452      33.8904      34.6993
050526.......................................................       1.2525       1.1600       1.1603      29.9495      31.3744      28.6212      29.8713
050528.......................................................       1.1675       1.1291       1.1291      28.6273      29.6838      30.6464      29.7397
050531.......................................................       1.0277       1.1762       1.1762      25.0157      26.9420      27.4627      26.4967
050534.......................................................       1.4487       1.1291       1.1291      29.7546      29.8603      33.2952      30.9702
050535.......................................................       1.4985       1.1600       1.1603      32.3646      32.3723      34.8889      33.3056
050537.......................................................       1.4722       1.3350       1.3350      27.4196      31.3844      36.4258      31.8666
050539.......................................................       1.2551            *            *      28.0586      29.8242            *      29.0033
050541.......................................................       1.3930       1.5669       1.5669      43.7765      46.1121      53.9701      48.2244
050543.......................................................       0.7326       1.1600       1.1603      25.7161      26.1103      26.9874      26.2597
050545.......................................................       0.7166       1.1762       1.1762      42.9451      30.5554      31.4513      35.1847
050546.......................................................       0.7168       1.1291       1.1291      52.7180      30.2329      33.9577      38.6191
050547.......................................................       0.9861       1.5049       1.5049      45.1842      33.2205      34.4268      37.9709
050548.......................................................       0.7147       1.1600       1.1603      37.1314      30.3775      33.5332      34.1652
050549.......................................................       1.5821       1.4294       1.1603      33.8288      34.9818      36.8840      35.2563
050550.......................................................       1.3092       1.1600       1.1603      31.1918      30.2302      31.3077      30.9052
050551.......................................................       1.3263       1.1600       1.1603      31.6782      31.6165      34.6310      32.6691
050552.......................................................       1.0959       1.1762       1.1762      26.8274      27.1744      31.8084      28.6605
050557.......................................................       1.5467       1.1731       1.1731      28.3111      31.8048      31.8447      30.7712
050559.......................................................          ***            *            *      26.9662            *            *      26.9662
050561.......................................................       1.2629       1.1762       1.1762      37.5863      38.8651      39.1626      38.5888
050567.......................................................       1.5546       1.1600       1.1603      30.1167      32.9829      36.4373      33.2519
050568.......................................................       1.1828       1.1353       1.1353      22.5008      24.4061      24.1895      23.7155
050569.......................................................       1.2260       1.4294       1.4294      30.4874      33.0259      34.1734      32.6118
050570.......................................................       1.5499       1.1600       1.1603      32.6896      34.0171      35.5233      34.1290
050571.......................................................       1.2097       1.1762       1.1762      32.1656      33.6156      34.9236      33.5914
050573.......................................................       1.6925       1.1291       1.1291      30.5249      34.1991      35.5274      33.4579
050575.......................................................       1.1724       1.1762       1.1762      23.2447      25.2513      25.2933      24.6933
050577.......................................................          ***            *            *      28.7060      30.8841      32.5645      30.7682
050578.......................................................       1.4960       1.1762       1.1762      31.5953      33.8825      37.2259      34.1510
050579.......................................................          ***            *            *      40.2740      39.4976      42.9387      40.7876
050580.......................................................       1.2568       1.1600       1.1603      29.4337      31.6256      33.1490      31.4028
050581.......................................................       1.4088       1.1762       1.1762      32.0823      32.1801      35.0108      33.1503
050583.......................................................       1.6923       1.1371       1.1371      33.5209      33.3697      35.7392      34.1719
050584.......................................................       1.4362       1.1600       1.1603      24.5757      24.8180      28.8553      26.1102
050585.......................................................       1.2218       1.1600       1.1603      27.2982      22.7121      22.4887      23.8337
050586.......................................................       1.2754       1.1600       1.1603      25.3551      27.4173      26.3755      26.3132
050588.......................................................       1.2773       1.1762       1.1762      32.3603      32.8212      33.0991      32.7769
050589.......................................................       1.2077       1.1600       1.1603      30.6273      30.9547      35.0014      32.2283
050590.......................................................       1.3770       1.3350       1.3350      31.5987      32.2142      39.4654      34.5389
050591.......................................................       1.1729       1.1762       1.1762      28.5915      28.8549      30.9334      29.4952
050592.......................................................       1.1345       1.1600       1.1603      32.5000      24.4542      27.7236      27.9860
050594.......................................................       1.9344       1.1600       1.1603      34.6747      34.7946      36.8272      35.4259
050597.......................................................       1.2248       1.1762       1.1762      25.4868      27.5691      29.5797      27.5512
050599.......................................................       1.9037       1.3350       1.3350      30.8420      38.1975      33.8834      34.3184
050601.......................................................       1.5196       1.1762       1.1762      35.0325      34.7409      36.6564      35.4896
050603.......................................................       1.3875       1.1600       1.1603      28.6982      30.2464      34.1227      31.1484
050604.......................................................       1.2051       1.5281       1.5281      45.4433      49.9429      56.4414      51.0552
050608.......................................................       1.3413       1.1291       1.1291      22.1999      23.3630      25.9073      23.7863
050609.......................................................       1.3376       1.1600       1.1603      38.4561      41.1797      43.2731      41.0915
050613.......................................................       1.0079       1.5049       1.5049            *            *      45.7255      45.7255
050615.......................................................       1.1030       1.1762       1.1762      32.8786      33.2909      36.1435      34.1052
050616.......................................................       1.3862       1.1739       1.1603      28.5636      36.9017      39.1701      35.1520
050618.......................................................       0.9803       1.1291       1.1291      25.4500      27.4539      30.9826      28.0403
050623.......................................................          ***            *            *      29.6550      32.0627            *      30.7447
050624.......................................................       1.2767       1.1762       1.1762      28.1941      32.2907      34.8735      31.8503
050625.......................................................       1.7608       1.1762       1.1762      33.5137      36.3631      38.7997      36.2505

[[Page 24172]]

 
050630.......................................................          ***            *            *      28.0726      30.9410            *      29.5481
050633.......................................................       1.2327       1.1719       1.1719      33.4771      35.3734      38.2742      35.7436
050636.......................................................       1.3124       1.1371       1.1371      27.2360      30.5156      33.1069      30.3577
050641.......................................................       1.1728       1.1762       1.1762      20.4720      21.4612      20.4706      20.7862
050644.......................................................       0.8979       1.1762       1.1762      25.6614      27.6547      29.0068      27.4716
050662.......................................................       0.8775       1.5281       1.5281      47.5065      32.6362      33.6809      38.4416
050663.......................................................       1.1419       1.1762       1.1762      25.1493      25.7747      26.8993      25.9210
050667.......................................................       0.9036       1.4527       1.4527      25.9250      26.3937      27.2269      26.5042
050668.......................................................       1.1034       1.5075       1.5075            *      31.8065      40.9413      35.0252
050674.......................................................       1.3084       1.3350       1.3350      38.4454      42.6866      48.7644      43.7800
050677.......................................................       1.4769       1.1762       1.1762      37.3389      38.7984      39.9638      38.8140
050678.......................................................       1.3278       1.1600       1.1603      29.1159      30.7220      32.1066      30.7504
050680.......................................................       1.2190       1.5669       1.5669      35.6614      38.3946      38.9269      37.8867
050681.......................................................       1.7997       1.1762       1.1762            *            *            *            *
050682.......................................................       0.9911       1.1291       1.1291      21.7264      21.7791      17.7264      20.0252
050684.......................................................       1.1508       1.1291       1.1291      25.2575      26.4234      28.9330      26.8758
050686.......................................................       1.2563       1.1291       1.1291      38.5595      40.9486      42.8975      40.9700
050688.......................................................       1.2419       1.5281       1.5281      41.3305      41.9325      44.3596      42.6254
050689.......................................................       1.5018       1.5669       1.5669      40.3815      42.2018      46.1901      42.9969
050690.......................................................       1.2765       1.5049       1.5049      43.9228      47.2769      52.2448      48.3299
050693.......................................................       1.3208       1.1600       1.1603      34.8040      35.0621      35.5736      35.1560
050694.......................................................       1.0803       1.1291       1.1291      26.7041      28.9544      32.3426      29.3794
050695.......................................................       1.0920       1.2038       1.2038      30.1226      35.6549      39.4080      35.4440
050696.......................................................       2.1492       1.1762       1.1762      36.9314      35.9220      38.1340      36.9904
050697.......................................................       1.1158       1.3205       1.3205      19.2603      25.1984      16.9270      19.9625
050698.......................................................       1.0543            *            *            *            *            *            *
050699.......................................................          ***            *            *      25.6818      26.8210      31.2540      27.9556
050701.......................................................       1.3443       1.1291       1.1291      29.6896      29.6253      33.5009      31.4867
050704.......................................................       1.0465       1.1762       1.1762      24.6609      25.3488      28.9925      26.5384
050707.......................................................       1.1989       1.5049       1.5049      32.4877      34.0550      35.8114      34.0977
050708.......................................................       1.7111       1.1291       1.1291      21.2163      22.5034      32.9787      25.2406
050709.......................................................       1.4082       1.1600       1.1603      21.9079      25.6119      26.9167      24.7734
050710.......................................................       1.3359       1.1291       1.1291      34.8311      39.9858      47.0098      41.2427
050713.......................................................          ***            *            *      20.7448      20.2803      21.3180      20.6998
050714.......................................................       1.4106       1.5509       1.5509      32.4491      33.6676      32.9341      33.0470
050717.......................................................       1.6850       1.1762       1.1762      34.5519      38.0796      38.9983      37.0998
050718.......................................................       1.1405       1.1291       1.1291      15.4037      21.4996      25.9059      20.4331
050720.......................................................       0.9455       1.1600       1.1603      24.8117      30.0812      29.7498      28.4890
050722.......................................................       0.9800       1.1371       1.1371            *            *      33.9652      33.9652
050723.......................................................       1.3104       1.1762       1.1762      34.9814      35.0119      39.8595      36.7280
050724.......................................................       1.9939       1.1291       1.1291            *      34.4267      29.4969      31.8092
050725.......................................................       0.9799       1.1762       1.1762      22.0946      21.7816      24.4527      22.7171
050726.......................................................       1.5792       1.1731       1.1731      27.0928      27.8433      32.0629      29.3587
050727.......................................................       1.3104       1.1762       1.1762      23.7179      24.3026      30.9146      26.5349
050728.......................................................       1.3772       1.5049       1.5049      31.4768      36.0820      39.6245      35.3141
050729.......................................................       1.4087       1.1762       1.1762            *      34.2580      36.8283      35.5529
050730.......................................................       1.1560       1.1762       1.1762            *      51.5425      37.2860      43.9757
050732.......................................................       2.4527       1.1291       1.1291            *            *            *            *
050733.......................................................       1.5564       1.3205       1.3205            *            *            *            *
050735.......................................................       1.4593            *            *            *            *            *            *
050736.......................................................       1.2171            *            *            *            *            *            *
050737.......................................................       1.4960            *            *            *            *            *            *
050738.......................................................       1.3749            *            *            *            *            *            *
050739.......................................................       1.6624            *            *            *            *            *            *
050740.......................................................       1.2695            *            *            *            *            *            *
050741.......................................................       1.4605            *            *            *            *            *            *
050742.......................................................       1.4578            *            *            *            *            *            *
050743.......................................................       1.1704            *            *            *            *            *            *
050744.......................................................       2.0392            *            *            *            *            *            *
050745.......................................................       1.2940            *            *            *            *            *            *
050746.......................................................       1.7795            *            *            *            *            *            *
050747.......................................................       1.3787            *            *            *            *            *            *
050749.......................................................       1.2647            *            *            *            *            *            *
050750.......................................................       2.2585            *            *            *            *            *            *
050751.......................................................       2.1455            *            *            *            *            *            *
050752.......................................................       1.3908            *            *            *            *            *            *

[[Page 24173]]

 
060001.......................................................       1.5478       0.9930       0.9930      24.9410      26.8470      28.5246      26.7856
060003.......................................................       1.4520       1.0805       1.0805      24.7856      24.2224      30.1449      26.4193
060004.......................................................       1.3094       1.0924       1.0924      28.0656      29.9649      32.9128      30.3597
060006.......................................................       1.4136       0.9331       0.9331      22.7493      24.5704      25.5300      24.3032
060007.......................................................          ***            *            *      21.4792            *            *      21.4792
060008.......................................................       1.2525       0.9331       0.9331      21.8037      23.3859      23.0325      22.7676
060009.......................................................       1.4588       1.0924       1.0924      27.0511      28.7645      31.2466      29.0996
060010.......................................................       1.7178       0.9689       0.9689      27.2290      28.9850      28.4315      28.2640
060011.......................................................       1.5317       1.0924       1.0924      26.1958      27.2833      34.2985      29.1788
060012.......................................................       1.4984       0.9331       0.9331      24.1557      26.2469      27.9068      26.0885
060013.......................................................       1.4281       0.9331       0.9331      24.9708      24.5994      27.6808      25.7684
060014.......................................................       1.8075       1.0924       1.0924      29.6744      31.2588      32.4518      31.1092
060015.......................................................       1.6923       1.0924       1.0924      30.1158      30.4533      33.5968      31.2391
060016.......................................................       1.2587       0.9331       0.9331      23.9655      25.6527      26.9441      25.5481
060018.......................................................       1.3005       0.9331       0.9331      23.6620      25.7628      25.3149      24.9213
060020.......................................................       1.5999       0.9331       0.9331      22.2052      22.6748      23.5825      22.8530
060022.......................................................       1.6231       0.9697       0.9697      25.7832      26.5238      28.8935      27.0838
060023.......................................................       1.7032       1.0805       1.0805      26.7285      27.7644      29.7290      28.0786
060024.......................................................       1.8041       1.0924       1.0924      28.7231      29.0130      30.3956      29.4074
060027.......................................................       1.5798       1.0805       1.0805      26.6348      28.0909      30.2413      28.4406
060028.......................................................       1.4361       1.0924       1.0924      27.9686      30.0448      32.0442      30.0599
060030.......................................................       1.3963       0.9689       0.9689      26.0011      26.6251      27.6439      26.7912
060031.......................................................       1.5545       0.9697       0.9697      25.6207      26.3650      28.4559      26.8116
060032.......................................................       1.5252       1.0924       1.0924      28.2234      30.4247      31.9803      30.1845
060034.......................................................       1.6754       1.0924       1.0924      28.4604      29.8445      31.4601      29.9383
060036.......................................................       1.1583       0.9331       0.9331      20.4635      20.7131      20.8128      20.6604
060041.......................................................       0.9165       0.9331       0.9331      22.7123      23.4978      23.9297      23.4036
060043.......................................................       1.0621       0.9331       0.9331      20.0939      18.7896      17.2960      18.6864
060044.......................................................       1.1635       1.0805       1.0805      25.2471      25.0360      26.8821      25.7042
060049.......................................................       1.3952       0.9594       0.9594      26.8089      29.0598      30.6057      28.8870
060050.......................................................          ***            *            *      21.9108            *            *      21.9108
060054.......................................................       1.4677       1.0037       1.0037      23.5803      22.3490      24.3711      23.4286
060057.......................................................          ***            *            *      26.9891            *            *      26.9891
060064.......................................................       1.6788       1.0924       1.0924      30.0963      31.3105      33.4859      31.6328
060065.......................................................       1.3952       1.0924       1.0924      28.5282      31.1987      33.7362      31.1126
060071.......................................................       1.1650       0.9331       0.9331      20.2706      25.7248      27.5209      24.6844
060075.......................................................       1.2838       1.0037       1.0037      30.7835      32.7563      33.9644      32.5290
060076.......................................................       1.2449       0.9331       0.9331      25.5406      26.8236      26.4669      26.2923
060096.......................................................       1.5490       1.0805       1.0805      27.4085      30.0602      33.4708      30.3136
060100.......................................................       1.7275       1.0924       1.0924      29.7690      32.1537      33.3856      31.7750
060103.......................................................       1.3008       1.0805       1.0805      28.8063      30.3002      33.2964      30.8687
060104.......................................................       1.3986       1.0924       1.0924      30.8625      32.0889      33.4664      32.1175
060107.......................................................       1.4001       1.0924       1.0924      26.8267      26.1883      27.1594      26.7219
060111.......................................................          ***            *            *      31.2571            *            *      31.2571
060112.......................................................       1.7095       1.0924       1.0924            *            *      36.1471      36.1471
060113.......................................................       1.2832       1.0924       1.0924            *            *            *            *
060114.......................................................       1.2889       1.0924       1.0924            *            *            *            *
060115.......................................................       0.8453            *            *            *            *            *            *
060116.......................................................       1.2462            *            *            *            *            *            *
060117.......................................................       1.2872            *            *            *            *            *            *
070001.......................................................       1.6340       1.2701       1.2511      32.2718      34.0302      35.1488      33.8080
070002.......................................................       1.8265       1.1750       1.1750      29.0663      31.1530      32.9351      31.0526
070003.......................................................       1.0862       1.1750       1.1750      31.3716      32.4197      33.5145      32.4479
070004.......................................................       1.1975       1.1750       1.1750      27.3004      29.2544      30.2004      28.9166
070005.......................................................       1.3661       1.2701       1.2511      29.3265      32.1668      33.4862      31.7706
070006 \2\...................................................       1.3682       1.3038       1.3008      33.9310      36.8469      38.1568      36.3107
070007.......................................................       1.3065       1.2020       1.2020      30.3648      31.7125      35.6535      32.6301
070008.......................................................       1.2465       1.1750       1.1750      24.9176      26.4806      27.6747      26.3851
070009.......................................................       1.2280       1.1750       1.1750      28.8649      30.2706      32.5288      30.5697
070010.......................................................       1.7865       1.3038       1.3008      33.1535      32.5798      34.7931      33.5340
070011.......................................................       1.4018       1.1750       1.1750      27.5391      29.9105      31.1602      29.5355
070012.......................................................       1.1831       1.1750       1.1750      40.3337      44.1424      30.3498      37.0108
070015.......................................................       1.3748       1.1750       1.1750      30.9728      33.4595      35.2743      33.2900
070016.......................................................       1.3865       1.2701       1.2511      29.6662      31.0903      31.3403      30.7038
070017.......................................................       1.3862       1.2701       1.2511      30.3951      31.7223      33.4075      31.8732
070018 \2\...................................................       1.3414       1.3038       1.3008      35.7189      37.6081      39.4816      37.7074

[[Page 24174]]

 
070019.......................................................       1.3161       1.2701       1.2511      29.6290      31.8148      34.6720      32.0589
070020.......................................................       1.3759       1.1823       1.1823      29.9507      31.0935      33.3626      31.4683
070021.......................................................       1.2443       1.1750       1.1750      31.4397      33.2357      36.0196      33.5900
070022.......................................................       1.7575       1.2701       1.2511      32.3625      35.4120      38.9946      35.6213
070024.......................................................       1.3670       1.2020       1.2020      31.0243      32.0430      35.2369      32.7950
070025.......................................................       1.8013       1.1750       1.1750      29.2540      30.9938      31.9792      30.7563
070027.......................................................       1.3452       1.1750       1.1750      27.3487      31.8018      30.8014      30.0429
070028.......................................................       1.6360       1.3038       1.3008      29.5653      31.5036      35.1796      32.0982
070029.......................................................       1.3189       1.1750       1.1750      26.3871      27.7213      30.7435      28.2936
070031.......................................................       1.3075       1.2701       1.2511      27.2359      28.9190      30.4813      28.9306
070033.......................................................       1.3631       1.3038       1.3008      35.5355      37.1929      39.7676      37.5730
070034 \2\...................................................       1.4079       1.3038       1.3008      35.6831      36.3899      38.1857      36.7733
070035.......................................................       1.2940       1.1750       1.1750      27.1816      27.5585      30.3920      28.3695
070036.......................................................       1.6631       1.2093       1.2093      34.0555      36.1610      38.8442      36.4123
070038.......................................................       1.1294       1.2093       1.2511      31.1133      25.7516      25.5738      26.3181
070039.......................................................       0.9397       1.2701       1.2511      35.0164      31.2269      32.8867      33.0224
080001.......................................................       1.6313       1.0941       1.0941      30.2463      30.0242      32.7311      31.0532
080002.......................................................          ***            *            *      26.4192      27.7932      29.1393      27.8103
080003.......................................................       1.5848       1.0941       1.0941      27.1131      29.2266      31.1057      29.2127
080004.......................................................       1.4833       1.0878       1.0878      26.0092      27.4921      29.3258      27.6577
080006.......................................................       1.2902       0.9843       0.9843      24.4204      25.6160      27.0472      25.7475
080007.......................................................       1.4550       1.0254       1.0254      24.6485      27.0074      29.7437      27.1759
090001.......................................................       1.7661       1.1028       1.1028      31.3552      35.0413      37.9529      34.8066
090002.......................................................          ***            *            *      29.6780            *            *      29.6780
090003.......................................................       1.2598       1.1076       1.1076      27.0514      29.2660      31.2552      29.2762
090004.......................................................       1.9157       1.1076       1.1076      29.9785      32.2021      35.6103      32.6016
090005.......................................................       1.3435       1.1076       1.1076      30.2504      30.7728      32.4581      31.1497
090006.......................................................       1.4536       1.1076       1.1076      25.9086      29.5590      29.1423      28.1875
090007.......................................................          ***            *            *      30.1419            *            *      30.1419
090008.......................................................       1.3953       1.1076       1.1076      29.6744      29.1059      32.8342      30.3957
090011.......................................................       2.0690       1.1076       1.1076      32.4412      34.0693      36.3623      34.2608
100001.......................................................       1.5529       0.9046       0.9046      25.2381      24.4060      23.8151      24.4521
100002.......................................................       1.4122       0.9642       0.9642      22.1269      25.3389      26.4462      24.6809
100004.......................................................       0.8962            *            *      16.2637      16.5974            *      16.4390
100006.......................................................       1.6390       0.9409       0.9409      26.2372      26.3789      27.9464      26.8585
100007.......................................................       1.6725       0.9409       0.9409      25.4333      26.5378      28.2465      26.8017
100008.......................................................       1.7204       0.9825       0.9825      25.7377      27.4314      28.9763      27.4811
100009.......................................................       1.4625       0.9825       0.9825      24.4666      25.9381      27.1166      25.8395
100010.......................................................          ***            *            *      26.9486            *            *      26.9486
100012.......................................................       1.6806       0.9339       0.9339      24.5762      26.3788      28.0401      26.3901
100014.......................................................       1.3972       0.9397       0.9397      22.3054      24.5862      25.3244      24.0840
100015.......................................................       1.3865       0.9249       0.9249      22.5781      24.6038      25.8553      24.2886
100017.......................................................       1.6159       0.9397       0.9397      22.9545      26.1580      27.5965      25.6638
100018.......................................................       1.6523       0.9935       0.9935      27.8582      28.1481      29.5692      28.5441
100019.......................................................       1.6733       0.9440       0.9440      25.5566      27.6179      28.1170      27.1634
100020.......................................................          ***            *            *      23.6106      23.9414      27.1058      24.9057
100022.......................................................       1.6879       1.0470       1.0470      29.0519      29.9345      33.2813      30.8780
100023.......................................................       1.5132       0.9409       0.9409      21.4015      23.0074      24.6790      23.0038
100024.......................................................       1.2661       0.9825       0.9825      27.6476      30.2395      29.4861      29.0764
100025.......................................................       1.6860       0.8609       0.8609      21.1174      22.1580      23.3147      22.2233
100026.......................................................       1.6048       0.8609       0.8609      21.3533      21.4703      22.9234      21.9413
100027.......................................................       0.9126       0.8609       0.8609      12.0314      16.1223      18.8639      15.6138
100028.......................................................       1.3425       0.9440       0.9440      23.7818      26.8661      27.4585      26.0611
100029.......................................................       1.2634       0.9825       0.9825      26.9307      27.5844      28.4463      27.6559
100030.......................................................       1.3103       0.9409       0.9409      22.4887      24.0943      24.7251      23.8482
100032.......................................................       1.7935       0.9249       0.9249      23.0174      25.2450      26.3898      24.9308
100034.......................................................       1.9078       0.9825       0.9825      24.4064      25.9415      27.9305      25.9959
100035.......................................................       1.5645       0.9866       0.9866      25.3590      26.9407      29.2732      27.1757
100038.......................................................       1.9590       1.0470       1.0470      27.4422      29.8583      31.0393      29.4968
100039.......................................................       1.4635       1.0470       1.0470      26.6016      28.4627      29.5742      28.2437
100040.......................................................       1.7080       0.9046       0.9046      23.5372      23.6443      25.9099      24.3687
100043.......................................................       1.3536       0.9249       0.9249      22.8963      25.2273      26.5006      24.9156
100044.......................................................       1.4428       0.9857       0.9857      26.3208      28.3596      29.7123      28.1591
100045.......................................................       1.3397       0.9409       0.9409      23.0520      26.9641      30.5941      27.0017
100046.......................................................       1.2924       0.9249       0.9249      26.6169      26.3673      27.4887      26.8296
100047.......................................................       1.7742       0.9453       0.9453      24.4212      25.0404      26.1017      25.2191

[[Page 24175]]

 
100048.......................................................       0.9448       0.8609       0.8609      18.3767      18.8771      19.7932      19.0265
100049.......................................................       1.2016       0.8908       0.8908      22.9532      22.9810      23.3622      23.1049
100050.......................................................       1.1313       0.9825       0.9825      20.6893      19.8713      21.7480      20.7633
100051.......................................................       1.3495       0.9409       0.9409      22.3311      23.1940      28.0190      24.4952
100052.......................................................       1.3169       0.8908       0.8908      20.9078      22.3920      23.5420      22.3120
100053.......................................................       1.2474       0.9825       0.9825      27.3383      27.3224      28.0804      27.5770
100054.......................................................       1.2414       0.8654       0.8654      25.7279      28.0512      29.1317      27.5948
100055.......................................................       1.3622       0.9249       0.9249      22.1051      23.5332      25.4970      23.6039
100056.......................................................          ***            *            *      25.7945            *            *      25.7945
100057.......................................................       1.5600       0.9409       0.9409      22.6038      25.3897      24.9844      24.3593
100061.......................................................       1.5507       0.9825       0.9825      26.7673      29.2565      31.0039      29.0171
100062.......................................................       1.7063       0.8964       0.8964      24.1413      25.2340      26.5512      25.3312
100063.......................................................       1.2658       0.9249       0.9249      21.5566      24.7026      26.0284      24.1067
100067.......................................................       1.4126       0.9249       0.9249      23.9333      26.1213      26.9257      25.6361
100068.......................................................       1.7656       0.9397       0.9397      24.9025      25.9202      27.0727      25.9472
100069.......................................................       1.3348       0.9249       0.9249      22.4386      24.7442      25.9129      24.3174
100070.......................................................       1.7383       0.9866       0.9866      23.7746      24.8883      27.0935      25.1963
100071.......................................................       1.2411       0.9249       0.9249      23.4176      24.9682      26.4245      25.0038
100072.......................................................       1.3793       0.9397       0.9397      24.2934      26.0459      26.3997      25.6529
100073.......................................................       1.7701       1.0470       1.0470      25.3685      30.3358      30.3162      28.6546
100075.......................................................       1.4953       0.9249       0.9249      23.3503      25.1691      26.0289      24.8882
100076.......................................................       1.2143       0.9825       0.9825      21.0777      21.9483      23.4786      22.0898
100077.......................................................       1.3599       0.9453       0.9453      24.3478      26.0347      29.4683      26.5871
100079.......................................................       1.6395            *            *            *            *            *            *
100080.......................................................       1.8174       0.9642       0.9642      26.3596      27.0126      28.4894      27.3255
100081.......................................................       1.0745       0.8609       0.8609      16.9168      15.6662      16.8158      16.4460
100084.......................................................       1.8081       0.9409       0.9409      25.4140      26.3393      26.7820      26.1607
100086.......................................................       1.2749       1.0470       1.0470      26.4817      28.2641      29.9772      28.2256
100087.......................................................       1.8986       0.9866       0.9866      25.9909      27.1531      30.3527      27.9094
100088.......................................................       1.6439       0.9046       0.9046      24.8729      25.9182      26.1923      25.6760
100090.......................................................       1.5387       0.9046       0.9046      24.0501      24.2422      25.0930      24.4705
100092.......................................................       1.5509       0.9440       0.9440      26.0856      28.4789      27.9279      27.5045
100093.......................................................       1.7611       0.8609       0.8609      21.1547      21.3524      22.2184      21.5835
100098.......................................................          ***            *            *      21.2505            *            *      21.2505
100099.......................................................       1.0847       0.8908       0.8908      20.4328      21.3036      24.7212      22.1811
100102.......................................................       1.1374       0.8734       0.8734      22.8850      23.8596      25.3617      24.0415
100103.......................................................       0.9737            *            *      21.7494            *            *      21.7494
100105.......................................................       1.4783       0.9604       0.9604      24.9503      26.8091      29.2659      27.0006
100106.......................................................       0.9711       0.8609       0.8609      20.2882      24.0389      23.8545      22.7821
100107.......................................................       1.2031       0.9339       0.9339      24.4484      26.1337      26.1391      25.5929
100108.......................................................       0.8066       0.8609       0.8609      16.3757      22.0750      21.2176      19.8907
100109.......................................................       1.3164       0.9409       0.9409      23.8836      24.9951      25.9430      24.9469
100110.......................................................       1.6056       0.9409       0.9409      28.3699      29.1494      29.4304      29.0104
100113.......................................................       1.9725       0.9299       0.9299      25.0067      26.3806      27.5595      26.3652
100114.......................................................       1.3113       0.9825       0.9825      27.7413      29.2195      29.2327      28.7304
100117.......................................................       1.1967       0.9046       0.9046      26.0451      26.4536      27.5443      26.7071
100118.......................................................       1.3392       0.9046       0.9046      23.6669      28.0569      28.2361      27.0580
100121.......................................................       1.1021       0.8908       0.8908      24.0937      24.8579      26.5604      25.1840
100122.......................................................       1.2277       0.8654       0.8654      21.2597      23.4751      23.9552      22.8872
100124.......................................................       1.1827       0.8609       0.8609      21.6483      22.7023      25.0550      23.1604
100125.......................................................       1.2466       0.9825       0.9825      25.3532      26.7452      29.5003      27.3520
100126.......................................................       1.3389       0.9249       0.9249      23.2996      24.4515      29.0390      25.6215
100127.......................................................       1.6178       0.9249       0.9249      21.3223      24.4485      26.1506      24.0288
100128.......................................................       2.1100       0.9249       0.9249      25.6763      29.4979      29.8875      28.4604
100130.......................................................       1.1732       0.9642       0.9642      22.8324      24.2046      25.2345      24.0576
100131.......................................................       1.3335       0.9825       0.9825      25.8316      29.2462      28.1549      27.7421
100132.......................................................       1.2373       0.9249       0.9249      23.0428      24.3293      26.2877      24.6022
100134.......................................................       0.9129       0.8609       0.8609      19.5337      20.9244      20.4785      20.3225
100135.......................................................       1.6218       0.9316       0.9316      22.3071      24.0024      28.0900      24.6354
100137.......................................................       1.2238       0.8908       0.8908      23.3692      25.1974      24.6076      24.4568
100139.......................................................       0.8408       0.9299       0.9299      14.5046      17.5489      16.6310      16.2799
100140.......................................................       1.1473       0.9046       0.9046      24.8165      26.4720      26.1383      25.8508
100142.......................................................       1.2230       0.8609       0.8609      20.7219      22.9577      23.8571      22.5245
100150.......................................................       1.3097       0.9825       0.9825      25.7122      26.1990      27.5276      26.4717
100151.......................................................       1.8299       0.9046       0.9046      26.1848      28.1322      30.5977      28.4241
100154.......................................................       1.5669       0.9825       0.9825      26.3703      27.6127      28.2710      27.4772

[[Page 24176]]

 
100156.......................................................       1.1245       0.8734       0.8734      22.2757      26.7092      27.4848      25.5333
100157.......................................................       1.5980       0.9249       0.9249      25.9133      27.3851      28.9595      27.4711
100160.......................................................       1.2422       0.8609       0.8609      27.2019      26.9851      31.2701      28.5770
100161.......................................................       1.5442       0.9409       0.9409      28.3607      28.8077      28.6336      28.6073
100166.......................................................       1.5055       0.9866       0.9866      24.4251      27.9618      29.6865      27.2716
100167.......................................................       1.2695       1.0470       1.0470      26.8584      30.3694      30.7365      29.3059
100168.......................................................       1.4259       0.9642       0.9642      26.0864      27.1292      27.9334      27.0344
100172.......................................................       1.3322       0.9825       0.9825      18.4651      18.2735      20.8673      19.1957
100173.......................................................       1.7421       0.9249       0.9249      22.4866      24.8721      26.6141      24.6478
100175.......................................................       0.9891       0.8840       0.8840      22.0666      23.5455      24.0790      23.2771
100176.......................................................       1.9676       0.9857       0.9857      29.8326      31.2694      31.0778      30.7413
100177.......................................................       1.2982       0.9440       0.9440      25.3973      26.6781      27.6011      26.6232
100179.......................................................       1.7788       0.9046       0.9046      26.6537      29.5619      29.6646      28.6728
100180.......................................................       1.3332       0.9249       0.9249      26.3299      27.1804      29.2623      27.6555
100181.......................................................       1.0919       0.9825       0.9825      19.5022      21.8540      21.8409      21.1771
100183.......................................................       1.2043       0.9825       0.9825      26.7893      27.4951      28.1843      27.5031
100187.......................................................       1.2393       0.9825       0.9825      26.1394      27.3653      28.0710      27.1892
100189.......................................................       1.2966       1.0470       1.0470      26.5763      28.4136      29.4643      28.2193
100191.......................................................       1.2986       0.9249       0.9249      24.3553      26.6340      27.8297      26.3354
100200.......................................................       1.4276       1.0470       1.0470      28.0926      29.8963      29.9888      29.3614
100204.......................................................       1.5591       0.9299       0.9299      24.4697      25.7537      27.3984      25.9174
100206.......................................................       1.3147       0.9249       0.9249      23.0340      25.2196      26.6863      25.0189
100208.......................................................          ***            *            *      24.9854            *            *      24.9854
100209.......................................................       1.3796       0.9825       0.9825      25.0778      26.6246      26.6405      26.1523
100210.......................................................       1.5797       1.0470       1.0470      28.6449      28.9486      29.7288      29.1000
100211.......................................................       1.2015       0.9249       0.9249            *      24.7095      23.9827      24.3359
100212.......................................................       1.5477       0.8964       0.8964      24.2669      24.7566      26.0396      25.0603
100213.......................................................       1.5951       0.9866       0.9866      25.1893      27.1936      27.3982      26.6057
100217.......................................................       1.2343       0.9857       0.9857      25.2635      25.2907      25.9973      25.5366
100220.......................................................       1.6552       0.9339       0.9339      25.0154      26.0905      27.8611      26.3924
100223.......................................................       1.5470       0.8654       0.8654      23.4556      24.7015      25.6022      24.5922
100224.......................................................       1.2356       1.0470       1.0470      23.3593      24.8077      26.1308      24.8045
100225.......................................................       1.2202       1.0470       1.0470      27.9473      28.4316      28.6655      28.3365
100226.......................................................       1.2371       0.9046       0.9046      27.8003      29.3317      28.7732      28.6694
100228.......................................................       1.3987       1.0470       1.0470      27.2873      29.8952      28.4669      28.6149
100230.......................................................       1.3410       1.0470       1.0470      26.3690      28.1703      29.6743      28.0367
100231.......................................................       1.7304       0.8609       0.8609      24.6994      25.5175      26.3337      25.5418
100232 h.....................................................       1.2545       0.9046       0.9046      23.9405      24.9322      27.3158      25.3587
100234.......................................................       1.3964       0.9642       0.9642      25.2574      26.3601      28.2662      26.6107
100236.......................................................       1.4175       0.9453       0.9453      25.9282      26.6585      28.1991      26.9446
100237.......................................................       1.9228       1.0470       1.0470      25.6112      31.3543      32.3006      29.5164
100238.......................................................       1.6275       0.9249       0.9249      27.1748      28.4302      29.9215      28.5609
100239.......................................................       1.2871       0.9866       0.9866      26.9668      27.7592      28.4351      27.7562
100240.......................................................       0.9280       0.9825       0.9825      23.4830      25.3265      25.7112      24.8537
100242.......................................................       1.4467       0.8609       0.8609      21.5130      24.0990      25.8928      23.8355
100243.......................................................       1.5924       0.9249       0.9249      25.2987      26.1131      27.1058      26.2400
100244.......................................................       1.3521       0.9339       0.9339      24.1515      25.2584      26.5235      25.3682
100246.......................................................       1.5959       0.9857       0.9857      27.6382      28.9894      29.9108      28.8806
100248.......................................................       1.5784       0.9249       0.9249      25.9170      27.7797      28.7311      27.5094
100249.......................................................       1.3230       0.9249       0.9249      23.4021      23.2084      24.0596      23.5536
100252.......................................................       1.2232       0.9857       0.9857      24.9860      25.8540      27.0442      25.9795
100253.......................................................       1.3805       0.9642       0.9642      24.4051      25.7121      27.9291      26.0507
100254.......................................................       1.5434       0.9316       0.9316      25.0192      25.7338      26.1147      25.6499
100255.......................................................       1.2809       0.9249       0.9249      22.2341      24.4808      26.3538      24.3804
100256.......................................................       1.8683       0.9249       0.9249      26.0629      28.8856      29.7926      28.2929
100258.......................................................       1.5255       1.0470       1.0470      31.8772      31.2482      31.3505      31.4813
100259.......................................................       1.2692       0.9249       0.9249      24.9404      26.0175      27.1642      26.0636
100260.......................................................       1.3677       0.9857       0.9857      25.2630      27.5188      27.0181      26.6532
100262.......................................................          ***            *            *      26.3954            *            *      26.3954
100264.......................................................       1.2637       0.9249       0.9249      25.0250      25.5489      25.9597      25.5115
100265.......................................................       1.3089       0.9249       0.9249      23.4758      24.1454      25.9086      24.5857
100266.......................................................       1.4274       0.8609       0.8609      22.6614      23.2340      23.7655      23.2568
100267.......................................................       1.2996       0.9866       0.9866      26.5059      27.3768      28.7517      27.5078
100268.......................................................       1.1892       0.9642       0.9642      29.8289      29.2898      29.9909      29.7065
100269.......................................................       1.3995       0.9642       0.9642      25.3228      26.7450      27.3632      26.5403
100275.......................................................       1.3040       0.9642       0.9642      24.3059      26.0361      27.0080      25.8478

[[Page 24177]]

 
100276.......................................................       1.2587       1.0470       1.0470      27.2589      30.0576      31.2531      29.5875
100277.......................................................       1.4104       0.9825       0.9825      47.3905      16.5427      20.7768      22.4551
100279.......................................................       1.3178       0.9339       0.9339      25.4909      26.8606      28.5951      27.0996
100281.......................................................       1.3391       1.0470       1.0470      27.0864      28.6660      29.8789      28.6295
100284.......................................................       1.0591       0.9825       0.9825      22.5927      23.8170      22.3173      22.9046
100285.......................................................       1.2194            *            *            *            *            *            *
100286.......................................................       1.6325       0.9935       0.9935      27.1051      29.4284      28.4751      28.3833
100287.......................................................       1.3417       0.9642       0.9642      28.2229      28.3427      28.2583      28.2764
100288.......................................................       1.5562       0.9642       0.9642      37.4785      33.8141      29.6965      33.2143
100289.......................................................       1.7571       1.0470       1.0470      28.4504      29.2915      29.5902      29.1535
100290.......................................................       1.1732       0.9191       0.9191            *      23.5080      25.1300      24.3178
100291.......................................................       1.3066       0.9440       0.9440            *            *      28.4799      28.4799
100292.......................................................       1.3038       0.8609       0.8609            *            *      26.9608      26.9608
100293.......................................................          ***            *            *            *            *      32.7722      32.7722
100294.......................................................          ***            *            *            *            *      30.3556      30.3556
100295.......................................................          ***            *            *            *            *      26.1791      26.1791
100296.......................................................       1.3555       0.9825       0.9825            *            *            *            *
100298.......................................................       0.8740       0.9316       0.9316            *            *            *            *
100299.......................................................       1.3010       0.9866       0.9866            *            *            *            *
110001.......................................................       1.2775       0.9644       0.9644      25.1164      25.3102      26.6205      25.6873
110002.......................................................       1.3523       0.9644       0.9644      21.8616      25.3897      26.3797      24.5871
110003.......................................................       1.2617       0.9046       0.9046      20.0968      21.4002      22.0049      21.1828
110004.......................................................       1.2789       0.8965       0.8965      22.7929      23.9911      24.4124      23.7130
110005.......................................................       1.2301       0.9761       0.9761      22.3645      22.9000      27.9633      24.5295
110006.......................................................       1.4702       0.9827       0.9827      25.0719      28.6090      28.9119      27.4847
110007.......................................................       1.6002       0.8969       0.8969      30.7430      23.8729      26.3197      26.5387
110008.......................................................       1.2995       0.9761       0.9761      23.4662      27.1711      30.1360      26.9747
110010.......................................................       2.1912       0.9761       0.9761      28.7690      29.7142      31.8635      30.1393
110011.......................................................       1.2378       0.9761       0.9761      25.4620      26.0899      28.0194      26.5176
110015.......................................................       1.1303       0.9761       0.9761      25.5661      26.6610      28.7369      27.0953
110016.......................................................       1.1761       0.7577       0.7577      18.8376      21.7610      20.7638      20.4328
110018.......................................................       1.1832       0.9761       0.9761      25.6485      28.2431      26.4698      26.7925
110020.......................................................       1.3269       0.9761       0.9761      24.8735      26.8501      27.1406      26.3040
110023.......................................................       1.3249       0.9644       0.9644      25.3746      27.3029      30.3424      27.7599
110024.......................................................       1.4064       0.9089       0.9089      23.8091      25.7205      27.3054      25.5765
110025.......................................................       1.4741       0.9046       0.9046      31.5253      26.1311      29.9555      28.9712
110026.......................................................       1.1102       0.7577       0.7577      20.5740      21.2826      21.3621      21.0771
110027.......................................................       1.0741       0.7964       0.7964      19.2323      20.2175      20.8174      20.0273
110028.......................................................       1.8298       0.9681       0.9681      25.1836      28.1619      30.5430      27.9386
110029.......................................................       1.7593       0.9644       0.9644      25.2335      24.8893      26.6096      25.6552
110030.......................................................       1.2303       0.9761       0.9761      25.0842      26.4770      28.1621      26.6637
110031.......................................................       1.2875       0.9761       0.9761      24.1711      24.7874      26.3138      25.1188
110032.......................................................       1.1329       0.7577       0.7577      20.7211      21.9407      22.5419      21.7322
110033.......................................................       1.3719       0.9761       0.9761      25.2326      28.3210      29.6154      27.8235
110034.......................................................       1.6774       0.9681       0.9681      24.4141      26.9986      28.0571      26.5634
110035.......................................................       1.6293       0.9761       0.9761      25.7562      27.4583      28.1179      27.1607
110036.......................................................       1.8177       0.9089       0.9089      25.4854      26.8789      27.7279      26.7470
110038.......................................................       1.4966       0.8101       0.8101      20.5880      21.2138      21.7736      21.2085
110039.......................................................       1.4547       0.9681       0.9681      19.4032      24.7248      25.8629      23.0782
110040.......................................................       1.1223       0.9644       0.9644      18.8744      19.7509      19.1800      19.2690
110041.......................................................       1.2552       0.9707       0.9707      21.5402      23.4074      24.7306      23.1719
110042.......................................................       1.0876       0.9761       0.9761      26.8321      28.6873      34.0887      29.8762
110043.......................................................       1.7925       0.9089       0.9089      25.2788      26.6323      23.9626      25.2951
110044.......................................................       1.1525       0.7577       0.7577      19.6940      20.9654      22.6491      21.0788
110045.......................................................       1.1388       0.9761       0.9761      21.3922      24.9821      23.5532      23.2970
110046.......................................................       1.1557       0.9761       0.9761      24.0022      23.8292      25.5453      24.4504
110049.......................................................          ***            *            *      19.8706            *            *      19.8706
110050.......................................................       1.1141       0.9050       0.9050      25.6020      26.1320      28.2504      26.6887
110051.......................................................       1.1491       0.7577       0.7577      19.0995      19.4276            *      19.2687
110054.......................................................       1.4092       0.9644       0.9644      22.2250      25.7085      26.5180      24.8264
110056.......................................................       0.9187            *            *      23.0080            *            *      23.0080
110059.......................................................       1.1352       0.7577       0.7577      18.7097      20.5565      20.6838      19.8951
110063.......................................................          ***            *            *      20.3760            *            *      20.3760
110064.......................................................       1.4874       0.8256       0.8256      23.8739      24.2739      23.6909      23.9385
110069.......................................................       1.2898       0.9176       0.9176      22.3006      24.1669      24.9679      23.8522
110071.......................................................       1.0437       0.7577       0.7577      13.3731      18.0224      19.7309      16.8213

[[Page 24178]]

 
110073.......................................................       1.0751       0.7577       0.7577      16.3610      18.6336      17.5422      17.4505
110074.......................................................       1.5434       0.9827       0.9827      27.5836      27.1207      29.1532      27.9899
110075.......................................................       1.2899       0.8958       0.8958      20.9973      22.0935      22.7715      21.9811
110076.......................................................       1.4276       0.9761       0.9761      25.2424      26.3506      28.1355      26.5899
110078.......................................................       2.0372       0.9761       0.9761      27.8627      29.5779      30.4031      29.3431
110079.......................................................       1.4419       0.9761       0.9761      24.5255      23.1024      26.4675      24.6603
110080.......................................................       1.2829       0.9761       0.9761      21.5482      22.3213      18.4242      20.7532
110082.......................................................       1.9077       0.9761       0.9761      28.9731      29.8366      30.9276      29.9458
110083.......................................................       1.9292       0.9761       0.9761      26.2604      27.8245      30.3920      28.2014
110086.......................................................       1.2886       0.7577       0.7577      20.8557      21.1509      21.2115      21.0747
110087.......................................................       1.4659       0.9761       0.9761      26.2872      28.0471      28.3256      27.5768
110089.......................................................       1.1203       0.7577       0.7577      21.2013      21.9509      22.3332      21.8399
110091.......................................................       1.2844       0.9761       0.9761      26.3857      26.5523      28.9885      27.4113
110092.......................................................       1.0523       0.7577       0.7577      18.7397      18.5527      20.2520      19.1704
110095.......................................................       1.4415       0.8101       0.8101      21.8709      23.4846      25.7326      23.7156
110096.......................................................       0.9724            *            *      19.4498            *            *      19.4498
110100.......................................................       0.9636       0.7577       0.7577      16.5833      16.5600      15.1511      16.0255
110101.......................................................       1.0753       0.7577       0.7577      14.4630      16.4270      18.1778      16.2572
110104.......................................................       1.0503       0.7577       0.7577      19.5575      18.7951      19.1452      19.1709
110105.......................................................       1.3027       0.7577       0.7577      20.6270      21.1077      22.7867      21.5133
110107.......................................................       1.9366       0.9554       0.9554      26.0763      26.2526      28.0519      26.8480
110109.......................................................       1.0020       0.7577       0.7577      20.4726      21.4280      21.8210      21.2959
110111.......................................................       1.1922       0.9681       0.9681      20.5577      29.2190      24.6109      24.2986
110112.......................................................       0.9195       0.7577       0.7577      21.0612      24.2463      21.7411      22.2315
110113.......................................................       1.0319       0.9681       0.9681      16.7641      19.1753      18.9512      18.3153
110115.......................................................       1.7116       0.9761       0.9761      29.8699      32.0197      31.9907      31.3106
110121.......................................................       1.0279       0.7577       0.7577      21.2534      21.6637      22.0498      21.6648
110122.......................................................       1.5567       0.8982       0.8982      22.0210      23.7589      24.7846      23.5480
110124.......................................................       1.0276       0.8005       0.8005      20.9334      22.7058      23.4296      22.3620
110125.......................................................       1.3252       0.9176       0.9176      22.1458      22.4238      23.3281      22.6254
110128.......................................................       1.2532       0.8958       0.8958      23.2576      24.4596      25.6176      24.4945
110129.......................................................       1.5112       0.8256       0.8256      22.4202      23.3631      24.4429      23.4176
110130.......................................................       0.9251       0.7577       0.7577      17.6529      18.7549      18.4928      18.3190
110132.......................................................       1.0227       0.7577       0.7577      18.9927      19.2307      20.1060      19.4424
110135.......................................................       1.2432       0.7577       0.7577      20.0057      20.4411      21.8451      20.8410
110136.......................................................          ***            *            *      22.7715      15.8573      18.5125      19.1561
110142.......................................................       0.9652       0.7577       0.7577      17.3328      18.1980      19.4290      18.3479
110143.......................................................       1.3959       0.9761       0.9761      25.4932      27.7055      27.6784      26.9990
110146.......................................................       1.0904       0.8363       0.8363      19.9221      23.9067      24.7255      22.8343
110149.......................................................          ***            *            *      24.7686      27.1477      28.2647      26.9026
110150.......................................................       1.2486       0.9644       0.9644      23.8157      22.6624      25.2397      23.8573
110153.......................................................       1.1463       0.9176       0.9176      22.8660      24.5368      24.4107      23.9661
110161.......................................................       1.4911       0.9761       0.9761      27.4435      29.3201      31.2120      29.3628
110163.......................................................       1.3865       0.8969       0.8969      25.5461      26.0764      28.0288      26.5286
110164.......................................................       1.5927       0.9554       0.9554      26.4450      27.0600      28.5216      27.3709
110165.......................................................       1.3817       0.9761       0.9761      24.3897      26.8378      27.1472      26.1300
110166.......................................................          ***            *            *      25.2264      26.8070            *      26.0253
110168.......................................................       1.8861       0.9644       0.9644      24.6321      27.0022      28.7602      26.8363
110172.......................................................       1.2080       0.9761       0.9761      27.0240      29.1703      30.7555      29.0077
110177.......................................................       1.7219       0.9681       0.9681      25.0129      26.7504      27.9520      26.6015
110179.......................................................          ***            *            *      26.1173      26.0759            *      26.0961
110183.......................................................       1.2204       0.9761       0.9761      27.6020      29.6133      29.9753      29.1744
110184.......................................................       1.1779       0.9761       0.9761      25.5420      26.5240      27.0140      26.4179
110186.......................................................       1.3488       0.8256       0.8256      23.2348      25.0299      26.1373      24.8057
110187.......................................................       1.2445       0.9644       0.9644      22.5730      24.2933      24.4380      23.8234
110189.......................................................       1.1035       0.9644       0.9644      23.9404      26.7653      25.5622      25.4422
110190.......................................................       1.0679       0.7759       0.7759      19.1054      14.2517      22.4774      18.1909
110191.......................................................       1.2940       0.9761       0.9761      25.8409      26.8277      27.2171      26.6346
110192.......................................................       1.3492       0.9761       0.9761      25.7406      26.7852      27.9800      26.8678
110193.......................................................          ***            *            *      27.8223      27.3341      27.8180      27.6526
110194.......................................................       0.9325       0.7577       0.7577      16.3148      18.4776      18.8136      17.9305
110198.......................................................       1.3451       0.9761       0.9761      30.8014      31.7748      31.7399      31.4753
110200.......................................................       1.8335       0.8256       0.8256      21.2177      22.3249      24.7384      22.6614
110201.......................................................       1.4386       0.9554       0.9554      27.0388      28.2232      30.6525      28.6696
110203.......................................................       0.9744       0.9761       0.9761      25.8951      26.8768      30.3037      27.7533
110205.......................................................       1.1502       0.9644       0.9644      20.6150      19.7409      21.5043      20.6527

[[Page 24179]]

 
110209.......................................................       0.5449       0.7577       0.7577      19.1000      19.0450      20.6610      19.6589
110212.......................................................       1.0965       0.8340       0.8340      20.9365      40.5120      23.5240      28.8400
110214.......................................................          ***            *            *            *            *      38.0916      38.0916
110215.......................................................       1.2932       0.9761       0.9761      23.9657      25.7886      27.6105      25.8891
110218.......................................................          ***            *            *      26.1073            *            *      26.1073
110219.......................................................       1.3711       0.9761       0.9761      27.1880      27.0362      28.9963      27.7481
110220.......................................................          ***            *            *            *            *      36.3797      36.3797
110221.......................................................          ***            *            *            *            *      27.9342      27.9342
110222.......................................................          ***            *            *            *            *      35.6600      35.6600
110224.......................................................       1.2679       0.9554       0.9554            *            *            *            *
110225.......................................................       1.1623       0.9761       0.9761            *            *            *            *
110226.......................................................       1.1684            *            *            *            *            *            *
120001.......................................................       1.7479       1.1066       1.1066      31.7108      34.7715      36.1455      34.2182
120002.......................................................       1.1953       1.0502       1.0502      26.9900      29.9913      31.1454      29.4877
120004.......................................................       1.2414       1.1066       1.1066      28.3569      28.6527      29.8958      28.9336
120005.......................................................       1.2996       1.0502       1.0502      26.9053      29.3405      30.7655      28.9478
120006.......................................................       1.2506       1.1066       1.1066      29.6751      31.2285      31.6553      30.8640
120007.......................................................       1.6798       1.1066       1.1066      28.7964      30.4247      30.8207      30.0248
120010.......................................................       1.8625       1.1066       1.1066      27.1265      30.1659      29.2456      28.7313
120011.......................................................       1.4183       1.1066       1.1066      31.7447      34.1643      37.6638      34.6233
120014.......................................................       1.2906       1.0502       1.0502      28.0786      28.6416      30.9983      29.2759
120016.......................................................          ***            *            *      52.1034      19.6034            *      31.3542
120019.......................................................       1.1569       1.0502       1.0502      28.9661      30.3809      30.9024      30.1294
120022.......................................................       1.8414       1.1066       1.1066      24.7875      26.6100      28.3925      26.5859
120024.......................................................       0.8882            *            *            *            *            *            *
120025.......................................................          ***            *            *      48.7148      30.2358            *      39.4887
120026.......................................................       1.3774       1.1066       1.1066      28.5048      30.3293      32.6726      30.6338
120027.......................................................       1.3041       1.1066       1.1066      26.4630      28.6717      28.6901      27.9388
120028.......................................................       1.3553       1.1066       1.1066      31.3195      30.3794      32.2641      31.3359
120029.......................................................       2.0189       1.1066       1.1066            *            *            *            *
130002.......................................................       1.4037       0.8674       0.8674      21.6626      23.6078      24.8996      23.4857
130003.......................................................       1.3819       1.0033       1.0033      25.4904      27.6345      29.1686      27.4795
130005.......................................................          ***            *            *      25.2550      25.7523            *      25.4954
130006.......................................................       1.7984       0.9404       0.9404      24.3982      25.3221      27.3657      25.7611
130007.......................................................       1.7777       0.9404       0.9404      24.8764      24.9562      28.8562      26.2212
130011.......................................................       1.2032            *            *      22.9336            *            *      22.9336
130013.......................................................       1.3238       0.9404       0.9404      26.3118      27.9209      28.4195      27.5522
130014.......................................................       1.2962       0.9404       0.9404      23.4789      24.3884      26.4165      24.7517
130018.......................................................       1.6875       0.9400       0.9400      23.9798      26.4125      27.5137      26.0217
130021.......................................................          ***            *            *      18.9400      16.1658            *      17.6183
130024.......................................................       1.0850       0.8949       0.8949      21.7853      23.3347      24.5799      23.2478
130025.......................................................       1.2211       0.8674       0.8674      19.7066      20.1452      21.7093      20.5485
130026.......................................................          ***            *            *      25.4020            *            *      25.4020
130028.......................................................       1.3940       0.9400       0.9400      25.2938      26.3443      27.8274      26.7013
130036.......................................................          ***            *            *      16.7907            *            *      16.7907
130049.......................................................       1.5643       1.0284       1.0284      24.5841      26.9749      27.6683      26.4480
130060.......................................................          ***            *            *      26.7516            *            *      26.7516
130062.......................................................       0.4992            *            *      16.7951      20.6642      25.4820      20.1910
130063.......................................................       1.3226       0.9404       0.9404      20.9502      22.5904      25.0864      22.8539
130065.......................................................       1.8682       0.9300       0.9300            *            *      21.5260      21.5260
130066.......................................................       2.0225       0.9696       0.9696            *            *            *            *
130067.......................................................       1.1199       0.9300       0.9300            *            *            *            *
140001.......................................................       1.0879       0.8334       0.8334      21.4779      22.3170      22.9464      22.2483
140002.......................................................       1.3285       0.9017       0.9017      24.4908      24.6954      27.0262      25.3949
140003.......................................................          ***            *            *      22.6230            *            *      22.6230
140007.......................................................       1.3267       1.0742       1.0742      26.7943      28.3482      30.5555      28.5893
140008.......................................................       1.4514       1.0742       1.0742      27.2211      28.5297      29.4264      28.3893
140010.......................................................       1.5134       1.0742       1.0742      31.5774      35.1024      32.1387      32.9542
140011.......................................................       1.1519       0.8334       0.8334      20.6338      22.4091      23.3923      22.1495
140012.......................................................       1.1895       1.0596       1.0596      24.3675      28.6564      28.7947      27.2494
140013.......................................................       1.4139       0.8973       0.8973      22.6022      23.3065      24.3673      23.3996
140015.......................................................       1.4234       0.8902       0.8902      22.2266      23.0600      24.3516      23.2245
140016.......................................................       1.0295            *            *      17.1372      18.1242            *      17.6389
140018.......................................................       1.4130       1.0742       1.0742      27.3334      27.7548      26.2598      27.1177
140019.......................................................       0.9335       0.8334       0.8334      18.4554      18.9228      20.5469      19.2999
140024.......................................................       1.0391            *            *      16.9672      17.5249            *      17.2349

[[Page 24180]]

 
140026.......................................................       1.1460       0.8680       0.8680      21.6847      23.0470      25.8658      23.4929
140027.......................................................          ***            *            *      22.6208            *            *      22.6208
140029.......................................................       1.5856       1.0742       1.0742      27.7304      28.6565      30.4267      29.0118
140030.......................................................       1.5703       1.0742       1.0742      28.7623      29.7771      30.8539      29.8244
140032.......................................................       1.2542       0.8902       0.8902      22.8157      24.0574      26.3265      24.4078
140033.......................................................       1.2032       1.0596       1.0596      26.1553      25.6068      26.6309      26.1186
140034.......................................................       1.2202       0.8902       0.8902      22.1003      23.0034      24.0132      23.0492
140040.......................................................       1.1819       0.8827       0.8827      20.0269      22.2969      23.0412      21.6957
140043.......................................................       1.2734       0.9773       0.9773      26.0330      26.7996      27.2076      26.6815
140045.......................................................       1.0786            *            *      21.0042      20.6548            *      20.8316
140046.......................................................       1.4780       0.8902       0.8902      22.5022      23.2127      25.1403      23.7433
140048.......................................................       1.2684       1.0742       1.0742      27.0874      28.2222      29.4775      28.2409
140049.......................................................       1.5191       1.0742       1.0742      26.6533      27.4009      29.7853      27.9674
140051.......................................................       1.5347       1.0742       1.0742      27.9935      27.7901      30.9784      28.8784
140052.......................................................       1.2841       0.9017       0.9017      22.2588      23.5662      25.9526      23.9370
140053.......................................................       1.8913       0.8900       0.8900      23.5477      24.8455      27.0098      25.1043
140054.......................................................       1.4870       1.0742       1.0742      31.7265      31.8564      33.1231      32.2061
140058.......................................................       1.2228       0.8902       0.8902      22.1269      22.8423      24.5345      23.1736
140059.......................................................       1.1165       0.9017       0.9017      22.7121      22.4651      22.7978      22.6554
140061.......................................................       1.0739            *            *      30.9925      20.8063            *      25.9797
140062.......................................................       1.2142       1.0742       1.0742      31.2359      34.7704      34.9018      33.6097
140063.......................................................       1.4093       1.0742       1.0742      26.5584      27.8306      28.3171      27.6213
140064.......................................................       1.1938       0.8827       0.8827      21.7470      22.0407      23.6796      22.5242
140065.......................................................       1.3865       1.0742       1.0742      26.1904      29.4678      30.5985      28.7875
140066.......................................................       1.1297       0.9017       0.9017      20.4353      21.9771      21.7172      21.3717
140067.......................................................       1.8182       0.8973       0.8973      23.5906      25.3986      27.3723      25.4762
140068.......................................................       1.1945       1.0742       1.0742      25.8963      27.3956      28.3348      27.2266
140075.......................................................       1.2767       1.0742       1.0742      26.9257      27.9325      27.0069      27.3106
140077.......................................................       1.0393       0.9017       0.9017      19.0922      19.1363      20.5654      19.5779
140079.......................................................          ***            *            *      29.3040            *            *      29.3040
140080.......................................................       1.4417       1.0742       1.0742      26.0109      23.2575      28.0751      25.6089
140082.......................................................       1.4773       1.0742       1.0742      26.8077      25.6645      29.2173      27.2244
140083.......................................................       1.0308       1.0742       1.0742      24.6491      26.2972      26.7552      25.9303
140084.......................................................       1.2289       1.0596       1.0596      27.6819      29.2515      30.0397      29.0292
140088.......................................................       1.8500       1.0742       1.0742      31.0364      32.4978      30.8245      31.4341
140089.......................................................       1.1914       0.8334       0.8334      22.1227      23.3401      24.5591      23.2899
140091.......................................................       1.8250       0.9649       0.9649      26.1075      26.8518      27.8742      26.9776
140093.......................................................       1.1831       0.9155       0.9155      22.1540      25.3127      27.5152      24.7343
140094.......................................................       1.0356       1.0742       1.0742      25.3678      27.9273      27.9141      27.1207
140095.......................................................       1.2507       1.0742       1.0742      29.9746      27.6799      26.6424      28.1556
140100.......................................................       1.3030       1.0596       1.0596      32.8743      37.0819      37.2217      35.8092
140101.......................................................       1.1672       1.0742       1.0742      25.4784      28.5365      29.2080      27.8662
140102.......................................................          ***            *            *      21.2278            *            *      21.2278
140103.......................................................       1.1961       1.0742       1.0742      21.7512      23.3258      23.8866      22.9977
140105.......................................................       1.2788       1.0742       1.0742      26.3054      27.4531      28.4390      27.3700
140109.......................................................       1.0917            *            *      17.8103      19.5675            *      18.6923
140110.......................................................       1.0910       1.0596       1.0596      25.6561      27.9844      29.3202      27.6755
140113.......................................................       1.5788       0.9649       0.9649      23.5337      26.7969      29.9552      26.5722
140114.......................................................       1.4160       1.0742       1.0742      25.7968      28.3014      28.6458      27.6452
140115.......................................................       1.0851       1.0742       1.0742      26.3677      25.1498      25.8357      25.7964
140116.......................................................       1.2978       1.0742       1.0742      30.5166      31.9902      34.3361      32.3584
140117.......................................................       1.5416       1.0742       1.0742      25.6314      26.8802      27.9774      26.8349
140118.......................................................       1.6195       1.0742       1.0742      27.7392      29.7570      32.2213      29.8836
140119.......................................................       1.7729       1.0742       1.0742      33.6302      36.1419      34.7716      34.8306
140120.......................................................       1.2239       0.8973       0.8973      22.5795      22.7375      24.0981      23.1900
140122.......................................................       1.4330       1.0742       1.0742      26.4991      28.4188      31.0736      28.6341
140124.......................................................       1.3392       1.0742       1.0742      35.2798      36.1327      36.4899      35.9612
140125.......................................................       1.2398       0.9017       0.9017      20.7189      20.4014      22.3436      21.1516
140127.......................................................       1.6317       0.8959       0.8959      22.8172      24.1658      25.0102      23.9945
140130.......................................................       1.2469       1.0596       1.0596      26.3518      29.5247      32.9615      29.7730
140133.......................................................       1.2969       1.0742       1.0742      26.1599      28.0339      30.6892      28.1483
140135.......................................................       1.4756       0.8334       0.8334      21.2104      22.3264      23.0885      22.2454
140137.......................................................       1.0253       0.9017       0.9017      20.5053      21.4700      23.4302      21.8888
140140.......................................................          ***            *            *      21.4710            *            *      21.4710
140141.......................................................       1.0512            *            *      23.0515      21.7871            *      22.4305
140143.......................................................       1.2279       0.8827       0.8827      23.8255      26.2954      26.2579      25.4680

[[Page 24181]]

 
140144.......................................................          ***            *            *      27.8046            *            *      27.8046
140145.......................................................       1.0954       0.9017       0.9017      21.6168      23.4608      25.4576      23.5453
140147.......................................................       1.1011       0.8334       0.8334      19.5896      19.8541      21.5005      20.3136
140148.......................................................       1.7345       0.8900       0.8900      23.0022      24.7031      25.6350      24.3700
140150.......................................................       1.6237       1.0742       1.0742      33.9013      35.2711      53.4891      41.2967
140151.......................................................       0.8172       1.0742       1.0742      22.4842      23.4879      25.1381      23.7102
140152.......................................................       1.0879       1.0742       1.0742      29.6882      27.6086      30.5283      29.2513
140155.......................................................       1.2917       1.0032       1.0032      27.6610      28.9724      29.8350      28.8823
140158.......................................................       1.4185       1.0742       1.0742      23.8542      27.0986      27.3765      25.9317
140160.......................................................       1.2622       0.9773       0.9773      22.7002      24.5373      25.6756      24.3339
140161.......................................................       1.1501       1.0596       1.0596      24.1071      23.1647      24.6442      23.9715
140162.......................................................       1.6074       0.8959       0.8959      26.0312      27.4472      28.9571      27.4950
140164.......................................................       1.7902       0.8902       0.8902      22.0424      23.7457      24.3913      23.3924
140165.......................................................       1.0595            *            *      15.9312      16.6304            *      16.2816
140166.......................................................       1.1868       0.8334       0.8334      21.7776      23.1005      26.5696      23.8462
140167.......................................................       1.1260       0.9728       0.9728      19.7610      22.8911      23.2552      21.9523
140168.......................................................          ***            *            *      20.0225            *            *      20.0225
140170.......................................................       0.9621            *            *      17.1608            *            *      17.1608
140172.......................................................       1.4090       1.0742       1.0742      27.1121      29.8568      32.0491      29.9831
140174.......................................................       1.4735       1.0742       1.0742      24.7011      27.8131      30.6391      27.6903
140176.......................................................       1.2059       1.0742       1.0742      28.9378      31.3490      32.8367      31.1310
140177.......................................................       0.9899       1.0742       1.0742      19.3328      22.5610      25.4042      22.6360
140179.......................................................       1.3042       1.0742       1.0742      26.3200      27.6376      29.1623      27.7184
140180.......................................................       1.2048       1.0742       1.0742      27.4366      28.3629      29.4449      28.4116
140181.......................................................       1.2002       1.0742       1.0742      23.6034      25.0100      24.7902      24.4674
140182.......................................................       1.5644       1.0742       1.0742      28.0337      28.2211      30.4042      28.7014
140184.......................................................       1.2402       0.8334       0.8334      20.1279      21.1802      24.5927      22.1636
140185.......................................................       1.4592       0.9017       0.9017      22.0222      23.8531      24.9794      23.6400
140186.......................................................       1.5570       1.0032       1.0032      28.1977      30.6951      29.4859      29.5088
140187.......................................................       1.5360       0.9017       0.9017      22.0674      23.2892      24.9822      23.4667
140189.......................................................       1.1691       0.9155       0.9155      25.6954      23.7198      22.2803      23.9070
140190.......................................................       1.0766            *            *      18.8530      19.8297            *      19.3398
140191.......................................................       1.2997       1.0742       1.0742      25.2817      25.8678      28.1849      26.4367
140193.......................................................          ***            *            *      22.9443            *            *      22.9443
140197.......................................................       1.3178       1.0742       1.0742      21.8060      23.0684      24.2236      22.9343
140199.......................................................       1.0459            *            *      21.3464      22.0315            *      21.6914
140200.......................................................       1.4752       1.0742       1.0742      24.9217      26.3379      28.3720      26.5054
140202.......................................................       1.5706       1.0596       1.0596      27.4336      29.7870      32.1701      29.9764
140203.......................................................          ***            *            *      28.2212            *            *      28.2212
140205.......................................................       1.7126       1.0150       1.0150            *            *            *            *
140206.......................................................       1.0867       1.0742       1.0742      27.5481      30.6561      29.1294      29.1455
140207.......................................................       1.2439       1.0742       1.0742      25.7331      24.1048      25.1473      24.9715
140208.......................................................       1.6564       1.0742       1.0742      27.6586      29.4708      29.7525      28.9886
140209.......................................................       1.5833       0.8973       0.8973      23.3886      24.5376      26.3371      24.7775
140210.......................................................       1.1359       0.8334       0.8334      16.6729      19.2639      20.5812      18.7925
140211.......................................................       1.2974       1.0742       1.0742      29.5114      29.7054      30.7546      30.0426
140213.......................................................       1.2144       1.0742       1.0742      29.1649      30.2945      31.3811      30.2935
140215.......................................................          ***            *            *      22.3097            *            *      22.3097
140217.......................................................       1.4968       1.0742       1.0742      29.3711      31.5324      32.7581      31.1722
140223.......................................................       1.4796       1.0742       1.0742      29.2540      30.4923      31.9618      30.5734
140224.......................................................       1.3603       1.0742       1.0742      29.0350      28.2177      29.8867      29.0497
140228.......................................................       1.5725       0.9987       0.9987      25.0074      25.6419      27.7259      26.1206
140231.......................................................       1.4875       1.0742       1.0742      28.3545      30.6410      30.0920      29.7474
140233.......................................................       1.6248       1.0596       1.0596      27.3379      28.6305      28.3631      28.1358
140234.......................................................       1.0969       0.8827       0.8827      23.2604      23.6928      24.7645      23.9187
140239.......................................................       1.5507       0.9987       0.9987      24.2112      29.0092      31.8210      28.3245
140240.......................................................       1.4058       1.0742       1.0742      27.2654      28.7310      30.1439      28.6637
140242.......................................................       1.4891       1.0742       1.0742      30.4005      32.0522      34.4226      32.3743
140245.......................................................          ***            *            *      16.0772            *            *      16.0772
140250.......................................................       1.1833       1.0742       1.0742      27.4628      28.5971      29.9198      28.6855
140251.......................................................       1.3420       1.0742       1.0742      26.7266      27.1687      28.4384      27.4435
140252.......................................................       1.3975       1.0742       1.0742      30.2656      33.3351      34.5410      32.7890
140258.......................................................       1.5438       1.0742       1.0742      27.9478      30.2639      33.6353      30.7068
140271.......................................................       0.8939            *            *      18.8535            *            *      18.8535
140275.......................................................       1.3373       0.8569       0.8569      25.2824      26.1473      27.9824      26.4533
140276.......................................................       1.8331       1.0742       1.0742      27.5936      29.8325      31.3200      29.6123

[[Page 24182]]

 
140280.......................................................       1.4395       0.8569       0.8569      21.9302      23.4447      22.5604      22.6515
140281.......................................................       1.6866       1.0742       1.0742      29.2602      30.4838      33.7817      31.1676
140285.......................................................          ***            *            *      17.7824      20.7576            *      19.1679
140286.......................................................       1.1273       1.0742       1.0742      28.4378      29.1543      31.0563      29.5696
140288.......................................................       1.5613       1.0742       1.0742      26.9581      29.3988      31.7089      29.3668
140289.......................................................       1.3194       0.9017       0.9017      22.3274      22.6211      24.5456      23.1903
140290.......................................................       1.3527       1.0742       1.0742      28.6926      31.7341      31.2636      30.6196
140291.......................................................       1.5063       1.0596       1.0596      28.2338      29.8958      31.3199      29.9025
140292.......................................................       1.1567       1.0742       1.0742      26.1781      27.6285      29.2990      27.7701
140294.......................................................       1.1615       0.8334       0.8334      22.6123      23.4504      24.0181      23.3722
140300.......................................................       1.1185       1.0742       1.0742      33.3983      34.8568      35.6231      34.6085
140301.......................................................       1.2721       1.0742       1.0742            *      31.7073      49.7125      37.1819
140303.......................................................       1.8671       1.0742       1.0742            *            *      29.8654      29.8654
140344.......................................................       0.7733            *            *            *            *            *            *
150001.......................................................       1.1131       0.9757       0.9757      27.1021      29.6844      28.3954      28.4082
150002.......................................................       1.4378       1.0596       1.0596      23.3804      25.0063      26.3713      24.8884
150003.......................................................       1.6318       0.8957       0.8957      23.3196      25.3458      27.0406      25.2176
150004.......................................................       1.4953       1.0596       1.0596      24.8884      26.8458      28.0176      26.5920
150005.......................................................       1.1856       0.9757       0.9757      25.4443      27.2369      29.5025      27.5016
150006.......................................................       1.3717       0.9543       0.9543      24.8976      26.4061      26.1674      25.8384
150007.......................................................       1.3603       0.9494       0.9494      23.5841      26.6073      29.4617      26.6700
150008.......................................................       1.4502       1.0596       1.0596      23.6953      26.6928      27.3400      25.9807
150009.......................................................       1.3886       0.9137       0.9137      20.4993      22.2147      24.9618      22.6002
150010.......................................................       1.4176       0.9494       0.9494      23.9740      26.8524      26.1311      25.6410
150011.......................................................       1.1850       0.9582       0.9582      23.2249      24.3490      25.3748      24.3343
150012.......................................................       1.5696       0.9677       0.9677      22.9314      27.3029      27.7477      25.8046
150013.......................................................       1.0122            *            *      19.7689      21.8465            *      20.8053
150014.......................................................          ***            *            *      26.5785            *            *      26.5785
150015.......................................................       1.3253       1.0596       1.0596      24.3015      26.2434      27.7478      26.1118
150017.......................................................       1.7827       0.9498       0.9498      23.7180      25.2342      27.1394      25.3937
150018.......................................................       1.6614       0.9421       0.9421      24.7048      26.3289      27.4616      26.1770
150021.......................................................       1.7672       0.9498       0.9498      27.8168      29.6967      29.5355      29.0360
150022.......................................................       1.1171       0.8728       0.8728      22.8035      22.6773      22.9027      22.7977
150023.......................................................       1.5443       0.8663       0.8663      23.1253      23.7159      26.3792      24.2243
150024.......................................................       1.3983       0.9757       0.9757      24.7879      27.1589      27.5637      26.5220
150026.......................................................       1.3092       0.9421       0.9421      23.7185      28.1127      28.7334      26.9980
150027.......................................................       1.0215            *            *      21.2855      17.4862            *      19.1736
150029.......................................................       1.4031       0.9677       0.9677      23.4103      26.9680      27.8939      25.8068
150030.......................................................       1.1595       0.9582       0.9582      24.4361      26.9533      28.0417      26.5118
150033.......................................................       1.6558       0.9757       0.9757      25.8851      27.9995      29.0207      27.6412
150034.......................................................       1.5452       1.0596       1.0596      23.9388      26.0465      28.1138      26.1270
150035.......................................................       1.5489       0.9361       0.9361      26.0952      26.6620      27.1031      26.6373
150037.......................................................       1.3067       0.9757       0.9757      27.7009      28.5451      30.7071      28.9916
150038.......................................................       1.1286       0.9757       0.9757      24.4188      28.8054      29.0433      27.4342
150042.......................................................       1.4612       0.8479       0.8479      21.9917      23.0102      22.3848      22.4673
150044.......................................................       1.3885       0.9137       0.9137      23.1200      23.7065      24.3939      23.7747
150045 h.....................................................       1.0516       0.9914       0.9914      24.2899      25.2225      27.1520       25.569
150046.......................................................       1.4240       0.8663       0.8663      21.0417      21.9369      24.1694      22.4186
150047.......................................................       1.7598       0.9498       0.9498      24.5455      25.8349      25.1553      25.1829
150048.......................................................       1.3838       0.9599       0.9599      24.5864      27.1817      27.4034      26.3728
150049.......................................................       1.2142            *            *      20.2178      22.3370            *      21.2543
150051.......................................................       1.5992       0.9582       0.9582      22.6866      23.7061      25.3577      23.9071
150052.......................................................       1.0642            *            *      19.6073      20.6339            *      20.1223
150056.......................................................       1.9057       0.9757       0.9757      27.6754      28.2842      29.5718      28.5127
150057.......................................................       2.0352       0.9757       0.9757      22.7804      24.8605      29.6310      25.6224
150058.......................................................       1.5547       0.9677       0.9677      26.9753      27.5341      29.3647      28.0150
150059.......................................................       1.5388       0.9757       0.9757      27.0792      28.5715      32.4123      29.3673
150060.......................................................       1.0871            *            *      23.2409      24.8544            *      24.0586
150061.......................................................       1.1363       0.8479       0.8479      21.3640      22.2822      21.7707      21.8139
150062.......................................................       1.0931            *            *      23.5550      24.6088            *      24.0884
150063.......................................................          ***            *            *      19.0377            *            *      19.0377
150064.......................................................       1.2156       0.8479       0.8479      21.6370      23.7707      25.1734      23.5270
150065.......................................................       1.2414       0.9582       0.9582      24.4451      25.9461      27.9073      26.1176
150069.......................................................       1.2501       0.9599       0.9599      25.3445      25.2655      25.9517      25.5268
150070.......................................................          ***            *            *      22.6260            *            *      22.6260
150072.......................................................       1.1595       0.8479       0.8479      20.3191      20.5111      21.3608      20.7440

[[Page 24183]]

 
150074.......................................................       1.4564       0.9757       0.9757      24.4374      25.2586      25.6634      25.1233
150075.......................................................       1.0933       0.9498       0.9498      24.2085      24.0745      25.6197      24.6280
150076.......................................................       1.2852       0.9543       0.9543      24.1434      28.1874      28.2428      26.8000
150078.......................................................       1.0122            *            *      21.2476            *            *      21.2476
150079.......................................................       1.1145            *            *      20.6486      21.4067            *      21.0466
150082.......................................................       1.7181       0.8844       0.8844      22.2054      25.5860      28.1847      25.2933
150084.......................................................       1.7659       0.9757       0.9757      28.7722      29.3905      29.5244      29.2252
150086.......................................................       1.2036       0.9599       0.9599      22.4471      23.9404      25.2450      23.9229
150088.......................................................       1.2606       0.9582       0.9582      23.0998      23.6253      26.2241      24.3172
150089.......................................................       1.5861       0.8479       0.8479      22.6545      25.0449      24.6068      24.0532
150090.......................................................       1.5494       1.0596       1.0596      24.6758      26.2899      29.4725      26.7855
150091 h.....................................................       1.1148       1.0071       1.0071      27.8087      30.6209      30.7951      29.8811
150096.......................................................       0.9023            *            *      21.9091            *            *      21.9091
150097.......................................................       1.1238       0.9757       0.9757      24.4179      25.0367      27.1660      25.5838
150100.......................................................       1.7215       0.8844       0.8844      22.2687      24.3530      25.0773      23.8670
150101.......................................................       1.0867       0.9498       0.9498      27.9745      29.1657      29.8966      29.0799
150102.......................................................       1.0400       0.9278       0.9278      22.6870      24.5923      25.3187      24.2235
150104.......................................................       1.0401       0.9757       0.9757      21.8172      25.5871      28.5451      25.2739
150106 h.....................................................       1.0633       0.9498       0.9498      20.9955      20.9387      19.9273      20.5636
150109.......................................................       1.4441       0.8957       0.8957      24.3786      23.5865      26.0186      24.6513
150112.......................................................       1.4182       0.9582       0.9582      24.7455      26.5643      27.6269      26.3492
150113.......................................................       1.2634       0.9582       0.9582      23.0450      24.8760      26.0356      24.6828
150115.......................................................       1.4534       0.8479       0.8479      20.5215      19.3411      22.3372      20.6746
150122.......................................................       1.1613       0.9582       0.9582      24.2471      26.0173            *      25.1559
150123.......................................................          ***            *            *      15.3050            *            *      15.3050
150124.......................................................       1.1063            *            *      18.8218      21.3933            *      20.1237
150125.......................................................       1.4997       1.0596       1.0596      24.3872      26.7666      27.1394      26.1113
150126.......................................................       1.4372       1.0596       1.0596      25.5585      26.9887      27.7563      26.7967
150128.......................................................       1.4280       0.9757       0.9757      23.1660      26.4976      28.2773      25.9381
150129.......................................................       1.1690       0.9757       0.9757      35.4311      29.9099      30.1445      31.4914
150130.......................................................       1.0939            *            *      21.5678      21.7399            *      21.6494
150132.......................................................          ***            *            *      24.2559      25.6257      27.7474      25.8793
150133.......................................................       1.2322       0.9498       0.9498      21.8839      22.7293      25.1827      23.2488
150134.......................................................       1.0669       0.9137       0.9137      22.1085      23.8526      26.1958      23.9695
150136.......................................................          ***            *            *      25.7004      26.2703            *      25.9880
150146.......................................................       1.0555       0.9498       0.9498      26.1168      29.3383      30.2135      28.6444
150147.......................................................       1.2950       1.0596       1.0596      32.3336      22.8456      27.0517      26.4997
150148.......................................................          ***            *            *      27.2081            *            *      27.2081
150149.......................................................       1.0182       0.8844       0.8844      23.8554      23.6361      24.7733      24.1065
150150.......................................................       1.2596       0.9498       0.9498      26.5138      25.5331      28.4744      26.8947
150151.......................................................          ***            *            *            *      38.1446            *      38.1446
150152.......................................................          ***            *            *            *      44.7143            *      44.7143
150153.......................................................       2.4953       0.9757       0.9757            *            *      32.2301      32.2301
150154.......................................................       2.5331       0.9757       0.9757            *            *      29.2863      29.2863
150155.......................................................          ***            *            *            *            *      45.0525      45.0525
150156.......................................................          ***            *            *            *            *      25.8304      25.8304
150157.......................................................       1.5402       0.9757       0.9757            *            *            *            *
150158.......................................................       1.1799            *            *            *            *            *            *
150159.......................................................       0.9066            *            *            *            *            *            *
150160.......................................................       1.8672            *            *            *            *            *            *
150323.......................................................       0.8865            *            *            *            *            *            *
150325.......................................................       0.8673            *            *            *            *            *            *
160001.......................................................       1.1633       0.8976       0.8976      23.8657      25.1220      25.0365      24.6447
160003.......................................................       0.8939            *            *      19.0037            *            *      19.0037
160005.......................................................       1.1884       0.8696       0.8696      21.1745      21.8950      23.7127      22.2743
160008.......................................................       1.0864       0.8696       0.8696      19.8066      20.7200      22.3526      20.9456
160013.......................................................       1.2716       0.8914       0.8914      23.0163      23.7163      24.6784      23.7825
160014.......................................................       0.9604            *            *      19.2447      20.5882            *      19.9190
160016.......................................................       1.5629       0.8976       0.8976      21.2785      23.3619      24.6900      23.1167
160020.......................................................       1.1096            *            *      19.0043      19.5554            *      19.2901
160024.......................................................       1.6059       0.9136       0.9136      24.2385      26.2392      27.4041      25.9650
160026.......................................................       1.0140            *            *      24.2045      24.7424            *      24.4805
160028.......................................................       1.3221       0.9453       0.9453      26.0052      26.2948      28.0717      26.9016
160029.......................................................       1.6161       0.9726       0.9726      24.9493      27.9277      29.7097      27.5319
160030.......................................................       1.4263       0.9819       0.9819      24.9920      26.7068      28.9474      26.8746
160031.......................................................       0.9870            *            *      18.5281      19.7368            *      19.1263

[[Page 24184]]

 
160032.......................................................       1.0729       0.8968       0.8968      22.3837      23.4727      25.7041      23.9167
160033.......................................................       1.7593       0.8696       0.8696      23.4148      24.6768      26.5814      24.9317
160034.......................................................       0.9775            *            *      19.4837      19.3503            *      19.4156
160039.......................................................       0.9863            *            *      20.9623      22.1180            *      21.5414
160040.......................................................       1.2803       0.8891       0.8696      21.8187      23.9053      25.6843      23.8388
160044.......................................................       1.1510            *            *      19.5635            *            *      19.5635
160045.......................................................       1.7325       0.8891       0.8891      24.4957      25.4153      26.9819      25.6677
160047.......................................................       1.4056       0.9453       0.9453      24.5000      25.2072      25.6964      25.1382
160048.......................................................       1.0401            *            *      19.5701      19.5832            *      19.5767
160050.......................................................       1.1294            *            *      23.8830      24.5403            *      24.2221
160057.......................................................       1.2446       0.9568       0.9568      22.0472      23.0937      25.1339      23.4637
160058.......................................................       1.9653       0.9726       0.9726      25.5244      27.1646      28.6411      27.1442
160064.......................................................       1.5286       0.9256       0.9256      27.6301      28.6139      28.7718      28.4086
160066.......................................................       1.0600            *            *      21.4631      22.7709            *      22.1300
160067.......................................................       1.3137       0.8891       0.8696      21.9418      23.4060      23.7824      23.1319
160069.......................................................       1.5111       0.9132       0.9132      22.7514      25.3402      27.7295      25.2986
160074.......................................................       1.0989            *            *      20.2418            *            *      20.2418
160076.......................................................          ***            *            *      20.9749            *            *      20.9749
160079.......................................................       1.5393       0.8891       0.8891      22.5299      23.7234      25.4508      23.9274
160080.......................................................       1.3064       0.8696       0.8696      23.5721      23.1837      25.9475      24.2696
160081.......................................................       1.1664            *            *      21.3614      23.1930            *      22.2788
160082.......................................................       1.8161       0.9136       0.9136      23.8181      26.4398      27.2896      25.8257
160083.......................................................       1.6913       0.9136       0.9136      25.0617      28.2193      27.3867      26.9189
160089.......................................................       1.2968       0.8976       0.8976      21.5693      22.6551      23.6643      22.6499
160090.......................................................       0.8236            *            *      21.2753            *            *      21.2753
160091.......................................................       0.9377            *            *      18.0630      17.9862            *      18.0240
160092.......................................................       0.9932            *            *      22.0841            *            *      22.0841
160101.......................................................       1.1187       0.9136       0.9136      24.2309      25.1000      23.7690      24.3536
160104.......................................................       1.5181       0.8696       0.8696      24.0075      24.9134      28.0389      25.6671
160106.......................................................          ***            *            *      21.4912            *            *      21.4912
160107.......................................................          ***            *            *      21.3754            *            *      21.3754
160110.......................................................       1.5282       0.8891       0.8696      24.1762      24.9434      26.9342      25.3634
160112.......................................................       1.2386       0.8696       0.8696      21.8901      23.0672      25.2434      23.4606
160113.......................................................          ***            *            *      18.6599            *            *      18.6599
160115.......................................................       1.0432            *            *      19.5764            *            *      19.5764
160116.......................................................       1.0175            *            *      22.2019            *            *      22.2019
160117.......................................................       1.3193       0.9132       0.9132      23.4250      25.0278      25.9502      24.8152
160118.......................................................          ***            *            *      18.3322      19.7764            *      19.0436
160122.......................................................       1.1051       0.8696       0.8696      22.9565      22.5872      23.9298      23.1689
160124.......................................................       1.1607       0.8696       0.8696      22.7223      23.1690      23.1591      23.0224
160126.......................................................       1.0173            *            *      20.3748      19.8323            *      20.1046
160140.......................................................       1.0475            *            *      22.5230            *            *      22.5230
160146.......................................................       1.4589       0.9201       0.9201      20.9583      22.9897      22.5441      22.1450
160147.......................................................       1.3443       0.8976       0.8976      26.6577      26.6438      28.6722      27.3688
160153.......................................................       1.6297       0.9201       0.9201      26.3671      28.9881      30.5992      28.6813
160154.......................................................       0.9033            *            *            *            *            *            *
160365.......................................................       0.7586            *            *            *            *            *            *
160366.......................................................       0.8054            *            *            *            *            *            *
170001.......................................................       1.2262       0.8017       0.8017      20.9837      21.9131      23.0583      21.9743
170006.......................................................       1.2593       0.8620       0.8620      20.6460      21.9019      24.5553      22.4217
170009.......................................................       1.0705       0.9501       0.9501      29.1979      29.2588      31.2360      29.8767
170010.......................................................       1.2077       0.8146       0.8146      21.2131      24.0008      24.9889      23.4347
170012.......................................................       1.6500       0.8832       0.8832      22.6869      24.7392      25.8453      24.4008
170013.......................................................       1.5264       0.8832       0.8832      23.1159      25.0419      25.9854      24.7349
170014.......................................................       1.0386       0.9501       0.9501      22.9772      23.5960      24.9156      23.8535
170015.......................................................       1.0240            *            *      19.1902      20.2367            *      19.7243
170016.......................................................       1.6420       0.8738       0.8738      24.2336      25.9482      26.3308      25.5277
170017.......................................................       1.1104       0.9093       0.9093      23.3030      24.7771      26.6342      24.9721
170018.......................................................       0.9385            *            *      17.9497            *            *      17.9497
170019.......................................................       1.1619            *            *      20.3243      22.0251            *      21.1885
170020.......................................................       1.5720       0.8832       0.8832      22.2571      23.1800      22.6799      22.7039
170022.......................................................       1.1286            *            *      22.9313      22.2878            *      22.6058
170023.......................................................       1.4438       0.8832       0.8832      23.2690      23.9808      24.4018      23.8806
170027.......................................................       1.4472       0.8017       0.8017      21.4678      22.5103      22.9256      22.2935
170033.......................................................       1.3383       0.8832       0.8832      20.0801      20.7865      22.0776      20.9737
170039.......................................................       0.9534       0.9093       0.9093      20.1983      21.5203      25.4845      22.1744

[[Page 24185]]

 
170040.......................................................       1.9280       0.9501       0.9501      27.1771      28.2856      28.9419      28.1702
170049.......................................................       1.4737       0.9501       0.9501      24.1208      24.7895      26.3910      25.1440
170052.......................................................       1.2142            *            *      17.3794      18.5291            *      17.9769
170054.......................................................          ***            *            *      17.5500            *            *      17.5500
170058.......................................................       1.0587       0.9501       0.9501      22.0398      23.3398      23.1208      22.8378
170068.......................................................       1.2219       0.9177       0.9177      20.8771      22.6087      22.6765      22.0710
170070.......................................................       0.9818            *            *      16.4767      16.0162            *      16.2556
170074.......................................................       1.2412       0.8017       0.8017      20.4936      21.0565      23.2439      21.6462
170075.......................................................       0.8380       0.8017       0.8017      16.2047      16.5444      18.8919      17.1984
170085.......................................................       0.9089            *            *      18.4867            *            *      18.4867
170086.......................................................       1.5716       0.8738       0.8738      22.7737      24.0812      25.4693      24.1433
170090.......................................................          ***            *            *      15.9807            *            *      15.9807
170093.......................................................       0.8381            *            *      16.8710      16.5553            *      16.7116
170094.......................................................       0.9782       0.8017       0.8017      20.3678      21.3887      20.9912      20.9361
170097.......................................................          ***            *            *      20.3391            *            *      20.3391
170098.......................................................       0.9894            *            *      20.0078      20.1242            *      20.0657
170103.......................................................       1.2387       0.9093       0.9093      21.4985      22.8707      23.7154      22.7347
170104.......................................................       1.5107       0.9501       0.9501      26.1866      26.9671      27.8829      27.0103
170105.......................................................       1.0190       0.8017       0.8017      19.6687      21.4422      21.9852      21.0428
170109.......................................................       1.0433       0.9501       0.9501      22.7166      23.2626      24.1847      23.3947
170110.......................................................       0.9597       0.8017       0.8017      21.8904      22.9195      22.8693      22.5555
170114.......................................................       0.8804            *            *      18.1610      18.9158            *      18.5532
170116.......................................................          ***            *            *      23.1127            *            *      23.1127
170120.......................................................       1.3358       0.8620       0.8620      19.8723      21.0499      22.1507      21.0257
170122.......................................................       1.6367       0.9093       0.9093      24.6532      25.3981      26.6964      25.5707
170123.......................................................       1.6568       0.9093       0.9093      26.4676      27.2239      28.2363      27.2774
170133.......................................................       1.0499       0.9501       0.9501      21.7748      22.9309      22.9094      22.5427
170137.......................................................       1.2403       0.8017       0.8017      22.7676      23.8863      24.7063      23.8048
170142.......................................................       1.3495       0.8591       0.8591      22.4095      22.5778      23.3910      22.8083
170143.......................................................       1.2000            *            *      19.7643      20.4459            *      20.1017
170144.......................................................          ***            *            *      24.4259      24.6260            *      24.5144
170145.......................................................       1.0697       0.8017       0.8017      21.4472      21.5756      23.1863      22.0533
170146.......................................................       1.4687       0.9501       0.9501      28.1965      29.1358      30.3055      29.2105
170147.......................................................       2.0068       0.9093       0.9093      23.1610      21.4753      22.7160      22.4146
170150.......................................................       1.1923       0.8017       0.8017      17.4916      18.5744      20.1810      18.7858
170166.......................................................       1.0396       0.8017       0.8017      18.5978      19.2842      19.8233      19.2265
170175.......................................................       1.3814       0.8832       0.8832      23.6262      23.9304      25.8196      24.4660
170176.......................................................       1.5073       0.9501       0.9501      24.2283      26.2366      28.0633      26.1546
170180.......................................................          ***            *            *            *      25.1366            *      25.1366
170182.......................................................       1.4744       0.9501       0.9501      24.3820      25.7443      28.2886      26.1597
170183.......................................................       1.9823       0.9093       0.9093      22.8633      24.5539      26.0515      24.4826
170185.......................................................       1.3263       0.9501       0.9501      24.8478      26.7797      29.1199      27.2051
170186.......................................................       2.6919       0.9093       0.9093      30.5157      31.7896      33.0190      31.8475
170187.......................................................       1.4655       0.8017       0.8017      21.0780      23.3702      24.4045      22.9793
170188.......................................................       2.0410       0.9501       0.9501      27.2225      29.9751      31.8257      29.7873
170190.......................................................       1.0729       0.8591       0.8591      22.4865      22.8729      22.9911      22.7762
170191.......................................................       1.6457       0.8017       0.8017      24.9599      21.3069      22.2346      22.8619
170192.......................................................       2.0073       0.9093       0.9093            *      27.9704      27.0735      27.4857
170193.......................................................       1.6307       0.8832       0.8832            *      24.7430      18.4870      21.4458
170194.......................................................       1.3722       0.9501       0.9501            *      27.9904      30.7548      29.6973
170195.......................................................       2.0069       0.9501       0.9501            *            *      30.6081      30.6081
170196.......................................................       2.2556       0.9093       0.9093            *            *            *            *
170332.......................................................       0.7372            *            *            *            *            *            *
170344.......................................................       0.7933            *            *            *            *            *            *
170374.......................................................       0.8095            *            *            *            *            *            *
170375.......................................................       0.7667            *            *            *            *            *            *
180001.......................................................       1.2904       0.9599       0.9599      24.7647      25.4217      27.4380      25.9006
180002.......................................................       1.0856       0.7793       0.7793      21.6843      22.9727      25.5510      23.4521
180004.......................................................       1.0814       0.7793       0.7793      19.0834      19.5437      21.2755      19.9789
180005.......................................................       1.0940       0.8759       0.8759      22.8871      24.5561      24.9313      24.1526
180006.......................................................       0.8701            *            *      15.7136      14.8011            *      15.2405
180007.......................................................       1.4568       0.9168       0.9168      21.8724      22.7606      26.4901      23.7049
180009.......................................................       1.6569       0.9009       0.9009      24.0971      25.3837      26.6728      25.3971
180010.......................................................       1.9267       0.9168       0.9168      26.4116      24.7256      25.7070      25.5805
180011.......................................................       1.3761       0.8928       0.8928      22.3183      22.7364      25.6662      23.5939
180012.......................................................       1.4709       0.9137       0.9137      22.9096      24.6642      25.8098      24.4828

[[Page 24186]]

 
180013.......................................................       1.4693       0.9571       0.9571      21.4728      22.9512      23.9232      22.7868
180016.......................................................       1.3146       0.9137       0.9137      22.2148      23.1832      24.9302      23.4667
180017.......................................................       1.2778       0.8207       0.8207      19.0694      20.8630      21.9306      20.6221
180018.......................................................       1.3860       0.8928       0.8928      18.3314      19.0992      20.9508      19.4438
180019.......................................................       1.1175       0.9599       0.9599      22.0379      24.1342      24.2365      23.4611
180020.......................................................       1.0710       0.7793       0.7793      22.3477      21.9494      24.3479      22.9113
180021.......................................................       0.9567       0.7793       0.7793      17.9346      18.5966      19.2640      18.6011
180024.......................................................       1.1122       0.9137       0.9137      23.6826      32.1824      31.3281      28.9328
180025.......................................................       1.1108       0.9137       0.9137      17.4781      19.1543      22.8383      19.7600
180026.......................................................       1.0695            *            *      15.8431      18.2120            *      17.0401
180027.......................................................       1.1962       0.8094       0.8094      22.1072      23.8763      21.2891      22.3439
180028.......................................................       0.9346       0.8759       0.8759      21.4766      24.7968      25.4328      23.9001
180029.......................................................       1.3805       0.8062       0.8062      21.2110      23.0536      25.1372      23.1824
180035.......................................................       1.6266       0.9599       0.9599      26.7702      29.8438      31.8857      29.5742
180036.......................................................       1.2029       0.9009       0.9009      23.1636      25.1154      25.8131      24.6472
180037.......................................................       1.2572       0.9137       0.9137      24.4451      25.7361      26.3742      25.5161
180038.......................................................       1.4800       0.8780       0.8780      22.2750      24.6348      25.9911      24.2496
180040.......................................................       2.0538       0.9137       0.9137      24.5590      26.2125      27.7343      26.2542
180041.......................................................          ***            *            *      18.5483            *            *      18.5483
180043.......................................................       1.1754       0.7793       0.7793      18.8436      19.0617      20.6947      19.5226
180044.......................................................       1.6181       0.8759       0.8759      21.6837      23.0971      24.6946      23.1584
180045.......................................................       1.3355       0.9599       0.9599      24.5856      25.8349      27.3369      25.9400
180046.......................................................       1.0532       0.9168       0.9168      24.7562      27.2244      27.5609      26.5441
180047.......................................................       0.9169            *            *      20.4768      21.8037            *      21.1276
180048.......................................................       1.2720       0.9137       0.9137      22.3601      21.6571      23.9768      22.6449
180049 h.....................................................       1.3907       0.9744       0.9744      19.4488      23.3407      23.1703      22.0488
180050.......................................................       1.1591       0.7793       0.7793      21.7150      22.6473      25.5270      23.2474
180051.......................................................       1.2771       0.8431       0.8431      19.2100      21.3312      23.0986      21.2619
180053.......................................................       1.0110       0.7793       0.7793      18.6610      19.1578      20.0309      19.3175
180054.......................................................          ***            *            *      19.0657            *            *      19.0657
180055.......................................................       1.1340            *            *      21.1989      20.7237            *      20.9496
180056.......................................................       1.1090       0.8844       0.8844      21.4695      22.8910      24.9363      23.0960
180063.......................................................       1.1323            *            *      15.9185      17.9741            *      17.0063
180064.......................................................       1.2625       0.7793       0.7793      15.3819      16.2638      17.2395      16.3222
180066.......................................................       1.1353       0.9571       0.9571      24.6359      24.9543      22.6968      24.0612
180067.......................................................       2.0454       0.9168       0.9168      24.0551      25.4080      27.3195      25.5822
180069.......................................................       1.0900       0.8759       0.8759      20.8797      22.3674      24.8052      22.7309
180070.......................................................       1.1763       0.7793       0.7793      17.4266      20.1308      20.6670      19.4044
180078.......................................................       1.1205       0.8759       0.8759      25.4196      26.2636      27.6613      26.4740
180079.......................................................       1.1252       0.7793       0.7793      19.5783      19.7791      20.0616      19.8220
180080.......................................................       1.2929       0.8278       0.8278      20.1651      21.7380      21.3549      21.0816
180087.......................................................       1.2016       0.7793       0.7793      17.7758      18.4331      19.5444      18.6024
180088.......................................................       1.6372       0.9137       0.9137      24.6053      27.5767      28.1804      26.8275
180092.......................................................       1.1833       0.9168       0.9168      22.4864      22.5679      24.2126      23.0944
180093.......................................................       1.5187       0.8545       0.8545      19.2748      20.5422      21.1607      20.3257
180095.......................................................       1.0540       0.7793       0.7793      17.1354      17.9677      17.9541      17.6956
180101.......................................................       1.1164       0.9168       0.9168      24.2242      25.4796      28.3249      26.0568
180102.......................................................       1.6318       0.8094       0.8094      19.1136      18.4388      21.2737      19.5783
180103.......................................................       2.1888       0.9168       0.9168      25.1577      26.9407      28.4766      26.8190
180104.......................................................       1.6266       0.8094       0.8094      22.8911      24.9441      25.9248      24.6219
180105.......................................................       0.8701       0.7793       0.7793      19.5364      19.7615      19.8581      19.7194
180106.......................................................       0.9335       0.7793       0.7793      15.7851      17.8020      19.1634      17.6990
180115.......................................................       0.9382       0.7793       0.7793      19.9316      20.9831      20.2666      20.3950
180116.......................................................       1.2247       0.8210       0.8210      21.8698      22.7353      23.1396      22.5915
180117.......................................................       0.9727       0.7793       0.7793      20.5952      21.1854      22.4436      21.4051
180124.......................................................       1.3041       0.9571       0.9571      21.4270      23.1917      24.9816      23.2096
180126.......................................................       1.0703            *            *      15.1776            *            *      15.1776
180127.......................................................       1.3028       0.9137       0.9137      21.4633      23.4765      24.8603      23.2919
180128.......................................................       0.9146       0.8075       0.8075      20.5575      20.8406      21.9414      21.1232
180130.......................................................       1.6643       0.9137       0.9137      24.8441      26.0278      27.7053      26.2114
180132.......................................................       1.4816       0.8928       0.8928      22.2101      23.7652      24.5256      23.5331
180134.......................................................       1.0218            *            *      17.3449      18.6779            *      18.0324
180138.......................................................       1.2283       0.9137       0.9137      25.1789      27.3400      28.8157      27.1346
180139.......................................................       1.0399       0.8928       0.8928      21.3797      23.5363      23.3285      22.7513
180141.......................................................       1.8300       0.9137       0.9137      24.3140      25.3042      25.3054      24.9917
180143.......................................................       1.6199       0.9168       0.9168      23.9125      25.1613      28.6078      26.0627

[[Page 24187]]

 
180144.......................................................          ***            *            *            *            *      30.3286      30.3286
180147.......................................................       1.6674       0.8164       0.8164            *            *            *            *
180148.......................................................       1.9111       0.7793       0.7793            *            *            *            *
180325.......................................................       0.6167            *            *            *            *            *            *
190001.......................................................       1.1128       0.8855       0.8855      19.5680      19.7516      21.5505      20.3938
190002.......................................................       1.6807       0.8300       0.8300      21.7000      22.0056      23.3871      22.3593
190003.......................................................       1.4747       0.8300       0.8300      21.8156      23.4977      25.1210      23.4734
190004.......................................................       1.3195       0.8003       0.8003      22.1835      23.3290      24.5339      23.3634
190005.......................................................       1.4444       0.8855       0.8855      20.7987      22.3208      23.3281      22.1604
190006.......................................................       1.3548       0.8300       0.8300      19.4573      22.2467      22.8415      21.4705
190007.......................................................       1.1671       0.7487       0.7487      18.7854      19.7528      21.6654      20.0400
190008.......................................................       1.7539       0.8003       0.8003      21.4137      24.0111      24.7413      23.4477
190009.......................................................       1.1787       0.8028       0.8028      18.8295      19.8404      21.1607      19.8729
190010.......................................................       1.0751            *            *      19.9788      21.6889            *      20.8295
190011.......................................................       1.0542       0.8015       0.8015      18.1525      19.7319      20.7613      19.5483
190013.......................................................       1.5067       0.7934       0.7934      19.6346      20.8626      21.8582      20.7874
190014.......................................................       1.2522       0.7487       0.7487      17.4740      22.4596      22.4213      20.6365
190015.......................................................       1.3280       0.8855       0.8855      22.1046      22.8875      24.0393      23.0562
190017 h.....................................................       1.3326       0.8535       0.8535      18.6962      21.5033      23.9006      21.2079
190019.......................................................       1.7368       0.8028       0.8028      23.0704      23.7168      24.9325      23.9113
190020.......................................................       1.1669       0.8102       0.8102      19.8505      21.6136      21.7393      21.0389
190025.......................................................       1.1904       0.7487       0.7487      20.4651      20.8950      22.7566      21.3808
190026.......................................................       1.5893       0.8028       0.8028      21.3386      22.5087      23.6452      22.5325
190027.......................................................       1.7130       0.7934       0.7934      21.2449      21.2526      24.1159      22.1755
190034.......................................................       1.1212       0.7487       0.7487      17.5002      19.6943      20.1435      19.1254
190036.......................................................       1.7154       0.8855       0.8855      23.7356      24.8152      26.1501      24.8932
190037.......................................................       1.0152       0.7934       0.7934      16.7629      18.6393      19.4805      18.2227
190039.......................................................       1.4789       0.8855       0.8855      23.3105      25.6665      24.8064      24.6160
190040.......................................................       1.3347       0.8855       0.8855      23.8076      26.7428      29.1926      26.4378
190041.......................................................       1.4817       0.8879       0.8879      23.9082      24.6734      28.2604      25.5075
190043.......................................................       0.9762            *            *      16.8944      17.3477            *      17.1195
190044 h.....................................................       1.2847       0.8300       0.8300      19.5304      19.5567      19.6876      19.5901
190045.......................................................       1.6052       0.8855       0.8855      24.0490      25.3854      26.1439      25.2015
190046.......................................................       1.4230       0.8855       0.8855      22.2884      24.2128      24.4763      23.6621
190048.......................................................       1.0930       0.7487       0.7487      18.6148      19.6288      24.1444      20.4885
190049.......................................................          ***            *            *      20.1229            *            *      20.1229
190050.......................................................       1.1065       0.7487       0.7487      18.5287      19.1076      20.2752      19.3127
190053.......................................................       1.0904       0.7487       0.7487      15.7258      16.4968      17.0974      16.4674
190054.......................................................       1.3124       0.7594       0.7594      20.3525      20.1108      22.5554      21.0238
190059.......................................................       0.8305            *            *      19.2396            *            *      19.2396
190060.......................................................       1.4882       0.7934       0.7934      22.2517      23.6278      23.7228      23.1972
190064.......................................................       1.5792       0.8102       0.8102      21.5514      23.3617      23.1018      22.6984
190065.......................................................       1.5196       0.8102       0.8102      23.0523      23.7450      23.2052      23.3343
190077.......................................................       0.9219            *            *      18.4043      18.8409            *      18.6185
190078 h.....................................................       1.0622       0.8535       0.8535      21.5782      21.3786      21.4302      21.4587
190079.......................................................       1.2803       0.8855       0.8855      21.8158      21.2546      24.5361      22.5734
190081.......................................................       0.8857       0.7487       0.7487      14.9141      15.6146      17.3888      15.9862
190083.......................................................       0.8253            *            *      19.2683            *            *      19.2683
190086.......................................................       1.2411       0.8015       0.8015      18.8306      19.8823      21.7601      20.1681
190088 h.....................................................       1.0582       0.9584       0.9584      22.5045      22.3480      23.7776      22.8555
190089.......................................................       1.0009            *            *      16.2961            *            *      16.2961
190090.......................................................       1.0399       0.7487       0.7487      20.0745      20.2045      21.9736      20.8003
190095.......................................................          ***            *            *      18.7302      18.0174            *      18.3606
190098.......................................................       1.6321       0.8879       0.8879      23.0802      24.6353      25.4941      24.4176
190099.......................................................       0.9927       0.8102       0.8102      21.1657      20.4597      21.4308      21.0206
190102.......................................................       1.5637       0.8300       0.8300      23.4618      25.2267      26.2644      24.9673
190106.......................................................       1.1741       0.8028       0.8028      21.5643      21.7228      22.9793      22.1017
190109.......................................................       1.1062       0.8003       0.8003      17.4842      18.6524      19.7946      18.5909
190110.......................................................       0.9270            *            *      19.0611            *            *      19.0611
190111.......................................................       1.6432       0.8879       0.8879      25.2370      24.4998      26.0669      25.2574
190114.......................................................       1.0698       0.7487       0.7487      14.6258      15.8031      15.8975      15.4576
190115.......................................................       1.1109       0.8879       0.8879      26.0272      26.6295      27.9894      26.8610
190116.......................................................       1.2757       0.7487       0.7487      18.6074      20.3844      21.4300      20.1684
190118.......................................................       0.9548       0.8879       0.8879      19.0200      19.7025      20.6847      19.8213
190122.......................................................       1.2678       0.8102       0.8102      19.3131      23.7082      21.6887      21.4626
190124.......................................................       1.5845       0.8855       0.8855      23.4862      24.6675      26.4280      24.8426

[[Page 24188]]

 
190125.......................................................       1.6592       0.8015       0.8015      22.3976      23.9649      25.7211      23.9666
190128.......................................................       1.0106       0.8102       0.8102      24.7842      27.9136      28.1804      26.9928
190130.......................................................       1.0390            *            *      16.6910            *            *      16.6910
190131.......................................................       1.1810       0.8855       0.8855      22.5032      25.1917      27.3959      25.0842
190133.......................................................       0.9292       0.7725       0.7725      14.3089      13.6266      17.7890      15.7239
190135.......................................................       1.5040       0.8855       0.8855      26.9920      26.8238      28.2929      27.3619
190140.......................................................       1.0098       0.7487       0.7487      17.0371      17.6936      18.5731      17.7798
190144 h.....................................................       1.1524       0.9584       0.9584      21.1658      21.7547      23.1334      22.0403
190145.......................................................       0.9656       0.7487       0.7487      17.3361      18.9678      18.4810      18.2716
190146.......................................................       1.5838       0.8855       0.8855      23.7721      26.1792      27.6317      25.7618
190148.......................................................          ***            *            *      20.8321            *            *      20.8321
190149.......................................................       0.9370            *            *      17.1671      18.8819            *      17.9835
190151.......................................................       0.9812       0.7487       0.7487      17.8741      18.6293      17.5239      18.0074
190152.......................................................       1.3746       0.8855       0.8855      27.4708      27.6099      29.4694      28.1681
190156.......................................................       0.8864            *            *      18.3702            *            *      18.3702
190158.......................................................       1.5509       0.8855       0.8855      26.2352      26.3042      27.1110      26.5427
190160.......................................................       1.5748       0.8015       0.8015      20.0025      21.6740      22.7598      21.4114
190161.......................................................       1.0826       0.7934       0.7934      17.8794      19.1022      22.3359      19.6222
190162.......................................................          ***            *            *      22.1781      25.0328      25.7829      24.2603
190164.......................................................       1.0953       0.8028       0.8028      21.4247      22.8599      24.0576      22.8477
190167.......................................................       1.1968       0.7487       0.7487      17.8604      24.3185      25.8153      22.5159
190175.......................................................       1.3812       0.8855       0.8855      24.6790      27.1531      26.1048      26.0265
190176.......................................................       1.7672       0.8855       0.8855      25.8482      25.6997      26.8503      26.1394
190177.......................................................       1.7055       0.8855       0.8855      25.4769      27.4621      27.9703      26.9919
190182.......................................................       1.0531       0.8855       0.8855      25.0837      28.4799      27.5625      26.9440
190183.......................................................       1.1374       0.8003       0.8003      18.3151      19.8084      22.0079      19.9316
190184.......................................................       0.9618       0.7648       0.7648      21.3191      23.9609      22.4219      22.5353
190185.......................................................       1.4457       0.8855       0.8855      24.4176      24.7912      26.1253      25.1793
190190.......................................................       0.8819       0.7648       0.7648      14.0052      16.1195      22.9091      18.5382
190191 h.....................................................       1.3219       0.8102       0.8102      22.3755      23.5734      23.3481      23.1104
190196.......................................................       0.9313       0.8300       0.8300      21.9355      24.7135      24.3478      23.6938
190197.......................................................       1.3995       0.8015       0.8015      22.9631      24.3735      25.2869      24.1817
190199.......................................................       1.1332       0.8102       0.8102      18.5317      14.1410      18.4387      16.8503
190200.......................................................          ***            *            *      26.4258      27.5681      29.3041      27.5730
190201.......................................................       1.4773       0.7934       0.7934      22.5588      24.5877      25.3816      24.2106
190202.......................................................       1.3534       0.8102       0.8102      21.8900      24.7944      26.9337      24.6847
190203.......................................................       5.8369       0.8855       0.8855      26.9099      26.8795      28.7207      27.4692
190204.......................................................       1.4705       0.8855       0.8855      28.8777      28.3684      28.9970      28.7443
190205.......................................................       1.7340       0.8300       0.8300      21.7696      24.4540      25.8360      24.0124
190206.......................................................       1.5267       0.8855       0.8855      26.9117      26.0139      26.9116      26.6047
190208.......................................................       0.8148       0.7487       0.7487      24.8409      24.2586      24.8507      24.6578
190218.......................................................       1.1776       0.8715       0.8715      23.9182      25.0356      26.1218      25.0378
190236.......................................................       1.4266       0.8879       0.8879      23.8233      23.6824      25.3463      24.2960
190240.......................................................          ***            *            *      13.9888            *            *      13.9888
190241.......................................................       1.4098       0.8003       0.8003      28.9620      23.9700      24.8072      25.7035
190242.......................................................       1.1366       0.8102       0.8102      20.5937      23.0072      24.3809      22.7673
190243.......................................................          ***            *            *      30.6060            *            *      30.6060
190245.......................................................       1.6145       0.8015       0.8015            *      27.1786      26.0610      26.6431
190246.......................................................       1.7005       0.7648       0.7648            *            *            *            *
190247.......................................................          ***            *            *            *            *      32.6169      32.6169
190248.......................................................          ***            *            *            *            *      22.5610      22.5610
190249.......................................................       1.6224       0.8102       0.8102            *            *      19.9654      19.9654
190250.......................................................       2.2982       0.8855       0.8855            *            *      30.7776      30.7776
190251.......................................................       1.3551       0.8102       0.8102            *            *      22.7409      22.7409
190252.......................................................          ***            *            *            *            *      23.5958      23.5958
190253.......................................................       1.0067       0.8855       0.8855            *            *      23.2202      23.2202
190254.......................................................          ***            *            *            *            *      32.7951      32.7951
190255.......................................................       0.7132       0.8300       0.8300            *            *      23.6948      23.6948
190256.......................................................       1.0318       0.8855       0.8855            *            *            *            *
190257.......................................................       1.6790       0.7487       0.7487            *            *      23.3563      23.3563
190258.......................................................       1.6850       0.8879       0.8879            *            *      31.4217      31.4217
190259.......................................................       1.6898       0.8300       0.8300            *            *            *            *
190260.......................................................       1.4951       0.8855       0.8855            *            *            *            *
190261.......................................................       0.8481       0.8015       0.8015            *            *            *            *
190262.......................................................       1.3581       0.8855       0.8855            *            *            *            *
190263.......................................................       2.3925       0.8300       0.8300            *            *            *            *

[[Page 24189]]

 
190264.......................................................       0.8475            *            *            *            *            *            *
190265.......................................................       1.7577            *            *            *            *            *            *
190266.......................................................       2.1798            *            *            *            *            *            *
190267.......................................................       1.1686            *            *            *            *            *            *
190268.......................................................       1.0792            *            *            *            *            *            *
190272.......................................................       1.5252            *            *            *            *            *            *
190315.......................................................       0.6227            *            *            *            *            *            *
190319.......................................................       0.6636            *            *            *            *            *            *
190322.......................................................       0.6534            *            *            *            *            *            *
200001.......................................................       1.3968       0.9702       0.9702      23.2210      25.1145      25.2214      24.5549
200002.......................................................       1.1618       0.8528       0.8528      24.1446      25.7478      25.8372      25.2072
200007.......................................................       1.0634            *            *      22.3920            *            *      22.3920
200008.......................................................       1.3499       0.9916       0.9916      25.1741      27.4412      28.1910      26.9280
200009.......................................................       1.9130       0.9916       0.9916      28.1409      31.1056      30.5597      29.9288
200012.......................................................       1.2286            *            *      24.1243      25.7623            *      24.9713
200013.......................................................       1.0902            *            *      23.9048      24.4131            *      24.1576
200018.......................................................       1.3112       0.8399       0.8399      24.3294      23.6337      23.3123      23.7070
200019.......................................................       1.2865       0.9916       0.9916      24.0926      25.1367      25.9081      25.0652
200020.......................................................       1.2500       1.0309       1.0309      28.7351      31.7083      33.4438      31.3595
200021.......................................................       1.2371       0.9916       0.9916      25.1027      24.5519      27.4575      25.7589
200024.......................................................       1.5547       0.9487       0.9487      24.6484      26.0080      26.9002      25.9263
200025.......................................................       1.1601       0.9916       0.9916      24.3646      26.0573      27.0379      25.8101
200026.......................................................          ***            *            *      21.9997            *            *      21.9997
200027.......................................................       1.2078            *            *      23.2912      26.3118            *      24.7659
200028.......................................................       1.0082            *            *      24.3061      24.3271            *      24.3172
200031.......................................................       1.2800       0.8399       0.8399      20.6202      21.9489      21.2055      21.2587
200032.......................................................       1.1803       0.8865       0.8865      24.2221      25.5227      26.6057      25.4585
200033.......................................................       1.8640       0.9702       0.9702      26.8727      28.6479      29.5897      28.3730
200034.......................................................       1.3356       0.9487       0.9487      26.1150      26.2926      27.3852      26.6073
200037.......................................................       1.1709       0.8399       0.8399      23.3490      23.2333      24.3927      23.6760
200039.......................................................       1.2856       0.9487       0.9487      24.0474      25.1196      24.9813      24.7257
200040.......................................................       1.2411       0.9916       0.9916      23.6791      25.5405      26.1019      25.0872
200041.......................................................       1.1777       0.8399       0.8399      23.6797      24.5532      24.8537      24.3828
200050.......................................................       1.2158       0.9702       0.9702      25.5233      26.4992      27.7986      26.6203
200052.......................................................       1.1205       0.8399       0.8399      22.7763      21.8726      22.6132      22.4260
200063.......................................................       1.1573       0.9487       0.9487      24.7235      25.0167      25.9508      25.2331
200066.......................................................       1.1290            *            *      21.6354            *            *      21.6354
210001.......................................................       1.4173       0.9211       0.9211      26.3144      27.7561      27.6008      27.2238
210002.......................................................       1.9843       1.0090       1.0090      25.2859      26.4992      32.7693      28.0377
210003.......................................................       1.6774       1.1076       1.1076      32.3042      29.8684      34.2570      32.1281
210004.......................................................       1.4303       1.1068       1.1068      29.4300      34.2392      33.2835      32.3122
210005.......................................................       1.2792       1.1028       1.1028      27.1276      28.7557      28.9736      28.2902
210006.......................................................       1.0955       1.0090       1.0090      25.6396      25.4081      26.5757      25.8788
210007.......................................................       1.9108       1.0090       1.0090      28.4496      30.2548      32.0607      30.2720
210008.......................................................       1.3721       1.0090       1.0090      26.3008      25.2833      24.6380      25.3549
210009.......................................................       1.7671       1.0090       1.0090      24.6332      26.2360      28.7516      26.5487
210010.......................................................          ***            *            *      24.5071      25.7775            *      25.1483
210011.......................................................       1.4072       1.0090       1.0090      24.8373      27.5031      29.9956      27.5064
210012.......................................................       1.6687       1.0090       1.0090      25.7934      27.4103      30.3738      27.9884
210013.......................................................       1.3016       1.0090       1.0090      23.9875      25.1348      28.1586      25.7366
210015.......................................................       1.3253       1.0090       1.0090      25.8532      28.2029      30.4000      28.1869
210016.......................................................       1.8484       1.1068       1.1068      28.6992      32.2081      32.9950      31.2873
210017.......................................................       1.2333       0.8946       0.8946      21.3983      23.2168      24.8570      23.1911
210018.......................................................       1.2046       1.1068       1.1068      27.5431      29.1870      29.7414      28.8513
210019.......................................................       1.7934       0.8958       0.8958      24.9252      26.1824      27.6140      26.2446
210022.......................................................       1.3768       1.1068       1.1068      30.1470      33.8015      35.4174      33.0730
210023.......................................................       1.4377       1.0299       1.0299      29.0844      30.4656      32.2959      30.6752
210024.......................................................       1.7307       1.0090       1.0090      27.1756      29.5579      31.0777      29.2823
210025.......................................................       1.2602       0.8946       0.8946      23.8943      26.0771      26.8894      25.5852
210027.......................................................       1.4414       0.8946       0.8946      23.9255      26.0111      25.5623      25.2157
210028.......................................................       1.1079       0.9458       0.9458      24.1265      25.9221      26.5604      25.5493
210029.......................................................       1.2797       1.0090       1.0090      31.2888      27.9741      31.4973      30.1510
210030.......................................................       1.3403       0.8946       0.8946      27.5507      29.5635      27.8221      28.3058
210032.......................................................       1.1400       1.0878       1.0878      25.7138      26.1829      27.3503      26.4352
210033.......................................................       1.1879       1.0090       1.0090      26.6113      29.0420      29.2098      28.3156
210034.......................................................       1.3061       1.0090       1.0090      26.3896      28.4308      30.7435      28.5652

[[Page 24190]]

 
210035.......................................................       1.2634       1.1076       1.1076      24.5198      26.1082      28.2974      26.3729
210037.......................................................       1.2148       0.8946       0.8946      24.1913      27.0973      27.4321      26.3569
210038.......................................................       1.1762       1.0090       1.0090      28.3414      29.5980      30.2311      29.4259
210039.......................................................       1.1341       1.1076       1.1076      25.8415      27.6940      30.6411      28.0851
210040.......................................................       1.2321       1.0090       1.0090      28.3723      29.3514      28.6883      28.8196
210043.......................................................       1.3335       1.0299       1.0299      24.3070      27.5657      28.0237      26.6189
210044.......................................................       1.3586       1.0090       1.0090      24.8083      28.8700      30.1590      27.9174
210045.......................................................       1.0603       0.8958       0.8958      15.0867      15.6380      14.3656      15.0218
210048.......................................................       1.3049       1.0377       1.0377      25.0617      28.4638      27.3793      27.0126
210049.......................................................       1.2098       1.0090       1.0090      25.9342      26.9656      26.7764      26.5560
210051.......................................................       1.3106       1.1076       1.1076      27.3692      29.2998      30.1862      28.9788
210054.......................................................       1.3557       1.1076       1.1076      24.6658      26.2295      27.6137      26.2370
210055.......................................................       1.2007       1.1076       1.1076      28.0014      29.9708      30.8388      29.6378
210056.......................................................       1.2815       1.0090       1.0090      26.6884      28.6091      30.5354      28.6855
210057.......................................................       1.4141       1.1068       1.1068      29.2233      32.2883      31.9780      31.2261
210058.......................................................       1.0867       1.0090       1.0090      24.8576      29.7841      31.7032      29.0401
210060.......................................................       1.1523       1.1076       1.1076      28.7531      28.5087      28.8466      28.7138
210061.......................................................       1.3223       0.8946       0.8946      24.1369      23.6662      23.0523      23.5621
220001.......................................................       1.2596       1.1318       1.1318      27.3238      29.0014      31.2085      29.1967
220002.......................................................       1.3298       1.1318       1.1318      28.9722      30.3598      32.8760      30.8268
220003.......................................................       1.0758            *            *      20.5790      22.0549            *      21.3294
220006.......................................................          ***            *            *      29.5946      30.8599      30.7330      30.4422
220008.......................................................       1.2830       1.0791       1.0791      27.1675      30.1043      30.9345      29.4497
220010.......................................................       1.2555       1.1318       1.1318      27.4161      29.7998      31.4253      29.5798
220011.......................................................       1.1836       1.1318       1.1318      32.6624      34.4064      32.7733      33.3053
220012.......................................................       1.5060       1.2553       1.2553      32.9791      35.7872      37.6096      35.5395
220015.......................................................       1.1800       1.0664       1.0664      25.5449      28.3397      29.7600      27.9761
220016.......................................................       1.1151       1.0664       1.0664      26.8798      28.0609      30.8663      28.6310
220017.......................................................       1.2644       1.1687       1.1687      28.8264      29.7108      31.2550      29.9361
220019.......................................................       1.1472       1.1318       1.1318      22.2294      23.2544      24.9623      23.5079
220020.......................................................       1.1731       1.0791       1.0791      24.2279      26.5305      27.8385      26.2353
220024.......................................................       1.3169       1.0664       1.0664      25.5837      27.3488      28.6898      27.1876
220025.......................................................       1.0713       1.1318       1.1318      24.5186      23.0637      26.0299      24.5351
220028.......................................................       1.5243       1.1318       1.1318      31.3592      32.0980      31.5587      31.6664
220029.......................................................       1.1194       1.1318       1.1318      28.1432      28.6970      31.1099      29.3471
220030.......................................................       1.1049       1.0664       1.0664      23.6257      24.4289      25.9633      24.7095
220031.......................................................       1.6617       1.1687       1.1687      32.2660      34.8183      37.0251      34.7408
220033.......................................................       1.1670       1.1318       1.1318      26.8049      28.2539      31.3862      28.8106
220035.......................................................       1.4035       1.1318       1.1318      27.5533      28.6238      31.2994      29.2385
220036.......................................................       1.5300       1.1687       1.1687      29.6296      31.5184      33.5361      31.6091
220041.......................................................          ***            *            *      29.7464            *            *      29.7464
220046.......................................................       1.4404       1.1318       1.0664      27.7726      28.1396      30.3602      28.8066
220049.......................................................       1.2204       1.1318       1.1318      27.0464      27.7517      30.6379      28.5150
220050.......................................................       1.1427       1.0664       1.0664      24.9945      26.3768      28.0886      26.5235
220051.......................................................       1.2556       1.0664       1.0664      26.5575      29.8380      30.6499      28.9958
220052.......................................................       1.1658       1.1687       1.1687      28.0925      29.8577      32.5961      30.0602
220058.......................................................       1.0009       1.1318       1.1318      25.0598      24.9642      26.7206      25.5650
220060.......................................................       1.1942       1.2181       1.2181      30.8242      32.3362      33.0544      32.1202
220062.......................................................       0.5772       1.1318       1.1318      21.9489      24.2779      24.9938      23.7495
220063.......................................................       1.2343       1.1318       1.1318      25.5840      27.3967      29.9941      27.6386
220065.......................................................       1.2426       1.0664       1.0664      24.8737      26.5513      27.5196      26.3247
220066.......................................................       1.3716       1.0664       1.0664      26.2561      27.1317      27.9943      27.1639
220067.......................................................       1.1669       1.1687       1.1687      28.5220      29.8911      30.3267      29.6132
220070.......................................................       1.1708       1.1318       1.1318      28.9100      31.9283      32.8480      31.0719
220071.......................................................       1.8540       1.1687       1.1687      31.8322      32.2936      35.5338      33.2847
220073.......................................................       1.2165       1.0791       1.0791      29.2399      31.3566      33.3418      31.2658
220074.......................................................       1.3020       1.1687       1.1687      27.5763      28.4930      30.0912      28.7684
220075.......................................................       1.5634       1.1687       1.1687      27.9503      29.1588      30.5079      29.2027
220076.......................................................          ***            *            *      27.2534      29.7507      27.4339      28.0834
220077.......................................................       1.7189       1.0918       1.0918      28.0935      30.2684      31.1933      29.9019
220080.......................................................       1.2116       1.1318       1.1318      27.1578      28.9835      29.5970      28.6365
220082.......................................................       1.2876       1.1318       1.1318      24.8060      26.9841      29.8247      27.2457
220083.......................................................       1.1521       1.1687       1.1687      29.9001      32.9143      33.7694      32.1442
220084.......................................................       1.2315       1.1318       1.1318      29.0505      32.5711      31.4451      31.0666
220086.......................................................       1.8147       1.1687       1.1687      31.7482      34.3667      33.7988      33.2870
220088.......................................................       1.8495       1.1687       1.1687      28.5711      28.5462      36.0913      30.7044

[[Page 24191]]

 
220089.......................................................       1.3003       1.1161       1.1161      32.4409      31.1708      32.4915      32.0184
220090.......................................................       1.2011       1.1318       1.1318      29.7945      30.8685      32.9169      31.2935
220095.......................................................       1.1330       1.1318       1.1318      24.9871      27.4273      28.5030      27.0085
220098.......................................................       1.1241       1.1318       1.1318      26.8538      28.8314      30.8540      28.8728
220100.......................................................       1.3422       1.1687       1.1687      28.4848      29.6912      31.4815      29.9431
220101.......................................................       1.2661       1.1318       1.1318      31.0834      33.1690      35.9902      33.5726
220105.......................................................       1.2410       1.1318       1.1318      30.0892      31.9421      33.2654      31.8424
220108.......................................................       1.1449       1.1687       1.1687      29.0804      30.6252      33.0443      30.9170
220110.......................................................       2.0017       1.1687       1.1687      35.4242      36.6084      39.0322      37.0923
220111.......................................................       1.1994       1.1687       1.1687      28.9092      31.1850      33.3309      31.2225
220116.......................................................       1.9564       1.1687       1.1687      32.2337      32.9988      36.5682      33.8543
220119.......................................................       1.1193       1.1687       1.1687      27.8372      30.1056      30.8989      29.6743
220126.......................................................       1.1729       1.1687       1.1687      26.7660      28.7805      31.8676      29.1255
220133.......................................................          ***            *            *      31.2981      33.6003            *      32.4924
220135.......................................................       1.3405       1.2553       1.2553      31.3246      33.9866      36.0887      33.8967
220153.......................................................       0.9848       1.0664       1.0664      18.9267            *      14.1334      17.1170
220154.......................................................       0.9336       1.1687       1.1687      30.9009      28.6462      35.5883      31.2859
220163.......................................................       1.6470       1.1318       1.1318      30.5056      33.6484      33.8384      32.5869
220171.......................................................       1.7942       1.1318       1.1318      28.9733      30.4036      32.0101      30.5076
220174.......................................................       1.1988       1.1318       1.1318      30.3356      31.7572      30.7270      30.9243
220176.......................................................       1.5414            *            *            *            *            *            *
230001.......................................................       1.0769            *            *      24.3660            *            *      24.3660
230002.......................................................       1.2952       1.0235       1.0391      27.0305      29.1410      28.6090      28.2640
230003.......................................................       1.2115       1.0737       0.9683      25.2596      26.1278      27.3169      26.2815
230004.......................................................       1.7321       1.0737       0.9961      25.5573      26.7206      29.1937      27.2248
230005 h.....................................................       1.2788       1.0853       1.0853      22.1018      24.1902      26.3043      24.1338
230006.......................................................       1.1218            *            *      22.7656      23.8835            *      23.3472
230013.......................................................       1.3549       1.0685       1.0235      22.7014      23.7822      24.5785      23.6715
230015.......................................................       1.0350       0.9414       0.9414      23.4512      24.6570      27.0741      25.0665
230017.......................................................       1.6823       1.0737       1.0737      27.3259      29.5178      31.7604      29.6143
230019.......................................................       1.5714       1.0685       1.0235      27.6563      28.4575      32.0970      29.3438
230020.......................................................       1.7351       1.0630       1.0391      26.8516      29.2869      29.1241      28.4427
230021.......................................................       1.5640       0.9191       0.9191      23.4663      24.9551      26.4485      24.9904
230022.......................................................       1.2895       0.9823       0.9823      22.2528      23.3000      25.0800      23.5509
230024.......................................................       1.5504       1.0630       1.0391      27.6555      30.0813      31.5988      29.7774
230027.......................................................       1.1269            *            *      22.5736      23.5511            *      23.0457
230029.......................................................       1.6096       1.0685       1.0235      27.9012      29.0935      32.7314      29.8511
230030.......................................................       1.2805       0.9055       0.9055      20.9867      22.3174      23.5494      22.3170
230031.......................................................       1.3726       1.0123       1.0123      23.2910      25.4678      28.9309      25.7151
230034.......................................................       1.3358       0.9055       0.9055      20.9195      26.7967      24.7096      24.1460
230035.......................................................       1.3084       0.9469       0.9469      20.9197      21.2317      24.6410      22.2545
230036.......................................................       1.3873       1.0040       1.0040      26.5854      28.3622      29.2811      28.0601
230037.......................................................       1.2855       1.0630       1.0391      24.7875      26.2000      28.6435      26.5799
230038.......................................................       1.7665       1.0737       0.9469      25.2499      26.3480      27.9064      26.5323
230040.......................................................       1.2170       0.9469       0.9469      21.9813      24.2349      25.5295      23.9840
230041.......................................................       1.5467       1.0139       1.0139      25.2518      26.1760      27.4599      26.3249
230042.......................................................       1.2127            *            *      24.3640      26.2037            *      25.3026
230046.......................................................       1.8770       1.0853       1.0853      29.2683      30.3591      31.8614      30.5717
230047.......................................................       1.4956       1.0235       1.0235      26.2447      28.1351      30.7000      28.4133
230053.......................................................       1.6058       1.0630       1.0391      28.3030      29.8703      32.3593      30.1185
230054.......................................................       2.0040       0.9620       0.9620      24.0137      24.9905      25.8181      24.9538
230055.......................................................       1.2536       0.9055       0.9055      23.7671      25.4143      26.6932      25.2940
230058.......................................................       1.1715       0.9055       0.9055      21.9308      24.0657      26.0394      24.0162
230059.......................................................       1.5561       1.0737       0.9469      23.1451      25.5350      27.6205      25.5084
230060.......................................................       1.2076       0.9055       0.9055      24.5073      25.5015      28.8932      26.2709
230065.......................................................          ***            *            *      27.9179      28.4631      32.3190      29.1033
230066.......................................................       1.3089       1.0737       0.9961      25.8517      27.4928      29.8291      27.8691
230069.......................................................       1.1416       1.0630       1.0391      27.6815      29.5556      31.3504      29.5335
230070.......................................................       1.6546       0.9055       0.9055      25.1587      24.2342      25.2886      24.8787
230071.......................................................       0.8889       1.0685       1.0235      24.7707      26.3907      28.1751      26.4737
230072.......................................................       1.4215       1.0737       0.9683      24.1560      24.4933      26.3114      25.0275
230075.......................................................       1.3157       0.9871       0.9871      24.1482      27.6193      28.5212      26.7496
230077.......................................................       2.0406       1.0685       1.0685      27.3117      27.6157      28.3061      27.7598
230078.......................................................       1.0339       0.9055       0.9055      21.9200      23.9901      26.2508      24.1481
230080.......................................................       1.3081       0.9055       0.9055      21.2840      21.2314      24.0443      22.1966
230081.......................................................       1.2045       0.9055       0.9055      20.6777      23.0788      24.5396      22.7915

[[Page 24192]]

 
230082.......................................................       0.9782            *            *      23.1240      22.2165            *      22.6498
230085.......................................................       1.2286       1.0737       1.0737      22.2569      22.7314      23.3957      22.8121
230086.......................................................       1.1583            *            *      20.8759            *            *      20.8759
230087.......................................................          ***            *            *            *      16.9168            *      16.9168
230089.......................................................       1.3507       1.0630       1.0391      23.9486      28.7015      30.4100      27.6217
230092.......................................................       1.3484       0.9823       0.9823      24.3768      26.3584      28.1764      26.3309
230093.......................................................       1.2207       0.9469       0.9469      24.5055      26.4967      26.0513      25.6772
230095.......................................................       1.3595       0.9055       0.9055      19.2244      21.3915      22.4323      21.0375
230096.......................................................       1.1658       1.0737       1.0737      26.7578      28.7681      30.6584      28.7161
230097.......................................................       1.8024       0.9469       0.9469      25.2104      26.5773      28.5361      26.7964
230099.......................................................       1.2294       1.0630       1.0391      25.0390      26.4882      28.7593      26.7894
230100.......................................................       1.2303       0.9055       0.9055      20.4565      21.8895      24.1824      22.1932
230101.......................................................       1.1612       0.9055       0.9055      23.1349      24.3772      25.3781      24.3329
230103.......................................................       1.0731            *            *      18.4304      21.6609            *      19.9258
230104.......................................................       1.6312       1.0630       1.0391      27.8864      30.5570      31.7701      30.0214
230105.......................................................       1.9789       1.0040       1.0040      24.6853      27.2705      32.8773      28.3242
230106.......................................................       1.0982       1.0737       0.9499      24.1128      24.3980      25.6113      24.7279
230108.......................................................       1.1275       0.9055       0.9055      22.4966      18.4063      20.8489      20.4585
230110.......................................................       1.2929       0.9055       0.9055      22.7621      28.7704      24.6324      25.3971
230117.......................................................       1.8782       1.0737       1.0737      29.6361      29.4775      32.3796      30.4251
230118.......................................................       1.0705       0.9055       0.9055      21.4886      22.3636      23.4529      22.4396
230119.......................................................       1.3083       1.0630       1.0391      29.2509      30.2441      30.5690      30.0291
230120.......................................................       1.1170            *            *      21.7894      24.1485            *      22.9553
230121.......................................................       1.2749       0.9823       0.9823      23.4394      24.5220      26.7038      24.8835
230124.......................................................       1.3714            *            *      23.0508            *            *      23.0508
230130.......................................................       1.7526       1.0685       1.0235      26.9907      26.6076      30.4881      28.0695
230132.......................................................       1.4085       1.0978       1.0978      29.9106      30.5318      32.7610      31.0442
230133.......................................................       1.3772       0.9055       0.9055      21.2273      24.3175      24.1542      23.2760
230135.......................................................       1.1854       1.0630       1.0391      23.9000      25.8406      26.3160      25.3904
230141.......................................................       1.6360       1.0978       1.0978      30.4643      28.6326      31.7206      30.2602
230142.......................................................       1.2984       1.0235       1.0391      25.6044      26.9433      27.7390      26.7874
230143.......................................................       1.2854            *            *      19.5387      21.4083            *      20.4663
230144.......................................................       1.5305       1.0853       1.0853            *            *            *            *
230145.......................................................          ***            *            *      17.2181            *            *      17.2181
230146.......................................................       1.3093       1.0630       1.0391      24.3891      26.3432      27.0190      25.9632
230149.......................................................          ***            *            *      21.4753            *            *      21.4753
230151.......................................................       1.3162       1.0685       1.0235      26.4669      28.2243      27.3926      27.3632
230153.......................................................       0.9954            *            *      22.3404      22.8644            *      22.6169
230155.......................................................          ***            *            *      24.0404            *            *      24.0404
230156.......................................................       1.5931       1.0853       1.0853      29.4855      31.1909      33.3966      31.3733
230165.......................................................       1.7163       1.0630       1.0391      27.3164      28.9636      29.3983      28.5661
230167.......................................................       1.5889       1.0096       1.0096      26.6828      27.4562      29.4375      27.8699
230169.......................................................          ***            *            *      27.1172      31.8442            *      29.3455
230171.......................................................          ***            *            *      22.0635            *            *      22.0635
230172.......................................................       1.2675            *            *      24.0236      25.7402            *      24.8835
230174.......................................................       1.3287       1.0737       0.9683      26.2770      27.6920      30.2951      28.1112
230176.......................................................       1.2860       1.0630       1.0391      25.6777      27.3605      27.8101      27.1746
230180.......................................................       1.0946       0.9055       0.9055      22.5454      24.7358      26.5277      24.6245
230184.......................................................          ***            *            *      21.9346      23.6707      34.0691      23.6789
230186.......................................................          ***            *            *      27.1126      26.2282            *      26.7039
230189.......................................................       0.9848            *            *      20.8605      23.0099            *      21.9754
230190.......................................................       0.9660       1.0737       1.0737      28.7365      29.9604      32.4001      30.3817
230193.......................................................       1.2369       1.0123       1.0123      24.3181      23.3565      25.2992      24.3281
230195.......................................................       1.4121       1.0235       1.0235      27.1266      28.2892      29.4364      28.3509
230197.......................................................       1.6117       1.0978       1.0978      28.3439      30.0367      32.8265      30.4301
230204.......................................................       1.3256       1.0235       1.0235      25.9871      29.1466      29.7273      28.2022
230207.......................................................       1.3967       1.0685       1.0235      22.2854      24.5201      25.4131      24.0831
230208.......................................................       1.1981       0.9469       0.9469      20.9420      21.9651      23.1625      22.0408
230212.......................................................       1.0156       1.0853       1.0853      27.3686      29.7980      32.5361      29.8062
230216.......................................................       1.6633       1.0123       1.0123      26.1468      27.5230      29.1364      27.6226
230217.......................................................       1.3064       0.9823       0.9823      26.7929      28.6075      29.7609      28.4930
230222 h.....................................................       1.3442       0.9283       0.9283      24.8925      26.9724      30.2084      27.4096
230223.......................................................       1.2478       1.0685       1.0235      27.1503      29.2853      28.7434      28.4016
230227.......................................................       1.5190       1.0235       1.0235      28.1105      29.5798      31.2231      29.6698
230230.......................................................       1.5144       1.0096       1.0096      25.4471      27.9607      30.0898      27.8390
230235.......................................................       0.9813            *            *      19.6046      21.8777            *      20.7318

[[Page 24193]]

 
230236.......................................................       1.4603       1.0737       0.9469      26.3988      28.4754      30.7222      28.5769
230239.......................................................       1.2296       0.9055       0.9055      21.1643      22.1040      21.2172      21.5040
230241.......................................................       1.2197       1.0123       1.0123      25.8671      27.4890      27.5447      26.9859
230244.......................................................       1.4048       1.0630       1.0391      25.3817      26.4326      28.0406      26.5791
230254.......................................................       1.4614       1.0685       1.0235      26.4431      28.1216      28.9407      27.8278
230257.......................................................       0.9689       1.0235       1.0235      25.4086      27.8197      30.1026      27.6619
230259.......................................................       1.2083       1.0853       1.0853      24.3067      26.8677      27.9433      26.4486
230264.......................................................       2.1504       1.0235       1.0235      19.9992      19.2398      22.3532      20.5167
230269.......................................................       1.4452       1.0685       1.0235      27.4732      28.8187      30.9490      29.1589
230270.......................................................       1.3222       1.0630       1.0391      26.1113      27.8488      25.2072      26.3816
230273.......................................................       1.5273       1.0630       1.0391      30.2209      29.9307      31.5014      30.5474
230275.......................................................       0.4787       0.9055       0.9055      30.2244      23.1095      23.7882      25.8693
230277.......................................................       1.3945       1.0685       1.0235      26.9231      29.1973      29.6262      28.6272
230279.......................................................       0.5318       1.0630       1.0391      23.1636      24.7673      27.1158      24.8848
230283.......................................................          ***            *            *      24.9272      26.2622      33.2824      26.4188
230289.......................................................          ***            *            *            *      29.7720            *      29.7720
230290.......................................................          ***            *            *      29.4792            *            *      29.4792
230291.......................................................          ***            *            *            *      30.9655            *      30.9655
230292.......................................................          ***            *            *            *      31.8943            *      31.8943
230294.......................................................          ***            *            *            *            *      31.3710      31.3710
230295.......................................................          ***            *            *            *            *      27.2229      27.2229
230296.......................................................       1.6564       1.0096       1.0096            *            *            *            *
230328.......................................................       0.6608            *            *            *            *            *            *
240001.......................................................       1.5162       1.0943       1.0943      29.9123      31.5753      33.3161      31.6280
240002.......................................................       1.8250       1.0157       1.0157      26.9608      28.9860      30.9011      28.9495
240004.......................................................       1.5995       1.0943       1.0943      27.8796      30.8072      32.7422      30.4106
240006.......................................................       1.0882       1.1246       1.1246      30.2330      30.1950      30.9169      30.4586
240007.......................................................       0.9780            *            *      23.7588            *            *      23.7588
240010.......................................................       2.0356       1.1246       1.1246      30.4139      31.3733      33.5850      31.7910
240011.......................................................          ***            *            *      22.9561            *            *      22.9561
240013.......................................................       1.3325            *            *      28.7202      28.3860            *      28.5544
240014.......................................................       1.0328       1.0943       1.0943      28.3788      29.8623      30.0296      29.4562
240016.......................................................       1.2570            *            *      24.9211      26.7814            *      25.9310
240017.......................................................       1.2425       0.9256       0.9256      23.3314      24.4417      24.2138      23.9977
240018.......................................................       1.2809       1.0842       1.0842      27.9218      25.6236      27.9842      27.0238
240019.......................................................       1.0723       1.0157       1.0157      27.5441      28.6723      32.3927      29.5002
240020.......................................................       1.0716       1.0943       1.0943      28.1568      31.2443      32.7931      30.6996
240021.......................................................       0.9533            *            *      23.7096      27.1235            *      25.3021
240022.......................................................       1.1345       0.9256       0.9256      23.7368      25.2066      27.4658      25.4771
240025.......................................................          ***            *            *      27.8656            *            *      27.8656
240027.......................................................       0.9013            *            *      20.2531      18.2481            *      19.1090
240029.......................................................       1.1341            *            *      24.3017      25.3568            *      24.8217
240030.......................................................       1.3375       0.9971       0.9971      23.3753      24.7154      26.4497      24.8644
240031.......................................................       0.9645            *            *      26.7242      26.7778            *      26.7517
240036.......................................................       1.6566       1.0842       1.0842      27.0821      28.0812      30.9000      28.6586
240037.......................................................       1.0394            *            *      24.3986            *            *      24.3986
240038.......................................................       1.5532       1.0943       1.0943      29.8465      31.0779      33.2288      31.4072
240040.......................................................       1.0905       1.0157       1.0157      26.3177      27.4895      27.3304      27.0645
240043.......................................................       1.1406       0.9256       0.9256      20.7155      21.8685      23.2097      21.9560
240044.......................................................       1.1339       1.0124       1.0124      24.3009      22.0973      25.1529      23.8283
240045.......................................................       1.0878            *            *      26.1743            *            *      26.1743
240047.......................................................       1.5452       1.0157       1.0157      29.1211      28.8288      28.4908      28.7805
240050.......................................................       1.0908       1.0943       1.0943      26.6687      26.4854      26.8525      26.6732
240052.......................................................       1.2502       0.9256       0.9256      24.9870      26.4256      28.0986      26.5338
240053.......................................................       1.4037       1.0943       1.0943      28.4733      29.5315      31.4458      29.8618
240056.......................................................       1.2278       1.0943       1.0943      30.8619      31.6623      33.3453      31.9671
240057.......................................................       1.8040       1.0943       1.0943      29.4870      30.6258      31.7172      30.6390
240059.......................................................       1.0849       1.0943       1.0943      28.6340      29.7916      31.6035      30.0547
240061.......................................................       1.7796       1.1246       1.1246      30.0031      30.6383      32.8216      31.1991
240063.......................................................       1.5489       1.0943       1.0943      29.9603      32.3487      34.2862      32.2192
240064.......................................................       1.2477       1.0157       1.0157      26.6996      29.9662      33.2930      30.5360
240066.......................................................       1.4590       1.0943       1.0943      30.2716      33.4532      36.4650      33.5054
240069.......................................................       1.1852       1.1246       1.1246      27.4990      28.9496      30.2048      28.9405
240071.......................................................       1.1457       1.1246       1.1246      26.4780      28.0585      29.9094      28.1696
240075.......................................................       1.1523       0.9971       0.9971      26.6607      26.1956      27.9350      26.9347
240076.......................................................       1.0765       1.0943       1.0943      28.4519      29.8562      31.5934      30.0582

[[Page 24194]]

 
240078.......................................................       1.6631       1.0943       1.0943      30.5339      32.3235      32.6859      31.8480
240079.......................................................          ***            *            *      20.9220            *            *      20.9220
240080.......................................................       1.8436       1.0943       1.0943      29.6274      31.6828      32.9636      31.4183
240083.......................................................       1.2072       0.9256       0.9256      25.0214      26.6582      26.9625      26.2728
240084.......................................................       1.1120       1.0157       1.0157      24.7856      26.8142      27.5846      26.3984
240087.......................................................       1.0241            *            *      24.8479            *            *      24.8479
240088.......................................................       1.3204       0.9971       0.9971      27.6323      28.0825      28.0161      27.9149
240093.......................................................       1.3161       1.0842       1.0842      23.7785      25.5805      26.9860      25.4182
240094.......................................................       1.1989            *            *      27.3974            *            *      27.3974
240100.......................................................       1.2983       0.9256       0.9256      25.3269      27.6299      30.4304      27.7995
240101.......................................................       1.1584       0.9256       0.9256      26.6078      25.5355      26.1979      26.0918
240103.......................................................       1.1155            *            *      22.5416      22.7078            *      22.6234
240104.......................................................       1.1722       1.0943       1.0943      30.1392      31.4306      32.5071      31.4775
240106.......................................................       1.5325       1.0943       1.0943      27.5171      29.3455      30.9325      29.3230
240107.......................................................       0.9182            *            *      25.5199            *            *      25.5199
240109.......................................................       0.9469            *            *      15.2076      16.5051            *      15.8386
240115.......................................................       1.6345       1.0943       1.0943      29.0261      31.3869      32.6799      31.0904
240117.......................................................       1.1572       0.9256       0.9256      22.0463      23.6230      23.7271      23.1567
240123.......................................................       1.1119            *            *      20.5755      21.7500            *      21.1868
240124.......................................................          ***            *            *      23.9297            *            *      23.9297
240127.......................................................          ***            *            *      24.4824            *            *      24.4824
240128.......................................................       1.0253       0.9256       0.9256      21.2638      21.5791      23.2704      22.0363
240132.......................................................       1.3295       1.0943       1.0943      29.5310      31.7139      32.8272      31.3936
240133.......................................................       1.1376            *            *      26.1836            *            *      26.1836
240135.......................................................          ***            *            *      16.1837            *            *      16.1837
240137.......................................................          ***            *            *      23.8666            *            *      23.8666
240139.......................................................          ***            *            *      23.7898            *            *      23.7898
240141.......................................................       1.1289       1.0943       1.0943      26.7173      26.4016      29.8940      27.9382
240143.......................................................       0.8821            *            *      21.1180      21.7416            *      21.4375
240152.......................................................       0.9917            *            *      27.3445      29.6196            *      28.5127
240154.......................................................       1.0591            *            *      23.9643            *            *      23.9643
240162.......................................................       1.1507            *            *      22.3136      22.2721            *      22.2926
240166.......................................................       1.1450       0.9256       0.9256      23.4265      25.7509      27.1602      25.4648
240179.......................................................          ***            *            *      20.8449            *            *      20.8449
240187.......................................................       1.2475       1.0842       1.0842      26.5129      27.8811      28.0014      27.4824
240196.......................................................       0.7780       1.0943       1.0943      28.9380      30.7719      32.4098      30.7649
240206.......................................................       0.8192       1.4448       1.4448            *            *            *            *
240207.......................................................       1.1912       1.0943       1.0943      29.2395      31.7665      32.6617      31.2871
240210.......................................................       1.2761       1.0943       1.0943      29.7227      32.1564      33.0565      31.6494
240211.......................................................       0.9917       1.0842       1.0842      44.4214      18.8503      23.5383      24.9982
240213.......................................................       1.3747       1.0943       1.0943      31.3974      32.7532      34.3377      32.9080
240366.......................................................       0.8163            *            *            *            *            *            *
250001.......................................................       1.8600       0.8278       0.8278      21.9176      22.7827      23.7029      22.8415
250002.......................................................       0.9030       0.8008       0.8008      20.1310      23.3845      23.9358      22.3598
250004.......................................................       1.9070       0.9032       0.9032      20.6828      24.1065      24.9720      23.2149
250006.......................................................       1.0729       0.9032       0.9032      21.4038      24.0191      24.9513      23.4457
250007.......................................................       1.2555       0.8914       0.8914      23.6933      25.8710      25.8218      25.1582
250009.......................................................       1.2768       0.8640       0.8640      20.4329      22.2323      22.2900      21.6627
250010.......................................................       1.0392       0.7579       0.7579      19.4130      19.4403      20.8939      19.9016
250012.......................................................       0.9166       0.9367       0.9367      20.0493      20.2921      20.2685      20.2019
250015.......................................................       1.0413       0.7579       0.7579      20.6931      20.7555      21.4605      20.9636
250017.......................................................       1.0388       0.7579       0.7579      18.1013      21.3950      22.0824      20.6762
250018.......................................................       0.8272       0.7579       0.7579      17.0689      16.6294      16.9042      16.8758
250019.......................................................       1.5866       0.8914       0.8914      22.8358      23.9741      26.3257      24.3649
250020.......................................................       0.9684       0.7579       0.7579      19.3390      21.4019      21.3531      20.6951
250021.......................................................          ***            *            *      15.1242      20.3559            *      16.1481
250023.......................................................       0.8560       0.8607       0.8607      16.1820      16.2418      17.0598      16.5022
250025.......................................................       1.1161       0.7579       0.7579      20.6892      20.5258      22.4404      21.2459
250027.......................................................       0.9523       0.7579       0.7579      17.3313      17.3481      23.1213      19.2559
250031.......................................................       1.3383       0.8278       0.8278      22.0850      21.4326      24.9777      22.6950
250034.......................................................       1.5646       0.9032       0.9032      20.6752      24.3189      26.4723      23.8164
250035.......................................................       0.8603       0.7579       0.7579      14.6149      17.2045      19.4498      17.1103
250036.......................................................       1.0150       0.8229       0.8229      17.8313      19.1975      19.2912      18.8229
250037.......................................................       0.8531            *            *      17.4463      17.4012            *      17.4232
250038.......................................................       0.9812       0.8278       0.8278      18.0209      18.9050      21.6995      19.5148
250039.......................................................       0.9171            *            *      15.2939      17.3155            *      16.2540

[[Page 24195]]

 
250040.......................................................       1.5081       0.8607       0.8607      21.3451      23.2285      24.9604      23.2173
250042.......................................................       1.1719       0.9032       0.9032      21.4117      23.4135      25.0292      23.2557
250043.......................................................       1.0266       0.7579       0.7579      18.3322      19.8098      18.5069      18.8884
250044.......................................................       1.0422       0.8008       0.8008      21.1198      23.3862      24.1915      22.8737
250045.......................................................       1.1328            *            *      25.0863      26.3831            *      25.7497
250048.......................................................       1.6466       0.8278       0.8278      21.6547      22.9765      25.5576      23.4215
250049.......................................................       0.8984       0.7579       0.7579      17.8154      17.7005      16.6336      17.2912
250050.......................................................       1.2572       0.7579       0.7579      18.3170      19.1467      20.2413      19.2614
250051.......................................................       0.8663       0.7579       0.7579       106908       106095      11.7079       109990
250057.......................................................       1.1351       0.7579       0.7579      19.6789      20.1900      22.5761      20.8199
250058.......................................................       1.2384       0.7579       0.7579      17.5160      18.1704      19.0087      18.2438
250059.......................................................       0.9837       0.7579       0.7579      17.7270      19.2977      20.6556      19.2080
250060.......................................................       0.8378       0.7579       0.7579      20.8115      16.8247      25.4246      20.6969
250061.......................................................       0.8786       0.7579       0.7579      15.2515      12.8174      16.2589      14.6266
250065.......................................................          ***            *            *      16.1984            *            *      16.1984
250067.......................................................       1.0700       0.7579       0.7579      20.1261      21.6911      23.4774      21.7391
250068.......................................................          ***            *            *      16.9585            *            *      16.9585
250069.......................................................       1.5415       0.7785       0.7785      21.6617      22.8162      16.1304      19.3701
250071.......................................................          ***            *            *      17.7149            *            *      17.7149
250072.......................................................       1.5965       0.8278       0.8278      22.9316      24.6587      26.4719      24.7138
250077.......................................................       0.9353       0.7579       0.7579      14.2271      14.7632      17.4410      15.4299
250078 \2\...................................................       1.6824       0.8607       0.8914      18.6563      20.9354      21.3612      20.3108
250079.......................................................       0.8320       0.8278       0.8278      27.2549      38.0031      44.8151      37.9933
250081.......................................................       1.2341       0.7785       0.7785      21.3830      24.7031      23.9285      23.1846
250082.......................................................       1.4493       0.8224       0.8224      20.5212      19.6966      23.1859      21.1022
250083.......................................................          ***            *            *      19.9484            *            *      19.9484
250084.......................................................       1.1750       0.7579       0.7579      21.8001      18.5775      19.4461      19.8188
250085.......................................................       0.9867       0.7579       0.7579      18.7367      19.7007      21.3859      19.9851
250093.......................................................       1.1742       0.7579       0.7579      18.8001      21.3237      22.3211      20.8049
250094.......................................................       1.6054       0.8607       0.8607      22.3312      22.7312      24.5599      23.2045
250095.......................................................       1.0280       0.7579       0.7579      19.9553      21.3511      20.0315      20.4379
250096.......................................................       1.1310       0.8278       0.8278      22.7458      22.6298      24.4706      23.2825
250097.......................................................       1.5757       0.8102       0.8102      19.4534      20.1687      22.0566      20.5452
250099.......................................................       1.2588       0.8278       0.8278      19.0333      19.5797      20.5324      19.7105
250100.......................................................       1.4755       0.7785       0.7785      22.0328      24.2209      26.2027      24.1667
250101.......................................................          ***            *            *      21.2234      19.3543            *      20.1785
250102.......................................................       1.6047       0.8278       0.8278      22.5518      24.2868      24.3828      23.7712
250104.......................................................       1.4423       0.8278       0.8278      21.4431      22.6591      23.5992      22.6152
250105.......................................................       0.9397            *            *      17.9468      18.1196            *      18.0323
250107.......................................................       0.9189            *            *      16.5369      17.8999            *      17.2381
250112.......................................................       0.9624       0.7579       0.7579      19.6172      21.2824      23.2090      21.4577
250117.......................................................       1.0940       0.8607       0.8607      19.9774      23.3673      22.2965      21.8104
250120.......................................................       1.0796       0.7579       0.7579      22.7607      23.4277      24.5030      23.5079
250122.......................................................       1.0886       0.8607       0.7579      23.7230      24.5854      27.7136      25.3125
250123.......................................................       1.3078       0.8914       0.8914      22.0486      24.5115      25.8310      24.1586
250124.......................................................       0.8426       0.8278       0.8278      15.4343      17.2181      18.4511      17.0346
250125.......................................................       1.3143       0.8914       0.8914      26.8379      27.7077      27.9165      27.4937
250126.......................................................       0.9024       0.9367       0.9367      20.4085      21.7111      24.0142      21.9434
250127.......................................................       0.8488       1.4448       1.4448            *            *            *            *
250128.......................................................       0.8921       0.7579       0.7579      15.9344      17.6269      17.8958      17.1308
250134.......................................................       0.7992       0.8278       0.8278      23.5608      25.8368      23.0509      24.1129
250136.......................................................       1.0417       0.8278       0.8278      22.5832      23.0637      24.6860      23.4511
250138.......................................................       1.3056       0.8278       0.8278      22.7902      23.8861      24.8531      23.8880
250141.......................................................       1.6112       0.9367       0.9367      24.5772      27.6158      29.0066      27.2108
250146.......................................................       0.9041            *            *      17.2328      18.6486            *      17.9106
250149.......................................................       0.8797       0.7579       0.7579      15.0367      15.0641      16.5424      15.5525
250151.......................................................       0.4842       0.7579       0.7579      21.8697      17.2205      19.1595      18.6189
250152.......................................................       0.9050       0.8278       0.8278            *      25.7837      27.1864      26.4345
250153.......................................................          ***            *            *            *      29.0461            *      29.0461
250155.......................................................          ***            *            *            *            *      22.3917      22.3917
250156.......................................................       1.6598       0.7579       0.7579            *            *            *            *
250159.......................................................       0.8786            *            *            *            *            *            *
250300.......................................................       0.6711            *            *            *            *            *            *
250302.......................................................       0.7681            *            *            *            *            *            *
250306.......................................................       0.8875            *            *            *            *            *            *
250311.......................................................       0.6819            *            *            *            *            *            *

[[Page 24196]]

 
250314.......................................................       0.8263            *            *            *            *            *            *
250317.......................................................       0.7015            *            *            *            *            *            *
250318.......................................................       0.7989            *            *            *            *            *            *
250319.......................................................       0.7364            *            *            *            *            *            *
250320.......................................................       0.7176            *            *            *            *            *            *
260001.......................................................       1.6784       0.8620       0.8620      25.3084      25.9250      27.1336      26.1147
260002.......................................................          ***            *            *      27.2329      26.4879            *      26.9807
260003.......................................................          ***            *            *      17.6339            *            *      17.6339
260004.......................................................       0.9693       0.8206       0.8206      16.7742      16.9421      17.2699      17.0026
260005.......................................................       1.4686       0.9017       0.9017      24.6142      26.5773      28.1696      26.5242
260006.......................................................       1.4688       0.8206       0.8206      26.4948      26.7587      30.1186      27.9482
260008.......................................................          ***            *            *      17.6040      18.9522            *      18.2612
260009.......................................................       1.2265       0.9501       0.9501      21.2729      22.1816      23.6333      22.3815
260011.......................................................       1.4257       0.8550       0.8550      21.4409      22.7061      24.4077      22.8791
260012.......................................................       1.1452            *            *      19.3389      20.3061            *      19.8719
260013.......................................................       1.0553            *            *      19.2065      20.5007            *      19.8516
260015.......................................................       1.0248       0.8206       0.8206      22.4450      22.5409      23.5052      22.8435
260017.......................................................       1.3611       0.8902       0.8902      21.1359      22.7022      23.3807      22.4549
260018.......................................................       1.0484            *            *      14.8425      17.0434            *      15.9088
260020.......................................................       1.7691       0.9017       0.9017      25.7898      26.0407      27.6200      26.5265
260021.......................................................       1.3788       0.9017       0.9017      27.8332      27.6330      29.3311      28.2357
260022.......................................................       1.2315       0.8696       0.8696      21.7707      22.8085      23.1569      22.5606
260023.......................................................       1.2983       0.9017       0.9017      21.2519      21.2077      23.3349      21.8971
260024.......................................................       1.1077       0.8206       0.8206      17.5351      18.4829      18.9172      18.3027
260025.......................................................       1.3739       0.8902       0.8902      20.0901      22.4645      22.2246      21.6146
260027.......................................................       1.6704       0.9501       0.9501      24.7605      25.3348      26.9815      25.6688
260029.......................................................       1.1287            *            *      22.2892            *            *      22.2892
260031.......................................................          ***            *            *      24.2877            *            *      24.2877
260032.......................................................       1.8631       0.9017       0.9017      23.1125      23.9478      25.5746      24.2130
260034.......................................................       0.9620       0.9501       0.9501      23.3034      24.1143      23.7530      23.7269
260035.......................................................       0.9284            *            *      16.8502      17.8741            *      17.3672
260036.......................................................       0.9601            *            *      20.1324      22.1912            *      21.0403
260039.......................................................       1.0479            *            *            *            *            *            *
260040.......................................................       1.6510       0.8490       0.8490      21.9452      23.3566      24.0972      23.1582
260044.......................................................       0.9223            *            *      20.0686            *            *      20.0686
260047.......................................................       1.5031       0.8206       0.8206      22.6169      24.4185      25.0084      24.0413
260048.......................................................       1.2049       0.9501       0.9501      25.8089      24.3906      27.9464      26.0146
260050.......................................................       1.2142       0.9993       0.9993      20.6364      23.6849      25.0389      23.2365
260052.......................................................       1.3392       0.9017       0.9017      22.5809      24.5165      26.1098      24.4028
260053.......................................................       1.1022            *            *      20.0051      21.6607            *      20.8214
260057.......................................................       1.1001       0.9501       0.9501      16.4875      19.3335      20.6191      18.7408
260059.......................................................       1.2035       0.8206       0.8206      18.6379      19.7243      23.1217      20.5682
260061.......................................................       1.1216       0.8206       0.8206      19.6674      21.5264      22.7333      21.2263
260062.......................................................       1.2337       0.9501       0.9501      26.0439      26.4539      27.6932      26.7397
260063.......................................................          ***            *            *      22.0826            *            *      22.0826
260064.......................................................       1.3185       0.8550       0.8550      19.1587      19.0543      21.6891      19.9635
260065.......................................................       1.7537       0.8490       0.8490      23.6969      23.0015      26.9359      24.5533
260067.......................................................       0.8877            *            *      16.5364      17.6256            *      17.0827
260068.......................................................       1.7594       0.8550       0.8550      23.9340      24.9504      25.8172      24.9247
260070.......................................................       0.9582       0.8206       0.8206      14.3881      18.4779      22.5048      18.8578
260073.......................................................       0.9941       0.8206       0.8206      19.2744      21.6214      21.9134      20.9434
260074.......................................................       1.2557       0.8550       0.8550      23.9301      24.8654      25.3754      24.7419
260077.......................................................       1.6328       0.9017       0.9017      23.5466      25.5782      26.2056      25.0998
260078.......................................................       1.3444       0.8206       0.8206      18.4017      19.0802      20.2858      19.2623
260080.......................................................       0.9295       0.8206       0.8206      11.2817      14.7774      16.6581      14.1755
260081.......................................................       1.5369       0.9017       0.9017      23.7447      26.3969      28.6641      26.2683
260085.......................................................       1.6015       0.9501       0.9501      24.6046      25.6302      26.9696      25.7362
260086.......................................................       0.8999            *            *      17.1202      19.1702            *      18.1866
260091.......................................................       1.5426       0.9017       0.9017      26.1149      27.2407      28.9307      27.4593
260094.......................................................       1.5689       0.8345       0.8345      20.6805      23.2544      24.0891      22.7688
260095.......................................................       1.3199       0.9501       0.9501      23.8671      25.5668      24.5424      24.6443
260096.......................................................       1.4703       0.9501       0.9501      25.9932      27.5592      29.7166      27.8481
260097.......................................................       1.1816       0.8631       0.8631      21.5077      21.3957      24.3155      22.4793
260102.......................................................       0.9158       0.9501       0.9501      22.9283      24.2368      27.3752      24.9011
260103.......................................................          ***            *            *      23.3175            *            *      23.3175
260104.......................................................       1.4999       0.9017       0.9017      24.0038      26.2867      28.5834      26.3843

[[Page 24197]]

 
260105.......................................................       1.7844       0.9017       0.9017      28.4652      28.8849      30.1547      29.1870
260107.......................................................       1.3536       0.9501       0.9501      24.2001      26.7782      26.1120      25.6719
260108.......................................................       1.8031       0.9017       0.9017      24.0936      24.9880      26.7305      25.3112
260110.......................................................       1.7032       0.8902       0.8902      22.2730      23.7978      24.6033      23.5975
260113.......................................................       1.1184       0.8210       0.8210      19.2467      20.9644      20.3219      20.1880
260115.......................................................       1.1842       0.9017       0.9017      21.7450      21.9859      23.2089      22.3429
260116.......................................................       1.1117       0.8210       0.8210      17.2698      18.5076      20.2843      18.6799
260119.......................................................       1.3503       0.8206       0.8206      22.1588      24.9937      25.3857      24.1933
260122.......................................................       1.0867            *            *      17.3270      20.8015            *      19.0424
260123.......................................................          ***            *            *      16.1169            *            *      16.1169
260127.......................................................       0.9496            *            *      22.5328      21.8534            *      22.1664
260134.......................................................          ***            *            *      18.1531            *            *      18.1531
260137.......................................................       1.6799       0.8620       0.8620      21.3426      22.7431      23.9849      22.7568
260138.......................................................       1.9860       0.9501       0.9501      27.8229      28.5610      30.1909      28.8843
260141.......................................................       1.8731       0.8550       0.8550      21.1511      22.4886      24.7555      22.6828
260142.......................................................       1.0575       0.8206       0.8206      19.6582      20.3993      21.1102      20.4022
260147.......................................................       0.9163       0.8206       0.8206      17.2291      18.5153      19.8920      18.5887
260159.......................................................          ***            *            *      26.8924      23.7427      23.3667      25.0036
260160.......................................................       1.0950       0.8206       0.8206      19.4997      21.0544      23.2474      21.4698
260162.......................................................       1.3128       0.9017       0.9017      24.1246      25.1423      27.0428      25.5018
260163.......................................................       1.1375       0.8206       0.8206      19.2885      20.1949      21.2854      20.2047
260164.......................................................       1.1012            *            *      19.5539      19.7068            *      19.6321
260166.......................................................       1.2031       0.9501       0.9501      25.5151      27.0237      29.7395      27.4350
260172.......................................................          ***            *            *      18.1438            *            *      18.1438
260175.......................................................       1.1223       0.9501       0.9501      21.1257      22.6171      24.1261      22.6182
260176.......................................................       1.7007       0.9017       0.9017      29.2184      27.4244      28.7405      28.4251
260177.......................................................       1.2297       0.9501       0.9501      25.0724      26.1178      27.2209      26.1484
260178.......................................................       1.8231       0.8550       0.8550      21.4781      22.2251      25.8033      23.2762
260179.......................................................       1.5349       0.9017       0.9017      24.8541      26.1419      26.6483      25.8935
260180.......................................................       1.5806       0.9017       0.9017      21.9679      26.7461      27.6875      25.4223
260183.......................................................       1.6192       0.8902       0.8902      23.3924      26.0418      27.4529      25.6739
260186.......................................................       1.6356       0.8550       0.8550      23.4317      25.3148      26.7114      25.2113
260189.......................................................       0.5844            *            *            *            *            *            *
260190.......................................................       1.2092       0.9501       0.9501      25.1653      26.4505      28.2087      26.6613
260191.......................................................       1.2955       0.9017       0.9017      22.4369      23.3856      24.3589      23.4174
260193.......................................................       1.1924       0.9501       0.9501      24.4705      26.2979      27.6919      26.2018
260195.......................................................       1.2645       0.8206       0.8206      20.1327      22.3958      22.3215      21.7669
260198.......................................................       1.1484       0.9017       0.9017      27.6116      27.5996      28.1088      27.7785
260200.......................................................       1.2426       0.9017       0.9017      25.1134      24.8624      28.8227      26.3660
260207.......................................................       1.0751       0.8490       0.8490      19.2467      19.7294      20.9045      20.0908
260209.......................................................       1.1133       0.8341       0.8341      21.8396      23.2430      24.8878      23.3114
260210.......................................................       1.2183       0.9017       0.9017            *      25.3782      26.5193      26.0224
260211.......................................................       1.6548       0.9501       0.9501            *      33.9109      39.2576      36.5853
260213.......................................................       1.7185       0.9501       0.9501            *            *            *            *
260214.......................................................       1.1966            *            *            *            *            *            *
260324.......................................................       0.6926            *            *            *            *            *            *
260326.......................................................       0.8398            *            *            *            *            *            *
270002 \2\...................................................       1.2593       0.8909       0.8909      20.7620      22.7322      24.3756      22.6537
270003.......................................................       1.2545       0.8781       0.8781      24.2823      26.4843      28.4192      26.4146
270004.......................................................       1.7115       0.8740       0.8740      22.9081      23.5454      25.1806      23.8999
270011.......................................................       0.9968       0.8781       0.8781      22.0710      22.1394      22.5874      22.2704
270012 \2\...................................................       1.6196       0.8909       0.8909      23.1697      25.2873      25.5002      24.6491
270014.......................................................       1.9153       0.8909       0.8909      25.0650      26.2025      26.3179      25.8695
270017.......................................................       1.3672       0.8909       0.8909      24.6186      27.5483      26.7552      26.3154
270021.......................................................       1.0409            *            *      21.6758      21.7056            *      21.6913
270023.......................................................       1.5356       0.8740       0.8909      25.5525      26.7576      26.4505      26.2685
270032.......................................................       1.0407       0.8740       0.8591      18.2377      19.6212      21.0457      19.6054
270036.......................................................       0.8297            *            *      21.8255      20.4242            *      20.9986
270049.......................................................       1.7342       0.8740       0.8740      24.6556      26.3996      26.8611      25.9770
270050.......................................................       1.1098            *            *      22.4195            *            *      22.4195
270051.......................................................       1.5813       0.8909       0.8909      26.4457      26.6619      25.1706      26.0404
270057.......................................................       1.2530       0.8740       0.8591      22.6251      24.2980      26.5171      24.5339
270060.......................................................       0.9595            *            *      16.6592      17.7564            *      17.1813
270074.......................................................       0.9013       1.4448       1.4448            *            *            *            *
270079.......................................................          ***            *            *      21.6382            *            *      21.6382
270081.......................................................       1.0056       0.8591       0.8591      17.3174      17.4862      18.9628      17.9008

[[Page 24198]]

 
270082.......................................................          ***            *            *      19.6173            *            *      19.6173
270084 \2\...................................................       1.0889            *            *      22.2340            *            *      22.2340
270086.......................................................       1.1747       0.8781       0.8781            *            *      23.0672      23.0672
270087.......................................................       1.1805       0.8591       0.8591            *            *      22.8163      22.8163
280003.......................................................       1.7898       1.0084       1.0084      27.2844      29.3921      30.8267      29.2098
280009.......................................................       1.8271       0.9746       0.9746      25.3162      26.7678      27.6871      26.5956
280010.......................................................          ***            *            *      22.6516            *            *      22.6516
280013.......................................................       1.7857       0.9453       0.9453      24.5214      26.1908      27.2546      25.9627
280020.......................................................       1.7128       1.0084       1.0084      25.7522      26.5068      27.6978      26.6945
280021.......................................................       1.1344            *            *      22.2864      22.0489            *      22.1652
280023.......................................................       1.3783       0.9746       0.9746      22.7207      22.3230      26.7240      23.8272
280030.......................................................       1.9075       0.9453       0.9453      32.5601      30.7481      30.4696      31.2643
280032.......................................................       1.3256       0.9746       0.9746      22.6510      23.6462      25.0787      23.7853
280040.......................................................       1.6714       0.9453       0.9453      25.2965      26.9827      28.4619      26.9500
280054.......................................................       1.2075            *            *      22.4241      23.5665            *      23.0039
280057.......................................................       0.8525            *            *      23.6793      20.4830            *      21.8581
280060.......................................................       1.6944       0.9453       0.9453      25.2288      26.2139      27.8379      26.5044
280061.......................................................       1.4064       0.9154       0.9154      23.9110      24.9482      25.9246      24.9668
280065.......................................................       1.2249       0.9636       0.9636      27.9937      26.0135      28.3954      27.4121
280077.......................................................       1.3131       0.9453       0.9453      24.0516      25.5624      27.0934      25.5691
280081.......................................................       1.5886       0.9453       0.9453      25.1973      26.0541      28.7505      26.6763
280105.......................................................       1.2640       0.9453       0.9453      25.0445      26.7555      28.0693      26.7054
280108.......................................................       1.0675            *            *      22.5584      23.2502            *      22.8979
280111.......................................................       1.1778       0.8691       0.8691      22.1424      23.4770      24.5663      23.4937
280117.......................................................       1.1313            *            *      22.0611      24.1521            *      23.1088
280119.......................................................       0.8523       1.4448       1.4448            *            *            *            *
280123.......................................................       0.9112       0.8828       0.8828      27.5207            *      12.1758      18.1112
280125.......................................................       1.4971       0.8816       0.8816      21.8385      21.7658      22.3025      21.9721
280127.......................................................       1.8457       1.0084       1.0084            *            *      31.8278      31.8278
280128.......................................................       3.0322       1.0084       1.0084            *            *      28.9234      28.9234
280129.......................................................       1.9223       0.9453       0.9453            *            *            *            *
280130.......................................................       1.3422       0.9453       0.9453            *            *            *            *
290001.......................................................       1.8273       1.1975       1.1975      27.3105      31.1981      35.3981      31.2171
290002.......................................................       0.9183       0.9569       0.9569      16.8433      18.3469      17.0514      17.4394
290003.......................................................       1.7512       1.1417       1.1417      27.1099      28.1625      30.4639      28.5720
290005.......................................................       1.4855       1.1417       1.1417      27.1531      27.6697      28.5735      27.8244
290006.......................................................       1.2047       1.1524       1.1524      26.3617      27.9502      30.0265      28.0763
290007.......................................................       1.6530       1.1417       1.1417      35.4193      37.5559      38.9568      37.2981
290008.......................................................       1.1651       0.9421       0.9421      26.4086      27.9714      28.3311      27.5573
290009.......................................................       1.7714       1.1975       1.1975      27.6011      29.8019      36.2577      31.1439
290010.......................................................       1.0541            *            *      23.8733      23.9654            *      23.9192
290012.......................................................       1.3212       1.1417       1.1417      27.2675      31.0843      33.4690      30.7038
290016.......................................................       1.2257            *            *      25.1726      26.1925            *      25.6684
290019.......................................................       1.3891       1.1524       1.1524      27.2484      28.6158      29.6855      28.5533
290020 h.....................................................       1.0427       1.1417       1.1417      21.3094      21.6993      20.9481      21.3644
290021.......................................................       1.7971       1.1417       1.1417      28.3837      33.2116      33.9446      31.8430
290022.......................................................       1.5768       1.1417       1.1417      29.8144      29.4422      30.4581      29.9084
290027.......................................................       0.9025       0.8967       0.8967      17.8850      15.1448      21.6128      18.3839
290032.......................................................       1.4163       1.1975       1.1975      29.4164      31.7105      32.0495      31.1084
290039.......................................................       1.5419       1.1417       1.1417      29.6801      31.2941      33.6718      31.6289
290041.......................................................       1.3158       1.1417       1.1417      30.1346      33.9878      35.5146      33.3938
290042.......................................................       0.4555       1.1417       1.1417            *            *            *            *
290044.......................................................          ***            *            *            *            *      38.1320      38.1320
290045.......................................................       1.5773       1.1417       1.1417      26.9319      30.9612      34.4022      31.2459
290046.......................................................       1.2702       1.1417       1.1417            *            *            *            *
290047.......................................................       1.4129       1.1417       1.1417            *            *            *            *
290049.......................................................       1.3499       1.0054       1.0054            *            *            *            *
290050.......................................................       1.1705            *            *            *            *            *            *
290051.......................................................       1.5597            *            *            *            *            *            *
300001.......................................................       1.5726       1.1665       1.1665      29.4130      27.5032      28.8432      28.5481
300003.......................................................       2.0572       1.1665       1.1665      27.8059      33.3560      34.5310      31.9387
300005.......................................................       1.3969       1.1665       1.1665      25.1869      25.6699      26.7123      25.8743
300006.......................................................       1.2070            *            *      20.6787      23.3200            *      21.9235
300007.......................................................       1.2792            *            *      25.3125            *            *      25.3125
300010.......................................................       1.1835            *            *      26.9346      27.5028            *      27.2341
300011.......................................................       1.2737       1.1665       1.1665      27.3325      28.4044      31.6428      29.1783

[[Page 24199]]

 
300012.......................................................       1.3755       1.1665       1.1665      28.4234      30.5198      30.3374      29.7075
300013.......................................................          ***            *            *      23.1529            *            *      23.1529
300014.......................................................       1.1978       1.1665       1.1665      25.5059      27.5151      29.2605      27.5032
300015.......................................................       1.0767            *            *      24.0620            *            *      24.0620
300016.......................................................          ***            *            *      24.5498            *            *      24.5498
300017.......................................................       1.2321       1.1665       1.1665      28.3959      29.6957      30.3051      29.4733
300018.......................................................       1.3845       1.1665       1.1665      28.0308      29.7209      29.6873      29.1985
300019.......................................................       1.2862       1.1665       1.1665      25.3845      25.9656      27.2631      26.2544
300020.......................................................       1.2090       1.1665       1.1665      26.8402      28.6723      30.5485      28.7305
300022.......................................................       1.0801            *            *      23.5948            *            *      23.5948
300023.......................................................       1.3630       1.1665       1.1665      25.4873      28.6309      30.9871      28.5288
300024.......................................................       1.6816            *            *      23.9205            *            *      23.9205
300029.......................................................       1.7658       1.1665       1.1665      26.9484      29.0806      29.9138      28.7021
300034.......................................................       2.0425       1.1665       1.1665      28.5375      29.7484      31.5753      29.9856
300308.......................................................       0.6393            *            *            *            *            *            *
300309.......................................................       0.7909            *            *            *            *            *            *
300310.......................................................       0.6299            *            *            *            *            *            *
310001.......................................................       1.7499       1.3215       1.3215      33.9360      35.3612      41.8952      37.1034
310002.......................................................       1.8830       1.3038       1.3008      35.4567      37.3461      38.9875      37.2295
310003.......................................................       1.2035       1.3215       1.3215      31.1040      32.8935      35.3962      33.1810
310005.......................................................       1.3045       1.1886       1.1886      27.5690      29.0084      31.6992      29.4759
310006.......................................................       1.1997       1.3215       1.3215      27.0436      27.4545      28.9780      27.8274
310008.......................................................       1.3218       1.3215       1.3215      29.5857      31.2579      32.2471      31.0509
310009.......................................................       1.2680       1.3038       1.3008      29.7760      32.7384      33.9105      32.0940
310010.......................................................       1.2806       1.1318       1.1318      25.3139      28.5852      33.1613      29.0668
310011.......................................................       1.2514       1.1341       1.1341      28.5241      30.8612      31.0823      30.1687
310012.......................................................       1.6373       1.3215       1.3215      33.1622      34.6882      38.1712      35.4125
310013.......................................................       1.2295       1.3038       1.3008      28.5016      30.6248      31.4496      30.2036
310014.......................................................       1.9216       1.1226       1.1226      32.7222      29.7204      30.9277      30.9970
310015.......................................................       1.9678       1.3038       1.3008      32.4980      36.4776      37.1869      35.4178
310016.......................................................       1.3082       1.3215       1.3215      28.9788      33.9862      34.3751      32.6794
310017.......................................................       1.3290       1.3038       1.3008      28.0930      30.9233      32.0816      30.4154
310018.......................................................       1.1885       1.3038       1.3008      26.9399      30.3381      31.1747      29.5340
310019.......................................................       1.6374       1.3215       1.3215      31.0524      29.6592      30.9463      30.5778
310020.......................................................       1.5424       1.3215       1.3215      29.3392      30.6722      32.7089      30.8843
310021.......................................................       1.6517       1.1886       1.1886      29.6308      31.3410      33.1764      31.3692
310022.......................................................       1.2444       1.1226       1.1226      26.1914      28.2024      28.9633      27.8379
310024.......................................................       1.3630       1.1886       1.1886      27.5278      30.9171      33.3774      30.6108
310025.......................................................       1.3032       1.3215       1.3215      27.7960      31.1274      34.3920      31.3534
310026.......................................................       1.1807       1.3215       1.3215      25.3970      27.5171      29.3348      27.4955
310027.......................................................       1.3584       1.1886       1.1886      27.0982      28.8314      29.1626      28.5991
310028.......................................................       1.2686       1.3038       1.1886      29.1101      31.3849      31.8631      30.8364
310029.......................................................       1.9437       1.1226       1.1226      29.1439      30.7707      33.7099      31.2185
310031.......................................................       3.0821       1.1242       1.1242      30.2345      33.9685      35.3478      33.2165
310032.......................................................       1.3129       1.1226       1.1226      27.8754      27.5232      29.1612      28.2024
310034.......................................................       1.3412       1.1242       1.1242      27.8517      29.9162      31.8300      29.8876
310037.......................................................       1.3580       1.3215       1.3215      32.1471      35.0329      38.0377      35.1550
310038.......................................................       2.0170       1.3038       1.3008      32.1977      33.4822      35.8746      33.9362
310039.......................................................       1.2537       1.3038       1.3008      27.1054      28.8292      31.8657      29.2627
310040.......................................................       1.3533       1.3215       1.3215      28.0068      34.1113      34.5838      32.1930
310041.......................................................       1.2800       1.1242       1.1242      29.7335      32.8085      33.3980      31.9565
310042.......................................................          ***            *            *      29.0207      30.7358      34.0717      31.1859
310044.......................................................       1.3686       1.1318       1.1318      27.7752      31.3206      31.9267      30.3672
310045.......................................................       1.7345       1.3215       1.3215      32.6359      34.1060      37.3128      34.7199
310047.......................................................       1.2988       1.1736       1.1736      28.3415      32.7880      35.2527      32.2796
310048.......................................................       1.3238       1.1886       1.1886      28.4715      30.2025      32.4064      30.4056
310049.......................................................          ***            *            *      32.7666      27.8564            *      30.6033
310050.......................................................       1.2381       1.3038       1.3008      27.2276      27.3033      29.5929      28.0821
310051.......................................................       1.3966       1.3038       1.1886      32.0113      33.7168      36.1453      33.9634
310052.......................................................       1.3415       1.1242       1.1242      28.1498      30.8036      32.8650      30.5913
310054.......................................................       1.2940       1.3038       1.3008      30.6905      34.1860      35.7990      33.5435
310057.......................................................       1.3251       1.1226       1.1226      26.4606      29.5221      28.6219      28.2552
310058.......................................................       1.0596       1.3215       1.3215      26.4816      28.0815      27.3745      27.2978
310060.......................................................       1.2437       1.3038       1.1226      23.2146      25.1575      27.6986      25.4776
310061.......................................................       1.2606       1.1226       1.1226      27.5400      28.2129      31.7646      29.1214
310063.......................................................       1.3618       1.1886       1.1886      28.3457      31.4884      32.1212      30.6378

[[Page 24200]]

 
310064.......................................................       1.5601       1.1736       1.1736      29.5979      33.4440      35.3987      32.8719
310067.......................................................          ***            *            *      26.8068            *            *      26.8068
310069.......................................................       1.2815       1.1226       1.1226      27.9656      28.1681      29.9598      28.7705
310070.......................................................       1.4011       1.3038       1.3008      32.1806      33.2310      33.7936      33.1015
310072.......................................................          ***            *            *      26.3520            *            *      26.3520
310073.......................................................       1.8401       1.1242       1.1242      29.6611      32.0329      33.2615      31.6839
310074.......................................................       1.2542       1.3215       1.3215      28.4361      29.4834      35.6666      31.1493
310075.......................................................       1.3069       1.1242       1.1242      26.2479      31.6870      31.9433      29.9126
310076.......................................................       1.6706       1.3038       1.3008      34.9428      36.4280      38.0720      36.4875
310077.......................................................          ***            *            *      30.7465      32.6644      34.0345      32.4516
310078.......................................................          ***            *            *      26.9589      29.8014      30.7927      29.2238
310081.......................................................       1.2351       1.1226       1.1226      26.4259      26.6136      29.8217      27.6431
310083.......................................................       1.2916       1.3038       1.3008      24.6563      28.2392      30.0128      27.5631
310084.......................................................       1.2146       1.1242       1.1242      29.9437      32.9001      34.3249      32.2493
310086.......................................................       1.2372       1.1226       1.1226      27.3601      29.3058      30.7666      29.1619
310088.......................................................       1.1889       1.1736       1.1736      25.5274      26.4966      29.0942      27.0316
310090.......................................................       1.2738       1.1886       1.1886      27.1661      30.8941      33.3364      30.3968
310091.......................................................       1.1950       1.1226       1.1226      27.1115      27.7204      28.8503      27.8956
310092.......................................................       1.4321       1.1318       1.1318      25.7071      29.4999      29.3843      28.2367
310093.......................................................       1.1892       1.3038       1.3008      25.8727      28.0401      29.9026      28.0649
310096.......................................................       2.0353       1.3038       1.3008      30.3675      34.4275      36.4988      33.8387
310105.......................................................       1.2260       1.3215       1.3215      30.9968      31.9769      29.9797      30.9490
310108.......................................................       1.3646       1.3038       1.3008      29.1548      30.1002      33.0791      30.7872
310110.......................................................       1.2908       1.1318       1.1318      27.8707      31.2164      33.2096      31.0583
310111.......................................................       1.2002       1.1242       1.1242      28.8692      30.7475      31.9533      30.6096
310112.......................................................       1.2755       1.1242       1.1242      28.9928      30.4192      30.9671      30.1683
310113.......................................................       1.2386       1.1242       1.1242      27.5203      29.6079      31.9823      29.7520
310115.......................................................       1.2894       1.3038       1.1226      26.2803      29.6020      30.6848      28.9374
310116.......................................................       1.2313       1.3215       1.3215      26.6287      25.6976      29.5404      27.2633
310118.......................................................       1.3298       1.3215       1.3215      28.1238      28.8797      31.9920      29.6477
310119.......................................................       1.8293       1.3038       1.3008      35.6786      37.7876      42.6911      38.8840
310120.......................................................       1.0683       1.3038       1.1886      27.2010      31.4110      29.5849      29.3345
310122.......................................................       1.8284       1.1242       1.1242            *            *            *            *
310123.......................................................       2.4750       1.2237       1.2237            *            *            *            *
310124.......................................................       1.7405       1.1592       1.1592            *            *            *            *
310125.......................................................       3.0573       1.1886       1.1886            *            *            *            *
320001.......................................................       1.5398       0.9477       0.9477      26.1962      26.9434      28.3114      27.2210
320002.......................................................       1.4251       1.0821       1.0821      28.6963      30.5158      32.0322      30.4616
320003.......................................................       1.1829       0.8982       0.8982      22.3911      28.1402      27.4758      25.7749
320004.......................................................       1.3224       0.8353       0.8353      24.0362      24.9481      24.7427      24.6089
320005.......................................................       1.3413       0.9477       0.9477      21.2164      23.8264      25.4686      23.5378
320006.......................................................       1.3228       0.9814       0.9814      22.5615      24.2812      26.6616      24.5380
320009.......................................................       1.5558       0.9477       0.9477      24.4237      22.8293      31.2529      25.5999
320011.......................................................       1.1211       0.8795       0.8795      23.1539      24.2279      25.6322      24.4026
320013.......................................................       1.1009       0.9814       0.9814      27.8671      28.9276      22.6383      25.9594
320014.......................................................       1.1072       0.9270       0.9270      26.7112      24.5310      26.0108      25.6452
320016.......................................................       1.1409       0.8353       0.8353      21.7001      23.5040      24.8595      23.3847
320017.......................................................       1.1564       0.9477       0.9477      23.6861      25.0286      31.3764      26.3396
320018.......................................................       1.4337       0.9333       0.9333      23.0915      23.2360      26.8414      24.1413
320019.......................................................       1.6146       0.9477       0.9477      31.2250      31.5192      29.5311      30.6451
320021.......................................................       1.6483       0.9477       0.9477      28.5620      27.2357      26.6064      27.3101
320022.......................................................       1.1318       0.8353       0.8353      22.1492      23.7160      24.3131      23.3995
320030.......................................................       1.0412       0.8353       0.8353      18.0990      22.1971      20.9229      20.3256
320033.......................................................       1.2017       0.9814       0.9814      24.1185      27.6393      32.4689      27.9429
320037.......................................................       1.1385       0.9477       0.9477      21.6080      23.3999      25.1973      23.4459
320038.......................................................       1.2203       0.8353       0.8353      21.2181      20.1533      21.5104      20.9623
320046.......................................................       1.1831            *            *      22.9114      24.3534            *      23.6315
320057.......................................................       0.8052       1.4448       1.4448            *            *            *            *
320058.......................................................       0.8101       1.4448       1.4448            *            *            *            *
320059.......................................................       0.8615       1.4448       1.4448            *            *            *            *
320060.......................................................       0.9188       1.4448       1.4448            *            *            *            *
320061.......................................................       0.8690       1.4448       1.4448            *            *            *            *
320062.......................................................       0.8781       1.4448       1.4448            *            *            *            *
320063.......................................................       1.2764       0.9737       0.9737      24.9141      24.4696      25.1341      24.8572
320065.......................................................       1.1554       0.9737       0.9737      21.6189      26.6603      26.9856      25.3295
320067.......................................................       0.8883       0.8353       0.8353      20.4431      23.7745      23.0640      22.5148

[[Page 24201]]

 
320069.......................................................       1.1144       0.8353       0.8353      19.7296      20.9167      22.2717      20.9948
320070.......................................................       0.9190       1.4448       1.4448            *            *            *            *
320074.......................................................       1.1380       0.9477       0.9477      35.5980      22.2175      31.3214      29.3022
320079.......................................................       1.0890       0.9477       0.9477      23.8092      25.2105      25.7148      24.9372
320083.......................................................       2.5979       0.9477       0.9477            *      28.2114      24.0257      25.7289
320084.......................................................       0.9804       0.8353       0.8353            *      17.2511      17.5258      17.4008
320085.......................................................       1.6874       0.9333       0.9333            *      24.8752      28.5627      26.8570
330001.......................................................          ***            *            *      31.3735      33.4718            *      32.4179
330002.......................................................       1.5005       1.3215       1.3215      29.3459      31.1924      30.4429      30.3409
330003.......................................................       1.3482       0.8753       0.8753      21.6506      22.9945      23.8448      22.8408
330004.......................................................       1.2620       1.0583       1.0583      23.9959      26.0445      27.5850      25.9379
330005.......................................................       1.5873       0.9475       0.9475      25.9287      29.0124      30.5004      28.4063
330006.......................................................       1.2604       1.3215       1.3215      29.7509      31.5370      32.4887      31.2785
330008.......................................................       1.1431       0.9475       0.9475      21.3269      21.8198      23.2197      22.1194
330009.......................................................       1.2062       1.3215       1.3215      35.8367      35.4986      35.4703      35.5997
330010.......................................................          ***            *            *      17.9178      19.6920      20.6440      19.2176
330011.......................................................       1.3098       0.8816       0.8816      20.3641      21.8008      24.9644      22.3720
330013.......................................................       1.9972       0.8753       0.8753      23.9070      24.5162      26.1086      24.8688
330014.......................................................       1.3121       1.3215       1.3215      35.4053      38.8123      41.9904      38.6661
330016.......................................................       0.9857       0.8267       0.8267      18.9388      28.4392      21.7319      22.2994
330019.......................................................       1.2870       1.3215       1.3215      32.3413      34.8266      36.2560      34.4888
330023 \2\...................................................       1.5742       1.3038       1.3215      29.2669      31.6208      35.2521      32.2225
330024.......................................................       1.8005       1.3215       1.3215      36.5648      37.8398      42.0169      38.6703
330025.......................................................       1.0804       0.9475       0.9475      19.7561      20.2775      21.2619      20.4337
330027.......................................................       1.4373       1.3038       1.3008      35.1325      39.0717      41.6731      38.5866
330028.......................................................       1.4210       1.3215       1.3215      33.5312      34.2709      36.1977      34.6170
330029.......................................................       0.4427       0.9475       0.9475      18.6623      19.1589      22.2943      19.8291
330030.......................................................       1.2380       0.9007       0.9007      22.4368      22.9937      24.1393      23.1393
330033.......................................................       1.1423       0.8267       0.8267      21.3762      22.5681      24.4951      22.7923
330036.......................................................       1.1271       1.3215       1.3215      27.6813      28.9409      28.6763      28.4126
330037.......................................................       1.1107       0.9007       0.9007      19.6385      20.6904      22.5429      20.9676
330041.......................................................       1.2505       1.3215       1.3215      36.2481      36.0286      36.9040      36.3905
330043.......................................................       1.3834       1.2701       1.2701      34.1039      34.7480      38.4138      35.7957
330044.......................................................       1.2969       0.8422       0.8422      23.1450      24.1907      25.2654      24.2192
330045.......................................................       1.3331       1.2701       1.2701      34.4956      36.1893      38.2951      36.3647
330046.......................................................       1.4281       1.3215       1.3215      42.0900      44.8494      49.9508      45.5451
330047 h.....................................................       1.2132       0.8753       0.8753      21.1244      24.0678      24.2099      23.2219
330049.......................................................       1.4505       1.3038       1.0913      25.7022      29.2904      29.7258      28.2859
330053.......................................................       1.0625       0.9007       0.9007      19.6807      18.5290      20.0581      19.4166
330055.......................................................       1.5596       1.3215       1.3215      35.1393      38.4839      41.2383      38.3132
330056.......................................................       1.4423       1.3215       1.3215      32.9295      37.8444      35.4120      35.3946
330057.......................................................       1.7075       0.8753       0.8753      22.6519      24.4680      26.1030      24.4281
330058.......................................................       1.3449       0.9007       0.9007      19.5520      21.3727      22.2270      21.0700
330059.......................................................       1.5303       1.3215       1.3215      38.1019      39.7386      41.0950      39.6782
330061.......................................................       1.2227       1.3215       1.3215      32.7427      33.2848      35.0321      33.7280
330062.......................................................       1.0487            *            *      21.4270      21.0464            *      21.2306
330064.......................................................       1.2592       1.3215       1.3215      38.5719      36.4276      37.5279      37.4900
330065.......................................................       1.0539       0.9475       0.9475      21.9192      23.9128      24.8627      23.5400
330066.......................................................       1.3403       0.8753       0.8753      23.0916      24.7941      28.5116      25.5240
330067 \2\...................................................       1.4381       1.3038       1.3215      34.8416      26.4243      27.2479      28.9882
330072.......................................................       1.3269       1.3215       1.3215      32.7905      36.4336      37.1569      35.4529
330073.......................................................       1.1317       0.9007       0.9007      19.0781      20.1490      22.3706      20.5067
330074.......................................................       1.2195       0.9007       0.9007      20.2874      21.4274      22.6971      21.4576
330075.......................................................       1.1127       0.9723       0.9723      22.0240      22.4188      23.0741      22.5194
330078.......................................................       1.4671       0.9475       0.9475      22.7762      23.3981      25.5249      23.9158
330079.......................................................       1.2417       0.9974       0.9974      22.1064      22.5237      24.6828      23.1380
330080.......................................................       1.1802       1.3215       1.3215      36.1171      39.1724      39.0128      38.1206
330084.......................................................       1.0859       0.8267       0.8267      22.6365      21.5455      21.8844      22.0141
330085.......................................................       1.1463       0.9428       0.9428      23.2927      23.9568      24.6752      23.9772
330086.......................................................       1.3556       1.3215       1.3215      28.8424      29.1784      32.4300      30.1863
330088.......................................................       1.0121       1.2701       1.2701      31.2631      31.3973      33.6229      32.0964
330090.......................................................       1.4380       0.8267       0.8267      22.7721      23.6174      25.2379      23.8595
330091.......................................................       1.3451       0.9475       0.9475      22.5796      23.8063      25.1750      23.8763
330094.......................................................       1.2611       0.9058       0.9058      22.1495      23.0001      24.7488      23.2787
330095.......................................................          ***            *            *      28.9914      31.9872      46.3616      32.4322
330096.......................................................       1.2346       0.8267       0.8267      22.4895      22.0337      22.9866      22.5018

[[Page 24202]]

 
330097.......................................................       1.1683            *            *      19.2233      20.3189            *      19.7495
330100.......................................................       0.9820       1.3215       1.3215      32.8406      34.4621      37.3387      34.9547
330101.......................................................       1.9087       1.3215       1.3215      39.2601      38.7503      40.4612      39.5161
330102.......................................................       1.3915       0.9475       0.9475      23.6141      24.8184      25.2287      24.5563
330103.......................................................       1.0850       0.8330       0.8330      18.8763      21.1452      22.5242      20.8126
330104.......................................................       1.3440       1.3215       1.3215      33.7556      32.8818      33.1903      33.2697
330106.......................................................       1.7400       1.4485       1.3008      39.8554      41.4561      42.8789      41.4391
330107.......................................................       1.2734       1.2701       1.2701      31.8528      31.3888      34.1234      32.4908
330108.......................................................       1.1383       0.8267       0.8267      21.4680      22.2607      22.7058      22.1280
330111.......................................................       1.0558       0.9475       0.9475      17.6185      20.9387      19.9803      19.4680
330115.......................................................       1.1814       0.9723       0.9723      20.5101      23.3043      25.2327      23.0156
330119.......................................................       1.7645       1.3215       1.3215      36.5873      39.1114      38.4828      38.0489
330121.......................................................       0.9476            *            *      19.7388            *            *      19.7388
330122.......................................................          ***            *            *      26.3849            *            *      26.3849
330125.......................................................       1.7528       0.9007       0.9007      24.6945      26.7118      26.7047      26.0770
330126.......................................................       1.2994       1.3038       1.1473      28.8299      31.6370      35.1728      33.1208
330127.......................................................       1.3343       1.3215       1.3215      43.7479      44.6103      44.4572      44.2717
330128.......................................................       1.2870       1.3215       1.3215      34.5289      37.7166      39.5738      37.2581
330132.......................................................       1.0988       0.8267       0.8267      16.3088      17.4946      20.2593      18.3351
330133.......................................................       1.3735       1.3215       1.3215      44.0704      36.6962      40.0269      40.0358
330135.......................................................       1.1836       1.3038       1.1473      26.9969      29.0837      28.2828      28.1734
330136.......................................................       1.4932       0.9428       0.9428      22.5447      24.2010      25.7642      24.2296
330140.......................................................       1.7494       0.9723       0.9723      23.5774      25.7573      27.0648      25.4535
330141.......................................................       1.3524       1.2701       1.2701      30.6616      34.8902      37.7577      34.5697
330144.......................................................       1.0534       0.8267       0.8267      20.1805      20.9935      22.9269      21.3429
330148.......................................................       1.0140            *            *      18.5443            *            *      18.5443
330151.......................................................       1.1572       0.8267       0.8267      17.6782      19.1841      21.5978      19.3648
330152.......................................................       1.2920       1.3215       1.3215      32.0616      36.5136      36.5762      35.0673
330153.......................................................       1.7108       0.8753       0.8753      21.9935      24.5219      26.2638      24.3225
330157.......................................................       1.3554       0.9428       0.9428      23.6939      25.2312      26.7341      25.2451
330158.......................................................       1.5438       1.3215       1.3215      33.0067      32.2990      37.6639      34.3802
330159.......................................................       1.4177       0.9723       0.9723      24.1916      28.9094      28.5063      27.1433
330160.......................................................       1.5992       1.3215       1.3215      34.0373      34.1960      35.8958      34.7339
330162.......................................................       1.3033       1.3215       1.3215      31.3812      32.1783      34.4443      32.6472
330163.......................................................       1.1712       0.9475       0.9475      22.4644      24.0200      27.0659      24.5702
330164.......................................................       1.4565       0.9007       0.9007      24.4306      28.8481      27.2894      26.8505
330166 h.....................................................       1.0648       0.8267       0.8267      18.8777      19.4360      20.4318      19.5757
330167.......................................................       1.7599       1.2838       1.3008      33.7365      34.4748      36.1041      34.7272
330169.......................................................       1.4208       1.3215       1.3215      38.3498      39.3361      44.3462      40.5303
330171.......................................................       1.1942       1.3215       1.3215      27.7810      30.0122      30.0593      29.2106
330175.......................................................       1.1464       0.8267       0.8267      21.1944      22.2067      23.7714      22.4153
330177.......................................................       1.0045       0.8267       0.8267      20.1850      19.6100      19.9735      19.9338
330180.......................................................       1.2313       0.8753       0.8753      21.9641      22.1920      23.7235      22.6242
330181.......................................................       1.3007       1.2838       1.3008      35.9334      38.5351      40.9623      38.5235
330182.......................................................       2.3224       1.3038       1.3008      36.3831      39.6038      40.0238      38.7114
330184.......................................................       1.4427       1.3215       1.3215      33.2843      34.4044      35.1901      34.3420
330185.......................................................       1.2291       1.2701       1.2701      31.0179      32.3466      34.2430      32.5908
330188.......................................................       1.2590       0.9475       0.9475      22.6803      23.9210      25.5586      24.0883
330189.......................................................       1.0679       0.8753       0.8753      19.2538      21.6229      22.9867      21.2142
330191.......................................................       1.2924       0.8753       0.8753      22.3719      24.0232      24.7436      23.7211
330193.......................................................       1.2808       1.3215       1.3215      36.9866      37.1807      38.7230      37.6472
330194.......................................................       1.8228       1.3215       1.3215      39.9177      43.9910      44.2515      42.7636
330195.......................................................       1.7332       1.3215       1.3215      38.6867      40.0206      39.5538      39.5038
330196.......................................................       1.3705       1.3215       1.3215      32.5883      33.2171      35.7930      33.8609
330197.......................................................       1.0633       0.8267       0.8267      22.3117      23.4291      26.7687      24.1549
330198.......................................................       1.3856       1.2838       1.3008      29.5359      30.5485      32.7085      30.9857
330199.......................................................       1.1511       1.3215       1.3215      32.7870      35.0059      38.2030      35.2594
330201.......................................................       1.6395       1.3215       1.3215      33.3215      39.3682      37.4511      36.6531
330202.......................................................       1.2806       1.3215       1.3215      34.3545      38.0129      36.6670      36.3901
330203.......................................................       1.4512       0.9723       0.9723      26.2459      26.5882      31.9331      28.1724
330204.......................................................       1.3265       1.3215       1.3215      30.3273      37.6849      38.9990      35.5345
330205.......................................................       1.2915       1.3038       1.1473      30.0101      32.1617      32.4144      31.6042
330208.......................................................       1.1799       1.3215       1.3215      28.2667      29.6282      31.4344      29.9593
330209.......................................................          ***            *            *      28.7213      29.7988      30.1376      29.5534
330211.......................................................       1.1264       0.8267       0.8267      21.1094      22.9966      24.3905      22.8006
330212.......................................................          ***            *            *      27.0585      27.2232            *      27.1435

[[Page 24203]]

 
330213.......................................................       1.0844       0.8267       0.8267      21.7208      22.5191      24.9647      23.1508
330214.......................................................       1.9477       1.3215       1.3215      33.7670      37.8500      42.1291      37.8343
330215.......................................................       1.2755       0.8422       0.8422      20.6343      22.6744      23.3466      22.2273
330218.......................................................       1.0776       0.9723       0.9723      21.4095      24.1106      26.2793      23.9406
330219.......................................................       1.7056       0.9475       0.9475      27.7400      29.3644      29.8772      28.9747
330221.......................................................       1.3793       1.3215       1.3215      34.7033      36.5539      39.1877      36.8432
330222.......................................................       1.2774       0.8753       0.8753      25.9825      23.9746      25.6286      25.1525
330223.......................................................       1.0219       0.8267       0.8267      18.4291      19.4229      23.6690      20.4211
330224.......................................................       1.3174       1.0583       1.0583      23.9379      25.7850      28.0293      25.9885
330225.......................................................       1.1580       1.2838       1.3008      28.9952      29.2719      31.9981      30.1465
330226.......................................................       1.3178       0.9007       0.9007      23.4783      21.8977      24.1599      23.1859
330229 h.....................................................       1.2036       0.8360       0.8360      19.5670      20.6095      21.8375      20.6728
330230.......................................................       0.9991       1.3215       1.3215      32.1101      33.3175      35.7536      33.6689
330231.......................................................       1.0210       1.3215       1.3215      33.9324      36.9619      39.1585      36.5993
330232.......................................................       1.1885       0.8753       0.8753      21.4765      24.4531      26.2367      24.0703
330233.......................................................       1.4774       1.3215       1.3215      41.9968      45.5132      46.4011      44.6873
330234.......................................................       2.2633       1.3215       1.3215      36.8500      40.6314      48.6802      41.8211
330235.......................................................       1.1768       0.9428       0.9428      22.1217      23.3866      25.6714      23.6691
330236.......................................................       1.5550       1.3215       1.3215      32.9391      35.6347      38.6055      35.7449
330238.......................................................       1.1812       0.9007       0.9007      19.2407      20.8639      21.8941      20.6562
330239 h.....................................................       1.2433       0.8360       0.8360      20.4936      21.5397      22.3783      21.4691
330240.......................................................       1.2427       1.3215       1.3215      40.7478      39.9450      42.8856      41.1747
330241.......................................................       1.8668       0.9723       0.9723      27.7213      29.0882      30.2601      29.0836
330242.......................................................       1.3276       1.3215       1.3215      32.2178      33.6926      36.2068      34.0089
330245.......................................................       1.8252       0.8422       0.8422      21.6857      22.8003      25.2401      23.2687
330246.......................................................       1.3306       1.2701       1.2701      31.6763      34.6329      36.8581      34.3345
330247.......................................................       0.7996       1.3215       1.3215      32.1733      32.2300      35.2706      33.1804
330249.......................................................       1.2670       0.9723       0.9723      21.4345      22.9834      24.5819      23.0385
330250.......................................................       1.3135       0.9355       0.9355      23.0641      25.1664      26.8227      25.0299
330259.......................................................       1.4044       1.2838       1.3008      30.0488      31.9152      33.2686      31.7934
330261.......................................................       1.3009       1.3215       1.3215      30.9356      30.7942      33.5583      31.7945
330263.......................................................       1.0260       0.8267       0.8267      20.8456      22.4675      23.6060      22.3341
330264.......................................................       1.2873       1.2701       1.1473      28.1501      30.0139      31.0746      29.7061
330265.......................................................       1.1926       0.9007       0.9007      19.9414      20.4635      21.6198      20.6587
330267.......................................................       1.4008       1.3215       1.3215      30.3709      31.5478      33.1643      31.7213
330268.......................................................       0.9452       0.8267       0.8267      18.9142      20.9720      25.6319      21.7316
330270.......................................................       2.0124       1.3215       1.3215      38.2605      42.2111      53.8973      44.3875
330273.......................................................       1.3585       1.3215       1.3215      29.5106      30.4720      36.3643      32.1579
330276.......................................................       1.1335       0.8330       0.8330      21.7826      22.2353      23.8846      22.6430
330277.......................................................       1.1855       0.9439       0.9439      25.1438      25.3582      26.5151      25.7061
330279.......................................................       1.4992       0.9475       0.9475      23.4816      25.2130      26.7728      25.2467
330285.......................................................       2.0268       0.9007       0.9007      27.1260      27.9018      29.9511      28.3309
330286.......................................................       1.3541       1.2701       1.2701      32.3244      33.3552      34.4498      33.4062
330290.......................................................       1.7641       1.3215       1.3215      36.3764      36.9981      40.0375      37.7918
330293.......................................................          ***            *            *      19.0290            *            *      19.0290
330304.......................................................       1.3150       1.3215       1.3215      33.4431      34.5761      36.2311      34.7931
330306.......................................................       1.4598       1.3215       1.3215      30.7551      35.6640      36.3448      34.3198
330307.......................................................       1.2821       0.9883       0.9883      25.4128      27.5699      29.2568      27.4840
330314.......................................................       1.2414       1.2701       1.2701      26.0150      25.5597      25.8968      25.8297
330316.......................................................       1.2614       1.3215       1.3215      33.1512      34.8623      35.1243      34.3638
330331.......................................................       1.2609       1.2838       1.3008      34.7052      36.1630      38.8882      36.6631
330332.......................................................       1.2980       1.2838       1.3008      31.8389      33.3050      34.7704      33.3802
330333.......................................................          ***            *            *      33.7637      26.1917            *      29.6102
330338.......................................................          ***            *            *      27.3859      31.3761      37.2825      32.0071
330339.......................................................       0.9158       0.8753       0.8753      22.2812      22.6569      24.0829      23.0041
330340.......................................................       1.2406       1.2701       1.2701      31.4322      33.9358      36.7304      34.0134
330350.......................................................       1.4882       1.3215       1.3215      39.3541      36.6250      43.5699      39.8450
330353.......................................................       1.1878       1.3215       1.3215      38.6962      37.6549      43.9114      40.1352
330357.......................................................       1.2787       1.3215       1.3215      34.3965      35.5975      37.5781      35.8277
330372.......................................................       1.2829       1.2838       1.3008      30.1505      32.6721      34.7591      32.6538
330385.......................................................       1.1485       1.3215       1.3215      42.6671      46.3221      47.0402      45.3358
330386.......................................................       1.2241       1.0583       1.0583      25.9228      27.9943      28.7592      27.5994
330389.......................................................       1.8452       1.3215       1.3215      34.7552      34.7669      36.9478      35.4956
330390.......................................................       1.2447       1.3215       1.3215      33.2628      36.0573      34.5945      34.5746
330393.......................................................       1.7531       1.2701       1.2701      34.8213      34.8095      37.6074      35.7608
330394.......................................................       1.6481       0.8816       0.8816      23.3505      25.2229      26.6945      25.0944

[[Page 24204]]

 
330395.......................................................       1.3957       1.3215       1.3215      35.4619      37.3096      35.7217      36.1690
330396.......................................................       1.3725       1.3215       1.3215      32.5345      35.0297      36.8429      34.7966
330397.......................................................       1.3754       1.3215       1.3215      34.5110      38.4741      36.7459      36.5053
330399.......................................................       1.1594       1.3215       1.3215      33.6753      32.3688      34.5604      33.5258
330401.......................................................       1.3754       1.2701       1.2701      35.7435      40.6249      37.3189      37.8874
330402.......................................................          ***            *            *      21.3302            *            *      21.3302
330403.......................................................          ***            *            *            *      23.1887      25.2042      24.1429
330404.......................................................       0.8753            *            *            *            *            *            *
330405.......................................................       0.8833            *            *            *            *            *            *
330406.......................................................       0.8810            *            *            *            *            *            *
340001.......................................................       1.5157       0.9520       0.9520      23.2436      25.0041      27.2111      25.1005
340002.......................................................       1.7808       0.9520       0.9110      25.1099      27.3349      28.4571      27.0078
340003.......................................................       1.1318       0.8607       0.8607      21.5562      23.3066      24.1238      22.9768
340004.......................................................       1.4174       0.9129       0.9129      24.2055      25.4474      26.6506      25.4397
340005.......................................................       1.0032            *            *      22.9830      22.3814            *      22.6704
340007.......................................................          ***            *            *      21.1519            *            *      21.1519
340008.......................................................       1.1135       0.9520       0.9520      24.2089      26.6314      26.2698      25.7197
340010.......................................................       1.3600       0.9570       0.9570      23.1349      24.5666      27.1894      24.9795
340011.......................................................       1.0750       0.8607       0.8607      18.1843      19.9484      20.0476      19.3757
340012.......................................................       1.3275       0.8607       0.8607      22.0583      22.7189      23.2312      22.6747
340013.......................................................       1.2343       0.9286       0.9286      22.4787      23.0261      24.3059      23.2775
340014.......................................................       1.5855       0.8992       0.8992      24.4831      25.1872      27.1685      25.6433
340015 h.....................................................       1.3320       0.9787       0.9787      24.3870      26.2276      28.1772      26.2865
340016.......................................................       1.2923       0.8607       0.8607      22.7574      23.0359      23.7376      23.1810
340017.......................................................       1.3200       0.9110       0.9110      22.8879      23.8229      22.7039      23.1314
340018.......................................................       1.2060            *            *      20.3840      23.7243            *      21.9193
340019.......................................................          ***            *            *      17.8768            *            *      17.8768
340020.......................................................       1.2238       0.8814       0.8814      24.1955      23.7995      26.1419      24.7053
340021.......................................................       1.2885       0.9520       0.9520      23.6884      26.0995      29.3286      26.4057
340023.......................................................       1.3674       0.9286       0.9286      23.2844      24.4897      26.2541      24.6946
340024.......................................................       1.1513       0.8607       0.8607      21.2671      22.2521      23.8742      22.4843
340025.......................................................       1.2791       0.9110       0.9110      20.9915      21.2276      23.1272      21.8404
340027.......................................................       1.1485       0.9300       0.9300      22.6107      23.6326      25.2357      23.8877
340028.......................................................       1.5457       0.8962       0.8962      24.6836      26.3298      26.5301      25.8563
340030.......................................................       2.0383       0.9805       0.9805      27.4664      29.0122      30.0506      28.8550
340032.......................................................       1.4184       0.9520       0.9520      24.8031      26.7475      27.7578      26.5096
340035.......................................................       1.0842       0.8607       0.8607      21.2407      23.5476      24.5596      23.1461
340036.......................................................       1.3160       0.9855       0.9855      22.2089      25.2077      26.3904      24.6981
340037.......................................................       1.0334       0.8823       0.8823      22.5089      21.6411      25.2974      23.1980
340038.......................................................       1.2308       0.8607       0.8607      14.0203      14.0713      23.1194      16.2732
340039.......................................................       1.2931       0.9520       0.9520      25.6605      27.1275      27.9102      26.9345
340040.......................................................       1.9365       0.9427       0.9427      24.1523      26.3325      27.9072      26.1644
340041.......................................................       1.2470       0.9029       0.9029      23.0497      23.6600      24.3510      23.7190
340042.......................................................       1.1867       0.8607       0.8607      22.1107      23.0236      24.3666      23.1693
340044.......................................................       1.0102            *            *      21.7089            *            *      21.7089
340045.......................................................       0.9486            *            *      14.5004      23.1918            *      18.3297
340047.......................................................       1.8343       0.8992       0.8992      25.3727      25.0605      27.8038      26.1074
340049.......................................................       1.8974       0.9805       0.9805      22.3082      30.4827      31.2630      28.1162
340050.......................................................       1.0680       0.8962       0.8962      21.4511      24.2533      25.6210      23.7875
340051.......................................................       1.2225       0.8901       0.8901      21.9069      23.4091      24.0706      23.1553
340053.......................................................       1.5721       0.9520       0.9520      26.9361      27.7261      28.5758      27.7590
340055.......................................................       1.2438       0.9029       0.9029      24.3728      24.1057      26.4405      24.9504
340060.......................................................       1.1227       0.8992       0.8992      22.4303      22.8657      22.3770      22.5569
340061.......................................................       1.7759       0.9805       0.9805      26.6657      27.5594      27.2893      27.1830
340064.......................................................       1.0805       0.8607       0.8607      22.3631      22.9143      23.9195      23.0608
340065.......................................................          ***            *            *      20.8413            *            *      20.8413
340068.......................................................       1.1865       0.9516       0.9516      20.8600      21.8830      22.4484      21.7271
340069.......................................................       1.8892       0.9805       0.9805      27.5045      27.4473      29.8633      28.2974
340070.......................................................       1.2950       0.8992       0.8992      23.6045      24.9033      25.6875      24.7454
340071.......................................................       1.0908       0.9570       0.9570      22.1854      25.4537      26.0452      24.6143
340072.......................................................       1.1732       0.8607       0.8607      21.3320      23.1163      24.8367      23.0580
340073.......................................................       1.4358       0.9805       0.9805      29.4189      30.2061      31.2882      30.3321
340075.......................................................       1.2096       0.9029       0.9029      24.1297      26.0225      25.4646      25.1678
340084.......................................................       1.1470       0.9520       0.9520      21.3227      21.2580      21.3338      21.3047
340085 h.....................................................       1.2078       0.9369       0.9369      23.0890      23.9793      25.8265      24.2485
340087.......................................................       1.2104       0.8607       0.8607      18.4202      22.0070      22.5608      20.8741

[[Page 24205]]

 
340088.......................................................          ***            *            *      24.3299            *            *      24.3299
340090.......................................................       1.3172       0.9855       0.9855      21.7173      23.4542      25.8788      23.8260
340091.......................................................       1.5502       0.9129       0.9129      24.9411      25.8266      26.0698      25.6286
340096 h.....................................................       1.2065       0.9369       0.9369      23.6345      25.2169      25.0546      24.6415
340097.......................................................       1.1989       0.8607       0.8607      22.5775      24.2127      25.6227      24.1152
340098.......................................................       1.4802       0.9520       0.9520      25.4823      27.3308      28.7253      27.1943
340099.......................................................       1.2462       0.8607       0.8607      20.0178      20.3683      21.6077      20.6547
340104.......................................................       0.8626       0.8823       0.8823      14.3252      15.7521      16.5594      15.5520
340106.......................................................       1.1004       0.8607       0.8607      22.6979      22.4894      25.2139      23.4325
340107.......................................................       1.1924       0.8869       0.8869      22.5583      22.9698      24.4751      23.3459
340109.......................................................       1.2610       0.8840       0.8840      22.3826      23.4419      25.4826      23.8242
340113.......................................................       1.8335       0.9520       0.9520      26.0776      28.2568      28.6890      27.7109
340114.......................................................       1.6228       0.9805       0.9805      25.4533      26.6813      28.7016      26.9713
340115.......................................................       1.6156       0.9805       0.9805      25.1907      25.0212      27.0359      25.7751
340116.......................................................       1.7312       0.9029       0.9029      26.1641      25.3213      27.1898      26.2312
340119.......................................................       1.2061       0.9520       0.9520      22.4821      24.2287      24.9657      23.9376
340120.......................................................       1.0248       0.8607       0.8607      21.8548      23.0916      24.7598      23.2664
340121.......................................................       1.0763       0.9840       0.9840      20.3701      21.7576      22.6663      21.6117
340123.......................................................       1.2907       0.8992       0.8992      23.1879      26.1083      25.6790      24.9990
340124.......................................................       1.0333       0.9570       0.9570      18.3866      20.8018      22.2436      20.3584
340126 h.....................................................       1.2954       0.9570       0.9570      23.5405      25.0189      26.8953      25.1845
340127.......................................................       1.1826       0.9805       0.9805      24.6096      25.7831      26.6726      25.7092
340129.......................................................       1.2866       0.9520       0.9520      24.1356      25.4902      26.3540      25.4160
340130.......................................................       1.3338       0.9520       0.9520      23.0937      25.2941      26.6451      25.1555
340131.......................................................       1.5363       0.9300       0.9300      25.2989      27.9358      27.8063      27.0592
340132.......................................................       1.1937       0.8607       0.8607      20.4222      21.3521      22.9792      21.6047
340133.......................................................       1.0422       0.8915       0.8915      22.1588      22.5558      22.8049      22.5184
340137.......................................................       0.9094       0.9029       0.9029      29.9903      21.0642      22.2880      25.0275
340138.......................................................       0.8891       0.9805       0.9805      27.4767      21.3670            *      24.4228
340141.......................................................       1.6287       0.9840       0.9840      24.8132      27.3355      29.5610      27.3178
340142.......................................................       1.2086       0.8607       0.8607      22.1298      22.9907      24.4531      23.2199
340143.......................................................       1.5034       0.9029       0.9029      24.8904      25.3633      28.6528      26.2974
340144.......................................................       1.2673       0.9520       0.9520      25.6538      27.2686      26.6107      26.5141
340145.......................................................       1.3036       0.9520       0.9520      23.7028      23.7131      25.4851      24.3247
340146.......................................................          ***            *            *      18.8354            *            *      18.8354
340147.......................................................       1.3166       0.9570       0.9570      23.9998      25.4534      26.6789      25.4056
340148.......................................................       1.5957       0.8992       0.8992      22.4205      23.5880      25.8143      23.9131
340151.......................................................       1.0985       0.8607       0.8607      22.2613      22.0052      22.6662      22.3143
340153.......................................................       1.8446       0.9520       0.9520      25.7078      26.4896      28.2013      26.7972
340155.......................................................       1.4243       0.9805       0.9805      28.8758      30.4940      30.5341      30.0011
340156.......................................................       0.8336       1.4448       1.4448            *            *            *            *
340158.......................................................       1.1327       0.9840       0.9840      23.4724      26.4849      28.1593      25.9520
340159.......................................................       1.1318       0.9805       0.9805      22.1872      23.2991      24.4603      23.3300
340160.......................................................       1.3065       0.8607       0.8607      19.1330      20.7525      21.8503      20.6086
340166.......................................................       1.3370       0.9520       0.9520      25.7398      26.0557      27.8366      26.5981
340168.......................................................       0.3885       0.9840       0.9840      16.8076      17.3249            *      17.0785
340171.......................................................       1.1788       0.9520       0.9520      27.2074      28.2734      29.1675      28.2636
340173.......................................................       1.2716       0.9805       0.9805      26.6128      27.5072      29.0996      27.8382
340177.......................................................       1.1493       0.8607       0.8607            *      24.7471      26.9929      25.8488
340178.......................................................          ***            *            *            *      28.7219            *      28.7219
340179.......................................................          ***            *            *            *            *      34.2396      34.2396
340182.......................................................          ***            *            *            *            *      28.2372      28.2372
340183.......................................................       1.1100            *            *            *            *            *            *
340322.......................................................       0.7923            *            *            *            *            *            *
350002.......................................................       1.7713       0.8485       0.7255      20.6474      22.0283      22.4948      21.7317
350003.......................................................       1.2047       0.7255       0.7255      25.3076      21.8061      23.7797      23.5084
350004.......................................................          ***            *            *      27.5891            *            *      27.5891
350006.......................................................       1.6121       0.7255       0.7255      19.5870      19.4985      20.7196      19.9754
350009.......................................................       1.1099       0.8485       0.8485      20.7014      23.0873      23.8524      22.5660
350010.......................................................       1.1294       0.8485       0.7237      18.5682      19.1965      20.2900      19.3694
350011.......................................................       2.0043       0.8485       0.8485      22.3896      23.1947      23.9046      23.2095
350014.......................................................       0.9021       0.8485       0.7237      18.5360      17.7565      17.9617      18.0556
350015.......................................................       1.6873       0.8485       0.7255      18.6381      20.1161      20.4658      19.8222
350017.......................................................       1.3520       0.8485       0.7237      20.1943      21.0243      21.8203      21.0001
350019 \2\...................................................       1.6973       0.8485       0.9256      24.2382      22.1960      23.6479      23.3102
350027.......................................................          ***            *            *      14.2262            *            *      14.2262

[[Page 24206]]

 
350030.......................................................       0.9937       0.8485       0.7237      19.2282      18.9978      20.0738      19.4364
350043.......................................................          ***            *            *      20.9732            *            *      20.9732
350061.......................................................       1.0456            *            *      18.6546      22.0515            *      20.3874
350063.......................................................       0.8764       1.4448       1.4448            *            *            *            *
350064.......................................................       0.8725       1.4448       1.4448            *            *            *            *
350070.......................................................       2.0130       0.8485       0.8485      24.4464      25.2836      25.9959      25.2624
360001.......................................................       1.4368       0.9599       0.9599      23.7750      23.9101      26.5234      24.7144
360002.......................................................       1.2119       0.8673       0.8673      22.6923      24.5789      25.2297      24.2006
360003.......................................................       1.8456       0.9599       0.9599      26.3180      27.5029      28.8816      27.5641
360006.......................................................       1.9839       1.0119       1.0119      25.7041      28.1698      30.8441      28.2373
360008.......................................................       1.3028       0.8759       0.8759      23.2545      24.5714      25.7859      24.5599
360009.......................................................       1.6056       0.9060       0.9060      23.2659      23.1012      24.8430      23.7552
360010.......................................................       1.2454       0.8737       0.8737      22.0262      23.1178      23.6797      22.9911
360011.......................................................       1.3176       0.9919       0.9919      22.4482      25.5340      27.0031      24.9499
360012.......................................................       1.3422       1.0119       1.0119      25.5913      27.5470      29.9512      27.8791
360013.......................................................       1.1193       0.9060       0.9060      25.1588      26.8129      27.2317      26.4104
360014.......................................................       1.1293       0.9919       0.9919      23.8305      25.3861      26.8524      25.3890
360016.......................................................       1.4722       0.9599       0.9599      24.6587      26.1283      27.7608      26.1961
360017.......................................................       1.8024       1.0119       1.0119      25.4969      27.2910      29.9598      27.6052
360019.......................................................       1.3228       0.9212       0.9212      24.1105      25.5926      26.9051      25.5454
360020.......................................................       1.6244       0.9212       0.9212      22.3795      24.4343      23.8636      23.5858
360024.......................................................          ***            *            *      24.0612      23.5793            *      23.9138
360025.......................................................       1.4743       0.9212       0.9212      23.6574      25.5633      27.6127      25.8025
360026.......................................................       1.3027       0.9049       0.9049      22.3303      23.5898      25.4053      23.7441
360027.......................................................       1.6825       0.9212       0.9212      24.7093      25.4894      27.1811      25.7999
360029.......................................................       1.1410       0.9588       0.9588      20.8778      22.7785      24.6599      22.7997
360031.......................................................          ***            *            *      24.4324            *            *      24.4324
360032 h.....................................................       1.1695       0.9060       0.9060      22.9759      23.2638      25.2551      23.8405
360034.......................................................          ***            *            *      25.1366            *            *      25.1366
360035.......................................................       1.7700       1.0119       1.0119      25.6895      27.5220      29.8683      27.7932
360036.......................................................       1.2134       0.9212       0.9212      25.0910      27.6094      28.4712      27.1094
360037.......................................................       1.4154       0.9378       0.9378      25.1615      24.3982      28.3912      25.9007
360038.......................................................       1.5182       0.9599       0.9599      24.8294      22.8009      23.6986      23.7742
360039.......................................................       1.4811       0.9919       0.9919      22.5921      24.0218      24.2491      23.6541
360040.......................................................       1.1486       0.8673       0.8673      22.8729      24.0942      25.2894      24.0903
360041.......................................................       1.4912       0.9378       0.9378      23.2625      24.1080      25.5889      24.3654
360044.......................................................       1.1134       0.8673       0.8673      20.4724      21.8411      21.8857      21.4070
360046.......................................................       1.2112       0.9599       0.9599      23.8918      25.0775      25.7145      24.9194
360047.......................................................       1.0125            *            *      17.1973      21.7248            *      19.5322
360048.......................................................       1.8468       0.9588       0.9588      27.2274      28.8107      29.1376      28.3862
360049.......................................................          ***            *            *      24.2605      25.8367      26.2059      25.4083
360051.......................................................       1.7024       0.9049       0.9049      25.1785      25.7556      27.0097      26.0022
360052.......................................................       1.6267       0.9049       0.9049      23.3285      24.5405      25.8613      24.5908
360054.......................................................       1.3415       0.8759       0.8759      20.3176      23.0376      23.1854      22.1915
360055.......................................................       1.4208       0.8815       0.8815      25.1475      26.3112      27.3781      26.2760
360056.......................................................       1.6221       0.9599       0.9599      23.4638      23.1024      27.1657      24.5328
360058.......................................................       1.0757       0.8673       0.8673      22.7943      23.4429      24.6591      23.6483
360059.......................................................       1.5786       0.9378       0.9378      25.5222      25.3516      28.8091      26.6068
360062.......................................................       1.4901       1.0119       1.0119      26.8091      28.6518      31.8334      29.2317
360064.......................................................       1.6168       0.8815       0.8815      22.8729      22.2393      25.2315      23.4351
360065.......................................................       1.2521       0.9212       0.9212      24.0868      26.3036      28.1088      26.2426
360066.......................................................       1.5217       0.9060       0.9060      25.2316      27.3362      27.8899      26.8407
360068.......................................................       1.8902       0.9588       0.9588      23.7895      25.8414      26.5008      25.3817
360069.......................................................       1.2137            *            *      25.7032      24.2444            *      24.9438
360070.......................................................       1.6590       0.9088       0.9088      23.1687      24.8863      26.4994      24.8533
360071 h.....................................................       1.1279       0.9060       0.9060      21.6176      22.0786      22.9101      22.1868
360072.......................................................       1.4686       1.0119       1.0119      23.0464      24.4332      25.5498      24.3891
360074.......................................................       1.2447       0.9588       0.9588      23.6172      24.9055      26.1751      24.8987
360075.......................................................       1.1859       0.9378       0.9378      24.7610      26.8453      27.1558      26.3365
360076.......................................................       1.4726       0.9599       0.9599      22.5943      25.9369      27.3636      25.2933
360077.......................................................       1.5136       0.9378       0.9378      24.7086      25.6505      29.2165      26.5561
360078.......................................................       1.3049       0.9212       0.9212      24.6821      26.1313      26.1568      25.6598
360079.......................................................       1.8031       0.9599       0.9599      25.8762      26.0935      26.1253      26.0376
360080.......................................................       1.1259       0.8673       0.8673      19.5436      20.8309      21.0795      20.5175
360081.......................................................       1.3277       0.9588       0.9588      25.1439      27.5695      30.4888      27.5972
360082.......................................................       1.3704       0.9378       0.9378      27.4264      27.1197      29.4729      28.0495

[[Page 24207]]

 
360084.......................................................       1.5807       0.8737       0.8737      25.2059      25.8415      27.7366      26.2609
360085.......................................................       2.1063       1.0119       1.0119      27.5792      29.0081      31.6756      29.4421
360086.......................................................       1.5487       0.9049       0.9049      22.3005      22.1859      24.8676      23.1200
360087.......................................................       1.3826       0.9378       0.9378      25.9131      25.4040      29.6489      27.0082
360089.......................................................       1.0966       0.8673       0.8673      21.0253      22.7951      25.4796      23.0814
360090.......................................................       1.5300       0.9588       0.9588      24.4291      26.7717      28.6236      26.5744
360091.......................................................       1.3038       0.9378       0.9378      26.0541      27.5067      26.2518      26.6013
360092.......................................................       1.2227       1.0119       1.0119      23.5100      25.6618      25.6879      24.9879
360093.......................................................       1.0458            *            *      24.1238            *            *      24.1238
360094.......................................................          ***            *            *      27.1864      26.6348            *      26.9890
360095.......................................................       1.3013       0.9588       0.9588      24.6984      26.1275      26.3654      25.7726
360096.......................................................       1.1174       0.8815       0.8815      22.2333      24.6317      25.6497      24.1705
360098.......................................................       1.3974       0.9378       0.9378      23.6413      24.8447      25.7314      24.7628
360100.......................................................       1.2146       0.9088       0.9088      19.0616      23.0561      25.3775      22.1813
360101.......................................................       1.3459       0.9378       0.9378      27.7584      26.6208      28.7561      27.7335
360106.......................................................       1.1149            *            *      21.6450      24.1588            *      22.9406
360107.......................................................       1.0901       0.9588       0.9588      24.5365      25.9697      25.0899      25.1975
360109.......................................................       1.0676       0.8673       0.8673      24.3236      25.4184      26.4649      25.4240
360112.......................................................       1.9284       0.9588       0.9588      26.7880      28.6784      31.4146      28.9038
360113.......................................................       1.2716       0.9599       0.9599      23.5138      25.6493      26.8972      25.2973
360115.......................................................       1.2507       0.9378       0.9378      24.0232      24.0052      25.4614      24.5372
360116.......................................................       1.2486       0.9599       0.9599      23.4049      18.0655      25.1390      22.2554
360118.......................................................       1.5454       0.9298       0.9298      24.2526      27.7289      27.5254      26.5502
360121.......................................................       1.2601       1.0630       1.0391      25.2037      24.5592      27.5575      25.7699
360123.......................................................       1.4622       0.9378       0.9378      24.1761      22.6523      27.1080      24.5618
360125.......................................................       1.2312       0.9212       0.9212      22.6871      22.1096      23.6342      22.8051
360128.......................................................       0.9991            *            *      18.5954      21.0066            *      19.7451
360129.......................................................       0.8850            *            *      19.5336            *            *      19.5336
360130.......................................................       1.4172       0.9378       0.9378      21.7015      22.9762      25.4768      23.6048
360131.......................................................       1.2611       0.9088       0.9088      23.1730      24.0495      25.7134      24.3448
360132.......................................................       1.3086       0.9599       0.9599      25.7991      25.9453      27.4285      26.3954
360133.......................................................       1.6046       0.9049       0.9049      23.9457      24.6208      28.9439      25.8164
360134.......................................................       1.7646       0.9599       0.9599      25.3013      29.2975      28.4609      27.6989
360137.......................................................       1.6613       0.9378       0.9378      25.7647      26.9522      25.1870      25.9473
360141.......................................................       1.5955       0.8815       0.8815      31.0127      27.7085      30.1241      29.6138
360142.......................................................       1.0183            *            *      21.2084      22.1610            *      21.6897
360143.......................................................       1.3785       0.9378       0.9378      23.8938      24.6306      28.4811      25.7432
360144.......................................................       1.2995       0.9378       0.9378      26.7160      25.7079      28.7129      27.0896
360145.......................................................       1.7603       0.9378       0.9378      23.4743      25.8268      26.3634      25.2160
360147.......................................................       1.4037       0.8673       0.8673      22.7172      24.1953      25.2136      24.0757
360148.......................................................       1.0686       0.8673       0.8673      24.4873      26.1946      26.3049      25.7083
360150.......................................................       1.2404       0.9212       0.9212      25.8703      24.7667      25.2592      25.2945
360151.......................................................       1.6537       0.9088       0.9088      22.2179      24.8629      26.0020      24.3233
360152.......................................................       1.5944       1.0119       1.0119      24.9894      27.9147      30.0354      27.4637
360153.......................................................       1.0121       0.8673       0.8673      19.0844      19.0226      19.1349      19.0821
360154.......................................................          ***            *            *      17.1274            *            *      17.1274
360155.......................................................       1.5025       0.9378       0.9378      23.9466      25.3909      26.8044      25.3987
360156.......................................................       1.1867       0.8886       0.8886      22.6709      24.0510      25.3478      24.0344
360159.......................................................       1.2285       0.9919       0.9919      25.7108      33.1613      28.6988      28.9897
360161.......................................................       1.3481       0.8815       0.8815      22.6005      24.3792      25.7944      24.2437
360163.......................................................       1.8980       0.9599       0.9599      25.7966      26.9728      29.1497      27.2933
360170.......................................................       1.2814       1.0119       1.0119      22.9359      24.3620      27.3245      25.1144
360172.......................................................       1.4157       0.9378       0.9378      23.4727      26.3501      27.9941      25.9423
360174.......................................................       1.2911       0.9049       0.9049      22.8167      24.9990      26.5821      24.8252
360175.......................................................       1.2853       0.9919       0.9919      24.6152      26.5949      27.7409      26.3745
360177.......................................................       1.1829            *            *      23.4256      24.4712            *      23.9572
360179.......................................................       1.6031       0.9599       0.9599      25.9429      28.8645      30.2960      28.4358
360180.......................................................       2.2529       0.9378       0.9378      26.8720      26.1514      29.5742      27.5212
360185.......................................................       1.2223       0.8815       0.8815      21.8641      23.7173      24.8364      23.4838
360187.......................................................       1.6071       0.9049       0.9049      23.8362      24.8173      25.1844      24.6459
360189.......................................................       1.1205       1.0119       1.0119      24.2512      24.2136      26.6418      25.0335
360192.......................................................       1.3080       0.9378       0.9378      26.2976      26.7577      26.6802      26.5811
360194.......................................................       1.4943            *            *      22.3297            *            *      22.3297
360195.......................................................       1.1127       0.9378       0.9378      25.8043      26.1280      25.5865      25.8335
360197.......................................................       1.1514       0.9919       0.9919      24.7539      27.0896      28.6572      26.8812
360203.......................................................       1.1904       0.8673       0.8673      21.5564      22.1414      23.2702      22.3580

[[Page 24208]]

 
360210.......................................................       1.1799       1.0119       1.0119      26.5665      27.8415      28.7970      27.7707
360211.......................................................       1.5528       0.8673       0.8673      23.0884      22.5449      25.6367      23.6870
360212.......................................................       1.3402       0.9378       0.9378      24.5310      25.2756      26.3396      25.4049
360218.......................................................       1.1646       1.0119       1.0119      24.4720      27.4288      29.1835      27.0945
360230.......................................................       1.5362       0.9378       0.9378      26.6444      27.0223      29.3334      27.7442
360234.......................................................       1.3735       0.9599       0.9599      23.3325      24.3625      26.6945      24.6936
360236.......................................................       1.2075       0.9599       0.9599      21.3795      35.8144      25.7297      25.5205
360239.......................................................       1.3163       0.9049       0.9049      24.4398      25.2474      25.9671      25.2853
360241.......................................................          ***            *            *      24.8089      24.7001      23.4843      24.1955
360245.......................................................       0.5410       0.9212       0.9212      18.7966      19.1885      20.0683      19.3751
360247.......................................................       0.3827       1.0119       1.0119      25.1083      19.8892      19.3874      21.2446
360253.......................................................       2.3855       0.9599       0.9599      28.2555      30.4276      31.4677      30.0805
360257.......................................................          ***            *            *      17.9652            *            *      17.9652
360258.......................................................       1.4162            *            *            *            *            *            *
360259.......................................................       1.2048       0.9588       0.9588            *      25.1338      26.3472      25.7673
360260.......................................................          ***            *            *            *      27.3903            *      27.3903
360261.......................................................       1.7902       0.9009       0.9009            *      22.5431      23.2578      22.9224
360262.......................................................       1.3180       0.9588       0.9588            *      27.1680      29.8320      28.5152
360263.......................................................       1.6984       0.9060       0.9060            *      20.8884      22.6737      21.7835
360264.......................................................          ***            *            *            *            *      36.4427      36.4427
360265.......................................................          ***            *            *            *            *      36.5621      36.5621
360266.......................................................       2.0048       1.0119       1.0119            *            *            *            *
360268.......................................................       2.3692       0.9049       0.9049            *            *            *            *
360269.......................................................       1.8533            *            *            *            *            *            *
360270.......................................................       1.0574            *            *            *            *            *            *
360271.......................................................       1.2708            *            *            *            *            *            *
360272.......................................................       1.3839            *            *            *            *            *            *
360319.......................................................       0.7559            *            *            *            *            *            *
360325.......................................................       0.8727            *            *            *            *            *            *
360327.......................................................       0.8846            *            *            *            *            *            *
360328.......................................................       0.6787            *            *            *            *            *            *
360330.......................................................       0.7444            *            *            *            *            *            *
370001.......................................................       1.7930       0.8146       0.8146      26.2391      27.7245      24.5650      26.1351
370002.......................................................       1.1799       0.7663       0.7663      19.7718      20.1479      21.1078      20.3588
370004.......................................................       1.0870       0.8620       0.8620      24.7694      25.3919      26.9577      25.6751
370006.......................................................       1.2934       0.8017       0.8017      16.9469      20.1063      22.7149      19.9948
370007.......................................................       1.0616       0.7663       0.7663      17.2084      17.6547      18.3587      17.7447
370008.......................................................       1.4174       0.8857       0.8857      22.7419      24.2978      25.3440      24.2102
370011.......................................................       0.9999       0.8857       0.8857      19.2266      19.7821      21.7538      20.1606
370013.......................................................       1.5053       0.8857       0.8857      22.6451      24.9295      26.7257      24.7559
370014.......................................................       1.0129       0.8376       0.8376      24.8138      25.3576      25.6283      25.2744
370015.......................................................       0.9407       0.8146       0.8146      21.1833      23.6693      24.1384      22.9965
370016 h.....................................................       1.5363       0.8857       0.8857      24.2737      25.4062      26.2547      25.3515
370018.......................................................       1.4528       0.8146       0.8146      23.4286      23.5336      25.0566      24.0042
370019.......................................................       1.2391       0.7663       0.7663      19.6761      21.4474      21.8628      20.9956
370020.......................................................       1.3420       0.7663       0.7663      17.4835      18.5046      19.0473      18.3584
370022.......................................................       1.2433       0.8116       0.8116      18.4217      19.6495      23.6102      20.4747
370023.......................................................       1.2712       0.7747       0.7747      20.6002      21.5762      23.0397      21.7646
370025.......................................................       1.2655       0.8146       0.8146      22.0287      23.5659      24.0174      23.2102
370026 h.....................................................       1.5216       0.8857       0.8857      22.5734      23.0848      25.8863      23.8389
370028.......................................................       1.8296       0.8857       0.8857      24.8661      26.6153      27.3471      26.2811
370029.......................................................       1.0748       0.7663       0.7663      22.1163      23.9956      26.2124      24.0953
370030.......................................................       1.0261       0.7663       0.7663      20.3315      23.3037      23.5362      22.4100
370032.......................................................       1.4505       0.8857       0.8857      21.6029      23.4843      24.9755      23.3829
370034.......................................................       1.2289       0.7663       0.7663      17.6247      18.2341      18.7092      18.1945
370036.......................................................       1.0525       0.7663       0.7663      16.9222      17.7576      18.8545      17.8650
370037.......................................................       1.6593       0.8857       0.8857      23.1256      23.9685      25.2235      24.1678
370039.......................................................       1.1293       0.8146       0.8146      21.0793      21.8220      23.1526      22.0252
370040.......................................................       1.0032       0.7761       0.7761      21.1061      22.4048      22.4840      21.9813
370041.......................................................       0.8640       0.8146       0.8146      22.0082      22.3496      21.1950      21.8627
370042.......................................................       0.8638            *            *      15.3613            *            *      15.3613
370043.......................................................          ***            *            *      21.5588            *            *      21.5588
370045.......................................................          ***            *            *      14.6370            *            *      14.6370
370047.......................................................       1.4165       0.8376       0.8376      19.7112      20.4657      23.1490      21.1519
370048.......................................................       1.1155       0.7663       0.7663      17.7273      19.2464      20.7363      19.2180
370049.......................................................       1.3251       0.8857       0.8857      21.6878      23.2171      23.8712      22.9296

[[Page 24209]]

 
370051.......................................................       1.0947       0.7663       0.7663      14.6254      17.2618      18.0757      16.5780
370054.......................................................       1.2331       0.7663       0.7663      21.5521      21.5043      22.3399      21.8038
370056.......................................................       1.8115       0.8116       0.8116      21.7647      22.0312      23.9116      22.5937
370057.......................................................       0.9668       0.8146       0.8146      18.0426      19.7284      19.2372      19.0104
370060.......................................................       0.9205       0.8146       0.8146      23.8007      18.7592      18.0984      20.1632
370064.......................................................       0.9620            *            *      14.1879      14.2053            *      14.1969
370065.......................................................       1.0168       0.7784       0.7784      20.6537      20.0226      20.4496      20.3712
370072.......................................................       0.7997       0.7663       0.7663      14.6387        99616       101559       109922
370076.......................................................          ***            *            *      21.5461            *            *      21.5461
370078.......................................................       1.5644       0.8146       0.8146      23.9507      25.4068      26.2455      25.2147
370080.......................................................       0.8779       0.7663       0.7663      17.4857      18.0665      18.5141      17.9718
370083.......................................................       0.9436       0.7663       0.7663      15.3447      16.8836      17.8617      16.5924
370084.......................................................       0.9721       0.7663       0.7663      17.2735      16.6514      17.2101      17.0695
370089.......................................................       1.1406       0.7663       0.7663      19.9021      20.4699      20.8401      20.4021
370091.......................................................       1.5557       0.8146       0.8146      22.9893      23.3357      24.0027      23.4438
370093.......................................................       1.5136       0.8857       0.8857      25.7296      26.9774      26.8853      26.5217
370094.......................................................       1.3850       0.8857       0.8857      22.0591      23.1191      23.7154      22.9859
370095.......................................................       0.9994            *            *      16.5310            *            *      16.5310
370097.......................................................       1.2947       0.8116       0.8116      21.7150      22.3267      24.1980      22.8129
370099.......................................................       1.0477       0.8146       0.8146      20.5217      20.5075      23.8980      21.5269
370100.......................................................       0.9904       0.7663       0.7663      14.1883      14.7712      15.5623      14.8564
370103.......................................................       0.9691       0.8003       0.8003      16.1408      17.8018      17.5353      17.2277
370105.......................................................       1.8529       0.8857       0.8857      22.1584      23.8978      25.8829      24.0992
370106.......................................................       1.3478       0.8857       0.8857      24.2393      26.5867      28.0721      26.3986
370112.......................................................       0.9375       0.7761       0.7761      15.4941      15.4471      16.0671      15.6827
370113.......................................................       1.1592       0.8599       0.8599      23.3011      25.3565      27.2827      25.2470
370114.......................................................       1.5625       0.8146       0.8146      21.0603      21.7880      22.5180      21.8058
370123.......................................................          ***            *            *      22.8174      25.4733            *      24.1041
370125.......................................................       0.8725            *            *      17.2013      17.1361            *      17.1678
370138.......................................................       1.0856       0.7663       0.7663      19.8308      18.3113      19.9220      19.3246
370139.......................................................       0.9531       0.7663       0.7663      17.8900      18.5225      18.3822      18.2581
370148.......................................................       1.5590       0.8857       0.8857      24.6194      25.2348      27.4012      25.7936
370149 h.....................................................       1.2268       0.9213       0.9213      21.0608      22.3537      23.1753      22.3280
370153.......................................................       1.0613       0.7663       0.7663      18.5417      19.8349      20.5204      19.6637
370156.......................................................       0.9835       0.7663       0.7663      16.6572      19.4743      22.3167      19.3770
370158.......................................................       1.0107       0.8857       0.8857      17.3161      18.5578      19.5733      18.4941
370166.......................................................       0.9240       0.8146       0.8146      21.9070      23.1681      22.8021      22.6015
370169.......................................................       0.9628       0.7663       0.7663      15.7686      15.8002      16.3268      15.9549
370170.......................................................       0.9292       1.4448       1.4448            *            *            *            *
370171.......................................................       0.8716       1.4448       1.4448            *            *            *            *
370172.......................................................       0.8898       1.4448       1.4448            *            *            *            *
370173.......................................................       0.8800       1.4448       1.4448            *            *            *            *
370174.......................................................       0.8491       1.4448       1.4448            *            *            *            *
370176.......................................................       1.1636       0.8146       0.8146      23.0324      25.0509      25.4392      24.5212
370177.......................................................       0.9561            *            *      15.6723      14.7193            *      15.1880
370178.......................................................       0.8982       0.7663       0.7663      14.9767      14.6070      14.9388      14.8411
370179.......................................................       0.9100            *            *      22.8322      23.5794            *      23.1700
370180.......................................................       1.1306       1.4448       1.4448            *            *            *            *
370183.......................................................       0.9428       0.8146       0.8146      20.5025      21.8147      24.2286      22.1884
370190.......................................................       1.3439       0.8146       0.8146      24.9455      33.1137      29.7322      29.3472
370192.......................................................       1.9008       0.8857       0.8857      26.1338      31.4930      27.7061      28.3751
370196.......................................................       0.8029       0.8857       0.8857      29.4383      22.6824      22.4776      24.9992
370199.......................................................       0.8699       0.8857       0.8857      23.7340      26.0451      25.0077      24.9496
370200.......................................................       1.2036       0.7663       0.7663      18.1008      17.6317      20.2539      18.6878
370201.......................................................       1.5499       0.8857       0.8857      23.1240      23.3550      25.7424      24.0321
370202.......................................................       1.5608       0.8146       0.8146      24.4920      25.1181      25.9091      25.2121
370203.......................................................       1.9071       0.8857       0.8857      21.2426      23.5190      23.1328      22.6893
370206.......................................................       1.6057       0.8857       0.8857      27.4495      26.0912      26.1889      26.4826
370209.......................................................          ***            *            *      32.8278            *            *      32.8278
370210.......................................................       2.0675       0.8146       0.8146      20.0360      21.2682      22.8799      21.4986
370211.......................................................       1.0016       0.8857       0.8857            *      26.5344      27.6884      27.1417
370212.......................................................       1.5926       0.8857       0.8857            *      21.0758      19.8743      20.4250
370213.......................................................          ***            *            *            *      29.3777            *      29.3777
370214.......................................................       1.0348       0.7663       0.7663            *            *      19.9843      19.9843
370215.......................................................       2.4607       0.8857       0.8857            *      32.3589      32.1819      32.2582
370216.......................................................       1.9400       0.8146       0.8146            *            *      26.6205      26.6205

[[Page 24210]]

 
370217.......................................................          ***            *            *            *            *      26.0370      26.0370
370218.......................................................       2.5671       0.8146       0.8146            *            *            *            *
370219.......................................................       1.9097            *            *            *            *            *            *
370220.......................................................       1.8202            *            *            *            *            *            *
370222.......................................................       1.5520            *            *            *            *            *            *
370223.......................................................       0.8668            *            *            *            *            *            *
380001.......................................................       1.3171       1.1405       1.1405      27.8554      30.0103      30.4600      29.5050
380002.......................................................       1.2551       0.9956       0.9956      26.3348      27.1861      30.2136      27.9532
380004.......................................................       1.7168       1.1405       1.1405      28.2466      30.5172      33.6461      30.8486
380005.......................................................       1.3327       1.0836       1.0836      28.0682      30.2211      31.3173      29.9539
380006.......................................................          ***            *            *      26.0475            *            *      26.0475
380007.......................................................       1.9152       1.1405       1.1405      31.5207      33.9969      34.7305      33.4267
380008.......................................................       1.2553            *            *      25.4494      25.8356            *      25.6457
380009.......................................................       1.9941       1.1405       1.1405      30.4198      31.7042      32.6878      31.6241
380010.......................................................          ***            *            *      27.5291      30.2957      35.0551      30.7377
380014.......................................................       1.9349       1.1536       1.1536      27.7255      29.9648      34.1502      30.6441
380017.......................................................       1.8577       1.1405       1.1405      31.7440      32.2447      34.4728      32.7888
380018.......................................................       1.9551       1.0836       1.0836      27.8952      28.0701      31.2271      29.1079
380020.......................................................       1.3797       1.0877       1.0877      25.8320      28.3563      30.3555      28.2037
380021.......................................................       1.4905       1.1405       1.1405      29.3001      29.3295      29.8854      29.5193
380022.......................................................       1.2577       1.1175       1.1175      27.8683      29.2642      30.8763      29.3903
380023.......................................................       1.2202            *            *      23.7073      26.5439            *      25.1052
380025.......................................................       1.3250       1.1405       1.1405      30.2628      33.2105      35.9576      33.1887
380026.......................................................       1.1244            *            *      26.5217            *            *      26.5217
380027.......................................................       1.2795       1.0525       1.0525      23.8758      25.5161      26.1995      25.2490
380029.......................................................       1.2944       1.0527       1.0527      26.2070      26.9966      29.4873      27.6967
380033.......................................................       1.7377       1.0877       1.0877      29.7995      30.8767      32.8129      31.1892
380035.......................................................          ***            *            *      26.4784            *            *      26.4784
380037.......................................................       1.3326       1.1405       1.1405      27.1884      30.5818      33.5871      30.5447
380038.......................................................       1.3226       1.1405       1.1405      30.5903      34.2303      36.0814      33.6061
380039.......................................................          ***            *            *      30.1544      32.3959      38.8009      33.4979
380040.......................................................       1.2511       0.9826       0.9826      28.4373      32.0103      32.4278      31.1380
380047.......................................................       1.7738       1.0749       1.0749      27.8385      29.8627      31.7128      29.8785
380050.......................................................       1.4281       1.0450       1.0450      24.2416      25.6190      26.9246      25.6371
380051.......................................................       1.5533       1.0527       1.0527      28.1305      29.7219      31.3732      29.7992
380052.......................................................       1.3106       0.9826       0.9826      22.6799      24.9476      26.0940      24.5630
380056.......................................................       1.0282       1.0527       1.0527      25.0068      25.1475      27.0740      25.8845
380060.......................................................       1.4189       1.1405       1.1405      30.2507      30.7041      32.3036      31.1160
380061.......................................................       1.6466       1.1405       1.1405      29.5145      29.8217      32.7612      30.7533
380066.......................................................          ***            *            *      27.5412            *            *      27.5412
380071.......................................................       1.3347       1.1405       1.1405      29.5740      30.2304      32.7599      30.8825
380072.......................................................          ***            *            *      22.5275            *            *      22.5275
380075.......................................................       1.3200       1.0836       1.0836      27.4795      29.0368      33.8954      30.0591
380081.......................................................       1.1954       0.9826       0.9826      21.0708      21.8850      26.7699      23.2864
380082.......................................................       1.2101       1.1405       1.1405      30.2721      32.3002      36.3613      33.0576
380089.......................................................       1.3636       1.1405       1.1405      30.8396      33.4214      35.0697      33.0748
380090.......................................................       1.2605       1.0525       1.0525      33.6822      34.4536      33.0782      33.7148
380091.......................................................       1.3973       1.1405       1.1405      35.7002      33.8950      40.6515      36.7344
380100.......................................................       1.7000            *            *            *            *            *            *
390001.......................................................       1.6581       0.9927       0.8503      22.4407      22.5309      24.2592      23.0730
390002.......................................................       1.2561       0.8671       0.8671      23.0113      22.4388      24.6765      23.3793
390003 h.....................................................       1.1504       0.9927       0.8503      21.3182      21.6478      23.1149      22.0126
390004.......................................................       1.6415       0.9413       0.9413      23.4063      24.3249      24.8914      24.2683
390005.......................................................       0.9824            *            *      19.0318            *            *      19.0318
390006.......................................................       1.8717       0.9263       0.9263      23.3960      25.1216      26.9964      25.2038
390008 h.....................................................       1.1526       0.8671       0.8671      21.0021      22.2680      23.1784      22.1394
390009.......................................................       1.7280       0.8705       0.8705      24.2789      25.5482      26.4813      25.4517
390010.......................................................       1.1892       0.8671       0.8671      21.6273      23.5390      24.0078      23.0255
390011.......................................................       1.2880       0.8633       0.8633      19.8602      21.9279      21.5963      21.1099
390012.......................................................       1.2958       1.1009       1.1009            *      28.5076      30.8519      29.6959
390013.......................................................       1.2264       0.9263       0.9263      23.3180      24.0044      24.9820      24.0935
390016 h.....................................................       1.2685       0.8671       0.8671      19.9899      21.9549      23.1263      21.8591
390017.......................................................          ***            *            *      20.6575            *            *      20.6575
390019.......................................................       1.1329       0.9927       0.9927      21.5137      23.4636      24.4718      23.1613
390022.......................................................          ***            *            *      31.0971      29.0710      31.6841      30.5765
390023.......................................................       1.2172       1.1009       1.1009      27.1600      31.7149      34.4844      31.2591

[[Page 24211]]

 
390024.......................................................       0.9546       1.1009       1.1009      37.4330      35.3959      31.7173      34.4317
390025.......................................................       0.5440       1.1009       1.1009      15.0282      17.2977      18.1275      16.8452
390026.......................................................       1.2123       1.1009       1.1009      27.0802      29.5157      31.6801      29.4675
390027.......................................................       1.5991       1.1009       1.1009      28.9159      35.8381      35.9249      33.5685
390028.......................................................       1.5682       0.8671       0.8671      23.6616      25.7246      27.8863      25.7953
390029.......................................................          ***            *            *      24.4276            *            *      24.4276
390030.......................................................       1.1912       0.9927       0.9927      20.9859      22.1581      23.3532      22.1863
390031.......................................................       1.2239       0.9534       0.9534      21.2949      22.6828      25.7851      23.2238
390032.......................................................       1.1807       0.8671       0.8671      20.9971      22.7205      24.1017      22.5468
390035.......................................................       1.2551       1.1009       1.1009      24.7281      26.2647      28.4959      26.5693
390036.......................................................       1.4696       0.8671       0.8671      23.3858      24.6032      22.6528      23.5100
390037.......................................................       1.3125       0.8671       0.8671      22.9008      24.7820      26.1465      24.6214
390039 h.....................................................       1.1700       0.8621       0.8621      17.8461      20.3787      21.9402      20.0570
390040.......................................................          ***            *            *      23.1807            *            *      23.1807
390041.......................................................       1.3108       0.8671       0.8671      20.6789      21.5925      23.2044      21.7988
390042.......................................................       1.3745       0.8671       0.8671      23.9632      25.6328      27.9366      25.8129
390043.......................................................       1.2148       0.8330       0.8330      20.9835      22.2549      23.4652      22.2302
390044.......................................................       1.6474       0.9842       0.9842      24.2586      27.1505      28.4484      26.6625
390045.......................................................       1.6290       0.8330       0.8330      22.2582      23.0712      24.0257      23.1327
390046.......................................................       1.6172       0.9768       0.9768      25.0825      27.2630      29.4366      27.2659
390048.......................................................       1.1056       0.9263       0.9263      23.6622      24.9759      27.4528      25.4111
390049.......................................................       1.6272       0.9927       0.9927      25.4056      27.1366      29.2676      27.3436
390050.......................................................       1.9670       0.8671       0.8671      24.5424      26.6931      27.8306      26.3967
390052.......................................................       1.1532       0.8330       0.8330      21.6736      23.3474      24.7791      23.2785
390054.......................................................       1.2022       0.9768       0.8503      21.4983      22.8087      24.6768      22.9563
390055.......................................................          ***            *            *      25.5675      25.6945            *      25.6356
390056.......................................................       1.0719       0.8372       0.8372            *      19.5537      23.5619      21.4544
390057.......................................................       1.3152       1.1009       1.1009      25.1901      27.9583      30.2759      27.8737
390058.......................................................       1.3058       0.9413       0.9413      25.3415      27.4799      26.7884      26.4926
390061.......................................................       1.4913       0.9768       0.9768      25.5012      28.4538      28.6399      27.5670
390062.......................................................       1.1330       0.8717       0.8717      19.0692      21.4052      21.7605      20.7628
390063.......................................................       1.7744       0.8705       0.8705      23.5469      24.7614      25.8275      24.7403
390065.......................................................       1.3030       1.1076       1.1076      23.4021      25.2188      28.1081      25.5499
390066.......................................................       1.2757       0.9263       0.9263      23.0891      24.2087      26.3047      24.5398
390067.......................................................       1.8178       0.9413       0.9413      25.4576      26.3287      28.9773      26.8680
390068.......................................................       1.3160       0.9768       0.9768      25.9890      25.8291      26.8043      26.1705
390070.......................................................       1.4291       1.1009       1.1009      26.9235      30.9499      34.2332      30.7526
390071.......................................................       0.9947       0.8330       0.8330      20.9443      21.8366      25.0434      22.4830
390072 h.....................................................       1.0662       0.9927       0.8503      22.0155      24.9388      24.8220      23.8819
390073.......................................................       1.6664       0.8717       0.8717      24.8013      26.3698      26.1445      25.7871
390074.......................................................       1.1018       0.8671       0.8671      21.0941      22.8545      23.9206      22.6224
390075.......................................................          ***            *            *      22.6530      24.6359            *      23.6261
390076.......................................................       1.3847       1.1009       1.1009      18.1276      27.9004      31.8947      25.1241
390079.......................................................       1.8657       0.8499       0.8499      21.4323      23.3053      22.3152      22.3289
390080.......................................................       1.2658       1.1009       1.1009      25.0921      27.2616      29.3486      27.3026
390081.......................................................       1.2210       1.0878       1.0878      28.7974      30.3840      32.2244      30.4889
390084.......................................................       1.1741       0.8330       0.8330      20.7799      19.8605      21.8951      20.8513
390086.......................................................       1.7187       0.8361       0.8361      20.7383      22.5317      23.6719      22.3560
390090.......................................................       1.8335       0.8671       0.8671      20.7474      25.2014      27.8713      24.6921
390091.......................................................       1.1438       0.8671       0.8671      20.8243      21.5586      22.0398      21.4679
390093.......................................................       1.2262       0.8330       0.8330      21.0427      21.4401      22.8098      21.7808
390095.......................................................       1.1833       0.9927       0.8503      21.0754      23.6240      21.9985      22.1929
390096.......................................................       1.5833       0.9842       0.9842      24.4145      27.0763      28.7966      26.8107
390097.......................................................       1.2509       1.1009       1.1009      25.3012      25.6660      26.8698      25.9841
390100.......................................................       1.7379       0.9768       0.9768      26.7267      27.7208      28.9921      27.8855
390101.......................................................       1.2730       0.9514       0.9514      20.1694      21.9418      22.6003      21.6003
390102.......................................................       1.4104       0.8671       0.8671      21.6629      24.8898      25.2152      24.0444
390103.......................................................       0.9404       0.8671       0.8671      18.6703      20.6775      20.7796      20.0065
390104.......................................................       1.0839       0.8330       0.8330      19.1803      19.6428      19.2769      19.3701
390107.......................................................       1.3848       0.8671       0.8671      23.1023      24.1386      24.5076      23.9477
390108.......................................................       1.2431       1.1009       1.1009      24.7486      27.2661      27.2284      26.4403
390109.......................................................       1.0688            *            *      18.7558      19.9156            *      19.3329
390110.......................................................       1.6421       0.8671       0.8671      23.3355      23.9808      27.8192      24.9894
390111.......................................................       2.0459       1.1009       1.1009      30.6809      32.6510      34.1737      32.5475
390112 h.....................................................       1.1876       0.8621       0.8621      16.6113      19.2126      20.1316      18.6193
390113.......................................................       1.3210       0.8673       0.8673      21.7729      22.2591      23.2491      22.4294

[[Page 24212]]

 
390114.......................................................       1.3855       0.8671       0.8671      22.6630      24.0473      26.9445      24.5624
390115.......................................................       1.4625       1.1009       1.1009      26.4751      27.7333      29.2480      27.8215
390116.......................................................       1.2624       1.1009       1.1009      28.5563      30.2722      31.7572      30.2754
390117.......................................................       1.1777       0.8330       0.8330      20.0040      20.3946      21.0086      20.4770
390118.......................................................       1.1753       0.8330       0.8330      19.3332      21.5001      20.4058      20.3988
390119.......................................................       1.2890       0.9927       0.8503      21.2761      22.2746      22.7221      22.1033
390121.......................................................       1.7647       0.8717       0.8717      22.0556      23.1408      26.3071      23.7780
390122.......................................................       1.1273       0.8330       0.8330      21.6981      22.5785      23.9861      22.7470
390123.......................................................       1.1806       1.1009       1.1009      25.2209      28.6269      32.0389      28.5662
390125.......................................................       1.2652       0.8330       0.8330      19.4406      20.9456      21.8553      20.7713
390127.......................................................       1.2773       1.1009       1.1009      28.9238      30.9374      32.5496      30.8978
390128.......................................................       1.1996       0.8671       0.8671      21.8837      23.1539      24.3440      23.1405
390130.......................................................       1.2097       0.8633       0.8633      21.0694      24.0685      23.7197      22.9210
390131.......................................................       1.3556       0.8671       0.8671      21.2164      22.6306      22.8611      22.2247
390132.......................................................       1.4330       1.1009       1.1009      26.8153      27.7250      28.9482      27.8442
390133.......................................................       1.6813       1.1009       1.1009      26.1458      28.7162      29.6905      28.2740
390135.......................................................          ***            *            *            *      24.4738            *      24.4738
390136.......................................................          ***            *            *      24.8042      22.1415      24.2200      23.7599
390137.......................................................       1.4828       0.9927       0.8503      21.8830      23.4877      24.4118      23.2305
390138.......................................................       1.2362       0.8330       0.8330      22.7210      24.2769      25.8021      24.2858
390139.......................................................       1.3183       1.1009       1.1009      28.2089      30.4246      33.4122      30.7557
390142.......................................................       1.4259       1.1009       1.1009      32.0827      32.5786      33.7285      32.8151
390145.......................................................       1.4891       0.8671       0.8671      22.4255      23.8041      24.9495      23.7235
390146.......................................................       1.2802       0.8330       0.8330      22.3260      25.2460      22.6594      23.4555
390147.......................................................       1.3039       0.8671       0.8671      23.6380      25.0971      26.5534      25.0934
390150.......................................................       1.1581       0.8330       0.8330      24.5256      24.1855      23.5572      24.0979
390151.......................................................       1.3329       1.1028       1.1028      25.1422      27.1539      29.9832      27.4878
390152.......................................................          ***            *            *      11.7774            *            *      11.7774
390153.......................................................       1.4275       1.1009       1.1009      27.5167      30.0586      32.4096      30.1880
390154.......................................................       1.2257       0.8330       0.8330      20.4408      20.6982      23.0482      21.3878
390156.......................................................       1.3466       1.0878       1.0878      27.8096      31.2571      32.2600      30.3947
390157.......................................................       1.3458       0.8671       0.8671      22.0222      22.7493      21.6936      22.1545
390160.......................................................       1.1891       0.8671       0.8671      19.5942      21.4877      24.3824      21.8172
390162.......................................................       1.4444       1.0127       1.0127            *      30.0900      35.4117      32.5988
390163.......................................................       1.2443       0.8671       0.8671      19.8863      22.1741      23.0960      21.6744
390164.......................................................       2.1047       0.8671       0.8671      25.1277      26.4971      26.4272      26.0933
390166.......................................................       1.1405       0.8671       0.8671      20.9510      24.9810      21.2366      22.3853
390168.......................................................       1.4614       0.8671       0.8671      21.9344      24.5820      26.1248      24.3161
390169.......................................................       1.4501       0.9927       0.8503      24.1682      27.2242      32.0181      27.6964
390173.......................................................       1.1370       0.8330       0.8330      21.6562      22.8220      24.2832      22.9513
390174.......................................................       1.6414       1.1009       1.1009      30.3725      32.6265      34.7231      32.5879
390176.......................................................       1.1087       0.8671       0.8671      17.1387            *      24.2733      19.5548
390178.......................................................       1.3316       0.8815       0.8815      19.2731      20.7270      22.5141      20.8263
390179.......................................................       1.4585       1.1009       1.1009      24.8350      27.2222      28.3835      26.8460
390180.......................................................       1.4150       1.0878       1.0878      30.4264      32.4375      35.3578      32.7463
390181.......................................................       1.0829       0.8330       0.8330      25.7357      24.4573      26.0384      25.3889
390183.......................................................       1.1072       0.8330       0.8330      22.0117      25.6554      27.5253      24.9187
390184.......................................................       1.2051       0.8671       0.8671      21.3407      22.5519      23.0254      22.3289
390185.......................................................       1.2931       0.9768       0.8503      21.8871      23.0202      25.8770      23.6157
390189.......................................................       1.1310       0.8330       0.8330      21.2711      22.3722      23.2078      22.3630
390191.......................................................       1.1347            *            *      19.2308      20.8761            *      20.0637
390192.......................................................       1.0319       0.9927       0.8503      20.0395      21.2620      21.2310      20.8428
390193.......................................................          ***            *            *      18.5516      20.1024            *      19.3425
390194.......................................................       1.1231       0.9927       0.9927      23.1814      25.4235      27.5277      25.4082
390195.......................................................       1.5955       1.1009       1.1009      28.3480      31.0019      33.2707      30.9412
390197.......................................................       1.3853       0.9927       0.9927      24.9234      25.7739      26.2868      25.6606
390198.......................................................       1.1139       0.8705       0.8705      16.8529      18.7222      20.8448      18.7246
390199.......................................................       1.1937       0.8330       0.8330      19.9653      21.3157      22.4727      21.2413
390200.......................................................          ***            *            *      23.1486      23.7471            *      23.4231
390201.......................................................       1.2935       0.8330       0.8330      24.8222      26.3658      27.5466      26.2970
390203.......................................................       1.6839       1.1009       1.1009      28.2741      28.9054      30.2714      29.1517
390204.......................................................       1.2831       1.1009       1.1009      25.6342      28.6829      29.6658      28.0375
390211.......................................................       1.2440       0.8815       0.8815      22.4472      23.1450      24.3990      23.3310
390215.......................................................          ***            *            *      26.4180      28.0402            *      27.0961
390217.......................................................       1.2022       0.8671       0.8671      21.3281      24.3610      23.6716      23.0524
390219.......................................................       1.3065       0.8671       0.8671      22.8559      25.1705      25.2892      24.4016

[[Page 24213]]

 
390220.......................................................       1.0838       1.1009       1.1009      24.7553      41.6138      28.3573      30.6553
390222.......................................................       1.2542       1.0878       1.0878      27.0954      28.7488      30.5995      28.8443
390223.......................................................       1.9980       1.1009       1.1009      28.2538      27.6407      29.4647      28.4678
390224.......................................................       0.8611            *            *      18.1226      18.7624            *      18.4428
390225.......................................................       1.1891       0.9768       0.9768      23.4945      24.9391      27.2964      25.3940
390226.......................................................       1.7575       1.1009       1.1009      27.0061      28.5890      32.2766      29.3055
390228.......................................................       1.3685       0.8671       0.8671      22.5999      23.3078      24.5021      23.4828
390231.......................................................       1.4447       1.1009       1.1009      27.0576      29.2653      30.8464      29.0891
390233.......................................................       1.3526       0.9514       0.9514      22.8667      24.8690      25.3424      24.3814
390236.......................................................       1.1748       0.8330       0.8330      21.9199      21.9169      22.6902      22.1761
390237.......................................................       1.5683       0.9927       0.8503      24.6316      26.9533      27.0591      26.1468
390238.......................................................          ***            *            *      26.4748            *            *      26.4748
390246.......................................................       1.1657       0.8330       0.8330      23.3275      20.1581      25.5357      22.7908
390256.......................................................       1.8697       0.9413       0.9413      24.2331      26.3619      28.6363      26.4469
390258.......................................................       1.5418       1.1009       1.1009      27.2038      29.4626      30.3079      29.0897
390263.......................................................       1.4554       0.9927       0.9927      23.4202      26.0170      27.8037      25.8192
390265.......................................................       1.4944       0.8671       0.8671      21.6751      23.4836      24.6360      23.2649
390266.......................................................       1.1801       0.8815       0.8815      19.2836      20.3918      21.2245      20.3113
390267.......................................................       1.1852       0.8671       0.8671      22.5464      23.1051      24.4937      23.3733
390268.......................................................       1.3621       0.8804       0.8804      24.2050      25.0021      26.0621      25.1256
390270.......................................................       1.4700       0.9768       0.8503      24.0837      24.1496      25.6462      24.6744
390272.......................................................       0.5282       1.1009       1.1009            *            *            *            *
390278.......................................................       0.5405       1.1009       1.1009      21.6893      23.6843      24.1725      23.1303
390279.......................................................       1.1033            *            *      15.3569      17.0012            *      16.1698
390285.......................................................       1.4961       1.1009       1.1009      33.5347      35.0427      37.2793      35.2062
390286.......................................................       1.1710       1.1009       1.1009      27.4090      28.1761      29.6638      28.3830
390287.......................................................          ***            *            *      35.7147      37.6569      38.9525      37.4292
390288.......................................................          ***            *            *      28.5267      29.7287      30.9493      29.7053
390289.......................................................          ***            *            *      28.4577      28.8826      30.7464      29.2939
390290.......................................................       1.9127       1.1009       1.1009      36.4991      37.9040      37.9834      37.4690
390291.......................................................          ***            *            *      21.3015            *            *      21.3015
390298.......................................................          ***            *            *      26.8290            *            *      26.8290
390299.......................................................          ***            *            *      31.9423            *            *      31.9423
390300.......................................................          ***            *            *      40.4697            *            *      40.4697
390301.......................................................          ***            *            *            *      30.9838            *      30.9838
390302.......................................................       2.1291            *            *            *            *            *            *
390303.......................................................          ***            *            *            *            *      27.8974      27.8974
390304.......................................................       1.2893       1.1009       1.1009            *            *      30.8572      30.8572
390307.......................................................       2.0672       0.8815       0.8815            *            *            *            *
390308.......................................................       0.8968       1.1009       1.1009            *            *            *            *
390309.......................................................       1.1904       1.1009       1.1009            *            *            *            *
390310.......................................................       2.5154       0.8330       0.8330            *            *            *            *
400001.......................................................       1.3197       0.4396       0.4396      16.1114      13.1847      13.9703      14.2429
400002.......................................................       1.7815       0.4852       0.4852      14.8607      16.7583      15.8300      15.7293
400003.......................................................       1.2707       0.4852       0.4852      13.0776      12.8329      14.2278      13.3681
400004.......................................................       1.2677       0.4396       0.4396       104716      14.3108      12.0952      12.1371
400005.......................................................       1.1979       0.4396       0.4396       102878       107207       108193       106148
400006.......................................................       1.1645       0.4396       0.4396        89919        92265        81860        87958
400007.......................................................       1.2128       0.4396       0.4396        87152        92463       102084        93717
400009.......................................................       1.0167       0.3242       0.3242        92007        93116        93834        93007
400010.......................................................       0.8436       0.3917       0.3917       109354       100962       100781       103657
400011.......................................................       1.0360       0.4396       0.4396        85868        85534        97022        89770
400012.......................................................       1.4590       0.4396       0.4396        83580        83802      11.9435        93674
400013.......................................................       1.2317       0.4396       0.4396        95584       103347       108428       102803
400014.......................................................       1.3296       0.3856       0.3856      11.7023      12.2169       105871      11.4707
400015.......................................................       1.3552       0.4396       0.4396      15.6066      15.6349      13.7075      14.9492
400016.......................................................       1.4419       0.4396       0.4396      15.3497      14.7607      16.5449      15.5555
400017.......................................................       1.1236       0.4396       0.4396       101238       102734       103148       102269
400018.......................................................       1.1948       0.4396       0.4396       107948      11.6165      11.7496      11.4151
400019.......................................................       1.4382       0.4396       0.4396      14.9892      12.8029      12.8992      13.4598
400021.......................................................       1.3198       0.4884       0.4884      13.8643      14.1533      14.4649      14.1568
400022.......................................................       1.3733       0.4852       0.4852      16.0539      15.9246      15.3806      15.7699
400024.......................................................       0.8278       0.3856       0.3856        91316      12.4649       105851       104594
400026.......................................................       1.0863       0.3242       0.3242       5.2085       5.8200        99034       6.4832
400028.......................................................       1.2282       0.4852       0.4852       103354       109808      11.4583       109391
400032.......................................................       1.1613       0.4396       0.4396       107195       102652       103523       104470

[[Page 24214]]

 
400044.......................................................       1.2533       0.4852       0.4852       107890      13.7509      15.0643      13.2982
400048.......................................................       1.1305       0.4396       0.4396      14.0887       104266        96590      11.4085
400061.......................................................       1.8741       0.4396       0.4396      15.1639      18.9123      18.1083      17.4205
400079.......................................................       1.1751       0.3917       0.3917        94218      12.7825        97136       104627
400087.......................................................       1.2553       0.4396       0.4396        95860       106849      11.1382       104923
400094.......................................................          ***            *            *        88646            *            *        88646
400098.......................................................       1.3208       0.4396       0.4396      13.7938      12.8230      14.0632      13.4998
400102.......................................................       1.2898       0.4396       0.4396       101795       102677       105904       103382
400103.......................................................       1.6742       0.3856       0.3856      12.8288        93859       108059       106890
400104.......................................................       1.1455       0.4396       0.4396        82758        93854      11.4349        97084
400105.......................................................       1.1547       0.4396       0.4396      12.7725      14.0219      15.6682      14.1165
400106.......................................................       1.1415       0.4396       0.4396        96902      11.4507       107533       106057
400109.......................................................       1.4063       0.4396       0.4396      14.2169      14.2111      14.3015      14.2434
400110.......................................................       1.1588       0.3861       0.3861      11.8458      12.3449      11.4297      11.8994
400111.......................................................       1.0981       0.3917       0.3917      13.4777      14.5029      14.5980      14.1786
400112.......................................................       1.1494       0.4396       0.4396        89469      19.3945       101536      11.4865
400113.......................................................       1.2376       0.4852       0.4852       100830        96778       108360       101888
400114.......................................................       1.1480       0.4396       0.4396      12.1920      11.5478       101147      11.2106
400115.......................................................       1.1597       0.4396       0.4396        91132      13.7392      12.3253      11.4989
400117.......................................................       1.1245       0.4396       0.4396       102911      12.7600       102910      11.0109
400118.......................................................       1.2557       0.4396       0.4396      11.9324      12.5743      12.8655      12.4718
400120.......................................................       1.3081       0.4396       0.4396      11.9714      12.7955      13.5787      12.8169
400121.......................................................       1.0060       0.4396       0.4396        86665        82197        97450        88283
400122.......................................................       1.9098       0.4396       0.4396        96463      11.2325        89500       101687
400123.......................................................       1.2218       0.3856       0.3856      11.8135      12.3041      13.1036      12.4082
400124.......................................................       2.9200       0.4396       0.4396      17.2258      16.1812      17.5453      16.9794
400125.......................................................       1.1716       0.4047       0.4047       107425      11.6386      11.9805      11.4266
400126.......................................................       1.2506       0.4884       0.4884      13.3932        98008      14.4278      11.9045
400127.......................................................       1.6978       0.4396       0.4396            *            *            *            *
400128.......................................................       1.0326            *            *            *            *            *            *
410001.......................................................       1.2798       1.0791       1.0791      27.0309      28.0816      28.7232      27.9407
410004.......................................................       1.2554       1.0791       1.0791      25.4578      27.4209      29.8160      27.5282
410005.......................................................       1.2518       1.0791       1.0791      27.1171      30.1606      28.0170      28.4104
410006.......................................................       1.3408       1.0791       1.0791      27.1842      29.4395      30.4938      29.0529
410007.......................................................       1.6795       1.0791       1.0791      30.1360      31.8548      33.2082      31.8053
410008.......................................................       1.2437       1.0791       1.0791      28.4245      29.6092      30.7042      29.5882
410009.......................................................       1.2546       1.0791       1.0791      27.7337      29.4094      31.8827      29.7343
410010.......................................................       1.2153       1.1318       1.1318      30.7826      32.8599      33.1837      32.3515
410011.......................................................       1.3425       1.0791       1.0791      28.5875      30.3787      34.1277      30.9611
410012.......................................................       1.7592       1.1318       1.1318      32.1679      32.6009      34.2578      33.0696
410013.......................................................       1.2452       1.2020       1.2020      31.7482      35.4624      36.1627      34.4667
420002.......................................................       1.5071       0.9520       0.9520      27.9312      28.2848      29.6120      28.6309
420004.......................................................       1.9971       0.9168       0.9168      26.0279      27.2620      28.2541      27.2127
420005.......................................................       1.0520       0.8604       0.8604      19.8167      23.1943      24.2198      22.4053
420006.......................................................          ***            *            *      22.8920      24.0811      24.5609      23.8460
420007.......................................................       1.6133       0.9286       0.9286      25.0395      25.2650      27.2262      25.8946
420009.......................................................       1.4085       0.9286       0.9286      23.8668      25.5079      27.3791      25.6316
420010.......................................................       1.1727       0.8604       0.8604      21.6478      23.4562      24.2841      23.1799
420011.......................................................       1.2007       0.9708       0.9708      20.8895      21.4030      21.7568      21.3667
420014.......................................................          ***            *            *      21.5658            *            *      21.5658
420015.......................................................       1.3233       0.9708       0.9708      24.7383      26.2154      21.2872      23.9502
420016.......................................................       0.9804       0.8604       0.8604      17.3837      17.1229      20.8597      18.3791
420018.......................................................       1.7486       0.8604       0.8604      23.6356      24.8024      21.8989      23.4144
420019.......................................................       1.0789       0.8604       0.8604      20.5472      22.5312      21.4165      21.4730
420020.......................................................       1.2657       0.9168       0.9168      24.6592      25.8883      27.8386      26.1025
420023.......................................................       1.7023       0.9708       0.9708      25.1035      26.7263      27.9657      26.5640
420026.......................................................       1.9244       0.8604       0.8604      29.2961      27.4814      28.0609      28.2225
420027.......................................................       1.6213       0.9286       0.9286      22.8322      25.1692      26.4925      24.8853
420030.......................................................       1.2546       0.9168       0.9168      24.2847      26.0079      27.0672      25.7933
420033.......................................................       1.1348       0.9708       0.9708      27.5740      31.8759      31.3764      30.3043
420036.......................................................       1.2159       0.9520       0.9520      21.9641      22.8294      23.9791      22.9381
420037.......................................................       1.3078       0.9708       0.9708      26.8750      29.4156      30.4783      28.9942
420038.......................................................       1.2810       0.9708       0.9708      22.6741      24.2259      26.1603      24.3482
420039.......................................................       1.0969       0.9192       0.9192      24.0637      25.1148      27.2085      25.4527
420043 h.....................................................       1.1624       0.9369       0.9369      22.9764      23.0555      23.3824      23.1477
420048.......................................................       1.2633       0.8604       0.8604      23.1515      24.1923      26.0899      24.4888

[[Page 24215]]

 
420049.......................................................       1.2698       0.8819       0.8819      23.2156      23.9722      25.5048      24.2429
420051.......................................................       1.5632       0.8604       0.8604      23.9455      24.8026      24.8652      24.5591
420053.......................................................       1.1371       0.8604       0.8604      21.1177      22.2825      22.7135      22.0833
420054.......................................................       1.0765       0.8604       0.8604      24.0653      24.8931      24.8011      24.5877
420055.......................................................       1.0631       0.8604       0.8604      20.3599      21.9764      23.3168      21.9025
420056.......................................................       1.3401       0.8604       0.8604      21.1640      21.6963      23.9218      22.2405
420057.......................................................       1.2668       0.8604       0.8604      19.7653      23.4311      22.2186      21.7975
420059.......................................................       1.0763            *            *      21.4260            *            *      21.4260
420061.......................................................          ***            *            *      20.8684            *            *      20.8684
420062.......................................................       1.0673       0.8739       0.8739      25.6683      25.9526      26.9629      26.2354
420064.......................................................       1.2144       0.8819       0.8819      22.1290      23.3610      24.2786      23.2388
420065.......................................................       1.4215       0.9168       0.9168      22.8674      24.5715      25.3741      24.2923
420066.......................................................       0.9904       0.8604       0.8604      20.5893      23.9048      24.4148      22.9867
420067.......................................................       1.3417       0.8958       0.8958      24.6038      25.0345      25.3722      25.0243
420068.......................................................       1.3345       0.9554       0.9554      22.2638      23.4248      25.2900      23.6594
420069.......................................................       1.1105       0.8604       0.8604      19.6959      20.5546      21.6426      20.6460
420070.......................................................       1.3141       0.8604       0.8604      22.4370      23.4355      23.9471      23.3117
420071.......................................................       1.4059       0.9286       0.9286      23.1727      24.9418      25.6422      24.6317
420072.......................................................       1.0863       0.8604       0.8604      17.5899      18.6742      17.2143      17.8091
420073.......................................................       1.3790       0.8604       0.8604      24.0274      24.5813      25.8074      24.8472
420075.......................................................       0.9046            *            *      16.4816            *            *      16.4816
420078.......................................................       1.8782       0.9708       0.9708      25.3032      28.9112      30.1670      28.1072
420079.......................................................       1.5771       0.9168       0.9168      25.2939      25.4935      26.9725      25.9340
420080.......................................................       1.4619       0.8958       0.8958      28.4569      28.4734      29.0327      28.6601
420082.......................................................       1.5148       0.9681       0.9681      26.1221      29.8528      30.7503      28.8866
420083.......................................................       1.4829       0.9286       0.9286      25.3043      27.1322      26.9176      26.4627
420085.......................................................       1.5804       0.9516       0.9516      25.3180      26.8692      27.7993      26.6577
420086.......................................................       1.4224       0.8604       0.8604      25.1372      25.8869      21.7594      24.0808
420087.......................................................       1.8048       0.9168       0.9168      23.2230      24.3609      25.4810      24.3588
420088.......................................................          ***            *            *      23.1273            *            *      23.1273
420089.......................................................       1.3305       0.9168       0.9168      25.2729      26.0074      28.9297      26.7899
420091.......................................................       1.3534       0.8604       0.8604      23.4710      26.9214      26.0435      25.5227
420093.......................................................          ***            *            *      25.1457      27.4766      28.6727      27.2207
420097.......................................................          ***            *            *      24.7809            *            *      24.7809
420098.......................................................       1.1589       0.8639       0.8639            *            *      31.3940      31.3940
420100.......................................................       1.9085            *            *            *            *            *            *
420101.......................................................       1.0458            *            *            *            *            *            *
430005.......................................................       1.3298       1.0359       0.8485      19.9454      22.3272      23.0896      21.7517
430008 \2\...................................................       1.0746       0.9456       0.9559      20.9442      23.3790      24.6127      22.8729
430011.......................................................          ***            *            *      20.6597            *            *      20.6597
430012.......................................................       1.2579       0.9456       0.9456      22.7530      24.0850      24.9285      23.9166
430013 \2\...................................................       1.1791       0.9456       0.9559      22.9675      25.1378      26.5894      24.8973
430014.......................................................       1.3196       0.8485       0.8485      25.5387      26.4964      27.4732      26.5372
430015.......................................................       1.1709       0.9456       0.8485      23.2035      22.7947      23.8702      23.2928
430016.......................................................       1.6875       0.9559       0.9559      26.1495      27.8453      30.2136      28.0429
430027.......................................................       1.7911       0.9559       0.9559      23.8477      26.2139      26.9443      25.7330
430029.......................................................       0.8746            *            *      20.2708            *            *      20.2708
430031 \2\...................................................       0.9582            *            *      15.6112      16.0346            *      15.8232
430043.......................................................          ***            *            *      17.2722            *            *      17.2722
430047.......................................................       1.0053            *            *      21.9116      18.8982            *      20.4712
430048.......................................................       1.3110       0.9456       0.8485      21.1718      23.0783      24.1611      22.8614
430060.......................................................       0.9031       0.9456       0.8485       102704            *      11.7945       109543
430064.......................................................       1.0621       0.9456       0.8485      16.4314      17.5376      17.2636      17.0895
430077.......................................................       1.7585       0.9456       1.0359      23.4835      25.1763      31.1834      26.6659
430081.......................................................       0.8530       1.4448       1.4448            *            *            *            *
430082.......................................................       0.7949       1.4448       1.4448            *            *            *            *
430083.......................................................       0.8473       1.4448       1.4448            *            *            *            *
430084.......................................................       0.9005       1.4448       1.4448            *            *            *            *
430085.......................................................       0.8408       1.4448       1.4448            *            *            *            *
430089.......................................................       1.6831       0.9201       0.9201      21.1109      22.5625      23.6025      22.5500
430090.......................................................       1.4802       0.9559       0.9559      26.0851      25.8460      28.9461      27.1155
430091.......................................................       2.1668       0.9456       1.0359      23.8897      24.3021      25.8667      24.7276
430092.......................................................       1.8623       0.8485       0.8485      20.2570      20.9486      23.4758      21.5566
430093.......................................................       0.9304       1.0359       1.0359      23.1526      29.5244      30.0783      27.8638
430094.......................................................       1.4722       0.9154       0.9154      18.5429      18.9099      22.5333      19.9282
430095.......................................................       2.4917       0.9559       0.9559      24.7074      28.1749      29.8113      27.7110

[[Page 24216]]

 
430096.......................................................       1.9427       0.8485       0.8485            *      21.6998      22.6901      22.1655
440001.......................................................       1.1169       0.8070       0.8070      17.4802      19.3100      20.2649      19.0060
440002.......................................................       1.7066       0.9032       0.9032      23.2177      24.6664      25.9742      24.6541
440003.......................................................       1.2347       0.9853       0.9853      24.5168      25.9209      28.8489      26.4731
440006.......................................................       1.4887       0.9853       0.9853      26.7983      28.5951      29.6894      28.3900
440007.......................................................       0.9516       0.7957       0.7957      13.7042      25.8236      19.4053      18.8359
440008.......................................................       1.0250       0.8640       0.8640      22.1405      23.4301      23.3316      22.9571
440009.......................................................       1.1899       0.7957       0.7957      21.1274      21.5970      23.1758      22.0061
440010.......................................................       0.9646       0.7957       0.7957      16.9060      17.1803      18.2555      17.4628
440011.......................................................       1.3341       0.8278       0.8278      21.6861      22.5068      23.9451      22.7588
440012.......................................................       1.5557       0.8078       0.8078      21.4769      22.3029      23.7400      22.4984
440015.......................................................       1.8501       0.8278       0.8278      22.5583      23.7422      25.0126      23.7907
440016.......................................................       1.0145       0.7957       0.7957      20.0982      22.1646      22.6177      21.6373
440017.......................................................       1.8336       0.8078       0.8078      22.5313      22.9364      24.4189      23.3049
440018.......................................................       1.1147       0.8070       0.8070      21.7239      23.3444      23.3049      22.8330
440019.......................................................       1.7779       0.8278       0.8278      23.8802      25.2553      25.8265      24.9572
440020.......................................................       1.0317       0.8829       0.8829      23.1718      23.9475      23.5480      23.5575
440023.......................................................       0.9906            *            *      17.0335            *            *      17.0335
440024.......................................................       1.3361       0.8841       0.8841      20.3658      23.2716      23.6564      22.4300
440025.......................................................       1.1289       0.8607       0.8607      19.5995      20.6798      21.4831      20.6130
440026.......................................................       0.6849            *            *      26.9149      26.8986      28.1548      27.3132
440029.......................................................       1.3750       0.9853       0.9853      25.8538      28.0779      29.2583      27.8141
440030.......................................................       1.3551       0.8013       0.8013      20.0586      22.1217      23.8651      22.0702
440031.......................................................       1.1563       0.7957       0.7957      18.0944      19.6685      20.3131      19.3798
440032.......................................................       1.1223       0.8062       0.8062      16.0734      18.5277      19.6994      18.1087
440033.......................................................       1.0675       0.7957       0.7957      18.7749      20.7917      20.0504      19.8739
440034.......................................................       1.6231       0.8278       0.8278      23.1121      23.5403      24.4772      23.7187
440035.......................................................       1.3627       0.9571       0.9571      22.3230      24.3752      26.2379      24.3199
440039.......................................................       2.1248       0.9853       0.9853      26.4647      28.4678      29.9015      28.3486
440040.......................................................       0.9305       0.7957       0.7957      17.7647      17.8510      18.2335      17.9564
440041.......................................................       0.9605            *            *      17.4074      17.9409            *      17.6972
440046.......................................................       1.1823       0.9853       0.9853      25.5329      26.1341      27.6435      26.4633
440047.......................................................       0.8929       0.8456       0.8456      20.4812      21.4280      22.3132      21.4112
440048.......................................................       1.8553       0.9367       0.9367      24.3283      27.7560      29.3776      27.0718
440049.......................................................       1.6271       0.9367       0.9367      22.9755      25.3043      26.9042      25.0712
440050.......................................................       1.3256       0.9110       0.9110      21.8972      23.1362      24.6283      23.2518
440051.......................................................       0.9873       0.8061       0.8061      20.7948      21.9108      23.7561      22.1363
440052.......................................................       1.0493       0.7957       0.7957      20.1875      21.1133      21.8224      21.0640
440053.......................................................       1.2859       0.9853       0.9853      23.9083      25.4345      27.2143      25.5366
440054.......................................................       1.1108       0.7957       0.7957      20.5992      21.4400      22.9137      21.6206
440056.......................................................       1.1517       0.8278       0.8278      20.4088      22.1068      22.6402      21.8021
440057.......................................................       1.0894       0.7957       0.7957      14.6242      16.4451      16.2043      15.7807
440058.......................................................       1.1733       0.8841       0.8841      22.6014      22.9263      24.5733      23.3536
440059.......................................................       1.5230       0.9571       0.9571      23.9301      26.3551      27.0398      25.7416
440060.......................................................       1.1113       0.8640       0.8640      22.7133      23.3014      24.2289      23.4440
440061.......................................................       1.0612       0.7957       0.7957      21.2085      21.8274      23.7972      22.1762
440063.......................................................       1.5519       0.8081       0.8081      21.8578      22.3256      24.2436      22.8424
440064.......................................................       1.0269       0.8965       0.8965      20.9742      22.0955      23.2881      22.0874
440065.......................................................       1.2273       0.9853       0.9853      21.4794      22.3247      24.5839      22.8185
440067.......................................................       1.1704       0.8278       0.8278      22.1410      23.1089      23.6433      22.9820
440068.......................................................       1.1108       0.8841       0.8841      23.1705      24.5971      25.5084      24.4008
440070.......................................................       0.9767       0.7957       0.7957      19.0240      19.4372      19.0125      19.1532
440072.......................................................       1.1510       0.9032       0.9032      20.9294      27.1443      24.1118      23.7250
440073.......................................................       1.4478       0.9571       0.9571      22.2959      23.9198      26.0153      24.0664
440081 h.....................................................       1.1987       0.8278       0.8278      19.0328      19.7878      20.6628      19.8630
440082.......................................................       2.1349       0.9853       0.9853      28.7828      27.9724      30.5997      29.1230
440083.......................................................       0.9462       0.7957       0.7957      16.0956      17.3329      23.4452      18.9853
440084.......................................................       1.2049       0.7957       0.7957      15.2825      16.3738      17.5206      16.4229
440091.......................................................       1.6877       0.8965       0.8965      26.1122      25.6797      26.8144      26.2154
440102.......................................................       1.1120       0.7957       0.7957      17.5140      17.5261      20.0410      18.3603
440104.......................................................       1.8282       0.8965       0.8965      23.3731      25.3739      26.5346      25.1499
440105.......................................................       1.0151       0.8081       0.8081      20.7821      22.3438      22.6923      21.9737
440109.......................................................       0.9889       0.7957       0.7957      18.2508      18.6720      19.6599      18.8870
440110.......................................................       1.1019       0.8278       0.8278      20.9039      21.3287      21.2955      21.1604
440111.......................................................       1.2995       0.9853       0.9853      25.8821      28.5705      29.5053      27.9706
440114.......................................................       1.0157            *            *      21.4271      24.0147            *      22.7665

[[Page 24217]]

 
440115.......................................................       0.9925       0.8456       0.8456      20.0642      21.7830      22.4307      21.4405
440120.......................................................       1.5709       0.8278       0.8278      23.9003      25.5961      26.0172      25.1825
440125.......................................................       1.6399       0.8278       0.8278      21.9337      22.4196      22.9618      22.4439
440130.......................................................       1.1653       0.7957       0.7957      21.6480      23.4517      24.3338      23.1392
440131.......................................................       1.1555       0.9367       0.9367      22.4119      24.9598      26.2835      24.5883
440132.......................................................       1.2915       0.7957       0.7957      20.5716      21.5085      23.0374      21.6966
440133.......................................................       1.6608       0.9853       0.9853      27.5019      26.2422      28.9034      27.5284
440135.......................................................       1.0517       0.7957       0.7957      25.3928      26.6615      28.4307      26.8611
440137.......................................................       1.0820       0.7957       0.7957      18.2073      20.6663      21.9678      20.1924
440141.......................................................       1.0091       0.7957       0.7957      19.4528      21.3313      22.2645      21.1533
440143.......................................................       0.9346            *            *      21.0374            *            *      21.0374
440144.......................................................       1.2554       0.7957       0.7957      22.3671      23.3828      23.6094      23.1261
440145.......................................................       0.9924            *            *      20.9863      20.7875            *      20.8882
440147.......................................................          ***            *            *      28.9038      31.4012      33.3608      31.2464
440148.......................................................       1.1184       0.9571       0.9571      23.0697      24.6412      24.2554      23.9966
440149.......................................................       1.0243            *            *      19.8020      20.4562            *      20.1312
440150.......................................................       1.3664       0.9853       0.9853      25.4952      26.8308      28.3249      26.8782
440151.......................................................       1.0878       0.9571       0.9571      23.3037      23.9808      26.7603      24.6946
440152.......................................................       1.8573       0.9367       0.9367      25.9495      26.5513      27.0829      26.5411
440153.......................................................       1.0530       0.7964       0.7964      22.7744      22.2846      22.7501      22.6002
440156.......................................................       1.5372       0.8965       0.8965      25.6333      26.9689      27.8265      26.8113
440159.......................................................       1.4567       0.9367       0.9367      21.1073      22.8645      24.4882      22.9041
440161.......................................................       1.7891       0.9853       0.9853      28.6774            *      29.5526      29.1459
440162.......................................................          ***            *            *      16.5305      21.1418      28.0859      21.5406
440166.......................................................          ***            *            *      27.1355      31.0779      35.4275      30.5015
440168.......................................................       0.9738       0.9367       0.9367      22.1764      22.8768      27.8781      24.3442
440173.......................................................       1.6130       0.8278       0.8278      20.8723      22.8846      22.9918      22.2791
440174.......................................................       0.8839       0.8329       0.8329      20.7960      22.0974      24.1697      22.3179
440175.......................................................       1.0159       0.9571       0.9571      24.0005      22.7299      24.6413      23.7639
440176.......................................................       1.2251       0.8078       0.8078      22.0079      23.6659      23.1222      22.9749
440180.......................................................       1.2535       0.8278       0.8278      21.9781      23.3808      25.2167      23.6141
440181.......................................................       0.9526       0.8364       0.8364      21.1406      22.7150      24.3293      22.7527
440182.......................................................       0.9870       0.7957       0.7957      20.2630      22.3612      23.2013      21.9586
440183.......................................................       1.6248       0.9367       0.9367      27.7769      27.1515      28.8310      27.9092
440184.......................................................       1.0336       0.8081       0.8081      20.8219      22.3475      24.3699      22.4690
440185.......................................................       1.1495       0.8841       0.8841      23.4172      23.9052      25.1022      24.2246
440186.......................................................       1.0327       0.9853       0.9853      24.6773      25.7445      27.3448      25.9302
440187.......................................................       1.1095       0.7957       0.7957      21.7637      21.3252      22.8652      21.9897
440189.......................................................       1.3834       0.8860       0.8860      24.7851      27.5435      27.8595      26.7516
440192.......................................................       1.0715       0.9571       0.9571      25.1119      25.7495      26.7266      25.8889
440193.......................................................       1.2853       0.9853       0.9853      24.3911      24.4299      24.8439      24.5603
440194.......................................................       1.3338       0.9853       0.9853      26.2498      26.6527      29.9809      27.7279
440197.......................................................       1.3107       0.9853       0.9853      26.4999      27.1534      29.6975      27.7361
440200.......................................................       0.9957       0.9853       0.9853      17.0633      17.7491      19.9962      18.2529
440203.......................................................       0.9226       0.7957       0.7957      17.7639      19.3864      23.2355      19.8845
440217.......................................................       1.3383       0.9367       0.9367      25.9667      28.5968      29.4892      28.0654
440218.......................................................       1.7741       0.9853       0.9853      26.3741      24.6465      24.3645      25.3056
440222.......................................................       0.9844       0.9367       0.9367      28.3879      29.7292      29.2515      29.1278
440225.......................................................       0.8475       0.8278       0.8278            *            *      26.4444      26.4444
440226.......................................................       1.5408       0.8278       0.8278            *            *      26.5721      26.5721
440227.......................................................       1.2278       0.9853       0.9853            *            *            *            *
440228.......................................................       1.3652       0.9367       0.9367            *            *            *            *
450002.......................................................       1.4375       0.9101       0.9101      25.4975      25.7171      28.0968      26.4037
450005.......................................................       1.0954       0.8612       0.8612      23.4049      23.5576      24.8874      23.9095
450007.......................................................       1.3241       0.8859       0.8859      19.2875      20.7321      22.7681      20.9365
450008.......................................................       1.2987       0.9131       0.9131      22.0934      22.9669      25.4507      23.5297
450010.......................................................       1.6039       0.8790       0.8360      22.4133      23.7529      25.0592      23.7488
450011.......................................................       1.7202       0.9064       0.9064      24.1576      24.8831      27.0743      25.3503
450014.......................................................          ***            *            *      22.5001            *            *      22.5001
450015.......................................................       1.5860       1.0087       1.0087      24.0730      27.4012      29.3737      26.9851
450016.......................................................          ***            *            *      22.1368            *            *      22.1368
450018.......................................................       1.5062       1.0030       1.0030      24.6443      26.7999      28.5226      26.6104
450020.......................................................       0.9622            *            *      17.7148      18.3047            *      18.0203
450021.......................................................       1.8322       1.0087       1.0087      28.5578      29.1350      30.1831      29.2883
450023.......................................................       1.4320       0.8554       0.8554      20.9278      22.0558      25.5410      22.7444
450024.......................................................       1.4841       0.9101       0.9101      22.4178      24.4195      25.4622      24.1268

[[Page 24218]]

 
450028.......................................................       1.5344       0.9474       0.9474      25.6030      26.8250      27.7693      26.7175
450029.......................................................       1.5535       0.8003       0.8003      23.9709      23.2995      23.7005      23.6494
450031.......................................................       1.4013       1.0087       1.0087      27.0328      27.9626      29.4827      28.2223
450032.......................................................       1.1925       0.8715       0.8715      20.8306      27.0748      21.2720      22.8525
450033.......................................................       1.6629       0.9474       0.9474      29.0541      28.4781      28.5174      28.6719
450034.......................................................       1.5793       0.8612       0.8612      23.4615      24.1589      26.2069      24.5798
450035.......................................................       1.5477       1.0030       1.0030      25.4580      26.2838      28.3361      26.6364
450037.......................................................       1.5982       0.8905       0.8905      23.1176      24.2684      26.3292      24.6149
450039.......................................................       1.3819       0.9870       0.9870      23.3034      24.7347      26.2041      24.8293
450040.......................................................       1.7828       0.8626       0.8626      23.8047      24.9590      25.9125      24.8722
450042.......................................................       1.7951       0.8653       0.8653      22.6936      24.1181      26.6885      24.5021
450044.......................................................       1.7267       1.0087       1.0087      25.8403      29.4308      32.4768      29.3230
450046.......................................................       1.5874       0.8578       0.8578      22.0695      23.4907      25.3629      23.6516
450047.......................................................       0.8361       0.9474       0.9474      22.7242      19.8221      21.2384      21.2173
450050.......................................................       0.9114            *            *      21.6933      23.3044            *      22.5039
450051.......................................................       1.8871       1.0087       1.0087      27.2523      28.0411      29.5795      28.3261
450052.......................................................       0.9776       0.8003       0.8003      19.7185      19.7774      21.1995      20.1263
450053.......................................................       0.9826       0.8003       0.8003      19.4978      21.9082      20.4980      20.6324
450054.......................................................       1.7608       0.9131       0.9131      25.1229      24.2782      27.7869      25.6677
450055.......................................................       1.1174       0.8003       0.8003      20.5235      22.1979      22.4127      21.7257
450056.......................................................       1.8144       0.9360       0.9360      25.6685      27.0530      28.2252      26.8936
450058.......................................................       1.5775       0.8859       0.8859      24.7442      25.9653      26.8533      25.8582
450059.......................................................       1.3376       0.9360       0.9360      26.8209      26.6535      27.4391      26.9795
450064.......................................................       1.4386       0.9870       0.9870      24.2920      23.8748      27.5350      25.2944
450068.......................................................       2.0792       1.0030       1.0030      26.2864      27.9633      29.9491      28.0965
450072.......................................................       1.1764       1.0030       1.0030      22.5010      24.0166      25.3658      23.9560
450073.......................................................       0.9681       0.8051       0.8051      20.0464      21.7337      24.6840      22.0875
450078.......................................................       0.9553       0.8003       0.8003      17.2196      15.8968      18.2067      17.0494
450079.......................................................       1.6954       1.0087       1.0087      27.0443      28.1096      29.8969      28.2854
450080.......................................................       1.2691       0.8905       0.8905      21.2482      22.9835      27.2213      23.6862
450082.......................................................       1.0789       0.8003       0.8003      20.9113      22.0442      23.3125      22.0908
450083.......................................................       1.7780       0.8854       0.8854      24.9182      25.8214      27.2160      26.0725
450085.......................................................       1.0382       0.8003       0.8003      19.4524      22.0840      23.4732      21.7012
450087.......................................................       1.4483       0.9870       0.9870      26.4203      29.1587      30.0371      28.5792
450090.......................................................       1.2044       0.8003       0.8003      17.6506      19.4244      20.9803      19.3653
450092.......................................................       1.2084       0.8003       0.8003      20.4921      23.2071      23.9641      22.5714
450094.......................................................          ***            *            *      25.3618      25.2434            *      25.3030
450096.......................................................       1.4283       0.8612       0.8612      22.8722      24.1619      26.1563      24.3175
450097.......................................................       1.4526       1.0030       1.0030      24.9380      26.4965      28.2316      26.5557
450098.......................................................       0.9594            *            *      22.9005      22.6626            *      22.7778
450099.......................................................       1.2289       0.9177       0.9177      24.0293      26.6796      28.8288      26.4791
450101.......................................................       1.5872       0.8653       0.8653      20.6575      23.6905      24.8496      23.0430
450102.......................................................       1.8228       0.8854       0.8854      23.1773      24.5503      25.3756      24.3986
450104.......................................................       1.2091       0.8859       0.8859      22.5165      23.8469      23.3944      23.2732
450107.......................................................       1.4218       0.9101       0.9101      23.8770      25.9326      27.9184      25.8765
450108.......................................................       1.1901       0.8859       0.8859      19.3561      19.4935      20.2479      19.7198
450112.......................................................          ***            *            *      22.5552            *            *      22.5552
450113.......................................................          ***            *            *            *      54.6681            *      54.6681
450119.......................................................       1.2924       0.8790       0.8790      24.1392      25.7008      27.6154      25.8461
450121.......................................................       1.4829       0.9870       0.9870      25.8826      25.7051      29.0897      26.9221
450123.......................................................       1.0580       0.8612       0.8612      19.5872      21.2154      23.0469      21.1313
450124.......................................................       1.8874       0.9360       0.9360      26.0280      27.4198      28.1018      27.2284
450126.......................................................       1.3432       1.0030       1.0030      27.3021      28.3033      28.8116      28.2181
450128.......................................................       1.2314       0.8790       0.8790      21.4190      23.3633      24.1195      22.9163
450130.......................................................       1.2180       0.8859       0.8859      20.2777      21.5226      23.5398      21.8292
450131.......................................................          ***            *            *      23.2317      23.7098      26.3279      24.2678
450132.......................................................       1.5414       1.0119       1.0119      26.8476      28.6954      30.2134      28.5936
450133.......................................................       1.6337       0.9802       0.9802      25.0972      26.8344      29.2478      27.1707
450135.......................................................       1.6922       0.9870       0.9870      24.3858      26.0755      27.9663      26.2251
450137.......................................................       1.6056       0.9870       0.9870      27.0081      30.4254      31.4048      29.7868
450140.......................................................          ***            *            *      22.4695            *            *      22.4695
450143.......................................................       1.0146       0.9360       0.9360      19.7487      21.8705      22.5280      21.4534
450144.......................................................       1.0731       0.9737       0.9737      20.9599      21.3289      25.6368      22.5854
450147.......................................................       1.4387       0.8554       0.8554      24.6203      23.9771      25.0247      24.5527
450148.......................................................       1.1848       0.9870       0.9870      23.5037      25.3498      27.5125      25.5034
450151.......................................................       1.2027       0.8003       0.8003      20.1356      22.2915      23.2545      21.9494

[[Page 24219]]

 
450152.......................................................       1.2274       0.9131       0.9131      21.6351      22.7463      24.1970      22.8540
450154.......................................................       1.3702       0.8003       0.8003      18.6058      21.2021      20.7952      20.1904
450155.......................................................       1.0271       0.8003       0.8003      17.9306      18.0589      21.3482      19.0936
450157.......................................................          ***            *            *      17.8812            *            *      17.8812
450160.......................................................       0.8255            *            *      21.9118            *            *      21.9118
450162.......................................................       1.3087       0.8626       0.8626      31.0645      30.9903      31.9964      31.3817
450163.......................................................       1.0883       0.8137       0.8137      20.3280      23.1400      23.4148      22.2842
450165.......................................................       1.0794       0.8859       0.8859      20.2414      24.3242      27.6487      24.0511
450176.......................................................       1.3564       0.8790       0.8790      20.9392      20.9297      23.6030      21.8256
450177.......................................................       1.1934       0.8003       0.8003      19.7657      21.3322      22.6615      21.2531
450178.......................................................       0.9382       0.8003       0.8003      20.2992      24.7301      23.9597      22.8868
450184.......................................................       1.5480       1.0030       1.0030      25.3935      26.7821      28.4921      26.9217
450185.......................................................          ***            *            *      15.5838            *            *      15.5838
450187.......................................................       1.1744       1.0030       1.0030      24.2400      25.6786      28.2045      26.0900
450188.......................................................       0.9551       0.8003       0.8003      18.9586      20.4070      21.4250      20.3073
450191.......................................................       1.1747       0.9360       0.9360      25.9078      26.0298      27.2533      26.4251
450192.......................................................       1.1719       0.9870       0.9870      22.5118      22.5880      23.8534      22.9951
450193.......................................................       2.0371       1.0030       1.0030      29.2751      32.2964      34.3517      32.0480
450194.......................................................       1.3875       0.9870       0.9870      22.3348      24.8972      23.5660      23.5448
450196.......................................................       1.4334       0.9870       0.9870      23.6170      24.7557      24.6006      24.3267
450200.......................................................       1.4680       0.8133       0.8133      22.0923      23.5344      24.2489      23.3064
450201.......................................................       0.9908       0.8003       0.8003      20.3350      20.9809      21.3642      20.8932
450203.......................................................       1.1593       0.9591       0.9591      23.3953      24.1675      25.9236      24.5529
450209.......................................................       1.9505       0.9177       0.9177      24.4977      26.0958      27.3634      25.9724
450210.......................................................       0.9811       0.8003       0.8003      19.6340      19.9832      21.1245      20.2859
450211.......................................................       1.3657       1.0030       1.0030      20.7982      23.8230      26.8071      23.6708
450213.......................................................       1.7804       0.8859       0.8859      21.7930      23.9676      25.1261      23.6580
450214.......................................................       1.1756       1.0030       1.0030      23.9112      25.9598      27.1030      25.6581
450219.......................................................       0.9943       0.8003       0.8003      20.8255      21.7934      22.0150      21.5883
450221.......................................................       1.1342       0.8003       0.8003      20.6887      20.3186      18.7121      19.9030
450222.......................................................       1.6242       1.0030       1.0030      26.2975      27.4426      30.3939      28.0745
450224.......................................................       1.3688       0.8854       0.8854      22.2250      24.1956      26.8950      24.3799
450229.......................................................       1.6311       0.8051       0.8051      19.8279      21.4459      23.2333      21.5168
450231.......................................................       1.6305       0.9177       0.9177      23.9532      25.2852      26.9729      25.4493
450234.......................................................       1.0419       0.8003       0.8003      23.6695      18.4451      19.9093      20.4175
450235.......................................................       1.0212       0.8003       0.8003      19.1453      21.5138      22.5969      21.1410
450236.......................................................       1.1103       0.8003       0.8003      19.2987      22.0788      22.4149      21.2880
450237.......................................................       1.6433       0.8859       0.8859      25.1504      24.8901      26.2898      25.4597
450239.......................................................       0.9627       0.9131       0.9131      21.8595      21.1945      21.1113      21.3735
450241.......................................................       1.0459       0.8003       0.8003      18.1155      18.7957      19.3886      18.7815
450243.......................................................       0.9884       0.8003       0.8003      14.0589      15.4636      13.3360      14.2632
450249.......................................................          ***            *            *      16.5616            *            *      16.5616
450253.......................................................       0.9522       1.0030       1.0030      19.6379      20.6124      23.1000      21.1869
450264.......................................................          ***            *            *      15.4111            *            *      15.4111
450269.......................................................          ***            *            *      14.8204            *            *      14.8204
450270.......................................................       1.2028       0.8003       0.8003      15.0879      14.4325      14.7319      14.7323
450271.......................................................       1.1409       0.9591       0.9591      19.4299      21.7719      23.0668      21.5257
450272.......................................................       1.2287       0.9360       0.9360      23.7933      25.7392      26.1100      25.2204
450276.......................................................       0.9774            *            *      16.0264      16.6319            *      16.3591
450280.......................................................       1.4735       1.0087       1.0087      27.4523      28.7233      29.7601      28.6474
450283.......................................................       1.0773       0.9870       0.9870      20.0069      20.9680      22.1481      21.1023
450289.......................................................       1.3615       1.0030       1.0030      27.3864      28.5665      31.2375      29.0702
450292.......................................................       1.2387       1.0087       1.0087      23.5330      25.0411      26.9725      25.1945
450293.......................................................       0.9057       0.8003       0.8003      20.0898      21.3136      21.3044      20.9173
450296.......................................................       1.0558       1.0030       1.0030      29.2006      27.9690      29.3120      28.8474
450299.......................................................       1.5796       0.9064       0.9064      25.8183      26.4933      28.2325      26.8807
450306.......................................................       0.9244       0.8051       0.8051      14.6699      15.9854      18.7874      16.2370
450315.......................................................       2.5813            *            *      27.9780            *      37.5788      29.8209
450324.......................................................       1.5411       0.8677       0.8677      23.6362      24.9128      25.2508      24.6392
450330.......................................................       1.1740       1.0030       1.0030      24.4310      25.5820      26.3863      25.4943
450340.......................................................       1.4257       0.8385       0.8385      22.7826      24.0636      24.9329      23.9318
450346.......................................................       1.4440       0.8612       0.8612      21.9717      22.2469      23.2733      22.5272
450347.......................................................       1.1769       1.0030       1.0030      22.8133      27.2203      28.3157      26.0371
450348.......................................................       1.0382       0.8003       0.8003      17.0198      18.7675      20.1752      18.7139
450351.......................................................       1.3031       0.9591       0.9591      23.5895      25.6859      27.1819      25.5145
450352.......................................................       1.1235       1.0087       1.0087      23.4297      24.8012      26.8535      24.9931

[[Page 24220]]

 
450353.......................................................          ***            *            *      20.9271      24.4454      26.2804      23.7695
450358.......................................................       1.9767       1.0030       1.0030      29.3408      30.4280      31.6216      30.5511
450362.......................................................       1.0967            *            *      22.0223      25.4372            *      23.7705
450369.......................................................       1.0336       0.8003       0.8003      17.5360      18.4848      18.6148      18.2736
450370.......................................................       1.2149       0.8261       0.8261      22.6815      20.0832      23.1229      21.8052
450372.......................................................       1.3337       1.0087       1.0087      26.8019      28.3359      31.1141      28.7696
450373.......................................................       0.9464       0.8003       0.8003      20.5789      22.2213      24.4712      22.5214
450374.......................................................       0.9179            *            *      17.4509      23.2285            *      19.8412
450378.......................................................       1.4503       1.0030       1.0030      29.5108      30.7684      31.4184      30.5485
450379.......................................................       1.3615       1.0087       1.0087      31.1573      30.6072      33.2816      31.6637
450381.......................................................       0.8992            *            *      20.9200      22.0482            *      21.4845
450388.......................................................       1.6213       0.8859       0.8859      24.1598      25.8674      26.9369      25.8147
450389.......................................................       1.2133       0.9870       0.9870      22.3803      23.8764      25.8283      24.1448
450393.......................................................       0.6586            *            *      24.6872      18.4551      21.5604      21.5244
450395.......................................................       1.0000       1.0030       1.0030      23.9689      24.8656      25.9571      25.0000
450399.......................................................       0.9374       0.8003       0.8003      19.5928      18.2074      19.0372      18.9411
450400.......................................................       1.2473       0.8653       0.8653      22.0103      23.1739      23.2029      22.8044
450403.......................................................       1.3393       1.0087       1.0087      27.8138      29.3063      29.0923      28.7792
450411.......................................................       0.9521       0.8003       0.8003      17.6570      19.6086      19.9183      19.1051
450417.......................................................       0.8854            *            *      17.8078      20.0350            *      18.9286
450418.......................................................       1.1696       1.0030       1.0030      27.0283      26.8434      28.2373      27.2737
450419.......................................................       1.2390       0.9870       0.9870      28.4122      31.0404      32.0315      30.5226
450422.......................................................       0.8834       1.0087       1.0087      29.5592      30.6659      33.8259      31.3662
450424.......................................................       1.3624       1.0030       1.0030      23.1253      28.3149      28.0195      26.6839
450431.......................................................       1.5063       0.9360       0.9360      24.7346      25.2477      26.9028      25.6684
450438.......................................................       1.1610       1.0030       1.0030      22.0476      21.9351      24.2571      22.6852
450446.......................................................       0.6285       1.0030       1.0030      14.9983      14.3132      17.4158      15.4882
450447.......................................................       1.2969       0.9870       0.9870      22.5602      23.5047      25.6376      23.9060
450451.......................................................       1.0902       0.9591       0.9591      22.3834      23.3042      24.3091      23.3428
450460.......................................................       0.9462       0.8003       0.8003      19.5709      20.5812      20.8068      20.3488
450462.......................................................       1.6945       1.0087       1.0087      25.6952      27.8923      29.2836      27.6909
450465.......................................................       1.1297       0.8438       0.8438      23.0130      22.4183      25.7148      23.7820
450469.......................................................       1.5249       0.8677       0.8677      26.6781      28.7890      25.4635      27.0045
450475.......................................................       1.0410       0.8905       0.8905      20.7983      23.5596      22.5480      22.3012
450484.......................................................       1.3812       0.8905       0.8905      23.0604      25.3527      27.0061      25.1666
450488.......................................................       1.0576       0.8905       0.8905      22.3949      23.9144      21.6331      22.6563
450489.......................................................       1.0092       0.8003       0.8003      19.6884      21.4771      21.5002      20.9158
450497.......................................................       1.0331       0.8003       0.8003      17.6614      18.8344      20.3909      18.9764
450498.......................................................       0.8847       0.8003       0.8003      16.4358      17.7822      17.2624      17.1563
450508.......................................................       1.4788       0.8854       0.8854      23.5066      23.9572      27.4558      25.0231
450514.......................................................       1.1107       0.8612       0.8612      21.4034      22.6552      25.9817      23.3480
450517.......................................................       0.9001            *            *      15.2707            *            *      15.2707
450518.......................................................       1.5203       0.8612       0.8612      22.2587      24.1194      27.9953      24.8239
450523.......................................................          ***            *            *      28.6387            *            *      28.6387
450530.......................................................       1.2387       1.0030       1.0030      26.1998      28.7451      28.7154      27.9282
450534.......................................................          ***            *            *      20.4715            *            *      20.4715
450535.......................................................          ***            *            *      29.4427            *            *      29.4427
450537.......................................................       1.4256       1.0087       1.0087      23.9256      27.5856      29.2821      26.9543
450539.......................................................       1.1901       0.8003       0.8003      20.0343      21.0442      22.4081      21.1538
450545.......................................................          ***            *            *      22.8130            *            *      22.8130
450547.......................................................       0.9991       0.9870       0.9870      21.8106      21.6542      23.5794      22.4240
450558.......................................................       1.8627       0.8051       0.8051      25.0837      26.1551      27.2223      26.1445
450563.......................................................       1.4314       0.9870       0.9870      27.9427      28.7289      31.4753      29.4391
450565.......................................................       1.3311       0.8489       0.8489      22.1971      23.8847      25.0379      23.7440
450571.......................................................       1.5740       0.8385       0.8385      20.9651      22.7703      24.7674      22.8421
450573.......................................................       1.1346       0.8003       0.8003      21.6974      20.1479      21.0286      20.9450
450578.......................................................       0.9184       0.8003       0.8003      20.0454      20.2695      22.5427      20.9417
450580.......................................................       1.0999       0.8003       0.8003      20.4293      21.1574      21.0151      20.8713
450584.......................................................       1.0160       0.8003       0.8003      19.0373      21.0808      20.0078      20.0299
450586.......................................................       0.9542       0.8003       0.8003      14.6574      16.1003      16.9880      15.9586
450587.......................................................       1.2144       0.8003       0.8003      19.9712      20.4512      22.8245      21.1183
450591.......................................................       1.1954       1.0030       1.0030      22.4991      23.9992      24.9309      23.8280
450596 h.....................................................       1.2159       1.0399       1.0399      24.7477      25.3317      27.4357      25.8078
450597.......................................................       0.9663       0.8080       0.8080      22.9337      23.1711      24.0480      23.3921
450604.......................................................       1.3085       0.8003       0.8003      20.5273      20.9514      23.5413      21.7183
450605.......................................................       1.0415       0.8578       0.8578      23.8820      22.2205      21.2497      22.3978

[[Page 24221]]

 
450609.......................................................          ***            *            *      18.3856            *            *      18.3856
450610.......................................................       1.6427       1.0030       1.0030      22.5451      26.8710      28.0329      25.7712
450615.......................................................       0.9957       0.8003       0.8003      18.2166      20.3028      20.8595      19.8661
450617.......................................................       1.5118       1.0030       1.0030      25.2211      26.5026      28.0634      26.6443
450620.......................................................       0.9569       0.8003       0.8003      18.1819      17.7138      18.2630      18.0543
450623.......................................................       1.1273            *            *      28.3354      28.3552            *      28.3456
450626.......................................................       0.8874            *            *      21.4445      26.8375            *      23.9299
450630.......................................................       1.5750       1.0030       1.0030      27.8856      29.6796      29.5706      29.0278
450631.......................................................          ***            *            *      24.5409            *            *      24.5409
450634.......................................................       1.6821       1.0087       1.0087      27.0412      28.1705      28.8277      28.0452
450638.......................................................       1.6272       1.0030       1.0030      29.5385      29.6184      31.5382      30.2289
450639.......................................................       1.4555       0.9870       0.9870      27.3593      29.2669      30.5176      29.1141
450641.......................................................       1.0274       0.8003       0.8003      17.0805      17.5845      18.0724      17.5796
450643.......................................................       1.3388       0.8003       0.8003      20.9674      21.1205      22.0843      21.4069
450644.......................................................       1.5418       1.0030       1.0030      27.2047      29.0186      30.0261      28.8421
450646.......................................................       1.3775       0.9101       0.9101      22.6541      23.8908      25.2251      23.9445
450647.......................................................       1.8824       1.0087       1.0087      28.8881      30.7334      31.6069      30.4271
450648.......................................................          ***            *            *      18.2826            *            *      18.2826
450649.......................................................          ***            *            *      18.1118            *            *      18.1118
450651.......................................................       1.5268       1.0087       1.0087      28.9829      32.4822      31.4063      30.9883
450653.......................................................       1.1680       0.9602       0.9602      21.8654      23.2603      24.9719      23.3175
450654.......................................................       0.9380       0.8003       0.8003      19.6054      19.9992      20.3563      20.0116
450656.......................................................       1.4785       0.8854       0.8854      22.7284      23.8280      24.8352      23.7707
450658.......................................................       0.9159       0.8003       0.8003      19.9597      20.5398      22.5532      21.0378
450659.......................................................       1.4296       1.0030       1.0030      28.8671      30.1727      30.9251      30.0073
450661.......................................................       1.0957       1.0119       1.0119      21.5537      23.2989      30.1358      25.0485
450662.......................................................       1.5098       0.9474       0.9474      24.5815      28.0913      28.8369      27.1837
450665.......................................................       0.9162            *            *      17.2566      18.6054            *      17.9420
450668.......................................................       1.5089       0.9101       0.9101      26.4508      26.2375      28.4134      27.0380
450669.......................................................       1.2095       1.0087       1.0087      25.6411      27.4507      28.4801      27.2455
450670.......................................................       1.3966       1.0030       1.0030      22.0495      25.1575      25.6979      24.2873
450672.......................................................       1.7679       0.9870       0.9870      26.7785      27.6359      29.8113      28.0976
450673.......................................................          ***            *            *      19.4030            *            *      19.4030
450674.......................................................       0.9764       1.0030       1.0030      26.8081            *      29.9733      28.3959
450675.......................................................       1.4004       0.9870       0.9870      26.1555      28.7765      29.1940      28.1661
450677.......................................................       1.3370       0.9870       0.9870      24.0218      27.3728      26.2333      25.8722
450678.......................................................       1.4692       1.0087       1.0087      30.1134      30.1500      31.5997      30.6214
450683.......................................................       1.1779       1.0087       1.0087      24.0080      24.6609      27.8588      25.4486
450684.......................................................       1.2365       1.0030       1.0030      26.2906      27.6789      29.5071      27.8823
450686.......................................................       1.6848       0.8626       0.8626      21.0565      23.2367      24.1869      22.8496
450688.......................................................       1.1915       1.0087       1.0087      23.7796      27.9057      27.1644      26.2965
450690.......................................................       1.4400       0.8854       0.8854      28.7529      28.2531      26.2559      27.8629
450694.......................................................       1.0611       1.0030       1.0030      22.3081      23.5790      23.7874      23.2343
450697.......................................................       1.4245       0.8859       0.8859      21.2662      23.7155      25.2110      23.5525
450698.......................................................       0.8804       0.8003       0.8003      18.5436      18.6494      18.9770      18.7269
450700.......................................................       0.9190            *            *      18.6373            *            *      18.6373
450702.......................................................       1.5435       0.8905       0.8905      24.8628      25.6147      27.5215      26.0104
450709.......................................................       1.2686       1.0030       1.0030      25.0932      25.4855      27.0908      25.8993
450711.......................................................       1.5506       0.8790       0.8790      24.8277      28.0104      26.9466      26.5934
450713.......................................................       1.5698       0.9360       0.9360      26.7190      27.2801      28.2291      27.4332
450715.......................................................       1.2907       1.0087       1.0087      16.1897      28.0365      16.2866      18.8856
450716.......................................................       1.2709       1.0030       1.0030      28.8043      30.8440      32.5978      30.7792
450718.......................................................       1.2315       0.9360       0.9360      27.6672      27.3408      28.2838      27.7793
450723.......................................................       1.4898       1.0087       1.0087      27.0055      28.0812      29.0905      28.0969
450730.......................................................       1.1844       1.0087       1.0087      30.7567      29.9430      31.7101      30.8172
450733.......................................................          ***            *            *      25.5624      26.4976            *      26.0340
450742.......................................................       1.2041       1.0087       1.0087      26.3414      26.1190      26.9752      26.5000
450743.......................................................       1.5163       1.0087       1.0087      24.7397      27.3213      28.8273      27.0434
450746.......................................................       0.9459       0.8003       0.8003      16.9209      12.4748      18.6717      15.8396
450747.......................................................       1.2804       0.9870       0.9870      24.2674      22.2870      24.3035      23.6023
450749.......................................................       1.0008       0.8003       0.8003      18.4095      17.8227      19.0712      18.4140
450751.......................................................          ***            *            *      22.9070      19.3265      18.5972      20.2183
450754.......................................................       0.9187       0.8003       0.8003      21.3043      20.8968      21.5435      21.2570
450755.......................................................       0.9654       0.8626       0.8626      19.5168      18.0092      18.3374      18.5256
450758.......................................................       1.9150       1.0087       1.0087      24.0226      25.6548      29.3846      26.3194
450760.......................................................       1.0178       0.9101       0.9101      25.7453      24.6349      24.2669      24.8052

[[Page 24222]]

 
450761.......................................................       0.8560            *            *      16.2605      15.7483            *      16.0004
450763.......................................................       1.0996            *            *      21.4171      22.4905            *      21.9641
450766.......................................................       1.9890       1.0087       1.0087      28.8576      30.0441      31.9184      30.2287
450770.......................................................       1.1856       0.9360       0.9360      20.1763      20.3656      23.9370      21.5080
450771.......................................................       1.7688       1.0087       1.0087      26.0618      31.3924      31.8002      29.9828
450774.......................................................       1.8338       1.0030       1.0030      24.8562      24.9683      28.2450      26.1216
450775.......................................................       1.2578       1.0030       1.0030      25.3924      24.4006      28.4183      25.9897
450779.......................................................       1.2479       0.9870       0.9870      22.5857      26.9908      29.7868      26.4311
450780.......................................................       1.8456       0.8859       0.8859      22.8688      23.9516      25.9821      24.3116
450788.......................................................       1.5907       0.8578       0.8578      24.2643      25.4172      26.4470      25.3993
450795.......................................................       1.4008       1.0030       1.0030      28.1448      23.7510      24.1271       24.947
450796.......................................................       1.8052       0.9177       0.9177      24.7564      27.9734      33.1303      28.4434
450797.......................................................          ***            *            *      23.8708      20.5379      25.4943      23.0765
450801.......................................................       1.4998       0.8133       0.8133      22.2426      23.0373      24.0387      23.1400
450803.......................................................       1.1764       1.0030       1.0030      26.3054      30.6093      28.7427      28.4813
450804.......................................................       1.8999       1.0030       1.0030      26.0003      26.0980      27.6508      26.5919
450808.......................................................       1.5092       0.9360       0.9360      22.8247      23.8067      23.2037      23.2780
450809.......................................................       1.5817       0.9360       0.9360      24.7763      26.3659      26.8214      26.0351
450811.......................................................       1.7444       0.8790       0.8790      23.1022      25.8491      27.3501      25.5331
450813.......................................................       1.1556       0.8859       0.8859      22.1326      25.5949      19.7649      22.3615
450820.......................................................       1.2973       1.0030       1.0030      27.9187      30.5288      31.7443      30.4578
450822.......................................................       1.2957       1.0087       1.0087      29.7067      31.1431      32.3722      31.1755
450824.......................................................       2.5318       0.9360       0.9360            *      26.7803      29.4735      28.1465
450825.......................................................       1.4848       0.8790       0.8790      18.7069      20.2959      20.8107      19.9847
450827.......................................................       1.3902       0.8360       0.8360      21.1788      20.9704      21.6247      21.2706
450828.......................................................       1.2653       0.8003       0.8003      21.4128      22.3667      23.8184      22.5374
450829.......................................................          ***            *            *      18.2860      19.5014      20.2816      19.3397
450830.......................................................       0.9567       0.9737       0.9737      26.9917      28.1617      27.4306      27.5236
450831.......................................................       1.5156       1.0030       1.0030      20.0581      22.7885      23.2295      22.2337
450832.......................................................       1.1631       1.0030       1.0030      26.4725      26.6628      27.5752      26.9176
450833.......................................................       1.1639       1.0087       1.0087      26.1256      26.0044      26.7732      26.3344
450834.......................................................       1.5529       0.9064       0.9064      22.7691      21.2204      21.6657      21.8609
450838.......................................................       1.1295       0.8003       0.8003      15.0454      15.8026      18.9487      16.8622
450839.......................................................       0.9411       0.8715       0.8715      21.1905      22.9711      24.5796      22.8436
450840.......................................................       1.0994       1.0087       1.0087      29.5215      31.1914      31.7263      30.9017
450841.......................................................       1.6187       0.9474       0.9474      17.6635      18.9468      21.5306      19.5628
450842.......................................................          ***            *            *      23.0945            *            *      23.0945
450844.......................................................       1.3022       1.0030       1.0030      34.4235      28.7296      30.9678      30.6606
450845.......................................................       1.9081       0.9101       0.9101      26.5040      27.7461      29.4977      28.0285
450846.......................................................          ***            *            *      24.0791            *            *      24.0791
450847.......................................................       1.2480       1.0030       1.0030      26.8892      27.6854      29.1327      27.9406
450848.......................................................       1.2400       1.0030       1.0030      26.5609      27.8100      29.8391      28.0986
450849.......................................................       2.1291            *            *            *            *            *            *
450850.......................................................       1.2694       0.9802       0.9802            *      22.1334      21.4794      21.7993
450851.......................................................       2.5587       1.0087       1.0087            *      30.1213      32.3361      31.2575
450852.......................................................          ***            *            *            *      30.0191            *      30.0191
450853.......................................................       1.9067       1.0087       1.0087            *            *      36.5119      36.5119
450854.......................................................          ***            *            *            *            *      26.3165      26.3165
450855.......................................................       1.5514       0.9474       0.9474            *            *      29.0580      29.0580
450856.......................................................       1.7966       0.8859       0.8859            *            *      35.3051      35.3051
450857.......................................................          ***            *            *            *            *      31.2379      31.2379
450860.......................................................       2.0577       1.0030       1.0030            *            *      23.8491      23.8491
450861.......................................................          ***            *            *            *            *      34.7198      34.7198
450862.......................................................       1.2197       1.0030       1.0030            *            *      31.8895      31.8895
450863.......................................................          ***            *            *            *            *      24.9637      24.9637
450864.......................................................       2.0286       0.8854       0.8854            *            *      23.3931      23.3931
450865.......................................................       1.1195       0.9360       0.9360            *            *      30.1339      30.1339
450866.......................................................          ***            *            *            *            *      15.5314      15.5314
450867.......................................................       1.3274       0.9360       0.9360            *            *      28.5160      28.5160
450868.......................................................       1.8150       1.0119       1.0119            *            *      28.5693      28.5693
450869.......................................................       1.9116       0.8790       0.8790            *            *      22.5945      22.5945
450870.......................................................          ***            *            *            *            *      37.1748      37.1748
450871.......................................................       1.8656       0.9360       0.9360            *            *            *            *
450872.......................................................       1.4150       0.9870       0.9870            *            *            *            *
450874.......................................................       1.4412       1.0087       1.0087            *            *            *            *
450875.......................................................       1.6727       0.9177       0.9177            *            *            *            *

[[Page 24223]]

 
450876.......................................................       2.2693       0.8626       0.8626            *            *            *            *
450877.......................................................       1.4111       0.9101       0.9101            *            *            *            *
450878.......................................................       2.7773       0.8859       0.8859            *            *            *            *
450879.......................................................       1.2140       0.8003       0.8003            *            *            *            *
450880.......................................................       1.6144       0.9870       0.9870            *            *            *            *
450881.......................................................       1.1914       0.8578       0.8578            *            *            *            *
450882.......................................................       1.7221       0.8854       0.8854            *            *            *            *
450883.......................................................       1.7263       1.0087       1.0087            *            *            *            *
450884.......................................................       1.0379       0.8905       0.8905            *            *            *            *
450885.......................................................       1.4615       1.0087       1.0087            *            *            *            *
450886.......................................................       1.5918            *            *            *            *            *            *
450887.......................................................       1.4961            *            *            *            *            *            *
450888.......................................................       1.3795            *            *            *            *            *            *
450889.......................................................       1.0565            *            *            *            *            *            *
450890.......................................................       2.0428            *            *            *            *            *            *
450891.......................................................       1.3902            *            *            *            *            *            *
450892.......................................................       1.5347            *            *            *            *            *            *
450893.......................................................       1.4462            *            *            *            *            *            *
450895.......................................................       1.4125            *            *            *            *            *            *
460001.......................................................       1.8808       0.9537       0.9537      25.6932      27.0757      28.7686      27.1707
460003.......................................................       1.5603       0.9421       0.9421      24.3527      26.1372      31.2768      27.1512
460004.......................................................       1.7146       0.9421       0.9421      25.2191      26.4498      27.8490      26.5381
460005.......................................................       1.3478       0.9421       0.9421      22.6809      23.5633      24.6804      23.6496
460006.......................................................       1.3807       0.9421       0.9421      24.4350      25.4787      26.8666      25.6213
460007.......................................................       1.3872       0.9295       0.9295      24.2875      25.6686      26.9107      25.6767
460008.......................................................       1.3859       0.9421       0.9421      24.4453      26.5672      29.9748      26.8870
460009.......................................................       1.8418       0.9421       0.9421      25.0984      26.2833      26.7990      26.0960
460010.......................................................       2.0585       0.9421       0.9421      26.2331      27.4648      28.9206      27.5686
460011.......................................................       1.2849       0.9537       0.9537      22.3601      23.4023      25.0983      23.5591
460013.......................................................       1.4239       0.9537       0.9537      23.4765      25.2448      27.5186      25.4104
460014.......................................................       1.0606       0.9421       0.9421      23.9400      24.1412      27.2777      25.1819
460015.......................................................       1.3717       0.9049       0.9049      24.0939      25.6576      27.1745      25.6692
460017.......................................................       1.3339       0.8555       0.8555      21.7082      23.0388      24.4174      22.9891
460018 h.....................................................       0.9103       1.1611       1.1611      18.8942      20.3755      20.3940      19.9191
460019.......................................................       1.3095       0.8163       0.8163      20.3625      19.9900      23.5051      21.2559
460020.......................................................       1.0267       0.8163       0.8163      19.4960      19.5669      19.3185      19.4673
460021.......................................................       1.7313       1.1240       1.1240      24.9725      26.3420      27.5173      26.3816
460023.......................................................       1.2110       0.9537       0.9537      25.0376      25.3094      26.8796      25.7898
460025.......................................................          ***            *            *      18.7978            *            *      18.7978
460026.......................................................       1.0018       0.8163       0.8163      22.7589      24.1547      26.3509      24.3848
460030.......................................................       1.2733       0.8163       0.8163      22.6129      23.4679      23.7148      23.2667
460032.......................................................          ***            *            *      22.8987            *            *      22.8987
460033.......................................................       0.8966       0.8163       0.8163      22.7816      22.0248      23.5580      22.7910
460035.......................................................       0.9428       0.8163       0.8163      16.9019      17.5723      19.3857      18.0032
460036.......................................................       1.2276            *            *      25.2647      27.2865            *      26.2960
460037.......................................................       0.9296            *            *      19.8478      21.1035            *      20.4672
460039.......................................................       1.0985       0.9021       0.9021      27.5912      28.5656      29.9657      28.7173
460041.......................................................       1.3476       0.9421       0.9421      24.0431      25.2744      26.7893      25.3668
460042.......................................................       1.3789       0.9421       0.9421      23.5819      22.9949      24.7532      23.7828
460043.......................................................       1.2960       0.9537       0.9537      26.6870      28.2089      29.4175      28.1330
460044.......................................................       1.3067       0.9421       0.9421      25.7342      26.6795      27.5967      26.7083
460047.......................................................       1.6867       0.9421       0.9421      25.1721      25.7920      28.0524      26.3519
460049.......................................................       1.9512       0.9421       0.9421      23.0683      24.5164      26.6558      24.8008
460051.......................................................       1.1320       0.9421       0.9421      23.4970      25.5881      27.8380      25.7324
460052.......................................................       1.4773       0.9537       0.9537      24.0797      25.3163      26.8923      25.5154
460054.......................................................       1.7394       0.9049       0.9049      23.5227      25.8668      25.1386      24.8669
470001.......................................................       1.2603       1.1381       1.1381      24.5499      27.7329      29.1057      27.1069
470003.......................................................       1.9722       1.1318       1.0986      24.6660      26.4919      28.1869      26.4264
470005.......................................................       1.3563       1.0986       1.0986      25.7288      29.8255      32.5203      29.3642
470006.......................................................       1.1527            *            *      26.0884      26.9651            *      26.5397
470008.......................................................       1.2850            *            *      21.8951            *            *      21.8951
470010.......................................................       1.2545            *            *      22.9777      26.1273            *      24.5339
470011.......................................................       1.1897       1.0986       1.0986      25.9246      28.3911      29.2637      27.8893
470012.......................................................       1.2567       1.0986       1.0986      22.9159      24.3425      25.6468      24.3436
470018.......................................................       1.1212            *            *      25.9300      28.3419            *      27.1737
470023.......................................................          ***            *            *      26.7486            *            *      26.7486

[[Page 24224]]

 
470024.......................................................       1.2067       1.0986       1.0986      23.7745      25.2427      27.3942      25.5325
470302.......................................................       0.9778            *            *            *            *            *            *
490001.......................................................       1.0802       0.8716       0.7966      21.7111      21.9953      22.9269      22.2279
490002.......................................................       1.0693       0.7966       0.7966      18.5220      19.5613      20.6251      19.6010
490003.......................................................          ***            *            *      23.8112      27.3456            *      25.4279
490004.......................................................       1.3075       0.9732       0.9732      24.4580      25.4597      26.9175      25.6513
490005.......................................................       1.6397       1.1076       1.1076      27.6425      28.5744      29.8963      28.7056
490006.......................................................          ***            *            *      16.7679            *            *      16.7679
490007.......................................................       2.2239       0.8840       0.8840      24.9533      26.2481      27.6665      26.3324
490009.......................................................       2.0155       1.0140       1.0140      27.5905      29.0740      30.6705      29.0947
490011.......................................................       1.4501       0.8840       0.8840      22.4410      24.5687      26.3250      24.4894
490012.......................................................       1.0263       0.7966       0.7966      18.3697      19.2275      20.4238      19.3376
490013.......................................................       1.3599       0.8716       0.8716      21.4838      22.4772      23.9524      22.6144
490015.......................................................          ***            *            *      22.5641            *            *      22.5641
490017.......................................................       1.4225       0.8840       0.8840      22.9632      24.6845      25.5899      24.4194
490018.......................................................       1.2773       0.9732       0.9732      23.2215      24.5196      25.5210      24.4582
490019 h.....................................................       1.1723       1.2316       1.2316      24.4524      25.9761      26.7428      25.7803
490020.......................................................       1.2380       0.9174       0.9174      23.6611      24.8001      26.6396      25.0712
490021.......................................................       1.4653       0.8716       0.8716      23.5930      24.6440      26.1509      24.8426
490022.......................................................       1.4931       1.1076       1.1076      25.0277      28.0749      32.2985      28.4160
490023.......................................................       1.2456       1.1076       1.1076      28.8354      29.7774      31.1609      29.9671
490024.......................................................       1.7466       0.8483       0.8677      21.7268      23.0982      25.7005      23.5054
490027.......................................................       1.1045       0.7966       0.7966      19.8345      18.9409      23.7402      20.7964
490031.......................................................          ***            *            *      22.4300      22.0579            *      22.2427
490032.......................................................       1.9877       0.9174       0.9174      22.8942      25.1381      25.6281      24.5660
490033.......................................................       1.0717       1.1076       1.1076      27.6355      30.0909      31.5482      29.8331
490037.......................................................       1.1924       0.7966       0.7966      19.0583      21.3035      23.3679      21.2221
490038.......................................................       1.2207       0.7988       0.7988      19.6427      22.3976      22.3842      21.4601
490040.......................................................       1.5159       1.1076       1.1076      30.1820      32.8738      33.5638      32.1968
490041.......................................................       1.3928       0.8840       0.8840      22.2955      24.5738      26.1445      24.3175
490042.......................................................       1.3030       0.8677       0.8677      20.5845      21.8749      24.4229      22.3975
490043.......................................................       1.1470       1.1076       1.1076      28.2969      30.8871      31.2740      30.3070
490044.......................................................       1.4671       0.8840       0.8840      22.1324      20.8351      23.3012      22.0713
490045.......................................................       1.2905       1.1076       1.1076      27.2132      28.8279      32.4604      29.4320
490046.......................................................       1.5680       0.8840       0.8840      24.6391      25.6328      26.6811      25.6856
490047.......................................................       1.0319            *            *      21.9156      22.5424            *      22.2282
490048.......................................................       1.4274       0.8716       0.8716      24.1639      25.0097      25.8371      25.0464
490050.......................................................       1.4890       1.1076       1.1076      29.4660      30.5037      31.8461      30.6123
490052.......................................................       1.6157       0.8840       0.8840      21.4035      22.8889      23.7544      22.6886
490053.......................................................       1.2486       0.8062       0.8062      20.9367      21.8432      22.7902      21.8500
490057.......................................................       1.6003       0.8840       0.8840      25.1898      26.1128      26.9303      26.0974
490059.......................................................       1.6024       0.9174       0.9174      26.1518      28.7276      28.7481      27.9332
490060.......................................................       1.0394       0.7966       0.7966      21.0828      22.4200      23.6087      22.3825
490063.......................................................       1.8203       1.1076       1.1076      29.4216      30.3632      32.4155      30.7714
490066.......................................................       1.3509       0.8840       0.8840      23.3835      24.7146      28.4793      25.5572
490067.......................................................       1.1965       0.9174       0.9174      21.8730      22.9188      24.5806      23.1010
490069.......................................................       1.5765       0.9174       0.9174      24.4542      26.8791      27.7682      26.4176
490071.......................................................       1.3096       0.9174       0.9174      27.0374      28.4381      29.7235      28.4129
490073.......................................................       1.7271       1.1076       1.1076      25.2859      31.7743      34.4692      29.6891
490075.......................................................       1.4710       0.8483       0.8483      22.8303      23.8191      25.1134      23.9198
490077.......................................................       1.4157       1.0140       1.0140      24.8309      26.0800      27.1434      26.0560
490079.......................................................       1.2785       0.8992       0.8992      19.8100      23.4728      23.3244      22.0780
490084.......................................................       1.1836       0.8133       0.8133      22.7945      24.5965      25.5067      24.2420
490088.......................................................       1.0918       0.8716       0.8716      21.4818      22.4186      24.1339      22.6632
490089.......................................................       1.0530       0.8677       0.8677      21.2123      22.6461      24.5879      22.9250
490090.......................................................       1.1113       0.7966       0.7966      21.3410      22.2907      24.3011      22.5541
490092.......................................................       1.0744       0.9174       0.9174      21.6466      23.8656      23.2472      22.8995
490093.......................................................       1.4535       0.8840       0.8840      23.6779      25.0751      26.1524      25.0724
490094.......................................................       0.9768       0.9174       0.9174      26.0755      26.5726      28.7249      27.1409
490097.......................................................       1.0622       0.7966       0.7966      23.5366      23.8005      25.7117      24.3445
490098.......................................................       1.1704       0.7966       0.7966      20.9805      21.7231      23.3102      22.0052
490101.......................................................       1.3361       1.1076       1.1076      30.1800      30.4285      31.9879      30.8879
490104.......................................................       0.8061       0.9174       0.9174      33.1215      17.3295            *      22.8307
490105.......................................................       0.9463       0.8062       0.8062      38.2813      24.7923      25.7327      29.8754
490106.......................................................       0.9937       0.9732       0.9732      30.1492      23.0199      23.7549      26.2572
490107.......................................................       1.3553       1.1076       1.1076      28.7296      29.7000      31.8461      30.1409

[[Page 24225]]

 
490108.......................................................       0.9836       0.8716       0.8716      27.9090      22.4345      22.7419      24.3793
490109.......................................................       0.9090       0.9174       0.9174      28.0548      21.9878      22.9347      24.2712
490110.......................................................       1.2759       0.8324       0.8324      21.3126      22.5974      24.4586      22.8433
490111.......................................................       1.2769       0.7966       0.7966      20.6373      22.0199      22.2094      21.6419
490112.......................................................       1.6505       0.9174       0.9174      25.8312      26.6453      27.5555      26.7023
490113.......................................................       1.2628       1.1076       1.1076      29.1786      29.5698      32.8354      30.5878
490114.......................................................       1.0602       0.7966       0.7966      20.0555      20.9116      21.8633      20.9404
490115.......................................................       1.1886       0.7966       0.7966      20.3615      21.4666      22.0483      21.3080
490116.......................................................       1.1906       0.8242       0.8242      21.3083      22.9017      24.2616      22.8382
490117.......................................................       1.1508       0.7966       0.7966      17.4111      18.0277      19.2372      18.2401
490118.......................................................       1.6833       0.9174       0.9174      26.8810      27.4050      28.6297      27.7063
490119.......................................................       1.2525       0.8840       0.8840      23.7813      25.2549      27.1954      25.4840
490120.......................................................       1.3625       0.8840       0.8840      23.1535      24.4434      26.2560      24.6055
490122.......................................................       1.4721       1.1076       1.1076      28.7020      31.0449      32.5825      30.7435
490123.......................................................       1.0815       0.7966       0.7966      22.9511      23.9233      25.0086      23.9568
490124.......................................................          ***            *            *      29.7939            *            *      29.7939
490126.......................................................       1.2231       0.7966       0.7966      23.1423      22.2859      22.9757      22.7925
490127.......................................................       1.1735       0.7966       0.7966      19.4005      20.4289      21.4512      20.3942
490130.......................................................       1.2008       0.8840       0.8840      22.0769      22.8512      24.2270      23.0561
490133.......................................................          ***            *            *            *      26.5683            *      26.5683
490134.......................................................       0.8128       0.7966       0.7966            *            *            *            *
490135.......................................................       0.6911       0.8677       0.8677            *            *            *            *
490136.......................................................       1.0827            *            *            *            *            *            *
500001.......................................................       1.6186       1.1438       1.1438      26.7502      29.3707      31.2869      29.1920
500002.......................................................       1.4423       1.0440       1.0440      25.0665      25.3347      27.7842      26.0658
500003.......................................................       1.3380       1.1255       1.1255      28.4174      29.6341      31.5127      29.8891
500005.......................................................       1.7822       1.1438       1.1438      31.4415      32.0972      33.3329      32.2891
500007.......................................................       1.3787       1.0722       1.0722      26.1318      28.0476      30.0980      28.1844
500008.......................................................       1.9554       1.1438       1.1438      31.0128      31.8837      33.3228      32.1022
500011.......................................................       1.3253       1.1438       1.1438      28.3391      30.6508      32.0074      30.3834
500012.......................................................       1.6684       1.0440       1.0440      29.2045      30.6856      30.4076      30.0653
500014.......................................................       1.6420       1.1438       1.1438      30.1061      33.7536      36.3225      33.4938
500015.......................................................       1.4667       1.1438       1.1438      30.1596      32.0592      34.5308      32.3201
500016.......................................................       1.7023       1.1255       1.1255      29.3634      31.4221      31.8609      30.9249
500019.......................................................       1.2686       1.0653       1.0653      26.9702      28.6669      30.4632      28.6734
500021.......................................................       1.3488       1.1255       1.1255      28.5926      30.1690      30.0500      29.6659
500023.......................................................       1.2010            *            *      27.3823            *            *      27.3823
500024.......................................................       1.7921       1.0907       1.0907      29.3946      30.7917      32.9554      31.0696
500025.......................................................       1.7858       1.1438       1.1438      31.7335      34.7252      38.5672      34.8346
500026.......................................................       1.4412       1.1438       1.1438      31.4152      33.2937      34.0225      32.9380
500027.......................................................       1.5753       1.1438       1.1438      29.5939      34.2175      35.7683      33.2591
500030.......................................................       1.7399       1.1088       1.1088      30.5926      32.7446      32.8247      32.0831
500031.......................................................       1.2764       1.0440       1.0440      28.5398      31.2186      33.2070      31.0095
500033.......................................................       1.3088       1.0440       1.0440      26.6704      29.4627      30.0929      28.7252
500036.......................................................       1.3769       1.0440       1.0440      26.0223      27.0072      28.5158      27.2093
500037.......................................................       1.0398       1.0440       1.0440      24.6548      26.9969      28.6509      26.6844
500039.......................................................       1.4810       1.1255       1.1255      27.9651      29.8809      32.3485      30.1316
500041.......................................................       1.3811       1.1405       1.1405      26.9101      26.7829      29.6411      27.7279
500044.......................................................       1.9738       1.0448       1.0448      26.9323      30.3164      28.5880      28.6194
500049.......................................................       1.3205       1.0440       1.0440      25.6104      27.1819      28.3014      27.1121
500050.......................................................       1.4378       1.1405       1.1405      26.8971      29.9791      32.5722      29.8732
500051.......................................................       1.7550       1.1438       1.1438      29.0100      31.9406      33.4078      31.5494
500052.......................................................       1.4362       1.1438       1.1438            *            *            *            *
500053.......................................................       1.2978       1.0440       1.0440      26.8074      28.4130      29.2529      28.1462
500054.......................................................       1.9895       1.0448       1.0448      28.8062      30.8067      32.1392      30.6203
500057.......................................................          ***            *            *      21.4393            *            *      21.4393
500058.......................................................       1.6738       1.0440       1.0440      28.4247      30.4699      31.3325      30.1884
500060.......................................................       1.3057       1.0440       1.0440      33.5169      34.1523      37.1307      34.9415
500064.......................................................       1.7930       1.1438       1.1438      31.1459      31.5371      32.0554      31.6041
500065.......................................................          ***            *            *      26.0960            *            *      26.0960
500072.......................................................       1.2016       1.1255       1.1255      29.3087      33.4863      31.8127      31.5390
500077.......................................................       1.4749       1.0448       1.0448      27.8819      29.4199      30.9414      29.4486
500079.......................................................       1.3526       1.1255       1.1255      28.4934      29.6623      31.8986      30.0378
500084.......................................................       1.3269       1.1438       1.1438      27.6306      29.3484      31.1336      29.4235
500088.......................................................       1.4147       1.1438       1.1438      31.2757      33.4302      34.7384      33.2062
500092.......................................................          ***            *            *      23.2466            *            *      23.2466

[[Page 24226]]

 
500104.......................................................       1.1367            *            *      27.0034            *            *      27.0034
500108.......................................................       1.6392       1.1255       1.1255      28.7206      29.4244      31.8504      30.0479
500110.......................................................          ***            *            *      25.4785            *            *      25.4785
500118.......................................................       1.0815            *            *      28.1074            *            *      28.1074
500119.......................................................       1.3571       1.0448       1.0448      27.2335      30.9999      29.2153      29.1384
500122.......................................................       1.2515            *            *      27.4405      30.1396            *      28.8217
500124.......................................................       1.3893       1.1438       1.1438      28.6598      31.5438      32.2351      30.8456
500129.......................................................       1.5958       1.1255       1.1255      30.0223      30.7536      32.5779      31.1547
500134.......................................................       0.5017       1.1438       1.1438      24.2990      26.8608      25.0035      25.4134
500139.......................................................       1.5171       1.0907       1.0907      29.2357      31.6591      34.6120      31.8023
500141.......................................................       1.3234       1.1438       1.1438      30.7478      30.5456      32.1853      31.2034
500143.......................................................       0.4565       1.1119       1.1119      20.7093      22.1419      22.6867      21.8786
500147.......................................................       0.9626            *            *      16.3669      24.5807            *      16.9814
500148.......................................................       1.1035       1.0440       1.0440      18.2168      22.2161      27.0350      21.6967
500150.......................................................       1.1543            *            *            *            *            *            *
500329.......................................................       0.7676            *            *            *            *            *            *
500334.......................................................       0.6580            *            *            *            *            *            *
500337.......................................................       0.8865            *            *            *            *            *            *
510001.......................................................       1.8662       0.8671       0.8671      22.9351      23.4477      24.9395      23.8162
510002.......................................................       1.2073       0.8677       0.8677      22.4751      25.9597      24.0032      24.1436
510006.......................................................       1.3300       0.8671       0.8671      22.2947      23.5727      24.5450      23.4754
510007.......................................................       1.6577       0.9009       0.9009      24.3499      25.2835      25.2802      24.9834
510008.......................................................       1.2502       0.9082       0.9082      24.5293      24.6959      25.5366      24.9190
510012.......................................................       0.9616       0.7637       0.7637      18.5816      18.2845      18.8211      18.5638
510013.......................................................       1.1563       0.7637       0.7637      19.9710      20.8782      22.7404      21.1637
510018.......................................................       1.0576       0.8294       0.8294      21.8475      20.5556      22.8201      21.7432
510022.......................................................       1.8746       0.8559       0.8559      24.1481      24.2125      26.2125      24.8409
510023.......................................................       1.3100       0.8072       0.8072      19.4321      20.4908      20.7734      20.2347
510024.......................................................       1.8007       0.8671       0.8671      23.3115      24.0444      25.2181      24.1883
510026.......................................................       0.9938       0.7637       0.7637      18.0855      16.6192      17.3777      17.2853
510028.......................................................       0.9801            *            *      23.0518      21.7134            *      22.3847
510029.......................................................       1.2865       0.8559       0.8559      21.7527      22.4556      23.3861      22.5557
510030.......................................................       1.1233       0.8449       0.8449      22.3658      21.5583      23.3535      22.4378
510031.......................................................       1.4609       0.8559       0.8559      21.6294      21.7637      23.0714      22.1614
510033.......................................................       1.5615       0.7964       0.7964      21.0707      23.0305      22.5839      22.2245
510038.......................................................       1.0077       0.7637       0.7637      16.8744      17.2832      19.0992      17.7660
510039.......................................................       1.2424       0.7749       0.7749      19.1280      19.5468      19.9164      19.5208
510043.......................................................          ***            *            *      16.0586            *            *      16.0586
510046.......................................................       1.3517       0.8294       0.8294      21.2792      21.2540      21.5642      21.3655
510047.......................................................       1.1634       0.8671       0.8671      23.2093      24.0954      26.2033      24.4801
510048.......................................................       1.1421       0.7637       0.7637      17.6785      17.5096      19.0606      18.0744
510050.......................................................       1.5568       0.7749       0.7749      20.1943      19.9766      20.8188      20.3257
510053.......................................................       1.1301       0.7637       0.7637      20.7538      20.8609      22.6334      21.4364
510055.......................................................       1.5283       0.9009       0.9009      29.3962      30.7868      29.1387      29.7610
510058.......................................................       1.3632       0.7964       0.7964      21.9352      22.6976      23.0760      22.5822
510059.......................................................       1.2304       0.8559       0.8559      18.8712      21.9550      21.8993      20.7922
510061.......................................................          ***            *            *      15.3355            *            *      15.3355
510062.......................................................       1.1472       0.8294       0.8294      21.1568      23.3216      24.8582      23.0758
510067.......................................................       1.1583       0.7637       0.7637      22.1582      21.2099      24.1938      22.5714
510068.......................................................       1.1019            *            *      20.0007      23.1011            *      21.5379
510070.......................................................       1.2161       0.8294       0.8294      21.1895      23.2382      23.1691      22.5946
510071.......................................................       1.2876       0.8294       0.8294      21.5439      23.1685      23.8043      22.8368
510072.......................................................       1.0728       0.7637       0.7637      19.7990      20.1997      20.8822      20.3279
510077.......................................................       1.1020       0.8759       0.8759      22.8104      23.6585      24.6316      23.7056
510082.......................................................       1.0846       0.7637       0.7637      16.4742      19.1878      19.8764      18.3863
510085.......................................................       1.3124       0.8559       0.8559      22.6563      23.7173      25.8288      24.1309
510086.......................................................       1.1062       0.7637       0.7637      17.8234      17.5933      19.0144      18.1416
510088.......................................................          ***            *            *      18.3401            *            *      18.3401
510089.......................................................          ***            *            *            *      27.7062            *      27.7062
510090.......................................................       2.2681            *            *            *            *            *            *
520002.......................................................       1.3605       0.9625       0.9625      23.7316      24.9950      26.5869      25.1359
520003.......................................................          ***            *            *      21.8662            *            *      21.8662
520004.......................................................       1.4679       0.9466       0.9466      24.4711      25.4639      27.0690      25.6990
520008.......................................................       1.5872       1.0241       1.0241      27.8127      29.8354      31.0949      29.6152
520009.......................................................       1.7236       0.9466       0.9466      23.4265      26.1503      27.7845      25.7871
520010.......................................................       1.1151            *            *      28.5569            *            *      28.5569

[[Page 24227]]

 
520011.......................................................       1.3314       0.9466       0.9466      23.7785      25.2747      27.1311      25.4700
520013.......................................................       1.4452       0.9644       0.9644      24.4766      26.6225      29.2111      26.8019
520014.......................................................          ***            *            *      22.1064            *            *      22.1064
520015.......................................................          ***            *            *      23.0403            *            *      23.0403
520017.......................................................       1.1783       0.9644       0.9644      23.4044      24.6676      28.0839      25.3651
520019.......................................................       1.3160       0.9466       0.9466      24.9871      26.7433      29.3066      27.0110
520021.......................................................       1.3354       1.0596       1.0596      25.4872      26.6935      28.1218      26.8573
520024.......................................................       1.0407            *            *      18.5072            *            *      18.5072
520026.......................................................          ***            *            *      26.1056            *            *      26.1056
520027.......................................................       1.2653       1.0241       1.0241      26.2516      27.6771      30.8126      28.3796
520028.......................................................       1.2954       1.0502       1.0502      25.7778      25.4164      26.5754      25.9267
520030.......................................................       1.7625       0.9799       0.9799      25.3807      27.0185      29.0074      27.1779
520032.......................................................       1.1081            *            *      25.3059            *            *      25.3059
520033.......................................................       1.2354       0.9466       0.9466      23.9791      25.0854      27.3306      25.5391
520034.......................................................       1.2062       0.9466       0.9466      23.6563      23.9850      25.9625      24.5645
520035.......................................................       1.3268       0.9543       0.9543      23.2625      24.7767      26.8252      24.9975
520037.......................................................       1.8330       0.9625       0.9625      28.6984      29.7234      28.7221      29.0476
520038.......................................................       1.2465       1.0241       1.0241      24.6650      26.6470      29.7288      27.0582
520040.......................................................       1.4799       1.0241       1.0241      23.8501      27.2325      28.7706      26.5424
520041.......................................................       1.0916       1.0731       1.0731      22.8236      22.7596      23.3086      22.9766
520042.......................................................       1.0028            *            *      24.0788            *            *      24.0788
520044.......................................................       1.3404       0.9543       0.9543      24.9387      26.0191      27.4740      26.1760
520045.......................................................       1.5980       0.9466       0.9466      24.5844      26.0030      27.9444      26.1871
520047.......................................................          ***            *            *      25.5346            *            *      25.5346
520048.......................................................       1.6307       0.9466       0.9466      23.1653      25.1724      27.0266      25.0694
520049.......................................................       2.1099       0.9791       0.9791      24.1083      25.9256      27.4599      25.7460
520051.......................................................       1.6916       1.0241       1.0241      28.8249      28.4880      31.5274      29.7523
520057.......................................................       1.2115       0.9584       0.9584      23.3205      25.3745      27.6395      25.5004
520059.......................................................       1.2603       1.0408       1.0408      26.5596      28.0906      29.8632      28.1945
520060.......................................................       1.2808       0.9489       0.9489      22.0132      23.8817      24.7482      23.5443
520062.......................................................       1.2708       1.0241       1.0241      24.9988      28.2215      29.4194      27.5670
520063.......................................................       1.1386       1.0241       1.0241      25.3674      27.4101      28.9251      27.2413
520064.......................................................       1.5155       1.0241       1.0241      27.1120      28.6101      30.2879      28.6292
520066.......................................................       1.4918       1.0502       1.0502      25.8812      27.1657      28.3573      27.1367
520068.......................................................       0.9097            *            *      23.4746      24.8184            *      24.1554
520070.......................................................       1.7287       0.9644       0.9644      23.9908      24.8935      27.5457      25.5329
520071.......................................................       1.2004       1.0098       1.0098      26.3154      27.6202      29.3878      27.7380
520075.......................................................       1.4697       0.9791       0.9791      26.0600      27.1699      29.8136      27.6374
520076.......................................................       1.2383       1.0502       1.0502      24.0879      26.1698      28.1355      26.1183
520078.......................................................       1.5311       1.0241       1.0241      25.7662      27.5989      29.6321      27.7034
520083.......................................................       1.7261       1.0731       1.0731      27.0012      28.8407      31.3634      29.1629
520084.......................................................          ***            *            *      25.5777            *            *      25.5777
520087.......................................................       1.7272       0.9466       0.9466      24.5280      27.3374      28.2823      26.6696
520088.......................................................       1.2906       1.0098       1.0098      26.0882      26.9936      29.8417      27.7181
520089.......................................................       1.5216       1.0731       1.0731      26.6013      30.0448      33.3398      30.0450
520091.......................................................       1.2880       0.9466       0.9466      24.8269      24.6320      25.9623      25.1681
520092.......................................................          ***            *            *      23.4043            *            *      23.4043
520094.......................................................          ***            *            *      25.3166      25.7567            *      25.5399
520095.......................................................       1.2375       1.0502       1.0502      28.6376      26.7863      28.5877      27.9986
520096.......................................................       1.3505       1.0098       1.0098      22.9929      24.5758      26.8566      25.0076
520097.......................................................       1.3955       0.9791       0.9791      25.1135      26.3321      29.8400      27.1169
520098.......................................................       1.9798       1.0731       1.0731      28.0730      30.6150      31.9008      30.2555
520100.......................................................       1.2806       0.9685       0.9685      24.5914      26.2161      29.0461      26.6330
520102.......................................................       1.1190       1.0098       1.0098      25.6146      26.8234      28.8280      27.1398
520103.......................................................       1.5698       1.0241       1.0241      25.5361      27.9147      29.8746      27.9295
520107.......................................................       1.2555       0.9620       0.9620      27.7413      28.3431      29.2809      28.4726
520109.......................................................       1.0588       0.9466       0.9466      22.4048      23.3271      24.2510      23.3292
520111.......................................................          ***            *            *      26.3095            *            *      26.3095
520112.......................................................          ***            *            *      20.4034            *            *      20.4034
520113.......................................................       1.2862       0.9620       0.9620      26.7926      27.4135      30.6517      28.3197
520114.......................................................          ***            *            *      22.0536            *            *      22.0536
520116.......................................................       1.2845       1.0098       1.0098      26.3057      26.9902      28.3092      27.2488
520117.......................................................          ***            *            *      22.0023            *            *      22.0023
520123.......................................................          ***            *            *      22.2430            *            *      22.2430
520132.......................................................       0.9607       0.9543       0.9543      21.6025      23.1941      24.6842      23.1837
520135.......................................................          ***            *            *      18.5618            *            *      18.5618

[[Page 24228]]

 
520136.......................................................       1.6741       1.0241       1.0241      25.5145      27.7703      30.5973      27.9356
520138.......................................................       1.8704       1.0241       1.0241      26.9047      28.4394      30.1937      28.5333
520139.......................................................       1.2833       1.0241       1.0241      25.4424      26.5110      28.5712      26.9062
520140.......................................................       1.6566       1.0241       1.0241      26.1616      28.4433      30.7141      28.4902
520148.......................................................       1.3242            *            *      26.2258            *            *      26.2258
520151.......................................................          ***            *            *      22.9592            *            *      22.9592
520152.......................................................       1.0783       0.9466       0.9466      23.2493      24.9392      28.9787      25.8522
520154.......................................................          ***            *            *      23.7160            *            *      23.7160
520156.......................................................          ***            *            *      24.9258            *            *      24.9258
520160.......................................................       1.8305       0.9466       0.9466      24.3528      25.7588      28.0219      26.0815
520161.......................................................          ***            *            *      24.0673            *            *      24.0673
520170.......................................................       1.4056       1.0241       1.0241      25.6124      27.2221      29.9758      27.6579
520173.......................................................       1.1252       1.0157       1.0157      26.2224      28.0995      29.7080      28.0206
520177.......................................................       1.6429       1.0241       1.0241      28.4663      30.7317      31.0104      30.1346
520178.......................................................       0.9970            *            *      23.0419      20.2666            *      21.6760
520189.......................................................       1.1658       1.0596       1.0596      26.3172      28.4720      28.1690      27.7706
520193.......................................................       1.6544       0.9791       0.9791            *      26.0885      28.6187      27.4400
520194.......................................................       1.3272       1.0241       1.0241            *      24.9408      31.0546      27.9475
520195.......................................................          ***            *            *            *      36.6973      36.6166      36.6568
520196.......................................................       1.6814       0.9644       0.9644            *      35.1043      40.4421      37.6718
520197.......................................................       2.6191       1.0241       1.0241            *            *            *            *
520198.......................................................       1.3597       0.9466       0.9466            *            *            *            *
520199.......................................................       2.3566       1.0241       1.0241            *            *            *            *
520200.......................................................       1.5982            *            *            *            *            *            *
520343.......................................................       0.8070            *            *            *            *            *            *
520344.......................................................       0.6245            *            *            *            *            *            *
520353.......................................................       0.6538            *            *            *            *            *            *
530002.......................................................       1.0826       0.9303       0.9303      25.2983      26.8356      28.6510      26.9256
530006.......................................................       1.1645       0.9303       0.9303      22.8344      24.9318      27.3112      24.9372
530007.......................................................          ***            *            *      19.3476      20.4391            *      19.9218
530008 \2\...................................................       1.1146       0.9303       0.9303      23.8271      23.8589      23.8665      23.8511
530009.......................................................       0.9305       0.9303       0.9303      24.2426      26.8316      25.4972      25.5320
530010 \2\...................................................       1.2318       0.9303       0.9303      23.9255      25.8482      26.3785      25.3803
530011.......................................................       1.1121       0.9303       0.9303      24.1396      24.8245      27.8493      25.6567
530012.......................................................       1.6973       0.9303       0.9303      24.3454      25.2526      27.0939      25.5544
530014.......................................................       1.5419       0.9303       0.9303      23.6907      24.5947      26.8898      25.0653
530015.......................................................       1.2091       0.9303       0.9303      26.3107      27.6876      30.4674      28.1564
530016.......................................................          ***            *            *      21.6575            *            *      21.6575
530017.......................................................       0.9926       0.9303       0.9303      23.5415      25.3362      27.8927      25.7008
530023.......................................................          ***            *            *      24.1493      21.3813            *      22.6795
530025.......................................................       1.2442       0.9594       0.9594      27.7988      28.6938      28.0007      28.1645
530031.......................................................          ***            *            *      16.3472            *            *      16.3472
530032.......................................................          ***       0.9303       0.9303      22.6584      25.7728      23.6562     23.9700
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Based on salaries adjusted for occupational mix, according to the calculation in section III.G. of the preamble to this proposed rule.
\2\ These hospitals are assigned a wage index value under a special exceptions policy (FY 2005 IPPS final rule, 69 FR 49105).
\3\ The case-mix index is based on the billed DRGs in the FY 2005 MedPAR. It is not transfer adjusted.
h These hospitals are assigned a wage index value under the rural hold harmless transition discussed in section III.H.3. of the preamble of the FY 2006
  IPPS final rule (70 FR 47378).
* Denotes wage data not available for the provider for that year.
** Based on the sum of the salaries and hours computed for Federal FYs 2005, 2006, and 2007.
*** Denotes MedPAR data not available for the provider for FY 2005.


  Table 3A.--FY 2007 and 3-Year Average Hourly Wage for Urban Areas by
                                  CBSA
   [*Based on the salaries and hours computed for Federal Fiscal Years
                          2005, 2006, and 2007]
------------------------------------------------------------------------
                                                  FY 2007       3-year
     CBSA code               Urban area           average      average
                                                hourly wage  hourly wage
------------------------------------------------------------------------
10180..............  Abilene, TX..............      23.7864      22.2341
10380..............  Aguadilla-Isabela-San          11.5958      11.9816
                      Sebastian, PR.
10420..............  Akron, OH................      25.5401      24.8498
10500..............  Albany, GA...............      26.5516      26.5372
10580..............  Albany-Schenectady-Troy,       25.9108      24.3176
                      NY.
10740..............  Albuquerque, NM..........      28.0546      27.6389

[[Page 24229]]

 
10780..............  Alexandria, LA...........      23.7639      22.6218
10900..............  Allentown-Bethlehem-           29.3872      27.4903
                      Easton, PA-NJ.
11020..............  Altoona, PA..............      25.8056      24.3129
11100..............  Amarillo, TX.............      27.1670      25.6933
11180..............  Ames, IA.................      28.9474      26.8746
11260..............  Anchorage, AK............      35.6559      33.7320
11300..............  Anderson, IN.............      26.1417      24.4749
11340..............  Anderson, SC.............      26.4925      24.8853
11460..............  Ann Arbor, MI............      32.1288      30.6219
11500..............  Anniston-Oxford, AL......      23.3427      21.9251
11540..............  Appleton, WI.............      27.9303      25.9663
11700..............  Asheville, NC............      26.9690      25.7974
12020..............  Athens-Clarke County, GA.      29.0907      27.8508
12060..............  Atlanta-Sandy Springs-         28.8960      27.5475
                      Marietta, GA.
12100..............  Atlantic City, NJ........      34.7415      32.0814
12220..............  Auburn-Opelika, AL.......      24.0249      22.8346
12260..............  Augusta-Richmond County,       28.6584      26.7093
                      GA-SC.
12420..............  Austin-Round Rock, TX....      27.7087      26.5210
12540..............  Bakersfield, CA..........      31.4405      29.2570
12580..............  Baltimore-Towson, MD.....      29.8705      27.9108
12620..............  Bangor, ME...............      28.7200      27.6266
12700..............  Barnstable Town, MA......      37.1619      35.0590
12940..............  Baton Rouge, LA..........      23.9840      23.3500
12980..............  Battle Creek, MI.........      28.7918      26.6912
13020..............  Bay City, MI.............      27.4599      26.3249
13140..............  Beaumont-Port Arthur, TX.      25.4926      23.9070
13380..............  Bellingham, WA...........      32.8247      32.0831
13460..............  Bend, OR.................      31.8191      30.0560
13644..............  Bethesda-Gaithersburg-         32.2704      31.0786
                      Frederick, MD.
13740..............  Billings, MT.............      25.8722      24.7779
13780..............  Binghamton, NY...........      26.0978      24.1488
13820..............  Birmingham-Hoover, AL....      26.4036      25.2200
13900..............  Bismarck, ND.............      21.4773      20.8617
13980..............  Blacksburg-Christiansburg-     24.3978      22.6378
                      Radford, VA.
14020..............  Bloomington, IN..........      25.3577      23.9071
14060..............  Bloomington-Normal, IL...      26.5223      25.3191
14260..............  Boise City-Nampa, ID.....      27.8382      25.9580
14484..............  Boston-Quincy, MA........      34.5981      32.6876
14500..............  Boulder, CO..............      30.6928      28.2498
14540..............  Bowling Green, KY........      24.1674      22.8806
14740..............  Bremerton-Silverdale, WA.      32.3485      30.1316
14860..............  Bridgeport-Stamford-           37.5692      35.6119
                      Norwalk, CT.
15180..............  Brownsville-Harlingen, TX      28.0460      27.4783
15260..............  Brunswick, GA............      29.9555      28.9712
15380..............  Buffalo-Niagara Falls, NY      28.0487      26.4035
15500..............  Burlington, NC...........      25.6875      24.7454
15540..............  Burlington-South               28.0878      26.3208
                      Burlington, VT.
15764..............  Cambridge-Newton-              32.3023      31.0383
                      Framingham, MA.
15804..............  Camden, NJ...............      30.7780      29.4794
15940..............  Canton-Massillon, OH.....      26.8199      25.1102
15980..............  Cape Coral-Fort Myers, FL      27.6466      26.1863
16180..............  Carson City, NV..........      29.6855      28.5533
16220..............  Casper, WY...............      27.0939      25.5544
16300..............  Cedar Rapids, IA.........      26.3211      24.9097
16580..............  Champaign-Urbana, IL.....      28.5638      26.8316
16620..............  Charleston, WV...........      25.3369      24.1265
16700..............  Charleston-North               27.0907      25.9477
                      Charleston, SC.
16740..............  Charlotte-Gastonia-            28.1830      27.0104
                      Concord, NC-SC.
16820..............  Charlottesville, VA......      30.0162      28.5508
16860..............  Chattanooga, TN-GA.......      26.5381      25.4499
16940..............  Cheyenne, WY.............      26.8898      25.0653
16974..............  Chicago-Naperville-            31.7996      30.2340
                      Joliet, IL.
17020..............  Chico, CA................      32.7893      29.9719
17140..............  Cincinnati-Middletown, OH-     28.4143      26.7824
                      KY-IN.
17300..............  Clarksville, TN-KY.......      24.9567      23.0900
17420..............  Cleveland, TN............      24.0739      22.5520
17460..............  Cleveland-Elyria-Mentor,       27.7626      26.3460
                      OH.
17660..............  Coeur d'Alene, ID........      27.6683      26.4480
17780..............  College Station-Bryan, TX      26.8320      25.3789

[[Page 24230]]

 
17820..............  Colorado Springs, CO.....      28.7059      26.9783
17860..............  Columbia, MO.............      25.3105      23.5598
17900..............  Columbia, SC.............      23.7907      24.6287
17980..............  Columbus, GA-AL..........      24.4401      23.7713
18020..............  Columbus, IN.............      27.6269      26.4443
18140..............  Columbus, OH.............      29.9564      27.7794
18580..............  Corpus Christi, TX.......      25.3934      24.0550
18700..............  Corvallis, OR............      34.1502      30.6441
19060..............  Cumberland, MD-WV........      26.1797      24.9454
19124..............  Dallas-Plano-Irving, TX..      29.8607      28.3711
19140..............  Dalton, GA...............      26.7899      25.7890
19180..............  Danville, IL.............      27.5152      24.7343
19260..............  Danville, VA.............      25.1134      23.9198
19340..............  Davenport-Moline-Rock          25.2896      24.2728
                      Island, IA-IL.
19380..............  Dayton, OH...............      26.7881      25.5826
19460..............  Decatur, AL..............      24.3313      23.8254
19500..............  Decatur, IL..............      24.2290      22.7819
19660..............  Deltona-Daytona Beach-         27.4687      25.7159
                      Ormond Beach, FL.
19740..............  Denver-Aurora, CO........      32.3384      30.3491
19780..............  Des Moines-West Des            27.0441      26.1907
                      Moines,IA.
19804..............  Detroit-Livonia-Dearborn,      30.2990      28.9283
                      MI.
20020..............  Dothan, AL...............      22.1225      21.2814
20100..............  Dover, DE................      29.3258      27.6577
20220..............  Dubuque, IA..............      27.0318      25.1096
20260..............  Duluth, MN-WI............      29.7746      28.5452
20500..............  Durham, NC...............      29.0174      28.2855
20740..............  Eau Claire, WI...........      28.5480      26.1872
20764..............  Edison, NJ...............      33.1853      31.3795
20940..............  El Centro, CA............      27.0989      25.2992
21060..............  Elizabethtown, KY........      25.8098      24.4828
21140..............  Elkhart-Goshen, IN.......      27.8902      26.4406
21300..............  Elmira, NY...............      24.3652      23.2597
21340..............  El Paso, TX..............      26.9405      25.4867
21500..............  Erie, PA.................      25.7679      24.3509
21604..............  Essex County, MA.........      30.8807      29.5199
21660..............  Eugene-Springfield, OR...      32.2004      30.4380
21780..............  Evansville, IN-KY........      26.1797      24.1900
21820..............  Fairbanks, AK............      32.7496      31.3425
21940..............  Fajardo, PR..............      11.9805      11.2321
22020..............  Fargo, ND-MN.............      24.4385      24.0588
22140..............  Farmington, NM...........      25.4686      23.5378
22180..............  Fayetteville, NC.........      26.5301      25.8728
22220..............  Fayetteville-Springdale-       25.9870      24.3862
                      Rogers, AR-MO.
22380..............  Flagstaff, AZ............      34.3731      32.2119
22420..............  Flint, MI................      32.4969      30.5849
22500..............  Florence, SC.............      24.9953      24.5176
22520..............  Florence-Muscle Shoals,        23.6570      22.5629
                      AL.
22540..............  Fond du Lac, WI..........      29.8417      27.7181
22660..............  Fort Collins-Loveland, CO      28.2139      27.8290
22744..............  Ft Lauderdale-Pompano          30.0138      28.6681
                      Beach-Deerfield.
22900..............  Fort Smith, AR-OK........      22.9758      22.6470
23020..............  Fort Walton Beach-             25.6192      24.5301
                      Crestview-Destin, FL.
23060..............  Fort Wayne, IN...........      28.1177      27.1394
23104..............  Fort Worth-Arlington, TX.      28.3931      26.7339
23420..............  Fresno, CA...............      32.5994      30.1075
23460..............  Gadsden, AL..............      23.9989      22.5094
23540..............  Gainesville, FL..........      27.5283      26.2765
23580..............  Gainesville, GA..........      26.6096      25.6552
23844..............  Gary, IN.................      27.4642      26.1115
24020..............  Glens Falls, NY..........      24.7436      23.7211
24140..............  Goldsboro, NC............      27.1894      24.9795
24220..............  Grand Forks, ND-MN.......      23.6479      23.2868
24300..............  Grand Junction, CO.......      28.7625      27.2627
24340..............  Grand Rapids-Wyoming, MI.      28.0304      26.4158
24500..............  Great Falls, MT..........      25.4356      24.6351
24540..............  Greeley, CO..............      28.5246      26.7856
24580..............  Green Bay, WI............      28.9831      27.0003
24660..............  Greensboro-High Point, NC      25.9172      25.2493
24780..............  Greenville, NC...........      27.9072      26.1644

[[Page 24231]]

 
24860..............  Greenville, SC...........      28.7379      27.2856
25020..............  Guayama, PR..............      09.5985      09.6952
25060..............  Gulfport-Biloxi, MS......      26.3877      24.9138
25180..............  Hagerstown-Martinsburg,        26.8867      26.4121
                      MD-WV.
25260..............  Hanford-Corcoran, CA.....      30.1059      27.7628
25420..............  Harrisburg-Carlisle, PA..      27.8666      26.2093
25500..............  Harrisonburg, VA.........      26.9175      25.6513
25540..............  Hartford-West Hartford-        32.3195      30.8426
                      East Hartford, C.
25620..............  Hattiesburg, MS..........      22.0583      20.9235
25860..............  Hickory-Lenoir-Morganton,      26.7289      25.6097
                      NC.
25980..............  \1\ Hinesville-Fort        ...........  ...........
                      Stewart, GA.
26100..............  Holland-Grand Haven, MI..      27.3564      25.9294
26180..............  Honolulu, HI.............      32.7585      31.0670
26300..............  Hot Springs, AR..........      26.0849      25.2942
26380..............  Houma-Bayou Cane-              23.6912      22.0451
                      Thibodaux, LA.
26420..............  Houston-Sugar Land-            29.6912      28.0218
                      Baytown, TX.
26580..............  Huntington-Ashland, WV-KY-     26.6703      26.1438
                      OH.
26620..............  Huntsville, AL...........      26.7216      25.2160
26820..............  Idaho Falls, ID..........      26.8982      25.7696
26900..............  Indianapolis-Carmel, IN..      28.8843      27.7580
26980..............  Iowa City, IA............      28.7929      27.2014
27060..............  Ithaca, NY...............      29.2568      27.4840
27100..............  Jackson, MI..............      28.3070      26.0872
27140..............  Jackson, MS..............      24.5054      23.2406
27180..............  Jackson, TN..............      26.2283      24.9470
27260..............  Jacksonville, FL.........      26.7802      26.0119
27340..............  Jacksonville, NC.........      24.3666      23.1693
27500..............  Janesville, WI...........      28.6711      26.9103
27620..............  Jefferson City, MO.......      24.6931      23.4008
27740..............  Johnson City, TN.........      23.8898      22.5898
27780..............  Johnstown, PA............      25.5195      23.6154
27860..............  Jonesboro, AR............      22.6678      22.1975
27900..............  Joplin, MO...............      25.5168      24.1603
28020..............  Kalamazoo-Portage, MI....      31.7833      29.6496
28100..............  Kankakee-Bradley, IL.....      29.6189      29.2729
28140..............  Kansas City, MO-KS.......      28.1260      26.6597
28420..............  Kennewick-Richland-Pasco,      30.6359      29.2912
                      WA.
28660..............  Killeen-Temple-Fort Hood,      27.0302      25.1082
                      TX.
28700..............  Kingsport-Bristol-             23.5950      22.6623
                      Bristol, TN-VA.
28740..............  Kingston, NY.............      27.7882      25.8209
28940..............  Knoxville, TN............      24.5065      23.6085
29020..............  Kokomo, IN...............      28.1040      26.2399
29100..............  La Crosse, WI-MN.........      27.9055      26.3466
29140..............  Lafayette, IN............      26.5151      24.9248
29180..............  Lafayette, LA............      24.5278      23.3229
29340..............  Lake Charles, LA.........      23.4856      22.1071
29404..............  Lake County-Kenosha            30.8117      29.1933
                      County, IL-WI.
29460..............  Lakeland, FL.............      26.3688      25.0264
29540..............  Lancaster, PA............      28.5843      27.3304
29620..............  Lansing-East Lansing, MI.      29.8859      27.5256
29700..............  Laredo, TX...............      23.2381      23.0084
29740..............  Las Cruces, NM...........      27.4404      24.7091
29820..............  Las Vegas-Paradise, NV...      33.7979      31.9159
29940..............  Lawrence, KS.............      24.7063      23.8048
30020..............  Lawton, OK...............      24.0253      22.6783
30140..............  Lebanon, PA..............      26.3047      24.5398
30300..............  Lewiston, ID-WA..........      29.1686      26.9241
30340..............  Lewiston-Auburn, ME......      27.0588      26.1610
30460..............  Lexington-Fayette, KY....      27.1389      25.7178
30620..............  Lima, OH.................      26.7593      25.7193
30700..............  Lincoln, NE..............      29.8510      28.4796
30780..............  Little Rock-North Little       26.3993      24.7894
                      Rock, AR.
30860..............  Logan, UT-ID.............      26.7880      25.5328
30980..............  Longview, TX.............      26.0655      24.6081
31020..............  Longview, WA.............      29.6411      27.7279
31084..............  Los Angeles-Long Beach-        34.8198      32.9747
                      Santa Ana, CA.
31140..............  Louisville-Jefferson           27.0486      25.7096
                      County, KY-IN.
31180..............  Lubbock, TX..............      25.5361      24.4128
31340..............  Lynchburg, VA............      25.8004      24.6790

[[Page 24232]]

 
31420..............  Macon, GA................      28.2812      27.0212
31460..............  Madera, CA...............      24.1895      23.7007
31540..............  Madison, WI..............      31.7670      29.6038
31700..............  Manchester-Nashua, NH....      30.3488      29.1140
31900..............  Mansfield, OH............      27.5254      26.5502
32420..............  Mayaguez, PR.............      11.4161      11.4868
32580..............  McAllen-Edinburg-Mission,      26.0218      24.4402
                      TX.
32780..............  Medford, OR..............      32.0766      29.5178
32820..............  Memphis, TN-MS-AR........      27.7288      26.1237
32900..............  Merced, CA...............      33.8080      30.8250
33124..............  Miami-Miami Beach-             29.0857      27.5003
                      Kendall, FL.
33140..............  Michigan City-La Porte,        26.9182      25.9742
                      IN.
33260..............  Midland, TX..............      29.0179      26.8535
33340..............  Milwaukee-Waukesha-West        30.3159      28.4862
                      Allis, WI.
33460..............  Minneapolis-St. Paul-          32.3959      30.8366
                      Bloomington, MN-WI.
33540..............  Missoula, MT.............      26.3724      26.0288
33660..............  Mobile, AL...............      23.5488      22.1987
33700..............  Modesto, CA..............      34.3892      33.1922
33740..............  Monroe, LA...............      23.7257      22.3272
33780..............  Monroe, MI...............      28.7593      26.7894
33860..............  Montgomery, AL...........      23.7850      23.2495
34060..............  Morgantown, WV...........      25.0126      23.9182
34100..............  Morristown, TN...........      23.5331      22.1874
34580..............  Mount Vernon-Anacortes,        31.1247      29.4347
                      WA.
34620..............  Muncie, IN...............      24.6068      24.0532
34740..............  Muskegon-Norton Shores,        29.4886      27.5164
                      MI.
34820..............  Myrtle Beach-Conway-North      26.1078      24.9580
                      Myrtle Beach,.
34900..............  Napa, CA.................      39.9176      36.1438
34940..............  Naples-Marco Island, FL..      29.4100      28.5222
34980..............  Nashville-Davidson--           29.1670      27.6979
                      Murfreesboro, TN.
35004..............  Nassau-Suffolk, NY.......      37.5989      35.8100
35084..............  Newark-Union, NJ-PA......      35.1861      33.0916
35300..............  New Haven-Milford, CT....      35.5112      33.3802
35380..............  New Orleans-Metairie-          26.2137      25.1311
                      Kenner, LA.
35644..............  New York-White Plains-         39.1188      37.0666
                      Wayne, NY-NJ.
35660..............  Niles-Benton Harbor, MI..      26.4279      24.9042
35980..............  Norwich-New London, CT...      35.4758      32.7007
36084..............  Oakland-Fremont-Hayward,       45.5784      42.9783
                      CA.
36100..............  Ocala, FL................      26.3570      25.2302
36140..............  Ocean City, NJ...........      31.0823      30.1687
36220..............  Odessa, TX...............      29.9544      27.9474
36260..............  Ogden-Clearfield, UT.....      26.6673      25.4290
36420..............  Oklahoma City, OK........      26.2178      25.1040
36500..............  Olympia, WA..............      32.8460      30.8309
36540..............  Omaha-Council Bluffs, NE-      27.9830      26.8115
                      IA.
36740..............  Orlando-Kissimmee, FL....      27.8531      26.6896
36780..............  Oshkosh-Neenah, WI.......      27.5278      25.6702
36980..............  Owensboro, KY............      25.9911      24.2496
37100..............  Oxnard-Thousand Oaks-          34.2883      32.1061
                      Ventura, CA.
37340..............  Palm Bay-Melbourne-            27.9443      27.0172
                      Titusville, FL.
37460..............  Panama City-Lynn Haven,        23.9351      22.6108
                      FL.
37620..............  Parkersburg-Marietta-          23.5762      22.9231
                      Vienna, WV-OH.
37700..............  Pascagoula, MS...........      24.3614      22.7858
37860..............  Pensacola-Ferry Pass-          23.6805      22.7437
                      Brent, FL.
37900..............  Peoria, IL...............      26.5635      24.9170
37964..............  Philadelphia, PA.........      32.5912      30.7325
38060..............  Phoenix-Mesa-Scottsdale,       30.5119      28.4597
                      AZ.
38220..............  Pine Bluff, AR...........      24.9343      24.0918
38300..............  Pittsburgh, PA...........      25.6688      24.4659
38340..............  Pittsfield, MA...........      30.4192      28.8465
38540..............  Pocatello, ID............      27.8274      26.4330
38660..............  Ponce, PR................      14.3623      13.8007
38860..............  Portland-South Portland-       29.3543      28.3363
                      Biddeford, ME.
38900..............  Portland-Vancouver-            33.7621      31.7618
                      Beaverton, OR-WA.
38940..............  Port St. Lucie-Fort            29.1805      28.0566
                      Pierce, FL.
39100..............  Poughkeepsie-Newburgh-         32.3052      30.9565
                      Middletown, NY.
39140..............  Prescott, AZ.............      29.1830      27.7138
39300..............  Providence-New Bedford-        31.9448      30.5097
                      Fall River, RI-M.
39340..............  Provo-Orem, UT...........      28.2332      26.6782

[[Page 24233]]

 
39380..............  Pueblo, CO...............      25.3116      24.2019
39460..............  Punta Gorda, FL..........      27.9209      26.2796
39540..............  Racine, WI...............      27.2461      25.4815
39580..............  Raleigh-Cary, NC.........      29.1738      27.5962
39660..............  Rapid City, SD...........      30.6665      26.5155
39740..............  Reading, PA..............      28.5418      26.7025
39820..............  Redding, CA..............      39.0919      34.6214
39900..............  Reno-Sparks, NV..........      35.4486      31.1844
40060..............  Richmond, VA.............      27.1570      25.9892
40140..............  Riverside-San Bernardino-      32.3625      30.7856
                      Ontario, CA.
40220..............  Roanoke, VA..............      25.6872      23.8222
40340..............  Rochester, MN............      33.2903      31.5856
40380..............  Rochester, NY............      26.6628      25.5814
40420..............  Rockford, IL.............      29.5658      27.6241
40484..............  Rockingham County, NH....      30.0790      28.7345
40580..............  Rocky Mount, NC..........      26.2562      25.0051
40660..............  Rome, GA.................      27.5523      25.7704
40900..............  Sacramento--Arden-Arcade--     39.5208      35.6723
                      Roseville, CA.
40980..............  Saginaw-Saginaw Township       26.4685      26.0187
                      North, MI.
41060..............  St. Cloud, MN............      30.9000      28.6361
41100..............  St. George, UT...........      27.5173      26.3816
41140..............  St. Joseph, MO-KS........      30.1186      27.9482
41180..............  St. Louis, MO-IL.........      26.6920      25.2435
41420..............  Salem, OR................      30.9397      29.3934
41500..............  Salinas, CA..............      42.7963      39.6031
41540..............  Salisbury, MD............      26.5170      25.2945
41620..............  Salt Lake City, UT.......      27.8903      26.5336
41660..............  San Angelo, TX...........      24.8207      23.1919
41700..............  San Antonio, TX..........      26.2255      25.0650
41740..............  San Diego-Carlsbad-San         33.6627      31.8471
                      Marcos, CA.
41780..............  Sandusky, OH.............      27.6127      25.5029
41884..............  San Francisco-San Mateo-       44.5507      41.8255
                      Redwood City, CA.
41900..............  San German-Cabo Rojo, PR.      14.4590      13.7105
41940..............  San Jose-Sunnyvale-Santa       45.2357      42.1510
                      Clara, CA.
41980..............  San Juan-Caguas-Guaynabo,      13.0139      12.7401
                      PR.
42020..............  San Luis Obispo-Paso           34.3866      31.7461
                      Robles, CA.
42044..............  Santa Ana-Anaheim-Irvine,      33.3993      32.1497
                      CA.
42060..............  Santa Barbara-Santa            32.7438      31.2878
                      Maria, CA.
42100..............  Santa Cruz-Watsonville,        45.9115      42.4999
                      CA.
42140..............  Santa Fe, NM.............      32.0322      30.4616
42220..............  Santa Rosa-Petaluma, CA..      42.8035      38.1447
42260..............  Sarasota-Bradenton-            29.2047      27.1715
                      Venice, FL.
42340..............  Savannah, GA.............      26.9048      26.1364
42540..............  Scranton--Wilkes-Barre,        25.1702      23.8157
                      PA.
42644..............  Seattle-Bellevue-Everett,      33.8592      32.2085
                      WA.
42680..............  Sebastian-Vero Beach,FL..      28.4305      26.6512
43100..............  Sheboygan, WI............      26.8090      25.1793
43300..............  Sherman-Denison, TX......      25.2237      25.7451
43340..............  Shreveport-Bossier City,       26.2834      24.9546
                      LA.
43580..............  Sioux City, IA-NE-SD.....      27.2365      25.7643
43620..............  Sioux Falls, SD..........      28.2963      26.7140
43780..............  South Bend-Mishawaka, IN-      28.6471      26.9212
                      MI.
43900..............  Spartanburg, SC..........      27.2103      26.0456
44060..............  Spokane, WA..............      30.9283      29.8346
44100..............  Springfield, IL..........      26.3463      24.5714
44140..............  Springfield, MA..........      29.8434      28.5001
44180..............  Springfield, MO..........      25.1318      23.6337
44220..............  Springfield, OH..........      25.0325      23.8848
44300..............  State College, PA........      26.0621      23.8363
44700..............  Stockton, CA.............      33.9933      31.2290
44940..............  Sumter, SC...............      23.9471      23.3117
45060..............  Syracuse, NY.............      28.7825      26.8883
45104..............  Tacoma, WA...............      31.9839      30.4570
45220..............  Tallahassee, FL..........      27.5786      24.8630
45300..............  Tampa-St. Petersburg-          27.2651      25.7804
                      Clearwater, FL.
45460..............  Terre Haute, IN..........      25.6447      23.6038
45500..............  Texarkana, TX-Texarkana,       24.0388      23.1664
                      AR.
45780..............  Toledo, OH...............      28.3827      26.7423
45820..............  Topeka, KS...............      25.8676      24.7876

[[Page 24234]]

 
45940..............  Trenton-Ewing, NJ........      32.1787      29.9319
46060..............  Tucson, AZ...............      27.3501      25.4760
46140..............  Tulsa, OK................      24.0631      23.6948
46220..............  Tuscaloosa, AL...........      25.5886      23.9087
46340..............  Tyler, TX................      26.1668      25.6693
46540..............  U a-Rome, NY.............      24.9320      23.4183
46660..............  Valdosta, GA.............      24.6888      23.8783
46700..............  Vallejo-Fairfield, CA....      44.8596      41.7866
47020..............  Victoria, TX.............      25.3226      23.4143
47220..............  Vineland-Millville-            29.1612      28.2024
                      Bridgeton, NJ.
47260..............  Virginia Beach-Norfolk-        26.1678      24.8408
                      Newport News, VA.
47300..............  Visalia-Porterville, CA..      29.6516      28.2016
47380..............  Waco, TX.................      25.6153      23.6453
47580..............  Warner Robins, GA........      24.8717      23.8719
47644..............  Warren-Troy-Farmington-        29.9684      28.0982
                      Hills, MI.
47894..............  Washington-Arlington-          32.7894      30.8030
                      Alexandria DC-VA.
47940..............  Waterloo-Cedar Falls, IA.      24.9273      23.9407
48140..............  Wausau, WI...............      29.0074      27.1779
48260..............  Weirton-Steubenville, WV-      23.8952      22.5028
                      OH.
48300..............  Wenatchee, WA............      30.6283      27.7041
48424..............  West Palm Beach-Boca           28.5424      27.9681
                      Raton-Boynton FL.
48540..............  Wheeling, WV-OH..........      20.7847      20.1450
48620..............  Wichita, KS..............      26.9190      25.8412
48660..............  Wichita Falls, TX........      24.7483      23.3505
48700..............  Williamsport, PA.........      24.0257      23.2070
48864..............  Wilmington, DE-MD-NJ.....      31.8188      30.2275
48900..............  Wilmington, NC...........      29.1306      26.7990
49020..............  Winchester, VA-WV........      29.8963      28.7056
49180..............  Winston-Salem, NC........      27.5311      25.8316
49340..............  Worcester, MA............      31.8136      30.5516
49420..............  Yakima, WA...............      29.1929      28.2566
49500..............  Yauco, PR................      11.4297      11.8994
49620..............  York-Hanover, PA.........      27.8747      26.0746
49660..............  Youngstown-Warren-             26.0937      24.8356
                      Boardman, OH-PA.
49700..............  Yuba City, CA............      31.8777      29.9596
49740..............  Yuma, AZ.................      27.1721     25.5234
------------------------------------------------------------------------
\1\ This area has no average hourly wage because there are no short-
  term, acute care hospitals in the area.


  Table 3B.--FY 2007 and 3-Year Average Hourly Wage for Urban Areas by
                                  CBSA
[*Based on the sum of the salaries and hours computed for Federal Fiscal
                       Years 2005, 2006, and 2007]
------------------------------------------------------------------------
                                                  FY 2007       3-year
     CBSA code               Urban area           average      average
                                                hourly wage  hourly wage
------------------------------------------------------------------------
01.................  Alabama..................      22.7063      21.2325
02.................  Alaska...................      31.5838      32.0136
03.................  Arizona..................      26.4457      24.8708
04.................  Arkansas.................      21.7888      20.7414
05.................  California...............      33.4249      30.5217
06.................  Colorado.................      27.6222      26.1254
07.................  Connecticut..............      34.7826      33.0280
08.................  Delaware.................      28.7837      26.9334
10.................  Florida..................      25.4848      24.0976
11.................  Georgia..................      22.4296      21.4509
12.................  Hawaii...................      31.0888      29.5623
13.................  Idaho....................      24.1337      22.6410
14.................  Illinois.................      24.6699      23.2118
15.................  Indiana..................      25.0993      23.9775
16.................  Iowa.....................      25.7422      23.7781
17.................  Kansas...................      23.6947      22.4420
18.................  Kentucky.................      23.0690      21.7676
19.................  Louisiana................      22.1373      20.7518
20.................  Maine....................      24.8632      24.4350
21.................  Maryland.................      26.4816      25.6822
22.................  Massachusetts \1\........  ...........  ...........
23.................  Michigan.................      26.8050      24.9080
24.................  Minnesota................      27.1347      25.6682

[[Page 24235]]

 
25.................  Mississippi..............      22.4345      21.3758
26.................  Missouri.................      23.5321      22.0469
27.................  Montana..................      25.4332      24.2378
28.................  Nebraska.................      25.7283      24.5703
29.................  Nevada...................      26.5440      25.4110
30.................  New Hampshire............      31.9560      29.2334
31.................  New Jersey \1\...........  ...........  ...........
32.................  New Mexico...............      24.7274      23.9765
33.................  New York.................      24.4634      22.9464
34.................  North Carolina...........      25.4805      24.0022
35.................  North Dakota.............      21.4222      20.7057
36.................  Ohio.....................      25.6736      24.4091
37.................  Oklahoma.................      22.6848      21.4287
38.................  Oregon...................      28.8984      27.3817
39.................  Pennsylvania.............      24.6593      23.2635
40.................  Puerto Rico \1\..........  ...........  ...........
41.................  Rhode Island \1\.........  ...........  ...........
42.................  South Carolina...........      25.4710      24.2433
43.................  South Dakota.............      25.1178      23.6533
44.................  Tennessee................      23.2955      22.0862
45.................  Texas....................      23.6920      22.3956
46.................  Utah.....................      24.1638      22.8805
47.................  Vermont..................      29.3826      26.8610
49.................  Virginia.................      23.5825      22.4069
50.................  Washington...............      30.4489      28.8509
51.................  West Virginia............      22.6063      21.6759
52.................  Wisconsin................      28.0229      26.4234
53.................  Wyoming..................      27.5393     25.7950
------------------------------------------------------------------------
\1\ All counties in the State or Territory are classified as urban, with
  the exception of Massachusetts. Massachusetts has area(s) designated
  as rural. However, no short-term, acute care hospitals were located in
  Rural Massachusetts during FY 2003, the base year for the FY 2007 wage
  index.


 TABLE 4A-1.--Wage Index and Capital Geographic Adjustment Factor (GAF)
                    for Urban Areas By CBSA--FY 2007
------------------------------------------------------------------------
                         Urban area (constituent       Wage
      CBSA  code                counties)             index       GAF
------------------------------------------------------------------------
10180................  Abilene, TX................     0.8051     0.8620
                        Callahan County, TX.......
                        Jones County, TX..........
                        Taylor County, TX.........
10380................  Aguadilla-Isabela-San           0.3917     0.5263
                        Sebasti[aacute]n, PR.
                        Aguada Municipio, PR......
                        Aguadilla Municipio, PR...
                        A[ntilde]asco Municipio,
                        PR.
                        Isabela Municipio, PR.....
                        Lares Municipio, PR.......
                        Moca Municipio, PR........
                        Rinc[oacute]n Municipio,
                        PR.
                        San Sebasti[aacute]n
                        Municipio, PR.
10420................  Akron, OH..................     0.8737     0.9117
                        Portage County, OH........
                        Summit County, OH.........
10500................  Albany, GA.................     0.8969     0.9282
                        Baker County, GA..........
                        Dougherty County, GA......
                        Lee County, GA............
                        Terrell County, GA........
                        Worth County, GA..........
10580................  Albany-Schenectady-Troy, NY     0.8753     0.9128
                        Albany County, NY.........
                        Rensselaer County, NY.....
                        Saratoga County, NY.......
                        Schenectady County, NY....
                        Schoharie County, NY......
10740................  Albuquerque, NM............     0.9477     0.9639
                        Bernalillo County, NM.....

[[Page 24236]]

 
                        Sandoval County, NM.......
                        Torrance County, NM.......
                        Valencia County, NM.......
10780................  Alexandria, LA.............     0.8028     0.8603
                        Grant Parish, LA..........
                        Rapides Parish, LA........
10900................  Allentown-Bethlehem-Easton,     0.9927     0.9950
                        PA-NJ (PA Hospitals).
                        Warren County, NJ.........
                        Carbon County, PA.........
                        Lehigh County, PA.........
                        Northampton County, PA....
10900................  \2\ Allentown-Bethlehem-        1.1226     1.0824
                        Easton, PA-NJ (NJ
                        Hospitals).
                        Warren County, NJ.........
                        Carbon County, PA.........
                        Lehigh County, PA.........
                        Northampton County, PA....
11020................  Altoona, PA................     0.8717     0.9103
                        Blair County, PA..........
11100................  Amarillo, TX...............     0.9177     0.9429
                        Armstrong County, TX......
                        Carson County, TX.........
                        Potter County, TX.........
                        Randall County, TX........
11180................  Ames, IA...................     0.9779     0.9848
                        Story County, IA..........
11260................  Anchorage, AK..............     1.2062     1.1370
                        Anchorage Municipality, AK
                        Matanuska-Susitna Borough,
                        AK.
11300................  Anderson, IN...............     0.8831     0.9184
                        Madison County, IN........
11340................  Anderson, SC...............     0.8949     0.9268
                        Anderson County, SC.......
11460................  \3\ Ann Arbor, MI..........     1.0853     1.0577
                        Washtenaw County, MI......
11500................  Anniston-Oxford, AL........     0.7978     0.8567
                        Calhoun County, AL........
11540................  \2\ Appleton, WI...........     0.9466     0.9631
                        Calumet County, WI........
                        Outagamie County, WI......
11700................  Asheville, NC..............     0.9110     0.9382
                        Buncombe County, NC.......
                        Haywood County, NC........
                        Henderson County, NC......
                        Madison County, NC........
12020................  Athens-Clarke County, GA...     0.9827     0.9881
                        Clarke County, GA.........
                        Madison County, GA........
                        Oconee County, GA.........
                        Oglethorpe County, GA.....
12060................  \1\ Atlanta-Sandy Springs-      0.9761     0.9836
                        Marietta, GA.
                        Barrow County, GA.........
                        Bartow County, GA.........
                        Butts County, GA..........
                        Carroll County, GA........
                        Cherokee County, GA.......
                        Clayton County, GA........
                        Cobb County, GA...........
                        Coweta County, GA.........
                        Dawson County, GA.........
                        DeKalb County, GA.........
                        Douglas County, GA........
                        Fayette County, GA........
                        Forsyth County, GA........
                        Fulton County, GA.........
                        Gwinnett County, GA.......
                        Haralson County, GA.......
                        Heard County, GA..........
                        Henry County, GA..........
                        Jasper County, GA.........
                        Lamar County, GA..........

[[Page 24237]]

 
                        Meriwether County, GA.....
                        Newton County, GA.........
                        Paulding County, GA.......
                        Pickens County, GA........
                        Pike County, GA...........
                        Rockdale County, GA.......
                        Spalding County, GA.......
                        Walton County, GA.........
12100................  Atlantic City, NJ..........     1.1736     1.1159
                        Atlantic County, NJ.......
12220................  Auburn-Opelika, AL.........     0.8116     0.8668
                        Lee County, AL............
12260................  Augusta-Richmond County, GA-    0.9681     0.9780
                        SC.
                        Burke County, GA..........
                        Columbia County, GA.......
                        McDuffie County, GA.......
                        Richmond County, GA.......
                        Aiken County, SC..........
                        Edgefield County, SC......
12420................  \1\ Austin-Round Rock, TX..     0.9360     0.9557
                        Bastrop County, TX........
                        Caldwell County, TX.......
                        Hays County, TX...........
                        Travis County, TX.........
                        Williamson County, TX.....
12540................  \2\ Bakersfield, CA........     1.1291     1.0867
                        Kern County, CA...........
12580................  \1\ Baltimore-Towson, MD...     1.0090     1.0062
                        Anne Arundel County, MD...
                        Baltimore County, MD......
                        Carroll County, MD........
                        Harford County, MD........
                        Howard County, MD.........
                        Queen Anne's County, MD...
                        Baltimore City, MD........
12620................  Bangor, ME.................     0.9702     0.9795
                        Penobscot County, ME......
12700................  Barnstable Town, MA........     1.2553     1.1685
                        Barnstable County, MA.....
12940................  Baton Rouge, LA............     0.8102     0.8658
                        Ascension Parish, LA......
                        East Baton Rouge Parish,
                        LA.
                        East Feliciana Parish, LA.
                        Iberville Parish, LA......
                        Livingston Parish, LA.....
                        Pointe Coupee Parish, LA..
                        St. Helena Parish, LA.....
                        West Baton Rouge Parish,
                        LA.
                        West Feliciana Parish, LA.
12980................  Battle Creek, MI...........     0.9726     0.9812
                        Calhoun County, MI........
13020................  Bay City, MI...............     1.0040     1.0027
                        Bay County, MI............
13140................  Beaumont-Port Arthur, TX...     0.8612     0.9027
                        Hardin County, TX.........
                        Jefferson County, TX......
                        Orange County, TX.........
13380................  Bellingham, WA.............     1.1088     1.0733
                        Whatcom County, WA........
13460................  Bend, OR...................     1.0749     1.0507
                        Deschutes County, OR......
13644................  \1\ Bethesda-Gaithersburg-      1.1028     1.0693
                        Frederick, MD.
                        Frederick County, MD......
                        Montgomery County, MD.....
13740................  Billings, MT...............     0.8740     0.9119
                        Carbon County, MT.........
                        Yellowstone County, MT....
13780................  Binghamton, NY.............     0.8816     0.9173
                        Broome County, NY.........
                        Tioga County, NY..........

[[Page 24238]]

 
13820................  \1\ Birmingham-Hoover, AL..     0.8919     0.9246
                        Bibb County, AL...........
                        Blount County, AL.........
                        Chilton County, AL........
                        Jefferson County, AL......
                        St. Clair County, AL......
                        Shelby County, AL.........
                        Walker County, AL.........
13900................  Bismarck, ND...............     0.7255     0.8027
                        Burleigh County, ND.......
                        Morton County, ND.........
13980................  Blacksburg-Christiansburg-      0.8242     0.8760
                        Radford, VA.
                        Giles County, VA..........
                        Montgomery County, VA.....
                        Pulaski County, VA........
                        Radford City, VA..........
14020................  Bloomington, IN............     0.8566     0.8994
                        Greene County, IN.........
                        Monroe County, IN.........
                        Owen County, IN...........
14060................  Bloomington-Normal, IL.....     0.8959     0.9275
                        McLean County, IL.........
14260................  Boise City-Nampa, ID.......     0.9404     0.9588
                        Ada County, ID............
                        Boise County, ID..........
                        Canyon County, ID.........
                        Gem County, ID............
                        Owyhee County, ID.........
14484................  \1\ Boston-Quincy, MA......     1.1687     1.1127
                        Norfolk County, MA........
                        Plymouth County, MA.......
                        Suffolk County, MA........
14500................  Boulder, CO................     1.0368     1.0251
                        Boulder County, CO........
14540................  Bowling Green, KY..........     0.8164     0.8703
                        Edmonson County, KY.......
                        Warren County, KY.........
14740................  Bremerton-Silverdale, WA...     1.0927     1.0626
                        Kitsap County, WA.........
14860................  Bridgeport-Stamford-            1.2691     1.1773
                        Norwalk, CT.
                        Fairfield County, CT......
15180................  Brownsville-Harlingen, TX..     0.9474     0.9637
                        Cameron County, TX........
15260................  Brunswick, GA..............     1.0119     1.0081
                        Brantley County, GA.......
                        Glynn County, GA..........
                        McIntosh County, GA.......
15380................  \1\ Buffalo-Niagara Falls,      0.9475     0.9637
                        NY.
                        Erie County, NY...........
                        Niagara County, NY........
15500................  Burlington, NC.............     0.8677     0.9074
                        Alamance County, NC.......
15540................  \2\ Burlington-South            1.0986     1.0665
                        Burlington, VT.
                        Chittenden County, VT.....
                        Franklin County, VT.......
                        Grand Isle County, VT.....
15764................  \1\ Cambridge-Newton-           1.0912     1.0616
                        Framingham, MA.
                        Middlesex County, MA......
15804................  \1\ Camden, NJ.............     1.1226     1.0824
                        Burlington County, NJ.....
                        Camden County, NJ.........
                        Gloucester County, NJ.....
15940................  Canton-Massillon, OH.......     0.9060     0.9346
                        Carroll County, OH........
                        Stark County, OH..........
15980................  Cape Coral-Fort Myers, FL..     0.9339     0.9542
                        Lee County, FL............
16180................  Carson City, NV............     1.0028     1.0019
                        Carson City, NV...........
16220................  \2\ Casper, WY.............     0.9303     0.9517

[[Page 24239]]

 
                        Natrona County, WY........
16300................  Cedar Rapids, IA...........     0.8891     0.9227
                        Benton County, IA.........
                        Jones County, IA..........
                        Linn County, IA...........
16580................  Champaign-Urbana, IL.......     0.9649     0.9758
                        Champaign County, IL......
                        Ford County, IL...........
                        Piatt County, IL..........
16620................  Charleston, WV.............     0.8559     0.8989
                        Boone County, WV..........
                        Clay County, WV...........
                        Kanawha County, WV........
                        Lincoln County, WV........
                        Putnam County, WV.........
16700................  Charleston-North                0.9168     0.9422
                        Charleston, SC.
                        Berkeley County, SC.......
                        Charleston County, SC.....
                        Dorchester County, SC.....
16740................  \1\ Charlotte-Gastonia-         0.9520     0.9669
                        Concord, NC-SC.
                        Anson County, NC..........
                        Cabarrus County, NC.......
                        Gaston County, NC.........
                        Mecklenburg County, NC....
                        Stanly County, NC.........
                        Union County, NC..........
                        York County, SC...........
16820................  Charlottesville, VA........     1.0140     1.0096
                        Albemarle County, VA......
                        Fluvanna County, VA.......
                        Greene County, VA.........
                        Nelson County, VA.........
                        Charlottesville City, VA..
16860................  Chattanooga, TN-GA.........     0.8965     0.9279
                        Catoosa County, GA........
                        Dade County, GA...........
                        Walker County, GA.........
                        Hamilton County, TN.......
                        Marion County, TN.........
                        Sequatchie County, TN.....
16940................  \2\ Cheyenne, WY...........     0.9303     0.9517
                        Laramie County, WY........
16974................  \1\ Chicago-Naperville-         1.0742     1.0502
                        Joliet, IL.
                        Cook County, IL...........
                        DeKalb County, IL.........
                        DuPage County, IL.........
                        Grundy County, IL.........
                        Kane County, IL...........
                        Kendall County, IL........
                        McHenry County, IL........
                        Will County, IL...........
17020................  \2\ Chico, CA..............     1.1291     1.0867
                        Butte County, CA..........
17140................  \1\ Cincinnati-Middletown,      0.9599     0.9724
                        OH-KY-IN.
                        Dearborn County, IN.......
                        Franklin County, IN.......
                        Ohio County, IN...........
                        Boone County, KY..........
                        Bracken County, KY........
                        Campbell County, KY.......
                        Gallatin County, KY.......
                        Grant County, KY..........
                        Kenton County, KY.........
                        Pendleton County, KY......
                        Brown County, OH..........
                        Butler County, OH.........
                        Clermont County, OH.......
                        Hamilton County, OH.......
                        Warren County, OH.........
17300................  Clarksville, TN-KY.........     0.8431     0.8897

[[Page 24240]]

 
                        Christian County, KY......
                        Trigg County, KY..........
                        Montgomery County, TN.....
                        Stewart County, TN........
17420................  Cleveland, TN..............     0.8132     0.8680
                        Bradley County, TN........
                        Polk County, TN...........
17460................  \1\ Cleveland-Elyria-           0.9378     0.9570
                        Mentor, OH.
                        Cuyahoga County, OH.......
                        Geauga County, OH.........
                        Lake County, OH...........
                        Lorain County, OH.........
                        Medina County, OH.........
17660................  Coeur d'Alene, ID..........     0.9347     0.9548
                        Kootenai County, ID.......
17780................  College Station-Bryan, TX..     0.9064     0.9349
                        Brazos County, TX.........
                        Burleson County, TX.......
                        Robertson County, TX......
17820................  Colorado Springs, CO.......     0.9697     0.9792
                        El Paso County, CO........
                        Teller County, CO.........
17860................  Columbia, MO...............     0.8550     0.8983
                        Boone County, MO..........
                        Howard County, MO.........
17900................  \2\ Columbia, SC...........     0.8604     0.9022
                        Calhoun County, SC........
                        Fairfield County, SC......
                        Kershaw County, SC........
                        Lexington County, SC......
                        Richland County, SC.......
                        Saluda County, SC.........
17980................  Columbus, GA-AL............     0.8256     0.8770
                        Russell County, AL........
                        Chattahoochee County, GA..
                        Harris County, GA.........
                        Marion County, GA.........
                        Muscogee County, GA.......
18020................  Columbus, IN...............     0.9333     0.9538
                        Bartholomew County, IN....
18140................  \1\ Columbus, OH...........     1.0119     1.0081
                        Delaware County, OH.......
                        Fairfield County, OH......
                        Franklin County, OH.......
                        Licking County, OH........
                        Madison County, OH........
                        Morrow County, OH.........
                        Pickaway County, OH.......
                        Union County, OH..........
18580................  Corpus Christi, TX.........     0.8578     0.9003
                        Aransas County, TX........
                        Nueces County, TX.........
                        San Patricio County, TX...
18700................  Corvallis, OR..............     1.1536     1.1028
                        Benton County, OR.........
19060................  \2\ Cumberland, MD-WV (MD       0.8946     0.9266
                        Hospitals).
                        Allegany County, MD.......
                        Mineral County, WV........
19060................  Cumberland, MD-WV (WV           0.8844     0.9193
                        Hospitals).
                        Allegany County, MD.......
                        Mineral County, WV........
19124................  \1\ Dallas-Plano-Irving, TX     1.0087     1.0059
                        Collin County, TX.........
                        Dallas County, TX.........
                        Delta County, TX..........
                        Denton County, TX.........
                        Ellis County, TX..........
                        Hunt County, TX...........
                        Kaufman County, TX........
                        Rockwall County, TX.......

[[Page 24241]]

 
19140................  Dalton, GA.................     0.9050     0.9339
                        Murray County, GA.........
                        Whitfield County, GA......
19180................  Danville, IL...............     0.9295     0.9512
                        Vermilion County, IL......
19260................  Danville, VA...............     0.8483     0.8935
                        Pittsylvania County, VA...
                        Danville City, VA.........
19340................  \2\ Davenport-Moline-Rock       0.8696     0.9088
                        Island, IA-IL (IA
                        Hospitals).
                        Henry County, IL..........
                        Mercer County, IL.........
                        Rock Island County, IL....
                        Scott County, IA..........
19340................  Davenport-Moline-Rock           0.8569     0.8996
                        Island, IA-IL (IL
                        Hospitals).
                        Henry County, IL..........
                        Mercer County, IL.........
                        Rock Island County, IL....
                        Scott County, IA..........
19380................  Dayton, OH.................     0.9049     0.9339
                        Greene County, OH.........
                        Miami County, OH..........
                        Montgomery County, OH.....
                        Preble County, OH.........
19460................  Decatur, AL................     0.8220     0.8744
                        Lawrence County, AL.......
                        Morgan County, AL.........
19500................  \2\ Decatur, IL............     0.8334     0.8827
                        Macon County, IL..........
19660................  Deltona-Daytona Beach-          0.9279     0.9500
                        Ormond Beach, FL.
                        Volusia County, FL........
19740................  \1\ Denver-Aurora, CO......     1.0924     1.0624
                        Adams County, CO..........
                        Arapahoe County, CO.......
                        Broomfield County, CO.....
                        Clear Creek County, CO....
                        Denver County, CO.........
                        Douglas County, CO........
                        Elbert County, CO.........
                        Gilpin County, CO.........
                        Jefferson County, CO......
                        Park County, CO...........
19780................  Des Moines-West Des Moines,     0.9136     0.9400
                        IA.
                        Dallas County, IA.........
                        Guthrie County, IA........
                        Madison County, IA........
                        Polk County, IA...........
                        Warren County, IA.........
19804................  \1\ Detroit-Livonia-            1.0235     1.0160
                        Dearborn, MI.
                        Wayne County, MI..........
20020................  \2\ Dothan, AL.............     0.7670     0.8339
                        Geneva County, AL.........
                        Henry County, AL..........
                        Houston County, AL........
20100................  Dover, DE..................     0.9906     0.9936
                        Kent County, DE...........
20220................  Dubuque, IA................     0.9132     0.9397
                        Dubuque County, IA........
20260................  Duluth, MN-WI..............     1.0157     1.0107
                        Carlton County, MN........
                        St. Louis County, MN......
                        Douglas County, WI........
20500................  Durham, NC.................     0.9805     0.9866
                        Chatham County, NC........
                        Durham County, NC.........
                        Orange County, NC.........
                        Person County, NC.........
20740................  Eau Claire, WI.............     0.9644     0.9755
                        Chippewa County, WI.......
                        Eau Claire County, WI.....
20764................  \1\ Edison, NJ.............     1.1242     1.0835

[[Page 24242]]

 
                        Middlesex County, NJ......
                        Monmouth County, NJ.......
                        Ocean County, NJ..........
                        Somerset County, NJ.......
20940................  \2\ El Centro, CA..........     1.1291     1.0867
                        Imperial County, CA.......
21060................  Elizabethtown, KY..........     0.8719     0.9104
                        Hardin County, KY.........
                        Larue County, KY..........
21140................  Elkhart-Goshen, IN.........     0.9421     0.9600
                        Elkhart County, IN........
21300................  \2\ Elmira, NY.............     0.8267     0.8778
                        Chemung County, NY........
21340................  El Paso, TX................     0.9101     0.9375
                        El Paso County, TX........
21500................  Erie, PA...................     0.8705     0.9094
                        Erie County, PA...........
21604................  \2\ Essex County, MA.......     1.0664     1.0450
                        Essex County, MA..........
21660................  Eugene-Springfield, OR.....     1.0877     1.0593
                        Lane County, OR...........
21780................  Evansville, IN-KY..........     0.8844     0.9193
                        Gibson County, IN.........
                        Posey County, IN..........
                        Vanderburgh County, IN....
                        Warrick County, IN........
                        Henderson County, KY......
                        Webster County, KY........
21820................  Fairbanks, AK..............     1.1063     1.0716
                        Fairbanks North Star
                        Borough, AK.
21940................  Fajardo, PR................     0.4047     0.5382
                        Ceiba Municipio, PR.......
                        Fajardo Municipio, PR.....
                        Luquillo Municipio, PR....
22020................  Fargo, ND-MN (ND Hospitals)     0.8485     0.8936
                        Clay County, MN...........
                        Cass County, ND...........
22020................  \2\ Fargo, ND-MN (MN            0.9256     0.9484
                        Hospitals).
                        Clay County, MN...........
                        Cass County, ND...........
22140................  Farmington, NM.............     0.8603     0.9021
                        San Juan County, NM.......
22180................  Fayetteville, NC...........     0.8962     0.9277
                        Cumberland County, NC.....
                        Hoke County, NC...........
22220................  Fayetteville-Springdale-        0.8779     0.9147
                        Rogers, AR-MO.
                        Benton County, AR.........
                        Madison County, AR........
                        Washington County, AR.....
                        McDonald County, MO.......
22380................  Flagstaff, AZ..............     1.1611     1.1077
                        Coconino County, AZ.......
22420................  Flint, MI..................     1.0978     1.0660
                        Genesee County, MI........
22500................  \2\ Florence, SC...........     0.8604     0.9022
                        Darlington County, SC.....
                        Florence County, SC.......
22520................  Florence-Muscle Shoals, AL.     0.8008     0.8589
                        Colbert County, AL........
                        Lauderdale County, AL.....
22540................  Fond du Lac, WI............     1.0081     1.0055
                        Fond du Lac County, WI....
22660................  Fort Collins-Loveland, CO..     0.9594     0.9720
                        Larimer County, CO........
22744................  \1\ Fort Lauderdale-Pompano     1.0470     1.0320
                        Beach-Deerfield Beach, FL.
                        Broward County, FL........
22900................  Fort Smith, AR-OK..........     0.7761     0.8407
                        Crawford County, AR.......
                        Franklin County, AR.......
                        Sebastian County, AR......

[[Page 24243]]

 
                        Le Flore County, OK.......
                        Sequoyah County, OK.......
23020................  Fort Walton Beach-Crestview-    0.8654     0.9057
                        Destin, FL.
                        Okaloosa County, FL.......
23060................  Fort Wayne, IN.............     0.9498     0.9653
                        Allen County, IN..........
                        Wells County, IN..........
                        Whitley County, IN........
23104................  \1\ Fort Worth-Arlington,       0.9591     0.9718
                        TX.
                        Johnson County, TX........
                        Parker County, TX.........
                        Tarrant County, TX........
                        Wise County, TX...........
23420................  \2\ Fresno, CA.............     1.1291     1.0867
                        Fresno County, CA.........
23460................  Gadsden, AL................     0.8107     0.8661
                        Etowah County, AL.........
23540................  Gainesville, FL............     0.9299     0.9514
                        Alachua County, FL........
                        Gilchrist County, FL......
23580................  Gainesville, GA............     0.8989     0.9296
                        Hall County, GA...........
23844................  Gary, IN...................     0.9278     0.9500
                        Jasper County, IN.........
                        Lake County, IN...........
                        Newton County, IN.........
                        Porter County, IN.........
24020................  Glens Falls, NY............     0.8359     0.8845
                        Warren County, NY.........
                        Washington County, NY.....
24140................  Goldsboro, NC..............     0.9185     0.9434
                        Wayne County, NC..........
24220................  Grand Forks, ND-MN (ND          0.7988     0.8574
                        Hospitals).
                        Polk County, MN...........
                        Grand Forks County, ND....
24220................  \2\ Grand Forks, ND-MN (MN      0.9256     0.9484
                        Hospitals).
                        Polk County, MN...........
                        Grand Forks County, ND....
24300................  Grand Junction, CO.........     1.0037     1.0025
                        Mesa County, CO...........
24340................  Grand Rapids-Wyoming, MI...     0.9469     0.9633
                        Barry County, MI..........
                        Ionia County, MI..........
                        Kent County, MI...........
                        Newaygo County, MI........
24500................  Great Falls, MT............     0.8781     0.9148
                        Cascade County, MT........
24540................  Greeley, CO................     0.9636     0.9749
                        Weld County, CO...........
24580................  Green Bay, WI..............     0.9791     0.9856
                        Brown County, WI..........
                        Kewaunee County, WI.......
                        Oconto County, WI.........
24660................  Greensboro-High Point, NC..     0.8992     0.9298
                        Guilford County, NC.......
                        Randolph County, NC.......
                        Rockingham County, NC.....
24780................  Greenville, NC.............     0.9427     0.9604
                        Greene County, NC.........
                        Pitt County, NC...........
24860................  Greenville, SC.............     0.9708     0.9799
                        Greenville County, SC.....
                        Laurens County, SC........
                        Pickens County, SC........
25020................  Guayama, PR................     0.3242     0.4624
                        Arroyo Municipio, PR......
                        Guayama Municipio, PR.....
                        Patillas Municipio, PR....
25060................  Gulfport-Biloxi, MS........     0.8914     0.9243
                        Hancock County, MS........

[[Page 24244]]

 
                        Harrison County, MS.......
                        Stone County, MS..........
25180................  Hagerstown-Martinsburg, MD-     0.9082     0.9362
                        WV.
                        Washington County, MD.....
                        Berkeley County, WV.......
                        Morgan County, WV.........
25260................  \2\ Hanford-Corcoran, CA...     1.1291     1.0867
                        Kings County, CA..........
25420................  Harrisburg-Carlisle, PA....     0.9413     0.9594
                        Cumberland County, PA.....
                        Dauphin County, PA........
                        Perry County, PA..........
25500................  Harrisonburg, VA...........     0.9093     0.9370
                        Rockingham County, VA.....
                        Harrisonburg City, VA.....
25540................  \1\ \2\ Hartford-West           1.1750     1.1168
                        Hartford-East Hartford, CT.
                        Hartford County, CT.......
                        Litchfield County, CT.....
                        Middlesex County, CT......
                        Tolland County, CT........
25620................  \2\ Hattiesburg, MS........     0.7579     0.8271
                        Forrest County, MS........
                        Lamar County, MS..........
                        Perry County, MS..........
25860................  Hickory-Lenoir-Morganton,       0.9029     0.9324
                        NC.
                        Alexander County, NC......
                        Burke County, NC..........
                        Caldwell County, NC.......
                        Catawba County, NC........
25980................  Hinesville-Fort Stewart, GA     0.7577     0.8270
                        Liberty County, GA........
                        Long County, GA...........
26100................  Holland-Grand Haven, MI....     0.9241     0.9474
                        Ottawa County, MI.........
26180................  Honolulu, HI...............     1.1066     1.0718
                        Honolulu County, HI.......
26300................  Hot Springs, AR............     0.8812     0.9170
                        Garland County, AR........
26380................  Houma-Bayou Cane-Thibodaux,     0.8003     0.8585
                        LA.
                        Lafourche Parish, LA......
                        Terrebonne Parish, LA.....
26420................  \1\ Houston-Sugar Land-         1.0030     1.0021
                        Baytown, TX.
                        Austin County, TX.........
                        Brazoria County, TX.......
                        Chambers County, TX.......
                        Fort Bend County, TX......
                        Galveston County, TX......
                        Harris County, TX.........
                        Liberty County, TX........
                        Montgomery County, TX.....
                        San Jacinto County, TX....
                        Waller County, TX.........
26580................  Huntington-Ashland, WV-KY-      0.9009     0.9310
                        OH.
                        Boyd County, KY...........
                        Greenup County, KY........
                        Lawrence County, OH.......
                        Cabell County, WV.........
                        Wayne County, WV..........
26620................  Huntsville, AL.............     0.9027     0.9323
                        Limestone County, AL......
                        Madison County, AL........
26820................  Idaho Falls, ID............     0.9300     0.9515
                        Bonneville County, ID.....
                        Jefferson County, ID......
26900................  \1\ Indianapolis-Carmel, IN     0.9757     0.9833
                        Boone County, IN..........
                        Brown County, IN..........
                        Hamilton County, IN.......
                        Hancock County, IN........
                        Hendricks County, IN......

[[Page 24245]]

 
                        Johnson County, IN........
                        Marion County, IN.........
                        Morgan County, IN.........
                        Putnam County, IN.........
                        Shelby County, IN.........
26980................  Iowa City, IA..............     0.9726     0.9812
                        Johnson County, IA........
                        Washington County, IA.....
27060................  Ithaca, NY.................     0.9883     0.9920
                        Tompkins County, NY.......
27100................  Jackson, MI................     0.9562     0.9698
                        Jackson County, MI........
27140................  Jackson, MS................     0.8278     0.8786
                        Copiah County, MS.........
                        Hinds County, MS..........
                        Madison County, MS........
                        Rankin County, MS.........
                        Simpson County, MS........     0.8860     0.9205
27180................  Jackson, TN................
                        Chester County, TN........
                        Madison County, TN........
27260................  \1\ Jacksonville, FL.......     0.9046     0.9336
                        Baker County, FL..........
                        Clay County, FL...........
                        Duval County, FL..........
                        Nassau County, FL.........
                        St. Johns County, FL......
27340................  \2\ Jacksonville, NC.......     0.8607     0.9024
                        Onslow County, NC.........
27500................  Janesville, WI.............     0.9685     0.9783
                        Rock County, WI...........
27620................  Jefferson City, MO.........     0.8341     0.8832
                        Callaway County, MO.......
                        Cole County, MO...........
                        Moniteau County, MO.......
                        Osage County, MO..........
27740................  Johnson City, TN...........     0.8070     0.8634
                        Carter County, TN.........
                        Unicoi County, TN.........
                        Washington County, TN.....
27780................  Johnstown, PA..............     0.8621     0.9034
                        Cambria County, PA........
27860................  Jonesboro, AR..............     0.7952     0.8548
                        Craighead County, AR......
                        Poinsett County, AR.......
27900................  Joplin, MO.................     0.8620     0.9033
                        Jasper County, MO.........
                        Newton County, MO.........
28020................  Kalamazoo-Portage, MI......     1.0737     1.0499
                        Kalamazoo County, MI......
                        Van Buren County, MI......
28100................  Kankakee-Bradley, IL.......     1.0005     1.0003
                        Kankakee County, IL.......
28140................  \1\ Kansas City, MO-KS.....     0.9501     0.9656
                        Franklin County, KS.......
                        Johnson County, KS........
                        Leavenworth County, KS....
                        Linn County, KS...........
                        Miami County, KS..........
                        Wyandotte County, KS......
                        Bates County, MO..........
                        Caldwell County, MO.......
                        Cass County, MO...........
                        Clay County, MO...........
                        Clinton County, MO........
                        Jackson County, MO........
                        Lafayette County, MO......
                        Platte County, MO.........
                        Ray County, MO............
28420................  \2\ Kennewick-Richland-         1.0440     1.0299
                        Pasco, WA.

[[Page 24246]]

 
                        Benton County, WA.........
                        Franklin County, WA.......
28660................  Killeen-Temple-Fort Hood,       0.9131     0.9396
                        TX.
                        Bell County, TX...........
                        Coryell County, TX........
                        Lampasas County, TX.......
28700................  Kingsport-Bristol-Bristol,      0.8062     0.8628
                        TN-VA.
                        Hawkins County, TN........
                        Sullivan County, TN.......
                        Bristol City, VA..........
                        Scott County, VA..........
                        Washington County, VA.....
28740................  Kingston, NY...............     0.9387     0.9576
                        Ulster County, NY.........
28940................  Knoxville, TN..............     0.8278     0.8786
                        Anderson County, TN.......
                        Blount County, TN.........
                        Knox County, TN...........
                        Loudon County, TN.........
                        Union County, TN..........
29020................  Kokomo, IN.................     0.9494     0.9651
                        Howard County, IN.........
                        Tipton County, IN.........
29100................  \2\ La Crosse, WI-MN (WI        0.9466     0.9631
                        Hospitals).
                        Houston County, MN........
                        La Crosse County, WI......
29100................  La Crosse, WI-MN (MN            0.9427     0.9604
                        Hospitals).
                        Houston County, MN........
                        La Crosse County, WI......
29140................  Lafayette, IN..............     0.8957     0.9273
                        Benton County, IN.........
                        Carroll County, IN........
                        Tippecanoe County, IN.....
29180................  Lafayette, LA..............     0.8300     0.8802
                        Lafayette Parish, LA......
                        St. Martin Parish, LA.....
29340................  Lake Charles, LA...........     0.7934     0.8534
                        Calcasieu Parish, LA......
                        Cameron Parish, LA........
29400................  Lake County-Kenosha County,     1.0408     1.0278
                        IL-WI.
                        Lake County, IL...........
                        Kenosha County, WI........
29460................  Lakeland, FL...............     0.8908     0.9239
                        Polk County, FL...........
29540................  Lancaster, PA..............     0.9768     0.9841
                        Lancaster County, PA......
29620................  Lansing-East Lansing, MI...     1.0096     1.0066
                        Clinton County, MI........
                        Eaton County, MI..........
                        Ingham County, MI.........
29700................  \2\ Laredo, TX.............     0.8003     0.8585
                        Webb County, TX...........
29740................  Las Cruces, NM.............     0.9270     0.9494
                        Dona Ana County, NM.......
29820................  \1\ Las Vegas-Paradise, NV.     1.1417     1.0950
                        Clark County, NV..........
29940................  Lawrence, KS...............     0.8346     0.8835
                        Douglas County, KS........
30020................  Lawton, OK.................     0.8116     0.8668
                        Comanche County, OK.......
30140................  Lebanon, PA................     0.8886     0.9223
                        Lebanon County, PA........
30300................  Lewiston, ID-WA (ID             0.9853     0.9899
                        Hospitals).
                        Nez Perce County, ID......
                        Asotin County, WA.........
30300................  \2\ Lewiston, ID-WA (WA         1.0440     1.0299
                        Hospitals).
                        Nez Perce County, ID......
                        Asotin County, WA.........
30340................  Lewiston-Auburn, ME........     0.9141     0.9403
                        Androscoggin County, ME...

[[Page 24247]]

 
30460................  Lexington-Fayette, KY......     0.9168     0.9422
                        Bourbon County, KY........
                        Clark County, KY..........
                        Fayette County, KY........
                        Jessamine County, KY......
                        Scott County, KY..........
                        Woodford County, KY.......
30620................  Lima, OH...................     0.9060     0.9346
                        Allen County, OH..........
30700................  Lincoln, NE................     1.0084     1.0057
                        Lancaster County, NE......
                        Seward County, NE.........
30780................  Little Rock-North Little        0.8918     0.9246
                        Rock, AR.
                        Faulkner County, AR.......
                        Grant County, AR..........
                        Lonoke County, AR.........
                        Perry County, AR..........
                        Pulaski County, AR........
                        Saline County, AR.........
30860................  Logan, UT-ID...............     0.9049     0.9339
                        Franklin County, ID.......
                        Cache County, UT..........
30980................  Longview, TX...............     0.8905     0.9237
                        Gregg County, TX..........
                        Rusk County, TX...........
                        Upshur County, TX.........
31020................  \2\ Longview, WA...........     1.0440     1.0299
                        Cowlitz County, WA........
31084................  \1\ \3\ Los Angeles-Long        1.1762     1.1175
                        Beach-Glendale, CA.
                        Los Angeles County, CA....
31140................  \1\ Louisville-Jefferson        0.9137     0.9401
                        County, KY-IN.
                        Clark County, IN..........
                        Floyd County, IN..........
                        Harrison County, IN.......
                        Washington County, IN.....
                        Bullitt County, KY........
                        Henry County, KY..........
                        Jefferson County, KY......
                        Meade County, KY..........
                        Nelson County, KY.........
                        Oldham County, KY.........
                        Shelby County, KY.........
                        Spencer County, KY........
                        Trimble County, KY........
31180................  Lubbock, TX................     0.8626     0.9037
                        Crosby County, TX.........
                        Lubbock County, TX........
31340................  Lynchburg, VA..............     0.8716     0.9102
                        Amherst County, VA........
                        Appomattox County, VA.....
                        Bedford County, VA........
                        Campbell County, VA.......
                        Bedford City, VA..........
                        Lynchburg City, VA........
31420................  Macon, GA..................     0.9554     0.9692
                        Bibb County, GA...........
                        Crawford County, GA.......
                        Jones County, GA..........
                        Monroe County, GA.........
                        Twiggs County, GA.........
31460................  \2\ Madera, CA.............     1.1291     1.0867
                        Madera County, CA.........
31540................  Madison, WI................     1.0731     1.0495
                        Columbia County, WI.......
                        Dane County, WI...........
                        Iowa County, WI...........
31700................  \2\ Manchester-Nashua, NH..     1.1665     1.1112
                        Hillsborough County, NH...
                        Merrimack County, NH......
31900................  Mansfield, OH..............     0.9298     0.9514

[[Page 24248]]

 
                        Richland County, OH.......
32420................  Mayag[uuml]ez, PR..........     0.3856     0.5207
                        Hormigueros Municipio, PR.
                        Mayag[uuml]ez Municipio,
                        PR.
32580................  McAllen-Edinburg-Mission,       0.8790     0.9155
                        TX.
                        Hidalgo County, TX........
32780................  Medford, OR................     1.0836     1.0565
                        Jackson County, OR........
32820................  \1\ Memphis, TN-MS-AR......     0.9367     0.9562
                        Crittenden County, AR.....
                        DeSoto County, MS.........
                        Marshall County, MS.......
                        Tate County, MS...........
                        Tunica County, MS.........
                        Fayette County, TN........
                        Shelby County, TN.........
                        Tipton County, TN.........
32900................  Merced, CA.................     1.1421     1.0953
                        Merced County, CA.........
33124................  \1\ Miami-Miami Beach-          0.9825     0.9880
                        Kendall, FL.
                        Miami-Dade County, FL.....
33140................  Michigan City-La Porte, IN.     0.9093     0.9370
                        LaPorte County, IN........
33260................  Midland, TX................     0.9802     0.9864
                        Midland County, TX........
33340................  \1\ Milwaukee-Waukesha-West     1.0241     1.0164
                        Allis, WI.
                        Milwaukee County, WI......
                        Ozaukee County, WI........
                        Washington County, WI.....
                        Waukesha County, WI.......
33460................  \1\ Minneapolis-St. Paul-       1.0943     1.0637
                        Bloomington, MN-WI.
                        Anoka County, MN..........
                        Carver County, MN.........
                        Chisago County, MN........
                        Dakota County, MN.........
                        Hennepin County, MN.......
                        Isanti County, MN.........
                        Ramsey County, MN.........
                        Scott County, MN..........
                        Sherburne County, MN......
                        Washington County, MN.....
                        Wright County, MN.........
                        Pierce County, WI.........
                        St. Croix County, WI......
33540................  Missoula, MT...............     0.8909     0.9239
                        Missoula County, MT.......
33660................  Mobile, AL.................     0.7955     0.8550
                        Mobile County, AL.........
33700................  Modesto, CA................     1.1731     1.1155
                        Stanislaus County, CA.....
33740................  Monroe, LA.................     0.8015     0.8594
                        Ouachita Parish, LA.......
                        Union Parish, LA..........
33780................  Monroe, MI.................     0.9715     0.9804
                        Monroe County, MI.........
33860................  Montgomery, AL.............     0.8035     0.8609
                        Autauga County, AL........
                        Elmore County, AL.........
                        Lowndes County, AL........
                        Montgomery County, AL.....
34060................  Morgantown, WV.............     0.8449     0.8910
                        Monongalia County, WV.....
                        Preston County, WV........
34100................  \2\ Morristown, TN.........     0.7957     0.8551
                        Grainger County, TN.......
                        Hamblen County, TN........
                        Jefferson County, TN......
34580................  Mount Vernon-Anacortes, WA.     1.0514     1.0349
                        Skagit County, WA.........
34620................  \2\ Muncie, IN.............     0.8479     0.8932

[[Page 24249]]

 
                        Delaware County, IN.......
34740................  \3\ Muskegon-Norton Shores,     0.9961     0.9973
                        MI.
                        Muskegon County, MI.......
34820................  Myrtle Beach-Conway-North       0.8819     0.9175
                        Myrtle Beach, SC.
                        Horry County, SC..........
34900................  Napa, CA...................     1.3484     1.2272
                        Napa County, CA...........
34940................  Naples-Marco Island, FL....     0.9935     0.9955
                        Collier County, FL........
34980................  \1\ Nashville-Davidson-         0.9853     0.9899
                        Murfreesboro, TN.
                        Cannon County, TN.........
                        Cheatham County, TN.......
                        Davidson County, TN.......
                        Dickson County, TN........
                        Hickman County, TN........
                        Macon County, TN..........
                        Robertson County, TN......
                        Rutherford County, TN.....
                        Smith County, TN..........
                        Sumner County, TN.........
                        Trousdale County, TN......
                        Williamson County, TN.....
                        Wilson County, TN.........
35004................  \1\ \3\ Nassau-Suffolk, NY.     1.2701     1.1779
                        Nassau County, NY.........
                        Suffolk County, NY........
35080................  \1\ Newark-Union, NJ-PA....     1.1886     1.1256
                        Essex County, NJ..........
                        Hunterdon County, NJ......
                        Morris County, NJ.........
                        Sussex County, NJ.........
                        Union County, NJ..........
                        Pike County, PA...........
35300................  New Haven-Milford, CT......     1.2093     1.1390
                        New Haven County, CT......
35380................  \1\ New Orleans-Metairie-       0.8855     0.9201
                        Kenner, LA.
                        Jefferson Parish, LA......
                        Orleans Parish, LA........
                        Plaquemines Parish, LA....
                        St. Bernard Parish, LA....
                        St. Charles Parish, LA....
                        St. John the Baptist
                        Parish, LA.
                        St. Tammany Parish, LA....
35644................  \1\ \3\ New York-White          1.3215     1.2103
                        Plains-Wayne, NY-NJ.
                        Bergen County, NJ.........
                        Hudson County, NJ.........
                        Passaic County, NJ........
                        Bronx County, NY..........
                        Kings County, NY..........
                        New York County, NY.......
                        Putnam County, NY.........
                        Queens County, NY.........
                        Richmond County, NY.......
                        Rockland County, NY.......
                        Westchester County, NY....
35660................  \2\ Niles-Benton Harbor, MI     0.9055     0.9343
                        Berrien County, MI........
35980................   Norwich-New London, CT....     1.2020     1.1343
                        New London County, CT.....
36084................  \1\ Oakland-Fremont-            1.5669     1.3601
                        Hayward, CA.
                        Alameda County, CA........
                        Contra Costa County, CA...
36100................  Ocala, FL..................     0.8904     0.9236
                        Marion County, FL.........
36140................  \2\ Ocean City, NJ.........     1.1226     1.0824
                        Cape May County, NJ.......
36220................  Odessa, TX.................     1.0119     1.0081
                        Ector County, TX..........
36260................  Ogden-Clearfield, UT.......     0.9021     0.9319
                        Davis County, UT..........

[[Page 24250]]

 
                        Morgan County, UT.........
                        Weber County, UT..........
36420................  \1\ Oklahoma City, OK......     0.8857     0.9202
                        Canadian County, OK.......
                        Cleveland County, OK......
                        Grady County, OK..........
                        Lincoln County, OK........
                        Logan County, OK..........
                        McClain County, OK........
                        Oklahoma County, OK.......
36500................  Olympia, WA................     1.1096     1.0738
                        Thurston County, WA.......
36540................  Omaha-Council Bluffs, NE-IA     0.9453     0.9622
                        Harrison County, IA.......
                        Mills County, IA..........
                        Pottawattamie County, IA..
                        Cass County, NE...........
                        Douglas County, NE........
                        Sarpy County, NE..........
                        Saunders County, NE.......
                        Washington County, NE.....
36740................  \1\ Orlando-Kissimmee, FL..     0.9409     0.9591
                        Lake County, FL...........
                        Orange County, FL.........
                        Osceola County, FL........
                        Seminole County, FL.......
36780................  \2\ Oshkosh-Neenah, WI.....     0.9466     0.9631
                        Winnebago County, WI......
36980................  Owensboro, KY..............     0.8780     0.9148
                        Daviess County, KY........
                        Hancock County, KY........
                        McLean County, KY.........
37100................  Oxnard-Thousand Oaks-           1.1583     1.1059
                        Ventura, CA.
                        Ventura County, CA........
37340................  Palm Bay-Melbourne-             0.9440     0.9613
                        Titusville, FL.
                        Brevard County, FL........
37460................  \2\ Panama City-Lynn Haven,     0.8609     0.9025
                        FL.
                        Bay County, FL............
37620................  Parkersburg-Marietta-           0.7964     0.8556
                        Vienna, WV-OH (WV
                        Hospitals).
                        Washington County, OH.....
                        Pleasants County, WV......
                        Wirt County, WV...........
                        Wood County, WV...........
37620................  \2\ Parkersburg-Marietta-       0.8673     0.9071
                        Vienna, WV-OH (OH
                        Hospitals).
                        Washington County, OH.....
                        Pleasants County, WV......
                        Wirt County, WV...........
                        Wood County, WV...........
37700................  Pascagoula, MS.............     0.8229     0.8750
                        George County, MS.........
                        Jackson County, MS........
37860................  \2\ Pensacola-Ferry Pass-       0.8609     0.9025
                        Brent, FL.
                        Escambia County, FL.......
                        Santa Rosa County, FL.....
37900................  Peoria, IL.................     0.8973     0.9285
                        Marshall County, IL.......
                        Peoria County, IL.........
                        Stark County, IL..........
                        Tazewell County, IL.......
                        Woodford County, IL.......
37964................  \1\ Philadelphia, PA.......     1.1009     1.0680
                        Bucks County, PA..........
                        Chester County, PA........
                        Delaware County, PA.......
                        Montgomery County, PA.....
                        Philadelphia County, PA...
38060................  \1\ Phoenix-Mesa-               1.0307     1.0209
                        Scottsdale, AZ.
                        Maricopa County, AZ.......
                        Pinal County, AZ..........
38220................  Pine Bluff, AR.............     0.8423     0.8891

[[Page 24251]]

 
                        Cleveland County, AR......
                        Jefferson County, AR......
                        Lincoln County, AR........
38300................  \1\ Pittsburgh, PA.........     0.8671     0.9070
                        Allegheny County, PA......
                        Armstrong County, PA......
                        Beaver County, PA.........
                        Butler County, PA.........
                        Fayette County, PA........
                        Washington County, PA.....
                        Westmoreland County, PA...
38340................  \2\ Pittsfield, MA.........     1.0664     1.0450
                        Berkshire County, MA......
38540................  Pocatello, ID..............     0.9400     0.9585
                        Bannock County, ID........
                        Power County, ID..........
38660................  Ponce, PR..................     0.4852     0.6094
                        Juana D[iacute]az
                        Municipio, PR.
                        Ponce Municipio, PR.......
                        Villalba Municipio, PR....
38860................  Portland-South Portland-        0.9916     0.9942
                        Biddeford, ME.
                        Cumberland County, ME.....
                        Sagadahoc County, ME......
                        York County, ME...........
38900................  \1\ Portland-Vancouver-         1.1405     1.0942
                        Beaverton, OR-WA.
                        Clackamas County, OR......
                        Columbia County, OR.......
                        Multnomah County, OR......
                        Washington County, OR.....
                        Yamhill County, OR........
                        Clark County, WA..........
                        Skamania County, WA.......
38940................  Port St. Lucie-Fort Pierce,     0.9857     0.9902
                        FL.
                        Martin County, FL.........
                        St. Lucie County, FL......
39100................  Poughkeepsie-Newburgh-          1.0913     1.0617
                        Middletown, NY.
                        Dutchess County, NY.......
                        Orange County, NY.........
39140................  Prescott, AZ...............     0.9858     0.9903
                        Yavapai County, AZ........
39300................  \1\ Providence-New Bedford-     1.0791     1.0535
                        Fall River, RI-MA.
                        Bristol County, MA........
                        Bristol County, RI........
                        Kent County, RI...........
                        Newport County, RI........
                        Providence County, RI.....
                        Washington County, RI.....
39340................  Provo-Orem, UT.............     0.9537     0.9681
                        Juab County, UT...........
                        Utah County, UT...........
39380................  \2\ Pueblo, CO.............     0.9331     0.9537
                        Pueblo County, CO.........
39460................  Punta Gorda, FL............     0.9432     0.9607
                        Charlotte County, FL......
39540................  \2\ Racine, WI.............     0.9466     0.9631
                        Racine County, WI.........
39580................  Raleigh-Cary, NC...........     0.9855     0.9900
                        Franklin County, NC.......
                        Johnston County, NC.......
                        Wake County, NC...........
39660................  Rapid City, SD.............     1.0359     1.0244
                        Meade County, SD..........
                        Pennington County, SD.....
39740................  Reading, PA................     0.9642     0.9753
                        Berks County, PA..........
39820................  Redding, CA................     1.3205     1.2097
                        Shasta County, CA.........
39900................  Reno-Sparks, NV............     1.1975     1.1314
                        Storey County, NV.........
                        Washoe County, NV.........

[[Page 24252]]

 
40060................  \1\ Richmond, VA...........     0.9174     0.9427
                        Amelia County, VA.........
                        Caroline County, VA.......
                        Charles City County, VA...
                        Chesterfield County, VA...
                        Cumberland County, VA.....
                        Dinwiddie County, VA......
                        Goochland County, VA......
                        Hanover County, VA........
                        Henrico County, VA........
                        King and Queen County, VA.
                        King William County, VA...
                        Louisa County, VA.........
                        New Kent County, VA.......
                        Powhatan County, VA.......
                        Prince George County, VA..
                        Sussex County, VA.........
                        Colonial Heights City, VA.
                        Hopewell City, VA.........
                        Petersburg City, VA.......
                        Richmond City, VA.........
40140................  \1\ \2\ Riverside-San           1.1291     1.0867
                        Bernardino-Ontario, CA.
                        Riverside County, CA......
                        San Bernardino County, CA.
40220................  Roanoke, VA................     0.8677     0.9074
                        Botetourt County, VA......
                        Craig County, VA..........
                        Franklin County, VA.......
                        Roanoke County, VA........
                        Roanoke City, VA..........
                        Salem City, VA............
40340................  Rochester, MN..............     1.1246     1.0837
                        Dodge County, MN..........
                        Olmsted County, MN........
                        Wabasha County, MN........
40380................  \1\ Rochester, NY..........     0.9007     0.9309
                        Livingston County, NY.....
                        Monroe County, NY.........
                        Ontario County, NY........
                        Orleans County, NY........
                        Wayne County, NY..........
40420................  Rockford, IL...............     0.9987     0.9991
                        Boone County, IL..........
                        Winnebago County, IL......
40484................  \2\ Rockingham County-          1.1665     1.1112
                        Strafford County, NH.
                        Rockingham County, NH.....
                        Strafford County, NH......
40580................  Rocky Mount, NC............     0.8869     0.9211
                        Edgecombe County, NC......
                        Nash County, NC...........
40660................  Rome, GA...................     0.9307     0.9520
                        Floyd County, GA..........
40900................  \1\ Sacramento--Arden-          1.3350     1.2188
                        Arcade--Roseville, CA.
                        El Dorado County, CA......
                        Placer County, CA.........
                        Sacramento County, CA.....
                        Yolo County, CA...........
40980................  \2\ Saginaw-Saginaw             0.9055     0.9343
                        Township North, MI.
                        Saginaw County, MI........
41060................  St. Cloud, MN..............     1.0438     1.0298
                        Benton County, MN.........
                        Stearns County, MN........
41100................  St. George, UT.............     0.9295     0.9512
                        Washington County, UT.....
41140................  St. Joseph, MO-KS..........     1.0174     1.0119
                        Doniphan County, KS.......
                        Andrew County, MO.........
                        Buchanan County, MO.......
                        DeKalb County, MO.........
41180................  \1\ St. Louis, MO-IL.......     0.9017     0.9316

[[Page 24253]]

 
                        Bond County, IL...........
                        Calhoun County, IL........
                        Clinton County, IL........
                        Jersey County, IL.........
                        Macoupin County, IL.......
                        Madison County, IL........
                        Monroe County, IL.........
                        St. Clair County, IL......
                        Crawford County, MO.......
                        Franklin County, MO.......
                        Jefferson County, MO......
                        Lincoln County, MO........
                        St. Charles County, MO....
                        St. Louis County, MO......
                        Warren County, MO.........
                        Washington County, MO.....
                        St. Louis City, MO........
41420................  Salem, OR..................     1.0452     1.0307
                        Marion County, OR.........
                        Polk County, OR...........
41500................  Salinas, CA................     1.4457     1.2871
                        Monterey County, CA.......
41540................  Salisbury, MD..............     0.8958     0.9274
                        Somerset County, MD.......
                        Wicomico County, MD.......
41620................  Salt Lake City, UT.........     0.9421     0.9600
                        Salt Lake County, UT......
                        Summit County, UT.........
                        Tooele County, UT.........
41660................  San Angelo, TX.............     0.8385     0.8864
                        Irion County, TX..........
                        Tom Green County, TX......
41700................  \1\ San Antonio, TX........     0.8859     0.9204
                        Atascosa County, TX.......
                        Bandera County, TX........
                        Bexar County, TX..........
                        Comal County, TX..........
                        Guadalupe County, TX......
                        Kendall County, TX........
                        Medina County, TX.........
                        Wilson County, TX.........
41740................  \1\ San Diego-Carlsbad-San      1.1371     1.0920
                        Marcos, CA.
                        San Diego County, CA......
41780................  Sandusky, OH...............     0.9328     0.9535
                        Erie County, OH...........
41884................  \1\ San Francisco-San Mateo-    1.5049     1.3230
                        Redwood City, CA.
                        Marin County, CA..........
                        San Francisco County, CA..
                        San Mateo County, CA......
41900................  San Germ[aacute]n-Cabo          0.4884     0.6122
                        Rojo, PR.
                        Cabo Rojo Municipio, PR...
                        Lajas Municipio, PR.......
                        Sabana Grande Municipio,
                        PR.
                        San Germ[aacute]n
                        Municipio, PR.
41940................  \1\ San Jose-Sunnyvale-         1.5281     1.3369
                        Santa Clara, CA.
                        San Benito County, CA.....
                        Santa Clara County, CA....
41980................  \1\ San Juan-Caguas-            0.4396     0.5696
                        Guaynabo, PR.
                        Aguas Buenas Municipio, PR
                        Aibonito Municipio, PR....
                        Arecibo Municipio, PR.....
                        Barceloneta Municipio, PR.
                        Barranquitas Municipio, PR
                        Bayam[oacute]n Municipio,
                        PR.
                        Caguas Municipio, PR......
                        Camuy Municipio, PR.......
                        Can[oacute]vanas
                        Municipio, PR.
                        Carolina Municipio, PR....
                        Cata[ntilde]o Municipio,
                        PR.
                        Cayey Municipio, PR.......

[[Page 24254]]

 
                        Ciales Municipio, PR......
                        Cidra Municipio, PR.......
                        Comer[iacute]o Municipio,
                        PR.
                        Corozal Municipio, PR.....
                        Dorado Municipio, PR......
                        Florida Municipio, PR.....
                        Guaynabo Municipio, PR....
                        Gurabo Municipio, PR......
                        Hatillo Municipio, PR.....
                        Humacao Municipio, PR.....
                        Juncos Municipio, PR......
                        Las Piedras Municipio, PR.
                        Lo[iacute]za Municipio, PR
                        Manat[iacute] Municipio,
                        PR.
                        Maunabo Municipio, PR.....
                        Morovis Municipio, PR.....
                        Naguabo Municipio, PR.....
                        Naranjito Municipio, PR...
                        Orocovis Municipio, PR....
                        Quebradillas Municipio, PR
                        R[iacute]o Grande
                        Municipio, PR.
                        San Juan Municipio, PR....
                        San Lorenzo Municipio, PR.
                        Toa Alta Municipio, PR....
                        Toa Baja Municipio, PR....
                        Trujillo Alto Municipio,
                        PR.
                        Vega Alta Municipio, PR...
                        Vega Baja Municipio, PR...
                        Yabucoa Municipio, PR.....
42020................  San Luis Obispo-Paso            1.1616     1.1080
                        Robles, CA.
                        San Luis Obispo County, CA
42044................  \1\ \2\ Santa Ana-Anaheim-      1.1291     1.0867
                        Irvine, CA.
                        Orange County, CA.........
42060................  \2\ Santa Barbara-Santa         1.1291     1.0867
                        Maria, CA.
                        Santa Barbara County, CA..
42100................  Santa Cruz-Watsonville, CA.     1.5509     1.3506
                        Santa Cruz County, CA.....
42140................  Santa Fe, NM...............     1.0821     1.0555
                        Santa Fe County, NM.......
42220................  Santa Rosa-Petaluma, CA....     1.4459     1.2872
                        Sonoma County, CA.........
42260................  Sarasota-Bradenton-Venice,      0.9866     0.9908
                        FL.
                        Manatee County, FL........
                        Sarasota County, FL.......
42340................  Savannah, GA...............     0.9089     0.9367
                        Bryan County, GA..........
                        Chatham County, GA........
                        Effingham County, GA......
42540................  Scranton--Wilkes-Barre, PA.     0.8503     0.8949
                        Lackawanna County, PA.....
                        Luzerne County, PA........
                        Wyoming County, PA........
42644................  \1\ Seattle-Bellevue-           1.1438     1.0964
                        Everett, WA.
                        King County, WA...........
                        Snohomish County, WA......
42680................  Sebastian-Vero Beach, FL...     0.9604     0.9727
                        Indian River County, FL...
43100................  \2\ Sheboygan, WI..........     0.9466     0.9631
                        Sheboygan County, WI......
43300................  Sherman-Denison, TX........     0.8521     0.8962
                        Grayson County, TX........
43340................  Shreveport-Bossier City, LA     0.8879     0.9218
                        Bossier Parish, LA........
                        Caddo Parish, LA..........
                        De Soto Parish, LA........
43580................  Sioux City, IA-NE-SD.......     0.9201     0.9446
                        Woodbury County, IA.......
                        Dakota County, NE.........
                        Dixon County, NE..........
                        Union County, SD..........

[[Page 24255]]

 
43620................  Sioux Falls, SD............     0.9559     0.9696
                        Lincoln County, SD........
                        McCook County, SD.........
                        Minnehaha County, SD......
                        Turner County, SD.........
43780................  South Bend-Mishawaka, IN-MI     0.9677     0.9778
                        St. Joseph County, IN.....
                        Cass County, MI...........
43900................  Spartanburg, SC............     0.9192     0.9439
                        Spartanburg County, SC....
44060................  Spokane, WA................     1.0448     1.0305
                        Spokane County, WA........
44100................  Springfield, IL............     0.8900     0.9233
                        Menard County, IL.........
                        Sangamon County, IL.......
44140................  \2\ Springfield, MA........     1.0664     1.0450
                        Franklin County, MA.......
                        Hampden County, MA........
                        Hampshire County, MA......
44180................  Springfield, MO............     0.8490     0.8940
                        Christian County, MO......
                        Dallas County, MO.........
                        Greene County, MO.........
                        Polk County, MO...........
                        Webster County, MO........
44220................  \2\ Springfield, OH........     0.8673     0.9071
                        Clark County, OH..........
44300................  State College, PA..........     0.8804     0.9165
                        Centre County, PA.........
44700................  Stockton, CA...............     1.1483     1.0993
                        San Joaquin County, CA....
44940................  \2\ Sumter, SC.............     0.8604     0.9022
                        Sumter County, SC.........
45060................  Syracuse, NY...............     0.9723     0.9809
                        Madison County, NY........
                        Onondaga County, NY.......
                        Oswego County, NY.........
45104................  Tacoma, WA.................     1.0907     1.0613
                        Pierce County, WA.........
45220................  Tallahassee, FL............     0.9316     0.9526
                        Gadsden County, FL........
                        Jefferson County, FL......
                        Leon County, FL...........
                        Wakulla County, FL........
45300................  \1\ Tampa-St. Petersburg-       0.9249     0.9479
                        Clearwater, FL.
                        Hernando County, FL.......
                        Hillsborough County, FL...
                        Pasco County, FL..........
                        Pinellas County, FL.......
45460................  Terre Haute, IN............     0.8663     0.9064
                        Clay County, IN...........
                        Sullivan County, IN.......
                        Vermillion County, IN.....
                        Vigo County, IN...........
45500................  Texarkana, TX-Texarkana, AR     0.8133     0.8680
                        Miller County, AR.........
                        Bowie County, TX..........
45780................  Toledo, OH.................     0.9588     0.9716
                        Fulton County, OH.........
                        Lucas County, OH..........
                        Ottawa County, OH.........
                        Wood County, OH...........
45820................  Topeka, KS.................     0.8738     0.9118
                        Jackson County, KS........
                        Jefferson County, KS......
                        Osage County, KS..........
                        Shawnee County, KS........
                        Wabaunsee County, KS......
45940................  \2\ Trenton-Ewing, NJ......     1.1226     1.0824
                        Mercer County, NJ.........

[[Page 24256]]

 
46060................  Tucson, AZ.................     0.9239     0.9472
                        Pima County, AZ...........
46140................  Tulsa, OK..................     0.8146     0.8690
                        Creek County, OK..........
                        Okmulgee County, OK.......
                        Osage County, OK..........
                        Pawnee County, OK.........
                        Rogers County, OK.........
                        Tulsa County, OK..........
                        Wagoner County, OK........
46220................  Tuscaloosa, AL.............     0.8644     0.9050
                        Greene County, AL.........
                        Hale County, AL...........
                        Tuscaloosa County, AL.....
46340................  Tyler, TX..................     0.8854     0.9200
                        Smith County, TX..........
46540................  Utica-Rome, NY.............     0.8422     0.8890
                        Herkimer County, NY.......
                        Oneida County, NY.........
46660................  Valdosta, GA...............     0.8340     0.8831
                        Brooks County, GA.........
                        Echols County, GA.........
                        Lanier County, GA.........
                        Lowndes County, GA........
46700................  Vallejo-Fairfield, CA......     1.5154     1.3293
                        Solano County, CA.........
47020................  Victoria, TX...............     0.8554     0.8986
                        Calhoun County, TX........
                        Goliad County, TX.........
                        Victoria County, TX.......
47220................  \2\ Vineland-Millville-         1.1226     1.0824
                        Bridgeton, NJ.
                        Cumberland County, NJ.....
47260................  \1\ Virginia Beach-Norfolk-     0.8840     0.9190
                        Newport News, VA-NC.
                        Currituck County, NC......
                        Gloucester County, VA.....
                        Isle of Wight County, VA..
                        James City County, VA.....
                        Mathews County, VA........
                        Surry County, VA..........
                        York County, VA...........
                        Chesapeake City, VA.......
                        Hampton City, VA..........
                        Newport News City, VA.....
                        Norfolk City, VA..........
                        Poquoson City, VA.........
                        Portsmouth City, VA.......
                        Suffolk City, VA..........
                        Virginia Beach City, VA...
                        Williamsburg City, VA.....
47300................  \1\ Visalia-Porterville, CA     1.1291     1.0867
                        Tulare County, CA.........
47380................  Waco, TX...................     0.8653     0.9057
                        McLennan County, TX.......
47580................  Warner Robins, GA..........     0.8402     0.8876
                        Houston County, GA........
47644................  \1\ Warren-Troy-Farmington      1.0123     1.0084
                        Hills, MI.
                        Lapeer County, MI.........
                        Livingston County, MI.....
                        Macomb County, MI.........
                        Oakland County, MI........
                        St. Clair County, MI......
47894................  \1\ Washington-Arlington-       1.1076     1.0725
                        Alexandria, DC-VA-MD-WV.
                        District of Columbia, DC..
                        Calvert County, MD........
                        Charles County, MD........
                        Prince George's County, MD
                        Arlington County, VA......
                        Clarke County, VA.........
                        Fairfax County, VA........
                        Fauquier County, VA.......

[[Page 24257]]

 
                        Loudoun County, VA........
                        Prince William County, VA.
                        Spotsylvania County, VA...
                        Stafford County, VA.......
                        Warren County, VA.........
                        Alexandria City, VA.......
                        Fairfax City, VA..........
                        Falls Church City, VA.....
                        Fredericksburg City, VA...
                        Manassas City, VA.........
                        Manassas Park City, VA....
                        Jefferson County, WV......
47940................  \2\ Waterloo-Cedar Falls,       0.8696     0.9088
                        IA.
                        Black Hawk County, IA.....
                        Bremer County, IA.........
                        Grundy County, IA.........
48140................  Wausau, WI.................     0.9799     0.9862
                        Marathon County, WI.......
48260................  Weirton-Steubenville, WV-OH     0.8072     0.8636
                        (WV Hospitals).
                        Jefferson County, OH......
                        Brooke County, WV.........
                        Hancock County, WV........
48260................  \2\ Weirton-Steubenville,       0.8673     0.9071
                        WV-OH (OH Hospitals).
                        Jefferson County, OH......
                        Brooke County, WV.........
                        Hancock County, WV........
48300................  \2\ Wenatchee, WA..........     1.0440     1.0299
                        Chelan County, WA.........
                        Douglas County, WA........
48424................  \1\ West Palm Beach-Boca        0.9642     0.9753
                        Raton-Boynton Beach, FL.
                        Palm Beach County, FL.....
48540................  \2\ Wheeling, WV-OH (WV         0.7637     0.8314
                        Hospitals).
                        Belmont County, OH........
                        Marshall County, WV.......
                        Ohio County, WV...........
48540................  \2\ Wheeling, WV-OH (OH         0.8673     0.9071
                        Hospitals).
                        Belmont County, OH........
                        Marshall County, WV.......
                        Ohio County, WV...........
48620................  Wichita, KS................     0.9093     0.9370
                        Butler County, KS.........
                        Harvey County, KS.........
                        Sedgwick County, KS.......
                        Sumner County, KS.........
48660................  Wichita Falls, TX..........     0.8360     0.8846
                        Archer County, TX.........
                        Clay County, TX...........
                        Wichita County, TX........
48700................  \2\ Williamsport, PA.......     0.8330     0.8824
                        Lycoming County, PA.......
48864................  Wilmington, DE-MD-NJ (DE,       1.0878     1.0593
                        MD Hospitals).
                        New Castle County, DE.....
                        Cecil County, MD..........
                        Salem County, NJ..........
48864................  \2\ Wilmington, DE-MD-NJ        1.1226     1.0824
                        (NJ Hospitals).
                        New Castle County, DE.....
                        Cecil County, MD..........
                        Salem County, NJ..........
48900................  Wilmington, NC.............     0.9840     0.9890
                        Brunswick County, NC......
                        New Hanover County, NC....
                        Pender County, NC.........
49020................  Winchester, VA-WV..........     1.0099     1.0068
                        Frederick County, VA......
                        Winchester City, VA.......
                        Hampshire County, WV......
49180................  Winston-Salem, NC..........     0.9300     0.9515
                        Davie County, NC..........
                        Forsyth County, NC........
                        Stokes County, NC.........

[[Page 24258]]

 
                        Yadkin County, NC.........
49340................  Worcester, MA..............     1.0747     1.0506
                        Worcester County, MA......
49420................  \2\ Yakima, WA.............     1.0440     1.0299
                        Yakima County, WA.........
49500................  Yauco, PR..................     0.3861     0.5212
                        Gu[aacute]nica Municipio,
                        PR.
                        Guayanilla Municipio, PR..
                        Pe[ntilde]uelas Municipio,
                        PR.
                        Yauco Municipio, PR.......
49620................  York-Hanover, PA...........     0.9416     0.9596
                        York County, PA...........
49660................  Youngstown-Warren-Boardman,     0.8815     0.9173
                        OH-PA.
                        Mahoning County, OH.......
                        Trumbull County, OH.......
                        Mercer County, PA.........
49700................  \2\ Yuba City, CA..........     1.1291     1.0867
                        Sutter County, CA.........
                        Yuba County, CA...........
49740................  Yuma, AZ...................     0.9179     0.9430
                        Yuma County, AZ ..........
------------------------------------------------------------------------
\1\ Large urban area.
\2\ Hospitals geographically located in the area are assigned the
  statewide rural wage index for FY 2007.
\3\ For this area, the wage index and GAF on this table are only
  effective from October 1, 2006 through March 31, 2007. See Table 4A-2
  for the values that are effective from April 1 through September 30,
  2007.


 Table 4A-2.--Wage Index and Capital Geographic Adjustment Factor (GAF)
for Certain Urban Areas by CBSA for the Period April 1 Through September
                                30, 2007*
------------------------------------------------------------------------
                         Urban area (constituent       Wage
      CBSA  code                counties)             index       GAF
------------------------------------------------------------------------
11460................  Ann Arbor, MI..............     1.0853     1.0577
                        Washtenaw County, MI
31084................  Los Angeles-Long Beach-         1.1762     1.1175
                        Glendale, CA.
                        Los Angeles County, CA....
34740................  Muskegon-Norton Shores, MI.     0.9961     0.9973
                        Muskegon County, MI.......
35004................  \1\ Nassau-Suffolk, NY.....     1.2701     1.1779
                        Nassau County, NY.........
                        Suffolk County, NY........
35644................  \1\ New York-White Plains-      1.3215     1.2103
                        Wayne, NY-NJ.
                        Bergen County, NJ.........
                        Hudson County, NJ.........
                        Passaic County, NJ........
                        Bronx County, NY..........
                        Kings County, NY..........
                        New York County, NY.......
                        Putnam County, NY.........
                        Queens County, NY.........
                        Richmond County, NY.......
                        Rockland County, NY.......
                        Westchester County, NY ...
------------------------------------------------------------------------
\1\ Large urban area.
* See Table 4A-1 for the wage index and GAF that are effective from
  October 1, 2006 through March 31, 2007. (For areas that are not listed
  on this table, the wage index and GAF on Table 4A-1 are effective for
  the entire FY 2007.)


Table 4B.--Wage Index and Capital Georgraphic Adjustment (GAF) for Rural
                          Areas by CBSA-FY 2007
------------------------------------------------------------------------
                                                       Wage
      CBSA  code              Nonurban area           index       GAF
------------------------------------------------------------------------
01...................  Alabama....................     0.7670     0.8339
02...................  Alaska.....................     1.0669     1.0453
03...................  Arizona....................     0.9158     0.9415
04...................  Arkansas...................     0.7366     0.8111
05...................  California.................     1.1291     1.0867
06...................  Colorado...................     0.9331     0.9537
07...................  Connecticut................     1.1750     1.1168

[[Page 24259]]

 
08...................  Delaware...................     0.9843     0.9892
10...................  Florida....................     0.8609     0.9025
11...................  Georgia....................     0.7577     0.8270
12...................  Hawaii.....................     1.0502     1.0341
13...................  Idaho......................     0.8674     0.9072
14...................  Illinois...................     0.8334     0.8827
15...................  Indiana....................     0.8479     0.8932
16...................  Iowa.......................     0.8696     0.9088
17...................  Kansas.....................     0.8017     0.8595
18...................  Kentucky...................     0.7793     0.8430
19...................  Louisiana..................     0.7487     0.8202
20...................  Maine......................     0.8399     0.8874
21...................  Maryland...................     0.8946     0.9266
22...................  Massachusetts \1\..........     1.0664     1.0450
23...................  Michigan...................     0.9055     0.9343
24...................  Minnesota..................     0.9256     0.9484
25...................  Mississippi................     0.7579     0.8271
26...................  Missouri...................     0.8206     0.8734
27...................  Montana....................     0.8591     0.9012
28...................  Nebraska...................     0.8691     0.9084
29...................  Nevada.....................     0.8967     0.9281
30...................  New Hampshire..............     1.1665     1.1112
31...................  New Jersey \1\.............     1.1226     1.0824
32...................  New Mexico.................     0.8353     0.8841
33...................  New York...................     0.8267     0.8778
34...................  North Carolina.............     0.8607     0.9024
35...................  North Dakota...............     0.7237     0.8014
36...................  Ohio.......................     0.8673     0.9071
37...................  Oklahoma...................     0.7663     0.8334
38...................  Oregon.....................     0.9826     0.9881
39...................  Pennsylvania...............     0.8330     0.8824
40...................  Puerto Rico \1\............  .........  .........
41...................  Rhode Island \1\...........     1.0791     1.0535
42...................  South Carolina.............     0.8604     0.9022
43...................  South Dakota...............     0.8485     0.8936
44...................  Tennessee..................     0.7957     0.8551
45...................  Texas......................     0.8003     0.8585
46...................  Utah.......................     0.8163     0.8702
47...................  Vermont....................     1.0986     1.0665
49...................  Virginia...................     0.7966     0.8558
50...................  Washington.................     1.0440     1.0299
51...................  West Virginia..............     0.7637     0.8314
52...................  Wisconsin..................     0.9466     0.9631
53...................  Wyoming....................     0.9303    0.9517
------------------------------------------------------------------------
\1\ All counties in the State or Territory are classified as urban, with
  the exception of Massachusetts. Massachusetts has area(s) designated
  as rural. However, no short-term, acute care hospitals were located in
  Rural Massachusetts during FY 2003, the base year for the FY 2007 wage
  index.
 Massachusetts, New Jersey, and Rhode Island rural floors are imputed as
  discussed in the FY 2005 IPPS final rule (69 FR 49109).


 Table 4C-1.--Wage Index and Capital Geographic Adjustment Factor (GAF)
          for Hospitals That Are Reclassified by CBSA--FY 2007
------------------------------------------------------------------------
                                                       Wage
      CBSA  code                   Area               index       GAF
------------------------------------------------------------------------
10180................  Abilene, TX................     0.8051     0.8620
10420................  Akron, OH..................     0.8737     0.9117
10580................  Albany-Schenectady-Troy, NY     0.8753     0.9128
10740................  Albuquerque, NM............     0.9477     0.9639
10780................  Alexandria, LA.............     0.8028     0.8603
10900................  Allentown-Bethlehem-Easton,     0.9927     0.9950
                        PA-NJ.
11100................  Amarillo, TX...............     0.9177     0.9429
11260................  Anchorage, AK..............     1.2062     1.1370
11460................  \1\Ann Arbor, MI...........     1.0630     1.0427
11500................  Anniston-Oxford, AL........     0.7978     0.8567
11700................  Asheville, NC..............     0.9110     0.9382
12020................  Athens-Clarke County, GA...     0.9707     0.9798
12060................  Atlanta-Sandy Springs-          0.9644     0.9755
                        Marietta, GA.
12260................  Augusta-Richmond County, GA-    0.9554     0.9692
                        SC.

[[Page 24260]]

 
12420................  Austin-Round Rock, TX......     0.9360     0.9557
12620................  Bangor, ME.................     0.9702     0.9795
12700................  Barnstable Town, MA........     1.2181     1.1447
12940................  Baton Rouge, LA............     0.8102     0.8658
13020................  Bay City, MI...............     1.0040     1.0027
13644................  Bethesda-Gaithersburg-          1.1028     1.0693
                        Frederick, MD.
13780................  Binghamton, NY.............     0.8499     0.8946
13820................  Birmingham-Hoover, AL......     0.8919     0.9246
13900................  Bismarck, ND...............     0.7255     0.8027
14484................  Boston-Quincy, MA..........     1.1318     1.0885
14540................  Bowling Green, KY..........     0.8164     0.8703
15380................  Buffalo-Niagara Falls, NY..     0.9475     0.9637
15540................  Burlington-South                0.9355     0.9554
                        Burlington, VT.
15764................  Cambridge-Newton-               1.0986     1.0665
                        Framingham, MA (VT
                        Hospitals).
15764................  Cambridge-Newton-               1.1665     1.1112
                        Framingham, MA (NH
                        Hospitals).
16180................  Carson City, NV............     0.9569     0.9703
16580................  Champaign-Urbana, IL.......     0.9155     0.9413
16620................  Charleston, WV.............     0.8294     0.8798
16700................  Charleston-North                0.9168     0.9422
                        Charleston, SC.
16740................  Charlotte-Gastonia-Concord,     0.9520     0.9669
                        NC-SC.
16820................  Charlottesville, VA........     0.9732     0.9816
16860................  Chattanooga, TN-GA.........     0.8841     0.9191
16974................  Chicago-Naperville-Joliet,      1.0596     1.0404
                        IL.
17140................  Cincinnati-Middletown, OH-      0.9599     0.9724
                        KY-IN.
17300................  Clarksville, TN-KY.........     0.8094     0.8652
17460................  Cleveland-Elyria-Mentor, OH     0.9212     0.9453
17780................  College Station-Bryan, TX..     0.9064     0.9349
17860................  Columbia, MO...............     0.8550     0.8983
17900................  Columbia, SC...............     0.8604     0.9022
17980................  Columbus, GA-AL............     0.8256     0.8770
18140................  Columbus, OH...............     0.9919     0.9944
18700................  Corvallis, OR..............     1.1175     1.0790
19124................  Dallas-Plano-Irving, TX....     0.9870     0.9911
19340................  Davenport-Moline-Rock           0.8696     0.9088
                        Island, IA-IL.
19380................  Dayton, OH.................     0.9049     0.9339
19460................  Decatur, AL................     0.8220     0.8744
19740................  Denver-Aurora, CO..........     1.0805     1.0545
19780................  Des Moines-West Des Moines,     0.8976     0.9287
                        IA.
19804................  Detroit-Livonia-Dearborn,       1.0235     1.0160
                        MI.
20100................  Dover, DE..................     0.9843     0.9892
20260................  Duluth, MN-WI..............     1.0157     1.0107
20500................  Durham, NC.................     0.9805     0.9866
20764................  Edison, NJ.................     1.1242     1.0835
21060................  Elizabethtown, KY..........     0.8207     0.8734
21500................  Erie, PA...................     0.8360     0.8846
21604................  Essex County, MA...........     1.1665     1.1112
21660................  Eugene-Springfield, OR.....     1.0525     1.0357
21780................  Evansville, IN-KY..........     0.8545     0.8979
22020                  Fargo, ND-MN...............     0.8485     0.8936
22180................  Fayetteville, NC...........     0.8962     0.9277
22220................  Fayetteville-Springdale-        0.8599     0.9018
                        Rogers, AR-MO.
22380................  Flagstaff, AZ..............     1.1121     1.0755
22420................  Flint, MI..................     1.0685     1.0464
22520................  Florence-Muscle Shoals, AL.     0.8008     0.8589
22540................  Fond du Lac, WI............     0.9489     0.9647
22660................  Fort Collins-Loveland, CO..     0.9594     0.9720
22744................  Fort Lauderdale-Pompano         1.0470     1.0320
                        Beach-Deerfield Beach, FL.
22900................  Fort Smith, AR-OK..........     0.7663     0.8334
23020................  Fort Walton Beach-Crestview-    0.8609     0.9025
                        Destin, FL.
23060................  Fort Wayne, IN.............     0.9498     0.9653
23104................  Fort Worth-Arlington, TX...     0.9591     0.9718
23540................  Gainesville, FL............     0.9299     0.9514
23844................  Gary, IN...................     0.9278     0.9500
24300................  Grand Junction, CO.........     1.0037     1.0025
24340................  Grand Rapids-Wyoming, MI...     0.9469     0.9633
24500................  Great Falls, MT............     0.8781     0.9148
24540................  Greeley, CO................     0.9636     0.9749
24580................  Green Bay, WI..............     0.9620     0.9738
24660................  Greensboro-High Point, NC..     0.8992     0.9298
24780................  Greenville, NC.............     0.9300     0.9515

[[Page 24261]]

 
24860................  Greenville, SC.............     0.9286     0.9505
25060................  Gulfport-Biloxi, MS........     0.8607     0.9024
25420................  Harrisburg-Carlisle, PA....     0.9263     0.9489
25540................  Hartford-West Hartford-East     1.1750     1.1168
                        Hartford, CT (CT
                        Hospitals).
25540................  Hartford-West Hartford-East     1.0918     1.0620
                        Hartford, CT (MA
                        Hospitals).
25860................  Hickory-Lenoir-Morganton,       0.8901     0.9234
                        NC.
26100................  Holland-Grand Haven, MI....     0.9241     0.9474
26180................  Honolulu, HI...............     1.1066     1.0718
26420................  Houston-Sugar Land-Baytown,     1.0030     1.0021
                        TX.
26580................  Huntington-Ashland, WV-KY-      0.8759     0.9133
                        OH.
26620................  Huntsville, AL.............     0.8829     0.9182
26820................  Idaho Falls, ID (ID             0.9300     0.9515
                        Hospitals).
26820................  Idaho Falls, ID (WY             0.9303     0.9517
                        Hospitals).
26900................  Indianapolis-Carmel, IN....     0.9582     0.9712
26980................  Iowa City, IA..............     0.9568     0.9702
27060................  Ithaca, NY.................     0.9439     0.9612
27140................  Jackson, MS................     0.8278     0.8786
27180................  Jackson, TN................     0.8640     0.9047
27260................  Jacksonville, FL...........     0.9046     0.9336
27860................  Jonesboro, AR (AR               0.7952     0.8548
                        Hospitals).
27860................  Jonesboro, AR (MO               0.8206     0.8734
                        Hospitals).
27900................  Joplin, MO.................     0.8620     0.9033
28020................  Kalamazoo-Portage, MI......     1.0737     1.0499
28100................  Kankakee-Bradley, IL.......     0.9728     0.9813
28140................  Kansas City, MO-KS.........     0.9501     0.9656
28420................  Kennewick-Richland-Pasco,       1.0440     1.0299
                        WA (WA Hospitals).
28420................  Kennewick-Richland-Pasco,       1.0033     1.0023
                        WA (ID Hospitals).
28700................  Kingsport-Bristol-Bristol,      0.8062     0.8628
                        TN-VA.
28740................  Kingston, NY...............     0.9058     0.9345
28940................  Knoxville, TN..............     0.8278     0.8786
29180................  Lafayette, LA..............     0.8300     0.8802
29404................  Lake County-Kenosha County,     1.0408     1.0278
                        IL-WI.
29460................  Lakeland, FL...............     0.8908     0.9239
29540................  Lancaster, PA..............     0.9768     0.9841
29620................  Lansing-East Lansing, MI...     0.9823     0.9878
29740................  Las Cruces, NM.............     0.9270     0.9494
29820................  Las Vegas-Paradise, NV.....     1.1240     1.0833
30020................  Lawton, OK.................     0.8116     0.8668
30460................  Lexington-Fayette, KY......     0.8928     0.9253
30620................  Lima, OH...................     0.9060     0.9346
30700................  Lincoln, NE................     0.9746     0.9825
30780................  Little Rock-North Little        0.8667     0.9067
                        Rock, AR.
30980................  Longview, TX...............     0.8905     0.9237
31084................  \1\ Los Angeles-Long Beach-     1.1600     1.1070
                        Santa Ana, CA.
31140................  Louisville-Jefferson            0.9137     0.9401
                        County, KY-IN.
31180................  Lubbock, TX................     0.8626     0.9037
31340................  Lynchburg, VA..............     0.8716     0.9102
31420................  Macon, GA..................     0.9176     0.9428
31540................  Madison, WI................     1.0502     1.0341
31700................  Manchester-Nashua, NH......     1.1665     1.1112
32780................  Medford, OR................     1.0450     1.0306
32820................  Memphis, TN-MS-AR..........     0.9032     0.9327
33124................  Miami-Miami Beach-Kendall,      0.9825     0.9880
                        FL.
33260................  Midland, TX................     0.9602     0.9726
33340................  Milwaukee-Waukesha-West         1.0098     1.0067
                        Allis, WI.
33460................  Minneapolis-St. Paul-           1.0842     1.0569
                        Bloomington, MN-WI.
33540................  Missoula, MT...............     0.8909     0.9239
33700................  Modesto, CA................     1.1731     1.1155
33740................  Monroe, LA.................     0.8015     0.8594
33860................  Montgomery, AL.............     0.8035     0.8609
34060................  Morgantown, WV.............     0.8449     0.8910
34980................  Nashville-Davidson--            0.9571     0.9704
                        Murfreesboro, TN.
35084................  Newark-Union, NJ-PA........     1.1886     1.1256
35300................  New Haven-Milford, CT......     1.2093     1.1390
35380................  New Orleans-Metairie-           0.8855     0.9201
                        Kenner, LA.
35644................  \1\ New York-White Plains-      1.3038     1.1992
                        Wayne, NY-NJ.
35980................  Norwich-New London, CT.....     1.2020     1.1343
36084................  Oakland-Fremont-Hayward, CA     1.5669     1.3601
36140................  Ocean City, NJ.............     1.0254     1.0173
36220................  Odessa, TX.................     0.9737     0.9819

[[Page 24262]]

 
36260................  Ogden-Clearfield, UT.......     0.9021     0.9319
36420................  Oklahoma City, OK..........     0.8857     0.9202
36540................  Omaha-Council Bluffs, NE-IA     0.9453     0.9622
36740................  Orlando-Kissimmee, FL......     0.9409     0.9591
37860................  Pensacola-Ferry Pass-Brent,     0.7999     0.8582
                        FL.
37900................  Peoria, IL.................     0.8827     0.9181
37964................  Philadelphia, PA (PA            1.1009     1.0680
                        Hospitals).
37964................  Philadelphia, PA (NJ            1.1226     1.0824
                        Hospitals).
38220................  Pine Bluff, AR.............     0.8224     0.8747
38300................  Pittsburgh, PA (PA and WV       0.8671     0.9070
                        Hospitals).
38300................  Pittsburgh, PA (OH              0.8673     0.9071
                        Hospitals).
38340................  Pittsfield, MA.............     1.0986     1.0665
38540................  Pocatello, ID..............     0.9400     0.9585
38860................  Portland-South Portland-        0.9487     0.9646
                        Biddeford, ME.
38900................  Portland-Vancouver-             1.1405     1.0942
                        Beaverton, OR-WA.
38940................  Port St. Lucie-Fort Pierce,     0.9857     0.9902
                        FL.
39100................  Poughkeepsie-Newburgh-          1.0583     1.0396
                        Middletown, NY.
39340................  Provo-Orem, UT.............     0.9537     0.9681
39580................  Raleigh-Cary, NC...........     0.9570     0.9704
39740................  Reading, PA................     0.9534     0.9678
39820................  Redding, CA................     1.2884     1.1895
39900................  Reno-Sparks, NV............     1.1524     1.1020
40060................  Richmond, VA...............     0.9174     0.9427
40220................  Roanoke, VA................     0.8677     0.9074
40340................  Rochester, MN..............     1.1246     1.0837
40380................  Rochester, NY..............     0.9007     0.9309
40420................  Rockford, IL...............     0.9773     0.9844
40484................  Rockingham County, NH......     1.0309     1.0211
40660................  Rome, GA...................     0.9307     0.9520
40900................  Sacramento--Arden-Arcade--      1.3350     1.2188
                        Roseville, CA.
40980................  Saginaw-Saginaw Township        0.9055     0.9343
                        North, MI.
41060................  St. Cloud, MN..............     0.9971     0.9980
41100................  St. George, UT.............     0.9295     0.9512
41140................  St. Joseph, MO-KS..........     0.9993     0.9995
41180................  St. Louis, MO-IL...........     0.8902     0.9234
41620................  Salt Lake City, UT.........     0.9421     0.9600
41700................  San Antonio, TX............     0.8859     0.9204
41884................  San Francisco-San Mateo-        1.5049     1.3230
                        Redwood City, CA.
41980................  San Juan-Caguas-Guaynabo,       0.4396     0.5696
                        PR.
42044................  Santa Ana-Anaheim-Irvine,       1.1291     1.0867
                        CA.
42140................  Santa Fe, NM...............     0.9814     0.9872
42220................  Santa Rosa-Petaluma, CA....     1.4294     1.2772
42260................  Sarasota-Bradenton-Venice,      0.9866     0.9908
                        FL.
42340................  Savannah, GA...............     0.8958     0.9274
42644................  Seattle-Bellevue-Everett,       1.1255     1.0843
                        WA.
43300................  Sherman-Denison, TX........     0.8376     0.8857
43340................  Shreveport-Bossier City, LA     0.8715     0.9101
43580................  Sioux City, IA-NE-SD.......     0.8816     0.9173
43620................  Sioux Falls, SD............     0.9456     0.9624
43780................  South Bend-Mishawaka, IN-MI     0.9543     0.9685
43900................  Spartanburg, SC............     0.9192     0.9439
44060................  Spokane, WA................     1.0284     1.0194
44180................  Springfield, MO............     0.8345     0.8835
44300................  State College, PA..........     0.8361     0.8846
44940................  Sumter, SC.................     0.8604     0.9022
45060................  Syracuse, NY...............     0.9428     0.9605
45104................  Tacoma, WA.................     1.0907     1.0613
45220................  Tallahassee, FL............     0.8982     0.9291
45300................  Tampa-St. Petersburg-           0.9249     0.9479
                        Clearwater, FL.
45500................  Texarkana, TX-Texarkana, AR     0.8133     0.8680
45780................  Toledo, OH.................     0.9588     0.9716
45820................  Topeka, KS.................     0.8591     0.9012
46140................  Tulsa, OK..................     0.8146     0.8690
46220................  Tuscaloosa, AL.............     0.7785     0.8424
46340................  Tyler, TX..................     0.8854     0.9200
46660................  Valdosta, GA...............     0.8101     0.8657
46700................  Vallejo-Fairfield, CA......     1.4527     1.2914
47260................  Virginia Beach-Norfolk-         0.8840     0.9190
                        Newport News, VA.
47380................  Waco, TX...................     0.8653     0.9057
47894................  Washington-Arlington-           1.1076     1.0725
                        Alexandria DC-VA.

[[Page 24263]]

 
48140................  Wausau, WI.................     0.9625     0.9742
48620................  Wichita, KS................     0.8832     0.9185
48700................  Williamsport, PA...........     0.8330     0.8824
48864................  Wilmington, DE-MD-NJ.......     1.0878     1.0593
48900................  Wilmington, NC.............     0.9516     0.9666
49180................  Winston-Salem, NC..........     0.9129     0.9395
49340................  Worcester, MA..............     1.1665     1.1112
49660................  Youngstown-Warren-Boardman,     0.8815     0.9173
                        OH-PA.
04...................  Arkansas...................     0.7487     0.8202
05...................  California.................     1.1291     1.0867
07...................  Connecticut................     1.1750     1.1168
10...................  Florida....................     0.8609     0.9025
14...................  Illinois...................     0.8210     0.8737
16...................  Iowa.......................     0.8696     0.9088
17...................  Kansas.....................     0.8017     0.8595
19...................  Louisiana..................     0.7487     0.8202
23...................  Michigan...................     0.9055     0.9343
24...................  Minnesota..................     0.9256     0.9484
26...................  Missouri...................     0.8206     0.8734
29...................  Nevada.....................     0.8674     0.9072
30...................  New Hampshire..............     1.1381     1.0926
33...................  New York...................     0.8267     0.8778
34...................  North Carolina.............     0.8607     0.9024
36...................  Ohio.......................     0.8673     0.9071
37...................  Oklahoma...................     0.7663     0.8334
38...................  Oregon.....................     0.9826     0.9881
39...................  Pennsylvania...............     0.8330     0.8824
44...................  Tennessee..................     0.7957     0.8551
45...................  Texas......................     0.8003     0.8585
47...................  Vermont....................     0.9974     0.9982
50...................  Washington.................     1.0440     1.0299
53...................  Wyoming....................     0.9154    0.9413
------------------------------------------------------------------------
\1\ For this area, the wage index and GAF on this table are only
  effective from October 1, 2006 through March 31, 2007. See Table 4C-2
  for the values that are effective from April 1 through September 30,
  2007.


 Table 4C-2.--Wage Index and Capital Geographic Adjustment Factor (GAF)
for Certain Hospitals That Are Reclassified by CBSA for the Period April
                      1 Through September 30, 2007*
------------------------------------------------------------------------
                                                       Wage
      CBSA  code                   Area               index       GAF
------------------------------------------------------------------------
11460................  Ann Arbor, MI..............     1.0391     1.0266
31084................  Los Angeles-Long Beach-         1.1603     1.1072
                        Santa Ana, CA.
34740................  Muskegon-Norton Shores, MI.     0.9683     0.9782
35004................  Nassau-Suffolk, NY.........     1.2511     1.1658
35644................  New York-White Plains-          1.3008    1.1973
                        Wayne, NY-NJ.
------------------------------------------------------------------------
* See Table 4C-1 for the wage index and GAF that are effective from
  October 1, 2006 through March 31, 2007. (For areas that are not listed
  on this table, the wage index and GAF on Table 4C-1 are effective for
  the entire FY 2007.)


        Table 4F.--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA--FY 2007
----------------------------------------------------------------------------------------------------------------
                                                                              Wage index--
      CBSA  code                   Area                Wage       GAF         reclassified     GAS--reclassified
                                                      index                    hospitals           hospitals
----------------------------------------------------------------------------------------------------------------
10380................  Aguadilla-Isabela-San           0.8950     0.9268  ...................  .................
                        Sebastian, PR.
21940................  Fajardo, PR................     0.9247     0.9478  ...................  .................
25020................  Guayama, PR................     0.7409     0.8144  ...................  .................
32420................  Mayaguez, PR...............     0.8812     0.9170  ...................  .................
38660................  Ponce, PR..................     1.1086     1.0732  ...................  .................
41900................  San German-Cabo Rojo, PR...     1.1160     1.0781  ...................  .................
41980................  San Juan-Caguas-Guaynabo,       1.0045     1.0031             1.0045              1.0031
                        PR.
49500................  Yauco, PR..................     0.8822     0.9177  ...................  .................
----------------------------------------------------------------------------------------------------------------

    The following list represents all hospitals that are eligible to 
have their wage index increased by the out-migration adjustment 
listed in this table. Hospitals cannot receive the out-migration 
adjustment if they are reclassified under section 1886(d)(10) of the

[[Page 24264]]

Act, reclassified under section 508 of Pub. L. 108-173, or 
redesignated under section 1886(d)(8) of the Act. If a hospital has 
a half fiscal year reclassification, the hospital will be eligible 
for the out-migration adjustment for the portion of the fiscal year 
that it is not reclassified. Hospitals that have already been 
reclassified under section 1886(d)(10) of the Act, reclassified 
under section 508 of Pub. L. 108-173, or redesignated under section 
1886(d)(8) of the Act for any portion of the fiscal year are 
designated with an asterisk Hospitals have 45 days from the 
publication of this proposed rule to review their individual 
situations to determine whether to submit a request to withdraw 
their reclassification/redesignation and receive the out-migration 
adjustment instead. We will automatically assume that hospitals that 
have already been reclassified under section 1886(d)(10) of the Act, 
reclassified under section 508 of Pub. L. 108-173, or redesignated 
under section 1886(d)(8) of the Act wish to retain their 
reclassification/redesignation status and waive the application of 
the out-migration adjustment. Hospitals are not required to provide 
CMS with any type of formal notification that they wish to remain 
reclassified/redesignated.

                                  Table 4J.--Out-Migration Adjustment--FY 2007
----------------------------------------------------------------------------------------------------------------
                                       Reclassified      Reclassified
            Provider No.              between 10/1/06   between 4/1/07     Out-migration     Qualifying county
                                        and 3/31/07      and 9/30/2007      adjustment              name
----------------------------------------------------------------------------------------------------------------
010005.............................                 *                 *            0.0259  MARSHALL.
010008.............................                 *                 *            0.0212  CRENSHAW.
010009.............................                 *                 *            0.0092  MORGAN.
010010.............................  ................  ................            0.0259  MARSHALL.
010012.............................                 *                 *            0.0205  DE KALB.
010022.............................                 *                 *            0.0714  CHEROKEE.
010025.............................                 *                 *            0.0235  CHAMBERS.
010029.............................                 *                 *            0.0107  LEE.
010035.............................                 *                 *            0.0375  CULLMAN.
010038.............................  ................  ................            0.0062  CALHOUN.
010045.............................                 *                 *            0.0160  FAYETTE.
010047.............................  ................  ................            0.0155  BUTLER.
010052.............................  ................  ................            0.0121  TALLAPOOSA.
010054.............................                 *                 *            0.0092  MORGAN.
010061.............................  ................  ................            0.0506  JACKSON.
010065.............................                 *                 *            0.0121  TALLAPOOSA.
010072.............................                 *                 *            0.0310  TALLADEGA.
010078.............................  ................  ................            0.0062  CALHOUN.
010083.............................                 *                 *            0.0121  BALDWIN.
010085.............................                 *                 *            0.0092  MORGAN.
010100.............................                 *                 *            0.0121  BALDWIN.
010101.............................                 *                 *            0.0310  TALLADEGA.
010109.............................  ................  ................            0.0451  PICKENS.
010129.............................  ................  ................            0.0121  BALDWIN.
010143.............................                 *                 *            0.0375  CULLMAN
010146.............................  ................  ................            0.0062  CALHOUN.
010150.............................                 *                 *            0.0155  BUTLER.
010158.............................                 *                 *            0.0093  FRANKLIN.
010164.............................                 *                 *            0.0310  TALLADEGA.
040014.............................                 *                 *            0.0159  WHITE.
040019.............................                 *                 *            0.0697  ST. FRANCIS.
040047.............................                 *                 *            0.0090  RANDOLPH.
040069.............................                 *                 *            0.0140  MISSISSIPPI.
040071.............................                 *                 *            0.0026  JEFFERSON.
040076.............................                 *                 *            0.1075  HOT SPRING.
040100.............................                 *                 *            0.0159  WHITE.
050008.............................  ................  ................            0.0026  SAN FRANCISCO.
050009.............................                 *                 *            0.0478  NAPA.
050013.............................                 *                 *            0.0478  NAPA.
050014.............................                 *                 *            0.0131  AMADOR.
050016.............................  ................  ................            0.0103  SAN LUIS OBISPO.
050042.............................                 *                 *            0.0219  TEHAMA.
050046.............................  ................                 *            0.0156  VENTURA.
050047.............................  ................  ................            0.0026  SAN FRANCISCO.
050055.............................  ................  ................            0.0026  SAN FRANCISCO.
050065.............................                 *                 *            0.0029  ORANGE.
050069.............................                 *                 *            0.0029  ORANGE.
050073.............................                 *                 *            0.0269  SOLANO.
050076.............................                 *                 *            0.0026  SAN FRANCISCO.
050082.............................  ................                 *            0.0156  VENTURA.
050084.............................  ................  ................            0.0555  SAN JOAQUIN.
050089.............................                 *                 *            0.0152  SAN BERNARDINO.
050090.............................                 *                 *            0.0308  SONOMA.
050099.............................                 *                 *            0.0152  SAN BERNARDINO.
050101.............................                 *                 *            0.0269  SOLANO.
050117.............................  ................  ................            0.0463  MERCED.
050118.............................                 *                 *            0.0555  SAN JOAQUIN.
050122.............................  ................  ................            0.0555  SAN JOAQUIN.
050129.............................                 *                 *            0.0152  SAN BERNARDINO.
050131.............................  ................  ................            0.0033  MARIN.

[[Page 24265]]

 
050133.............................  ................  ................            0.0170  YUBA.
050136.............................                 *                 *            0.0308  SONOMA.
050140.............................                 *                 *            0.0152  SAN BERNARDINO.
050150.............................                 *                 *            0.0316  NEVADA.
050152.............................  ................  ................            0.0026  SAN FRANCISCO.
050159.............................  ................                 *            0.0156  VENTURA.
050167.............................  ................  ................            0.0555  SAN JOAQUIN.
050168.............................                 *                 *            0.0029  ORANGE.
050173.............................                 *                 *            0.0029  ORANGE.
050174.............................                 *                 *            0.0308  SONOMA.
050177.............................  ................  ................            0.0156  VENTURA.
050193.............................                 *                 *            0.0029  ORANGE.
050224.............................                 *                 *            0.0029  ORANGE.
050226.............................                 *                 *            0.0029  ORANGE.
050228.............................                 *                 *            0.0026  SAN FRANCISCO.
050230.............................                 *                 *            0.0029  ORANGE.
050232.............................  ................  ................            0.0103  SAN LUIS OBISPO.
050236.............................  ................                 *            0.0156  VENTURA.
050245.............................                 *                 *            0.0152  SAN BERNARDINO.
050272.............................                 *                 *            0.0152  SAN BERNARDINO.
050279.............................                 *                 *            0.0152  SAN BERNARDINO.
050291.............................                 *                 *            0.0308  SONOMA.
050298.............................                 *                 *            0.0152  SAN BERNARDINO.
050300.............................                 *                 *            0.0152  SAN BERNARDINO.
050313.............................  ................  ................            0.0555  SAN JOAQUIN.
050325.............................  ................  ................            0.0176  TUOLUMNE.
050327.............................                 *                 *            0.0152  SAN BERNARDINO.
050335.............................  ................  ................            0.0176  TUOLUMNE.
050336.............................  ................  ................            0.0555  SAN JOAQUIN.
050348.............................                 *                 *            0.0029  ORANGE.
050360.............................  ................  ................            0.0033  MARIN.
050367.............................                 *                 *            0.0269  SOLANO.
050385.............................                 *                 *            0.0308  SONOMA.
050394.............................  ................                 *            0.0156  VENTURA.
050407.............................  ................  ................            0.0026  SAN FRANCISCO.
050426.............................                 *                 *            0.0029  ORANGE.
050444.............................  ................  ................            0.0463  MERCED.
050454.............................  ................  ................            0.0026  SAN FRANCISCO.
050457.............................  ................  ................            0.0026  SAN FRANCISCO.
050469.............................                 *                 *            0.0152  SAN BERNARDINO.
050476.............................  ................  ................            0.0257  LAKE.
050494.............................                 *  ................            0.0316  NEVADA.
050506.............................  ................  ................            0.0103  SAN LUIS OBISPO.
050510.............................                 *                 *            0.0033  MARIN.
050517.............................                 *                 *            0.0152  SAN BERNARDINO.
050526.............................                 *                 *            0.0029  ORANGE.
050528.............................                 *                 *            0.0463  MERCED.
050535.............................                 *                 *            0.0029  ORANGE.
050543.............................                 *                 *            0.0029  ORANGE.
050547.............................                 *                 *            0.0308  SONOMA.
050548.............................                 *                 *            0.0029  ORANGE.
050549.............................                 *                 *            0.0156  VENTURA.
050550.............................                 *                 *            0.0029  ORANGE.
050551.............................                 *                 *            0.0029  ORANGE.
050567.............................                 *                 *            0.0029  ORANGE.
050568.............................  ................  ................            0.0062  MADERA.
050570.............................                 *                 *            0.0029  ORANGE.
050580.............................                 *                 *            0.0029  ORANGE.
050584.............................                 *                 *            0.0152  SAN BERNARDINO.
050585.............................                 *                 *            0.0029  ORANGE.
050586.............................                 *                 *            0.0152  SAN BERNARDINO.
050589.............................                 *                 *            0.0029  ORANGE.
050592.............................                 *                 *            0.0029  ORANGE.
050594.............................                 *                 *            0.0029  ORANGE.
050603.............................                 *                 *            0.0029  ORANGE.
050609.............................                 *                 *            0.0029  ORANGE.
050616.............................  ................                 *            0.0156  VENTURA.
050618.............................                 *                 *            0.0152  SAN BERNARDINO.
050633.............................  ................  ................            0.0103  SAN LUIS OBISPO.
050667.............................                 *                 *            0.0478  NAPA.

[[Page 24266]]

 
050668.............................  ................  ................            0.0026  SAN FRANCISCO.
050678.............................                 *                 *            0.0029  ORANGE.
050680.............................                 *                 *            0.0269  SOLANO.
050690.............................                 *                 *            0.0308  SONOMA.
050693.............................                 *                 *            0.0029  ORANGE.
050695.............................  ................  ................            0.0555  SAN JOAQUIN.
050720.............................                 *                 *            0.0029  ORANGE.
050728.............................                 *                 *            0.0308  SONOMA.
050731.............................  ................  ................            0.0152  SAN BERNARDINO.
060001.............................  ................  ................            0.0294  WELD.
060003.............................                 *                 *            0.0203  BOULDER.
060010.............................  ................  ................            0.0095  LARIMER.
060027.............................                 *                 *            0.0203  BOULDER.
060030.............................  ................  ................            0.0095  LARIMER.
060103.............................                 *                 *            0.0203  BOULDER.
070003.............................                 *                 *            0.0009  WINDHAM.
070006.............................                 *                 *            0.0047  FAIRFIELD.
070010.............................                 *                 *            0.0047  FAIRFIELD.
070018.............................                 *                 *            0.0047  FAIRFIELD.
070020.............................  ................  ................            0.0073  MIDDLESEX.
070021.............................                 *                 *            0.0009  WINDHAM.
070028.............................                 *                 *            0.0047  FAIRFIELD.
070033.............................                 *                 *            0.0047  FAIRFIELD.
070034.............................                 *                 *            0.0047  FAIRFIELD.
080001.............................  ................  ................            0.0063  NEW CASTLE.
080003.............................  ................  ................            0.0063  NEW CASTLE.
100014.............................  ................  ................            0.0118  VOLUSIA.
100017.............................  ................  ................            0.0118  VOLUSIA.
100045.............................                 *                 *            0.0118  VOLUSIA.
100047.............................  ................  ................            0.0021  CHARLOTTE.
100062.............................  ................  ................            0.0060  MARION.
100068.............................  ................  ................            0.0118  VOLUSIA.
100072.............................  ................  ................            0.0118  VOLUSIA.
100077.............................  ................  ................            0.0021  CHARLOTTE.
100102.............................  ................  ................            0.0125  COLUMBIA.
100118.............................                 *                 *            0.0398  FLAGLER.
100156.............................  ................  ................            0.0125  COLUMBIA.
100175.............................  ................  ................            0.0231  DE SOTO.
100212.............................  ................  ................            0.0060  MARION.
100232.............................                 *                 *            0.0347  PUTNAM.
100236.............................  ................  ................            0.0021  CHARLOTTE.
100252.............................                 *                 *            0.0233  OKEECHOBEE.
100290.............................  ................  ................            0.0582  SUMTER.
110023.............................                 *                 *            0.0500  GORDON.
110027.............................  ................  ................            0.0387  FRANKLIN.
110029.............................                 *                 *            0.0063  HALL.
110041.............................                 *                 *            0.0777  HABERSHAM.
110069.............................                 *                 *            0.0474  HOUSTON.
110124.............................  ................  ................            0.0428  WAYNE.
110136.............................  ................  ................            0.0261  BALDWIN
110146.............................  ................  ................            0.0786  CAMDEN.
110150.............................                 *                 *            0.0261  BALDWIN
110153.............................                 *                 *            0.0474  HOUSTON.
110187.............................                 *                 *            0.1172  LUMPKIN.
110189.............................                 *                 *            0.0031  FANNIN.
110190.............................  ................  ................            0.0182  MACON.
110205.............................                 *                 *            0.0779  GILMER.
130003.............................                 *                 *            0.0095  NEZ PERCE.
130024.............................  ................  ................            0.0275  BONNER.
130049.............................                 *                 *            0.0349  KOOTENAI.
130066.............................  ................  ................            0.0349  KOOTENAI.
140012.............................                 *                 *            0.0220  LEE.
140026.............................  ................  ................            0.0346  LA SALLE.
140033.............................                 *                 *            0.0147  LAKE.
140043.............................                 *                 *            0.0046  WHITESIDE.
140058.............................                 *                 *            0.0081  MORGAN.
140084.............................                 *                 *            0.0147  LAKE.
140100.............................                 *                 *            0.0147  LAKE.
140110.............................                 *                 *            0.0346  LA SALLE.
140130.............................                 *                 *            0.0147  LAKE.

[[Page 24267]]

 
140155.............................  ................  ................            0.0027  KANKAKEE.
140160.............................                 *                 *            0.0286  STEPHENSON.
140161.............................                 *                 *            0.0138  LIVINGSTON.
140186.............................  ................  ................            0.0027  KANKAKEE.
140202.............................                 *                 *            0.0147  LAKE.
140205.............................  ................  ................            0.0163  BOONE.
140234.............................                 *                 *            0.0346  LA SALLE.
140291.............................                 *                 *            0.0147  LAKE.
150006.............................                 *                 *            0.0084  LA PORTE.
150015.............................                 *                 *            0.0084  LA PORTE.
150022.............................  ................  ................            0.0249  MONTGOMERY.
150030.............................                 *                 *            0.0201  HENRY.
150035.............................  ................  ................            0.0083  PORTER.
150045.............................  ................  ................            0.0416  DE KALB.
150065.............................                 *                 *            0.0139  JACKSON.
150076.............................                 *                 *            0.0189  MARSHALL.
150088.............................                 *                 *            0.0196  MADISON.
150091.............................  ................  ................            0.0573  HUNTINGTON.
150102.............................                 *                 *            0.0160  STARKE.
150113.............................                 *                 *            0.0196  MADISON.
150122.............................                 *                 *            0.0199  RIPLEY.
150146.............................                 *                 *            0.0440  NOBLE.
160013.............................  ................  ................            0.0218  MUSCATINE.
160030.............................  ................  ................            0.0040  STORY.
160032.............................  ................  ................            0.0272  JASPER.
160080.............................                 *                 *            0.0049  CLINTON.
170137.............................                 *                 *            0.0336  DOUGLAS.
180012.............................                 *                 *            0.0083  HARDIN.
180049.............................  ................  ................            0.0576  MADISON.
180066.............................                 *                 *            0.0567  LOGAN.
180127.............................                 *                 *            0.0352  FRANKLIN.
180128.............................  ................  ................            0.0282  LAWRENCE.
190001.............................                 *                 *            0.0645  WASHINGTON.
190003.............................                 *                 *            0.0107  IBERIA.
190015.............................                 *                 *            0.0401  TANGIPAHOA.
190017.............................  ................  ................            0.0235  ST. LANDRY.
190054.............................  ................  ................            0.0107  IBERIA.
190078.............................  ................  ................            0.0235  ST. LANDRY.
190088.............................  ................  ................            0.0705  WEBSTER.
190099.............................                 *                 *            0.0390  AVOYELLES.
190106.............................                 *                 *            0.0238  ALLEN.
190133.............................  ................  ................            0.0238  ALLEN.
190144.............................  ................  ................            0.0705  WEBSTER.
190184.............................  ................  ................            0.0161  CALDWELL.
190190.............................  ................  ................            0.0161  CALDWELL.
190191.............................                 *                 *            0.0235  ST. LANDRY.
190246.............................  ................  ................            0.0161  CALDWELL.
200002.............................  ................  ................            0.0129  LINCOLN.
200024.............................                 *                 *            0.0071  ANDROSCOGGIN.
200032.............................  ................  ................            0.0466  OXFORD.
200034.............................                 *                 *            0.0071  ANDROSCOGGIN.
200050.............................                 *                 *            0.0140  HANCOCK.
210001.............................  ................  ................            0.0129  WASHINGTON.
210004.............................  ................  ................            0.0040  MONTGOMERY.
210016.............................  ................  ................            0.0040  MONTGOMERY.
210018.............................  ................  ................            0.0040  MONTGOMERY.
210022.............................  ................  ................            0.0040  MONTGOMERY.
210023.............................  ................  ................            0.0209  ANNE ARUNDEL.
210028.............................  ................  ................            0.0512  ST. MARYS.
210043.............................  ................  ................            0.0209  ANNE ARUNDEL.
210048.............................  ................  ................            0.0287  HOWARD.
210057.............................  ................  ................            0.0040  MONTGOMERY.
220001.............................                 *                 *            0.0056  WORCESTER.
220002.............................                 *                 *            0.0249  MIDDLESEX.
220006.............................  ................  ................            0.0306  ESSEX.
220010.............................                 *                 *            0.0306  ESSEX.
220011.............................                 *                 *            0.0249  MIDDLESEX.
220019.............................                 *                 *            0.0056  WORCESTER.
220025.............................                 *                 *            0.0056  WORCESTER.
220028.............................                 *                 *            0.0056  WORCESTER.

[[Page 24268]]

 
220029.............................                 *                 *            0.0306  ESSEX.
220033.............................                 *                 *            0.0306  ESSEX.
220035.............................                 *                 *            0.0306  ESSEX.
220049.............................                 *                 *            0.0249  MIDDLESEX.
220058.............................                 *                 *            0.0056  WORCESTER.
220062.............................                 *                 *            0.0056  WORCESTER.
220063.............................                 *                 *            0.0249  MIDDLESEX.
220070.............................                 *                 *            0.0249  MIDDLESEX.
220080.............................                 *                 *            0.0306  ESSEX.
220082.............................                 *                 *            0.0249  MIDDLESEX.
220084.............................                 *                 *            0.0249  MIDDLESEX.
220089.............................  ................  ................            0.0249  MIDDLESEX.
220090.............................                 *                 *            0.0056  WORCESTER.
220095.............................                 *                 *            0.0056  WORCESTER.
220098.............................                 *                 *            0.0249  MIDDLESEX.
220101.............................                 *                 *            0.0249  MIDDLESEX.
220105.............................                 *                 *            0.0249  MIDDLESEX.
220163.............................                 *                 *            0.0056  WORCESTER.
220171.............................                 *                 *            0.0249  MIDDLESEX.
220174.............................                 *                 *            0.0306  ESSEX.
230003.............................                 *                 *            0.0035  OTTAWA.
230013.............................                 *                 *            0.0091  OAKLAND.
230015.............................  ................  ................            0.0359  ST. JOSEPH.
230019.............................                 *                 *            0.0091  OAKLAND.
230021.............................  ................  ................            0.0136  BERRIEN.
230022.............................                 *                 *            0.0113  BRANCH.
230029.............................                 *                 *            0.0091  OAKLAND.
230037.............................                 *                 *            0.0178  HILLSADLE.
230041.............................  ................  ................            0.0099  BAY.
230047.............................                 *                 *            0.0082  MACOMB.
230069.............................                 *                 *            0.0487  LIVINGSTON.
230071.............................                 *                 *            0.0091  OAKLAND.
230072.............................                 *                 *            0.0035  OTTAWA.
230075.............................  ................  ................            0.0145  CALHOUN.
230078.............................                 *                 *            0.0136  BERRIEN.
230092.............................                 *                 *            0.0389  JACKSON.
230093.............................                 *                 *            0.0079  MECOSTA.
230096.............................                 *                 *            0.0359  ST. JOSEPH.
230099.............................                 *                 *            0.0339  MONROE.
230106.............................  ................                 *            0.0030  NEWAYGO.
230121.............................                 *                 *            0.0691  SHIAWASSEE.
230130.............................                 *                 *            0.0091  OAKLAND.
230151.............................                 *                 *            0.0091  OAKLAND.
230174.............................                 *                 *            0.0035  OTTAWA.
230184.............................  ................  ................            0.0389  JACKSON.
230195.............................                 *                 *            0.0082  MACOMB.
230204.............................                 *                 *            0.0082  MACOMB.
230207.............................                 *                 *            0.0091  OAKLAND.
230217.............................                 *                 *            0.0145  CALHOUN.
230222.............................  ................  ................            0.0228  MIDLAND.
230223.............................                 *                 *            0.0091  OAKLAND.
230227.............................                 *                 *            0.0082  MACOMB.
230254.............................                 *                 *            0.0091  OAKLAND.
230257.............................                 *                 *            0.0082  MACOMB.
230264.............................                 *                 *            0.0082  MACOMB.
230269.............................                 *                 *            0.0091  OAKLAND.
230277.............................                 *                 *            0.0091  OAKLAND.
230279.............................                 *                 *            0.0487  LIVINGSTON.
240018.............................                 *                 *            0.1196  GOODHUE.
240044.............................  ................  ................            0.0868  WINONA.
240064.............................                 *                 *            0.0138  ITASCA.
240069.............................                 *                 *            0.0419  STEELE.
240071.............................                 *                 *            0.0454  RICE.
240187.............................                 *                 *            0.0506  MC LEOD.
240211.............................                 *                 *            0.0705  PINE.
250040.............................                 *                 *            0.0294  JACKSON.
260011.............................                 *                 *            0.0007  COLE.
260047.............................                 *                 *            0.0007  COLE.
260074.............................                 *                 *            0.0158  RANDOLPH.
260097.............................  ................  ................            0.0425  JOHNSON.

[[Page 24269]]

 
280077.............................                 *                 *            0.0089  DODGE.
280123.............................  ................  ................            0.0137  GAGE.
290019.............................                 *                 *            0.0026  CARSON CITY.
290049.............................  ................  ................            0.0026  CARSON CITY.
300011.............................                 *                 *            0.0069  HILLSBOURGH.
300012.............................                 *                 *            0.0069  HILLSBOURGH.
300017.............................                 *                 *            0.0361  ROCKINGHAM.
300020.............................                 *                 *            0.0069  HILLSBOURGH.
300023.............................                 *                 *            0.0361  ROCKINGHAM.
300029.............................                 *                 *            0.0361  ROCKINGHAM.
300034.............................                 *                 *            0.0069  HILLSBOURGH.
310002.............................                 *                 *            0.0351  ESSEX.
310009.............................                 *                 *            0.0351  ESSEX.
310010.............................  ................  ................            0.0092  MERCER.
310011.............................  ................  ................            0.0115  CAPE MAY.
310013.............................                 *                 *            0.0351  ESSEX.
310018.............................                 *                 *            0.0351  ESSEX.
310021.............................                 *                 *            0.0092  MERCER.
310038.............................                 *                 *            0.0350  MIDDLESEX.
310039.............................                 *                 *            0.0350  MIDDLESEX.
310044.............................  ................  ................            0.0092  MERCER.
310054.............................                 *                 *            0.0351  ESSEX.
310070.............................                 *                 *            0.0350  MIDDLESEX.
310076.............................                 *                 *            0.0351  ESSEX.
310078.............................                 *                 *            0.0351  ESSEX.
310083.............................                 *                 *            0.0351  ESSEX.
310092.............................  ................  ................            0.0092  MERCER.
310093.............................                 *                 *            0.0351  ESSEX.
310096.............................                 *                 *            0.0351  ESSEX.
310108.............................                 *                 *            0.0350  MIDDLESEX.
310110.............................  ................  ................            0.0092  MERCER.
310119.............................                 *                 *            0.0351  ESSEX.
310123.............................  ................  ................            0.0351  ESSEX.
310124.............................  ................  ................            0.0350  MIDDLESEX.
320003.............................  ................  ................            0.0629  SAN MIGUEL
320011.............................  ................  ................            0.0442  RIO ARRIBA.
320018.............................  ................  ................            0.0063  DONA ANA.
320085.............................  ................  ................            0.0063  DONA ANA.
330004.............................                 *                 *            0.0959  ULSTER.
330008.............................                 *                 *            0.0470  WYOMING.
330027.............................                 *                 *            0.0137  NASSAU.
330094.............................                 *                 *            0.0778  COLUMBIA.
330106.............................                 *                 *            0.0137  NASSAU.
330126.............................                 *  ................            0.0560  ORANGE.
330135.............................                 *  ................            0.0560  ORANGE.
330167.............................  ................                 *            0.0137  NASSAU.
330181.............................  ................                 *            0.0137  NASSAU.
330182.............................                 *                 *            0.0137  NASSAU.
330191.............................                 *                 *            0.0026  WARREN.
330198.............................  ................                 *            0.0137  NASSAU.
330205.............................                 *  ................            0.0560  ORANGE.
330209.............................                 *  ................            0.0560  ORANGE.
330224.............................                 *                 *            0.0959  ULSTER.
330225.............................  ................                 *            0.0137  NASSAU.
330235.............................                 *                 *            0.0270  CAYUGA.
330259.............................  ................                 *            0.0137  NASSAU.
330264.............................                 *  ................            0.0560  ORANGE.
330276.............................  ................  ................            0.0063  FULTON.
330331.............................  ................                 *            0.0137  NASSAU.
330332.............................  ................                 *            0.0137  NASSAU.
330372.............................  ................                 *            0.0137  NASSAU.
330386.............................                 *                 *            0.1139  SULLIVAN.
340015.............................  ................  ................            0.0267  ROWAN.
340020.............................  ................  ................            0.0207  LEE.
340021.............................                 *                 *            0.0216  CLEVELAND.
340037.............................  ................  ................            0.0216  CLEVELAND.
340039.............................                 *                 *            0.0144  IREDELL.
340069.............................                 *                 *            0.0053  WAKE.
340070.............................                 *                 *            0.0448  ALAMANCE.
340073.............................                 *                 *            0.0053  WAKE.

[[Page 24270]]

 
340085.............................  ................  ................            0.0377  DAVIDSON.
340096.............................  ................  ................            0.0377  DAVIDSON.
340104.............................  ................  ................            0.0216  CLEVELAND.
340114.............................                 *                 *            0.0053  WAKE.
340126.............................                 *                 *            0.0161  WILSON.
340127.............................                 *                 *            0.0961  GRANVILLE.
340129.............................                 *                 *            0.0144  IREDELL.
340133.............................  ................  ................            0.0308  MARTIN.
340138.............................                 *                 *            0.0053  WAKE.
340144.............................                 *                 *            0.0144  IREDELL.
340145.............................                 *                 *            0.0563  LINCOLN.
340173.............................                 *                 *            0.0053  WAKE.
360013.............................                 *                 *            0.0166  SHELBY.
360025.............................                 *                 *            0.0087  ERIE.
360036.............................                 *                 *            0.0263  WAYNE.
360065.............................                 *                 *            0.0141  HURON.
360070.............................  ................  ................            0.0028  STARK.
360078.............................                 *                 *            0.0159  PORTAGE.
360084.............................                 *                 *            0.0028  STARK.
360086.............................                 *                 *            0.0168  CLARK.
360095.............................                 *                 *            0.0087  HANCOCK.
360100.............................  ................  ................            0.0028  STARK.
360107.............................                 *                 *            0.0213  SANDUSKY
360131.............................  ................  ................            0.0028  STARK.
360151.............................  ................  ................            0.0028  STARK.
360156.............................  ................  ................            0.0213  SANDUSKY
360175.............................                 *                 *            0.0159  CLINTON.
360187.............................                 *                 *            0.0168  CLARK.
360197.............................                 *                 *            0.0092  LOGAN.
360267.............................  ................  ................            0.0028  STARK.
370004.............................                 *                 *            0.0193  OTTAWA.
370014.............................                 *                 *            0.0831  BRYAN.
370015.............................                 *                 *            0.0463  MAYES.
370023.............................  ................  ................            0.0084  STEPHENS.
370065.............................  ................  ................            0.0121  CRAIG.
370113.............................                 *                 *            0.0205  DELAWRE.
370149.............................  ................  ................            0.0356  POTTAWATOMIE.
380002.............................  ................  ................            0.0130  JOSEPHINE.
380022.............................                 *                 *            0.0201  LINN.
380029.............................  ................  ................            0.0075  MARION.
380051.............................  ................  ................            0.0075  MARION.
380056.............................  ................  ................            0.0075  MARION.
390011.............................  ................  ................            0.0012  CAMBRIA.
390030.............................                 *                 *            0.0276  SCHUYLKILL.
390031.............................                 *                 *            0.0276  SCHUYLKILL.
390044.............................  ................  ................            0.0200  BERKS.
390046.............................                 *                 *            0.0098  YORK.
390056.............................  ................  ................            0.0042  HUNTINGDON.
390065.............................                 *                 *            0.0501  ADAMS.
390066.............................                 *                 *            0.0259  LEBANON.
390096.............................  ................  ................            0.0200  BERKS.
390101.............................  ................  ................            0.0098  YORK.
390110.............................                 *                 *            0.0012  CAMBRIA.
390130.............................  ................  ................            0.0012  CAMBRIA.
390138.............................                 *                 *            0.0325  FRANKLIN.
390146.............................                 *                 *            0.0053  WARREN.
390150.............................                 *                 *            0.0206  GREENE.
390151.............................                 *                 *            0.0325  FRANKLIN.
390162.............................  ................  ................            0.0200  NORTHAMPTON.
390181.............................                 *                 *            0.0276  SCHUYLKILL.
390183.............................                 *                 *            0.0276  SCHUYLKILL.
390201.............................                 *                 *            0.1127  MONROE.
390233.............................  ................  ................            0.0098  YORK.
420007.............................                 *                 *            0.0001  SPARTANBURG.
420009.............................                 *                 *            0.0153  OCONEE.
420020.............................                 *                 *            0.0035  GEORGETOWN.
420027.............................                 *                 *            0.0210  ANDERSON.
420030.............................                 *                 *            0.0103  COLLETON.
420039.............................                 *                 *            0.0153  UNION.
420043.............................  ................  ................            0.0177  CHEROKEE.

[[Page 24271]]

 
420062.............................  ................  ................            0.0135  CHESTERFIELD.
420068.............................                 *                 *            0.0097  ORANGE.BURG
420070.............................                 *                 *            0.0101  SUMTER.
420083.............................                 *                 *            0.0001  SPARTANBURG.
420093.............................  ................  ................            0.0001  SPARTANBURG.
420098.............................  ................  ................            0.0035  GEORGETOWN.
440008.............................                 *                 *            0.0663  HENDERSON.
440012.............................  ................  ................            0.0016  SULLIVAN.
440017.............................  ................  ................            0.0016  SULLIVAN.
440024.............................                 *                 *            0.0387  BRADLEY.
440030.............................  ................  ................            0.0056  HAMBLEN.
440035.............................                 *                 *            0.0441  MONTGOMERY.
440047.............................  ................  ................            0.0499  GIBSON.
440051.............................  ................  ................            0.0104  MC NAIRY.
440056.............................  ................  ................            0.0321  JEFFERSON.
440060.............................                 *                 *            0.0499  GIBSON.
440063.............................  ................  ................            0.0011  WASHINGTON.
440067.............................                 *                 *            0.0056  HAMBLEN.
440073.............................                 *                 *            0.0513  MAURY.
440105.............................  ................  ................            0.0011  WASHINGTON.
440115.............................  ................  ................            0.0499  GIBSON.
440148.............................                 *                 *            0.0568  DE KALB.
440153.............................  ................  ................            0.0007  COCKE.
440174.............................  ................  ................            0.0372  HAYWOOD.
440176.............................  ................  ................            0.0016  SULLIVAN.
440181.............................  ................  ................            0.0407  HARDEMAN.
440184.............................  ................  ................            0.0011  WASHINGTON.
440185.............................                 *                 *            0.0387  BRADLEY.
450032.............................                 *                 *            0.0416  HARRISON.
450039.............................                 *                 *            0.0097  TARRANT.
450059.............................                 *                 *            0.0073  COMAL.
450064.............................                 *                 *            0.0097  TARRANT.
450087.............................                 *                 *            0.0097  TARRANT.
450099.............................                 *                 *            0.0180  GRAY.
450121.............................                 *                 *            0.0097  TARRANT.
450135.............................                 *                 *            0.0097  TARRANT.
450137.............................                 *                 *            0.0097  TARRANT.
450144.............................                 *                 *            0.0573  ANDREWS.
450163.............................  ................  ................            0.0134  KELBERG.
450187.............................                 *                 *            0.0264  WASHINGTON.
450194.............................                 *                 *            0.0328  CHEROKEE.
450214.............................                 *                 *            0.0368  WHARTON.
450224.............................                 *                 *            0.0411  WOOD.
450324.............................  ................  ................            0.0156  GRAYSON.
450347.............................                 *                 *            0.0427  WALKER.
450370.............................  ................  ................            0.0258  COLORADO.
450389.............................                 *                 *            0.0881  HENDERSON.
450395.............................                 *                 *            0.0484  POLK.
450419.............................                 *                 *            0.0097  TARRANT.
450438.............................                 *                 *            0.0258  COLORADO.
450447.............................                 *                 *            0.0358  NAVARRO.
450451.............................                 *                 *            0.0551  SOMERVELL.
450465.............................  ................  ................            0.0435  MATAGORDA.
450469.............................  ................  ................            0.0156  GRAYSON.
450547.............................                 *                 *            0.0411  WOOD.
450563.............................                 *                 *            0.0097  TARRANT.
450565.............................  ................  ................            0.0486  PALO PINTO.
450596.............................  ................  ................            0.0808  HOOD.
450597.............................  ................  ................            0.0077  DE WIT.
450639.............................                 *                 *            0.0097  TARRANT.
450672.............................                 *                 *            0.0097  TARRANT.
450675.............................                 *                 *            0.0097  TARRANT.
450677.............................                 *                 *            0.0097  TARRANT.
450694.............................                 *                 *            0.0368  WHARTON.
450747.............................                 *                 *            0.0195  ANDERSON.
450755.............................                 *                 *            0.0484  HOCKLEY.
450779.............................                 *                 *            0.0097  TARRANT.
450813.............................                 *                 *            0.0195  ANDERSON.
450858.............................                 *                 *            0.0097  TARRANT.
450872.............................                 *                 *            0.0097  TARRANT.

[[Page 24272]]

 
450880.............................                 *                 *            0.0097  TARRANT.
460017.............................  ................  ................            0.0392  BOX ELDER.
460039.............................                 *                 *            0.0392  BOX ELDER.
490019.............................  ................  ................            0.1240  CULPEPER.
490038.............................  ................  ................            0.0022  SMYTH.
490084.............................  ................  ................            0.0167  ESSEX.
490105.............................                 *                 *            0.0022  SMYTH.
490110.............................  ................  ................            0.0082  MONTGOMERY.
500003.............................                 *                 *            0.0208  SKAGIT.
500007.............................  ................  ................            0.0208  SKAGIT.
500019.............................  ................  ................            0.0213  LEWIS.
500021.............................                 *                 *            0.0055  PIERCE.
500024.............................                 *                 *            0.0023  THURSTON.
500039.............................                 *                 *            0.0174  KITSAP.
500041.............................                 *                 *            0.0118  COWLITZ.
500079.............................                 *                 *            0.0055  PIERCE.
500108.............................                 *                 *            0.0055  PIERCE.
500129.............................                 *                 *            0.0055  PIERCE.
500139.............................                 *                 *            0.0023  THURSTON.
500143.............................  ................  ................            0.0023  THURSTON.
510018.............................                 *                 *            0.0209  JACKSON.
510039.............................  ................  ................            0.0112  OHIO.
510047.............................                 *                 *            0.0275  MARION.
510050.............................  ................  ................            0.0112  OHIO.
510077.............................                 *                 *            0.0021  MINGO.
520028.............................                 *                 *            0.0157  GREEN.
520035.............................  ................  ................            0.0077  SHEBOYGAN.
520044.............................  ................  ................            0.0077  SHEBOYGAN.
520057.............................  ................  ................            0.0118  SAUK.
520059.............................                 *                 *            0.0200  RACINE.
520071.............................                 *                 *            0.0239  JEFFERSON.
520095.............................                 *                 *            0.0118  SAUK.
520096.............................                 *                 *            0.0200  RACINE.
520102.............................                 *                 *            0.0298  WALWORTH
520116.............................                 *                 *            0.0239  JEFFERSON.
520132.............................  ................  ................            0.0077  SHEBOYGAN.
----------------------------------------------------------------------------------------------------------------


             Table 5.--List of Diagnosis-Related Groups, Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                     FY 07 proposed rule   FY 07 proposed rule                                                                     Geometric  Arithmetic
        DRG          post-acute care DRG     special pay DRG      MDC           Type                 DRG title          Weights    mean LOS    mean LOS
--------------------------------------------------------------------------------------------------------------------------------------------------------
1.................  Yes.................  No..................      01  SURG................  CRANIOTOMY AGE >17 W        3.5289         7.3         9.8
                                                                                               CC.
2.................  Yes.................  No..................      01  SURG................  CRANIOTOMY AGE >17 W/O      1.9870         3.4         4.4
                                                                                               CC.
3.................  No..................  No..................      01  SURG*...............  CRANIOTOMY AGE 0-17...      1.9870         9.2        12.5
4.................  No..................  No..................      01  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
5.................  No..................  No..................      01  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
6.................  No..................  No..................      01  SURG................  CARPAL TUNNEL RELEASE.      0.7965         2.1         3.1
7.................  Yes.................  Yes.................      01  SURG................  PERIPH & CRANIAL NERVE      2.5775         6.6         9.5
                                                                                               & DOTHER NERV SYST
                                                                                               PROC W CC.
8.................  Yes.................  Yes.................      01  SURG................  PERIPH & CRANIAL NERVE      1.4057         2.0         2.8
                                                                                               & DOTHER NERV SYST
                                                                                               PROC W/O CC.
9.................  No..................  No..................      01  MED.................  SPINAL DISORDERS &          1.4543         4.4         6.2
                                                                                               INJURIES.
10................  Yes.................  No..................      01  MED.................  NERVOUS SYSTEM              1.2513         4.6         6.0
                                                                                               NEOPLASMS W CC.
11................  Yes.................  No..................      01  MED.................  NERVOUS SYSTEM              0.8359         2.7         3.6
                                                                                               DNEOPLASMS W/O CC.
12................  Yes.................  No..................      01  MED.................  DEGENERATIVE NERVOUS        1.0105         4.4         5.6
                                                                                               SYSTEM DISORDERS.
13................  Yes.................  No..................      01  MED.................  MULTIPLE SCLEROSIS &        0.9266         4.0         4.9
                                                                                               DCEREBELLAR ATAXIA.
14................  Yes.................  No..................      01  MED.................  INTRACRANIAL                1.2480         4.3         5.5
                                                                                               HEMORRHAGE OR
                                                                                               DCEREBRAL INFARCTION.
15................  Yes.................  No..................      01  MED.................  NONSPECIFIC CVA &           0.9170         3.1         4.0
                                                                                               PRECEREBRAL OCCLUSION
                                                                                               W/O INFARCT.
16................  Yes.................  No..................      01  MED.................  NONSPECIFIC                 1.3632         5.0         6.4
                                                                                               CEREBROVASCULAR
                                                                                               DISORDERS W CC.

[[Page 24273]]

 
17................  Yes.................  No..................      01  MED.................  NONSPECIFIC                 0.6692         2.4         3.0
                                                                                               CEREBROVASCULAR
                                                                                               ISORDERS W/O CC.
18................  Yes.................  No..................      01  MED.................  CRANIAL & PERIPHERAL        1.0501         4.1         5.2
                                                                                               NERVE DISORDERS W CC.
19................  Yes.................  No..................      01  MED.................  CRANIAL & PERIPHERAL        0.7128         2.7         3.4
                                                                                               NERVE DISORDERS W/O
                                                                                               CC.
20................  Yes.................  No..................      01  MED.................  NERVOUS SYSTEM              2.7596         8.0        10.3
                                                                                               INFECTION EXCEPT
                                                                                               VIRAL DMENINGITIS.
21................  No..................  No..................      01  MED.................  VIRAL MENINGITIS......      1.4536         4.7         6.2
22................  No..................  No..................      01  MED.................  HYPERTENSIVE                1.2386         3.9         5.0
                                                                                               ENCEPHALOPATHY.
23................  No..................  No..................      01  MED.................  NONTRAUMATIC STUPOR &       0.8423         3.0         3.9
                                                                                               COMA.
24................  Yes.................  No..................      01  MED.................  SEIZURE & HEADACHE AGE      1.0388         3.5         4.7
                                                                                               >17 W CC.
25................  Yes.................  No..................      01  MED.................  SEIZURE & HEADACHE AGE      0.6436         2.5         3.1
                                                                                               >17 W/O CC.
26................  No..................  No..................      01  MED.................  SEIZURE & HEADACHE AGE      1.1844         2.6         3.8
                                                                                               0-17.
27................  No..................  No..................      01  MED.................  TRAUMATIC STUPOR &          1.4281         3.1         4.8
                                                                                               COMA, COMA >1 HR.
28................  Yes.................  No..................      01  MED.................  TRAUMATIC STUPOR &          1.4037         4.2         5.7
                                                                                               COMA, COMA <1 HR AGE
                                                                                               >17 W CC.
29................  Yes.................  No..................      01  MED.................  TRAUMATIC STUPOR &          0.7658         2.6         3.2
                                                                                               COMA, COMA <1 HR AGE
                                                                                               >17 W/O CC.
30................  No..................  No..................      01  MED*................  TRAUMATIC STUPOR &          0.7658           *           *
                                                                                               COMA, COMA <1 HR AGE
                                                                                               0-17.
31................  No..................  No..................      01  MED.................  CONCUSSION AGE >17 W        0.9511         3.0         3.9
                                                                                               CC.
32................  No..................  No..................      01  MED.................  CONCUSSION AGE >17 W/O      0.5859         1.8         2.3
                                                                                               CC.
33................  No..................  No..................      01  MED*................  CONCUSSION AGE 0-17...      0.5859           *           *
34................  Yes.................  No..................      01  MED.................  OTHER DISORDERS OF          1.0347         3.6         4.8
                                                                                               NERVOUS SYSTEM W CC.
35................  Yes.................  No..................      01  MED.................  OTHER DISORDERS OF          0.6453         2.5         3.1
                                                                                               NERVOUS SYSTEM W/O CC.
36................  No..................  No..................      02  SURG................  RETINAL PROCEDURES....      0.7936         1.3         1.7
37................  No..................  No..................      02  SURG................  ORBITAL PROCEDURES....      1.2193         2.7         4.1
38................  No..................  No..................      02  SURG................  PRIMARY IRIS                0.5783         2.2         2.8
                                                                                               PROCEDURES.
39................  No..................  No..................      02  SURG................  LENS PROCEDURES WITH        0.7098         1.5         2.0
                                                                                               OR WITHOUT VITRECTOMY.
40................  No..................  No..................      02  SURG................  EXTRAOCULAR PROCEDURES      1.1061         3.0         4.1
                                                                                               EXCEPT ORBIT AGE >17.
41................  No..................  No..................      02  SURG*...............  EXTRAOCULAR PROCEDURES      1.1061           *           *
                                                                                               EXCEPT ORBIT AGE 0-17.
42................  No..................  No..................      02  SURG................  INTRAOCULAR PROCEDURES      0.9264         2.1         3.0
                                                                                               EXCEPT RETINA, IRIS &
                                                                                               LENS.
43................  No..................  No..................      02  MED.................  HYPHEMA...............      0.5799         2.4         3.0
44................  No..................  No..................      02  MED.................  ACUTE MAJOR EYE             0.8191         3.8         4.8
                                                                                               INFECTIONS.
45................  No..................  No..................      02  MED.................  NEUROLOGICAL EYE            0.6809         2.5         3.0
                                                                                               DISORDERS.
46................  No..................  No..................      02  MED.................  OTHER DISORDERS OF THE      0.8135         3.2         4.2
                                                                                               EYE AGE >17 W CC.
47................  No..................  No..................      02  MED.................  OTHER DISORDERS OF THE      0.5728         2.4         3.0
                                                                                               EYE AGE >17 W/O CC.
48................  No..................  No..................      02  MED*................  OTHER DISORDERS OF THE      0.5728           *           *
                                                                                               EYE AGE 0-17.
49................  No..................  No..................      03  SURG................  MAJOR HEAD & NECK           1.7653         3.2         4.5
                                                                                               PROCEDURES.
50................  No..................  No..................      03  SURG................  SIALOADENECTOMY.......      0.8292         1.5         1.9
51................  No..................  No..................      03  SURG................  SALIVARY GLAND              0.8841         1.9         2.7
                                                                                               PROCEDURES EXCEPT
                                                                                               SIALOADENECTOMY.
52................  No..................  No..................      03  SURG................  CLEFT LIP & PALATE          0.7608         1.4         1.7
                                                                                               REPAIR.
53................  No..................  No..................      03  SURG................  SINUS & MASTOID             1.2984         2.5         4.0
                                                                                               PROCEDURES AGE >17.
54................  No..................  No..................      03  SURG*...............  SINUS & MASTOID             1.2984           *           *
                                                                                               PROCEDURES AGE 0-17.
55................  No..................  No..................      03  SURG................  MISCELLANEOUS EAR,          0.9555         1.9         2.9
                                                                                               NOSE, MOUTH & THROAT
                                                                                               PROCEDURES.
56................  No..................  No..................      03  SURG................  RHINOPLASTY...........      0.9535         1.9         2.7
57................  No..................  No..................      03  SURG................  T&A PROC, EXCEPT            1.0220         2.1         3.2
                                                                                               TONSILLECTOMY &/OR
                                                                                               ADENOIDECTOMY ONLY,
                                                                                               AGE >17.
58................  No..................  No..................      03  SURG*...............  T&A PROC, EXCEPT            1.0220           *           *
                                                                                               TONSILLECTOMY &/OR
                                                                                               ADENOIDECTOMY ONLY,
                                                                                               AGE 0-17.

[[Page 24274]]

 
59................  No..................  No..................      03  SURG................  TONSILLECTOMY &/OR          0.7380         1.8         2.4
                                                                                               ADENOIDECTOMY ONLY,
                                                                                               AGE >17.
60................  No..................  No..................      03  SURG*...............  TONSILLECTOMY &/OR          0.7380         1.4         1.7
                                                                                               ADENOIDECTOMY ONLY,
                                                                                               AGE 0-17.
61................  No..................  No..................      03  SURG................  MYRINGOTOMY W TUBE          1.5534         3.7         6.1
                                                                                               INSERTION AGE >17.
62................  No..................  No..................      03  SURG*...............  MYRINGOTOMY W TUBE          1.5534         1.3         1.5
                                                                                               INSERTION AGE 0-17.
63................  No..................  No..................      03  SURG................  OTHER EAR, NOSE, MOUTH      1.4153         3.0         4.5
                                                                                               & THROAT O.R.
                                                                                               PROCEDURES.
64................  No..................  No..................      03  MED.................  EAR, NOSE, MOUTH &          1.2875         4.2         6.3
                                                                                               THROAT MALIGNANCY.
65................  No..................  No..................      03  MED.................  DYSEQUILIBRIUM........      0.5799         2.3         2.8
66................  No..................  No..................      03  MED.................  EPISTAXIS.............      0.6790         2.4         3.1
67................  No..................  No..................      03  MED.................  EPIGLOTTITIS..........      0.9830         2.8         3.7
68................  No..................  No..................      03  MED.................  OTITIS MEDIA & URI AGE      0.7572         3.1         3.8
                                                                                               >17 W CC.
69................  No..................  No..................      03  MED.................  OTITIS MEDIA & URI AGE      0.5706         2.5         2.9
                                                                                               >17 W/O CC.
70................  No..................  No..................      03  MED.................  OTITIS MEDIA & URI AGE      0.4794         2.0         2.3
                                                                                               0-17.
71................  No..................  No..................      03  MED.................  LARYNGOTRACHEITIS.....      0.9064         3.4         4.4
72................  No..................  No..................      03  MED.................  NASAL TRAUMA &              0.7502         2.6         3.3
                                                                                               DEFORMITY.
73................  Yes.................  No..................      03  MED.................  OTHER EAR, NOSE, MOUTH      0.9140         3.3         4.3
                                                                                               & THROAT DIAGNOSES
                                                                                               AGE >17.
74................  No..................  No..................      03  MED*................  OTHER EAR, NOSE, MOUTH      0.9140         3.3         3.3
                                                                                               & THROAT DIAGNOSES
                                                                                               AGE 0-17.
75................  Yes.................  No..................      04  SURG................  MAJOR CHEST PROCEDURES      3.0790         7.4         9.7
76................  Yes.................  No..................      04  SURG................  OTHER RESP SYSTEM O.R.      2.7410         8.2        10.7
                                                                                               PROCEDURES W CC.
77................  Yes.................  No..................      04  SURG................  OTHER RESP SYSTEM O.R.      1.1515         3.3         4.5
                                                                                               PROCEDURES W/O CC.
78................  Yes.................  No..................      04  MED.................  PULMONARY EMBOLISM....      1.3229         5.3         6.2
79................  Yes.................  No..................      04  MED.................  RESPIRATORY INFECTIONS      1.7331         6.7         8.3
                                                                                               & INFLAMMATIONS AGE
                                                                                               >17 W CC.
80................  Yes.................  No..................      04  MED.................  RESPIRATORY INFECTIONS      1.0190         4.3         5.3
                                                                                               & INFLAMMATIONS AGE
                                                                                               >17 W/O CC.
81................  No..................  No..................      04  MED*................  RESPIRATORY INFECTIONS      1.7331         5.2         6.2
                                                                                               & INFLAMMATIONS AGE 0-
                                                                                               7.
82................  Yes.................  No..................      04  MED.................  RESPIRATORY NEOPLASMS.      1.4335         5.1         6.8
83................  Yes.................  No..................      04  MED.................  MAJOR CHEST TRAUMA W        1.1185         4.2         5.3
                                                                                               CC.
84................  Yes.................  No..................      04  MED.................  MAJOR CHEST TRAUMA W/O      0.6523         2.6         3.2
                                                                                               CC.
85................  Yes.................  No..................      04  MED.................  PLEURAL EFFUSION W CC.      1.2935         4.7         6.2
86................  Yes.................  No..................      04  MED.................  PLEURAL EFFUSION W/O        0.7154         2.7         3.5
                                                                                               CC.
87................  No..................  No..................      04  MED.................  PULMONARY EDEMA &           1.5310         4.9         6.4
                                                                                               ESPIRATORY FAILURE.
88................  No..................  No..................      04  MED.................  CHRONIC OBSTRUCTIVE         0.9557         4.0         4.9
                                                                                               PULMONARY DISEASE.
89................  Yes.................  No..................      04  MED.................  SIMPLE PNEUMONIA &          1.1291         4.6         5.6
                                                                                               PLEURISY AGE >17 W CC.
90................  Yes.................  No..................      04  MED.................  SIMPLE PNEUMONIA &          0.7043         3.2         3.7
                                                                                               PLEURISY AGE >17 W/O
                                                                                               CC.
91................  No..................  No..................      04  MED.................  SIMPLE PNEUMONIA &          0.7054         2.5         3.4
                                                                                               PLEURISY AGE 0-17.
92................  Yes.................  No..................      04  MED.................  INTERSTITIAL LUNG           1.2410         4.8         6.0
                                                                                               DISEASE W CC.
93................  Yes.................  No..................      04  MED.................  INTERSTITIAL LUNG           0.7539         3.0         3.8
                                                                                               DISEASE W/O CC.
94................  No..................  No..................      04  MED.................  PNEUMOTHORAX W CC.....      1.2852         4.5         5.9
95................  No..................  No..................      04  MED.................  PNEUMOTHORAX W/O CC...      0.7018         2.7         3.4
96................  No..................  No..................      04  MED.................  BRONCHITIS & ASTHMA         0.8093         3.5         4.3
                                                                                               AGE >17 W CC.
97................  No..................  No..................      04  MED.................  BRONCHITIS & ASTHMA         0.6199         2.8         3.4
                                                                                               AGE >17 W/O CC.
98................  No..................  No..................      04  MED.................  BRONCHITIS & ASTHMA         0.6892         2.8         3.1
                                                                                               AGE 0-17.
99................  No..................  No..................      04  MED.................  RESPIRATORY SIGNS &         0.7101         2.4         3.1
                                                                                               SYMPTOMS W CC.
100...............  No..................  No..................      04  MED.................  RESPIRATORY SIGNS &         0.5098         1.7         2.1
                                                                                               SYMPTOMS W/O CC.
101...............  Yes.................  No..................      04  MED.................  OTHER RESPIRATORY           0.9106         3.2         4.2
                                                                                               DSYSTEM DIAGNOSES W
                                                                                               CC.
102...............  Yes.................  No..................      04  MED.................  OTHER RESPIRATORY           0.5625         2.0         2.5
                                                                                               SYSTEM DIAGNOSES W/O
                                                                                               CC.

[[Page 24275]]

 
103...............  No..................  No..................     PRE  SURG................  HEART TRANSPLANT OR        19.5988        22.2        35.1
                                                                                               IMPLANT OF HEART
                                                                                               ASSIST SYSTEM.
104...............  Yes.................  No..................      05  SURG................  CARDIAC VALVE & OTH         7.4447        12.8        15.1
                                                                                               MAJOR CARDIOTHORACIC
                                                                                               PROC W CARD CATH.
105...............  Yes.................  No..................      05  SURG................  CARDIAC VALVE & OTH         5.6619         8.4        10.2
                                                                                               MAJOR CARDIOTHORACIC
                                                                                               PROC W/O CARD CATH.
106...............  No..................  No..................      05  SURG................  CORONARY BYPASS W PTCA      5.9701         9.3        10.9
107...............  Yes.................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
108...............  Yes.................  No..................      05  SURG................  OTHER CARDIOTHORACIC        5.4207         8.8        10.9
                                                                                               PROCEDURES.
109...............  Yes.................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
110...............  No..................  No..................      05  SURG................  MAJOR CARDIOVASCULAR        3.6419         5.4         8.1
                                                                                               PROCEDURES W CC.
111...............  No..................  No..................      05  SURG................  MAJOR CARDIOVASCULAR        2.2318         2.3         3.1
                                                                                               PROCEDURES W/O CC.
112...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
113...............  Yes.................  No..................      05  SURG................  AMPUTATION FOR CIRC         3.3828        10.8        13.7
                                                                                               SYSTEM DISORDERS
                                                                                               EXCEPT UPPER LIMB &
                                                                                               TOE.
114...............  Yes.................  No..................      05  SURG................  UPPER LIMB & TOE            1.8874         6.6         8.7
                                                                                               AMPUTATION FOR CIRC
                                                                                               SYSTEM DISORDERS.
115...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
116...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
117...............  No..................  No..................      05  SURG................  CARDIAC PACEMAKER           1.2528         2.6         4.3
                                                                                               REVISION EXCEPT
                                                                                               DEVICE REPLACEMENT.
118...............  No..................  No..................      05  SURG................  CARDIAC PACEMAKER           1.3882         2.0         3.0
                                                                                               DEVICE REPLACEMENT.
119...............  No..................  No..................      05  SURG................  VEIN LIGATION &             1.4787         3.3         5.4
                                                                                               STRIPPING.
120...............  Yes.................  No..................      05  SURG................  OTHER CIRCULATORY           2.3109         6.0         9.2
                                                                                               SYSTEM O.R.
                                                                                               PROCEDURES.
121...............  Yes.................  No..................      05  MED.................  CIRCULATORY DISORDERS       1.6883         5.2         6.5
                                                                                               W AMI & MAJOR COMP,
                                                                                               DISCHARGED ALIVE.
122...............  No..................  No..................      05  MED.................  CIRCULATORY DISORDERS       0.9802         2.7         3.4
                                                                                               W AMI W/O MAJOR COMP,
                                                                                               DISCHARGED ALIVE.
123...............  No..................  No..................      05  MED.................  CIRCULATORY DISORDERS       1.6053         2.9         4.7
                                                                                               W AMI, EXPIRED.
124...............  No..................  No..................      05  MED.................  CIRCULATORY DISORDERS       1.1670         3.3         4.4
                                                                                               EXCEPT AMI, W CARD
                                                                                               CATH & COMPLEX DIAG.
125...............  No..................  No..................      05  MED.................  CIRCULATORY DISORDERS       0.7862         2.1         2.7
                                                                                               EXCEPT AMI, W CARD
                                                                                               CATH W/O COMPLEX DIAG.
126...............  Yes.................  No..................      05  MED.................  ACUTE & SUBACUTE            2.5526         9.0        11.3
                                                                                               ENDOCARDITIS.
127...............  Yes.................  No..................      05  MED.................  HEART FAILURE & SHOCK.      1.0635         4.1         5.1
128...............  No..................  No..................      05  MED.................  DEEP VEIN                   0.8850         4.4         5.2
                                                                                               THROMBOPHLEBITIS.
129...............  No..................  No..................      05  MED.................  CARDIAC ARREST,             1.1301         1.6         2.5
                                                                                               UNEXPLAINED.
130...............  Yes.................  No..................      05  MED.................  PERIPHERAL VASCULAR         1.0637         4.3         5.5
                                                                                               DISORDERS W CC.
131...............  Yes.................  No..................      05  MED.................  PERIPHERAL VASCULAR         0.6813         3.1         3.7
                                                                                               DISORDERS W/O CC.
132...............  No..................  No..................      05  MED.................  ATHEROSCLEROSIS W CC..      0.6482         2.2         2.8
133...............  No..................  No..................      05  MED.................  ATHEROSCLEROSIS W/O CC      0.5237         1.8         2.1
134...............  No..................  No..................      05  MED.................  HYPERTENSION..........      0.6464         2.5         3.1
135...............  No..................  No..................      05  MED.................  CARDIAC CONGENITAL &        0.9122         3.3         4.3
                                                                                               VALVULAR DISORDERS
                                                                                               AGE >17 W CC.
136...............  No..................  No..................      05  MED.................  CARDIAC CONGENITAL &        0.5684         2.1         2.7
                                                                                               VALVULAR DISORDERS
                                                                                               AGE >17 W/O CC.
137...............  No..................  No..................      05  MED*................  CARDIAC CONGENITAL &        0.9122           *           *
                                                                                               VALVULAR DISORDERS
                                                                                               AGE 0-17.
138...............  No..................  No..................      05  MED.................  CARDIAC ARRHYTHMIA &        0.8504         3.0         3.9
                                                                                               CONDUCTION DISORDERS
                                                                                               W CC.
139...............  No..................  No..................      05  MED.................  CARDIAC ARRHYTHMIA &        0.5221         2.0         2.4
                                                                                               CONDUCTION DISORDERS
                                                                                               W/O CC.
140...............  No..................  No..................      05  MED.................  ANGINA PECTORIS.......      0.5846         1.9         2.4
141...............  No..................  No..................      05  MED.................  SYNCOPE & COLLAPSE W        0.7009         2.7         3.4
                                                                                               CC.
142...............  No..................  No..................      05  MED.................  SYNCOPE & COLLAPSE W/O      0.5312         2.1         2.5
                                                                                               CC.
143...............  No..................  No..................      05  MED.................  CHEST PAIN............      0.5137         1.7         2.1

[[Page 24276]]

 
144...............  Yes.................  No..................      05  MED.................  OTHER CIRCULATORY           1.3781         4.2         5.9
                                                                                               SYSTEM DIAGNOSES W CC.
145...............  Yes.................  No..................      05  MED.................  OTHER CIRCULATORY           0.5993         2.0         2.5
                                                                                               SYSTEM DIAGNOSES W/O
                                                                                               CC.
146...............  Yes.................  No..................      06  SURG................  RECTAL RESECTION W CC.      2.8001         8.4         9.9
147...............  Yes.................  No..................      06  SURG................  RECTAL RESECTION W/O        1.5698         4.9         5.6
                                                                                               CC.
148...............  Yes.................  No..................      06  SURG................  MAJOR SMALL & LARGE         3.5831         9.9        12.1
                                                                                               BOWEL PROCEDURES W CC.
149...............  Yes.................  No..................      06  SURG................  MAJOR SMALL & LARGE         1.5441         5.1         5.7
                                                                                               BOWEL PROCEDURES W/O
                                                                                               CC.
150...............  Yes.................  No..................      06  SURG................  PERITONEAL                  2.9172         8.7        10.8
                                                                                               ADHESIOLYSIS W CC.
151...............  Yes.................  No..................      06  SURG................  PERITONEAL                  1.3530         4.0         5.0
                                                                                               ADHESIOLYSIS W/O CC.
152...............  No..................  No..................      06  SURG................  MINOR SMALL & LARGE         2.0074         6.5         7.9
                                                                                               BOWEL PROCEDURES W CC.
153...............  No..................  No..................      06  SURG................  MINOR SMALL & LARGE         1.1984         4.4         4.9
                                                                                               BOWEL PROCEDURES W/O
                                                                                               CC.
154...............  Yes.................  No..................      06  SURG................  STOMACH, ESOPHAGEAL &       4.2032         9.7        13.2
                                                                                               DUODENAL PROCEDURES
                                                                                               AGE >17 W CC.
155...............  Yes.................  No..................      06  SURG................  STOMACH, ESOPHAGEAL &       1.3089         3.0         4.0
                                                                                               DUODENAL PROCEDURES
                                                                                               AGE >17 W/O CC.
156...............  No..................  No..................      06  SURG................  STOMACH, ESOPHAGEAL &       1.3089         8.9         9.3
                                                                                               DUODENAL PROCEDURES
                                                                                               AGE 0-17.
157...............  Yes.................  No..................      06  SURG................  ANAL & STOMAL               1.4076         4.2         5.8
                                                                                               PROCEDURES W CC.
158...............  Yes.................  No..................      06  SURG................  ANAL & STOMAL               0.7114         2.1         2.6
                                                                                               PROCEDURES W/O CC.
159...............  No..................  No..................      06  SURG................  HERNIA PROCEDURES           1.4745         3.7         5.1
                                                                                               EXCEPT INGUINAL &
                                                                                               FEMORAL AGE >17 W CC.
160...............  No..................  No..................      06  SURG................  HERNIA PROCEDURES           0.8749         2.2         2.7
                                                                                               EXCEPT INGUINAL &
                                                                                               FEMORAL AGE >17 W/O
                                                                                               CC.
161...............  No..................  No..................      06  SURG................  INGUINAL & FEMORAL          1.2461         3.2         4.5
                                                                                               HERNIA PROCEDURES AGE
                                                                                               >17 W CC.
162...............  No..................  No..................      06  SURG................  INGUINAL & FEMORAL          0.6982         1.7         2.1
                                                                                               HERNIA PROCEDURES AGE
                                                                                               >17 W/O CC.
163...............  No..................  No..................      06  SURG*...............  HERNIA PROCEDURES AGE       0.6982         2.3         2.8
                                                                                               0-17.
164...............  No..................  No..................      06  SURG................  APPENDECTOMY W              2.2048         6.4         7.7
                                                                                               COMPLICATED PRINCIPAL
                                                                                               DIAG W CC.
165...............  No..................  No..................      06  SURG................  APPENDECTOMY W              1.1907         3.4         4.0
                                                                                               COMPLICATED PRINCIPAL
                                                                                               DIAG W/O CC.
166...............  No..................  No..................      06  SURG................  APPENDECTOMY W/O            1.3900         3.2         4.3
                                                                                               COMPLICATED PRINCIPAL
                                                                                               DIAG W CC.
167...............  No..................  No..................      06  SURG................  APPENDECTOMY W/O            0.8536         1.8         2.1
                                                                                               COMPLICATED PRINCIPAL
                                                                                               DIAG W/O CC.
168...............  No..................  No..................      03  SURG................  MOUTH PROCEDURES W CC.      1.3278         3.4         4.9
169...............  No..................  No..................      03  SURG................  MOUTH PROCEDURES W/O        0.7643         1.9         2.4
                                                                                               CC.
170...............  Yes.................  No..................      06  SURG................  OTHER DIGESTIVE SYSTEM      2.9351         7.8        10.9
                                                                                               O.R. PROCEDURES W CC.
171...............  Yes.................  No..................      06  SURG................  OTHER DIGESTIVE SYSTEM      1.2434         3.1         4.2
                                                                                               O.R. PROCEDURES W/O
                                                                                               CC.
172...............  Yes.................  No..................      06  MED.................  DIGESTIVE MALIGNANCY W      1.4585         5.1         6.9
                                                                                               CC.
173...............  Yes.................  No..................      06  MED.................  DIGESTIVE MALIGNANCY W/     0.7562         2.7         3.5
                                                                                               O CC.
174...............  No..................  No..................      06  MED.................  G.I. HEMORRHAGE W CC..      1.1360         3.8         4.7
175...............  No..................  No..................      06  MED.................  G.I. HEMORRHAGE W/O CC      0.6295         2.4         2.9
176...............  Yes.................  No..................      06  MED.................  COMPLICATED PEPTIC          1.1757         4.0         5.1
                                                                                               ULCER.
177...............  No..................  No..................      06  MED.................  UNCOMPLICATED PEPTIC        0.9595         3.6         4.4
                                                                                               ULCER W CC.
178...............  No..................  No..................      06  MED.................  UNCOMPLICATED PEPTIC        0.6833         2.6         3.1
                                                                                               ULCER W/O CC.
179...............  No..................  No..................      06  MED.................  INFLAMMATORY BOWEL          1.1460         4.5         5.8
                                                                                               DISEASE.
180...............  Yes.................  No..................      06  MED.................  G.I. OBSTRUCTION W CC.      1.0702         4.1         5.3
181...............  Yes.................  No..................      06  MED.................  G.I. OBSTRUCTION W/O        0.6400         2.8         3.3
                                                                                               CC.
182...............  No..................  No..................      06  MED.................  ESOPHAGITIS, GASTROENT      0.9046         3.4         4.5
                                                                                               & MISC DIGEST
                                                                                               DISORDERS AGE >17 W
                                                                                               CC.
183...............  No..................  No..................      06  MED.................  ESOPHAGITIS, GASTROENT      0.6078         2.4         2.9
                                                                                               & MISC DIGEST
                                                                                               DISORDERS AGE >17 W/O
                                                                                               CC.
184...............  No..................  No..................      06  MED.................  ESOPHAGITIS, GASTROENT      0.8504         2.8         4.3
                                                                                               & MISC DIGEST
                                                                                               DISORDERS AGE 0-17.
185...............  No..................  No..................      03  MED.................  DENTAL & ORAL DIS           0.9381         3.3         4.5
                                                                                               EXCEPT EXTRACTIONS &
                                                                                               RESTORATIONS, AGE >17.
186...............  No..................  No..................      03  MED*................  DENTAL & ORAL DIS           0.9381         2.6         3.1
                                                                                               EXCEPT EXTRACTIONS &
                                                                                               RESTORATIONS, AGE 0-
                                                                                               17.

[[Page 24277]]

 
187...............  No..................  No..................      03  MED.................  DENTAL EXTRACTIONS &        0.8880         3.1         4.2
                                                                                               RESTORATIONS.
188...............  Yes.................  No..................      06  MED.................  OTHER DIGESTIVE SYSTEM      1.1808         4.1         5.5
                                                                                               DIAGNOSES AGE >17 W
                                                                                               CC.
189...............  Yes.................  No..................      06  MED.................  OTHER DIGESTIVE SYSTEM      0.6314         2.4         3.1
                                                                                               DIAGNOSES AGE >17 W/O
                                                                                               CC.
190...............  No..................  No..................      06  MED.................  OTHER DIGESTIVE SYSTEM      1.0119         3.5         4.9
                                                                                               DIAGNOSES AGE 0-17.
191...............  Yes.................  No..................      07  SURG................  PANCREAS, LIVER &           3.9647         8.8        12.5
                                                                                               SHUNT PROCEDURES W CC.
192...............  Yes.................  No..................      07  SURG................  PANCREAS, LIVER &           1.7088         4.2         5.5
                                                                                               SHUNT PROCEDURES W/O
                                                                                               CC.
193...............  No..................  No..................      07  SURG................  BILIARY TRACT PROC          3.4693        10.1        12.6
                                                                                               EXCEPT ONLY CHOLECYST
                                                                                               W OR W/O C.D.E. W CC.
194...............  No..................  No..................      07  SURG................  BILIARY TRACT PROC          1.6583         5.4         6.4
                                                                                               EXCEPT ONLY CHOLECYST
                                                                                               W OR W/O C.D.E. W/O
                                                                                               CC.
195...............  No..................  No..................      07  SURG................  CHOLECYSTECTOMY W           3.0330         8.8        10.6
                                                                                               C.D.E. W CC.
196...............  No..................  No..................      07  SURG................  CHOLECYSTECTOMY W           1.5984         4.5         5.3
                                                                                               C.D.E. W/O CC.
197...............  Yes.................  No..................      07  SURG................  CHOLECYSTECTOMY EXCEPT      2.6196         7.4         9.1
                                                                                               BY LAPAROSCOPE W/O
                                                                                               C.D.E. W CC.
198...............  Yes.................  No..................      07  SURG................  CHOLECYSTECTOMY EXCEPT      1.2463         3.7         4.3
                                                                                               BY LAPAROSCOPE W/O
                                                                                               C.D.E. W/O CC.
199...............  No..................  No..................      07  SURG................  HEPATOBILIARY               2.3139         6.4         9.0
                                                                                               DIAGNOSTIC PROCEDURE
                                                                                               FOR MALIGNANCY.
200...............  No..................  No..................      07  SURG................  HEPATOBILIARY               3.0580         6.5        10.4
                                                                                               DIAGNOSTIC PROCEDURE
                                                                                               FOR NON-MALIGNANCY.
201...............  No..................  No..................      07  SURG................  OTHER HEPATOBILIARY OR      3.6519        10.0        13.6
                                                                                               PANCREAS O.R.
                                                                                               PROCEDURES.
202...............  No..................  No..................      07  MED.................  CIRRHOSIS & ALCOHOLIC       1.4205         4.6         6.2
                                                                                               HEPATITIS.
203...............  No..................  No..................      07  MED.................  MALIGNANCY OF               1.3745         4.8         6.5
                                                                                               HEPATOBILIARY SYSTEM
                                                                                               OR PANCREAS.
204...............  No..................  No..................      07  MED.................  DISORDERS OF PANCREAS       1.1749         4.1         5.4
                                                                                               EXCEPT MALIGNANCY.
205...............  Yes.................  No..................      07  MED.................  DISORDERS OF LIVER          1.2942         4.4         5.9
                                                                                               EXCEPT MALIG,CIRR,ALC
                                                                                               HEPA W CC.
206...............  Yes.................  No..................      07  MED.................  DISORDERS OF LIVER          0.7720         3.0         3.8
                                                                                               EXCEPT MALIG,CIRR,ALC
                                                                                               HEPA W/O CC.
207...............  No..................  No..................      07  MED.................  DISORDERS OF THE            1.2145         4.1         5.3
                                                                                               BILIARY TRACT W CC.
208...............  No..................  No..................      07  MED.................  DISORDERS OF THE            0.6986         2.4         3.0
                                                                                               BILIARY TRACT W/O CC.
209...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
210...............  Yes.................  Yes.................      08  SURG................  HIP & FEMUR PROCEDURES      2.0150         6.0         6.8
                                                                                               EXCEPT MAJOR JOINT
                                                                                               AGE >17 W CC.
211...............  Yes.................  Yes.................      08  SURG................  HIP & FEMUR PROCEDURES      1.3653         4.3         4.6
                                                                                               EXCEPT MAJOR JOINT
                                                                                               AGE >17 W/O CC.
212...............  No..................  No..................      08  SURG................  HIP & FEMUR PROCEDURES      0.9730         2.2         2.5
                                                                                               EXCEPT MAJOR JOINT
                                                                                               AGE 0-17.
213...............  Yes.................  No..................      08  SURG................  AMPUTATION FOR              2.2463         7.1         9.5
                                                                                               MUSCULOSKELETAL
                                                                                               SYSTEM & CONN TISSUE
                                                                                               DISORDERS.
214...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
215...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
216...............  Yes.................  No..................      08  SURG................  BIOPSIES OF                 1.7169         3.1         5.4
                                                                                               MUSCULOSKELETAL
                                                                                               SYSTEM & CONNECTIVE
                                                                                               TISSUE.
217...............  Yes.................  No..................      08  SURG................  WND DEBRID & SKN GRFT       3.1361         9.0        12.8
                                                                                               EXCEPT HAND,FOR
                                                                                               MUSCSKELET & CONN
                                                                                               TISS DIS.
218...............  Yes.................  No..................      08  SURG................  LOWER EXTREM & HUMER        1.7105         4.4         5.5
                                                                                               PROC EXCEPT
                                                                                               HIP,FOOT,FEMUR AGE
                                                                                               >17 W CC.
219...............  Yes.................  No..................      08  SURG................  LOWER EXTREM & HUMER        1.1071         2.7         3.2
                                                                                               PROC EXCEPT
                                                                                               HIP,FOOT,FEMUR AGE
                                                                                               >17 W/O CC.
220...............  No..................  No..................      08  SURG*...............  LOWER EXTREM & HUMER        1.1071         2.6         4.0
                                                                                               PROC EXCEPT
                                                                                               HIP,FOOT,FEMUR AGE 0-
                                                                                               17.
221...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
222...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0

[[Page 24278]]

 
223...............  No..................  No..................      08  SURG................  MAJOR SHOULDER/ELBOW        1.1303         2.4         3.3
                                                                                               PROC, OR OTHER UPPER
                                                                                               EXTREMITY PROC W CC.
224...............  No..................  No..................      08  SURG................  SHOULDER,ELBOW OR           0.8067         1.6         1.9
                                                                                               FOREARM PROC,EXC
                                                                                               MAJOR JOINT PROC, W/O
                                                                                               CC.
225...............  Yes.................  No..................      08  SURG................  FOOT PROCEDURES.......      1.3235         3.8         5.4
226...............  Yes.................  No..................      08  SURG................  SOFT TISSUE PROCEDURES      1.6783         4.6         6.5
                                                                                               W CC.
227...............  Yes.................  No..................      08  SURG................  SOFT TISSUE PROCEDURES      0.8719         2.1         2.6
                                                                                               W/O CC.
228...............  No..................  No..................      08  SURG................  MAJOR THUMB OR JOINT        1.1877         2.9         4.2
                                                                                               PROC,OR OTH HAND OR
                                                                                               WRIST PROC W CC.
229...............  No..................  No..................      08  SURG................  HAND OR WRIST PROC,         0.7617         2.0         2.5
                                                                                               EXCEPT MAJOR JOINT
                                                                                               PROC, W/O CC.
230...............  No..................  No..................      08  SURG................  LOCAL EXCISION &            1.4347         3.6         5.4
                                                                                               REMOVAL OF INT FIX
                                                                                               DEVICES OF HIP &
                                                                                               FEMUR.
231...............  No..................  No..................      08  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
232...............  No..................  No..................      08  SURG................  ARTHROSCOPY...........      0.9804         1.9         2.7
233...............  Yes.................  Yes.................      08  SURG................  OTHER MUSCULOSKELET         1.8831         4.4         6.4
                                                                                               SYS & CONN TISS O.R.
                                                                                               PROC W CC.
234...............  Yes.................  Yes.................      08  SURG................  OTHER MUSCULOSKELET         1.1441         1.9         2.7
                                                                                               SYS & CONN TISS O.R.
                                                                                               PROC W/O CC.
235...............  Yes.................  No..................      08  MED.................  FRACTURES OF FEMUR....      0.9366         3.8         4.9
236...............  Yes.................  No..................      08  MED.................  FRACTURES OF HIP &          0.8791         3.8         4.5
                                                                                               PELVIS.
237...............  No..................  No..................      08  MED.................  SPRAINS, STRAINS, &         0.7345         3.0         3.8
                                                                                               DISLOCATIONS OF HIP,
                                                                                               PELVIS & THIGH.
238...............  Yes.................  No..................      08  MED.................  OSTEOMYELITIS.........      1.5466         6.5         8.4
239...............  Yes.................  No..................      08  MED.................  PATHOLOGICAL FRACTURES      1.2001         4.9         6.2
                                                                                               & MUSCULOSKELETAL &
                                                                                               CONN TISS MALIGNANCY.
240...............  Yes.................  No..................      08  MED.................  CONNECTIVE TISSUE           1.4523         4.9         6.5
                                                                                               DISORDERS W CC.
241...............  Yes.................  No..................      08  MED.................  CONNECTIVE TISSUE           0.7172         3.0         3.6
                                                                                               DISORDERS W/O CC.
242...............  No..................  No..................      08  MED.................  SEPTIC ARTHRITIS......      1.2350         5.1         6.5
243...............  No..................  No..................      08  MED.................  MEDICAL BACK PROBLEMS.      0.8680         3.6         4.5
244...............  Yes.................  No..................      08  MED.................  BONE DISEASES &             0.8186         3.6         4.5
                                                                                               SPECIFIC
                                                                                               ARTHROPATHIES W CC.
245...............  Yes.................  No..................      08  MED.................  BONE DISEASES &             0.5581         2.5         3.1
                                                                                               SPECIFIC
                                                                                               ARTHROPATHIES W/O CC.
246...............  No..................  No..................      08  MED.................  NON-SPECIFIC                0.6742         2.8         3.6
                                                                                               ARTHROPATHIES.
247...............  No..................  No..................      08  MED.................  SIGNS & SYMPTOMS OF         0.6852         2.6         3.3
                                                                                               MUSCULOSKELETAL
                                                                                               SYSTEM & CONN TISSUE.
248...............  No..................  No..................      08  MED.................  TENDONITIS, MYOSITIS &      0.9368         3.8         4.8
                                                                                               BURSITIS.
249...............  No..................  No..................      08  MED.................  AFTERCARE,                  0.8157         2.8         4.0
                                                                                               MUSCULOSKELETAL
                                                                                               SYSTEM & CONNECTIVE
                                                                                               TISSUE.
250...............  Yes.................  No..................      08  MED.................  FX, SPRN, STRN & DISL       0.7774         3.2         3.9
                                                                                               OF FOREARM, HAND,
                                                                                               FOOT AGE >17 W CC.
251...............  Yes.................  No..................      08  MED.................  FX, SPRN, STRN & DISL       0.5561         2.3         2.8
                                                                                               OF FOREARM, HAND,
                                                                                               FOOT AGE >17 W/O CC.
252...............  No..................  No..................      08  MED*................  FX, SPRN, STRN & DISL       0.5561           *           *
                                                                                               OF FOREARM, HAND,
                                                                                               FOOT AGE 0-17.
253...............  Yes.................  No..................      08  MED.................  FX, SPRN, STRN & DISL       0.9049         3.8         4.6
                                                                                               OF DUPARM, LOWLEG EX
                                                                                               FOOT AGE >17 W CC.
254...............  Yes.................  No..................      08  MED.................  FX, SPRN, STRN & DISL       0.5741         2.6         3.1
                                                                                               OF UPARM, LOWLEG EX
                                                                                               FOOT AGE >17 W/O CC.
255...............  No..................  No..................      08  MED*................  FX, SPRN, STRN & DISL       0.5741           *           *
                                                                                               OF UPARM, LOWLEG EX
                                                                                               FOOT AGE 0-17.
256...............  Yes.................  No..................      08  MED.................  OTHER MUSCULOSKELETAL       0.9598         3.9         5.1
                                                                                               SYSTEM & CONNECTIVE
                                                                                               TISSUE DIAGNOSES.
257...............  No..................  No..................      09  SURG................  TOTAL MASTECTOMY FOR        0.9016         2.0         2.6
                                                                                               MALIGNANCY W CC.
258...............  No..................  No..................      09  SURG................  TOTAL MASTECTOMY FOR        0.7045         1.5         1.7
                                                                                               MALIGNANCY W/O CC.
259...............  No..................  No..................      09  SURG................  SUBTOTAL MASTECTOMY         0.9445         1.8         2.8
                                                                                               FOR MALIGNANCY W CC.
260...............  No..................  No..................      09  SURG................  SUBTOTAL MASTECTOMY         0.6437         1.2         1.4
                                                                                               FOR MALIGNANCY W/O CC.

[[Page 24279]]

 
261...............  No..................  No..................      09  SURG................  BREAST PROC FOR NON-        0.8875         1.6         2.2
                                                                                               MALIGNANCY EXCEPT
                                                                                               BIOPSY & LOCAL
                                                                                               EXCISION.
262...............  No..................  No..................      09  SURG................  BREAST BIOPSY & LOCAL       1.0346         3.2         4.6
                                                                                               EXCISION FOR NON-
                                                                                               MALIGNANCY.
263...............  Yes.................  No..................      09  SURG................  SKIN GRAFT &/OR DEBRID      2.2702         8.3        11.1
                                                                                               FOR SKN ULCER OR
                                                                                               CELLULITIS W CC.
264...............  Yes.................  No..................      09  SURG................  SKIN GRAFT &/OR DEBRID      1.2644         4.9         6.4
                                                                                               FOR SKN ULCER OR
                                                                                               CELLULITIS W/O CC.
265...............  Yes.................  No..................      09  SURG................  SKIN GRAFT &/OR DEBRID      1.6907         4.2         6.7
                                                                                               EXCEPT FOR SKIN ULCER
                                                                                               OR CELLULITIS W CC.
266...............  Yes.................  No..................      09  SURG................  SKIN GRAFT &/OR DEBRID      0.9200         2.2         3.0
                                                                                               EXCEPT FOR SKIN ULCER
                                                                                               OR CELLULITIS W/O CC.
267...............  No..................  No..................      09  SURG................  PERIANAL & PILONIDAL        0.9870         2.8         4.2
                                                                                               PROCEDURES.
268...............  No..................  No..................      09  SURG................  SKIN, SUBCUTANEOUS          1.2352         2.4         3.7
                                                                                               TISSUE & BREAST
                                                                                               PLASTIC PROCEDURES.
269...............  Yes.................  No..................      09  SURG................  OTHER SKIN, SUBCUT          1.8802         6.0         8.2
                                                                                               TISS & BREAST PROC W
                                                                                               CC.
270...............  Yes.................  No..................      09  SURG................  OTHER SKIN, SUBCUT          0.8949         2.7         3.6
                                                                                               TISS & BREAST PROC W/
                                                                                               O CC.
271...............  Yes.................  No..................      09  MED.................  SKIN ULCERS...........      1.2353         5.6         7.1
272...............  Yes.................  No..................      09  MED.................  MAJOR SKIN DISORDERS W      1.1364         4.5         5.9
                                                                                               CC.
273...............  Yes.................  No..................      09  MED.................  MAJOR SKIN DISORDERS W/     0.6838         2.9         3.7
                                                                                               O CC.
274...............  No..................  No..................      09  MED.................  MALIGNANT BREAST            1.2180         4.5         6.2
                                                                                               DISORDERS W CC.
275...............  No..................  No..................      09  MED.................  MALIGNANT BREAST            0.6697         2.3         3.3
                                                                                               DISORDERS W/O CC.
276...............  No..................  No..................      09  MED.................  NON-MALIGANT BREAST         0.8441         3.6         4.6
                                                                                               DISORDERS.
277...............  Yes.................  No..................      09  MED.................  CELLULITIS AGE >17 W        1.0015         4.5         5.5
                                                                                               CC.
278...............  Yes.................  No..................      09  MED.................  CELLULITIS AGE >17 W/O      0.6817         3.4         4.0
                                                                                               CC.
279...............  No..................  No..................      09  MED*................  CELLULITIS AGE 0-17...      0.6817         3.9         4.2
280...............  Yes.................  No..................      09  MED.................  TRAUMA TO THE SKIN,         0.8212         3.2         4.1
                                                                                               SUBCUT TISS & BREAST
                                                                                               AGE >17 W CC.
281...............  Yes.................  No..................      09  MED.................  TRAUMA TO THE SKIN,         0.5678         2.3         2.8
                                                                                               SUBCUT TISS & BREAST
                                                                                               AGE >17 W/O CC.
282...............  No..................  No..................      09  MED*................  TRAUMA TO THE SKIN,         0.5678           *           *
                                                                                               SUBCUT TISS & BREAST
                                                                                               AGE 0-17.
283...............  Yes.................  No..................      09  MED.................  MINOR SKIN DISORDERS W      0.8525         3.5         4.6
                                                                                               CC.
284...............  Yes.................  No..................      09  MED.................  MINOR SKIN DISORDERS W/     0.5295         2.3         2.9
                                                                                               O CC.
285...............  Yes.................  No..................      10  SURG................  AMPUTAT OF LOWER LIMB       2.3169         8.1        10.3
                                                                                               FOR ENDOCRINE,
                                                                                               NUTRIT, & METABOL
                                                                                               DISORDERS.
286...............  No..................  No..................      10  SURG................  ADRENAL & PITUITARY         1.9369         3.8         5.2
                                                                                               PROCEDURES.
287...............  Yes.................  No..................      10  SURG................  SKIN GRAFTS & WOUND         2.0354         7.6        10.0
                                                                                               DEBRID FOR ENDOC,
                                                                                               NUTRIT & METAB
                                                                                               DISORDERS.
288...............  No..................  No..................      10  SURG................  O.R. PROCEDURES FOR         1.7332         2.9         3.7
                                                                                               OBESITY.
289...............  No..................  No..................      10  SURG................  PARATHYROID PROCEDURES      0.8548         1.6         2.4
290...............  No..................  No..................      10  SURG................  THYROID PROCEDURES....      0.8454         1.5         2.0
291...............  No..................  No..................      10  SURG................  THYROGLOSSAL                0.5867         1.3         1.5
                                                                                               PROCEDURES.
292...............  Yes.................  No..................      10  SURG................  OTHER ENDOCRINE,            2.6043         7.3        10.2
                                                                                               NUTRIT & METAB O.R.
                                                                                               PROC W CC.
293...............  Yes.................  No..................      10  SURG................  OTHER ENDOCRINE,            1.3605         3.4         4.7
                                                                                               NUTRIT & METAB O.R.
                                                                                               PROC W/O CC.
294...............  Yes.................  No..................      10  MED.................  DIABETES AGE >35......      0.8642         3.3         4.3
295...............  No..................  No..................      10  MED.................  DIABETES AGE 0-35.....      0.9301         2.8         3.7
296...............  Yes.................  No..................      10  MED.................  NUTRITIONAL & MISC          0.9041         3.6         4.7
                                                                                               METABOLIC DISORDERS
                                                                                               AGE >17 W CC.
297...............  Yes.................  No..................      10  MED.................  NUTRITIONAL & MISC          0.5589         2.5         3.0
                                                                                               METABOLIC DISORDERS
                                                                                               AGE >17 W/O CC.
298...............  No..................  No..................      10  MED.................  NUTRITIONAL & MISC          0.7622         2.5         3.6
                                                                                               METABOLIC DISORDERS
                                                                                               AGE 0-17.
299...............  No..................  No..................      10  MED.................  INBORN ERRORS OF            1.1353         3.8         5.1
                                                                                               METABOLISM.
300...............  Yes.................  No..................      10  MED.................  ENDOCRINE DISORDERS W       1.1666         4.6         5.9
                                                                                               CC.
301...............  Yes.................  No..................      10  MED.................  ENDOCRINE DISORDERS W/      0.6427         2.7         3.4
                                                                                               O CC.
302...............  No..................  No..................      11  SURG................  KIDNEY TRANSPLANT.....      5.5466         6.8         8.0
303...............  No..................  No..................      11  SURG................  KIDNEY, URETER & MAJOR      2.3084         5.7         7.3
                                                                                               BLADDER PROCEDURES
                                                                                               FOR NEOPLASM.
304...............  Yes.................  No..................      11  SURG................  KIDNEY, URETER & MAJOR      2.3631         6.0         8.5
                                                                                               BLADDER PROC FOR NON-
                                                                                               NEOPL W CC.

[[Page 24280]]

 
305...............  Yes.................  No..................      11  SURG................  KIDNEY, URETER & MAJOR      1.1498         2.5         3.1
                                                                                               BLADDER PROC FOR NON-
                                                                                               NEOPL W/O CC.
306...............  No..................  No..................      11  SURG................  PROSTATECTOMY W CC....      1.3307         3.6         5.6
307...............  No..................  No..................      11  SURG................  PROSTATECTOMY W/O CC..      0.6569         1.7         2.0
308...............  No..................  No..................      11  SURG................  MINOR BLADDER               1.7066         3.9         6.2
                                                                                               PROCEDURES W CC.
309...............  No..................  No..................      11  SURG................  MINOR BLADDER               0.9014         1.6         2.0
                                                                                               PROCEDURES W/O CC.
310...............  No..................  No..................      11  SURG................  TRANSURETHRAL               1.1913         3.1         4.5
                                                                                               PROCEDURES W CC.
311...............  No..................  No..................      11  SURG................  TRANSURETHRAL               0.6397         1.5         1.9
                                                                                               PROCEDURES W/O CC.
312...............  No..................  No..................      11  SURG................  URETHRAL PROCEDURES,        1.1947         3.3         4.9
                                                                                               AGE >17 W CC.
313...............  No..................  No..................      11  SURG................  URETHRAL PROCEDURES,        0.7523         1.8         2.4
                                                                                               AGE >17 W/O CC.
314...............  No..................  No..................      11  SURG*...............  URETHRAL PROCEDURES,        0.7523        29.4        89.0
                                                                                               AGE 0-17.
315...............  No..................  No..................      11  SURG................  OTHER KIDNEY & URINARY      1.9482         3.7         6.7
                                                                                               TRACT O.R. PROCEDURES.
316...............  Yes.................  No..................      11  MED.................  RENAL FAILURE.........      1.3481         4.8         6.3
317...............  No..................  No..................      11  MED.................  ADMIT FOR RENAL             0.8454         2.4         3.5
                                                                                               DIALYSIS.
318...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      1.2571         4.4         6.0
                                                                                               NEOPLASMS W CC.
319...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.6169         1.9         2.6
                                                                                               NEOPLASMS W/O CC.
320...............  Yes.................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.9538         4.1         5.1
                                                                                               INFECTIONS AGE >17 W
                                                                                               CC.
321...............  Yes.................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.6512         3.0         3.6
                                                                                               INFECTIONS AGE >17 W/
                                                                                               O CC.
322...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.7212         3.1         3.6
                                                                                               INFECTIONS AGE 0-17.
323...............  No..................  No..................      11  MED.................  URINARY STONES W CC,        0.8239         2.3         3.1
                                                                                               D&/OR ESW LITHOTRIPSY.
324...............  No..................  No..................      11  MED.................  URINARY STONES W/O CC.      0.5233         1.6         1.8
325...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.7334         2.9         3.7
                                                                                               SIGNS & SYMPTOMS AGE
                                                                                               >17 W CC.
326...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.4932         2.1         2.6
                                                                                               SIGNS & SYMPTOMS AGE
                                                                                               >17 W/O CC.
327...............  No..................  No..................      11  MED.................  KIDNEY & URINARY TRACT      0.3724         1.8         2.0
                                                                                               SIGNS & SYMPTOMS AGE
                                                                                               0-17.
328...............  No..................  No..................      11  MED.................  URETHRAL STRICTURE AGE      0.7346         2.5         3.4
                                                                                               >17 W CC.
329...............  No..................  No..................      11  MED.................  URETHRAL STRICTURE AGE      0.4671         1.4         1.7
                                                                                               >17 W/O CC.
330...............  No..................  No..................      11  MED*................  URETHRAL STRICTURE AGE      0.4671           *           *
                                                                                               0-17.
331...............  Yes.................  No..................      11  MED.................  OTHER KIDNEY & URINARY      1.1580         4.2         5.5
                                                                                               TRACT DIAGNOSES AGE
                                                                                               >17 W CC.
332...............  Yes.................  No..................      11  MED.................  OTHER KIDNEY & URINARY      0.6602         2.4         3.1
                                                                                               TRACT DIAGNOSES AGE
                                                                                               >17 W/O CC.
333...............  No..................  No..................      11  MED.................  OTHER KIDNEY & URINARY      1.1833         3.7         5.4
                                                                                               TRACT DIAGNOSES AGE 0-
                                                                                               17.
334...............  No..................  No..................      12  SURG................  MAJOR MALE PELVIC           1.4154         3.3         4.0
                                                                                               PROCEDURES W CC.
335...............  No..................  No..................      12  SURG................  MAJOR MALE PELVIC           1.0701         2.2         2.5
                                                                                               PROCEDURES W/O CC.
336...............  No..................  No..................      12  SURG................  TRANSURETHRAL               0.8824         2.4         3.2
                                                                                               PROSTATECTOMY W CC.
337...............  No..................  No..................      12  SURG................  TRANSURETHRAL               0.5989         1.6         1.8
                                                                                               PROSTATECTOMY W/O CC.
338...............  No..................  No..................      12  SURG................  TESTES PROCEDURES, FOR      1.4072         3.7         5.8
                                                                                               MALIGNANCY.
339...............  No..................  No..................      12  SURG................  TESTES PROCEDURES, NON-     1.3418         3.3         5.2
                                                                                               MALIGNANCY AGE >17.
340...............  No..................  No..................      12  SURG*...............  TESTES PROCEDURES, NON-     1.3418           *           *
                                                                                               MALIGNANCY AGE 0-17.
341...............  No..................  No..................      12  SURG................  PENIS PROCEDURES......      1.2527         1.9         3.2
342...............  No..................  No..................      12  SURG................  CIRCUMCISION AGE >17..      0.8546         2.3         3.0
343...............  No..................  No..................      12  SURG*...............  CIRCUMCISION AGE 0-17.      0.8546           *           *
344...............  No..................  No..................      12  SURG................  OTHER MALE                  1.1078         1.8         2.7
                                                                                               REPRODUCTIVE SYSTEM
                                                                                               O.R. PROCEDURES FOR
                                                                                               MALIGNANCY.

[[Page 24281]]

 
345...............  No..................  No..................      12  SURG................  OTHER MALE                  1.3524         3.4         5.4
                                                                                               REPRODUCTIVE SYSTEM
                                                                                               O.R. PROC EXCEPT FOR
                                                                                               MALIGNANCY.
346...............  No..................  No..................      12  MED.................  MALIGNANCY, MALE            1.1351         4.5         5.9
                                                                                               REPRODUCTIVE SYSTEM,
                                                                                               W CC.
347...............  No..................  No..................      12  MED.................  MALIGNANCY, MALE            0.5734         2.0         2.7
                                                                                               REPRODUCTIVE SYSTEM,
                                                                                               W/O CC.
348...............  No..................  No..................      12  MED.................  BENIGN PROSTATIC            0.7721         3.1         4.0
                                                                                               HYPERTROPHY W CC.
349...............  No..................  No..................      12  MED.................  BENIGN PROSTATIC            0.4942         2.1         2.6
                                                                                               HYPERTROPHY W/O CC.
350...............  No..................  No..................      12  MED.................  INFLAMMATION OF THE         0.8552         3.6         4.5
                                                                                               MALE REPRODUCTIVE
                                                                                               SYSTEM.
351...............  No..................  No..................      12  MED*................  STERILIZATION, MALE...      0.8690           *           *
352...............  No..................  No..................      12  MED.................  OTHER MALE                  0.8690         3.0         4.2
                                                                                               REPRODUCTIVE SYSTEM
                                                                                               DIAGNOSES.
353...............  No..................  No..................      13  SURG................  PELVIC EVISCERATION,        1.7446         4.5         6.0
                                                                                               DRADICAL HYSTERECTOMY
                                                                                               & RADICAL VULVECTOMY.
354...............  No..................  No..................      13  SURG................  UTERINE, ADNEXA PROC        1.5594         4.5         5.6
                                                                                               FOR NON-OVARIAN/
                                                                                               ADNEXAL MALIG W CC.
355...............  No..................  No..................      13  SURG................  UTERINE, ADNEXA PROC        0.9349         2.8         3.0
                                                                                               FOR NON-OVARIAN/
                                                                                               ADNEXAL MALIG W/O CC.
356...............  No..................  No..................      13  SURG................  FEMALE REPRODUCTIVE         0.7426         1.6         1.9
                                                                                               SYSTEM RECONSTRUCTIVE
                                                                                               PROCEDURES.
357...............  No..................  No..................      13  SURG................  UTERINE & ADNEXA PROC       2.2785         6.4         8.0
                                                                                               FOR OVARIAN OR
                                                                                               ADNEXAL MALIGNANCY.
358...............  No..................  No..................      13  SURG................  UTERINE & ADNEXA PROC       1.1816         3.1         3.9
                                                                                               FOR NON-MALIGNANCY W
                                                                                               CC.
359...............  No..................  No..................      13  SURG................  UTERINE & ADNEXA PROC       0.8258         2.1         2.3
                                                                                               FOR NON-MALIGNANCY W/
                                                                                               O CC.
360...............  No..................  No..................      13  SURG................  VAGINA, CERVIX & VULVA      0.8803         2.0         2.5
                                                                                               PROCEDURES.
361...............  No..................  No..................      13  SURG................  LAPAROSCOPY &               1.1046         2.1         3.0
                                                                                               INCISIONAL TUBAL
                                                                                               INTERRUPTION.
362...............  No..................  No..................      13  SURG*...............  ENDOSCOPIC TUBAL            1.1046         1.0         1.0
                                                                                               INTERRUPTION.
363...............  No..................  No..................      13  SURG................  D&C, CONIZATION &           1.0198         2.8         4.1
                                                                                               RADIO-IMPLANT, FOR
                                                                                               MALIGNANCY.
364...............  No..................  No..................      13  SURG................  D&C, CONIZATION EXCEPT      0.9331         3.0         4.2
                                                                                               FOR MALIGNANCY.
365...............  No..................  No..................      13  SURG................  OTHER FEMALE                2.0803         5.3         7.9
                                                                                               REPRODUCTIVE SYSTEM
                                                                                               O.R. PROCEDURES.
366...............  No..................  No..................      13  MED.................  MALIGNANCY, FEMALE          1.2888         4.6         6.3
                                                                                               REPRODUCTIVE SYSTEM W
                                                                                               CC.
367...............  No..................  No..................      13  MED.................  MALIGNANCY, FEMALE          0.5895         2.3         3.0
                                                                                               REPRODUCTIVE SYSTEM W/
                                                                                               O CC.
368...............  No..................  No..................      13  MED.................  INFECTIONS, FEMALE          1.2262         5.0         6.4
                                                                                               REPRODUCTIVE SYSTEM.
369...............  No..................  No..................      13  MED.................  MENSTRUAL & OTHER           0.6696         2.5         3.3
                                                                                               FEMALE REPRODUCTIVE
                                                                                               SYSTEM DISORDERS.
370...............  No..................  No..................      14  SURG................  CESAREAN SECTION W CC.      1.1080         4.0         5.0
371...............  No..................  No..................      14  SURG................  CESAREAN SECTION W/O        0.7664         3.1         3.4
                                                                                               CC.
372...............  No..................  No..................      14  MED.................  VAGINAL DELIVERY W          0.7390         2.7         3.5
                                                                                               COMPLICATING
                                                                                               DIAGNOSES.
373...............  No..................  No..................      14  MED.................  VAGINAL DELIVERY W/O        0.5276         2.1         2.2
                                                                                               COMPLICATING
                                                                                               DIAGNOSES.
374...............  No..................  No..................      14  SURG................  VAGINAL DELIVERY W          0.7708         2.4         3.0
                                                                                               STERILIZATION &/OR
                                                                                               D&C.
375...............  No..................  No..................      14  SURG................  VAGINAL DELIVERY W          1.2156         4.0         6.2
                                                                                               O.R. PROC EXCEPT
                                                                                               STERIL &/OR D&C.
376...............  No..................  No..................      14  MED.................  POSTPARTUM & POST           0.7273         2.5         3.3
                                                                                               ABORTION DIAGNOSES W/
                                                                                               O O.R. PROCEDURE.
377...............  No..................  No..................      14  SURG................  POSTPARTUM & POST           1.5307         3.1         4.4
                                                                                               ABORTION DIAGNOSES W
                                                                                               O.R. PROCEDURE.
378...............  No..................  No..................      14  MED.................  ECTOPIC PREGNANCY.....      0.7782         1.8         2.2
379...............  No..................  No..................      14  MED.................  THREATENED ABORTION...      0.5628         2.2         3.2
380...............  No..................  No..................      14  MED.................  ABORTION W/O D&C......      0.4872         1.5         2.0

[[Page 24282]]

 
381...............  No..................  No..................      14  SURG................  ABORTION W D&C,             0.7239         1.7         2.4
                                                                                               ASPIRATION CURETTAGE
                                                                                               OR HYSTEROTOMY.
382...............  No..................  No..................      14  MED.................  FALSE LABOR...........      0.2783         1.3         1.5
383...............  No..................  No..................      14  MED.................  OTHER ANTEPARTUM            0.6683         2.6         3.7
                                                                                               DIAGNOSES W MEDICAL
                                                                                               COMPLICATIONS.
384...............  No..................  No..................      14  MED.................  OTHER ANTEPARTUM            0.4601         1.7         2.5
                                                                                               DIAGNOSES W/O MEDICAL
                                                                                               COMPLICATIONS.
385...............  No..................  No..................      15  MED*................  NEONATES, DIED OR           1.4095           *           *
                                                                                               TRANSFERRED TO
                                                                                               ANOTHER ACUTE CARE
                                                                                               FACILITY.
386...............  No..................  No..................      15  MED*................  EXTREME IMMATURITY OR        4.648           *           *
                                                                                               RESPIRATORY DISTRESS
                                                                                               SYNDROME, NEONATE.
387...............  No..................  No..................      15  MED*................  PREMATURITY W MAJOR         3.1744           *           *
                                                                                               PROBLEMS.
388...............  No..................  No..................      15  MED*................  PREMATURITY W/O MAJOR       1.9153           *           *
                                                                                               PROBLEMS.
389...............  No..................  No..................      15  MED*................  FULL TERM NEONATE W         3.2608         1.8         2.0
                                                                                               MAJOR PROBLEMS.
390...............  No..................  No..................      15  MED*................  NEONATE W OTHER             1.1541           *           *
                                                                                               SIGNIFICANT PROBLEMS.
391...............  No..................  No..................      15  MED*................  NORMAL NEWBORN........      0.1562           *           *
392...............  No..................  No..................      16  SURG................  SPLENECTOMY AGE >17...      3.1188         6.3         8.8
393...............  No..................  No..................      16  SURG*...............  SPLENECTOMY AGE 0--7..      3.1188           *           *
394...............  No..................  No..................      16  SURG................  OTHER O.R. PROCEDURES       1.8725         4.4         7.3
                                                                                               OF THE BLOOD AND
                                                                                               BLOOD FORMING ORGANS.
395...............  Yes.................  No..................      16  MED.................  RED BLOOD CELL              0.9413         3.2         4.3
                                                                                               DISORDERS AGE >17.
396...............  No..................  No..................      16  MED.................  RED BLOOD CELL              0.6888         2.5         3.0
                                                                                               DISORDERS AGE 0-17.
397...............  No..................  No..................      16  MED.................  COAGULATION DISORDERS.      1.3611         3.7         5.1
398...............  No..................  No..................      16  MED.................  RETICULOENDOTHELIAL &       1.2912         4.4         5.7
                                                                                               IMMUNITY DISORDERS W
                                                                                               CC.
399...............  No..................  No..................      16  MED.................  RETICULOENDOTHELIAL &       0.7064         2.7         3.4
                                                                                               IMMUNITY DISORDERS W/
                                                                                               O CC.
400...............  No..................  No..................      17  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
401...............  Yes.................  No..................      17  SURG................  LYMPHOMA & NON-ACUTE        2.8703         8.1        11.2
                                                                                               LEUKEMIA W OTHER O.R.
                                                                                               PROC W CC.
402...............  Yes.................  No..................      17  SURG................  LYMPHOMA & NON-ACUTE        1.1380         2.8         3.9
                                                                                               LEUKEMIA W OTHER O.R.
                                                                                               PROC W/O CC.
403...............  Yes.................  No..................      17  MED.................  LYMPHOMA & NON-ACUTE        1.8986         5.7         8.0
                                                                                               LEUKEMIA W CC.
404...............  Yes.................  No..................      17  MED.................  LYMPHOMA & NON-ACUTE        0.9137         3.0         4.0
                                                                                               LEUKEMIA W/O CC.
405...............  No..................  No..................      17  MED*................  ACUTE LEUKEMIA W/O          3.4703           *           *
                                                                                               MAJOR O.R. PROCEDURE
                                                                                               AGE 0-17.
406...............  No..................  No..................      17  SURG................  MYELOPROLIF DISORD OR       2.7839         6.7         9.4
                                                                                               POORLY DIFF NEOPL W
                                                                                               MAJ O.R.PROC W CC.
407...............  No..................  No..................      17  SURG................  MYELOPROLIF DISORD OR       1.1617         2.9         3.5
                                                                                               POORLY DIFF NEOPL W
                                                                                               MAJ O.R.PROC W/O CC.
408...............  No..................  No..................      17  SURG................  MYELOPROLIF DISORD OR       2.1388         5.1         8.2
                                                                                               POORLY DIFF NEOPL W
                                                                                               OTHER O.R.PROC.
409...............  No..................  No..................      17  MED.................  RADIOTHERAPY..........      1.2059         4.5         6.0
410...............  No..................  No..................      17  MED.................  CHEMOTHERAPY W/O ACUTE      1.0178         2.9         3.8
                                                                                               LEUKEMIA AS SECONDARY
                                                                                               DIAGNOSIS.
411...............  No..................  No..................      17  MED*................  HISTORY OF MALIGNANCY       0.6205         1.6         2.0
                                                                                               W/O ENDOSCOPY.
412...............  No..................  No..................      17  MED*................  HISTORY OF MALIGNANCY       0.6205         1.4         1.5
                                                                                               W ENDOSCOPY.
413...............  No..................  No..................      17  MED.................  OTHER MYELOPROLIF DIS       1.4097         5.1         6.8
                                                                                               OR POORLY DIFF NEOPL
                                                                                               DIAG W CC.
414...............  No..................  No..................      17  MED.................  OTHER MYELOPROLIF DIS       0.8055         3.0         4.0
                                                                                               OR POORLY DIFF NEOPL
                                                                                               DIAG W/O CC.
415...............  Yes.................  No..................      18  SURG................  O.R. PROCEDURE FOR          4.1393        11.0        14.8
                                                                                               INFECTIOUS &
                                                                                               PARASITIC DISEASES.
416...............  Yes.................  No..................      18  MED.................  SEPTICEMIA AGE >17....      1.8340         5.7         7.6
417...............  No..................  No..................      18  MED.................  SEPTICEMIA AGE 0-17...      1.9140         5.2         6.5
418...............  Yes.................  No..................      18  MED.................  POSTOPERATIVE & POST-       1.1938         4.7         6.1
                                                                                               TRAUMATIC INFECTIONS.

[[Page 24283]]

 
419...............  No..................  No..................      18  MED.................  FEVER OF UNKNOWN            0.8951         3.4         4.4
                                                                                               ORIGIN AGE >17 W CC.
420...............  No..................  No..................      18  MED.................  FEVER OF UNKNOWN            0.6263         2.6         3.2
                                                                                               ORIGIN AGE >17 W/O CC.
421...............  No..................  No..................      18  MED.................  VIRAL ILLNESS AGE >17.      0.8210         3.1         4.0
422...............  No..................  No..................      18  MED.................  VIRAL ILLNESS & FEVER       0.8240         2.6         3.7
                                                                                               OF UNKNOWN ORIGIN AGE
                                                                                               0-17.
423...............  Yes.................  No..................      18  MED.................  OTHER INFECTIOUS &          1.9053         5.9         8.2
                                                                                               PARASITIC DISEASES
                                                                                               DIAGNOSES.
424...............  No..................  No..................      19  SURG................  O.R. PROCEDURE W            2.3978         7.4        11.4
                                                                                               PRINCIPAL DIAGNOSES
                                                                                               OF MENTAL ILLNESS.
425...............  No..................  No..................      19  MED.................  ACUTE ADJUSTMENT            0.7075         2.6         3.5
                                                                                               REACTION &
                                                                                               PSYCHOSOCIAL
                                                                                               DYSFUNCTION.
426...............  No..................  No..................      19  MED.................  DEPRESSIVE NEUROSES...      0.7464         3.2         4.5
427...............  No..................  No..................      19  MED.................  NEUROSES EXCEPT             0.8104         3.2         4.7
                                                                                               DEPRESSIVE.
428...............  No..................  No..................      19  MED.................  DISORDERS OF                1.1577         4.5         7.3
                                                                                               PERSONALITY & IMPULSE
                                                                                               CONTROL.
429...............  Yes.................  No..................      19  MED.................  ORGANIC DISTURBANCES &      0.9614         4.4         5.8
                                                                                               MENTAL RETARDATION.
430...............  Yes.................  No..................      19  MED.................  PSYCHOSES.............      1.2316         5.9         8.0
431...............  No..................  No..................      19  MED.................  CHILDHOOD MENTAL            1.0504         4.3         6.8
                                                                                               DISORDERS.
432...............  No..................  No..................      19  MED.................  OTHER MENTAL DISORDER       0.7280         2.7         4.0
                                                                                               DIAGNOSES.
433...............  No..................  No..................      20  MED.................  ALCOHOL/DRUG ABUSE OR       0.4017         2.1         2.8
                                                                                               DEPENDENCE, LEFT AMA.
434...............  No..................  No..................      20  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
435...............  No..................  No..................      20  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
436...............  No..................  No..................      20  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
437...............  No..................  No..................      20  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
438...............  No..................  No..................      20  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
439...............  No..................  No..................      21  SURG................  SKIN GRAFTS FOR             2.0857         5.4         8.4
                                                                                               INJURIES.
440...............  Yes.................  No..................      21  SURG................  WOUND DEBRIDEMENTS FOR      2.0128         5.6         8.5
                                                                                               INJURIES.
441...............  No..................  No..................      21  SURG................  HAND PROCEDURES FOR         1.0682         2.3         3.5
                                                                                               INJURIES.
442...............  Yes.................  No..................      21  SURG................  OTHER O.R. PROCEDURES       2.6213         5.9         8.9
                                                                                               FOR INJURIES W CC.
443...............  Yes.................  No..................      21  SURG................  OTHER O.R. PROCEDURES       1.0919         2.7         3.5
                                                                                               FOR INJURIES W/O CC.
444...............  Yes.................  No..................      21  MED.................  TRAUMATIC INJURY AGE        0.8329         3.2         4.1
                                                                                               >17 W CC.
445...............  Yes.................  No..................      21  MED.................  TRAUMATIC INJURY AGE        0.5792         2.3         2.8
                                                                                               >17 W/O CC.
446...............  No..................  No..................      21  MED*................  TRAUMATIC INJURY AGE 0-     0.5792           *           *
                                                                                               17.
447...............  No..................  No..................      21  MED.................  ALLERGIC REACTIONS AGE      0.6470         1.9         2.6
                                                                                               >17.
448...............  No..................  No..................      21  MED*................  ALLERGIC REACTIONS AGE      0.6470           *           *
                                                                                               0-17.
449...............  No..................  No..................      21  MED.................  POISONING & TOXIC           0.9882         2.7         3.7
                                                                                               EFFECTS OF DRUGS AGE
                                                                                               >17 W CC.
450...............  No..................  No..................      21  MED.................  POISONING & TOXIC           0.5741         1.6         2.0
                                                                                               EFFECTS OF DRUGS AGE
                                                                                               >17 W/O CC.
451...............  No..................  No..................      21  MED*................  POISONING & TOXIC           0.5741        10.2        10.5
                                                                                               EFFECTS OF DRUGS AGE
                                                                                               0-17.
452...............  No..................  No..................      21  MED.................  COMPLICATIONS OF            1.1377         3.5         4.9
                                                                                               TREATMENT W CC.
453...............  No..................  No..................      21  MED.................  COMPLICATIONS OF            0.5867         2.2         2.8
                                                                                               TREATMENT W/O CC.
454...............  No..................  No..................      21  MED.................  OTHER INJURY,               0.9136         3.0         4.1
                                                                                               POISONING & TOXIC
                                                                                               EFFECT DIAG W CC.
455...............  No..................  No..................      21  MED.................  OTHER INJURY,               0.5053         1.8         2.3
                                                                                               POISONING & TOXIC
                                                                                               EFFECT DIAG W/O CC.
456...............  No..................  No..................      22  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
457...............  No..................  No..................      22  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
458...............  No..................  No..................      22  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
459...............  No..................  No..................      22  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
460...............  No..................  No..................      22  MED.................  NO LONGER VALID.......      0.0000         0.0         0.0
461...............  No..................  No..................      23  SURG................  O.R. PROC W DIAGNOSES       1.5386         3.3         5.6
                                                                                               OF OTHER CONTACT W
                                                                                               HEALTH SERVICES.
462...............  Yes.................  No..................      23  MED.................  REHABILITATION........      1.5753         8.4         9.9
463...............  Yes.................  No..................      23  MED.................  SIGNS & SYMPTOMS W CC.      0.7661         3.1         3.9
464...............  Yes.................  No..................      23  MED.................  SIGNS & SYMPTOMS W/O        0.5663         2.4         2.9
                                                                                               CC.
465...............  No..................  No..................      23  MED.................  AFTERCARE W HISTORY OF      0.6205         2.5         3.6
                                                                                               MALIGNANCY AS
                                                                                               SECONDARY DIAGNOSIS.
466...............  No..................  No..................      23  MED.................  AFTERCARE W/O HISTORY       0.7848         2.7         5.0
                                                                                               OF MALIGNANCY AS
                                                                                               SECONDARY DIAGNOSIS.

[[Page 24284]]

 
467...............  No..................  No..................      23  MED.................  OTHER FACTORS               0.5408         1.9         2.7
                                                                                               INFLUENCING HEALTH
                                                                                               STATUS.
468...............  Yes.................  No..................  ......  SURG................  EXTENSIVE O.R.              3.8122         9.6        12.9
                                                                                               PROCEDURE UNRELATED
                                                                                               TO PRINCIPAL
                                                                                               DIAGNOSIS.
469...............  No..................  No..................  ......  **..................  PRINCIPAL DIAGNOSIS         0.0000         0.0         0.0
                                                                                               INVALID AS DISCHARGE
                                                                                               DIAGNOSIS.
470...............  No..................  No..................  ......  **..................  UNGROUPABLE...........      0.0000         0.0         0.0
471...............  Yes.................  Yes.................      08  SURG................  BILATERAL OR MULTIPLE       2.7365         4.2         4.6
                                                                                               MAJOR JOINT PROCS OF
                                                                                               LOWER EXTREMITY.
472...............  No..................  No..................      22  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
473...............  No..................  No..................      17  MED.................  ACUTE LEUKEMIA W/O          3.4703         7.3        12.7
                                                                                               MAJOR O.R. PROCEDURE
                                                                                               AGE >17.
474...............  No..................  No..................      04  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
475...............  Yes.................  No..................      04  MED.................  RESPIRATORY SYSTEM          3.8279         7.9        10.9
                                                                                               DIAGNOSIS WITH
                                                                                               VENTILATOR SUPPORT.
476...............  No..................  No..................  ......  SURG................  PROSTATIC O.R.              2.1079         6.9        10.0
                                                                                               PROCEDURE UNRELATED
                                                                                               TO PRINCIPAL
                                                                                               DIAGNOSIS.
477...............  Yes.................  No..................  ......  SURG................  NON-EXTENSIVE O.R.          2.0694         5.9         8.6
                                                                                               PROCEDURE UNRELATED
                                                                                               TO PRINCIPAL
                                                                                               DIAGNOSIS.
478...............  Yes.................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
479...............  No..................  No..................      05  SURG................  OTHER VASCULAR              1.2715         1.9         2.6
                                                                                               PROCEDURES W/O CC.
480...............  No..................  No..................     PRE  SURG................  LIVER TRANSPLANT AND/      11.7482        14.0        19.2
                                                                                               OR INTESTINAL
                                                                                               TRANSPLANT.
481...............  No..................  No..................     PRE  SURG................  BONE MARROW TRANSPLANT      7.1983        18.7        22.0
482...............  Yes.................  No..................     PRE  SURG................  TRACHEOSTOMY FOR            3.5956         9.4        11.8
                                                                                               FACE,MOUTH & NECK
                                                                                               DIAGNOSES.
483...............  No..................  No..................     PRE  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
484...............  No..................  No..................      24  SURG................  CRANIOTOMY FOR              5.3652         8.6        12.8
                                                                                               MULTIPLE SIGNIFICANT
                                                                                               TRAUMA.
485...............  Yes.................  No..................      24  SURG................  LIMB REATTACHMENT, HIP      3.5846         8.1         9.9
                                                                                               AND FEMUR PROC FOR
                                                                                               MULTIPLE SIGNIFICANT
                                                                                               TRAUMA.
486...............  No..................  No..................      24  SURG................  OTHER O.R. PROCEDURES       5.1310         8.5        12.3
                                                                                               FOR MULTIPLE
                                                                                               SIGNIFICANT TRAUMA.
487...............  Yes.................  No..................      24  MED.................  OTHER MULTIPLE              2.1184         5.2         7.1
                                                                                               SIGNIFICANT TRAUMA.
488...............  No..................  No..................      25  SURG................  HIV W EXTENSIVE O.R.        4.8181        12.2        17.5
                                                                                               PROCEDURE.
489...............  No..................  No..................      25  MED.................  HIV W MAJOR RELATED         1.7760         5.8         8.2
                                                                                               CONDITION.
490...............  No..................  No..................      25  MED.................  HIV W OR W/O OTHER          1.0808         3.8         5.3
                                                                                               RELATED CONDITION.
491...............  No..................  No..................      08  SURG................  MAJOR JOINT & LIMB          1.5997         2.5         3.0
                                                                                               REATTACHMENT
                                                                                               PROCEDURES OF UPPER
                                                                                               EXTREMITY.
492...............  No..................  No..................      17  MED.................  CHEMOTHERAPY W ACUTE        3.6663         8.9        13.8
                                                                                               LEUKEMIA OR W USE OF
                                                                                               HI DOSE CHEMOAGENT.
493...............  No..................  No..................      07  SURG................  LAPAROSCOPIC                1.7812         4.6         6.0
                                                                                               CHOLECYSTECTOMY W/O
                                                                                               C.D.E. W CC.
494...............  No..................  No..................      07  SURG................  LAPAROSCOPIC                0.9795         2.1         2.7
                                                                                               CHOLECYSTECTOMY W/O
                                                                                               C.D.E. W/O CC.
495...............  No..................  No..................     PRE  SURG................  LUNG TRANSPLANT.......     10.0630        14.2        17.0
496...............  No..................  No..................      08  SURG................  COMBINED ANTERIOR/          5.3926         6.4         8.8
                                                                                               POSTERIOR SPINAL
                                                                                               FUSION.
497...............  Yes.................  Yes.................      08  SURG................  SPINAL FUSION EXCEPT        3.3300         4.8         5.7
                                                                                               CERVICAL W CC.
498...............  Yes.................  Yes.................      08  SURG................  SPINAL FUSION EXCEPT        2.5267         3.3         3.7
                                                                                               CERVICAL W/O CC.
499...............  No..................  No..................      08  SURG................  BACK & NECK PROCEDURES      1.3408         3.0         4.2
                                                                                               EXCEPT SPINAL FUSION
                                                                                               W CC.
500...............  No..................  No..................      08  SURG................  BACK & NECK PROCEDURES      0.8707         1.8         2.2
                                                                                               DEXCEPT SPINAL FUSION
                                                                                               W/O CC.
501...............  Yes.................  No..................      08  SURG................  KNEE PROCEDURES W PDX       2.7150         8.4        10.4
                                                                                               OF INFECTION W CC.
502...............  Yes.................  No..................      08  SURG................  KNEE PROCEDURES W PDX       1.5598         5.0         5.8
                                                                                               OF INFECTION W/O CC.
503...............  No..................  No..................      08  SURG................  KNEE PROCEDURES W/O         1.2375         3.0         3.9
                                                                                               PDX OF INFECTION.

[[Page 24285]]

 
504...............  No..................  No..................      22  SURG................  EXTEN. BURNS OR FULL       13.2723        21.0        28.3
                                                                                               THICKNESS BURN W/MV
                                                                                               96+HRS W/SKIN GFT.
505...............  No..................  No..................      22  MED.................  EXTEN. BURNS OR FULL        3.0532         2.8         6.4
                                                                                               THICKNESS BURN W/MV
                                                                                               96+HRS W/O SKIN GFT.
506...............  No..................  No..................      22  SURG................  FULL THICKNESS BURN W       4.7246        10.9        15.2
                                                                                               DSKIN GRAFT OR INHAL
                                                                                               INJ W CC OR SIG
                                                                                               TRAUMA.
507...............  No..................  No..................      22  SURG................  FULL THICKNESS BURN W       2.2603         5.5         7.8
                                                                                               SKIN GRFT OR INHAL
                                                                                               INJ W/O CC OR SIG
                                                                                               TRAUMA.
508...............  No..................  No..................      22  MED.................  FULL THICKNESS BURN W/      1.6171         5.3         7.5
                                                                                               O SKIN GRFT OR INHAL
                                                                                               INJ W CC OR SIG
                                                                                               TRAUMA.
509...............  No..................  No..................      22  MED.................  FULL THICKNESS BURN W/      1.1338         3.7         5.3
                                                                                               O SKIN GRFT OR INH
                                                                                               INJ W/O CC OR SIG
                                                                                               TRAUMA.
510...............  No..................  No..................      22  MED.................  NON-EXTENSIVE BURNS W       1.4467         4.1         6.1
                                                                                               CC OR SIGNIFICANT
                                                                                               TRAUMA.
511...............  No..................  No..................      22  MED.................  NON-EXTENSIVE BURNS W/      0.8610         2.6         3.7
                                                                                               O CC OR SIGNIFICANT
                                                                                               DTRAUMA.
512...............  No..................  No..................     PRE  SURG................  SIMULTANEOUS PANCREAS/      9.9384        11.1        13.5
                                                                                               KIDNEY TRANSPLANT.
513...............  No..................  No..................     PRE  SURG................  PANCREAS TRANSPLANT...      6.5546         8.8        10.0
514...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
515...............  No..................  No..................      05  SURG................  CARDIAC DEFIBRILLATOR       4.1471         2.2         3.8
                                                                                               IMPLANT W/O CARDIAC
                                                                                               CATH.
516...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
517...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
518...............  No..................  No..................      05  SURG................  PERC CARDIO PROC W/O        1.1424         1.8         2.5
                                                                                               CORONARY ARTERY STENT
                                                                                               OR AMI.
519...............  No..................  No..................      08  SURG................  CERVICAL SPINAL FUSION      2.2859         2.9         4.7
                                                                                               W CC.
520...............  No..................  No..................      08  SURG................  CERVICAL SPINAL FUSION      1.4721         1.6         1.9
                                                                                               W/O CC.
521...............  Yes.................  No..................      20  MED.................  ALCOHOL/DRUG ABUSE OR       0.9157         4.0         5.4
                                                                                               DEPENDENCE W CC.
522...............  Yes.................  No..................      20  MED.................  ALC/DRUG ABUSE OR           1.0575         8.1        10.5
                                                                                               DEPEND W
                                                                                               REHABILITATION
                                                                                               THERAPY W/O CC.
523...............  No..................  No..................      20  MED.................  ALC/DRUG ABUSE OR           0.5474         3.2         3.8
                                                                                               DEPEND W/O
                                                                                               REHABILITATION
                                                                                               THERAPY W/O CC.
524...............  No..................  No..................      01  MED.................  TRANSIENT ISCHEMIA....      0.6913         2.6         3.1
525...............  No..................  No..................      05  SURG................  OTHER HEART ASSIST         12.0673         7.7        14.5
                                                                                               SYSTEM IMPLANT.
526...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
527...............  No..................  No..................      05  SURG................  NO LONGER VALID.......      0.0000         0.0         0.0
528...............  No..................  No..................      01  SURG................  INTRACRANIAL VASCULAR       7.3829        13.3        16.4
                                                                                               PROC W PDX HEMORRHAGE.
529...............  Yes.................  No..................      01  SURG................  VENTRICULAR SHUNT           2.2423         4.7         7.5
                                                                                               PROCEDURES W CC.
530...............  Yes.................  No..................      01  SURG................  VENTRICULAR SHUNT           1.1697         2.3         3.0
                                                                                               PROCEDURES W/O CC.
531...............  Yes.................  No..................      01  SURG................  SPINAL PROCEDURES W CC      3.0552         6.3         9.1
532...............  Yes.................  No..................      01  SURG................  SPINAL PROCEDURES W/O       1.3777         2.8         3.6
                                                                                               CC.
533...............  No..................  No..................      01  SURG................  EXTRACRANIAL                1.4911         2.3         3.7
                                                                                               PROCEDURES W CC.
534...............  No..................  No..................      01  SURG................  EXTRACRANIAL                0.9668         1.4         1.7
                                                                                               PROCEDURES W/O CC.
535...............  No..................  No..................      05  SURG................  CARDIAC DEFIB IMPLANT       5.8951         6.9         9.2
                                                                                               W CARDIAC CATH W AMI/
                                                                                               HF/SHOCK.
536...............  No..................  No..................      05  SURG................  CARDIAC DEFIB IMPLANT       5.2199         5.5         7.3
                                                                                               W CARDIAC CATH W/O
                                                                                               AMI/HF/SHOCK.
537...............  Yes.................  No..................      08  SURG................  LOCAL EXCIS & REMOV OF      1.8568         4.7         6.6
                                                                                               INT FIX DEV EXCEPT
                                                                                               HIP & FEMUR W CC.
538...............  Yes.................  No..................      08  SURG................  LOCAL EXCIS & REMOV OF      1.0223         2.2         2.9
                                                                                               INT FIX DEV EXCEPT
                                                                                               HIP & FEMUR W/O CC.
539...............  No..................  No..................      17  SURG................  LYMPHOMA & LEUKEMIA W       3.1235         6.8        10.5
                                                                                               MAJOR OR PROCEDURE W
                                                                                               CC.
540...............  No..................  No..................      17  SURG................  LYMPHOMA & LEUKEMIA W       1.1837         2.6         3.5
                                                                                               MAJOR OR PROCEDURE W/
                                                                                               O CC.
541...............  Yes.................  No..................     PRE  SURG................  ECMO OR TRACH W MV         19.9990        36.9        44.1
                                                                                               96+HRS OR PDX EXC
                                                                                               FACE, MOUTH & NECK W
                                                                                               MAJ O.R..
542...............  Yes.................  No..................     PRE  SURG................  TRACH W MV 96+HRS OR       12.5966        27.2        32.6
                                                                                               PDX EXC FACE, MOUTH &
                                                                                               NECK W/O MAJ O.R..

[[Page 24286]]

 
543...............  Yes.................  No..................      01  SURG................  CRANIOTOMY W/IMPLANT        4.6474         8.4        12.0
                                                                                               OF CHEMO AGENT OR
                                                                                               ACUTE COMPLX CNS PDX.
544...............  Yes.................  No..................      08  SURG................  MAJOR JOINT                 1.8941         4.0         4.4
                                                                                               REPLACEMENT OR
                                                                                               REATTACHMENT OF LOWER
                                                                                               EXTREMITY.
545...............  Yes.................  Yes.................      08  SURG................  REVISION OF HIP OR          2.4127         4.5         5.2
                                                                                               KNEE REPLACEMENT.
546...............  No..................  No..................      08  SURG................  SPINAL FUSION EXC CERV      4.8421         6.9         8.7
                                                                                               WITH CURVATURE OF THE
                                                                                               SPINE OR MALIG.
547...............  Yes.................  No..................      05  SURG................  CORONARY BYPASS W           5.6862        10.9        12.4
                                                                                               CARDIAC CATH W MAJOR
                                                                                               CV DX.
548...............  Yes.................  No..................      05  SURG................  CORONARY BYPASS W           4.1762         8.1         8.9
                                                                                               CARDIAC CATH W/O
                                                                                               MAJOR CV DX.
549...............  Yes.................  Yes.................      05  SURG................  CORONARY BYPASS W/O         4.8829         8.7        10.3
                                                                                               CARDIAC CATH W MAJOR
                                                                                               CV DX.
550...............  Yes.................  Yes.................      05  SURG................  CORONARY BYPASS W/O         3.4598         6.2         6.8
                                                                                               CARDIAC CATH W/O
                                                                                               MAJOR CV DX.
551...............  No..................  No..................      05  SURG................  PERMANENT CARDIAC           2.6339         4.2         6.1
                                                                                               PACEMAKER IMPL W MAJ
                                                                                               CV DX OR AICD LEAD OR
                                                                                               GNRTR.
552...............  No..................  No..................      05  SURG................  OTHER PERMANENT             1.7670         2.5         3.5
                                                                                               CARDIAC PACEMAKER
                                                                                               IMPLANT W/O MAJOR CV
                                                                                               DX.
553...............  Yes.................  No..................      05  SURG................  OTHER VASCULAR              2.8371         6.3         9.3
                                                                                               PROCEDURES W CC W
                                                                                               MAJOR CV DX.
554...............  Yes.................  No..................      05  SURG................  OTHER VASCULAR              1.9483         3.7         5.6
                                                                                               PROCEDURES W CC W/O
                                                                                               MAJOR CV DX.
555...............  No..................  No..................      05  SURG................  PERCUTANEOUS                1.8654         3.4         4.8
                                                                                               CARDIOVASCULAR PROC W
                                                                                               MAJOR CV DX.
556...............  No..................  No..................      05  SURG................  PERCUTANEOUS                1.2241         1.6         2.0
                                                                                               CARDIOVASC PROC W NON-
                                                                                               DRUG-ELUTING STENT W/
                                                                                               O MAJ CV DX.
557...............  No..................  No..................      05  SURG................  PERCUTANEOUS                2.1323         3.0         4.1
                                                                                               CARDIOVASCULAR PROC W
                                                                                               DRUG-ELUTING STENT W
                                                                                               MAJOR CV DX.
558...............  No..................  No..................      05  SURG................  PERCUTANEOUS                1.4299         1.5         1.8
                                                                                               CARDIOVASCULAR PROC W
                                                                                               DRUG-ELUTING STENT W/
                                                                                               O MAJ CV DX.
559...............  No..................  No..................      08  MED.................  ACUTE ISCHEMIC STROKE       2.2370         5.4        6.9
                                                                                               WITH USE OF
                                                                                               THROMBOLYTIC AGENT.
--------------------------------------------------------------------------------------------------------------------------------------------------------
DRGS 469 and 470 contain cases which could not be assigned to valid drgs.
Note: An asterisk in the gmlos or amlos column indicates there is no data to compute.
Note: Arithmetic mean is presented for informational purposes only.
Note: Geometric mean is used only to determine payment for transfer cases.
Note: Relative weights are based on medicare patient data and may not be appropriate for other patients.


                     Table 6A.--New Diagnosis Codes
------------------------------------------------------------------------
Diagnosis code    Description       CC       MDC             DRG
------------------------------------------------------------------------
052.2.........  Postvaricella    Y               1  20, 543
                 myelitis.
053.14........  Herpes zoster    Y               1  20, 543
                 myelitis.
054.74........  Herpes simplex   Y               1  20, 543
                 myelitis.
238.71........  Essential        N              16  398, 399
                 thrombocythemi
                 a.
238.72........  Low grade        N              16  395, 396
                 myelodysplasti
                 c syndrome
                 lesions.
238.73........  High grade       N              16  395, 396
                 myelodysplasti
                 c syndrome
                 lesions.
238.74........  Myelodysplastic  N              16  395, 396
                 syndrome with
                 5q deletion.
238.75........  Myelodysplastic  N              16  395, 396
                 syndrome,
                 unspecified.
238.76........  Myelofibrosis    N              17  401, 402, 403, 404,
                 with myeloid                        539, 540
                 Metaplasia.
238.79........  Other lymphatic  N              17  401, 402, 403, 404,
                 and                                 539, 540
                 Hematopoietic
                 tissues.
277.30........  Amyloidosis,     N               8  240, 241
                 unspecified.
277.31........  Familial         N               8  240, 241
                 Mediterranean
                 fever.
277.39........  Other            N               8  240, 241
                 amyloidosis.
284.01........  Constitutional   N              16  395, 396
                 red blood cell
                 aplasia.
284.09........  Other            N              16  395, 396
                 constitutional
                 aplastic
                 anemia.
284.1.........  Pancytopenia...  N              16  395, 396

[[Page 24287]]

 
284.2.........  Myelophthisis..  N              17  401, 402, 403, 404,
                                                     539, 540
288.00........  Neutropenia,     N              16  398, 399
                 unspecified.                   25  490
288.01........  Congenital       N              16  398, 399
                 neutropenia.                   25  490
288.02........  Cyclic           N              16  398, 399
                 neutropenia.                   25  490
288.03........  Drug induced     N              16  398, 399
                 neutropenia.                   25  490
288.04........  Neutropenia due  N              16  398, 399
                 to infection.                  25  490
288.09........  Other            N              16  398, 399
                 neutropenia.                   25  490
288.4.........  Hemophagocytic   N              16  398, 399
                 syndromes.
288.50........  Leukocytopenia,  N              16  398, 399
                 unspecified.
288.51........  Lymphocytopenia  N              16  398, 399
288.59........  Other decreased  N              16  398, 399
                 white blood
                 cell count.
288.60........  Leukocytosis,    N              16  398, 399
                 unspecified.
288.61........  Lymphocytosis    N              16  398, 399
                 (symptomatic).
288.62........  Leukemoid        N              16  398, 399
                 reaction.
288.63........  Monocytosis      N              16  398, 399
                 (symptomatic).
288.64........  Plasmacytosis..  N              16  398, 399
288.65........  Basophilia.....  N              16  398, 399
288.69........  Other elevated   N              16  398, 399
                 white blood
                 cell count.
289.53........  Neutropenic      N              16  398, 399
                 splenomegaly.
289.83........  Myelofibrosis..  N              17  401, 402, 403, 404,
                                                     539, 540
323.01........  Encephalitis     N               1  20, 543
                 and
                 encephalomyeli
                 tis in viral
                 diseases
                 classified
                 elsewhere.
323.02........  Myelitis in      N               1  20, 543
                 viral diseases
                 classified
                 elsewhere.
323.41........  Other            N               1  20, 543
                 encephalitis
                 and
                 encephalomyeli
                 tis due to
                 infection
                 classified
                 elsewhere.
323.42........  Other myelitis   N               1  20, 543
                 due to
                 infection
                 classified
                 elsewhere.
323.51........  Encephalitis     N               1  20, 543
                 and
                 encephalomyeli
                 tis following
                 immunization
                 procedures.
323.52........  Myelitis         N               1  20, 543
                 following
                 immunization
                 procedures.
323.61........  Infectious       N               1  20, 543
                 acute
                 disseminated
                 encephalomyeli
                 tis (ADEM).
323.62........  Other            N               1  20, 543
                 postinfectious
                 encephalitis
                 and
                 encephalomyeli
                 tis.
323.63........  Postinfectious   N               1  20, 543
                 myelitis.
323.71........  Toxic            N               1  34, 35, 543
                 encephalitis
                 and
                 encephalomyeli
                 tis.
323.72........  Toxic myelitis.  N               1  34, 35, 543
323.81........  Other causes of  N               1  20, 543
                 encephalitis                   25  489
                 and
                 encephalomyeli
                 tis.
323.82........  Other causes of  N               1  20, 543
                 myelitis.                      25  489
331.83........  Mild cognitive   N               1  12
                 impairment, so
                 stated.
333.71........  Athetoid         N               1  12
                 cerebral palsy.
333.72........  Acute dystonia   N               1  34, 35
                 due to drugs.
333.79........  Other acquired   N               1  34, 35
                 torsion
                 dystonia.
333.85........  Subacute         N               1  34, 35
                 dyskinesia due
                 to drugs.
338.0.........  Central pain     N              23  463, 464
                 syndrome.
338.11........  Acute pain due   N              23  463, 464
                 to trauma.
338.12........  Acute post-      N              23  463, 464
                 thoracotomy
                 pain.
338.18........  Other acute      N              23  463, 464
                 postoperative
                 pain.
338.19........  Other acute      N              23  463, 464
                 pain.
338.21........  Chronic pain     N              23  463, 464
                 due to trauma.
338.22........  Chronic post-    N              23  463, 464
                 thoracotomy
                 pain.
338.28........  Other chronic    N              23  463, 464
                 postoperative
                 pain.
338.29........  Other chronic    N              23  463, 464
                 pain.
338.3.........  Neoplasm         N              23  463, 464
                 related pain
                 (acute)
                 (chronic).
338.4.........  Chronic pain     N              23  463, 464
                 syndrome.
341.20........  Acute            N               1  20, 543
                 (transverse)
                 myelitis NOS.
341.21........  Acute            N               1  20, 543
                 (transverse)
                 myelitis in
                 conditions
                 classified
                 elsewhere.
341.22........  Idiopathic       N               1  20, 543
                 transverse
                 myelitis.
377.43........  Optic nerve      N               2  45
                 hypoplasia.
379.60........  Inflammation     N               2  46, 47, 48
                 (infection) of
                 postprocedural
                 bleb,
                 unspecified.
379.61........  Inflammation     N               2  46, 47, 48
                 (infection) of
                 postprocedural
                 bleb, stage 1.
379.62........  Inflammation     N               2  46, 47, 48
                 (infection) of
                 postprocedural
                 bleb, stage 2.
379.63........  Inflammation     N               2  46, 47, 48
                 (infection) of
                 postprocedural
                 bleb, stage 3.
389.15........  Sensorineural    N               3  73, 74
                 hearing loss,
                 unilateral.
389.16........  Sensorineural    N               3  73, 74
                 hearing loss,
                 asymmetrical.
429.83........  Takotsubo        N               5  144, 145
                 syndrome.

[[Page 24288]]

 
478.11........  Nasal mucositis  N               3  15, 73, 74
                 (ulcerative).                      391 \1\
478.19........  Other disease    N               3  73, 74
                 of nasal                       15  391 \1\
                 cavity and
                 sinuses.
518.7.........  Transfusion      Y               4  101, 102
                 related acute
                 lung injury
                 (TRALI).
519.11........  Acute            N             PRE  482
                 bronchospasm.                   4  96, 97, 98
519.19........  Other diseases   N             PRE  482
                 of trachea and                  4  96, 97, 98
                 bronchus.
521.81........  Cracked tooth..  N             PRE  482
                                                 3  185, 186, 187
521.89........  Other specific   N             PRE  482
                 diseases of                     3  185, 186, 187
                 hard tissues
                 of teeth.
523.00........  Acute            N             PRE  482
                 gingivitis,                     3  185, 186, 187
                 plaque induced.
523.01........  Acute            N             PRE  482
                 gingivitis,                     3  185, 186, 187
                 non-plaque
                 induced.
523.10........  Chronic          N             PRE  482
                 gingivitis,                     3  185, 186, 187
                 plaque induced.
523.11........  Chronic          N             PRE  482
                 gingivitis,                     3  185, 186, 187
                 non-plaque
                 induced.
523.30........  Aggressive       N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 unspecified.
523.31........  Aggressive       N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 localized.
523.32........  Aggressive       N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 generalized.
523.33........  Acute            N             PRE  482
                 periodontitis.                  3  185, 186, 187
523.40........  Chronic          N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 unspecified.
523.41........  Chronic          N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 localized.
523.42........  Chronic          N             PRE  482
                 periodontitis,                  3  185, 186, 187
                 generalized.
525.60........  Unspecified      N             PRE  482
                 unsatisfactory                  3  185, 186, 187
                 restoration of
                 tooth.
525.61........  Open             N             PRE  482
                 restoration                     3  185, 186, 187
                 margins.
525.62........  Unrepairable     N             PRE  482
                 overhanging of                  3  185, 186, 187
                 dental
                 restorative
                 materials.
525.63........  Fractured        N             PRE  482
                 dental                          3  185, 186, 187
                 restorative
                 material
                 without loss
                 of material.
525.64........  Fractured        N             PRE  482
                 dental                          3  185, 186, 187
                 restorative
                 material with
                 loss of
                 material.
525.65........  Contour of       N             PRE  482
                 existing                        3  185, 186, 187
                 restoration of
                 tooth
                 biologically
                 incompatible
                 with oral
                 health.
525.66........  Allergy to       N             PRE  482
                 existing                        3  185, 186, 187
                 dental
                 restorative
                 material.
525.67........  Poor aesthetics  N             PRE  482
                 of existing                     3  185, 186, 187
                 restoration.
525.69........  Other            N             PRE  482
                 unsatisfactory                  3  185, 186, 187
                 restoration of
                 existing tooth.
526.61........  Perforation of   N             PRE  482
                 root canal                      3  185, 186, 187
                 space.
526.62........  Endodontic       N             PRE  482
                 overfill.                       3  185, 186, 187
526.63........  Endodontic       N             PRE  482
                 underfill.                      3  185, 186, 187
526.69........  Other            N             PRE  482
                 periradicular                   3  185, 186, 187
                 pathology
                 associated
                 with previous
                 endodontic
                 treatment.
528.00........  Stomatitis and   N             PRE  482
                 mucositis,                      3  185, 186, 187
                 unspecified.
528.01........  Mucositis        N             PRE  482
                 (ulcerative)                    3  185, 186, 187
                 due to
                 antineoplastic
                 therapy.
528.02........  Mucositis        N             PRE  482
                 (ulcerative)                    3  185, 186, 187
                 due to other
                 drugs.
528.09........  Other            N             PRE  482
                 stomatitis and                  3  185, 186, 187
                 mucositis
                 (ulcerative).
538...........  Gastrointestina  N               6  182, 183, 184
                 l mucositis
                 (ulcerative).
608.20........  Torsion of       N              12  352
                 testis,
                 unspecified.

[[Page 24289]]

 
608.21........  Extravaginal     N              12  352
                 torsion of
                 spermatic cord.
608.22........  Intravaginal     N              12  352
                 torsion of
                 spermatic cord.
608.23........  Torsion of       N              12  352
                 appendix
                 testis.
608.24........  Torsion of       N              12  352
                 appendix
                 epididymis.
616.81........  Mucositis        N              13  358, 359, 368
                 (ulcerative)
                 of cervix,
                 vagina, and
                 vulva.
616.89........  Other            N              13  358, 359, 368
                 inflammatory
                 disease of
                 cervix, vagina
                 and vulva.
618.84........  Cervical stump   N              13  358, 359, 369
                 prolapse.
629.29........  Other female     N              13  358, 359, 369
                 genital
                 mutilation
                 status.
629.81........  Habitual         N              13  358, 359, 368
                 aborter
                 without
                 current
                 pregnancy.
629.89........  Other specified  N              13  358, 359, 368
                 disorders of
                 female genital
                 organs.
649.00........  Tobacco use      N              14  469
                 disorder
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.01........  Tobacco use      N              14  370, 371, 372, 373,
                 disorder                            374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.02........  Tobacco use      N              14  370, 371, 372, 373,
                 disorder                            374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.03........  Tobacco use      N              14  383, 384
                 disorder
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 antepartum
                 condition or
                 complication.
649.04........  Tobacco use      N              14  376, 377
                 disorder
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 postpartum
                 condition or
                 complication.
649.10........  Obesity          N              14  469
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.11........  Obesity          N              14  370, 371, 372, 373,
                 complicating                        374, 375
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.12........  Obesity          N              14  370, 371, 372, 373,
                 complicating                        374, 375
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.13........  Obesity          N              14  383, 384
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 antepartum
                 condition or
                 complication.
649.14........  Obesity          N              14  376, 377
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 postpartum
                 condition or
                 complication.
649.20........  Bariatric        N              14  469
                 surgery status
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.21........  Bariatric        N              14  370, 371, 372, 373,
                 surgery status                      374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.22........  Bariatric        N              14  370, 371, 372, 373,
                 surgery status                      374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.23........  Bariatric        N              14  383, 384
                 surgery status
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 antepartum
                 condition or
                 complication.
649.24........  Bariatric        N              14  376, 377
                 surgery status
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 postpartum
                 condition or
                 complication.
649.30........  Coagulation      N              14  469
                 defects
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.31........  Coagulation      N              14  370, 371, 372, 373,
                 defects                             374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.32........  Coagulation      N              14  370, 371, 372, 373,
                 defects                             374, 375
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.33........  Coagulation      N              14  383, 384
                 defects
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 antepartum
                 condition or
                 complication.
649.34........  Coagulation      N              14  376, 377
                 defects
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 postpartum
                 condition or
                 complication.
649.40........  Epilepsy         N              14  469
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.41........  Epilepsy         N              14  370, 371, 372, 373,
                 complicating                        374, 375
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.42........  Epilepsy         N              14  370, 371, 372, 373,
                 complicating                        374, 375
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.43........  Epilepsy         N              14  383, 384
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 antepartum
                 condition or
                 complication.
649.44........  Epilepsy         N              14  376, 377
                 complicating
                 pregnancy,
                 childbirth, or
                 the
                 puerperium,
                 postpartum
                 condition or
                 complication.
649.50........  Spotting         N              14  469
                 complicating
                 pregnancy,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.51........  Spotting         N              14  370, 371, 372, 373,
                 complicating                        374, 375
                 pregnancy,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.53........  Spotting         N              14  383, 384
                 complicating
                 pregnancy,
                 antepartum
                 condition or
                 complication.
649.60........  Uterine size     N              14  469
                 date
                 discrepancy,
                 unspecified as
                 to episode of
                 care or not
                 applicable.
649.61........  Uterine size     N              14  370, 371, 372, 373,
                 date                                374, 375
                 discrepancy,
                 delivered,
                 with or
                 without
                 mention of
                 antepartum
                 condition.
649.62........  Uterine size     N              14  370, 371, 372, 373,
                 date                                374, 375
                 discrepancy,
                 delivered,
                 with mention
                 of postpartum
                 complication.
649.63........  Uterine size     N              14  383, 384
                 date
                 discrepancy,
                 antepartum
                 condition or
                 complication.
649.64........  Uterine size     N              14  376, 377
                 date
                 discrepancy,
                 postpartum
                 condition or
                 complication.

[[Page 24290]]

 
729.71........  Nontraumatic     N               8  248
                 compartment
                 syndrome of
                 upper
                 extremity.
729.72........  Nontraumatic     N               8  248
                 compartment
                 syndrome of
                 lower
                 extremity.
729.73........  Nontraumatic     N               8  248
                 compartment
                 syndrome of
                 abdomen.
729.79........  Nontraumatic     N               8  248
                 compartment
                 syndrome of
                 other sites.
731.3.........  Major osseous    N               8  244, 245
                 defects.
780.32........  Complex febrile  Y               1  24, 25, 26
                 convulsions.
780.96........  Generalized      N              23  463, 464
                 pain.
780.97........  Altered mental   N              23  463, 464
                 status.
784.91........  Postnasal drip.  N               3  73, 74
784.99........  Other symptoms   N               3  73, 74
                 involving head
                 and neck.
788.64........  Urinary          N              11  325, 326, 327
                 hesitancy.
788.65........  Straining on     N              11  325, 326, 327
                 urination.
793.91........  Image test       N              23  463, 464
                 inconclusive
                 due to excess
                 body fat.
793.99........  Other            N              23  463, 464
                 nonspecific
                 abnormal
                 findings on
                 radiological
                 and other
                 examinations
                 of body
                 structure.
795.06........  Papanicolaou     N              13  358, 359, 369
                 smear of
                 cervix with
                 cytologic
                 evidence of
                 malignancy.
795.81........  Elevated         N              23  463, 464
                 carcinoembryon
                 ic antigen
                 [CEA].
795.82........  Elevated cancer  N              23  463, 464
                 antigen 125
                 [CA 125].
795.89........  Other abnormal   N              23  463, 464
                 tumor markers.
958.90........  Compartment      N              21  454, 455
                 syndrome,
                 unspecified.
958.91........  Traumatic        N              21  454, 455
                 compartment
                 syndrome of
                 upper
                 extremity.
958.92........  Traumatic        N              21  454, 455
                 compartment
                 syndrome of
                 lower
                 extremity.
958.93........  Traumatic        N              21  454, 455
                 compartment
                 syndrome of
                 abdomen.
958.99........  Traumatic        N              21  454, 455
                 compartment
                 syndrome of
                 other sites.
995.20........  Unspecified      N              15  387 \2\, 389 \2\
                 adverse effect                 21  449, 450, 451
                 of unspecified
                 drug,
                 medicinal and
                 biological
                 substance.
995.21........  Arthus           N              15  387 \2\, 389 \2\
                 phenomenon.                    21  449, 450, 451
995.22........  Unspecified      N              15  387 \2\, 389 \2\
                 adverse effect                 21  449, 450, 451
                 of anesthesia.
995.23........  Unspecified      N              15  387 \2\, 389 \2\
                 adverse effect                 21  449, 450, 451
                 of insulin.
995.27........  Other drug       N              15  387 \2\, 389 \2\
                 allergy.                       21  449, 450, 451
995.29........  Unspecified      N              15  387 \2\, 389 \2\
                 adverse effect                 21  449, 450, 451
                 of other drug,
                 medicinal and
                 biological
                 substance.
V18.51........  Family history,  N              23  467
                 Colonic polyps.
V18.59........  Family history,  N              23  467
                 Other
                 digestive
                 disorders.
V26.34........  Testing of male  N              23  467
                 for genetic
                 disease
                 carrier status.
V26.35........  Encounter for    N              23  467
                 testing of
                 male partner
                 of habitual
                 aborter.
V26.39........  Other genetic    N              23  467
                 testing of
                 male.
V45.86........  Bariatric        N              23  467
                 surgery status.
V58.30........  Encounter for    N              23  467
                 change or
                 removal of
                 nonsurgical
                 wound dressing.
V58.31........  Encounter for    N              23  467
                 change or
                 removal of
                 surgical wound
                 dressing.
V58.32........  Encounter for    N              23  467
                 removal of
                 sutures.
V72.11........  Encounter for    N              23  467
                 hearing                        15  391 \1\
                 examinationfol
                 lowing failed
                 hearing
                 screening.
V72.19........  Other            N              23  467
                 examination of                 15  391 \1\
                 ears and
                 hearing.
V82.71........  Screening for    N              23  467
                 genetic
                 disease
                 carrier status.
V82.79........  Other genetic    N              23  467
                 screening.
V85.51........  Body Mass        N              23  467
                 Index,
                 pediatric,
                 less than 5th
                 percentile for
                 age.
V85.52........  Body Mass        N              23  467
                 Index,
                 pediatric, 5th
                 percentile to
                 less than 85th
                 percentile for
                 age.
V85.53........  Body Mass        N              23  467
                 Index,
                 pediatric,
                 85th
                 percentile to
                 less than 95th
                 percentile for
                 age.
V85.54........  Body Mass        N              23  467
                 Index,
                 pediatric,
                 greater than
                 or equal to
                 95th
                 percentile for
                 age.
V86.0.........  Estrogen         N              23  467
                 receptor
                 positive
                 status [ER+].
V86.1.........  Estrogen         N              23  467
                 receptor
                 negative
                 status [ER-].
------------------------------------------------------------------------
 \1\ On ``Only secondary diagnosis'' list.
 \2\ Principal or secondary diagnosis of major problem.


                     Table 6B.--New Procedure Codes
------------------------------------------------------------------------
Procedure code    Description      O.R.      MDC             DRG
------------------------------------------------------------------------
00.44.........  Procedure on     N
                 vessel
                 bifurcation.
00.56.........  Insertion or     Y               5  117,120 \1\
                 replacement of
                 implantable
                 pressure
                 sensor (lead)
                 for
                 intracardiac
                 hemodynamic
                 monitoring.
00.57.........  Implantation or  Y               5  118,120 \1\
                 replacement of
                 subcutaneous
                 device for
                 intracardiac
                 hemodynamic
                 monitoring.
37.20.........  Noninvasive      N
                 programmed
                 electrical
                 stimulation
                 [NIPS].

[[Page 24291]]

 
39.74.........  Endovascular     Y               1  1, 2, 3, 543
                 removal of                     21  442, 443
                 obstruction                    24  486
                 from head and
                 neck vessel(s).
68.41.........  Laparoscopic     Y              13  354, 355, 357,
                 total                          14  358, 359
                 abdominal                          375
                 hysterectomy.
68.49.........  Other and        Y              13  354, 355, 357,358,
                 unspecified                    14   359
                 total                              375
                 abdominal
                 hysterectomy.
68.61.........  Laparoscopic     Y              13  353
                 radical                        14  375
                 abdominal
                 hysterectomy.
68.69.........  Other and        Y              13  353
                 unspecified                    14  375
                 radical
                 abdominal
                 hysterectomy.
68.71.........  Laparoscopic     Y              13  353
                 radical                        14  375
                 vaginal
                 hysterectomy
                 [LRVH].
68.79.........  Other and        Y              13  353
                 unspecified                    14  375
                 radical
                 vaginal
                 hysterectomy.
------------------------------------------------------------------------
 \1\ Assigned to DRG 120 when both Code 00.56 and Code 00.57 are
  reported.


                   Table 6C.--Invalid Diagnosis Codes
------------------------------------------------------------------------
Diagnosis code    Description       CC       MDC             DRG
------------------------------------------------------------------------
238.7.........  Other lymphatic  N              17  401, 402, 403, 404,
                 and                                 539, 540
                 hematopoietic
                 tissues.
277.3.........  Amyloidosis....  N               8  240, 241
284.0.........  Constitutional   Y              16  395, 396
                 aplastic
                 anemia.
288.0.........  Agranulocytosis  Y              16  398, 399 490
                                                25
323.0.........  Encephalitis in  N               1  20, 543
                 viral diseases
                 classified
                 elsewhere.
323.4.........  Other            N               1  20, 543
                 encephalitis
                 due to
                 infection
                 classified
                 elsewhere.
323.5.........  Encephalitis     N               1  20, 543
                 following
                 immunization
                 procedures.
323.6.........  Postinfectious   N               1  20, 543
                 encephalitis.
323.7.........  Toxic            N               1  34, 35, 543
                 encephalitis.
323.8.........  Other causes of  N               1  20, 543 489
                 encephalitis.                  25
333.7.........  Symptomatic      N               1  12
                 torsion
                 dystonia.
478.1.........  Other diseases   N               3  73, 74 391 \1\
                 of nasal                       15
                 cavity and
                 sinuses.
519.1.........  Other diseases   N             PRE  482
                 of trachea and                  4  96, 97, 98
                 bronchus, not
                 elsewhere
                 classified.
521.8.........  Other specific   N             PRE  482
                 diseases of                     3  185, 186, 187
                 hard tissues
                 of teeth.
523.0.........  Acute            N             PRE  482
                 gingivitis.                     3  185, 186, 187
523.1.........  Chronic          N             PRE  482
                 gingivitis.                     3  185, 186, 187
523.3.........  Acute            N             PRE  482
                 periodontitis.                  3  185, 186, 187
523.4.........  Chronic          N             PRE  482
                 periodontitis.                  3  185, 186, 187
528.0.........  Stomatitis.....  N             PRE  482
                                                 3  185, 186, 187
608.2.........  Torsion of       N              12  352
                 testis.
616.8.........  Other specified  N              13  358, 359, 368
                 inflammatory
                 diseases of
                 cervix,
                 vagina, and
                 vulva.
629.8.........  Other specified  N              13  358, 359, 369
                 disorders of
                 female genital
                 organs.
784.9.........  Other symptoms   N               3  73, 74
                 involving head
                 and neck.
793.9.........  Other            N              23  463, 464
                 nonspecific
                 abnormal
                 findings on
                 radiological
                 and other
                 examinations
                 of body
                 structure.
995.2.........  Unspecified      N              15  387 \2\, 389 \2\
                 adverse effect                 21  449, 450, 451
                 of drug,
                 medicinal and
                 biological
                 substance.
V18.5.........  Family history,  N              23  467
                 Digestive
                 disorders.
V58.3.........  Attention to     N              23  467
                 surgical
                 dressings and
                 sutures.
V72.1.........  Examination of   N              15  391 \1\
                 ears and                       23  467
                 hearing.
------------------------------------------------------------------------
\1\ On ``Only secondary diagnosis'' list.
\2\ Principal or secondary diagnosis of major problem.


[[Page 24292]]


                   Table 6D.--Invalid Procedure Codes
------------------------------------------------------------------------
Procedure code    Description      O.R.      MDC             DRG
------------------------------------------------------------------------
68.4..........  Total abdominal  Y              13  354, 355, 357, 358,
                 hysterectomy.                  14   359
                                                    375
68.6..........  Radical          Y              13  353
                 abdominal                      14  375
                 hysterectomy.
68.7..........  Radical vaginal  Y              13  353
                 hysterectomy.                  14  375
------------------------------------------------------------------------


                                       Table 6E.--Revised Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
     Diagnosis code             Description                  CC             MDC                 DRG
----------------------------------------------------------------------------------------------------------------
255.10.................  Hyperaldosteronism,        N                          10  300, 301
                          unspecified.
285.29.................  Anemia of other chronic    N                          16  395, 396
                          disease.
323.1..................  Encephalitis, myelitis,    N                           1  20, 543
                          and encephalomyelitis in
                          rickettsial diseases
                          classified elsewhere.
323.2..................  Encephalitis, myelitis,    N                           1  20, 543
                          and encephalomyelitis in
                          protozoal diseases
                          classified elsewhere.
323.9..................  Unspecified causes of      N                           1  20, 543
                          encephalitis, myelitis,                              25  489
                          and encephalomyelitis.
333.6..................  Genetic torsion dystonia.  N                           1  12
345.40.................  Localization-related       N                           1  24, 25, 26
                          (focal) (partial)
                          epilepsy and epileptic
                          syndromes with complex
                          partial seizures,
                          without mention of
                          intractable epilepsy.
345.41.................  Localization-related       Y                           1  24, 25, 26
                          (focal) (partial)
                          epilepsy and epileptic
                          syndromes with complex
                          partial seizures, with
                          intractable epilepsy.
345.50.................  Localization-related       N                           1  24, 25, 26
                          (focal) (partial)
                          epilepsy and epileptic
                          syndromes with simple
                          partial seizures,
                          without mention of
                          intractable epilepsy.
345.51.................  Localization-related       Y                           1  24, 25, 26
                          (focal) (partial)
                          epilepsy and epileptic
                          syndromes with simple
                          partial seizures, with
                          intractable epilepsy.
345.80.................  Other forms of epilepsy    N                           1  24, 25, 26
                          and recurrent seizures,
                          without mention of
                          intractable epilepsy.
345.81.................  Other forms of epilepsy    Y                           1  24, 25, 26
                          and recurrent seizures,
                          with intractable
                          epilepsy.
389.11.................  Sensory hearing loss,      N                           3  73, 74
                          bilateral.
389.12.................  Neural hearing loss,       N                           3  73, 74
                          bilateral.
389.14.................  Central hearing loss,      N                           3  73, 74
                          bilateral.
389.18.................  Sensorineural hearing      N                           3  73, 74
                          loss of combined types,
                          bilateral.
403.00.................  Hypertensive chronic       Y                          11  331, 332, 333
                          kidney disease,
                          malignant, with chronic
                          kidney disease stage I
                          through stage IV, or
                          unspecified.
403.01.................  Hypertensive chronic       Y                      PRE 11  512 \1\, 513 \1\
                          kidney disease,                                          315, 316
                          malignant, with chronic
                          kidney disease stage V
                          or end stage renal
                          disease.
403.10.................  Hypertensive chronic       N                          11  331, 332, 333
                          kidney disease, benign,
                          with chronic kidney
                          disease stage I through
                          stage IV, or unspecified.
403.11.................  Hypertensive chronic       Y                      PRE 11  512 \1\, 513 \1\
                          kidney disease, benign,                                  315, 316
                          with chronic kidney
                          disease stage V or end
                          stage renal disease.
403.90.................  Hypertensive chronic       N                          11  331, 332, 333
                          kidney disease,
                          unspecified, with
                          chronic kidney disease
                          stage I through stage
                          IV, or unspecified.
403.91.................  Hypertensive chronic       Y                      PRE 11  512 \1\, 513 \1\
                          kidney disease,                                          315, 316
                          unspecified, with
                          chronic kidney disease
                          stage V or end stage
                          renal disease.
404.00.................  Hypertensive heart and     Y                           5  134
                          chronic kidney disease,
                          malignant, without heart
                          failure and with chronic
                          kidney disease stage I
                          through stage IV, or
                          unspecified.
404.01.................  Hypertensive heart and     Y                           5  121 \2\, 124 \3\,
                          chronic kidney disease,                         .......  127, 535,
                          malignant, with heart                           .......  547 \4\, 549 \4\,
                          failure and with chronic                        .......  551 \4\, 553 \4\,
                          kidney disease stage I                          .......  555 \4\, 557 \4\
                          through stage IV, or                                 15  387 \5\, 389 \5\
                          unspecified.
404.02.................  Hypertensive heart and     Y                      PRE 11  512 \1\, 513 \1\
                          chronic kidney disease,                                  315, 316
                          malignant, without heart
                          failure and with chronic
                          kidney disease stage V
                          or end stage renal
                          disease.
404.03.................  Hypertensive heart and     Y                         PRE  512 \1\, 513 \1\
                          chronic kidney disease,                               5  121 \2\, 124 \3\,
                          malignant, with heart                           .......  127, 535,
                          failure and with chronic                        .......  547 \4\, 549 \4\,
                          kidney disease stage V                          .......  551 \4\, 553 \4\,
                          or end stage renal                              .......  555 \4\, 557 \4\
                          disease.                                             15  387 \5\, 389 \5\
404.10.................  Hypertensive heart and     N                           5  134
                          chronic kidney disease,
                          benign, without heart
                          failure and with chronic
                          kidney disease stage I
                          through stage IV, or
                          unspecified.

[[Page 24293]]

 
404.11.................  Hypertensive heart and     Y                           5  121 \2\, 124 \3\,
                          chronic kidney disease,                         .......  127, 535,
                          benign, with heart                              .......  547 \4\, 549 \4\,
                          failure and with chronic                        .......  551 \4\, 553 \4\,
                          kidney disease stage I                          .......  555 \4\, 557 \4\
                          through stage IV, or                                 15  387 \5\, 389 \5\
                          unspecified.
404.12.................  Hypertensive heart and     Y                      PRE 11  512 \1\, 513 \1\
                          chronic kidney disease,                                  315, 316
                          benign, without heart
                          failure and with chronic
                          kidney disease stage V
                          or end stage renal
                          disease.
404.13.................  Hypertensive heart and     Y                         PRE  512 \1\, 513 \1\
                          chronic kidney disease,                               5  121 \2\, 124 \3\,
                          benign, with heart                              .......  127, 535,
                          failure and chronic                             .......  547 \4\, 549 \4\,
                          kidney disease stage V                          .......  551 \4\, 553 \4\,
                          or end stage renal                              .......  5554, 557 \4\
                          disease.                                             15  387 \5\, 389 \5\
404.90.................  Hypertensive heart and     N                           5  134
                          chronic kidney disease,
                          unspecified, without
                          heart failure and with
                          chronic kidney disease
                          stage I through stage
                          IV, or unspecified.
404.91.................  Hypertensive heart and     Y                           5  121 \2\, 124 \3\,
                          chronic kidney disease,                         .......  127, 535,
                          unspecified, with heart                         .......  547 \4\, 549 \4\,
                          failure and with chronic                        .......  551 \4\, 553 \4\,
                          kidney disease stage I                          .......  555 \4\, 557 \4\
                          through stage IV, or                                 15  387 \5\, 389 \5\
                          unspecified.
404.92.................  Hypertensive heart and     Y                      PRE 11  512 \1\, 513 \1\
                          chronic kidney disease,                                  315, 316
                          unspecified, without
                          heart failure and with
                          chronic kidney disease
                          stage V or end stage
                          renal disease.
404.93.................  Hypertensive heart and     Y                         PRE  512 \1\, 513 \1\
                          chronic kidney disease,                               5  121 \2\, 124 \3\,
                          unspecified, with heart                         .......  127, 535,
                          failure and chronic                             .......  547 \4\, 549 \4\,
                          kidney disease stage V                          .......  551 \4\, 553 \4\,
                          or end stage renal                              .......  555 \4\, 557 \4\
                          disease.                                             15  387 \5\, 389 \5\
524.21.................  Malocclusion, Angle's      N                         PRE  482
                          class I.                                              3  185, 186, 187
524.22.................  Malocclusion, Angle's      N                         PRE  482
                          class II.                                             3  185, 186, 187
524.23.................  Malocclusion, Angle's      N                         PRE  482
                          class III.                                            3  185, 186, 187
524.35.................  Rotation of tooth/teeth..  N                         PRE  482
                                                                                3  185, 186, 187
600.00.................  Hypertrophy (benign) of    N                          12  348, 349
                          prostate without-urinary
                          obstruction and other
                          lower urinary tract
                          (LUTS) symptoms (LUTS).
600.01.................  Hypertrophy (benign) of    N                          12  348, 349
                          prostate with urinary
                          obstruction and other
                          lower urinary tract
                          symptoms (LUTS).
600.20.................  Benign localized           N                          12  348, 349
                          hyperplasia of prostate
                          without urinary
                          obstruction and other
                          lower urinary tract
                          symptoms (LUTS).
600.21.................  Benign localized           N                          12  348, 349
                          hyperplasia of prostate
                          with urinary obstruction
                          and other lower urinary
                          tract symptoms (LUTS).
600.90.................  Hyperplasia of prostate,   N                          12  348, 349
                          unspecified, without
                          urinary obstruction and
                          other lower urinary
                          symptoms (LUTS).
600.91.................  Hyperplasia of prostate,   N                          12  348, 349
                          unspecified, with
                          urinary obstruction and
                          other lower urinary
                          symptoms (LUTS).
780.31.................  Febrile convulsions        Y                           1  15 24, 25, 26 387 \5\, 389
                          (simple), unspecified.                                    \5\
780.95.................  Excessive crying of        N                          23  463, 464
                          child, adolescent, or
                          adult.
790.93.................  Elevated prostate          N                          23  463, 464
                          specific antigen [PSA].
873.63.................  Tooth (broken)             N                           3  185, 186,
                          (fractured) (due to                                  24  187 487
                          trauma), without mention
                          of complication.
873.73.................  Tooth (broken)             N                           3  185, 186, 187
                          (fractured) (due to                                  24  487
                          trauma), complicated.
995.91.................  Sepsis...................  Y                          18  416, 417
995.92.................  Severe sepsis............  Y                          18  416, 417
995.93.................  Systemic inflammatory      Y                          18  416, 417
                          response syndrome due to
                          noninfectious process
                          without acute organ
                          dysfunction.
995.94.................  Systemic inflammatory      Y                          18  416, 417
                          response syndrome due to
                          noninfectious process
                          with acute organ
                          dysfunction.
V26.31.................  Testing of female for      N                          23  467
                          genetic disease carrier
                          status.
V26.32.................  Other genetic testing of   N                          23  467
                          female.
----------------------------------------------------------------------------------------------------------------
\1\ Principal or secondary diagnosis.
\2\ Principal or secondary diagnosis of major complication.

[[Page 24294]]

 
\3\ Principal or secondary diagnosis of complex diagnosis.
\4\ Principal or secondary diagnosis of major cardiovascular.
\5\ Principal or secondary diagnosis of major problem.


                Table 6F.--Revised Procedure Code Titles
------------------------------------------------------------------------
Procedure code    Description      O.R.      MDC             DRG
------------------------------------------------------------------------
37.26.........  Catheter based   N*              5  104, 518, 555, 556,
                 invasive                            557, 558
                 electrophysiol
                 ogic testing.
------------------------------------------------------------------------
*Non-O.R. code that affects DRG assignment.


             Table 6G.--Additions To The CC Exclusions List
[CCs that are added to the list, effective October 1, 2006, are included
     in this table. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.]
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
*0519
 0522
*0522
 0520
 0521
 0522
 0527
 0528
 0529
 05314
 05474
*0527
 0522
*0528
 0522
*0529
 0522
*0530
 05314
*05310
 05314
*05311
 05314
*05312
 05314
*05313
 05314
*05314
 0522
 0530
 05310
 05311
 05312
 05313
 05314
 05319
 05379
 0538
 05474
*05319
 05314
*05379
 05314
*0538
 05314
*0539
 05314
*05472
 05314
*05474
 0522
 0530
 05310
 05311
 05312
 05313
 05314
 05319
 05379
 0538
 0543
 0545
 05471
 05472
 05474
 05479
 0548
*05479
 05314
 05474
*0548
 05314
 05474
*0549
 05314
 05474
*07888
 0522
 05314
 05474
*07889
 0522
 05314
 05474
*07981
 0522
 05314
 05474
*07988
 0522
 05314
 05474
*07989
 0522
 05314
 05474
*07998
 0522
 05314
 05474
*07999
 0522
 05314
 05474
*1398
 0522
 05314
 05474
*28401
 2800
 2814
 2818
 28241
 28242
 28249
 28260
 28261
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2848
 2849
 2850
 2851
*28409
 2800
 2814
 2818
 28241
 28242
 28249
 28260
 28261
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2848
 2849
 2850
 2851
*2841
 2800
 2814

[[Page 24295]]

 
 2818
 28241
 28242
 28249
 28260
 28261
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2848
 2849
 2850
 2851
*2842
 2800
 2814
 2818
 28241
 28242
 28249
 28260
 28261
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2848
 2849
 2850
 2851
*28800
 2881
 28981
 28982
*28801
 2881
 28981
 28982
*28802
 2881
 28981
 28982
*28803
 2881
 28981
 28982
*28804
 2881
 28981
 28982
*28809
 2881
 28981
 28982
*2884
 2881
 28981
 28982
*28850
 2881
 28981
 28982
*28851
 2881
 28981
 28982
*28859
 2881
 28981
 28982
*28860
 2881
 28981
 28982
*28861
 2881
 28981
 28982
*28862
 2881
 28981
 28982
*28863
 2881
 28981
 28982
*28864
 2881
 28981
 28982
*28865
 2881
 28981
 28982
*28869
 2881
 28981
 28982
*28953
 2881
 28981
 28982
*28983
 2800
 2814
 2818
 28241
 28242
 28249
 28260
 28261
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2848
 2849
 2850
 2851
 2860
 2861
 2862
 2863
 2864
 2865
 2866
 2867
 2869
 2870
 2871
 2872
 28730
 28731
 28732
 28733
 28739
 2874
 2875
 2878
 2879
 2881
 28981
 28982
*32301
 0522
 05314
 05474
 34982
*32302
 0522
 05314
 05474
 34982
*32341
 0522
 05314
 05474
 34982
*32342
 0522
 05314
 05474
 34982
*32351
 0522
 05314
 05474
 34982
*32352
 0522
 05314
 05474
 34982
*32361
 0522
 05314

[[Page 24296]]

 
 05474
 34982
*32362
 0522
 05314
 05474
 34982
*32363
 0522
 05314
 05474
 34982
*32371
 0522
 05314
 05474
 34982
*32372
 0522
 05314
 05474
 34982
*32381
 0522
 05314
 05474
 34982
*32382
 0522
 05314
 05474
 34982
*33183
 3314
*33371
 7817
*33372
 7817
*33379
 7817
*33385
 7817
*3380
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33811
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33812
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33818
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33819
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33821
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994

[[Page 24297]]

 
*33822
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33828
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*33829
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*3383
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*3384
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*34120
 0522
 05314
 05474
 34982
*34121
 0522
 05314
 05474
 34982
*34122
 0522
 05314
 05474
 34982
*34500
 78032
*34501
 78032
*34510
 78032
*34511
 78032
*3452
 78032
*3453
 78032
*34540
 78032
*34541
 78032
*34550
 78032
*34551
 78032
*34560
 78032
*34561
 78032
*34570
 78032
*34571
 78032
*34580
 78032
*34581
 78032
*34590
 78032
*34591
 78032
*3488
 78032
*3489
 78032
*34989
 78032
*3499
 78032
*37960
 37700
 37701
 37702
*37961
 37700
 37701
 37702
*37962

[[Page 24298]]

 
 37700
 37701
 37702
*37963
 37700
 37701
 37702
*5187
 5187
 9973
*51911
 51900
 51901
 51902
 51909
*51919
 51900
 51901
 51902
 51909
*52800
 5283
*52801
 5283
*52802
 5283
*52809
 5283
*538
 5273
 5274
 53021
 53100
 53101
 53110
 53111
 53120
 53121
 53131
 53140
 53141
 53150
 53151
 53160
 53161
 53171
 53191
 53200
 53201
 53210
 53211
 53220
 53221
 53231
 53240
 53241
 53250
 53251
 53260
 53261
 53271
 53291
 53300
 53301
 53310
 53311
 53320
 53321
 53331
 53340
 53341
 53350
 53351
 53360
 53361
 53371
 53391
 53400
 53401
 53410
 53411
 53420
 53421
 53431
 53440
 53441
 53450
 53451
 53460
 53461
 53471
 53491
 5400
 5401
 5409
 55000
 55001
 55002
 55003
 55010
 55011
 55012
 55013
 55100
 55101
 55102
 55103
 5511
 55120
 55121
 55129
 5518
 5519
 55200
 55201
 55202
 55203
*61681
 6140
 6143
 6145
 6150
 6163
 6164
*61689
 6140
 6143
 6145
 6150
 6163
 6164
*62929
 6140
 6143
 6145
 6150
 6163
 6164
 6207
*62981
 6140
 6143
 6145
 6150
 6163
 6164
 6207
*62989
 6140
 6143
 6145
 6150
 6163
 6164
 6207
*64900
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24299]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64901
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24300]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24301]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64902
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24302]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64903
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800

[[Page 24303]]

 
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64904
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802

[[Page 24304]]

 
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64910
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261

[[Page 24305]]

 
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64911
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24306]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64912
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24307]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24308]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64913
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24309]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64914
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800

[[Page 24310]]

 
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64920
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802

[[Page 24311]]

 
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64921
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261

[[Page 24312]]

 
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64922
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24313]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64923
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24314]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24315]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64924
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24316]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64930
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800

[[Page 24317]]

 
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64931
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802

[[Page 24318]]

 
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64932
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261

[[Page 24319]]

 
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64933
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24320]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64934
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24321]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24322]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64940
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24323]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64941
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800

[[Page 24324]]

 
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64942
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802

[[Page 24325]]

 
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64943
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261

[[Page 24326]]

 
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64944
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24327]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64950
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24328]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24329]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64951
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24330]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64953
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800

[[Page 24331]]

 
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64960
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802

[[Page 24332]]

 
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64961
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261

[[Page 24333]]

 
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64962
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003

[[Page 24334]]

 
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64963
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422

[[Page 24335]]

 
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334

[[Page 24336]]

 
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*64964
 63400
 63401
 63402
 63410
 63411
 63412
 63420
 63421
 63422
 63430
 63431
 63432
 63440
 63441
 63442
 63450
 63451
 63452
 63460
 63461
 63462
 63470
 63471
 63472
 63480
 63481
 63482
 63490
 63491
 63492
 6390
 6391
 6392
 6393
 6394
 6395
 6396
 6398
 6399
 64000
 64001
 64003
 64080
 64081
 64083
 64090
 64091
 64093
 64100
 64101
 64103
 64110
 64111
 64113
 64130
 64131
 64133
 64180
 64181
 64183
 64190
 64191
 64193
 64240
 64241
 64242
 64243
 64244
 64250
 64251
 64252
 64253
 64254
 64260
 64261
 64262
 64263
 64264
 64270
 64271
 64272
 64273
 64274
 64400
 64403
 64410
 64413
 64660
 64661
 64662
 64663
 64664
 64670
 64671
 64673
 64730
 64731
 64732
 64733
 64734
 64740
 64741
 64742
 64743
 64744
 64800
 64801
 64802
 64803
 64804
 64820
 64821
 64822
 64823
 64824
 64830
 64831
 64832
 64833
 64834
 64850
 64851
 64852
 64853
 64854
 64860
 64861
 64862
 64863
 64864
 65930
 65931
 65933
 66500
 66501
 66503
 66510
 66511
 66632
 66634
 66800
 66801
 66802
 66803
 66804
 66810
 66811
 66812
 66813
 66814
 66820
 66821
 66822
 66823
 66824
 66880
 66881
 66882
 66883
 66884
 66890
 66891
 66892
 66893
 66894
 66910
 66911
 66912
 66913
 66914
 66930
 66932
 66934
 67000

[[Page 24337]]

 
 67002
 67004
 67120
 67121
 67122
 67123
 67124
 67130
 67131
 67133
 67140
 67142
 67144
 67300
 67301
 67302
 67303
 67304
 67310
 67311
 67312
 67313
 67314
 67320
 67321
 67322
 67323
 67324
 67330
 67331
 67332
 67333
 67334
 67380
 67381
 67382
 67383
 67384
 67400
 67401
 67402
 67403
 67404
 67410
 67412
 67420
 67422
 67424
 67450
 67451
 67452
 67453
 67454
 67510
 67511
 67512
*7790
 78032
*7791
 78032
*78031
 78032
*78032
 78031
 78032
 78039
*78039
 78032
*78091
 78032
*78092
 78032
*78093
 78032
*78094
 78032
*78095
 78032
*78096
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*78097
 04082
 44024
 78001
 78003
 7801
 78031
 78032
 78039
 7817
 7854
 78550
 78551
 78552
 78559
 7863
 78820
 78829
 7895
 7907
 7911
 7913
 79901
 79902
 7991
 7994
*78099
 78032
*78864
 78820
 78829
*78865
 78820
 78829
*79981
 78032
*79989
 78032
*95890
 80000
 80001
 80002
 80003
 80004
 80005
 80006
 80009
 80010
 80011
 80012
 80013
 80014
 80015
 80016
 80019
 80020
 80021
 80022
 80023
 80024
 80025
 80026
 80029
 80030
 80031
 80032
 80033
 80034
 80035
 80036
 80039
 80040
 80041
 80042
 80043
 80044
 80045
 80046
 80049
 80050
 80051
 80052
 80053
 80054
 80055
 80056
 80059
 80060
 80061
 80062
 80063
 80064
 80065
 80066

[[Page 24338]]

 
 80069
 80070
 80071
 80072
 80073
 80074
 80075
 80076
 80079
 80080
 80081
 80082
 80083
 80084
 80085
 80086
 80089
 80090
 80091
 80092
 80093
 80094
 80095
 80096
 80099
 80100
 80101
 80102
 80103
 80104
 80105
 80106
 80109
 80110
 80111
 80112
 80113
 80114
 80115
 80116
 80119
 80120
 80121
 80122
 80123
 80124
 80125
 80126
 80129
 80130
 80131
 80132
 80133
 80134
 80135
 80136
 80139
 80140
 80141
 80142
 80143
 80144
 80145
 80146
 80149
 80150
 80151
 80152
 80153
 80154
 80155
 80156
 80159
 80160
 80161
 80162
 80163
 80164
 80165
 80166
 80169
 80170
 80171
 80172
 80173
 80174
 80175
 80176
 80179
 80180
 80181
 80182
 80183
 80184
 80185
 80186
 80189
 80190
 80191
 80192
 80193
 80194
 80195
 80196
 80199
 8021
 80220
 80221
 80222
 80223
 80224
 80225
 80226
 80227
 80228
 80229
 80230
 80231
 80232
 80233
 80234
 80235
 80236
 80237
 80238
 80239
 8024
 8025
 8026
 8027
 8028
 8029
 80300
 80301
 80302
 80303
 80304
 80305
 80306
 80309
 80310
 80311
 80312
 80313
 80314
 80315
 80316
 80319
 80320
 80321
 80322
 80323
 80324
 80325
 80326
 80329
 80330
 80331
 80332
 80333
 80334
 80335
 80336
 80339
 80340
 80341
 80342
 80343
 80344
 80345
 80346
 80349
 80350
 80351
 80352
 80353
 80354
 80355
 80356
 80359
 80360
 80361
 80362
 80363
 80364
 80365
 80366
 80369
 80370
 80371
 80372
 80373
 80374
 80375
 80376
 80379
 80380
 80381

[[Page 24339]]

 
 80382
 80383
 80384
 80385
 80386
 80389
 80390
 80391
 80392
 80393
 80394
 80395
 80396
 80399
 80400
 80401
 80402
 80403
 80404
 80405
 80406
 80409
 80410
 80411
 80412
 80413
 80414
 80415
 80416
 80419
 80420
 80421
 80422
 80423
 80424
 80425
 80426
 80429
 80430
 80431
 80432
 80433
 80434
 80435
 80436
 80439
 80440
 80441
 80442
 80443
 80444
 80445
 80446
 80449
 80450
 80451
 80452
 80453
 80454
 80455
 80456
 80459
 80460
 80461
 80462
 80463
 80464
 80465
 80466
 80469
 80470
 80471
 80472
 80473
 80474
 80475
 80476
 80479
 80480
 80481
 80482
 80483
 80484
 80485
 80486
 80489
 80490
 80491
 80492
 80493
 80494
 80495
 80496
 80499
 80500
 80501
 80502
 80503
 80504
 80505
 80506
 80507
 80508
 80510
 80511
 80512
 80513
 80514
 80515
 80516
 80517
 80518
 8052
 8053
 8054
 8055
 8056
 8057
 8058
 8059
 80600
 80601
 80602
 80603
 80604
 80605
 80606
 80607
 80608
 80609
 80610
 80611
 80612
 80613
 80614
 80615
 80616
 80617
 80618
 80619
 80620
 80621
 80622
 80623
 80624
 80625
 80626
 80627
 80628
 80629
 80630
 80631
 80632
 80633
 80634
 80635
 80636
 80637
 80638
 80639
 8064
 8065
 80660
 80661
 80662
 80669
 80670
 80671
 80672
 80679
 8068
 8069
 80704
 80705
 80706
 80707
 80708
 80709
 80710
 80711
 80712
 80713
 80714
 80715
 80716
 80717
 80718
 80719
 8072
 8073
 8074
 8075
 8076
 8080
 8081
 8082
 8083
 80843

[[Page 24340]]

 
 80849
 80851
 80852
 80853
 80859
 8088
 8089
 82000
 82001
 82002
 82003
 82009
 82010
 82011
 82012
 82013
 82019
 82020
 82021
 82022
 82030
 82031
 82032
 8208
 8209
 82100
 82101
 82110
 82111
 83900
 83901
 83902
 83903
 83904
 83905
 83906
 83907
 83908
 83910
 83911
 83912
 83913
 83914
 83915
 83916
 83917
 83918
 8500
 85011
 85012
 8502
 8503
 8504
 8505
 8509
 85100
 85101
 85102
 85103
 85104
 85105
 85106
 85109
 85110
 85111
 85112
 85113
 85114
 85115
 85116
 85119
 85120
 85121
 85122
 85123
 85124
 85125
 85126
 85129
 85130
 85131
 85132
 85133
 85134
 85135
 85136
 85139
 85140
 85141
 85142
 85143
 85144
 85145
 85146
 85149
 85150
 85151
 85152
 85153
 85154
 85155
 85156
 85159
 85160
 85161
 85162
 85163
 85164
 85165
 85166
 85169
 85170
 85171
 85172
 85173
 85174
 85175
 85176
 85179
 85180
 85181
 85182
 85183
 85184
 85185
 85186
 85189
 85190
 85191
 85192
 85193
 85194
 85195
 85196
 85199
 85200
 85201
 85202
 85203
 85204
 85205
 85206
 85209
 85210
 85211
 85212
 85213
 85214
 85215
 85216
 85219
 85220
 85221
 85222
 85223
 85224
 85225
 85226
 85229
 85230
 85231
 85232
 85233
 85234
 85235
 85236
 85239
 85240
 85241
 85242
 85243
 85244
 85245
 85246
 85249
 85250
 85251
 85252
 85253
 85254
 85255
 85256
 85259
 85300
 85301
 85302
 85303
 85304
 85305
 85306
 85309
 85310
 85311
 85312
 85313
 85314
 85315
 85316

[[Page 24341]]

 
 85319
 85400
 85401
 85402
 85403
 85404
 85405
 85406
 85409
 85410
 85411
 85412
 85413
 85414
 85415
 85416
 85419
 8600
 8601
 8602
 8603
 8604
 8605
 86101
 86102
 86103
 86110
 86111
 86112
 86113
 86122
 86130
 86131
 86132
 8621
 86221
 86222
 86229
 86231
 86232
 86239
 8629
 8631
 86330
 86331
 86339
 86350
 86351
 86352
 86353
 86354
 86355
 86356
 86359
 86390
 86391
 86392
 86393
 86394
 86395
 86399
 86400
 86401
 86402
 86403
 86404
 86405
 86409
 86410
 86411
 86412
 86413
 86414
 86415
 86419
 86500
 86501
 86502
 86503
 86504
 86509
 86510
 86511
 86512
 86513
 86514
 86519
 86600
 86601
 86602
 86603
 86610
 86611
 86612
 86613
 8670
 8671
 8672
 8673
 8674
 8675
 8676
 8677
 8678
 8679
 86800
 86801
 86802
 86803
 86804
 86809
 86810
 86811
 86812
 86813
 86814
 86819
 8690
 8691
 8703
 8704
 8708
 8709
 8710
 8711
 8712
 8713
 8714
 8719
 87272
 87273
 87274
 87333
 8739
 87400
 87401
 87402
 87410
 87411
 87412
 8743
 8745
 8750
 8751
 8870
 8871
 8872
 8873
 8874
 8875
 8876
 8877
 8960
 8961
 8962
 8963
 8970
 8971
 8972
 8973
 8974
 8975
 8976
 8977
 90000
 90001
 90002
 90003
 9001
 90081
 90082
 90089
 9009
 9010
 9011
 9012
 9013
 90141
 90142
 90183
 9020
 90210
 90211
 90219
 90220
 90222
 90223
 90224
 90225
 90226
 90227
 90229
 90231
 90232
 90233
 90234
 90239
 90240

[[Page 24342]]

 
 90241
 90242
 90249
 90250
 90251
 90252
 90253
 90254
 90259
 90287
 9251
 9252
 9290
 95200
 95201
 95202
 95203
 95204
 95205
 95206
 95207
 95208
 95209
 95210
 95211
 95212
 95213
 95214
 95215
 95216
 95217
 95218
 95219
 9522
 9523
 9524
 9528
 9529
 9530
 9531
 9532
 9533
 9534
 9535
 9538
 9539
 9580
 9581
 9582
 9583
 9584
 9585
 9587
*95891
 80000
 80001
 80002
 80003
 80004
 80005
 80006
 80009
 80010
 80011
 80012
 80013
 80014
 80015
 80016
 80019
 80020
 80021
 80022
 80023
 80024
 80025
 80026
 80029
 80030
 80031
 80032
 80033
 80034
 80035
 80036
 80039
 80040
 80041
 80042
 80043
 80044
 80045
 80046
 80049
 80050
 80051
 80052
 80053
 80054
 80055
 80056
 80059
 80060
 80061
 80062
 80063
 80064
 80065
 80066
 80069
 80070
 80071
 80072
 80073
 80074
 80075
 80076
 80079
 80080
 80081
 80082
 80083
 80084
 80085
 80086
 80089
 80090
 80091
 80092
 80093
 80094
 80095
 80096
 80099
 80100
 80101
 80102
 80103
 80104
 80105
 80106
 80109
 80110
 80111
 80112
 80113
 80114
 80115
 80116
 80119
 80120
 80121
 80122
 80123
 80124
 80125
 80126
 80129
 80130
 80131
 80132
 80133
 80134
 80135
 80136
 80139
 80140
 80141
 80142
 80143
 80144
 80145
 80146
 80149
 80150
 80151
 80152
 80153
 80154
 80155
 80156
 80159
 80160
 80161
 80162
 80163
 80164
 80165
 80166
 80169
 80170
 80171
 80172
 80173
 80174
 80175
 80176
 80179

[[Page 24343]]

 
 80180
 80181
 80182
 80183
 80184
 80185
 80186
 80189
 80190
 80191
 80192
 80193
 80194
 80195
 80196
 80199
 8021
 80220
 80221
 80222
 80223
 80224
 80225
 80226
 80227
 80228
 80229
 80230
 80231
 80232
 80233
 80234
 80235
 80236
 80237
 80238
 80239
 8024
 8025
 8026
 8027
 8028
 8029
 80300
 80301
 80302
 80303
 80304
 80305
 80306
 80309
 80310
 80311
 80312
 80313
 80314
 80315
 80316
 80319
 80320
 80321
 80322
 80323
 80324
 80325
 80326
 80329
 80330
 80331
 80332
 80333
 80334
 80335
 80336
 80339
 80340
 80341
 80342
 80343
 80344
 80345
 80346
 80349
 80350
 80351
 80352
 80353
 80354
 80355
 80356
 80359
 80360
 80361
 80362
 80363
 80364
 80365
 80366
 80369
 80370
 80371
 80372
 80373
 80374
 80375
 80376
 80379
 80380
 80381
 80382
 80383
 80384
 80385
 80386
 80389
 80390
 80391
 80392
 80393
 80394
 80395
 80396
 80399
 80400
 80401
 80402
 80403
 80404
 80405
 80406
 80409
 80410
 80411
 80412
 80413
 80414
 80415
 80416
 80419
 80420
 80421
 80422
 80423
 80424
 80425
 80426
 80429
 80430
 80431
 80432
 80433
 80434
 80435
 80436
 80439
 80440
 80441
 80442
 80443
 80444
 80445
 80446
 80449
 80450
 80451
 80452
 80453
 80454
 80455
 80456
 80459
 80460
 80461
 80462
 80463
 80464
 80465
 80466
 80469
 80470
 80471
 80472
 80473
 80474
 80475
 80476
 80479
 80480
 80481
 80482
 80483
 80484
 80485
 80486
 80489
 80490
 80491
 80492

[[Page 24344]]

 
 80493
 80494
 80495
 80496
 80499
 80500
 80501
 80502
 80503
 80504
 80505
 80506
 80507
 80508
 80510
 80511
 80512
 80513
 80514
 80515
 80516
 80517
 80518
 8052
 8053
 8054
 8055
 8056
 8057
 8058
 8059
 80600
 80601
 80602
 80603
 80604
 80605
 80606
 80607
 80608
 80609
 80610
 80611
 80612
 80613
 80614
 80615
 80616
 80617
 80618
 80619
 80620
 80621
 80622
 80623
 80624
 80625
 80626
 80627
 80628
 80629
 80630
 80631
 80632
 80633
 80634
 80635
 80636
 80637
 80638
 80639
 8064
 8065
 80660
 80661
 80662
 80669
 80670
 80671
 80672
 80679
 8068
 8069
 80704
 80705
 80706
 80707
 80708
 80709
 80710
 80711
 80712
 80713
 80714
 80715
 80716
 80717
 80718
 80719
 8072
 8073
 8074
 8075
 8076
 8080
 8081
 8082
 8083
 80843
 80849
 80851
 80852
 80853
 80859
 8088
 8089
 82000
 82001
 82002
 82003
 82009
 82010
 82011
 82012
 82013
 82019
 82020
 82021
 82022
 82030
 82031
 82032
 8208
 8209
 82100
 82101
 82110
 82111
 83900
 83901
 83902
 83903
 83904
 83905
 83906
 83907
 83908
 83910
 83911
 83912
 83913
 83914
 83915
 83916
 83917
 83918
 8500
 85011
 85012
 8502
 8503
 8504
 8505
 8509
 85100
 85101
 85102
 85103
 85104
 85105
 85106
 85109
 85110
 85111
 85112
 85113
 85114
 85115
 85116
 85119
 85120
 85121
 85122
 85123
 85124
 85125
 85126
 85129
 85130
 85131
 85132
 85133
 85134
 85135
 85136
 85139
 85140
 85141

[[Page 24345]]

 
 85142
 85143
 85144
 85145
 85146
 85149
 85150
 85151
 85152
 85153
 85154
 85155
 85156
 85159
 85160
 85161
 85162
 85163
 85164
 85165
 85166
 85169
 85170
 85171
 85172
 85173
 85174
 85175
 85176
 85179
 85180
 85181
 85182
 85183
 85184
 85185
 85186
 85189
 85190
 85191
 85192
 85193
 85194
 85195
 85196
 85199
 85200
 85201
 85202
 85203
 85204
 85205
 85206
 85209
 85210
 85211
 85212
 85213
 85214
 85215
 85216
 85219
 85220
 85221
 85222
 85223
 85224
 85225
 85226
 85229
 85230
 85231
 85232
 85233
 85234
 85235
 85236
 85239
 85240
 85241
 85242
 85243
 85244
 85245
 85246
 85249
 85250
 85251
 85252
 85253
 85254
 85255
 85256
 85259
 85300
 85301
 85302
 85303
 85304
 85305
 85306
 85309
 85310
 85311
 85312
 85313
 85314
 85315
 85316
 85319
 85400
 85401
 85402
 85403
 85404
 85405
 85406
 85409
 85410
 85411
 85412
 85413
 85414
 85415
 85416
 85419
 8600
 8601
 8602
 8603
 8604
 8605
 86101
 86102
 86103
 86110
 86111
 86112
 86113
 86122
 86130
 86131
 86132
 8621
 86221
 86222
 86229
 86231
 86232
 86239
 8629
 8631
 86330
 86331
 86339
 86350
 86351
 86352
 86353
 86354
 86355
 86356
 86359
 86390
 86391
 86392
 86393
 86394
 86395
 86399
 86400
 86401
 86402
 86403
 86404
 86405
 86409
 86410
 86411
 86412
 86413
 86414
 86415
 86419
 86500
 86501
 86502
 86503
 86504
 86509
 86510
 86511
 86512
 86513
 86514
 86519
 86600
 86601

[[Page 24346]]

 
 86602
 86603
 86610
 86611
 86612
 86613
 8670
 8671
 8672
 8673
 8674
 8675
 8676
 8677
 8678
 8679
 86800
 86801
 86802
 86803
 86804
 86809
 86810
 86811
 86812
 86813
 86814
 86819
 8690
 8691
 8703
 8704
 8708
 8709
 8710
 8711
 8712
 8713
 8714
 8719
 87272
 87273
 87274
 87333
 8739
 87400
 87401
 87402
 87410
 87411
 87412
 8743
 8745
 8750
 8751
 8870
 8871
 8872
 8873
 8874
 8875
 8876
 8877
 8960
 8961
 8962
 8963
 8970
 8971
 8972
 8973
 8974
 8975
 8976
 8977
 90000
 90001
 90002
 90003
 9001
 90081
 90082
 90089
 9009
 9010
 9011
 9012
 9013
 90141
 90142
 90183
 9020
 90210
 90211
 90219
 90220
 90222
 90223
 90224
 90225
 90226
 90227
 90229
 90231
 90232
 90233
 90234
 90239
 90240
 90241
 90242
 90249
 90250
 90251
 90252
 90253
 90254
 90259
 90287
 9251
 9252
 9290
 95200
 95201
 95202
 95203
 95204
 95205
 95206
 95207
 95208
 95209
 95210
 95211
 95212
 95213
 95214
 95215
 95216
 95217
 95218
 95219
 9522
 9523
 9524
 9528
 9529
 9530
 9531
 9532
 9533
 9534
 9535
 9538
 9539
 9580
 9581
 9582
 9583
 9584
 9585
 9587
*95892
 80000
 80001
 80002
 80003
 80004
 80005
 80006
 80009
 80010
 80011
 80012
 80013
 80014
 80015
 80016
 80019
 80020
 80021
 80022
 80023
 80024
 80025
 80026
 80029
 80030
 80031
 80032
 80033
 80034
 80035
 80036
 80039
 80040
 80041
 80042

[[Page 24347]]

 
 80043
 80044
 80045
 80046
 80049
 80050
 80051
 80052
 80053
 80054
 80055
 80056
 80059
 80060
 80061
 80062
 80063
 80064
 80065
 80066
 80069
 80070
 80071
 80072
 80073
 80074
 80075
 80076
 80079
 80080
 80081
 80082
 80083
 80084
 80085
 80086
 80089
 80090
 80091
 80092
 80093
 80094
 80095
 80096
 80099
 80100
 80101
 80102
 80103
 80104
 80105
 80106
 80109
 80110
 80111
 80112
 80113
 80114
 80115
 80116
 80119
 80120
 80121
 80122
 80123
 80124
 80125
 80126
 80129
 80130
 80131
 80132
 80133
 80134
 80135
 80136
 80139
 80140
 80141
 80142
 80143
 80144
 80145
 80146
 80149
 80150
 80151
 80152
 80153
 80154
 80155
 80156
 80159
 80160
 80161
 80162
 80163
 80164
 80165
 80166
 80169
 80170
 80171
 80172
 80173
 80174
 80175
 80176
 80179
 80180
 80181
 80182
 80183
 80184
 80185
 80186
 80189
 80190
 80191
 80192
 80193
 80194
 80195
 80196
 80199
 8021
 80220
 80221
 80222
 80223
 80224
 80225
 80226
 80227
 80228
 80229
 80230
 80231
 80232
 80233
 80234
 80235
 80236
 80237
 80238
 80239
 8024
 8025
 8026
 8027
 8028
 8029
 80300
 80301
 80302
 80303
 80304
 80305
 80306
 80309
 80310
 80311
 80312
 80313
 80314
 80315
 80316
 80319
 80320
 80321
 80322
 80323
 80324
 80325
 80326
 80329
 80330
 80331
 80332
 80333
 80334
 80335
 80336
 80339
 80340
 80341
 80342
 80343
 80344
 80345
 80346
 80349
 80350
 80351
 80352
 80353
 80354
 80355

[[Page 24348]]

 
 80356
 80359
 80360
 80361
 80362
 80363
 80364
 80365
 80366
 80369
 80370
 80371
 80372
 80373
 80374
 80375
 80376
 80379
 80380
 80381
 80382
 80383
 80384
 80385
 80386
 80389
 80390
 80391
 80392
 80393
 80394
 80395
 80396
 80399
 80400
 80401
 80402
 80403
 80404
 80405
 80406
 80409
 80410
 80411
 80412
 80413
 80414
 80415
 80416
 80419
 80420
 80421
 80422
 80423
 80424
 80425
 80426
 80429
 80430
 80431
 80432
 80433
 80434
 80435
 80436
 80439
 80440
 80441
 80442
 80443
 80444
 80445
 80446
 80449
 80450
 80451
 80452
 80453
 80454
 80455
 80456
 80459
 80460
 80461
 80462
 80463
 80464
 80465
 80466
 80469
 80470
 80471
 80472
 80473
 80474
 80475
 80476
 80479
 80480
 80481
 80482
 80483
 80484
 80485
 80486
 80489
 80490
 80491
 80492
 80493
 80494
 80495
 80496
 80499
 80500
 80501
 80502
 80503
 80504
 80505
 80506
 80507
 80508
 80510
 80511
 80512
 80513
 80514
 80515
 80516
 80517
 80518
 8052
 8053
 8054
 8055
 8056
 8057
 8058
 8059
 80600
 80601
 80602
 80603
 80604
 80605
 80606
 80607
 80608
 80609
 80610
 80611
 80612
 80613
 80614
 80615
 80616
 80617
 80618
 80619
 80620
 80621
 80622
 80623
 80624
 80625
 80626
 80627
 80628
 80629
 80630
 80631
 80632
 80633
 80634
 80635
 80636
 80637
 80638
 80639
 8064
 8065
 80660
 80661
 80662
 80669
 80670
 80671
 80672
 80679
 8068
 8069
 80704
 80705
 80706
 80707
 80708
 80709

[[Page 24349]]

 
 80710
 80711
 80712
 80713
 80714
 80715
 80716
 80717
 80718
 80719
 8072
 8073
 8074
 8075
 8076
 8080
 8081
 8082
 8083
 80843
 80849
 80851
 80852
 80853
 80859
 8088
 8089
 82000
 82001
 82002
 82003
 82009
 82010
 82011
 82012
 82013
 82019
 82020
 82021
 82022
 82030
 82031
 82032
 8208
 8209
 82100
 82101
 82110
 82111
 83900
 83901
 83902
 83903
 83904
 83905
 83906
 83907
 83908
 83910
 83911
 83912
 83913
 83914
 83915
 83916
 83917
 83918
 8500
 85011
 85012
 8502
 8503
 8504
 8505
 8509
 85100
 85101
 85102
 85103
 85104
 85105
 85106
 85109
 85110
 85111
 85112
 85113
 85114
 85115
 85116
 85119
 85120
 85121
 85122
 85123
 85124
 85125
 85126
 85129
 85130
 85131
 85132
 85133
 85134
 85135
 85136
 85139
 85140
 85141
 85142
 85143
 85144
 85145
 85146
 85149
 85150
 85151
 85152
 85153
 85154
 85155
 85156
 85159
 85160
 85161
 85162
 85163
 85164
 85165
 85166
 85169
 85170
 85171
 85172
 85173
 85174
 85175
 85176
 85179
 85180
 85181
 85182
 85183
 85184
 85185
 85186
 85189
 85190
 85191
 85192
 85193
 85194
 85195
 85196
 85199
 85200
 85201
 85202
 85203
 85204
 85205
 85206
 85209
 85210
 85211
 85212
 85213
 85214
 85215
 85216
 85219
 85220
 85221
 85222
 85223
 85224
 85225
 85226
 85229
 85230
 85231
 85232
 85233
 85234
 85235
 85236
 85239
 85240
 85241
 85242
 85243
 85244
 85245
 85246
 85249
 85250
 85251
 85252

[[Page 24350]]

 
 85253
 85254
 85255
 85256
 85259
 85300
 85301
 85302
 85303
 85304
 85305
 85306
 85309
 85310
 85311
 85312
 85313
 85314
 85315
 85316
 85319
 85400
 85401
 85402
 85403
 85404
 85405
 85406
 85409
 85410
 85411
 85412
 85413
 85414
 85415
 85416
 85419
 8600
 8601
 8602
 8603
 8604
 8605
 86101
 86102
 86103
 86110
 86111
 86112
 86113
 86122
 86130
 86131
 86132
 8621
 86221
 86222
 86229
 86231
 86232
 86239
 8629
 8631
 86330
 86331
 86339
 86350
 86351
 86352
 86353
 86354
 86355
 86356
 86359
 86390
 86391
 86392
 86393
 86394
 86395
 86399
 86400
 86401
 86402
 86403
 86404
 86405
 86409
 86410
 86411
 86412
 86413
 86414
 86415
 86419
 86500
 86501
 86502
 86503
 86504
 86509
 86510
 86511
 86512
 86513
 86514
 86519
 86600
 86601
 86602
 86603
 86610
 86611
 86612
 86613
 8670
 8671
 8672
 8673
 8674
 8675
 8676
 8677
 8678
 8679
 86800
 86801
 86802
 86803
 86804
 86809
 86810
 86811
 86812
 86813
 86814
 86819
 8690
 8691
 8703
 8704
 8708
 8709
 8710
 8711
 8712
 8713
 8714
 8719
 87272
 87273
 87274
 87333
 8739
 87400
 87401
 87402
 87410
 87411
 87412
 8743
 8745
 8750
 8751
 8870
 8871
 8872
 8873
 8874
 8875
 8876
 8877
 8960
 8961
 8962
 8963
 8970
 8971
 8972
 8973
 8974
 8975
 8976
 8977
 90000
 90001
 90002
 90003
 9001
 90081
 90082
 90089
 9009
 9010
 9011
 9012
 9013
 90141

[[Page 24351]]

 
 90142
 90183
 9020
 90210
 90211
 90219
 90220
 90222
 90223
 90224
 90225
 90226
 90227
 90229
 90231
 90232
 90233
 90234
 90239
 90240
 90241
 90242
 90249
 90250
 90251
 90252
 90253
 90254
 90259
 90287
 9251
 9252
 9290
 95200
 95201
 95202
 95203
 95204
 95205
 95206
 95207
 95208
 95209
 95210
 95211
 95212
 95213
 95214
 95215
 95216
 95217
 95218
 95219
 9522
 9523
 9524
 9528
 9529
 9530
 9531
 9532
 9533
 9534
 9535
 9538
 9539
 9580
 9581
 9582
 9583
 9584
 9585
 9587
*95893
 80000
 80001
 80002
 80003
 80004
 80005
 80006
 80009
 80010
 80011
 80012
 80013
 80014
 80015
 80016
 80019
 80020
 80021
 80022
 80023
 80024
 80025
 80026
 80029
 80030
 80031
 80032
 80033
 80034
 80035
 80036
 80039
 80040
 80041
 80042
 80043
 80044
 80045
 80046
 80049
 80050
 80051
 80052
 80053
 80054
 80055
 80056
 80059
 80060
 80061
 80062
 80063
 80064
 80065
 80066
 80069
 80070
 80071
 80072
 80073
 80074
 80075
 80076
 80079
 80080
 80081
 80082
 80083
 80084
 80085
 80086
 80089
 80090
 80091
 80092
 80093
 80094
 80095
 80096
 80099
 80100
 80101
 80102
 80103
 80104
 80105
 80106
 80109
 80110
 80111
 112
 80113
 80114
 80115
 80116
 80119
 80120
 80121
 80122
 80123
 80124
 80125
 80126
 80129
 80130
 80131
 80132
 80133
 80134
 80135
 80136
 80139
 80140
 80141
 80142
 80143
 80144
 80145
 80146
 80149
 80150
 80151
 80152
 80153

[[Page 24352]]

 
 80154
 80155
 80156
 80159
 80160
 80161
 80162
 80163
 80164
 80165
 80166
 80169
 80170
 80171
 80172
 80173
 80174
 80175
 80176
 80179
 80180
 80181
 80182
 80183
 80184
 80185
 80186
 80189
 80190
 80191
 80192
 80193
 80194
 80195
 80196
 80199
 8021
 80220
 80221
 80222
 80223
 80224
 80225
 80226
 80227
 80228
 80229
 80230
 80231
 80232
 80233
 80234
 80235
 80236
 80237
 80238
 80239
 8024
 8025
 8026
 8027
 8028
 8029
 80300
 80301
 80302
 80303
 80304
 80305
 80306
 80309
 80310
 80311
 80312
 80313
 80314
 80315
 80316
 80319
 80320
 80321
 80322
 80323
 80324
 80325
 80326
 80329
 80330
 80331
 80332
 80333
 80334
 80335
 80336
 80339
 80340
 80341
 80342
 80343
 80344
 80345
 80346
 80349
 80350
 80351
 80352
 80353
 80354
 80355
 80356
 80359
 80360
 80361
 80362
 80363
 80364
 80365
 80366
 80369
 80370
 80371
 80372
 80373
 80374
 80375
 80376
 80379
 80380
 80381
 80382
 80383
 80384
 80385
 80386
 80389
 80390
 80391
 80392
 80393
 80394
 80395
 80396
 80399
 80400
 80401
 80402
 80403
 80404
 80405
 80406
 80409
 80410
 80411
 80412
 80413
 80414
 80415
 80416
 80419
 80420
 80421
 80422
 80423
 80424
 80425
 80426
 80429
 80430
 80431
 80432
 80433
 80434
 80435
 80436
 80439
 80440
 80441
 80442
 80443
 80444
 80445
 80446
 80449
 80450
 80451
 80452
 80453
 80454
 80455
 80456
 80459
 80460
 80461
 80462
 80463
 80464
 80465
 80466

[[Page 24353]]

 
 80469
 80470
 80471
 80472
 80473
 80474
 80475
 80476
 80479
 80480
 80481
 80482
 80483
 80484
 80485
 80486
 80489
 80490
 80491
 80492
 80493
 80494
 80495
 80496
 80499
 80500
 80501
 80502
 80503
 80504
 80505
 80506
 80507
 80508
 80510
 80511
 80512
 80513
 80514
 80515
 80516
 80517
 80518
 8052
 8053
 8054
 8055
 8056
 8057
 8058
 8059
 80600
 80601
 80602
 80603
 80604
 80605
 80606
 80607
 80608
 80609
 80610
 80611
 80612
 80613
 80614
 80615
 80616
 80617
 80618
 80619
 80620
 80621
 80622
 80623
 80624
 80625
 80626
 80627
 80628
 80629
 80630
 80631
 80632
 80633
 80634
 80635
 80636
 80637
 80638
 80639
 8064
 8065
 80660
 80661
 80662
 80669
 80670
 80671
 80672
 80679
 8068
 8069
 80704
 80705
 80706
 80707
 80708
 80709
 80710
 80711
 80712
 80713
 80714
 80715
 80716
 80717
 80718
 80719
 8072
 8073
 8074
 8075
 8076
 8080
 8081
 8082
 8083
 80843
 80849
 80851
 80852
 80853
 80859
 8088
 8089
 82000
 82001
 82002
 82003
 82009
 82010
 82011
 82012
 82013
 82019
 82020
 82021
 82022
 82030
 82031
 82032
 8208
 8209
 82100
 82101
 82110
 82111
 83900
 83901
 83902
 83903
 83904
 83905
 83906
 83907
 83908
 83910
 83911
 83912
 83913
 83914
 83915
 83916
 83917
 83918
 8500
 85011
 85012
 8502
 8503
 8504
 8505
 8509
 85100
 85101
 85102
 85103
 85104
 85105
 85106
 85109
 85110
 85111
 85112
 85113
 85114
 85115

[[Page 24354]]

 
 85116
 85119
 85120
 85121
 85122
 85123
 85124
 85125
 85126
 85129
 85130
 85131
 85132
 85133
 85134
 85135
 85136
 85139
 85140
 85141
 85142
 85143
 85144
 85145
 85146
 85149
 85150
 85151
 85152
 85153
 85154
 85155
 85156
 85159
 85160
 85161
 85162
 85163
 85164
 85165
 85166
 85169
 85170
 85171
 85172
 85173
 85174
 85175
 85176
 85179
 85180
 85181
 85182
 85183
 85184
 85185
 85186
 85189
 85190
 85191
 85192
 85193
 85194
 85195
 85196
 85199
 85200
 85201
 85202
 85203
 85204
 85205
 85206
 85209
 85210
 85211
 85212
 85213
 85214
 85215
 85216
 85219
 85220
 85221
 85222
 85223
 85224
 85225
 85226
 85229
 85230
 85231
 85232
 85233
 85234
 85235
 85236
 85239
 85240
 85241
 85242
 85243
 85244
 85245
 85246
 85249
 85250
 85251
 85252
 85253
 85254
 85255
 85256
 85259
 85300
 85301
 85302
 85303
 85304
 85305
 85306
 85309
 85310
 85311
 85312
 85313
 85314
 85315
 85316
 85319
 85400
 85401
 85402
 85403
 85404
 85405
 85406
 85409
 85410
 85411
 85412
 85413
 85414
 85415
 85416
 85419
 8600
 8601
 8602
 8603
 8604
 8605
 86101
 86102
 86103
 86110
 86111
 86112
 86113
 86122
 86130
 86131
 86132
 8621
 86221
 86222
 86229
 86231
 86232
 86239
 8629
 8631
 86330
 86331
 86339
 86350
 86351
 86352
 86353
 86354
 86355
 86356
 86359
 86390
 86391
 86392
 86393
 86394
 86395
 86399
 86400
 86401
 86402
 86403
 86404
 86405
 86409
 86410

[[Page 24355]]

 
 86411
 86412
 86413
 86414
 86415
 86419
 86500
 86501
 86502
 86503
 86504
 86509
 86510
 86511
 86512
 86513
 86514
 86519
 86600
 86601
 86602
 86603
 86610
 86611
 86612
 86613
 8670
 8671
 8672
 8673
 8674
 8675
 8676
 8677
 8678
 8679
 86800
 86801
 86802
 86803
 86804
 86809
 86810
 86811
 86812
 86813
 86814
 86819
 8690
 8691
 8703
 8704
 8708
 8709
 8710
 8711
 8712
 8713
 8714
 8719
 87272
 87273
 87274
 87333
 8739
 87400
 87401
 87402
 87410
 87411
 87412
 8743
 8745
 8750
 8751
 8870
 8871
 8872
 8873
 8874
 8875
 8876
 8877
 8960
 8961
 8962
 8963
 8970
 8971
 8972
 8973
 8974
 8975
 8976
 8977
 90000
 90001
 90002
 90003
 9001
 90081
 90082
 90089
 9009
 9010
 9011
 9012
 9013
 90141
 90142
 90183
 9020
 90210
 90211
 90219
 90220
 90222
 90223
 90224
 90225
 90226
 90227
 90229
 90231
 90232
 90233
 90234
 90239
 90240
 90241
 90242
 90249
 90250
 90251
 90252
 90253
 90254
 90259
 90287
 9251
 9252
 9290
 95200
 95201
 95202
 95203
 95204
 95205
 95206
 95207
 95208
 95209
 95210
 95211
 95212
 95213
 95214
 95215
 95216
 95217
 95218
 95219
 9522
 9523
 9524
 9528
 9529
 9530
 9531
 9532
 9533
 9534
 9535
 9538
 9539
 9580
 9581
 9582
 9583
 9584
 9585
 9587
*95899
 80000
 80001
 80002
 80003
 80004
 80005
 80006
 80009
 80010
 80011
 80012
 80013
 80014
 80015
 80016

[[Page 24356]]

 
 80019
 80020
 80021
 80022
 80023
 80024
 80025
 80026
 80029
 80030
 80031
 80032
 80033
 80034
 80035
 80036
 80039
 80040
 80041
 80042
 80043
 80044
 80045
 80046
 80049
 80050
 80051
 80052
 80053
 80054
 80055
 80056
 80059
 80060
 80061
 80062
 80063
 80064
 80065
 80066
 80069
 80070
 80071
 80072
 80073
 80074
 80075
 80076
 80079
 80080
 80081
 80082
 80083
 80084
 80085
 80086
 80089
 80090
 80091
 80092
 80093
 80094
 80095
 80096
 80099
 80100
 80101
 80102
 80103
 80104
 80105
 80106
 80109
 80110
 80111
 80112
 80113
 80114
 80115
 80116
 80119
 80120
 80121
 80122
 80123
 80124
 80125
 80126
 80129
 80130
 80131
 80132
 80133
 80134
 80135
 80136
 80139
 80140
 80141
 80142
 80143
 80144
 80145
 80146
 80149
 80150
 80151
 80152
 80153
 80154
 80155
 80156
 80159
 80160
 80161
 80162
 80163
 80164
 80165
 80166
 80169
 80170
 80171
 80172
 80173
 80174
 80175
 80176
 80179
 80180
 80181
 80182
 80183
 80184
 80185
 80186
 80189
 80190
 80191
 80192
 80193
 80194
 80195
 80196
 80199
 8021
 80220
 80221
 80222
 80223
 80224
 80225
 80226
 80227
 80228
 80229
 80230
 80231
 80232
 80233
 80234
 80235
 80236
 80237
 80238
 80239
 8024
 8025
 8026
 8027
 8028
 8029
 80300
 80301
 80302
 80303
 80304
 80305
 80306
 80309
 80310
 80311
 80312
 80313
 80314
 80315
 80316
 80319
 80320
 80321
 80322
 80323
 80324
 80325
 80326
 80329
 80330
 80331

[[Page 24357]]

 
 80332
 80333
 80334
 80335
 80336
 80339
 80340
 80341
 80342
 80343
 80344
 80345
 80346
 80349
 80350
 80351
 80352
 80353
 80354
 80355
 80356
 80359
 80360
 80361
 80362
 80363
 80364
 80365
 80366
 80369
 80370
 80371
 80372
 80373
 80374
 80375
 80376
 80379
 80380
 80381
 80382
 80383
 80384
 80385
 80386
 80389
 80390
 80391
 80392
 80393
 80394
 80395
 80396
 80399
 80400
 80401
 80402
 80403
 80404
 80405
 80406
 80409
 80410
 80411
 80412
 80413
 80414
 80415
 80416
 80419
 80420
 80421
 80422
 80423
 80424
 80425
 80426
 80429
 80430
 80431
 80432
 80433
 80434
 80435
 80436
 80439
 80440
 80441
 80442
 80443
 80444
 80445
 80446
 80449
 80450
 80451
 80452
 80453
 80454
 80455
 80456
 80459
 80460
 80461
 80462
 80463
 80464
 80465
 80466
 80469
 80470
 80471
 80472
 80473
 80474
 80475
 80476
 80479
 80480
 80481
 80482
 80483
 80484
 80485
 80486
 80489
 80490
 80491
 80492
 80493
 80494
 80495
 80496
 80499
 80500
 80501
 80502
 80503
 80504
 80505
 80506
 80507
 80508
 80510
 80511
 80512
 80513
 80514
 80515
 80516
 80517
 80518
 8052
 8053
 8054
 8055
 8056
 8057
 8058
 8059
 80600
 80601
 80602
 80603
 80604
 80605
 80606
 80607
 80608
 80609
 80610
 80611
 80612
 80613
 80614
 80615
 80616
 80617
 80618
 80619
 80620
 80621
 80622
 80623
 80624
 80625
 80626
 80627
 80628
 80629
 80630
 80631
 80632
 80633
 80634
 80635
 80636
 80637

[[Page 24358]]

 
 80638
 80639
 8064
 8065
 80660
 80661
 80662
 80669
 80670
 80671
 80672
 80679
 8068
 8069
 80704
 80705
 80706
 80707
 80708
 80709
 80710
 80711
 80712
 80713
 80714
 80715
 80716
 80717
 80718
 80719
 8072
 8073
 8074
 8075
 8076
 8080
 8081
 8082
 8083
 80843
 80849
 80851
 80852
 80853
 80859
 8088
 8089
 82000
 82001
 82002
 82003
 82009
 82010
 82011
 82012
 82013
 82019
 82020
 82021
 82022
 82030
 82031
 82032
 8208
 8209
 82100
 82101
 82110
 82111
 83900
 83901
 83902
 83903
 83904
 83905
 83906
 83907
 83908
 83910
 83911
 83912
 83913
 83914
 83915
 83916
 83917
 83918
 8500
 85011
 85012
 8502
 8503
 8504
 8505
 8509
 85100
 85101
 85102
 85103
 85104
 85105
 85106
 85109
 85110
 85111
 85112
 85113
 85114
 85115
 85116
 85119
 85120
 85121
 85122
 85123
 85124
 85125
 85126
 85129
 85130
 85131
 85132
 85133
 85134
 85135
 85136
 85139
 85140
 85141
 85142
 85143
 85144
 85145
 85146
 85149
 85150
 85151
 85152
 85153
 85154
 85155
 85156
 85159
 85160
 85161
 85162
 85163
 85164
 85165
 85166
 85169
 85170
 85171
 85172
 85173
 85174
 85175
 85176
 85179
 85180
 85181
 85182
 85183
 85184
 85185
 85186
 85189
 85190
 85191
 85192
 85193
 85194
 85195
 85196
 85199
 85200
 85201
 85202
 85203
 85204
 85205
 85206
 85209
 85210
 85211
 85212
 85213
 85214
 85215
 85216
 85219
 85220
 85221
 85222
 85223
 85224
 85225
 85226

[[Page 24359]]

 
 85229
 85230
 85231
 85232
 85233
 85234
 85235
 85236
 85239
 85240
 85241
 85242
 85243
 85244
 85245
 85246
 85249
 85250
 85251
 85252
 85253
 85254
 85255
 85256
 85259
 85300
 85301
 85302
 85303
 85304
 85305
 85306
 85309
 85310
 85311
 85312
 85313
 85314
 85315
 85316
 85319
 85400
 85401
 85402
 85403
 85404
 85405
 85406
 85409
 85410
 85411
 85412
 85413
 85414
 85415
 85416
 85419
 8600
 8601
 8602
 8603
 8604
 8605
 86101
 86102
 86103
 86110
 86111
 86112
 86113
 86122
 86130
 86131
 86132
 8621
 86221
 86222
 86229
 86231
 86232
 86239
 8629
 8631
 86330
 86331
 86339
 86350
 86351
 86352
 86353
 86354
 86355
 86356
 86359
 86390
 86391
 86392
 86393
 86394
 86395
 86399
 86400
 86401
 86402
 86403
 86404
 86405
 86409
 86410
 86411
 86412
 86413
 86414
 86415
 86419
 86500
 86501
 86502
 86503
 86504
 86509
 86510
 86511
 86512
 86513
 86514
 86519
 86600
 86601
 86602
 86603
 86610
 86611
 86612
 86613
 8670
 8671
 8672
 8673
 8674
 8675
 8676
 8677
 8678
 8679
 86800
 86801
 86802
 86803
 86804
 86809
 86810
 86811
 86812
 86813
 86814
 86819
 8690
 8691
 8703
 8704
 8708
 8709
 8710
 8711
 8712
 8713
 8714
 8719
 87272
 87273
 87274
 87333
 8739
 87400
 87401
 87402
 87410
 87411
 87412
 8743
 8745
 8750
 8751
 8870
 8871
 8872
 8873
 8874
 8875
 8876
 8877
 8960
 8961
 8962
 8963
 8970
 8971

[[Page 24360]]

 
 8972
 8973
 8974
 8975
 8976
 8977
 90000
 90001
 90002
 90003
 9001
 90081
 90082
 90089
 9009
 9010
 9011
 9012
 9013
 90141
 90142
 90183
 9020
 90210
 90211
 90219
 90220
 90222
 90223
 90224
 90225
 90226
 90227
 90229
 90231
 90232
 90233
 90234
 90239
 90240
 90241
 90242
 90249
 90250
 90251
 90252
 90253
 90254
 90259
 90287
 9251
 9252
 9290
 95200
 95201
 95202
 95203
 95204
 95205
 95206
 95207
 95208
 95209
 95210
 95211
 95212
 95213
 95214
 95215
 95216
 95217
 95218
 95219
 9522
 9523
 9524
 9528
 9529
 9530
 9531
 9532
 9533
 9534
 9535
 9538
 9539
 9580
 9581
 9582
 9583
 9584
 9585
 9587
*9973
 5187
*99791
 5187
*99799
 5187
*99881
 5187
*99883
 5187
*99889
 5187
*9989
 5187
------------------------------------------------------------------------


            Table 6H.--Deletions From the CC Exclusions List
   [CCs that are deleted from the list, effective October 1, 2006, are
included in this table. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.]
------------------------------------------------------------------------
 
-------------------------------------------------------------------------
*2800
 2840
*2801
 2840
*2808
 2840
*2809
 2840
*2810
 2840
*2811
 2840
*2812
 2840
*2813
 2840
*2814
 2840
*2818
 2840
*2819
 2840
*2820
 2840
*2821
 2840
*2822
 2840
*2823
 2840
*28241
 2840
*28242
 2840
*28249
 2840
*2825
 2840
*28260
 2840
*28261
 2840
*28262
 2840
*28263
 2840
*28264
 2840
*28268
 2840
*28269
 2840
*2827
 2840
*2828
 2840
*2829
 2840
*2830
 2840
*28310
 2840
*28311
 2840
*28319
 2840
*2832
 2840
*2839
 2840
*2840
 2800
 2814
 2818
 28241
 28242
 28249
 28260
 28261

[[Page 24361]]

 
 28262
 28263
 28264
 28268
 28269
 2830
 28310
 28311
 28319
 2832
 2839
 2840
 2848
 2849
 2850
 2851
*2848
 2840
*2849
 2840
*2850
 2840
*2851
 2840
*28521
 2840
*28522
 2840
*28529
 2840
*2858
 2840
*2859
 2840
*2880
 2880
 2881
 28981
 28982
*2881
 2880
*2882
 2880
*2883
 2880
*2888
 2880
*2889
 2880
*28981
 2840
 2880
*28982
 2840
 2880
*28989
 2840
 2880
*2899
 2840
 2880
*3230
 34982
*3234
 34982
*3235
 34982
*3236
 34982
*3237
 34982
*3238
 34982
*3337
 7817
*5173
 2840
*5191
 51900
 51901
 51902
 51909
*5280
 5283
*6168
 6140
 6143
 6145
 6150
 6163
 6164
*6298
 6140
 6143
 6145
 6150
 6163
 6164
 6207
------------------------------------------------------------------------


          Table 7A.--Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 2005 MedPAR Update December 2005 Grouper V23.0
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Arithmetic
                   DRG                       Number of     mean  length-       10th            25th            50th            75th            90th
                                            discharges        of-stay       percentile      percentile      percentile      percentile      percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1.......................................          24,336          9.6056               2               4               7              12              19
2.......................................          10,279          4.3955               1               2               4               6               8
3.......................................               2         12.5000               4               4              21              21              21
6.......................................             291          3.0619               1               1               2               4               7
7.......................................          14,913          9.2679               2               4               7              12              19
8.......................................           3,415          2.7628               1               1               2               3               6
9.......................................           1,761          6.0023               1               3               4               7              11
10......................................          19,577          5.9190               2               3               4               7              12
11......................................           3,075          3.5463               1               2               3               5               7
12......................................          56,255          5.3867               2               3               4               6              10
13......................................           7,499          4.8481               2               3               4               6               8
14......................................         278,220          5.3760               2               3               4               7              10
15......................................          20,045          4.0130               1               2               3               5               8
16......................................          17,338          6.2840               2               3               5               8              12
17......................................           2,968          3.0387               1               1               2               4               6
18......................................          33,376          5.1560               2               3               4               6              10
19......................................           8,423          3.3765               1               2               3               4               6
20......................................           6,408          9.8262               3               5               8              13              19
21......................................           2,205          6.2036               2               3               5               8              12
22......................................           3,151          5.0232               2               2               4               6              10
23......................................          10,668          3.8978               1               2               3               5               7
24......................................          63,283          4.6436               1               2               3               6               9
25......................................          27,276          3.1226               1               2               3               4               6
26......................................              24          3.7917               1               1               2               5               9
27......................................           5,925          4.7406               1               1               3               6              10

[[Page 24362]]

 
28......................................          19,839          5.5783               1               2               4               7              11
29......................................           6,500          3.2209               1               1               3               4               6
31......................................           4,967          3.9088               1               2               3               5               7
32......................................           1,857          2.2752               1               1               2               3               4
34......................................          27,466          4.7076               1               2               4               6               9
35......................................           7,830          3.0425               1               1               3               4               6
36......................................           1,207          1.6694               1               1               1               1               3
37......................................           1,233          4.0706               1               1               3               5               9
38......................................              49          2.8367               1               1               2               3               6
39......................................             362          2.0193               1               1               1               2               4
40......................................           1,252          4.1262               1               1               4               5               7
42......................................             941          3.0595               1               1               2               4               7
43......................................             123          2.9431               1               1               2               4               5
44......................................           1,311          4.7414               2               3               4               6               9
45......................................           2,766          3.0387               1               2               2               4               6
46......................................           3,942          4.1870               1               2               3               5               8
47......................................           1,322          3.0242               1               1               2               4               6
49......................................           2,415          4.5172               1               2               3               5               9
50......................................           2,025          1.8652               1               1               1               2               3
51......................................             192          2.6979               1               1               1               3               6
52......................................             317          1.7003               1               1               1               2               3
53......................................           2,138          3.9995               1               1               2               5               9
55......................................           1,367          2.8983               1               1               2               3               6
56......................................             450          2.6800               1               1               2               3               5
57......................................             881          3.1510               1               1               2               3               7
59......................................             127          2.3780               1               1               2               3               5
60......................................               3          1.6667               1               1               1               3               3
61......................................             222          6.0541               1               1               4               8              13
62......................................               4          1.5000               1               1               1               1               3
63......................................           2,826          4.5467               1               1               3               6              10
64......................................           3,252          6.2232               1               2               4               8              13
65......................................          40,702          2.7629               1               1               2               3               5
66......................................           8,210          3.1097               1               1               2               4               6
67......................................             379          3.6992               1               2               3               5               8
68......................................          19,066          3.8447               1               2               3               5               7
69......................................           5,201          2.9435               1               2               3               4               5
70......................................              23          2.3478               1               1               2               3               4
71......................................              71          4.3380               1               2               3               5               8
72......................................           1,341          3.3057               1               2               3               4               6
73......................................           9,967          4.2892               1               2               3               5               8
74......................................               3          3.3333               3               3               3               4               4
75......................................          46,673          9.5853               3               5               7              12              19
76......................................          47,942         10.4748               3               5               8              13              19
77......................................           2,086          4.5005               1               2               4               6               9
78......................................          49,512          6.0951               2               4               5               7              10
79......................................         160,409          8.0438               3               4               7              10              15
80......................................           7,190          5.2405               2               3               4               7              10
81......................................               6          6.1667               2               3               5               8               8
82......................................          63,099          6.6687               2               3               5               9              13
83......................................           7,053          5.1999               2               3               4               6              10
84......................................           1,379          3.1407               1               2               3               4               6
85......................................          22,193          6.1053               2               3               5               8              12
86......................................           1,726          3.4936               1               2               3               5               7
87......................................          96,631          6.3599               2               3               5               8              12
88......................................         427,997          4.8483               2               3               4               6               9
89......................................         555,221          5.5216               2               3               5               7              10
90......................................          43,748          3.7105               2               2               3               5               6
91......................................              53          3.4151               1               1               2               4               6
92......................................          16,534          5.9330               2               3               5               7              11
93......................................           1,446          3.7420               1               2               3               5               7
94......................................          13,561          5.8975               2               3               5               8              12
95......................................           1,568          3.3846               1               2               3               4               6
96......................................          60,151          4.2912               2               2               4               5               8
97......................................          27,006          3.3549               1               2               3               4               6
98......................................              13          3.0769               2               2               2               4               6
99......................................          21,448          3.1000               1               1               2               4               6
100.....................................           6,432          2.1206               1               1               2               3               4
101.....................................          23,374          4.1844               1               2               3               5               8
102.....................................           4,920          2.5317               1               1               2               3               5

[[Page 24363]]

 
103.....................................             859         34.9488               8              11              22              45              76
104.....................................          20,084         14.6532               6               8              12              18              26
105.....................................          32,527          9.9333               4               6               8              11              18
106.....................................           3,427         10.9311               5               7               9              13              18
108.....................................           8,740         10.7237               4               6               9              13              20
110.....................................          57,543          8.0134               1               3               6              10              16
111.....................................          10,746          3.1084               1               1               2               5               6
113.....................................          34,591         12.5649               4               6              10              15              24
114.....................................           7,940          8.3304               2               4               7              11              16
117.....................................           5,332          4.2815               1               1               2               5               9
118.....................................           7,631          3.0250               1               1               2               4               7
119.....................................             965          5.3751               1               1               3               7              13
120.....................................          33,340          8.9613               1               3               6              12              19
121.....................................         150,106          6.2060               2               3               5               8              12
122.....................................          54,557          3.3059               1               1               3               4               6
123.....................................          29,530          4.7386               1               1               3               6              11
124.....................................         120,235          4.3915               1               2               3               6               9
125.....................................          92,072          2.7033               1               1               2               3               5
126.....................................           5,417         10.6799               3               6               9              13              20
127.....................................         668,008          5.0818               2               3               4               6               9
128.....................................           4,229          5.1726               2               3               5               6               9
129.....................................           3,511          2.5483               1               1               1               2               5
130.....................................          87,632          5.3553               1               3               4               7              10
131.....................................          22,947          3.6999               1               2               3               5               6
132.....................................         101,483          2.7988               1               1               2               3               5
133.....................................           5,883          2.1321               1               1               2               3               4
134.....................................          40,294          3.0936               1               2               2               4               6
135.....................................           7,172          4.2876               1               2               3               5               8
136.....................................             936          2.6880               1               1               2               3               5
138.....................................         206,196          3.8775               1               2               3               5               7
139.....................................          74,082          2.4272               1               1               2               3               4
140.....................................          31,544          2.4063               1               1               2               3               4
141.....................................         123,475          3.4314               1               2               3               4               6
142.....................................          49,367          2.4888               1               1               2               3               5
143.....................................         238,376          2.0951               1               1               2               3               4
144.....................................         104,952          5.8085               1               2               4               7              12
145.....................................           5,728          2.5513               1               1               2               3               5
146.....................................          10,226          9.7570               4               6               8              11              17
147.....................................           2,608          5.5498               2               4               5               7               9
148.....................................         132,689         11.9313               5               6               9              15              22
149.....................................          19,473          5.6473               3               4               5               7               8
150.....................................          22,894         10.7215               4               6               9              13              19
151.....................................           5,368          5.0183               1               2               4               7               9
152.....................................           5,000          7.9332               3               5               7               9              14
153.....................................           1,947          4.8639               2               3               5               6               7
154.....................................          26,973         12.9702               3               6              10              16              25
155.....................................           5,995          3.9585               1               2               3               6               8
156.....................................               4          9.2500               7               7               8               8              14
157.....................................           8,294          5.6907               1               2               4               7              11
158.....................................           3,710          2.6447               1               1               2               3               5
159.....................................          19,181          5.0884               1               2               4               6              10
160.....................................          11,929          2.6554               1               1               2               3               5
161.....................................          10,141          4.5089               1               2               3               6               9
162.....................................           4,954          2.0838               1               1               2               3               4
163.....................................               4          2.7500               1               1               2               3               5
164.....................................           5,972          7.6911               3               4               7               9              13
165.....................................           2,447          4.0016               2               2               4               5               7
166.....................................           5,128          4.3235               1               2               3               5               8
167.....................................           4,877          2.1300               1               1               2               3               4
168.....................................           1,532          4.8570               1               2               3               6              10
169.....................................             772          2.3964               1               1               2               3               5
170.....................................          17,895         10.7070               2               5               8              13              21
171.....................................           1,404          4.1695               1               2               3               5               8
172.....................................          33,137          6.7936               2               3               5               8              13
173.....................................           2,230          3.5309               1               1               3               4               7
174.....................................         261,063          4.6851               2               3               4               6               8
175.....................................          29,906          2.8557               1               2               2               4               5
176.....................................          14,599          5.0884               2               3               4               6               9
177.....................................           7,657          4.4324               2               2               4               5               8

[[Page 24364]]

 
178.....................................           2,550          3.0761               1               2               3               4               5
179.....................................          14,661          5.7827               2               3               4               7              11
180.....................................          91,338          5.2551               2               3               4               6              10
181.....................................          25,241          3.3112               1               2               3               4               6
182.....................................         297,097          4.4814               1               2               3               6               8
183.....................................          81,861          2.8942               1               1               2               4               5
184.....................................              76          4.3421               1               2               3               4               8
185.....................................           6,243          4.4810               1               2               3               6               9
186.....................................               7          3.1429               1               2               2               3               5
187.....................................             645          4.2016               1               2               3               6               8
188.....................................          93,582          5.4542               1               2               4               7              11
189.....................................          13,160          3.0575               1               1               2               4               6
190.....................................              63          4.8730               1               2               3               6               8
191.....................................          10,550         12.3736               3               6               9              15              25
192.....................................           1,376          5.5094               1               3               5               7               9
193.....................................           4,039         12.5519               5               7              10              15              23
194.....................................             463          6.3672               2               4               6               8              11
195.....................................           2,835         10.5661               4               6               9              13              18
196.....................................             595          5.3647               2               3               5               7              10
197.....................................          16,352          9.0237               3               5               7              11              16
198.....................................           4,110          4.3275               2               3               4               5               7
199.....................................           1,478          9.0068               2               4               7              12              19
200.....................................           1,014         10.3156               1               3               7              13              21
201.....................................           2,707         13.5670               3               6              10              17              27
202.....................................          27,516          6.1369               2               3               5               8              12
203.....................................          32,333          6.4419               2               3               5               8              13
204.....................................          69,207          5.3851               2               3               4               6              10
205.....................................          32,741          5.8448               2               3               4               7              12
206.....................................           2,042          3.7958               1               2               3               5               7
207.....................................          38,339          5.2460               1               2               4               7              10
208.....................................           9,538          2.9494               1               1               2               4               6
210.....................................         126,376          6.6274               3               4               5               8              11
211.....................................          25,712          4.5900               3               3               4               5               7
212.....................................              10          2.5000               1               2               2               4               4
213.....................................           9,459          8.9875               2               4               7              11              18
216.....................................          19,928          5.3145               1               1               3               7              13
217.....................................          15,593         12.1150               3               5               8              15              24
218.....................................          29,975          5.3809               2               3               4               7              10
219.....................................          21,059          3.1663               1               2               3               4               5
220.....................................               2          4.0000               1               1               7               7               7
223.....................................          12,649          3.2641               1               1               2               4               7
224.....................................           9,937          1.9359               1               1               1               2               3
225.....................................           6,246          5.2730               1               2               4               7              11
226.....................................           6,736          6.3550               1               3               4               8              13
227.....................................           4,868          2.6313               1               1               2               3               5
228.....................................           2,680          4.1981               1               1               3               5               9
229.....................................           1,123          2.4880               1               1               2               3               5
230.....................................           2,459          5.4254               1               2               4               7              11
232.....................................             568          2.7394               1               1               2               3               6
233.....................................          18,412          6.3241               1               2               5               8              13
234.....................................           9,074          2.6676               1               1               1               3               6
235.....................................           4,753          4.6749               1               2               4               6               8
236.....................................          41,727          4.4100               1               3               4               5               8
237.....................................           1,918          3.7873               1               2               3               5               7
238.....................................           9,766          8.0468               2               4               6              10              15
239.....................................          40,272          6.0349               2               3               5               7              11
240.....................................          12,903          6.4095               2               3               5               8              12
241.....................................           2,833          3.6287               1               2               3               4               6
242.....................................           2,729          6.4723               2               3               5               8              12
243.....................................         100,743          4.4942               1               2               4               6               8
244.....................................          17,027          4.4384               1               2               4               6               8
245.....................................           5,905          3.1160               1               1               3               4               6
246.....................................           1,407          3.5586               1               2               3               4               7
247.....................................          21,432          3.2912               1               2               3               4               6
248.....................................          16,495          4.8125               2               3               4               6               9
249.....................................          13,445          3.9212               1               1               3               5               8
250.....................................           4,144          3.8446               1               2               3               5               7
251.....................................           2,068          2.7964               1               1               3               3               5
252.....................................               1          1.0000               1               1               1               1               1

[[Page 24365]]

 
253.....................................          24,751          4.5342               2               3               4               5               8
254.....................................           9,993          3.0679               1               2               3               4               5
255.....................................               1          1.0000               1               1               1               1               1
256.....................................           7,608          4.9628               1               2               4               6               9
257.....................................          13,094          2.5466               1               1               2               3               5
258.....................................          11,391          1.6969               1               1               1               2               3
259.....................................           2,658          2.8503               1               1               1               3               7
260.....................................           2,432          1.4030               1               1               1               1               2
261.....................................           1,570          2.1949               1               1               1               2               4
262.....................................             599          4.6194               1               2               3               6               9
263.....................................          22,466         10.4537               3               5               7              13              20
264.....................................           3,905          6.2453               2               3               5               7              11
265.....................................           4,011          6.5410               1               2               4               8              14
266.....................................           2,221          3.0360               1               1               2               4               6
267.....................................             273          4.2125               1               1               3               5               9
268.....................................             994          3.6579               1               1               2               4               7
269.....................................          11,015          7.9966               2               3               6              10              15
270.....................................           2,568          3.5927               1               1               3               5               7
271.....................................          21,705          6.7812               2               3               5               8              12
272.....................................           6,079          5.8138               2               3               4               7              11
273.....................................           1,267          3.7119               1               2               3               5               7
274.....................................           2,242          6.1704               1               3               5               8              12
275.....................................             180          3.2056               1               1               2               4               7
276.....................................           1,623          4.6161               1               2               4               6               8
277.....................................         119,318          5.4224               2               3               4               7              10
278.....................................          33,958          3.9963               2               2               3               5               7
279.....................................               6          4.1667               2               3               5               5               5
280.....................................          19,321          3.9877               1               2               3               5               7
281.....................................           6,560          2.8002               1               1               2               4               5
283.....................................           6,782          4.5823               1               2               3               6               9
284.....................................           1,870          2.9128               1               1               2               4               5
285.....................................           8,034          9.8114               3               5               8              12              18
286.....................................           2,859          5.1784               2               2               4               6              10
287.....................................           5,418          9.5314               3               5               7              11              17
288.....................................          11,270          3.7031               1               2               3               4               6
289.....................................           6,334          2.3892               1               1               1               2               5
290.....................................          11,872          2.0299               1               1               1               2               3
291.....................................              59          1.4915               1               1               1               1               2
292.....................................           7,563         10.0186               2               4               8              12              19
293.....................................             319          4.6865               1               2               3               6               9
294.....................................          97,793          4.2386               1               2               3               5               8
295.....................................           4,360          3.6961               1               2               3               4               7
296.....................................         247,607          4.6431               1               2               4               6               9
297.....................................          42,717          3.0296               1               2               3               4               5
298.....................................             110          3.5545               1               1               2               4               6
299.....................................           1,544          5.1101               1               2               4               6              10
300.....................................          21,677          5.8069               2               3               5               7              11
301.....................................           3,920          3.3571               1               2               3               4               6
302.....................................          10,267          7.9781               4               5               6               9              14
303.....................................          24,561          7.2806               3               4               6               8              14
304.....................................          14,043          8.3545               2               3               6              10              17
305.....................................           3,003          3.1052               1               2               3               4               6
306.....................................           5,792          5.5830               1               2               3               8              13
307.....................................           1,943          2.0314               1               1               2               2               3
308.....................................           6,673          6.1560               1               2               4               8              14
309.....................................           3,268          1.9819               1               1               1               2               4
310.....................................          25,310          4.4992               1               2               3               6              10
311.....................................           5,873          1.8502               1               1               1               2               3
312.....................................           1,322          4.9448               1               2               3               6              11
313.....................................             502          2.3845               1               1               2               3               5
314.....................................               2         89.0000               5               5             173             173             173
315.....................................          34,708          6.7296               1               1               4               9              16
316.....................................         204,595          6.1566               2               3               5               8              12
317.....................................           2,698          3.4959               1               1               2               4               7
318.....................................           5,901          5.9548               1               3               4               8              12
319.....................................             386          2.5466               1               1               2               3               5
320.....................................         225,362          4.9903               2               3               4               6               9
321.....................................          32,132          3.5412               1               2               3               4               6
322.....................................              67          3.5821               2               2               3               4               6

[[Page 24366]]

 
323.....................................          20,435          3.1085               1               1               2               4               6
324.....................................           4,625          1.8461               1               1               1               2               3
325.....................................           9,915          3.7382               1               2               3               5               7
326.....................................           2,596          2.5559               1               1               2               3               5
327.....................................              11          2.0000               1               1               2               2               3
328.....................................             574          3.3885               1               1               3               4               7
329.....................................              55          1.6727               1               1               1               2               3
331.....................................          56,928          5.4050               1               2               4               7              10
332.....................................           4,148          3.0668               1               1               2               4               6
333.....................................             242          5.3719               1               2               4               6              10
334.....................................           9,483          4.0363               1               2               3               5               7
335.....................................          12,125          2.4941               1               2               2               3               4
336.....................................          28,106          3.2238               1               1               2               4               7
337.....................................          21,429          1.8439               1               1               2               2               3
338.....................................             670          5.7910               1               2               4               8              13
339.....................................           1,226          5.1835               1               2               3               7              11
340.....................................               1          2.0000               2               2               2               2               2
341.....................................           3,118          3.2049               1               1               1               3               7
342.....................................             455          3.0440               1               1               2               3               6
344.....................................           2,346          2.7289               1               1               1               3               7
345.....................................           1,393          5.4113               1               2               3               7              12
346.....................................           4,007          5.8982               2               3               4               7              11
347.....................................             247          2.7126               1               1               2               4               6
348.....................................           4,275          4.0044               1               2               3               5               8
349.....................................             556          2.6529               1               1               2               3               5
350.....................................           7,277          4.5139               2               2               4               6               8
352.....................................           1,176          4.1896               1               2               3               5               9
353.....................................           3,076          6.0039               2               3               4               7              11
354.....................................           7,559          5.5536               2               3               4               6              10
355.....................................           4,995          3.0162               2               2               3               3               4
356.....................................          22,243          1.8699               1               1               2               2               3
357.....................................           5,525          8.0443               3               4               6              10              15
358.....................................          20,877          3.8586               2               2               3               4               7
359.....................................          28,606          2.3498               1               2               2               3               3
360.....................................          14,265          2.5481               1               1               2               3               4
361.....................................             288          2.9688               1               1               2               3               7
362.....................................               2          1.0000               1               1               1               1               1
363.....................................           1,979          4.0889               1               2               2               4               9
364.....................................           1,367          4.1895               1               2               3               5               8
365.....................................           1,607          7.8363               2               3               5              10              16
366.....................................           4,664          6.2281               2               3               5               8              12
367.....................................             449          3.0356               1               1               2               4               6
368.....................................           4,156          6.3780               2               3               5               8              12
369.....................................           3,783          3.2495               1               1               2               4               6
370.....................................           2,212          5.0190               2               3               4               5               7
371.....................................           2,662          3.3933               2               3               3               4               4
372.....................................           1,355          3.4635               2               2               2               3               5
373.....................................           5,213          2.2486               1               2               2               3               3
374.....................................             153          2.9739               2               2               2               3               4
375.....................................              13          6.2308               1               2               3               7              15
376.....................................             474          3.2911               1               2               2               4               7
377.....................................             111          4.4414               1               2               3               6               9
378.....................................             204          2.1716               1               1               2               3               4
379.....................................             486          3.1914               1               1               2               3               6
380.....................................             111          1.9910               1               1               1               2               4
381.....................................             172          2.4186               1               1               1               2               5
382.....................................              51          1.4510               1               1               1               1               3
383.....................................           2,816          3.6364               1               1               2               4               7
384.....................................             147          2.4966               1               1               1               3               4
387.....................................               1          9.0000               9               9               9               9               9
389.....................................               3          2.0000               1               1               2               3               3
392.....................................           2,121          8.8237               2               4               6              11              19
394.....................................           2,760          7.2779               1               2               5               9              16
395.....................................         115,737          4.2702               1               2               3               5               8
396.....................................              20          2.9500               1               2               3               3               4
397.....................................          16,460          5.1170               1               2               4               6              10
398.....................................          18,608          5.7065               2               3               4               7              11
399.....................................           1,644          3.3802               1               2               3               4               6
401.....................................           6,443         11.0118               2               5               8              14              22

[[Page 24367]]

 
402.....................................           1,341          3.8926               1               1               3               5               9
403.....................................          31,520          7.8447               2               3               6              10              16
404.....................................           3,629          3.9862               1               2               3               5               8
406.....................................           2,301          9.4198               2               4               7              12              20
407.....................................             608          3.5049               1               2               3               5               6
408.....................................           1,941          8.1891               1               2               5              11              19
409.....................................           1,735          5.9873               2               3               4               6              12
410.....................................          29,030          3.7625               1               2               3               5               6
411.....................................               5          2.0000               1               1               1               3               4
412.....................................               8          1.5000               1               1               1               2               2
413.....................................           5,728          6.7263               2               3               5               9              13
414.....................................             481          4.0520               1               2               3               5               7
415.....................................          55,707         14.0947               4               6              11              17              27
416.....................................         287,777          7.4539               2               3               6               9              14
417.....................................              33          6.5455               2               3               5               8              12
418.....................................          29,900          6.0648               2               3               5               7              11
419.....................................          17,739          4.3418               1               2               3               5               8
420.....................................           3,054          3.1673               1               2               3               4               6
421.....................................          13,253          4.0073               1               2               3               5               7
422.....................................              77          3.6753               1               2               2               4               7
423.....................................           9,078          8.0063               2               3               6              10              16
424.....................................           1,034         11.3598               2               4               8              14              23
425.....................................          13,110          3.4657               1               1               3               4               7
426.....................................           4,246          4.3243               1               2               3               5               8
427.....................................           1,575          4.6387               1               2               3               5               8
428.....................................             831          7.2972               1               2               4               7              13
429.....................................          24,106          5.5073               2               3               4               6              10
430.....................................          75,207          7.7972               2               3               6               9              14
431.....................................             338          6.8402               1               2               4               7              12
432.....................................             401          4.0449               1               1               3               4               8
433.....................................           5,146          2.9195               1               1               2               3               6
439.....................................           1,750          8.5280               1               3               5              10              17
440.....................................           5,181          8.1670               2               3               5               9              16
441.....................................             687          3.4731               1               1               2               4               7
442.....................................          18,533          8.6498               2               3               6              10              18
443.....................................           3,572          3.5269               1               1               3               5               7
444.....................................           6,005          4.0206               1               2               3               5               7
445.....................................           2,261          2.8178               1               1               2               4               5
447.....................................           6,342          2.5732               1               1               2               3               5
449.....................................          40,821          3.6926               1               1               3               4               7
450.....................................           7,412          1.9899               1               1               1               2               4
451.....................................               2         10.5000               8               8              13              13              13
452.....................................          28,666          4.9275               1               2               3               6              10
453.....................................           5,381          2.7640               1               1               2               3               5
454.....................................           4,755          4.1085               1               2               3               5               8
455.....................................             885          2.3017               1               1               2               3               4
461.....................................           2,271          5.5685               1               1               3               7              12
462.....................................           7,873          9.5382               4               5               7              10              12
463.....................................          32,987          3.8751               1               2               3               5               7
464.....................................           7,681          2.9046               1               1               2               4               5
465.....................................             171          3.6023               1               1               2               5               8
466.....................................           1,250          4.7560               1               1               2               5               8
467.....................................           1,037          2.6914               1               1               2               3               6
468.....................................          51,814         12.5399               3               6              10              16              24
471.....................................          16,680          4.8562               3               3               4               5               8
473.....................................           8,558         12.4167               2               3               7              17              32
475.....................................         119,967         10.6391               2               5               9              14              20
476.....................................           2,841          9.9335               1               4               8              14              19
477.....................................          28,081          8.5088               1               3               7              11              17
479.....................................          27,608          2.5529               1               1               2               3               5
480.....................................             884         19.1618               6               8              13              23              39
481.....................................           1,183         22.0211              12              16              20              24              33
482.....................................           5,078         11.2115               4               6               9              13              20
484.....................................             456         12.7741               2               5              10              17              26
485.....................................           3,658          9.4672               4               5               7              11              17
486.....................................           2,607         12.1952               2               5              10              16              25
487.....................................           4,878          6.8569               1               3               5               9              14
488.....................................             823         17.4836               4               7              13              21              35
489.....................................          13,668          8.1512               2               3               6              10              16

[[Page 24368]]

 
490.....................................           5,341          5.3026               1               2               4               7              10
491.....................................          22,698          3.0177               1               2               2               3               5
492.....................................           3,897         13.8111               3               5               6              23              32
493.....................................          60,917          6.0332               2               3               5               8              11
494.....................................          24,482          2.6885               1               1               2               4               5
495.....................................             336         17.0417               8              10              13              20              33
496.....................................           3,710          8.7685               3               4               6              10              18
497.....................................          31,247          5.6724               3               3               5               6               9
498.....................................          21,409          3.6627               2               3               3               4               6
499.....................................          35,214          4.1547               1               2               3               5               8
500.....................................          46,705          2.1886               1               1               2               3               4
501.....................................           3,172          9.8373               4               5               8              12              18
502.....................................             756          5.7315               2               3               5               7              10
503.....................................           5,863          3.9168               1               2               3               5               7
504.....................................             191         28.1885               8              13              24              36              51
505.....................................             180          6.3611               1               1               2               7              15
506.....................................             964         15.2656               3               7              12              20              30
507.....................................             323          7.7895               1               3               6              10              15
508.....................................             663          7.4087               1               3               5               9              15
509.....................................             157          5.2038               1               2               3               6              11
510.....................................           1,798          6.0801               1               2               4               7              12
511.....................................             636          3.6840               1               1               2               5               8
512.....................................             530         13.5491               6               8              10              14              25
513.....................................             213         10.0235               5               7               8              11              17
515.....................................          58,194          3.8449               1               1               2               5               9
518.....................................          23,656          2.4643               1               1               1               3               5
519.....................................          12,546          4.6720               1               1               3               6              11
520.....................................          16,538          1.9346               1               1               1               2               4
521.....................................          32,469          5.4433               2               3               4               7              11
522.....................................           5,805          9.2951               4               4               7              12              17
523.....................................          15,604          3.8646               1               2               3               5               6
524.....................................         109,168          3.1419               1               2               3               4               6
525.....................................             203         13.8719               1               3               7              17              35
528.....................................           1,841         16.2960               6               9              14              21              29
529.....................................           5,110          7.2626               1               2               4               9              16
530.....................................           3,374          2.9452               1               1               2               3               6
531.....................................           4,874          8.9241               2               4               7              11              18
532.....................................           2,832          3.6335               1               1               3               5               7
533.....................................          46,528          3.6527               1               1               2               4               8
534.....................................          42,555          1.7237               1               1               1               2               3
535.....................................           8,766          9.2450               2               4               8              12              17
536.....................................           8,191          7.2792               2               3               6               9              14
537.....................................           8,953          6.4996               1               3               5               8              13
538.....................................           5,456          2.9041               1               1               2               4               6
539.....................................           4,954         10.5365               2               4               7              14              23
540.....................................           1,493          3.5050               1               1               3               4               7
541.....................................          25,010         41.5518              16              23              34              50              73
542.....................................          23,224         30.4308              11              17              25              37              53
543.....................................           5,478         11.7158               2               5               9              16              24
544.....................................         445,170          4.3989               3               3               4               5               7
545.....................................          43,505          5.0296               3               3               4               6               8
546.....................................           2,348          8.7709               3               4               7              10              16
547.....................................          32,613         12.1280               6               8              10              14              20
548.....................................          32,131          8.7786               5               6               8              10              13
549.....................................          13,102         10.1125               5               6               8              12              18
550.....................................          34,474          6.7767               4               5               6               8              10
551.....................................          53,809          6.0733               1               2               5               8              12
552.....................................          81,920          3.4753               1               1               2               5               7
553.....................................          39,195          9.0732               1               3               7              12              19
554.....................................          77,181          5.5751               1               2               4               7              12
555.....................................          37,296          4.8187               1               2               3               6              10
556.....................................          18,962          2.0159               1               1               1               2               4
557.....................................         123,883          4.1057               1               2               3               5               8
558.....................................         192,407          1.8118               1               1               1               2               4
559.....................................           2,889          6.8463               2               3               5               8              13
                                              12,149,409
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 24369]]


          Table 7B.--Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 2005 MedPAR Update December 2005 Grouper V24.0
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Arithmetic
                   DRG                       Number of     mean  length-       10th            25th            50th            75th            90th
                                            discharges        of-stay       percentile      percentile      percentile      percentile      percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1.......................................          24,342          9.6035               2               4               7              12              19
2.......................................          10,268          4.3919               1               2               4               6               8
3.......................................               2         12.5000               4               4              21              21              21
6.......................................             291          3.0619               1               1               2               4               7
7.......................................          14,937          9.2561               2               4               7              12              19
8.......................................           3,419          2.7640               1               1               2               3               6
9.......................................           1,762          6.0335               1               3               4               7              11
10......................................          19,573          5.9187               2               3               4               7              12
11......................................           3,070          3.5476               1               2               3               5               7
12......................................          57,060          5.4770               2               3               4               6              10
13......................................           7,489          4.8484               2               3               4               6               8
14......................................         278,444          5.3747               2               3               4               7              10
15......................................          19,998          4.0114               1               2               3               5               7
16......................................          17,374          6.2850               2               3               5               8              12
17......................................           2,960          3.0372               1               1               2               4               6
18......................................          33,407          5.1537               2               3               4               6              10
19......................................           8,413          3.3808               1               2               3               4               6
20......................................           6,389          9.8455               3               5               8              12              18
21......................................           2,204          6.1892               2               3               5               8              12
22......................................           3,158          5.0130               2               2               4               6              10
23......................................          10,736          3.9275               1               2               3               5               7
24......................................          63,274          4.6447               1               2               3               6               9
25......................................          27,221          3.1235               1               2               3               4               6
26......................................              24          3.7917               1               1               2               5               9
27......................................           5,910          4.7389               1               1               3               6              10
28......................................          19,811          5.5762               1               2               4               7              11
29......................................           6,491          3.2169               1               1               3               4               6
31......................................           4,963          3.9079               1               2               3               5               7
32......................................           1,854          2.2681               1               1               2               3               4
34......................................          27,481          4.7113               1               2               4               6               9
35......................................           7,817          3.0380               1               1               3               4               6
36......................................           1,207          1.6827               1               1               1               1               3
37......................................           1,228          4.0847               1               1               3               5               9
38......................................              49          2.8367               1               1               2               3               6
39......................................             361          2.0305               1               1               1               2               4
40......................................           1,251          4.1431               1               1               4               5               7
42......................................             943          3.0403               1               1               2               4               7
43......................................             123          2.9512               1               1               2               4               5
44......................................           1,298          4.7473               2               3               4               6               8
45......................................           2,761          3.0315               1               2               2               4               6
46......................................           3,930          4.1880               1               2               3               5               8
47......................................           1,310          3.0069               1               1               2               4               6
49......................................           2,417          4.5122               1               2               3               5               9
50......................................           2,024          1.8656               1               1               1               2               3
51......................................             191          2.6859               1               1               1               3               6
52......................................             316          1.7025               1               1               1               2               3
53......................................           2,144          4.0005               1               1               2               5               9
55......................................           1,365          2.8864               1               1               2               3               6
56......................................             451          2.6674               1               1               2               3               5
57......................................             882          3.1610               1               1               2               3               7
59......................................             127          2.3780               1               1               2               3               5
60......................................               3          1.6667               1               1               1               3               3
61......................................             222          6.0541               1               1               4               8              13
62......................................               4          1.5000               1               1               1               1               3
63......................................           2,819          4.5413               1               1               3               6              10
64......................................           3,237          6.2252               1               2               4               8              13
65......................................          40,692          2.7630               1               1               2               3               5
66......................................           8,202          3.1099               1               1               2               4               6
67......................................             378          3.6958               1               2               3               5               8
68......................................          19,016          3.8478               1               2               3               5               7
69......................................           5,160          2.9453               1               2               3               4               5
70......................................              23          2.3478               1               1               2               3               4
71......................................              70          4.3429               1               2               3               5               7
72......................................           1,338          3.3169               1               2               3               4               6
73......................................           9,943          4.2956               1               2               3               5               8
74......................................               3          3.3333               3               3               3               4               4
75......................................          46,669          9.5793               3               5               7              12              19
76......................................          48,046         10.4814               3               5               8              13              20
77......................................           2,086          4.4971               1               2               4               6               9

[[Page 24370]]

 
78......................................          49,542          6.0974               2               4               5               7              10
79......................................         160,422          8.0472               3               4               7              10              15
80......................................           7,151          5.2225               2               3               4               6               9
81......................................               6          6.1667               2               3               5               8               8
82......................................          63,105          6.6705               2               3               5               9              13
83......................................           7,054          5.2007               2               3               4               6              10
84......................................           1,379          3.1378               1               2               3               4               6
85......................................          22,190          6.1035               2               3               5               8              12
86......................................           1,719          3.4607               1               2               3               5               7
87......................................          96,722          6.3636               2               3               5               8              12
88......................................         428,131          4.8522               2               3               4               6               9
89......................................         554,927          5.5242               2               3               5               7              10
90......................................         143,397          3.7046               2               2               3               5               6
91......................................              53          3.4151               1               1               2               4               6
92......................................          16,515          5.9398               2               3               5               7              11
93......................................           1,431          3.7519               1               2               3               5               7
94......................................          13,559          5.9001               2               3               5               8              12
95......................................           1,567          3.3854               1               2               3               4               6
96......................................          60,067          4.2943               2               2               4               5               8
97......................................          26,938          3.3583               1               2               3               4               6
98......................................              13          3.0769               2               2               2               4               6
99......................................          21,398          3.0985               1               1               2               4               6
100.....................................           6,411          2.1093               1               1               2               3               4
101.....................................          23,326          4.1821               1               2               3               5               8
102.....................................           4,896          2.5353               1               1               2               3               5
103.....................................             859         34.9488               8              11              22              45              76
104.....................................          20,062         14.6431               6               8              12              18              26
105.....................................          32,513          9.9310               4               6               8              11              18
106.....................................           3,425         10.9323               5               7               9              13              18
108.....................................           8,715         10.7177               4               6               9              13              19
110.....................................          57,507          8.0074               1               3               6              10              16
111.....................................          10,723          3.1038               1               1               2               4               6
113.....................................          34,611         12.5574               4               6              10              15              24
114.....................................           7,947          8.3434               2               4               7              11              16
117.....................................           5,333          4.2738               1               1               2               5               9
118.....................................           7,615          3.0223               1               1               2               4               7
119.....................................             964          5.3932               1               1               3               7              13
120.....................................          33,418          8.9638               1               3               6              12              19
121.....................................         150,021          6.2025               2               3               5               8              12
122.....................................          54,501          3.3056               1               1               3               4               6
123.....................................          29,532          4.7330               1               1               3               6              11
124.....................................         120,245          4.3891               1               2               3               6               9
125.....................................          92,047          2.7024               1               1               2               3               5
126.....................................           5,419         10.7123               3               6               9              13              20
127.....................................         668,127          5.0831               2               3               4               6               9
128.....................................           4,228          5.1824               2               3               5               6               9
129.....................................           3,516          2.5444               1               1               1               2               5
130.....................................          87,532          5.3515               1               3               4               7              10
131.....................................          22,847          3.7023               1               2               3               5               6
132.....................................         101,519          2.8000               1               1               2               3               5
133.....................................           5,861          2.1435               1               1               2               3               4
134.....................................          40,204          3.0925               1               2               2               4               6
135.....................................           7,152          4.2875               1               2               3               5               8
136.....................................             934          2.6938               1               1               2               3               5
138.....................................         206,178          3.8766               1               2               3               5               7
139.....................................          73,962          2.4279               1               1               2               3               4
140.....................................          31,440          2.4072               1               1               2               3               4
141.....................................         123,506          3.4313               1               2               3               4               6
142.....................................          49,357          2.4907               1               1               2               3               4
143.....................................         238,140          2.0969               1               1               2               3               4
144.....................................         105,005          5.8109               1               2               4               7              12
145.....................................           5,713          2.5452               1               1               2               3               5
146.....................................          10,240          9.7635               4               6               8              11              17
147.....................................           2,600          5.5485               2               4               5               7               8
148.....................................         132,760         11.9306               5               6               9              15              22
149.....................................          19,451          5.6456               3               4               5               7               8
150.....................................          22,923         10.7178               4               6               9              13              19
151.....................................           5,379          5.0134               1               2               4               7               9
152.....................................           5,000          7.9154               3               5               7               9              14

[[Page 24371]]

 
153.....................................           1,943          4.8636               2               3               5               6               7
154.....................................          26,986         12.9751               3               6              10              16              25
155.....................................           5,993          3.9580               1               2               3               6               8
156.....................................               4          9.2500               7               7               8               8              14
157.....................................           8,303          5.6904               1               2               4               7              11
158.....................................           3,703          2.6425               1               1               2               3               5
159.....................................          19,177          5.0870               1               2               4               6              10
160.....................................          11,919          2.6539               1               1               2               3               5
161.....................................          10,150          4.5100               1               2               3               6               9
162.....................................           4,955          2.0852               1               1               2               3               4
163.....................................               4          2.7500               1               1               2               3               5
164.....................................           5,979          7.6887               3               4               7               9              14
165.....................................           2,445          4.0045               2               2               4               5               7
166.....................................           5,128          4.3249               1               2               3               5               8
167.....................................           4,888          2.1291               1               1               2               3               4
168.....................................           1,531          4.8537               1               2               3               6              10
169.....................................             771          2.3904               1               1               2               3               5
170.....................................          17,892         10.6930               2               5               8              13              21
171.....................................           1,402          4.1676               1               2               3               5               8
172.....................................          33,088          6.7832               2               3               5               8              13
173.....................................           2,201          3.4993               1               1               3               4               7
174.....................................         261,230          4.6845               2               3               4               6               8
175.....................................          29,881          2.8559               1               2               2               4               5
176.....................................          14,624          5.0844               2               3               4               6               9
177.....................................           7,655          4.4286               2               2               4               5               8
178.....................................           2,554          3.0779               1               2               3               4               5
179.....................................          14,667          5.7799               2               3               4               7              11
180.....................................          91,385          5.2542               2               3               4               6              10
181.....................................          25,208          3.3076               1               2               3               4               6
182.....................................         297,098          4.4827               1               2               3               6               8
183.....................................          81,695          2.8952               1               1               2               4               5
184.....................................              76          4.3421               1               2               3               4               8
185.....................................           6,238          4.4833               1               2               3               6               9
186.....................................               7          3.1429               1               2               2               3               5
187.....................................             640          4.1984               1               2               3               6               8
188.....................................          93,553          5.4513               1               2               4               7              11
189.....................................          13,057          3.0531               1               1               2               4               6
190.....................................              63          4.8730               1               2               3               6               8
191.....................................          10,552         12.3500               3               6               9              15              25
192.....................................           1,376          5.4964               1               3               5               7               9
193.....................................           4,034         12.5473               5               7              10              15              23
194.....................................             463          6.3672               2               4               6               8              11
195.....................................           2,835         10.5686               4               6               9              13              18
196.....................................             594          5.3468               2               3               5               7              10
197.....................................          16,367          9.0180               3               5               7              11              16
198.....................................           4,102          4.3206               2               3               4               5               7
199.....................................           1,473          8.9885               2               4               7              12              19
200.....................................           1,013         10.3416               1               3               7              13              21
201.....................................           2,713         13.5584               3               6              10              17              27
202.....................................          27,472          6.1313               2               3               5               8              12
203.....................................          32,349          6.4399               2               3               5               8              13
204.....................................          69,238          5.3850               2               3               4               6              10
205.....................................          32,709          5.8510               2               3               4               7              11
206.....................................           2,040          3.8103               1               2               3               5               7
207.....................................          38,281          5.2408               1               2               4               7              10
208.....................................           9,447          2.9451               1               1               2               4               5
210.....................................         126,388          6.6248               3               4               6               8              11
211.....................................          25,730          4.5898               3               3               4               5               7
212.....................................              10          2.5000               1               2               2               4               4
213.....................................           9,465          8.9718               2               4               7              11              18
216.....................................          19,942          5.3156               1               1               3               7              13
217.....................................          15,610         12.0976               3               5               8              15              24
218.....................................          30,001          5.3765               2               3               4               7              10
219.....................................          21,067          3.1625               1               2               3               4               5
220.....................................               2          4.0000               1               1               7               7               7
223.....................................          12,657          3.2634               1               1               2               4               7
224.....................................           9,940          1.9360               1               1               1               2               3
225.....................................           6,246          5.2789               1               2               4               7              11
226.....................................           6,748          6.3594               1               3               4               8              13

[[Page 24372]]

 
227.....................................           4,864          2.6301               1               1               2               3               5
228.....................................           2,673          4.1968               1               1               3               5               9
229.....................................           1,118          2.4875               1               1               2               3               5
230.....................................           2,464          5.4180               1               2               4               7              11
232.....................................             569          2.7346               1               1               2               3               6
233.....................................          18,441          6.3221               1               2               5               8              13
234.....................................           9,076          2.6644               1               1               1               3               6
235.....................................           4,745          4.6565               1               2               4               6               8
236.....................................          41,690          4.4064               1               3               4               5               8
237.....................................           1,918          3.7904               1               2               3               5               7
238.....................................           9,728          8.0118               2               4               6              10              15
239.....................................          40,288          6.0331               2               3               5               7              11
240.....................................          12,888          6.4250               2               3               5               8              12
241.....................................           2,812          3.6348               1               2               3               4               6
242.....................................           2,724          6.4589               2               3               5               8              12
243.....................................         100,724          4.4958               1               2               4               6               8
244.....................................          16,990          4.4383               1               2               4               5               8
245.....................................           5,860          3.1056               1               1               3               4               6
246.....................................           1,400          3.5536               1               2               3               4               7
247.....................................          21,406          3.2872               1               2               3               4               6
248.....................................          16,433          4.8139               2               3               4               6               9
249.....................................          13,453          3.9550               1               1               3               5               8
250.....................................           4,139          3.8425               1               2               3               5               7
251.....................................           2,049          2.8019               1               1               3               3               5
252.....................................               1          1.0000               1               1               1               1               1
253.....................................          24,733          4.5276               2               3               4               5               8
254.....................................           9,965          3.0711               1               2               3               4               5
255.....................................               1          1.0000               1               1               1               1               1
256.....................................           7,577          4.9555               1               2               4               6               9
257.....................................          13,101          2.5513               1               1               2               3               5
258.....................................          11,379          1.6977               1               1               1               2               3
259.....................................           2,656          2.8407               1               1               1               3               7
260.....................................           2,435          1.4049               1               1               1               1               2
261.....................................           1,573          2.1933               1               1               1               2               4
262.....................................             596          4.6393               1               2               3               6               9
263.....................................          22,506         10.4499               3               5               7              13              20
264.....................................           3,901          6.2153               2               3               5               7              11
265.....................................           4,014          6.5399               1               2               4               8              14
266.....................................           2,220          3.0171               1               1               2               4               6
267.....................................             272          4.2132               1               1               3               5               8
268.....................................             992          3.6563               1               1               2               4               7
269.....................................          11,031          7.9837               2               3               6              10              15
270.....................................           2,565          3.5977               1               1               3               5               7
271.....................................          21,624          6.7865               2               3               5               8              12
272.....................................           6,071          5.8122               2               3               4               7              11
273.....................................           1,263          3.7126               1               2               3               5               7
274.....................................           2,223          6.1858               1               3               5               8              12
275.....................................             173          3.3064               1               1               2               4               6
276.....................................           1,615          4.6136               1               2               4               6               8
277.....................................         119,112          5.4229               2               3               4               7              10
278.....................................          33,788          3.9930               2               2               3               5               7
279.....................................               6          4.1667               2               3               5               5               5
280.....................................          19,291          3.9889               1               2               3               5               7
281.....................................           6,530          2.8018               1               1               2               4               5
283.....................................           6,765          4.5808               1               2               3               6               9
284.....................................           1,856          2.9230               1               1               2               4               5
285.....................................           8,029          9.8162               3               5               8              12              18
286.....................................           2,853          5.1854               2               2               4               6              10
287.....................................           5,440          9.5362               3               5               7              11              18
288.....................................          11,290          3.7006               1               2               3               4               6
289.....................................           6,337          2.3926               1               1               1               2               5
290.....................................          11,858          2.0279               1               1               1               2               3
291.....................................              59          1.4915               1               1               1               1               2
292.....................................           7,564         10.0071               2               4               8              12              19
293.....................................             316          4.7089               1               2               3               6               8
294.....................................          97,541          4.2412               1               2               3               5               8
295.....................................           4,362          3.6997               1               2               3               4               7
296.....................................         247,608          4.6432               1               2               4               6               9
297.....................................          42,673          3.0303               1               2               3               4               5

[[Page 24373]]

 
298.....................................             110          3.5545               1               1               2               4               6
299.....................................           1,541          5.1304               1               2               4               6              10
300.....................................          21,697          5.8067               2               3               5               7              11
301.....................................           3,912          3.3566               1               2               3               4               6
302.....................................          10,255          7.9757               4               5               6               9              13
303.....................................          24,546          7.2813               3               4               6               8              14
304.....................................          14,020          8.3536               2               3               6              10              17
305.....................................           2,996          3.1031               1               2               3               4               6
306.....................................           5,804          5.5829               1               2               3               8              13
307.....................................           1,942          2.0391               1               1               2               2               3
308.....................................           6,675          6.1486               1               2               4               8              14
309.....................................           3,267          1.9773               1               1               1               2               4
310.....................................          25,304          4.4981               1               2               3               6              10
311.....................................           5,872          1.8551               1               1               1               2               3
312.....................................           1,320          4.9356               1               2               3               6              10
313.....................................             501          2.3852               1               1               2               3               5
314.....................................              12         89.0000               5               5             173             173             173
315.....................................          34,750          6.7385               1               1               4               9              16
316.....................................         204,504          6.1586               2               3               5               8              12
317.....................................           2,696          3.4970               1               1               2               4               7
318.....................................           5,891          5.9701               1               3               4               8              12
319.....................................             382          2.5733               1               1               2               3               5
320.....................................         225,245          4.9895               2               3               4               6               9
321.....................................          31,997          3.5392               1               2               3               4               6
322.....................................              67          3.5821               2               2               3               4               6
323.....................................          20,408          3.1059               1               1               2               4               6
324.....................................           4,621          1.8455               1               1               1               2               3
325.....................................           9,909          3.7375               1               2               3               5               7
326.....................................           2,596          2.5632               1               1               2               3               5
327.....................................              11          2.0000               1               1               2               2               3
328.....................................             573          3.3805               1               1               3               4               6
329.....................................              54          1.6852               1               1               1               2               3
331.....................................          56,851          5.4046               1               2               4               7              10
332.....................................           4,131          3.0690               1               1               2               4               6
333.....................................             242          5.3719               1               2               4               6              10
334.....................................           9,503          4.0414               1               2               3               5               7
335.....................................          12,142          2.4975               1               2               2               3               4
336.....................................          28,146          3.2243               1               1               2               4               7
337.....................................          21,461          1.8444               1               1               2               2               3
338.....................................             674          5.7908               1               2               4               8              13
339.....................................           1,230          5.1976               1               2               3               7              12
340.....................................               1          2.0000               2               2               2               2               2
341.....................................           3,120          3.2032               1               1               1               3               7
342.....................................             456          3.0395               1               1               2               3               6
344.....................................           2,342          2.7331               1               1               1               3               7
345.....................................           1,387          5.4232               1               2               3               7              12
346.....................................           3,983          5.8943               2               3               4               7              11
347.....................................             240          2.6917               1               1               2               3               5
348.....................................           4,273          4.0059               1               2               3               5               8
349.....................................             555          2.6396               1               1               2               3               5
350.....................................           7,266          4.5140               2               2               4               6               8
352.....................................           1,176          4.1820               1               2               3               5               9
353.....................................           3,082          6.0039               2               3               4               7              11
354.....................................           7,554          5.5586               2               3               4               6              10
355.....................................           4,988          3.0158               2               2               3               3               4
356.....................................          22,223          1.8694               1               1               2               2               3
357.....................................           5,519          8.0364               3               4               6              10              15
358.....................................          20,865          3.8574               2               2               3               4               7
359.....................................          28,581          2.3500               1               2               2               3               3
360.....................................          14,256          2.5446               1               1               2               3               4
361.....................................             287          2.9756               1               1               2               3               6
362.....................................               2          1.0000               1               1               1               1               1
363.....................................           1,979          4.0859               1               2               2               4               9
364.....................................           1,377          4.1888               1               2               3               5               9
365.....................................           1,605          7.8517               2               3               5              10              16
366.....................................           4,644          6.2351               2               3               5               8              12
367.....................................             437          3.0092               1               1               2               4               5
368.....................................           4,150          6.4051               2               3               5               8              12
369.....................................           3,727          3.2667               1               1               2               4               6

[[Page 24374]]

 
370.....................................           2,209          5.0023               2               3               4               5               7
371.....................................           2,663          3.3924               2               3               3               4               4
372.....................................           1,349          3.4633               2               2               2               3               5
373.....................................           5,186          2.2443               1               2               2               3               3
374.....................................             153          2.9739               2               2               2               3               4
375.....................................              13          6.2308               1               2               3               7              15
376.....................................             473          3.2939               1               2               2               4               7
377.....................................             109          4.4495               1               2               3               6               8
378.....................................             203          2.1773               1               1               2               3               4
379.....................................             484          3.2004               1               1               2               3               6
380.....................................             110          2.0273               1               1               1               2               4
381.....................................             170          2.4294               1               1               1               2               4
382.....................................              49          1.4694               1               1               1               1               2
383.....................................           2,780          3.6439               1               1               2               4               7
384.....................................             147          2.4966               1               1               1               3               4
387.....................................               1          9.0000               9               9               9               9               9
389.....................................               3          2.0000               1               1               2               3               3
392.....................................           2,120          8.8330               2               4               6              11              19
394.....................................           2,758          7.2708               1               2               5               9              16
395.....................................         115,655          4.2739               1               2               3               5               8
396.....................................              20          2.9500               1               2               3               3               4
397.....................................          16,459          5.1109               1               2               4               6              10
398.....................................          18,615          5.7086               2               3               4               7              11
399.....................................           1,633          3.3791               1               2               3               4               6
401.....................................           6,439         11.0110               2               5               8              14              22
402.....................................           1,340          3.8955               1               1               3               5               8
403.....................................          31,515          7.8539               2               3               6              10              16
404.....................................           3,614          3.9801               1               2               3               5               8
406.....................................           2,300          9.4235               2               4               7              12              20
407.....................................             610          3.5049               1               2               3               5               7
408.....................................           1,943          8.2203               1               2               5              11              19
409.....................................           1,740          5.9891               2               3               4               6              12
410.....................................          29,094          3.7690               1               2               3               5               6
411.....................................               5          2.0000               1               1               1               3               4
412.....................................               8          1.5000               1               1               1               2               2
413.....................................           5,728          6.7243               2               3               5               9              13
414.....................................             478          4.0146               1               2               3               5               7
415.....................................          55,770         14.0714               4               6              11              17              28
416.....................................         288,297          7.4530               2               4               6               9              14
417.....................................              33          6.5455               2               3               5               8              12
418.....................................          29,873          6.0664               2               3               5               7              11
419.....................................          17,681          4.3426               1               2               3               5               8
420.....................................           3,029          3.1700               1               2               3               4               6
421.....................................          13,246          4.0091               1               2               3               5               7
422.....................................              77          3.6753               1               2               2               4               7
423.....................................           9,067          8.0275               2               3               6              10              16
424.....................................           1,033         11.3679               2               4               8              14              23
425.....................................          13,142          3.4810               1               1               3               4               7
426.....................................           4,389          4.5129               1               2               3               5               9
427.....................................           1,603          4.7324               1               2               3               6               9
428.....................................             855          7.3111               1               2               4               8              14
429.....................................          24,588          5.6295               2               3               4               7              10
430.....................................          76,498          7.8309               2               3               6               9              15
431.....................................             339          6.8171               1               2               4               7              12
432.....................................             400          4.0400               1               1               3               4               8
433.....................................           4,640          2.8390               1               1               2               3               4
439.....................................           1,751          8.3501               1               3               5              10              17
440.....................................           5,187          8.1656               2               3               5               9              17
441.....................................             685          3.4730               1               1               2               4               7
442.....................................          18,537          8.6463               2               3               6              10              18
443.....................................           3,580          3.5260               1               1               3               5               7
444.....................................           5,993          4.0310               1               2               3               5               7
445.....................................           2,240          2.8210               1               1               2               4               5
447.....................................           6,355          2.5769               1               1               2               3               5
449.....................................          40,805          3.6894               1               1               3               4               7
450.....................................           7,411          1.9873               1               1               1               2               4
451.....................................               2         10.5000               8               8              13              13              13
452.....................................          28,672          4.9315               1               2               3               6              10
453.....................................           5,363          2.7583               1               1               2               3               5

[[Page 24375]]

 
454.....................................           4,747          4.1062               1               2               3               5               8
455.....................................             885          2.2814               1               1               2               3               4
461.....................................           2,273          5.5794               1               1               3               7              13
462.....................................           8,971          9.5207               4               6               8              11              16
463.....................................          32,939          3.8728               1               2               3               5               7
464.....................................           7,650          2.8997               1               1               2               4               5
465.....................................             165          3.6182               1               1               2               4               6
466.....................................           1,205          4.9842               1               1               2               5               7
467.....................................           1,028          2.6625               1               1               2               3               5
468.....................................          51,844         12.5282               3               6              10              16              24
471.....................................          15,609          4.5466               3               3               4               5               7
473.....................................           8,557         12.4122               2               3               7              17              32
475.....................................         120,026         10.6390               2               5               9              14              21
476.....................................           2,847          9.9424               1               4               8              14              20
477.....................................          28,111          8.5004               1               3               7              11              17
479.....................................          27,545          2.5522               1               1               2               3               5
480.....................................             884         19.1618               6               8              13              23              39
481.....................................           1,183         22.0211              12              16              20              24              33
482.....................................           5,072         11.1808               4               6               9              13              20
484.....................................             455         12.7560               2               5              10              17              26
485.....................................           3,660          9.4104               4               5               7              11              17
486.....................................           2,600         12.1862               2               5              10              16              25
487.....................................           4,866          6.8531               1               3               5               9              14
488.....................................             820         17.4744               4               7              13              21              34
489.....................................          13,634          8.1556               2               3               6              10              16
490.....................................           5,299          5.3025               1               2               4               6              10
491.....................................          22,716          3.0154               1               2               2               3               5
492.....................................           3,906         13.7983               3               5               6              23              32
493.....................................          60,947          6.0341               2               3               5               8              11
494.....................................          24,474          2.6904               1               1               2               4               5
495.....................................             336         17.0417               8              10              13              20              33
496.....................................           3,715          8.7505               3               4               6              10              18
497.....................................          31,285          5.6682               3               3               5               6               9
498.....................................          21,475          3.6630               2               3               3               4               6
499.....................................          35,262          4.1552               1               2               3               5               8
500.....................................          46,802          2.1900               1               1               2               3               4
501.....................................           3,178          9.8420               4               5               8              12              18
502.....................................             756          5.7116               2               3               5               7              10
503.....................................           5,879          3.9160               1               2               3               5               7
504.....................................             190         28.2789               8              13              24              36              51
505.....................................             177          6.3503               1               1               2               6              13
506.....................................             960         15.2063               3               7              12              20              30
507.....................................             322          7.7702               1               3               6              10              15
508.....................................             658          7.3708               1               3               5               9              14
509.....................................             156          5.2179               1               2               3               6              11
510.....................................           1,779          6.0438               1               2               4               7              12
511.....................................             626          3.6773               1               1               2               4               7
512.....................................             530         13.5491               6               8              10              14              25
513.....................................             213         10.0235               5               7               8              11              17
515.....................................          58,196          3.8438               1               1               2               5               9
518.....................................          23,688          2.4604               1               1               1               3               5
519.....................................          12,559          4.6661               1               1               3               6              11
520.....................................          16,572          1.9340               1               1               1               2               4
521.....................................          29,820          5.2943               1               2               4               6               8
522.....................................           3,580         10.3455               3               4               5               7               8
523.....................................          14,736          3.8210               1               2               3               4               6
524.....................................         109,259          3.1436               1               2               3               4               6
525.....................................             203         13.9458               1               3               7              17              35
528.....................................           1,838         16.2927               6               9              14              21              29
529.....................................           5,103          7.2536               1               2               4               9              16
530.....................................           3,371          2.9436               1               1               2               3               6
531.....................................           4,884          8.9378               2               4               7              11              18
532.....................................           2,838          3.6350               1               1               3               5               7
533.....................................          46,516          3.6549               1               1               2               4               8
534.....................................          42,526          1.7237               1               1               1               2               3
535.....................................           8,772          9.2410               2               4               8              12              18
536.....................................           8,193          7.2754               2               3               6               9              14
537.....................................           8,952          6.4947               1               3               5               8              13
538.....................................           5,452          2.9057               1               1               2               4               6

[[Page 24376]]

 
539.....................................           4,962         10.5316               2               4               7              14              23
540.....................................           1,495          3.5010               1               1               3               4               7
541.....................................          24,941         41.4444              16              23              34              50              72
542.....................................          23,183         30.3714              11              17              25              37              53
543.....................................           5,475         11.7145               2               5               9              16              24
544.....................................         445,895          4.3971               3               3               4               5               7
545.....................................          44,700          5.1342               3               3               4               6               9
546.....................................           2,349          8.7292               3               4               7              10              16
547.....................................          32,600         12.1272               6               8              10              14              20
548.....................................          32,135          8.7775               5               6               8              10              13
549.....................................          13,107         10.1157               5               6               8              12              18
550.....................................          34,471          6.7739               4               5               6               8              10
551.....................................          53,828          6.0746               1               2               5               8              12
552.....................................          81,945          3.4779               1               1               2               5               7
553.....................................          39,190          9.0613               1               3               7              12              19
554.....................................          77,166          5.5699               1               2               4               7              12
555.....................................          37,283          4.8161               1               2               3               6              10
556.....................................          18,925          2.0092               1               1               1               2               4
557.....................................         123,799          4.1037               1               2               3               5               8
558.....................................         192,346          1.8113               1               1               1               2               4
559.....................................           2,886          6.8257               2               3               5               8              13
                                              12,144,751
--------------------------------------------------------------------------------------------------------------------------------------------------------


Table 8A.--Statewide Average Operating Cost-to-Charge Ratios--March 2006
------------------------------------------------------------------------
                       State                          Urban      Rural
------------------------------------------------------------------------
Alabama...........................................      0.265      0.334
Alaska............................................      0.423      0.719
Arizona...........................................      0.285       0.37
Arkansas..........................................       0.34      0.357
California........................................       0.24      0.347
Colorado..........................................      0.314      0.486
Connecticut.......................................      0.428        0.5
Delaware..........................................      0.528      0.508
District of Columbia..............................      0.397  .........
Florida...........................................      0.252        0.3
Georgia...........................................      0.355      0.404
Hawaii............................................      0.384      0.432
Idaho.............................................       0.48      0.528
Illinois..........................................      0.326      0.418
Indiana...........................................      0.424      0.454
Iowa..............................................       0.39      0.467
Kansas............................................      0.299      0.454
Kentucky..........................................      0.386      0.394
Louisiana.........................................      0.308      0.374
Maine.............................................      0.496      0.475
Maryland..........................................      0.763      0.882
Massachusetts.....................................      0.472  .........
Michigan..........................................      0.376      0.474
Minnesota.........................................      0.391       0.52
Mississippi.......................................      0.331       0.38
Missouri..........................................      0.333      0.387
Montana...........................................      0.431      0.478
Nebraska..........................................      0.361      0.475
Nevada............................................       0.24      0.477
New Hampshire.....................................      0.463      0.463
New Jersey........................................       0.18  .........
New Mexico........................................      0.385       0.39
New York..........................................      0.365      0.526
North Carolina....................................      0.439      0.433
North Dakota......................................       0.43      0.455
Ohio..............................................      0.376      0.549
Oklahoma..........................................      0.321      0.405
Oregon............................................      0.474      0.475
Pennsylvania......................................      0.282      0.444
Puerto Rico.......................................      0.461  .........
Rhode Island......................................      0.409  .........
South Carolina....................................      0.294      0.297
South Dakota......................................      0.375      0.461
Tennessee.........................................      0.324      0.386
Texas.............................................      0.282      0.369
Utah..............................................      0.423      0.589
Vermont...........................................      0.555      0.627
Virginia..........................................      0.366      0.378
Washington........................................      0.427      0.469
West Virginia.....................................      0.488      0.454
Wisconsin.........................................      0.442      0.481
Wyoming...........................................        0.4      0.561
------------------------------------------------------------------------


 Table 8B.--Statewide Average Capital Cost-to-Charge Ratios--March 2006
------------------------------------------------------------------------
                            State                                Ratio
------------------------------------------------------------------------
Alabama......................................................      0.026
Alaska.......................................................      0.042
Arizona......................................................      0.026
Arkansas.....................................................      0.027
California...................................................      0.016
Colorado.....................................................       0.03
Connecticut..................................................       0.03
Delaware.....................................................      0.042
District of Columbia.........................................      0.027
Florida......................................................      0.024
Georgia......................................................      0.032
Hawaii.......................................................      0.033
Idaho........................................................      0.037
Illinois.....................................................      0.027
Indiana......................................................      0.038
Iowa.........................................................       0.03
Kansas.......................................................      0.032
Kentucky.....................................................      0.031
Louisiana....................................................      0.031
Maine........................................................      0.035
Maryland.....................................................      0.013
Massachusetts................................................      0.034
Michigan.....................................................      0.032
Minnesota....................................................      0.029
Mississippi..................................................       0.03
Missouri.....................................................      0.027
Montana......................................................      0.039
Nebraska.....................................................      0.038
Nevada.......................................................      0.021
New Hampshire................................................      0.037
New Jersey...................................................      0.013
New Mexico...................................................      0.034
New York.....................................................       0.03
North Carolina...............................................      0.037
North Dakota.................................................       0.04
Ohio.........................................................      0.031
Oklahoma.....................................................      0.031
Oregon.......................................................      0.032
Pennsylvania.................................................      0.023
Puerto Rico..................................................      0.035
Rhode Island.................................................      0.023
South Carolina...............................................      0.027
South Dakota.................................................      0.037
Tennessee....................................................      0.033
Texas........................................................      0.028
Utah.........................................................      0.039
Vermont......................................................      0.043
Virginia.....................................................      0.037
Washington...................................................      0.035
West Virginia................................................      0.034
Wisconsin....................................................      0.038
Wyoming......................................................      0.047
------------------------------------------------------------------------


[[Page 24377]]


  Table 8C.--Statewide Average Total Cost-to-Charge Ratios for LTCHS--
                               March 2006
------------------------------------------------------------------------
                       State                          Urban      Rural
------------------------------------------------------------------------
Alabama...........................................      0.291      0.365
Alaska............................................      0.458      0.788
Arizona...........................................      0.307      0.407
Arkansas..........................................      0.368      0.390
California........................................      0.254      0.368
Colorado..........................................      0.350      0.531
Connecticut.......................................      0.454      0.538
Delaware..........................................      0.567      0.558
District of Columbia*.............................      0.436  .........
Florida...........................................      0.276      0.343
Georgia...........................................      0.384      0.439
Hawaii............................................      0.417      0.465
Idaho.............................................      0.516      0.573
Illinois..........................................      0.351      0.457
Indiana...........................................      0.462      0.499
Iowa..............................................      0.412      0.506
Kansas............................................      0.326      0.495
Kentucky..........................................      0.418      0.423
Louisiana.........................................      0.340      0.402
Maine.............................................      0.533      0.507
Maryland**........................................      0.361      0.458
Massachusetts*....................................      0.501  .........
Michigan..........................................      0.410      0.510
Minnesota.........................................      0.419      0.550
Mississippi.......................................      0.360      0.407
Missouri..........................................      0.357      0.430
Montana...........................................      0.467      0.522
Nebraska..........................................      0.395      0.523
Nevada............................................      0.259      0.550
New Hampshire.....................................      0.501      0.498
New Jersey*.......................................      0.194  .........
New Mexico........................................      0.418      0.415
New York..........................................      0.393      0.561
North Carolina....................................      0.478      0.476
North Dakota......................................      0.467      0.504
Ohio..............................................      0.404      0.595
Oklahoma..........................................      0.351      0.441
Oregon............................................      0.507      0.513
Pennsylvania......................................      0.299      0.479
Puerto Rico*......................................      0.493  .........
Rhode Island*.....................................      0.432  .........
South Carolina....................................      0.320      0.326
South Dakota......................................      0.410      0.506
Tennessee.........................................      0.360      0.421
Texas.............................................      0.307      0.404
Utah..............................................      0.460      0.649
Vermont...........................................      0.601      0.667
Virginia..........................................      0.399      0.419
Washington........................................      0.462      0.516
West Virginia.....................................      0.515      0.487
Wisconsin.........................................      0.483      0.519
Wyoming...........................................      0.440     0.614
------------------------------------------------------------------------
* All counties in the State or Territory are classified as urban, with
  the exception of Massachusetts, which has areas designated as rural.
  However, no short-term acute care IPPS hospitals or LTCHs are located
  in those areas as of March 2005.
** National average IPPS total cost-to-charge ratios, as discussed in
  section II.F.5. of this proposed rule.


        Table 9A.--Hospital Reclassifications and Redesignations by Individual Hospital and CBSA--FY2007
----------------------------------------------------------------------------------------------------------------
                                                       Reclassified      Reclassified
           Provider No.             Geographic CBSA  CBSA  10/1/2006-  CBSA  4/1/2007-9/          LUGAR
                                                         3/31/2007          30/2007
----------------------------------------------------------------------------------------------------------------
010005...........................                01             13820             13820
010008...........................                01             33860             33860
010009...........................             19460             26620             26620
010012...........................                01             16860             16860
010022...........................                01             40660             40660  LUGAR
010025...........................                01             17980             17980
010029...........................             12220             17980             17980
010035...........................                01             13820             13820
010044...........................                01             13820             13820
010045...........................                01             13820             13820
010054...........................             19460             26620             26620
010059...........................             19460             26620             26620
010065...........................                01             33860             33860
010072...........................                01             11500             11500  LUGAR
010083...........................                01             37860             37860
010085...........................             19460             26620             26620
010100...........................                01             37860             37860
010101...........................                01             11500             11500  LUGAR
010118...........................                01             46220             46220
010126...........................                01             33860             33860
010143...........................                01             13820             13820
010150...........................                01             33860             33860
010158...........................                01             19460             19460
010164...........................                01             11500             11500  LUGAR
020008...........................                02             11260             11260
030007...........................                03             22380             22380
030033...........................                03             22380             22380
040014...........................                04             30780             30780
040017...........................                04             22220             22220
040019...........................                04             32820             32820
040020...........................             27860             32820             32820
040027...........................                04             44180             44180
040039...........................                04                26                26
040041...........................                04             30780             30780
040047...........................                04                26                26
040069...........................                04             32820             32820
040071...........................             38220             30780             30780
040076...........................                04             30780             30780
040080...........................                04             27860             27860
040088...........................                04             43340             43340
040091...........................                04             45500             45500

[[Page 24378]]

 
040100...........................                04             30780             30780
040119...........................                04             30780             30780
050006...........................                05             39820             39820
050009...........................             34900             46700             46700
050013...........................             34900             46700             46700
050014...........................                05             40900             40900
050022...........................             40140             42044             42044
050042...........................                05             39820             39820
050046...........................             37100  ................             31084  .......................
050054...........................                40             42044             42044  .......................
050065...........................             42044             31084             31084
050069...........................             42044             31084             31084
050071...........................             41940             36084             36084
050073...........................             46700             36084             36084
050076...........................             41884             36084             36084
050082...........................             37100  ................             31084
050089...........................                40             31084             31084
050090...........................             42220             41884             41884
050099...........................                40             31084             31084
050101...........................             46700             36084             36084
050102...........................                40             42044             42044
050118...........................             44700             33700             33700
050129...........................                40             31084             31084
050136...........................             42220             41884             41884
050140...........................                40             31084             31084
050150...........................                05             40900             40900
050159...........................             37100  ................             31084
050168...........................             42044             31084             31084
050173...........................             42044             31084             31084
050174...........................             42220             41884             41884
050193...........................             42044             31084             31084
050197...........................             41884             36084             36084
050224...........................             42044             31084             31084
050226...........................             42044             31084             31084
050228...........................             41884             36084             36084
050230...........................             42044             31084             31084
050236...........................             37100  ................             31084
050243...........................                40             42044             42044
050245...........................                40             31084             31084
050251...........................                05             39900             39900
050272...........................                40             31084             31084
050279...........................                40             31084             31084
050291...........................             42220             41884             41884
050292...........................                40             42044             42044
050298...........................                40             31084             31084
050300...........................                40             31084             31084
050327...........................                40             31084             31084
050329...........................                40             42044             42044
050348...........................             42044             31084             31084
050367...........................             46700             36084             36084
050385...........................             42220             41884             41884
050390...........................                40             42044             42044
050394...........................             37100  ................             31084
050423...........................                40             42044             42044
050426...........................             42044             31084             31084
050430...........................                05             39900             39900
050510...........................             41884             36084             36084
050517...........................                40             31084             31084
050526...........................             42044             31084             31084
050534...........................                40             42044             42044
050535...........................             42044             31084             31084
050541...........................             41884             36084             36084
050543...........................             42044             31084             31084
050547...........................             42220             41884             41884
050548...........................             42044             31084             31084
050549...........................             37100  ................             31084
050550...........................             42044             31084             31084
050551...........................             42044             31084             31084

[[Page 24379]]

 
050567...........................             42044             31084             31084
050569...........................                05             42220             42220
050570...........................             42044             31084             31084
050573...........................                40             42044             42044
050580...........................             42044             31084             31084
050584...........................                40             31084             31084
050585...........................             42044             31084             31084
050586...........................                40             31084             31084
050589...........................             42044             31084             31084
050592...........................             42044             31084             31084
050594...........................             42044             31084             31084
050603...........................             42044             31084             31084
050609...........................             42044             31084             31084
050616...........................             37100  ................             31084
050667...........................             34900             46700             46700
050678...........................             42044             31084             31084
050680...........................             46700             36084             36084
050684...........................                40             42044             42044
050686...........................                40             42044             42044
050690...........................             42220             41884             41884
050693...........................             42044             31084             31084
050694...........................                40             42044             42044
050701...........................                40             42044             42044
050709...........................                40             31084             31084
050718...........................                40             42044             42044
050720...........................             42044             31084             31084
050728...........................             42220             41884             41884
050749...........................             37100  ................             31084
060003...........................             14500             19740             19740
060023...........................             24300             19740             19740
060027...........................             14500             19740             19740
060044...........................                06             19740             19740
060049...........................                06             22660             22660
060075...........................                06             24300             24300
060096...........................                06             19740             19740
060103...........................             14500             19740             19740
070001...........................             35300  ................             35004
070003...........................                07             25540             25540  LUGAR
070005...........................             35300  ................             35004
070006...........................             14860  ................             35644
070010...........................             14860  ................             35644
070016...........................             35300  ................             35004
070017...........................             35300  ................             35004
070018...........................             14860  ................             35644
070019...........................             35300  ................             35004
070021...........................                07             25540             25540  LUGAR
070022...........................             35300  ................             35004
070028...........................             14860  ................             35644
070031...........................             35300  ................             35004
070033...........................             14860             35644             35644
070034...........................             14860  ................             35644
070036...........................             25540             35300             35300
070038...........................             35300  ................             35004
070039...........................             35300  ................             35004
080004...........................             20100             48864             48864
080004...........................                08             20100             20100
080006...........................                08             36140             36140
090001...........................             47894             13644             13644
100022...........................             33124             22744             22744
100023...........................                10             36740             36740
100024...........................                10             33124             33124
100045...........................             19660             36740             36740
100049...........................                10             29460             29460
100081...........................                10             23020             23020  LUGAR
100109...........................                10             36740             36740
100118...........................                10             27260             27260
100139...........................                10             23540             23540  LUGAR
100150...........................                10             33124             33124

[[Page 24380]]

 
100157...........................             29460             45300             45300
100176...........................             48424             38940             38940
100217...........................             42680             38940             38940
100232...........................                10             27260             27260
100239...........................             45300             42260             42260
100249...........................                10             45300             45300
100252...........................                10             38940             38940
100258...........................             48424             22744             22744
100292...........................                10             23020             23020  LUGAR
110001...........................             19140             12060             12060
110002...........................                11             12060             12060
110003...........................                11             27260             27260
110023...........................                11             12060             12060
110025...........................             15260             27260             27260
110029...........................             23580             12060             12060
110038...........................                11             46660             46660
110040...........................                11             12060             12060  LUGAR
110041...........................                11             12020             12020
110052...........................                11             16860             16860  LUGAR
110054...........................             40660             12060             12060
110069...........................             47580             31420             31420
110075...........................                11             42340             42340
110088...........................                11             12060             12060  LUGAR
110095...........................                11             46660             46660
110117...........................                11             12060             12060  LUGAR
110122...........................             46660             45220             45220
110125...........................                11             31420             31420
110128...........................                11             42340             42340
110150...........................                11             12060             12060
110153...........................             47580             31420             31420
110168...........................             40660             12060             12060
110187...........................                11             12060             12060  LUGAR
110189...........................                11             12060             12060
110205...........................                11             12060             12060
120028...........................                12             26180             26180
130002...........................                13                29                29
130003...........................             30300             28420             28420
130018...........................                13             38540             38540
130049...........................             17660             44060             44060
130067...........................                13             26820             26820  LUGAR
140012...........................                14             16974             16974
140015...........................                14             41180             41180
140032...........................                14             41180             41180
140033...........................             29404             16974             16974
140034...........................                14             41180             41180
140040...........................                14             37900             37900
140043...........................                14             40420             40420
140046...........................                14             41180             41180
140058...........................                14             41180             41180
140064...........................                14             37900             37900
140084...........................             29404             16974             16974
140093...........................             19180             16580             16580
140100...........................             29404             16974             16974
140110...........................                14             16974             16974
140130...........................             29404             16974             16974
140143...........................                14             37900             37900
140160...........................                14             40420             40420
140161...........................                14             16974             16974
140164...........................                14             41180             41180
140167...........................                14             28100             28100  LUGAR
140189...........................                14             16580             16580
140202...........................             29404             16974             16974
140233...........................             40420             16974             16974
140234...........................                14             37900             37900
140236...........................                14             28100             28100  LUGAR
140291...........................             29404             16974             16974
150002...........................             23844             16974             16974
150004...........................             23844             16974             16974

[[Page 24381]]

 
150006...........................             33140             43780             43780
150008...........................             23844             16974             16974
150011...........................                15             26900             26900
150015...........................             33140             16974             16974
150030...........................                15             26900             26900  LUGAR
150034...........................             23844             16974             16974
150048...........................                15             17140             17140
150051...........................                14               020             26900  26900
150065...........................                15             26900             26900
150069...........................                15             17140             17140
150076...........................                15             43780             43780
150088...........................             11300             26900             26900
150090...........................             23844             16974             16974
150102...........................                15             23844             23844  LUGAR
150112...........................             18020             26900             26900
150113...........................             11300             26900             26900
150122...........................                15             26900             26900
150125...........................             23844             16974             16974
150126...........................             23844             16974             16974
150133...........................                15             23060             23060
150146...........................                15             23060             23060
150147...........................             23844             16974             16974
160001...........................                16             19780             19780
160016...........................                16             19780             19780
160057...........................                16             26980             26980
160064...........................                16                24                24
160080...........................                16             19340             19340
160089...........................                16             19780             19780
160147...........................                16             19780             19780
170006...........................                17             27900             27900
170010...........................                17             46140             46140
170012...........................                17             48620             48620
170013...........................                17             48620             48620
170020...........................                17             48620             48620
170023...........................                17             48620             48620
170033...........................                17             48620             48620
170058...........................                17             28140             28140
170068...........................                17             11100             11100
170120...........................                17             27900             27900
170142...........................                17             45820             45820
170175...........................                17             48620             48620
170190...........................                17             45820             45820
170193...........................                17             48620             48620
180005...........................                18             26580             26580
180011...........................                18             30460             30460
180012...........................             21060             31140             31140
180013...........................             14540             34980             34980
180017...........................                18             21060             21060
180018...........................                18             30460             30460
180019...........................                18             17140             17140
180024...........................                18             31140             31140
180027...........................                18             17300             17300
180028...........................                18             26580             26580
180029...........................                18             28700             28700
180044...........................                18             26580             26580
180048...........................                18             31140             31140
180066...........................                18             34980             34980
180069...........................                18             26580             26580
180075...........................                18             14540             14540  LUGAR
180078...........................                18             26580             26580
180080...........................                18             28940             28940
180093...........................                18             21780             21780
180102...........................                18             17300             17300
180104...........................                18             17300             17300
180116...........................                18                14                14
180124...........................             14540             34980             34980
180127...........................                18             31140             31140
180132...........................                18             30460             30460

[[Page 24382]]

 
180139...........................                18             30460             30460
190001...........................                19             35380             35380
190003...........................                19             29180             29180
190015...........................                19             35380             35380
190086...........................                19             33740             33740
190099...........................                19             12940             12940
190106...........................                19             10780             10780
190131...........................             12940             35380             35380
190155...........................                19             12940             12940  LUGAR
190164...........................                19             10780             10780
190191...........................                19             12940             12940
190208...........................                19                04                04
190218...........................                19             43340             43340
190223...........................                19             12940             12940  LUGAR
200020...........................             38860             40484             40484
200024...........................             30340             38860             38860
200034...........................             30340             38860             38860
200039...........................                20             38860             38860
200050...........................                20             12620             12620
200063...........................                20             38860             38860
220001...........................             49340             14484             14484
220002...........................             15764             14484             14484
220010...........................             21604             14484             14484
220011...........................             15764             14484             14484
220019...........................             49340             14484             14484
220025...........................             49340             14484             14484
220028...........................             49340             14484             14484
220029...........................             21604             14484             14484
220033...........................             21604             14484             14484
220035...........................             21604             14484             14484
220049...........................             15764             14484             14484
220058...........................             49340             14484             14484
220060...........................             14484             12700             12700
220062...........................             49340             14484             14484
220063...........................             15764             14484             14484
220070...........................             15764             14484             14484
220077...........................             44140             25540             25540
220080...........................             21604             14484             14484
220082...........................             15764             14484             14484
220084...........................             15764             14484             14484
220090...........................             49340             14484             14484
220095...........................             49340             14484             14484
220098...........................             15764             14484             14484
220101...........................             15764             14484             14484
220105...........................             15764             14484             14484
220133...........................             15764             14484             14484
220163...........................             49340             14484             14484
220171...........................             15764             14484             14484
220174...........................             21604             14484             14484
230002...........................             19804  ................             11460
230003...........................             26100  ................             34740
230013...........................             47644  ................             19804
230019...........................             47644  ................             19804
230020...........................             19804  ................             11460
230022...........................                23             29620             29620
230024...........................             19804  ................             11460
230029...........................             47644  ................             19804
230030...........................                23             40980             40980
230035...........................                23             24340             24340  LUGAR
230036...........................                23             13020             13020
230037...........................                23             11460             11460
230047...........................             47644             19804             19804
230053...........................             19804  ................             11460
230054...........................                23             24580             24580
230065...........................  ................             19804             11460
230069...........................             47644             11460             11460
230071...........................             47644  ................             19804
230072...........................             26100  ................             34740

[[Page 24383]]

 
230077...........................             40980             22420             22420
230080...........................                23             40980             40980
230089...........................             19804  ................             11460
230092...........................             27100             29620             29620
230093...........................                23             24340             24340
230096...........................                23             28020             28020
230097...........................                23             24340             24340
230099...........................             33780             11460             11460
230104...........................             19804  ................             11460
230105...........................                23             13020             13020
230119...........................             19804  ................             11460
230121...........................                23             29620             29620  LUGAR
230130...........................             47644  ................             19804
230134...........................                23             26100             26100  LUGAR
230135...........................             19804  ................             11460
230142...........................             19804  ................             11460
230146...........................             19804  ................             11460
230151...........................             47644  ................             19804
230165...........................  ................             19804             11460
230174...........................             26100  ................             34740
230176...........................             19804  ................             11460
230195...........................             47644             19804             19804
230204...........................             47644             19804             19804
230207...........................             47644  ................             19804
230208...........................                23             24340             24340  LUGAR
230217...........................             12980             29620             29620
230223...........................             47644  ................             19804
230227...........................             47644             19804             19804
230244...........................             19804             11460             11460
230254...........................             47644  ................             19804
230257...........................             47644             19804             19804
230264...........................             47644             19804             19804
230269...........................             47644  ................             19804
230270...........................             19804  ................             11460
230273...........................             19804  ................             11460
230277...........................             47644  ................             19804
230279...........................             47644             11460             11460
230293...........................             19804  ................             11460
230295...........................                23             26100             26100  LUGAR
240018...........................                24             33460             33460
240030...........................                24             41060             41060
240036...........................             41060             33460             33460
240064...........................                24             20260             20260
240069...........................                24             40340             40340
240071...........................                24             40340             40340
240075...........................                24            410060            410060
240088...........................                24            410060            410060
240093...........................                24             33460             33460
241050...........................                24             40340             40340  LUGAR
240150...........................                24             40340             40340  LUGAR
240187...........................                24             33460             33460
240211...........................                24             33460             33460
250002...........................                25             22520             22520
250004...........................                25             32820             32820
250006...........................                25             32820             32820
250009...........................                25             27180             27180
250023...........................                25            250060            250060  LUGAR
250031...........................                25             27140             27140
250034...........................                25             32820             32820
250040...........................             37700            250060            250060
250042...........................                25             32820             32820
250044...........................                25             22520             22520
250069...........................                25             46220             46220
250079...........................                25             27140             27140
250081...........................                25             46220             46220
250082...........................                25             38220             38220
250094...........................             25620            250060            250060
250097...........................                25             12940             12940

[[Page 24384]]

 
250099...........................                25             27140             27140
250100...........................                25             46220             46220
250104...........................                25             27140             27140
250117...........................                25            250060            250060  LUGAR
260009...........................                26             28140             28140
260011...........................             27620             17860             17860
260015...........................                26             27860             27860
260017...........................                26             41180             41180
260022...........................                26                16                16
260025...........................                26             41180             41180
260049...........................                26             44180             44180  LUGAR
260050...........................                26             41140             41140
260064...........................                26             17860             17860
260074...........................                26             17860             17860
260094...........................                26             44180             44180
260110...........................                26             41180             41180
260113...........................                26                14                14
260116...........................                26                14                14
260119...........................                26             27860             27860
260175...........................                26             28140             28140
260183...........................                26             41180             41180
260186...........................                26             17860             17860
270003...........................                27             24500             24500
270011...........................                27             24500             24500
270017...........................                27             33540             33540
270051...........................                27             33540             33540
280009...........................                28            300700            300700
280023...........................                28            300700            300700
280032...........................                28            300700            300700
280061...........................                28                53                53
280065...........................                28             24540             24540
280077...........................                28             36540             36540
280125...........................                28             43580             43580
290002...........................                29             16180             16180  LUGAR
290006...........................                29             39900             39900
290008...........................                29             41620             41620
290019...........................             16180             39900             39900
300005...........................                30             31700             31700
300011...........................             31700             15764             15764
300012...........................             31700             15764             15764
300014...........................             40484             31700             31700
300017...........................             40484             21604             21604
300018...........................             40484             31700             31700
300019...........................                30             49340             49340
300020...........................             31700             15764             15764
300023...........................             40484             21604             21604
300029...........................             40484             21604             21604
300034...........................             31700             15764             15764
310002...........................             35084             35644             35644
310009...........................             35084             35644             35644
310013...........................             35084             35644             35644
310014...........................             15804             37964             37964
310015...........................             35084             35644             35644
310017...........................             35084             35644             35644
310018...........................             35084             35644             35644
310021...........................             45940             35084             35084
310031...........................             15804             20764             20764
310038...........................             20764             35644             35644
310039...........................             20764             35644             35644
310048...........................             20764             35084             35084
310050...........................             35084             35644             35644
310054...........................             35084             35644             35644
310070...........................             20764             35644             35644
310076...........................             35084             35644             35644
310078...........................             35084             35644             35644
310081...........................             15804             37964             37964
310083...........................             35084             35644             35644
310093...........................             35084             35644             35644

[[Page 24385]]

 
310096...........................             35084             35644             35644
310108...........................             20764             35644             35644
310119...........................             35084             35644             35644
320005...........................             22140             10740             10740
320006...........................                32             42140             42140
320013...........................                32             42140             42140
320014...........................                32             29740             29740
320033...........................                32             42140             42140  LUGAR
320063...........................                32             36220             36220
320065...........................                32             36220             36220
330004...........................             28740             39100             39100
330008...........................                33             15380             15380  LUGAR
330027...........................             35004             35644             35644
330038...........................                33             40380             40380  LUGAR
330073...........................                33             40380             40380  LUGAR
330079...........................                33                47                47
330085...........................                33            450060            450060
330094...........................                33             28740             28740
330103...........................                33                39                39
330106...........................             35004  ................             35644
330136...........................                33            450060            450060
330157...........................                33            450060            450060
330167...........................             35004  ................             35644
330181...........................             35004  ................             35644
330182...........................             35004             35644             35644
330191...........................             24020             10580             10580
330198...........................             35004  ................             35644
330224...........................             28740             39100             39100
330225...........................             35004  ................             35644
330229...........................             27460             21500             21500
330235...........................                33            450060            450060  LUGAR
330239...........................             27460             21500             21500
330250...........................                33             15540             15540
330259...........................             35004  ................             35644
330277...........................                33            270060            270060
330331...........................             35004  ................             35644
330332...........................             35004  ................             35644
330359...........................                33             39100             39100  LUGAR
330372...........................             35004  ................             35644
330386...........................                33             39100             39100
340004...........................             24660             49180             49180
340008...........................                34             16740             16740
340010...........................             24140             39580             39580
340013...........................                34             24860             24860
340014...........................             49180             24660             24660
340021...........................                34             16740             16740
340023...........................             11700             24860             24860
340027...........................                34             24780             24780
340039...........................                34             16740             16740
340047...........................             49180             24660             24660
340050...........................                34             22180             22180
340051...........................                34             25860             25860
340068...........................                34             48900             48900
340069...........................             39580            200500            200500
340070...........................             15500             24660             24660
340071...........................                34             39580             39580  LUGAR
340073...........................             39580            200500            200500
340091...........................             24660             49180             49180
340109...........................                34             47260             47260
340114...........................             39580            200500            200500
340115...........................                34            200500            200500
340124...........................                34             39580             39580  LUGAR
340126...........................                34             39580             39580
340127...........................                34            200500            200500
340129...........................                34             16740             16740
340131...........................                34             24780             24780
340136...........................                34            200500            200500  LUGAR
340138...........................             39580            200500            200500

[[Page 24386]]

 
340144...........................                34             16740             16740
401345...........................                34             16740             16740  LUGAR
340147...........................             40580             39580             39580
340148...........................             49180             24660             24660
340173...........................             39580            200500            200500
350003...........................                35             13900             13900
350006...........................                35             13900             13900
350009...........................                35             22020             22020
360008...........................                36             26580             26580
360010...........................                36             10420             10420
360011...........................                36             18140             18140
360013...........................                36             30620             30620
360014...........................                36             18140             18140
360019...........................             10420             17460             17460
360020...........................             10420             17460             17460
360025...........................             41780             17460             17460
360027...........................             10420             17460             17460
360036...........................                36             17460             17460
360039...........................                36             18140             18140
360054...........................                36             26580             26580
360065...........................                36             17460             17460
360078...........................             10420             17460             17460
360079...........................             19380             17140             17140
360084...........................             15940             10420             10420
360086...........................             44220             19380             19380
360095...........................                36             45780             45780
360096...........................                36             49660             49660  LUGAR
360107...........................                36             45780             45780
360121...........................                36             11460             11460
360125...........................                36             17460             17460  LUGAR
360150...........................             10420             17460             17460
360159...........................                36             18140             18140
360175...........................                36             18140             18140
360185...........................                36             49660             49660  LUGAR
360187...........................             44220             19380             19380
360197...........................                36             18140             18140
360211...........................             48260             38300             38300
360238...........................                36             49660             49660  LUGAR
360241...........................             10420             17460             17460
360245...........................                36             17460             17460  LUGAR
360253...........................             19380             17140             17140
370004...........................                37             27900             27900
370006...........................                37                17                17
370014...........................                37             43300             43300
370015...........................                37             46140             46140
370016...........................                37             36420             36420
370018...........................                37             46140             46140
370022...........................                37             30020             30020
370025...........................                37             46140             46140
370026...........................                37             36420             36420
370034...........................                37             22900             22900
370047...........................                37             43300             43300
370049...........................                37             36420             36420
370099...........................                37             46140             46140
370103...........................                37                45                45
370113...........................                37             22220             22220
380001...........................                38             38900             38900
380022...........................                38             18700             18700  LUGAR
380027...........................                38             21660             21660
380050...........................                38             32780             32780
380090...........................                38             21660             21660
390006...........................                39             25420             25420
390013...........................                39             25420             25420
390030...........................                39             10900             10900
390031...........................                39             39740             39740  LUGAR
390046...........................             49620             29540             29540
390048...........................                39             25420             25420
390065...........................                39             47894             47894

[[Page 24387]]

 
390066...........................             30140             25420             25420
390071...........................                39             48700             48700  LUGAR
390079...........................                39             13780             13780
390081...........................             37964             48864             48864
390086...........................                39             44300             44300
390091...........................                39             38300             38300
390110...........................             27780             38300             38300
390113...........................                39                36                36
390133...........................             10900             37964             37964
390151...........................                39             13644             13644
390156...........................             37964             48864             48864
390180...........................             37964             48864             48864
390222...........................             37964             48864             48864
390246...........................                39             48700             48700
400048...........................             25020             41980             41980
410010...........................             39300             14484             14484
410012...........................             39300             14484             14484
410013...........................             39300             35980             35980
420007...........................             43900             24860             24860
420009...........................                42             24860             24860  LUGAR
420020...........................                42             16700             16700
420027...........................             11340             24860             24860
420028...........................                42             44940             44940  LUGAR
420030...........................                42             16700             16700
420036...........................                42             16740             16740
420039...........................                42             43900             43900  LUGAR
420067...........................                42             42340             42340
420068...........................                42             12260             12260
420069...........................                42             44940             44940  LUGAR
420070...........................             44940             17900             17900
420071...........................                42             24860             24860
420080...........................                42             42340             42340
420083...........................             43900             24860             24860
420085...........................             34820             48900             48900
430012...........................                43             43620             43620
430014...........................                43             22020             22020
430094...........................                43                53                53
440002...........................             27180             32820             32820
440008...........................                44             27180             27180
440020...........................                44             26620             26620
440024...........................             17420             16860             16860
440025...........................                44                34                34
440035...........................             17300             34980             34980
440050...........................                44             11700             11700
440058...........................                44             16860             16860
440059...........................                44             34980             34980
440060...........................                44             27180             27180
440067...........................             34100             28940             28940
440068...........................                44             16860             16860
440072...........................                44             32820             32820
440073...........................                44             34980             34980
440148...........................                44             34980             34980
440151...........................                44             34980             34980
440175...........................                44             34980             34980
440180...........................                44             28940             28940
440185...........................             17420             16860             16860
440192...........................                44             34980             34980
450007...........................                45             41700             41700
450032...........................                45             43340             43340
450039...........................             23104             19124             19124
450059...........................             41700             12420             12420
450064...........................             23104             19124             19124
450073...........................                45             10180             10180
450080...........................                45             30980             30980
450087...........................             23104             19124             19124
450099...........................                45             11100             11100
450121...........................             23104             19124             19124
450135...........................             23104             19124             19124

[[Page 24388]]

 
450137...........................             23104             19124             19124
450144...........................                45             36220             36220
450148...........................             23104             19124             19124
450187...........................                45             26420             26420
450192...........................                45             19124             19124
450194...........................                45             19124             19124
450196...........................                45             19124             19124
450211...........................                45             26420             26420
450214...........................                45             26420             26420
450224...........................                45             46340             46340
450283...........................                45             19124             19124  LUGAR
450286...........................                45             17780             17780  LUGAR
450347...........................                45             26420             26420
450351...........................                45             23104             23104
450389...........................                45             19124             19124  LUGAR
450395...........................                45             26420             26420
450400...........................                45             47380             47380
450419...........................             23104             19124             19124
450438...........................                45             26420             26420
450447...........................                45             19124             19124
450451...........................                45             23104             23104
450484...........................                45             30980             30980
450508...........................                45             46340             46340
450547...........................                45             19124             19124
450563...........................             23104             19124             19124
450639...........................             23104             19124             19124
450653...........................                45             33260             33260
450656...........................                45             46340             46340
450672...........................             23104             19124             19124
450675...........................             23104             19124             19124
450677...........................             23104             19124             19124
450694...........................                45             26420             26420
450747...........................                45             19124             19124
450755...........................                45             31180             31180
450770...........................                45             12420             12420  LUGAR
450779...........................             23104             19124             19124
450813...........................                45             41700             41700
450830...........................                45             36220             36220
450839...........................                45             43340             43340
450858...........................             23104             19124             19124
450872...........................             23104             19124             19124
450880...........................             23104             19124             19124
460004...........................             36260             41620             41620
460005...........................             36260             41620             41620
460007...........................                46             41100             41100
460011...........................                46             39340             39340
460021...........................             41100             29820             29820
460039...........................                46             36260             36260
460041...........................             36260             41620             41620
460042...........................             36260             41620             41620
470001...........................                47                30                30
470011...........................                47             15764             15764
470012...........................                47             38340             38340
490004...........................             25500             16820             16820
490005...........................             49020             47894             47894
490013...........................                49             31340             31340
490018...........................                49             16820             16820
490042...........................             13980             40220             40220
490048...........................             40220             31340             31340
490079...........................                49             24660             24660
490092...........................                49            400060            400060
490105...........................                49             28700             28700
490106...........................                49             16820             16820
490109...........................             47260            400060            400060
500002...........................                50             28420             28420
500003...........................             34580             42644             42644
500016...........................             48300             42644             42644
500021...........................             45104             42644             42644

[[Page 24389]]

 
500024...........................             36500             45104             45104
500039...........................             14740             42644             42644
500041...........................             31020             38900             38900
500072...........................                50             42644             42644
500079...........................             45104             42644             42644
500108...........................             45104             42644             42644
500129...........................             45104             42644             42644
500139...........................             36500             45104             45104
510001...........................            340060             38300             38300
510002...........................                51             40220             40220
510006...........................                51             38300             38300
510018...........................                51             16620             16620  LUGAR
510024...........................            340060             38300             38300
510030...........................                51            340060            340060
510046...........................                51             16620             16620
510047...........................                51             38300             38300
510062...........................                51             16620             16620
510070...........................                51             16620             16620
510071...........................                51             16620             16620
510077...........................                51             26580             26580
520002...........................                52             48140             48140
520021...........................             29404             16974             16974
520028...........................                52             31540             31540
520037...........................                52             48140             48140
520059...........................             39540             29404             29404
520060...........................                52             22540             22540  LUGAR
520066...........................             27500             31540             31540
520071...........................                52             33340             33340  LUGAR
520076...........................                52             31540             31540
520088...........................             22540             33340             33340
520094...........................             39540             33340             33340
520095...........................                52             31540             31540
520096...........................             39540             33340             33340
520102...........................                52             33340             33340  LUGAR
520107...........................                52             24580             24580
520113...........................                52             24580             24580
520116...........................                52             33340             33340  LUGAR
520173...........................                52             20260             20260
520189...........................             29404             16974             16974
530015...........................                53             26820             26820
530025...........................                53             22660             22660
----------------------------------------------------------------------------------------------------------------


 Table 9B.--Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Public Law
                                                108-173--FY 2007
----------------------------------------------------------------------------------------------------------------
                                                            Wage index CBSA-- Wage index CBSA--
        Provider number            Note    Geographic CBSA     10/1/06-3/31/    4/1/2007-9/30/  Own Wage index--
                                                                   07               2007*        10/1/06-3/31/07
----------------------------------------------------------------------------------------------------------------
050494.........................  .......                05             42220  ................  ................
050549.........................  .......             37100             42220  ................  ................
070001.........................  .......             35300             35004  ................  ................
070005.........................  .......             35300             35004  ................  ................
070006.........................        *             14860             35644  ................  ................
070010.........................  .......             14860             35644  ................  ................
070016.........................  .......             35300             35004  ................  ................
070017.........................  .......             35300             35004  ................  ................
070018.........................        *             14860             35644  ................  ................
070019.........................  .......             35300             35004  ................  ................
070022.........................  .......             35300             35004  ................  ................
070028.........................  .......             14860             35644  ................  ................
070031.........................  .......             35300             35004  ................  ................
070034.........................        *             14860             35644  ................  ................
070039.........................  .......             35300             35004  ................  ................
160040.........................  .......             47940             16300  ................  ................
160067.........................  .......             47940             16300  ................  ................

[[Page 24390]]

 
160110.........................  .......             47940             16300  ................  ................
220046.........................  .......             38340             14484  ................  ................
230003.........................  .......             26100             28020  ................  ................
230004.........................  .......             34740             28020  ................  ................
230013.........................  .......             47644             22420  ................  ................
230019.........................  .......             47644             22420  ................  ................
230020.........................  .......             19804             11460  ................  ................
230024.........................  .......             19804             11460  ................  ................
230029.........................  .......             47644             22420  ................  ................
230038.........................  .......             24340             28020  ................  ................
230053.........................  .......             19804             11460  ................  ................
230059.........................  .......             24340             28020  ................  ................
230066.........................  .......             34740             28020  ................  ................
230071.........................  .......             47644             22420  ................  ................
230072.........................  .......             26100             28020  ................  ................
230089.........................  .......             19804             11460  ................  ................
230104.........................  .......             19804             11460  ................  ................
230106.........................  .......             24340             28020  ................  ................
230119.........................  .......             19804             11460  ................  ................
230130.........................  .......             47644             22420  ................  ................
230135.........................  .......             19804             11460  ................  ................
230146.........................  .......             19804             11460  ................  ................
230151.........................  .......             47644             22420  ................  ................
230165.........................  .......             19804             11460  ................  ................
230174.........................  .......             26100             28020  ................  ................
230176.........................  .......             19804             11460  ................  ................
230207.........................  .......             47644             22420  ................  ................
230223.........................  .......             47644             22420  ................  ................
230236.........................  .......             24340             28020  ................  ................
230254.........................  .......             47644             22420  ................  ................
230269.........................  .......             47644             22420  ................  ................
230270.........................  .......             19804             11460  ................  ................
230273.........................  .......             19804             11460  ................  ................
230277.........................  .......             47644             22420  ................  ................
250078.........................        *             25620             25060             25060  ................
250122.........................  .......                25             25060  ................  ................
270002.........................        *                27             33540             33540  ................
270012.........................        *             24500             33540             33540  ................
270023.........................  .......             33540             13740  ................  ................
270032.........................  .......                27             13740  ................  ................
270057.........................  .......                27             13740  ................  ................
310028.........................  .......             35084             35644  ................  ................
310051.........................  .......             35084             35644  ................  ................
310060.........................  .......             10900             35644  ................  ................
310115.........................  .......             10900             35644  ................  ................
310120.........................  .......             35084             35644  ................  ................
330023.........................        *             39100             35644             35644  ................
330049.........................  .......             39100             35644  ................  ................
330067.........................        *             39100             35644             35644  ................
330106.........................  .......             35004  ................  ................            1.4485
330126.........................  .......             39100             35644  ................  ................
330135.........................  .......             39100             35644  ................  ................
330205.........................  .......             39100             35644  ................  ................
330209.........................  .......             39100             35004  ................  ................
330264.........................  .......             39100             35004  ................  ................
340002.........................  .......             11700             16740  ................  ................
350002.........................  .......             13900             22020  ................  ................
350010.........................  .......                35             22020  ................  ................
350014.........................  .......                35             22020  ................  ................
350015.........................  .......             13900             22020  ................  ................
350017.........................  .......                35             22020  ................  ................
350019.........................        *             24220             22020             22020  ................
350030.........................  .......                35             22020  ................  ................
390001.........................  .......             42540             10900  ................  ................
390003.........................  .......                39             10900  ................  ................
390054.........................  .......             42540             29540  ................  ................
390072.........................  .......                39             10900  ................  ................
390095.........................  .......             42540             10900  ................  ................

[[Page 24391]]

 
390119.........................  .......             42540             10900  ................  ................
390137.........................  .......             42540             10900  ................  ................
390169.........................  .......             42540             10900  ................  ................
390185.........................  .......             42540             29540  ................  ................
390192.........................  .......             42540             10900  ................  ................
390237.........................  .......             42540             10900  ................  ................
390270.........................  .......             42540             29540  ................  ................
430005.........................  .......                43             39660  ................  ................
430008.........................        *                43             43620             43620  ................
430013.........................        *                43             43620             43620  ................
430015.........................  .......                43             43620  ................  ................
430048.........................  .......                43             43620  ................  ................
430060.........................  .......                43             43620  ................  ................
430064.........................  .......                43             43620  ................  ................
430077.........................  .......             39660             43620  ................  ................
430091.........................  .......             39660             43620  ................  ................
450010.........................  .......             48660             32580  ................  ................
450072.........................  .......             26420             26420  ................  ................
450591.........................  .......             26420             26420  ................  ................
470003.........................  .......             15540             14484  ................  ................
490001.........................  .......                49             31340  ................  ................
490024.........................  .......             40220             19260  ................  ................
530008.........................        *                53             16220             16220  ................
530010.........................        *                53             16220             16220  ................
----------------------------------------------------------------------------------------------------------------
* These hospitals are assigned a wage index value under a special exceptions policy (see the FY 2005 IPPS final
  rule, 69 FR 49105).


 Table 9C.--Hospitals Redesignated as Rural Under Section 1886(d)(8)(E)
                           of the Act--FY 2007
------------------------------------------------------------------------
                                            Geographic     Redesignated
             Provider number                   CBSA         rural area
------------------------------------------------------------------------
050192..................................           23420              05
050469..................................           40140              05
050528..................................           32900              05
050618..................................           40140              05
070004..................................           25540              07
100048..................................           37860              10
100134..................................           27260              10
170137..................................           29940              17
190048..................................           26380              19
230078..................................           35660              23
260006..................................           41140              26
260047..................................           27620              26
260195..................................           44180              26
330268..................................           10580              33
370054..................................           36420              37
380040..................................           13460              38
390052..................................              39              39
390084..................................              39              39
390093..................................              39              39
390118..................................              39              39
390125..................................              39              39
390138..................................              39              39
390146..................................              39              39
390150..................................              39              39
390181..................................              39              39
390183..................................              39              39
390189..................................              39              39
390199..................................              39              39
390201..................................              39              39
440135..................................           34980              44
450052..................................              45              45
450078..................................           10180              45
450243..................................           10180              45
450348..................................              45              45
500060..................................           42644              50
500148..................................           48300              50
------------------------------------------------------------------------


[[Page 24392]]


    Table 10.--Geometric Mean Plus the Lesser of .75 of the National
Adjusted Operating Standardized Payment Amount (Increased to Reflect the
 Difference Between Costs and Charges) or .75 of One Standard Deviation
     of Mean Charges by Diagnosis-Related Group (DRG) March 2006 \1\
------------------------------------------------------------------------
                                                 Number of
                      DRG                          cases      Threshold
------------------------------------------------------------------------
1.............................................       24,328      $53,938
2.............................................       10,275      $37,402
3.............................................            2      $70,158
6.............................................          291      $16,552
7.............................................       14,912      $41,716
8.............................................        3,415      $31,108
9.............................................        1,761      $25,283
10............................................       19,574      $25,017
11............................................        3,075      $18,962
12............................................       56,224      $18,919
13............................................        7,495      $17,715
14............................................      278,100      $24,927
15............................................       20,038      $20,826
16............................................       17,333      $26,314
17............................................        2,966      $15,701
18............................................       33,356      $21,320
19............................................        8,416      $15,732
20............................................        6,407      $40,783
21............................................        2,205      $26,935
22............................................        3,151      $23,912
23............................................       10,668      $16,962
24............................................       63,265      $21,159
25............................................       27,269      $13,798
26............................................           24      $20,300
27............................................        5,923      $25,046
28............................................       19,837      $25,435
29............................................        6,498      $15,810
31............................................        4,967      $21,053
32............................................        1,856      $14,058
34............................................       27,462      $21,201
35............................................        7,825      $14,408
36............................................        1,203      $15,522
37............................................        1,233      $24,385
38............................................           48      $11,080
39............................................          362      $14,021
40............................................        1,251      $21,938
42............................................          941      $17,594
43............................................          123      $12,806
44............................................        1,310      $14,842
45............................................        2,765      $16,531
46............................................        3,942      $16,755
47............................................        1,322      $12,080
49............................................        2,414      $31,141
50............................................        2,023      $19,180
51............................................          192      $19,172
52............................................          316      $16,103
53............................................        2,137      $26,620
55............................................        1,366      $20,219
56............................................          450      $19,353
57............................................          881      $20,358
59............................................          127      $15,100
60............................................            3      $18,913
61............................................          222      $28,884
62............................................            4       $7,210
63............................................        2,826      $26,658
64............................................        3,252      $23,164
65............................................       40,693      $13,497
66............................................        8,208      $12,916
67............................................          379      $17,295
68............................................       19,063      $14,128
69............................................        5,200      $10,627
70............................................           23       $7,427
71............................................           71      $15,648
72............................................        1,341      $16,527
73............................................        9,963      $18,049
74............................................            3       $8,105
75............................................       46,661      $48,108
76............................................       47,934      $43,517
77............................................        2,086      $25,753
78............................................       49,495      $26,329
79............................................      160,350      $29,300
80............................................        7,187      $18,853
81............................................            6      $25,887
82............................................       63,071      $26,543
83............................................        7,053      $21,671
84............................................        1,379      $12,820
85............................................       22,188      $25,115
86............................................        1,726      $15,503
87............................................       96,594      $26,870
88............................................      427,896      $19,083
89............................................      555,084      $22,017
90............................................       43,729      $13,109
91............................................           53      $11,679
92............................................       16,529      $24,748
93............................................        1,446      $16,248
94............................................       13,561      $23,676
95............................................        1,568      $12,581
96............................................       60,141      $15,900
97............................................       26,997      $11,754
98............................................           13      $12,587
99............................................       21,440      $15,705
100...........................................        6,425      $12,166
101...........................................       23,372      $18,530
102...........................................        4,916      $12,328
103...........................................          859     $234,201
104...........................................       20,077     $124,179
105...........................................       32,514      $93,739
106...........................................        3,427     $111,298
108...........................................        8,740      $89,367
110...........................................       57,543      $59,240
111...........................................       10,744      $45,073
113...........................................       34,572      $45,534
114...........................................        7,940      $30,209
117...........................................        5,331      $25,603
118...........................................        7,618      $33,248
119...........................................          965      $25,877
120...........................................       33,337      $36,476
121...........................................      150,081      $29,689
122...........................................       54,533      $21,009
123...........................................       29,519      $25,707
124...........................................      120,197      $29,665
125...........................................       92,007      $23,825
126...........................................        5,415      $40,840
127...........................................      667,830      $21,961
128...........................................        4,228      $15,640
129...........................................        3,504      $21,695
130...........................................       87,619      $20,101
131...........................................       22,939      $12,055
132...........................................      101,445      $13,662
133...........................................        5,877      $12,148
134...........................................       40,280      $13,518
135...........................................        7,169      $19,603
136...........................................          936      $14,048
138...........................................      206,144      $17,801
139...........................................       74,055      $11,519
140...........................................       31,532      $11,134
141...........................................      123,443      $16,543
142...........................................       49,350      $13,194
143...........................................      238,325      $12,583
144...........................................      104,907      $24,478
145...........................................        5,727      $12,846
146...........................................       10,217      $45,078
147...........................................        2,607      $31,265
148...........................................      132,645      $51,883
149...........................................       19,460      $30,248
150...........................................       22,886      $45,015
151...........................................        5,365      $27,699
152...........................................        4,995      $33,362
153...........................................        1,946      $23,355
154...........................................       26,968      $56,652
155...........................................        5,992      $27,799
156...........................................            4      $43,037
157...........................................        8,291      $25,914
158...........................................        3,707      $14,374
159...........................................       19,172      $28,300
160...........................................       11,919      $18,834
161...........................................       10,136      $25,538
162...........................................        4,950      $15,241
163...........................................            4      $14,007
164...........................................        5,971      $38,851
165...........................................        2,443      $25,609
166...........................................        5,126      $29,243
167...........................................        4,864      $19,695
168...........................................        1,532      $25,261
169...........................................          770      $16,756
170...........................................       17,890      $44,542
171...........................................        1,404      $26,663
172...........................................       33,122      $26,316
173...........................................        2,229      $16,793
174...........................................      260,944      $22,036
175...........................................       29,891      $12,609
176...........................................       14,595      $23,998
177...........................................        7,656      $20,625
178...........................................        2,548      $15,447
179...........................................       14,654      $23,043
180...........................................       91,305      $20,909
181...........................................       25,234      $12,552
182...........................................      297,038      $18,449
183...........................................       81,833      $13,162
184...........................................           76      $14,814
185...........................................        6,240      $18,863
186...........................................            7       $5,726
187...........................................          644      $18,582
188...........................................       93,551      $22,996
189...........................................       13,148      $13,298
190...........................................           63      $16,464
191...........................................       10,546      $54,836
192...........................................        1,376      $32,518
193...........................................        4,038      $51,797
194...........................................          461      $32,202

[[Page 24393]]

 
195...........................................        2,835      $50,330
196...........................................          594      $32,533
197...........................................       16,347      $42,001
198...........................................        4,105      $26,117
199...........................................        1,477      $37,170
200...........................................        1,014      $39,833
201...........................................        2,707      $52,939
202...........................................       27,497      $25,079
203...........................................       32,322      $26,139
204...........................................       69,183      $22,933
205...........................................       32,722      $23,282
206...........................................        2,041      $16,152
207...........................................       38,324      $24,655
208...........................................        9,535      $15,457
210...........................................      126,270      $36,343
211...........................................       25,668      $26,696
212...........................................           10      $18,770
213...........................................        9,455      $33,757
216...........................................       19,927      $35,368
217...........................................       15,590      $41,834
218...........................................       29,952      $32,692
219...........................................       21,035      $23,451
220...........................................            2      $24,004
223...........................................       12,641      $25,348
224...........................................        9,914      $18,586
225...........................................        6,246      $26,078
226...........................................        6,735      $29,288
227...........................................        4,867      $18,609
228...........................................        2,680      $24,599
229...........................................        1,123      $15,669
230...........................................        2,458      $26,420
232...........................................          566      $20,841
233...........................................       18,408      $34,741
234...........................................        9,070      $27,627
235...........................................        4,753      $16,296
236...........................................       41,708      $15,403
237...........................................        1,917      $13,860
238...........................................        9,766      $26,257
239...........................................       40,264      $23,062
240...........................................       12,897      $24,260
241...........................................        2,829      $14,155
242...........................................        2,726      $22,458
243...........................................      100,715      $17,004
244...........................................       17,015      $15,399
245...........................................        5,904      $10,392
246...........................................        1,407      $13,311
247...........................................       21,424      $12,727
248...........................................       16,489      $18,894
249...........................................       13,442      $15,428
250...........................................        4,144      $15,072
251...........................................        2,068      $10,611
253...........................................       24,748      $16,493
254...........................................        9,990      $10,194
256...........................................        7,606      $18,047
257...........................................       13,084      $19,605
258...........................................       11,372      $15,439
259...........................................        2,657      $21,683
260...........................................        2,421      $15,090
261...........................................        1,568      $20,742
262...........................................          599      $20,894
263...........................................       22,459      $32,488
264...........................................        3,905      $22,421
265...........................................        4,011      $28,291
266...........................................        2,221      $19,694
267...........................................          273      $20,005
268...........................................          994      $25,612
269...........................................       11,014      $30,475
270...........................................        2,567      $17,712
271...........................................       21,702      $21,485
272...........................................        6,074      $20,835
273...........................................        1,267      $12,661
274...........................................        2,242      $22,532
275...........................................          180      $12,564
276...........................................        1,623      $15,496
277...........................................      119,279      $18,413
278...........................................       33,947      $11,744
279...........................................            6       $9,165
280...........................................       19,317      $16,070
281...........................................        6,558      $11,023
283...........................................        6,779      $15,588
284...........................................        1,870       $9,582
285...........................................        8,029      $35,326
286...........................................        2,858      $34,797
287...........................................        5,417      $31,354
288...........................................       11,262      $36,453
289...........................................        6,326      $19,747
290...........................................       11,850      $18,894
291...........................................           59      $13,196
292...........................................        7,563      $41,631
293...........................................          319      $27,017
294...........................................       97,778      $16,203
295...........................................        4,359      $16,127
296...........................................      247,564      $17,305
297...........................................       42,713      $10,753
298...........................................          110      $11,321
299...........................................        1,544      $21,193
300...........................................       21,668      $23,141
301...........................................        3,917      $13,502
302...........................................       10,266      $53,482
303...........................................       24,555      $38,849
304...........................................       14,042      $37,954
305...........................................        3,000      $25,713
306...........................................        5,792      $25,952
307...........................................        1,941      $13,794
308...........................................        6,672      $29,226
309...........................................        3,267      $20,392
310...........................................       25,307      $25,305
311...........................................        5,868      $14,225
312...........................................        1,322      $24,353
313...........................................          502      $16,746
314...........................................            2      $63,207
315...........................................       34,708      $34,675
316...........................................      204,537      $24,329
317...........................................        2,695      $17,236
318...........................................        5,900      $23,909
319...........................................          386      $13,776
320...........................................      225,308      $18,217
321...........................................       32,125      $12,238
322...........................................           67      $13,312
323...........................................       20,424      $18,227
324...........................................        4,622      $11,415
325...........................................        9,912      $14,526
326...........................................        2,596       $9,757
327...........................................           11       $4,343
328...........................................          574      $15,429
329...........................................           55      $11,791
331...........................................       56,911      $22,376
332...........................................        4,148      $13,671
333...........................................          242      $18,937
334...........................................        9,480      $29,861
335...........................................       12,115      $24,029
336...........................................       28,104      $18,105
337...........................................       21,412      $12,512
338...........................................          670      $26,885
339...........................................        1,226      $24,456
341...........................................        3,118      $26,313
342...........................................          455      $16,807
344...........................................        2,344      $26,216
345...........................................        1,393      $24,179
346...........................................        4,006      $22,303
347...........................................          247      $11,878
348...........................................        4,275      $15,630
349...........................................          556      $10,034
350...........................................        7,275      $16,391
352...........................................        1,176      $16,670
353...........................................        3,075      $31,137
354...........................................        7,556      $29,687
355...........................................        4,982      $19,301
356...........................................       22,197      $16,341
357...........................................        5,521      $37,813
358...........................................       20,865      $24,333
359...........................................       28,554      $17,289
360...........................................       14,250      $19,091
361...........................................          288      $23,723
362...........................................            2       $6,842
363...........................................        1,978      $22,611
364...........................................        1,366      $20,070
365...........................................        1,607      $32,785
366...........................................        4,664      $23,778
367...........................................          448      $13,000
368...........................................        4,156      $23,392
369...........................................        3,780      $14,156
370...........................................        2,210      $17,586
371...........................................        2,656      $12,644
372...........................................        1,354      $10,859
373...........................................        5,201       $7,550
374...........................................          153      $12,838
375...........................................           13      $21,703
376...........................................          474      $12,994
377...........................................          111      $24,218
378...........................................          203      $16,225
379...........................................          486       $7,975
380...........................................          111       $9,309
381...........................................          172      $14,935
382...........................................           51       $3,954
383...........................................        2,816      $10,480
384...........................................          147       $7,366
389...........................................            3      $24,011
392...........................................        2,120      $45,705
394...........................................        2,758      $30,927

[[Page 24394]]

 
395...........................................      115,676      $18,128
396...........................................           20      $13,145
397...........................................       16,409      $23,004
398...........................................       18,602      $24,048
399...........................................        1,639      $14,974
401...........................................        6,443      $43,881
402...........................................        1,341      $25,131
403...........................................       31,499      $29,820
404...........................................        3,625      $19,967
406...........................................        2,300      $42,504
407...........................................          608      $24,913
408...........................................        1,941      $33,805
409...........................................        1,733      $24,885
410...........................................       29,018      $23,855
411...........................................            5       $9,742
412...........................................            8       $9,732
413...........................................        5,727      $25,493
414...........................................          481      $16,066
415...........................................       55,695      $54,398
416...........................................      287,720      $29,284
417...........................................           33      $28,169
418...........................................       29,891      $22,126
419...........................................       17,735      $18,517
420...........................................        3,052      $12,846
421...........................................       13,248      $16,145
422...........................................           77      $11,732
423...........................................        9,071      $28,338
424...........................................        1,034      $36,130
425...........................................       13,105      $13,590
426...........................................        4,244      $10,349
427...........................................        1,575      $11,169
428...........................................          831      $13,862
429...........................................       24,102      $16,887
430...........................................       75,185      $13,563
431...........................................          338      $12,778
432...........................................          401      $14,072
433...........................................        5,145       $6,348
439...........................................        1,750      $29,718
440...........................................        5,181      $29,513
441...........................................          687      $20,575
442...........................................       18,524      $37,538
443...........................................        3,570      $22,683
444...........................................        6,004      $16,185
445...........................................        2,259      $11,272
447...........................................        6,341      $11,444
449...........................................       40,812      $18,232
450...........................................        7,395       $9,416
451...........................................            2      $19,140
452...........................................       28,659      $21,691
453...........................................        5,379      $11,466
454...........................................        4,754      $17,818
455...........................................          885      $10,307
461...........................................        2,271      $27,863
462...........................................        7,854      $16,912
463...........................................       32,979      $15,084
464...........................................        7,677      $11,282
465...........................................          171      $12,777
466...........................................        1,250      $13,996
467...........................................        1,035       $9,965
468...........................................       51,806      $57,172
470...........................................          130      $25,466
471...........................................       15,526      $55,551
473...........................................        8,554      $38,397
475...........................................      119,935      $50,639
476...........................................        2,840      $35,418
477...........................................       28,074      $34,213
479...........................................       27,582      $30,586
480...........................................          884     $128,973
481...........................................        1,183      $91,460
482...........................................        5,076      $49,252
484...........................................          456      $75,162
485...........................................        3,658      $51,585
486...........................................        2,607      $68,837
487...........................................        4,877      $31,891
488...........................................          823      $63,400
489...........................................       13,661      $28,266
490...........................................        5,338      $21,522
491...........................................       22,679      $35,764
492...........................................        3,897      $44,664
493...........................................       60,901      $34,560
494...........................................       24,434      $22,745
495...........................................          336     $120,908
496...........................................        3,709      $96,697
497...........................................       31,216      $62,841
498...........................................       21,383      $51,886
499...........................................       35,204      $28,301
500...........................................       46,619      $19,840
501...........................................        3,171      $42,481
502...........................................          756      $29,355
503...........................................        5,858      $26,581
504...........................................          191     $146,367
505...........................................          180      $27,936
506...........................................          964      $50,384
507...........................................          323      $31,731
508...........................................          662      $23,639
509...........................................          157      $16,201
510...........................................        1,797      $21,194
511...........................................          636      $13,509
512...........................................          530      $90,375
513...........................................          213     $101,858
515...........................................       58,105      $86,680
518...........................................       23,620      $34,456
519...........................................       12,544      $44,211
520...........................................       16,505      $35,796
521...........................................       32,468      $14,497
522...........................................        5,801      $10,106
523...........................................       15,604       $8,206
524...........................................      109,106      $16,158
525...........................................          203     $151,063
528...........................................        1,841     $107,892
529...........................................        5,109      $36,423
530...........................................        3,372      $25,893
531...........................................        4,873      $45,214
532...........................................        2,832      $27,950
533...........................................       46,519      $30,298
534...........................................       42,490      $22,177
535...........................................        8,761     $119,733
536...........................................        8,187     $109,139
537...........................................        8,952      $32,582
538...........................................        5,453      $22,363
539...........................................        4,953      $44,654
540...........................................        1,491      $25,570
541...........................................       25,000     $250,176
542...........................................       23,215     $150,533
543...........................................        5,478      $64,504
544...........................................      444,509      $39,461
545...........................................       44,574      $45,048
546...........................................        2,345      $83,613
547...........................................       32,602      $97,976
548...........................................       32,109      $79,666
549...........................................       13,098      $81,112
550...........................................       34,456      $63,667
551...........................................       53,802      $51,436
552...........................................       81,841      $40,493
553...........................................       39,188      $46,843
554...........................................       77,170      $36,841
555...........................................       37,270      $42,704
556...........................................       18,914      $37,680
557...........................................      123,764      $51,183
558...........................................      191,880      $42,313
559...........................................        2,887     $40,716
------------------------------------------------------------------------
\1\ Cases taken from the FY 2005 MedPAR file; DRGs are from GROUPER
  Version 24.0.


    Table 11.--Proposed FY 2007 LTC-DRGs, Relative Weights, Geometric
 Average Length of Stay, and \5/6\THS of the Geometric Average Length of
                                  Stay
------------------------------------------------------------------------
                                                             Proposed  5/
                                                  Proposed   6ths of the
                                     Proposed    geometric    geometric
    LTC-DRG         Description      relative     average      average
                                      weight     length of    length of
                                                    stay         stay
------------------------------------------------------------------------
1..............  \5\ CRANIOTOMY         1.6479         35.5         29.6
                  AGE >17 W CC.

[[Page 24395]]

 
2..............  \7\ CRANIOTOMY         1.6479         35.5         29.6
                  AGE > 17 W/O CC.
3..............  \7\ CRANIOTOMY         1.6479         35.5         29.6
                  AGE 0-17.
6..............  \7\ CARPAL             0.4109         17.1         14.3
                  TUNNEL RELEASE.
7..............  PERIPH & CRANIAL       1.2119         36.2         30.2
                  NERVE & OTHER
                  NERV SYST PROC
                  W CC.
8..............  \2\ PERIPH &           0.5655         21.2         17.7
                  CRANIAL NERVE &
                  OTHER NERV SYST
                  PROC W/O CC.
9..............  SPINAL DISORDERS       1.0474         34.0         28.3
                  & INJURIES.
10.............  NERVOUS SYSTEM         0.6992         22.1         18.4
                  NEOPLASMS W CC.
11.............  \2\ NERVOUS            0.5655         21.2         17.7
                  SYSTEM
                  NEOPLASMS W/O
                  CC.
12.............  DEGENERATIVE           0.6811         25.2         21.0
                  NERVOUS SYSTEM
                  DISORDERS.
13.............  MULTIPLE               0.6043         23.1         19.3
                  SCLEROSIS &
                  CEREBELLAR
                  ATAXIA.
14.............  INTERCRANIAL           0.6798         24.8         20.7
                  HEMORRHAGE OR
                  STROKE WITH
                  INFARCT.
15.............  NONSPECIFIC CVA        0.7779         26.1         21.8
                  & PRECEREBRAL
                  OCCULUSION
                  WITHOUT INFARCT.
16.............  NONSPECIFIC            0.6960         23.1         19.3
                  CEREBROVASCULAR
                  DISORDERS W CC.
17.............  \1\ NONSPECIFIC        0.4109         17.1         14.3
                  CEREBROVASCULAR
                  DISORDERS W/O
                  CC.
18.............  CRANIAL &              0.7397         25.2         21.0
                  PERIPHERAL
                  NERVE DISORDERS
                  W CC.
19.............  CRANIAL &              0.4526         19.5         16.3
                  PERIPHERAL
                  NERVE DISORDERS
                  W/O CC.
20.............  NERVOUS SYSTEM         0.9141         24.9         20.8
                  INFECTION
                  EXCEPT VIRAL
                  MENINGITIS.
21.............  \3\ VIRAL              0.7858         25.2         21.0
                  MENINGITIS.
22.............  \3\ HYPERTENSIVE       0.7858         25.2         21.0
                  ENCEPHALOPATHY.
23.............  NONTRAUMATIC           1.0124         29.4         24.5
                  STUPOR & COMA.
24.............  SEIZURE &              0.7194         23.8         19.8
                  HEADACHE AGE
                  >17 W CC.
25.............  \2\ SEIZURE &          0.5655         21.2         17.7
                  HEADACHE AGE
                  >17 W/O CC.
26.............  \7\ SEIZURE &          0.5655         21.1         17.6
                  HEADACHE AGE 0-
                  17.
27.............  TRAUMATIC STUPOR       1.0016         30.6         25.5
                  & COMA, COMA >1
                  HR.
28.............  TRAUMATIC STUPOR       0.8052         25.8         21.5
                  & COMA, COMA >1
                  HR AGE >17 W CC.
29.............  \1\ TRAUMATIC          0.4109         17.1         14.3
                  STUPOR & COMA,
                  COMA >1 HR AGE
                  >17 W/O CC.
30.............  \7\ TRAUMATIC          0.4109         17.1         14.3
                  STUPOR & COMA,
                  COMA <1 HR AGE
                  0-17.
31.............  \1\ CONCUSSION         0.4109         17.1         14.3
                  AGE >17 W CC.
32.............  \7\ CONCUSSION         0.5655         21.1         17.6
                  AGE >17 W/O CC.
33.............  \7\ CONCUSSION         0.5655         21.1         17.6
                  AGE 0-17.
34.............  OTHER DISORDERS        0.7057         23.4         19.5
                  OF NERVOUS
                  SYSTEM W CC.
35.............  OTHER DISORDERS        0.5093         21.1         17.6
                  OF NERVOUS
                  SYSTEM W/O CC.
36.............  \7\ RETINAL            0.5655         21.1         17.6
                  PROCEDURES.
37.............  \7\ ORBITAL            0.5655         21.1         17.6
                  PROCEDURES.
38.............  \7\ PRIMARY IRIS       0.5655         21.1         17.6
                  PROCEDURES.
39.............  \7\ LENS               0.5655         21.1         17.6
                  PROCEDURES WITH
                  OR WITHOUT
                  VITRECTOMY.
40.............  \7\ EXTRAOCULAR        0.5655         21.1         17.6
                  PROCEDURES
                  EXCEPT ORBIT
                  AGE >17.
41.............  \7\ EXTRAOCULAR        0.5655         21.1         17.6
                  PROCEDURES
                  EXCEPT ORBIT
                  AGE 0-17.
42.............  \7\ INTRAOCULAR        0.5655         21.1         17.6
                  PROCEDURES
                  EXCEPT RETINA,
                  IRIS & LENS.
43.............  \7\ HYPHEMA.....       0.4109         17.1         14.3
44.............  \3\ ACUTE MAJOR        0.7858         25.2         21.0
                  EYE INFECTIONS.
45.............  \1\ NEUROLOGICAL       0.4109         17.1         14.3
                  EYE DISORDERS.
46.............  \2\ OTHER              0.5655         21.2         17.7
                  DISORDERS OF
                  THE EYE AGE >17
                  W CC.
47.............  \7\ OTHER              0.4109         17.1         14.3
                  DISORDERS OF
                  THE EYE AGE >17
                  W/O CC.
48.............  \7\ OTHER              0.4109         17.1         14.3
                  DISORDERS OF
                  THE EYE AGE 0-
                  17.
49.............  \7\ MAJOR HEAD &       1.1162         29.5         24.6
                  NECK PROCEDURES.
50.............  \7\                    1.1162         29.5         24.6
                  SIALOADENECTOMY.
51.............  \7\ SALIVARY           1.1162         29.5         24.6
                  GLAND
                  PROCEDURES
                  EXCEPT
                  SIALOADENECTOMY.
52.............  \7\ CLEFT LIP &        1.1162         29.5         24.6
                  PALATE REPAIR.
53.............  \7\ SINUS &            1.1162         29.5         24.6
                  MASTOID
                  PROCEDURES AGE
                  >17.
54.............  \7\ SINUS &            1.1162         29.5         24.6
                  MASTOID
                  PROCEDURES AGE
                  0-17.
55.............  \4\                    1.1162         29.5         24.6
                  MISCELLANEOUS
                  EAR, NOSE,
                  MOUTH & THROAT
                  PROCEDURES.
56.............  \7\ RHINOPLASTY.       1.1162         29.5         24.6
57.............  \7\ T&A PROC,          0.4109         17.1         14.3
                  EXCEPT
                  TONSILLECTOMY &/
                  OR
                  ADENOIDECTOMY
                  ONLY, AGE >17.
58.............  \7\ T&A PROC,          0.4109         17.1         14.3
                  EXCEPT
                  TONSILLECTOMY &/
                  OR
                  ADENOIDECTOMY
                  ONLY, AGE 0-17.
59.............  \7\                    0.4109         17.1         14.3
                  TONSILLECTOMY &/
                  OR
                  ADENOIDECTOMY
                  ONLY, AGE >17.
60.............  \7\                    0.4109         17.1         14.3
                  TONSILLECTOMY &/
                  OR
                  ADENOIDECTOMY
                  ONLY, AGE 0-17.
61.............  \7\ MYRINGOTOMY        0.4109         17.1         14.3
                  W TUBE
                  INSERTION AGE
                  >17.
62.............  \7\ MYRINGOTOMY        0.4109         17.1         14.3
                  W TUBE
                  INSERTION AGE 0-
                  17.
63.............  \4\ OTHER EAR,         1.1162         29.5         24.6
                  NOSE, MOUTH &
                  THROAT O.R.
                  PROCEDURES.
64.............  EAR, NOSE, MOUTH       1.1890         26.2         21.8
                  & THROAT
                  MALIGNANCY.
65.............  \1\                    0.4109         17.1         14.3
                  DYSEQUILIBRIUM.
66.............  \7\ EPISTAXIS...       0.4109         17.1         14.3
67.............  \3\ EPIGLOTTITIS       0.7858         25.2         21.0
68.............  OTITIS MEDIA &         0.6238         20.3         16.9
                  URI AGE >17 W
                  CC.

[[Page 24396]]

 
69.............  \1\ OTITIS MEDIA       0.4109         17.1         14.3
                  & URI AGE >17 W/
                  O CC.
70.............  \7\ OTITIS MEDIA       0.4109         17.1         14.3
                  & URI AGE 0-17.
71.............  \7\                    0.5655         21.1         17.6
                  LARYNGOTRACHEIT
                  IS.
72.............  \3\ NASAL TRAUMA       0.7858         25.2         21.0
                  & DEFORMITY.
73.............  \7\ OTHER EAR,         0.7761         22.9         19.1
                  NOSE, MOUTH &
                  THROAT
                  DIAGNOSES AGE
                  >17.
74.............  \7\ OTHER EAR,         0.4109         17.1         14.3
                  NOSE, MOUTH &
                  THROAT
                  DIAGNOSES AGE 0-
                  17.
75.............  MAJOR CHEST            2.1021         33.8         28.2
                  PROCEDURES.
76.............  OTHER RESP             2.3766         42.2         35.2
                  SYSTEM O.R.
                  PROCEDURES W CC.
77.............  \2\ OTHER RESP         0.5655         21.2         17.7
                  SYSTEM O.R.
                  PROCEDURES W/O
                  CC.
78.............  PULMONARY              0.6774         22.6         18.8
                  EMBOLISM.
79.............  RESPIRATORY            0.8185         22.7         18.9
                  INFECTIONS &
                  INFLAMMATIONS
                  AGE >17 W CC.
80.............  RESPIRATORY            0.6565         20.9         17.4
                  INFECTIONS &
                  INFLAMMATIONS
                  AGE >17 W/O CC.
81.............  \7\ RESPIRATORY        0.4109         17.1         14.3
                  INFECTIONS &
                  INFLAMMATIONS
                  AGE 0-17.
82.............  RESPIRATORY            0.8276         21.4         17.8
                  NEOPLASMS.
83.............  \1\ MAJOR CHEST        0.4109         17.1         14.3
                  TRAUMA W CC.
84.............  \7\ MAJOR CHEST        0.4109         17.1         14.3
                  TRAUMA W/O CC.
85.............  PLEURAL EFFUSION       0.6980         21.4         17.8
                  W CC.
86.............  \7\ PLEURAL            0.4109         17.1         14.3
                  EFFUSION W/O CC.
87.............  PULMONARY EDEMA        1.0305         24.8         20.7
                  & RESPIRATORY
                  FAILURE.
88.............  CHRONIC                0.6417         19.3         16.1
                  OBSTRUCTIVE
                  PULMONARY
                  DISEASE.
89.............  SIMPLE PNEUMONIA       0.6826         20.6         17.2
                  & PLEURISY AGE
                  >17 W CC.
90.............  SIMPLE PNEUMONIA        .4981         17.8         14.8
                  & PLEURISY AGE
                  >17 W/O CC.
91.............  \7\ SIMPLE             0.5655         21.1         17.6
                  PNEUMONIA &
                  PLEURISY AGE 0-
                  17.
92.............  INTERSTITIAL           0.6673         19.6         16.3
                  LUNG DISEASE W
                  CC.
93.............  \1\ INTERSTITIAL       0.4109         17.1         14.3
                  LUNG DISEASE W/
                  O CC.
94.............  \8\ PNEUMOTHORAX       0.6826         21.3         17.8
                  W CC.
95.............  \8\ PNEUMOTHORAX       0.6826         21.3         17.8
                  W/O CC.
96.............  \8\ BRONCHITIS &       0.6245         19.1         15.9
                  ASTHMA AGE >17
                  W CC.
97.............  \8\ BRONCHITIS &       0.6245         19.1         15.9
                  ASTHMA AGE >17
                  W/O CC.
98.............  \7\ BRONCHITIS &       0.5655         21.1         17.6
                  ASTHMA AGE 0-17.
99.............  RESPIRATORY            0.9396         24.5         20.4
                  SIGNS &
                  SYMPTOMS W CC.
100............  \3\ RESPIRATORY        0.7858         25.2         21.0
                  SIGNS &
                  SYMPTOMS W/O CC.
101............  OTHER                  0.8165         22.2         18.5
                  RESPIRATORY
                  SYSTEM
                  DIAGNOSES W CC.
102............  \1\ OTHER              0.4109         17.1         14.3
                  RESPIRATORY
                  SYSTEM
                  DIAGNOSES W/O
                  CC.
103............  6HEART                 0.0000          0.0          0.0
                  TRANSPLANT OR
                  IMPLANT OF
                  HEART ASSIST
                  SYSTEM.
104............  \7\ CARDIAC            1.1162         29.5         24.6
                  VALVE & OTHER
                  MAJOR
                  CARDIOTHORACIC
                  PROC W CARDIAC
                  CATH.
105............  \7\ CARDIAC            1.1162         29.5         24.6
                  VALVE & OTHER
                  MAJOR
                  CARDIOTHORACIC
                  PROC W/O
                  CARDIAC CATH.
106............  \7\ CORONARY           1.1162         29.5         24.6
                  BYPASS W PTCA.
108............  \7\ OTHER              1.1162         29.5         24.6
                  CARDIOTHORACIC
                  PROCEDURES.
110............  \4\ MAJOR              1.1162         29.5         24.6
                  CARDIOVASCULAR
                  PROCEDURES W CC.
111............  \7\ MAJOR              1.1162         29.5         24.6
                  CARDIOVASCULAR
                  PROCEDURES W/O
                  CC.
113............  AMPUTATION FOR         1.3939         35.8         29.8
                  CIRC SYSTEM
                  DISORDERS
                  EXCEPT UPPER
                  LIMB & TOE.
114............  UPPER LIMB & TOE       1.2598         33.0         27.5
                  AMPUTATION FOR
                  CIRC SYSTEM
                  DISORDERS.
117............  \3\ CARDIAC            0.7858         25.2         21.0
                  PACEMAKER
                  REVISION EXCEPT
                  DEVICE
                  REPLACEMENT.
118............  \3\ CARDIAC            0.7858         25.2         21.0
                  PACEMAKER
                  DEVICE
                  REPLACEMENT.
119............  \3\ VEIN               0.7858         25.2         21.0
                  LIGATION &
                  STRIPPING.
120............  OTHER                  1.0891         31.3         26.1
                  CIRCULATORY
                  SYSTEM O.R.
                  PROCEDURES.
121............  CIRCULATORY            0.7517         22.6         18.8
                  DISORDERS W AMI
                  & MAJOR COMP,
                  DISCHARGED
                  ALIVE.
122............  \2\CIRCULATORY         0.5655         21.2         17.7
                  DISORDERS W AMI
                  W/O MAJOR COMP,
                  DISCHARGED
                  ALIVE.
123............  CIRCULATORY            0.7900         17.0         14.2
                  DISORDERS W
                  AMI, EXPIRED.
124............  \4\ CIRCULATORY        1.1162         29.5         24.6
                  DISORDERS
                  EXCEPT AMI, W
                  CARD CATH &
                  COMPLEX DIAG.
125............  \1\ CIRCULATORY        0.4109         17.1         14.3
                  DISORDERS
                  EXCEPT AMI, W
                  CARD CATH W/O
                  COMPLEX DIAG.
126............  ACUTE & SUBACUTE       0.8925         26.3         21.9
                  ENDOCARDITIS.
127............  HEART FAILURE &        0.6854         21.2         17.7
                  SHOCK.
128............  \2\ DEEP VEIN          0.5655         21.2         17.7
                  THROMBOPHLEBITI
                  S.
129............  \1\ CARDIAC            0.4109         17.1         14.3
                  ARREST,
                  UNEXPLAINED.
130............  PERIPHERAL             0.6488         22.8         19.0
                  VASCULAR
                  DISORDERS W CC.
131............  PERIPHERAL             0.5233         21.0         17.5
                  VASCULAR
                  DISORDERS W/O
                  CC.
132............  ATHEROSCLEROSIS        0.6584         20.5         17.1
                  W CC.
133............  \2\                    0.5655         21.2         17.7
                  ATHEROSCLEROSIS
                  W/O CC.
134............  HYPERTENSION....       0.4895         21.3         17.8
135............  CARDIAC                0.8015         23.9         19.9
                  CONGENITAL &
                  VALVULAR
                  DISORDERS AGE
                  >17 W CC.
136............  \1\ CARDIAC            0.4109         17.1         14.3
                  CONGENITAL &
                  VALVULAR
                  DISORDERS AGE
                  >17 W/O CC.
137............  \7\ CARDIAC            0.4109         17.1         14.3
                  CONGENITAL &
                  VALVULAR
                  DISORDERS AGE 0-
                  17.

[[Page 24397]]

 
138............  CARDIAC                0.6619         21.9         18.3
                  ARRHYTHMIA &
                  CONDUCTION
                  DISORDERS W CC.
139............  \2\ CARDIAC            0.5655         21.2         17.7
                  ARRHYTHMIA &
                  CONDUCTION
                  DISORDERS W/O
                  CC.
140............  \2\ ANGINA             0.5655         21.2         17.7
                  PECTORIS.
141............  \8\ SYNCOPE &          0.5918         22.1         18.4
                  COLLAPSE W CC.
142............  \8\ SYNCOPE &          0.5918         22.1         18.4
                  COLLAPSE W/O CC.
143............  \1\ CHEST PAIN..       0.4109         17.1         14.3
144............  OTHER                  0.7725         22.1         18.4
                  CIRCULATORY
                  SYSTEM
                  DIAGNOSES W CC.
145............  OTHER                  0.4305         17.0         14.2
                  CIRCULATORY
                  SYSTEM
                  DIAGNOSES W/O
                  CC.
146............  \5\ RECTAL             1.6479         35.5         29.6
                  RESECTION W CC.
147............  \7\ RECTAL             1.6479         35.5         29.6
                  RESECTION W/O
                  CC.
148............  MAJOR SMALL &          1.8374         34.2         28.5
                  LARGE BOWEL
                  PROCEDURES W CC.
149............  \7\ MAJOR SMALL        0.7858         25.2         21.0
                  & LARGE BOWEL
                  PROCEDURES W/O
                  CC.
150............  \5\ PERITONEAL         1.6479         35.5         29.6
                  ADHESIOLYSIS W
                  CC.
151............  \7\ PERITONEAL         0.4109         17.1         14.3
                  ADHESIOLYSIS W/
                  O CC.
152............  \5\ MINOR SMALL        1.6479         35.5         29.6
                  & LARGE BOWEL
                  PROCEDURES W CC.
153............  \7\ MINOR SMALL        1.6479         35.5         29.6
                  & LARGE BOWEL
                  PROCEDURES W/O
                  CC.
154............  \5\ STOMACH,           1.6479         35.5         29.6
                  ESOPHAGEAL &
                  DUODENAL
                  PROCEDURES AGE
                  >17 W CC.
155............  \7\ STOMACH,           1.6479         35.5         29.6
                  ESOPHAGEAL &
                  DUODENAL
                  PROCEDURES AGE
                  >17 W/O CC.
156............  \7\ STOMACH,           1.6479         35.5         29.6
                  ESOPHAGEAL &
                  DUODENAL
                  PROCEDURES AGE
                  0-17.
157............  \4\ ANAL &             1.1162         29.5         24.6
                  STOMAL
                  PROCEDURES W CC.
158............  \7\ ANAL &             1.1162         29.5         24.6
                  STOMAL
                  PROCEDURES W/O
                  CC.
159............  \5\ HERNIA             1.6479         35.5         29.6
                  PROCEDURES
                  EXCEPT INGUINAL
                  & FEMORAL AGE
                  >17 W CC.
160............  \1\ HERNIA             0.4109         17.1         14.3
                  PROCEDURES
                  EXCEPT INGUINAL
                  & FEMORAL AGE
                  >17 W/O CC.
161............  \7\ INGUINAL &         0.4109         17.1         14.3
                  FEMORAL HERNIA
                  PROCEDURES AGE
                  >17 W CC.
162............  \7\ INGUINAL &         0.4109         17.1         14.3
                  FEMORAL HERNIA
                  PROCEDURES AGE
                  >17 W/O CC.
163............  \7\ HERNIA             0.4109         17.1         14.3
                  PROCEDURES AGE
                  0-17.
164............  \7\ APPENDECTOMY       1.6479         35.5         29.6
                  W COMPLICATED
                  PRINCIPAL DIAG
                  W CC.
165............  \7\ APPENDECTOMY       1.6479         35.5         29.6
                  W COMPLICATED
                  PRINCIPAL DIAG
                  W/O CC.
166............  \7\ APPENDECTOMY       1.6479         35.5         29.6
                  W/O COMPLICATED
                  PRINCIPAL DIAG
                  W CC.
167............  \7\ APPENDECTOMY       1.6479         35.5         29.6
                  W/O COMPLICATED
                  PRINCIPAL DIAG
                  W/O CC.
168............  \5\ MOUTH              1.6479         35.5         29.6
                  PROCEDURES W CC.
169............  \7\ MOUTH              0.5655         21.1         17.6
                  PROCEDURES W/O
                  CC.
170............  OTHER DIGESTIVE        1.6242         35.7         29.8
                  SYSTEM O.R.
                  PROCEDURES W CC.
171............  \3\ OTHER              0.7858         25.2         21.0
                  DIGESTIVE
                  SYSTEM O.R.
                  PROCEDURES W/O
                  CC.
172............  DIGESTIVE              0.8564         21.8         18.2
                  MALIGNANCY W CC.
173............  \2\ DIGESTIVE          0.5655         21.2         17.7
                  MALIGNANCY W/O
                  CC.
174............  G.I. HEMORRHAGE        0.6886         22.7         18.9
                  W CC.
175............  \2\ G.I.               0.5655         21.2         17.7
                  HEMORRHAGE W/O
                  CC.
176............  COMPLICATED            0.9293         25.4         21.2
                  PEPTIC ULCER.
177............  \2\                    0.5655         21.2         17.7
                  UNCOMPLICATED
                  PEPTIC ULCER W
                  CC.
178............  \7\                    0.4109         17.1         14.3
                  UNCOMPLICATED
                  PEPTIC ULCER W/
                  O CC.
179............  INFLAMMATORY           0.8190         23.3         19.4
                  BOWEL DISEASE.
180............  G.I. OBSTRUCTION       0.9222         22.9         19.1
                  W CC.
181............  \1\ G.I.               0.4109         17.1         14.3
                  OBSTRUCTION W/O
                  CC.
182............  ESOPHAGITIS,           0.8044         22.5         18.8
                  GASTROENT &
                  MISC DIGEST
                  DISORDERS AGE
                  >17 W CC.
183............  ESOPHAGITIS,           0.4656         17.6         14.7
                  GASTROENT &
                  MISC DIGEST
                  DISORDERS AGE
                  >17 W/O CC.
184............  \7\ ESOPHAGITIS,       0.4109         17.1         14.3
                  GASTROENT &
                  MISC DIGEST
                  DISORDERS AGE 0-
                  17.
185............  DENTAL & ORAL          0.6611         23.2         19.3
                  DIS EXCEPT
                  EXTRACTIONS &
                  RESTORATIONS,
                  AGE >17.
186............  \7\ DENTAL &           0.5655         21.1         17.6
                  ORAL DIS EXCEPT
                  EXTRACTIONS &
                  RESTORATIONS,
                  AGE 0-17.
187............  \7\ DENTAL             0.5655         21.1         17.6
                  EXTRACTIONS &
                  RESTORATIONS.
188............  OTHER DIGESTIVE        0.9485         24.1         20.1
                  SYSTEM
                  DIAGNOSES AGE
                  >17 W CC.
189............  OTHER DIGESTIVE        0.5316         18.1         15.1
                  SYSTEM
                  DIAGNOSES AGE
                  >17 W/O CC.
190............  \7\ OTHER              0.5655         21.1         17.6
                  DIGESTIVE
                  SYSTEM
                  DIAGNOSES AGE 0-
                  17.
191............  \5\ PANCREAS,          1.6479         35.5         29.6
                  LIVER & SHUNT
                  PROCEDURES W CC.
192............  \7\ PANCREAS,          1.6479         35.5         29.6
                  LIVER & SHUNT
                  PROCEDURES W/O
                  CC.
193............  \5\ BILIARY            1.6479         35.5         29.6
                  TRACT PROC
                  EXCEPT ONLY
                  CHOLECYST W OR
                  W/O C.D.E. W CC.
194............  \7\ BILIARY            1.6479         35.5         29.6
                  TRACT PROC
                  EXCEPT ONLY
                  CHOLECYST W OR
                  W/O C.D.E. W/O
                  CC.
195............  \5\                    1.6479         35.5         29.6
                  CHOLECYSTECTOMY
                  W C.D.E. W CC.
196............  \7\                    1.1162         29.5         24.6
                  CHOLECYSTECTOMY
                  W C.D.E. W/O CC.
197............  \4\                    1.1162         29.5         24.6
                  CHOLECYSTECTOMY
                  EXCEPT BY
                  LAPAROSCOPE W/O
                  C.D.E. W CC.
198............  \7\                    1.1162         29.5         24.6
                  CHOLECYSTECTOMY
                  EXCEPT BY
                  LAPAROSCOPE W/O
                  C.D.E. W/O CC.
199............  \3\                    0.7858         25.2         21.0
                  HEPATOBILIARY
                  DIAGNOSTIC
                  PROCEDURE FOR
                  MALIGNANCY.
200............  \5\                    1.6479         35.5         29.6
                  HEPATOBILIARY
                  DIAGNOSTIC
                  PROCEDURE FOR
                  NON-MALIGNANCY.
201............  OTHER                  1.5988         28.8         24.0
                  HEPATOBILIARY
                  OR PANCREAS
                  O.R. PROCEDURES.
202............  CIRRHOSIS &            0.6038         20.2         16.8
                  ALCOHOLIC
                  HEPATITIS.
203............  MALIGNANCY OF          0.7053         19.4         16.2
                  HEPATOBILIARY
                  SYSTEM OR
                  PANCREAS.

[[Page 24398]]

 
204............  DISORDERS OF           0.8882         22.1         18.4
                  PANCREAS EXCEPT
                  MALIGNANCY.
205............  DISORDERS OF           0.6990         23.1         19.3
                  LIVER EXCEPT
                  MALIG,CIRR,ALC
                  HEPA W CC.
206............  \2\ DISORDERS OF       0.5655         21.2         17.7
                  LIVER EXCEPT
                  MALIG,CIRR,ALC
                  HEPA W/O CC.
207............  DISORDERS OF THE       0.7310         21.5         17.9
                  BILIARY TRACT W
                  CC.
208............  \1\ DISORDERS OF       0.4109         17.1         14.3
                  THE BILIARY
                  TRACT W/O CC.
210............  HIP & FEMUR            1.4809         41.9         34.9
                  PROCEDURES
                  EXCEPT MAJOR
                  JOINT AGE >17 W
                  CC.
211............  \7\ HIP & FEMUR        1.6479         35.5         29.6
                  PROCEDURES
                  EXCEPT MAJOR
                  JOINT AGE >17 W/
                  O CC.
212............  \7\ HIP & FEMUR        1.6479         35.5         29.6
                  PROCEDURES
                  EXCEPT MAJOR
                  JOINT AGE 0-17.
213............  AMPUTATION FOR         1.1780         33.4         27.8
                  MUSCULOSKELETAL
                  SYSTEM & CONN
                  TISSUE
                  DISORDERS.
216............  BIOPSIES OF            1.2173         37.5         31.3
                  MUSCULOSKELETAL
                  SYSTEM &
                  CONNECTIVE
                  TISSUE.
217............  WND DEBRID & SKN       1.2470         36.5         30.4
                  GRFT EXCEPT
                  HAND,FOR
                  MUSCSKELET &
                  CONN TISS DIS.
218............  \5\ LOWER EXTREM       1.6479         35.5         29.6
                  & HUMER PROC
                  EXCEPT
                  HIP,FOOT,FEMUR
                  AGE >17 W CC.
219............  \7\ LOWER EXTREM       1.6479         35.5         29.6
                  & HUMER PROC
                  EXCEPT
                  HIP,FOOT,FEMUR
                  AGE >17 W/O CC.
220............  \7\ LOWER EXTREM       1.6479         35.5         29.6
                  & HUMER PROC
                  EXCEPT
                  HIP,FOOT,FEMUR
                  AGE 0-17.
223............  \4\ MAJOR              1.1162         29.5         24.6
                  SHOULDER/ELBOW
                  PROC, OR OTHER
                  UPPER EXTREMITY
                  PROC W CC.
224............  \1\                    0.4109         17.1         14.3
                  SHOULDER,ELBOW
                  OR FOREARM
                  PROC,EXC MAJOR
                  JOINT PROC, W/O
                  CC.
225............  FOOT PROCEDURES.       0.9579         30.6         25.5
226............  SOFT TISSUE            1.0653         34.3         28.6
                  PROCEDURES W CC.
227............  \3\ SOFT TISSUE        0.7858         25.2         21.0
                  PROCEDURES W/O
                  CC.
228............  \3\ MAJOR THUMB        0.7858         25.2         21.0
                  OR JOINT
                  PROC,OR OTH
                  HAND OR WRIST
                  PROC W CC.
229............  \7\ HAND OR            0.4109         17.1         14.3
                  WRIST PROC,
                  EXCEPT MAJOR
                  JOINT PROC, W/O
                  CC.
230............  \5\ LOCAL              1.6479         35.5         29.6
                  EXCISION &
                  REMOVAL OF INT
                  FIX DEVICES OF
                  HIP & FEMUR.
232............  \5\ ARTHROSCOPY.       1.6479         35.5         29.6
233............  OTHER                  1.1794         32.4         27.0
                  MUSCULOSKELET
                  SYS & CONN TISS
                  O.R. PROC W CC.
234............  \7\ OTHER              0.4109         17.1         14.3
                  MUSCULOSKELET
                  SYS & CONN TISS
                  O.R. PROC W/O
                  CC.
235............  \3\ FRACTURES OF       0.7858         25.2         21.0
                  FEMUR.
236............  FRACTURES OF HIP       0.6874         28.9         24.1
                  & PELVIS.
237............  \1\ SPRAINS,           0.4109         17.1         14.3
                  STRAINS, &
                  DISLOCATIONS OF
                  HIP, PELVIS &
                  THIGH.
238............  OSTEOMYELITIS...       0.8602         28.4         23.7
239............  PATHOLOGICAL           0.6059         20.5         17.1
                  FRACTURES &
                  MUSCULOSKELETAL
                  & CONN TISS
                  MALIGNANCY.
240............  CONNECTIVE             0.7178         22.4         18.7
                  TISSUE
                  DISORDERS W CC.
241............  \1\ CONNECTIVE         0.4109         17.1         14.3
                  TISSUE
                  DISORDERS W/O
                  CC.
242............  SEPTIC ARTHRITIS       0.7699         26.1         21.8
243............  MEDICAL BACK           0.6021         22.2         18.5
                  PROBLEMS.
244............  BONE DISEASES &        0.5541         22.0         18.3
                  SPECIFIC
                  ARTHROPATHIES W
                  CC.
245............  BONE DISEASES &        0.4464         19.4         16.2
                  SPECIFIC
                  ARTHROPATHIES W/
                  O CC.
246............  \2\ NON-SPECIFIC       0.5655         21.2         17.7
                  ARTHROPATHIES.
247............  SIGNS & SYMPTOMS       0.4591         17.6         14.7
                  OF
                  MUSCULOSKELETAL
                  SYSTEM & CONN
                  TISSUE.
248............  TENDONITIS,            0.7341         23.2         19.3
                  MYOSITIS &
                  BURSITIS.
249............  AFTERCARE,             0.6387         24.0         20.0
                  MUSCULOSKELETAL
                  SYSTEM &
                  CONNECTIVE
                  TISSUE.
250............  \1\ FX, SPRN,          0.4109         17.1         14.3
                  STRN & DISL OF
                  FOREARM, HAND,
                  FOOT AGE >17 W
                  CC.
251............  \7\ FX, SPRN,          0.4109         17.1         14.3
                  STRN & DISL OF
                  FOREARM, HAND,
                  FOOT AGE >17 W/
                  O CC.
252............  \7\ FX, SPRN,          0.5655         21.1         17.6
                  STRN & DISL OF
                  FOREARM, HAND,
                  FOOT AGE 0-17.
253............  FX, SPRN, STRN &       0.5636         24.0         20.0
                  DISL OF
                  UPARM,LOWLEG EX
                  FOOT AGE >17 W
                  CC.
254............  \1\ FX, SPRN,          0.4109         17.1         14.3
                  STRN & DISL OF
                  UPARM,LOWLEG EX
                  FOOT AGE >17 W/
                  O CC.
255............  \7\ FX, SPRN,          0.5655         21.1         17.6
                  STRN & DISL OF
                  UPARM,LOWLEG EX
                  FOOT AGE 0-17.
256............  OTHER                  0.7208         23.7         19.8
                  MUSCULOSKELETAL
                  SYSTEM &
                  CONNECTIVE
                  TISSUE
                  DIAGNOSES.
257............  \4\ TOTAL              1.1162         29.5         24.6
                  MASTECTOMY FOR
                  MALIGNANCY W CC.
258............  \7\ TOTAL              0.7858         25.2         21.0
                  MASTECTOMY FOR
                  MALIGNANCY W/O
                  CC.
259............  \3\ SUBTOTAL           0.7858         25.2         21.0
                  MASTECTOMY FOR
                  MALIGNANCY W CC.
260............  \7\ SUBTOTAL           0.7858         25.2         21.0
                  MASTECTOMY FOR
                  MALIGNANCY W/O
                  CC.
261............  \2\ BREAST PROC        0.5655         21.2         17.7
                  FOR NON-
                  MALIGNANCY
                  EXCEPT BIOPSY &
                  LOCAL EXCISION.
262............  \4\ BREAST             1.1162         29.5         24.6
                  BIOPSY & LOCAL
                  EXCISION FOR
                  NON- MALIGNANCY.
263............  SKIN GRAFT &/OR        1.2749         38.0         31.7
                  DEBRID FOR SKN
                  ULCER OR
                  CELLULITIS W CC.
264............  SKIN GRAFT &/OR        0.8524         29.9         24.9
                  DEBRID FOR SKN
                  ULCER OR
                  CELLULITIS W/O
                  CC.
265............  SKIN GRAFT &/OR        1.1068         30.2         25.2
                  DEBRID EXCEPT
                  FOR SKIN ULCER
                  OR CELLULITIS W
                  CC.
266............  \3\ SKIN GRAFT &/      0.7858         25.2         21.0
                  OR DEBRID
                  EXCEPT FOR SKIN
                  ULCER OR
                  CELLULITIS W/O
                  CC.
267............  \7\ PERIANAL &         0.7858         25.2         21.0
                  PILONIDAL
                  PROCEDURES.
268............  \4\ SKIN,              1.1162         29.5         24.6
                  SUBCUTANEOUS
                  TISSUE & BREAST
                  PLASTIC
                  PROCEDURES.
269............  OTHER SKIN,            1.2137         34.7         28.9
                  SUBCUT TISS &
                  BREAST PROC W
                  CC.
270............  \3\ OTHER SKIN,        0.7858         25.2         21.0
                  SUBCUT TISS &
                  BREAST PROC W/O
                  CC.
271............  SKIN ULCERS.....       0.8290         26.8         22.3
272............  MAJOR SKIN             0.6576         23.1         19.3
                  DISORDERS W CC.
273............  \1\ MAJOR SKIN         0.4109         17.1         14.3
                  DISORDERS W/O
                  CC.

[[Page 24399]]

 
274............  MALIGNANT BREAST       0.7277         21.8         18.2
                  DISORDERS W CC.
275............  \7\ MALIGNANT          0.7858         25.2         21.0
                  BREAST
                  DISORDERS W/O
                  CC.
276............  \2\ NON-MALIGANT       0.5655         21.2         17.7
                  BREAST
                  DISORDERS.
277............  CELLULITIS AGE         0.6087         20.8         17.3
                  >17 W CC.
278............  CELLULITIS AGE         0.4243         18.0         15.0
                  >17 W/O CC.
279............  \7\ CELLULITIS         0.4109         17.1         14.3
                  AGE 0-17.
280............  TRAUMA TO THE          0.6981         23.9         19.9
                  SKIN, SUBCUT
                  TISS & BREAST
                  AGE >17 W CC.
281............  \2\ TRAUMA TO          0.5655         21.2         17.7
                  THE SKIN,
                  SUBCUT TISS &
                  BREAST AGE >17
                  W/O CC.
282............  \7\ TRAUMA TO          0.5655         21.1         17.6
                  THE SKIN,
                  SUBCUT TISS &
                  BREAST AGE 0-17.
283............  MINOR SKIN             0.6946         23.1         19.3
                  DISORDERS W CC.
284............  \2\ MINOR SKIN         0.5655         21.2         17.7
                  DISORDERS W/O
                  CC.
285............  AMPUTAT OF LOWER       1.2354         31.3         26.1
                  LIMB FOR
                  ENDOCRINE,NUTRI
                  T,& METABOL
                  DISORDERS.
286............  \7\ ADRENAL &          1.1162         29.5         24.6
                  PITUITARY
                  PROCEDURES.
287............  SKIN GRAFTS &          1.0502         33.0         27.5
                  WOUND DEBRID
                  FOR ENDOC,
                  NUTRIT & METAB
                  DISORDERS.
288............  4O.R. PROCEDURES       1.1162         29.5         24.6
                  FOR OBESITY.
289............  \7\ PARATHYROID        1.1162         29.5         24.6
                  PROCEDURES.
290............  \7\ THYROID            1.1162         29.5         24.6
                  PROCEDURES.
291............  \7\ THYROGLOSSAL       1.1162         29.5         24.6
                  PROCEDURES.
292............  \8\ OTHER              1.1673         31.9         26.6
                  ENDOCRINE,
                  NUTRIT & METAB
                  O.R. PROC W CC.
293............  \8\ OTHER              1.1673         31.9         26.6
                  ENDOCRINE,
                  NUTRIT & METAB
                  O.R. PROC W/O
                  CC.
294............  DIABETES AGE >35       0.6986         23.8         19.8
295............  \2\ DIABETES AGE       0.5655         21.2         17.7
                  0-35.
296............  NUTRITIONAL &          0.7114         22.3         18.6
                  MISC METABOLIC
                  DISORDERS AGE
                  >17 W CC.
297............  NUTRITIONAL &          0.4609         19.3         16.1
                  MISC METABOLIC
                  DISORDERS AGE
                  >17 W/O CC.
298............  \7\ NUTRITIONAL        0.4109         17.1         14.3
                  & MISC
                  METABOLIC
                  DISORDERS AGE 0-
                  17.
299............  \3\ INBORN             0.7858         25.2         21.0
                  ERRORS OF
                  METABOLISM.
300............  DENDOCRINE             0.7053         23.7         19.8
                  DISORDERS W CC.
301............  \2\ ENDOCRINE          0.5655         21.2         17.7
                  DISORDERS W/O
                  CC.
302............  \6\ KIDNEY             0.0000          0.0          0.0
                  TRANSPLANT.
303............  \7\                    0.7858         25.2         21.0
                  KIDNEY,URETER &
                  MAJOR BLADDER
                  PROCEDURES FOR
                  NEOPLASM.
304............  \5\                    1.6479         35.5         29.6
                  KIDNEY,URETER &
                  MAJOR BLADDER
                  PROC FOR NON-
                  NEOPL W CC.
305............  \7\                    0.7858         25.2         21.0
                  KIDNEY,URETER &
                  MAJOR BLADDER
                  PROC FOR NON-
                  NEOPL W/O CC.
306............  \4\                    1.1162         29.5         24.6
                  PROSTATECTOMY W
                  CC.
307............  \7\                    1.1162         29.5         24.6
                  PROSTATECTOMY W/
                  O CC.
308............  \4\ MINOR              1.1162         29.5         24.6
                  BLADDER
                  PROCEDURES W CC.
309............  \7\ MINOR              1.1162         29.5         24.6
                  BLADDER
                  PROCEDURES W/O
                  CC.
310............  \4\                    1.1162         29.5         24.6
                  TRANSURETHRAL
                  PROCEDURES W CC.
311............  \7\                    1.1162         29.5         24.6
                  TRANSURETHRAL
                  PROCEDURES W/O
                  CC.
312............  \3\ URETHRAL           0.7858         25.2         21.0
                  PROCEDURES, AGE
                  >17 W CC.
313............  \7\ URETHRAL           0.7858         25.2         21.0
                  PROCEDURES, AGE
                  >17 W/O CC.
314............  \7\ URETHRAL           0.7858         25.2         21.0
                  PROCEDURES, AGE
                  0-17.
315............  OTHER KIDNEY &         1.3823         33.4         27.8
                  URINARY TRACT
                  O.R. PROCEDURES.
316............  RENAL FAILURE...       0.8342         22.9         19.1
317............  ADMIT FOR RENAL        0.9186         24.3         20.3
                  DIALYSIS.
318............  KIDNEY & URINARY       0.7713         21.3         17.8
                  TRACT NEOPLASMS
                  W CC.
319............  \7\ KIDNEY &           0.7858         25.2         21.0
                  URINARY TRACT
                  NEOPLASMS W/O
                  CC.
320............  KIDNEY & URINARY       0.6181         21.6         18.0
                  TRACT
                  INFECTIONS AGE
                  >17 W CC.
321............  KIDNEY & URINARY       0.4478         18.5         15.4
                  TRACT
                  INFECTIONS AGE
                  >17 W/O CC.
322............  \7\ KIDNEY &           0.4109         17.1         14.3
                  URINARY TRACT
                  INFECTIONS AGE
                  0- 17.
323............  \1\ URINARY            0.4109         17.1         14.3
                  STONES W CC, &/
                  OR ESW
                  LITHOTRIPSY.
324............  \1\ URINARY            0.4109         17.1         14.3
                  STONES W/O CC.
325............  \2\ KIDNEY &           0.5655         21.2         17.7
                  URINARY TRACT
                  SIGNS &
                  SYMPTOMS AGE
                  >17 W CC.
326............  \7\ KIDNEY &           0.4109         17.1         14.3
                  URINARY TRACT
                  SIGNS &
                  SYMPTOMS AGE
                  >17 W/O CC.
327............  \7\ KIDNEY &           0.4109         17.1         14.3
                  URINARY TRACT
                  SIGNS &
                  SYMPTOMS AGE 0-
                  17.
328............  \7\ URETHRAL           0.5655         21.1         17.6
                  STRICTURE AGE
                  >17 W CC.
329............  \7\ URETHRAL           0.5655         21.1         17.6
                  STRICTURE AGE
                  >17 W/O CC.
330............  \7\ URETHRAL           0.5655         21.1         17.6
                  STRICTURE AGE 0-
                  17.
331............  OTHER KIDNEY &         0.7776         22.5         18.8
                  URINARY TRACT
                  DIAGNOSES AGE
                  >17 W CC.
332............  \1\ OTHER KIDNEY       0.4109         17.1         14.3
                  & URINARY TRACT
                  DIAGNOSES AGE
                  >17 W/O CC.
333............  \7\ OTHER KIDNEY       0.4109         17.1         14.3
                  & URINARY TRACT
                  DIAGNOSES AGE 0-
                  17.
334............  \7\ MAJOR MALE         0.4109         17.1         14.3
                  PELVIC
                  PROCEDURES W CC.
335............  \1\ MAJOR MALE         0.4109         17.1         14.3
                  PELVIC
                  PROCEDURES W/O
                  CC.
336............  \4\                    1.1162         29.5         24.6
                  TRANSURETHRAL
                  PROSTATECTOMY W
                  CC.
337............  \7\                    1.1162         29.5         24.6
                  TRANSURETHRAL
                  PROSTATECTOMY W/
                  O CC.
338............  \3\ TESTES             0.7858         25.2         21.0
                  PROCEDURES, FOR
                  MALIGNANCY.
339............  \3\ TESTES             0.7858         25.2         21.0
                  PROCEDURES, NON-
                  MALIGNANCY AGE
                  >17.

[[Page 24400]]

 
340............  \7\ TESTES             0.7858         25.2         21.0
                  PROCEDURES, NON-
                  MALIGNANCY AGE
                  0-17.
341............  \5\ PENIS              1.6479         35.5         29.6
                  PROCEDURES.
342............  \7\ CIRCUMCISION       0.7858         25.2         21.0
                  AGE >17.
343............  \7\ CIRCUMCISION       0.7858         25.2         21.0
                  AGE 0-17.
344............  \3\ OTHER MALE         0.7858         25.2         21.0
                  REPRODUCTIVE
                  SYSTEM O.R.
                  PROCEDURES FOR
                  MALIGNANCY.
345............  \4\ OTHER MALE         1.1162         29.5         24.6
                  REPRODUCTIVE
                  SYSTEM O.R.
                  PROC EXCEPT FOR
                  MALIGNANCY.
346............  \3\ MALIGNANCY,        0.7858         25.2         21.0
                  MALE
                  REPRODUCTIVE
                  SYSTEM, W CC.
347............  \1\ MALIGNANCY,        0.4109         17.1         14.3
                  MALE
                  REPRODUCTIVE
                  SYSTEM, W/O CC.
348............  \2\ BENIGN             0.5655         21.2         17.7
                  PROSTATIC
                  HYPERTROPHY W
                  CC.
349............  \7\ BENIGN             0.7858         25.2         21.0
                  PROSTATIC
                  HYPERTROPHY W/O
                  CC.
350............  INFLAMMATION OF        0.5630         21.0         17.5
                  THE MALE
                  REPRODUCTIVE
                  SYSTEM.
351............  \7\                    0.7858         25.2         21.0
                  STERILIZATION,
                  MALE.
352............  OTHER MALE             0.8138         27.1         22.6
                  REPRODUCTIVE
                  SYSTEM
                  DIAGNOSES.
353............  \7\ PELVIC             1.1162         29.5         24.6
                  EVISCERATION,
                  RADICAL
                  HYSTERECTOMY &
                  RADICAL
                  VULVECTOMY.
354............  \7\                    1.1162         29.5         24.6
                  UTERINE,ADNEXA
                  PROC FOR NON-
                  OVARIAN/ADNEXAL
                  MALIG W CC.
355............  \7\                    1.1162         29.5         24.6
                  UTERINE,ADNEXA
                  PROC FOR NON-
                  OVARIAN/ADNEXAL
                  MALIG W/O CC.
356............  \7\ FEMALE             1.1162         29.5         24.6
                  REPRODUCTIVE
                  SYSTEM
                  RECONSTRUCTIVE
                  PROCEDURES.
357............  \7\ UTERINE &          1.1162         29.5         24.6
                  ADNEXA PROC FOR
                  OVARIAN OR
                  ADNEXAL
                  MALIGNANCY.
358............  \7\ UTERINE &          1.1162         29.5         24.6
                  ADNEXA PROC FOR
                  NON-MALIGNANCY
                  W CC.
359............  \7\ UTERINE &          1.1162         29.5         24.6
                  ADNEXA PROC FOR
                  NON-MALIGNANCY
                  W/O CC.
360............  \7\ VAGINA,            1.1162         29.5         24.6
                  CERVIX & VULVA
                  PROCEDURES.
361............  \7\ LAPAROSCOPY        0.4109         17.1         14.3
                  & INCISIONAL
                  TUBAL
                  INTERRUPTION.
362............  \7\ ENDOSCOPIC         0.4109         17.1         14.3
                  TUBAL
                  INTERRUPTION.
363............  \7\ D&C,               0.4109         17.1         14.3
                  CONIZATION &
                  RADIO-IMPLANT,
                  FOR MALIGNANCY.
364............  \7\ D&C,               0.4109         17.1         14.3
                  CONIZATION
                  EXCEPT FOR
                  MALIGNANCY.
365............  \4\ OTHER FEMALE       1.1162         29.5         24.6
                  REPRODUCTIVE
                  SYSTEM O.R.
                  PROCEDURES.
366............  MALIGNANCY,            0.9119         21.6         18.0
                  FEMALE
                  REPRODUCTIVE
                  SYSTEM W CC.
367............  \1\ MALIGNANCY,        0.4109         17.1         14.3
                  FEMALE
                  REPRODUCTIVE
                  SYSTEM W/O CC.
368............  INFECTIONS,            0.7859         21.3         17.8
                  FEMALE
                  REPRODUCTIVE
                  SYSTEM.
369............  \3\ MENSTRUAL &        0.7858         25.2         21.0
                  OTHER FEMALE
                  REPRODUCTIVE
                  SYSTEM
                  DISORDERS.
370............  \7\ CESAREAN           0.4109         17.1         14.3
                  SECTION W CC.
371............  \7\ CESAREAN           0.4109         17.1         14.3
                  SECTION W/O CC.
372............  \7\ VAGINAL            0.4109         17.1         14.3
                  DELIVERY W
                  COMPLICATING
                  DIAGNOSES.
373............  \7\ VAGINAL            0.4109         17.1         14.3
                  DELIVERY W/O
                  COMPLICATING
                  DIAGNOSES.
374............  \7\ VAGINAL            0.4109         17.1         14.3
                  DELIVERY W
                  STERILIZATION &/
                  OR D&C.
375............  \7\ VAGINAL            0.4109         17.1         14.3
                  DELIVERY W O.R.
                  PROC EXCEPT
                  STERIL &/OR D&C.
376............  \4\ POSTPARTUM &       1.1162         29.5         24.6
                  POST ABORTION
                  DIAGNOSES W/O
                  O.R. PROCEDURE.
377............  \7\ POSTPARTUM &       0.4109         17.1         14.3
                  POST ABORTION
                  DIAGNOSES W
                  O.R. PROCEDURE.
378............  \7\ ECTOPIC            0.4109         17.1         14.3
                  PREGNANCY.
379............  \7\ THREATENED         0.4109         17.1         14.3
                  ABORTION.
380............  \7\ ABORTION W/O       0.4109         17.1         14.3
                  D&C.
381............  \7\ ABORTION W         0.4109         17.1         14.3
                  D&C, ASPIRATION
                  CURETTAGE OR
                  HYSTEROTOMY.
382............  \7\ FALSE LABOR.       0.4109         17.1         14.3
383............  \1\ OTHER              0.4109         17.1         14.3
                  ANTEPARTUM
                  DIAGNOSES W
                  MEDICAL
                  COMPLICATIONS.
384............  \7\ OTHER              0.4109         17.1         14.3
                  ANTEPARTUM
                  DIAGNOSES W/O
                  MEDICAL
                  COMPLICATIONS.
385............  \7\ NEONATES,          0.4109         17.1         14.3
                  DIED OR
                  TRANSFERRED TO
                  ANOTHER ACUTE
                  CARE FACILITY.
386............  \7\ EXTREME            0.4109         17.1         14.3
                  IMMATURITY.
387............  \7\ PREMATURITY        0.4109         17.1         14.3
                  W MAJOR
                  PROBLEMS.
388............  \7\ PREMATURITY        0.4109         17.1         14.3
                  W/O MAJOR
                  PROBLEMS.
389............  \7\ FULL TERM          0.4109         17.1         14.3
                  NEONATE W MAJOR
                  PROBLEMS.
390............  \7\ NEONATE W          0.4109         17.1         14.3
                  OTHER
                  SIGNIFICANT
                  PROBLEMS.
391............  \7\ NORMAL             0.4109         17.1         14.3
                  NEWBORN.
392............  \7\ SPLENECTOMY        1.1162         29.5         24.6
                  AGE >17.
393............  \7\ SPLENECTOMY        1.1162         29.5         24.6
                  AGE 0-17.
394............  \4\ OTHER O.R.         1.1162         29.5         24.6
                  PROCEDURES OF
                  THE BLOOD AND
                  BLOOD FORMING
                  ORGANS.
395............  RED BLOOD CELL         0.6736         21.4         17.8
                  DISORDERS AGE
                  >17.
396............  \7\RED BLOOD           0.4109         17.1         14.3
                  CELL DISORDERS
                  AGE 0-17.
397............  COAGULATION            0.8331         20.4         17.0
                  DISORDERS.
398............  RETICULOENDOTHEL       0.6890         21.0         17.5
                  IAL & IMMUNITY
                  DISORDERS W CC.
399............  \1\                    0.4109         17.1         14.3
                  RETICULOENDOTHE
                  LIAL & IMMUNITY
                  DISORDERS W/O
                  CC.
401............  \4\ LYMPHOMA &         1.1162         29.5         24.6
                  NON-ACUTE
                  LEUKEMIA W
                  OTHER O.R. PROC
                  W CC.
402............  \7\ LYMPHOMA &         0.5655         21.1         17.6
                  NON-ACUTE
                  LEUKEMIA W
                  OTHER O.R. PROC
                  W/O CC.
403............  LYMPHOMA & NON-        0.8776         23.7         19.8
                  ACUTE LEUKEMIA
                  W CC.
404............  \3\ LYMPHOMA &         0.7858         25.2         21.0
                  NON-ACUTE
                  LEUKEMIA W/O CC.
405............  \7\ ACUTE              0.7858         25.2         21.0
                  LEUKEMIA W/O
                  MAJOR O.R.
                  PROCEDURE AGE 0-
                  17.

[[Page 24401]]

 
406............  \5\ MYELOPROLIF        1.6479         35.5         29.6
                  DISORD OR
                  POORLY DIFF
                  NEOPL W MAJ
                  O.R.PROC W CC.
407............  \7\ MYELOPROLIF        1.1162         29.5         24.6
                  DISORD OR
                  POORLY DIFF
                  NEOPL W MAJ
                  O.R.PROC W/O CC.
408............  \4\ MYELOPROLIF        1.1162         29.5         24.6
                  DISORD OR
                  POORLY DIFF
                  NEOPL W OTHER
                  O.R.PROC.
409............  RADIOTHERAPY....       0.8417         23.2         19.3
410............  CHEMOTHERAPY W/O       1.2412         28.5         23.8
                  ACUTE LEUKEMIA
                  AS SECONDARY
                  DIAGNOSIS.
411............  \7\ HISTORY OF         0.5655         21.1         17.6
                  MALIGNANCY W/O
                  ENDOSCOPY.
412............  \7\ HISTORY OF         0.5655         21.1         17.6
                  MALIGNANCY W
                  ENDOSCOPY.
413............  OTHER                  0.8476         21.4         17.8
                  MYELOPROLIF DIS
                  OR POORLY DIFF
                  NEOPL DIAG W CC.
414............  \3\ OTHER              0.7858         25.2         21.0
                  MYELOPROLIF DIS
                  OR POORLY DIFF
                  NEOPL DIAG W/O
                  CC.
415............  O.R. PROCEDURE         1.3974         35.4         29.5
                  FOR INFECTIOUS
                  & PARASITIC
                  DISEASES.
416............  SEPTICEMIA AGE         0.8081         23.0         19.2
                  >17.
417............  \7\ SEPTICEMIA         0.7858         25.2         21.0
                  AGE 0-17.
418............  POSTOPERATIVE &        0.7961         24.0         20.0
                  POST-TRAUMATIC
                  INFECTIONS.
419............  \2\ FEVER OF           0.5655         21.2         17.7
                  UNKNOWN ORIGIN
                  AGE >17 W CC.
420............  \2\ FEVER OF           0.5655         21.2         17.7
                  UNKNOWN ORIGIN
                  AGE >17 W/O CC.
421............  VIRAL ILLNESS          0.7080         20.4         17.0
                  AGE >17.
422............  \7\ VIRAL              0.4109         17.1         14.3
                  ILLNESS & FEVER
                  OF UNKNOWN
                  ORIGIN AGE 0-17.
423............  OTHER INFECTIOUS       1.0463         23.2         19.3
                  & PARASITIC
                  DISEASES
                  DIAGNOSES.
424............  \3\ O.R.               0.7858         25.2         21.0
                  PROCEDURE W
                  PRINCIPAL
                  DIAGNOSES OF
                  MENTAL ILLNESS.
425............  \1\ ACUTE              0.4109         17.1         14.3
                  ADJUSTMENT
                  REACTION &
                  PSYCHOLOGICAL
                  DYSFUNCTION.
426............  DEPRESSIVE             0.4007         22.5         18.8
                  NEUROSES.
427............  \2\ NEUROSES           0.5655         21.2         17.7
                  EXCEPT
                  DEPRESSIVE.
428............  DISORDERS OF           0.5164         24.5         20.4
                  PERSONALITY &
                  IMPULSE CONTROL.
429............  ORGANIC                0.5281         23.9         19.9
                  DISTURBANCES &
                  MENTAL
                  RETARDATION.
430............  PSYCHOSES.......       0.3970         23.0         19.2
431............  \2\ CHILDHOOD          0.5655         21.2         17.7
                  MENTAL
                  DISORDERS.
432............  \1\ OTHER MENTAL       0.4109         17.1         14.3
                  DISORDER
                  DIAGNOSES.
433............  \7\ ALCOHOL/DRUG       0.4109         17.1         14.3
                  ABUSE OR
                  DEPENDENCE,
                  LEFT AMA.
439............  SKIN GRAFTS FOR        1.2390         35.9         29.9
                  INJURIES.
440............  WOUND                  1.2253         34.3         28.6
                  DEBRIDEMENTS
                  FOR INJURIES.
441............  \2\ HAND               0.5655         21.2         17.7
                  PROCEDURES FOR
                  INJURIES.
442............  OTHER O.R.             1.3453         34.6         28.8
                  PROCEDURES FOR
                  INJURIES W CC.
443............  \7\ OTHER O.R.         0.5655         21.1         17.6
                  PROCEDURES FOR
                  INJURIES W/O CC.
444............  TRAUMATIC INJURY       0.6607         23.2         19.3
                  AGE >17 W CC.
445............  \2\ TRAUMATIC          0.5655         21.2         17.7
                  INJURY AGE >17
                  W/O CC.
446............  \7\ TRAUMATIC          0.5655         21.1         17.6
                  INJURY AGE 0-17.
447............  \2\ ALLERGIC           0.5655         21.2         17.7
                  REACTIONS AGE
                  >17.
448............  \7\ ALLERGIC           0.5655         21.1         17.6
                  REACTIONS AGE 0-
                  17.
449............  \3\ POISONING &        0.7858         25.2         21.0
                  TOXIC EFFECTS
                  OF DRUGS AGE
                  >17 W CC.
450............  \7\ POISONING &        0.7858         25.2         21.0
                  TOXIC EFFECTS
                  OF DRUGS AGE
                  >17 W/O CC.
451............  \7\ POISONING &        0.7858         25.2         21.0
                  TOXIC EFFECTS
                  OF DRUGS AGE 0-
                  17.
452............  COMPLICATIONS OF       0.9301         25.7         21.4
                  TREATMENT W CC.
453............  COMPLICATIONS OF       0.5809         21.6         18.0
                  TREATMENT W/O
                  CC.
454............  \3\ OTHER              0.7858         25.2         21.0
                  INJURY,
                  POISONING &
                  TOXIC EFFECT
                  DIAG W CC.
455............  \7\ OTHER              0.7858         25.2         21.0
                  INJURY,
                  POISONING &
                  TOXIC EFFECT
                  DIAG W/O CC.
461............  O.R. PROC W            1.1512         32.7         27.3
                  DIAGNOSES OF
                  OTHER CONTACT W
                  HEALTH SERVICES.
462............  REHABILITATION..       0.5847         22.1         18.4
463............  SIGNS & SYMPTOMS       0.6113         22.9         19.1
                  W CC.
464............  SIGNS & SYMPTOMS       0.5850         24.3         20.3
                  W/O CC.
465............  AFTERCARE W            0.6869         21.2         17.7
                  HISTORY OF
                  MALIGNANCY AS
                  SECONDARY
                  DIAGNOSIS.
466............  AFTERCARE W/O          0.6666         21.6         18.0
                  HISTORY OF
                  MALIGNANCY AS
                  SECONDARY
                  DIAGNOSIS.
467............  \3\ OTHER              0.7858         25.2         21.0
                  FACTORS
                  INFLUENCING
                  HEALTH STATUS.
468............  EXTENSIVE O.R.         2.1241         40.2         33.5
                  PROCEDURE
                  UNRELATED TO
                  PRINCIPAL
                  DIAGNOSIS.
469............  \6\ PRINCIPAL          0.0000          0.0          0.0
                  DIAGNOSIS
                  INVALID AS
                  DISCHARGE
                  DIAGNOSIS.
470............  \6\ UNGROUPABLE.       0.0000          0.0          0.0
471............  \5\ BILATERAL OR       1.6479         35.5         29.6
                  MULTIPLE MAJOR
                  JOINT PROCS OF
                  LOWER EXTREMITY.
473............  ACUTE LEUKEMIA W/      0.9992         25.3         21.1
                  O MAJOR O.R.
                  PROCEDURE AGE
                  >17.
475............  RESPIRATORY            1.9875         33.4         27.8
                  SYSTEM
                  DIAGNOSIS WITH
                  VENTILATOR
                  SUPPORT.
476............  \5\ PROSTATIC          1.6479         35.5         29.6
                  O.R. PROCEDURE
                  UNRELATED TO
                  PRINCIPAL
                  DIAGNOSIS.
477............  NON-EXTENSIVE          1.5211         35.9         29.9
                  O.R. PROCEDURE
                  UNRELATED TO
                  PRINCIPAL
                  DIAGNOSIS.
479............  \2\ OTHER              0.5655         21.2         17.7
                  VASCULAR
                  PROCEDURES W/O
                  CC.
480............  \6\ LIVER              0.0000          0.0          0.0
                  TRANSPLANT.
481............  \7\ BONE MARROW        1.1162         29.5         24.6
                  TRANSPLANT.
482............  \5\ TRACHEOSTOMY       1.6479         35.5         29.6
                  FOR FACE,MOUTH
                  & NECK
                  DIAGNOSES.
484............  \7\ CRANIOTOMY         1.6479         35.5         29.6
                  FOR MULTIPLE
                  SIGNIFICANT
                  TRAUMA.
485............  \7\ LIMB               1.1162         29.5         24.6
                  REATTACHMENT,
                  HIP AND FEMUR
                  PROC FOR
                  MULTIPLE
                  SIGNIFICANT TR.

[[Page 24402]]

 
486............  \3\ OTHER O.R.         0.7858         25.2         21.0
                  PROCEDURES FOR
                  MULTIPLE
                  SIGNIFICANT
                  TRAUMA.
487............  \4\ OTHER              1.1162         29.5         24.6
                  MULTIPLE
                  SIGNIFICANT
                  TRAUMA.
488............  \4\ HIV W              1.1162         29.5         24.6
                  EXTENSIVE O.R.
                  PROCEDURE.
489............  HIV W MAJOR            0.9391         21.8         18.2
                  RELATED
                  CONDITION.
490............  HIV W OR W/O           0.6590         20.3         16.9
                  OTHER RELATED
                  CONDITION.
491............  \5\ MAJOR JOINT        1.6479         35.5         29.6
                  & LIMB
                  REATTACHMENT
                  PROCEDURES OF
                  UPPER EXTREMITY.
492............  \2\ CHEMOTHERAPY       0.5655         21.2         17.7
                  W ACUTE
                  LEUKEMIA AS
                  SECONDARY
                  DIAGNOSIS.
493............  \4\ LAPAROSCOPIC       1.1162         29.5         24.6
                  CHOLECYSTECTOMY
                  W/O C.D.E. W CC.
494............  \7\ LAPAROSCOPIC       1.1162         29.5         24.6
                  CHOLECYSTECTOMY
                  W/O C.D.E. W/O
                  CC.
495............  \6\ LUNG               0.0000          0.0          0.0
                  TRANSPLANT.
496............  \4\ COMBINED           1.1162         29.5         24.6
                  ANTERIOR/
                  POSTERIOR
                  SPINAL FUSION.
497............  \5\ SPINAL             1.6479         35.5         29.6
                  FUSION W CC.
498............  \7\ SPINAL             1.6479         35.5         29.6
                  FUSION W/O CC.
499............  \5\ BACK & NECK        1.6479         35.5         29.6
                  PROCEDURES
                  EXCEPT SPINAL
                  FUSION W CC.
500............  \4\ BACK & NECK        1.1162         29.5         24.6
                  PROCEDURES
                  EXCEPT SPINAL
                  FUSION W/O CC.
501............  KNEE PROCEDURES        1.2227         33.3         27.8
                  W PDX OF
                  INFECTION W CC.
502............  \2\ KNEE               0.5655         21.2         17.7
                  PROCEDURES W
                  PDX OF
                  INFECTION W/O
                  CC.
503............  \4\ KNEE               1.1162         29.5         24.6
                  PROCEDURES W/O
                  PDX OF
                  INFECTION.
504............  \5\ EXTENSIVE          1.6479         35.5         29.6
                  BURN OR FULL
                  THICKNESS BURNS
                  WITH MECH VENT
                  96+ HOURS WITH
                  SKIN GRAFT.
505............  \5\ EXTENSIVE          1.6479         35.5         29.6
                  BURN OR FULL
                  THICKNESS BURNS
                  WITH MECH VENT
                  96+ HOURS
                  WITHOUT SKIN
                  GRAFT.
506............  \4\ FULL               1.1162         29.5         24.6
                  THICKNESS BURN
                  W SKIN GRAFT OR
                  INHAL INJ W CC
                  OR SIG TRAUMA.
507............  \7\ FULL               0.4109         17.1         14.3
                  THICKNESS BURN
                  W SKIN GRFT OR
                  INHAL INJ W/O
                  CC OR SIG
                  TRAUMA.
508............  FULL THICKNESS         0.7585         25.6         21.3
                  BURN W/O SKIN
                  GRFT OR INHAL
                  INJ W CC OR SIG
                  TRAUMA.
509............  \1\ FULL               0.4109         17.1         14.3
                  THICKNESS BURN
                  W/O SKIN GRFT
                  OR INH INJ W/O
                  CC OR SIG
                  TRAUMA.
510............  NON-EXTENSIVE          0.6740         22.6         18.8
                  BURNS W CC OR
                  SIGNIFICANT
                  TRAUMA.
511............  \1\ NON-               0.4109         17.1         14.3
                  EXTENSIVE BURNS
                  W/O CC OR
                  SIGNIFICANT
                  TRAUMA.
512............  \6\ SIMULTANEOUS       0.0000          0.0          0.0
                  PANCREAS/KIDNEY
                  TRANSPLANT.
513............  \6\ PANCREAS           0.0000          0.0          0.0
                  TRANSPLANT.
515............  \5\ CARDIAC            1.6479         35.5         29.6
                  DEFIBRILATOR
                  IMPLANT W/O
                  CARDIAC CATH.
518............  \7\ PERCUTANEOUS       0.4109         17.1         14.3
                  CARDIVASCULAR
                  PROC W/O
                  CORONARY ARTERY
                  STENT OR AMI.
519............  \4\ CERVICAL           1.1162         29.5         24.6
                  SPINAL FUSION W
                  CC.
520............  \7\ CERVICAL           1.6479         35.5         29.6
                  SPINAL FUSION W/
                  O CC.
521............  \2\ ALCOHOL/DRUG       0.5655         21.2         17.7
                  ABUSE OR
                  DEPENDENCE W CC.
522............  \7\ ALCOHOL/DRUG       0.5655         21.1         17.6
                  ABUSE OR
                  DEPENDENCE W
                  REHABILITATION
                  THERAPY W/O CC.
523............  \1\ ALCOHOL/DRUG       0.4109         17.1         14.3
                  ABUSE OR
                  DEPENDENCE W/O
                  REHABILITATION
                  THERAPY W/O CC.
524............  \2\ TRANSIENT          0.5655         21.2         17.7
                  ISCHEMIA.
525............  \7\ OTHER HEART        1.6479         35.5         29.6
                  ASSIST SYSTEM
                  IMPLANT.
528............  \7\ INTRACRANIAL       1.6479         35.5         29.6
                  VASCULAR PROC W
                  PDX HEMORRHAGE.
529............  \5\ VENTRICULAR        1.6479         35.5         29.6
                  SHUNT
                  PROCEDURES W CC.
530............  \7\ VENTRICULAR        1.6479         35.5         29.6
                  SHUNT
                  PROCEDURES W/O
                  CC.
531............  \5\ SPINAL             1.6479         35.5         29.6
                  PROCEDURES WITH
                  CC.
532............  \3\ SPINAL             0.7858         25.2         21.0
                  PROCEDURES
                  WITHOUT CC.
533............  \5\ EXTRACRANIAL       1.6479         35.5         29.6
                  VASCULAR
                  PROCEDURES WITH
                  CC.
534............  \7\ EXTRACRANIAL       1.1162         29.5         24.6
                  VASCULAR
                  PROCEDURES
                  WITHOUT CC.
535............  \5\ CARDIAC            1.6479         35.5         29.6
                  DEFIB IMPLANT W
                  CARDIAC CATH W
                  AMI/HF/SHOCK.
536............  \7\ CARDIAC            1.6479         35.5         29.6
                  DEFIB IMPLANT W
                  CARDIAC CATH W/
                  O AMI/HF/SHOCK.
537............  LOCAL EXCISION         1.4500         39.6         33.0
                  AND REMOVAL OF
                  INTERNAL
                  FIXATION
                  DEVICES EXCEPT
                  HIP AND FEMUR
                  WITH CC.
538............  \4\ LOCAL              1.1162         29.5         24.6
                  EXCISION AND
                  REMOVAL OF
                  INTERNAL
                  FIXATION
                  DEVICES EXCEPT
                  HIP AND FEMUR
                  WITHOUT CC.
539............  \4\ LYMPHOMA AND       1.1162         29.5         24.6
                  LEUKEMIA WITH
                  MAJOR O.R.
                  PROCEDURE WITH
                  CC.
540............  \7\ LYMPHOMA AND       0.4109         17.1         14.3
                  LEUKEMIA WITH
                  MAJOR O.R.
                  PROCEDURE
                  WITHOUT CC.
541............  ECMO OR TRACH W        3.8042         57.7         48.1
                  MECH VENT 96+
                  HRS OR PDX
                  EXCEPT
                  FACE,MOUTH &
                  NECK DIAG WITH
                  MAJOR OR.
542............  TRACH W MECH           2.8365         44.7         37.3
                  VENT 96+ HRS OR
                  PDX EXCEPT
                  FACE,MOUTH &
                  NECK DIAG
                  WITHOUT MAJOR
                  OR.
543............  \5\ CRANIOTOMY W       1.6479         35.5         29.6
                  IMPLANT OF
                  CHEMO AGENT OR
                  ACUTE COMPLEX
                  CNS PDX.
544............  \5\ MAJOR JOINT        1.6479         35.5         29.6
                  REPLACEMENT OR
                  REATTACHMENT OF
                  LOWER EXTREMITY.
545............  \5\ REVISION OF        1.6479         35.5         29.6
                  HIP OR KNEE
                  REPLACEMENT.
546............  \7\ SPINAL             1.6479         35.5         29.6
                  FUSION EXCEPT
                  CERVICAL WITH
                  CURVATURE OF
                  SPINE OR
                  MALIGNANCY.

[[Page 24403]]

 
547............  \7\ CORONARY           1.6479         35.5         29.6
                  BYPASS WITH
                  CARDIAC CATH
                  WITH MAJOR CV
                  DIAGNOSIS.
548............  \7\ CORONARY           1.6479         35.5         29.6
                  BYPASS WITH
                  CARDIAC CATH
                  WITHOUT MAJOR
                  CV DIAGNOSIS.
549............  \7\ CORONARY           1.6479         35.5         29.6
                  BYPASS WITHOUT
                  CARDIAC CATH
                  WITH MAJOR CV
                  DIAGNOSIS.
550............  \7\ CORONARY           1.6479         35.5         29.6
                  BYPASS WITHOUT
                  CARDIAC CATH
                  WITHOUT MAJOR
                  CV DIAGNOSIS.
551............  PERMANENT              1.6087         29.5         24.6
                  CARDIAC
                  PACEMAKER
                  IMPLANT WITH
                  MAJOR CV
                  DIAGNOSIS OR
                  AICD LEAD OR
                  GNRTR.
552............  \4\ OTHER              1.1162         29.5         24.6
                  PERMANENT
                  CARDIAC
                  PACEMAKER
                  IMPLANT WITHOUT
                  MAJOR CV
                  DIAGNOSIS.
553............  OTHER VASCULAR         1.5536         31.8         26.5
                  PROCEDURES WITH
                  CC WITH MAJOR
                  CV DIAGNOSIS.
554............  OTHER VASCULAR         1.2892         31.6         26.3
                  PROCEDURES WITH
                  CC WITHOUT
                  MAJOR CV
                  DIAGNOSIS.
555............  \3\ PERCUTANEOUS       0.7858         25.2         21.0
                  CARDIOVASCULAR
                  PROC WITH MAJOR
                  CV DIAGNOSIS.
556............  \7\ PERCUTANEOUS       0.4109         17.1         14.3
                  CARDIOVASCULAR
                  PROC WITH NON-
                  DRUG-ELUTING
                  STENT WITHOUT
                  MAJOR CV
                  DIAGNOSIS.
557............  \4\ PERCUTANEOUS       1.1162         29.5         24.6
                  CARDIOVASCULAR
                  PROC WITH DRUG-
                  ELUTING STENT
                  WITH MAJOR CV
                  DIAGNOSIS.
558............  \7\ PERCUTANEOUS       0.4109         17.1         14.3
                  CARDIOVASCULAR
                  PROC WITH DRUG-
                  ELUTING STENT
                  WITHOUT MAJOR
                  CV DIAGNOSIS.
559............  \7\ ACUTE              0.7858         25.2        21.0
                  ISCHEMIC STROKE
                  WITH USE OF
                  THROMBOLYTIC
                  AGENT.
------------------------------------------------------------------------
\1\ Proposed relative weights for these proposed LTC-DRGs were
  determined by assigning these cases to proposed low-volume quintile 1.
 
\2\ Proposed relative weights for these proposed LTC-DRGs were
  determined by assigning these cases to proposed low-volume quintile 2.
 
\3\ Proposed relative weights for these proposed LTC-DRGs were
  determined by assigning these cases to proposed low-volume quintile 3.
 
\4\ Proposed relative weights for these proposed LTC-DRGs were
  determined by assigning these cases to proposed low-volume quintile 4.
 
\5\ Proposed relative weights for these proposed LTC-DRGs were
  determined by assigning these cases to proposed low-volume quintile 5.
 
\6\ Proposed relative weights for these proposed LTC-DRGs were assigned
  a value of 0.0000.
\7\ Proposed relative weights for these LTC-DRGs were determined by
  assigning these cases to the appropriate proposed low volume quintile
  because they had no LTCH cases in the FY 2005 MedPAR file.
\8\ Proposed relative weights for these proposed LTC-DRGs were
  determined after adjusting to account for nonmonotonicity (see step 5
  above).


[[Page 24404]]

Appendix A--Regulatory Impact Analysis

    (If you choose to comment on the issues in this section, please 
include the caption ``Impact Analysis'' at the beginning of your 
comment.)

I. Overall Impact

    We have examined the impacts of this proposed rule as required 
by Executive Order 12866 (September 1993, Regulatory Planning and 
Review) and 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 (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).
    We have determined that this proposed rule is a major rule as 
defined in 5 U.S.C. 804(2). We estimate that the proposed changes 
for FY 2007 operating and capital payments will redistribute in 
excess of $100 million among different types of inpatient cases. 
Further, the market basket update to IPPS rates required by the 
statute will result in an approximate $3.33 billion increase in FY 
2007 operating and capital payments. This amount does not reflect 
changes in hospital admissions or case-mix intensity, which would 
also affect overall payment changes.
    The RFA requires agencies to analyze options for regulatory 
relief of small businesses. For purposes of the RFA, small entities 
include small businesses, nonprofit organizations, and government 
agencies. Most hospitals and most other providers and suppliers are 
considered to be 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 final rule that 
sets forth size standards for health care industries at 65 FR 69432, 
November 17, 2000.) For purposes of the RFA, all hospitals and other 
providers and suppliers are considered to be small entities. 
Individuals and States are not included in the definition of a small 
entity. We believe that this proposed rule will have a significant 
impact on small entities as explained in this Appendix. Because we 
acknowledge that many of the affected entities are small entities, 
the analysis discussed throughout the preamble of this proposed rule 
constitutes our initial regulatory flexibility analysis. Therefore, 
we are soliciting comments on our estimates and analysis of the 
impact of this proposed rule on those small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis for any proposed rule that 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, we no 
longer employ NECMAs to define urban areas in New England. 
Therefore, we now define a small rural hospital as a hospital that 
is located outside of an MSA and has fewer than 100 beds. Section 
601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) 
designated hospitals in certain New England counties as belonging to 
the adjacent NECMA. Thus, for purposes of the IPPS, we continue to 
classify these hospitals as urban hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any 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 will not mandate any requirements for 
State, local, or tribal governments, nor will it affect private 
sector costs.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on 
State and local governments, preempts State law, or otherwise has 
Federalism implications. As stated above, this proposed rule will 
not have a substantial effect on State and local governments.
    The following analysis, in conjunction with the remainder of 
this document, demonstrates that this proposed rule is consistent 
with the regulatory philosophy and principles identified in 
Executive Order 12866, the RFA, and section 1102(b) of the Act. The 
proposed rule will affect payments to a substantial number of small 
rural hospitals, as well as other classes of hospitals, and the 
effects on some hospitals may be significant.

II. Objectives

    The primary objective of the IPPS is to create incentives for 
hospitals to operate efficiently and minimize unnecessary costs 
while at the same time ensuring that payments are sufficient to 
adequately compensate hospitals for their legitimate costs. In 
addition, we share national goals of preserving the Medicare 
Hospital Insurance Trust Fund.
    We believe the changes in this proposed rule will further each 
of these goals while maintaining the financial viability of the 
hospital industry and ensuring access to high quality health care 
for Medicare beneficiaries. We expect that these proposed changes 
will ensure that the outcomes of this payment system are reasonable 
and equitable while avoiding or minimizing unintended adverse 
consequences.

III. Limitations of Our Analysis

    The following quantitative analysis presents the projected 
effects of our proposed policy changes, as well as statutory changes 
effective for FY 2007, on various hospital groups. We estimate the 
effects of individual policy changes by estimating payments per case 
while holding all other payment policies constant. We use the best 
data available, but, generally, we do not attempt to predict 
behavioral responses to our policy changes (with the exception of 
the anticipated improvements in documentation and coding that may 
lead to increases in observed but not real case-mix in response to 
the adoption of consolidated severity DRGs in FY 2008 (if not 
earlier), and we do not make adjustments for future changes in such 
variables as admissions, lengths of stay, or case-mix. As we have 
done in the previous proposed rules, we are soliciting comments and 
information about the anticipated effects of these proposed changes 
on hospitals and our methodology for estimating them. Any timely 
comments that we receive in response to this proposed rule will be 
addressed in the final rule.

IV. Hospitals Included In and Excluded From the IPPS

    The prospective payment systems for hospital inpatient operating 
and capital-related costs encompass nearly all general short-term, 
acute care hospitals that participate in the Medicare program. There 
were 35 Indian Health Service hospitals in our database, which we 
excluded from the analysis due to the special characteristics of the 
prospective payment method for these hospitals. Among other short-
term, acute care hospitals, only the 46 such hospitals in Maryland 
remain excluded from the IPPS under the waiver at section 1814(b)(3) 
of the Act.
    As of March 2006, there are 3,539 IPPS hospitals to be included 
in our analysis. This represents about 59 percent of all Medicare-
participating hospitals. The majority of this impact analysis 
focuses on this set of hospitals. There are also approximately 1,274 
critical access hospitals (CAHs). These small, limited service 
hospitals are paid on the basis of reasonable costs rather than 
under the IPPS. There are also 1,188 specialty hospitals and units 
that are excluded from the IPPS. These specialty hospitals include 
psychiatric hospitals and units (now referred to as IPFs), 
rehabilitation hospitals and units (now referred to as IRFs), long-
term care hospitals (now referred to as LTCHs), Religious Non-
Medical Health Care Institutions (RNHCIs), children's hospitals, and 
cancer hospitals. The impacts of our proposed policy changes on 
these hospitals are discussed below.

V. Effects on Excluded Hospitals and Hospital Units

    As of March 2006, there were 1,188 hospitals excluded from the 
IPPS. Of these 1,188 hospitals, 476 IPFs, 81 children's hospitals, 
11 cancer hospitals, and 17 RNHCIs are being paid, in whole or in 
part, on a reasonable cost basis subject to the rate-of-increase 
ceiling under Sec.  413.40. The

[[Page 24405]]

remaining providers, 217 IRFs and 386 LTCHs, are paid 100 percent of 
the Federal prospective rate under the IRF PPS and the LTCH PPS, 
respectively. (We note that, currently, there are 16 LTCHs that are 
being paid under the LTCH PPS transition blend methodology, which is 
based in part on a reasonable cost that is subject to a rate-of-
increase ceiling under Sec.  413.40. For cost reporting periods that 
will begin during FY 2007, these LTCHs will no longer receive a 
portion of their payment that is based in part on a reasonable cost 
subject to a rate-of-increase ceiling under Sec.  413.40 because, in 
accordance with Sec.  412.533, LTCHs are paid 100 percent of the 
adjusted Federal prospective payment amount for cost reporting 
periods beginning on or after October 1, 2006. In addition, there 
are 1,317 IPFs (paid on a blend of the IPF PPS per diem payment and 
the TEFRA reasonable cost-based payment) and 1,011 IRFs (paid under 
the IRF PPS) in hospitals otherwise subject to the IPPS. Under Sec.  
413.40(a)(2)(i)(A), the rate-of-increase ceiling is not applicable 
to the 93 IPPS excluded hospitals and units in Maryland that are 
paid in accordance with the waiver at section 1814(b)(3) of the Act.
    In the past, hospitals and units excluded from the IPPS have 
been paid based on their reasonable costs subject to limits as 
established by the Tax Equity and Fiscal Responsibility Act of 1982 
(TEFRA). Hospitals that continue to be paid fully on a reasonable 
cost basis are subject to TEFRA limits for FY 2007. For these 
hospitals (cancer and children's hospitals), consistent with section 
1886(b)(3)(B)(ii) of the Act, the proposed update will be the 
percentage increase in the FY 2007 IPPS operating market basket, 
currently estimated to be 3.4 percent. In addition, in accordance 
with Sec.  403.752(a) of the regulations, RNHCIs are paid under 
Sec.  413.40, which also uses section 1886(b)(3)(B)(ii) of the Act 
to update the percentage increase in the rate-of-increase limits. 
For RNHCIs, the proposed update will be the percentage increase in 
the FY 2007 IPPS operating market basket increase, currently 
estimated to be 3.4 percent.
    IRFs are paid under a prospective payment system (IRF PPS) for 
cost reporting periods beginning on or after January 1, 2002. For 
cost reporting periods beginning during FY 2007, the IRF PPS is 
based on 100 percent of the adjusted Federal IRF prospective payment 
amount, updated annually. Therefore, these hospitals are not 
affected by this proposed rule.
    Effective for cost reporting periods beginning on or after 
October 1, 2002, LTCHs are paid under a LTCH PPS, based on a Federal 
prospective payment amount that is updated annually. Existing LTCHs 
receive a blended payment that consists of the Federal prospective 
payment rate and a reasonable cost-based payment rate over a 5-year 
transition period, unless the LTCH elects to be paid at 100 percent 
of the Federal prospective rate at the beginning of any of its cost 
reporting periods during the 5-year transition period. Under Sec.  
412.533, the 5-year transition period for all existing hospitals 
subject to the LTCH PPS begins with the LTCH's first cost reporting 
period beginning on or after October 1, 2002, and extends through 
the LTCH's cost reporting period beginning on or after October 1, 
2006. In accordance with Sec.  412.533, for cost reporting periods 
beginning on or after October 1, 2006, the LTCH PPS transition blend 
percentages are 100 percent of the Federal prospective payment 
amount and zero percent of the amount calculated under reasonable 
cost principles. Therefore, even though FY 2007 is the fifth year of 
the 5-year transition period established under Sec.  412.533, 
because the reasonable cost principles amount is zero percent for 
cost reporting periods beginning during FY 2007, LTCHs will no 
longer receive a portion of their payment that is based in part on a 
reasonable cost subject to the rate-to-increase ceiling beginning 
with cost reporting periods beginning on or after October 1, 2006. 
Thus, there is no longer a need for an update factor for LTCH's 
TEFRA target amount for FY 2007 and beyond.
    Section 124 of the Medicare, Medicaid, and SCHIP Balanced Budget 
Refinement Act of 1999 (BBRA) required the development of a per diem 
prospective payment system (PPS) for payment of inpatient hospital 
services furnished in IPFs. The final rule implementing the IPF PPS 
(69 FR 66922) established a 3-year transition to the IPF PPS during 
which some providers will receive a blend of the IPF PPS per diem 
payment and the TEFRA reasonable cost-based payment. For purposes of 
determining what the TEFRA payment to the IPF will be, we updated 
the IPF's TEFRA target amount by the excluded hospital market basket 
percentage increase of 3.6 percent.
    The impact on excluded hospitals and hospital units of the 
update in the rate-of-increase limit depends on the cumulative cost 
increases experienced by each excluded hospital or unit since its 
applicable base period. For excluded hospitals and units that have 
maintained their cost increases at a level below the rate-of-
increase limits since their base period, the major effect is on the 
level of incentive payments these hospitals and hospital units 
receive. Conversely, for excluded hospitals and hospital units with 
per-case cost increases above the cumulative update in their rate-
of-increase limits, the major effect is the amount of excess costs 
that will not be reimbursed.
    We note that, under Sec.  413.40(d)(3), an excluded hospital or 
unit whose costs exceed 110 percent of its rate-of-increase limit 
receives its rate-of-increase limit plus 50 percent of the 
difference between its reasonable costs and 110 percent of the 
limit, not to exceed 110 percent of its limit. In addition, under 
the various provisions set forth in Sec.  413.40, certain excluded 
hospitals and hospital units can obtain payment adjustments for 
justifiable increases in operating costs that exceed the limit. 
However, at the same time, by generally limiting payment increases, 
we continue to provide an incentive for excluded hospitals and 
hospital units to restrain the growth in their spending for patient 
services.

VI. Quantitative Effects of the Proposed Policy Changes Under the IPPS 
for Operating Costs

A. Basis and Methodology of Estimates

    In this proposed rule, we are announcing policy changes and 
payment rate updates for the IPPS for operating costs. Changes to 
the capital payments are discussed in section VIII. of this 
Appendix. Based on the overall percentage change in payments per 
case estimated using our payment simulation model (a 3.4 percent 
increase), we estimate that total FY 2007 operating and capital 
payments will increase $3.33 billion compared to FY 2006 largely due 
to the statutorily mandated update to IPPS rates. This amount does 
not reflect changes in hospital admissions or case-mix intensity, 
which would also affect overall payment changes.
    We have prepared separate impact analyses of the proposed 
changes to each system. This section deals with proposed changes to 
the operating prospective payment system. Our payment simulation 
model relies on the most recent available data to enable us to 
estimate the impacts on payments per case of certain changes we are 
proposing in this rule. However, there are other changes we are 
proposing for which we do not have data available that would allow 
us to estimate the payment impacts using this model. For those 
proposed changes, we have attempted to predict the payment impacts 
based upon our experience and other more limited data.
    The data used in developing the quantitative analyses of changes 
in payments per case presented below are taken from the FY 2005 
MedPAR file and the most current Provider-Specific File that is used 
for payment purposes. Although the analyses of the changes to the 
operating PPS do not incorporate cost data, data from the most 
recently available hospital cost report were used to categorize 
hospitals. Our analysis has several qualifications. First, we do not 
make adjustments for behavioral changes that hospitals may adopt in 
response to the proposed policy changes, and we do not adjust for 
future changes in such variables as admissions, lengths of stay, or 
case-mix. (However, as we indicated earlier, we are planning to 
adopt a severity DRG system in FY 2008 (if not earlier) and expect 
to make adjustments to the standardized amounts to account for 
anticipated improvements in documentation and coding that may lead 
to increases in observed but not real case mix). Second, due to the 
interdependent nature of the IPPS payment components, it is very 
difficult to precisely quantify the impact associated with each 
proposed change. Third, we use various sources for the data used to 
categorize hospitals in the tables. In some cases, particularly the 
number of beds, there is a fair degree of variation in the data from 
different sources. We have attempted to construct these variables 
with the best available source overall. However, for individual 
hospitals, some miscategorizations are possible.
    Using cases from the FY 2005 MedPAR file, we simulated payments 
under the operating IPPS given various combinations of payment 
parameters. Any short-term, acute

[[Page 24406]]

care hospitals not paid under the IPPS (Indian Health Service 
hospitals and hospitals in Maryland) were excluded from the 
simulations. The impact of payments under the capital IPPS, or the 
impact of payments for costs other than inpatient operating costs, 
are not analyzed in this section. Estimated payment impacts of 
proposed FY 2007 changes to the capital IPPS are discussed in 
section VIII. of this Appendix.
    The proposed changes discussed separately below are the 
following:
     The effect of a reduced update to the standardized 
amount for hospitals that do not comply with section 
1886(b)(3)(B)(viii) of the Act by submitting quality data in 
accordance with our requirements.
     The effects of the MDH payment changes set forth in 
section 5003 of Pub. L. 109-171.
     The effects of the annual reclassification of diagnoses 
and procedures and the recalibration of the DRG relative weights 
required by section 1886(d)(4)(C) of the Act.
     The effects of the proposed changes in hospitals' wage 
index values reflecting wage data from hospitals' cost reporting 
periods beginning during FY 2003, compared to the FY 2002 wage data.
     The effects of the proposed wage and recalibration 
budget neutrality factors.
     The effects of the remaining labor market area 
transition for those hospitals that were urban under the old labor 
market area designations and are now considered rural hospitals.
     The effects of geographic reclassifications by the 
MGCRB that will be effective in FY 2007.
     The effects of section 505 of Pub. L. 108-173, which 
provides for an increase in a hospital's wage index if the hospital 
qualifies by meeting a threshold percentage of residents of the 
county where the hospital is located who commute to work at 
hospitals in counties with higher wage indexes.
     The total change in payments based on proposed FY 2007 
policies and MMA-imposed changes relative to payments based on FY 
2006 policies.
    To illustrate the impacts of the proposed FY 2007 changes, our 
analysis begins with a FY 2006 baseline simulation model using: The 
proposed update of 3.4 percent; the FY 2006 DRG GROUPER (version 
23.0); the CBSA designations for hospitals based on OMB's June 2003 
MSA definitions; the FY 2006 wage index; and no MGCRB 
reclassifications. Outlier payments are set at 5.1 percent of total 
operating DRG and outlier payments.
    Section 1886(b)(3)(B)(vii) of the Act, as added by section 
501(b) of Pub. L. 108-173, and amended by section 5001(a) of Pub. L. 
109-171, provides that, for FYs 2005 through 2006, the update 
factors will be reduced by 0.4 percentage points for any hospital 
that does not submit quality data. Section 5001(a) of Pub. L. 109-
171 provides that for FY 2007 and subsequent years, the update 
factor will be reduced by 2.0 percentage points for any hospital 
that does not submit quality data or that fails the quality data 
validation process. At the time this impact was prepared, 115 
providers did not receive the full market basket rate-of-increate 
for FY 2006 because they failed the quality data submission process. 
For purposes of the simulations shown below, we modeled the payment 
changes for FY 2007 using a reduced update for these 115 hospitals. 
However, we do not have enough information to determine which 
hospitals will not receive the full market basket rate-of-increase 
for FY 2007 at this time.
    Each proposed and statutory policy change is then added 
incrementally to this baseline, finally arriving at an FY 2007 model 
incorporating all of the proposed changes. This simulation allows us 
to isolate the effects of each proposed change.
    Our final comparison illustrates the percent change in payments 
per case from FY 2006 to FY 2007. Three factors not discussed 
separately have significant impacts here. The first is the update to 
the standardized amount. In accordance with section 1886(b)(3)(B)(i) 
of the Act, we have updated standardized amounts for FY 2007 using 
the most recently forecasted hospital market basket increase for FY 
2007 of 3.4 percent. (Hospitals that fail to comply with the quality 
data submission requirement to receive the full update will receive 
an update reduced by 2.0 percentage points to 1.4 percent.) Under 
section 1886(b)(3)(B)(iv) of the Act, the updates to the hospital-
specific amounts for sole community hospitals (SCHs) and for 
Medicare-dependent small rural hospitals (MDHs) are also equal to 
the market basket increase, or 3.4 percent.
    A second significant factor that affects changes in hospitals' 
payments per case from FY 2006 to FY 2007 is the change in MGCRB 
status from one year to the next. That is, payments may be reduced 
for hospitals reclassified in FY 2006 that are no longer 
reclassified in FY 2007. Conversely, payments may increase for 
hospitals not reclassified in FY 2006 that are reclassified in FY 
2007. In some cases, these impacts can be quite substantial, so if a 
relatively small number of hospitals in a particular category lose 
their reclassification status, the percentage change in payments for 
the category may be below the national mean. However, this effect is 
alleviated by section 1886(d)(10)(D)(v) of the Act, which provides 
that reclassifications for purposes of the wage index are for a 3-
year period.
    A third significant factor is that we currently estimate that 
actual outlier payments during FY 2006 will be 4.7 percent of total 
DRG payments. When the FY 2006 final rule was published, we 
projected FY 2006 outlier payments would be 5.1 percent of total DRG 
plus outlier payments; the average standardized amounts were offset 
correspondingly. The effects of the lower than expected outlier 
payments during FY 2006 (as discussed in the Addendum to this 
proposed rule) are reflected in the analyses below comparing our 
current estimates of FY 2006 payments per case to estimated FY 2007 
payments per case (with outlier payments projected to equal 5.1 
percent of total DRG payments).

B. Analysis of Table I

    Table I displays the results of our analysis of proposed changes 
for FY 2007. The table categorizes hospitals by various geographic 
and special payment consideration groups to illustrate the varying 
impacts on different types of hospitals. The top row of the table 
shows the overall impact on the 3,522 hospitals included in the 
analysis. There are 222 fewer hospitals than were included in the 
impact analysis in the FY 2006 final rule (70 FR 47690).
    The next four rows of Table I contain hospitals categorized 
according to their geographic location: All urban, which is further 
divided into large urban and other urban; and rural. There are 2,517 
hospitals located in urban areas included in our analysis. Among 
these, there are 1,391 hospitals located in large urban areas 
(populations over 1 million), and 1,126 hospitals in other urban 
areas (populations of 1 million or fewer). In addition, there are 
1,005 hospitals in rural areas. The next two groupings are by bed-
size categories, shown separately for urban and rural hospitals. The 
final groupings by geographic location are by census divisions, also 
shown separately for urban and rural hospitals.
    The second part of Table I shows hospital groups based on 
hospitals' proposed FY 2007 payment classifications, including any 
reclassifications under section 1886(d)(10) of the Act. For example, 
the rows labeled urban, large urban, other urban, and rural show 
that the number of hospitals paid based on these categorizations 
after consideration of geographic reclassifications (including 
reclassifications under 1886(d)(8)(B) and 1886(d)(8)(E) which have 
implications for capital payments) are 2,539, 1,400, 1,139, and 983, 
respectively.
    The next three groupings examine the impacts of the proposed 
changes on hospitals grouped by whether or not they have GME 
residency programs (teaching hospitals that receive an IME 
adjustment) or receive DSH payments, or some combination of these 
two adjustments. There are 2,449 non-teaching hospitals in our 
analysis, 836 teaching hospitals with fewer than 100 residents, and 
237 teaching hospitals with 100 or more residents.
    In the DSH categories, hospitals are grouped according to their 
DSH payment status, and whether they are considered urban or rural 
for DSH purposes. The next category groups hospitals considered 
urban after geographic reclassification, in terms of whether they 
receive the IME adjustment, the DSH adjustment, both, or neither.
    The next five rows examine the impacts of the proposed changes 
on rural hospitals by special payment groups (sole community 
hospitals (SCHs), rural referral centers (RRCs), and Medicare 
dependent hospitals (MDHs)), as well as rural hospitals not 
receiving a special payment designation. There were 140 RRCs, 341 
SCHs, 126 MDHs, 80 hospitals that are both SCHs and RRCs and 8 
hospitals that are both MDHs and RRCs.
    The next two groupings are based on type of ownership and the 
hospital's Medicare utilization expressed as a percent of total 
patient days. These data are taken primarily from the FY 2004 
Medicare cost reports, if available (otherwise FY 2003 data are 
used).
    The next series of groupings concern the geographic 
reclassification status of

[[Page 24407]]

hospitals. The first grouping displays all urban hospitals that were 
reclassified by the MGCRB for FY 2007. The next grouping shows the 
MGCRB rural reclassifications. The final three rows in Table I 
contain hospitals located in urban counties, but deemed to be rural 
under section 1886(d)(8)(E) of the Act, hospitals located in rural 
counties but deemed to be urban under section 1886(d)(8)(B) of the 
Act, and hospitals currently reclassified under section 508 of 
Public Law 108-173, which expires on March 31, 2007.

                                                Table I.--Impact Analysis of Proposed Changes for FY 2007
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                    Wage index
                                                                    Hospital              DRG rel.  transition
                                             Quality                specific              wts. and      for                           Out-       All FY
                                  No. of    data rate    DRA MDH     costs     FY 2007      wage     hospitals        MGCRB         migration     2007
                                hospitals  difference  provisions   wts, DRG  wage data    index      moving    reclassifications  adjustment   changes
                                   \1\         \2\         \3\      changes      \5\      changes   from urban         \8\             \9\        \10\
                                                                      \4\                   \6\      to rural
                                                                                                        \7\
(1)                                   (2)         (3)         (4)        (5)        (6)        (7)         (8)            (9)            (10)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Hospitals.................      3,522         0.0         0.1        0.1        0.0        0.0         0.0            0.0             0.1        3.4
By Geographic Location:
    Urban hospitals...........      2,517         0.0         0.0       -0.2        0.1       -0.4         0.0           -0.3             0.1        3.0
    Large urban areas               1,391         0.0         0.0        0.1        0.0        0.0         0.0           -0.5             0.0        3.4
     (populations over 1
     million).................
    Other urban areas               1,126         0.0         0.0       -0.8        0.1       -0.8         0.0           -0.2             0.1        2.5
     (populations of 1 million
     or fewer)................
    Rural hospitals...........      1,005         0.0         0.5        3.0        0.0        2.8         0.3            2.2             0.1        6.7
    Bed Size (Urban):
        0-99 beds.............        590        -0.1         0.1        0.9        0.1        0.8         0.0           -0.5             0.0        4.1
        100-199 beds..........        865         0.0         0.0        1.9        0.2        2.0         0.0           -0.2             0.0        5.2
        200-299 beds..........        482         0.0         0.0        0.1        0.1        0.0         0.0           -0.3             0.1        3.4
        300-499 beds..........        414         0.0         0.0       -1.1        0.1       -1.2         0.0           -0.4             0.1        2.2
        500 or more beds......        166         0.0         0.0       -1.5       -0.1       -1.8         0.0           -0.4             0.0        1.6
    Bed Size (Rural):
        0-49 beds.............        349        -0.1         0.9        5.8       -0.1        5.7         0.1            0.9             0.2       10.1
        50-99 beds............        366         0.0         1.3        4.6        0.0        4.5         0.3            1.1             0.2        9.3
        100-149 beds..........        179         0.0         0.1        3.0        0.0        2.9         0.5            2.6             0.1        6.2
        150-199 beds..........         64         0.0         0.0        1.2       -0.1        1.0         0.5            3.7             0.1        4.2
        200 or more beds......         47         0.0         0.0       -0.1       -0.2       -0.4         0.0            3.3             0.0        2.9
    Urban by Region:
        New England...........        127         0.0         0.0        0.5        0.7        1.0         0.0            0.4             0.0        3.2
        Middle Atlantic.......        353         0.0         0.0        0.1        0.2        0.1         0.0           -0.1             0.1        3.0
        South Atlantic........        381         0.0         0.0       -0.6       -0.4       -1.1         0.0           -0.4             0.0        2.6
        East North Central....        388         0.0         0.0       -0.2        0.2       -0.2         0.0            0.3             0.0        3.0
        East South Central....        163         0.0         0.0       -0.7       -0.4       -1.3         0.0           -0.5             0.1        2.5
        West North Central....        156         0.0         0.0       -1.2       -0.1       -1.4         0.0           -0.7             0.0        2.1
        West South Central....        350         0.0         0.0       -0.5       -0.4       -1.1         0.0           -0.6             0.0        2.6
        Mountain..............        143         0.0         0.0       -1.1        0.6       -0.6         0.0           -0.4             0.0        3.0
        Pacific...............        404         0.0         0.0        0.7        0.6        1.1         0.0           -0.3             0.1        4.5
        Puerto Rico...........         52         0.0         0.0        3.2       -1.4        1.6         0.0           -0.7             0.0        5.0
    Rural by Region:
        New England...........         19         0.0         2.6        1.9       -0.4        1.5         0.0            2.1             0.1        7.7
        Middle Atlantic.......         72         0.0         1.2        2.9        0.3        3.1         0.1            2.1             0.0        7.7
        South Atlantic........        175         0.0         0.2        3.7        0.0        3.5         0.2            2.3             0.2        6.9
        East North Central....        125         0.0         0.6        2.0       -2.0        1.7         0.1            1.7             0.0        5.8
        East South Central....        181         0.0         0.2        3.1        0.0        2.9         0.2            2.8             0.1        6.4
        West North Central....        118         0.0         0.9        1.9        0.1        2.0         0.0            2.0             0.1        6.3
        West South Central....        191         0.0         0.4        3.8       -0.1        3.6         0.6            3.0             0.2        7.1
        Mountain..............         80         0.0         0.0        2.7       -0.2        2.5         2.3            0.6             0.1        5.6
        Pacific...............         44         0.0         0.3        3.7        0.1        3.8         0.0            1.9             0.1        7.4
By Payment Classification:
    Urban hospitals...........      2,539         0.0         0.0       -0.2        0.1       -0.3         0.0           -0.3             0.1        3.0
    Large urban areas               1,400         0.0         0.0        0.1        0.0        0.0         0.0            -04             0.0        3.4
     (populations over 1
     million).................
    Other urban areas               1,139         0.0         0.0       -0.7        0.1       -0.8         0.0           -0.2             0.1        2.5
     (populations of 1 million
     or fewer)................
    Rural Areas...............        983         0.0         0.5        2.9        0.0        2.7         0.3            2.1             0.1        6.6
    Teaching Status:
        Nonteaching...........      2,449         0.0         0.1        1.3        0.0        1.2         0.0            0.2             0.1        4.8
        Fewer than 100                836         0.0         0.0       -0.7        0.0       -0.9         0.0           -0.2             0.0        2.6
         residents............
        100 or more residents.        237         0.0         0.0       -0.9        0.2       -0.9         0.0           -0.3             0.0        2.6
    Urban DSH:
        Non-DSH...............        854         0.0         0.1       -0.8        0.0       -1.0         0.0           -0.1             0.0        2.6
        100 or more beds......      1,513         0.0         0.0       -0.1        0.1       -0.2         0.0           -0.3             0.1        3.1
        Less than 100 beds....        333         0.0         0.1        3.7        0.3        3.9         0.0           -0.4             0.0        7.2
    Rural DSH:
        SCH...................        383         0.0         0.9        4.4        0.0        4.4         0.3            0.7             0.1        8.7
        RRC...................        196         0.0         0.1        1.5       -0.1        1.3         0.2            3.7             0.0        4.6
    Other Rural:
        100 or more beds......         55         0.0         0.0        4.5        0.2        4.5         1.1            1.0             0.3        7.2
        Less than 100 beds....        188        -0.1         0.0        5.8        0.0        5.7         0.4            1.0             0.4        9.1
    Urban teaching and DSH:
        Both teaching and DSH.        809         0.0         0.0       -0.6        0.0       -0.8         0.0           -0.4             0.0        2.5
        Teaching and no DSH...        198         0.0         0.0       -1.4        0.1       -1.5         0.0           -0.1             0.1        1.6
        No teaching and DSH...      1,037         0.0         0.0        1.3        0.1        1.3         0.0           -0.2             0.1        4.7
        No teaching and no DSH        495         0.0         0.0       -0.6       -0.1       -0.9         0.0           -0.3             0.0        2.8
    Rural Hospital Types:
        Non special status            288        -0.1         0.0        5.1        0.1        5.0         0.8            1.0             0.4        8.2
         hospitals............

[[Page 24408]]

 
        RRC...................        140         0.0         0.0        1.1       -0.1        0.9         0.3            4.3             0.0        4.3
        SCH...................        341         0.0         0.0        4.1        0.0        4.0         0.3            0.5             0.1        7.5
        MDH...................        126         0.0         5.9        5.3        0.0        5.2         0.0            0.8             0.1       14.6
        SCH and RRC...........         80         0.0         0.0        1.1       -0.2        0.9         0.0            2.2             0.0        4.1
        MDH and RRC...........          8         0.0        12.8        2.6        0.0        2.7         0.0            0.8             0.0       17.5
    Type of Ownership:
        Voluntary.............      2,087         0.0         0.1       -0.1        0.1       -0.2         0.0           -0.1             0.1        3.1
        Proprietary...........        831         0.0         0.0        0.3       -0.1        0.0         0.1            0.0             0.0        3.7
        Government............        604         0.0         0.1        1.2        0.1        1.2         0.0            0.1             0.1        4.7
Medicare Utilization as a
 Percent of Inpatient Days:
    0-25......................        252         0.0         0.0        2.3        0.5        2.6         0.0           -0.3             0.0        5.8
    25-50.....................      1,302         0.0         0.0       -0.4        0.0       -0.6         0.0           -0.4             0.0        2.8
    50-65.....................      1,490         0.0         0.1        0.5        0.1        0.4         0.0            0.4             0.1        3.9
    Over 65...................        459         0.0         0.4        0.5       -0.1        0.2         0.0            0.5             0.1        4.1
    Unknown...................         19        -0.2         0.0        3.8        0.5        4.1         0.0           -0.3             0.0        8.2
Urban Hospitals Reclassified          319         0.0         0.0       -0.3        0.2       -0.3         0.0            2.1             0.0        3.1
 by the Medicare Geographic
 Classification Review Board:
 First Half FY 2007
 Reclassifications............
Urban Nonreclassified, First        2,119         0.0         0.0       -0.2        0.0       -0.4         0.0           -0.7             0.1        3.1
 Half FY 2007.................
All Urban Hospitals                   339         0.0         0.0       -0.2        0.1       -0.2         0.0            1.9             0.0        3.2
 Reclassified Second Half FY
 2007.........................
Urban Nonreclassified               2,099         0.0         0.0       -0.2        0.0       -0.4         0.0           -0.7             0.1        3.1
 Hospitals Second Half FY 2007
All Rural Hospitals                   385         0.0         0.5        1.8        0.0        1.6         0.1            3.8             0.0        5.3
 Reclassified Full Year FY
 2007.........................
Rural Nonreclassified                 604        -0.1         0.6        4.8        0.0        4.6         0.6            0.0             0.3        8.8
 Hospitals Full Year 2007.....
All Section 401 Reclassified           38         0.0         3.0        3.1        0.1        3.2         0.0           -0.3             0.0        9.2
 Hospitals....................
Other Reclassified Hospitals           54        -0.1         0.5        4.8          0        4.7         0.0            4.0             0.0        8.7
 (Section 1886(d)(8)(B))......
Section 508 Hospitals.........         95         0.0         0.0       -0.4        0.3       -0.2         0.0           -0.2             0.1       0.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the
  national total. Discharge data are from FY 2003, and hospital cost report data are from reporting periods beginning in FY 2002 and FY 2001.
\2\ This column displays the payment impact of the hospitals that did not submit quality update information.
\3\ This column displays the impact of the Deficit Reduction Act section 5003 that apply to Medicare Dependent Hospitals.
\4\ This column displays the payment impact of the changes to the V24 GROUPER and the recalibration of the DRG HSRVcc weights based on FY 2005 MedPAR
  data in accordance with section 1886(d)(4)(C)(iii) of the Act.
\5\ This column displays the payment impact of updating the wage index data to the FY 2003 cost report data.
\6\ This column displays the payment impact of the budget neutrality factor for DRG and wage index changes data in accordance with section
  1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act.
\7\ Shown here are the effects of providing rural hospitals formerly located in urban areas with urban wage index values in FY 2007. The effects
  reflected here are budget neutral: this column therefore includes the effect of the 0.999591 adjustment that we have applied to the rates to ensure
  budget neutrality.
\8\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate
  the FY 2007 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2007. Reclassification for
  prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.991727.
\9\ This column displays the impact of the FY 2007 implementation of section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage
  index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at
  hospitals in counties with higher wage indexes.
\10\ This column shows changes in payments from FY 2006 to FY 2007. It incorporates all of the changes displayed in Columns 3, 4, 7, 8, and 9 (the
  changes displayed in Columns 5 and 6 are included in Column 7). It also reflects the impact of the FY 2007 update, changes in hospitals'
  reclassification status in FY 2007 compared to FY 2006, and the changes in payments as a result of continuing the reclassifications under section 508
  of Pub. L. 108-173. The sum of these impacts may be different from the percentage changes shown here due to rounding and interactive effect.

C. Effects on the Hospitals That Failed the Quality Data Submission 
Process (Column 2)

    Column 2 of Table I shows the effect of assigning a reduced 
update to the standardized amount to hospitals that either fail to 
submit quality data or fail the data validation requirements. This 
column shows the effect of paying these providers based on an update 
of market basket, less 2.0 percentage points (1.4 percent) relative 
to a full market basket update (3.4 percent), for FY 2007. There are 
115 hospitals in this analysis that we expect will not receive the 
full market basket update for FY 2007. Most of these hospitals are 
either small rural or small urban hospitals. We project that these 
hospitals will receive an overall decrease in payments of 0.1 
percent from last year's payment.

D. Effects of the DRA Provision Related to MDHs (Column 3)

    In Column 3 of Table I, we show the effects of implementing 
section 5003 of Pub. L. 109-171 for MDHs. Section 5003 requires MDHs 
to rebase their hospital-specific rate to the FY 2002 cost reporting 
period, if doing so increases their target amount. It also increases 
the hospital-specific payment amount from the Federal rate plus 50 
percent of the difference between the Federal rate and the hospital-
specific amount (presuming the hospital-specific amount exceeds the 
Federal amount) to the Federal rate plus 75 percent of the 
difference. In addition, MDHs are no longer subject to the 12-
percent cap on their DSH payments, effective FY 2007.
    This column compares the FY 2007 payment rates under the section 
5003 provisions to payments under the FY 2006 MDH provisions. (The 
MDH provisions were set to expire at the end of FY 2006 but were 
extended by section 5003(a)(1)). Overall, hospitals experience a 0.1 
percent increase. This is primarily due to the substantial increase 
in payments to MDH providers; MDH providers experience a 5.9 percent 
increase while MDH/RRC combination providers experience a 12.8 
percent increase.

E. Effects of the Changes to the DRG Reclassifications and Relative 
Cost-Based Weights (Column 4)

    In Column 4 of Table I, we present the combined effects of the 
DRG reclassifications and recalibration, as discussed in section II. 
of the preamble to this proposed rule. Section 1886(d)(4)(C)(i) of 
the Act requires us annually to make appropriate classification 
changes in order to reflect changes in treatment patterns, 
technology, and any other

[[Page 24409]]

factors that may change the relative use of hospital resources.
    As discussed in the preamble of this proposed rule, we are 
proposing to change the relative weight calculation methodology from 
a charge-based method to a hospital specific, cost center adjusted 
method. In this column, we compare aggregate payments using the 
proposed FY 2007 hospital-specific cost weights (GROUPER Version 24) 
to the FY 2006 DRG relative charge weights (GROUPER Version 23.0). 
This method is described in more detail in section II of the 
preamble to this proposed rule. We note that, consistent with 
section 1886(d)(4)(C)(iii) of the Act, we have applied a budget 
neutrality factor to ensure that the overall payment impact of the 
DRG changes (combined with the wage index changes) is budget 
neutral. This budget neutrality factor of 0.998363 is applied to 
payments in Column 6. Because this is a combined DRG 
reclassification and recalibration and wage index budget neutrality 
factor, it is not applied to payments in Column 4. We have not 
proposed substantial changes to the FY 2007 GROUPER in this rule so 
most of the differences observed in this column illustrate the 
effect of setting the relative weights under the HSRVcc methodology, 
which is discussed in detail in section II.C. of the preamble to 
this proposed rule.
    In general, surgical DRGs tend to have charges concentrated in 
ancillary cost center groups while medical DRGs tend to have charges 
concentrated in routine or intensive care unit (ICU) cost center 
groups. As discussed in the preamble of this proposed rule, the cost 
to charge ratios for ancillary cost center groups are lower than the 
cost to charge ratios for routine and ICU cost center groups, 
indicating that the charge mark ups for ancillary services are 
higher. Because the HSRVcc weighting methodology adjusts the weights 
to remove differential mark-ups in charges, the FY 2007 weights are 
redistributed among medical and surgical DRGs, which will result in 
a redistribution of payments among hospitals according to the types 
of cases they provide. For instance, hospitals that perform more 
surgical procedures are likely to experience decreases in payments 
while hospitals with heavy concentrations of medical DRGs are 
expected to experience increases in payments. Hospitals with a case-
mix that is equal to average will see little or no change in 
payment.
    Rural DSH hospitals with less than 100 beds and small rural 
hospitals (0-49 beds) show the greatest increase in payments of 5.8 
percent. Urban hospitals with more than 500 beds and teaching 
hospitals with no DSH payments have the largest decrease in payments 
with declines of 1.5 and 1.4 percent respectively. Urban hospitals 
in West North Central, Mountain, East South Central, South Atlantic, 
West South Central, and East North Central experience decreases in 
payment of .2 to 1.2 percent.

F. Effects of Proposed Wage Index Changes (Column 5)

    Section 1886(d)(3)(E) of the Act requires that, beginning 
October 1, 1993, we annually update the wage data used to calculate 
the wage index. In accordance with this requirement, the proposed 
wage index for FY 2007 is based on data submitted for hospital cost 
reporting periods beginning on or after October 1, 2002 and before 
October 1, 2003. The impact of the new data on hospital payments is 
isolated in Column 5 by holding the other payment parameters 
constant in this simulation. That is, Column 5 shows the percentage 
changes in payments when going from a model using the FY 2006 wage 
index, based on FY 2002 wage data, to a model using the proposed FY 
2007 pre-reclassification wage index, based on FY 2003 wage data. 
The wage data collected on the FY 2003 cost report are the same as 
the FY 2002 wage data those were used to calculate the FY 2006 wage 
index.
    Column 5 shows the impacts of updating the wage data using FY 
2003 cost reports. Overall, the new wage data will lead to a 0.0 
percent change for all hospitals and a 0.1 percent increase for 
hospitals in urban areas. This increase is due to fluctuations in 
the wage data. Among regions, the largest increase is in the urban 
New England region, which experiences a 0.7 percent increase. The 
largest decline from updating the wage data is seen in the Puerto 
Rico region (a 1.4 percent decrease).
    In looking at the wage data itself, the national average hourly 
wage increased 5.7 percent compared to FY 2006. Therefore, the only 
manner in which to maintain or exceed the previous year's wage index 
was to match or exceed the national 5.7 percent increase in average 
hourly wage. Of the 3,500 hospitals with wage data for both FYs 2006 
and 2007, 1,606, or 45.9 percent, also experienced an average hourly 
wage increase of 5.7 percent or more.
    The following chart compares the shifts in wage index values for 
hospitals for FY 2007 relative to FY 2006. Among urban hospitals, 45 
will experience an increase of between 5 percent and 10 percent and 
3 will experience an increase of more than 10 percent. No rural 
hospitals will experience increases greater than 5 percent. However, 
996 rural hospitals will experience increases or decreases of less 
than 5 percent, while 2,380 urban hospitals will experience 
increases or decreases of less than 5 percent. Sixty urban hospitals 
will experience decreases in their wage index values of at least 5 
percent, but less than 10 percent. Twelve urban hospitals will 
experience decreases in their wage index values of greater than 10 
percent. Four rural hospitals will experience decreases of more than 
10 percent.
    The following chart shows the projected impact for urban and 
rural hospitals.

------------------------------------------------------------------------
                                                   Number of hospitals
  Percentage change in area wage index values  -------------------------
                                                   Urban        Rural
------------------------------------------------------------------------
Increase more than 10 percent.................            3            0
Increase more than 5 percent and less than 10            45            0
 percent......................................
Increase or decrease less than 5 percent......        2,380          996
Decrease more than 5 percent and less than 10            60            0
 percent......................................
Decrease more than 10 percent.................           12            4
------------------------------------------------------------------------

G. Combined Effects of Proposed DRG and Wage Index Changes, 
Including Budget Neutrality Adjustment (Column 6)

    The impact of the DRG reclassifications on aggregate payments is 
required by section 1886(d)(4)(C)(iii) of the Act to be budget 
neutral. In addition, section 1886(d)(3)(E) of the Act specifies 
that any updates or adjustments to the wage index are to be budget 
neutral. As noted in the Addendum to this proposed rule, in 
determining the budget neutrality factor, we compared simulated 
aggregate payments using the FY 2006 DRG relative weights, the 
blended wage index, and labor share percentage to simulated 
aggregate payments using the proposed FY 2007 DRG relative weights 
and wage index.
    We computed a wage and DRG recalibration budget neutrality 
factor of 0.998363. The 0.0 percent impact for all hospitals 
demonstrates that these changes, in combination with the budget 
neutrality factor, are budget neutral. In Table I, the combined 
overall impacts of the effects of both the DRG reclassifications and 
the updated wage index are shown in Column 6. The changes in this 
column are the sum of the proposed changes in Columns 4 and 5, 
combined with the budget neutrality factor and the wage index floor 
for urban areas required by section 4410 of Pub. L. 105-33 to be 
budget neutral. There also may be some variation of plus or minus 
0.1 percentage point due to rounding.
    Small rural hospitals show a 5.7 percent increase in payments 
that is primarily due to the change to the relative weight 
methodology used in the DRG recalibration process. Among urban 
regions, the largest impacts are in the Pacific region and Puerto 
Rico, with 1.1 and 1.6 percent increases, respectively. The West 
North Central region experiences the largest decrease of 1.4 
percent. Among rural regions, the Pacific region benefits the most 
with a 3.8 percent increase, while the New England region 
experiences the smallest increase (1.5 percent).

[[Page 24410]]

H. Effects of the 3-Year Provision Allowing Urban Hospitals That 
Were Converted to Rural as a Result of the FY 2005 Labor Market 
Area Changes To Maintain the Wage Index of the Urban Labor Market 
Area in Which They Were Formerly Located (Column 7)

    To help alleviate the decreased payments for urban hospitals 
that became rural under the new labor market area definitions, for 
purposes of the wage index, we adopted a policy in FY 2005 to allow 
them to maintain the wage index assignment of the MSA where they 
were located for the 3-year period FY 2005, FY 2006, and FY 2007. 
Column 7 shows the impact of the remaining labor market area 
transition, for those hospitals that were urban under the old labor 
market area designations and are now considered rural hospitals. 
Section 1886(d)(3)(E) of the Act specifies that any updates or 
adjustments to the wage index are to be budget neutral. Therefore, 
we applied an adjustment of 0.999591 to ensure that the effects of 
reclassification are budget neutral as indicated by the zero effect 
on payments to hospitals overall. The rural hospital row shows a 0.3 
percent benefit from this provision as these hold harmless hospitals 
are now considered geographically rural.

I. Effects of MGCRB Reclassifications (Column 8)

    Our impact analysis to this point has assumed hospitals are paid 
on the basis of their actual geographic location (with the exception 
of ongoing policies that provide that certain hospitals receive 
payments on other bases than where they are geographically located, 
such as hospitals in rural counties that are deemed urban under 
section 1886(d)(8)(B) of the Act). The changes in Column 8 reflect 
the per case payment impact of moving from this baseline to a 
simulation incorporating the MGCRB decisions for FY 2007 which 
affect hospitals' wage index area assignments.
    By February 28 of each year, the MGCRB makes reclassification 
determinations that will be effective for the next fiscal year, 
which begins on October 1. The MGCRB may approve a hospital's 
reclassification request for the purpose of using another area's 
wage index value. The proposed FY 2007 wage index values incorporate 
all of the MGCRB's reclassification decisions for FY 2007. The wage 
index values also reflect any decisions made by the CMS 
Administrator through the appeals and review process through 
February 28, 2006.
    For FY 2007, as stated in the FY 2006 IPPS final rule (70 FR 
47382, August 12, 2005), we established procedural rules under 
section 1886(d)(10)(D)(v) of the Act to address specific 
circumstances where individual and group reclassifications involve a 
section 508 hospital. The rules were designed to recognize the 
special circumstances of section 508 hospital reclassifications 
ending mid-year during FY 2007 and were intended to allow previously 
approved reclassifications to continue through March 31, 2007, and 
new section 1886(d)(10) reclassifications to begin April 1, 2007, 
upon the conclusion of the section 508 reclassifications. Under 
these procedural rules, some section 1886(d)(10) hospital 
reclassifications are only in effect for the second half of the 
fiscal year.
    The first and second half fiscal year section 1886(d)(10) 
reclassifications permitted under these procedural rules have 
implications for the calculation of the reclassified wage indices 
and the reclassification budget neutrality factor. Section 
1886(d)(8)(c) of the Act provides requirements for determining the 
wage index values for hospitals that were reclassified as a result 
of the MGCRB decisions under 1886(d)(10) of the Act. As provided in 
the statute, we are required to calculate a separate wage index for 
hospitals reclassified to an area if including the wage data for the 
reclassified hospitals would reduce the area wage index by more than 
1 percent.
    Because of the half-year reclassifications permitted under the 
procedural rules, in this proposed rule we are proposing to issue 
two separate wage indexes for affected areas (one effective from 
October 1, 2006 through March 31, 2007 and a second reclassified 
wage index effective April 1, 2007 through September 30, 2007). The 
proposed FY 2007 wage index values are calculated based on the wage 
data for hospitals reclassified to the area in the respective half 
of the fiscal year. The impact of this policy is modeled in Column 8 
of Table I above.
    The overall effect of geographic reclassification is required by 
section 1886(d)(8)(D) of the Act to be budget neutral. In this 
proposed rule, we are proposing to calculate one budget neutrality 
adjustment that reflects the average of the adjustments required for 
first and second half fiscal year reclassifications, respectively. 
Therefore, we applied an adjustment of 0.991727 to ensure that the 
effects of the section 1886(d)(10) reclassifications are budget 
neutral. (See section II.A. of the Addendum to this proposed rule.)
    As a group, rural hospitals benefit from geographic 
reclassification. We estimate that their payments will rise 2.2 
percent as shown in Column 8. Payments to urban hospitals will 
decline by 0.3 percent. Hospitals in other urban areas will 
experience an overall decrease in payments of 0.2 percent, while 
large urban hospitals will lose 0.5 percent. Among urban hospital 
groups (that is, bed size, census division, and special payment 
status), payments generally would decline.
    A positive impact is evident among all of the rural hospital 
groups. The smallest increase among the rural census divisions is 
0.6 percent for the Mountain region. The largest increases are in 
the rural East South Central region, with an increase of 2.8 
percent, and in the West South Central region, which would 
experience an increase of 3.0 percent.
    Urban hospitals reclassified for the first half of FY 2007 are 
expected to receive an increase of 2.1 percent and urban hospitals 
reclassified for the second half of FY 2007 are expected to receive 
a 1.9 percent increase in payments. The same set of rural hospital 
providers are reclassified for the entire FY 2007 year and are 
expected to receive a 3.8 percent increase in payments from the 
MGCRB changes. Payments to urban hospitals that did not reclassify 
for either the first or second half of FY 2007 are expected to 
decrease slightly (by 0.7 percent) due to the MGCRB changes. FY 2007 
payments to non-reclassifying rural hospitals are not affected by 
the MGCRB changes.

J. Effects of the Proposed Wage Index Adjustment for Out-Migration 
(Column 9)

    Section 1886(d)(13) of the Act, as added by section 505 of Pub. 
L. 108-173, provides for an increase in the wage index for hospitals 
located in certain counties that have a relatively high percentage 
of hospital employees who reside in the county, but work in a 
different area with a higher wage index. Hospitals located in 
counties that qualify for the payment adjustment are to receive an 
increase in the wage index that is equal to a weighted average of 
the difference between the wage index of the resident county and the 
higher wage index work area(s), weighted by the overall percentage 
of workers who are employed in an area with a higher wage index. 
Using our established criteria, 321 counties and 586 hospitals 
qualify to receive a commuting adjustment in FY 2007.
    Due to the statutory formula to calculate the adjustment and the 
small number of counties that qualify, the impact on hospitals is 
minimal, with an overall impact on all hospitals of 0.1 percent.

K. Effects of All Changes (Column 10)

    Column 10 compares our estimate of payments per case, 
incorporating all changes reflected in this proposed rule for FY 
2007 (including statutory changes), to our estimate of payments per 
case in FY 2006. This column includes all of the proposed policy 
changes. Column 10 reflects all FY 2007 changes relative to FY 2006, 
shown in Columns 2 through 9 and those not applied until the final 
rates are calculated. The average increase for all hospitals is 
approximately 3.4 percent. This increase includes the effects of the 
3.4 percent market basket update. It also reflects the 0.4 
percentage point difference between the projected outlier payments 
in FY 2006 (5.1 percent of total DRG payments) and the current 
estimate of the percentage of actual outlier payments in FY 2006 
(4.7 percent), as described in the introduction to this Appendix and 
the Addendum to this proposed rule. As a result, payments are 
projected to be 0.4 percentage points lower in FY 2006 than 
originally estimated, resulting in a 0.4 percentage point greater 
increase for FY 2007 than would otherwise occur. In addition, the 
impact of section 505 adjustments accounted for a 0.1 percent 
increase. Indirect medical education formula changes for teaching 
hospitals under section 502 of Pub. L. 108-173, changes in payments 
due to the difference between the FY 2006 and FY 2007 wage index 
values assigned to providers reclassified under section 508 of Pub. 
L. 108-173, and changes in the incremental increase in payments from 
section 505 of Pub. L. 108-173 out-migration adjustments account for 
the remaining -0.5 percent.
    There might also be interactive effects among the various 
factors comprising the payment system that we are not able to

[[Page 24411]]

isolate. For these reasons, the values in Column 10 may not equal 
the product of the percentage changes described above.
    The overall change in payments per case for hospitals in FY 2007 
would increase by 3.4 percent. Hospitals in urban areas would 
experience a 3.0 percent increase in payments per case compared to 
FY 2006. Hospitals in large urban areas would experience a 3.4 
percent increase in payments and hospitals in other urban areas 
would experience a 2.5 percent increase in payments. Hospitals in 
rural areas, meanwhile, would experience a 6.7 percent payment 
increase.
    Among urban census divisions, the largest payment increases 
would be 4.6 percent in the Pacific region and 5.0 percent in Puerto 
Rico. The smallest urban increase would occur in the West North 
Central region, with an increase of 2.1 percent.
    Among rural regions in Column 10, no hospital category would 
experience overall payment decreases. The New England and Middle 
Atlantic regions would benefit the most, with 7.7 percent increases. 
The smallest increase would occur in the Mountain region, with a 5.6 
percent increase in payments.
    Among special categories of rural hospitals in Column 10, MDH/
RRC providers receive an increase in payments of 17.5 percent and 
MDH providers receive an increase of 14.6 percent, primarily due to 
the changes to MDH payments set forth in section 5003 of Pub. L. 
109-171. SCHs also see a positive increase of 7.5 percent.
    Urban hospitals reclassified for the first half of FY 2007 are 
anticipated to receive an increase of 3.1 percent, while urban 
hospitals that reclassified for the second half of FY 2007 are 
expected to receive an increase of 3.2 percent. The same set of 
rural hospitals is reclassified for the first and second half of FY 
2007. Rural hospitals reclassifying for the entire year of FY 2007 
are anticipated to receive a 5.3 percent payment increase. Those 
hospitals located in rural counties, but deemed to be urban under 
section 1886(d)(8)(B) of the Act are expected to receive an increase 
in payments of 8.7 percent. Hospitals that were reclassified under 
section 508 of Pub. L. 108-173, which is only effective through 
March 31, 2007, are expected to receive an increase of 0.6 percent. 
This is due in large part to the fact that the 508 wage index is 
only in effect for 6 months of FY 2007. Of the 95 section 508 
providers listed in this row, 28 have a reduction in their FY 2007 
blended final wage index (relative to their FY 2006 final wage 
index) of between 5 and 10 percent while 55 others have a reduction 
of 0 to 5 percent in their wage index values.

L. Effects of Policy on Payment Adjustments for Low-Volume 
Hospitals

    For FY 2007, we are proposing to continue to apply the volume 
adjustment criteria we specified in the FY 2005 IPPS final rule (69 
FR 49099). We expect that two providers would receive the low-volume 
adjustment for FY 2007. We estimate the impact of these providers 
receiving the additional 25-percent payment increase to be 
approximately $90,000.

M. Impact Analysis of Table II

    Table II presents the projected impact of the proposed changes 
for FY 2007 for urban and rural hospitals and for the different 
categories of hospitals shown in Table I. It compares the estimated 
payments per case for FY 2006 with the average estimated per case 
payments for FY 2007, as calculated under our models. Thus, this 
table presents, in terms of the average dollar amounts paid per 
discharge, the combined effects of the changes presented in Table I. 
The percentage changes shown in the last column of Table II equal 
the percentage changes in average payments from Column 10 of Table 
I.

 Table II.--Impact Analysis of Changes for FY 2007 Operating Prospective
                             Payment System
                           [Payments Per Case]
------------------------------------------------------------------------
                                          Average    Average
                                          FY 2006    FY 2007     All FY
                              Number of   payment    payment      2007
                              hospitals   per case   per case   changes;
                                            \1\        \1\
                                    (1)        (2)        (3)        (4)
------------------------------------------------------------------------
All hospitals...............      3,522      8,529      8,820        3.4
By Geographic Location:
    Urban hospitals.........      2,517      8,933      9,201        3.0
    Large urban areas             1,391      9,335      9,652        3.4
     (populations over 1
     million)...............
    Other urban areas             1,126      8,449      8,657        2.5
     (populations of 1
     million or fewer)......
    Rural hospitals.........      1,005      6,268      6,685        6.7
    Bed Size (Urban):
        0-99 beds...........        590      6,736      7,015        4.1
        100-199 beds........        865      7,465      7,856        5.2
        200-299 beds........        482      8,377      8,666        3.4
        300-499 beds........        414      9,437      9,647        2.2
        500 or more beds....        166     11,294     11,470        1.6
    Bed Size (Rural):
        0-49 beds...........        349      5,285      5,817       10.1
        50-99 beds..........        366      5,669      6,199        9.3
        100-149 beds........        179      6,218      6,604        6.2
        150-199 beds........         64      7,053      7,351        4.2
        200 or more beds....         47      7,871      8,102        2.9
    Urban by Region:
        New England.........        127      9,406      9,706        3.2
        Middle Atlantic.....        353      9,735     10,026        3.0
        South Atlantic......        381      8,483      8,702        2.6
        East North Central..        388      8,555      8,815        3.0
        East South Central..        163      8,252      8,460        2.5
        West North Central..        156      8,681      8,860        2.1
        West South Central..        350      8,447      8,663        2.6
        Mountain............        143      8,872      9,140        3.0
        Pacific.............        404     10,705     11,193        4.6
        Puerto Rico.........         52      4,187      4,395        5.0
    Rural by Region:
        New England.........         19      8,209      8,838        7.7
        Middle Atlantic.....         72      6,283      6,766        7.7
        South Atlantic......        175      6,057      6,477        6.9
        East North Central..        125      6,482      6,860        5.8
        East South Central..        181      6,013      6,396        6.4

[[Page 24412]]

 
        West North Central..        118      6,460      6,864        6.3
        West South Central..        191      5,730      6,137        7.1
        Mountain............         80      6,723      7,099        5.6
        Pacific.............         44      7,707      8,278        7.4
By Payment Classification:
    Urban hospitals.........      2,539      8,916      9,185        3.0
    Large urban areas             1,400      9,321      9,639        3.4
     (populations over 1
     million)...............
    Other urban areas             1,139      8,426      8,636        2.5
     (populations of 1
     million or fewer)......
    Rural areas.............        983      6,317      6,732        6.6
    Teaching Status:
        Non-teaching........      2,449      7,131      7,475        4.8
        Fewer than 100              836      8,634      8,857        2.6
         Residents..........
        100 or more                 237     12,590     12,857        2.1
         Residents..........
    Urban DSH:
        Non-DSH.............        854      7,716      7,915        2.6
        100 or more beds....      1,513      9,398      9,691        3.1
        Less than 100 beds..        333      6,217      6,664        7.2
    Rural DSH:
        SCH.................        383      5,860      6,371        8.7
        RRC.................        196      7,013      7,338        4.6
        Other Rural:........
        100 or more beds....         55      5,729      6,144        7.2
        Less than 100 beds..        188      5,140      5,606        9.1
    Urban teaching and DSH:
        Both teaching and           809     10,329     10,590        2.5
         DSH................
        Teaching and no DSH.        198      8,614      8,752        1.6
        No teaching and DSH.      1,037      7,624      7,982        4.7
        No teaching and no          495      7,246      7,446        2.8
         DSH................
    Rural Hospital Types:
        Non special status          288      5,367      5,807        8.2
         hospitals..........
        RRC.................        140      6,982      7,282        4.3
        SCH.................        341      6,079      6,535        7.5
        MDH.................        126      5,245      6,012       14.6
        SCH and RRC.........         80      7,261      7,562        4.1
        MDH and RRC.........          8      6,483      7,619       17.5
    Type of Ownership:
        Voluntary...........      2,087      8,658      8,930        3.1
        Proprietary.........        831      7,734      8,023        3.7
        Government..........        604      8,783      9,192        4.7
    Medicare Utilization as
     a Percent of Inpatient
     Days:
        0-25................        252     12,185     12,897        5.8
        25-50...............      1,302      9,712      9,982        2.8
        50-65...............      1,490      7,458      7,745        3.9
        Over 65.............        459      6,668      6,940        4.1
        Unknown.............         19      6,427      6,956        8.2
Hospitals Reclassified by
 the Medicare Geographic
 Classification Review
 Board: FY 2005
 Reclassifications..........
Urban Hospitals Reclassified        319      8,750      9,024        3.1
 by the Medicare Geographic
 Classification Review
 Board: First Half FY 2007
 Reclassifications..........
Urban Nonreclassified, First      2,119      8,933      9,212        3.1
 Half FY 2007...............
All Urban Hospitals                 339      8,746      9,027        3.2
 Reclassified Second Half FY
 2007.......................
Urban Nonreclassified             2,099      8,935      9,213        3.1
 Hospitals Second Half FY
 2007.......................
All Rural Hospitals                 385      6,782      7,143        5.3
 Reclassified Second Half FY
 2007.......................
Rural Nonreclassified               604      5,616      6,108        8.8
 Hospitals Second Half FY
 2007.......................
All Section 401 Reclassified         38      6,945      7,580        9.2
 Hospitals..................
Other Reclassified Hospitals         54      5,871      6,380        8.7
 (Section 1886(d)(8)(B))....
Section 508 Hospitals.......         95      9,341      9,401        0.6
------------------------------------------------------------------------
\1\ These payment amounts per case do not reflect any estimates of
  annual case-mix increase.

VII. Effects of Other Proposed Policy Changes

    In addition to those proposed changes discussed above that we 
are able to model using our IPPS payment simulation model, we are 
making various other changes in this proposed rule. Generally, we 
have limited or no specific data available with which to estimate 
the impacts of these changes. Our estimates of the likely impacts 
associated with these other changes are discussed below.

[[Page 24413]]

A. Effects of LTC-DRG Reclassifications and Relative Weights for 
LTCHs

    In section II.F. of the preamble to this proposed rule, we 
discuss the proposed changes in the LTC-DRG relative weights for FY 
2007, which are based on the proposed version 24.0 of the CMS 
GROUPER (including the proposed changes in the classifications, 
relative weights and geometric mean length of stay for each LTC-
DRG). As also discussed in that same section of this proposed rule, 
currently, there is no statutory or regulatory requirement that the 
annual update to the LTC-DRG classifications and relative weights be 
done in a budget neutral manner. As discussed in the FY 2006 IPPS 
final rule (70 FR 47701), the LTCH PPS is still in the midst of a 
transition from a reasonable cost-based payment system to fully 
Federal PPS payments, during which time LTCH coding and data are 
still in flux.
    The LTCH PPS was implemented for cost reporting periods 
beginning on or after October 1, 2002 (FY 2003). Therefore, the FY 
2005 MedPAR data used to compute the proposed FY 2007 LTC-DRG 
relative weights are based on LTCH claims data taken from only the 
second full year of the LTCH PPS. Based on LTCH cases in the 
December 2005 update of the FY 2005 MedPAR files, we estimate that 
the proposed changes to the LTC-DRG classifications and relative 
weights for FY 2007 would result in an aggregate decrease in LTCH 
PPS payments of approximately 1.4 percent based on the data from the 
363 LTCHs in our database. (We note that this estimated aggregate 
decrease in LTCH PPS payments of approximately 1.4 percent was 
determined based on the current payment rates and policies 
established in the RY 2006 LTCH PPS final rule (70 FR 24168 through 
24261, May 6, 2005) and do not include any proposed policy or 
changes presented in the RY 2007 LTCH PPS proposed rule (71 FR 4648-
4779, January 27, 2006).)
    When we compared the GROUPER Version 23.0 (FY 2006) LTC-DRG 
relative weights to the proposed GROUPER Version 24.0 (FY 2007) 
proposed LTC-DRG relative weights, we found that approximately 62 
percent of the LTC-DRGs would have a higher relative weight under 
Version 23.0, while the remaining approximately 38 percent of the 
LTC-DRGs would have a higher relative weight under Version 24.0. We 
also found that, based on FY 2005 LTCH cases, the GROUPER Version 
23.0 LTC-DRG relative weights were, on average, approximately 3.1 
percent higher than the proposed GROUPER Version 24.0 LTC-DRG 
relative weights. In addition, based on an analysis of the most 
recent available LTCH claims data from the FY 2005 MedPAR file, we 
continue to observe that the average proposed LTC-DRG relative 
weight decreases due to an increase of relatively lower charge cases 
being assigned to LTC-DRGs with higher relative weights in the prior 
year.
    Contributing to this increase in these relatively lower charge 
cases being assigned to proposed LTC-DRGs with higher relative 
weights in the prior year are improvements in coding practices, 
which are typical when moving from a reasonable cost-based payment 
system to a PPS. The impact of including additional cases with 
relatively lower charges into LTC-DRGs that had a relatively higher 
relative weight in the GROUPER Version 23.0 (FY 2006) is a decrease 
in the average relative weight for those LTC-DRGs in the proposed 
GROUPER Version 24.0. As noted above in section II.F. of the 
preamble to this proposed rule, LTCHs are a specialized provider 
type that typically do not treat a broad spectrum of patients in 
their facilities with many different diagnoses. While there are 526 
valid proposed GROUPER Version 24.0 LTC-DRGs, 191 LTC-DRGs have no 
LTCH cases. In addition, another 173 LTC-DRGs are categorized as 
``low volume'' (that is, have less than 25 cases annually). 
Consequently, only about 162 LTC-DRGs are used by most LTCHs on a 
``regular basis'' (that is, nationally LTCHs discharge, in total, an 
average of 25 or more of these cases annually).
    Of these 162 LTC-DRGs that are used on a ``regular basis,'' we 
found that approximately 60 percent of the LTC-DRGs would have 
higher relative weights under GROUPER Version 23.0 in comparison to 
proposed GROUPER Version 24.0, and the remaining 40 percent of the 
162 LTC-DRGs that are used on a ``regular basis'' would have higher 
relative weights under proposed GROUPER Version 24 in comparison to 
GROUPER Version 23.0. In addition, about 25 percent of the 162 LTC-
DRGs that are used on a ``regular basis'' would experience a 
decrease in the average charge per case as compared to the average 
charge per case in that DRG based on FY 2004 data, which generally 
results in a lower relative weight. Moreover, of the162 LTC-DRGs 
that are used on a ``regular basis,'' approximately 63 percent of 
those LTC-DRGs would experience a change in the average charge per 
case from FY 2004 LTCH data as compared to FY 2005 LTCH data that is 
less than the increase in overall average LTCH charges across all 
LTC-DRGs from FY 2004 to FY 2005 of about 8.3 percent. Accordingly, 
those LTC-DRGs would also have a proposed reduction in their 
relative weight as compared to the relative weight in FY 2006. For 
those LTC-DRGs in which the average charge within the LTC-DRG 
increase is less than 8.3 percent, the proposed relative weights for 
those LTC-DRGs would decrease because the average charge for each of 
those LTC-DRGs is being divided by a larger number (that is, the 
average charge across all LTC-DRGs). For the reasons discussed 
above, we believe that the proposed changes in the LTC-DRG relative 
weights, which include a significant number of LTC-DRGs with lower 
proposed relative weights, would result in approximately a 1.4 
percent decrease in estimated aggregate LTCH PPS payments.

B. Effects of Proposed New Technology Add-On Payments

    In section II.G. of the preamble to this proposed rule, we 
discuss proposed add-on payments for new medical services and 
technologies. As explained in that section, we are no longer 
required to ensure that any add-on payments for new technology under 
section 1886(d)(5)(K) of the Act are budget neutral. However, we are 
still providing an estimate of the payment increases here, as they 
will have an impact on total payments made in FY 2007. New 
technology add-on payments are limited to the lesser of 50 percent 
of the costs of the technology, or 50 percent of the costs in excess 
of the DRG payment for the case. Because it is difficult to predict 
the actual new technology add-on payment for each case, we are 
estimating the increase in payment for FY 2007 as if every claim 
with these add-on payments will receive the maximum add-on payment. 
As discussed in section II.G. of the preamble to this proposed rule, 
we are not proposing to approve any of the new technology 
applications that were filed for FY 2007 for new technology add-on 
payment at this time.
    However, we are proposing to continue to make add-on payments in 
FY 2007 for two technologies that were approved for FY 2006 new 
technology add-on payments: Restore[reg] Rechargeable Implantable 
Neurostimulator and GORE TAG. We estimate these payments for these 
technologies will increase overall FY 2007 payments by $6.01 million 
and $16.61 million, respectively. The total increase in payments for 
these two new technologies, approximately $22.6 million, is not 
reflected in the tables.

C. Effects of Requirements for Hospital Reporting of Quality Data 
for Annual Hospital Payment Update

    In section IV.A. of the preamble to this proposed rule, we 
discuss new requirements for hospital reporting of quality data 
based on our continuing experience with this program and recent 
legislation. Section 5001(a) of Pub. L. 109-171 (DRA) sets out 
extensive new requirements for the Reporting Hospital Quality Data 
for Annual Payment Update (RHQDAPU) program. The RHQDAPU program was 
established to implement section 501(b) of Pub. L. 108-173 (MMA). 
Section 5001(a) of Pub. L. 109-171 revised the mechanism used to 
update the standardized amount for payment for hospital inpatient 
operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the 
Act provide that the payment update for FY 2007 and each subsequent 
fiscal year will be reduced by 2.0 percentage points for any 
``subsection (d) hospital'' that does not submit certain quality 
data in a form and manner, and at a time, specified by the 
Secretary.
    We have modeled the payment impact of this change in Table 1 of 
this Appendix, and discussed it in section VI. of this Appendix. We 
discuss other policy changes we propose to make to the RHQDAPU 
program in section IV.A. of the preamble to this proposed rule.
    We also note that, for the FY 2007 payment update, hospitals 
must pass our validation requirement of a minimum of 80 percent 
reliability, based upon our chart-audit validation process, for the 
first three quarters of data from CY 2005. These data were due to 
the QIO Clinical Warehouse by July 15, 2005 (first quarter CY 2005 
discharges), November 15, 2005 (second quarter CY 2005 discharges), 
and February 15, 2005 (third quarter CY 2005 discharges). We have 
continued our efforts to ensure that QIOs provide assistance to all 
hospitals that wish to submit data. In the preamble of this

[[Page 24414]]

proposed rule, we are providing additional validation criteria to 
ensure that the quality data being sent to CMS are accurate. The 
requirement of 5 charts per hospital will result in approximately 
19,000 charts per quarter total submitted to the agency. We 
reimburse hospitals for the cost of sending charts to the Clinical 
Data Abstraction Center (CDAC) at the rate of 12 cents per page for 
copying and approximately $4.00 per chart for postage. Our 
experience shows that the average chart received at the CDAC is 
approximately 140 pages. Thus, the agency will have expenditures of 
approximately $380,000 per quarter to collect the charts. Given that 
we reimburse for the data collection effort, we believe that a 
requirement for five charts per hospital per quarter represents a 
minimal burden to the participating hospital.

D. Effects of Other Proposed Policy Changes Affecting Sole 
Community Hospitals (SCHs) and Medicare-Dependent, Small Rural 
Hospitals (MDHs)

    In section IV.C. of the preamble to this proposed rule, we 
discuss the payment changes for MDHs made by section 5003 of Pub. L. 
109-171. We modeled the payment impact of these changes in Table 1 
of this Appendix and discussed them in section VI. of this Appendix.
    In addition, in section IV.C.2. of the preamble to this proposed 
rule, we discussed a proposed change to the data source and 
methodology that we would use to compute the volume decrease 
adjustment for MDHs and SCHs. If certain requirements are met, this 
adjustment may be made if the hospital's total discharges decrease 
by more than 5 percent from one cost reporting period to the next. 
We do not believe that these proposed changes, which would not take 
effect until FY 2008, will have any significant impact on Medicare 
payment to these hospitals.

E. Effects of Proposed Policy on Payment for Direct Costs of 
Graduate Medical Education

1. Determination of Weighted Average GME PRAs for Merged Teaching 
Hospitals

    In section IV.H.2. of the preamble to this proposed rule, we 
discuss our proposed changes related to determining the weighted 
average GME PRA for a merged teaching hospital. Our current policy 
is that when two or more teaching hospitals merge, we determine a 
weighted PRA for the surviving merged hospital using GME costs and 
resident data from the base year cost report for each teaching 
hospital in the merger. We are proposing to revise our policy to 
determine a merged teaching hospital's PRA by using PRA data and FTE 
resident data from the most recent settled cost reports of the 
merging hospitals, rather than using the direct GME cost data from 
the hospitals' base year cost report. This proposed policy revision 
is administrative in nature, and we do not foresee that the proposed 
revision would result in payment increases to merged teaching 
hospitals.

2. Determination of PRAs for New Teaching Hospitals

    In section IV.H.3. of the preamble to this proposed rule, we 
discuss the methodology for determining the hospital-specific PRA 
for new teaching hospitals and propose to make a change to the 
existing regulations at Sec.  413.77(e) in order to specify a base 
period for certain situations, that is, for new teaching hospitals 
that did not have residents on duty during the first month of the 
cost reporting period in which the hospital became a new teaching 
hospital. The proposed base period for these hospitals would be the 
next cost reporting period following the cost reporting period where 
any residents were on duty at the new teaching hospital. Because 
this proposed change is administrative in nature, we do not foresee 
that it would result in a financial impact for FY 2007.

3. Requirements for Counting and Appropriate Documentation of FTE 
Residents

    In section IV.H.4. of the preamble to this proposed rule, we are 
proposing to clarify the policies that apply in determining 
hospitals' FTE resident counts for Medicare GME payment purposes. 
Because this is a clarification of existing policy, there is no 
financial impact for FY 2007.

4. Resident Time Spent in Nonpatient Care Activities as Part of an 
Approved Residency Program

    In section IV.H.5. of the preamble to this proposed rule, we are 
proposing to clarify our policy that, with respect to residency 
training in nonhospital settings, only the time residents spend in 
patient care activities may be counted for purposes of direct GME 
and IME payments; and with respect to training in the hospital, 
residents training in all areas of the hospital complex may be 
counted for direct GME purposes, but may only be counted for IME 
purposes if the residents are furnishing patient care. Because we 
are proposing to clarify existing policy, there is no financial 
impact of this proposed clarification for FY 2007.

F. Effects of Proposed Policy Changes Relating to Emergency 
Services Under EMTALA

    In section IV.J. of the preamble to this proposed rule, we 
discuss several proposed policy changes under the EMTALA 
requirements. We are proposing to clarify that any participating 
hospital with specialized capabilities or facilities, even if it 
does not have a dedicated emergency department, may not refuse to 
accept an appropriate transfer if the hospital has the capacity to 
treat the individual. We note that this proposed revision does not 
reflect any change in current CMS policy. We further note that the 
revision would not require hospitals without dedicated emergency 
departments to open dedicated emergency departments nor would it 
impose any EMTALA obligation on these hospitals with respect to 
individuals who come to the hospital as their initial point of entry 
into the medical system seeking a medical screening examination or 
treatment for a medical condition. Thus, there would be no impact on 
Medicare payment policies or practices.
    In addition, we are proposing to modify the definition of 
``labor'' to state that a woman experiencing contractions is in true 
labor unless a physician, certified nurse-midwife, or other 
qualified medical person acting within his or her scope of practice 
as defined in hospital medical staff bylaws and State law, certifies 
that, after a reasonable time of observation, the woman is in false 
labor. The effect of this change would be to have a single, uniform 
policy on the personnel who are authorized to make a determination 
as to whether an individual has an emergency medical condition. This 
proposal would have a Medicare payment effect, if any, only on 
payments to physicians and nonphysician practitioners under the 
physician fee schedule. The amount of any impact would be negligible 
because only a very small number of Medicare beneficiaries are women 
of childbearing age.

G. Effects of Policy on Rural Community Hospital Demonstration 
Program

    In section IV.L. of the preamble to this proposed rule, we 
discuss our implementation of section 410A of Pub.L. 108-173 that 
required the Secretary to establish a demonstration that will modify 
reimbursement for inpatient services for up to 15 small rural 
hospitals. Section 410A(c)(2) requires that ``in conducting the 
demonstration program under this section, the Secretary shall ensure 
that the aggregate payments made by the Secretary do not exceed the 
amount which the Secretary would have paid if the demonstration 
program under this section was not implemented.'' As discussed in 
section IV.L. of the preamble to this proposed rule, we are 
satisfying this requirement by adjusting national IPPS rates by a 
factor that is sufficient to account for the added costs of this 
demonstration. We estimate that the average additional annual 
payment for FY 2007 that will be made to each participating hospital 
under the demonstration will be approximately $1,021,985. We based 
this estimate on the recent historical experience of the difference 
between inpatient cost and payment for hospitals that are 
participating in the demonstration. For the 9 participating 
hospitals, the total annual impact of the demonstration program is 
estimated to be $9,197,870. The proposed adjustment factor to the 
Federal rate used in calculating Medicare inpatient prospective 
payments as a result of the demonstration is 0.999905.

H. Effects of Proposed Policy on Hospitals-Within-Hospitals and 
Satellite Facilities

    In section VI.A.5. of the preamble to this proposed rule, we 
discuss our proposal to revise the regulations for grandfathered 
HwHs, grandfathered hospital satellites and grandfathered satellite 
units at Sec. Sec.  412.22(f), 412.22(h)(3), and 412.25(e)(3), 
respectively, to allow these facilities to reduce their square 
footage or number of beds without jeopardizing their grandfathered 
status. We also discuss our proposal to revise the HwH provision at 
Sec.  412.22(f)(3) that would allow for increases or decreases in 
square footage, or decreases in the number of beds of the HwH that 
are made necessary by the relocation of a hospital in order to 
permit construction or renovation necessary to comply with Federal, 
State, or local law affecting the physical facility or because of 
catastrophic events such as fires, floods, earthquakes, or 
tornadoes.

[[Page 24415]]

    Because we are proposing to allow these currently grandfathered 
HwHs, hospital satellites and satellite units to retain their 
grandfathered status if they reduce their square footage or number 
of beds, there would be no effect on the treatment of such hospitals 
as a result of this proposal. Because payments to HwHs and 
satellites are made on a per discharge basis (either under a PPS or 
under reasonable cost principles), if grandfathered HwHs and 
satellites were to reduce their size in the event this proposal is 
implemented, the effect of this change would likely be a reduction 
in Medicare payments to such hospitals and satellites because they 
would probably have fewer discharges. However, we cannot predict 
which HwHs or satellite facilities will opt to decrease their size 
or bed numbers nor can we predict the conditions under which HwHs 
would have to seek CMS approval for changes in the terms and 
conditions of their present construction or renovation of square 
footage or bed numbers made necessary by relocation of a hospital to 
permit compliance with Federal, State or local law affecting the 
physical facility or because of catastrophic events, and therefore, 
we are unable to quantify the impact of these proposed changes.

I. Effects of Proposed Policy Changes to the Methodology for 
Determining LTCH CCRs and the Reconciliation of LTCH PPS Outlier 
Payments

    In section VI.A.6. of the preamble to this proposed rule, we 
discuss our proposal to revise and clarify the existing policies 
governing the determination of LTCHs' CCRs and the reconciliation of 
high-cost and short-stay outlier payments under the LTCH PPS. Under 
the LTCH PPS high-cost outlier and short-stay outlier policies, CCRs 
are used to determine the estimated cost of the case by multiplying 
the LTCH's overall CCR by the Medicare allowable charges for the 
case.
    In that section, specifically, we present our proposal to revise 
our methodology for determining the annual LTCH CCR ceiling. Based 
on the most recent complete IPPS total CCR data, we are proposing a 
total CCR ceiling of 1.313 under the LTCH PPS effective October 1, 
2006. This proposed ceiling was determined based on the same data 
used to determine the separate proposed IPPS operating CCR ceiling 
(1.25) and proposed IPPS capital CCR ceiling (0.158). The LTCH CCR 
ceiling determined under our current ``combined'' methodology would 
result in a slightly higher LTCH CCR ceiling (that is, 1.25 + 0.158 
= 1.408) for FY 2007 compared to the proposed ``total'' CCR ceiling 
of 1.313 for FY 2007. However, we note that, based on the most 
recent complete IPPS and LTCH CCR data, there are no LTCHs that 
currently have a CCR that is greater than the proposed ceiling of 
1.313 (the highest LTCH CCR in the database of 363 LTCHs is 1.132). 
Therefore, based on these data, because no LTCHs currently have a 
CCR that is in excess of the proposed LTCH CCR ceiling, we believe 
that there would be no significant impact on LTCH PPS payments based 
on this proposed policy.
    Also in section VI.A.6. of the preamble to this proposed rule, 
we discuss our proposal to revise our methodology for determining 
the applicable statewide average LTCH CCRs. Based on the most recent 
complete IPPS total CCR data, the proposed LTCH PPS statewide 
average CCRs that would be effective October 1, 2006, are presented 
in Table 8C of the Addendum to this proposed rule. A comparison of 
the proposed statewide average total CCRs in Table 8C of the 
Addendum to this proposed rule to the ``combined'' statewide average 
CCRs that would be calculated under our existing methodology from 
the proposed operating PPS statewide average CCRs in Table 8A of the 
Addendum to this proposed rule and the proposed capital PPS 
statewide average CCRs in Table 8B of the Addendum to this proposed 
rule shows that the proposed changes to our methodology for 
determining LTCH statewide average CCRs would result in minor 
changes in the average CCR for each state. In particular, the 
largest decrease in a statewide average CCR (with the exception of 
Maryland, which would be assigned the national average total CCR as 
discussed in section VI.A.6 of the preamble of this proposed rule) 
would be in urban Indiana (-1.9 percent), and there are currently no 
LTCHs located in Indiana. The largest increase in a statewide 
average CCR would be in urban District of Columbia (2.8 percent), 
and there are currently only two LTCHs located in the District of 
Columbia. Thus, we believe that the proposed change in the 
methodology for determining the applicable statewide average LTCH 
CCRs would result in no significant impact on LTCH PPS payments.
    In addition, in section VI.A.6 of the preamble of this proposed 
rule we discussed our proposal to codify in Subpart O of 42 CFR Part 
412 the provisions governing the determination of LTCHs' CCRs and 
the reconciliation of high cost and short-stay outlier payments 
under the LTCH PPS, including proposed modifications and editorial 
clarifications to our existing methodology. These proposals are 
similar or almost identical (except for the minor clarifications and 
modifications) to our current policy governing the determination of 
LTCHs' CCRs and the reconciliation of high cost and short-stay 
outlier payments under the LTCH PPS, and therefore, there would be 
no expected impact if such policies were codified.

J. Effects of Proposed Policy on Payment for Services Furnished 
Outside the United States

    In section VII. of the preamble to this proposed rule, we 
discuss our proposed clarification of our regulations regarding 
payment for Medicare services furnished outside the United States. 
The clarification proposes to revise references in our regulations 
that could be read to limit Medicare payment for certain services 
furnished outside the United States to services furnished in Canada 
or Mexico, contrary to the provisions of the Act. Only a small 
fraction of Medicare claims are paid as a result of services 
furnished outside of the United States. Moreover, we are unaware of 
any claims for payment that would otherwise satisfy the requirements 
under the Act that have not been paid due to the language in our 
current regulations. Therefore, because we are proposing to clarify 
existing policy, this proposed clarification has little or no 
financial impact for FY 2007.

K. Effects of Proposed Policy on Limitation on Payments to SNFs

    In section IX. of the preamble to this proposed rule, we discuss 
our proposed implementation of section 5004 of Pub. L. 109-171, 
which mandated that, for cost reporting periods beginning on or 
after October 1, 2005, Medicare payments to SNFs for certain 
otherwise allowable debt amounts attributable to the coinsurance 
amounts for patients who are not full-benefit dual eligible 
individuals be reduced by 30 percent. We anticipate that the 
provisions of section 5004 of Pub. L. 109-171 will result in a 
decrease in payments to SNFs of $490 million over the 5-year period 
from FY 2006 to FY 2010.

VIII. Impact of Proposed Changes in the Capital PPS

A. General Considerations

    Fiscal year (FY) 2001 was the last year of the 10-year 
transition period established to phase in the PPS for hospital 
capital-related costs. During the transition period, hospitals were 
paid under one of two payment methodologies: fully prospective or 
hold harmless. Under the fully prospective methodology, hospitals 
were paid a blend of the capital Federal rate and their hospital-
specific rate (see Sec.  412.340). Under the hold-harmless 
methodology, unless a hospital elected payment based on 100 percent 
of the capital Federal rate, hospitals were paid 85 percent of 
reasonable costs for old capital costs (100 percent for SCHs) plus 
an amount for new capital costs based on a proportion of the capital 
Federal rate (see Sec.  412.344). As we state in section V. of the 
preamble of this proposed rule, with the 10-year transition period 
ending with hospital cost reporting periods beginning on or after 
October 1, 2001 (FY 2002), beginning in FY 2002 capital prospective 
payment system payments for most hospitals are based solely on the 
capital Federal rate. Therefore, we no longer include information on 
obligated capital costs or projections of old capital costs and new 
capital costs, which were factors needed to calculate payments 
during the transition period, for our impact analysis.
    In accordance with Sec.  412.312, the basic methodology for 
determining a capital PPS payment is:
    (Standard Federal Rate) x (DRG weight) x (Geographic Adjustment 
Factor (GAF)) x (Large Urban Add-on, if applicable) x (COLA for 
hospitals located in Alaska and Hawaii) x (1 + Disproportionate 
Share (DSH) Adjustment Factor + Indirect Medical Education (IME) 
Adjustment Factor, if applicable).
    In addition, hospitals may also receive outlier payments for 
those cases that qualify under the threshold established for each 
fiscal year.
    The data used in developing the impact analysis presented below 
are taken from the December 2005 update of the FY 2005 MedPAR file 
and the December 2005 update of the Provider-Specific File that is 
used for payment purposes. Although the analyses of

[[Page 24416]]

the changes to the capital prospective payment system do not 
incorporate cost data, we used the December 2005 update of the most 
recently available hospital cost report data (FYs 2003-2004) to 
categorize hospitals. Our analysis has several qualifications. 
First, we do not make adjustments for behavioral changes that 
hospitals may adopt in response to policy changes. Second, due to 
the interdependent nature of the IPPS, it is very difficult to 
precisely quantify the impact associated with each change. Third, we 
draw upon various sources for the data used to categorize hospitals 
in the tables. In some cases (for instance, the number of beds), 
there is a fair degree of variation in the data from different 
sources. We have attempted to construct these variables with the 
best available sources overall. However, for individual hospitals, 
some miscategorizations are possible.
    Using cases from the December 2005 update of the FY 2005 MedPAR 
file, we simulated payments under the capital PPS for FY 2006 and FY 
2007 for a comparison of total payments per case. Any short-term, 
acute care hospitals not paid under the general IPPS (Indian Health 
Service hospitals and hospitals in Maryland) are excluded from the 
simulations.
    As we explain in section III.A. of the Addendum to this proposed 
rule, payments are no longer made under the regular exceptions 
provision under Sec. Sec.  412.348(b) through (e). Therefore, we no 
longer use the actuarial capital cost model (described in Appendix B 
of the August 1, 2001 proposed rule (66 FR 40099)). We modeled 
payments for each hospital by multiplying the capital Federal rate 
by the GAF and the hospital's case-mix. We then added estimated 
payments for indirect medical education, disproportionate share, 
large urban add-on, and outliers, if applicable. For purposes of 
this impact analysis, the model includes the following assumptions:
     We estimate that the Medicare case-mix index will 
increase by 1.0 percent in both FYs 2006 and 2007.
     We estimate that the Medicare discharges will be 13.5 
million in FY 2006 and 13.1 million in FY 2007 for a 3.0 percent 
decrease from FY 2006 to FY 2007.
     The capital Federal rate was updated beginning in FY 
1996 by an analytical framework that considers changes in the prices 
associated with capital-related costs and adjustments to account for 
forecast error, changes in the case-mix index, allowable changes in 
intensity, and other factors. The proposed FY 2007 update is 0.8 
percent (see section III.A.1. of the Addendum to this proposed 
rule).
     In addition to the proposed FY 2007 update factor, the 
proposed FY 2007 capital Federal rate was calculated based on a 
proposed GAF/DRG budget neutrality factor of 1.0012, a proposed 
outlier adjustment factor of 0.9513, and a proposed exceptions 
adjustment factor of 0.9997.

B. Results

    We used the actuarial model described above to estimate the 
potential impact of our proposed changes for FY 2007 on total 
capital payments per case, using a universe of 3,522 hospitals. As 
described above, the individual hospital payment parameters are 
taken from the best available data, including the December 2005 
update of the FY 2005 MedPAR file, the December 2005 update to the 
Provider-Specific File, and the most recent cost report data from 
the December 2005 update of HCRIS. In Table III, we present a 
comparison of total payments per case for FY 2006 compared to FY 
2007 based on the proposed FY 2007 payment policies. Column 2 shows 
estimates of payments per case under our model for FY 2006. Column 3 
shows estimates of payments per case under our model for FY 2007. 
Column 4 shows the total percentage change in payments from FY 2006 
to FY 2007. The change represented in Column 4 includes the proposed 
0.8 percent update to the capital Federal rate, a proposed 0.0 
percent increase in case-mix, proposed changes in the adjustments to 
the capital Federal rate (for example, the effect of the proposed 
hospital wage index on the GAF), and reclassifications by the MGCRB. 
The comparisons are provided by: (1) Geographic location; (2) 
region; and (3) payment classification.
    The simulation results show that, on average, capital payments 
per case can be expected to increase 2.0 percent in FY 2007. In 
addition to the 0.8 percent increase due to the capital market 
basket update, this projected increase in capital payments per case 
is largely attributable to the proposed change in the DRG 
recalibration process methodology for FY 2007 as discussed in 
section II.C. of the preamble, and to a lesser extent, an estimated 
increase in capital PPS outlier payments. The results of our 
comparisons by geographic location and by region are indicative of 
the results we expected after applying the proposed changes to the 
DRG recalibration methodology.
    The geographic comparison shows that urban hospitals are 
expected to experience a 1.7 percent increase in IPPS capital 
payments per case, while rural hospitals are expected to experience 
a 4.6 percent increase in capital payments per case. This difference 
is mostly due to the proposed changes to the methodology used to 
recalibrate DRGs discussed in section II.C. of the preamble of this 
proposed rule. As discussed in greater detail in that section of 
this proposed rule, analysis of our current methodology for setting 
DRG weights (using gross charges) indicates that bias is introduced 
into the weighting process. Specifically, we have also observed that 
ancillary service cost centers, in general, have higher charge 
markups than routine and ICU service cost centers, and therefore, 
higher weights for DRGs that use more ancillary services as opposed 
to DRGs that use more routine services. Surgical DRGs tend to have 
charges concentrated in ancillary cost center groups while medical 
DRGs tend to have charges concentrated in routine or ICU cost center 
groups. The bias in our current methodology results in artificially 
higher DRG relative weights for hospitals that are generally more 
expensive, such as teaching hospitals and specialty hospitals. 
Hospitals with these characteristics are generally found in urban 
locations.
    Since the proposed HSRVcc weighting methodology (discussed in 
section II.C. of the preamble of this proposed rule) would adjust 
the weights to remove differential markups in charges, the proposed 
FY 2007 DRG relative weights are redistributed among medical and 
surgical DRGs, which translates into a redistribution of payments 
among hospitals. For instance, hospitals that perform more surgical 
procedures (such as many urban hospitals) are likely to experience 
decreases in payments, while hospitals with heavy concentrations of 
medical DRGs (such as many rural hospitals) are expected to 
experience increases in payments as a result of this proposed change 
in our DRG recalibration methodology.
    All regions are estimated to receive an increase in total 
capital payments per case from FY 2006 to FY 2007. Changes by region 
vary from a minimum increase of 0.7 percent (West North Central 
urban) to a maximum increase of 6.1 percent (Pacific rural). As 
previously discussed, the relatively small increase in projected 
capital payments per discharge for hospitals located in the urban 
regions and the larger increase for hospitals in rural regions is 
largely attributable to the proposed changes in the DRG 
recalibration methodology. Hospitals located in Puerto Rico are 
expected to experience an increase in total capital payments per 
case of 2.4 percent. This slightly higher than average increase in 
payment per case for hospitals located in Puerto Rico is, again, 
largely due to the proposed changes in the DRG recalibration 
methodology. By type of ownership, government hospitals are 
projected to have the largest rate of increase of total payment 
changes (3.2 percent). Similarly, payments to voluntary and 
proprietary hospitals are expected to increase 1.8 percent and 2.1 
percent, respectively. As noted above, this slightly larger 
projected increase in capital payments per case for government 
hospitals is mostly due to the changes in the DRG calibration 
methodology.
    Section 1886(d)(10) of the Act established the MGCRB. Before FY 
2005, hospitals could apply to the MGCRB for reclassification for 
purposes of the standardized amount, wage index, or both. Section 
401(c) of Pub. L. 108-173 equalized the standardized amounts under 
the operating IPPS. Therefore, beginning in FY 2005, there is no 
longer reclassification for the purposes of the standardized 
amounts; however, hospitals still may apply for reclassification for 
purposes of the wage index for FY 2007. Reclassification for wage 
index purposes also affects the GAF because that factor is 
constructed from the hospital wage index.
    As discussed in section III.H.5. of the preamble of this 
proposed rule, procedural rules were established in the FY 2006 
final rule (70 FR 47382) to recognize the special circumstances of 
section 508 hospital reclassifications ending mid-year during FY 
2007. Under these procedural rules, some Sec.  1886(d)(10) hospital 
reclassifications are only in effect for the second half of the 
fiscal year. These half fiscal year reclassifications have 
implications for the calculation of reclassified wage indices and 
therefore, affect capital payments since GAF values are calculated 
from the hospital wage index.
    To present the effects of the hospitals being reclassified for 
FY 2007, we show the average

[[Page 24417]]

payments per case for reclassified hospitals for each half of FY 
2007 compared to the average payments per case for the same time 
period in FY 2006. The reclassified groups are compared to all other 
nonreclassified hospitals for the same time period. These categories 
are further identified by urban and rural designation. In general, 
the average payments per case in the first half of FY 2007 is the 
same as the average payments per case in the second half of FY 2007 
with the exception of urban reclassifications, which increases by 
0.1 percent (1.9 percent to 2.0 percent) for the second half of FY 
2007. Rural hospitals, both reclassified and non-reclassified, are 
expected to have the largest increases in payments, although rural 
non-reclassified hospitals are projected to have the greater 
increase of 6.3 percent (for both halves of FY 2007) as compared to 
the 3.5 percent increase for rural reclassified hospitals (for both 
halves of FY 2007). As explained above in this section, this larger 
than average increase in payments per case from FY 2006 to FY 2007 
for both rural reclassified and non-reclassified hospitals is mostly 
due to the redistributive effects of the proposed changes in the DRG 
recalibration methodology. Conversely, for urban hospitals, 
reclassified (urban) hospitals are projected to have increases of 
1.9 percent and 2.0 percent in the first and second halves of FY 
2007, respectively, while non-reclassified (urban) hospitals are 
projected to have a slightly lesser increase of 1.7 percent.
    As discussed in section VI.B. of the preamble of this proposed 
rule, we are proposing a technical revision to Sec.  412.316(b) and 
Sec.  412.320 to clarify that hospitals reclassified as rural under 
Sec.  412.103 are not eligible for the large urban add-on or for 
capital DSH to reflect our historic policy that hospitals 
reclassified as rural under Sec.  412.103 also are considered rural 
under capital PPS regulations. Currently, there are 38 hospitals 
that reclassified under this regulation and only 12 of these 
hospitals (about 0.3 percent of all IPPS hospitals) would be 
affected by the proposed technical revisions to sections Sec.  
412.316(b) and Sec.  412.320 concerning the treatment of hospitals 
reclassified as rural under section Sec.  412.103. Based on the most 
recent available data, we estimate that the impact of these proposed 
changes would be less than a 0.00001 percent decrease in aggregate 
IPPS payments.

                                Table III.--Comparison of Total Payments Per Case
                            [FY 2006 Payments Compared To Proposed FY 2007 Payments]
----------------------------------------------------------------------------------------------------------------
                                                                    Average FY      Average FY
                                                     Number of    2006 payments/  2007 payments/      Change
                                                     hospitals         case            case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...............................           3,522             740             755             2.0
    Large urban areas (populations over 1                  1,391             823             840             2.1
     million)...................................
    Other urban areas (populations of 1 million            1,126             729             738             1.2
     of fewer)..................................
    Rural areas.................................           1,005             512             535             4.6
    Urban hospitals.............................           2,517             780             794             1.7
        0-99 beds...............................             590             607             624             2.7
        100-199 beds............................             865             660             684             3.8
        200-299 beds............................             482             735             750             2.0
        300-499 beds............................             414             816             823             0.9
        500 or more beds........................             166             978             984             0.7
    Rural hospitals.............................           1,005             512             535             4.6
        0-49 beds...............................             349             422             454             7.6
        50-99 beds..............................             366             472             501             6.3
        100-149 beds............................             179             514             537             4.3
        150-199 beds............................              64             567             582             2.7
        200 or more beds........................              47             630             642             1.8
By Region:
    Urban by Region.............................           2,517             780             794             1.7
        New England.............................             127             831             853             2.7
        Middle Atlantic.........................             353             844             862             2.1
        South Atlantic..........................             381             746             754             1.1
        East North Central......................             388             766             781             1.9
        East South Central......................             163             713             720             0.9
        West North Central......................             156             769             775             0.7
        West South Central......................             350             729             737             1.1
        Mountain................................             143             787             799             1.6
        Pacific.................................             404             899             926             3.0
        Puerto Rico.............................              52             342             351             2.4
    Rural by Region.............................           1,005             512             535             4.6
        New England.............................              19             685             709             3.5
        Middle Atlantic.........................              72             516             539             4.5
        South Atlantic..........................             175             497             522             5.0
        East North Central......................             125             544             566             4.2
        East South Central......................             181             475             496             4.4
        West North Central......................             118             533             555             4.1
        West South Central......................             191             470             494             5.1
        Mountain................................              80             535             554             3.5
        Pacific.................................              44             615             652             6.1
By Payment Classification:
    All hospitals...............................           3,522             740             755             2.0
    Large urban areas (populations over 1                  1,400             821             839             2.1
     million)...................................
    Other urban areas (populations of 1 million            1,139             728             737             1.3
     of fewer)..................................
    Rural areas.................................             983             513             536             4.5
    Teaching Status.............................
        Non-teaching............................           2,449             621             640             3.0
        Fewer than 100 Residents................             836             753             762             1.2
        100 or more Residents...................             237           1,075           1,090             1.4
        Urban DSH:
            100 or more beds....................           1,513             806             821             1.8

[[Page 24418]]

 
            Less than 100 beds..................             333             542             572             5.6
        Rural DSH:
            Sole Community (SCH/EACH)...........             383             465             493             6.1
            Referral Center (RRC/EACH)..........             196             567             585             3.0
            Other Rural:
                100 or more beds................              55             469             496             5.8
                Less than 100 beds..............             188             425             457             7.4
    Urban teaching and DSH:
        Both teaching and DSH...................             809             884             896             1.4
        Teaching and no DSH.....................             198             792             798             0.7
        No teaching and DSH.....................           1,037             658             678             3.1
        No teaching and no DSH..................             495             682             691             1.3
    Rural Hospital Types:
        Non special status hospitals............             288             448             477             6.6
        RRC/EACH................................              40             575             590             2.6
        SCH/EACH................................             341             479             507             5.8
        Medicare-dependent hospitals (MDH)......             126             433             463             6.9
        SCH, RRC and EACH.......................              80             577             596             3.3
Hospitals Reclassified by the Medicare
 Geographic Classification Review Board:
    FY2007 Reclassifications:
        All Urban Reclassified 1st Half.........             316             767             782             1.9
        All Urban Non-Reclassified 1st Half.....           2,178             783             796             1.7
        All Rural Reclassified 1st Half.........             373             556             576             3.5
        All Rural Non-Reclassified 1st Half.....             563             451             480             6.3
        All Urban Reclassified 2nd Half.........             374             785             801             2.0
        All Urban Non-Reclassified 2nd Half.....           2,120             780             793             1.7
        All Rural Reclassified 2nd Half.........             373             556             576             3.5
        All Rural Non-Reclassified 2nd Half.....             563             451             480             6.3
        All Section 401 Reclassified Hospitals..              38             516             537             4.1
        Other Reclassified Hospitals (Section                 54             513             544             6.1
         1886(d)(8)(B)).........................
    Type of Ownership:
        Voluntary...............................           2,087             757             770             1.8
        Proprietary.............................             831             670             685             2.1
        Government..............................             604             727             751             3.2
    Medicare Utilization as a Percent of
     Inpatient Days:
        0-25....................................             252             970           1,016             4.7
        25-50...................................           1,302             838             851             1.5
        50-65...................................           1,490             655             670             2.4
        Over 65.................................             459             589             601             2.1
----------------------------------------------------------------------------------------------------------------

IX. Alternatives Considered

    This proposed rule contains a range of policies, including some 
proposals related to specific DRA and MMA provisions. The preamble 
of this proposed rule provides descriptions of the statutory 
provisions that are addressed, identifies those policies when 
discretion has been exercised, presents rationale for our decisions 
and, where relevant, alternatives that were considered.

X. Overall Conclusion

    The changes in this proposed rule would affect all classes of 
hospitals. Some hospitals are expected to experience significant 
gains and others less significant gains, but overall hospitals are 
projected to experience positive updates in IPPS payments in FY 
2007. Table I of section VI of this Appendix demonstrates the 
estimated distributional impact of the IPPS budget neutrality 
requirements for DRG and wage index changes, for the hold harmless 
transition for rural hospitals formerly classified as urban, and for 
the wage index reclassifications under the MGCRB. Table I also shows 
an overall increase of 3.4 percent in operating payments, which, in 
conjunction with the estimated 2.0 percent increase in capital 
payments to IPPS providers shown in Table III of section VIII of 
this Appendix, should result in a net increase of $3.33 billion to 
IPPS providers. The discussions presented in the previous pages, in 
combination with the rest of this proposed rule, constitute a 
regulatory impact analysis.

XI. Accounting Statement

    As required by OMB Circular A-4 (available at http://www.whitehousegov/omb/circulars/a004/a-4.pdf), in Table IV 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 on providers as a result of the proposed changes 
to the IPPS, the LTCH case-mix, and the limitation on payments to 
SNFs for bad debt presented in this rule. All expenditures are 
classified as transfers to Medicare providers.

      Table IV.--Accounting Statement: Classification of Estimated
                  Expenditures from FY 2006 to FY 2007
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  $3.809 Billion.

[[Page 24419]]

 
From Whom to Whom......................  Federal Government to IPPS
                                          Medicare Providers, LTCHs, and
                                          SNFs.
                                        --------------------------------
    Total..............................  $3.809 Billion.
------------------------------------------------------------------------

XII. Executive Order 12866

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

Appendix B: Recommendation of Update Factors for Operating Cost Rates 
of Payment for Inpatient Hospital Services

    (If you choose to comment on issues in this section, please 
include the caption ``Update Factors'' at the beginning of your 
comment.)

I. Background

    Section 1886(e)(4)(A) of the Act requires that the Secretary, 
taking into consideration the recommendations of the Medicare 
Payment Advisory Commission (MedPAC), recommend update factors for 
inpatient hospital services for each fiscal year that take into 
account the amounts necessary for the efficient and effective 
delivery of medically appropriate and necessary care of high 
quality. Under section 1886(e)(5)(B) of the Act, we are required to 
publish the proposed and final update factors recommended by the 
Secretary in the proposed and final IPPS rules respectively. 
Accordingly, this Appendix provides the recommendations of 
appropriate update factors for the IPPS standardized amount, the 
hospital-specific rates for SCHs and MDHs, and the rate-of-increase 
limits for hospitals and hospital units excluded from the IPPS. We 
also discuss our response to MedPAC's recommended update factors for 
inpatient hospital services.

II. Inpatient Hospital Update for FY 2007

    Section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 
5001(a) of Pub. L. 109-171, sets the FY 2007 percentage increase in 
the operating cost standardized amount equal to the rate-of-increase 
in the hospital market basket for IPPS hospitals in all areas, 
subject to the hospital submitting quality information under rules 
established by the Secretary under section 1886(b)(3)(B)(viii) of 
the Act. For hospitals that do not provide these data, the update is 
equal to the market basket percentage increase less 2.0 percentage 
points. Consistent with current law, based on the Office of the 
Actuary's first quarter 2006 forecast of the FY 2007 market basket 
increase, we are estimating that the FY 2007 update to the 
standardized amount will be 3.4 percent (that is, the current 
estimate of the market basket rate-of-increase) for hospitals in all 
areas, provided the hospital submits quality data in accordance with 
our rules. For hospitals that do not submit quality data, we are 
estimating that the update to the standardized amount will be 1.4 
percent (that is, the current estimate of the market basket rate-of-
increase minus 2.0 percentage points).
    Section 1886(b)(3)(B)(iv) of the Act sets the FY 2007 percentage 
increase in the hospital-specific rates applicable to SCHs and MDHs 
equal to the rate set forth in section 1886(b)(3)(B)(i) of the Act 
(that is, the same update factor as for all other hospitals subject 
to the IPPS, or the rate-of-increase in the market basket). 
Therefore, the update to the hospital-specific rates applicable to 
SCHs and MDHs is also estimated to be 3.4 percent.
    Section 1886(b)(3)(B)(ii) of the Act is used for purposes of 
determining the percentage increase in the rate-of-increase limits 
for children's and cancer hospitals. Section 1886(b)(3)(B)(ii) of 
the Act sets the percentage increase in the rate-of-increase limits 
equal to the market basket percentage increase for years after FY 
2002. In accordance with Sec.  403.752(a) of the regulations, RNHCIs 
are paid under Sec.  413.40, which also uses section 
1886(b)(3)(B)(ii) of the Act to update the percentage increase in 
the rate-of-increase limits. Section 1886(j)(3)(C) of the Act 
addresses the increase factor for the Federal prospective payment 
rate of IRFs. Section 123 of Pub. L. 106-113, as amended by section 
307(b) of Pub. L. 106-554, provides the statutory authority for 
updating payment rates under the LTCH PPS. In addition, section 124 
of the BBRA provides the statutory authority for updating the 
payment rates of IPFs. Under this broad authority, IPFs that are not 
defined as new under Sec.  412.426(c) will be paid under a blend 
methodology for cost reporting periods beginning on or after January 
1, 2005, through June 30, 2008. The blend methodology consists of a 
blend of the estimated Federal per diem payment amount and a 
facility-specific payment amount. Under the authority of section 124 
of the BBRA, the estimated Federal per diem payment amount is 
updated and the facility-specific payment is updated in accordance 
with 42 CFR Part 413, which uses section 1886(b)(3)(B)(ii) of the 
Act to determine the percentage increase in the rate-of-increase 
limits. New IPFs are paid based on 100 percent of the Federal per 
diem payment amount, which is updated under the authority of section 
124 of the BBRA.
    In addition, some LTCHs and IPFs are transitioning to 100 
percent of the Federal rate and currently receive a blend of 
reasonable cost-based payments computed under the TEFRA methodology 
and their respective Federal payment rates. As discussed below, the 
transition ends for LTCHs (not defined as new and that have not 
elected to be paid under 100 percent of the Federal rate) for cost 
reporting periods beginning on or after October 1, 2006. Therefore, 
because no portion of LTCHs' prospective payments will be based on 
reasonable costs for cost reporting periods beginning on or after 
October 1, 2006, we are not proposing an FY 2007 rate-of-increase 
adjustment under section 1886(b)(3)(B)(ii) of the Act for LTCHs. Any 
IPFs that receive reasonable cost-based payments will have that 
portion of its payments determined subject to the TEFRA rate-of-
increase limits for FY 2007.
    Currently, children's hospitals, cancer hospitals and RNHCIs are 
the remaining three types of hospitals still reimbursed fully under 
reasonable costs. As we discuss in section IV. of the Addendum to 
this proposed rule, we are proposing to provide an estimate of the 
FY 2007 IPPS operating market basket percentage increase (3.4 
percent) that will be used to update the target limits for 
children's hospitals, cancer hospitals, and RNHCIs.
    Effective since cost reporting periods beginning FY 2003, LTCHs 
have been paid under the LTCH PPS, which was implemented with a 5-
year transition period for LTCHs not defined as new under Sec.  
412.23(e)(4) (hereafter referred to as ``existing''). (Refer to 67 
FR 55954, August 30, 2002.) An existing LTCH could have elected to 
be paid on 100 percent of the Federal prospective rate at the start 
of any of its cost reporting periods during the 5-year transition 
period. During this transition period, if an existing LTCH did not 
elect to be paid 100 percent of the Federal prospective payment 
rate, it received a payment which consisted of a blend of its 
reasonable cost-based payment (subject to the TEFRA rate-of-increase 
limits) and the Federal prospective payment rate. Because the 
transition period ends with LTCH cost reporting periods beginning on 
or after October 1, 2006, those LTCHs who now receive blended 
payments will be paid based on 100 percent of the Federal 
prospective rate.
    Effective for cost reporting periods beginning on or after 
January 1, 2005, IPFs are paid under the IPF PPS. IPF PPS payments 
are based on a Federal per diem rate that is based on the sum of the 
average routine operating, ancillary, and capital costs for each 
patient day of psychiatric care in an IPF, adjusted for budget 
neutrality. During a transition period between January 1, 2005 and 
January 1, 2008, existing IPFs are paid based on a blend of the 
reasonable cost-based payments, subject to the TEFRA limit, and the 
Federal per diem base rate. For cost reporting periods beginning on 
or after January 1, 2008, IPFs will be paid based on 100 percent of 
the Federal per diem rate. For purposes of the update factor for FY 
2007, the portion of the IPF PPS transitional blend payment based on 
reasonable costs would be determined by updating the IPF's TEFRA 
limit by the current estimate of the excluded

[[Page 24420]]

hospital market basket, which is estimated to be 3.6 percent. The 
estimated update to the Federal per diem rate for July 1, 2006, 
through June 30, 2007, was provided in the RY 2007 IPF proposed rule 
(71 FR 3620).
    IRFs are paid under the IRF PPS for cost reporting periods 
beginning on or after January 1, 2002. For cost reporting periods 
beginning on or after October 1, 2002 (FY 2003), and thereafter, the 
Federal prospective payments to IRFs are based on 100 percent of the 
adjusted Federal IRF prospective payment amount, updated annually. 
(Refer to the IRF final rule (69 FR 45721).)

III. Secretary's Recommendation

    In previous years, in making a recommendation, we included an 
update framework that analyzed hospital productivity, scientific and 
technological advances, practice pattern changes, changes in case-
mix, the effects of reclassification on recalibration and forecast 
error correction. Although we have used this framework in past 
years, as we stated in the FY 2006 proposed rule, we are no longer 
including this analysis in our recommendation for the update (70 FR 
23672, May 4, 2005).
    MedPAC is recommending an inpatient hospital update equal to the 
market basket rate of increase for FY 2007 minus an adjustment 
factor of 0.45 percentage points. The 0.45 percentage point 
reduction represents half of estimated productivity growth in the 
general economy for 2007 that the Commission expects the hospital 
industry to achieve. MedPAC's rationale for this update 
recommendation is described in more detail below. Using the 2006 
first quarter forecast from the Office of the Actuary of the FY 2007 
market basket increase and an adjustment factor based on the FY 2007 
President's budget, we are recommending an update to the 
standardized amount of 2.95 percent (that is, the market basket 
rate-of-increase of 3.4 minus an adjustment factor of 0.45 
percentage points). Our update recommendation is the same as 
MedPAC's.
    In addition to making a recommendation for IPPS hospitals, in 
accordance with section 1886(e)(4)(A) of the Act, we are also 
recommending update factors for all other types of hospitals. Using 
the 2006 first quarter forecast from the Office of the Actuary of 
the FY 2007 market basket increase and an adjustment factor based on 
the FY 2007 President's budget, for FY 2007, for SCHs and MDHs, we 
are recommending an update of 2.95 percent.
    For FY 2007, for children's hospitals, cancer hospitals, and 
RNHCIs, based on the first quarter forecast from the Office of the 
Actuary of the FY 2007 market basket increase and an adjustment 
factor from the FY 2007 President's budget, we are also recommending 
an update of 2.95 percent to the target limits.
    For IPFs that are currently paid a blend of reasonable cost-
based (subject to the TEFRA limits) and Federal prospective payment 
amounts, based on the latest estimate from the Office of the Actuary 
and an adjustment factor from the FY 2007 President's budget, we are 
recommending an update factor of 3.15 percent for the portion of the 
payment that is based on reasonable costs, subject to the TEFRA 
limits.
    We note that section 1886(e)(3) of the Act directs the Secretary 
to report to Congress an initial estimate of the recommendation of 
an appropriate payment inflation update for inpatient hospital 
services for the upcoming fiscal year. In the Secretary's Report to 
Congress this year, the Secretary recommended the President's FY 
2007 update of 2.95 percent (3.4 percent minus an adjustment factor 
of 0.45 percentage points) for the market basket update for the 
TEFRA portion of IPF blended payment rates. The difference between 
the update recommendation in the Secretary's Report to Congress and 
the update we are recommending in this proposed rule (3.15 percent) 
is due to the availability and use of more recent data for the 
market basket than were available at the time the Secretary's 
recommendation was developed.
    Consistent with our proposal in the RY 2007 LTCH PPS proposed 
rule (71 FR 4667, January 27, 2006), we are recommending the Federal 
rate remain unchanged for RY 2007. In the RY 2007 IPF PPS proposed 
rule (71 FR 3620, January 23, 2006), we proposed an update factor of 
4.5 percent to the IPF PPS for RY 2007. The proposed update reflects 
an increase from the 18-month period beginning January 1, 2005, when 
the IPF PPS was first adopted. Consistent with the RY 2007 IPF 
proposed rule, we are recommending an update factor of 4.5 percent 
for inpatient psychiatric facilities. Finally, consistent with the 
President's FY 2007 budget, we are recommending the Federal rate to 
the IRF PPS remain unchanged for FY 2007.

IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating 
Payments in Traditional Medicare

    In the past, MedPAC has suggested specific adjustments to its 
update recommendation for each of the factors discussed under 
section III. of this Appendix. In its March 2006 Report to Congress, 
MedPAC assessed the adequacy of current payments and costs and the 
relationship between payments and an appropriate cost base, 
utilizing an established methodology used by the Commission in the 
past several years.
    Despite a projected negative overall Medicare margin of -2.2 
percent in 2006, the Commission recommended an update to the 
hospital inpatient rates equal to the increase in the hospital 
market basket minus an adjustment factor of 0.45 percentage points. 
The 0.45 percentage point reduction represents half of an estimate 
of productivity growth in the general economy for 2007 that the 
Commission expects the hospital industry to achieve.
    MedPAC noted that, notwithstanding negative overall Medicare 
margins, most of the indicators of Medicare payment adequacy to 
hospitals are positive, including beneficiaries' access to care, 
increased access to capital, and service volume increases. MedPAC 
also noted that Medicare payment rates should cover the costs of 
efficient hospitals and that, ``more efficient hospitals may not be 
performing as poorly as the [hospital] industry's aggregate margin 
would suggest.''
    Response: We agree with MedPAC and are also recommending an 
inpatient hospital update equal to the market basket minus an 
adjustment factor of 0.45 percentage points. However, we note that 
the law would need to be changed in order for the MedPAC 
recommendation and our update recommendation to be applied. Without 
a change in law, we will update the IPPS rates by the full market 
basket, which we currently estimate to be 3.4 percent for FY 2007, 
for hospitals that submit quality data that meet our validation 
requirements. For all other hospitals, the IPPS update will equal 
the market basket minus 2.0 percentage points.
    In addition, because the operating and capital prospective 
payment systems remain separate, we are proposing to continue to use 
separate updates for operating and capital payments. The proposed 
update to the capital payment rate is discussed in section III. of 
the Addendum to this proposed rule.

[[Page 24421]]



  Appendix C.--Combinations of Proposed Consolidated Severity-Adjusted
                                  DRGs
------------------------------------------------------------------------
                             Consolidated
       Type           MDC      severity-       Consolidated severity-
                             adjusted DRG     adjusted DRG description
------------------------------------------------------------------------
S.................        0             1  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT SOI 1
                                            & 2.
S.................        0             2  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT SOI 3.
S.................        0             3  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT SOI 4.
S.................        0             4  HEART &/OR LUNG TRANSPLANT
                                            SOI 1 & 2.
S.................        0             5  HEART &/OR LUNG TRANSPLANT
                                            SOI 3.
S.................        0             6  HEART &/OR LUNG TRANSPLANT
                                            SOI 4.
S.................        0             7  BONE MARROW TRANSPLANT SOI 1.
S.................        0             8  BONE MARROW TRANSPLANT SOI 2.
S.................        0             9  BONE MARROW TRANSPLANT SOI 3.
S.................        0            10  BONE MARROW TRANSPLANT SOI 4.
S.................        0            11  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W
                                            EXTENSIVE PROCEDURE SOI 1 &
                                            2.
S.................        0            12  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W
                                            EXTENSIVE PROCEDURE SOI 3.
S.................        0            13  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W
                                            EXTENSIVE PROCEDURE SOI 4.
S.................        0            14  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/O
                                            EXTENSIVE PROCEDURE SOI 1 &
                                            2.
S.................        0            15  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/O
                                            EXTENSIVE PROCEDURE SOI 3.
S.................        0            16  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/O
                                            EXTENSIVE PROCEDURE SOI 4.
S.................        0            17  PANCREAS TRANSPLANT SOI 1 &
                                            2.
S.................        0            18  PANCREAS TRANSPLANT SOI 3.
S.................        0            19  PANCREAS TRANSPLANT SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES SOI
                                            4.
S.................        1            21  CRANIOTOMY FOR TRAUMA SOI 1.
S.................        1            22  CRANIOTOMY FOR TRAUMA SOI 2.
S.................        1            23  CRANIOTOMY FOR TRAUMA SOI 3.
S.................        1            24  CRANIOTOMY EXCEPT FOR TRAUMA
                                            SOI 1.
S.................        1            25  CRANIOTOMY EXCEPT FOR TRAUMA
                                            SOI 2.
S.................        1            26  CRANIOTOMY EXCEPT FOR TRAUMA
                                            SOI 3.
S.................        1            27  VENTRICULAR SHUNT PROCEDURES
                                            SOI 1.
S.................        1            28  VENTRICULAR SHUNT PROCEDURES
                                            SOI 2.
S.................        1            29  VENTRICULAR SHUNT PROCEDURES
                                            SOI 3.
S.................        1            30  SPINAL PROCEDURES SOI 1.
S.................        1            31  SPINAL PROCEDURES SOI 2.
S.................        1            32  SPINAL PROCEDURES SOI 3.
S.................        1            33  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 1.
S.................        1            34  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 2.
S.................        1            35  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 3.
S.................        1            36  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 1.
S.................        1            37  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 2.
S.................        1            38  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 3.
M.................        1            39  NERVOUS SYSTEM MEDICAL
                                            DIAGNOSES EXCEPT INFECTIONS
                                            SOI 4.
M.................        1            40  INFECTIONS OF NERVOUS SYSTEM
                                            SOI 4.
M.................        1            41  SPINAL DISORDERS & INJURIES
                                            SOI 1.
M.................        1            42  SPINAL DISORDERS & INJURIES
                                            SOI 2.
M.................        1            43  SPINAL DISORDERS & INJURIES
                                            SOI 3.
M.................        1            44  NERVOUS SYSTEM MALIGNANCY SOI
                                            1.
M.................        1            45  NERVOUS SYSTEM MALIGNANCY SOI
                                            2.
M.................        1            46  NERVOUS SYSTEM MALIGNANCY SOI
                                            3.
M.................        1            47  DEGENERATIVE NERVOUS SYSTEM
                                            DISORDERS EXC MULT SCLEROSIS
                                            SOI 1.
M.................        1            48  DEGENERATIVE NERVOUS SYSTEM
                                            DISORDERS EXC MULT SCLEROSIS
                                            SOI 2.
M.................        1            49  DEGENERATIVE NERVOUS SYSTEM
                                            DISORDERS EXC MULT SCLEROSIS
                                            SOI 3.
M.................        1            50  MULTIPLE SCLEROSIS & OTHER
                                            DEMYELINATING DISEASES SOI
                                            1.
M.................        1            51  MULTIPLE SCLEROSIS & OTHER
                                            DEMYELINATING DISEASES SOI
                                            2.
M.................        1            52  MULTIPLE SCLEROSIS & OTHER
                                            DEMYELINATING DISEASES SOI
                                            3.
M.................        1            53  INTRACRANIAL HEMORRHAGE SOI
                                            1.
M.................        1            54  INTRACRANIAL HEMORRHAGE SOI
                                            2.
M.................        1            55  INTRACRANIAL HEMORRHAGE SOI
                                            3.
M.................        1            56  CVA & PRECEREBRAL OCCLUSION W
                                            INFARCT SOI 1.
M.................        1            57  CVA & PRECEREBRAL OCCLUSION W
                                            INFARCT SOI 2.
M.................        1            58  CVA & PRECEREBRAL OCCLUSION W
                                            INFARCT SOI 3.
M.................        1            59  NONSPECIFIC CVA & PRECEREBRAL
                                            OCCLUSION W/O INFARCT SOI 1.
M.................        1            60  NONSPECIFIC CVA & PRECEREBRAL
                                            OCCLUSION W/O INFARCT SOI 2.
M.................        1            61  NONSPECIFIC CVA & PRECEREBRAL
                                            OCCLUSION W/O INFARCT SOI 3.
M.................        1            62  TRANSIENT ISCHEMIA SOI 1.
M.................        1            63  TRANSIENT ISCHEMIA SOI 2.
M.................        1            64  TRANSIENT ISCHEMIA SOI 3.
M.................        1            65  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE DISORDERS
                                            SOI 1.
M.................        1            66  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE DISORDERS
                                            SOI 2.
M.................        1            67  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE DISORDERS
                                            SOI 3.
M.................        1            68  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS SYSTEM
                                            SOI 1.
M.................        1            69  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS SYSTEM
                                            SOI 2.

[[Page 24422]]

 
M.................        1            70  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS SYSTEM
                                            SOI 3.
M.................        1            71  NON-BACTERIAL INFECTIONS OF
                                            NERVOUS SYSTEM EXC VIRAL
                                            MENINGITIS SOI 1.
M.................        1            72  NON-BACTERIAL INFECTIONS OF
                                            NERVOUS SYSTEM EXC VIRAL
                                            MENINGITIS SOI 2.
M.................        1            73  NON-BACTERIAL INFECTIONS OF
                                            NERVOUS SYSTEM EXC VIRAL
                                            MENINGITIS SOI 3.
M.................        1            74  VIRAL MENINGITIS SOI 1.
M.................        1            75  VIRAL MENINGITIS SOI 2.
M.................        1            76  VIRAL MENINGITIS SOI 3.
M.................        1            77  NONTRAUMATIC STUPOR & COMA
                                            SOI 1.
M.................        1            78  NONTRAUMATIC STUPOR & COMA
                                            SOI 2.
M.................        1            79  NONTRAUMATIC STUPOR & COMA
                                            SOI 3.
M.................        1            80  SEIZURE SOI 1.
M.................        1            81  SEIZURE SOI 2.
M.................        1            82  SEIZURE SOI 3.
M.................        1            83  MIGRAINE & OTHER HEADACHES
                                            SOI 1.
M.................        1            84  MIGRAINE & OTHER HEADACHES
                                            SOI 2.
M.................        1            85  MIGRAINE & OTHER HEADACHES
                                            SOI 3.
M.................        1            86  HEAD TRAUMA W COMA >1 HR OR
                                            HEMORRHAGE SOI 1.
M.................        1            87  HEAD TRAUMA W COMA >1 HR OR
                                            HEMORRHAGE SOI 2.
M.................        1            88  HEAD TRAUMA W COMA >1 HR OR
                                            HEMORRHAGE SOI 3.
M.................        1            89  BRAIN CONTUSION/LACERATION &
                                            COMPLICATED SKULL FX, COMA <
                                            1 HR OR NO COMA SOI 1.
M.................        1            90  BRAIN CONTUSION/LACERATION &
                                            COMPLICATED SKULL FX, COMA <
                                            1 HR OR NO COMA SOI 2.
M.................        1            91  BRAIN CONTUSION/LACERATION &
                                            COMPLICATED SKULL FX, COMA <
                                            1 HR OR NO COMA SOI 3.
M.................        1            92  CONCUSSION, CLOSED SKULL FX
                                            NOS,UNCOMPLICATED
                                            INTRACRANIAL INJURY, COMA <
                                            1 HR OR NO COMA SOI 1.
M.................        1            93  CONCUSSION, CLOSED SKULL FX
                                            NOS,UNCOMPLICATED
                                            INTRACRANIAL INJURY, COMA <
                                            1 HR OR NO COMA SOI 2.
M.................        1            94  CONCUSSION, CLOSED SKULL FX
                                            NOS,UNCOMPLICATED
                                            INTRACRANIAL INJURY, COMA <
                                            1 HR OR NO COMA SOI 3.
M.................        1            95  OTHER DISORDERS OF NERVOUS
                                            SYSTEM SOI 1.
M.................        1            96  OTHER DISORDERS OF NERVOUS
                                            SYSTEM SOI 2.
M.................        1            97  OTHER DISORDERS OF NERVOUS
                                            SYSTEM SOI 3.
S.................        2            98  EYE PROCEDURES SOI 4.
S.................        2            99  ORBITAL PROCEDURES SOI 1.
S.................        2           100  ORBITAL PROCEDURES SOI 2.
S.................        2           101  ORBITAL PROCEDURES SOI 3.
S.................        2           102  EYE PROCEDURES EXCEPT ORBIT
                                            SOI 1.
S.................        2           103  EYE PROCEDURES EXCEPT ORBIT
                                            SOI 2.
S.................        2           104  EYE PROCEDURES EXCEPT ORBIT
                                            SOI 3.
M.................        2           105  EYE DIAGNOSES SOI 4.
M.................        2           106  ACUTE MAJOR EYE INFECTIONS
                                            SOI 1.
M.................        2           107  ACUTE MAJOR EYE INFECTIONS
                                            SOI 2.
M.................        2           108  ACUTE MAJOR EYE INFECTIONS
                                            SOI 3.
M.................        2           109  EYE DISORDERS EXCEPT MAJOR
                                            INFECTIONS SOI 1.
M.................        2           110  EYE DISORDERS EXCEPT MAJOR
                                            INFECTIONS SOI 2.
M.................        2           111  EYE DISORDERS EXCEPT MAJOR
                                            INFECTIONS SOI 3.
S.................        3           112  EAR, NOSE, MOUTH & THROAT
                                            PROCEDURES SOI 4.
S.................        3           113  MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 1.
S.................        3           114  MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 2.
S.................        3           115  MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 3.
S.................        3           116  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 1.
S.................        3           117  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 2.
S.................        3           118  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 3.
S.................        3           119  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 1.
S.................        3           120  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 2.
S.................        3           121  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 3.
S.................        3           122  FACIAL BONE PROCEDURES EXCEPT
                                            MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 1.
S.................        3           123  FACIAL BONE PROCEDURES EXCEPT
                                            MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 2.
S.................        3           124  FACIAL BONE PROCEDURES EXCEPT
                                            MAJOR CRANIAL/FACIAL BONE
                                            PROCEDURES SOI 3.
S.................        3           125  SINUS & MASTOID PROCEDURES
                                            SOI 1.
S.................        3           126  SINUS & MASTOID PROCEDURES
                                            SOI 2.
S.................        3           127  SINUS & MASTOID PROCEDURES
                                            SOI 3.
S.................        3           128  CLEFT LIP & PALATE REPAIR SOI
                                            1.
S.................        3           129  CLEFT LIP & PALATE REPAIR SOI
                                            2.
S.................        3           130  CLEFT LIP & PALATE REPAIR SOI
                                            3.
S.................        3           131  TONSIL & ADENOID PROCEDURES
                                            SOI 1.
S.................        3           132  TONSIL & ADENOID PROCEDURES
                                            SOI 2.
S.................        3           133  TONSIL & ADENOID PROCEDURES
                                            SOI 3.
S.................        3           134  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 1.
S.................        3           135  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 2.
S.................        3           136  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 3

[[Page 24423]]

 
M.................        3           137  EAR, NOSE, MOUTH & THROAT
                                            DIAGNOSES SOI 4.
M.................        3           138  EAR, NOSE, MOUTH, THROAT,
                                            CRANIAL/FACIAL MALIGNANCIES
                                            . SOI 1.
M.................        3           139  EAR, NOSE, MOUTH, THROAT,
                                            CRANIAL/FACIAL MALIGNANCIES
                                            . SOI 2.
M.................        3           140  EAR, NOSE, MOUTH, THROAT,
                                            CRANIAL/FACIAL MALIGNANCIES
                                            . SOI 3.
M.................        3           141  VERTIGO & OTHER LABYRINTH
                                            DISORDERS SOI 1.
M.................        3           142  VERTIGO & OTHER LABYRINTH
                                            DISORDERS SOI 2.
M.................        3           143  VERTIGO & OTHER LABYRINTH
                                            DISORDERS SOI 3.
M.................        3           144  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 1.
M.................        3           145  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 2.
M.................        3           146  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 3.
M.................        3           147  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 1.
M.................        3           148  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 2.
M.................        3           149  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 3.
M.................        3           150  OTHER EAR, NOSE, MOUTH,THROAT
                                            & CRANIAL/FACIAL DIAGNOSES
                                            SOI 1.
M.................        3           151  OTHER EAR, NOSE, MOUTH,THROAT
                                            & CRANIAL/FACIAL DIAGNOSES
                                            SOI 2.
M.................        3           152  OTHER EAR, NOSE, MOUTH,THROAT
                                            & CRANIAL/FACIAL DIAGNOSES
                                            SOI 3.
S.................        4           153  RESPIRATORY & CHEST
                                            PROCEDURES SOI 4.
S.................        4           154  MAJOR RESPIRATORY & CHEST
                                            PROCEDURES SOI 1.
S.................        4           155  MAJOR RESPIRATORY & CHEST
                                            PROCEDURES SOI 2.
S.................        4           156  MAJOR RESPIRATORY & CHEST
                                            PROCEDURES SOI 3.
S.................        4           157  OTHER RESPIRATORY & CHEST
                                            PROCEDURES SOI 1.
S.................        4           158  OTHER RESPIRATORY & CHEST
                                            PROCEDURES SOI 2.
S.................        4           159  OTHER RESPIRATORY & CHEST
                                            PROCEDURES SOI 3.
M.................        4           160  RESPIRATORY SYSTEM DIAGNOSES
                                            EXCEPT W VENTILATOR .
                                            SUPPORT 96+ HOURS SOI 4.
M.................        4           161  RESPIRATORY SYSTEM DIAGNOSIS
                                            W VENTILATOR SUPPORT 96+
                                            HOURS SOI 1.
M.................        4           162  RESPIRATORY SYSTEM DIAGNOSIS
                                            W VENTILATOR SUPPORT 96+
                                            HOURS SOI 2.
M.................        4           163  RESPIRATORY SYSTEM DIAGNOSIS
                                            W VENTILATOR SUPPORT 96+
                                            HOURS SOI 3.
M.................        4           164  RESPIRATORY SYSTEM DIAGNOSIS
                                            W VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           165  CYSTIC FIBROSIS - PULMONARY
                                            DISEASE SOI 1.
M.................        4           166  CYSTIC FIBROSIS - PULMONARY
                                            DISEASE SOI 2.
M.................        4           167  CYSTIC FIBROSIS - PULMONARY
                                            DISEASE SOI 3.
M.................        4           168  PULMONARY EDEMA & RESPIRATORY
                                            FAILURE SOI 1.
M.................        4           169  PULMONARY EDEMA & RESPIRATORY
                                            FAILURE SOI 2.
M.................        4           170  PULMONARY EDEMA & RESPIRATORY
                                            FAILURE SOI 3.
M.................        4           171  PULMONARY EMBOLISM SOI 1.
M.................        4           172  PULMONARY EMBOLISM SOI 2.
M.................        4           173  PULMONARY EMBOLISM SOI 3.
M.................        4           174  MAJOR CHEST & RESPIRATORY
                                            TRAUMA SOI 1.
M.................        4           175  MAJOR CHEST & RESPIRATORY
                                            TRAUMA SOI 2.
M.................        4           176  MAJOR CHEST & RESPIRATORY
                                            TRAUMA SOI 3.
M.................        4           177  RESPIRATORY MALIGNANCY SOI 1.
M.................        4           178  RESPIRATORY MALIGNANCY SOI 2.
M.................        4           179  RESPIRATORY MALIGNANCY SOI 3.
M.................        4           180  MAJOR RESPIRATORY INFECTIONS
                                            & INFLAMMATIONS SOI 1.
M.................        4           181  MAJOR RESPIRATORY INFECTIONS
                                            & INFLAMMATIONS SOI 2.
M.................        4           182  MAJOR RESPIRATORY INFECTIONS
                                            & INFLAMMATIONS SOI 3.
M.................        4           183  BRONCHIOLITIS & RSV PNEUMONIA
                                            SOI 1.
M.................        4           184  BRONCHIOLITIS & RSV PNEUMONIA
                                            SOI 2.
M.................        4           185  BRONCHIOLITIS & RSV PNEUMONIA
                                            SOI 3.
M.................        4           186  OTHER PNEUMONIA SOI 1.
M.................        4           187  OTHER PNEUMONIA SOI 2.
M.................        4           188  OTHER PNEUMONIA SOI 3.
M.................        4           189  CHRONIC OBSTRUCTIVE PULMONARY
                                            DISEASE SOI 1.
M.................        4           190  CHRONIC OBSTRUCTIVE PULMONARY
                                            DISEASE SOI 2.
M.................        4           191  CHRONIC OBSTRUCTIVE PULMONARY
                                            DISEASE SOI 3.
M.................        4           192  ASTHMA SOI 1.
M.................        4           193  ASTHMA SOI 2.
M.................        4           194  ASTHMA SOI 3.
M.................        4           195  INTERSTITIAL LUNG DISEASE SOI
                                            1.
M.................        4           196  INTERSTITIAL LUNG DISEASE SOI
                                            2.
M.................        4           197  INTERSTITIAL LUNG DISEASE SOI
                                            3.
M.................        4           198  OTHER RESPIRATORY DIAGNOSES
                                            EXCEPT SIGNS, SYMPTOMS & .
                                            MINOR DIAGNOSES SOI 1.
M.................        4           199  OTHER RESPIRATORY DIAGNOSES
                                            EXCEPT SIGNS, SYMPTOMS & .
                                            MINOR DIAGNOSES SOI 2.
M.................        4           200  OTHER RESPIRATORY DIAGNOSES
                                            EXCEPT SIGNS, SYMPTOMS & .
                                            MINOR DIAGNOSES SOI 3.
M.................        4           201  RESPIRATORY SIGNS, SYMPTOMS &
                                            MINOR DIAGNOSES SOI 1.
M.................        4           202  RESPIRATORY SIGNS, SYMPTOMS &
                                            MINOR DIAGNOSES SOI 2.
M.................        4           203  RESPIRATORY SIGNS, SYMPTOMS &
                                            MINOR DIAGNOSES SOI 3.
S.................        5           204  CARDIOTHORACIC PROCEDURES SOI
                                            4.
S.................        5           205  VASCULAR PROCEDURES SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 4.

[[Page 24424]]

 
S.................        5           207  CARDIAC DEFIBRILLATOR & HEART
                                            ASSIST IMPLANT SOI 1.
S.................        5           208  CARDIAC DEFIBRILLATOR & HEART
                                            ASSIST IMPLANT SOI 2.
S.................        5           209  CARDIAC DEFIBRILLATOR & HEART
                                            ASSIST IMPLANT SOI 3.
S.................        5           210  CARDIAC VALVE PROCEDURES W
                                            CARDIAC CATHETERIZATION .
                                            SOI 1.
S.................        5           211  CARDIAC VALVE PROCEDURES W
                                            CARDIAC CATHETERIZATION .
                                            SOI 2.
S.................        5           212  CARDIAC VALVE PROCEDURES W
                                            CARDIAC CATHETERIZATION .
                                            SOI 3.
S.................        5           213  CARDIAC VALVE PROCEDURES W/O
                                            CARDIAC CATHETERIZATION SOI
                                            1.
S.................        5           214  CARDIAC VALVE PROCEDURES W/O
                                            CARDIAC CATHETERIZATION SOI
                                            2.
S.................        5           215  CARDIAC VALVE PROCEDURES W/O
                                            CARDIAC CATHETERIZATION SOI
                                            3.
S.................        5           216  CORONARY BYPASS W CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 1.
S.................        5           217  CORONARY BYPASS W CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 2.
S.................        5           218  CORONARY BYPASS W CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 3.
S.................        5           219  CORONARY BYPASS W/O CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 1.
S.................        5           220  CORONARY BYPASS W/O CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 2.
S.................        5           221  CORONARY BYPASS W/O CARDIAC
                                            CATH OR PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 3.
S.................        5           222  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 1.
S.................        5           223  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 2.
S.................        5           224  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 3.
S.................        5           225  MAJOR THORACIC & ABDOMINAL
                                            VASCULAR PROCEDURES SOI 1.
S.................        5           226  MAJOR THORACIC & ABDOMINAL
                                            VASCULAR PROCEDURES SOI 2.
S.................        5           227  MAJOR THORACIC & ABDOMINAL
                                            VASCULAR PROCEDURES SOI 3.
S.................        5           228  PERMANENT CARDIAC PACEMAKER
                                            IMPLANT W AMI, HEART FAILURE
                                            OR SHOCK SOI 1.
S.................        5           229  PERMANENT CARDIAC PACEMAKER
                                            IMPLANT W AMI, HEART FAILURE
                                            OR SHOCK SOI 2.
S.................        5           230  PERMANENT CARDIAC PACEMAKER
                                            IMPLANT W AMI, HEART FAILURE
                                            OR SHOCK SOI 3.
S.................        5           231  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 1.
S.................        5           232  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 2.
S.................        5           233  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 3.
S.................        5           234  OTHER VASCULAR PROCEDURES SOI
                                            1.
S.................        5           235  OTHER VASCULAR PROCEDURES SOI
                                            2.
S.................        5           236  OTHER VASCULAR PROCEDURES SOI
                                            3.
S.................        5           237  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 1.
S.................        5           238  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 2.
S.................        5           239  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 3.
S.................        5           240  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 1.
S.................        5           241  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 2.
S.................        5           242  PERCUTANEOUS CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 3.
S.................        5           243  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 1.
S.................        5           244  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 2.
S.................        5           245  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 3.
S.................        5           246  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE REPLACEMENT
                                            SOI 1.
S.................        5           247  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE REPLACEMENT
                                            SOI 2.
S.................        5           248  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE REPLACEMENT
                                            SOI 3.
S.................        5           249  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 1.
S.................        5           250  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 2.
S.................        5           251  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 3.
M.................        5           252  CIRCULATORY SYSTEM DIAGNOSES
                                            SOI 4.
M.................        5           253  ACUTE MYOCARDIAL INFARCTION
                                            SOI 1.
M.................        5           254  ACUTE MYOCARDIAL INFARCTION
                                            SOI 2.
M.................        5           255  ACUTE MYOCARDIAL INFARCTION
                                            SOI 3.
M.................        5           256  CARDIAC CATHETERIZATION W
                                            CIRC DISORD EXC ISCHEMIC
                                            HEART DISEASE SOI 1.
M.................        5           257  CARDIAC CATHETERIZATION W
                                            CIRC DISORD EXC ISCHEMIC
                                            HEART DISEASE SOI 2.
M.................        5           258  CARDIAC CATHETERIZATION W
                                            CIRC DISORD EXC ISCHEMIC
                                            HEART DISEASE SOI 3.
M.................        5           259  CARDIAC CATHETERIZATION FOR
                                            ISCHEMIC HEART DISEASE SOI
                                            1.
M.................        5           260  CARDIAC CATHETERIZATION FOR
                                            ISCHEMIC HEART DISEASE SOI
                                            2.
M.................        5           261  CARDIAC CATHETERIZATION FOR
                                            ISCHEMIC HEART DISEASE SOI
                                            3.
M.................        5           262  ACUTE & SUBACUTE ENDOCARDITIS
                                            SOI 1.
M.................        5           263  ACUTE & SUBACUTE ENDOCARDITIS
                                            SOI 2.
M.................        5           264  ACUTE & SUBACUTE ENDOCARDITIS
                                            SOI 3.
M.................        5           265  HEART FAILURE SOI 1.
M.................        5           266  HEART FAILURE SOI 2.
M.................        5           267  HEART FAILURE SOI 3.
M.................        5           268  CARDIAC ARREST SOI 1.
M.................        5           269  CARDIAC ARREST SOI 2.
M.................        5           270  CARDIAC ARREST SOI 3.
M.................        5           271  PERIPHERAL & OTHER VASCULAR
                                            DISORDERS SOI 1.
M.................        5           272  PERIPHERAL & OTHER VASCULAR
                                            DISORDERS SOI 2.
M.................        5           273  PERIPHERAL & OTHER VASCULAR
                                            DISORDERS SOI 3.
M.................        5           274  ANGINA PECTORIS & CORONARY
                                            ATHEROSCLEROSIS SOI 1.
M.................        5           275  ANGINA PECTORIS & CORONARY
                                            ATHEROSCLEROSIS SOI 2.
M.................        5           276  ANGINA PECTORIS & CORONARY
                                            ATHEROSCLEROSIS SOI 3.

[[Page 24425]]

 
M.................        5           277  HYPERTENSION SOI 1.
M.................        5           278  HYPERTENSION SOI 2.
M.................        5           279  HYPERTENSION SOI 3.
M.................        5           280  CARDIAC STRUCTURAL & VALVULAR
                                            DISORDERS SOI 1.
M.................        5           281  CARDIAC STRUCTURAL & VALVULAR
                                            DISORDERS SOI 2.
M.................        5           282  CARDIAC STRUCTURAL & VALVULAR
                                            DISORDERS SOI 3.
M.................        5           283  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI 1.
M.................        5           284  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI 2.
M.................        5           285  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI 3.
M.................        5           286  CHEST PAIN SOI 1.
M.................        5           287  CHEST PAIN SOI 2.
M.................        5           288  CHEST PAIN SOI 3.
M.................        5           289  SYNCOPE & COLLAPSE SOI 1.
M.................        5           290  SYNCOPE & COLLAPSE SOI 2.
M.................        5           291  SYNCOPE & COLLAPSE SOI 3.
M.................        5           292  CARDIOMYOPATHY SOI 1.
M.................        5           293  CARDIOMYOPATHY SOI 2.
M.................        5           294  CARDIOMYOPATHY SOI 3.
M.................        5           295  MALFUNCTION, REACTION,
                                            COMPLICATION OF CARDIAC/VASC
                                            DEVICE OR PROCEDURE SOI 1.
M.................        5           296  MALFUNCTION, REACTION,
                                            COMPLICATION OF CARDIAC/VASC
                                            DEVICE OR PROCEDURE SOI 2.
M.................        5           297  MALFUNCTION, REACTION,
                                            COMPLICATION OF CARDIAC/VASC
                                            DEVICE OR PROCEDURE SOI 3.
M.................        5           298  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 1.
M.................        5           299  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 2.
M.................        5           300  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 3.
S.................        6           301  MAJOR GASTROINTESTINAL
                                            PROCEDURES SOI 4.
S.................        6           302  OTHER GASTROINTESTINAL &
                                            ABDOMINAL PROCEDURES SOI 4.
S.................        6           303  MAJOR STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 1.
S.................        6           304  MAJOR STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 2.
S.................        6           305  MAJOR STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 3.
S.................        6           306  MAJOR SMALL & LARGE BOWEL
                                            PROCEDURES SOI 1.
S.................        6           307  MAJOR SMALL & LARGE BOWEL
                                            PROCEDURES SOI 2.
S.................        6           308  MAJOR SMALL & LARGE BOWEL
                                            PROCEDURES SOI 3.
S.................        6           309  OTHER STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 1.
S.................        6           310  OTHER STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 2.
S.................        6           311  OTHER STOMACH, ESOPHAGEAL &
                                            DUODENAL PROCEDURES SOI 3.
S.................        6           312  OTHER SMALL & LARGE BOWEL
                                            PROCEDURES SOI 1.
S.................        6           313  OTHER SMALL & LARGE BOWEL
                                            PROCEDURES SOI 2.
S.................        6           314  OTHER SMALL & LARGE BOWEL
                                            PROCEDURES SOI 3.
S.................        6           315  PERITONEAL ADHESIOLYSIS SOI
                                            1.
S.................        6           316  PERITONEAL ADHESIOLYSIS SOI
                                            2.
S.................        6           317  PERITONEAL ADHESIOLYSIS SOI
                                            3.
S.................        6           318  APPENDECTOMY SOI 1.
S.................        6           319  APPENDECTOMY SOI 2.
S.................        6           320  APPENDECTOMY SOI 3.
S.................        6           321  ANAL PROCEDURES SOI 1.
S.................        6           322  ANAL PROCEDURES SOI 2.
S.................        6           323  ANAL PROCEDURES SOI 3.
S.................        6           324  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &
                                            UMBILICAL SOI 1.
S.................        6           325  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &
                                            UMBILICAL SOI 2.
S.................        6           326  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &
                                            UMBILICAL SOI 3.
S.................        6           327  INGUINAL, FEMORAL & UMBILICAL
                                            HERNIA PROCEDURES SOI 1.
S.................        6           328  INGUINAL, FEMORAL & UMBILICAL
                                            HERNIA PROCEDURES SOI 2.
S.................        6           329  INGUINAL, FEMORAL & UMBILICAL
                                            HERNIA PROCEDURES SOI 3.
S.................        6           330  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI 1.
S.................        6           331  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI 2.
S.................        6           332  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI 3.
M.................        6           333  DIGESTIVE SYSTEM DIAGNOSES
                                            SOI 4.
M.................        6           334  DIGESTIVE MALIGNANCY SOI 1.
M.................        6           335  DIGESTIVE MALIGNANCY SOI 2.
M.................        6           336  DIGESTIVE MALIGNANCY SOI 3.
M.................        6           337  PEPTIC ULCER & GASTRITIS SOI
                                            1.
M.................        6           338  PEPTIC ULCER & GASTRITIS SOI
                                            2.
M.................        6           339  PEPTIC ULCER & GASTRITIS SOI
                                            3.
M.................        6           340  MAJOR ESOPHAGEAL DISORDERS
                                            SOI 1.
M.................        6           341  MAJOR ESOPHAGEAL DISORDERS
                                            SOI 2.
M.................        6           342  MAJOR ESOPHAGEAL DISORDERS
                                            SOI 3.
M.................        6           343  OTHER ESOPHAGEAL DISORDERS
                                            SOI 1.
M.................        6           344  OTHER ESOPHAGEAL DISORDERS
                                            SOI 2.
M.................        6           345  OTHER ESOPHAGEAL DISORDERS
                                            SOI 3.
M.................        6           346  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 1.

[[Page 24426]]

 
M.................        6           347  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 2.
M.................        6           348  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 3.
M.................        6           349  INFLAMMATORY BOWEL DISEASE
                                            SOI 1.
M.................        6           350  INFLAMMATORY BOWEL DISEASE
                                            SOI 2.
M.................        6           351  INFLAMMATORY BOWEL DISEASE
                                            SOI 3.
M.................        6           352  GASTROINTESTINAL VASCULAR
                                            INSUFFICIENCY SOI 1.
M.................        6           353  GASTROINTESTINAL VASCULAR
                                            INSUFFICIENCY SOI 2.
M.................        6           354  GASTROINTESTINAL VASCULAR
                                            INSUFFICIENCY SOI 3.
M.................        6           355  INTESTINAL OBSTRUCTION SOI 1.
M.................        6           356  INTESTINAL OBSTRUCTION SOI 2.
M.................        6           357  INTESTINAL OBSTRUCTION SOI 3.
M.................        6           358  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS SOI 1.
M.................        6           359  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS SOI 2.
M.................        6           360  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS SOI 3.
M.................        6           361  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA &
                                            VOMITING SOI 1.
M.................        6           362  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA &
                                            VOMITING SOI 2.
M.................        6           363  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA &
                                            VOMITING SOI 3.
M.................        6           364  ABDOMINAL PAIN SOI 1.
M.................        6           365  ABDOMINAL PAIN SOI 2.
M.................        6           366  ABDOMINAL PAIN SOI 3.
M.................        6           367  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI DEVICE OR
                                            PROCEDURE SOI 1.
M.................        6           368  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI DEVICE OR
                                            PROCEDURE SOI 2.
M.................        6           369  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI DEVICE OR
                                            PROCEDURE SOI 3.
M.................        6           370  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL HEMORRHAGE
                                            SOI 1.
M.................        6           371  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL HEMORRHAGE
                                            SOI 2.
M.................        6           372  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL HEMORRHAGE
                                            SOI 3.
M.................        6           373  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 1.
M.................        6           374  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 2.
M.................        6           375  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 3.
S.................        7           376  MAJOR HEPATOBILIARY, PANCREAS
                                            & LIVER PROCEDURES SOI 4.
S.................        7           377  CHOLECYSTECTOMY AND OTHER
                                            HEPATOBILIARY, PANCREAS &
                                            ABDOMINAL PROCEDURES SOI 4.
S.................        7           378  MAJOR PANCREAS, LIVER & SHUNT
                                            PROCEDURES SOI 1.
S.................        7           379  MAJOR PANCREAS, LIVER & SHUNT
                                            PROCEDURES SOI 2.
S.................        7           380  MAJOR PANCREAS, LIVER & SHUNT
                                            PROCEDURES SOI 3.
S.................        7           381  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 1.
S.................        7           382  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 2.
S.................        7           383  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 3.
S.................        7           384  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 1.
S.................        7           385  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 2.
S.................        7           386  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 3.
S.................        7           387  LAPAROSCOPIC CHOLECYSTECTOMY
                                            SOI 1.
S.................        7           388  LAPAROSCOPIC CHOLECYSTECTOMY
                                            SOI 2.
S.................        7           389  LAPAROSCOPIC CHOLECYSTECTOMY
                                            SOI 3.
S.................        7           390  OTHER HEPATOBILIARY, PANCREAS
                                            & ABDOMINAL PROCEDURES SOI
                                            1.
S.................        7           391  OTHER HEPATOBILIARY, PANCREAS
                                            & ABDOMINAL PROCEDURES SOI
                                            2.
S.................        7           392  OTHER HEPATOBILIARY, PANCREAS
                                            & ABDOMINAL PROCEDURES SOI
                                            3.
M.................        7           393  HEPATOBILIARY, PANCREAS &
                                            ABDOMINAL DIAGNOSES SOI 4.
M.................        7           394  HEPATIC COMA & OTHER MAJOR
                                            ACUTE LIVER DISORDERS SOI 1.
M.................        7           395  HEPATIC COMA & OTHER MAJOR
                                            ACUTE LIVER DISORDERS SOI 2.
M.................        7           396  HEPATIC COMA & OTHER MAJOR
                                            ACUTE LIVER DISORDERS SOI 3.
M.................        7           397  ALCOHOLIC LIVER DISEASE SOI
                                            1.
M.................        7           398  ALCOHOLIC LIVER DISEASE SOI
                                            2.
M.................        7           399  ALCOHOLIC LIVER DISEASE SOI
                                            3.
M.................        7           400  MALIGNANCY OF HEPATOBILIARY
                                            SYSTEM & PANCREAS SOI 1.
M.................        7           401  MALIGNANCY OF HEPATOBILIARY
                                            SYSTEM & PANCREAS SOI 2.
M.................        7           402  MALIGNANCY OF HEPATOBILIARY
                                            SYSTEM & PANCREAS SOI 3.
M.................        7           403  DISORDERS OF PANCREAS EXCEPT
                                            MALIGNANCY SOI 1.
M.................        7           404  DISORDERS OF PANCREAS EXCEPT
                                            MALIGNANCY SOI 2.
M.................        7           405  DISORDERS OF PANCREAS EXCEPT
                                            MALIGNANCY SOI 3.
M.................        7           406  OTHER DISORDERS OF THE LIVER
                                            SOI 1.
M.................        7           407  OTHER DISORDERS OF THE LIVER
                                            SOI 2.
M.................        7           408  OTHER DISORDERS OF THE LIVER
                                            SOI 3.
M.................        7           409  DISORDERS OF GALLBLADDER &
                                            BILIARY TRACT SOI 1.
M.................        7           410  DISORDERS OF GALLBLADDER &
                                            BILIARY TRACT SOI 2.
M.................        7           411  DISORDERS OF GALLBLADDER &
                                            BILIARY TRACT SOI 3.
S.................        8           412  MUSCULOSKELETAL SYSTEM &
                                            CONNECTIVE TISSUE PROCEDURES
                                            EXCEPT SPINAL FUSION SOI 4.
S.................        8           413  SPINAL FUSION PROCEDURES SOI
                                            4.
S.................        8           414  HIP JOINT REPLACEMENT SOI 1.
S.................        8           415  HIP JOINT REPLACEMENT SOI 2.
S.................        8           416  HIP JOINT REPLACEMENT SOI 3.

[[Page 24427]]

 
S.................        8           417  KNEE JOINT REPLACEMENT SOI 1.
S.................        8           418  KNEE JOINT REPLACEMENT SOI 2.
S.................        8           419  KNEE JOINT REPLACEMENT SOI 3.
S.................        8           420  DORSAL & LUMBAR FUSION PROC
                                            FOR CURVATURE OF BACK SOI 1.
S.................        8           421  DORSAL & LUMBAR FUSION PROC
                                            FOR CURVATURE OF BACK SOI 2.
S.................        8           422  DORSAL & LUMBAR FUSION PROC
                                            FOR CURVATURE OF BACK SOI 3.
S.................        8           423  DORSAL & LUMBAR FUSION PROC
                                            EXCEPT FOR CURVATURE OF BACK
                                            SOI 1.
S.................        8           424  DORSAL & LUMBAR FUSION PROC
                                            EXCEPT FOR CURVATURE OF BACK
                                            SOI 2.
S.................        8           425  DORSAL & LUMBAR FUSION PROC
                                            EXCEPT FOR CURVATURE OF BACK
                                            SOI 3.
S.................        8           426  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 1.
S.................        8           427  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 2.
S.................        8           428  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 3.
S.................        8           429  HIP & FEMUR PROCEDURES FOR
                                            TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 1.
S.................        8           430  HIP & FEMUR PROCEDURES FOR
                                            TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 2.
S.................        8           431  HIP & FEMUR PROCEDURES FOR
                                            TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 3.
S.................        8           432  HIP & FEMUR PROCEDURES FOR
                                            NON-TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 1.
S.................        8           433  HIP & FEMUR PROCEDURES FOR
                                            NON-TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 2.
S.................        8           434  HIP & FEMUR PROCEDURES FOR
                                            NON-TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 3.
S.................        8           435  INTERVERTEBRAL DISC EXCISION
                                            & DECOMPRESSION SOI 1.
S.................        8           436  INTERVERTEBRAL DISC EXCISION
                                            & DECOMPRESSION SOI 2.
S.................        8           437  INTERVERTEBRAL DISC EXCISION
                                            & DECOMPRESSION SOI 3.
S.................        8           438  SKIN GRAFT, EXCEPT HAND, FOR
                                            MUSCULOSKELETAL & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 1.
S.................        8           439  SKIN GRAFT, EXCEPT HAND, FOR
                                            MUSCULOSKELETAL & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 2.
S.................        8           440  SKIN GRAFT, EXCEPT HAND, FOR
                                            MUSCULOSKELETAL & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 3.
S.................        8           441  SKIN GRAFT, EXCEPT HAND, FOR
                                            MUSCULOSKELETAL & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 4.
S.................        8           442  KNEE & LOWER LEG PROCEDURES
                                            EXCEPT FOOT SOI 1.
S.................        8           443  KNEE & LOWER LEG PROCEDURES
                                            EXCEPT FOOT SOI 2.
S.................        8           444  KNEE & LOWER LEG PROCEDURES
                                            EXCEPT FOOT SOI 3.
S.................        8           445  FOOT & TOE PROCEDURES SOI 1.
S.................        8           446  FOOT & TOE PROCEDURES SOI 2.
S.................        8           447  FOOT & TOE PROCEDURES SOI 3.
S.................        8           448  SHOULDER, UPPER ARM & FOREARM
                                            PROCEDURES SOI 1.
S.................        8           449  SHOULDER, UPPER ARM & FOREARM
                                            PROCEDURES SOI 2.
S.................        8           450  SHOULDER, UPPER ARM & FOREARM
                                            PROCEDURES SOI 3.
S.................        8           451  HAND & WRIST PROCEDURES SOI
                                            1.
S.................        8           452  HAND & WRIST PROCEDURES SOI
                                            2.
S.................        8           453  HAND & WRIST PROCEDURES SOI
                                            3.
S.................        8           454  TENDON, MUSCLE & OTHER SOFT
                                            TISSUE PROCEDURES SOI 1.
S.................        8           455  TENDON, MUSCLE & OTHER SOFT
                                            TISSUE PROCEDURES SOI 2.
S.................        8           456  TENDON, MUSCLE & OTHER SOFT
                                            TISSUE PROCEDURES SOI 3.
S.................        8           457  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            PROCEDURES SOI 1.
S.................        8           458  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            PROCEDURES SOI 2.
S.................        8           459  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            PROCEDURES SOI 3.
S.................        8           460  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            PROCEDURES SOI 4.
S.................        8           461  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC
                                            DISC EXCIS/DECOMP SOI 1.
S.................        8           462  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC
                                            DISC EXCIS/DECOMP SOI 2.
S.................        8           463  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC
                                            DISC EXCIS/DECOMP SOI 3.
M.................        8           464  MUSCULOSKELETAL SYSTEM &
                                            CONNECTIVE TISSUE DIAGNOSES
                                            SOI 4.
M.................        8           465  FRACTURE OF FEMUR SOI 1.
M.................        8           466  FRACTURE OF FEMUR SOI 2.
M.................        8           467  FRACTURE OF FEMUR SOI 3.
M.................        8           468  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 1.
M.................        8           469  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 2.
M.................        8           470  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 3.
M.................        8           471  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS & BACK
                                            SOI 1.
M.................        8           472  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS & BACK
                                            SOI 2.
M.................        8           473  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS & BACK
                                            SOI 3.
M.................        8           474  MUSCULOSKELETAL MALIGNANCY &
                                            PATHOL FRACTURE D/T MUSCSKEL
                                            MALIG SOI 1.
M.................        8           475  MUSCULOSKELETAL MALIGNANCY &
                                            PATHOL FRACTURE D/T MUSCSKEL
                                            MALIG SOI 2.
M.................        8           476  MUSCULOSKELETAL MALIGNANCY &
                                            PATHOL FRACTURE D/T MUSCSKEL
                                            MALIG SOI 3.
M.................        8           477  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL INFECTIONS
                                            SOI 1.
M.................        8           478  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL INFECTIONS
                                            SOI 2.
M.................        8           479  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL INFECTIONS
                                            SOI 3.
M.................        8           480  CONNECTIVE TISSUE DISORDERS
                                            SOI 1.
M.................        8           481  CONNECTIVE TISSUE DISORDERS
                                            SOI 2.
M.................        8           482  CONNECTIVE TISSUE DISORDERS
                                            SOI 3.
M.................        8           483  OTHER BACK & NECK DISORDERS,
                                            FRACTURES & INJURIES SOI 1.
M.................        8           484  OTHER BACK & NECK DISORDERS,
                                            FRACTURES & INJURIES SOI 2.
M.................        8           485  OTHER BACK & NECK DISORDERS,
                                            FRACTURES & INJURIES SOI 3.
M.................        8           486  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC DEVICE
                                            OR PROCEDURE SOI 1.

[[Page 24428]]

 
M.................        8           487  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC DEVICE
                                            OR PROCEDURE SOI 2.
M.................        8           488  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC DEVICE
                                            OR PROCEDURE SOI 3.
M.................        8           489  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            DIAGNOSES SOI 1.
M.................        8           490  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            DIAGNOSES SOI 2.
M.................        8           491  OTHER MUSCULOSKELETAL SYSTEM
                                            & CONNECTIVE TISSUE
                                            DIAGNOSES SOI 3.
S.................        9           492  SKIN, SUBCUTANEOUS TISSUE,
                                            BREAST & RELATED PROCEDURES
                                            SOI 4.
S.................        9           493  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 1.
S.................        9           494  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 2.
S.................        9           495  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 3.
S.................        9           496  MASTECTOMY PROCEDURES SOI 1.
S.................        9           497  MASTECTOMY PROCEDURES SOI 2.
S.................        9           498  MASTECTOMY PROCEDURES SOI 3.
S.................        9           499  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 1.
S.................        9           500  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 2.
S.................        9           501  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 3.
S.................        9           502  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED PROCEDURES
                                            SOI 1.
S.................        9           503  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED PROCEDURES
                                            SOI 2.
S.................        9           504  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED PROCEDURES
                                            SOI 3.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE &
                                            BREAST DIAGNOSES SOI 4.
M.................        9           506  SKIN ULCERS SOI 1.
M.................        9           507  SKIN ULCERS SOI 2.
M.................        9           508  SKIN ULCERS SOI 3.
M.................        9           509  MAJOR SKIN DISORDERS SOI 1.
M.................        9           510  MAJOR SKIN DISORDERS SOI 2.
M.................        9           511  MAJOR SKIN DISORDERS SOI 3.
M.................        9           512  MALIGNANT BREAST DISORDERS
                                            SOI 1.
M.................        9           513  MALIGNANT BREAST DISORDERS
                                            SOI 2.
M.................        9           514  MALIGNANT BREAST DISORDERS
                                            SOI 3.
M.................        9           515  CELLULITIS & OTHER BACTERIAL
                                            SKIN INFECTIONS SOI 1.
M.................        9           516  CELLULITIS & OTHER BACTERIAL
                                            SKIN INFECTIONS SOI 2.
M.................        9           517  CELLULITIS & OTHER BACTERIAL
                                            SKIN INFECTIONS SOI 3.
M.................        9           518  CONTUSION, OPEN WOUND & OTHER
                                            TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI 1.
M.................        9           519  CONTUSION, OPEN WOUND & OTHER
                                            TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI 2.
M.................        9           520  CONTUSION, OPEN WOUND & OTHER
                                            TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI 3.
M.................        9           521  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST DISORDERS
                                            SOI 1.
M.................        9           522  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST DISORDERS
                                            SOI 2.
M.................        9           523  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST DISORDERS
                                            SOI 3.
S.................       10           524  PROCEDURES FOR ENDOCRINE,
                                            NUTRITIONAL & METABOLIC
                                            DISORDERS SOI 4.
S.................       10           525  PITUITARY & ADRENAL
                                            PROCEDURES SOI 1.
S.................       10           526  PITUITARY & ADRENAL
                                            PROCEDURES SOI 2.
S.................       10           527  PITUITARY & ADRENAL
                                            PROCEDURES SOI 3.
S.................       10           528  PROCEDURES FOR OBESITY SOI 1.
S.................       10           529  PROCEDURES FOR OBESITY SOI 2.
S.................       10           530  PROCEDURES FOR OBESITY SOI 3.
S.................       10           531  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES SOI
                                            1.
S.................       10           532  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES SOI
                                            2.
S.................       10           533  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES SOI
                                            3.
S.................       10           534  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &
                                            METABOLIC DISORDERS SOI 1.
S.................       10           535  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &
                                            METABOLIC DISORDERS SOI 2.
S.................       10           536  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &
                                            METABOLIC DISORDERS SOI 3.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4.
M.................       10           538  DIABETES SOI 1.
M.................       10           539  DIABETES SOI 2.
M.................       10           540  DIABETES SOI 3.
M.................       10           541  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER NUTRITIONAL
                                            DISORDERS SOI 1.
M.................       10           542  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER NUTRITIONAL
                                            DISORDERS SOI 2.
M.................       10           543  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER NUTRITIONAL
                                            DISORDERS SOI 3.
M.................       10           544  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS SOI 1.
M.................       10           545  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS SOI 2.
M.................       10           546  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS SOI 3.
M.................       10           547  INBORN ERRORS OF METABOLISM
                                            SOI 1.
M.................       10           548  INBORN ERRORS OF METABOLISM
                                            SOI 2.
M.................       10           549  INBORN ERRORS OF METABOLISM
                                            SOI 3.
M.................       10           550  OTHER ENDOCRINE DISORDERS SOI
                                            1.
M.................       10           551  OTHER ENDOCRINE DISORDERS SOI
                                            2.
M.................       10           552  OTHER ENDOCRINE DISORDERS SOI
                                            3.
M.................       10           553  ELECTROLYTE DISORDERS EXCEPT
                                            HYPOVOLEMIA RELATED SOI 1.
M.................       10           554  ELECTROLYTE DISORDERS EXCEPT
                                            HYPOVOLEMIA RELATED SOI 2.
M.................       10           555  ELECTROLYTE DISORDERS EXCEPT
                                            HYPOVOLEMIA RELATED SOI 3.
S.................       11           556  URINARY TRACT & RELATED
                                            PROCEDURES EXCEPT KIDNEY
                                            TRANSPLANT SOI 4.

[[Page 24429]]

 
S.................       11           557  KIDNEY TRANSPLANT SOI 1.
S.................       11           558  KIDNEY TRANSPLANT SOI 2.
S.................       11           559  KIDNEY TRANSPLANT SOI 3.
S.................       11           560  KIDNEY TRANSPLANT SOI 4.
S.................       11           561  MAJOR BLADDER PROCEDURES SOI
                                            1.
S.................       11           562  MAJOR BLADDER PROCEDURES SOI
                                            2.
S.................       11           563  MAJOR BLADDER PROCEDURES SOI
                                            3.
S.................       11           564  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR MALIGNANCY
                                            SOI 1.
S.................       11           565  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR MALIGNANCY
                                            SOI 2.
S.................       11           566  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR MALIGNANCY
                                            SOI 3.
S.................       11           567  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR NONMALIGNANCY
                                            SOI 1.
S.................       11           568  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR NONMALIGNANCY
                                            SOI 2.
S.................       11           569  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR NONMALIGNANCY
                                            SOI 3.
S.................       11           570  RENAL DIALYSIS ACCESS DEVICE
                                            PROCEDURE ONLY SOI 1.
S.................       11           571  RENAL DIALYSIS ACCESS DEVICE
                                            PROCEDURE ONLY SOI 2.
S.................       11           572  RENAL DIALYSIS ACCESS DEVICE
                                            PROCEDURE ONLY SOI 3.
S.................       11           573  OTHER BLADDER PROCEDURES SOI
                                            1.
S.................       11           574  OTHER BLADDER PROCEDURES SOI
                                            2.
S.................       11           575  OTHER BLADDER PROCEDURES SOI
                                            3.
S.................       11           576  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 1.
S.................       11           577  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 2.
S.................       11           578  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 3.
S.................       11           579  OTHER KIDNEY, URINARY TRACT &
                                            RELATED PROCEDURES SOI 1.
S.................       11           580  OTHER KIDNEY, URINARY TRACT &
                                            RELATED PROCEDURES SOI 2.
S.................       11           581  OTHER KIDNEY, URINARY TRACT &
                                            RELATED PROCEDURES SOI 3.
M.................       11           582  KIDNEY & URINARY TRACT
                                            DIAGNOSES SOI 4.
M.................       11           583  RENAL FAILURE SOI 1.
M.................       11           584  RENAL FAILURE SOI 2.
M.................       11           585  RENAL FAILURE SOI 3.
M.................       11           586  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 1.
M.................       11           587  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 2.
M.................       11           588  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 3.
M.................       11           589  NEPHRITIS & NEPHROSIS SOI 1.
M.................       11           590  NEPHRITIS & NEPHROSIS SOI 2.
M.................       11           591  NEPHRITIS & NEPHROSIS SOI 3.
M.................       11           592  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 1.
M.................       11           593  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 2.
M.................       11           594  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 3.
M.................       11           595  URINARY STONES & ACQUIRED
                                            UPPER URINARY TRACT
                                            OBSTRUCTION SOI 1.
M.................       11           596  URINARY STONES & ACQUIRED
                                            UPPER URINARY TRACT
                                            OBSTRUCTION SOI 2.
M.................       11           597  URINARY STONES & ACQUIRED
                                            UPPER URINARY TRACT
                                            OBSTRUCTION SOI 3.
M.................       11           598  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY
                                            DEVICE OR PROC SOI 1.
M.................       11           599  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY
                                            DEVICE OR PROC SOI 2.
M.................       11           600  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY
                                            DEVICE OR PROC SOI 3.
M.................       11           601  OTHER KIDNEY & URINARY TRACT
                                            DIAGNOSES, SIGNS & SYMPTOMS
                                            SOI 1.
M.................       11           602  OTHER KIDNEY & URINARY TRACT
                                            DIAGNOSES, SIGNS & SYMPTOMS
                                            SOI 2.
M.................       11           603  OTHER KIDNEY & URINARY TRACT
                                            DIAGNOSES, SIGNS & SYMPTOMS
                                            SOI 3.
S.................       12           604  MALE REPRODUCTIVE SYSTEM &
                                            RELATED PROCEDURES SOI 4.
S.................       12           605  MAJOR MALE PELVIC PROCEDURES
                                            SOI 1.
S.................       12           606  MAJOR MALE PELVIC PROCEDURES
                                            SOI 2.
S.................       12           607  MAJOR MALE PELVIC PROCEDURES
                                            SOI 3.
S.................       12           608  PENIS PROCEDURES SOI 1.
S.................       12           609  PENIS PROCEDURES SOI 2.
S.................       12           610  PENIS PROCEDURES SOI 3.
S.................       12           611  TRANSURETHRAL PROSTATECTOMY
                                            SOI 1.
S.................       12           612  TRANSURETHRAL PROSTATECTOMY
                                            SOI 2.
S.................       12           613  TRANSURETHRAL PROSTATECTOMY
                                            SOI 3.
S.................       12           614  TESTES & SCROTAL PROCEDURES
                                            SOI 1.
S.................       12           615  TESTES & SCROTAL PROCEDURES
                                            SOI 2.
S.................       12           616  TESTES & SCROTAL PROCEDURES
                                            SOI 3.
S.................       12           617  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 1.
S.................       12           618  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 2.
S.................       12           619  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 3.
M.................       12           620  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES SOI 4.
M.................       12           621  MALIGNANCY, MALE REPRODUCTIVE
                                            SYSTEM SOI 1.
M.................       12           622  MALIGNANCY, MALE REPRODUCTIVE
                                            SYSTEM SOI 2.
M.................       12           623  MALIGNANCY, MALE REPRODUCTIVE
                                            SYSTEM SOI 3.
M.................       12           624  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT MALIGNANCY
                                            SOI 1.
M.................       12           625  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT MALIGNANCY
                                            SOI 2.
M.................       12           626  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT MALIGNANCY
                                            SOI 3.

[[Page 24430]]

 
S.................       13           627  FEMALE REPRODUCTIVE SYSTEM &
                                            RELATED PROCEDURES SOI 4.
S.................       13           628  PELVIC EVISCERATION, RADICAL
                                            HYSTERECTOMY & OTHER RADICAL
                                            GYN PROCS SOI 1.
S.................       13           629  PELVIC EVISCERATION, RADICAL
                                            HYSTERECTOMY & OTHER RADICAL
                                            GYN PROCS SOI 2.
S.................       13           630  PELVIC EVISCERATION, RADICAL
                                            HYSTERECTOMY & OTHER RADICAL
                                            GYN PROCS SOI 3.
S.................       13           631  UTERINE & ADNEXA PROCEDURES
                                            FOR OVARIAN & ADNEXAL
                                            MALIGNANCY SOI 1.
S.................       13           632  UTERINE & ADNEXA PROCEDURES
                                            FOR OVARIAN & ADNEXAL
                                            MALIGNANCY SOI 2.
S.................       13           633  UTERINE & ADNEXA PROCEDURES
                                            FOR OVARIAN & ADNEXAL
                                            MALIGNANCY SOI 3.
S.................       13           634  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-OVARIAN & NON-
                                            ADNEXAL MALIG SOI 1.
S.................       13           635  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-OVARIAN & NON-
                                            ADNEXAL MALIG SOI 2.
S.................       13           636  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-OVARIAN & NON-
                                            ADNEXAL MALIG SOI 3.
S.................       13           637  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 1.
S.................       13           638  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 2.
S.................       13           639  UTERINE & ADNEXA PROCEDURES
                                            FOR NON-MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 3.
S.................       13           640  FEMALE REPRODUCTIVE SYSTEM
                                            RECONSTRUCTIVE PROCEDURES
                                            SOI 1.
S.................       13           641  FEMALE REPRODUCTIVE SYSTEM
                                            RECONSTRUCTIVE PROCEDURES
                                            SOI 2.
S.................       13           642  FEMALE REPRODUCTIVE SYSTEM
                                            RECONSTRUCTIVE PROCEDURES
                                            SOI 3.
S.................       13           643  DILATION & CURETTAGE FOR NON-
                                            OBSTETRIC DIAGNOSES SOI 1.
S.................       13           644  DILATION & CURETTAGE FOR NON-
                                            OBSTETRIC DIAGNOSES SOI 2.
S.................       13           645  DILATION & CURETTAGE FOR NON-
                                            OBSTETRIC DIAGNOSES SOI 3.
S.................       13           646  OTHER FEMALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 1.
S.................       13           647  OTHER FEMALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 2.
S.................       13           648  OTHER FEMALE REPRODUCTIVE
                                            SYSTEM & RELATED PROCEDURES
                                            SOI 3.
S.................       13           649  UTERINE & ADNEXA PROCEDURES
                                            FOR LEIOMYOMA SOI 1.
S.................       13           650  UTERINE & ADNEXA PROCEDURES
                                            FOR LEIOMYOMA SOI 2.
S.................       13           651  UTERINE & ADNEXA PROCEDURES
                                            FOR LEIOMYOMA SOI 3.
M.................       13           652  FEMALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES SOI 4.
M.................       13           653  FEMALE REPRODUCTIVE SYSTEM
                                            MALIGNANCY SOI 1.
M.................       13           654  FEMALE REPRODUCTIVE SYSTEM
                                            MALIGNANCY SOI 2.
M.................       13           655  FEMALE REPRODUCTIVE SYSTEM
                                            MALIGNANCY SOI 3.
M.................       13           656  FEMALE REPRODUCTIVE SYSTEM
                                            INFECTIONS SOI 1.
M.................       13           657  FEMALE REPRODUCTIVE SYSTEM
                                            INFECTIONS SOI 2.
M.................       13           658  FEMALE REPRODUCTIVE SYSTEM
                                            INFECTIONS SOI 3.
M.................       13           659  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 1.
M.................       13           660  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 2.
M.................       13           661  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 3.
S.................       14           662  O.R. PROC FOR OBSTETRIC
                                            DIAGNOSES EXCEPT CESAREAN
                                            DELIVERY SOI 4.
S.................       14           663  CESAREAN DELIVERY SOI 1.
S.................       14           664  CESAREAN DELIVERY SOI 2.
S.................       14           665  CESAREAN DELIVERY SOI 3.
S.................       14           666  CESAREAN DELIVERY SOI 4.
S.................       14           667  VAGINAL DELIVERY PROCEDURES
                                            SOI 1.
S.................       14           668  VAGINAL DELIVERY PROCEDURES
                                            SOI 2.
S.................       14           669  VAGINAL DELIVERY PROCEDURES
                                            SOI 3.
S.................       14           670  OTHER PROCEDURES FOR
                                            OBSTETRIC DIAGNOSES EXCEPT
                                            DELIVERY DIAGNOSES SOI 1.
S.................       14           671  OTHER PROCEDURES FOR
                                            OBSTETRIC DIAGNOSES EXCEPT
                                            DELIVERY DIAGNOSES SOI 2.
S.................       14           672  OTHER PROCEDURES FOR
                                            OBSTETRIC DIAGNOSES EXCEPT
                                            DELIVERY DIAGNOSES SOI 3.
M.................       14           673  ANTEPARTUM DIAGNOSES EXCEPT
                                            VAGINAL DELIVERY DIAGNOSIS
                                            SOI 4.
M.................       14           674  VAGINAL DELIVERY SOI 1.
M.................       14           675  VAGINAL DELIVERY SOI 2.
M.................       14           676  VAGINAL DELIVERY SOI 3.
M.................       14           677  VAGINAL DELIVERY SOI 4.
M.................       14           678  POSTPARTUM & ABORTION
                                            DIAGNOSES W/O PROCEDURE SOI
                                            1.
M.................       14           679  POSTPARTUM & ABORTION
                                            DIAGNOSES W/O PROCEDURE SOI
                                            2.
M.................       14           680  POSTPARTUM & ABORTION
                                            DIAGNOSES W/O PROCEDURE SOI
                                            3.
M.................       14           681  ANTEPARTUM DIAGNOSES SOI 1.
M.................       14           682  ANTEPARTUM DIAGNOSES SOI 2.
M.................       14           683  ANTEPARTUM DIAGNOSES SOI 3.
M.................       15           684  NEONATE, TRANSFERRED <5 DAYS
                                            OLD SOI 1 & 2.
M.................       15           685  NEONATE, TRANSFERRED <5 DAYS
                                            OLD SOI 3 & 4.
M.................       15           686  EXTREME IMMATURITY OR
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 1 & 2.
M.................       15           687  EXTREME IMMATURITY OR
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 3 & 4.
M.................       15           688  PREMAUTRITY WITH MAJOR
                                            PROBLEMS SOI 1 & 2.
M.................       15           689  PREMAUTRITY WITH MAJOR
                                            PROBLEMS SOI 3 & 4.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR
                                            PROBLEMS SOI 1 & 2.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR
                                            PROBLEMS SOI 3 & 4.
M.................       15           692  FULL TERM NEONATE WITH MAJOR
                                            PROBLEMS SOI 1 & 2.
M.................       15           693  FULL TERM NEONATE WITH MAJOR
                                            PROBLEMS SOI 3 & 4.
M.................       15           694  NEONATE WITH OTHER
                                            SIGNIFICANT PROBLEMS SOI 1 &
                                            2.
M.................       15           695  NEONATE WITH OTHER
                                            SIGNIFICANT PROBLEMS SOI 3 &
                                            4.
M.................       15           696  NEONATE > 2,000 GRAMS WITHOUT
                                            SIGNIFICANT PROBLEMS SOI 1 &
                                            2.

[[Page 24431]]

 
M.................       15           697  NEONATE > 2,000 GRAMS WITHOUT
                                            SIGNIFICANT PROBLEMS SOI 3 &
                                            4.
S.................       16           698  PROCEDURES OF BLOOD & BLOOD-
                                            FORMING ORGANS SOI 4.
S.................       16           699  SPLENECTOMY SOI 1.
S.................       16           700  SPLENECTOMY SOI 2.
S.................       16           701  SPLENECTOMY SOI 3.
S.................       16           702  OTHER PROCEDURES OF BLOOD &
                                            BLOOD-FORMING ORGANS SOI 1.
S.................       16           703  OTHER PROCEDURES OF BLOOD &
                                            BLOOD-FORMING ORGANS SOI 2.
S.................       16           704  OTHER PROCEDURES OF BLOOD &
                                            BLOOD-FORMING ORGANS SOI 3.
M.................       16           705  ANEMIA & DIAGNOSES OF BLOOD &
                                            BLOOD-FORMING ORGANS SOI 4.
M.................       16           706  MAJOR HEMATOLOGIC/IMMUNOLOGIC
                                            DIAG EXC SICKLE CELL CRISIS
                                            & COAGUL SOI 1.
M.................       16           707  MAJOR HEMATOLOGIC/IMMUNOLOGIC
                                            DIAG EXC SICKLE CELL CRISIS
                                            & COAGUL SOI 2.
M.................       16           708  MAJOR HEMATOLOGIC/IMMUNOLOGIC
                                            DIAG EXC SICKLE CELL CRISIS
                                            & COAGUL SOI 3.
M.................       16           709  COAGULATION & PLATELET
                                            DISORDERS SOI 1.
M.................       16           710  COAGULATION & PLATELET
                                            DISORDERS SOI 2.
M.................       16           711  COAGULATION & PLATELET
                                            DISORDERS SOI 3.
M.................       16           712  SICKLE CELL ANEMIA CRISIS SOI
                                            1.
M.................       16           713  SICKLE CELL ANEMIA CRISIS SOI
                                            2.
M.................       16           714  SICKLE CELL ANEMIA CRISIS SOI
                                            3.
M.................       16           715  OTHER ANEMIA & DISORDERS OF
                                            BLOOD & BLOOD-FORMING ORGANS
                                            SOI 1.
M.................       16           716  OTHER ANEMIA & DISORDERS OF
                                            BLOOD & BLOOD-FORMING ORGANS
                                            SOI 2.
M.................       16           717  OTHER ANEMIA & DISORDERS OF
                                            BLOOD & BLOOD-FORMING ORGANS
                                            SOI 3.
S.................       17           718  PROCEDURES FOR LYMPHATIC/
                                            HEMATOPOIETIC/OTHER
                                            NEOPLASMS SOI 4.
S.................       17           719  MAJOR O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 1.
S.................       17           720  MAJOR O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 2.
S.................       17           721  MAJOR O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 3.
S.................       17           722  OTHER O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 1.
S.................       17           723  OTHER O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 2.
S.................       17           724  OTHER O.R. PROCEDURES FOR
                                            LYMPHATIC/HEMATOPOIETIC/
                                            OTHER NEOPLASMS SOI 3.
M.................       17           725  LEUKEMIA, LYMPHOMA, MYELOMA,
                                            CHEMOTHERAPY, AND
                                            RADIOTHERAPY SOI 4.
M.................       17           726  ACUTE LEUKEMIA SOI 1.
M.................       17           727  ACUTE LEUKEMIA SOI 2.
M.................       17           728  ACUTE LEUKEMIA SOI 3.
M.................       17           729  LYMPHOMA, MYELOMA & NON-ACUTE
                                            LEUKEMIA SOI 1.
M.................       17           730  LYMPHOMA, MYELOMA & NON-ACUTE
                                            LEUKEMIA SOI 2.
M.................       17           731  LYMPHOMA, MYELOMA & NON-ACUTE
                                            LEUKEMIA SOI 3.
M.................       17           732  RADIOTHERAPY SOI 1.
M.................       17           733  RADIOTHERAPY SOI 2.
M.................       17           734  RADIOTHERAPY SOI 3.
M.................       17           735  CHEMOTHERAPY SOI 1.
M.................       17           736  CHEMOTHERAPY SOI 2.
M.................       17           737  CHEMOTHERAPY SOI 3.
M.................       17           738  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS OF
                                            UNCERTAIN BEHAVIOR SOI 1.
M.................       17           739  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS OF
                                            UNCERTAIN BEHAVIOR SOI 2.
M.................       17           740  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS OF
                                            UNCERTAIN BEHAVIOR SOI 3.
M.................       17           741  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS OF
                                            UNCERTAIN BEHAVIOR SOI 4.
S.................       18           742  INFECTIOUS & PARASITIC
                                            DISEASES W O.R. PROCEDURE
                                            SOI 4.
S.................       18           743  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W
                                            O.R. PROCEDURE SOI 1.
S.................       18           744  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W
                                            O.R. PROCEDURE SOI 2.
S.................       18           745  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W
                                            O.R. PROCEDURE SOI 3.
S.................       18           746  POST-OP, POST-TRAUMA, OTHER
                                            DEVICE INFECTIONS W O.R.
                                            PROCEDURE SOI 1.
S.................       18           747  POST-OP, POST-TRAUMA, OTHER
                                            DEVICE INFECTIONS W O.R.
                                            PROCEDURE SOI 2.
S.................       18           748  POST-OP, POST-TRAUMA, OTHER
                                            DEVICE INFECTIONS W O.R.
                                            PROCEDURE SOI 3.
M.................       18           749  INFECTIOUS & PARASITIC
                                            DISEASES SOI 4.
M.................       18           750  SEPTICEMIA & DISSEMINATED
                                            INFECTIONS SOI 1.
M.................       18           751  SEPTICEMIA & DISSEMINATED
                                            INFECTIONS SOI 2.
M.................       18           752  SEPTICEMIA & DISSEMINATED
                                            INFECTIONS SOI 3.
M.................       18           753  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 1.
M.................       18           754  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 2.
M.................       18           755  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 3.
M.................       18           756  FEVER SOI 1.
M.................       18           757  FEVER SOI 2.
M.................       18           758  FEVER SOI 3.
M.................       18           759  VIRAL ILLNESS SOI 1.
M.................       18           760  VIRAL ILLNESS SOI 2.
M.................       18           761  VIRAL ILLNESS SOI 3.
M.................       18           762  OTHER INFECTIOUS & PARASITIC
                                            DISEASES SOI 1.
M.................       18           763  OTHER INFECTIOUS & PARASITIC
                                            DISEASES SOI 2.
M.................       18           764  OTHER INFECTIOUS & PARASITIC
                                            DISEASES SOI 3.
S.................       19           765  MENTAL ILLNESS DIAGNOSIS W
                                            O.R. PROCEDURE SOI 1.
S.................       19           766  MENTAL ILLNESS DIAGNOSIS W
                                            O.R. PROCEDURE SOI 2.

[[Page 24432]]

 
S.................       19           767  MENTAL ILLNESS DIAGNOSIS W
                                            O.R. PROCEDURE SOI 3.
S.................       19           768  MENTAL ILLNESS DIAGNOSIS W
                                            O.R. PROCEDURE SOI 4.
M.................       19           769  MAJOR DEPRESSIVE,
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 1.
M.................       19           770  MAJOR DEPRESSIVE,
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 2.
M.................       19           771  MAJOR DEPRESSIVE,
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 3.
M.................       19           772  MAJOR DEPRESSIVE,
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 4.
M.................       19           773  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 1.
M.................       19           774  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 2.
M.................       19           775  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 3.
M.................       19           776  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 4.
M.................       19           777  OTHER MENTAL HEALTH DISORDERS
                                            SOI 1.
M.................       19           778  OTHER MENTAL HEALTH DISORDERS
                                            SOI 2.
M.................       19           779  OTHER MENTAL HEALTH DISORDERS
                                            SOI 3.
M.................       19           780  OTHER MENTAL HEALTH DISORDERS
                                            SOI 4.
M.................       20           781  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST
                                            MEDICAL ADVICE SOI 1 & 2.
M.................       20           782  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST
                                            MEDICAL ADVICE SOI 3 & 4.
M.................       20           783  DRUG ABUSE & DEPENDENCE
                                            DIAGNOSES SOI 1.
M.................       20           784  DRUG ABUSE & DEPENDENCE
                                            DIAGNOSES SOI 2.
M.................       20           785  DRUG ABUSE & DEPENDENCE
                                            DIAGNOSES SOI 3.
M.................       20           786  DRUG ABUSE & DEPENDENCE
                                            DIAGNOSES SOI 4.
S.................       21           787  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF TREATMENT
                                            SOI 1.
S.................       21           788  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF TREATMENT
                                            SOI 2.
S.................       21           789  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF TREATMENT
                                            SOI 3.
S.................       21           790  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF TREATMENT
                                            SOI 4.
M.................       21           791  INJURIES, POISONINGS & TOXIC
                                            EFFECTS OF DRUGS DIAGNOSES
                                            SOI 4.
M.................       21           792  ALLERGIC REACTIONS SOI 1.
M.................       21           793  ALLERGIC REACTIONS SOI 2.
M.................       21           794  ALLERGIC REACTIONS SOI 3.
M.................       21           795  POISONING OF MEDICINAL AGENTS
                                            SOI 1.
M.................       21           796  POISONING OF MEDICINAL AGENTS
                                            SOI 2.
M.................       21           797  POISONING OF MEDICINAL AGENTS
                                            SOI 3.
M.................       21           798  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 1.
M.................       21           799  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 2.
M.................       21           800  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 3.
M.................       21           801  OTHER INJURY, POISONING &
                                            TOXIC EFFECT DIAGNOSES SOI
                                            1.
M.................       21           802  OTHER INJURY, POISONING &
                                            TOXIC EFFECT DIAGNOSES SOI
                                            2.
M.................       21           803  OTHER INJURY, POISONING &
                                            TOXIC EFFECT DIAGNOSES SOI
                                            3.
S.................       22           804  BURN PROCEDURES SOI 4.
S.................       22           805  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W SKIN GRAFT
                                            SOI 1.
S.................       22           806  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W SKIN GRAFT
                                            SOI 2.
S.................       22           807  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W SKIN GRAFT
                                            SOI 3.
M.................       22           808  BURN DIAGNOSES SOI 4.
M.................       22           809  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W/O SKIN
                                            GRAFT SOI 1.
M.................       22           810  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W/O SKIN
                                            GRAFT SOI 2.
M.................       22           811  EXTENSIVE 3RD DEGREE OR FULL
                                            THICKNESS BURNS W/O SKIN
                                            GRAFT SOI 3.
M.................       22           812  PARTIAL THICKNESS BURNS W OR
                                            W/O SKIN GRAFT SOI 1.
M.................       22           813  PARTIAL THICKNESS BURNS W OR
                                            W/O SKIN GRAFT SOI 2.
M.................       22           814  PARTIAL THICKNESS BURNS W OR
                                            W/O SKIN GRAFT SOI 3.
S.................       23           815  PROCEDURE W DIAG OF REHAB,
                                            AFTERCARE OR OTH CONTACT W
                                            HEALTH SERVICE SOI 1.
S.................       23           816  PROCEDURE W DIAG OF REHAB,
                                            AFTERCARE OR OTH CONTACT W
                                            HEALTH SERVICE SOI 2.
S.................       23           817  PROCEDURE W DIAG OF REHAB,
                                            AFTERCARE OR OTH CONTACT W
                                            HEALTH SERVICE SOI 3.
S.................       23           818  PROCEDURE W DIAG OF REHAB,
                                            AFTERCARE OR OTH CONTACT W
                                            HEALTH SERVICE SOI 4.
M.................       23           819  REHABILITATION / AFTERCARE /
                                            CONVALESCENCE EXCEPT
                                            NEONATAL AFTERCARE SOI 4.
M.................       23           820  REHABILITATION SOI 1.
M.................       23           821  REHABILITATION SOI 2.
M.................       23           822  REHABILITATION SOI 3.
M.................       23           823  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING HEALTH
                                            STATUS SOI 1.
M.................       23           824  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING HEALTH
                                            STATUS SOI 2.
M.................       23           825  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING HEALTH
                                            STATUS SOI 3.
M.................       23           826  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 1.
M.................       23           827  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 2.
M.................       23           828  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 3.
M.................       24           829  HIV DIAGNOSES SOI 4.
M.................       24           830  HIV W MULTIPLE MAJOR HIV
                                            RELATED CONDITIONS SOI 1 &
                                            2.
M.................       24           831  HIV W MULTIPLE MAJOR HIV
                                            RELATED CONDITIONS SOI 3.
M.................       24           832  HIV W MAJOR HIV RELATED
                                            CONDITION SOI 1 & 2.
M.................       24           833  HIV W MAJOR HIV RELATED
                                            CONDITION SOI 3.
M.................       24           834  HIV W MULTIPLE SIGNIFICANT
                                            HIV RELATED CONDITIONS SOI 1
                                            & 2.
M.................       24           835  HIV W MULTIPLE SIGNIFICANT
                                            HIV RELATED CONDITIONS SOI
                                            3.
M.................       24           836  HIV W ONE SIGNIF HIV COND OR
                                            W/O SIGNIF RELATED COND SOI
                                            1.

[[Page 24433]]

 
M.................       24           837  HIV W ONE SIGNIF HIV COND OR
                                            W/O SIGNIF RELATED COND SOI
                                            2.
M.................       24           838  HIV W ONE SIGNIF HIV COND OR
                                            W/O SIGNIF RELATED COND SOI
                                            3.
S.................       25           839  MULTIPLE SIGNIFICANT TRAUMA
                                            PROCEDURES SOI 4.
S.................       25           840  CRANIOTOMY FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1 &
                                            2.
S.................       25           841  CRANIOTOMY FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 3.
S.................       25           842  EXTENSIVE ABDOMINAL/THORACIC
                                            PROCEDURES FOR MULT
                                            SIGNIFICANT TRAUMA SOI 1 &
                                            2.
S.................       25           843  EXTENSIVE ABDOMINAL/THORACIC
                                            PROCEDURES FOR MULT
                                            SIGNIFICANT TRAUMA SOI 3.
S.................       25           844  MUSCULOSKELETAL & OTHER
                                            PROCEDURES FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1 &
                                            2.
S.................       25           845  MUSCULOSKELETAL & OTHER
                                            PROCEDURES FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 3.
M.................       25           846  MULTIPLE SIGNIFICANT TRAUMA W/
                                            O O.R. PROCEDURE SOI 1 & 2.
M.................       25           847  MULTIPLE SIGNIFICANT TRAUMA W/
                                            O O.R. PROCEDURE SOI 3.
M.................       25           848  MULTIPLE SIGNIFICANT TRAUMA W/
                                            O O.R. PROCEDURE SOI 4.
S.................       25           987  EXTENSIVE PROCEDURE UNRELATED
                                            TO PRINCIPAL DIAGNOSIS SOI
                                            1.
S.................       25           988  EXTENSIVE PROCEDURE UNRELATED
                                            TO PRINCIPAL DIAGNOSIS SOI
                                            2.
S.................       25           989  EXTENSIVE PROCEDURE UNRELATED
                                            TO PRINCIPAL DIAGNOSIS SOI
                                            3.
S.................       25           990  EXTENSIVE PROCEDURE UNRELATED
                                            TO PRINCIPAL DIAGNOSIS SOI
                                            4.
S.................       25           991  NON MAJOR PROCEDURE UNRELATED
                                            TO PRINCIPAL DIAGNOSIS SOI
                                            4.
S.................       25           992  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI 1.
S.................       25           993  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI 2.
S.................       25           994  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI 3.
S.................       25           995  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 1.
S.................       25           996  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 2.
S.................       25           997  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 3.
                         26           998  PRINCIPAL DIAGNOSIS INVALID
                                            AS DISCHARGE DIAGNOSIS.
                         26           999  UNGROUPABLE.
------------------------------------------------------------------------
M = Medical.
S = Surgical.
SOI = Severity of Illness Subclass


          Appendix D.--Crosswalk of Proposed Consolidated Severity-Adjusted DRGs To Respective APR DRGs
----------------------------------------------------------------------------------------------------------------
                             Consolidated
       TYPE           MDC      severity-     Consolidated severity-   APR DRG    SOI       APR DRG description
                             adjusted DRG  adjusted  DRG description
----------------------------------------------------------------------------------------------------------------
S.................        0             1  LIVER TRANSPLANT AND/OR        001        1  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT                        INTESTINAL TRANSPLANT
                                            SOI 1 & 2.                                   SOI 1.
S.................        0             1  LIVER TRANSPLANT AND/OR        001        2  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT                        INTESTINAL TRANSPLANT
                                            SOI 1 & 2.                                   SOI 2.
S.................        0             2  LIVER TRANSPLANT AND/OR        001        3  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT                        INTESTINAL TRANSPLANT
                                            SOI 3.                                       SOI 3.
S.................        0             3  LIVER TRANSPLANT AND/OR        001        4  LIVER TRANSPLANT AND/OR
                                            INTESTINAL TRANSPLANT                        INTESTINAL TRANSPLANT
                                            SOI 4.                                       SOI 4.
S.................        0             4  HEART &/OR LUNG                002        1  HEART &/OR LUNG
                                            TRANSPLANT SOI 1 & 2.                        TRANSPLANT SOI 1.
S.................        0             4  HEART &/OR LUNG                002        2  HEART &/OR LUNG
                                            TRANSPLANT SOI 1 & 2.                        TRANSPLANT SOI 2.
S.................        0             5  HEART &/OR LUNG                002        3  HEART &/OR LUNG
                                            TRANSPLANT SOI 3.                            TRANSPLANT SOI 3.
S.................        0             6  HEART &/OR LUNG                002        4  HEART &/OR LUNG
                                            TRANSPLANT SOI 4.                            TRANSPLANT SOI 4.
S.................        0             7  BONE MARROW TRANSPLANT         003        1  BONE MARROW TRANSPLANT
                                            SOI 1.                                       SOI 1.
S.................        0             8  BONE MARROW TRANSPLANT         003        2  BONE MARROW TRANSPLANT
                                            SOI 2.                                       SOI 2.
S.................        0             9  BONE MARROW TRANSPLANT         003        3  BONE MARROW TRANSPLANT
                                            SOI 3.                                       SOI 3.
S.................        0            10  BONE MARROW TRANSPLANT         003        4  BONE MARROW TRANSPLANT
                                            SOI 4.                                       SOI 4.
S.................        0            11  TRACHEOSTOMY W LONG TERM       004        1  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W                     MECHANICAL VENTILATION
                                            EXTENSIVE PROCEDURE SOI                      W EXTENSIVE PROCEDURE
                                            1 & 2.                                       SOI 1.
S.................        0            11  TRACHEOSTOMY W LONG TERM       004        2  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W                     MECHANICAL VENTILATION
                                            EXTENSIVE PROCEDURE SOI                      W EXTENSIVE PROCEDURE
                                            1 & 2.                                       SOI 2.
S.................        0            12  TRACHEOSTOMY W LONG TERM       004        3  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W                     MECHANICAL VENTILATION
                                            EXTENSIVE PROCEDURE SOI                      W EXTENSIVE PROCEDURE
                                            3.                                           SOI 3.
S.................        0            13  TRACHEOSTOMY W LONG TERM       004        4  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W                     MECHANICAL VENTILATION
                                            EXTENSIVE PROCEDURE SOI                      W EXTENSIVE PROCEDURE
                                            4.                                           SOI 4.
S.................        0            14  TRACHEOSTOMY W LONG TERM       005        1  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/                    MECHANICAL VENTILATION
                                            O EXTENSIVE PROCEDURE                        W/O EXTENSIVE PROCEDURE
                                            SOI 1 & 2.                                   SOI 1.

[[Page 24434]]

 
S.................        0            14  TRACHEOSTOMY W LONG TERM       005        2  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/                    MECHANICAL VENTILATION
                                            O EXTENSIVE PROCEDURE                        W/O EXTENSIVE PROCEDURE
                                            SOI 1 & 2.                                   SOI 2.
S.................        0            15  TRACHEOSTOMY W LONG TERM       005        3  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/                    MECHANICAL VENTILATION
                                            O EXTENSIVE PROCEDURE                        W/O EXTENSIVE PROCEDURE
                                            SOI 3.                                       SOI 3.
S.................        0            16  TRACHEOSTOMY W LONG TERM       005        4  TRACHEOSTOMY W LONG TERM
                                            MECHANICAL VENTILATION W/                    MECHANICAL VENTILATION
                                            O EXTENSIVE PROCEDURE                        W/O EXTENSIVE PROCEDURE
                                            SOI 4.                                       SOI 4.
S.................        0            17  PANCREAS TRANSPLANT SOI 1      006        1  PANCREAS TRANSPLANT SOI
                                            & 2.                                         1.
S.................        0            17  PANCREAS TRANSPLANT SOI 1      006        2  PANCREAS TRANSPLANT SOI
                                            & 2.                                         2.
S.................        0            18  PANCREAS TRANSPLANT SOI 3      006        3  PANCREAS TRANSPLANT SOI
                                                                                         3.
S.................        0            19  PANCREAS TRANSPLANT SOI 4      006        4  PANCREAS TRANSPLANT SOI
                                                                                         4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       020        4  CRANIOTOMY FOR TRAUMA
                                            SOI 4.                                       SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       021        4  CRANIOTOMY EXCEPT FOR
                                            SOI 4.                                       TRAUMA SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       022        4  VENTRICULAR SHUNT
                                            SOI 4.                                       PROCEDURES SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       023        4  SPINAL PROCEDURES SOI 4.
                                            SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       024        4  EXTRACRANIAL VASCULAR
                                            SOI 4.                                       PROCEDURES SOI 4.
S.................        1            20  NERVOUS SYSTEM PROCDURES       026        4  OTHER NERVOUS SYSTEM &
                                            SOI 4.                                       RELATED PROCEDURES SOI
                                                                                         4.
S.................        1            21  CRANIOTOMY FOR TRAUMA SOI      020        1  CRANIOTOMY FOR TRAUMA
                                            1.                                           SOI 1.
S.................        1            22  CRANIOTOMY FOR TRAUMA SOI      020        2  CRANIOTOMY FOR TRAUMA
                                            2.                                           SOI 2.
S.................        1            23  CRANIOTOMY FOR TRAUMA SOI      020        3  CRANIOTOMY FOR TRAUMA
                                            3.                                           SOI 3.
S.................        1            24  CRANIOTOMY EXCEPT FOR          021        1  CRANIOTOMY EXCEPT FOR
                                            TRAUMA SOI 1.                                TRAUMA SOI 1.
S.................        1            25  CRANIOTOMY EXCEPT FOR          021        2  CRANIOTOMY EXCEPT FOR
                                            TRAUMA SOI 2.                                TRAUMA SOI 2.
S.................        1            26  CRANIOTOMY EXCEPT FOR          021        3  CRANIOTOMY EXCEPT FOR
                                            TRAUMA SOI 3.                                TRAUMA SOI 3.
S.................        1            27  VENTRICULAR SHUNT              022        1  VENTRICULAR SHUNT
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        1            28  VENTRICULAR SHUNT              022        2  VENTRICULAR SHUNT
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        1            29  VENTRICULAR SHUNT              022        3  VENTRICULAR SHUNT
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        1            30  SPINAL PROCEDURES SOI 1..      023        1  SPINAL PROCEDURES SOI 1.
S.................        1            31  SPINAL PROCEDURES SOI 2..      023        2  SPINAL PROCEDURES SOI 2.
S.................        1            32  SPINAL PROCEDURES SOI 3..      023        3  SPINAL PROCEDURES SOI 3.
S.................        1            33  EXTRACRANIAL VASCULAR          024        1  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        1            34  EXTRACRANIAL VASCULAR          024        2  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        1            35  EXTRACRANIAL VASCULAR          024        3  EXTRACRANIAL VASCULAR
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        1            36  OTHER NERVOUS SYSTEM &         026        1  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 1.                    RELATED PROCEDURES SOI
                                                                                         1.
S.................        1            37  OTHER NERVOUS SYSTEM &         026        2  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 2.                    RELATED PROCEDURES SOI
                                                                                         2.
S.................        1            38  OTHER NERVOUS SYSTEM &         026        3  OTHER NERVOUS SYSTEM &
                                            RELATED PROCEDURES SOI 3.                    RELATED PROCEDURES SOI
                                                                                         3.
M.................        1            39  NERVOUS SYSTEM MEDICAL         040        4  SPINAL DISORDERS &
                                            DIAGNOSES EXCEPT                             INJURIES SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         041        4  NERVOUS SYSTEM
                                            DIAGNOSES EXCEPT                             MALIGNANCY SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         042        4  DEGENERATIVE NERVOUS
                                            DIAGNOSES EXCEPT                             SYSTEM DISORDERS EXC
                                            INFECTIONS SOI 4.                            MULT SCLEROSIS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         043        4  MULTIPLE SCLEROSIS &
                                            DIAGNOSES EXCEPT                             OTHER DEMYELINATING
                                            INFECTIONS SOI 4.                            DISEASES SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         044        4  INTRACRANIAL HEMORRHAGE
                                            DIAGNOSES EXCEPT                             SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         045        4  CVA & PRECEREBRAL
                                            DIAGNOSES EXCEPT                             OCCLUSION W INFARCT SOI
                                            INFECTIONS SOI 4.                            4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         046        4  NONSPECIFIC CVA &
                                            DIAGNOSES EXCEPT                             PRECEREBRAL OCCLUSION W/
                                            INFECTIONS SOI 4.                            O INFARCT SOI 4.

[[Page 24435]]

 
M.................        1            39  NERVOUS SYSTEM MEDICAL         047        4  TRANSIENT ISCHEMIA SOI
                                            DIAGNOSES EXCEPT                             4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         048        4  PERIPHERAL, CRANIAL &
                                            DIAGNOSES EXCEPT                             AUTONOMIC NERVE
                                            INFECTIONS SOI 4.                            DISORDERS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         051        4  VIRAL MENINGITIS SOI 4.
                                            DIAGNOSES EXCEPT
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         052        4  NONTRAUMATIC STUPOR &
                                            DIAGNOSES EXCEPT                             COMA SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         053        4  SEIZURE SOI 4.
                                            DIAGNOSES EXCEPT
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         054        4  MIGRAINE & OTHER
                                            DIAGNOSES EXCEPT                             HEADACHES SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         055        4  HEAD TRAUMA W COMA >1 HR
                                            DIAGNOSES EXCEPT                             OR HEMORRHAGE SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         056        4  BRAIN CONTUSION/
                                            DIAGNOSES EXCEPT                             LACERATION &
                                            INFECTIONS SOI 4.                            COMPLICATED SKULL FX,
                                                                                         COMA <1 HR OR NO COMA
                                                                                         SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         057        4  CONCUSSION, CLOSED SKULL
                                            DIAGNOSES EXCEPT                             FX NOS, UNCOMPLICATED
                                            INFECTIONS SOI 4.                            INTRACRANIAL INJURY,
                                                                                         COMA <1 HR OR NO COMA
                                                                                         SOI 4.
M.................        1            39  NERVOUS SYSTEM MEDICAL         058        4  OTHER DISORDERS OF
                                            DIAGNOSES EXCEPT                             NERVOUS SYSTEM SOI 4.
                                            INFECTIONS SOI 4.
M.................        1            40  INFECTIONS OF NERVOUS          049        4  BACTERIAL & TUBERCULOUS
                                            SYSTEM SOI 4.                                INFECTIONS OF NERVOUS
                                                                                         SYSTEM SOI 4.
M.................        1            40  INFECTIONS OF NERVOUS          050        4  NON-BACTERIAL INFECTIONS
                                            SYSTEM SOI 4.                                OF NERVOUS SYSTEM EXC
                                                                                         VIRAL MENINGITIS SOI 4.
M.................        1            41  SPINAL DISORDERS &             040        1  SPINAL DISORDERS &
                                            INJURIES SOI 1.                              INJURIES SOI 1.
M.................        1            42  SPINAL DISORDERS &             040        2  SPINAL DISORDERS &
                                            INJURIES SOI 2.                              INJURIES SOI 2.
M.................        1            43  SPINAL DISORDERS &             040        3  SPINAL DISORDERS &
                                            INJURIES SOI 3.                              INJURIES SOI 3.
M.................        1            44  NERVOUS SYSTEM MALIGNANCY      041        1  NERVOUS SYSTEM
                                            SOI 1.                                       MALIGNANCY SOI 1.
M.................        1            45  NERVOUS SYSTEM MALIGNANCY      041        2  NERVOUS SYSTEM
                                            SOI 2.                                       MALIGNANCY SOI 2.
M.................        1            46  NERVOUS SYSTEM MALIGNANCY      041        3  NERVOUS SYSTEM
                                            SOI 3.                                       MALIGNANCY SOI 3.
M.................        1            47  DEGENERATIVE NERVOUS           042        1  DEGENERATIVE NERVOUS
                                            SYSTEM DISORDERS EXC                         SYSTEM DISORDERS EXC
                                            MULT SCLEROSIS SOI 1.                        MULT SCLEROSIS SOI 1.
M.................        1            48  DEGENERATIVE NERVOUS           042        2  DEGENERATIVE NERVOUS
                                            SYSTEM DISORDERS EXC                         SYSTEM DISORDERS EXC
                                            MULT SCLEROSIS SOI 2.                        MULT SCLEROSIS SOI 2.
M.................        1            49  DEGENERATIVE NERVOUS           042        3  DEGENERATIVE NERVOUS
                                            SYSTEM DISORDERS EXC                         SYSTEM DISORDERS EXC
                                            MULT SCLEROSIS SOI 3.                        MULT SCLEROSIS SOI 3.
M.................        1            50  MULTIPLE SCLEROSIS &           043        1  MULTIPLE SCLEROSIS &
                                            OTHER DEMYELINATING                          OTHER DEMYELINATING
                                            DISEASES SOI 1.                              DISEASES SOI 1.
M.................        1            51  MULTIPLE SCLEROSIS &           043        2  MULTIPLE SCLEROSIS &
                                            OTHER DEMYELINATING                          OTHER DEMYELINATING
                                            DISEASES SOI 2.                              DISEASES SOI 2.
M.................        1            52  MULTIPLE SCLEROSIS &           043        3  MULTIPLE SCLEROSIS &
                                            OTHER DEMYELINATING                          OTHER DEMYELINATING
                                            DISEASES SOI 3.                              DISEASES SOI 3.
M.................        1            53  INTRACRANIAL HEMORRHAGE        044        1  INTRACRANIAL HEMORRHAGE
                                            SOI 1.                                       SOI 1.
M.................        1            54  INTRACRANIAL HEMORRHAGE        044        2  INTRACRANIAL HEMORRHAGE
                                            SOI 2.                                       SOI 2.
M.................        1            55  INTRACRANIAL HEMORRHAGE        044        3  INTRACRANIAL HEMORRHAGE
                                            SOI 3.                                       SOI 3.
M.................        1            56  CVA & PRECEREBRAL              045        1  CVA & PRECEREBRAL
                                            OCCLUSION W INFARCT SOI                      OCCLUSION W INFARCT SOI
                                            1.                                           1.
M.................        1            57  CVA & PRECEREBRAL              045        2  CVA & PRECEREBRAL
                                            OCCLUSION W INFARCT SOI                      OCCLUSION W INFARCT SOI
                                            2.                                           2.
M.................        1            58  CVA & PRECEREBRAL              045        3  CVA & PRECEREBRAL
                                            OCCLUSION W INFARCT SOI                      OCCLUSION W INFARCT SOI
                                            3.                                           3.
M.................        1            59  NONSPECIFIC CVA &              046        1  NONSPECIFIC CVA &
                                            PRECEREBRAL OCCLUSION W/                     PRECEREBRAL OCCLUSION W/
                                            O INFARCT SOI 1.                             O INFARCT SOI 1.
M.................        1            60  NONSPECIFIC CVA &              046        2  NONSPECIFIC CVA &
                                            PRECEREBRAL OCCLUSION W/                     PRECEREBRAL OCCLUSION W/
                                            O INFARCT SOI 2.                             O INFARCT SOI 2.
M.................        1            61  NONSPECIFIC CVA &              046        3  NONSPECIFIC CVA &
                                            PRECEREBRAL OCCLUSION W/                     PRECEREBRAL OCCLUSION W/
                                            O INFARCT SOI 3.                             O INFARCT SOI 3.
M.................        1            62  TRANSIENT ISCHEMIA SOI 1.      047        1  TRANSIENT ISCHEMIA SOI
                                                                                         1.
M.................        1            63  TRANSIENT ISCHEMIA SOI 2.      047        2  TRANSIENT ISCHEMIA SOI
                                                                                         2.
M.................        1            64  TRANSIENT ISCHEMIA SOI 3.      047        3  TRANSIENT ISCHEMIA SOI
                                                                                         3.
M.................        1            65  PERIPHERAL, CRANIAL &          048        1  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE                              AUTONOMIC NERVE
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.

[[Page 24436]]

 
M.................        1            66  PERIPHERAL, CRANIAL &          048        2  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE                              AUTONOMIC NERVE
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        1            67  PERIPHERAL, CRANIAL &          048        3  PERIPHERAL, CRANIAL &
                                            AUTONOMIC NERVE                              AUTONOMIC NERVE
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        1            68  BACTERIAL & TUBERCULOUS        049        1  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS                        INFECTIONS OF NERVOUS
                                            SYSTEM SOI 1.                                SYSTEM SOI 1.
M.................        1            69  BACTERIAL & TUBERCULOUS        049        2  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS                        INFECTIONS OF NERVOUS
                                            SYSTEM SOI 2.                                SYSTEM SOI 2.
M.................        1            70  BACTERIAL & TUBERCULOUS        049        3  BACTERIAL & TUBERCULOUS
                                            INFECTIONS OF NERVOUS                        INFECTIONS OF NERVOUS
                                            SYSTEM SOI 3.                                SYSTEM SOI 3.
M.................        1            71  NON-BACTERIAL INFECTIONS       050        1  NON-BACTERIAL INFECTIONS
                                            OF NERVOUS SYSTEM EXC                        OF NERVOUS SYSTEM EXC
                                            VIRAL MENINGITIS SOI 1.                      VIRAL MENINGITIS SOI 1.
M.................        1            72  NON-BACTERIAL INFECTIONS       050        2  NON-BACTERIAL INFECTIONS
                                            OF NERVOUS SYSTEM EXC                        OF NERVOUS SYSTEM EXC
                                            VIRAL MENINGITIS SOI 2.                      VIRAL MENINGITIS SOI 2.
M.................        1            73  NON-BACTERIAL INFECTIONS       050        3  NON-BACTERIAL INFECTIONS
                                            OF NERVOUS SYSTEM EXC                        OF NERVOUS SYSTEM EXC
                                            VIRAL MENINGITIS SOI 3.                      VIRAL MENINGITIS SOI 3.
M.................        1            74  VIRAL MENINGITIS SOI 1...      051        1  VIRAL MENINGITIS SOI 1.
M.................        1            75  VIRAL MENINGITIS SOI 2...      051        2  VIRAL MENINGITIS SOI 2.
M.................        1            76  VIRAL MENINGITIS SOI 3...      051        3  VIRAL MENINGITIS SOI 3.
M.................        1            77  NONTRAUMATIC STUPOR &          052        1  NONTRAUMATIC STUPOR &
                                            COMA SOI 1.                                  COMA SOI 1.
M.................        1            78  NONTRAUMATIC STUPOR &          052        2  NONTRAUMATIC STUPOR &
                                            COMA SOI 2.                                  COMA SOI 2.
M.................        1            79  NONTRAUMATIC STUPOR &          052        3  NONTRAUMATIC STUPOR &
                                            COMA SOI 3.                                  COMA SOI 3.
M.................        1            80  SEIZURE SOI 1............      053        1  SEIZURE SOI 1.
M.................        1            81  SEIZURE SOI 2............      053        2  SEIZURE SOI 2.
M.................        1            82  SEIZURE SOI 3............      053        3  SEIZURE SOI 3.
M.................        1            83  MIGRAINE & OTHER               054        1  MIGRAINE & OTHER
                                            HEADACHES SOI 1.                             HEADACHES SOI 1.
M.................        1            84  MIGRAINE & OTHER               054        2  MIGRAINE & OTHER
                                            HEADACHES SOI 2.                             HEADACHES SOI 2.
M.................        1            85  MIGRAINE & OTHER               054        3  MIGRAINE & OTHER
                                            HEADACHES SOI 3.                             HEADACHES SOI 3.
M.................        1            86  HEAD TRAUMA W COMA >1 HR       055        1  HEAD TRAUMA W COMA >1 HR
                                            OR HEMORRHAGE SOI 1.                         OR HEMORRHAGE SOI 1.
M.................        1            87  HEAD TRAUMA W COMA >1 HR       055        2  HEAD TRAUMA W COMA >1 HR
                                            OR HEMORRHAGE SOI 2.                         OR HEMORRHAGE SOI 2.
M.................        1            88  HEAD TRAUMA W COMA >1 HR       055        3  HEAD TRAUMA W COMA >1 HR
                                            OR HEMORRHAGE SOI 3.                         OR HEMORRHAGE SOI 3.
M.................        1            89  BRAIN CONTUSION/               056        1  BRAIN CONTUSION/
                                            LACERATION & COMPLICATED                     LACERATION &
                                            SKULL FX, COMA <1 HR OR                      COMPLICATED SKULL FX,
                                            NO COMA SOI 1.                               COMA <1 HR OR NO COMA
                                                                                         SOI 1.
M.................        1            90  BRAIN CONTUSION/               056        2  BRAIN CONTUSION/
                                            LACERATION & COMPLICATED                     LACERATION &
                                            SKULL FX, COMA <1 HR OR                      COMPLICATED SKULL FX,
                                            NO COMA SOI 2.                               COMA <1 HR OR NO COMA
                                                                                         SOI 2.
M.................        1            91  BRAIN CONTUSION/               056        3  BRAIN CONTUSION/
                                            LACERATION & COMPLICATED                     LACERATION &
                                            SKULL FX, COMA <1 HR OR                      COMPLICATED SKULL FX,
                                            NO COMA SOI 3.                               COMA <1 HR OR NO COMA
                                                                                         SOI 3.
M.................        1            92  CONCUSSION, CLOSED SKULL       057        1  CONCUSSION, CLOSED SKULL
                                            FX NOS, UNCOMPLICATED                        FX NOS, UNCOMPLICATED
                                            INTRACRANIAL INJURY,                         INTRACRANIAL INJURY,
                                            COMA <1 HR OR NO COMA                        COMA <1 HR OR NO COMA
                                            SOI 1.                                       SOI 1.
M.................        1            93  CONCUSSION, CLOSED SKULL       057        2  CONCUSSION, CLOSED SKULL
                                            FX NOS, UNCOMPLICATED                        FX NOS, UNCOMPLICATED
                                            INTRACRANIAL INJURY,                         INTRACRANIAL INJURY,
                                            COMA <1 HR OR NO COMA                        COMA <1 HR OR NO COMA
                                            SOI 2.                                       SOI 2.
M.................        1            94  CONCUSSION, CLOSED SKULL       057        3  CONCUSSION, CLOSED SKULL
                                            FX NOS, UNCOMPLICATED                        FX NOS, UNCOMPLICATED
                                            INTRACRANIAL INJURY,                         INTRACRANIAL INJURY,
                                            COMA <1 HR OR NO COMA                        COMA <1 HR OR NO COMA
                                            SOI 3.                                       SOI 3.
M.................        1            95  OTHER DISORDERS OF             058        1  OTHER DISORDERS OF
                                            NERVOUS SYSTEM SOI 1.                        NERVOUS SYSTEM SOI 1.
M.................        1            96  OTHER DISORDERS OF             058        2  OTHER DISORDERS OF
                                            NERVOUS SYSTEM SOI 2.                        NERVOUS SYSTEM SOI 2.
M.................        1            97  OTHER DISORDERS OF             058        3  OTHER DISORDERS OF
                                            NERVOUS SYSTEM SOI 3.                        NERVOUS SYSTEM SOI 3.
S.................        2            98  EYE PROCEDURES SOI 4.....      070        4  ORBITAL PROCEDURES SOI
                                                                                         4.

[[Page 24437]]

 
S.................        2            98  EYE PROCEDURES SOI 4.....      073        4  EYE PROCEDURES EXCEPT
                                                                                         ORBIT SOI 4.
S.................        2            99  ORBITAL PROCEDURES SOI 1.      070        1  ORBITAL PROCEDURES SOI
                                                                                         1.
S.................        2           100  ORBITAL PROCEDURES SOI 2.      070        2  ORBITAL PROCEDURES SOI
                                                                                         2.
S.................        2           101  ORBITAL PROCEDURES SOI 3.      070        3  ORBITAL PROCEDURES SOI
                                                                                         3.
S.................        2           102  EYE PROCEDURES EXCEPT          073        1  EYE PROCEDURES EXCEPT
                                            ORBIT SOI 1.                                 ORBIT SOI 1.
S.................        2           103  EYE PROCEDURES EXCEPT          073        2  EYE PROCEDURES EXCEPT
                                            ORBIT SOI 2.                                 ORBIT SOI 2.
S.................        2           104  EYE PROCEDURES EXCEPT          073        3  EYE PROCEDURES EXCEPT
                                            ORBIT SOI 3.                                 ORBIT SOI 3.
M.................        2           105  EYE DIAGNOSES SOI 4......      080        4  ACUTE MAJOR EYE
                                                                                         INFECTIONS SOI 4.
M.................        2           105  EYE DIAGNOSES SOI 4......      082        4  EYE DISORDERS EXCEPT
                                                                                         MAJOR INFECTIONS SOI 4.
M.................        2           106  ACUTE MAJOR EYE                080        1  ACUTE MAJOR EYE
                                            INFECTIONS SOI 1.                            INFECTIONS SOI 1.
M.................        2           107  ACUTE MAJOR EYE                080        2  ACUTE MAJOR EYE
                                            INFECTIONS SOI 2.                            INFECTIONS SOI 2.
M.................        2           108  ACUTE MAJOR EYE                080        3  ACUTE MAJOR EYE
                                            INFECTIONS SOI 3.                            INFECTIONS SOI 3.
M.................        2           109  EYE DISORDERS EXCEPT           082        1  EYE DISORDERS EXCEPT
                                            MAJOR INFECTIONS SOI 1.                      MAJOR INFECTIONS SOI 1.
M.................        2           110  EYE DISORDERS EXCEPT           082        2  EYE DISORDERS EXCEPT
                                            MAJOR INFECTIONS SOI 2.                      MAJOR INFECTIONS SOI 2.
M.................        2           111  EYE DISORDERS EXCEPT           082        3  EYE DISORDERS EXCEPT
                                            MAJOR INFECTIONS SOI 3.                      MAJOR INFECTIONS SOI 3.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      089        4  MAJOR CRANIAL/FACIAL
                                            PROCEDURES SOI 4.                            BONE PROCEDURES SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      090        4  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      091        4  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      092        4  FACIAL BONE PROCEDURES
                                            PROCEDURES SOI 4.                            EXCEPT MAJOR CRANIAL/
                                                                                         FACIAL BONE PROCEDURES
                                                                                         SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      093        4  SINUS & MASTOID
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      095        4  CLEFT LIP & PALATE
                                            PROCEDURES SOI 4.                            REPAIR SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      097        4  TONSIL & ADENOID
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        3           112  EAR, NOSE, MOUTH & THROAT      098        4  OTHER EAR, NOSE, MOUTH &
                                            PROCEDURES SOI 4.                            THROAT PROCEDURES SOI
                                                                                         4.
S.................        3           113  MAJOR CRANIAL/FACIAL BONE      089        1  MAJOR CRANIAL/FACIAL
                                            PROCEDURES SOI 1.                            BONE PROCEDURES SOI 1.
S.................        3           114  MAJOR CRANIAL/FACIAL BONE      089        2  MAJOR CRANIAL/FACIAL
                                            PROCEDURES SOI 2.                            BONE PROCEDURES SOI 2.
S.................        3           115  MAJOR CRANIAL/FACIAL BONE      089        3  MAJOR CRANIAL/FACIAL
                                            PROCEDURES SOI 3.                            BONE PROCEDURES SOI 3.
S.................        3           116  MAJOR LARYNX & TRACHEA         090        1  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        3           117  MAJOR LARYNX & TRACHEA         090        2  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        3           118  MAJOR LARYNX & TRACHEA         090        3  MAJOR LARYNX & TRACHEA
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        3           119  OTHER MAJOR HEAD & NECK        091        1  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        3           120  OTHER MAJOR HEAD & NECK        091        2  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        3           121  OTHER MAJOR HEAD & NECK        091        3  OTHER MAJOR HEAD & NECK
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        3           122  FACIAL BONE PROCEDURES         092        1  FACIAL BONE PROCEDURES
                                            EXCEPT MAJOR CRANIAL/                        EXCEPT MAJOR CRANIAL/
                                            FACIAL BONE PROCEDURES                       FACIAL BONE PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................        3           123  FACIAL BONE PROCEDURES         092        2  FACIAL BONE PROCEDURES
                                            EXCEPT MAJOR CRANIAL/                        EXCEPT MAJOR CRANIAL/
                                            FACIAL BONE PROCEDURES                       FACIAL BONE PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................        3           124  FACIAL BONE PROCEDURES         092        3  FACIAL BONE PROCEDURES
                                            EXCEPT MAJOR CRANIAL/                        EXCEPT MAJOR CRANIAL/
                                            FACIAL BONE PROCEDURES                       FACIAL BONE PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................        3           125  SINUS & MASTOID                093        1  SINUS & MASTOID
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        3           126  SINUS & MASTOID                093        2  SINUS & MASTOID
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.

[[Page 24438]]

 
S.................        3           127  SINUS & MASTOID                093        3  SINUS & MASTOID
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        3           128  CLEFT LIP & PALATE REPAIR      095        1  CLEFT LIP & PALATE
                                            SOI 1.                                       REPAIR SOI 1.
S.................        3           129  CLEFT LIP & PALATE REPAIR      095        2  CLEFT LIP & PALATE
                                            SOI 2.                                       REPAIR SOI 2.
S.................        3           130  CLEFT LIP & PALATE REPAIR      095        3  CLEFT LIP & PALATE
                                            SOI 3.                                       REPAIR SOI 3.
S.................        3           131  TONSIL & ADENOID               097        1  TONSIL & ADENOID
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        3           132  TONSIL & ADENOID               097        2  TONSIL & ADENOID
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        3           133  TONSIL & ADENOID               097        3  TONSIL & ADENOID
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        3           134  OTHER EAR, NOSE, MOUTH &       098        1  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 1.                     THROAT PROCEDURES SOI
                                                                                         1.
S.................        3           135  OTHER EAR, NOSE, MOUTH &       098        2  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 2.                     THROAT PROCEDURES SOI
                                                                                         2.
S.................        3           136  OTHER EAR, NOSE, MOUTH &       098        3  OTHER EAR, NOSE, MOUTH &
                                            THROAT PROCEDURES SOI 3.                     THROAT PROCEDURES SOI
                                                                                         3.
M.................        3           137  EAR, NOSE, MOUTH & THROAT      110        4  EAR, NOSE, MOUTH,
                                            DIAGNOSES SOI 4.                             THROAT, CRANIAL/FACIAL
                                                                                         MALIGNANCIES SOI 4.
M.................        3           137  EAR, NOSE, MOUTH & THROAT      111        4  VERTIGO & OTHER
                                            DIAGNOSES SOI 4.                             LABYRINTH DISORDERS SOI
                                                                                         4.
M.................        3           137  EAR, NOSE, MOUTH & THROAT      113        4  INFECTIONS OF UPPER
                                            DIAGNOSES SOI 4.                             RESPIRATORY TRACT SOI
                                                                                         4.
M.................        3           137  EAR, NOSE, MOUTH & THROAT      114        4  DENTAL & ORAL DISEASES &
                                            DIAGNOSES SOI 4.                             INJURIES SOI 4.
M.................        3           137  EAR, NOSE, MOUTH & THROAT      115        4  OTHER EAR, NOSE,
                                            DIAGNOSES SOI 4.                             MOUTH,THROAT & CRANIAL/
                                                                                         FACIAL DIAGNOSES SOI 4.
M.................        3           138  EAR, NOSE, MOUTH, THROAT,      110        1  EAR, NOSE, MOUTH,
                                            CRANIAL/FACIAL                               THROAT, CRANIAL/FACIAL
                                            MALIGNANCIES SOI 1.                          MALIGNANCIES SOI 1.
M.................        3           139  EAR, NOSE, MOUTH, THROAT,      110        2  EAR, NOSE, MOUTH,
                                            CRANIAL/FACIAL                               THROAT, CRANIAL/FACIAL
                                            MALIGNANCIES SOI 2.                          MALIGNANCIES SOI 2.
M.................        3           140  EAR, NOSE, MOUTH, THROAT,      110        3  EAR, NOSE, MOUTH,
                                            CRANIAL/FACIAL                               THROAT, CRANIAL/FACIAL
                                            MALIGNANCIES SOI 3.                          MALIGNANCIES SOI 3.
M.................        3           141  VERTIGO & OTHER LABYRINTH      111        1  VERTIGO & OTHER
                                            DISORDERS SOI 1.                             LABYRINTH DISORDERS SOI
                                                                                         1.
M.................        3           142  VERTIGO & OTHER LABYRINTH      111        2  VERTIGO & OTHER
                                            DISORDERS SOI 2.                             LABYRINTH DISORDERS SOI
                                                                                         2.
M.................        3           143  VERTIGO & OTHER LABYRINTH      111        3  VERTIGO & OTHER
                                            DISORDERS SOI 3.                             LABYRINTH DISORDERS SOI
                                                                                         3.
M.................        3           144  INFECTIONS OF UPPER            113        1  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 1.                     RESPIRATORY TRACT SOI
                                                                                         1.
M.................        3           145  INFECTIONS OF UPPER            113        2  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 2.                     RESPIRATORY TRACT SOI
                                                                                         2.
M.................        3           146  INFECTIONS OF UPPER            113        3  INFECTIONS OF UPPER
                                            RESPIRATORY TRACT SOI 3.                     RESPIRATORY TRACT SOI
                                                                                         3.
M.................        3           147  DENTAL & ORAL DISEASES &       114        1  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 1.                              INJURIES SOI 1.
M.................        3           148  DENTAL & ORAL DISEASES &       114        2  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 2.                              INJURIES SOI 2.
M.................        3           149  DENTAL & ORAL DISEASES &       114        3  DENTAL & ORAL DISEASES &
                                            INJURIES SOI 3.                              INJURIES SOI 3.
M.................        3           150  OTHER EAR, NOSE, MOUTH,        115        1  OTHER EAR, NOSE, MOUTH,
                                            THROAT & CRANIAL/FACIAL                      THROAT & CRANIAL/FACIAL
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
M.................        3           151  OTHER EAR, NOSE, MOUTH,        115        2  OTHER EAR, NOSE, MOUTH,
                                            THROAT & CRANIAL/FACIAL                      THROAT & CRANIAL/FACIAL
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
M.................        3           152  OTHER EAR, NOSE, MOUTH,        115        3  OTHER EAR, NOSE, MOUTH,
                                            THROAT & CRANIAL/FACIAL                      THROAT & CRANIAL/FACIAL
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        4           153  RESPIRATORY & CHEST            120        4  MAJOR RESPIRATORY &
                                            PROCEDURES SOI 4.                            CHEST PROCEDURES SOI 4.
S.................        4           153  RESPIRATORY & CHEST            121        4  OTHER RESPIRATORY &
                                            PROCEDURES SOI 4.                            CHEST PROCEDURES SOI 4.
S.................        4           154  MAJOR RESPIRATORY & CHEST      120        1  MAJOR RESPIRATORY &
                                            PROCEDURES SOI 1.                            CHEST PROCEDURES SOI 1.
S.................        4           155  MAJOR RESPIRATORY & CHEST      120        2  MAJOR RESPIRATORY &
                                            PROCEDURES SOI 2.                            CHEST PROCEDURES SOI 2.
S.................        4           156  MAJOR RESPIRATORY & CHEST      120        3  MAJOR RESPIRATORY &
                                            PROCEDURES SOI 3.                            CHEST PROCEDURES SOI 3.
S.................        4           157  OTHER RESPIRATORY & CHEST      121        1  OTHER RESPIRATORY &
                                            PROCEDURES SOI 1.                            CHEST PROCEDURES SOI 1.

[[Page 24439]]

 
S.................        4           158  OTHER RESPIRATORY & CHEST      121        2  OTHER RESPIRATORY &
                                            PROCEDURES SOI 2.                            CHEST PROCEDURES SOI 2.
S.................        4           159  OTHER RESPIRATORY & CHEST      121        3  OTHER RESPIRATORY &
                                            PROCEDURES SOI 3.                            CHEST PROCEDURES SOI 3.
M.................        4           160  RESPIRATORY SYSTEM             131        4  CYSTIC FIBROSIS--
                                            DIAGNOSES EXCEPT W                           PULMONARY DISEASE SOI
                                            VENTILATOR SUPPORT 96+                       4.
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             132        4  BPD & OTH CHRONIC
                                            DIAGNOSES EXCEPT W                           RESPIRATORY DISEASES
                                            VENTILATOR SUPPORT 96+                       ARISING IN PERINATAL
                                            HOURS SOI 4.                                 PERIOD SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             133        4  PULMONARY EDEMA &
                                            DIAGNOSES EXCEPT W                           RESPIRATORY FAILURE SOI
                                            VENTILATOR SUPPORT 96+                       4.
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             134        4  PULMONARY EMBOLISM SOI
                                            DIAGNOSES EXCEPT W                           4.
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             135        4  MAJOR CHEST &
                                            DIAGNOSES EXCEPT W                           RESPIRATORY TRAUMA SOI
                                            VENTILATOR SUPPORT 96+                       4.
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             136        4  RESPIRATORY MALIGNANCY
                                            DIAGNOSES EXCEPT W                           SOI 4.
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             137        4  MAJOR RESPIRATORY
                                            DIAGNOSES EXCEPT W                           INFECTIONS &
                                            VENTILATOR SUPPORT 96+                       INFLAMMATIONS SOI 4.
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             138        4  BRONCHIOLITIS & RSV
                                            DIAGNOSES EXCEPT W                           PNEUMONIA SOI 4.
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             139        4  OTHER PNEUMONIA SOI 4.
                                            DIAGNOSES EXCEPT W
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             140        4  CHRONIC OBSTRUCTIVE
                                            DIAGNOSES EXCEPT W                           PULMONARY DISEASE SOI
                                            VENTILATOR SUPPORT 96+                       4.
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             141        4  ASTHMA SOI 4.
                                            DIAGNOSES EXCEPT W
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             142        4  INTERSTITIAL LUNG
                                            DIAGNOSES EXCEPT W                           DISEASE SOI 4.
                                            VENTILATOR SUPPORT 96+
                                            HOURS SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             143        4  OTHER RESPIRATORY
                                            DIAGNOSES EXCEPT W                           DIAGNOSES EXCEPT SIGNS,
                                            VENTILATOR SUPPORT 96+                       SYMPTOMS & MINOR
                                            HOURS SOI 4.                                 DIAGNOSES SOI 4.
M.................        4           160  RESPIRATORY SYSTEM             144        4  RESPIRATORY SIGNS,
                                            DIAGNOSES EXCEPT W                           SYMPTOMS & MINOR
                                            VENTILATOR SUPPORT 96+                       DIAGNOSES SOI 4.
                                            HOURS SOI 4.
M.................        4           161  RESPIRATORY SYSTEM             130        1  RESPIRATORY SYSTEM
                                            DIAGNOSIS W VENTILATOR                       DIAGNOSIS W VENTILATOR
                                            SUPPORT 96+ HOURS SOI 1.                     SUPPORT 96+ HOURS SOI
                                                                                         1.
M.................        4           162  RESPIRATORY SYSTEM             130        2  RESPIRATORY SYSTEM
                                            DIAGNOSIS W VENTILATOR                       DIAGNOSIS W VENTILATOR
                                            SUPPORT 96+ HOURS SOI 2.                     SUPPORT 96+ HOURS SOI
                                                                                         2.
M.................        4           163  RESPIRATORY SYSTEM             130        3  RESPIRATORY SYSTEM
                                            DIAGNOSIS W VENTILATOR                       DIAGNOSIS W VENTILATOR
                                            SUPPORT 96+ HOURS SOI 3.                     SUPPORT 96+ HOURS SOI
                                                                                         3.
M.................        4           164  RESPIRATORY SYSTEM             130        4  RESPIRATORY SYSTEM
                                            DIAGNOSIS W VENTILATOR                       DIAGNOSIS W VENTILATOR
                                            SUPPORT 96+ HOURS SOI 4.                     SUPPORT 96+ HOURS SOI
                                                                                         4.
M.................        4           165  CYSTIC FIBROSIS--              131        1  CYSTIC FIBROSIS--
                                            PULMONARY DISEASE SOI 1.                     PULMONARY DISEASE SOI
                                                                                         1.
M.................        4           166  CYSTIC FIBROSIS--              131        2  CYSTIC FIBROSIS--
                                            PULMONARY DISEASE SOI 2.                     PULMONARY DISEASE SOI
                                                                                         2.
M.................        4           167  CYSTIC FIBROSIS--              131        3  CYSTIC FIBROSIS--
                                            PULMONARY DISEASE SOI 3.                     PULMONARY DISEASE SOI
                                                                                         3.
M.................        4           168  PULMONARY EDEMA &              133        1  PULMONARY EDEMA &
                                            RESPIRATORY FAILURE SOI                      RESPIRATORY FAILURE SOI
                                            1.                                           1.
M.................        4           169  PULMONARY EDEMA &              133        2  PULMONARY EDEMA &
                                            RESPIRATORY FAILURE SOI                      RESPIRATORY FAILURE SOI
                                            2.                                           2.

[[Page 24440]]

 
M.................        4           170  PULMONARY EDEMA &              133        3  PULMONARY EDEMA &
                                            RESPIRATORY FAILURE SOI                      RESPIRATORY FAILURE SOI
                                            3.                                           3.
M.................        4           171  PULMONARY EMBOLISM SOI 1.      134        1  PULMONARY EMBOLISM SOI
                                                                                         1.
M.................        4           172  PULMONARY EMBOLISM SOI 2.      134        2  PULMONARY EMBOLISM SOI
                                                                                         2.
M.................        4           173  PULMONARY EMBOLISM SOI 3.      134        3  PULMONARY EMBOLISM SOI
                                                                                         3.
M.................        4           174  MAJOR CHEST & RESPIRATORY      135        1  MAJOR CHEST &
                                            TRAUMA SOI 1.                                RESPIRATORY TRAUMA SOI
                                                                                         1.
M.................        4           175  MAJOR CHEST & RESPIRATORY      135        2  MAJOR CHEST &
                                            TRAUMA SOI 2.                                RESPIRATORY TRAUMA SOI
                                                                                         2.
M.................        4           176  MAJOR CHEST & RESPIRATORY      135        3  MAJOR CHEST &
                                            TRAUMA SOI 3.                                RESPIRATORY TRAUMA SOI
                                                                                         3.
M.................        4           177  RESPIRATORY MALIGNANCY         136        1  RESPIRATORY MALIGNANCY
                                            SOI 1.                                       SOI 1.
M.................        4           178  RESPIRATORY MALIGNANCY         136        2  RESPIRATORY MALIGNANCY
                                            SOI 2.                                       SOI 2.
M.................        4           179  RESPIRATORY MALIGNANCY         136        3  RESPIRATORY MALIGNANCY
                                            SOI 3.                                       SOI 3.
M.................        4           180  MAJOR RESPIRATORY              137        1  MAJOR RESPIRATORY
                                            INFECTIONS &                                 INFECTIONS &
                                            INFLAMMATIONS SOI 1.                         INFLAMMATIONS SOI 1.
M.................        4           181  MAJOR RESPIRATORY              137        2  MAJOR RESPIRATORY
                                            INFECTIONS &                                 INFECTIONS &
                                            INFLAMMATIONS SOI 2.                         INFLAMMATIONS SOI 2.
M.................        4           182  MAJOR RESPIRATORY              137        3  MAJOR RESPIRATORY
                                            INFECTIONS &                                 INFECTIONS &
                                            INFLAMMATIONS SOI 3.                         INFLAMMATIONS SOI 3.
M.................        4           183  BRONCHIOLITIS & RSV            138        1  BRONCHIOLITIS & RSV
                                            PNEUMONIA SOI 1.                             PNEUMONIA SOI 1.
M.................        4           184  BRONCHIOLITIS & RSV            138        2  BRONCHIOLITIS & RSV
                                            PNEUMONIA SOI 2.                             PNEUMONIA SOI 2.
M.................        4           185  BRONCHIOLITIS & RSV            138        3  BRONCHIOLITIS & RSV
                                            PNEUMONIA SOI 3.                             PNEUMONIA SOI 3.
M.................        4           186  OTHER PNEUMONIA SOI 1....      139        1  OTHER PNEUMONIA SOI 1.
M.................        4           187  OTHER PNEUMONIA SOI 2....      139        2  OTHER PNEUMONIA SOI 2.
M.................        4           188  OTHER PNEUMONIA SOI 3....      139        3  OTHER PNEUMONIA SOI 3.
M.................        4           189  CHRONIC OBSTRUCTIVE            140        1  CHRONIC OBSTRUCTIVE
                                            PULMONARY DISEASE SOI 1.                     PULMONARY DISEASE SOI
                                                                                         1.
M.................        4           190  CHRONIC OBSTRUCTIVE            140        2  CHRONIC OBSTRUCTIVE
                                            PULMONARY DISEASE SOI 2.                     PULMONARY DISEASE SOI
                                                                                         2.
M.................        4           191  CHRONIC OBSTRUCTIVE            140        3  CHRONIC OBSTRUCTIVE
                                            PULMONARY DISEASE SOI 3.                     PULMONARY DISEASE SOI
                                                                                         3.
M.................        4           192  ASTHMA SOI 1.............      141        1  ASTHMA SOI 1.
M.................        4           193  ASTHMA SOI 2.............      141        2  ASTHMA SOI 2.
M.................        4           194  ASTHMA SOI 3.............      141        3  ASTHMA SOI 3.
M.................        4           195  INTERSTITIAL LUNG DISEASE      132        1  BPD & OTH CHRONIC
                                            SOI 1.                                       RESPIRATORY DISEASES
                                                                                         ARISING IN PERINATAL
                                                                                         PERIOD SOI 1.
M.................        4           195  INTERSTITIAL LUNG DISEASE      142        1  INTERSTITIAL LUNG
                                            SOI 1.                                       DISEASE SOI 1.
M.................        4           196  INTERSTITIAL LUNG DISEASE      132        2  BPD & OTH CHRONIC
                                            SOI 2.                                       RESPIRATORY DISEASES
                                                                                         ARISING IN PERINATAL
                                                                                         PERIOD SOI 2.
M.................        4           196  INTERSTITIAL LUNG DISEASE      142        2  INTERSTITIAL LUNG
                                            SOI 2.                                       DISEASE SOI 2.
M.................        4           197  INTERSTITIAL LUNG DISEASE      132        3  BPD & OTH CHRONIC
                                            SOI 3.                                       RESPIRATORY DISEASES
                                                                                         ARISING IN PERINATAL
                                                                                         PERIOD SOI 3.
M.................        4           197  INTERSTITIAL LUNG DISEASE      142        3  INTERSTITIAL LUNG
                                            SOI 3.                                       DISEASE SOI 3.
M.................        4           198  OTHER RESPIRATORY              143        1  OTHER RESPIRATORY
                                            DIAGNOSES EXCEPT SIGNS,                      DIAGNOSES EXCEPT SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
M.................        4           199  OTHER RESPIRATORY              143        2  OTHER RESPIRATORY
                                            DIAGNOSES EXCEPT SIGNS,                      DIAGNOSES EXCEPT SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
M.................        4           200  OTHER RESPIRATORY              143        3  OTHER RESPIRATORY
                                            DIAGNOSES EXCEPT SIGNS,                      DIAGNOSES EXCEPT SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
M.................        4           201  RESPIRATORY SIGNS,             144        1  RESPIRATORY SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
M.................        4           202  RESPIRATORY SIGNS,             144        2  RESPIRATORY SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
M.................        4           203  RESPIRATORY SIGNS,             144        3  RESPIRATORY SIGNS,
                                            SYMPTOMS & MINOR                             SYMPTOMS & MINOR
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        5           204  CARDIOTHORACIC PROCEDURES      160        4  MAJOR CARDIOTHORACIC
                                            SOI 4.                                       REPAIR OF HEART ANOMALY
                                                                                         SOI 4.
S.................        5           204  CARDIOTHORACIC PROCEDURES      161        4  CARDIAC DEFIBRILLATOR &
                                            SOI 4.                                       HEART ASSIST IMPLANT
                                                                                         SOI 4.

[[Page 24441]]

 
S.................        5           204  CARDIOTHORACIC PROCEDURES      162        4  CARDIAC VALVE PROCEDURES
                                            SOI 4.                                       W CARDIAC
                                                                                         CATHETERIZATION SOI 4.
S.................        5           204  CARDIOTHORACIC PROCEDURES      163        4  CARDIAC VALVE PROCEDURES
                                            SOI 4.                                       W/O CARDIAC
                                                                                         CATHETERIZATION SOI 4.
S.................        5           204  CARDIOTHORACIC PROCEDURES      165        4  CORONARY BYPASS W
                                            SOI 4.                                       CARDIAC CATH OR
                                                                                         PERCUTANEOUS CARDIAC
                                                                                         PROCEDURE SOI 4.
S.................        5           204  CARDIOTHORACIC PROCEDURES      166        4  CORONARY BYPASS W/O
                                            SOI 4.                                       CARDIAC CATH OR
                                                                                         PERCUTANEOUS CARDIAC
                                                                                         PROCEDURE SOI 4.
S.................        5           204  CARDIOTHORACIC PROCEDURES      167        4  OTHER CARDIOTHORACIC
                                            SOI 4.                                       PROCEDURES SOI 4.
S.................        5           205  VASCULAR PROCEDURES SOI 4      169        4  MAJOR THORACIC &
                                                                                         ABDOMINAL VASCULAR
                                                                                         PROCEDURES SOI 4.
S.................        5           205  VASCULAR PROCEDURES SOI 4      173        4  OTHER VASCULAR
                                                                                         PROCEDURES SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       170        4  PERMANENT CARDIAC
                                            PROCEDURES SOI 4.                            PACEMAKER IMPLANT W
                                                                                         AMI, HEART FAILURE OR
                                                                                         SHOCK SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       171        4  PERM CARDIAC PACEMAKER
                                            PROCEDURES SOI 4.                            IMPLANT W/O AMI, HEART
                                                                                         FAILURE OR SHOCK SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       174        4  PERCUTANEOUS
                                            PROCEDURES SOI 4.                            CARDIOVASCULAR
                                                                                         PROCEDURES W AMI SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       175        4  PERCUTANEOUS
                                            PROCEDURES SOI 4.                            CARDIOVASCULAR
                                                                                         PROCEDURES W/O AMI SOI
                                                                                         4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       176        4  CARDIAC PACEMAKER &
                                            PROCEDURES SOI 4.                            DEFIBRILLATOR DEVICE
                                                                                         REPLACEMENT SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       177        4  CARDIAC PACEMAKER &
                                            PROCEDURES SOI 4.                            DEFIBRILLATOR REVISION
                                                                                         EXCEPT DEVICE
                                                                                         REPLACEMENT SOI 4.
S.................        5           206  OTHER CIRCULATORY SYSTEM       180        4  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        5           207  CARDIAC DEFIBRILLATOR &        161        1  CARDIAC DEFIBRILLATOR &
                                            HEART ASSIST IMPLANT SOI                     HEART ASSIST IMPLANT
                                            1.                                           SOI 1.
S.................        5           208  CARDIAC DEFIBRILLATOR &        161        2  CARDIAC DEFIBRILLATOR &
                                            HEART ASSIST IMPLANT SOI                     HEART ASSIST IMPLANT
                                            2.                                           SOI 2.
S.................        5           209  CARDIAC DEFIBRILLATOR &        161        3  CARDIAC DEFIBRILLATOR &
                                            HEART ASSIST IMPLANT SOI                     HEART ASSIST IMPLANT
                                            3.                                           SOI 3.
S.................        5           210  CARDIAC VALVE PROCEDURES       162        1  CARDIAC VALVE PROCEDURES
                                            W CARDIAC                                    W CARDIAC
                                            CATHETERIZATION SOI 1.                       CATHETERIZATION SOI 1.
S.................        5           211  CARDIAC VALVE PROCEDURES       162        2  CARDIAC VALVE PROCEDURES
                                            W CARDIAC                                    W CARDIAC
                                            CATHETERIZATION SOI 2.                       CATHETERIZATION SOI 2.
S.................        5           212  CARDIAC VALVE PROCEDURES       162        3  CARDIAC VALVE PROCEDURES
                                            W CARDIAC                                    W CARDIAC
                                            CATHETERIZATION SOI 3.                       CATHETERIZATION SOI 3.
S.................        5           213  CARDIAC VALVE PROCEDURES       163        1  CARDIAC VALVE PROCEDURES
                                            W/O CARDIAC                                  W/O CARDIAC
                                            CATHETERIZATION SOI 1.                       CATHETERIZATION SOI 1.
S.................        5           214  CARDIAC VALVE PROCEDURES       163        2  CARDIAC VALVE PROCEDURES
                                            W/O CARDIAC                                  W/O CARDIAC
                                            CATHETERIZATION SOI 2.                       CATHETERIZATION SOI 2.
S.................        5           215  CARDIAC VALVE PROCEDURES       163        3  CARDIAC VALVE PROCEDURES
                                            W/O CARDIAC                                  W/O CARDIAC
                                            CATHETERIZATION SOI 3.                       CATHETERIZATION SOI 3.
S.................        5           216  CORONARY BYPASS W CARDIAC      165        1  CORONARY BYPASS W
                                            CATH OR PERCUTANEOUS                         CARDIAC CATH OR
                                            CARDIAC PROCEDURE SOI 1.                     PERCUTANEOUS CARDIAC
                                                                                         PROCEDURE SOI 1.
S.................        5           217  CORONARY BYPASS W CARDIAC      165        2  CORONARY BYPASS W
                                            CATH OR PERCUTANEOUS                         CARDIAC CATH OR
                                            CARDIAC PROCEDURE SOI 2.                     PERCUTANEOUS CARDIAC
                                                                                         PROCEDURE SOI 2.
S.................        5           218  CORONARY BYPASS W CARDIAC      165        3  CORONARY BYPASS W
                                            CATH OR PERCUTANEOUS                         CARDIAC CATH OR
                                            CARDIAC PROCEDURE SOI 3.                     PERCUTANEOUS CARDIAC
                                                                                         PROCEDURE SOI 3.
S.................        5           219  CORONARY BYPASS W/O            166        1  CORONARY BYPASS W/O
                                            CARDIAC CATH OR                              CARDIAC CATH OR
                                            PERCUTANEOUS CARDIAC                         PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 1.                             PROCEDURE SOI 1.
S.................        5           220  CORONARY BYPASS W/O            166        2  CORONARY BYPASS W/O
                                            CARDIAC CATH OR                              CARDIAC CATH OR
                                            PERCUTANEOUS CARDIAC                         PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 2.                             PROCEDURE SOI 2.

[[Page 24442]]

 
S.................        5           221  CORONARY BYPASS W/O            166        3  CORONARY BYPASS W/O
                                            CARDIAC CATH OR                              CARDIAC CATH OR
                                            PERCUTANEOUS CARDIAC                         PERCUTANEOUS CARDIAC
                                            PROCEDURE SOI 3.                             PROCEDURE SOI 3.
S.................        5           222  OTHER CARDIOTHORACIC           160        1  MAJOR CARDIOTHORACIC
                                            PROCEDURES SOI 1.                            REPAIR OF HEART ANOMALY
                                                                                         SOI 1.
S.................        5           222  OTHER CARDIOTHORACIC           167        1  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        5           223  OTHER CARDIOTHORACIC           160        2  MAJOR CARDIOTHORACIC
                                            PROCEDURES SOI 2.                            REPAIR OF HEART ANOMALY
                                                                                         SOI 2.
S.................        5           223  OTHER CARDIOTHORACIC           167        2  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        5           224  OTHER CARDIOTHORACIC           160        3  MAJOR CARDIOTHORACIC
                                            PROCEDURES SOI 3.                            REPAIR OF HEART ANOMALY
                                                                                         SOI 3.
S.................        5           224  OTHER CARDIOTHORACIC           167        3  OTHER CARDIOTHORACIC
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        5          225.  MAJOR THORACIC &               169        1  MAJOR THORACIC &
                                            ABDOMINAL VASCULAR                           ABDOMINAL VASCULAR
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        5          226.  MAJOR THORACIC &               169        2  MAJOR THORACIC &
                                            ABDOMINAL VASCULAR                           ABDOMINAL VASCULAR
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        5           227  MAJOR THORACIC &               169        3  MAJOR THORACIC &
                                            ABDOMINAL VASCULAR                           ABDOMINAL VASCULAR
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        5           228  PERMANENT CARDIAC              170        1  PERMANENT CARDIAC
                                            PACEMAKER IMPLANT W AMI,                     PACEMAKER IMPLANT W
                                            HEART FAILURE OR SHOCK                       AMI, HEART FAILURE OR
                                            SOI 1.                                       SHOCK SOI 1.
S.................        5           229  PERMANENT CARDIAC              170        2  PERMANENT CARDIAC
                                            PACEMAKER IMPLANT W AMI,                     PACEMAKER IMPLANT W
                                            HEART FAILURE OR SHOCK                       AMI, HEART FAILURE OR
                                            SOI 2.                                       SHOCK SOI 2.
S.................        5           230  PERMANENT CARDIAC              170        3  PERMANENT CARDIAC
                                            PACEMAKER IMPLANT W AMI,                     PACEMAKER IMPLANT W
                                            HEART FAILURE OR SHOCK                       AMI, HEART FAILURE OR
                                            SOI 3.                                       SHOCK SOI 3.
S.................        5           231  PERM CARDIAC PACEMAKER         171        1  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART                       IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 1.                      FAILURE OR SHOCK SOI 1.
S.................        5           232  PERM CARDIAC PACEMAKER         171        2  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART                       IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 2.                      FAILURE OR SHOCK SOI 2.
S.................        5           233  PERM CARDIAC PACEMAKER         171        3  PERM CARDIAC PACEMAKER
                                            IMPLANT W/O AMI, HEART                       IMPLANT W/O AMI, HEART
                                            FAILURE OR SHOCK SOI 3.                      FAILURE OR SHOCK SOI 3.
S.................        5           234  OTHER VASCULAR PROCEDURES      173        1  OTHER VASCULAR
                                            SOI 1.                                       PROCEDURES SOI 1.
S.................        5           235  OTHER VASCULAR PROCEDURES      173        2  OTHER VASCULAR
                                            SOI 2.                                       PROCEDURES SOI 2.
S.................        5           236  OTHER VASCULAR PROCEDURES      173        3  OTHER VASCULAR
                                            SOI 3.                                       PROCEDURES SOI 3.
S.................        5           237  PERCUTANEOUS                   174        1  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 1.                      PROCEDURES W AMI SOI 1.
S.................        5           238  PERCUTANEOUS                   174        2  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 2.                      PROCEDURES W AMI SOI 2.
S.................        5           239  PERCUTANEOUS                   174        3  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W AMI SOI 3.                      PROCEDURES W AMI SOI 3.
S.................        5           240  PERCUTANEOUS                   175        1  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 1.                    PROCEDURES W/O AMI SOI
                                                                                         1.
S.................        5           241  PERCUTANEOUS                   175        2  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 2.                    PROCEDURES W/O AMI SOI
                                                                                         2.
S.................        5           242  PERCUTANEOUS                   175        3  PERCUTANEOUS
                                            CARDIOVASCULAR                               CARDIOVASCULAR
                                            PROCEDURES W/O AMI SOI 3.                    PROCEDURES W/O AMI SOI
                                                                                         3.
S.................        5           243  CARDIAC PACEMAKER &            176        1  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE                         DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 1.                           REPLACEMENT SOI 1.
S.................        5           244  CARDIAC PACEMAKER &            176        2  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE                         DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 2.                           REPLACEMENT SOI 2.
S.................        5           245  CARDIAC PACEMAKER &            176        3  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR DEVICE                         DEFIBRILLATOR DEVICE
                                            REPLACEMENT SOI 3.                           REPLACEMENT SOI 3.
S.................        5           246  CARDIAC PACEMAKER &            177        1  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION                       DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE                                EXCEPT DEVICE
                                            REPLACEMENT SOI 1.                           REPLACEMENT SOI 1.

[[Page 24443]]

 
S.................        5           247  CARDIAC PACEMAKER &            177        2  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION                       DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE                                EXCEPT DEVICE
                                            REPLACEMENT SOI 2.                           REPLACEMENT SOI 2.
S.................        5           248  CARDIAC PACEMAKER &            177        3  CARDIAC PACEMAKER &
                                            DEFIBRILLATOR REVISION                       DEFIBRILLATOR REVISION
                                            EXCEPT DEVICE                                EXCEPT DEVICE
                                            REPLACEMENT SOI 3.                           REPLACEMENT SOI 3.
S.................        5           249  OTHER CIRCULATORY SYSTEM       180        1  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        5           250  OTHER CIRCULATORY SYSTEM       180        2  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        5           251  OTHER CIRCULATORY SYSTEM       180        3  OTHER CIRCULATORY SYSTEM
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
M.................        5           252  CIRCULATORY SYSTEM             190        4  ACUTE MYOCARDIAL
                                            DIAGNOSES SOI 4.                             INFARCTION SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             191        4  CARDIAC CATHETERIZATION
                                            DIAGNOSES SOI 4.                             W CIRC DISORD EXC
                                                                                         ISCHEMIC HEART DISEASE
                                                                                         SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             192        4  CARDIAC CATHETERIZATION
                                            DIAGNOSES SOI 4.                             FOR ISCHEMIC HEART
                                                                                         DISEASE SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             193        4  ACUTE & SUBACUTE
                                            DIAGNOSES SOI 4.                             ENDOCARDITIS SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             194        4  HEART FAILURE SOI 4.
                                            DIAGNOSES SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             196        4  CARDIAC ARREST SOI 4.
                                            DIAGNOSES SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             197        4  PERIPHERAL & OTHER
                                            DIAGNOSES SOI 4.                             VASCULAR DISORDERS SOI
                                                                                         4.
M.................        5           252  CIRCULATORY SYSTEM             198        4  ANGINA PECTORIS &
                                            DIAGNOSES SOI 4.                             CORONARY
                                                                                         ATHEROSCLEROSIS SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             199        4  HYPERTENSION SOI 4.
                                            DIAGNOSES SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             200        4  CARDIAC STRUCTURAL &
                                            DIAGNOSES SOI 4.                             VALVULAR DISORDERS SOI
                                                                                         4.
M.................        5           252  CIRCULATORY SYSTEM             201        4  CARDIAC ARRHYTHMIA &
                                            DIAGNOSES SOI 4.                             CONDUCTION DISORDERS
                                                                                         SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             203        4  CHEST PAIN SOI 4.
                                            DIAGNOSES SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             204        4  SYNCOPE & COLLAPSE SOI
                                            DIAGNOSES SOI 4.                             4.
M.................        5           252  CIRCULATORY SYSTEM             205        4  CARDIOMYOPATHY SOI 4.
                                            DIAGNOSES SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             206        4  MALFUNCTION, REACTION,
                                            DIAGNOSES SOI 4.                             COMP LICATION OF
                                                                                         CARDIAC/VASC DEVICE OR
                                                                                         PROCEDURE SOI 4.
M.................        5           252  CIRCULATORY SYSTEM             207        4  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 4.                             DIAGNOSES SOI 4.
M.................        5           253  ACUTE MYOCARDIAL               190        1  ACUTE MYOCARDIAL
                                            INFARCTION SOI 1.                            INFARCTION SOI 1.
M.................        5           254  ACUTE MYOCARDIAL               190        2  ACUTE MYOCARDIAL
                                            INFARCTION SOI 2.                            INFARCTION SOI 2.
M.................        5           255  ACUTE MYOCARDIAL               190        3  ACUTE MYOCARDIAL
                                            INFARCTION SOI 3.                            INFARCTION SOI 3.
M.................        5           256  CARDIAC CATHETERIZATION W      191        1  CARDIAC CATHETERIZATION
                                            CIRC DISORD EXC ISCHEMIC                     W CIRC DISORD EXC
                                            HEART DISEASE SOI 1.                         ISCHEMIC HEART DISEASE
                                                                                         SOI 1.
M.................        5           257  CARDIAC CATHETERIZATION W      191        2  CARDIAC CATHETERIZATION
                                            CIRC DISORD EXC ISCHEMIC                     W CIRC DISORD EXC
                                            HEART DISEASE SOI 2.                         ISCHEMIC HEART DISEASE
                                                                                         SOI 2.
M.................        5           258  CARDIAC CATHETERIZATION W      191        3  CARDIAC CATHETERIZATION
                                            CIRC DISORD EXC ISCHEMIC                     W CIRC DISORD EXC
                                            HEART DISEASE SOI 3.                         ISCHEMIC HEART DISEASE
                                                                                         SOI 3.
M.................        5           259  CARDIAC CATHETERIZATION        192        1  CARDIAC CATHETERIZATION
                                            FOR ISCHEMIC HEART                           FOR ISCHEMIC HEART
                                            DISEASE SOI 1.                               DISEASE SOI 1.
M.................        5           260  CARDIAC CATHETERIZATION        192        2  CARDIAC CATHETERIZATION
                                            FOR ISCHEMIC HEART                           FOR ISCHEMIC HEART
                                            DISEASE SOI 2.                               DISEASE SOI 2.
M.................        5           261  CARDIAC CATHETERIZATION        192        3  CARDIAC CATHETERIZATION
                                            FOR ISCHEMIC HEART                           FOR ISCHEMIC HEART
                                            DISEASE SOI 3.                               DISEASE SOI 3.
M.................        5           262  ACUTE & SUBACUTE               193        1  ACUTE & SUBACUTE
                                            ENDOCARDITIS SOI 1.                          ENDOCARDITIS SOI 1.

[[Page 24444]]

 
M.................        5           263  ACUTE & SUBACUTE               193        2  ACUTE & SUBACUTE
                                            ENDOCARDITIS SOI 2.                          ENDOCARDITIS SOI 2.
M.................        5           264  ACUTE & SUBACUTE               193        3  ACUTE & SUBACUTE
                                            ENDOCARDITIS SOI 3.                          ENDOCARDITIS SOI 3.
M.................        5           265  HEART FAILURE SOI 1......      194        1  HEART FAILURE SOI 1.
M.................        5           266  HEART FAILURE SOI 2......      194        2  HEART FAILURE SOI 2.
M.................        5           267  HEART FAILURE SOI 3......      194        3  HEART FAILURE SOI 3.
M.................        5           268  CARDIAC ARREST SOI 1.....      196        1  CARDIAC ARREST SOI 1.
M.................        5           269  CARDIAC ARREST SOI 2.....      196        2  CARDIAC ARREST SOI 2.
M.................        5           270  CARDIAC ARREST SOI 3.....      196        3  CARDIAC ARREST SOI 3.
M.................        5           271  PERIPHERAL & OTHER             197        1  PERIPHERAL & OTHER
                                            VASCULAR DISORDERS SOI 1.                    VASCULAR DISORDERS SOI
                                                                                         1.
M.................        5           272  PERIPHERAL & OTHER             197        2  PERIPHERAL & OTHER
                                            VASCULAR DISORDERS SOI 2.                    VASCULAR DISORDERS SOI
                                                                                         2.
M.................        5           273  PERIPHERAL & OTHER             197        3  PERIPHERAL & OTHER
                                            VASCULAR DISORDERS SOI 3.                    VASCULAR DISORDERS SOI
                                                                                         3.
M.................        5           274  ANGINA PECTORIS &              198        1  ANGINA PECTORIS &
                                            CORONARY ATHEROSCLEROSIS                     CORONARY
                                            SOI 1.                                       ATHEROSCLEROSIS SOI 1.
M.................        5           275  ANGINA PECTORIS &              198        2  ANGINA PECTORIS &
                                            CORONARY ATHEROSCLEROSIS                     CORONARY
                                            SOI 2.                                       ATHEROSCLEROSIS SOI 2.
M.................        5           276  ANGINA PECTORIS &              198        3  ANGINA PECTORIS &
                                            CORONARY ATHEROSCLEROSIS                     CORONARY
                                            SOI 3.                                       ATHEROSCLEROSIS SOI 3.
M.................        5           277  HYPERTENSION SOI 1.......      199        1  HYPERTENSION SOI 1.
M.................        5           278  HYPERTENSION SOI 2.......      199        2  HYPERTENSION SOI 2.
M.................        5           279  HYPERTENSION SOI 3.......      199        3  HYPERTENSION SOI 3.
M.................        5           280  CARDIAC STRUCTURAL &           200        1  CARDIAC STRUCTURAL &
                                            VALVULAR DISORDERS SOI 1.                    VALVULAR DISORDERS SOI
                                                                                         1.
M.................        5           281  CARDIAC STRUCTURAL &           200        2  CARDIAC STRUCTURAL &
                                            VALVULAR DISORDERS SOI 2.                    VALVULAR DISORDERS SOI
                                                                                         2.
M.................        5           282  CARDIAC STRUCTURAL &           200        3  CARDIAC STRUCTURAL &
                                            VALVULAR DISORDERS SOI 3.                    VALVULAR DISORDERS SOI
                                                                                         3.
M.................        5           283  CARDIAC ARRHYTHMIA &           201        1  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI                     CONDUCTION DISORDERS
                                            1.                                           SOI 1.
M.................        5           284  CARDIAC ARRHYTHMIA &           201        2  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI                     CONDUCTION DISORDERS
                                            2.                                           SOI 2.
M.................        5           285  CARDIAC ARRHYTHMIA &           201        3  CARDIAC ARRHYTHMIA &
                                            CONDUCTION DISORDERS SOI                     CONDUCTION DISORDERS
                                            3.                                           SOI 3.
M.................        5           286  CHEST PAIN SOI 1.........      203        1  CHEST PAIN SOI 1.
M.................        5           287  CHEST PAIN SOI 2.........      203        2  CHEST PAIN SOI 2.
M.................        5           288  CHEST PAIN SOI 3.........      203        3  CHEST PAIN SOI 3.
M.................        5           289  SYNCOPE & COLLAPSE SOI 1.      204        1  SYNCOPE & COLLAPSE SOI
                                                                                         1.
M.................        5           290  SYNCOPE & COLLAPSE SOI 2.      204        2  SYNCOPE & COLLAPSE SOI
                                                                                         2.
M.................        5           291  SYNCOPE & COLLAPSE SOI 3.      204        3  SYNCOPE & COLLAPSE SOI
                                                                                         3.
M.................        5           292  CARDIOMYOPATHY SOI 1.....      205        1  CARDIOMYOPATHY SOI 1.
M.................        5           293  CARDIOMYOPATHY SOI 2.....      205        2  CARDIOMYOPATHY SOI 2.
M.................        5           294  CARDIOMYOPATHY SOI 3.....      205        3  CARDIOMYOPATHY SOI 3.
M.................        5           295  MALFUNCTION, REACTION, CO      206        1  MALFUNCTION, REACTION,
                                            MPLICATION OF CARDIAC/                       COMP LICATION OF
                                            VASC DEVICE OR PROCEDURE                     CARDIAC/VASC DEVICE OR
                                            SOI 1.                                       PROCEDURE SOI 1.
M.................        5           296  MALFUNCTION, REACTION,         206        2  MALFUNCTION, REACTION,
                                            CO. MPLICATION OF                            COMP LICATION OF
                                            CARDIAC/VASC DEVICE OR                       CARDIAC/VASC DEVICE OR
                                            PROCEDURE SOI 2.                             PROCEDURE SOI 2.
M.................        5           297  MALFUNCTION, REACTION,         206        3  MALFUNCTION, REACTION,
                                            CO. MPLICATION OF                            COMP LICATION OF
                                            CARDIAC/VASC DEVICE OR                       CARDIAC/VASC DEVICE OR
                                            PROCEDURE SOI 3.                             PROCEDURE SOI 3.
M.................        5           298  OTHER CIRCULATORY SYSTEM       207        1  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
M.................        5           299  OTHER CIRCULATORY SYSTEM       207        2  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
M.................        5           300  OTHER CIRCULATORY SYSTEM       207        3  OTHER CIRCULATORY SYSTEM
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        6           301  MAJOR GASTROINTESTINAL         220        4  MAJOR STOMACH,
                                            PROCEDURES SOI 4.                            ESOPHAGEAL & DUODENAL
                                                                                         PROCEDURES SOI 4.
S.................        6           301  MAJOR GASTROINTESTINAL         221        4  MAJOR SMALL & LARGE
                                            PROCEDURES SOI 4.                            BOWEL PROCEDURES SOI 4.
S.................        6           301  MAJOR GASTROINTESTINAL         222        4  OTHER STOMACH,
                                            PROCEDURES SOI 4.                            ESOPHAGEAL & DUODENAL
                                                                                         PROCEDURES SOI 4.
S.................        6           301  MAJOR GASTROINTESTINAL         223        4  OTHER SMALL & LARGE
                                            PROCEDURES SOI 4.                            BOWEL PROCEDURES SOI 4.

[[Page 24445]]

 
S.................        6           302  OTHER GASTROINTESTINAL &       224        4  PERITONEAL ADHESIOLYSIS
                                            ABDOMINAL PROCEDURES SOI                     SOI 4.
                                            4.
S.................        6           302  OTHER GASTROINTESTINAL &       225        4  APPENDECTOMY SOI 4.
                                            ABDOMINAL PROCEDURES SOI
                                            4.
S.................        6           302  OTHER GASTROINTESTINAL &       226        4  ANAL PROCEDURES SOI 4.
                                            ABDOMINAL PROCEDURES SOI
                                            4.
S.................        6           302  OTHER GASTROINTESTINAL &       227        4  HERNIA PROCEDURES EXCEPT
                                            ABDOMINAL PROCEDURES SOI                     INGUINAL, FEMORAL &
                                            4.                                           UMBILICAL SOI 4.
S.................        6           302  OTHER GASTROINTESTINAL &       228        4  INGUINAL, FEMORAL &
                                            ABDOMINAL PROCEDURES SOI                     UMBILICAL HERNIA
                                            4.                                           PROCEDURES SOI 4.
S.................        6           302  OTHER GASTROINTESTINAL &       229        4  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI                     ABDOMINAL PROCEDURES
                                            4.                                           SOI 4.
S.................        6           303  MAJOR STOMACH, ESOPHAGEAL      220        1  MAJOR STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 1.                                       PROCEDURES SOI 1.
S.................        6           304  MAJOR STOMACH, ESOPHAGEAL      220        2  MAJOR STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 2.                                       PROCEDURES SOI 2.
S.................        6           305  MAJOR STOMACH, ESOPHAGEAL      220        3  MAJOR STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 3.                                       PROCEDURES SOI 3.
S.................        6           306  MAJOR SMALL & LARGE BOWEL      221        1  MAJOR SMALL & LARGE
                                            PROCEDURES SOI 1.                            BOWEL PROCEDURES SOI 1.
S.................        6           307  MAJOR SMALL & LARGE BOWEL      221        2  MAJOR SMALL & LARGE
                                            PROCEDURES SOI 2.                            BOWEL PROCEDURES SOI 2.
S.................        6           308  MAJOR SMALL & LARGE BOWEL      221        3  MAJOR SMALL & LARGE
                                            PROCEDURES SOI 3.                            BOWEL PROCEDURES SOI 3.
S.................        6           309  OTHER STOMACH, ESOPHAGEAL      222        1  OTHER STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 1.                                       PROCEDURES SOI 1.
S.................        6           310  OTHER STOMACH, ESOPHAGEAL      222        2  OTHER STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 2.                                       PROCEDURES SOI 2.
S.................        6           311  OTHER STOMACH, ESOPHAGEAL      222        3  OTHER STOMACH,
                                            & DUODENAL PROCEDURES                        ESOPHAGEAL & DUODENAL
                                            SOI 3.                                       PROCEDURES SOI 3.
S.................        6           312  OTHER SMALL & LARGE BOWEL      223        1  OTHER SMALL & LARGE
                                            PROCEDURES SOI 1.                            BOWEL PROCEDURES SOI 1.
S.................        6           313  OTHER SMALL & LARGE BOWEL      223        2  OTHER SMALL & LARGE
                                            PROCEDURES SOI 2.                            BOWEL PROCEDURES SOI 2.
S.................        6           314  OTHER SMALL & LARGE BOWEL      223        3  OTHER SMALL & LARGE
                                            PROCEDURES SOI 3.                            BOWEL PROCEDURES SOI 3.
S.................        6           315  PERITONEAL ADHESIOLYSIS        224        1  PERITONEAL ADHESIOLYSIS
                                            SOI 1.                                       SOI 1.
S.................        6           316  PERITONEAL ADHESIOLYSIS        224        2  PERITONEAL ADHESIOLYSIS
                                            SOI 2.                                       SOI 2.
S.................        6           317  PERITONEAL ADHESIOLYSIS        224        3  PERITONEAL ADHESIOLYSIS
                                            SOI 3.                                       SOI 3.
S.................        6           318  APPENDECTOMY SOI 1.......      225        1  APPENDECTOMY SOI 1.
S.................        6           319  APPENDECTOMY SOI 2.......      225        2  APPENDECTOMY SOI 2.
S.................        6           320  APPENDECTOMY SOI 3.......      225        3  APPENDECTOMY SOI 3.
S.................        6           321  ANAL PROCEDURES SOI 1....      226        1  ANAL PROCEDURES SOI 1.
S.................        6           322  ANAL PROCEDURES SOI 2....      226        2  ANAL PROCEDURES SOI 2.
S.................        6           323  ANAL PROCEDURES SOI 3....      226        3  ANAL PROCEDURES SOI 3.
S.................        6           324  HERNIA PROCEDURES EXCEPT       227        1  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &                          INGUINAL, FEMORAL &
                                            UMBILICAL SOI 1.                             UMBILICAL SOI 1.
S.................        6           325  HERNIA PROCEDURES EXCEPT       227        2  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &                          INGUINAL, FEMORAL &
                                            UMBILICAL SOI 2.                             UMBILICAL SOI 2.
S.................        6           326  HERNIA PROCEDURES EXCEPT       227        3  HERNIA PROCEDURES EXCEPT
                                            INGUINAL, FEMORAL &                          INGUINAL, FEMORAL &
                                            UMBILICAL SOI 3.                             UMBILICAL SOI 3.
S.................        6           327  INGUINAL, FEMORAL &            228        1  INGUINAL, FEMORAL &
                                            UMBILICAL HERNIA                             UMBILICAL HERNIA
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        6           328  INGUINAL, FEMORAL &            228        2  INGUINAL, FEMORAL &
                                            UMBILICAL HERNIA                             UMBILICAL HERNIA
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        6           329  INGUINAL, FEMORAL &            228        3  INGUINAL, FEMORAL &
                                            UMBILICAL HERNIA                             UMBILICAL HERNIA
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        6           330  OTHER DIGESTIVE SYSTEM &       229        1  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI                     ABDOMINAL PROCEDURES
                                            1.                                           SOI 1.
S.................        6           331  OTHER DIGESTIVE SYSTEM &       229        2  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI                     ABDOMINAL PROCEDURES
                                            2.                                           SOI 2.
S.................        6           332  OTHER DIGESTIVE SYSTEM &       229        3  OTHER DIGESTIVE SYSTEM &
                                            ABDOMINAL PROCEDURES SOI                     ABDOMINAL PROCEDURES
                                            3.                                           SOI 3.
M.................        6           333  DIGESTIVE SYSTEM               240        4  DIGESTIVE MALIGNANCY SOI
                                            DIAGNOSES SOI 4.                             4.
M.................        6           333  DIGESTIVE SYSTEM               241        4  PEPTIC ULCER & GASTRITIS
                                            DIAGNOSES SOI 4.                             SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               242        4  MAJOR ESOPHAGEAL
                                            DIAGNOSES SOI 4.                             DISORDERS SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               243        4  OTHER ESOPHAGEAL
                                            DIAGNOSES SOI 4.                             DISORDERS SOI 4.

[[Page 24446]]

 
M.................        6           333  DIGESTIVE SYSTEM               244        4  DIVERTICULITIS &
                                            DIAGNOSES SOI 4.                             DIVERTICULOSIS SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               245        4  INFLAMMATORY BOWEL
                                            DIAGNOSES SOI 4.                             DISEASE SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               246        4  GASTROINTESTINAL
                                            DIAGNOSES SOI 4.                             VASCULAR INSUFFICIENCY
                                                                                         SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               247        4  INTESTINAL OBSTRUCTION
                                            DIAGNOSES SOI 4.                             SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               248        4  MAJOR GASTROINTESTINAL &
                                            DIAGNOSES SOI 4.                             PERITONEAL INFECTIONS
                                                                                         SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               249        4  NON-BACTERIAL
                                            DIAGNOSES SOI 4.                             GASTROENTERITIS, NAUSEA
                                                                                         & VOMITING SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               251        4  ABDOMINAL PAIN SOI 4.
                                            DIAGNOSES SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               252        4  MALFUNCTION, REACTION &
                                            DIAGNOSES SOI 4.                             COMPLICATION OF GI
                                                                                         DEVICE OR PROCEDURE SOI
                                                                                         4.
M.................        6           333  DIGESTIVE SYSTEM               253        4  OTHER & UNSPECIFIED
                                            DIAGNOSES SOI 4.                             GASTROINTESTINAL
                                                                                         HEMORRHAGE SOI 4.
M.................        6           333  DIGESTIVE SYSTEM               254        4  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 4.                             DIAGNOSES SOI 4.
M.................        6           334  DIGESTIVE MALIGNANCY SOI       240        1  DIGESTIVE MALIGNANCY SOI
                                            1.                                           1.
M.................        6           335  DIGESTIVE MALIGNANCY SOI       240        2  DIGESTIVE MALIGNANCY SOI
                                            2.                                           2.
M.................        6           336  DIGESTIVE MALIGNANCY SOI       240        3  DIGESTIVE MALIGNANCY SOI
                                            3.                                           3.
M.................        6           337  PEPTIC ULCER & GASTRITIS       241        1  PEPTIC ULCER & GASTRITIS
                                            SOI 1.                                       SOI 1.
M.................        6           338  PEPTIC ULCER & GASTRITIS       241        2  PEPTIC ULCER & GASTRITIS
                                            SOI 2.                                       SOI 2.
M.................        6           339  PEPTIC ULCER & GASTRITIS       241        3  PEPTIC ULCER & GASTRITIS
                                            SOI 3.                                       SOI 3.
M.................        6           340  MAJOR ESOPHAGEAL               242        1  MAJOR ESOPHAGEAL
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        6           341  MAJOR ESOPHAGEAL               242        2  MAJOR ESOPHAGEAL
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        6           342  MAJOR ESOPHAGEAL               242        3  MAJOR ESOPHAGEAL
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        6           343  OTHER ESOPHAGEAL               243        1  OTHER ESOPHAGEAL
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        6           344  OTHER ESOPHAGEAL               243        2  OTHER ESOPHAGEAL
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        6           345  OTHER ESOPHAGEAL               243        3  OTHER ESOPHAGEAL
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        6           346  DIVERTICULITIS &               244        1  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 1.                        DIVERTICULOSIS SOI 1.
M.................        6           347  DIVERTICULITIS &               244        2  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 2.                        DIVERTICULOSIS SOI 2.
M.................        6           348  DIVERTICULITIS &               244        3  DIVERTICULITIS &
                                            DIVERTICULOSIS SOI 3.                        DIVERTICULOSIS SOI 3.
M.................        6           349  INFLAMMATORY BOWEL             245        1  INFLAMMATORY BOWEL
                                            DISEASE SOI 1.                               DISEASE SOI 1.
M.................        6           350  INFLAMMATORY BOWEL             245        2  INFLAMMATORY BOWEL
                                            DISEASE SOI 2.                               DISEASE SOI 2.
M.................        6           351  INFLAMMATORY BOWEL             245        3  INFLAMMATORY BOWEL
                                            DISEASE SOI 3.                               DISEASE SOI 3.
M.................        6           352  GASTROINTESTINAL VASCULAR      246        1  GASTROINTESTINAL
                                            INSUFFICIENCY SOI 1.                         VASCULAR INSUFFICIENCY
                                                                                         SOI 1.
M.................        6           353  GASTROINTESTINAL VASCULAR      246        2  GASTROINTESTINAL
                                            INSUFFICIENCY SOI 2.                         VASCULAR INSUFFICIENCY
                                                                                         SOI 2.
M.................        6           354  GASTROINTESTINAL VASCULAR      246        3  GASTROINTESTINAL
                                            INSUFFICIENCY SOI 3.                         VASCULAR INSUFFICIENCY
                                                                                         SOI 3.
M.................        6           355  INTESTINAL OBSTRUCTION         247        1  INTESTINAL OBSTRUCTION
                                            SOI 1.                                       SOI 1.
M.................        6           356  INTESTINAL OBSTRUCTION         247        2  INTESTINAL OBSTRUCTION
                                            SOI 2.                                       SOI 2.
M.................        6           357  INTESTINAL OBSTRUCTION         247        3  INTESTINAL OBSTRUCTION
                                            SOI 3.                                       SOI 3.
M.................        6           358  MAJOR GASTROINTESTINAL &       248        1  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS                        PERITONEAL INFECTIONS
                                            SOI 1.                                       SOI 1.
M.................        6           359  MAJOR GASTROINTESTINAL &       248        2  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS                        PERITONEAL INFECTIONS
                                            SOI 2.                                       SOI 2.
M.................        6           360  MAJOR GASTROINTESTINAL &       248        3  MAJOR GASTROINTESTINAL &
                                            PERITONEAL INFECTIONS                        PERITONEAL INFECTIONS
                                            SOI 3.                                       SOI 3.
M.................        6           361  NON-BACTERIAL                  249        1  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA                      GASTROENTERITIS, NAUSEA
                                            & VOMITING SOI 1.                            & VOMITING SOI 1.
M.................        6           362  NON-BACTERIAL                  249        2  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA                      GASTROENTERITIS, NAUSEA
                                            & VOMITING SOI 2.                            & VOMITING SOI 2.

[[Page 24447]]

 
M.................        6           363  NON-BACTERIAL                  249        3  NON-BACTERIAL
                                            GASTROENTERITIS, NAUSEA                      GASTROENTERITIS, NAUSEA
                                            & VOMITING SOI 3.                            & VOMITING SOI 3.
M.................        6           364  ABDOMINAL PAIN SOI 1.....      251        1  ABDOMINAL PAIN SOI 1.
M.................        6           365  ABDOMINAL PAIN SOI 2.....      251        2  ABDOMINAL PAIN SOI 2.
M.................        6           366  ABDOMINAL PAIN SOI 3.....      251        3  ABDOMINAL PAIN SOI 3.
M.................        6           367  MALFUNCTION, REACTION &        252        1  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI                           COMPLICATION OF GI
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            1.                                           1.
M.................        6           368  MALFUNCTION, REACTION &        252        2  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI                           COMPLICATION OF GI
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            2.                                           2.
M.................        6           369  MALFUNCTION, REACTION &        252        3  MALFUNCTION, REACTION &
                                            COMPLICATION OF GI                           COMPLICATION OF GI
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            3.                                           3.
M.................        6           370  OTHER & UNSPECIFIED            253        1  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL                             GASTROINTESTINAL
                                            HEMORRHAGE SOI 1.                            HEMORRHAGE SOI 1.
M.................        6           371  OTHER & UNSPECIFIED            253        2  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL                             GASTROINTESTINAL
                                            HEMORRHAGE SOI 2.                            HEMORRHAGE SOI 2.
M.................        6           372  OTHER & UNSPECIFIED            253        3  OTHER & UNSPECIFIED
                                            GASTROINTESTINAL                             GASTROINTESTINAL
                                            HEMORRHAGE SOI 3.                            HEMORRHAGE SOI 3.
M.................        6           373  OTHER DIGESTIVE SYSTEM         254        1  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
M.................        6           374  OTHER DIGESTIVE SYSTEM         254        2  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
M.................        6           375  OTHER DIGESTIVE SYSTEM         254        3  OTHER DIGESTIVE SYSTEM
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        7           376  MAJOR HEPATOBILIARY,           260        4  MAJOR PANCREAS, LIVER &
                                            PANCREAS & LIVER                             SHUNT PROCEDURES SOI 4.
                                            PROCEDURES SOI 4.
S.................        7           376  MAJOR HEPATOBILIARY,           261        4  MAJOR BILIARY TRACT
                                            PANCREAS & LIVER                             PROCEDURES SOI 4.
                                            PROCEDURES SOI 4.
S.................        7           377  CHOLECYSTECTOMY AND OTHER      262        4  CHOLECYSTECTOMY EXCEPT
                                            HEPATOBILIARY, PANCREAS                      LAPAROSCOPIC SOI 4.
                                            & ABDOMINAL PROCEDURES
                                            SOI 4.
S.................        7           377  CHOLECYSTECTOMY AND OTHER      264        4  OTHER HEPATOBILIARY,
                                            HEPATOBILIARY, PANCREAS                      PANCREAS & ABDOMINAL
                                            & ABDOMINAL PROCEDURES                       PROCEDURES SOI 4.
                                            SOI 4.
S.................        7           377  CHOLECYSTECTOMY AND OTHER      263        4  LAPAROSCOPIC
                                            HEPATOBILIARY, PANCREAS                      CHOLECYSTECTOMY SOI 4.
                                            & ABDOMINAL PROCEDURES
                                            SOI 4.
S.................        7           378  MAJOR PANCREAS, LIVER &        260        1  MAJOR PANCREAS, LIVER &
                                            SHUNT PROCEDURES SOI 1.                      SHUNT PROCEDURES SOI 1.
S.................        7           379  MAJOR PANCREAS, LIVER &        260        2  MAJOR PANCREAS, LIVER &
                                            SHUNT PROCEDURES SOI 2.                      SHUNT PROCEDURES SOI 2.
S.................        7           380  MAJOR PANCREAS, LIVER &        260        3  MAJOR PANCREAS, LIVER &
                                            SHUNT PROCEDURES SOI 3.                      SHUNT PROCEDURES SOI 3.
S.................        7           381  MAJOR BILIARY TRACT            261        1  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        7           382  MAJOR BILIARY TRACT            261        2  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        7           383  MAJOR BILIARY TRACT            261        3  MAJOR BILIARY TRACT
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................        7           384  CHOLECYSTECTOMY EXCEPT         262        1  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 1.                          LAPAROSCOPIC SOI 1.
S.................        7           385  CHOLECYSTECTOMY EXCEPT         262        2  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 2.                          LAPAROSCOPIC SOI 2.
S.................        7           386  CHOLECYSTECTOMY EXCEPT         262        3  CHOLECYSTECTOMY EXCEPT
                                            LAPAROSCOPIC SOI 3.                          LAPAROSCOPIC SOI 3.
S.................        7           387  LAPAROSCOPIC                   263        1  LAPAROSCOPIC
                                            CHOLECYSTECTOMY SOI 1.                       CHOLECYSTECTOMY SOI 1.
S.................        7           388  LAPAROSCOPIC                   263        2  LAPAROSCOPIC
                                            CHOLECYSTECTOMY SOI 2.                       CHOLECYSTECTOMY SOI 2.
S.................        7           389  LAPAROSCOPIC                   263        3  LAPAROSCOPIC
                                            CHOLECYSTECTOMY SOI 3.                       CHOLECYSTECTOMY SOI 3.
S.................        7           390  OTHER HEPATOBILIARY,           264        1  OTHER HEPATOBILIARY,
                                            PANCREAS & ABDOMINAL                         PANCREAS & ABDOMINAL
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        7           391  OTHER HEPATOBILIARY,           264        2  OTHER HEPATOBILIARY,
                                            PANCREAS & ABDOMINAL                         PANCREAS & ABDOMINAL
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        7           392  OTHER HEPATOBILIARY,           264        3  OTHER HEPATOBILIARY,
                                            PANCREAS & ABDOMINAL                         PANCREAS & ABDOMINAL
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.

[[Page 24448]]

 
M.................        7           393  HEPATOBILIARY, PANCREAS &      279        4  HEPATIC COMA & OTHER
                                            ABDOMINAL DIAGNOSES SOI                      MAJOR ACUTE LIVER
                                            4.                                           DISORDERS SOI 4.
M.................        7           393  HEPATOBILIARY, PANCREAS &      280        4  ALCOHOLIC LIVER DISEASE
                                            ABDOMINAL DIAGNOSES SOI                      SOI 4.
                                            4.
M.................        7           393  HEPATOBILIARY, PANCREAS &      281        4  MALIGNANCY OF
                                            ABDOMINAL DIAGNOSES SOI                      HEPATOBILIARY SYSTEM &
                                            4.                                           PANCREAS SOI 4.
M.................        7           393  HEPATOBILIARY, PANCREAS &      282        4  DISORDERS OF PANCREAS
                                            ABDOMINAL DIAGNOSES SOI                      EXCEPT MALIGNANCY SOI
                                            4.                                           4.
M.................        7           393  HEPATOBILIARY, PANCREAS &      283        4  OTHER DISORDERS OF THE
                                            ABDOMINAL DIAGNOSES SOI                      LIVER SOI 4.
                                            4.
M.................        7           393  HEPATOBILIARY, PANCREAS &      284        4  DISORDERS OF GALLBLADDER
                                            ABDOMINAL DIAGNOSES SOI                      & BILIARY TRACT SOI 4.
                                            4.
M.................        7           394  HEPATIC COMA & OTHER           279        1  HEPATIC COMA & OTHER
                                            MAJOR ACUTE LIVER                            MAJOR ACUTE LIVER
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        7           395  HEPATIC COMA & OTHER           279        2  HEPATIC COMA & OTHER
                                            MAJOR ACUTE LIVER                            MAJOR ACUTE LIVER
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        7           396  HEPATIC COMA & OTHER           279        3  HEPATIC COMA & OTHER
                                            MAJOR ACUTE LIVER                            MAJOR ACUTE LIVER
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        7           397  ALCOHOLIC LIVER DISEASE        280        1  ALCOHOLIC LIVER DISEASE
                                            SOI 1.                                       SOI 1.
M.................        7           398  ALCOHOLIC LIVER DISEASE        280        2  ALCOHOLIC LIVER DISEASE
                                            SOI 2.                                       SOI 2.
M.................        7           399  ALCOHOLIC LIVER DISEASE        280        3  ALCOHOLIC LIVER DISEASE
                                            SOI 3.                                       SOI 3.
M.................        7           400  MALIGNANCY OF                  281        1  MALIGNANCY OF
                                            HEPATOBILIARY SYSTEM &                       HEPATOBILIARY SYSTEM &
                                            PANCREAS SOI 1.                              PANCREAS SOI 1.
M.................        7           401  MALIGNANCY OF                  281        2  MALIGNANCY OF
                                            HEPATOBILIARY SYSTEM &                       HEPATOBILIARY SYSTEM &
                                            PANCREAS SOI 2.                              PANCREAS SOI 2.
M.................        7           402  MALIGNANCY OF                  281        3  MALIGNANCY OF
                                            HEPATOBILIARY SYSTEM &                       HEPATOBILIARY SYSTEM &
                                            PANCREAS SOI 3.                              PANCREAS SOI 3.
M.................        7           403  DISORDERS OF PANCREAS          282        1  DISORDERS OF PANCREAS
                                            EXCEPT MALIGNANCY SOI 1.                     EXCEPT MALIGNANCY SOI
                                                                                         1.
M.................        7           404  DISORDERS OF PANCREAS          282        2  DISORDERS OF PANCREAS
                                            EXCEPT MALIGNANCY SOI 2.                     EXCEPT MALIGNANCY SOI
                                                                                         2.
M.................        7           405  DISORDERS OF PANCREAS          282        3  DISORDERS OF PANCREAS
                                            EXCEPT MALIGNANCY SOI 3.                     EXCEPT MALIGNANCY SOI
                                                                                         3.
M.................        7           406  OTHER DISORDERS OF THE         283        1  OTHER DISORDERS OF THE
                                            LIVER SOI 1.                                 LIVER SOI 1.
M.................        7           407  OTHER DISORDERS OF THE         283        2  OTHER DISORDERS OF THE
                                            LIVER SOI 2.                                 LIVER SOI 2.
M.................        7           408  OTHER DISORDERS OF THE         283        3  OTHER DISORDERS OF THE
                                            LIVER SOI 3.                                 LIVER SOI 3.
M.................        7           409  DISORDERS OF GALLBLADDER       284        1  DISORDERS OF GALLBLADDER
                                            & BILIARY TRACT SOI 1.                       & BILIARY TRACT SOI 1.
M.................        7           410  DISORDERS OF GALLBLADDER       284        2  DISORDERS OF GALLBLADDER
                                            & BILIARY TRACT SOI 2.                       & BILIARY TRACT SOI 2.
M.................        7           411  DISORDERS OF GALLBLADDER       284        3  DISORDERS OF GALLBLADDER
                                            & BILIARY TRACT SOI 3.                       & BILIARY TRACT SOI 3.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       301        4  HIP JOINT REPLACEMENT
                                            CONNECTIVE TISSUE                            SOI 4.
                                            PROCEDURES EXCEPT SPINAL
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       302        4  KNEE JOINT REPLACEMENT
                                            CONNECTIVE TISSUE                            SOI 4.
                                            PROCEDURES EXCEPT SPINAL
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       305        4  AMPUTATION OF LOWER LIMB
                                            CONNECTIVE TISSUE                            EXCEPT TOES SOI 4.
                                            PROCEDURES EXCEPT SPINAL
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       308        4  HIP & FEMUR PROCEDURES
                                            CONNECTIVE TISSUE                            FOR TRAUMA EXCEPT JOINT
                                            PROCEDURES EXCEPT SPINAL                     REPLACEMENT SOI 4.
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       309        4  HIP & FEMUR PROCEDURES
                                            CONNECTIVE TISSUE                            FOR NON-TRAUMA EXCEPT
                                            PROCEDURES EXCEPT SPINAL                     JOINT REPLACEMENT SOI
                                            FUSION SOI 4.                                4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       310        4  INTERVERTEBRAL DISC
                                            CONNECTIVE TISSUE                            EXCISION &
                                            PROCEDURES EXCEPT SPINAL                     DECOMPRESSION SOI 4.
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       313        4  KNEE & LOWER LEG
                                            CONNECTIVE TISSUE                            PROCEDURES EXCEPT FOOT
                                            PROCEDURES EXCEPT SPINAL                     SOI 4.
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       314        4  FOOT & TOE PROCEDURES
                                            CONNECTIVE TISSUE                            SOI 4.
                                            PROCEDURES EXCEPT SPINAL
                                            FUSION SOI 4.

[[Page 24449]]

 
S.................        8           412  MUSCULOSKELETAL SYSTEM &       315        4  SHOULDER, UPPER ARM &
                                            CONNECTIVE TISSUE                            FOREARM PROCEDURES SOI
                                            PROCEDURES EXCEPT SPINAL                     4.
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       316        4  HAND & WRIST PROCEDURES
                                            CONNECTIVE TISSUE                            SOI 4.
                                            PROCEDURES EXCEPT SPINAL
                                            FUSION SOI 4.
S.................        8           412  MUSCULOSKELETAL SYSTEM &       317        4  TENDON, MUSCLE & OTHER
                                            CONNECTIVE TISSUE                            SOFT TISSUE PROCEDURES
                                            PROCEDURES EXCEPT SPINAL                     SOI 4.
                                            FUSION SOI 4.
S.................        8           413  SPINAL FUSION PROCEDURES       303        4  DORSAL & LUMBAR FUSION
                                            SOI 4.                                       PROC FOR CURVATURE OF
                                                                                         BACK SOI 4.
S.................        8           413  SPINAL FUSION PROCEDURES       304        4  DORSAL & LUMBAR FUSION
                                            SOI 4.                                       PROC EXCEPT FOR
                                                                                         CURVATURE OF BACK SOI
                                                                                         4.
S.................        8           413  SPINAL FUSION PROCEDURES       321        4  CERVICAL SPINAL FUSION &
                                            SOI 4.                                       OTHER BACK/NECK PROC
                                                                                         EXC DISC EXCIS/DECOMP
                                                                                         SOI 4.
S.................        8           414  HIP JOINT REPLACEMENT SOI      301        1  HIP JOINT REPLACEMENT
                                            1.                                           SOI 1.
S.................        8           415  HIP JOINT REPLACEMENT SOI      301        2  HIP JOINT REPLACEMENT
                                            2.                                           SOI 2.
S.................        8           416  HIP JOINT REPLACEMENT SOI      301        3  HIP JOINT REPLACEMENT
                                            3.                                           SOI 3.
S.................        8           417  KNEE JOINT REPLACEMENT         302        1  KNEE JOINT REPLACEMENT
                                            SOI 1.                                       SOI 1.
S.................        8           418  KNEE JOINT REPLACEMENT         302        2  KNEE JOINT REPLACEMENT
                                            SOI 2.                                       SOI 2.
S.................        8           419  KNEE JOINT REPLACEMENT         302        3  KNEE JOINT REPLACEMENT
                                            SOI 3.                                       SOI 3.
S.................        8           420  DORSAL & LUMBAR FUSION         303        1  DORSAL & LUMBAR FUSION
                                            PROC FOR CURVATURE OF                        PROC FOR CURVATURE OF
                                            BACK SOI 1.                                  BACK SOI 1.
S.................        8           421  DORSAL & LUMBAR FUSION         303        2  DORSAL & LUMBAR FUSION
                                            PROC FOR CURVATURE OF                        PROC FOR CURVATURE OF
                                            BACK SOI 2.                                  BACK SOI 2.
S.................        8           422  DORSAL & LUMBAR FUSION         303        3  DORSAL & LUMBAR FUSION
                                            PROC FOR CURVATURE OF                        PROC FOR CURVATURE OF
                                            BACK SOI 3.                                  BACK SOI 3.
S.................        8           423  DORSAL & LUMBAR FUSION         304        1  DORSAL & LUMBAR FUSION
                                            PROC EXCEPT FOR                              PROC EXCEPT FOR
                                            CURVATURE OF BACK SOI 1.                     CURVATURE OF BACK SOI
                                                                                         1.
S.................        8           424  DORSAL & LUMBAR FUSION         304        2  DORSAL & LUMBAR FUSION
                                            PROC EXCEPT FOR                              PROC EXCEPT FOR
                                            CURVATURE OF BACK SOI 2.                     CURVATURE OF BACK SOI
                                                                                         2.
S.................        8           425  DORSAL & LUMBAR FUSION         304        3  DORSAL & LUMBAR FUSION
                                            PROC EXCEPT FOR                              PROC EXCEPT FOR
                                            CURVATURE OF BACK SOI 3.                     CURVATURE OF BACK SOI
                                                                                         3.
S.................        8           426  AMPUTATION OF LOWER LIMB       305        1  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 1.                           EXCEPT TOES SOI 1.
S.................        8           427  AMPUTATION OF LOWER LIMB       305        2  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 2.                           EXCEPT TOES SOI 2.
S.................        8           428  AMPUTATION OF LOWER LIMB       305        3  AMPUTATION OF LOWER LIMB
                                            EXCEPT TOES SOI 3.                           EXCEPT TOES SOI 3.
S.................        8           429  HIP & FEMUR PROCEDURES         308        1  HIP & FEMUR PROCEDURES
                                            FOR TRAUMA EXCEPT JOINT                      FOR TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 1.                           REPLACEMENT SOI 1.
S.................        8           430  HIP & FEMUR PROCEDURES         308        2  HIP & FEMUR PROCEDURES
                                            FOR TRAUMA EXCEPT JOINT                      FOR TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 2.                           REPLACEMENT SOI 2.
S.................        8           431  HIP & FEMUR PROCEDURES         308        3  HIP & FEMUR PROCEDURES
                                            FOR TRAUMA EXCEPT JOINT                      FOR TRAUMA EXCEPT JOINT
                                            REPLACEMENT SOI 3.                           REPLACEMENT SOI 3.
S.................        8           432  HIP & FEMUR PROCEDURES         309        1  HIP & FEMUR PROCEDURES
                                            FOR NON-TRAUMA EXCEPT                        FOR NON-TRAUMA EXCEPT
                                            JOINT REPLACEMENT SOI 1.                     JOINT REPLACEMENT SOI
                                                                                         1.
S.................        8           433  HIP & FEMUR PROCEDURES         309        2  HIP & FEMUR PROCEDURES
                                            FOR NON-TRAUMA EXCEPT                        FOR NON-TRAUMA EXCEPT
                                            JOINT REPLACEMENT SOI 2.                     JOINT REPLACEMENT SOI
                                                                                         2.
S.................        8           434  HIP & FEMUR PROCEDURES         309        3  HIP & FEMUR PROCEDURES
                                            FOR NON-TRAUMA EXCEPT                        FOR NON-TRAUMA EXCEPT
                                            JOINT REPLACEMENT SOI 3.                     JOINT REPLACEMENT SOI
                                                                                         3.
S.................        8           435  INTERVERTEBRAL DISC            310        1  INTERVERTEBRAL DISC
                                            EXCISION & DECOMPRESSION                     EXCISION &
                                            SOI 1.                                       DECOMPRESSION SOI 1.
S.................        8           436  INTERVERTEBRAL DISC            310        2  INTERVERTEBRAL DISC
                                            EXCISION & DECOMPRESSION                     EXCISION &
                                            SOI 2.                                       DECOMPRESSION SOI 2.
S.................        8           437  INTERVERTEBRAL DISC            310        3  INTERVERTEBRAL DISC
                                            EXCISION & DECOMPRESSION                     EXCISION &
                                            SOI 3.                                       DECOMPRESSION SOI 3.

[[Page 24450]]

 
S.................        8           438  SKIN GRAFT, EXCEPT HAND,       312        1  SKIN GRAFT, EXCEPT HAND,
                                            FOR MUSCULOSKELETAL &                        FOR MUSCULOSKELETAL &
                                            CONNECTIVE TISSUE                            CONNECTIVE TISSUE
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
S.................        8           439  SKIN GRAFT, EXCEPT HAND,       312        2  SKIN GRAFT, EXCEPT HAND,
                                            FOR MUSCULOSKELETAL &                        FOR MUSCULOSKELETAL &
                                            CONNECTIVE TISSUE                            CONNECTIVE TISSUE
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
S.................        8           440  SKIN GRAFT, EXCEPT HAND,       312        3  SKIN GRAFT, EXCEPT HAND,
                                            FOR MUSCULOSKELETAL &                        FOR MUSCULOSKELETAL &
                                            CONNECTIVE TISSUE                            CONNECTIVE TISSUE
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        8           441  SKIN GRAFT, EXCEPT HAND,       312        4  SKIN GRAFT, EXCEPT HAND,
                                            FOR MUSCULOSKELETAL &                        FOR MUSCULOSKELETAL &
                                            CONNECTIVE TISSUE                            CONNECTIVE TISSUE
                                            DIAGNOSES SOI 4.                             DIAGNOSES SOI 4.
S.................        8           442  KNEE & LOWER LEG               313        1  KNEE & LOWER LEG
                                            PROCEDURES EXCEPT FOOT                       PROCEDURES EXCEPT FOOT
                                            SOI 1.                                       SOI 1.
S.................        8           443  KNEE & LOWER LEG               313        2  KNEE & LOWER LEG
                                            PROCEDURES EXCEPT FOOT                       PROCEDURES EXCEPT FOOT
                                            SOI 2.                                       SOI 2.
S.................        8           444  KNEE & LOWER LEG               313        3  KNEE & LOWER LEG
                                            PROCEDURES EXCEPT FOOT                       PROCEDURES EXCEPT FOOT
                                            SOI 3.                                       SOI 3.
S.................        8           445  FOOT & TOE PROCEDURES SOI      314        1  FOOT & TOE PROCEDURES
                                            1.                                           SOI 1.
S.................        8           446  FOOT & TOE PROCEDURES SOI      314        2  FOOT & TOE PROCEDURES
                                            2.                                           SOI 2.
S.................        8           447  FOOT & TOE PROCEDURES SOI      314        3  FOOT & TOE PROCEDURES
                                            3.                                           SOI 3.
S.................        8           448  SHOULDER, UPPER ARM &          315        1  SHOULDER, UPPER ARM &
                                            FOREARM PROCEDURES SOI 1.                    FOREARM PROCEDURES SOI
                                                                                         1.
S.................        8           449  SHOULDER, UPPER ARM &          315        2  SHOULDER, UPPER ARM &
                                            FOREARM PROCEDURES SOI 2.                    FOREARM PROCEDURES SOI
                                                                                         2.
S.................        8           450  SHOULDER, UPPER ARM &          315        3  SHOULDER, UPPER ARM &
                                            FOREARM PROCEDURES SOI 3.                    FOREARM PROCEDURES SOI
                                                                                         3.
S.................        8           451  HAND & WRIST PROCEDURES        316        1  HAND & WRIST PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................        8           452  HAND & WRIST PROCEDURES        316        2  HAND & WRIST PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................        8           453  HAND & WRIST PROCEDURES        316        3  HAND & WRIST PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................        8           454  TENDON, MUSCLE & OTHER         317        1  TENDON, MUSCLE & OTHER
                                            SOFT TISSUE PROCEDURES                       SOFT TISSUE PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................        8           455  TENDON, MUSCLE & OTHER         317        2  TENDON, MUSCLE & OTHER
                                            SOFT TISSUE PROCEDURES                       SOFT TISSUE PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................        8           456  TENDON, MUSCLE & OTHER         317        3  TENDON, MUSCLE & OTHER
                                            SOFT TISSUE PROCEDURES                       SOFT TISSUE PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................        8           457  OTHER MUSCULOSKELETAL          320        1  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE PROCEDURES SOI 1.                     TISSUE PROCEDURES SOI
                                                                                         1.
S.................        8           458  OTHER MUSCULOSKELETAL          320        2  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE PROCEDURES SOI 2.                     TISSUE PROCEDURES SOI
                                                                                         2.
S.................        8           459  OTHER MUSCULOSKELETAL          320        3  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE PROCEDURES SOI 3.                     TISSUE PROCEDURES SOI
                                                                                         3.
S.................        8           460  OTHER MUSCULOSKELETAL          320        4  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE PROCEDURES SOI 4.                     TISSUE PROCEDURES SOI
                                                                                         4.
S.................        8           461  CERVICAL SPINAL FUSION &       321        1  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC                     OTHER BACK/NECK PROC
                                            DISC EXCIS/DECOMP SOI 1.                     EXC DISC EXCIS/DECOMP
                                                                                         SOI 1.
S.................        8           462  CERVICAL SPINAL FUSION &       321        2  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC                     OTHER BACK/NECK PROC
                                            DISC EXCIS/DECOMP SOI 2.                     EXC DISC EXCIS/DECOMP
                                                                                         SOI 2.
S.................        8           463  CERVICAL SPINAL FUSION &       321        3  CERVICAL SPINAL FUSION &
                                            OTHER BACK/NECK PROC EXC                     OTHER BACK/NECK PROC
                                            DISC EXCIS/DECOMP SOI 3.                     EXC DISC EXCIS/DECOMP
                                                                                         SOI 3.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       340        4  FRACTURE OF FEMUR SOI 4.
                                            CONNECTIVE TISSUE
                                            DIAGNOSES SOI 4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       341        4  FRACTURE OF PELVIS OR
                                            CONNECTIVE TISSUE                            DISLOCATION OF HIP SOI
                                            DIAGNOSES SOI 4.                             4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       342        4  FRACTURES & DISLOCATIONS
                                            CONNECTIVE TISSUE                            EXCEPT FEMUR, PELVIS &
                                            DIAGNOSES SOI 4.                             BACK SOI 4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       343        4  MUSCULOSKELETAL
                                            CONNECTIVE TISSUE                            MALIGNANCY & PATHOL
                                            DIAGNOSES SOI 4.                             FRACTURE D/T MUSCSKEL
                                                                                         MALIG SOI 4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       344        4  OSTEOMYELITIS, SEPTIC
                                            CONNECTIVE TISSUE                            ARTHRITIS & OTHER
                                            DIAGNOSES SOI 4.                             MUSCULOSKELETAL
                                                                                         INFECTIONS SOI 4.

[[Page 24451]]

 
M.................        8           464  MUSCULOSKELETAL SYSTEM &       346        4  CONNECTIVE TISSUE
                                            CONNECTIVE TISSUE                            DISORDERS SOI 4.
                                            DIAGNOSES SOI 4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       347        4  OTHER BACK & NECK
                                            CONNECTIVE TISSUE                            DISORDERS, FRACTURES &
                                            DIAGNOSES SOI 4.                             INJURIES SOI 4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       349        4  MALFUNCTION, REACTION,
                                            CONNECTIVE TISSUE                            COMPLIC OF ORTHOPEDIC
                                            DIAGNOSES SOI 4.                             DEVICE OR PROCEDURE SOI
                                                                                         4.
M.................        8           464  MUSCULOSKELETAL SYSTEM &       351        4  OTHER MUSCULOSKELETAL
                                            CONNECTIVE TISSUE                            SYSTEM & CONNECTIVE
                                            DIAGNOSES SOI 4.                             TISSUE DIAGNOSES SOI 4.
M.................        8           465  FRACTURE OF FEMUR SOI 1..      340        1  FRACTURE OF FEMUR SOI 1.
M.................        8           466  FRACTURE OF FEMUR SOI 2..      340        2  FRACTURE OF FEMUR SOI 2.
M.................        8           467  FRACTURE OF FEMUR SOI 3..      340        3  FRACTURE OF FEMUR SOI 3.
M.................        8           468  FRACTURE OF PELVIS OR          341        1  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 1.                    DISLOCATION OF HIP SOI
                                                                                         1.
M.................        8           469  FRACTURE OF PELVIS OR          341        2  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 2.                    DISLOCATION OF HIP SOI
                                                                                         2.
M.................        8           470  FRACTURE OF PELVIS OR          341        3  FRACTURE OF PELVIS OR
                                            DISLOCATION OF HIP SOI 3.                    DISLOCATION OF HIP SOI
                                                                                         3.
M.................        8           471  FRACTURES & DISLOCATIONS       342        1  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS &                       EXCEPT FEMUR, PELVIS &
                                            BACK SOI 1.                                  BACK SOI 1.
M.................        8           472  FRACTURES & DISLOCATIONS       342        2  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS &                       EXCEPT FEMUR, PELVIS &
                                            BACK SOI 2.                                  BACK SOI 2.
M.................        8           473  FRACTURES & DISLOCATIONS       342        3  FRACTURES & DISLOCATIONS
                                            EXCEPT FEMUR, PELVIS &                       EXCEPT FEMUR, PELVIS &
                                            BACK SOI 3.                                  BACK SOI 3.
M.................        8           474  MUSCULOSKELETAL                343        1  MUSCULOSKELETAL
                                            MALIGNANCY & PATHOL                          MALIGNANCY & PATHOL
                                            FRACTURE D/T MUSCSKEL                        FRACTURE D/T MUSCSKEL
                                            MALIG SOI 1.                                 MALIG SOI 1.
M.................        8           475  MUSCULOSKELETAL                343        2  MUSCULOSKELETAL
                                            MALIGNANCY & PATHOL                          MALIGNANCY & PATHOL
                                            FRACTURE D/T MUSCSKEL                        FRACTURE D/T MUSCSKEL
                                            MALIG SOI 2.                                 MALIG SOI 2.
M.................        8           476  MUSCULOSKELETAL                343        3  MUSCULOSKELETAL
                                            MALIGNANCY & PATHOL                          MALIGNANCY & PATHOL
                                            FRACTURE D/T MUSCSKEL                        FRACTURE D/T MUSCSKEL
                                            MALIG SOI 3.                                 MALIG SOI 3.
M.................        8           477  OSTEOMYELITIS, SEPTIC          344        1  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL                              MUSCULOSKELETAL
                                            INFECTIONS SOI 1.                            INFECTIONS SOI 1.
M.................        8           478  OSTEOMYELITIS, SEPTIC          344        2  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL                              MUSCULOSKELETAL
                                            INFECTIONS SOI 2.                            INFECTIONS SOI 2.
M.................        8           479  OSTEOMYELITIS, SEPTIC          344        3  OSTEOMYELITIS, SEPTIC
                                            ARTHRITIS & OTHER                            ARTHRITIS & OTHER
                                            MUSCULOSKELETAL                              MUSCULOSKELETAL
                                            INFECTIONS SOI 3.                            INFECTIONS SOI 3.
M.................        8           480  CONNECTIVE TISSUE              346        1  CONNECTIVE TISSUE
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        8           481  CONNECTIVE TISSUE              346        2  CONNECTIVE TISSUE
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        8           482  CONNECTIVE TISSUE              346        3  CONNECTIVE TISSUE
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        8           483  OTHER BACK & NECK              347        1  OTHER BACK & NECK
                                            DISORDERS, FRACTURES &                       DISORDERS, FRACTURES &
                                            INJURIES SOI 1.                              INJURIES SOI 1.
M.................        8           484  OTHER BACK & NECK              347        2  OTHER BACK & NECK
                                            DISORDERS, FRACTURES &                       DISORDERS, FRACTURES &
                                            INJURIES SOI 2.                              INJURIES SOI 2.
M.................        8           485  OTHER BACK & NECK              347        3  OTHER BACK & NECK
                                            DISORDERS, FRACTURES &                       DISORDERS, FRACTURES &
                                            INJURIES SOI 3.                              INJURIES SOI 3.
M.................        8           486  MALFUNCTION, REACTION,         349        1  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC                        COMPLIC OF ORTHOPEDIC
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            1.                                           1.
M.................        8           487  MALFUNCTION, REACTION,         349        2  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC                        COMPLIC OF ORTHOPEDIC
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            2.                                           2.
M.................        8           488  MALFUNCTION, REACTION,         349        3  MALFUNCTION, REACTION,
                                            COMPLIC OF ORTHOPEDIC                        COMPLIC OF ORTHOPEDIC
                                            DEVICE OR PROCEDURE SOI                      DEVICE OR PROCEDURE SOI
                                            3.                                           3.
M.................        8           489  OTHER MUSCULOSKELETAL          351        1  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 1.                      TISSUE DIAGNOSES SOI 1.

[[Page 24452]]

 
M.................        8           490  OTHER MUSCULOSKELETAL          351        2  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 2.                      TISSUE DIAGNOSES SOI 2.
M.................        8           491  OTHER MUSCULOSKELETAL          351        3  OTHER MUSCULOSKELETAL
                                            SYSTEM & CONNECTIVE                          SYSTEM & CONNECTIVE
                                            TISSUE DIAGNOSES SOI 3.                      TISSUE DIAGNOSES SOI 3.
S.................        9           492  SKIN, SUBCUTANEOUS             361        4  SKIN GRAFT FOR SKIN &
                                            TISSUE, BREAST & RELATED                     SUBCUTANEOUS TISSUE
                                            PROCEDURES SOI 4.                            DIAGNOSES SOI 4.
S.................        9           492  SKIN, SUBCUTANEOUS             362        4  MASTECTOMY PROCEDURES
                                            TISSUE, BREAST & RELATED                     SOI 4.
                                            PROCEDURES SOI 4.
S.................        9           492  SKIN, SUBCUTANEOUS             363        4  BREAST PROCEDURES EXCEPT
                                            TISSUE, BREAST & RELATED                     MASTECTOMY SOI 4.
                                            PROCEDURES SOI 4.
S.................        9           492  SKIN, SUBCUTANEOUS             364        4  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE, BREAST & RELATED                     TISSUE & RELATED
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................        9           493  SKIN GRAFT FOR SKIN &          361        1  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE                          SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
S.................        9           494  SKIN GRAFT FOR SKIN &          361        2  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE                          SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
S.................        9           495  SKIN GRAFT FOR SKIN &          361        3  SKIN GRAFT FOR SKIN &
                                            SUBCUTANEOUS TISSUE                          SUBCUTANEOUS TISSUE
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
S.................        9           496  MASTECTOMY PROCEDURES SOI      362        1  MASTECTOMY PROCEDURES
                                            1.                                           SOI 1.
S.................        9           497  MASTECTOMY PROCEDURES SOI      362        2  MASTECTOMY PROCEDURES
                                            2.                                           SOI 2.
S.................        9           498  MASTECTOMY PROCEDURES SOI      362        3  MASTECTOMY PROCEDURES
                                            3.                                           SOI 3.
S.................        9           499  BREAST PROCEDURES EXCEPT       363        1  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 1.                            MASTECTOMY SOI 1.
S.................        9           500  BREAST PROCEDURES EXCEPT       363        2  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 2.                            MASTECTOMY SOI 2.
S.................        9           501  BREAST PROCEDURES EXCEPT       363        3  BREAST PROCEDURES EXCEPT
                                            MASTECTOMY SOI 3.                            MASTECTOMY SOI 3.
S.................        9           502  OTHER SKIN, SUBCUTANEOUS       364        1  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED                             TISSUE & RELATED
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................        9           503  OTHER SKIN, SUBCUTANEOUS       364        2  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED                             TISSUE & RELATED
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................        9           504  OTHER SKIN, SUBCUTANEOUS       364        3  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & RELATED                             TISSUE & RELATED
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      380        4  SKIN ULCERS SOI 4.
                                            & BREAST DIAGNOSES SOI 4.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      381        4  MAJOR SKIN DISORDERS SOI
                                            & BREAST DIAGNOSES SOI 4.                    4.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      382        4  MALIGNANT BREAST
                                            & BREAST DIAGNOSES SOI 4.                    DISORDERS SOI 4.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      383        4  CELLULITIS & OTHER
                                            & BREAST DIAGNOSES SOI 4.                    BACTERIAL SKIN
                                                                                         INFECTIONS SOI 4.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      384        4  CONTUSION, OPEN WOUND &
                                            & BREAST DIAGNOSES SOI 4.                    OTHER TRAUMA TO SKIN &
                                                                                         SUBCUTANEOUS TISSUE SOI
                                                                                         4.
M.................        9           505  SKIN, SUBCUTANEOUS TISSUE      385        4  OTHER SKIN, SUBCUTANEOUS
                                            & BREAST DIAGNOSES SOI 4.                    TISSUE & BREAST
                                                                                         DISORDERS SOI 4.
M.................        9           506  SKIN ULCERS SOI 1........      380        1  SKIN ULCERS SOI 1.
M.................        9           507  SKIN ULCERS SOI 2........      380        2  SKIN ULCERS SOI 2.
M.................        9           508  SKIN ULCERS SOI 3........      380        3  SKIN ULCERS SOI 3.
M.................        9           509  MAJOR SKIN DISORDERS SOI       381        1  MAJOR SKIN DISORDERS SOI
                                            1.                                           1.
M.................        9           510  MAJOR SKIN DISORDERS SOI       381        2  MAJOR SKIN DISORDERS SOI
                                            2.                                           2.
M.................        9           511  MAJOR SKIN DISORDERS SOI       381        3  MAJOR SKIN DISORDERS SOI
                                            3.                                           3.
M.................        9           512  MALIGNANT BREAST               382        1  MALIGNANT BREAST
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        9           513  MALIGNANT BREAST               382        2  MALIGNANT BREAST
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        9           514  MALIGNANT BREAST               382        3  MALIGNANT BREAST
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................        9           515  CELLULITIS & OTHER             383        1  CELLULITIS & OTHER
                                            BACTERIAL SKIN                               BACTERIAL SKIN
                                            INFECTIONS SOI 1.                            INFECTIONS SOI 1.
M.................        9           516  CELLULITIS & OTHER             383        2  CELLULITIS & OTHER
                                            BACTERIAL SKIN                               BACTERIAL SKIN
                                            INFECTIONS SOI 2.                            INFECTIONS SOI 2.
M.................        9           517  CELLULITIS & OTHER             383        3  CELLULITIS & OTHER
                                            BACTERIAL SKIN                               BACTERIAL SKIN
                                            INFECTIONS SOI 3.                            INFECTIONS SOI 3.

[[Page 24453]]

 
M.................        9           518  CONTUSION, OPEN WOUND &        384        1  CONTUSION, OPEN WOUND &
                                            OTHER TRAUMA TO SKIN &                       OTHER TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI                      SUBCUTANEOUS TISSUE SOI
                                            1.                                           1.
M.................        9           519  CONTUSION, OPEN WOUND &        384        2  CONTUSION, OPEN WOUND &
                                            OTHER TRAUMA TO SKIN &                       OTHER TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI                      SUBCUTANEOUS TISSUE SOI
                                            2.                                           2.
M.................        9           520  CONTUSION, OPEN WOUND &        384        3  CONTUSION, OPEN WOUND &
                                            OTHER TRAUMA TO SKIN &                       OTHER TRAUMA TO SKIN &
                                            SUBCUTANEOUS TISSUE SOI                      SUBCUTANEOUS TISSUE SOI
                                            3.                                           3.
M.................        9           521  OTHER SKIN, SUBCUTANEOUS       385        1  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST                              TISSUE & BREAST
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................        9           522  OTHER SKIN, SUBCUTANEOUS       385        2  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST                              TISSUE & BREAST
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................        9           523  OTHER SKIN, SUBCUTANEOUS       385        3  OTHER SKIN, SUBCUTANEOUS
                                            TISSUE & BREAST                              TISSUE & BREAST
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
S.................       10           524  PROCEDURES FOR ENDOCRINE,      401        4  PITUITARY & ADRENAL
                                            NUTRITIONAL & METABOLIC                      PROCEDURES SOI 4.
                                            DISORDERS SOI 4.
S.................       10           524  PROCEDURES FOR ENDOCRINE,      403        4  PROCEDURES FOR OBESITY
                                            NUTRITIONAL & METABOLIC                      SOI 4.
                                            DISORDERS SOI 4.
S.................       10           524  PROCEDURES FOR ENDOCRINE,      404        4  THYROID, PARATHYROID &
                                            NUTRITIONAL & METABOLIC                      THYROGLOSSAL PROCEDURES
                                            DISORDERS SOI 4.                             SOI 4.
S.................       10           524  PROCEDURES FOR ENDOCRINE,      405        4  OTHER PROCEDURES FOR
                                            NUTRITIONAL & METABOLIC                      ENDOCRINE, NUTRITIONAL
                                            DISORDERS SOI 4.                             & METABOLIC DISORDERS
                                                                                         SOI 4.
S.................       10           525  PITUITARY & ADRENAL            401        1  PITUITARY & ADRENAL
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       10           526  PITUITARY & ADRENAL            401        2  PITUITARY & ADRENAL
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       10           527  PITUITARY & ADRENAL            401        3  PITUITARY & ADRENAL
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................       10           528  PROCEDURES FOR OBESITY         403        1  PROCEDURES FOR OBESITY
                                            SOI 1.                                       SOI 1.
S.................       10           529  PROCEDURES FOR OBESITY         403        2  PROCEDURES FOR OBESITY
                                            SOI 2.                                       SOI 2.
S.................       10           530  PROCEDURES FOR OBESITY         403        3  PROCEDURES FOR OBESITY
                                            SOI 3.                                       SOI 3.
S.................       10           531  THYROID, PARATHYROID &         404        1  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES                      THYROGLOSSAL PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................       10           532  THYROID, PARATHYROID &         404        2  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES                      THYROGLOSSAL PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................       10           533  THYROID, PARATHYROID &         404        3  THYROID, PARATHYROID &
                                            THYROGLOSSAL PROCEDURES                      THYROGLOSSAL PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................       10           534  OTHER PROCEDURES FOR           405        1  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &                     ENDOCRINE, NUTRITIONAL
                                            METABOLIC DISORDERS SOI                      & METABOLIC DISORDERS
                                            1.                                           SOI 1.
S.................       10           535  OTHER PROCEDURES FOR           405        2  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &                     ENDOCRINE, NUTRITIONAL
                                            METABOLIC DISORDERS SOI                      & METABOLIC DISORDERS
                                            2.                                           SOI 2.
S.................       10           536  OTHER PROCEDURES FOR           405        3  OTHER PROCEDURES FOR
                                            ENDOCRINE, NUTRITIONAL &                     ENDOCRINE, NUTRITIONAL
                                            METABOLIC DISORDERS SOI                      & METABOLIC DISORDERS
                                            3.                                           SOI 3.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      420        4  DIABETES SOI 4.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      421        4  MALNUTRITION, FAILURE TO
                                                                                         THRIVE & OTHER
                                                                                         NUTRITIONAL DISORDERS
                                                                                         SOI 4.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      422        4  HYPOVOLEMIA & RELATED
                                                                                         ELECTROLYTE DISORDERS
                                                                                         SOI 4.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      423        4  INBORN ERRORS OF
                                                                                         METABOLISM SOI 4.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      424        4  OTHER ENDOCRINE
                                                                                         DISORDERS SOI 4.
M.................       10           537  ENDOCRINE DIAGNOSES SOI 4      425        4  ELECTROLYTE DISORDERS
                                                                                         EXCEPT HYPOVOLEMIA
                                                                                         RELATED SOI 4.
M.................       10           538  DIABETES SOI 1...........      420        1  DIABETES SOI 1.
M.................       10           539  DIABETES SOI 2...........      420        2  DIABETES SOI 2.
M.................       10           540  DIABETES SOI 3...........      420        3  DIABETES SOI 3.

[[Page 24454]]

 
M.................       10           541  MALNUTRITION, FAILURE TO       421        1  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER                               THRIVE & OTHER
                                            NUTRITIONAL DISORDERS                        NUTRITIONAL DISORDERS
                                            SOI 1.                                       SOI 1.
M.................       10           542  MALNUTRITION, FAILURE TO       421        2  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER                               THRIVE & OTHER
                                            NUTRITIONAL DISORDERS                        NUTRITIONAL DISORDERS
                                            SOI 2.                                       SOI 2.
M.................       10           543  MALNUTRITION, FAILURE TO       421        3  MALNUTRITION, FAILURE TO
                                            THRIVE & OTHER                               THRIVE & OTHER
                                            NUTRITIONAL DISORDERS                        NUTRITIONAL DISORDERS
                                            SOI 3.                                       SOI 3.
M.................       10           544  HYPOVOLEMIA & RELATED          422        1  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS                        ELECTROLYTE DISORDERS
                                            SOI 1.                                       SOI 1.
M.................       10           545  HYPOVOLEMIA & RELATED          422        2  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS                        ELECTROLYTE DISORDERS
                                            SOI 2.                                       SOI 2.
M.................       10           546  HYPOVOLEMIA & RELATED          422        3  HYPOVOLEMIA & RELATED
                                            ELECTROLYTE DISORDERS                        ELECTROLYTE DISORDERS
                                            SOI 3.                                       SOI 3.
M.................       10           547  INBORN ERRORS OF               423        1  INBORN ERRORS OF
                                            METABOLISM SOI 1.                            METABOLISM SOI 1.
M.................       10           548  INBORN ERRORS OF               423        2  INBORN ERRORS OF
                                            METABOLISM SOI 2.                            METABOLISM SOI 2.
M.................       10           549  INBORN ERRORS OF               423        3  INBORN ERRORS OF
                                            METABOLISM SOI 3.                            METABOLISM SOI 3.
M.................       10           550  OTHER ENDOCRINE DISORDERS      424        1  OTHER ENDOCRINE
                                            SOI 1.                                       DISORDERS SOI 1.
M.................       10           551  OTHER ENDOCRINE DISORDERS      424        2  OTHER ENDOCRINE
                                            SOI 2.                                       DISORDERS SOI 2.
M.................       10           552  OTHER ENDOCRINE DISORDERS      424        3  OTHER ENDOCRINE
                                            SOI 3.                                       DISORDERS SOI 3.
M.................       10           553  ELECTROLYTE DISORDERS          425        1  ELECTROLYTE DISORDERS
                                            EXCEPT HYPOVOLEMIA                           EXCEPT HYPOVOLEMIA
                                            RELATED SOI 1.                               RELATED SOI 1.
M.................       10           554  ELECTROLYTE DISORDERS          425        2  ELECTROLYTE DISORDERS
                                            EXCEPT HYPOVOLEMIA                           EXCEPT HYPOVOLEMIA
                                            RELATED SOI 2.                               RELATED SOI 2.
M.................       10           555  ELECTROLYTE DISORDERS          425        3  ELECTROLYTE DISORDERS
                                            EXCEPT HYPOVOLEMIA                           EXCEPT HYPOVOLEMIA
                                            RELATED SOI 3.                               RELATED SOI 3.
S.................       11           556  URINARY TRACT & RELATED        441        4  MAJOR BLADDER PROCEDURES
                                            PROCEDURES EXCEPT KIDNEY                     SOI 4.
                                            TRANSPLANT SOI 4.
S.................       11           556  URINARY TRACT & RELATED        442        4  KIDNEY & URINARY TRACT
                                            PROCEDURES EXCEPT KIDNEY                     PROCEDURES FOR
                                            TRANSPLANT SOI 4.                            MALIGNANCY SOI 4.
S.................       11           556  URINARY TRACT & RELATED        443        4  KIDNEY & URINARY TRACT
                                            PROCEDURES EXCEPT KIDNEY                     PROCEDURES FOR
                                            TRANSPLANT SOI 4.                            NONMALIGNANCY SOI 4.
S.................       11           556  URINARY TRACT & RELATED        444        4  RENAL DIALYSIS ACCESS
                                            PROCEDURES EXCEPT KIDNEY                     DEVICE PROCEDURE ONLY
                                            TRANSPLANT SOI 4.                            SOI 4.
S.................       11           556  URINARY TRACT & RELATED        445        4  OTHER BLADDER PROCEDURES
                                            PROCEDURES EXCEPT KIDNEY                     SOI 4.
                                            TRANSPLANT SOI 4.
S.................       11           556  URINARY TRACT & RELATED        446        4  URETHRAL & TRANSURETHRAL
                                            PROCEDURES EXCEPT KIDNEY                     PROCEDURES SOI 4.
                                            TRANSPLANT SOI 4.
S.................       11           556  URINARY TRACT & RELATED        447        4  OTHER KIDNEY, URINARY
                                            PROCEDURES EXCEPT KIDNEY                     TRACT & RELATED
                                            TRANSPLANT SOI 4.                            PROCEDURES SOI 4.
S.................       11           557  KIDNEY TRANSPLANT SOI 1..      440        1  KIDNEY TRANSPLANT SOI 1.
S.................       11           558  KIDNEY TRANSPLANT SOI 2..      440        2  KIDNEY TRANSPLANT SOI 2.
S.................       11           559  KIDNEY TRANSPLANT SOI 3..      440        3  KIDNEY TRANSPLANT SOI 3.
S.................       11           560  KIDNEY TRANSPLANT SOI 4..      440        4  KIDNEY TRANSPLANT SOI 4.
S.................       11           561  MAJOR BLADDER PROCEDURES       441        1  MAJOR BLADDER PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................       11           562  MAJOR BLADDER PROCEDURES       441        2  MAJOR BLADDER PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................       11           563  MAJOR BLADDER PROCEDURES       441        3  MAJOR BLADDER PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................       11           564  KIDNEY & URINARY TRACT         442        1  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            MALIGNANCY SOI 1.                            MALIGNANCY SOI 1.
S.................       11           565  KIDNEY & URINARY TRACT         442        2  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            MALIGNANCY SOI 2.                            MALIGNANCY SOI 2.
S.................       11           566  KIDNEY & URINARY TRACT         442        3  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            MALIGNANCY SOI 3.                            MALIGNANCY SOI 3.
S.................       11           567  KIDNEY & URINARY TRACT         443        1  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            NONMALIGNANCY SOI 1.                         NONMALIGNANCY SOI 1.
S.................       11           568  KIDNEY & URINARY TRACT         443        2  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            NONMALIGNANCY SOI 2.                         NONMALIGNANCY SOI 2.

[[Page 24455]]

 
S.................       11           569  KIDNEY & URINARY TRACT         443        3  KIDNEY & URINARY TRACT
                                            PROCEDURES FOR                               PROCEDURES FOR
                                            NONMALIGNANCY SOI 3.                         NONMALIGNANCY SOI 3.
S.................       11           570  RENAL DIALYSIS ACCESS          444        1  RENAL DIALYSIS ACCESS
                                            DEVICE PROCEDURE ONLY                        DEVICE PROCEDURE ONLY
                                            SOI 1.                                       SOI 1.
S.................       11           571  RENAL DIALYSIS ACCESS          444        2  RENAL DIALYSIS ACCESS
                                            DEVICE PROCEDURE ONLY                        DEVICE PROCEDURE ONLY
                                            SOI 2.                                       SOI 2.
S.................       11           572  RENAL DIALYSIS ACCESS          444        3  RENAL DIALYSIS ACCESS
                                            DEVICE PROCEDURE ONLY                        DEVICE PROCEDURE ONLY
                                            SOI 3.                                       SOI 3.
S.................       11           573  OTHER BLADDER PROCEDURES       445        1  OTHER BLADDER PROCEDURES
                                            SOI 1.                                       SOI 1.
S.................       11           574  OTHER BLADDER PROCEDURES       445        2  OTHER BLADDER PROCEDURES
                                            SOI 2.                                       SOI 2.
S.................       11           575  OTHER BLADDER PROCEDURES       445        3  OTHER BLADDER PROCEDURES
                                            SOI 3.                                       SOI 3.
S.................       11           576  URETHRAL & TRANSURETHRAL       446        1  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       11           577  URETHRAL & TRANSURETHRAL       446        2  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       11           578  URETHRAL & TRANSURETHRAL       446        3  URETHRAL & TRANSURETHRAL
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................       11           579  OTHER KIDNEY, URINARY          447        1  OTHER KIDNEY, URINARY
                                            TRACT & RELATED                              TRACT & RELATED
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       11           580  OTHER KIDNEY, URINARY          447        2  OTHER KIDNEY, URINARY
                                            TRACT & RELATED                              TRACT & RELATED
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       11           581  OTHER KIDNEY, URINARY          447        3  OTHER KIDNEY, URINARY
                                            TRACT & RELATED                              TRACT & RELATED
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
M.................       11           582  KIDNEY & URINARY TRACT         460        4  RENAL FAILURE SOI 4.
                                            DIAGNOSES SOI 4.
M.................       11           582  KIDNEY & URINARY TRACT         461        4  KIDNEY & URINARY TRACT
                                            DIAGNOSES SOI 4.                             MALIGNANCY SOI 4.
M.................       11           582  KIDNEY & URINARY TRACT         462        4  NEPHRITIS & NEPHROSIS
                                            DIAGNOSES SOI 4.                             SOI 4.
M.................       11           582  KIDNEY & URINARY TRACT         463        4  KIDNEY & URINARY TRACT
                                            DIAGNOSES SOI 4.                             INFECTIONS SOI 4.
M.................       11           582  KIDNEY & URINARY TRACT         465        4  URINARY STONES &
                                            DIAGNOSES SOI 4.                             ACQUIRED UPPER URINARY
                                                                                         TRACT OBSTRUCTION SOI
                                                                                         4.
M.................       11           582  KIDNEY & URINARY TRACT         466        4  MALFUNCTION, REACTION,
                                            DIAGNOSES SOI 4.                             COMPLIC OF
                                                                                         GENITOURINARY DEVICE OR
                                                                                         PROC SOI 4.
M.................       11           582  KIDNEY & URINARY TRACT         468        4  OTHER KIDNEY & URINARY
                                            DIAGNOSES SOI 4.                             TRACT DIAGNOSES, SIGNS
                                                                                         & SYMPTOMS SOI 4.
M.................       11           583  RENAL FAILURE SOI 1......      460        1  RENAL FAILURE SOI 1.
M.................       11           584  RENAL FAILURE SOI 2......      460        2  RENAL FAILURE SOI 2.
M.................       11           585  RENAL FAILURE SOI 3......      460        3  RENAL FAILURE SOI 3.
M.................       11           586  KIDNEY & URINARY TRACT         461        1  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 1.                            MALIGNANCY SOI 1.
M.................       11           587  KIDNEY & URINARY TRACT         461        2  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 2.                            MALIGNANCY SOI 2.
M.................       11           588  KIDNEY & URINARY TRACT         461        3  KIDNEY & URINARY TRACT
                                            MALIGNANCY SOI 3.                            MALIGNANCY SOI 3.
M.................       11           589  NEPHRITIS & NEPHROSIS SOI      462        1  NEPHRITIS & NEPHROSIS
                                            1.                                           SOI 1.
M.................       11           590  NEPHRITIS & NEPHROSIS SOI      462        2  NEPHRITIS & NEPHROSIS
                                            2.                                           SOI 2.
M.................       11           591  NEPHRITIS & NEPHROSIS SOI      462        3  NEPHRITIS & NEPHROSIS
                                            3.                                           SOI 3.
M.................       11           592  KIDNEY & URINARY TRACT         463        1  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 1.                            INFECTIONS SOI 1.
M.................       11           593  KIDNEY & URINARY TRACT         463        2  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 2.                            INFECTIONS SOI 2.
M.................       11           594  KIDNEY & URINARY TRACT         463        3  KIDNEY & URINARY TRACT
                                            INFECTIONS SOI 3.                            INFECTIONS SOI 3.
M.................       11           595  URINARY STONES & ACQUIRED      465        1  URINARY STONES &
                                            UPPER URINARY TRACT                          ACQUIRED UPPER URINARY
                                            OBSTRUCTION SOI 1.                           TRACT OBSTRUCTION SOI
                                                                                         1.
M.................       11           596  URINARY STONES & ACQUIRED      465        2  URINARY STONES &
                                            UPPER URINARY TRACT                          ACQUIRED UPPER URINARY
                                            OBSTRUCTION SOI 2.                           TRACT OBSTRUCTION SOI
                                                                                         2.
M.................       11           597  URINARY STONES & ACQUIRED      465        3  URINARY STONES &
                                            UPPER URINARY TRACT                          ACQUIRED UPPER URINARY
                                            OBSTRUCTION SOI 3.                           TRACT OBSTRUCTION SOI
                                                                                         3.

[[Page 24456]]

 
M.................       11           598  MALFUNCTION, REACTION,         466        1  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY                     COMPLIC OF
                                            DEVICE OR PROC SOI 1.                        GENITOURINARY DEVICE OR
                                                                                         PROC SOI 1.
M.................       11           599  MALFUNCTION, REACTION,         466        2  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY                     COMPLIC OF
                                            DEVICE OR PROC SOI 2.                        GENITOURINARY DEVICE OR
                                                                                         PROC SOI 2.
M.................       11           600  MALFUNCTION, REACTION,         466        3  MALFUNCTION, REACTION,
                                            COMPLIC OF GENITOURINARY                     COMPLIC OF
                                            DEVICE OR PROC SOI 3.                        GENITOURINARY DEVICE OR
                                                                                         PROC SOI 3.
M.................       11           601  OTHER KIDNEY & URINARY         468        1  OTHER KIDNEY & URINARY
                                            TRACT DIAGNOSES, SIGNS &                     TRACT DIAGNOSES, SIGNS
                                            SYMPTOMS SOI 1.                              & SYMPTOMS SOI 1.
M.................       11           602  OTHER KIDNEY & URINARY         468        2  OTHER KIDNEY & URINARY
                                            TRACT DIAGNOSES, SIGNS &                     TRACT DIAGNOSES, SIGNS
                                            SYMPTOMS SOI 2.                              & SYMPTOMS SOI 2.
M.................       11           603  OTHER KIDNEY & URINARY         468        3  OTHER KIDNEY & URINARY
                                            TRACT DIAGNOSES, SIGNS &                     TRACT DIAGNOSES, SIGNS
                                            SYMPTOMS SOI 3.                              & SYMPTOMS SOI 3.
S.................       12           604  MALE REPRODUCTIVE SYSTEM       480        4  MAJOR MALE PELVIC
                                            & RELATED PROCEDURES SOI                     PROCEDURES SOI 4.
                                            4.
S.................       12           604  MALE REPRODUCTIVE SYSTEM       481        4  PENIS PROCEDURES SOI 4.
                                            & RELATED PROCEDURES SOI
                                            4.
S.................       12           604  MALE REPRODUCTIVE SYSTEM       482        4  TRANSURETHRAL
                                            & RELATED PROCEDURES SOI                     PROSTATECTOMY SOI 4.
                                            4.
S.................       12           604  MALE REPRODUCTIVE SYSTEM       483        4  TESTES & SCROTAL
                                            & RELATED PROCEDURES SOI                     PROCEDURES SOI 4.
                                            4.
S.................       12           604  MALE REPRODUCTIVE SYSTEM       484        4  OTHER MALE REPRODUCTIVE
                                            & RELATED PROCEDURES SOI                     SYSTEM & RELATED
                                            4.                                           PROCEDURES SOI 4.
S.................       12           605  MAJOR MALE PELVIC              480        1  MAJOR MALE PELVIC
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       12           606  MAJOR MALE PELVIC              480        2  MAJOR MALE PELVIC
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       12           607  MAJOR MALE PELVIC              480        3  MAJOR MALE PELVIC
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................       12           608  PENIS PROCEDURES SOI 1...      481        1  PENIS PROCEDURES SOI 1.
S.................       12           609  PENIS PROCEDURES SOI 2...      481        2  PENIS PROCEDURES SOI 2.
S.................       12           610  PENIS PROCEDURES SOI 3...      481        3  PENIS PROCEDURES SOI 3.
S.................       12           611  TRANSURETHRAL                  482        1  TRANSURETHRAL
                                            PROSTATECTOMY SOI 1.                         PROSTATECTOMY SOI 1.
S.................       12           612  TRANSURETHRAL                  482        2  TRANSURETHRAL
                                            PROSTATECTOMY SOI 2.                         PROSTATECTOMY SOI 2.
S.................       12           613  TRANSURETHRAL                  482        3  TRANSURETHRAL
                                            PROSTATECTOMY SOI 3.                         PROSTATECTOMY SOI 3.
S.................       12           614  TESTES & SCROTAL               483        1  TESTES & SCROTAL
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       12           615  TESTES & SCROTAL               483        2  TESTES & SCROTAL
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       12           616  TESTES & SCROTAL               483        3  TESTES & SCROTAL
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................       12           617  OTHER MALE REPRODUCTIVE        484        1  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED                             SYSTEM & RELATED
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       12           618  OTHER MALE REPRODUCTIVE        484        2  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED                             SYSTEM & RELATED
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       12           619  OTHER MALE REPRODUCTIVE        484        3  OTHER MALE REPRODUCTIVE
                                            SYSTEM & RELATED                             SYSTEM & RELATED
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
M.................       12           620  MALE REPRODUCTIVE SYSTEM       500        4  MALIGNANCY, MALE
                                            DIAGNOSES SOI 4.                             REPRODUCTIVE SYSTEM SOI
                                                                                         4.
M.................       12           620  MALE REPRODUCTIVE SYSTEM       501        4  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES SOI 4.                             DIAGNOSES EXCEPT
                                                                                         MALIGNANCY SOI 4.
M.................       12           621  MALIGNANCY, MALE               500        1  MALIGNANCY, MALE
                                            REPRODUCTIVE SYSTEM SOI                      REPRODUCTIVE SYSTEM SOI
                                            1.                                           1.
M.................       12           622  MALIGNANCY, MALE               500        2  MALIGNANCY, MALE
                                            REPRODUCTIVE SYSTEM SOI                      REPRODUCTIVE SYSTEM SOI
                                            2.                                           2.
M.................       12           623  MALIGNANCY, MALE               500        3  MALIGNANCY, MALE
                                            REPRODUCTIVE SYSTEM SOI                      REPRODUCTIVE SYSTEM SOI
                                            3.                                           3.
M.................       12           624  MALE REPRODUCTIVE SYSTEM       501        1  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT                             DIAGNOSES EXCEPT
                                            MALIGNANCY SOI 1.                            MALIGNANCY SOI 1.
M.................       12           625  MALE REPRODUCTIVE SYSTEM       501        2  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT                             DIAGNOSES EXCEPT
                                            MALIGNANCY SOI 2.                            MALIGNANCY SOI 2.

[[Page 24457]]

 
M.................       12           626  MALE REPRODUCTIVE SYSTEM       501        3  MALE REPRODUCTIVE SYSTEM
                                            DIAGNOSES EXCEPT                             DIAGNOSES EXCEPT
                                            MALIGNANCY SOI 3.                            MALIGNANCY SOI 3.
S.................       13           627  FEMALE REPRODUCTIVE            510        4  PELVIC EVISCERATION,
                                            SYSTEM & RELATED                             RADICAL HYSTERECTOMY &
                                            PROCEDURES SOI 4.                            OTHER RADICAL GYN PROCS
                                                                                         SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            511        4  UTERINE & ADNEXA
                                            SYSTEM & RELATED                             PROCEDURES FOR OVARIAN
                                            PROCEDURES SOI 4.                            & ADNEXAL MALIGNANCY
                                                                                         SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            512        4  UTERINE & ADNEXA
                                            SYSTEM & RELATED                             PROCEDURES FOR NON-
                                            PROCEDURES SOI 4.                            OVARIAN & NON-ADNEXAL
                                                                                         MALIG SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            513        4  UTERINE & ADNEXA
                                            SYSTEM & RELATED                             PROCEDURES FOR NON-
                                            PROCEDURES SOI 4.                            MALIGNANCY EXCEPT
                                                                                         LEIOMYOMA SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            514        4  FEMALE REPRODUCTIVE
                                            SYSTEM & RELATED                             SYSTEM RECONSTRUCTIVE
                                            PROCEDURES SOI 4.                            PROCEDURES SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            517        4  DILATION & CURETTAGE FOR
                                            SYSTEM & RELATED                             NON-OBSTETRIC DIAGNOSES
                                            PROCEDURES SOI 4.                            SOI 4.
S.................       13           627  FEMALE REPRODUCTIVE            518        4  OTHER FEMALE
                                            SYSTEM & RELATED                             REPRODUCTIVE SYSTEM &
                                            PROCEDURES SOI 4.                            RELATED PROCEDURES SOI
                                                                                         4.
S.................       13           627  FEMALE REPRODUCTIVE            519        4  UTERINE & ADNEXA
                                            SYSTEM & RELATED                             PROCEDURES FOR
                                            PROCEDURES SOI 4.                            LEIOMYOMA SOI 4.
S.................       13           628  PELVIC EVISCERATION,           510        1  PELVIC EVISCERATION,
                                            RADICAL HYSTERECTOMY &                       RADICAL HYSTERECTOMY &
                                            OTHER RADICAL GYN PROCS                      OTHER RADICAL GYN PROCS
                                            SOI 1.                                       SOI 1.
S.................       13           629  PELVIC EVISCERATION,           510        2  PELVIC EVISCERATION,
                                            RADICAL HYSTERECTOMY &                       RADICAL HYSTERECTOMY &
                                            OTHER RADICAL GYN PROCS                      OTHER RADICAL GYN PROCS
                                            SOI 2.                                       SOI 2.
S.................       13           630  PELVIC EVISCERATION,           510        3  PELVIC EVISCERATION,
                                            RADICAL HYSTERECTOMY &                       RADICAL HYSTERECTOMY &
                                            OTHER RADICAL GYN PROCS                      OTHER RADICAL GYN PROCS
                                            SOI 3.                                       SOI 3.
S.................       13           631  UTERINE & ADNEXA               511        1  UTERINE & ADNEXA
                                            PROCEDURES FOR OVARIAN &                     PROCEDURES FOR OVARIAN
                                            ADNEXAL MALIGNANCY SOI 1.                    & ADNEXAL MALIGNANCY
                                                                                         SOI 1.
S.................       13           632  UTERINE & ADNEXA               511        2  UTERINE & ADNEXA
                                            PROCEDURES FOR OVARIAN &                     PROCEDURES FOR OVARIAN
                                            ADNEXAL MALIGNANCY SOI 2.                    & ADNEXAL MALIGNANCY
                                                                                         SOI 2.
S.................       13           633  UTERINE & ADNEXA               511        3  UTERINE & ADNEXA
                                            PROCEDURES FOR OVARIAN &                     PROCEDURES FOR OVARIAN
                                            ADNEXAL MALIGNANCY SOI 3.                    & ADNEXAL MALIGNANCY
                                                                                         SOI 3.
S.................       13           634  UTERINE & ADNEXA               512        1  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            OVARIAN & NON-ADNEXAL                        OVARIAN & NON-ADNEXAL
                                            MALIG SOI 1.                                 MALIG SOI 1.
S.................       13           635  UTERINE & ADNEXA               512        2  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            OVARIAN & NON-ADNEXAL                        OVARIAN & NON-ADNEXAL
                                            MALIG SOI 2.                                 MALIG SOI 2.
S.................       13           636  UTERINE & ADNEXA               512        3  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            OVARIAN & NON-ADNEXAL                        OVARIAN & NON-ADNEXAL
                                            MALIG SOI 3.                                 MALIG SOI 3.
S.................       13           637  UTERINE & ADNEXA               513        1  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            MALIGNANCY EXCEPT                            MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 1.                             LEIOMYOMA SOI 1.
S.................       13           638  UTERINE & ADNEXA               513        2  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            MALIGNANCY EXCEPT                            MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 2.                             LEIOMYOMA SOI 2.
S.................       13           639  UTERINE & ADNEXA               513        3  UTERINE & ADNEXA
                                            PROCEDURES FOR NON-                          PROCEDURES FOR NON-
                                            MALIGNANCY EXCEPT                            MALIGNANCY EXCEPT
                                            LEIOMYOMA SOI 3.                             LEIOMYOMA SOI 3.
S.................       13           640  FEMALE REPRODUCTIVE            514        1  FEMALE REPRODUCTIVE
                                            SYSTEM RECONSTRUCTIVE                        SYSTEM RECONSTRUCTIVE
                                            PROCEDURES SOI 1.                            PROCEDURES SOI 1.
S.................       13           641  FEMALE REPRODUCTIVE            514        2  FEMALE REPRODUCTIVE
                                            SYSTEM RECONSTRUCTIVE                        SYSTEM RECONSTRUCTIVE
                                            PROCEDURES SOI 2.                            PROCEDURES SOI 2.
S.................       13           642  FEMALE REPRODUCTIVE            514        3  FEMALE REPRODUCTIVE
                                            SYSTEM RECONSTRUCTIVE                        SYSTEM RECONSTRUCTIVE
                                            PROCEDURES SOI 3.                            PROCEDURES SOI 3.
S.................       13           643  DILATION & CURETTAGE FOR       517        1  DILATION & CURETTAGE FOR
                                            NON-OBSTETRIC DIAGNOSES                      NON-OBSTETRIC DIAGNOSES
                                            SOI 1.                                       SOI 1.
S.................       13           644  DILATION & CURETTAGE FOR       517        2  DILATION & CURETTAGE FOR
                                            NON-OBSTETRIC DIAGNOSES                      NON-OBSTETRIC DIAGNOSES
                                            SOI 2.                                       SOI 2.

[[Page 24458]]

 
S.................       13           645  DILATION & CURETTAGE FOR       517        3  DILATION & CURETTAGE FOR
                                            NON-OBSTETRIC DIAGNOSES                      NON-OBSTETRIC DIAGNOSES
                                            SOI 3.                                       SOI 3.
S.................       13           646  OTHER FEMALE REPRODUCTIVE      518        1  OTHER FEMALE
                                            SYSTEM & RELATED                             REPRODUCTIVE SYSTEM &
                                            PROCEDURES SOI 1.                            RELATED PROCEDURES SOI
                                                                                         1.
S.................       13           647  OTHER FEMALE REPRODUCTIVE      518        2  OTHER FEMALE
                                            SYSTEM & RELATED                             REPRODUCTIVE SYSTEM &
                                            PROCEDURES SOI 2.                            RELATED PROCEDURES SOI
                                                                                         2.
S.................       13           648  OTHER FEMALE REPRODUCTIVE      518        3  OTHER FEMALE
                                            SYSTEM & RELATED                             REPRODUCTIVE SYSTEM &
                                            PROCEDURES SOI 3.                            RELATED PROCEDURES SOI
                                                                                         3.
S.................       13           649  UTERINE & ADNEXA               519        1  UTERINE & ADNEXA
                                            PROCEDURES FOR LEIOMYOMA                     PROCEDURES FOR
                                            SOI 1.                                       LEIOMYOMA SOI 1.
S.................       13           650  UTERINE & ADNEXA               519        2  UTERINE & ADNEXA
                                            PROCEDURES FOR LEIOMYOMA                     PROCEDURES FOR
                                            SOI 2.                                       LEIOMYOMA SOI 2.
S.................       13           651  UTERINE & ADNEXA               519        3  UTERINE & ADNEXA
                                            PROCEDURES FOR LEIOMYOMA                     PROCEDURES FOR
                                            SOI 3.                                       LEIOMYOMA SOI 3.
M.................       13           652  FEMALE REPRODUCTIVE            530        4  FEMALE REPRODUCTIVE
                                            SYSTEM DIAGNOSES SOI 4.                      SYSTEM MALIGNANCY SOI
                                                                                         4.
M.................       13           652  FEMALE REPRODUCTIVE            531        4  FEMALE REPRODUCTIVE
                                            SYSTEM DIAGNOSES SOI 4.                      SYSTEM INFECTIONS SOI
                                                                                         4.
M.................       13           652  FEMALE REPRODUCTIVE            532        4  MENSTRUAL & OTHER FEMALE
                                            SYSTEM DIAGNOSES SOI 4.                      REPRODUCTIVE SYSTEM
                                                                                         DISORDERS SOI 4.
M.................       13           653  FEMALE REPRODUCTIVE            530        1  FEMALE REPRODUCTIVE
                                            SYSTEM MALIGNANCY SOI 1.                     SYSTEM MALIGNANCY SOI
                                                                                         1.
M.................       13           654  FEMALE REPRODUCTIVE            530        2  FEMALE REPRODUCTIVE
                                            SYSTEM MALIGNANCY SOI 2.                     SYSTEM MALIGNANCY SOI
                                                                                         2.
M.................       13           655  FEMALE REPRODUCTIVE            530        3  FEMALE REPRODUCTIVE
                                            SYSTEM MALIGNANCY SOI 3.                     SYSTEM MALIGNANCY SOI
                                                                                         3.
M.................       13           656  FEMALE REPRODUCTIVE            531        1  FEMALE REPRODUCTIVE
                                            SYSTEM INFECTIONS SOI 1.                     SYSTEM INFECTIONS SOI
                                                                                         1.
M.................       13           657  FEMALE REPRODUCTIVE            531        2  FEMALE REPRODUCTIVE
                                            SYSTEM INFECTIONS SOI 2.                     SYSTEM INFECTIONS SOI
                                                                                         2.
M.................       13           658  FEMALE REPRODUCTIVE            531        3  FEMALE REPRODUCTIVE
                                            SYSTEM INFECTIONS SOI 3.                     SYSTEM INFECTIONS SOI
                                                                                         3.
M.................       13           659  MENSTRUAL & OTHER FEMALE       532        1  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM                          REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................       13           660  MENSTRUAL & OTHER FEMALE       532        2  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM                          REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................       13           661  MENSTRUAL & OTHER FEMALE       532        3  MENSTRUAL & OTHER FEMALE
                                            REPRODUCTIVE SYSTEM                          REPRODUCTIVE SYSTEM
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
S.................       14           662  O.R. PROC FOR OBSTETRIC        541        4  VAGINAL DELIVERY W
                                            DIAGNOSES EXCEPT                             STERILIZATION &/OR D&C
                                            CESAREAN DELIVERY SOI 4.                     SOI 4.
S.................       14           662  O.R. PROC FOR OBSTETRIC        542        4  VAGINAL DELIVERY W
                                            DIAGNOSES EXCEPT                             COMPLICATING PROCEDURES
                                            CESAREAN DELIVERY SOI 4.                     EXC STERILIZATION &/OR
                                                                                         D&C SOI 4.
S.................       14           662  O.R. PROC FOR OBSTETRIC        544        4  D&C, ASPIRATION
                                            DIAGNOSES EXCEPT                             CURETTAGE OR
                                            CESAREAN DELIVERY SOI 4.                     HYSTEROTOMY FOR
                                                                                         OBSTETRIC DIAGNOSES SOI
                                                                                         4.
S.................       14           662  O.R. PROC FOR OBSTETRIC        545        4  ECTOPIC PREGNANCY
                                            DIAGNOSES EXCEPT                             PROCEDURE SOI 4.
                                            CESAREAN DELIVERY SOI 4.
S.................       14           662  O.R. PROC FOR OBSTETRIC        546        4  OTHER O.R. PROC FOR
                                            DIAGNOSES EXCEPT                             OBSTETRIC DIAGNOSES
                                            CESAREAN DELIVERY SOI 4.                     EXCEPT DELIVERY
                                                                                         DIAGNOSES SOI 4.
S.................       14           663  CESAREAN DELIVERY SOI 1..      540        1  CESAREAN DELIVERY SOI 1.
S.................       14           664  CESAREAN DELIVERY SOI 2..      540        2  CESAREAN DELIVERY SOI 2.
S.................       14           665  CESAREAN DELIVERY SOI 3..      540        3  CESAREAN DELIVERY SOI 3.
S.................       14           666  CESAREAN DELIVERY SOI 4..      540        4  CESAREAN DELIVERY SOI 4.
S.................       14           667  VAGINAL DELIVERY               541        1  VAGINAL DELIVERY W
                                            PROCEDURES SOI 1.                            STERILIZATION &/OR D&C
                                                                                         SOI 1.
S.................       14           667  VAGINAL DELIVERY               542        1  VAGINAL DELIVERY W
                                            PROCEDURES SOI 1.                            COMPLICATING PROCEDURES
                                                                                         EXC STERILIZATION &/OR
                                                                                         D&C SOI 1.
S.................       14           668  VAGINAL DELIVERY               541        2  VAGINAL DELIVERY W
                                            PROCEDURES SOI 2.                            STERILIZATION &/OR D&C
                                                                                         SOI 2.
S.................       14           668  VAGINAL DELIVERY               542        2  VAGINAL DELIVERY W
                                            PROCEDURES SOI 2.                            COMPLICATING PROCEDURES
                                                                                         EXC STERILIZATION &/OR
                                                                                         D&C SOI 2.
S.................       14           669  VAGINAL DELIVERY               541        3  VAGINAL DELIVERY W
                                            PROCEDURES SOI 3.                            STERILIZATION &/OR D&C
                                                                                         SOI 3.

[[Page 24459]]

 
S.................       14           669  VAGINAL DELIVERY               542        3  VAGINAL DELIVERY W
                                            PROCEDURES SOI 3.                            COMPLICATING PROCEDURES
                                                                                         EXC STERILIZATION &/OR
                                                                                         D&C SOI 3.
S.................       14           670  OTHER PROCEDURES FOR           544        1  D&C, ASPIRATION
                                            OBSTETRIC DIAGNOSES                          CURETTAGE OR
                                            EXCEPT DELIVERY                              HYSTEROTOMY FOR
                                            DIAGNOSES SOI 1.                             OBSTETRIC DIAGNOSES SOI
                                                                                         1.
S.................       14           670  OTHER PROCEDURES FOR           545        1  ECTOPIC PREGNANCY
                                            OBSTETRIC DIAGNOSES                          PROCEDURE SOI 1.
                                            EXCEPT DELIVERY
                                            DIAGNOSES SOI 1.
S.................       14           670  OTHER PROCEDURES FOR           546        1  OTHER O.R. PROC FOR
                                            OBSTETRIC DIAGNOSES                          OBSTETRIC DIAGNOSES
                                            EXCEPT DELIVERY                              EXCEPT DELIVERY
                                            DIAGNOSES SOI 1.                             DIAGNOSES SOI 1.
S.................       14           671  OTHER PROCEDURES FOR           544        2  D&C, ASPIRATION
                                            OBSTETRIC DIAGNOSES                          CURETTAGE OR
                                            EXCEPT DELIVERY                              HYSTEROTOMY FOR
                                            DIAGNOSES SOI 2.                             OBSTETRIC DIAGNOSES SOI
                                                                                         2.
S.................       14           671  OTHER PROCEDURES FOR           545        2  ECTOPIC PREGNANCY
                                            OBSTETRIC DIAGNOSES                          PROCEDURE SOI 2.
                                            EXCEPT DELIVERY
                                            DIAGNOSES SOI 2.
S.................       14           671  OTHER PROCEDURES FOR           546        2  OTHER O.R. PROC FOR
                                            OBSTETRIC DIAGNOSES                          OBSTETRIC DIAGNOSES
                                            EXCEPT DELIVERY                              EXCEPT DELIVERY
                                            DIAGNOSES SOI 2.                             DIAGNOSES SOI 2.
S.................       14           672  OTHER PROCEDURES FOR           544        3  D&C, ASPIRATION
                                            OBSTETRIC DIAGNOSES                          CURETTAGE OR
                                            EXCEPT DELIVERY                              HYSTEROTOMY FOR
                                            DIAGNOSES SOI 3.                             OBSTETRIC DIAGNOSES SOI
                                                                                         3.
S.................       14           672  OTHER PROCEDURES FOR           545        3  ECTOPIC PREGNANCY
                                            OBSTETRIC DIAGNOSES                          PROCEDURE SOI 3.
                                            EXCEPT DELIVERY
                                            DIAGNOSES SOI 3.
S.................       14           672  OTHER PROCEDURES FOR           546        3  OTHER O.R. PROC FOR
                                            OBSTETRIC DIAGNOSES                          OBSTETRIC DIAGNOSES
                                            EXCEPT DELIVERY                              EXCEPT DELIVERY
                                            DIAGNOSES SOI 3.                             DIAGNOSES SOI 3.
M.................       14           673  ANTEPARTUM DIAGNOSES           561        4  POSTPARTUM & POST
                                            EXCEPT VAGINAL DELIVERY                      ABORTION DIAGNOSES W/O
                                            DIAGNOSIS SOI 4.                             PROCEDURE SOI 4.
M.................       14           673  ANTEPARTUM DIAGNOSES           563        4  THREATENED ABORTION SOI
                                            EXCEPT VAGINAL DELIVERY                      4.
                                            DIAGNOSIS SOI 4.
M.................       14           673  ANTEPARTUM DIAGNOSES           564        4  ABORTION W/O D&C,
                                            EXCEPT VAGINAL DELIVERY                      ASPIRATION CURETTAGE OR
                                            DIAGNOSIS SOI 4.                             HYSTEROTOMY SOI 4.
M.................       14           673  ANTEPARTUM DIAGNOSES           565        4  FALSE LABOR SOI 4.
                                            EXCEPT VAGINAL DELIVERY
                                            DIAGNOSIS SOI 4.
M.................       14           673  ANTEPARTUM DIAGNOSES           566        4  OTHER ANTEPARTUM
                                            EXCEPT VAGINAL DELIVERY                      DIAGNOSES SOI 4.
                                            DIAGNOSIS SOI 4.
M.................       14           674  VAGINAL DELIVERY SOI 1...      560        1  VAGINAL DELIVERY SOI 1.
M.................       14           675  VAGINAL DELIVERY SOI 2...      560        2  VAGINAL DELIVERY SOI 2.
M.................       14           676  VAGINAL DELIVERY SOI 3...      560        3  VAGINAL DELIVERY SOI 3.
M.................       14           677  VAGINAL DELIVERY SOI 4...      560        4  VAGINAL DELIVERY SOI 4.
M.................       14           678  POSTPARTUM & ABORTION          561        1  POSTPARTUM & POST
                                            DIAGNOSES W/O PROCEDURE                      ABORTION DIAGNOSES W/O
                                            SOI 1.                                       PROCEDURE SOI 1.
M.................       14           678  POSTPARTUM & ABORTION          564        1  ABORTION W/O D&C,
                                            DIAGNOSES W/O PROCEDURE                      ASPIRATION CURETTAGE OR
                                            SOI 1.                                       HYSTEROTOMY SOI 1.
M.................       14           679  POSTPARTUM & ABORTION          561        2  POSTPARTUM & POST
                                            DIAGNOSES W/O PROCEDURE                      ABORTION DIAGNOSES W/O
                                            SOI 2.                                       PROCEDURE SOI 2.
M.................       14           679  POSTPARTUM & ABORTION          564        2  ABORTION W/O D&C,
                                            DIAGNOSES W/O PROCEDURE                      ASPIRATION CURETTAGE OR
                                            SOI 2.                                       HYSTEROTOMY SOI 2.
M.................       14           680  POSTPARTUM & ABORTION          561        3  POSTPARTUM & POST
                                            DIAGNOSES W/O PROCEDURE                      ABORTION DIAGNOSES W/O
                                            SOI 3.                                       PROCEDURE SOI 3.
M.................       14           680  POSTPARTUM & ABORTION          564        3  ABORTION W/O D&C,
                                            DIAGNOSES W/O PROCEDURE                      ASPIRATION CURETTAGE OR
                                            SOI 3.                                       HYSTEROTOMY SOI 3.
M.................       14           681  ANTEPARTUM DIAGNOSES SOI       563        1  THREATENED ABORTION SOI
                                            1.                                           1.
M.................       14           681  ANTEPARTUM DIAGNOSES SOI       565        1  FALSE LABOR SOI 1.
                                            1.
M.................       14           681  ANTEPARTUM DIAGNOSES SOI       566        1  OTHER ANTEPARTUM
                                            1.                                           DIAGNOSES SOI 1.
M.................       14           682  ANTEPARTUM DIAGNOSES SOI       563        2  THREATENED ABORTION SOI
                                            2.                                           2.
M.................       14           682  ANTEPARTUM DIAGNOSES SOI       565        2  FALSE LABOR SOI 2.
                                            2.
M.................       14           682  ANTEPARTUM DIAGNOSES SOI       566        2  OTHER ANTEPARTUM
                                            2.                                           DIAGNOSES SOI 2.
M.................       14           683  ANTEPARTUM DIAGNOSES SOI       563        3  THREATENED ABORTION SOI
                                            3.                                           3.

[[Page 24460]]

 
M.................       14           683  ANTEPARTUM DIAGNOSES SOI       565        3  FALSE LABOR SOI 3.
                                            3.
M.................       14           683  ANTEPARTUM DIAGNOSES SOI       566        3  OTHER ANTEPARTUM
                                            3.                                           DIAGNOSES SOI 3.
M.................       15           684  NEONATE, TRANSFERRED <5        580        1  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 1 & 2.                          DAYS OLD, NOT BORN HERE
                                                                                         SOI 1.
M.................       15           684  NEONATE, TRANSFERRED <5        580        2  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 1 & 2.                          DAYS OLD, NOT BORN HERE
                                                                                         SOI 2.
M.................       15           684  NEONATE, TRANSFERRED <5        581        1  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 1 & 2.                          DAYS OLD, BORN HERE SOI
                                                                                         1.
M.................       15           684  NEONATE, TRANSFERRED <5        581        2  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 1 & 2.                          DAYS OLD, BORN HERE SOI
                                                                                         2.
M.................       15           685  NEONATE, TRANSFERRED <5        580        3  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 3 & 4.                          DAYS OLD, NOT BORN HERE
                                                                                         SOI 3.
M.................       15           685  NEONATE, TRANSFERRED <5        580        4  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 3 & 4.                          DAYS OLD, NOT BORN HERE
                                                                                         SOI 4.
M.................       15           685  NEONATE, TRANSFERRED <5        581        3  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 3 & 4.                          DAYS OLD, BORN HERE SOI
                                                                                         3.
M.................       15           685  NEONATE, TRANSFERRED <5        581        4  NEONATE, TRANSFERRED <5
                                            DAYS OLD SOI 3 & 4.                          DAYS OLD, BORN HERE SOI
                                                                                         4.
M.................       15           686  EXTREME IMMATURITY OR          583        1  NEONATE W ECMO SOI 1.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          583        2  NEONATE W ECMO SOI 2.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          588        1  NEONATE BWT <1500G W
                                            RESPIRATORY DISTRESS                         MAJOR PROCEDURE SOI 1.
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          588        2  NEONATE BWT <1500G W
                                            RESPIRATORY DISTRESS                         MAJOR PROCEDURE SOI 2.
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          589        1  NEONATE BWT <500G SOI 1.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          589        2  NEONATE BWT <500G SOI 2.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 1
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          591        1  NEONATE BIRTHWT 500-749G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 1                      1.
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          591        2  NEONATE BIRTHWT 500-749G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 1                      2.
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          593        1  NEONATE BIRTHWT 750-999G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 1                      1.
                                            & 2.
M.................       15           686  EXTREME IMMATURITY OR          593        2  NEONATE BIRTHWT 750-999G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 1                      2.
                                            & 2.
M.................       15           687  EXTREME IMMATURITY OR          583        3  NEONATE W ECMO SOI 3.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 3
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          583        4  NEONATE W ECMO SOI 4.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 3
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          588        3  NEONATE BWT <1500G W
                                            RESPIRATORY DISTRESS                         MAJOR PROCEDURE SOI 3.
                                            SYNDROME, NEONATE SOI 3
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          588        4  NEONATE BWT <1500G W
                                            RESPIRATORY DISTRESS                         MAJOR PROCEDURE SOI 4.
                                            SYNDROME, NEONATE SOI 3
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          589        3  NEONATE BWT <500G SOI 3.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 3
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          589        4  NEONATE BWT <500G SOI 4.
                                            RESPIRATORY DISTRESS
                                            SYNDROME, NEONATE SOI 3
                                            & 4.

[[Page 24461]]

 
M.................       15           687  EXTREME IMMATURITY OR          591        3  NEONATE BIRTHWT 500-749G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 3                      3.
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          591        4  NEONATE BIRTHWT 500-749G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 3                      4.
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          593        3  NEONATE BIRTHWT 750-999G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 3                      3.
                                            & 4.
M.................       15           687  EXTREME IMMATURITY OR          593        4  NEONATE BIRTHWT 750-999G
                                            RESPIRATORY DISTRESS                         W/O MAJOR PROCEDURE SOI
                                            SYNDROME, NEONATE SOI 3                      4.
                                            & 4.
M.................       15           688  PREMAUTRITY WITH MAJOR         602        1  NEONATE BWT 1000-1249G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         602        2  NEONATE BWT 1000-1249G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         607        1  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         607        2  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         609        1  NEONATE BWT 1500-2499G W
                                            PROBLEMS SOI 1 & 2.                          MAJOR PROCEDURE SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         609        2  NEONATE BWT 1500-2499G W
                                            PROBLEMS SOI 1 & 2.                          MAJOR PROCEDURE SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         611        1  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 1 & 2.                          1999G W MAJOR ANOMALY
                                                                                         SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         611        2  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 1 & 2.                          1999G W MAJOR ANOMALY
                                                                                         SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         612        1  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         612        2  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 1 amp; 2.                       RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         613        1  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 1 & 2.                          1999G W CONGENITAL/
                                                                                         PERINATAL INFECTION SOI
                                                                                         1.
M.................       15           688  PREMAUTRITY WITH MAJOR         613        2  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 1 & 2.                          1999G W CONGENITAL/
                                                                                         PERINATAL INFECTION SOI
                                                                                         2.
M.................       15           688  PREMAUTRITY WITH MAJOR         621        1  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          MAJOR ANOMALY SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         621        2  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          MAJOR ANOMALY SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         622        1  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         622        2  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 2.
M.................       15           688  PREMAUTRITY WITH MAJOR         623        1  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 1.
M.................       15           688  PREMAUTRITY WITH MAJOR         623        2  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 2.
M.................       15           689  PREMAUTRITY WITH MAJOR         602        3  NEONATE BWT 1000-1249G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         602        4  NEONATE BWT 1000-1249G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         607        3  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 3.

[[Page 24462]]

 
M.................       15           689  PREMAUTRITY WITH MAJOR         607        4  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP OR MAJ ANOM SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         609        3  NEONATE BWT 1500-2499G W
                                            PROBLEMS SOI 3 & 4.                          MAJOR PROCEDURE SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         609        4  NEONATE BWT 1500-2499G W
                                            PROBLEMS SOI 3 & 4.                          MAJOR PROCEDURE SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         611        3  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 3 & 4.                          1999G W MAJOR ANOMALY
                                                                                         SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         611        4  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 3 & 4.                          1999G W MAJOR ANOMALY
                                                                                         SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         612        3  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         612        4  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         613        3  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 3 & 4.                          1999G W CONGENITAL/
                                                                                         PERINATAL INFECTION SOI
                                                                                         3.
M.................       15           689  PREMAUTRITY WITH MAJOR         613        4  NEONATE BIRTHWT 1500-
                                            PROBLEMS SOI 3 & 4.                          1999G W CONGENITAL/
                                                                                         PERINATAL INFECTION SOI
                                                                                         4.
M.................       15           689  PREMAUTRITY WITH MAJOR         621        3  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          MAJOR ANOMALY SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         621        4  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          MAJOR ANOMALY SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         622        3  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         622        4  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          RESP DIST SYND/OTH MAJ
                                                                                         RESP COND SOI 4.
M.................       15           689  PREMAUTRITY WITH MAJOR         623        3  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 3.
M.................       15           689  PREMAUTRITY WITH MAJOR         623        4  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 4.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      603        1  NEONATE BIRTHWT 1000-
                                            PROBLEMS SOI 1 & 2.                          1249G W OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 1.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      603        2  NEONATE BIRTHWT 1000-
                                            PROBLEMS SOI 1 & 2.                          1249G W OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 2.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      608        1  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 1 & 2.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 1.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      608        2  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 1 & 2.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 2.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      614        1  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 1 & 2.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 1.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      614        2  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 1 & 2.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 2.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      625        1  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          OTHER SIGNIFICANT
                                                                                         CONDITION SOI 1.
M.................       15           690  PREMAUTRITY WITHOUT MAJOR      625        2  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 1 & 2.                          OTHER SIGNIFICANT
                                                                                         CONDITION SOI 2.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      603        3  NEONATE BIRTHWT 1000-
                                            PROBLEMS SOI 3 & 4.                          1249G W OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 3.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      603        4  NEONATE BIRTHWT 1000-
                                            PROBLEMS SOI 3 & 4.                          1249G W OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 4.

[[Page 24463]]

 
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      608        3  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 3 & 4.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 3.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      608        4  NEONATE BWT 1250-1499G W
                                            PROBLEMS SOI 3 & 4.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 4.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      614        3  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 3 & 4.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 3.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      614        4  NEONATE BWT 1500-1999G W
                                            PROBLEMS SOI 3 & 4.                          OR W/O OTHER
                                                                                         SIGNIFICANT CONDITION
                                                                                         SOI 4.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      625        3  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          OTHER SIGNIFICANT
                                                                                         CONDITION SOI 3.
M.................       15           691  PREMAUTRITY WITHOUT MAJOR      625        4  NEONATE BWT 2000-2499G W
                                            PROBLEMS SOI 3 & 4.                          OTHER SIGNIFICANT
                                                                                         CONDITION SOI 4.
M.................       15           692  FULL TERM NEONATE WITH         630        1  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    MAJOR CARDIOVASCULAR
                                                                                         PROCEDURE SOI 1.
M.................       15           692  FULL TERM NEONATE WITH         630        2  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    MAJOR CARDIOVASCULAR
                                                                                         PROCEDURE SOI 2.
M.................       15           692  FULL TERM NEONATE WITH         631        1  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    OTHER MAJOR PROCEDURE
                                                                                         SOI 1.
M.................       15           692  FULL TERM NEONATE WITH         631        2  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    OTHER MAJOR PROCEDURE
                                                                                         SOI 2.
M.................       15           692  FULL TERM NEONATE WITH         633        1  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    MAJOR ANOMALY SOI 1.
M.................       15           692  FULL TERM NEONATE WITH         633        2  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    MAJOR ANOMALY SOI 2.
M.................       15           692  FULL TERM NEONATE WITH         634        1  NEONATE, BIRTHWT >2499G
                                            MAJOR PROBLEMS SOI 1 & 2.                    W RESP DIST SYND/OTH
                                                                                         MAJ RESP COND SOI 1.
M.................       15           692  FULL TERM NEONATE WITH         634        2  NEONATE, BIRTHWT >2499G
                                            MAJOR PROBLEMS SOI 1 & 2.                    W RESP DIST SYND/OTH
                                                                                         MAJ RESP COND SOI 2.
M.................       15           692  FULL TERM NEONATE WITH         636        1  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 1.
M.................       15           692  FULL TERM NEONATE WITH         636        2  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 1 & 2.                    CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 2.
M.................       15           693  FULL TERM NEONATE WITH         630        3  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    MAJOR CARDIOVASCULAR
                                                                                         PROCEDURE SOI 3.
M.................       15           693  FULL TERM NEONATE WITH         630        4  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    MAJOR CARDIOVASCULAR
                                                                                         PROCEDURE SOI 4.
M.................       15           693  FULL TERM NEONATE WITH         631        3  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    OTHER MAJOR PROCEDURE
                                                                                         SOI 3.
M.................       15           693  FULL TERM NEONATE WITH         631        4  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    OTHER MAJOR PROCEDURE
                                                                                         SOI 4.
M.................       15           693  FULL TERM NEONATE WITH         633        3  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    MAJOR ANOMALY SOI 3.
M.................       15           693  FULL TERM NEONATE WITH         633        4  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    MAJOR ANOMALY SOI 4.
M.................       15           693  FULL TERM NEONATE WITH         634        3  NEONATE, BIRTHWT >2499G
                                            MAJOR PROBLEMS SOI 3 & 4.                    W RESP DIST SYND/OTH
                                                                                         MAJ RESP COND SOI 3.
M.................       15           693  FULL TERM NEONATE WITH         634        4  NEONATE, BIRTHWT >2499G
                                            MAJOR PROBLEMS SOI 3 & 4.                    W RESP DIST SYND/OTH
                                                                                         MAJ RESP COND SOI 4.
M.................       15           693  FULL TERM NEONATE WITH         636        3  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 3.
M.................       15           693  FULL TERM NEONATE WITH         636        4  NEONATE BIRTHWT >2499G W
                                            MAJOR PROBLEMS SOI 3 & 4.                    CONGENITAL/PERINATAL
                                                                                         INFECTION SOI 4.

[[Page 24464]]

 
M.................       15           694  NEONATE WITH OTHER             639        1  NEONATE BIRTHWT >2499G W
                                            SIGNIFICANT PROBLEMS SOI                     OTHER SIGNIFICANT
                                            1 & 2.                                       CONDITION SOI 1.
M.................       15           694  NEONATE WITH OTHER             639        2  NEONATE BIRTHWT >2499G W
                                            SIGNIFICANT PROBLEMS SOI                     OTHER SIGNIFICANT
                                            1 & 2.                                       CONDITION SOI 2.
M.................       15           695  NEONATE WITH OTHER             639        3  NEONATE BIRTHWT >2499G W
                                            SIGNIFICANT PROBLEMS SOI                     OTHER SIGNIFICANT
                                            3 & 4.                                       CONDITION SOI 3.
M.................       15           695  NEONATE WITH OTHER             639        4  NEONATE BIRTHWT >2499G W
                                            SIGNIFICANT PROBLEMS SOI                     OTHER SIGNIFICANT
                                            3 & 4.                                       CONDITION SOI 4.
M.................       15           696  NEONATE >2,000 GRAMS           626        1  NEONATE BWT 2000-2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 1 & 2.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 1.
M.................       15           696  NEONATE >2,000 GRAMS           626        2  NEONATE BWT 2000-2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 1 & 2.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 2.
M.................       15           696  NEONATE >2,000 GRAMS           640        1  NEONATE BIRTHWT >2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 1 & 2.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 1.
M.................       15           696  NEONATE >2,000 GRAMS           640        2  NEONATE BIRTHWT >2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 1 & 2.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 2.
M.................       15           697  NEONATE >2,000 GRAMS           626        3  NEONATE BWT 2000-2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 3 & 4.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 3.
M.................       15           697  NEONATE >2,000 GRAMS           626        4  NEONATE BWT 2000-2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 3 & 4.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 4.
M.................       15           697  NEONATE >2,000 GRAMS           640        3  NEONATE BIRTHWT >2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 3 & 4.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 3.
M.................       15           697  NEONATE >2,000 GRAMS           640        4  NEONATE BIRTHWT >2499G,
                                            WITHOUT SIGNIFICANT                          NORMAL NEWBORN OR
                                            PROBLEMS SOI 3 & 4.                          NEONATE W OTHER PROBLEM
                                                                                         SOI 4.
S.................       16           698  PROCEDURES OF BLOOD &          650        4  SPLENECTOMY SOI 4.
                                            BLOOD-FORMING ORGANS SOI
                                            4.
S.................       16           698  PROCEDURES OF BLOOD &          651        4  OTHER PROCEDURES OF
                                            BLOOD-FORMING ORGANS SOI                     BLOOD & BLOOD-FORMING
                                            4.                                           ORGANS SOI 4.
S.................       16           699  SPLENECTOMY SOI 1........      650        1  SPLENECTOMY SOI 1.
S.................       16           700  SPLENECTOMY SOI 2........      650        2  SPLENECTOMY SOI 2.
S.................       16           701  SPLENECTOMY SOI 3........      650        3  SPLENECTOMY SOI 3.
S.................       16           702  OTHER PROCEDURES OF BLOOD      651        1  OTHER PROCEDURES OF
                                            & BLOOD-FORMING ORGANS                       BLOOD & BLOOD-FORMING
                                            SOI 1.                                       ORGANS SOI 1.
S.................       16           703  OTHER PROCEDURES OF BLOOD      651        2  OTHER PROCEDURES OF
                                            & BLOOD-FORMING ORGANS                       BLOOD & BLOOD-FORMING
                                            SOI 2.                                       ORGANS SOI 2.
S.................       16           704  OTHER PROCEDURES OF BLOOD      651        3  OTHER PROCEDURES OF
                                            & BLOOD-FORMING ORGANS                       BLOOD & BLOOD-FORMING
                                            SOI 3.                                       ORGANS SOI 3.
M.................       16           705  ANEMIA & DIAGNOSES OF          660        4  MAJOR HEMATOLOGIC/
                                            BLOOD & BLOOD-FORMING                        IMMUNOLOGIC DIAG EXC
                                            ORGANS SOI 4.                                SICKLE CELL CRISIS &
                                                                                         COAGUL SOI 4.
M.................       16           705  ANEMIA & DIAGNOSES OF          661        4  COAGULATION & PLATELET
                                            BLOOD & BLOOD-FORMING                        DISORDERS SOI 4.
                                            ORGANS SOI 4.
M.................       16           705  ANEMIA & DIAGNOSES OF          662        4  SICKLE CELL ANEMIA
                                            BLOOD & BLOOD-FORMING                        CRISIS SOI 4.
                                            ORGANS SOI 4.
M.................       16           705  ANEMIA & DIAGNOSES OF          663        4  OTHER ANEMIA & DISORDERS
                                            BLOOD & BLOOD-FORMING                        OF BLOOD & BLOOD-
                                            ORGANS SOI 4.                                FORMING ORGANS SOI 4.
M.................       16           706  MAJOR HEMATOLOGIC/             660        1  MAJOR HEMATOLOGIC/
                                            IMMUNOLOGIC DIAG EXC                         IMMUNOLOGIC DIAG EXC
                                            SICKLE CELL CRISIS &                         SICKLE CELL CRISIS &
                                            COAGUL SOI 1.                                COAGUL SOI 1.
M.................       16           707  MAJOR HEMATOLOGIC/             660        2  MAJOR HEMATOLOGIC/
                                            IMMUNOLOGIC DIAG EXC                         IMMUNOLOGIC DIAG EXC
                                            SICKLE CELL CRISIS &                         SICKLE CELL CRISIS &
                                            COAGUL SOI 2.                                COAGUL SOI 2.
M.................       16           708  MAJOR HEMATOLOGIC/             660        3  MAJOR HEMATOLOGIC/
                                            IMMUNOLOGIC DIAG EXC                         IMMUNOLOGIC DIAG EXC
                                            SICKLE CELL CRISIS &                         SICKLE CELL CRISIS &
                                            COAGUL SOI 3.                                COAGUL SOI 3.
M.................       16           709  COAGULATION & PLATELET         661        1  COAGULATION & PLATELET
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................       16           710  COAGULATION & PLATELET         661        2  COAGULATION & PLATELET
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.

[[Page 24465]]

 
M.................       16           711  COAGULATION & PLATELET         661        3  COAGULATION & PLATELET
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................       16           712  SICKLE CELL ANEMIA CRISIS      662        1  SICKLE CELL ANEMIA
                                            SOI 1.                                       CRISIS SOI 1.
M.................       16           713  SICKLE CELL ANEMIA CRISIS      662        2  SICKLE CELL ANEMIA
                                            SOI 2.                                       CRISIS SOI 2.
M.................       16           714  SICKLE CELL ANEMIA CRISIS      662        3  SICKLE CELL ANEMIA
                                            SOI 3.                                       CRISIS SOI 3.
M.................       16           715  OTHER ANEMIA & DISORDERS       663        1  OTHER ANEMIA & DISORDERS
                                            OF BLOOD & BLOOD-FORMING                     OF BLOOD & BLOOD-
                                            ORGANS SOI 1.                                FORMING ORGANS SOI 1.
M.................       16           716  OTHER ANEMIA & DISORDERS       663        2  OTHER ANEMIA & DISORDERS
                                            OF BLOOD & BLOOD-FORMING                     OF BLOOD & BLOOD-
                                            ORGANS SOI 2.                                FORMING ORGANS SOI 2.
M.................       16           717  OTHER ANEMIA & DISORDERS       663        3  OTHER ANEMIA & DISORDERS
                                            OF BLOOD & BLOOD-FORMING                     OF BLOOD & BLOOD-
                                            ORGANS SOI 3.                                FORMING ORGANS SOI 3.
S.................       17           718  PROCEDURES FOR LYMPHATIC/      680        4  MAJOR O.R. PROCEDURES
                                            HEMATOPOIETIC/OTHER                          FOR LYMPHATIC/
                                            NEOPLASMS SOI 4.                             HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 4.
S.................       17           718  PROCEDURES FOR LYMPHATIC/      681        4  OTHER O.R. PROCEDURES
                                            HEMATOPOIETIC/OTHER                          FOR LYMPHATIC/
                                            NEOPLASMS SOI 4.                             HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 4.
S.................       17           719  MAJOR O.R. PROCEDURES FOR      680        1  MAJOR O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 1.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 1.
S.................       17           720  MAJOR O.R. PROCEDURES FOR      680        2  MAJOR O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 2.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 2.
S.................       17           721  MAJOR O.R. PROCEDURES FOR      680        3  MAJOR O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 3.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 3.
S.................       17           722  OTHER O.R. PROCEDURES FOR      681        1  OTHER O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 1.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 1.
S.................       17           723  OTHER O.R. PROCEDURES FOR      681        2  OTHER O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 2.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 2.
S.................       17           724  OTHER O.R. PROCEDURES FOR      681        3  OTHER O.R. PROCEDURES
                                            LYMPHATIC/HEMATOPOIETIC/                     FOR LYMPHATIC/
                                            OTHER NEOPLASMS SOI 3.                       HEMATOPOIETIC/OTHER
                                                                                         NEOPLASMS SOI 3.
M.................       17           725  LEUKEMIA, LYMPHOMA,            690        4  ACUTE LEUKEMIA SOI 4.
                                            MYELOMA, CHEMOTHERAPY,
                                            AND RADIOTHERAPY SOI 4.
M.................       17           725  LEUKEMIA, LYMPHOMA,            691        4  LYMPHOMA, MYELOMA & NON-
                                            MYELOMA, CHEMOTHERAPY,                       ACUTE LEUKEMIA SOI 4.
                                            AND RADIOTHERAPY SOI 4.
M.................       17           725  LEUKEMIA, LYMPHOMA,            692        4  RADIOTHERAPY SOI 4.
                                            MYELOMA, CHEMOTHERAPY,
                                            AND RADIOTHERAPY SOI 4.
M.................       17           725  LEUKEMIA, LYMPHOMA,            693        4  CHEMOTHERAPY SOI 4.
                                            MYELOMA, CHEMOTHERAPY,
                                            AND RADIOTHERAPY SOI 4.
M.................       17           726  ACUTE LEUKEMIA SOI 1.....      690        1  ACUTE LEUKEMIA SOI 1.
M.................       17           727  ACUTE LEUKEMIA SOI 2.....      690        2  ACUTE LEUKEMIA SOI 2.
M.................       17           728  ACUTE LEUKEMIA SOI 3.....      690        3  ACUTE LEUKEMIA SOI 3.
M.................       17           729  LYMPHOMA, MYELOMA & NON-       691        1  LYMPHOMA, MYELOMA & NON-
                                            ACUTE LEUKEMIA SOI 1.                        ACUTE LEUKEMIA SOI 1.
M.................       17           730  LYMPHOMA, MYELOMA & NON-       691        2  LYMPHOMA, MYELOMA & NON-
                                            ACUTE LEUKEMIA SOI 2.                        ACUTE LEUKEMIA SOI 2.
M.................       17           731  LYMPHOMA, MYELOMA & NON-       691        3  LYMPHOMA, MYELOMA & NON-
                                            ACUTE LEUKEMIA SOI 3.                        ACUTE LEUKEMIA SOI 3.
M.................       17           732  RADIOTHERAPY SOI 1.......      692        1  RADIOTHERAPY SOI 1.
M.................       17           733  RADIOTHERAPY SOI 2.......      692        2  RADIOTHERAPY SOI 2.
M.................       17           734  RADIOTHERAPY SOI 3.......      692        3  RADIOTHERAPY SOI 3.
M.................       17           735  CHEMOTHERAPY SOI 1.......      693        1  CHEMOTHERAPY SOI 1.
M.................       17           736  CHEMOTHERAPY SOI 2.......      693        2  CHEMOTHERAPY SOI 2.
M.................       17           737  CHEMOTHERAPY SOI 3.......      693        3  CHEMOTHERAPY SOI 3.
M.................       17           738  LYMPHATIC & OTHER              694        1  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS                     MALIGNANCIES &
                                            OF UNCERTAIN BEHAVIOR                        NEOPLASMS OF UNCERTAIN
                                            SOI 1.                                       BEHAVIOR SOI 1.

[[Page 24466]]

 
M.................       17           739  LYMPHATIC & OTHER              694        2  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS                     MALIGNANCIES &
                                            OF UNCERTAIN BEHAVIOR                        NEOPLASMS OF UNCERTAIN
                                            SOI 2.                                       BEHAVIOR SOI 2.
M.................       17           740  LYMPHATIC & OTHER              694        3  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS                     MALIGNANCIES &
                                            OF UNCERTAIN BEHAVIOR                        NEOPLASMS OF UNCERTAIN
                                            SOI 3.                                       BEHAVIOR SOI 3.
M.................       17           741  LYMPHATIC & OTHER              694        4  LYMPHATIC & OTHER
                                            MALIGNANCIES & NEOPLASMS                     MALIGNANCIES &
                                            OF UNCERTAIN BEHAVIOR                        NEOPLASMS OF UNCERTAIN
                                            SOI 4.                                       BEHAVIOR SOI 4.
S.................       18           742  INFECTIOUS & PARASITIC         710        4  INFECTIOUS & PARASITIC
                                            DISEASES W O.R.                              DISEASES INCLUDING HIV
                                            PROCEDURE SOI 4.                             W O.R. PROCEDURE SOI 4.
S.................       18           742  INFECTIOUS & PARASITIC         711        4  POST-OP, POST-TRAUMA,
                                            DISEASES W O.R.                              OTHER DEVICE INFECTIONS
                                            PROCEDURE SOI 4.                             W O.R. PROCEDURE SOI 4.
S.................       18           743  INFECTIOUS & PARASITIC         710        1  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W                     DISEASES INCLUDING HIV
                                            O.R. PROCEDURE SOI 1.                        W O.R. PROCEDURE SOI 1.
S.................       18           744  INFECTIOUS & PARASITIC         710        2  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W                     DISEASES INCLUDING HIV
                                            O.R. PROCEDURE SOI 2.                        W O.R. PROCEDURE SOI 2.
S.................       18           745  INFECTIOUS & PARASITIC         710        3  INFECTIOUS & PARASITIC
                                            DISEASES INCLUDING HIV W                     DISEASES INCLUDING HIV
                                            O.R. PROCEDURE SOI 3.                        W O.R. PROCEDURE SOI 3.
S.................       18           746  POST-OP, POST-TRAUMA,          711        1  POST-OP, POST-TRAUMA,
                                            OTHER DEVICE INFECTIONS                      OTHER DEVICE INFECTIONS
                                            W O.R. PROCEDURE SOI 1.                      W O.R. PROCEDURE SOI 1.
S.................       18           747  POST-OP, POST-TRAUMA,          711        2  POST-OP, POST-TRAUMA,
                                            OTHER DEVICE INFECTIONS                      OTHER DEVICE INFECTIONS
                                            W O.R. PROCEDURE SOI 2.                      W O.R. PROCEDURE SOI 2.
S.................       18           748  POST-OP, POST-TRAUMA,          711        3  POST-OP, POST-TRAUMA,
                                            OTHER DEVICE INFECTIONS                      OTHER DEVICE INFECTIONS
                                            W O.R. PROCEDURE SOI 3.                      W O.R. PROCEDURE SOI 3.
M.................       18           749  INFECTIOUS & PARASITIC         720        4  SEPTICEMIA &
                                            DISEASES SOI 4.                              DISSEMINATED INFECTIONS
                                                                                         SOI 4.
M.................       18           749  INFECTIOUS & PARASITIC         721        4  POST-OPERATIVE, POST-
                                            DISEASES SOI 4.                              TRAUMATIC, OTHER DEVICE
                                                                                         INFECTIONS SOI 4.
M.................       18           749  INFECTIOUS & PARASITIC         722        4  FEVER SOI 4.
                                            DISEASES SOI 4.
M.................       18           749  INFECTIOUS & PARASITIC         723        4  VIRAL ILLNESS SOI 4.
                                            DISEASES SOI 4.
M.................       18           749  INFECTIOUS & PARASITIC         724        4  OTHER INFECTIOUS &
                                            DISEASES SOI 4.                              PARASITIC DISEASES SOI
                                                                                         4.
M.................       18           750  SEPTICEMIA & DISSEMINATED      720        1  SEPTICEMIA &
                                            INFECTIONS SOI 1.                            DISSEMINATED INFECTIONS
                                                                                         SOI 1.
M.................       18           751  SEPTICEMIA & DISSEMINATED      720        2  SEPTICEMIA &
                                            INFECTIONS SOI 2.                            DISSEMINATED INFECTIONS
                                                                                         SOI 2.
M.................       18           752  SEPTICEMIA & DISSEMINATED      720        3  SEPTICEMIA &
                                            INFECTIONS SOI 3.                            DISSEMINATED INFECTIONS
                                                                                         SOI 3.
M.................       18           753  POST-OPERATIVE, POST-          721        1  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE                      TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 1.                            INFECTIONS SOI 1.
M.................       18           754  POST-OPERATIVE, POST-          721        2  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE                      TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 2.                            INFECTIONS SOI 2.
M.................       18           755  POST-OPERATIVE, POST-          721        3  POST-OPERATIVE, POST-
                                            TRAUMATIC, OTHER DEVICE                      TRAUMATIC, OTHER DEVICE
                                            INFECTIONS SOI 3.                            INFECTIONS SOI 3.
M.................       18           756  FEVER SOI 1..............      722        1  FEVER SOI 1.
M.................       18           757  FEVER SOI 2..............      722        2  FEVER SOI 2.
M.................       18           758  FEVER SOI 3..............      722        3  FEVER SOI 3.
M.................       18           759  VIRAL ILLNESS SOI 1......      723        1  VIRAL ILLNESS SOI 1.
M.................       18           760  VIRAL ILLNESS SOI 2......      723        2  VIRAL ILLNESS SOI 2.
M.................       18           761  VIRAL ILLNESS SOI 3......      723        3  VIRAL ILLNESS SOI 3.
M.................       18           762  OTHER INFECTIOUS &             724        1  OTHER INFECTIOUS &
                                            PARASITIC DISEASES SOI 1.                    PARASITIC DISEASES SOI
                                                                                         1.
M.................       18           763  OTHER INFECTIOUS &             724        2  OTHER INFECTIOUS &
                                            PARASITIC DISEASES SOI 2.                    PARASITIC DISEASES SOI
                                                                                         2.
M.................       18           764  OTHER INFECTIOUS &             724        3  OTHER INFECTIOUS &
                                            PARASITIC DISEASES SOI 3.                    PARASITIC DISEASES SOI
                                                                                         3.
S.................       19           765  MENTAL ILLNESS DIAGNOSIS       740        1  MENTAL ILLNESS DIAGNOSIS
                                            W O.R. PROCEDURE SOI 1.                      W O.R. PROCEDURE SOI 1.

[[Page 24467]]

 
S.................       19           766  MENTAL ILLNESS DIAGNOSIS       740        2  MENTAL ILLNESS DIAGNOSIS
                                            W O.R. PROCEDURE SOI 2.                      W O.R. PROCEDURE SOI 2.
S.................       19           767  MENTAL ILLNESS DIAGNOSIS       740        3  MENTAL ILLNESS DIAGNOSIS
                                            W O.R. PROCEDURE SOI 3.                      W O.R. PROCEDURE SOI 3.
S.................       19           768  MENTAL ILLNESS DIAGNOSIS       740        4  MENTAL ILLNESS DIAGNOSIS
                                            W O.R. PROCEDURE SOI 4.                      W O.R. PROCEDURE SOI 4.
M.................       19           769  MAJOR DEPRESSIVE,              750        1  SCHIZOPHRENIA SOI 1.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 1.
M.................       19           769  MAJOR DEPRESSIVE,              751        1  MAJOR DEPRESSIVE
                                            SCHIZOPHRENIA & BIPOLAR                      DISORDERS & OTHER/
                                            DISORDERS SOI 1.                             UNSPECIFIED PSYCHOSES
                                                                                         SOI 1.
M.................       19           769  MAJOR DEPRESSIVE,              753        1  BIPOLAR DISORDERS SOI 1.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 1.
M.................       19           770  MAJOR DEPRESSIVE,              750        2  SCHIZOPHRENIA SOI 2.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 2.
M.................       19           770  MAJOR DEPRESSIVE,              751        2  MAJOR DEPRESSIVE
                                            SCHIZOPHRENIA & BIPOLAR                      DISORDERS & OTHER/
                                            DISORDERS SOI 2.                             UNSPECIFIED PSYCHOSES
                                                                                         SOI 2.
M.................       19           770  MAJOR DEPRESSIVE,              753        2  BIPOLAR DISORDERS SOI 2.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 2.
M.................       19           771  MAJOR DEPRESSIVE,              750        3  SCHIZOPHRENIA SOI 3.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 3.
M.................       19           771  MAJOR DEPRESSIVE,              751        3  MAJOR DEPRESSIVE
                                            SCHIZOPHRENIA & BIPOLAR                      DISORDERS & OTHER/
                                            DISORDERS SOI 3.                             UNSPECIFIED PSYCHOSES
                                                                                         SOI 3.
M.................       19           771  MAJOR DEPRESSIVE,              753        3  BIPOLAR DISORDERS SOI 3.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 3.
M.................       19           772  MAJOR DEPRESSIVE,              750        4  SCHIZOPHRENIA SOI 4.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 4.
M.................       19           772  MAJOR DEPRESSIVE,              751        4  MAJOR DEPRESSIVE
                                            SCHIZOPHRENIA & BIPOLAR                      DISORDERS & OTHER/
                                            DISORDERS SOI 4.                             UNSPECIFIED PSYCHOSES
                                                                                         SOI 4.
M.................       19           772  MAJOR DEPRESSIVE,              753        4  BIPOLAR DISORDERS SOI 4.
                                            SCHIZOPHRENIA & BIPOLAR
                                            DISORDERS SOI 4.
M.................       19           773  ORGANIC MENTAL HEALTH          757        1  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 1.                          DISTURBANCES SOI 1.
M.................       19           774  ORGANIC MENTAL HEALTH          757        2  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 2.                          DISTURBANCES SOI 2.
M.................       19           775  ORGANIC MENTAL HEALTH          757        3  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 3.                          DISTURBANCES SOI 3.
M.................       19           776  ORGANIC MENTAL HEALTH          757        4  ORGANIC MENTAL HEALTH
                                            DISTURBANCES SOI 4.                          DISTURBANCES SOI 4.
M.................       19           777  OTHER MENTAL HEALTH            752        1  DISORDERS OF PERSONALITY
                                            DISORDERS SOI 1.                             & IMPULSE CONTROL SOI
                                                                                         1.
M.................       19           777  OTHER MENTAL HEALTH            754        1  DEPRESSION EXCEPT MAJOR
                                            DISORDERS SOI 1.                             DEPRESSIVE DISORDER SOI
                                                                                         1.
M.................       19           777  OTHER MENTAL HEALTH            755        1  ADJUSTMENT DISORDERS &
                                            DISORDERS SOI 1.                             NEUROSES EXCEPT
                                                                                         DEPRESSIVE DIAGNOSES
                                                                                         SOI 1.
M.................       19           777  OTHER MENTAL HEALTH            756        1  ACUTE ANXIETY & DELIRIUM
                                            DISORDERS SOI 1.                             STATES SOI 1.
M.................       19           777  OTHER MENTAL HEALTH            758        1  CHILDHOOD BEHAVIORAL
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................       19           777  OTHER MENTAL HEALTH            759        1  EATING DISORDERS SOI 1.
                                            DISORDERS SOI 1.
M.................       19           777  OTHER MENTAL HEALTH            760        1  OTHER MENTAL HEALTH
                                            DISORDERS SOI 1.                             DISORDERS SOI 1.
M.................       19           778  OTHER MENTAL HEALTH            752        2  DISORDERS OF PERSONALITY
                                            DISORDERS SOI 2.                             & IMPULSE CONTROL SOI
                                                                                         2.
M.................       19           778  OTHER MENTAL HEALTH            754        2  DEPRESSION EXCEPT MAJOR
                                            DISORDERS SOI 2.                             DEPRESSIVE DISORDER SOI
                                                                                         2.
M.................       19           778  OTHER MENTAL HEALTH            755        2  ADJUSTMENT DISORDERS &
                                            DISORDERS SOI 2.                             NEUROSES EXCEPT
                                                                                         DEPRESSIVE DIAGNOSES
                                                                                         SOI 2.
M.................       19           778  OTHER MENTAL HEALTH            756        2  ACUTE ANXIETY & DELIRIUM
                                            DISORDERS SOI 2.                             STATES SOI 2.
M.................       19           778  OTHER MENTAL HEALTH            758        2  CHILDHOOD BEHAVIORAL
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.

[[Page 24468]]

 
M.................       19           778  OTHER MENTAL HEALTH            759        2  EATING DISORDERS SOI 2.
                                            DISORDERS SOI 2.
M.................       19           778  OTHER MENTAL HEALTH            760        2  OTHER MENTAL HEALTH
                                            DISORDERS SOI 2.                             DISORDERS SOI 2.
M.................       19           779  OTHER MENTAL HEALTH            752        3  DISORDERS OF PERSONALITY
                                            DISORDERS SOI 3.                             & IMPULSE CONTROL SOI
                                                                                         3.
M.................       19           779  OTHER MENTAL HEALTH            754        3  DEPRESSION EXCEPT MAJOR
                                            DISORDERS SOI 3.                             DEPRESSIVE DISORDER SOI
                                                                                         3.
M.................       19           779  OTHER MENTAL HEALTH            755        3  ADJUSTMENT DISORDERS &
                                            DISORDERS SOI 3.                             NEUROSES EXCEPT
                                                                                         DEPRESSIVE DIAGNOSES
                                                                                         SOI 3.
M.................       19           779  OTHER MENTAL HEALTH            756        3  ACUTE ANXIETY & DELIRIUM
                                            DISORDERS SOI 3.                             STATES SOI 3.
M.................       19           779  OTHER MENTAL HEALTH            758        3  CHILDHOOD BEHAVIORAL
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................       19           779  OTHER MENTAL HEALTH            759        3  EATING DISORDERS SOI 3.
                                            DISORDERS SOI 3.
M.................       19           779  OTHER MENTAL HEALTH            760        3  OTHER MENTAL HEALTH
                                            DISORDERS SOI 3.                             DISORDERS SOI 3.
M.................       19           780  OTHER MENTAL HEALTH            752        4  DISORDERS OF PERSONALITY
                                            DISORDERS SOI 4.                             & IMPULSE CONTROL SOI
                                                                                         4.
M.................       19           780  OTHER MENTAL HEALTH            754        4  DEPRESSION EXCEPT MAJOR
                                            DISORDERS SOI 4.                             DEPRESSIVE DISORDER SOI
                                                                                         4.
M.................       19           780  OTHER MENTAL HEALTH            755        4  ADJUSTMENT DISORDERS &
                                            DISORDERS SOI 4.                             NEUROSES EXCEPT
                                                                                         DEPRESSIVE DIAGNOSES
                                                                                         SOI 4.
M.................       19           780  OTHER MENTAL HEALTH            756        4  ACUTE ANXIETY & DELIRIUM
                                            DISORDERS SOI 4.                             STATES SOI 4.
M.................       19           780  OTHER MENTAL HEALTH            758        4  CHILDHOOD BEHAVIORAL
                                            DISORDERS SOI 4.                             DISORDERS SOI 4.
M.................       19           780  OTHER MENTAL HEALTH            759        4  EATING DISORDERS SOI 4.
                                            DISORDERS SOI 4.
M.................       19           780  OTHER MENTAL HEALTH            760        4  OTHER MENTAL HEALTH
                                            DISORDERS SOI 4.                             DISORDERS SOI 4.
M.................       20           781  DRUG & ALCOHOL ABUSE OR        770        1  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST                     DEPENDENCE, LEFT
                                            MEDICAL ADVICE SOI 1 & 2.                    AGAINST MEDICAL ADVICE
                                                                                         SOI 1.
M.................       20           781  DRUG & ALCOHOL ABUSE OR        770        2  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST                     DEPENDENCE, LEFT
                                            MEDICAL ADVICE SOI 1 & 2.                    AGAINST MEDICAL ADVICE
                                                                                         SOI 2.
M.................       20           782  DRUG & ALCOHOL ABUSE OR        770        3  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST                     DEPENDENCE, LEFT
                                            MEDICAL ADVICE SOI 3 & 4.                    AGAINST MEDICAL ADVICE
                                                                                         SOI 3.
M.................       20           782  DRUG & ALCOHOL ABUSE OR        770        4  DRUG & ALCOHOL ABUSE OR
                                            DEPENDENCE, LEFT AGAINST                     DEPENDENCE, LEFT
                                            MEDICAL ADVICE SOI 3 & 4.                    AGAINST MEDICAL ADVICE
                                                                                         SOI 4.
M.................       20           783  DRUG ABUSE & DEPENDENCE        772        1  ALCOHOL & DRUG
                                            DIAGNOSES SOI 1.                             DEPENDENCE W REHAB OR
                                                                                         REHAB/DETOX THERAPY SOI
                                                                                         1.
M.................       20           783  DRUG ABUSE & DEPENDENCE        773        1  OPIOID ABUSE &
                                            DIAGNOSES SOI 1.                             DEPENDENCE SOI 1.
M.................       20           783  DRUG ABUSE & DEPENDENCE        774        1  COCAINE ABUSE &
                                            DIAGNOSES SOI 1.                             DEPENDENCE SOI 1.
M.................       20           783  DRUG ABUSE & DEPENDENCE        775        1  ALCOHOL ABUSE &
                                            DIAGNOSES SOI 1.                             DEPENDENCE SOI 1.
M.................       20           783  DRUG ABUSE & DEPENDENCE        776        1  OTHER DRUG ABUSE &
                                            DIAGNOSES SOI 1.                             DEPENDENCE SOI 1.
M.................       20           784  DRUG ABUSE & DEPENDENCE        772        2  ALCOHOL & DRUG
                                            DIAGNOSES SOI 2.                             DEPENDENCE W REHAB OR
                                                                                         REHAB/DETOX THERAPY SOI
                                                                                         2.
M.................       20           784  DRUG ABUSE & DEPENDENCE        773        2  OPIOID ABUSE &
                                            DIAGNOSES SOI 2.                             DEPENDENCE SOI 2.
M.................       20           784  DRUG ABUSE & DEPENDENCE        774        2  COCAINE ABUSE &
                                            DIAGNOSES SOI 2.                             DEPENDENCE SOI 2.
M.................       20           784  DRUG ABUSE & DEPENDENCE        775        2  ALCOHOL ABUSE &
                                            DIAGNOSES SOI 2.                             DEPENDENCE SOI 2.
M.................       20           784  DRUG ABUSE & DEPENDENCE        776        2  OTHER DRUG ABUSE &
                                            DIAGNOSES SOI 2.                             DEPENDENCE SOI 2.

[[Page 24469]]

 
M.................       20           785  DRUG ABUSE & DEPENDENCE        772        3  ALCOHOL & DRUG
                                            DIAGNOSES SOI 3.                             DEPENDENCE W REHAB OR
                                                                                         REHAB/DETOX THERAPY SOI
                                                                                         3.
M.................       20           785  DRUG ABUSE & DEPENDENCE        773        3  OPIOID ABUSE &
                                            DIAGNOSES SOI 3.                             DEPENDENCE SOI 3.
M.................       20           785  DRUG ABUSE & DEPENDENCE        774        3  COCAINE ABUSE &
                                            DIAGNOSES SOI 3.                             DEPENDENCE SOI 3.
M.................       20           785  DRUG ABUSE & DEPENDENCE        775        3  ALCOHOL ABUSE &
                                            DIAGNOSES SOI 3.                             DEPENDENCE SOI 3.
M.................       20           785  DRUG ABUSE & DEPENDENCE        776        3  OTHER DRUG ABUSE &
                                            DIAGNOSES SOI 3.                             DEPENDENCE SOI 3.
M.................       20           786  DRUG ABUSE & DEPENDENCE        772        4  ALCOHOL & DRUG
                                            DIAGNOSES SOI 4.                             DEPENDENCE W REHAB OR
                                                                                         REHAB/DETOX THERAPY SOI
                                                                                         4.
M.................       20           786  DRUG ABUSE & DEPENDENCE        773        4  OPIOID ABUSE &
                                            DIAGNOSES SOI 4.                             DEPENDENCE SOI 4.
M.................       20           786  DRUG ABUSE & DEPENDENCE        774        4  COCAINE ABUSE &
                                            DIAGNOSES SOI 4.                             DEPENDENCE SOI 4.
M.................       20           786  DRUG ABUSE & DEPENDENCE        775        4  ALCOHOL ABUSE &
                                            DIAGNOSES SOI 4.                             DEPENDENCE SOI 4.
M.................       20           786  DRUG ABUSE & DEPENDENCE        776        4  OTHER DRUG ABUSE &
                                            DIAGNOSES SOI 4.                             DEPENDENCE SOI 4.
S.................       21           787  O.R. PROCEDURE FOR OTHER       791        1  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF                             COMPLICATIONS OF
                                            TREATMENT SOI 1.                             TREATMENT SOI 1.
S.................       21           788  O.R. PROCEDURE FOR OTHER       791        2  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF                             COMPLICATIONS OF
                                            TREATMENT SOI 2.                             TREATMENT SOI 2.
S.................       21           789  O.R. PROCEDURE FOR OTHER       791        3  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF                             COMPLICATIONS OF
                                            TREATMENT SOI 3.                             TREATMENT SOI 3.
S.................       21           790  O.R. PROCEDURE FOR OTHER       791        4  O.R. PROCEDURE FOR OTHER
                                            COMPLICATIONS OF                             COMPLICATIONS OF
                                            TREATMENT SOI 4.                             TREATMENT SOI 4.
M.................       21           791  INJURIES, POISONINGS &         811        4  ALLERGIC REACTIONS SOI
                                            TOXIC EFFECTS OF DRUGS                       4.
                                            DIAGNOSES SOI 4.
M.................       21           791  INJURIES, POISONINGS &         812        4  POISONING OF MEDICINAL
                                            TOXIC EFFECTS OF DRUGS                       AGENTS SOI 4.
                                            DIAGNOSES SOI 4.
M.................       21           791  INJURIES, POISONINGS &         813        4  OTHER COMPLICATIONS OF
                                            TOXIC EFFECTS OF DRUGS                       TREATMENT SOI 4.
                                            DIAGNOSES SOI 4.
M.................       21           791  INJURIES, POISONINGS &         815        4  OTHER INJURY, POISONING
                                            TOXIC EFFECTS OF DRUGS                       & TOXIC EFFECT
                                            DIAGNOSES SOI 4.                             DIAGNOSES SOI 4.
M.................       21           791  INJURIES, POISONINGS &         816        4  TOXIC EFFECTS OF NON-
                                            TOXIC EFFECTS OF DRUGS                       MEDICINAL SUBSTANCES
                                            DIAGNOSES SOI 4.                             SOI 4.
M.................       21           792  ALLERGIC REACTIONS SOI 1.      811        1  ALLERGIC REACTIONS SOI
                                                                                         1.
M.................       21           793  ALLERGIC REACTIONS SOI 2.      811        2  ALLERGIC REACTIONS SOI
                                                                                         2.
M.................       21           794  ALLERGIC REACTIONS SOI 3.      811        3  ALLERGIC REACTIONS SOI
                                                                                         3.
M.................       21           795  POISONING OF MEDICINAL         812        1  POISONING OF MEDICINAL
                                            AGENTS SOI 1.                                AGENTS SOI 1.
M.................       21           796  POISONING OF MEDICINAL         812        2  POISONING OF MEDICINAL
                                            AGENTS SOI 2.                                AGENTS SOI 2.
M.................       21           797  POISONING OF MEDICINAL         812        3  POISONING OF MEDICINAL
                                            AGENTS SOI 3.                                AGENTS SOI 3.
M.................       21           798  OTHER COMPLICATIONS OF         813        1  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 1.                             TREATMENT SOI 1.
M.................       21           799  OTHER COMPLICATIONS OF         813        2  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 2.                             TREATMENT SOI 2.
M.................       21           800  OTHER COMPLICATIONS OF         813        3  OTHER COMPLICATIONS OF
                                            TREATMENT SOI 3.                             TREATMENT SOI 3.
M.................       21           801  OTHER INJURY, POISONING &      815        1  OTHER INJURY, POISONING
                                            TOXIC EFFECT DIAGNOSES                       & TOXIC EFFECT
                                            SOI 1.                                       DIAGNOSES SOI 1.
M.................       21           801  OTHER INJURY, POISONING &      816        1  TOXIC EFFECTS OF NON-
                                            TOXIC EFFECT DIAGNOSES                       MEDICINAL SUBSTANCES
                                            SOI 1.                                       SOI 1.
M.................       21           802  OTHER INJURY, POISONING &      815        2  OTHER INJURY, POISONING
                                            TOXIC EFFECT DIAGNOSES                       & TOXIC EFFECT
                                            SOI 2.                                       DIAGNOSES SOI 2.
M.................       21           802  OTHER INJURY, POISONING &      816        2  TOXIC EFFECTS OF NON-
                                            TOXIC EFFECT DIAGNOSES                       MEDICINAL SUBSTANCES
                                            SOI 2.                                       SOI 2.
M.................       21           803  OTHER INJURY, POISONING &      815        3  OTHER INJURY, POISONING
                                            TOXIC EFFECT DIAGNOSES                       & TOXIC EFFECT
                                            SOI 3.                                       DIAGNOSES SOI 3.
M.................       21           803  OTHER INJURY, POISONING &      816        3  TOXIC EFFECTS OF NON-
                                            TOXIC EFFECT DIAGNOSES                       MEDICINAL SUBSTANCES
                                            SOI 3.                                       SOI 3.
S.................       22           804  BURN PROCEDURES SOI 4....      841        4  EXTENSIVE 3RD DEGREE
                                                                                         BURNS W SKIN GRAFT SOI
                                                                                         4.

[[Page 24470]]

 
S.................       22           804  BURN PROCEDURES SOI 4....      842        4  FULL THICKNESS BURNS W
                                                                                         SKIN GRAFT SOI 4.
S.................       22           805  EXTENSIVE 3RD DEGREE OR        841        1  EXTENSIVE 3RD DEGREE
                                            FULL THICKNESS BURNS W                       BURNS W SKIN GRAFT SOI
                                            SKIN GRAFT SOI 1.                            1.
S.................       22           805  EXTENSIVE 3RD DEGREE OR        842        1  FULL THICKNESS BURNS W
                                            FULL THICKNESS BURNS W                       SKIN GRAFT SOI 1.
                                            SKIN GRAFT SOI 1.
S.................       22           806  EXTENSIVE 3RD DEGREE OR        841        2  EXTENSIVE 3RD DEGREE
                                            FULL THICKNESS BURNS W                       BURNS W SKIN GRAFT SOI
                                            SKIN GRAFT SOI 2.                            2.
S.................       22           806  EXTENSIVE 3RD DEGREE OR        842        2  FULL THICKNESS BURNS W
                                            FULL THICKNESS BURNS W                       SKIN GRAFT SOI 2.
                                            SKIN GRAFT SOI 2.
S.................       22           807  EXTENSIVE 3RD DEGREE OR        841        3  EXTENSIVE 3RD DEGREE
                                            FULL THICKNESS BURNS W                       BURNS W SKIN GRAFT SOI
                                            SKIN GRAFT SOI 3.                            3.
S.................       22           807  EXTENSIVE 3RD DEGREE OR        842        3  FULL THICKNESS BURNS W
                                            FULL THICKNESS BURNS W                       SKIN GRAFT SOI 3.
                                            SKIN GRAFT SOI 3.
M.................       22           808  BURN DIAGNOSES SOI 4.....      843        4  EXTENSIVE 3RD DEGREE OR
                                                                                         FULL THICKNESS BURNS W/
                                                                                         O SKIN GRAFT SOI 4.
M.................       22           808  BURN DIAGNOSES SOI 4.....      844        4  PARTIAL THICKNESS BURNS
                                                                                         W OR W/O SKIN GRAFT SOI
                                                                                         4.
M.................       22           809  EXTENSIVE 3RD DEGREE OR        843        1  EXTENSIVE 3RD DEGREE OR
                                            FULL THICKNESS BURNS W/O                     FULL THICKNESS BURNS W/
                                            SKIN GRAFT SOI 1.                            O SKIN GRAFT SOI 1.
M.................       22           810  EXTENSIVE 3RD DEGREE OR        843        2  EXTENSIVE 3RD DEGREE OR
                                            FULL THICKNESS BURNS W/O                     FULL THICKNESS BURNS W/
                                            SKIN GRAFT SOI 2.                            O SKIN GRAFT SOI 2.
M.................       22           811  EXTENSIVE 3RD DEGREE OR        843        3  EXTENSIVE 3RD DEGREE OR
                                            FULL THICKNESS BURNS W/O                     FULL THICKNESS BURNS W/
                                            SKIN GRAFT SOI 3.                            O SKIN GRAFT SOI 3.
M.................       22           812  PARTIAL THICKNESS BURNS W      844        1  PARTIAL THICKNESS BURNS
                                            OR W/O SKIN GRAFT SOI 1.                     W OR W/O SKIN GRAFT SOI
                                                                                         1.
M.................       22           813  PARTIAL THICKNESS BURNS W      844        2  PARTIAL THICKNESS BURNS
                                            OR W/O SKIN GRAFT SOI 2.                     W OR W/O SKIN GRAFT SOI
                                                                                         2.
M.................       22           814  PARTIAL THICKNESS BURNS W      844        3  PARTIAL THICKNESS BURNS
                                            OR W/O SKIN GRAFT SOI 3.                     W OR W/O SKIN GRAFT SOI
                                                                                         3.
S.................       23           815  PROCEDURE W DIAG OF            850        1  PROCEDURE W DIAG OF
                                            REHAB, AFTERCARE OR OTH                      REHAB, AFTERCARE OR OTH
                                            CONTACT W HEALTH SERVICE                     CONTACT W HEALTH
                                            SOI 1.                                       SERVICE SOI 1.
S.................       23           816  PROCEDURE W DIAG OF            850        2  PROCEDURE W DIAG OF
                                            REHAB, AFTERCARE OR OTH                      REHAB, AFTERCARE OR OTH
                                            CONTACT W HEALTH SERVICE                     CONTACT W HEALTH
                                            SOI 2.                                       SERVICE SOI 2.
S.................       23           817  PROCEDURE W DIAG OF            850        3  PROCEDURE W DIAG OF
                                            REHAB, AFTERCARE OR OTH                      REHAB, AFTERCARE OR OTH
                                            CONTACT W HEALTH SERVICE                     CONTACT W HEALTH
                                            SOI 3.                                       SERVICE SOI 3.
S.................       23           818  PROCEDURE W DIAG OF            850        4  PROCEDURE W DIAG OF
                                            REHAB, AFTERCARE OR OTH                      REHAB, AFTERCARE OR OTH
                                            CONTACT W HEALTH SERVICE                     CONTACT W HEALTH
                                            SOI 4.                                       SERVICE SOI 4.
M.................       23           819  REHABILITATION/AFTERCARE/      860        4  REHABILITATION SOI 4.
                                            CONVALESCENCE EXCEPT
                                            NEONATAL AFTERCARE SOI 4.
M.................       23           819  REHABILITATION/AFTERCARE/      861        4  SIGNS, SYMPTOMS & OTHER
                                            CONVALESCENCE EXCEPT                         FACTORS INFLUENCING
                                            NEONATAL AFTERCARE SOI 4.                    HEALTH STATUS SOI 4.
M.................       23           819  REHABILITATION/AFTERCARE/      862        4  OTHER AFTERCARE &
                                            CONVALESCENCE EXCEPT                         CONVALESCENCE SOI 4.
                                            NEONATAL AFTERCARE SOI 4.
M.................       23           819  REHABILITATION/AFTERCARE/      863        4  NEONATAL AFTERCARE SOI
                                            CONVALESCENCE EXCEPT                         4.
                                            NEONATAL AFTERCARE SOI 4.
M.................       23           820  REHABILITATION SOI 1.....      860        1  REHABILITATION SOI 1.
M.................       23           821  REHABILITATION SOI 2.....      860        2  REHABILITATION SOI 2.
M.................       23           822  REHABILITATION SOI 3.....      860        3  REHABILITATION SOI 3.
M.................       23           823  SIGNS, SYMPTOMS & OTHER        861        1  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING                          FACTORS INFLUENCING
                                            HEALTH STATUS SOI 1.                         HEALTH STATUS SOI 1.

[[Page 24471]]

 
M.................       23           824  SIGNS, SYMPTOMS & OTHER        861        2  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING                          FACTORS INFLUENCING
                                            HEALTH STATUS SOI 2.                         HEALTH STATUS SOI 2.
M.................       23           825  SIGNS, SYMPTOMS & OTHER        861        3  SIGNS, SYMPTOMS & OTHER
                                            FACTORS INFLUENCING                          FACTORS INFLUENCING
                                            HEALTH STATUS SOI 3.                         HEALTH STATUS SOI 3.
M.................       23           826  OTHER AFTERCARE &              862        1  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 1.                         CONVALESCENCE SOI 1.
M.................       23           826  OTHER AFTERCARE &              863        1  NEONATAL AFTERCARE SOI
                                            CONVALESCENCE SOI 1.                         1.
M.................       23           827  OTHER AFTERCARE &              862        2  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 2.                         CONVALESCENCE SOI 2.
M.................       23           827  OTHER AFTERCARE &              863        2  NEONATAL AFTERCARE SOI
                                            CONVALESCENCE SOI 2.                         2.
M.................       23           828  OTHER AFTERCARE &              862        3  OTHER AFTERCARE &
                                            CONVALESCENCE SOI 3.                         CONVALESCENCE SOI 3.
M.................       23           828  OTHER AFTERCARE &              863        3  NEONATAL AFTERCARE SOI
                                            CONVALESCENCE SOI 3.                         3.
M.................       24           829  HIV DIAGNOSES SOI 4......      890        4  HIV W MULTIPLE MAJOR HIV
                                                                                         RELATED CONDITIONS SOI
                                                                                         4.
M.................       24           829  HIV DIAGNOSES SOI 4......      892        4  HIV W MAJOR HIV RELATED
                                                                                         CONDITION SOI 4.
M.................       24           829  HIV DIAGNOSES SOI 4......      893        4  HIV W MULTIPLE
                                                                                         SIGNIFICANT HIV RELATED
                                                                                         CONDITIONS SOI 4.
M.................       24           829  HIV DIAGNOSES SOI 4......      894        4  HIV W ONE SIGNIF HIV
                                                                                         COND OR W/O SIGNIF
                                                                                         RELATED COND SOI 4.
M.................       24           830  HIV W MULTIPLE MAJOR HIV       890        1  HIV W MULTIPLE MAJOR HIV
                                            RELATED CONDITIONS SOI 1                     RELATED CONDITIONS SOI
                                            & 2.                                         1.
M.................       24           830  HIV W MULTIPLE MAJOR HIV       890        2  HIV W MULTIPLE MAJOR HIV
                                            RELATED CONDITIONS SOI 1                     RELATED CONDITIONS SOI
                                            & 2.                                         2.
M.................       24           831  HIV W MULTIPLE MAJOR HIV       890        3  HIV W MULTIPLE MAJOR HIV
                                            RELATED CONDITIONS SOI 3.                    RELATED CONDITIONS SOI
                                                                                         3.
M.................       24           832  HIV W MAJOR HIV RELATED        892        1  HIV W MAJOR HIV RELATED
                                            CONDITION SOI 1 & 2.                         CONDITION SOI 1.
M.................       24           832  HIV W MAJOR HIV RELATED        892        2  HIV W MAJOR HIV RELATED
                                            CONDITION SOI 1 & 2.                         CONDITION SOI 2.
M.................       24           833  HIV W MAJOR HIV RELATED        892        3  HIV W MAJOR HIV RELATED
                                            CONDITION SOI 3.                             CONDITION SOI 3.
M.................       24           834  HIV W MULTIPLE                 893        1  HIV W MULTIPLE
                                            SIGNIFICANT HIV RELATED                      SIGNIFICANT HIV RELATED
                                            CONDITIONS SOI 1 & 2.                        CONDITIONS SOI 1.
M.................       24           834  HIV W MULTIPLE                 893        2  HIV W MULTIPLE
                                            SIGNIFICANT HIV RELATED                      SIGNIFICANT HIV RELATED
                                            CONDITIONS SOI 1 & 2.                        CONDITIONS SOI 2.
M.................       24           835  HIV W MULTIPLE                 893        3  HIV W MULTIPLE
                                            SIGNIFICANT HIV RELATED                      SIGNIFICANT HIV RELATED
                                            CONDITIONS SOI 3.                            CONDITIONS SOI 3.
M.................       24           836  HIV W ONE SIGNIF HIV COND      894        1  HIV W ONE SIGNIF HIV
                                            OR W/O SIGNIF RELATED                        COND OR W/O SIGNIF
                                            COND SOI 1.                                  RELATED COND SOI 1.
M.................       24           837  HIV W ONE SIGNIF HIV COND      894        2  HIV W ONE SIGNIF HIV
                                            OR W/O SIGNIF RELATED                        COND OR W/O SIGNIF
                                            COND SOI 2.                                  RELATED COND SOI 2.
M.................       24           838  HIV W ONE SIGNIF HIV COND      894        3  HIV W ONE SIGNIF HIV
                                            OR W/O SIGNIF RELATED                        COND OR W/O SIGNIF
                                            COND SOI 3.                                  RELATED COND SOI 3.
S.................       25           839  MULTIPLE SIGNIFICANT           910        4  CRANIOTOMY FOR MULTIPLE
                                            TRAUMA PROCEDURES SOI 4.                     SIGNIFICANT TRAUMA SOI
                                                                                         4.
S.................       25           839  MULTIPLE SIGNIFICANT           911        4  EXTENSIVE ABDOMINAL/
                                            TRAUMA PROCEDURES SOI 4.                     THORACIC PROCEDURES FOR
                                                                                         MULT SIGNIFICANT TRAUMA
                                                                                         SOI 4.
S.................       25           839  MULTIPLE SIGNIFICANT           912        4  MUSCULOSKELETAL & OTHER
                                            TRAUMA PROCEDURES SOI 4.                     PROCEDURES FOR MULTIPLE
                                                                                         SIGNIFICANT TRAUMA SOI
                                                                                         4.
S.................       25           840  CRANIOTOMY FOR MULTIPLE        910        1  CRANIOTOMY FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1                     SIGNIFICANT TRAUMA SOI
                                            & 2.                                         1.
S.................       25           840  CRANIOTOMY FOR MULTIPLE        910        2  CRANIOTOMY FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1                     SIGNIFICANT TRAUMA SOI
                                            & 2.                                         2.
S.................       25           841  CRANIOTOMY FOR MULTIPLE        910        3  CRANIOTOMY FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 3.                    SIGNIFICANT TRAUMA SOI
                                                                                         3.
S.................       25           842  EXTENSIVE ABDOMINAL/           911        1  EXTENSIVE ABDOMINAL/
                                            THORACIC PROCEDURES FOR                      THORACIC PROCEDURES FOR
                                            MULT SIGNIFICANT TRAUMA                      MULT SIGNIFICANT TRAUMA
                                            SOI 1 & 2.                                   SOI 1.
S.................       25           842  EXTENSIVE ABDOMINAL/           911        2  EXTENSIVE ABDOMINAL/
                                            THORACIC PROCEDURES FOR                      THORACIC PROCEDURES FOR
                                            MULT SIGNIFICANT TRAUMA                      MULT SIGNIFICANT TRAUMA
                                            SOI 1 & 2.                                   SOI 2.

[[Page 24472]]

 
S.................       25           843  EXTENSIVE ABDOMINAL/           911        3  EXTENSIVE ABDOMINAL/
                                            THORACIC PROCEDURES FOR                      THORACIC PROCEDURES FOR
                                            MULT SIGNIFICANT TRAUMA                      MULT SIGNIFICANT TRAUMA
                                            SOI 3.                                       SOI 3.
S.................       25           844  MUSCULOSKELETAL & OTHER        912        1  MUSCULOSKELETAL & OTHER
                                            PROCEDURES FOR MULTIPLE                      PROCEDURES FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1                     SIGNIFICANT TRAUMA SOI
                                            & 2.                                         1.
S.................       25           844  MUSCULOSKELETAL & OTHER        912        2  MUSCULOSKELETAL & OTHER
                                            PROCEDURES FOR MULTIPLE                      PROCEDURES FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 1                     SIGNIFICANT TRAUMA SOI
                                            & 2.                                         2.
S.................       25           845  MUSCULOSKELETAL & OTHER        912        3  MUSCULOSKELETAL & OTHER
                                            PROCEDURES FOR MULTIPLE                      PROCEDURES FOR MULTIPLE
                                            SIGNIFICANT TRAUMA SOI 3.                    SIGNIFICANT TRAUMA SOI
                                                                                         3.
M.................       25           846  MULTIPLE SIGNIFICANT           930        1  MULTIPLE SIGNIFICANT
                                            TRAUMA W/O O.R.                              TRAUMA W/O O.R.
                                            PROCEDURE SOI 1 & 2.                         PROCEDURE SOI 1.
M.................       25           846  MULTIPLE SIGNIFICANT           930        2  MULTIPLE SIGNIFICANT
                                            TRAUMA W/O O.R.                              TRAUMA W/O O.R.
                                            PROCEDURE SOI 1 & 2.                         PROCEDURE SOI 2.
M.................       25           847  MULTIPLE SIGNIFICANT           930        3  MULTIPLE SIGNIFICANT
                                            TRAUMA W/O O.R.                              TRAUMA W/O O.R.
                                            PROCEDURE SOI 3.                             PROCEDURE SOI 3.
M.................       25           848  MULTIPLE SIGNIFICANT           930        4  MULTIPLE SIGNIFICANT
                                            TRAUMA W/O O.R.                              TRAUMA W/O O.R.
                                            PROCEDURE SOI 4.                             PROCEDURE SOI 4.
S.................       25           987  EXTENSIVE PROCEDURE            950        1  EXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 1.                             DIAGNOSIS SOI 1.
S.................       25           988  EXTENSIVE PROCEDURE            950        2  EXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 2.                             DIAGNOSIS SOI 2.
S.................       25           989  EXTENSIVE PROCEDURE            950        3  EXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 3.                             DIAGNOSIS SOI 3.
S.................       25           990  EXTENSIVE PROCEDURE            950        4  EXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 4.                             DIAGNOSIS SOI 4.
S.................       25           991  NON MAJOR PROCEDURE            951        4  MODERATELY EXTENSIVE
                                            UNRELATED TO PRINCIPAL                       PROCEDURE UNRELATED TO
                                            DIAGNOSIS SOI 4.                             PRINCIPAL DIAGNOSIS SOI
                                                                                         4.
S.................       25           991  NON MAJOR PROCEDURE            952        4  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 4.                             DIAGNOSIS SOI 4.
S.................       25           992  MODERATELY EXTENSIVE           951        1  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO                       PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI                      PRINCIPAL DIAGNOSIS SOI
                                            1.                                           1.
S.................       25           993  MODERATELY EXTENSIVE           951        2  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO                       PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI                      PRINCIPAL DIAGNOSIS SOI
                                            2.                                           2.
S.................       25           994  MODERATELY EXTENSIVE           951        3  MODERATELY EXTENSIVE
                                            PROCEDURE UNRELATED TO                       PROCEDURE UNRELATED TO
                                            PRINCIPAL DIAGNOSIS SOI                      PRINCIPAL DIAGNOSIS SOI
                                            3.                                           3.
S.................       25           995  NONEXTENSIVE PROCEDURE         952        1  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 1.                             DIAGNOSIS SOI 1.
S.................       25           996  NONEXTENSIVE PROCEDURE         952        2  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 2.                             DIAGNOSIS SOI 2.
S.................       25           997  NONEXTENSIVE PROCEDURE         952        3  NONEXTENSIVE PROCEDURE
                                            UNRELATED TO PRINCIPAL                       UNRELATED TO PRINCIPAL
                                            DIAGNOSIS SOI 3.                             DIAGNOSIS SOI 3.
                         26           998  PRINCIPAL DIAGNOSIS            955        0  PRINCIPAL DIAGNOSIS
                                            INVALID AS DISCHARGE                         INVALID AS DISCHARGE
                                            DIAGNOSIS.                                   DIAGNOSIS.
                         26           999  UNGROUPABLE..............      956        0  UNGROUPABLE.
----------------------------------------------------------------------------------------------------------------
M = Medical.
S = Surgical.
SOI = Severity of Illness Subclass

[FR Doc. 06-3629 Filed 4-12-06; 4:22 pm]
BILLING CODE 4120-01-P